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Wilbeck J, Davis WD, Tyler D, Schumann L, Kapu A. Analysis of nurse practitioner practice in US emergency departments: Evidence supporting educational preparation, credentialing, scope of practice, and outcomes. J Am Assoc Nurse Pract 2023; 35:373-379. [PMID: 37159426 DOI: 10.1097/jxx.0000000000000874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 03/29/2023] [Indexed: 05/11/2023]
Abstract
ABSTRACT The nurse practitioner (NP) role within emergency care has grown in recent years and now there are an estimated 25,000 NPs employed in diverse emergency care settings. Despite this significant growth and expansion of the NP within emergency care areas, challenges exist. In addition to the pervasive confusion regarding the NP role in emergency care, data and statistics detailing characteristics and outcomes of NP practice in emergency care are either lacking or misrepresented. This article explores barriers and provides current and accurate information describing the current educational preparation, credentialing, scope of practice, and outcomes among NPs in US emergency departments. The totality of available evidence reviewed supports safe, timely, efficient, and patient-centered care provided by NPs in emergency care.
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Affiliation(s)
- Jennifer Wilbeck
- Vanderbilt University School of Nursing, Nashville, Tennessee
- American Academy of Emergency Nurse Practitioners, Leander, Texas
| | - Wesley D Davis
- American Academy of Emergency Nurse Practitioners, Leander, Texas
- College of Nursing, University of South Alabama, Mobile, Alabama
| | - Diane Tyler
- American Academy of Nurse Practitioners Certification Board, Austin, Texas
| | - Lorna Schumann
- American Academy of Nurse Practitioners Certification Board, Austin, Texas
| | - April Kapu
- Vanderbilt University School of Nursing, Nashville, Tennessee
- American Association of Nurse Practitioners, Austin, Texas
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Monahan AC, Feldman SS, Fitzgerald TP. Reducing Crowding in Emergency Departments With Early Prediction of Hospital Admission of Adult Patients Using Biomarkers Collected at Triage: Retrospective Cohort Study. JMIR BIOINFORMATICS AND BIOTECHNOLOGY 2022; 3:e38845. [PMID: 38935936 PMCID: PMC11135233 DOI: 10.2196/38845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/05/2022] [Accepted: 07/17/2022] [Indexed: 06/29/2024]
Abstract
BACKGROUND Emergency department crowding continues to threaten patient safety and cause poor patient outcomes. Prior models designed to predict hospital admission have had biases. Predictive models that successfully estimate the probability of patient hospital admission would be useful in reducing or preventing emergency department "boarding" and hospital "exit block" and would reduce emergency department crowding by initiating earlier hospital admission and avoiding protracted bed procurement processes. OBJECTIVE To develop a model to predict imminent adult patient hospital admission from the emergency department early in the patient visit by utilizing existing clinical descriptors (ie, patient biomarkers) that are routinely collected at triage and captured in the hospital's electronic medical records. Biomarkers are advantageous for modeling due to their early and routine collection at triage; instantaneous availability; standardized definition, measurement, and interpretation; and their freedom from the confines of patient histories (ie, they are not affected by inaccurate patient reports on medical history, unavailable reports, or delayed report retrieval). METHODS This retrospective cohort study evaluated 1 year of consecutive data events among adult patients admitted to the emergency department and developed an algorithm that predicted which patients would require imminent hospital admission. Eight predictor variables were evaluated for their roles in the outcome of the patient emergency department visit. Logistic regression was used to model the study data. RESULTS The 8-predictor model included the following biomarkers: age, systolic blood pressure, diastolic blood pressure, heart rate, respiration rate, temperature, gender, and acuity level. The model used these biomarkers to identify emergency department patients who required hospital admission. Our model performed well, with good agreement between observed and predicted admissions, indicating a well-fitting and well-calibrated model that showed good ability to discriminate between patients who would and would not be admitted. CONCLUSIONS This prediction model based on primary data identified emergency department patients with an increased risk of hospital admission. This actionable information can be used to improve patient care and hospital operations, especially by reducing emergency department crowding by looking ahead to predict which patients are likely to be admitted following triage, thereby providing needed information to initiate the complex admission and bed assignment processes much earlier in the care continuum.
