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Paterson E, Chari S, McCormack L, Sanderson P. Application of a Human Factors Systems Approach to Healthcare Control Centres for Managing Patient Flow: A Scoping Review. J Med Syst 2024; 48:62. [PMID: 38888610 PMCID: PMC11189321 DOI: 10.1007/s10916-024-02071-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 04/25/2024] [Indexed: 06/20/2024]
Abstract
Over the past decade, healthcare systems have started to establish control centres to manage patient flow, with a view to removing delays and increasing the quality of care. Such centres-here dubbed Healthcare Capacity Command/Coordination Centres (HCCCs)-are a challenge to design and operate. Broad-ranging surveys of HCCCs have been lacking, and design for their human users is only starting to be addressed. In this review we identified 73 papers describing different kinds of HCCCs, classifying them according to whether they describe virtual or physical control centres, the kinds of situations they handle, and the different levels of Rasmussen's [1] risk management framework that they integrate. Most of the papers (71%) describe physical HCCCs established as control centres, whereas 29% of the papers describe virtual HCCCs staffed by stakeholders in separate locations. Principal functions of the HCCCs described are categorised as business as usual (BAU) (48%), surge management (15%), emergency response (18%), and mass casualty management (19%). The organisation layers that the HCCCs incorporate are classified according to the risk management framework; HCCCs managing BAU involve lower levels of the framework, whereas HCCCs handling the more emergent functions involve all levels. Major challenges confronting HCCCs include the dissemination of information about healthcare system status, and the management of perspectives and goals from different parts of the healthcare system. HCCCs that take the form of physical control centres are just starting to be analysed using human factors principles that will make staff more effective and productive at managing patient flow.
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Affiliation(s)
- Estrella Paterson
- School of Psychology, The University of Queensland, Brisbane, Australia.
- School of Business, The University of Queensland, Brisbane, Australia.
| | - Satyan Chari
- Clinical Excellence Queensland, Queensland Health, Brisbane, Australia
| | - Linda McCormack
- Clinical Excellence Queensland, Queensland Health, Brisbane, Australia
| | - Penelope Sanderson
- School of Psychology, The University of Queensland, Brisbane, Australia
- School of Clinical Medicine, The University of Queensland, Brisbane, Australia
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Samadbeik M, Staib A, Boyle J, Khanna S, Bosley E, Bodnar D, Lind J, Austin JA, Tanner S, Meshkat Y, de Courten B, Sullivan C. Patient flow in emergency departments: a comprehensive umbrella review of solutions and challenges across the health system. BMC Health Serv Res 2024; 24:274. [PMID: 38443894 PMCID: PMC10913567 DOI: 10.1186/s12913-024-10725-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 02/14/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Globally, emergency departments (EDs) are overcrowded and unable to meet an ever-increasing demand for care. The aim of this study is to comprehensively review and synthesise literature on potential solutions and challenges throughout the entire health system, focusing on ED patient flow. METHODS An umbrella review was conducted to comprehensively summarise and synthesise the available evidence from multiple research syntheses. A comprehensive search strategy was employed in four databases alongside government or organisational websites in March 2023. Gray literature and reports were also searched. Quality was assessed using the JBI critical appraisal checklist for systematic reviews and research syntheses. We summarised and classified findings using qualitative synthesis, the Population-Capacity-Process (PCP) model, and the input/throughput/output (I/T/O) model of ED patient flow and synthesised intervention outcomes based on the Quadruple Aim framework. RESULTS The search strategy yielded 1263 articles, of which 39 were included in the umbrella review. Patient flow interventions were categorised into human factors, management-organisation interventions, and infrastructure and mapped to the relevant component of the patient journey from pre-ED to post-ED interventions. Most interventions had mixed or quadruple nonsignificant outcomes. The majority of interventions for enhancing ED patient flow were primarily related to the 'within-ED' phase of the patient journey. Fewer interventions were identified for the 'post-ED' phase (acute inpatient transfer, subacute inpatient transfer, hospital at home, discharge home, or residential care) and the 'pre-ED' phase. The intervention outcomes were aligned with the aim (QAIM), which aims to improve patient care experience, enhance population health, optimise efficiency, and enhance staff satisfaction. CONCLUSIONS This study found that there was a wide range of interventions used to address patient flow, but the effectiveness of these interventions varied, and most interventions were focused on the ED. Interventions for the remainder of the patient journey were largely neglected. The metrics reported were mainly focused on efficiency measures rather than addressing all quadrants of the quadruple aim. Further research is needed to investigate and enhance the effectiveness of interventions outside the ED in improving ED patient flow. It is essential to develop interventions that relate to all three phases of patient flow: pre-ED, within-ED, and post-ED.
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Affiliation(s)
- Mahnaz Samadbeik
- Faculty of Medicine, Centre for Health Services Research, The University of Queensland, Brisbane, Australia.
- Faculty of Medicine, Queensland Digital Health Centre, The University of Queensland, Brisbane, QLD, 4072, Australia.
| | - Andrew Staib
- Princess Alexandra Hospital, Brisbane, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Justin Boyle
- The Australian E-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
| | - Sankalp Khanna
- The Australian E-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
| | - Emma Bosley
- Queensland Ambulance Service, Queensland Government, Brisbane, Australia
| | - Daniel Bodnar
- Queensland Ambulance Service, Queensland Government, Brisbane, Australia
| | - James Lind
- Gold Coast University Hospital, Gold Coast, Australia
| | - Jodie A Austin
- Faculty of Medicine, Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Faculty of Medicine, Queensland Digital Health Centre, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Sarah Tanner
- Faculty of Medicine, Queensland Digital Health Centre, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Yasaman Meshkat
- Faculty of Medicine, Queensland Digital Health Centre, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Barbora de Courten
- Faculty of Medicine, Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Faculty of Medicine, Queensland Digital Health Centre, The University of Queensland, Brisbane, QLD, 4072, Australia
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
| | - Clair Sullivan
- Faculty of Medicine, Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Faculty of Medicine, Queensland Digital Health Centre, The University of Queensland, Brisbane, QLD, 4072, Australia
- Department of Health, Metro North Hospital and Health Service, Brisbane, Australia
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
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Kabil G, Frost SA, Hatcher D, Shetty A, McNally S. Facilitators and barriers of appropriate and timely initiation of intravenous fluids in patients with sepsis in emergency departments: a consensus development Delphi study. BMC Nurs 2023; 22:402. [PMID: 37891553 PMCID: PMC10604401 DOI: 10.1186/s12912-023-01561-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Sepsis is a life-threatening medical emergency in which appropriate and timely administration of intravenous fluids to patients with features of hypotension is critical to prevent multi-organ failure and subsequent death. However, compliance with recommended fluid administration is reported to be poor. There is a lack of consensus among emergency clinicians on some of the determinant factors influencing fluid administration in sepsis. Thus, the aim of this study was to identify the level of consensus among key stakeholders in emergency departments regarding the facilitators, barriers, and strategies to improve fluid administration. METHODS The modified Delphi questionnaire with 23 statements exploring barriers, facilitators, and strategies to improve fluid administration was developed from the integration of findings from previous phases of the study involving emergency department clinicians. A two-round modified Delphi survey was conducted among key stakeholders with managerial, educational, supervision and leadership responsibilities using a "Reactive Delphi technique" from March 2023 to June 2023. The statements were rated for importance on a 9-point Likert scale. The RAND/UCLA Appropriateness Method (RAM) was used to identify the level of consensus (agreement/disagreement). RESULTS Of the 21 panellists who completed Round 1 survey, 18 (86%) also completed Round 2. The panellists rated 9 out of 10 (90%) barriers, 3 out of 4 (75%) facilitators and all 9 (100%) improvement strategies as important. Out of the total 23 statements, 18 (78%) had agreement among the panellists. Incomplete vital signs at triage (Median = 9, IQR 7.25 to 9.00) as a barrier, awareness of importance of fluid administration in sepsis (Median = 9, IQR 8.00 to 9.00) as facilitator and provision of nurse-initiated intravenous fluids (Median = 9, IQR 8.00 to 9.00) as an improvement strategy were the highest rated statements. CONCLUSION This is the first Delphi study identifying consensus on facilitators, barriers, and strategies to specifically improve intravenous fluid administration in sepsis in Australia. We identified 18 consensus-based factors associated with appropriate and timely administration of intravenous fluids in sepsis. This study offers empirical evidence to support the implementation of the identified strategies to improve patient outcomes.
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Affiliation(s)
- Gladis Kabil
- Western Sydney University, School of Nursing and Midwifery, Sydney, Australia.
- Department of Emergency, Westmead Hospital, Sydney, Australia.
| | - Steven A Frost
- South Western Sydney Nursing and Midwifery Research, Ingham Institute of Applied Medical Research, Sydney, Australia
- University of New South Wales, Sydney, Australia
- School of Nursing and Midwifery, University of Wollongong, Wollongong, Australia
| | - Deborah Hatcher
- Western Sydney University, School of Nursing and Midwifery, Sydney, Australia
| | - Amith Shetty
- Westmead Institute for Medical Research, Sydney, Australia
- NSW Ministry of Health, Sydney, Australia
| | - Stephen McNally
- Western Sydney University, School of Nursing and Midwifery, Sydney, Australia
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Salter MD, Beaver S, Hasler L, Manivel V, Aziz O, Mallows JL. Determination of emergency nurse practitioner and plastic surgery trainee disposition decision agreement for plastic surgery emergency department presentations: A prospective study. Emerg Med Australas 2023; 35:739-745. [PMID: 36971043 DOI: 10.1111/1742-6723.14203] [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: 09/07/2022] [Revised: 03/09/2023] [Accepted: 03/14/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE To examine if there was a high degree of agreement for disposition decisions of emergency nurse practitioners (ENP) compared to plastic surgery trainees (PST) for plastic surgery presentations. METHODS A prospective study of disposition decision agreement from February 2020 to January 2021 for patients who required plastic surgery consultation and managed exclusively by an ENP. Absolute percentages were used to determine the exact disposition decision accuracy of ENP and the PST, while Cohen's kappa compared disposition decision agreement. Sub-analyses of age, gender, ENP experience and presenting condition agreement were also completed. To mitigate confounding factors, operative management (OM) and non-OM groups were analysed. RESULTS The study recruited 342 patients who presented mostly with finger or hand-related conditions (82%, n = 279) and managed by an ENP with less than 10 years of experience (65%, n = 224). Disposition decisions by ENP compared to PST were the same in 80% (n = 274) of cases. Disposition agreement for all patients was 0.72 (95% confidence interval 0.66-0.78). For the OM and non-OM groups, disposition decisions were the same in 94% (n = 320), with a Cohen's kappa 0.85 (95% confidence interval 0.79-0.91). Seven patients (2%) were discharged to GP care by the ENP when determined to need further plastic surgery involvement by the PST. CONCLUSIONS Disposition decisions by ENP and PST were the same in most cases and had a high overall level of agreement. This may lead to greater autonomy of ENP care and reduced ED length of stay and occupancy.
