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Naouri D, Yordanov Y, Lapidus N, Pelletier-Fleury N. Cost-effectiveness analysis of direct admission to acute geriatric unit versus admission after an emergency department visit for elderly patients. BMC Geriatr 2023; 23:283. [PMID: 37165336 PMCID: PMC10173646 DOI: 10.1186/s12877-023-03985-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 04/20/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Elderly individuals represent an increasing proportion of emergency department (ED) users. In the Greater Paris University Hospitals (APHP) direct-admission study, direct admission (DA) to an acute geriatric unit (AGU) was associated with a shorter hospital length of stay (LOS), lower post-acute care transfers, and lower risk of an ED return visit in the month following the AGU hospitalization compared with admission after an ED visit. Until now, no economic evaluation of DA has been available. METHODS We aimed to evaluate the cost-effectiveness of DA to an AGU versus admission after an ED visit in elderly patients. This was conducted alongside the APHP direct-admission study which used electronic medical records and administrative claims data from the Greater Paris University Hospitals (APHP) Health Data Warehouse and involved 19 different AGUs. We included all patients ≥ 75 years old who were admitted to an AGU for more than 24 h between January 1, 2013 and December 31, 2018. The effectiveness criterion was the occurrence of ED return visit in the month following AGU hospitalization. We compared the costs of an AGU stay in the DA versus the ED visit group. The perspective was that of the payer. To characterise and summarize uncertainty, we used a non-parametric bootstrap resampling and constructed cost-effectiveness accessibility curves. RESULTS At baseline, mean costs per patient were €5113 and €5131 in the DA and ED visit groups, respectively. ED return visit rates were 3.3% (n = 81) in the DA group and 3.9% (n = 160) in the ED group (p = 0.21). After bootstrap, the incremental cost-effectiveness ratio was €-4249 (95%CI= -66,001; +45,547) per ED return visit averted. Acceptability curves showed that DA could be considered a cost-effective intervention at a threshold of €-2405 per ED return visit avoided. CONCLUSION The results of this cost-effectiveness analysis of DA to an AGU versus admission after an ED visit for elderly patients argues in favor of DA, which could help provide support for public decision making.
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Affiliation(s)
- Diane Naouri
- Centre for Research in Epidemiology and Population Health, French National Institute of Health and Medical Research (INSERM U1018), Université Paris- Saclay, Université Paris-Sud, UVSQ, Villejuif, France.
| | - Youri Yordanov
- Service d'Accueil des Urgences, Sorbonne Université, APHP, Hôpital Saint Antoine, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR-S 1136, Paris, France
| | - Nathanael Lapidus
- Public Health Department, Saint-Antoine Hospital, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, AP-HP, Paris, F75012, France
| | - Nathalie Pelletier-Fleury
- Centre for Research in Epidemiology and Population Health, French National Institute of Health and Medical Research (INSERM U1018), Université Paris- Saclay, Université Paris-Sud, UVSQ, Villejuif, France
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Naouri D, Panjo H, Moïsi L, El Khoury C, Serre P, Schmidt J, Yordanov Y, Pelletier-Fleury N. The Association Between Age and Admission to an Inappropriate Ward: A Cross-Sectional Survey in France. Health Serv Insights 2023; 16:11786329231174340. [PMID: 37197083 PMCID: PMC10184193 DOI: 10.1177/11786329231174340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 04/15/2023] [Indexed: 05/19/2023] Open
Abstract
Half of elderly patient hospitalizations are preceded by an emergency department (ED) visit. Hospitalization in inappropriate wards (IWs), which is more frequent in case of ED overcrowding and high hospital occupancy, leads to increased morbidity. Elderly individuals are the most exposed to these negative health care outcomes. Based on a nationwide cross-sectional survey involving all EDs in France, the aim of this study was to explore whether age was associated with admission to an IW after visiting an ED. Among the 4384 patients admitted in a medical ward, 4065 were admitted in the same hospital where the ED was located, among which 17.7% were admitted to an IW. Older age was associated with an increased likelihood of being admitted to an IW (OR = 1.39; 95% CI = 1.02-1.90 for patients aged 85 years and older and OR = 1.40; 95% CI = 1.02-1.91 for patients aged 75-84 years, compared with those under 45 years). ED visits during peak periods and cardio-pulmonary presenting complaint were also associated with an increased likelihood of admission to an IW. Despite their higher vulnerability, elderly patients are more likely to be admitted to an IW than younger patients. This result reinforces the need for special attention to be given to the hospitalization of this fragile population.
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Affiliation(s)
- Diane Naouri
- Centre for Research in Epidemiology and Population Health, French National Institute of Health and Medical Research (INSERM U1018), Université Paris-Saclay, Université Paris-Sud, UVSQ, Villejuif, France
- D Naouri, Centre de recherche en épidémiologie et santé des populations (CESP), Hôpital Paul Brousse, 12 Avenue Paul Vaillant Couturier, Villejuif 94800, France.
| | - Henri Panjo
- Centre for Research in Epidemiology and Population Health, French National Institute of Health and Medical Research (INSERM U1018), Université Paris-Saclay, Université Paris-Sud, UVSQ, Villejuif, France
| | - Laura Moïsi
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, Unité de Gériatrie Aigue, Paris, France
| | | | - Patrice Serre
- French Society of Emergency Medicine (SFMU), Paris, France
| | | | - Youri Yordanov
- French Society of Emergency Medicine (SFMU), Paris, France
| | - Nathalie Pelletier-Fleury
- Centre for Research in Epidemiology and Population Health, French National Institute of Health and Medical Research (INSERM U1018), Université Paris-Saclay, Université Paris-Sud, UVSQ, Villejuif, France
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Emergency department use and length of stay by younger and older adults: Nottingham cohort study in the emergency department (NOCED). Aging Clin Exp Res 2022; 34:2873-2885. [PMID: 36074240 PMCID: PMC9453701 DOI: 10.1007/s40520-022-02226-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 08/09/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Younger and older adults attending the Emergency Department (ED) are a heterogeneous population. Longer length of ED stay is associated with adverse outcomes and may vary by age. AIMS To evaluate the associations between age and (1) clinical characteristics and (2) length of ED stay among adults attending ED. METHODS The NOttingham Cohort study in the Emergency Department (NOCED)-a retrospective cohort study-comprises new consecutive ED attendances by adults ≥ 18 years, at a secondary/tertiary care hospital, in 2019. Length of ED stay was dichotomised as < 4 and ≥ 4 h. The associations between age and length of ED stay were analysed by binary logistic regression and adjusted for socio-demographic and clinical factors including triage acuity. RESULTS 146,636 attendances were analysed; 75,636 (51.6%) resulted in a length of ED stay ≥ 4 h. Attendances of adults aged 65 to 74 years, 75 to 84 years and ≥ 85 years, respectively, had an increased risk (odds ratio (95% confidence interval) of length of ED stay ≥ 4 h of 1.52 (1.45-1.58), 1.65 (1.58-1.72), and 1.84 (1.75-1.93), compared to those of adults 18 to 64 years (all p < 0.001). These findings remained consistent in the subsets of attendances leading to hospital admission and those leading to discharge from ED. DISCUSSION AND CONCLUSION In this real-world cohort study, older adults were more likely to have a length of ED stay ≥ 4 h, with the oldest old having the highest risk. ED target times should take into account age of attendees.