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Affiliation(s)
| | - Sue S Feldman
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Tony P Fitzgerald
- School of Mathematical Sciences, University College Cork, Cork, Ireland
- School of Public Health, University College Cork, Cork, Ireland
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Jeyaraman MM, Alder RN, Copstein L, Al-Yousif N, Suss R, Zarychanski R, Doupe MB, Berthelot S, Mireault J, Tardif P, Askin N, Buchel T, Rabbani R, Beaudry T, Hartwell M, Shimmin C, Edwards J, Halas G, Sevcik W, Tricco AC, Chochinov A, Rowe BH, Abou-Setta AM. Impact of employing primary healthcare professionals in emergency department triage on patient flow outcomes: a systematic review and meta-analysis. BMJ Open 2022; 12:e052850. [PMID: 35443941 PMCID: PMC9058787 DOI: 10.1136/bmjopen-2021-052850] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 02/26/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To identify, critically appraise and summarise evidence on the impact of employing primary healthcare professionals (PHCPs: family physicians/general practitioners (GPs), nurse practitioners (NP) and nurses with increased authority) in the emergency department (ED) triage, on patient flow outcomes. METHODS We searched Medline (Ovid), EMBASE (Ovid), Cochrane Library (Wiley) and CINAHL (EBSCO) (inception to January 2020). Our primary outcome was the time to provider initial assessment (PIA). Secondary outcomes included time to triage, proportion of patients leaving without being seen (LWBS), length of stay (ED LOS), proportion of patients leaving against medical advice (LAMA), number of repeat ED visits and patient satisfaction. Two independent reviewers selected studies, extracted data and assessed study quality using the National Institute for Health and Care Excellence quality assessment tool. RESULTS From 23 973 records, 40 comparative studies including 10 randomised controlled trials (RCTs) and 13 pre-post studies were included. PHCP interventions were led by NP (n=14), GP (n=3) or nurses with increased authority (n=23) at triage. In all studies, PHCP-led intervention effectiveness was compared with the traditional nurse-led triage model. Median duration of the interventions was 6 months. Study quality was generally low (confounding bias); 7 RCTs were classified as moderate quality. Most studies reported that PHCP-led triage interventions decreased the PIA (13/14), ED LOS (29/30), proportion of patients LWBS (8/10), time to triage (3/3) and repeat ED visits (5/6), and increased the patient satisfaction (8/10). The proportion of patients LAMA did not differ between groups (3/3). Evidence from RCTs (n=8) as well as other study designs showed a significant decrease in ED LOS favouring the PHCP-led interventions. CONCLUSIONS Overall, PHCP-led triage interventions improved ED patient flow metrics. There was a significant decrease in ED LOS irrespective of the study design, favouring the PHCP-led interventions. Evidence from well-designed high-quality RCTs is required prior to widespread implementation. PROSPERO REGISTRATION NUMBER CRD42020148053.