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Affiliation(s)
- Mark D Salter
- Emergency Department, Nepean Hospital, Sydney, New South Wales, Australia
- The University of Sydney Nepean Clinical School, Sydney, New South Wales, Australia
| | - Sarah Beaver
- Emergency Department, Nepean Hospital, Sydney, New South Wales, Australia
| | - Linda Hasler
- Emergency Department, Nepean Hospital, Sydney, New South Wales, Australia
| | - Vijay Manivel
- Emergency Department, Nepean Hospital, Sydney, New South Wales, Australia
- The University of Sydney Nepean Clinical School, Sydney, New South Wales, Australia
| | - Omar Aziz
- Emergency Department, Nepean Hospital, Sydney, New South Wales, Australia
| | - James L Mallows
- Emergency Department, Nepean Hospital, Sydney, New South Wales, Australia
- The University of Sydney Nepean Clinical School, Sydney, New South Wales, Australia
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Downie S, Walsh J, Kirk-Brown A, Haines TP. How can scope of practice be described and conceptualised in medical and health professions? A systematic review for scoping and content analysis. Int J Health Plann Manage 2023; 38:1184-1211. [PMID: 37434288 DOI: 10.1002/hpm.3678] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/11/2023] [Accepted: 06/22/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND The term scope of practice (SOP) refers to the limits of a health professional's knowledge, skills and experience and reflects all tasks and activities they undertake within the context of their professional role. Inconsistency in definitions of SOP contributes to uncertainty and confusion regarding professional practice boundaries and potentially impacts societal access to safe, effective and efficient healthcare options. The aim of this paper is to understand the conceptual diversity that may exist in terminology used to describe medical, nursing/midwifery and allied health SOP within an Australian practice context exemplar. METHODS A systematic review for scoping and content analysis of SOP definitions and concepts, involving inductive thematic analysis and synthesis of published and grey literature. RESULTS The initial search strategy yielded 11,863 hits, of which 379 were suitable for inclusion. Data coding identified various SOP terms and definitions and the emergence of six, conceptual elements underpinning the theoretical construct. These were subsequently proposed as a preliminary conceptual model ('Solar') to explain how the six conceptual elements may be applied across various professions, clinical settings and jurisdictions to better understand and address current and evolving SOP issues. CONCLUSION The findings of this study highlight limited consistency in SOP definitions and terminology within a single jurisdiction, and the conceptual complexity of the underlying theoretical construct. Further research is required to build on the proposed 'Solar' conceptual model and create a universal SOP definition across jurisdictions, to enhance understanding of the importance of SOP to workforce policy, clinical governance, service models and patient outcomes.
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Affiliation(s)
- Sharon Downie
- Medical Workforce, The Royal Children's Hospital, Victoria, Australia
- Executive Health Management Program, Monash University, Victoria, Australia
| | - Jill Walsh
- Medical Workforce, The Royal Children's Hospital, Victoria, Australia
- Executive Health Management Program, Monash University, Victoria, Australia
| | - Andrea Kirk-Brown
- Department of Management, Faculty of Business and Economics, Monash University, Victoria, Australia
| | - Terry P Haines
- Head of School, School of Primary and Allied Health Care & National Centre for Healthy Ageing, Monash University, Victoria, Australia
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Carfagnini QA, Ayanso A, Law MP, Orlando E, Faught BE. What Factors Increase Odds of Long-Stay Delayed Discharge in Alternate Level of Care Patients? J Am Med Dir Assoc 2023; 24:1327-1333. [PMID: 36996875 DOI: 10.1016/j.jamda.2023.02.104] [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: 08/11/2022] [Revised: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE The objective of this study was to determine the factors that increase the odds of long-stay delayed discharge in alternate level of care (ALC) patients using data collected from the Ontario Wait Time Information System (WTIS) database. DESIGN Retrospective cohort study utilizing data from Niagara Health's WTIS database. WTIS includes individuals admitted to any of the Niagara Health sites that have been designated as ALC. SETTING AND PARTICIPANTS Sample consisted of 16,429 ALC patients who received care in Niagara Health hospitals from September 2014 to September 2019 and were recorded in the WTIS database. METHODS ALC designation of 30 or more days was used as the threshold for a long-stay delayed discharge. This study used binary logistic regression modeling to analyze sex, age, admission source, and discharge destination as well needs/barriers requirements to assess the likelihood of a long-stay delayed discharge among acute care (AC) and post-acute care (PAC) patients given the presence of each variable. Sample sizes calculations and receiver operating characteristic curves were used to verify the validity of the regression model. RESULTS Overall, 10.2% of the sample were considered long-stay ALC patients. Both AC and PAC long-stay ALC patients were more likely to be male [OR = 1.23, (1.06-1.43); OR = 1.28, (1.03-1.60)] and have a discharge destination of a long-term care bed [OR = 28.68, (22.83-36.04); OR = 6.22, (4.75-8.15)]. AC patients had bariatric [OR = 7.16, (3.45-14.83)], behavioral [OR = 1.89, (1.22-2.91)], infection (isolation) [OR = 2.31, (1.63-3.28)], and feeding [OR = 6.38, (1.82-22.30)] barriers hindering discharge. PAC patients had no significant barriers hindering patient discharge. CONCLUSIONS AND IMPLICATIONS Shifting the focus from ALC patient designation to short- vs long-stay ALC patients allowed this study to focus on the subset of patients that are disproportionately affecting delayed discharges. Understanding the importance of specialized patient requirements in addition to clinical factors can help hospitals become more prepared in preventing delayed discharges.
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Affiliation(s)
- Quinten A Carfagnini
- Faculty of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada.
| | - Anteneh Ayanso
- Goodman School of Business, Brock University, St. Catharines, Ontario, Canada
| | - Madelyn P Law
- Faculty of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Elaina Orlando
- Faculty of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada; Niagara Health, St. Catharines, Ontario, Canada
| | - Brent E Faught
- Faculty of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
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7
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Lal PB, Wishart LR, Ward EC, Schwarz M, Seabrook M, Coccetti A. Understanding barriers and facilitators to speech-language pathology service delivery in the emergency department. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 25:509-522. [PMID: 35579003 DOI: 10.1080/17549507.2022.2071465] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Timely speech-language pathology (SLP) involvement with dysphagic patients in the Emergency Department (ED) may improve patient outcomes. This study utilised qualitative interviews to understand current models and explore factors which have influenced establishment and current dysphagia service provision in Australian EDs. METHOD Semi-structured interviews were conducted with representatives from 12 acute hospital facilities with a SLP ED service. Interview transcripts were analysed using plain content analysis to identify key themes. Sub-analysis using the Consolidated Framework for Implementation Research (CFIR) model was undertaken for facilities with more "expanded" models (n = 4). RESULT SLP ED service models ranged from referral-only services, to models with referral-only and proactive SLP-led screening procedures (classified as "expanded"). Patient-related factors, the ED setting, SLP service factors and perceptions of dysphagia management were key themes reported to impact service delivery. With expanded models, 14 CFIR constructs (innovation source, external policy and incentives, networks and communications, stakeholders and relative priority) were identified as facilitators, while four constructs (adaptability, cost, compatibility, available resources) were barriers to services. CONCLUSION There are service-specific issues with providing SLP care within the ED. Factors related to the unique ED environment must be considered by SLP departments when establishing/optimising dysphagia management within the ED.
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Affiliation(s)
- Pranika B Lal
- School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia
- Speech Pathology Department, Logan Hospital, Metro South Hospital & Health Service, Queensland, Australia, and
| | - Laurelie R Wishart
- School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia
- Centre for Functioning and Health Research, Metro South Hospital & Health Service, Queensland, Australia
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia
- Centre for Functioning and Health Research, Metro South Hospital & Health Service, Queensland, Australia
| | - Maria Schwarz
- Bayside Health Service, Metro South Hospital & Health Service, Queensland, Australia
| | - Marnie Seabrook
- Speech Pathology Department, Logan Hospital, Metro South Hospital & Health Service, Queensland, Australia, and
| | - Anne Coccetti
- Bayside Health Service, Metro South Hospital & Health Service, Queensland, Australia
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Bo Y, Liu QB, Tong Y. The Effects of Adopting Mobile Health and Fitness Apps on Hospital Visits: Quasi-Experimental Study. J Med Internet Res 2023; 25:e45681. [PMID: 37505809 PMCID: PMC10422177 DOI: 10.2196/45681] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/09/2023] [Accepted: 06/05/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Overcrowding in public hospitals, a common issue in many countries, leads to a range of negative outcomes, such as insufficient access to medical services and patient dissatisfaction. Prior literature regarding solutions to reducing hospital overcrowding primarily focuses on organizational-level operational efficiency. However, few studies have investigated the strategies from the individual patient perspective. Specifically, we considered using mobile health and fitness apps to promote users' health behaviors and produce health benefits, thereby reducing hospital visits. OBJECTIVE This study estimated the causal effect of health and fitness app adoption on hospital visits by exploiting the staggered timing of adoption. We also investigated how the effect varied with users' socioeconomic status and digital literacy. This study provides causal evidence for the effects of health apps, extends the digital health literature, and sheds light on mobile health policies. METHODS This study used a data set containing health and fitness app use and hospital-related geolocation data of 267,651 Chinese mobile phone users from January to December 2019. We used the difference-in-differences and difference-in-difference-in-differences designs to estimate the causal effect. We performed a sensitivity analysis to establish the robustness of the findings. We also conducted heterogeneity analyses based on the interactions of postadoption indicators with users' consumption levels, city tiers, and digital literacy. RESULTS The preferred model (difference-in-difference-in-differences) showed a significant decrease in hospital visits after the adoption of health and fitness apps. App adoption led to a 5.8% (P<.001), 13.1% (P<.001), and 18.4% reduction (P<.001) in hospital visits 1, 2, and 3 months after adoption, respectively. In addition, the moderation analysis shows that the effect is greater for users with high consumption levels, in high-tier cities, or with high digital literacy. CONCLUSIONS This study estimated the causal effect of health and fitness app adoption on hospital visits. The results and sensitivity analysis showed that app adoption can reduce users' hospital visits. The effect varies with users' consumption levels, city tiers, and digital literacy. These findings provide useful insights for multiple stakeholders in the Chinese health care context.