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Dubucs X, Balen F, Charpentier S, Lauque D, De Souto Barreto P, Tavassoli N, Houze-Cerfon CH, Rolland Y. Factors associated with Emergency Medical Dispatcher request and residents' inappropriate transfers from Nursing Homes to Emergency Department. Eur Geriatr Med 2021; 13:351-357. [PMID: 34652784 DOI: 10.1007/s41999-021-00574-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 10/05/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE In the last decades, the amount of emergency department (ED) transfers of nursing home (NH) residents has disproportionally increased in western countries. The main role of emergency medical dispatcher (EMD) among this population is to refer residents to EDs in the most appropriate way. The aim of this study was to assess risk factors of inappropriate transfers from NH to ED after EMD request. METHODS This research was a secondary analysis of a prospective observational multicenter study carried out in 17 EDs entitled FINE aimed to assess potentially inappropriate transfer prevalence among this population. Inappropriate transfers were determined in the FINE study threw a standardized approach by a unique expert team. RESULTS Overall, 572/1037 (55.2%) of residents were transferred to the ED after an EMD's decision. Among them, 92/572 (16.1%) transfers was defined as inappropriate. The average age was 87.3 years old (SD = 0.3). The main reason for ED transfer were falls (217/572, 37.9%). In multivariate analysis, the presence of a Special Care Unit in NH was significantly associated with a high rate of inappropriate transfer (OR 1.78; 95 CI [1.07-2.93]; p = 0.02) whereas a medical examination by a general practitioner before the transfer (OR 0.55; 95 CI [0.33-0.83]; p = 0.02) and a prompt access to psychiatric advice (OR 0.54; 95 CI [0.33-0.84]; p = 0.007) were associated with a low rate of potentially inappropriate transfer. CONCLUSION Promoting onsite medical assessment and partnership thanks to available geriatrician's advice may help the emergency medical dispatcher to improve the appropriateness of residents' transfer from Nursing Home to the emergency department.
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Affiliation(s)
- Xavier Dubucs
- Emergency Department, Toulouse University Hospital, 31059, Toulouse, France.
| | - Frederic Balen
- Emergency Department, Toulouse University Hospital, 31059, Toulouse, France
- INSERM, U1295, F-31073, Toulouse, France
| | - Sandrine Charpentier
- Emergency Department, Toulouse University Hospital, 31059, Toulouse, France
- INSERM, U1295, F-31073, Toulouse, France
| | - Dominique Lauque
- Emergency Department, Toulouse University Hospital, 31059, Toulouse, France
| | | | - Neda Tavassoli
- Gérontopôle, Toulouse University Hospital, 31059, Toulouse, France
| | | | - Yves Rolland
- INSERM, U1295, F-31073, Toulouse, France
- Gérontopôle, Toulouse University Hospital, 31059, Toulouse, France
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Féral-Pierssens AL. Inégalités sociales de santé et médecine d’urgence. ANNALES FRANCAISES DE MEDECINE D URGENCE 2021. [DOI: 10.3166/afmu-2020-0302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
En France, le système de santé est basé sur un principe d’universalité et les indicateurs macroscopiques y sont satisfaisants. Toutefois, des inégalités de santé persistent touchant particulièrement les populations vulnérables. Celles-ci peuvent voir s’ériger des barrières financières, institutionnelles ou cognitives qui entravent leur accès aux soins et participent à l’altération de leur état de santé. L’exercice de la médecine d’urgence n’est pas exempté des problématiques soulevées par ces inégalités sociales de santé qu’il s’agisse : du rôle des services d’urgence dans la sanctuarisation de l’accès aux soins ; des pathologies urgentes plus fréquentes ou plus graves observées parmi les populations les plus vulnérables ; de la qualité des soins administrés qui est parfois suboptimale. La première partie de cet article indique ce qui définit la vulnérabilité d’une population puis il présente les spécificités des prises en charge aux urgences. Il détaille ensuite les barrières à l’accès aux soins qui persistent ainsi que les répercussions du renoncement sur le recours aux services d’urgence. Enfin, l’exemple du contexte actuel de la pandémie du Sars-Cov2 permet de mettre en lumière les nombreuses interactions qui existent entre vulnérabilité et état de santé. Les questions de l’organisation de l’offre de soins en amont des urgences et des conditions réelles de son accessibilité pour tous sont des éléments fondamentaux qui impactent la pratique de la médecine d’urgence. Il appartient aussi aux professionnels de s’en saisir et de mobiliser avec force les décideurs publics sur ces sujets.
