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Lacey B, West A, Craig S. Parents' and carers' impression of "quality" within a Paediatric Emergency Department. BMC Pediatr 2021; 21:313. [PMID: 34256736 PMCID: PMC8276454 DOI: 10.1186/s12887-021-02752-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/27/2021] [Indexed: 11/21/2022] Open
Abstract
Background Quality improvement systems are needed to overcome the ‘Quality Gap’ – difference between evidence-based guidelines and the care delivered. While there are a large array of potential quality assurance measures exists in the Paediatric Emergency Department, parent’s/carer’s perception of these is unknown. This study aimed to identify what ‘quality of care’ means to parents/carers of Paediatric Emergency Department (PED) patients, further determine which aspects of these are most important to them. Also, to identify which of the existing PED quality measures are most important to parents/carers, and their preferred method of providing feedback. Methods A Modified Rand-Delphi study was performed with parents/carers as the expert group and consensus was obtained from them via three web-based surveys. All parents/carers of children attending a tertiary paediatric hospital during six-week in winter were eligible– no exclusions. Quality measures scoring at least 7 on a 9-point Likert scale during the final survey were considered “very important”, while those scoring at least an 8 were considered “extremely important”. Results One hundred four parents/carers responded from a total of 1095 participants. Parents/carers generated 527 free text entries, to the initial survey on what ‘quality of care’ means. These were mapped to 48 quality measure which they ranked on subsequent surveys. Eighteen quality measures were considered very important by at least 90% of respondents. Of these, six were considered extremely important by at least 70% of respondents: ‘Thorough medical assessment’ (84%); ‘A triage system’ (84%); ‘Experienced and knowledgeable staff that are skilled in paediatrics’ (77%); ‘Resources and equipment available to provide care’ (72%); and ‘Clear follow up plans and reviews that are communicated and scheduled’ (72%). Parents/carers considered existing quality measures as important with ‘timely treatment of a critical condition’ as the most important. Most participants preferred to provide anonymous feedback (N = 69, 66%), online (N = 77, 72%) after discharge (N = 82, 70%). Conclusion We have elicited what ‘quality of care’ means to parents/carers, and which aspects are most important to them. Parents/carers consider commonly used PED quality measure as very important. However, they are less important than outcomes generated by themselves. Further parents/carers in this study preferred to provide feedback that was anonymous and electronically distributed after they leave the ED. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02752-7.
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Affiliation(s)
- Brendan Lacey
- Paediatric Emergency Department, Emergency Service, Monash Health, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, 3168, Australia.
| | - Adam West
- Paediatric Emergency Department, Emergency Service, Monash Health, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, 3168, Australia
| | - Simon Craig
- Paediatric Emergency Department, Emergency Service, Monash Health, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, 3168, Australia.,Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia.,Monash Children's Hospital, Locked Bag 29, Clayton South, Victoria, Australia
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Huang IA, Tuan PL, Jaing TH, Wu CT, Chao M, Wang HH, Hsia SH, Hsiao HJ, Chang YC. Comparisons between Full-time and Part-time Pediatric Emergency Physicians in Pediatric Emergency Department. Pediatr Neonatol 2016; 57:371-377. [PMID: 27178642 DOI: 10.1016/j.pedneo.2015.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 08/31/2015] [Accepted: 10/30/2015] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Pediatric emergency medicine is a young field that has established itself in recent decades. Many unanswered questions remain regarding how to deliver better pediatric emergency care. The implementation of full-time pediatric emergency physicians is a quality improvement strategy for child care in Taiwan. The aim of this study is to evaluate the quality of care under different physician coverage models in the pediatric emergency department (ED). METHODS The medical records of 132,398 patients visiting the pediatric ED of a tertiary care university hospital during January 2004 to December 2006 were retrospectively reviewed. Full-time pediatric emergency physicians are the group specializing in the pediatric emergency medicine, and they only work in the pediatric ED. Part-time pediatricians specializing in other subspecialties also can work an extra shift in the pediatric ED, with the majority working in their inpatient and outpatient services. We compared quality performance indicators, including: mortality rate, the 72-hour return visit rate, length of stay, admission rate, and the rate of being kept for observation between full-time and part-time pediatric emergency physicians. RESULTS An average of 3678 ± 125 [mean ± standard error (SE)] visits per month (with a range of 2487-6646) were observed. The trends in quality of care, observed monthly, indicated that the 72-hour return rate was 2-6% and length of stay in the ED decreased from 11.5 hours to 3.2 hours over the study period. The annual mortality rate within 48 hours of admission to the ED increased from 0.04% to 0.05% and then decreased to 0.02%, and the overall mortality rate dropped from 0.13% to 0.07%. Multivariate analyses indicated that there was no change in the 72-hour return visit rate for full-time pediatric emergency physicians; they were more likely to admit and keep patients for observation [odds ratio = 1.43 and odds ratio = 1.71, respectively], and these results were similar to those of senior physicians. CONCLUSION Full-time pediatric emergency physicians in the pediatric ED decreased the mortality rate and length of stay in the ED, but had no change in the 72-hour return visit rate. This pilot study shows that the quality of care in pediatric ED after the implementation of full-time pediatric emergency physicians needs further evaluation.