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Affiliation(s)
- Yan Bo
- Department of Data Science and Engineering Management, School of Management, Zhejiang University, Hangzhou, China
- Department of Information Systems, College of Business, City University of Hong Kong, Hong Kong, China
| | - Qianqian Ben Liu
- Department of Information Systems, College of Business, City University of Hong Kong, Hong Kong, China
| | - Yu Tong
- Department of Data Science and Engineering Management, School of Management, Zhejiang University, Hangzhou, China
- Center for Research on Zhejiang Digital Development and Governance, Hangzhou, China
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Sher L, Semciw A, Jessup RL, Carrodus A, Boyd J. Structured evaluation of a virtual emergency department triage model of care: A study protocol. Emerg Med Australas 2022; 34:907-912. [PMID: 35570401 PMCID: PMC9790376 DOI: 10.1111/1742-6723.14010] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 02/10/2022] [Accepted: 04/21/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE A new virtual ED service was introduced into a hospital network in the northern suburbs of Melbourne in response to changing needs during the COVID-19 pandemic. The 'virtual ED' utilises a telehealth model as a means of assessment for appropriately selected patients to facilitate either complete care or navigation into streamlined pathways for ongoing care, in some cases bypassing the ED entirely where appropriate. The proposed study aims to evaluate the implementation of the model and identify future improvement opportunities, assess the impact on traditional health service delivery processes and patient experience, and determine the acceptability of the 'virtual ED' model of care. METHODS The present study will consist of a pre-post- implementation evaluation using the RE-AIM framework. Routine health service data will be collected for 6 months post-implementation of the virtual ED model and compared to 24 months prior to implementation. Prospective data will be collected using routinely collected and survey data. Interviews and focus groups will be conducted to understand consumer and clinician perspectives on barriers and enablers to implementation and adoption of the virtual ED. RESULTS Descriptive statistics will be used to describe the study population and key outcomes, including changes in ED presentations and length of stay. Thematic analysis will be conducted on transcribed interviews and focus group data. This will be triangulated with data collected from patient feedback surveys. CONCLUSION This project will support the delivery of care to ED patients by evaluating the 'virtual ED' model of care.
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Affiliation(s)
- Loren Sher
- Emergency DepartmentNorthern Hospital EppingMelbourneVictoriaAustralia,School of Psychology and Public HealthLa Trobe UniversityMelbourneVictoriaAustralia
| | - Adam Semciw
- School of Allied Health, Human Services and SportLa Trobe UniversityMelbourneVictoriaAustralia,Allied Health Research, Northern Hospital EppingMelbourneVictoriaAustralia
| | - Rebecca L Jessup
- School of Allied Health, Human Services and SportLa Trobe UniversityMelbourneVictoriaAustralia,Allied Health Research, Northern Hospital EppingMelbourneVictoriaAustralia
| | - Ariana Carrodus
- Project Management Office, Northern Hospital EppingMelbourneVictoriaAustralia
| | - James Boyd
- School of Psychology and Public HealthLa Trobe UniversityMelbourneVictoriaAustralia
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Kreindler S, Aboud Z, Hastings S, Winters S, Johnson K, Mallinson S, Brierley M. How Do Health Systems Address Patient Flow When Services Are Misaligned With Population Needs? A Qualitative Study. Int J Health Policy Manag 2022; 11:1362-1372. [PMID: 33949820 PMCID: PMC9808352 DOI: 10.34172/ijhpm.2021.36] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 03/30/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Patient flow through health services is increasingly recognized as a system issue, yet the flow literature has focused overwhelmingly on localized interventions, with limited examination of system-level causes or remedies. Research suggests that intractable flow problems may reflect a basic misalignment between service offerings and population needs, requiring fundamental system redesign. However, little is known about health systems' approaches to population-capacity misalignment, and guidance for system redesign remains underdeveloped. METHODS This qualitative study, part of a broader investigation of patient flow in urban Western Canada, explored health-system strategies to address or prevent population-capacity misalignment. We conducted in-depth interviews with a purposive sample of managers in 10 jurisdictions across 4 provinces (N = 300), spanning all healthcare sectors and levels of management. We used the constant comparative method to develop an understanding of relevant strategies and derive principles for system design. RESULTS All regions showed evidence of pervasive population-capacity misalignment. The most superficial level of response - mutual accommodation (case-by-case problem solving) - was most prevalent; capacity (re)allocation occurred less frequently; population redefinition most rarely. Participants' insights yielded a general principle: Define populations on the basis of clusters of co-occurring need. However, defining such clusters demands a difficult balance between narrowness/rigidity and breadth/flexibility. Deeper analysis suggested a further principle: Populations that can be divided into homogeneous subgroups experiencing similar needs (eg, surgical patients) are best served by narrow/ rigid models; heterogeneous populations featuring diverse constellations of need (eg, frail older adults) require broad/ flexible models. CONCLUSION To remedy population-capacity misalignment, health system planners should determine whether clusters of population need are separable vs. fused, select an appropriate service model for each population, allocate sufficient capacity, and only then promote mutual accommodation to address exceptions. Overreliance on case-by-case solutions to systemic problems ensures the persistence of population-capacity misalignment.
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Affiliation(s)
- Sara Kreindler
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg Regional Health Authority/University of Manitoba, Winnipeg, MB, Canada
| | - Zaid Aboud
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Stephanie Hastings
- Health Systems Evaluation & Evidence, Alberta Health Services, Calgary, AB, Canada
| | - Shannon Winters
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg Regional Health Authority/University of Manitoba, Winnipeg, MB, Canada
| | - Keir Johnson
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg Regional Health Authority/University of Manitoba, Winnipeg, MB, Canada
| | - Sara Mallinson
- Health Systems Evaluation & Evidence, Alberta Health Services, Calgary, AB, Canada
| | - Meaghan Brierley
- Health Systems Evaluation & Evidence, Alberta Health Services, Calgary, AB, Canada
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Emergency department nurse-initiated protocols for paediatric febrile neutropenia: A scoping review. Collegian 2022. [DOI: 10.1016/j.colegn.2021.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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12
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Crilly J, Bartlett D, Sladdin I, Pellatt R, Young JT, Ham W, Porter L. Patient profile and outcomes of traumatic injury: The impact of mode of arrival to the emergency department. Collegian 2022. [DOI: 10.1016/j.colegn.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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13
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Innes K, Jackson D, Plummer V, Elliott D. Exploration and model development for emergency department waiting room nurse role: Synthesis of a three-phase sequential mixed methods study. Int Emerg Nurs 2021; 59:101075. [PMID: 34597868 DOI: 10.1016/j.ienj.2021.101075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 07/13/2021] [Accepted: 08/20/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND To improve flow and care in waiting rooms, some emergency departments introduced a specific nursing role to care for this patient cohort with the aim of commencing interventions early, improving patient safety by reassessing and enhancing communication. The objective of the research was to explore to what extent does qualitative interviews and quantitative survey contribute to describing emergency department waiting room nurses, through integration and synthesis of findings from a multiphase mixed methods study. METHODS Multiphase mixed methods exploratory sequential design with integration of findings. Data integration occurred during the phases and when assimilating all findings. FINDINGS Experienced emergency nurses, preferably with graduate qualifications, who are autonomous practitioners with highly developed communication skills, clinical decision making and proficiency in assessment and monitoring are required to perform the role. The waiting room nurse provides patient-centered care and ensures safe, timely care is delivered to those in the waiting room. A standardised approach and high risk of exposure to occupational stressors need to be considered. CONCLUSIONS This mixed methods sequential design explored the waiting room nurse role from the perspective of emergency nurses generating new knowledge into the role. This advanced practice nursing role contributes to patient safety and delivery of patient centred care in the emergency department waiting room.
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Affiliation(s)
- Kelli Innes
- University of Technology Sydney, Faculty of Health, 15 Broadway, Ultimo, NSW 2007, Australia; Monash University, Monash Nursing and Midwifery, 47-49 Moorooduc Highway, Frankston, Victoria 3199, Australia.
| | - Debra Jackson
- University of Technology Sydney, Faculty of Health, 15 Broadway, Ultimo, NSW 2007, Australia; The University of Sydney, Sydney Nursing School, Camperdown, N.S.W. 2006, Australia.
| | - Virginia Plummer
- Monash University, Monash Nursing and Midwifery, 47-49 Moorooduc Highway, Frankston, Victoria 3199, Australia; Federation University Australia, School of Health, 72-100 Clyde Road, Berwick, Victoria 3806, Australia.
| | - Doug Elliott
- University of Technology Sydney, Faculty of Health, 15 Broadway, Ultimo, NSW 2007, Australia.
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14
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Mashao K, Heyns T, White Z. Areas of delay related to prolonged length of stay in an emergency department of an academic hospital in South Africa. Afr J Emerg Med 2021; 11:237-241. [PMID: 33747758 PMCID: PMC7966966 DOI: 10.1016/j.afjem.2021.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/20/2020] [Accepted: 02/01/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Globally, length of stay of patients in emergency departments remains a challenge. Remaining in the emergency department for >12 h increases health care costs, morbidity and mortality rates and leads to crowding and lower patient satisfaction.The aim of this research was to describe the areas of delay related to prolonged length of stay in the emergency department of an academic hospital. Methods A quantitative retrospective study was done. The Input-Throughput-Output model was used to identify the areas of patients' journey through the emergency department. The possible areas of delay where then described. Using systematic sampling, a total of 100 patient files managed in an emergency department of an academic hospital in South Africa were audited over a period of 3 months. Descriptive statistics and regression analysis was used to analyse data. Results The mean length of stay of patients in the emergency department was 73 h 49 min. The length of stay per phase was: input (3 h 17 min), throughput (16 h 25 min) and output (54 h 7 min). A strong significant relationship found between the length of stay and the time taken between disposition decision (throughput phase) disposition decision to admission or discharge of patients from the ED (output phase) (p < 0.05). Conclusion The output phase was identified as the longest area of delay in this study, with the time taken between disposition decision to admission or discharge of patients from the ED (patients waiting for inpatient beds) as the main significant area of delay.