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Janda S, Sindhu S, Watthayu N, Limruangrong P, Viwatwongkasem C, Boonsawat W. Re-attendance at Emergency Department for Elderly Patients with Chronic Obstructive Pulmonary Disease Exacerbation. AGEING INTERNATIONAL 2020. [DOI: 10.1007/s12126-020-09387-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Gomes JCP, Dias RD, de Barros JV, Velasco IT, Jacob Filho W. The growing impact of older patients in the emergency department: a 5-year retrospective analysis in Brazil. BMC Emerg Med 2020; 20:47. [PMID: 32527325 PMCID: PMC7291438 DOI: 10.1186/s12873-020-00341-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 05/25/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The average age of the global population is rising at an increasing rate. There is a disproportional increase in Emergency Department (ED) visits by older people worldwide. In the Brazilian health system, complex and severely ill patients and those requiring specialized urgent procedures are referred to tertiary level care. As far as we know, no other study in Latin America has analyzed the impact of demographic changes in tertiary ED attendance. AIM To describe the sociodemographic characteristics and outcomes of tertiary Brazilian ED users. METHODS Design: Observational cross-sectional analytic study. SETTING Emergency Department, tertiary university hospital, São Paulo, Brazil. PARTICIPANTS patients aged 18 years or older attending a tertiary ED (2009-2013). The primary outcomes were hospitalization and mortality; the secondary outcome was ICU admission. Age was categorized as 'young adults' (18-39y), 'adults' (40-59y), 'young-older adults' (60-79y), and 'old-older adults' (80-109y). Other variables included sex, reason for attendance, time of ED visit, mode of presentation, type of hospitalization, main procedure, length of hospital stay (LOS) and length of ICU stay (ICU-LOS). We calculated descriptive statistics, built generalized linear mixed models for each outcome and estimated Odds Ratios (95% CI) for the independent categorical variables. The significance level was 5% with Bonferroni correction. RESULTS Older age-groups represented 26.6% of 333,028 ED visits, 40.7% of admissions, 42.7% of ICU admissions and 58% of all deaths. Old-older patients accounted for 5.1% of ED visits, 9.5% of admissions and 10.1% of ICU admissions. Hospitalization, ICU admission and mortality rates increased with older age in both sexes. LOS and ICU-LOS were similar across age-groups. The proportions of visits and admissions attributed to young adults decreased annually, while those of people aged 60 or over increased. The ORs for hospitalization, ICU admission and mortality associated with the old-older group were 3.49 (95% CI = 3.15-3.87), 1.27 (1.15-1.39) and 5.93 (5.29-6.66) respectively, with young adults as the reference. CONCLUSIONS In tertiary ED, age is an important risk factor for hospitalization and mortality, but not for ICU admission. Old-older people are at the greatest risk and demand further subgroup stratification.
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Affiliation(s)
- João Carlos Pereira Gomes
- Emergency Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av Dr. Enéas Carvalho de Aguiar, 255, 5° andar, s.5023, São Paulo, SP, CEP: 05403-010, Brazil.
| | - Roger Daglius Dias
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, MA, USA
| | - Jacson Venancio de Barros
- Department of Information Technology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Irineu Tadeu Velasco
- Emergency Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av Dr. Enéas Carvalho de Aguiar, 255, 5° andar, s.5023, São Paulo, SP, CEP: 05403-010, Brazil
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Wilson Jacob Filho
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
- Division of Geriatrics, Department of Internal Medicine, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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Quinn J, Buchanan S, Myint PK, Ellis G. Older patients are more likely to breach the 4-hour target in Scotland. Emerg Med J 2020; 37:807-810. [PMID: 32482758 DOI: 10.1136/emermed-2019-209099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 03/30/2020] [Accepted: 04/02/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine if age is a factor in a patients' likelihood of breaching the 4 hour time target to admission/discharge in emergency departments (EDs) within NHS Scotland. METHODS We used data from the Information Service Division Scotland to analyse all ED attendances in Scotland between January 2015 and September 2018 (n=5 596 642). We assessed the likelihood of time to admission/discharge being within 4 hours, 8 hours and 12 hours for all age categories (reference category 20 to 24 years). Univariable logistic regressions were carried out for sex, Scottish Index of Multiple Deprivation level and both major (potentially life threatening) and minor (not immediately life threatening) incidences. RESULTS The likelihood of breaching the 4-hour target increased linearly with age from 15 to 19 years upward. Patients ≥85 years were significantly (p<0.001) more likely to have breached than patients aged 20 to 24 years (OR 3.80, 95% CI: 3.73 to 3.86). When considering major incidents, patients aged ≥85 years were more likely to have breached than those aged 20 to 24 years (OR 2.05, 95% CI: 2.01 to 2.09, p<0.001). The same was true of minor incidents (OR 2.85, 95% CI: 2.73 to 2.98, p<0.001). CONCLUSIONS Older age is associated with a higher probability of breaching waiting time targets in a linear fashion within NHS Scotland, which is consistent with previous single hospital or regional studies. This association may be due to the higher proportion of elderly patients being admitted or a more systemic issue, but regardless, the elderly are being put more at risk.
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Affiliation(s)
- Jonathan Quinn
- Ageing Clinical and Experimental Research Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Scott Buchanan
- NHS National Services Scotland, Information Services Division, Healthcare Improvement Scotland, Edinburgh, UK
| | - Phyo Kyaw Myint
- Ageing Clinical and Experimental Research Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.,Department of Medicine for the Elderly, NHS Grampian, Aberdeen, UK
| | - Graham Ellis
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK .,NHS Lanarkshire, Bothwell, UK
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Mahmood A, Wyant DK, Kedia S, Ahn S, Powell MP, Jiang Y, Bhuyan SS. Self-Check-In Kiosks Utilization and Their Association With Wait Times in Emergency Departments in the United States. J Emerg Med 2020; 58:829-840. [PMID: 31924466 DOI: 10.1016/j.jemermed.2019.11.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 10/30/2019] [Accepted: 11/10/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Delayed care in emergency departments (EDs) is a serious problem in the United States. Patient wait time is considered a critical measure of delayed care in EDs. Several strategies have been employed by EDs to reduce wait time, including implementation of self-check-in kiosks. However, the effect of kiosks on wait time in EDs is understudied. OBJECTIVES To assess the association between patient wait time and utilization of self-check-in kiosks in EDs. To investigate a series of other patient-, ED-, and hospital-level predictors of wait time in EDs. METHODS Using data from the 2015 and 2016 National Hospital Ambulatory Medical Care Survey, we analyzed 40,528 ED visits by constructing a multivariable linear regression model of the log-transformed wait time data as an outcome, then computing percent changes in wait times. RESULTS During the study period, about 9% of EDs in the United States implemented kiosks. In our linear regression model, the wait time in EDs with kiosk self-check-in services was 56.8% shorter (95% confidence interval ̶ 130% to ̶ 6.4%, p < 0.05) compared with EDs without kiosk services. In addition to kiosks, patients' day of visit, arrival time, triage assessment, arrival by ambulance, chronic medical conditions, ED boarding, hospitals' full-capacity protocol, and hospitals' location were significant predictors of wait time. CONCLUSIONS Self-check-in kiosks are associated with shorter ED wait time in the United States. However, prolonged ED wait time continues to be a system-wide problem, and warrants multilayered interventions to address this challenge for those who are in acute need of immediate care.