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Affiliation(s)
- Maya M Jeyaraman
- George and Fay Yee Center for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rachel N Alder
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Leslie Copstein
- George and Fay Yee Center for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nameer Al-Yousif
- George and Fay Yee Center for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Roger Suss
- Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ryan Zarychanski
- Department of Medical Oncology and Hematology, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Malcolm B Doupe
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Simon Berthelot
- Centre de recherche du CHU de Québec-Université Laval, Axe Santé des populations et Pratiques optimales en santé, Laval, Quebec, Canada
| | - Jean Mireault
- HEC Pôle santé, Université de Montréal, Montreal, Quebec, Canada
| | - Patrick Tardif
- Department of Emergency Medicine, Cité de la santé de Laval, Laval, Quebec, Canada
| | - Nicole Askin
- WRHA Virtual Library, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tamara Buchel
- Manitoba College of Family Physicians, Winnipeg, Manitoba, Canada
| | - Rasheda Rabbani
- George and Fay Yee Center for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Thomas Beaudry
- Patient and Public Engagement Collaborative Partnership, George & Fay Yee Center for Healthcare Innovation, Winnipeg, Manitoba, Canada
| | - Melissa Hartwell
- Primary and Integrated Health care Innovation Network, Edmonton, Alberta, Canada
| | - Carolyn Shimmin
- George and Fay Yee Center for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jeanette Edwards
- Community Health Quality and Learning, Shared Health Manitoba, Winnipeg, Manitoba, Canada
| | - Gayle Halas
- Manitoba Primary and Integrated Health care Innovation Network, Winnipeg, Manitoba, Canada
| | - William Sevcik
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Andrea C Tricco
- Knowledge Translation Program, St. Michael's Hospital Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
| | - Alecs Chochinov
- Department of Emergency Medicine, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brian H Rowe
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Ahmed M Abou-Setta
- George and Fay Yee Center for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
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Cetin-Sahin D, McCusker J, Ciampi A, Cossette S, Vadeboncoeur A, Vu TTM, Veillette N, Ducharme F, Belzile E, Lachance PA, Mah R, Berthelot S. Front-line emergency department nurses' and physicians' assessments of processes of elder-friendly care for quality improvement. Int Emerg Nurs 2021; 58:101049. [PMID: 34509169 DOI: 10.1016/j.ienj.2021.101049] [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: 09/06/2020] [Revised: 06/10/2021] [Accepted: 06/23/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Geriatric emergency department (ED) care has gained increasing importance and interest due to increasing visits in seniors. AIM Among ED front-line nurses and physicians, to assess and compare ratings of elder-friendly care process indicators, variability in ratings, and concurrent validity of ratings. METHODS Four Quebec EDs' full-time registered nurses and physicians rated their geriatric care using 9 subscales. Nurse and physician subscale scores were compared. Inter-rater variability within disciplines and variability between nurses and physicians were measured. Associations between the subscale scores and perceived overall quality of care were tested. RESULTS 38 nurses and 36 physicians completed the survey (83% of 89 eligible). Scores differed by discipline for 3 of 9 subscales computed; nurses had higher mean scores on Protocols, Family-Centered Discharge, and Staff Education. Very high variation for Staff Education was found within disciplines. Variations for Family-Centered Discharge differed significantly between nurses and physicians. Almost all subscale scores were significantly positively associated with perceived overall quality of care. CONCLUSIONS ED nurses and physicians rate geriatric care components similarly except for protocols, discharge processes, and continuing education. The subscales have concurrent validity. Results suggest a need for improvement in continuing educational strategies with a particular attention to discharge processes.
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Affiliation(s)
- Deniz Cetin-Sahin
- St. Mary's Research Centre, St. Mary's Hospital Center, 3830 Avenue Lacombe, Suite 4720, Montreal, QC H3T 1M5, Canada; Department of Family Medicine, McGill University, 5858 chemin de la Côte-des-Neiges, Montreal, QC H3S 1Z1, Canada; Center for Research in Aging, Donald Berman Maimonides Geriatric Centre, 5795 Avenue Caldwell, Côte Saint-Luc, QC H4W 1W3, Canada.
| | - Jane McCusker
- St. Mary's Research Centre, St. Mary's Hospital Center, 3830 Avenue Lacombe, Suite 4720, Montreal, QC H3T 1M5, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Avenue des Pins Ouest, Montreal, QC H3A 1A2, Canada.
| | - Antonio Ciampi
- St. Mary's Research Centre, St. Mary's Hospital Center, 3830 Avenue Lacombe, Suite 4720, Montreal, QC H3T 1M5, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Avenue des Pins Ouest, Montreal, QC H3A 1A2, Canada.