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Affiliation(s)
- Kapari Mashao
- University of Pretoria, Department of Nursing Science, Pretoria, South Africa
| | - Tanya Heyns
- University of Pretoria, Department of Nursing Science, Pretoria, South Africa
| | - Zelda White
- University of Pretoria, Department of Human Nutrition, Pretoria, South Africa
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15
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Northcott KMT, Gibson K, Peters MDJ. Nurse-initiated protocols in the emergency department management of pediatric oncology patients with fever and suspected neutropenia: a scoping review protocol. JBI Evid Synth 2021; 19:1243-1250. [PMID: 33156131 DOI: 10.11124/jbies-20-00149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The objective of this review is to provide an overview of the existing evidence regarding nurse-initiated protocols in the emergency department management of pediatric oncology patients with fever and suspected neutropenia. INTRODUCTION Febrile neutropenia in pediatric oncology patients poses a significant burden of increased morbidity and mortality. Prompt, efficient emergency care and rapid antibiotic administration within 60 minutes of presentation to hospital is required to prevent clinical deterioration and reduce rates of intensive care admission and mortality. Efficient emergency department care delivery is impacted by modern day challenges, such as increasing user-demand, limited resources, and lack of flow. In response to this, to expedite care provision, practice guidelines have been developed to include nurse-initiated protocols that guide nurses to initiate specific predetermined investigations and interventions for patients meeting certain criteria. Febrile neutropenic pediatric patients may be a specific group that can benefit from nurse-initiated protocols due to the time-critical nature of required care. INCLUSION CRITERIA The scoping review will consider literature that reports on nurse-initiated protocols in the management of pediatric febrile oncology patients with suspected neutropenia in the emergency department setting. METHODS JBI methodology for scoping reviews will guide the review process. English-language literature from 2000 to present will be searched in Embase, MEDLINE, Scopus, Emcare, CINAHL Plus, and gray literature in Google Scholar, Open Grey, and Theses Global. Critical appraisal will not be performed. A tabular and accompanying narrative summary of the information will present extracted evidence aligned to the review's objective and questions.
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Affiliation(s)
- Katie M T Northcott
- University of South Australia, Clinical & Health Sciences, Rosemary Bryant AO Research Centre, Adelaide, SA, Australia.,The Women's and Children's Hospital, Adelaide, SA, Australia
| | - Kim Gibson
- University of South Australia, UniSA Clinical & Health Sciences, Adelaide, SA, Australia
| | - Micah D J Peters
- University of South Australia, Clinical & Health Sciences, Rosemary Bryant AO Research Centre, Adelaide, SA, Australia.,Adelaide Nursing School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia.,The Centre for Evidence-based Practice South Australia (CEPSA): A JBI Centre of Excellence, Adelaide, SA, Australia
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16
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Volochtchuk AVL, Leite H. Process improvement approaches in emergency departments: a review of the current knowledge. INTERNATIONAL JOURNAL OF QUALITY & RELIABILITY MANAGEMENT 2021. [DOI: 10.1108/ijqrm-09-2020-0330] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe healthcare system has been under pressure to provide timely and quality healthcare. The influx of patients in the emergency departments (EDs) is testing the capacity of the system to its limit. In order to increase EDs' capacity and performance, healthcare managers and practitioners are adopting process improvement (PI) approaches in their operations. Thus, this study aims to identify the main PI approaches implemented in EDs, as well as the benefits and barriers to implement these approaches.Design/methodology/approachThe study is based on a rigorous systematic literature review of 115 papers. Furthermore, under the lens of thematic analysis, the authors present the descriptive and prescriptive findings.FindingsThe descriptive analysis found copious information related to PI approaches implemented in EDs, such as main PIs used in EDs, type of methodological procedures applied, as well as a set of barriers and benefits. Aiming to provide an in-depth analysis and prescriptive results, the authors carried out a thematic analysis that found underlying barriers (e.g. organisational, technical and behavioural) and benefits (e.g. for patients, the organisation and processes) of PI implementation in EDs.Originality/valueThe authors contribute to knowledge by providing a comprehensive review of the main PI methodologies applied in EDs, underscoring the most prominent ones. This study goes beyond descriptive studies that identify lists of barriers and benefits, and instead the authors categorize prescriptive elements that influence these barriers and benefits. Finally, this study raises discussions about the behavioural influence of patients and medical staff on the implementation of PI approaches.
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17
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Higgins C, Smith BH, Colvin L. Examination of the clinical factors associated with attendance at emergency departments for chronic pain management and the cost of treatment relative to that of other significant medical conditions. Pain 2021; 162:886-894. [PMID: 33021568 DOI: 10.1097/j.pain.0000000000002098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
Abstract
ABSTRACT Little is known about risk factors for emergency department (ED) attendance for chronic pain (CP) management and the relative service burden. We examined ED utilisation in patients with CP, identified risk factors associated with attendance for chronic musculoskeletal pain (CMP), and estimated the comparative cost of treatment. The study cohort comprised a random sample of 3700 adults from the general population in Tayside, Scotland. Linked regional extracts, spanning a 12-month period, were obtained from national registers, providing information on ED attendances, community-dispensed prescribing, and outpatient clinic attendances. The National Health Service Scotland Cost Book was used to ascertain the current average cost of an ED attendance (£130; ∼$167). All-cause ED attendance was higher in those with CP (68.5%; n = 252) than without (29.3%; n = 967). In the entire cohort, more patients attended the ED for the treatment of CMP than for any other medical condition (n = 119; 32.3% of those with CP). Risk factors for ED attendance for CMP were: recent analgesic dose decreases (OR = 4.55); and transitioning from opioid to nonopioid analgesics (OR = 5.08). Characteristics protective of ED attendance for CMP were: being in receipt of strong opioids (OR = 0.21); transitioning from nonopioid to opioid analgesics (OR = 0.25); recent analgesic dose increases (OR = 0.24); and being prescribed tricyclic antidepressants (OR = 0.10), benzodiazepines (OR = 0.46), or hypnotics (OR = 0.45). Chronic musculoskeletal pain was one of the most expensive conditions to treat (£17,680 [∼$22,668] per annum), conferring a substantial burden on ED services. Improved understanding of the risk/protective factors could inform healthcare redesign to reduce avoidable ED attendances for CMP management.
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Affiliation(s)
- Cassie Higgins
- Division of Population Health and Genomics, School of Medicine, Ninewells Hospital, University of Dundee, Dundee, United Kingdom
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18
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Xu H(G, Kynoch K, Tuckett A, Eley R. Effectiveness of interventions to reduce emergency department staff occupational stress and/or burnout: a systematic review. JBI Evid Synth 2020; 18:1156-1188. [DOI: 10.11124/jbisrir-d-19-00252] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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19
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Connell CJ, Plummer V, Crawford K, Endacott R, Foley P, Griffiths DL, Innes K, Nayna Schwerdtle P, Walker LE, Morphet J. Practice priorities for acute care nursing: A Delphi study. J Clin Nurs 2020; 29:2615-2625. [PMID: 32279359 DOI: 10.1111/jocn.15284] [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: 09/18/2019] [Revised: 03/02/2020] [Accepted: 03/23/2020] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES To describe the risk and frequency of challenges in acute care nursing, and the practice priorities in Australian hospital wards based upon expert consensus. BACKGROUND Health care is facing increasing demands that are negatively impacting upon the safety and quality of nursing care. DESIGN Delphi Method. METHOD A three-round electronic Delphi method was used to collect and synthesise expert consensus opinion of 30 participants in Rounds One and Two of the survey, and 12 participants in Round Three. The study was carried out from July to December 2016. This study complied with the STROBE checklist. RESULTS High patient acuity or complexity, as well as inadequate bed space on wards, are "very high" risks that occur "often" and "very often," respectively. The pressure to admit patients, delayed medical review and patient boarding are all "high" risks that occur "often." Though only occurring "sometimes," inadequate numbers and skill mix of staff, suboptimal communication and early or inappropriate discharge all pose a "very high" risk to patient care. CONCLUSION The key practice priorities for nurse managers should include the design, implementation and evaluation of sustainable system-wide frameworks, processes and models of care that address patient boarding, communication and discharge processes, job satisfaction, staffing numbers and expertise. RELEVANCE TO CLINICAL PRACTICE This study provides a description of the challenges that face acute care nursing in the provision of safe and high-quality care.
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Affiliation(s)
| | - Virginia Plummer
- Nursing and Midwifery, Monash University and Peninsula Health, Frankston, Vic., Australia
| | | | - Ruth Endacott
- Nursing and Midwifery, Monash University, Frankston, Vic., Australia.,School of Nursing and Midwifery, University of Plymouth, Plymouth, UK
| | - Pieternella Foley
- Nursing and Midwifery, Monash University, Frankston, Vic., Australia
| | | | - Kelli Innes
- Nursing and Midwifery, Monash University, Frankston, Vic., Australia
| | - Patricia Nayna Schwerdtle
- Nursing and Midwifery, Monash University, Frankston, Vic., Australia.,Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Lorraine E Walker
- Nursing and Midwifery, Monash University, Frankston, Vic., Australia
| | - Julia Morphet
- Nursing and Midwifery, Monash University, Frankston, Vic., Australia.,Monash Emergency Research Collaborative (MERC), Monash Health, Frankston, Vic., Australia
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20
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Ortíz-Barrios MA, Alfaro-Saíz JJ. Methodological Approaches to Support Process Improvement in Emergency Departments: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082664. [PMID: 32294985 PMCID: PMC7216091 DOI: 10.3390/ijerph17082664] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/22/2020] [Accepted: 04/03/2020] [Indexed: 02/07/2023]
Abstract
The most commonly used techniques for addressing each Emergency Department (ED) problem (overcrowding, prolonged waiting time, extended length of stay, excessive patient flow time, and high left-without-being-seen (LWBS) rates) were specified to provide healthcare managers and researchers with a useful framework for effectively solving these operational deficiencies. Finally, we identified the existing research tendencies and highlighted opportunities for future work. We implemented the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology to undertake a review including scholarly articles published between April 1993 and October 2019. The selected papers were categorized considering the leading ED problems and publication year. Two hundred and three (203) papers distributed in 120 journals were found to meet the inclusion criteria. Furthermore, computer simulation and lean manufacturing were concluded to be the most prominent approaches for addressing the leading operational problems in EDs. In future interventions, ED administrators and researchers are widely advised to combine Operations Research (OR) methods, quality-based techniques, and data-driven approaches for upgrading the performance of EDs. On a different tack, more interventions are required for tackling overcrowding and high left-without-being-seen rates.