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Affiliation(s)
- Asos Mahmood
- Division of Health Systems Management and Policy, School of Public Health, The University of Memphis, Memphis, Tennessee
| | - David K Wyant
- The Jack C. Massey Graduate School of Business, Belmont University, Nashville, Tennessee
| | - Satish Kedia
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, Memphis, Tennessee
| | - SangNam Ahn
- Division of Health Systems Management and Policy, School of Public Health, The University of Memphis, Memphis, Tennessee
| | - M Paige Powell
- Division of Health Systems Management and Policy, School of Public Health, The University of Memphis, Memphis, Tennessee
| | - Yu Jiang
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, The University of Memphis, Memphis, Tennessee
| | - Soumitra S Bhuyan
- Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, New Jersey
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Pan W, Zhang K, Li H, Wu M, Weng J. Older adults are prioritized in terms of waiting time under the emergency triage system in Guangzhou, China. Geriatr Gerontol Int 2019; 19:786-791. [PMID: 31199567 DOI: 10.1111/ggi.13714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 04/24/2019] [Accepted: 05/11/2019] [Indexed: 11/27/2022]
Abstract
AIM To assess whether elderly patients are prioritized under the emergency triage system in Guangzhou, China. METHODS This was a cross-sectional survey of clinical data from adult visitors to the emergency department of the Third Affiliated Hospital of Sun Yat-sen University between 1 August 2015 and 31 December 2017. The primary end-point was receiving the first medical service within the target waiting time, which varied according to the triage level of the patient. Multivariate logistic regression was used to determine whether age was an independent predictor of a shorter waiting time. RESULTS Data from 262 282 emergency patients were analyzed. The mean age of patients was 35.97 years, and 7.5% were aged ≥65 years. In total, 88.3% of patients received medical service within the target waiting time, and 87.4% of elderly patients received medical service within the target waiting time. Multivariate logistic regression analysis showed that advanced age was independently associated with receiving medical service within the target waiting time (adjusted odds ratio 1.258, 95% confidence interval 1.198-1.321; P < 0.001). The triage level, type of emergency subdivision, availability of outpatient services and time of day were also associated with receiving medical service within the target waiting time. CONCLUSION Under the emergency triage system of the hospital, older adults are more likely to receive medical service within the target waiting time than younger patients. Geriatr Gerontol Int 2019; 19: 786-791.
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Affiliation(s)
- Wen Pan
- Department of Emergency, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Department of Endocrinology and Metabolism, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Kouxing Zhang
- Department of Emergency, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Haitao Li
- Information Section, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Miaolue Wu
- Department of Emergency, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jianping Weng
- Department of Endocrinology and Metabolism, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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De Stefano C, Philippon AL, Krastinova E, Hausfater P, Riou B, Adnet F, Freund Y. Effect of emergency physician burnout on patient waiting times. Intern Emerg Med 2018; 13:421-428. [PMID: 28677043 DOI: 10.1007/s11739-017-1706-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 06/29/2017] [Indexed: 11/29/2022]
Abstract
Burnout is common in emergency physicians. This syndrome may negatively affect patient care and alter work productivity. We seek to assess whether burnout of emergency physicians impacts waiting times in the emergency department. Prospective study in an academic ED. All patients who visited the main ED for a 4-month period in 2016 were included. Target waiting times are assigned by triage nurse to patients on arrival depending on their severity. The primary endpoint was an exceeded target waiting time for ED patients. All emergency physicians were surveyed by a psychologist to assess their level of burnout using the Maslach Burnout Inventory. We defined the level of burnout of the day in the ED as the mean burnout level of the physicians working that day (8:30 to the 8:30 the next day). A logistic regression model was performed to assess whether burnout level of the day was independently associated with prolonged waiting times, along with previously reported predictors. Target waiting time was exceeded in 7524 patients (59%). Twenty-six emergency physicians were surveyed. Median burnout score was 35 [Interquartile (24-49)]. A burnout level of the day higher than 35 was independently associated with an exceeded target waiting time (adjusted odds ratio 1.54, 95% confidence interval 1.39-1.70), together with previously reported predictors (i.e., day of the week, time of the day, trauma, age and daily census). Burnout of emergency physicians was independently associated with a prolonged waiting time for patients visiting the ED.
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Affiliation(s)
- Carla De Stefano
- Emergency Department, Hopital Avicenne, Assistance Publique-Hôpitaux de Paris (APHP), Bobigny, France
- Université Sorbonne Paris Cité, Paris XIII Nord, Bobigny, France
| | - Anne-Laure Philippon
- Emergency Department, service d'accueil des urgences, Hôpital Pitié-Salpêtrière, APHP, 47-83 bd de l'hôpital, 75013, Paris, France
- Paris Sorbonne Universités, UPMC Univ Paris 06, Paris, France
| | - Evguenia Krastinova
- Plateforme de recherche Clinique de l'est Parisien (URCEST-CRCEST), APHP, Hôpital St Antoine, Paris, France
| | - Pierre Hausfater
- Emergency Department, service d'accueil des urgences, Hôpital Pitié-Salpêtrière, APHP, 47-83 bd de l'hôpital, 75013, Paris, France
- Paris Sorbonne Universités, UPMC Univ Paris 06, Paris, France
| | - Bruno Riou
- Emergency Department, service d'accueil des urgences, Hôpital Pitié-Salpêtrière, APHP, 47-83 bd de l'hôpital, 75013, Paris, France
- Paris Sorbonne Universités, UPMC Univ Paris 06, Paris, France
| | - Frederic Adnet
- Emergency Department, Hopital Avicenne, Assistance Publique-Hôpitaux de Paris (APHP), Bobigny, France
- Université Sorbonne Paris Cité, Paris XIII Nord, Bobigny, France
| | - Yonathan Freund
- Emergency Department, service d'accueil des urgences, Hôpital Pitié-Salpêtrière, APHP, 47-83 bd de l'hôpital, 75013, Paris, France.