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Affiliation(s)
- I-Anne Huang
- Department of Pediatrics, Chang Gung Memorial Hospital at Keelung, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Pao-Lan Tuan
- Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tang-Her Jaing
- Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chang-Teng Wu
- Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Minston Chao
- Department and Graduate Institute of Health Care Management, Chang Gung University, Taoyuan, Taiwan
| | - Hui-Hsuan Wang
- Department and Graduate Institute of Health Care Management, Chang Gung University, Taoyuan, Taiwan.
| | - Shao-Hsuan Hsia
- Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
| | - Hsiang-Ju Hsiao
- Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yu-Ching Chang
- Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
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Naidoo L, Mahomed OH. Impact of Lean on patient cycle and waiting times at a rural district hospital in KwaZulu-Natal. Afr J Prim Health Care Fam Med 2016; 8:e1-9. [PMID: 27543283 PMCID: PMC4969513 DOI: 10.4102/phcfm.v8i1.1084] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 04/18/2016] [Accepted: 03/03/2016] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Prolonged waiting time is a source of patient dissatisfaction with health care and is negatively associated with patient satisfaction. Prolonged waiting times in many district hospitals result in many dissatisfied patients, overworked and frustrated staff, and poor quality of care because of the perceived increased workload. AIM The aim of the study was to determine the impact of Lean principles techniques, and tools on the operational efficiency in the outpatient department (OPD) of a rural district hospital. SETTING The study was conducted at the Catherine Booth Hospital (CBH) - a rural district hospital in KwaZulu-Natal, South Africa. METHODS This was an action research study with pre-, intermediate-, and post-implementation assessments. Cycle and waiting times were measured by direct observation on two occasions before, approximately two-weekly during, and on two occasions after Lean implementation. A standardised data collection tool was completed by the researcher at each of the six key service nodes in the OPD to capture the waiting times and cycle times. RESULTS All six service nodes showed a reduction in cycle times and waiting times between the baseline assessment and post-Lean implementation measurement. Significant reduction was achieved in cycle times (27%; p < 0.05) and waiting times (from 11.93 to 10 min; p = 0.03) at the Investigations node. Although the target reduction was not achieved for the Consulting Room node, there was a significant reduction in waiting times from 80.95 to 74.43 min, (p < 0.001). The average efficiency increased from 16.35% (baseline) to 20.13% (post-intervention). CONCLUSION The application of Lean principles, tools and techniques provides hospital managers with an evidence-based management approach to resolving problems and improving quality indicators.
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Affiliation(s)
| | - Ozayr H Mahomed
- Discipline of Public Health Medicine, University of KwaZulu-Natal.
