Ten Recommendations for Reducing Unnecessary Emergency Department Visits

How to Manage Red Alert in Emergency and Disaster Unit in the Hospital? Evidence From London

This research gave an overview of coordinated hospital planning issues. In these issues, patients desire an arrangement for different source types, ideally as quickly as time permits. This field of context has just picked up academic interest, despite its reality since 1995. The way may discover a clarification for the above aspect that managing the hospital sources is regularly performed separately without taking a bigger picture. Therefore, it is particularly valid if the sources are situated in different departments. Another subsequent clarification may be related to the notoriety of the patient flow context. Hence, patients shouldn't be planned in these issues to be queued for another source or leave the system in case of their satisfaction of solicitation for the services at a particular source. The primary contribution of the present research is assisting present and new scholars via enumeration for every progression of the study of accessible decisions in the present context. Such means could be represented by major references for scientists to discover such studies endeavors tailored to their respective requirements. This principle removes the message: scientists ought to consistently coordinate their decisions concerning the setting, the capacity, and the approaches, as not all blends are conceivable.

Alternatives to direct emergency department conveyance of ambulance patients: a scoping review of the evidence

Background

The role of ambulance services is shifting, due in part to more intermediate, non-urgent patients who do not require direct emergency department conveyance, yet who cannot be safely left at home alone. Evidence surrounding the safety, effectiveness and efficiency of alternate care routes is not well known.

Methods

This scoping review sought to identify all studies that examined alternate routes of care for the non-urgent “intermediate” patient, as triaged on scene. Search terms for the sample (ambulances, paramedics, etc.) and intervention (e.g. referrals, alternate care route, non-conveyance) were combined. Articles were systematically searched using four databases and grey literature sources (February 2020). Independent researchers screened title-abstract and full text stages.

Results

Of 16,037 records, 41 examined alternate routes of care after triage by the on-scene paramedic. Eighteen articles considered quantitative patient data, 12 studies provided qualitative perspectives while 11 were consensus or opinion-based articles. The benefits of alternative schemes are well-recognised by patients, paramedics and stakeholders and there is supporting evidence for a positive impact on patient-centered care and operational efficiency. Challenges to successful use of schemes included: patient safety resulting from incorrect triage decisions, inadequate training, lack of formal partnerships between ambulance and supporting services, and insufficient evidence to support safe implementation or continued use. Studies often inaccurately defined success using proxies for patient safety (e.g. decision comparisons, rates of secondary contact). Finally, patients expressed willingness for such schemes but their preference must be better understood.

Conclusions

This broad summary offers initial support for alternate routes of care for intermediate, non-urgent patients. Even so, most studies lacked methodologically rigorous evidence and failed to evaluate safe patient outcomes. Some remedies appear to be available such as formal triage pathways, targeted training and organisational support, however there is an urgent need for more research and dissemination in this area.

The development of a nursing assessment and symptom management clinic

The Anne Arundel Medical Center (AAMC) DeCesaris Cancer Institute (DCI) began its participation in the ONS Foundation-supported Breast Cancer Care Quality Measures Set pilot study in 2010. The design and measures of the project were intriguing, paving a path for DCI to define quality measures and outcomes that were of value to the AAMC's oncology population and system. As the pilot program was getting underway, measurement instruments were selected for fatigue, distress, and sleep-wake disturbances. These were used as quality measures for care of patients receiving chemotherapy, to be reported to the Oncology Quality Council, AAMC DCI's Executive Quality Council, and the AAMC Board of Directors. Scores for these quality measures, as well as patient satisfaction scores for the Outpatient Infusion Center, have increased markedly since the 2010 pilot test. The increases in scores inspired nursing leadership, in conjunction with AAMC DCI's Medical Oncology Executive Committee, to develop an innovative nursing model, the advanced oncology nurse practitioner-led symptom management clinic, to systematically and efficiently treat the needs of patients with cancer.

The impacts of subsidized health insurance on employees' use of preventive health services

This study presents an uncontrolled preliminary evaluation of a pilot health insurance subsidy program and addresses whether provision of subsidized insurance that required employee contribution had an impact upon preventive health utilization among small businesses and their employees. Self-report questionnaires were mailed to the employees; these included questions on use of preventive health services before and after enrollment in the subsidy program. The analysis was stratified by self-reported prior enrollment in an insurance program to compare employees with and without prior health insurance. The findings suggest significant increases in health service utilization among the previously uninsured. Regular checkups more than doubled (p < .0001), as did the number of individuals receiving regular blood work (p < .0001). Nearly twice the number of individuals filled regular prescriptions after enrollment in the subsidy program as compared with before (p < .0001). This study suggests that employees of small businesses are willing to contribute to the cost of a health insurance premium, and once insured are more likely to use preventive services. A model of shared cost responsibility is an effective way to provide affordable insurance to small-business employees, thus increasing preventive services in these populations.