- Paris Sorbonne Universités, UPMC Univ Paris 06, Paris, France.
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Lemachatti N, Hellmann R, Wargon M, Hausfater P, Riou B, Sullivan A, Camargo C, Freund Y. Descriptif de l'activité des structures des urgences en Île-de-France à l'aide du questionnaire « National Emergency Department Inventory » (NEDI) appliqué au système français. ANNALES FRANCAISES DE MEDECINE D URGENCE 2018. [DOI: 10.3166/afmu-2018-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction : La base de données NEDI (National Emergency Department Inventory) repose sur un descriptif de l'activité des structures des urgences (SU). Elle rend compte de la diversité de ces structures au niveau national et international. L'objectif de cette étude NEDI-Paris était de décrire l'organisation des SU en Île-de-France et les moyens à disposition, selon le statut public ou privé.
Méthode : Les SU ouvertes 24 heures/24 et 7 jours/7 ont été inclus. Un questionnaire comprenant 29 items a permis de recueillir les caractéristiques de ces services et les données relatives à l'activité de l'année 2015. Un taux de participation de 80 % était souhaité dans le cadre des enquêtes NEDI pour assurer une exhaustivité des résultats.
Résultats : Sur 117 services éligibles, 97 ont participé à l'étude, soit un taux de réponse de 83 %. L'ensemble de ces services était localisé dans des établissements hospitaliers. Le service était sur un seul site géographique dans 86 % des cas. Le nombre annuel médian de visites était de 34 000 (interquartile : 23 000–56 000). Soixante-six centres (68 %) appartenaient au système public, dont 22 centres universitaires et 31 centres (32 %) étaient des services privés. Les urgences adultes, pédiatriques et mixtes représentaient respectivement 54, 26 et 20 % de l'offre de soins. Un temps d'attente inférieur à une heure était rapporté par 25 % des services : 42 % pour les services privés versus 17 % dans le public (p = 0,01). Un taux d'hospitalisation inférieur à 20 % était rapporté par 54 % des centres, similaire entre public et privé (60 vs 50 % ; p = 0,40). Parmi les services interrogés, 22 % ont déclaré fonctionner en surcharge, plus fréquemment dans le public comparativement aux services privés (27 vs 10 %). La gestion 24 heures/24 et 7 jours/7 de certaines pathologies de même que la disponibilité de certains spécialistes étaient le plus souvent observées dans les hôpitaux publics, notamment universitaires.
Conclusion : L'enquête NEDI en Île-de-France a montré une hétérogénéité dans les caractéristiques et les moyens à disposition des SU. Un déterminant majeur de ces disparités repose sur le statut public versus privé. Une réflexion peut être menée à partir de ces résultats.
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Comment améliorer la prise en charge des patients âgés aux urgences ? ANNALES FRANCAISES DE MEDECINE D URGENCE 2016. [DOI: 10.1007/s13341-016-0660-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Arrouy L, Strohmenger L, Attal J, Moussu MC, Braconnier S, Beaune S. Évaluation de la mise en place d’un fast-track pour les personnes âgées de plus de 85 ans dans un service d’urgence. ANNALES FRANCAISES DE MEDECINE D URGENCE 2016. [DOI: 10.1007/s13341-016-0658-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Feral-Pierssens AL, Aubry A, Truchot J, Raynal PA, Boiffier M, Hutin A, Leleu A, Debruyne G, Joly LM, Juvin P, Riou B, Freund Y. Emergency Care for Homeless Patients: A French Multicenter Cohort Study. Am J Public Health 2016; 106:893-8. [PMID: 26985613 DOI: 10.2105/ajph.2015.303038] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To determine whether homeless patients experience suboptimal care in the emergency department (ED) by the provision of fewer health care resources. METHODS We conducted a prospective multicenter cohort study in 30 EDs in France. During 72 hours in March 2015, all homeless patients that visited the participating EDs were included in the study. The primary health care service measure was the order by the physician of a diagnostic investigation or provision of a treatment in the ED. Secondary measures of health care services included ED waiting time, number and type of investigations per patient, treatment in the ED, and discharge disposition. RESULTS A total of 254 homeless patients and 254 nonhomeless patients were included. After excluding homeless patients that attended the ED for the sole purpose of housing, we analyzed 214 homeless and 214 nonhomeless. We found no significant difference between the 2 groups in terms of health care resource consumption, and for our secondary endpoints. CONCLUSIONS We did not find significant differences in the level of medical care delivered in French EDs to homeless patients compared with matched nonhomeless patients.