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Affiliation(s)
- Miguel Angel Ortíz-Barrios
- Department of Industrial Management, Agroindustry and Operations, Universidad de la Costa CUC, Barranquilla 081001, Colombia
- Correspondence: ; Tel.: +57-3007239699
| | - Juan-José Alfaro-Saíz
- Research Centre on Production Management and Engineering, Universitat Politècnica de València, 46022 Valencia, Spain;
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21
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Uwamahoro C, Aluisio AR, Chu E, Reibling E, Mutabazi Z, Karim N, Byiringiro JC, Levine AC, Guptill M. Evaluation of a modified South African Triage Score as a predictor of patient disposition at a tertiary hospital in Rwanda. Afr J Emerg Med 2020; 10:17-22. [PMID: 32161707 PMCID: PMC7058878 DOI: 10.1016/j.afjem.2019.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 10/24/2019] [Accepted: 10/28/2019] [Indexed: 11/25/2022] Open
Abstract
Background Triage is essential for efficient and effective delivery of care in emergency centers (ECs) where numerous patients present simultaneously with varying acuity of conditions. Implementing EC triage systems provides a method of recognizing which patients may require admission and are at higher risks for poor health outcomes. Rwanda is experiencing increased demand for emergency care; however, triage has not been well-studied. The University Teaching Hospital of Kigali (UTH-K) is an urban tertiary care health center utilizing a locally modified South African Triage Score (mSATS) that classifies patients into five color categories. Our study evaluated the utility of the mSATS tool at UTH-K. Methods UTH-K implemented mSATS in April 2013. All patients aged 15 years or older from August 2015 to July 2016 were eligible for inclusion in the database. Variables of interest included demographic information, mSATS category, patient case type (trauma or medical), disposition from the ED and mortality. Results 1438 cases were randomly sampled; the majority were male (61.9%) and median age was 35 years. Injuries accounted for 56.7% of the cases while medical conditions affected 43.3%. Admission likelihood significantly increased with higher triage color category for medical patients (OR: Yellow = 3.61, p < .001 to Red (with alarm) = 7.80, p < .01). Likelihood for trauma patients, however, was not significantly increased (OR: Yellow = .84, p = .75 to Red (with alarm) = 1.50, p = .65). Mortality rates increased with increasing triage category with the red with alarm category having the highest mortality (7.7%, OR 18.91). Conclusion The mSATS tool accurately predicted patient disposition and mortality for the overall ED population. The mSATS tool provided useful clinical guidance on the need for hospital admission for medical patients but did not accurately predict patient disposition for injured patients. Further trauma-specific triage studies are needed to improve emergency care in Rwanda.
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22
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Singer A, Kosowan L, Katz A, Ronksley P, McBrien K, Halas G, Williamson T. Characterizing patients with high use of the primary and tertiary care systems: A retrospective cohort study. Health Policy 2020; 124:291-297. [PMID: 32033837 DOI: 10.1016/j.healthpol.2020.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 01/22/2020] [Accepted: 01/27/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To utilize complementary data from primary care and administrative health and social services to describe the clinical, social and demographic characteristics of high users of health care services. METHODS We conducted a retrospective cohort study using data from the Manitoba Primary Care Research Network (MaPCReN) and the Manitoba Centre for Health Policy Research Data Repository in Canada. We assessed data from 193,760 patients with at least one visit to a primary care provider between 2011 and 2016. We defined HU within the following areas: primary care, hospital discharges, length of stay and emergency department visits. Descriptive statistics and logistic regression was used to identify key demographic, social, and medical complexities associated with HU. RESULTS Between 2011 and 2016, 30.8 % of patients had HU during at least one year within at least one area. Among patients with HU, 5 % had persistent HU (HU for ≥2 years) and 359 (0.6 %) had HU across all four definitions. Medical complexity was associated with HU for patients with hospital discharges, ED visits and primary care visits, whereas socially complex patients were more likely to have a longer LOS, and visit the ED. CONCLUSIONS There were unique characteristics in the various HU cohorts including medical, social, and demographic features that can inform strategies aimed at improving health system efficiency in managing patients with HU.
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Affiliation(s)
- Alexander Singer
- Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave., Winnipeg, MB, R3T 2N2, Canada.
| | - Leanne Kosowan
- Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave., Winnipeg, MB, R3T 2N2, Canada.
| | - Alan Katz
- Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave., Winnipeg, MB, R3T 2N2, Canada; Department of Community Health Sciences and Department of Family Medicine within the Max Rady College of Medicine, Rady Faculty of Health Sciences at the University of Manitoba, 408-727 McDermot Ave., Winnipeg, MB, R3E 3P5, Canada.
| | - Paul Ronksley
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
| | - Kerry McBrien
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
| | - Gayle Halas
- Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave., Winnipeg, MB, R3T 2N2, Canada.
| | - Tyler Williamson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
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Crilly J, Johnston AN, Wallis M, O'Dwyer J, Byrnes J, Scuffham P, Zhang P, Bosley E, Chaboyer W, Green D. Improving emergency department transfer for patients arriving by ambulance: A retrospective observational study. Emerg Med Australas 2019; 32:271-280. [PMID: 31867883 PMCID: PMC7155107 DOI: 10.1111/1742-6723.13407] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 09/20/2019] [Accepted: 09/21/2019] [Indexed: 11/29/2022]
Abstract
Objective Extended delays in the transfer of patients from ambulance to ED can compromise patient flow. The present study aimed to describe the relationship between the use of an Emergency Department Ambulance Off‐Load Nurse (EDAOLN) role, ED processes of care and cost effectiveness. Methods This was a retrospective observational study over three periods of before (T1), during (T2) and after (T3) the introduction of the EDAOLN role in 2012. Ambulance, ED and cost data were linked and used for analysis. Processes of care measures analysed included: time to be seen by a doctor from ED arrival (primary outcome), ambulance‐ED offload compliance, proportion of patients seen within recommended triage timeframe, ED length of stay (LoS), proportion of patients transferred, admitted or discharged from the ED within 4 h and cost effectiveness. Results A total of 6045 people made 7010 presentations to the ED by ambulance over the study period. Several measures improved significantly between T1 and T2 including offload compliance (T1: 58%; T2: 63%), time to be seen (T1: 31 min; T2: 28 min), ED LoS (T1: 335 min; T2: 306 min), ED LoS <4 h (T1: 31%; T2: 33%). Some measures carried over into T3, albeit to a lesser extent. Post‐hoc analyses showed that outcomes improved most for less urgent patients. The annualised net cost of the EDAOLN (if funded from additional resources) of $130 721 could result in an annualised reduction of approximately 3912 h in waiting time to be seen by a doctor. Conclusion With the EDAOLN role in place, slight outcome improvements in several key ambulance and ED efficiency criteria were noted. During times of ED crowding, the EDAOLN role may be one cost‐effective strategy to consider.
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Affiliation(s)
- Julia Crilly
- Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast Health, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Amy Nb Johnston
- Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast Health, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Department of Emergency Medicine, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.,School of Nursing, Midwifery and Social Work, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Marianne Wallis
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Maroochydore DC, Queensland, Australia
| | - John O'Dwyer
- Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast Health, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Australian eHealth Research Centre, Herston, Queensland, Australia
| | - Joshua Byrnes
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,School of Medicine, Griffith University Nathan Campus, Brisbane, Queensland, Australia
| | - Paul Scuffham
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,School of Medicine, Griffith University Nathan Campus, Brisbane, Queensland, Australia
| | - Ping Zhang
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Emma Bosley
- Office of the Commissioner, Queensland Ambulance Service, Department of Health, Brisbane, Queensland, Australia
| | - Wendy Chaboyer
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - David Green
- Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast Health, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,School of Medicine, Griffith University Nathan Campus, Brisbane, Queensland, Australia
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24
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Frank C, Elmqvist C. Staff strategies for dealing with care situations at an emergency department. Scand J Caring Sci 2019; 34:1038-1044. [PMID: 31865626 DOI: 10.1111/scs.12812] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 11/28/2019] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Overcrowding is a common international problem at Emergency Departments often due to those patients get recommendations or referrals from other health professionals to seek care at the emergency department. Crowding brings with it an amount of adverse consequences for both patients and staff, and knowledge about staff's strategies of dealing with this caring situation is limited. AIM The aim of the present study was thus to describe staffs' strategies to deal with the caring situations at an emergency department. METHOD Secondary analysis has been made of 18 qualitative interviews grounded in a lifeworld perspective. The interviews were analysed by qualitative content analysis. FINDINGS The results showed that the staff at the ED worked in twofold directions using both proactive and reactive strategies in order to deal with the care situation when caring for patients at ED. The proactive strategy is optimising conditions, controlling patient flow and being boundary. The reactive strategy is about customising the conversation and holding an open approach. CONCLUSION In conclusion, the proactive strategy is to make what you decided for unseen circumstances. The reactive strategy is then about less anticipation of the encounter, waiting for the patient to act and react to it. IMPLICATION The result can have implications with respect to developing and improving care at crowded Emergency departments. Knowledge about strategies creates a fundament for developing visible sustainable structure for patient flow in making work patient safety for patients, staff and organisation.
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Affiliation(s)
- Catharina Frank
- Centre of Interprofessional Cooperation and Coordination within Emergency Care (CICE), Department of Health and Caring Sciences, Linneaus University, Växjö, Sweden
| | - Carina Elmqvist
- Centre of Interprofessional Cooperation and Coordination within Emergency Care (CICE), Department of Health and Caring Sciences, Linneaus University, Växjö, Sweden
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Gulion N, Vergnes JN. Improving Person-Centered Access to Dental Care: The Walk-In Dental Encounters in Non-Emergency Situations (WIDENESS). Dent J (Basel) 2019; 7:E116. [PMID: 31847289 PMCID: PMC6960503 DOI: 10.3390/dj7040116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 12/09/2019] [Accepted: 12/11/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND We hypothesized that access to dental care could be improved by the conceptualization of a new type of consultation: The walk-in dental encounter for non-emergency situations (WIDENESS). The aim of this study was to assess patient perspectives regarding walk-in dental consultations, with a particular focus on non-emergency situations. METHODS We followed a qualitative research approach using a semi-structured interview guide in a sample of random participants recruited from the dental department of the Toulouse University Hospital, France. We performed a thematic analysis of the interview transcripts. Data saturation was obtained after interviewing 11 participants. RESULTS When asked about walk-in dental consultations, three main topics emerged: (1) Walk-in dental consultation in general is important for emergency situations, but WIDENESS did not correspond to any specific long-standing need from participants; (2) WIDENESS could be a way to improve access to oral care (facilitating access to care relative to time constraints, reduction of dentist-related anxiety, better overall follow-up for the care pathway, and the complementary nature of consultations with and without appointments); and (3) WIDENESS has some potential drawbacks-apprehension about long waiting times was mentioned by several participants. CONCLUSIONS Participants found the idea of WIDENESS promising, despite spontaneously mentioned reservations, which constitute major challenges to its implementation.
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Affiliation(s)
- Noémie Gulion
- Faculty of Dentistry, Dental Public Health Department, University Hospital of Toulouse, 3, chemin des maraîchers, 31400 Toulouse, France;
| | - Jean-Noel Vergnes
- Faculty of Dentistry, Dental Public Health Department, University Hospital of Toulouse, 3, chemin des maraîchers, 31400 Toulouse, France;
- Faculty of Dentistry, McGill University, 2001 McGill College Ave, Montreal, QC H3A 1G1, Canada
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Butler A, Love AD, Young JT, Kinner SA. Frequent Attendance to the Emergency Department after Release from Prison: a Prospective Data Linkage Study. J Behav Health Serv Res 2019; 47:544-559. [PMID: 31820327 PMCID: PMC7578130 DOI: 10.1007/s11414-019-09685-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this paper was to identify characteristics and predictors of frequent emergency department (ED) use among people released from prisons in Queensland, Australia. Baseline interview data from a sample of sentenced adults were linked to ED and hospital records. The association between baseline characteristics and frequent ED attendance was modelled by fitting multivariate logistic regression models. Participants who had ≥ 4 visits to the ED in any 365-day period of community follow-up were defined as frequent attenders (FA). The analyses included 1307 people and mean follow-up time in the community was 1063 days. After adjusting for covariates, those with a dual diagnoses of mental illness and substance use (RR = 2.42, 95% CI 1.47–3.99) and those with mental illness alone (RR = 2.47, 95% CI 1.29–4.73) were at higher risk of frequent ED attendance, compared with those with no disorder. Future research should assess whether individually tailored transition supports from prison to community reduce the frequency of ED use among this population.