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Borland ML, Shepherd M. Quality in paediatric emergency medicine: Measurement and reporting. J Paediatr Child Health 2016; 52:131-6. [PMID: 27062615 DOI: 10.1111/jpc.13077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 07/12/2015] [Accepted: 07/30/2015] [Indexed: 11/29/2022]
Abstract
There is a clear demand for quality in the delivery of health care around the world; paediatric emergency medicine is no exception to this movement. It has been identified that gaps exist in the quality of acute care provided to children. Regulatory bodies in Australia and New Zealand are moving to mandate the implementation of quality targets and measures. Within the paediatric emergency department (ED), there is a lack of research into paediatric specific indicators. The existing literature regarding paediatric acute care quality measures has been recently summarised, and expert consensus has now been reported. It is clear that there is much work to be performed to generalise this work to ED. We review suggestions from the current literature relating to feasible indicators within the paediatric acute care setting. We propose options to develop a quality 'scorecard' that could be used to assist Australian and New Zealand EDs with quality measurement and benchmarking for their paediatric patients.
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Affiliation(s)
- Meredith L Borland
- Emergency Department, Princess Margaret Hospital, Perth, Western Australia, Australia.,Schools of Paediatric and Child Health, Western Australia, Australia.,Primary Aboriginal and Rural Healthcare, University of Western Australia, Perth, Western Australia, Australia
| | - Mike Shepherd
- Children's Emergency Department, Starship Children's Hospital.,Auckland District Health Board.,Department of Paediatrics, University of Auckland, Auckland, New Zealand
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Barata I, Brown KM, Fitzmaurice L, Griffin ES, Snow SK. Best practices for improving flow and care of pediatric patients in the emergency department. Pediatrics 2015; 135:e273-83. [PMID: 25548334 DOI: 10.1542/peds.2014-3425] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This report provides a summary of best practices for improving flow, reducing waiting times, and improving the quality of care of pediatric patients in the emergency department.
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Chan H, Lo S, Lee L, Lo W, Yu W, Wu Y, Ho S, Yeung R, Chan J. Lean techniques for the improvement of patients' flow in emergency department. World J Emerg Med 2014; 5:24-8. [PMID: 25215143 DOI: 10.5847/wjem.j.issn.1920-8642.2014.01.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 11/17/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Emergency departments (EDs) face problems with overcrowding, access block, cost containment, and increasing demand from patients. In order to resolve these problems, there is rising interest to an approach called "lean" management. This study aims to (1) evaluate the current patient flow in ED, (2) to identify and eliminate the non-valued added process, and (3) to modify the existing process. METHODS It was a quantitative, pre- and post-lean design study with a series of lean management work implemented to improve the admission and blood result waiting time. These included structured re-design process, priority admission triage (PAT) program, enhanced communication with medical department, and use of new high sensitivity troponin-T (hsTnT) blood test. Triage waiting time, consultation waiting time, blood result time, admission waiting time, total processing time and ED length of stay were compared. RESULTS Among all the processes carried out in ED, the most time consuming processes were to wait for an admission bed (38.24 minutes; SD 66.35) and blood testing result (mean 52.73 minutes, SD 24.03). The triage waiting time and end waiting time for consultation were significantly decreased. The admission waiting time of emergency medical ward (EMW) was significantly decreased from 54.76 minutes to 24.45 minutes after implementation of PAT program (P<0.05). CONCLUSION The application of lean management can improve the patient flow in ED. Acquiescence to the principle of lean is crucial to enhance high quality emergency care and patient satisfaction.
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Affiliation(s)
- Hy Chan
- Emergency Department, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
| | - Sm Lo
- Emergency Department, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
| | - Lly Lee
- Emergency Department, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
| | - Wyl Lo
- Emergency Department, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
| | - Wc Yu
- Emergency Department, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
| | - Yf Wu
- Emergency Department, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
| | - St Ho
- Emergency Department, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
| | - Rsd Yeung
- Emergency Department, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
| | - Jts Chan
- Emergency Department, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
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Sánchez Etxaniz J, Luaces I Cubells C, Benito Fernández J. Cumplimiento de los requisitos de los servicios de urgencias de España: encuesta de autoevaluación. An Pediatr (Barc) 2011; 75:115-23. [DOI: 10.1016/j.anpedi.2011.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Revised: 02/05/2011] [Accepted: 02/16/2011] [Indexed: 11/28/2022] Open
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Mahajan P. Quality in Pediatric Emergency Medicine: A Learning Curve and a Curveball. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2011. [DOI: 10.1016/j.cpem.2011.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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