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Affiliation(s)
- Anne-Laure Feral-Pierssens
- Anne-Laure Feral-Pierssens and Philippe Juvin are with Emergency Department, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes, Paris, France. Adeline Aubry, Geraud Debruyne, Bruno Riou, and Yonathan Freund are with Emergency Department, Hôpital Pitié-Salpêtriere, APHP, Paris. Jennifer Truchot is with Emergency Department, Hôpital Lariboisière, APHP, Paris. Pierre-Alexis Raynal is with Emergency Department, Hôpital Saint-Antoine, APHP, Paris. Mathieu Boiffier is with Emergency Department, Centre Hospitalier Universitaire de Nice, France. Alice Hutin is with Emergency Department, Hôpital Cochin, APHP, Paris. Agathe Leleu is with Emergency Department, Hôpital Bichat, APHP, Paris. Luc-Marie Joly is with Emergency Department, Hôpital Charles Nicolle, Rouen, France. Pierre-Alexis Raynal, Bruno Riou, and Yanathan Freund are also with Sorbonne Université, UPMC univ Paris 06, Paris
| | - Adeline Aubry
- Anne-Laure Feral-Pierssens and Philippe Juvin are with Emergency Department, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes, Paris, France. Adeline Aubry, Geraud Debruyne, Bruno Riou, and Yonathan Freund are with Emergency Department, Hôpital Pitié-Salpêtriere, APHP, Paris. Jennifer Truchot is with Emergency Department, Hôpital Lariboisière, APHP, Paris. Pierre-Alexis Raynal is with Emergency Department, Hôpital Saint-Antoine, APHP, Paris. Mathieu Boiffier is with Emergency Department, Centre Hospitalier Universitaire de Nice, France. Alice Hutin is with Emergency Department, Hôpital Cochin, APHP, Paris. Agathe Leleu is with Emergency Department, Hôpital Bichat, APHP, Paris. Luc-Marie Joly is with Emergency Department, Hôpital Charles Nicolle, Rouen, France. Pierre-Alexis Raynal, Bruno Riou, and Yanathan Freund are also with Sorbonne Université, UPMC univ Paris 06, Paris
| | - Jennifer Truchot
- Anne-Laure Feral-Pierssens and Philippe Juvin are with Emergency Department, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes, Paris, France. Adeline Aubry, Geraud Debruyne, Bruno Riou, and Yonathan Freund are with Emergency Department, Hôpital Pitié-Salpêtriere, APHP, Paris. Jennifer Truchot is with Emergency Department, Hôpital Lariboisière, APHP, Paris. Pierre-Alexis Raynal is with Emergency Department, Hôpital Saint-Antoine, APHP, Paris. Mathieu Boiffier is with Emergency Department, Centre Hospitalier Universitaire de Nice, France. Alice Hutin is with Emergency Department, Hôpital Cochin, APHP, Paris. Agathe Leleu is with Emergency Department, Hôpital Bichat, APHP, Paris. Luc-Marie Joly is with Emergency Department, Hôpital Charles Nicolle, Rouen, France. Pierre-Alexis Raynal, Bruno Riou, and Yanathan Freund are also with Sorbonne Université, UPMC univ Paris 06, Paris
| | - Pierre-Alexis Raynal
- Anne-Laure Feral-Pierssens and Philippe Juvin are with Emergency Department, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes, Paris, France. Adeline Aubry, Geraud Debruyne, Bruno Riou, and Yonathan Freund are with Emergency Department, Hôpital Pitié-Salpêtriere, APHP, Paris. Jennifer Truchot is with Emergency Department, Hôpital Lariboisière, APHP, Paris. Pierre-Alexis Raynal is with Emergency Department, Hôpital Saint-Antoine, APHP, Paris. Mathieu Boiffier is with Emergency Department, Centre Hospitalier Universitaire de Nice, France. Alice Hutin is with Emergency Department, Hôpital Cochin, APHP, Paris. Agathe Leleu is with Emergency Department, Hôpital Bichat, APHP, Paris. Luc-Marie Joly is with Emergency Department, Hôpital Charles Nicolle, Rouen, France. Pierre-Alexis Raynal, Bruno Riou, and Yanathan Freund are also with Sorbonne Université, UPMC univ Paris 06, Paris
| | - Mathieu Boiffier
- Anne-Laure Feral-Pierssens and Philippe Juvin are with Emergency Department, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes, Paris, France. Adeline Aubry, Geraud Debruyne, Bruno Riou, and Yonathan Freund are with Emergency Department, Hôpital Pitié-Salpêtriere, APHP, Paris. Jennifer Truchot is with Emergency Department, Hôpital Lariboisière, APHP, Paris. Pierre-Alexis Raynal is with Emergency Department, Hôpital Saint-Antoine, APHP, Paris. Mathieu Boiffier is with Emergency Department, Centre Hospitalier Universitaire de Nice, France. Alice Hutin is with Emergency Department, Hôpital Cochin, APHP, Paris. Agathe Leleu is with Emergency Department, Hôpital Bichat, APHP, Paris. Luc-Marie Joly is with Emergency Department, Hôpital Charles Nicolle, Rouen, France. Pierre-Alexis Raynal, Bruno Riou, and Yanathan Freund are also with Sorbonne Université, UPMC univ Paris 06, Paris
| | - Alice Hutin
- Anne-Laure Feral-Pierssens and Philippe Juvin are with Emergency Department, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes, Paris, France. Adeline Aubry, Geraud Debruyne, Bruno Riou, and Yonathan Freund are with Emergency Department, Hôpital Pitié-Salpêtriere, APHP, Paris. Jennifer Truchot is with Emergency Department, Hôpital Lariboisière, APHP, Paris. Pierre-Alexis Raynal is with Emergency Department, Hôpital Saint-Antoine, APHP, Paris. Mathieu Boiffier is with Emergency Department, Centre Hospitalier Universitaire de Nice, France. Alice Hutin is with Emergency Department, Hôpital Cochin, APHP, Paris. Agathe Leleu is with Emergency Department, Hôpital Bichat, APHP, Paris. Luc-Marie Joly is with Emergency Department, Hôpital Charles Nicolle, Rouen, France. Pierre-Alexis Raynal, Bruno Riou, and Yanathan Freund are also with Sorbonne Université, UPMC univ Paris 06, Paris
| | - Agathe Leleu
- Anne-Laure Feral-Pierssens and Philippe Juvin are with Emergency Department, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes, Paris, France. Adeline Aubry, Geraud Debruyne, Bruno Riou, and Yonathan Freund are with Emergency Department, Hôpital Pitié-Salpêtriere, APHP, Paris. Jennifer Truchot is with Emergency Department, Hôpital Lariboisière, APHP, Paris. Pierre-Alexis Raynal is with Emergency Department, Hôpital Saint-Antoine, APHP, Paris. Mathieu Boiffier is with Emergency Department, Centre Hospitalier Universitaire de Nice, France. Alice Hutin is with Emergency Department, Hôpital Cochin, APHP, Paris. Agathe Leleu is with Emergency Department, Hôpital Bichat, APHP, Paris. Luc-Marie Joly is with Emergency Department, Hôpital Charles Nicolle, Rouen, France. Pierre-Alexis Raynal, Bruno Riou, and Yanathan Freund are also with Sorbonne Université, UPMC univ Paris 06, Paris
| | - Geraud Debruyne