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Affiliation(s)
- Amanda Butler
- Faculty of Health Sciences, Simon Fraser University, 313-1286 14th Avenue West, Vancouver, BC, V6H 1P9, Canada.
| | - Alexander D Love
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Jesse T Young
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Stuart A Kinner
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia
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Giles TM, Hammad K, Breaden K, Drummond C, Bradley SL, Gerace A, Muir-Cochrane E. Nurses' perceptions and experiences of caring for patients who die in the emergency department setting. Int Emerg Nurs 2019; 47:100789. [PMID: 31495727 DOI: 10.1016/j.ienj.2019.100789] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 06/16/2019] [Accepted: 07/18/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The number of people dying in emergency departments (EDs) is increasing. However, EDs are not well designed or resourced for safe and effective End-Of-Life (EOL) care encounters, and there is little evidence regarding clinicians' perceptions and experiences of providing such care when the death is sudden and unexpected. AIM This study explored nurses' perceptions and experiences of caring for patients who die suddenly and unexpectedly in the ED. METHODS Open-end responses were collected as part of a larger descriptive survey design. The qualitative data were analysed thematically. RESULTS 211 ED nurse completed the online survey. Within the qualitative data, five themes were identified during analysis: 1) key elements of EOL care, 2) systemic and environmental barriers, 3) educational deficits, 4) role ambiguity, and 5) emotional impact. Participants identified communication, a standardised approach, and better educational preparedness as the most important elements of EOL care when the death was sudden and unexpected. CONCLUSIONS ED nurses want to provide high quality care to dying patients and their families. However, their efforts are hampered by systemic and environmental barriers outside their control. There is a need for a culture shift to overcome the barriers that currently obstruct ED nurses from providing meaningful and effective EOL care in the ED.
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Affiliation(s)
- Tracey M Giles
- College of Nursing and Midwifery, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | - Karen Hammad
- College of Nursing and Midwifery, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | - Katrina Breaden
- College of Nursing and Midwifery, Flinders University, Bedford Park, Adelaide, South Australia, Australia.
| | - Christine Drummond
- Central Adelaide Palliative Services, Woodville, Adelaide, South Australia, Australia
| | - Sandra L Bradley
- College of Nursing and Midwifery, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | - Adam Gerace
- CQ University, Wayville, Adelaide, South Australia, Australia
| | - Eimear Muir-Cochrane
- College of Nursing and Midwifery, Flinders University, Bedford Park, Adelaide, South Australia, Australia
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Choosing wisely in the ED: The diagnostic cascade of needless medical testing in a two-level study. Am J Emerg Med 2019; 37:1705-1708. [DOI: 10.1016/j.ajem.2018.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/10/2018] [Accepted: 12/11/2018] [Indexed: 11/20/2022] Open
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Elder E, Johnston AN, Wallis M, Greenslade JH, Crilly J. Emergency clinician perceptions of occupational stressors and coping strategies: A multi-site study. Int Emerg Nurs 2019; 45:17-24. [DOI: 10.1016/j.ienj.2019.03.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 03/25/2019] [Accepted: 03/27/2019] [Indexed: 11/16/2022]
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Burchard R, Oikonomoulas V, Soost C, Zoremba M, Graw JA. Indicated trauma emergency department utilization – A comparison between patients’ self-assessment and professional evaluation. Int Emerg Nurs 2019; 44:30-34. [DOI: 10.1016/j.ienj.2019.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 02/10/2019] [Accepted: 02/23/2019] [Indexed: 10/27/2022]
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Abstract
BACKGROUND Long boarding time in emergency department (ED) leads to increased morbidity and mortality. Prediction of admissions upon triage could improve ED care efficiency and decrease boarding time. OBJECTIVE To develop a real-time automated model (MA) to predict admissions upon triage and compare this model with triage nurse prediction (TNP). PATIENTS AND METHODS A cross-sectional study was conducted in four EDs during 1 month. MA used only variables available upon triage and included in the national French Electronic Emergency Department Abstract. For each patient, the triage nurse assessed the hospitalization risk on a 10-point Likert scale. Performances of MA and TNP were compared using the area under the receiver operating characteristic curves, the accuracy, and the daily and hourly mean difference between predicted and observed number of admission. RESULTS A total of 11 653 patients visited the EDs, and 19.5-24.7% were admitted according to the emergency. The area under the curves (AUCs) of TNP [0.815 (0.805-0.826)] and MA [0.815 (0.805-0.825)] were similar. Across EDs, the AUCs of TNP were significantly different (P < 0.001) in all EDs, whereas AUCs of MA were all similar (P>0.2). Originally, using daily and hourly aggregated data, the percentage of errors concerning the number of predicted admission were 8.7 and 34.4%, respectively, for MA and 9.9 and 35.4%, respectively, for TNP. CONCLUSION A simple model using variables available in all EDs in France performed well to predict admission upon triage. However, when analyzed at an hourly level, it overestimated the number of inpatient beds needed by a third. More research is needed to define adequate use of these models.
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Prang KH, Canaway R, Bismark M, Dunt D, Kelaher M. The impact of Australian healthcare reforms on emergency department time-based process outcomes: An interrupted time series study. PLoS One 2018; 13:e0209043. [PMID: 30540856 PMCID: PMC6291126 DOI: 10.1371/journal.pone.0209043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 11/27/2018] [Indexed: 12/01/2022] Open
Abstract
Background In 2011, the Australian government introduced national healthcare reforms aimed at increasing the timeliness and quality of hospital care. The healthcare reforms included, but were not limited to, emergency department (ED) time-based targets, financial incentives, and public performance reporting of hospital data. We sought to evaluate the impact of the national healthcare reforms on ED time-based process outcomes. Methods A quasi-experimental study of ED presentations from 2006 to 2016 in the state of Victoria, Australia. Uncontrolled, interrupted time-series analyses were used to evaluate, by hospital peer groups, the effect of national healthcare reforms on: patient wait times for treatment; treatment within recommended time; and patient departure within four hours of arrival in ED. Results There were small improvements in ED time-based process outcomes following the introduction of the national healthcare reforms. These occurred in most hospital peer groups immediately and over the longer term, across the various triage categories. The largest improvements occurred in small hospitals and smallest improvements in medium sized hospitals. ED time-based targets, now abolished by the Australian government, were not achieved in any hospital peer groups. Conclusions Our findings suggest that national healthcare reforms had the potential to prompt fundamental changes in ED processes leading to significant improvements in ED performances across most hospital peer groups but were generally unable to reach the ED targets imposed nationally. ED performances also varied by hospital peer groups. Attention to ED time-based process outcomes within hospital peer groups may provide insights into hospital practices that could improve the quality and efficiency of ED care.
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Affiliation(s)
- Khic-Houy Prang
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rachel Canaway
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Marie Bismark
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - David Dunt
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Margaret Kelaher
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- * E-mail:
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Innes K, Jackson D, Plummer V, Elliott D. A profile of the waiting room nurse in emergency departments: An online survey of Australian nurses exploring implementation and perceptions. Int Emerg Nurs 2018; 43:67-73. [PMID: 30381142 DOI: 10.1016/j.ienj.2018.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 08/27/2018] [Accepted: 10/12/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND In response to increasing waiting times, adverse patient outcomes and patient dissatisfaction, some emergency departments introduced a Waiting Room Nurse role. Despite implementation into routine practice, there remains limited formal evaluation of the role. AIM To explore the implementation of a Waiting Room Nurse role in Australian emergency departments and emergency nurses' perceptions. METHODS Survey design. A 40-item survey was developed, piloted and then distributed to members of a professional College for online completion. Responses for closed-ended and open-ended items were reported using frequencies or proportions, and quantitative content analysis, respectively. RESULTS Respondents (n = 197) reported that 51 emergency departments allocated a Waiting Room Nurse, with varying hours of operation. Five key areas of responsibility were: patient care, patient safety, escalation of care, triage and communication. Role variations were identified in experience, preparation and supporting policies. Challenges, including workload and personal safety issues, were reported. CONCLUSIONS The role was perceived as vital, especially at times of high demand, in ensuring that patients were safe to wait, detecting deterioration and escalating care as needed. Communication and therapeutic relationships were key to effective performance. Challenges identified had clear implications for the welfare of nurses performing the role.
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Affiliation(s)
- Kelli Innes
- Faculty of Health University of Technology Sydney, 15 Broadway, Ultimo, N.S.W 2007, Australia; Nursing and Midwifery, Monash University, 47-49 Moorooduc Highway, Frankston, Victoria 3199, Australia.
| | - Debra Jackson
- Faculty of Health University of Technology Sydney, 15 Broadway, Ultimo, N.S.W 2007, Australia.
| | - Virginia Plummer
- Nursing and Midwifery, Monash University, 47-49 Moorooduc Highway, Frankston, Victoria 3199, Australia; Peninsula Health, 2 Hastings Road, Frankston, Victoria 3199, Australia.
| | - Doug Elliott
- Faculty of Health University of Technology Sydney, 15 Broadway, Ultimo, N.S.W 2007, Australia.
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A different crowd, a different crowding level? The predefined thresholds of crowding scales may not be optimal for all emergency departments. Int Emerg Nurs 2018; 41:25-30. [DOI: 10.1016/j.ienj.2018.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 04/10/2018] [Accepted: 05/28/2018] [Indexed: 11/21/2022]
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35
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Which indicators to include in a crowding scale in an emergency department? A national French Delphi study. Eur J Emerg Med 2018; 25:257-263. [DOI: 10.1097/mej.0000000000000454] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Considine J, Curtis K, Shaban RZ, Fry M. Consensus-based clinical research priorities for emergency nursing in Australia. Australas Emerg Care 2018; 21:43-50. [PMID: 30998874 DOI: 10.1016/j.auec.2018.03.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 03/18/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Research is vital to responding to contemporary challenges of providing safe, high quality emergency nursing care, yet the research priorities for emergency nursing practice in Australia are unknown. This study aimed to establish research priorities for emergency nursing in Australia. METHODS A two-stage descriptive, exploratory study was conducted. First, research themes were identified through a survey of 232 emergency nurses the Delphi Technique (2 rounds) was used to rank and prioritise the research themes. RESULTS There were five research themes with a CVI≥0.90: (i) recognising and responding to deteriorating ED patients; (ii) effect of access block on clinical care of admitted ICU patients; (iii) effects of ED overcrowding on clinical care; (iv) scope of practice of specialist emergency nurses; and (v) effect of access block on clinical care of admitted ward patients. These are reflected in four broad research priority areas: professional issues, patient safety, emergency care of vulnerable populations, and healthcare system issues. CONCLUSION Future research should focus on these priority areas in partnership with other emergency disciplines to enable safe, high quality emergency care, and, to inform the practice of emergency nursing in Australia.