- Anne-Laure Feral-Pierssens and Philippe Juvin are with Emergency Department, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes, Paris, France. Adeline Aubry, Geraud Debruyne, Bruno Riou, and Yonathan Freund are with Emergency Department, Hôpital Pitié-Salpêtriere, APHP, Paris. Jennifer Truchot is with Emergency Department, Hôpital Lariboisière, APHP, Paris. Pierre-Alexis Raynal is with Emergency Department, Hôpital Saint-Antoine, APHP, Paris. Mathieu Boiffier is with Emergency Department, Centre Hospitalier Universitaire de Nice, France. Alice Hutin is with Emergency Department, Hôpital Cochin, APHP, Paris. Agathe Leleu is with Emergency Department, Hôpital Bichat, APHP, Paris. Luc-Marie Joly is with Emergency Department, Hôpital Charles Nicolle, Rouen, France. Pierre-Alexis Raynal, Bruno Riou, and Yanathan Freund are also with Sorbonne Université, UPMC univ Paris 06, Paris
| | - Luc-Marie Joly
- Anne-Laure Feral-Pierssens and Philippe Juvin are with Emergency Department, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes, Paris, France. Adeline Aubry, Geraud Debruyne, Bruno Riou, and Yonathan Freund are with Emergency Department, Hôpital Pitié-Salpêtriere, APHP, Paris. Jennifer Truchot is with Emergency Department, Hôpital Lariboisière, APHP, Paris. Pierre-Alexis Raynal is with Emergency Department, Hôpital Saint-Antoine, APHP, Paris. Mathieu Boiffier is with Emergency Department, Centre Hospitalier Universitaire de Nice, France. Alice Hutin is with Emergency Department, Hôpital Cochin, APHP, Paris. Agathe Leleu is with Emergency Department, Hôpital Bichat, APHP, Paris. Luc-Marie Joly is with Emergency Department, Hôpital Charles Nicolle, Rouen, France. Pierre-Alexis Raynal, Bruno Riou, and Yanathan Freund are also with Sorbonne Université, UPMC univ Paris 06, Paris
| | - Philippe Juvin
- Anne-Laure Feral-Pierssens and Philippe Juvin are with Emergency Department, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes, Paris, France. Adeline Aubry, Geraud Debruyne, Bruno Riou, and Yonathan Freund are with Emergency Department, Hôpital Pitié-Salpêtriere, APHP, Paris. Jennifer Truchot is with Emergency Department, Hôpital Lariboisière, APHP, Paris. Pierre-Alexis Raynal is with Emergency Department, Hôpital Saint-Antoine, APHP, Paris. Mathieu Boiffier is with Emergency Department, Centre Hospitalier Universitaire de Nice, France. Alice Hutin is with Emergency Department, Hôpital Cochin, APHP, Paris. Agathe Leleu is with Emergency Department, Hôpital Bichat, APHP, Paris. Luc-Marie Joly is with Emergency Department, Hôpital Charles Nicolle, Rouen, France. Pierre-Alexis Raynal, Bruno Riou, and Yanathan Freund are also with Sorbonne Université, UPMC univ Paris 06, Paris
| | - Bruno Riou
- Anne-Laure Feral-Pierssens and Philippe Juvin are with Emergency Department, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes, Paris, France. Adeline Aubry, Geraud Debruyne, Bruno Riou, and Yonathan Freund are with Emergency Department, Hôpital Pitié-Salpêtriere, APHP, Paris. Jennifer Truchot is with Emergency Department, Hôpital Lariboisière, APHP, Paris. Pierre-Alexis Raynal is with Emergency Department, Hôpital Saint-Antoine, APHP, Paris. Mathieu Boiffier is with Emergency Department, Centre Hospitalier Universitaire de Nice, France. Alice Hutin is with Emergency Department, Hôpital Cochin, APHP, Paris. Agathe Leleu is with Emergency Department, Hôpital Bichat, APHP, Paris. Luc-Marie Joly is with Emergency Department, Hôpital Charles Nicolle, Rouen, France. Pierre-Alexis Raynal, Bruno Riou, and Yanathan Freund are also with Sorbonne Université, UPMC univ Paris 06, Paris
| | - Yonathan Freund
- Anne-Laure Feral-Pierssens and Philippe Juvin are with Emergency Department, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes, Paris, France. Adeline Aubry, Geraud Debruyne, Bruno Riou, and Yonathan Freund are with Emergency Department, Hôpital Pitié-Salpêtriere, APHP, Paris. Jennifer Truchot is with Emergency Department, Hôpital Lariboisière, APHP, Paris. Pierre-Alexis Raynal is with Emergency Department, Hôpital Saint-Antoine, APHP, Paris. Mathieu Boiffier is with Emergency Department, Centre Hospitalier Universitaire de Nice, France. Alice Hutin is with Emergency Department, Hôpital Cochin, APHP, Paris. Agathe Leleu is with Emergency Department, Hôpital Bichat, APHP, Paris. Luc-Marie Joly is with Emergency Department, Hôpital Charles Nicolle, Rouen, France. Pierre-Alexis Raynal, Bruno Riou, and Yanathan Freund are also with Sorbonne Université, UPMC univ Paris 06, Paris
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Freund Y, Rousseau A, Berard L, Goulet H, Ray P, Bloom B, Simon T, Riou B. Cross-checking to reduce adverse events resulting from medical errors in the emergency department: study protocol of the CHARMED cluster randomized study. BMC Emerg Med 2015; 15:21. [PMID: 26340941 PMCID: PMC4560890 DOI: 10.1186/s12873-015-0046-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 08/18/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Medical errors and preventable adverse events are a major cause of concern, especially in the emergency department (ED) where its prevalence has been reported to be roughly of 5-10% of visits. Due to a short length of stay, emergency patients are often managed by a sole physician - in contrast with other specialties where they can benefit from multiples handover, ward rounds and staff meetings. As some studies report that the rate and severity of errors may decrease when there is more than one physician involved in the management in different settings, we sought to assess the impact of regular systematic cross-checkings between physicians in the ED. DESIGN The CHARMED (Cross-checking to reduce adverse events resulting from medical errors in the emergency department) study is a multicenter cluster randomized study that aim to evaluate the reduction of the rate of severe medical errors with implementation of systematic cross checkings between emergency physician, compared to a control period with usual care. This study will evaluate the effect of this intervention on the rate of severe medical errors (i.e. preventable adverse events or near miss) using a previously described two-level chart abstraction. We made the hypothesis that implementing frequent and systematic cross checking will reduce the rate of severe medical errors from 10 to 6% - 1584 patients will be included, 140 for each period in each center. DISCUSSION The CHARMED study will be the largest study that analyse unselected ED charts for medical errors. This could provide evidence that frequent systematic cross-checking will reduce the incidence of severe medical errors. TRIAL REGISTRATION Clinical Trials, NCT02356926.
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Affiliation(s)
- Yonathan Freund
- Paris Sorbonne Université, UPMC univ-Paris 6, Paris, France.
- Emergency Department, Hopital Pitie-Salpetriere, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.
| | - Alexandra Rousseau
- APHP, GH HUEP, Hôpital St Antoine, Plateforme de recherche Clinique de l'est Parisien (URCEST-CRCEST), Paris, France.
| | - Laurence Berard
- APHP, GH HUEP, Hôpital St Antoine, Plateforme de recherche Clinique de l'est Parisien (URCEST-CRCEST), Paris, France.
| | - Helene Goulet
- Emergency Department, Hopital Pitie-Salpetriere, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.
| | - Patrick Ray
- Paris Sorbonne Université, UPMC univ-Paris 6, Paris, France.
- Emergency Department, Hopital Tenon, APHP, Paris, France.
| | - Benjamin Bloom
- Emergency Department, Royal London Hospital, Barts Health NHS Trust, London, UK.
| | - Tabassome Simon
- Paris Sorbonne Université, UPMC univ-Paris 6, Paris, France.
- APHP, GH HUEP, Hôpital St Antoine, Plateforme de recherche Clinique de l'est Parisien (URCEST-CRCEST), Paris, France.
| | - Bruno Riou
- Paris Sorbonne Université, UPMC univ-Paris 6, Paris, France.
- Emergency Department, Hopital Pitie-Salpetriere, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.
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Perimal-Lewis L, Ben-Tovim DI, Li JY, Hakendorf PH, Thompson CH. Emergency department lengths of stay: characteristics favouring a delay to the admission decision as distinct from a delay while awaiting an inpatient bed. Intern Med J 2015; 44:384-9. [PMID: 24612154 DOI: 10.1111/imj.12385] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 02/09/2014] [Accepted: 02/10/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND A prolonged stay for a patient within the emergency department (ED) can adversely affect the outcome of their ensuing hospital admission. AIMS To investigate the characteristics of those eventual general medical hospital inpatients who stay in the ED awaiting a decision to be admitted and then await a bed. METHODS Data from Flinders Medical Centre's patient journey database were analysed. The analysis was carried out on 19 476 patients admitted as an emergency under the General Medicine units. RESULTS A less urgent Australian Triage Scale category significantly prolonged triage-to-admit time but did not affect boarding time. The decision to admit a patient took 29% longer for patients who presented to the ED outside of working hours. However, a decision to admit taken outside working hours meant the boarding time was over 3 h shorter than if the decision had been taken inside working hours. For every additional patient in the ED at the time of presentation, the admission decision was delayed by about half a minute. Every additional patient in the ED at the time of an admission decision increased boarding time by almost 10 min. CONCLUSION Outside of working hours, patients presenting to ED have longer triage-to-admit times while patients for admission have shorter boarding times. ED congestion delays admission decisions only slightly and prolongs patients' boarding times to a greater extent. Strategies to reduce the time patients spend in ED should differ depending on whether a decision to admit the patient has been reached.
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Affiliation(s)
- L Perimal-Lewis
- School of Computer Science, Engineering and Mathematics, Flinders University, Adelaide, South Australia, Australia
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Burnod A, Choquet C, Houissa H, Danis J, Pellenc Q, Duchateau FX. [Medical decision in a very elderly patient: a case report of application of the Leonetti law in emergency medicine]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2014; 33:361-363. [PMID: 24821341 DOI: 10.1016/j.annfar.2014.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 03/20/2014] [Indexed: 06/03/2023]
Abstract
Advanced care decision in emergency medicine is difficult for the elderly. How to be fair, avoiding an unreasonable obstinacy? Based on the case of very old person, we show how an optimal management can be decided in accordance with the spirit of the law.
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Affiliation(s)
- A Burnod
- Smur, hôpital Beaujon, hôpitaux universitaires Paris Nord Val-de-Seine, 100, boulevard du Général-Leclerc, 92110 Clichy, France; Unité de soins de supports et soins palliatifs, institut Curie, 75005 Paris, France.
| | - C Choquet
- Service d'accueil des urgences, hôpital Bichat, hôpitaux universitaires Paris Nord Val-de-Seine, 75018 Paris, France
| | - H Houissa
- Service d'anesthésie-réanimation chirurgicale, hôpital Bichat, hôpitaux universitaires Paris Nord Val-de-Seine, 75018 Paris, France
| | - J Danis
- Unité de soins de supports et soins palliatifs, institut Curie, 75005 Paris, France
| | - Q Pellenc
- Service de chirurgie vasculaire et thoracique, hôpital Bichat, hôpitaux universitaires Paris Nord Val-de-Seine, 75018 Paris, France
| | - F X Duchateau
- Smur, hôpital Beaujon, hôpitaux universitaires Paris Nord Val-de-Seine, 100, boulevard du Général-Leclerc, 92110 Clichy, France
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Éducation thérapeutique dans l’insuffisance surrénale : un outil encore insuffisamment utilisé pour éviter ou traiter précocement l’insuffisance surrénale aiguë. Presse Med 2014; 43:444-52. [DOI: 10.1016/j.lpm.2014.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 01/17/2014] [Accepted: 01/28/2014] [Indexed: 11/19/2022] Open
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