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Affiliation(s)
- Julie Considine
- Deakin University, Geelong: School of Nursing and Midwifery and Centre for Quality and Patient Safety Research, Victoria, Australia; Centre for Quality and Patient Safety Research - Eastern Health Partnership, Box Hill, Victoria, Australia.
| | - Kate Curtis
- Sydney Nursing School, The University of Sydney, Clinical Nurse Consultant - Emergency, Illawarra Shoalhaven Local Health District, Camperdown, New South Wales, Australia.
| | - Ramon Z Shaban
- Sydney Nursing School and Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney and Western Sydney Local Health District, Westmead Institute for Medical Research, 179 Hawkesbury Road, Westmead, NSW, Australia.
| | - Margaret Fry
- Nursing and Midwifery Directorate Northern Sydney Local Health District, St Leonards, NSW, Australia; Faculty of Health, University of Technology Sydney, Sydney, Australia.
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Gill SD, Lane SE, Sheridan M, Ellis E, Smith D, Stella J. Why do 'fast track' patients stay more than four hours in the emergency department? An investigation of factors that predict length of stay. Emerg Med Australas 2018; 30:641-647. [PMID: 29569844 DOI: 10.1111/1742-6723.12964] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 12/28/2017] [Accepted: 01/30/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Low-acuity 'fast track' patients represent a large portion of Australian EDs' workload and must be managed efficiently to meet the National Emergency Access Target. The current study determined the relative importance and estimated marginal effects of patient and system-related variables in predicting ED fast track patients who stayed longer than 4 h in the ED. METHODS Data for ED presentations between 1 July 2014 and 30 June 2015 were collected from a large regional Australian public hospital. Only 'fast track' patients were included in the analysis. A gradient boosting machine was used to predict which patients would have an ED length of stay greater or less than 4 h. The performance of the final model was tested using a validation data set that was withheld from the initial analysis. A total of 27 variables were analysed. RESULTS The model's performance was very good (area under receiver operating characteristic curve 0.89, where 1.0 is perfect prediction). The five most important variables for predicting length of stay were time-dependent and system-related (not patient-related); these were the amount of time taken from when the patient arrived at the ED to: (i) order imaging; (ii) order pathology; (iii) request admission to hospital; (iv) allocate a clinician to care for the patient; and (v) handover a patient between ED clinicians. CONCLUSIONS We identified the most important variables for predicting length of stay greater than 4 h for fast track patients in our ED. Identifying factors that influence length of stay is a necessary step towards understanding ED patient flow and identifying improvement opportunities.
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Affiliation(s)
- Stephen D Gill
- Emergency Department, University Hospital Geelong, Geelong, Victoria, Australia.,Physiotherapy Department, University Hospital Geelong, Geelong, Victoria, Australia.,Barwon Centre for Orthopaedic Research and Education (B-CORE), Geelong, Victoria, Australia
| | - Stephen E Lane
- Centre of Excellence for Biosecurity Risk Analysis, School of BioSciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Sheridan
- Emergency Department, University Hospital Geelong, Geelong, Victoria, Australia
| | - Elizabeth Ellis
- Emergency Department, University Hospital Geelong, Geelong, Victoria, Australia
| | - Darren Smith
- Emergency Department, University Hospital Geelong, Geelong, Victoria, Australia
| | - Julian Stella
- Emergency Department, University Hospital Geelong, Geelong, Victoria, Australia
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Florkowski C, Don-Wauchope A, Gimenez N, Rodriguez-Capote K, Wils J, Zemlin A. Point-of-care testing (POCT) and evidence-based laboratory medicine (EBLM) - does it leverage any advantage in clinical decision making? Crit Rev Clin Lab Sci 2017; 54:471-494. [PMID: 29169287 DOI: 10.1080/10408363.2017.1399336] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Point-of-care testing (POCT) is the analysis of patient specimens outside the clinical laboratory, near or at the site of patient care, usually performed by clinical staff without laboratory training, although it also encompasses patient self-monitoring. It is able to provide a rapid result near the patient and which can be acted upon immediately. The key driver is the concept that clinical decision making may be delayed when samples are sent to the clinical laboratory. Balanced against this are considerations of increased costs for purchase and maintenance of equipment, staff training, connectivity to the laboratory information system (LIS), quality control (QC) and external quality assurance (EQA) procedures, all required for accreditation under ISO 22870. The justification for POCT depends upon being able to demonstrate that a more timely result (shorter turnaround times (TATs)) is able to leverage a clinically important advantage in decision making compared with the central laboratory (CL). In the four decades since POCT was adapted for the self-monitoring of blood glucose levels by subjects with diabetes, numerous new POCT methodologies have become available, enabling the clinician to receive results and initiate treatment more rapidly. However, these instruments are often operated by staff not trained in laboratory medicine and hence are prone to errors in the analytical phase (as opposed to laboratory testing where the analytical phase has the least errors). In some environments, particularly remote rural settings, the CL may be at a considerable distance and timely availability of cardiac troponins and other analytes can triage referrals to the main centers, thus avoiding expensive unnecessary patient transportation costs. However, in the Emergency Department, availability of more rapid results with POCT does not always translate into shorter stays due to other barriers to implementation of care. In this review, we apply the principles of evidence-based laboratory medicine (EBLM) looking for high quality systematic reviews and meta-analyses, ideally underpinned by randomized controlled trials (RCTs), looking for evidence of whether POCT confers any advantage in clinical decision making in different scenarios.
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Affiliation(s)
| | | | | | | | - Julien Wils
- e Department of Pharmacology , University Hospital of Rouen , Rouen , France
| | - Annalise Zemlin
- f University of Stellenbosch and National Health Laboratory Service (NHLS), Tygerberg Hospital , Cape Town , South Africa
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Could musculo-skeletal radiograph interpretation by radiographers be a source of support to Australian medical interns: A quantitative evaluation. Radiography (Lond) 2017; 23:321-329. [DOI: 10.1016/j.radi.2017.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 06/11/2017] [Accepted: 07/01/2017] [Indexed: 11/20/2022]
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40
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Kreindler SA. The three paradoxes of patient flow: an explanatory case study. BMC Health Serv Res 2017; 17:481. [PMID: 28701232 PMCID: PMC5508770 DOI: 10.1186/s12913-017-2416-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 06/28/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Health systems in many jurisdictions struggle to reduce Emergency Department congestion and improve patient flow across the continuum of care. Flow is often described as a systemic issue requiring a "system approach"; however, the implications of this idea remain poorly understood. Focusing on a Canadian regional health system whose flow problems have been particularly intractable, this study sought to determine what system-level flaws impede healthcare organizations from improving flow. METHODS This study drew primarily on qualitative data from in-depth interviews with 62 senior, middle and departmental managers representing the Region, its programs and sites; quantitative analysis of key flow indicators (1999-2012) and review of ~700 documents furnished important context. Examination of the interview data revealed that the most striking feature of the dataset was contradiction; accordingly, a technique of dialectical analysis was developed to examine observed contradictions at successively deeper levels. RESULTS Analysis uncovered three paradoxes: "Many Small Successes and One Big Failure" (initiatives improve parts of the system but fail to fix underlying system constraints); "Your Innovation Is My Aggravation" (local innovation clashes with regional integration); and most critically, "Your Order Is My Chaos" (rules that improve service organization for my patients create obstacles for yours). This last emerges when some entities (sites/hospitals) define their patients in terms of their location in the system, while others (regional programs) define them in terms of their needs/characteristics. As accountability for improving flow was distributed among groups that thus variously defined their patients, local efforts achieved little for the overall system, and often clashed with each other. These paradoxes are indicative of a fundamental antagonism between the system's parts and the whole. CONCLUSION An accretion of flow initiatives in all parts of the system will never add up to a system approach, and may indeed perpetuate the paradoxes. What is needed is a coherent strategy of defining patient populations by needs, analyzing their entire trajectories of care, and developing consistent processes to better meet those needs.
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Affiliation(s)
- Sara A Kreindler
- Department of Community Health Sciences and Health Systems Performance Platform, George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, 451-753 McDermot Ave, Winnipeg, MB, R3E 0T6, Canada.
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Blay N, Roche MA, Duffield C, Gallagher R. Intrahospital transfers and the impact on nursing workload. J Clin Nurs 2017; 26:4822-4829. [PMID: 28382638 DOI: 10.1111/jocn.13838] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2017] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To determine the rate of patient moves and the impact on nurses' time. BACKGROUND Bed shortages and strategies designed to increase patient flow have led to a global increase in patient transfers between wards. The impact of transferring patients between wards and between beds within a ward on nurses' workload has not previously been measured. DESIGN A two-stage sequential study. Retrospective analysis of hospital data and a prospective observational-timing study. METHODS Secondary analysis of an administrative data set to inform the rate of ward and bed transfers (n = 34,715) was undertaken followed by an observational-timing study of nurses' activities associated with patient transfers (n = 75). RESULTS Over 10,000 patients were moved 34,715 times in 1 year which equates to an average of 2.4 transfers per patient. On average, patient transfers took 42 min and bed transfers took 11 min of nurses' time. Based on the frequency of patient moves, 11.3 full-time equivalent nurses are needed to move patients within the site hospital each month. CONCLUSION Transferring patients is workload intensive on nurses' time and should be included in nursing workload measurement systems. RELEVANCE TO CLINICAL PRACTICE Nurses at the site hospital spend over 1700 hr each month on activities associated with transferring patients, meaning that less time is available for nursing care.
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Affiliation(s)
- Nicole Blay
- Centre for Health Services Management, Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia.,Western Sydney University, Parramatta, NSW, Australia
| | - Michael A Roche
- Centre for Health Services Management, Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia.,Mental Health Drug and Alcohol Nursing, Northern Sydney Local Health District, North Ryde, NSW, Australia.,School of Nursing, Midwifery & Paramedicine, Australian Catholic University, North Sydney, NSW, Australia
| | - Christine Duffield
- Centre for Health Services Management, Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia.,Nursing and Health Services Management, Edith Cowen University, Joondalup, WA, Australia
| | - Robyn Gallagher
- Charles Perkins Centre, Sydney Nursing School, University of Sydney, Camperdown, NSW, Australia
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Van Der Linden MC, Khursheed M, Hooda K, Pines JM, Van Der Linden N. Two emergency departments, 6000km apart: Differences in patient flow and staff perceptions about crowding. Int Emerg Nurs 2017; 35:30-36. [PMID: 28659247 DOI: 10.1016/j.ienj.2017.06.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 06/05/2017] [Accepted: 06/06/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Emergency department (ED) crowding is a worldwide public health issue. In this study, patient flow and staff perceptions of crowding were assessed in Pakistan (Aga Khan University Hospital (AKUH)) and in the Netherlands (Haaglanden Medical Centre Westeinde (HMCW)). Bottlenecks affecting ED patient flow were identified. METHODS First, a one-year review of patient visits was performed. Second, staff perceptions about ED crowding were collected using face-to-face interviews. Non-participant observation and document review were used to interpret the findings. RESULTS At AKUH 58,839 (160visits/day) and at HMCW 50,802 visits (140visits/day) were registered. Length of stay (LOS) at AKUH was significantly longer than at HMCW (279min (IQR 357) vs. 100min (IQR 152)). There were major differences in patient acuities, admission and mortality rates, indicating a sicker population at AKUH. Respondents from both departments experienced hampered patient flow on a daily basis, and perceived similar causes for crowding: increased patients' complexity, long treatment times, and poor availability of inpatient beds. CONCLUSION Despite differences in environment, demographics, and ED patient flow, respondents perceived similar bottlenecks in patient flow. Interventions should be tailored to specific ED and hospital needs. For both EDs, improving the outflow of boarded patients is essential.
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Affiliation(s)
| | - Munawar Khursheed
- Emergency Department, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Jesse M Pines
- Office for Clinical Practice Innovation, Departments of Emergency Medicine and Health Policy & Management, George Washington University, Washington, DC, USA
| | - Naomi Van Der Linden
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
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Burke JA, Greenslade J, Chabrowska J, Greenslade K, Jones S, Montana J, Bell A, O'Connor A. Two Hour Evaluation and Referral Model for Shorter Turnaround Times in the emergency department. Emerg Med Australas 2017; 29:315-323. [PMID: 28455884 DOI: 10.1111/1742-6723.12781] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 03/05/2017] [Accepted: 03/15/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The objective of this study was to assess the implementation of a novel ED model of care, which combines clinical streaming, team-based assessment and early senior consultation to reduce length of stay. METHODS A pre-post-intervention study was used to compare ED performance following an extensive clinical redesign programme. Clinical teams and work sequences were reconfigured to promote the role of the staff specialist, with a focus on earlier decisions regarding disposition. Primary outcome measures were ED length of stay and National Emergency Access Target (NEAT) compliance. Secondary outcomes included referral and workup times, wait times by triage category, ambulance offload times, ward discharges and unit transfers within 24 h of admission, representation within 48 h, and Medical Emergency Response Team (MERT) calls within 24 h of admission. RESULTS Two seasonally matched 26 week intervals were compared with adjustment for demographics, triage category and arrival by ambulance. Overall, there was an 18.4% rise in NEAT performance (95% confidence interval (CI): 17.7-19.1) while ED length of stay decreased by a total of 86.8 min (95% CI: 83.6-90.1). Time series analysis did not suggest any preexisting trends to explain these results. The average time to referral decreased by 74.7 min (95% CI: 69.8-79.6) and waiting times decreased across all triage categories. Rates of MERT activation and unplanned representation were unchanged. CONCLUSION A facilitated team leader role for senior doctors can help to reduce length of stay by via early disposition, without significant risks to the patient.
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Affiliation(s)
- John A Burke
- Department of Emergency Medicine, Royal Brisbane Hospital, Brisbane, Queensland, Australia
| | - Jaimi Greenslade
- Department of Emergency Medicine, Royal Brisbane Hospital, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Jadwiga Chabrowska
- Department of Emergency Medicine, Royal Brisbane Hospital, Brisbane, Queensland, Australia
| | - Katherine Greenslade
- Department of Emergency Medicine, Royal Brisbane Hospital, Brisbane, Queensland, Australia
| | - Sally Jones
- Department of Emergency Medicine, Royal Brisbane Hospital, Brisbane, Queensland, Australia
| | - Jacqueline Montana
- Department of Emergency Medicine, Royal Brisbane Hospital, Brisbane, Queensland, Australia
| | - Anthony Bell
- Department of Emergency Medicine, Royal Brisbane Hospital, Brisbane, Queensland, Australia
| | - Alan O'Connor
- Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia.,Department of Emergency Medicine, Riverland General Hospital, Adelaide, South Australia, Australia.,Department of Emergency Medicine, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
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Burgess L, Kynoch K. Effectiveness of nurse-initiated interventions on patient outcomes in the emergency department: a systematic review protocol. ACTA ACUST UNITED AC 2017; 15:873-881. [DOI: 10.11124/jbisrir-2016-003042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Innes K, Jackson D, Plummer V, Elliott D. Emergency department waiting room nurse role: A key informant perspective. ACTA ACUST UNITED AC 2017; 20:6-11. [PMID: 28108139 DOI: 10.1016/j.aenj.2016.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 12/08/2016] [Accepted: 12/08/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Emergency departments have become overcrowded with increased waiting times. Strategies to decrease waiting times include time-based key performance indicators and introduction of a waiting room nurse role. The aim of the waiting room nurse role is to expedite care by assessing and managing patients in the waiting room. There is limited literature examining this role. METHODS This paper presents results of semi-structured interviews with five key informants to explore why and how the waiting room nurse role was implemented in Australian emergency departments. Data were thematically analysed. RESULTS Five key informants from five emergency departments across two Australian jurisdictions (Victoria and New South Wales) reported that the role was introduced to reduce waiting times and improve quality and safety of care in the ED waiting room. Critical to introducing the role was defining and supporting the scope of practice, experience and preparation of the nurses. Role implementation required champions to overcome identified challenges, including funding. There has been limited evaluation of the role. CONCLUSIONS The waiting room nurse role was introduced to decrease waiting times and contributed to risk mitigation. Common to all roles was standing orders, while preparation and experience varied. Further research into the role is required.
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Affiliation(s)
- Kelli Innes
- Faculty of Health, University of Technology Sydney, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia.
| | - Debra Jackson
- Oxford University Hospitals NHS Foundation Trust, Faculty of Health and Life Sciences, Oxford Brookes University, United Kingdom
| | - Virginia Plummer
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia; Peninsula Health, Hastings Road Frankston, 3199, Australia
| | - Doug Elliott
- Faculty of Health, University of Technology Sydney, Australia
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Majid Z, Masood I. Implementation of a triage system in Pakistan: the need of the hour. Trop Doct 2016; 47:88-89. [PMID: 27932691 DOI: 10.1177/0049475516643437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In today's world, an effective emergency department (ED) cannot function properly without having a triage system. Though available in various forms, this essentially categorises patients according to the seriousness of their condition and the priority of their need.Pakistan is yet to introduce this system and where it exists, it is in its infancy. A disaster-prone country such as ours, which is frequently faced with both man-made and natural calamities, could benefit tremendously from its introduction. The activity of EDs would be streamlined and precious lives would be saved.
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Affiliation(s)
- Zain Majid
- Post-graduate trainee, Department of Medicine, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Irfan Masood
- Post-graduate trainee, Department of Surgery, Civil Hospital Karachi, Pakistan
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‘Care in a chair’ – The impact of an overcrowded Emergency Department on the time to treatment and length of stay of self-presenting patients with abdominal pain. Int Emerg Nurs 2016; 29:9-14. [DOI: 10.1016/j.ienj.2016.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 08/01/2016] [Accepted: 08/14/2016] [Indexed: 11/20/2022]
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Implementing Triage Standing Orders in the Emergency Department Leads to Reduced Physician-to-Disposition Times. ACTA ACUST UNITED AC 2016. [DOI: 10.1155/2016/7213625] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Emergency departments (EDs) throughout USA have improvised various processes to curb the “national epidemic” termed ED “crowding.” Standing orders (SOs), one such process, are medical orders approved by the medical director and entered by nurses when patients cannot be seen expeditiously, expediting medical decision-making and decreasing length of stay (LOS) and time to disposition. This retrospective cohort study evaluates the impact of SOs on ED LOS and disposition time at a large university ED. Results indicate that SOs significantly improve ED throughput by reducing disposition time by up to 16.9% (p=0.04), which is especially significant in busy ED settings. SOs by themselves are not sufficient for a complete diagnostic assessment. Strategies such as having a provider in the waiting area may help make key decisions earlier.
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Cheng DR, McCartney LE, West A, Craig SS. Effect of a pager notification system on Australasian Triage Scale category 2 patients in a paediatric emergency department. Emerg Med Australas 2016; 28:434-8. [PMID: 27197755 DOI: 10.1111/1742-6723.12587] [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: 10/02/2014] [Revised: 01/29/2016] [Accepted: 03/23/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Australasian EDs have introduced innovative processes to ensure safe and timely management of patients. Our ED introduced a dedicated pager system to provide rapid assessment of Australasian Triage Scale (ATS) category 2 patients in an attempt to expedite ED care. The present paper aims to evaluate the impact of this initiative on time to clinician, ED length of stay (LOS) and clinical outcomes in a tertiary paediatric ED. METHODS Retrospective structured chart review on patients presenting in a 2 month period before the intervention (August-September 2009) and the same time 1 year later. Patients were grouped into common ATS category 2 presentations and analysed in these subcategories. Clinical indicators of appropriate and timely performance were selected from best practice performance guidelines. RESULTS 779 ATS category 2 patients were seen during the two periods: 370 pre-intervention and 409 post-intervention. The overall percentage of ATS category 2 patients seen within the target time increased by 22.3%, although there was no significant change in ED LOS. The median time for patients from triage to being seen by an ED clinician improved from 10 to 6 min (P < 0.01). However, we were unable to demonstrate an impact of the pager system on various clinical quality indicators. CONCLUSIONS The rapid assessment pager system proved beneficial in reducing triage to clinician times for ATS category 2 patients but showed no improvement in overall ED LOS or disease-specific clinical quality indicators. Further research is needed to determine the influence of other components of ED functioning on clinical outcomes, as well as the overall clinical impact a pager system has on other measures of quality such as patient satisfaction and other subgroups of patients.
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Affiliation(s)
- Daryl R Cheng
- Monash Children's Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Laura E McCartney
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Adam West
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.,Monash Emergency, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Simon S Craig
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.,Monash Emergency, Monash Medical Centre, Melbourne, Victoria, Australia
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