| | - Sylvie Cossette
- University of Montreal, 2900 Edouard Montpetit Blvd, Montreal, QC H3T 1J4, Canada; Montreal Heart Institute Research Center, 5000 rue Bélanger, Montreal, QC H1T 1C8, Canada.
| | - Alain Vadeboncoeur
- University of Montreal, 2900 Edouard Montpetit Blvd, Montreal, QC H3T 1J4, Canada; Emergency Department, Montreal Heart Institute, rue 5000 Bélanger, Montreal, QC H1T 1C8, Canada.
| | - T T Minh Vu
- University of Montreal, 2900 Edouard Montpetit Blvd, Montreal, QC H3T 1J4, Canada; Research Centre, Institut universitaire de gériatrie de Montréal, 4545 chemin Queen Mary, Montreal, QC H3W 1W6, Canada; Centre hospitalier de l'Université de Montréal, 1051 Rue Sanguinet, Montreal, QC H2X 3E4, Canada.
| | - Nathalie Veillette
- University of Montreal, 2900 Edouard Montpetit Blvd, Montreal, QC H3T 1J4, Canada; Research Centre, Institut universitaire de gériatrie de Montréal, 4545 chemin Queen Mary, Montreal, QC H3W 1W6, Canada.
| | - Francine Ducharme
- University of Montreal, 2900 Edouard Montpetit Blvd, Montreal, QC H3T 1J4, Canada; Research Centre, Institut universitaire de gériatrie de Montréal, 4545 chemin Queen Mary, Montreal, QC H3W 1W6, Canada; Faculty of Nursing, Université de Montréal, Pavillon Marguerite-d'Youville, 2375, chemin de la Côte-Ste-Catherine, Montreal, QC H3T 1A8, Canada.
| | - Eric Belzile
- St. Mary's Research Centre, St. Mary's Hospital Center, 3830 Avenue Lacombe, Suite 4720, Montreal, QC H3T 1M5, Canada.
| | - Paul-André Lachance
- University of Montreal, 2900 Edouard Montpetit Blvd, Montreal, QC H3T 1J4, Canada; Hôpital Cité-de-la-Santé, 1755 Boulevard René-Laennec, Laval, QC H7M 3L9, Canada.
| | - Rick Mah
- St. Mary's Hospital Center, 3830 Avenue Lacombe, Emergency Department, Montreal, QC H3T 1M5, Canada; Department of Emergency Medicine, Faculty of Medicine, McGill University, 1001, boul. Décarie, D05.2017.2, Montreal, QC H4A 3J1, Canada.
| | - Simon Berthelot
- Centre de recherche du Centre hospitalier universitaire de Québec-Université Laval, 2705, boulevard Laurier, Quebec City, QC G1V 4G2, Canada.
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Alignment of Nurse Practitioner Educational Preparation and Scope of Practice in United States Emergency Departments: A Systematic Review of the Literature. J Emerg Nurs 2021; 47:563-581. [PMID: 34275527 DOI: 10.1016/j.jen.2021.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION National debate persists surrounding the expanded use of nurse practitioners in the emergency department. Current understanding of the alignment of nurse practitioner educational preparation and practice parameters in United States emergency departments is inchoate. The objective of this review was to seek evidence to support that nurse practitioner education and training align with current practices in the emergency department. METHODS A Preferred Reporting Items for Systematic Reviews and Meta-Analyses guided systematic review of the existing literature was conducted of 4 relevant databases. Level of evidence and quality assignments were made for each article using Grading of Recommendations, Assessment, Development, and Evaluation or Confidence in Evidence from Reviews of Qualitative Research as appropriate. RESULTS Nurse practitioners are increasingly staffing emergency departments, providing care to both patients classified as high-acuity and low-acuity. Reports of nurse practitioner scope of practice vary widely. No studies evaluated alignment of educational preparation and training for actual clinical practice. DISCUSSION This review of the literature was inconclusive, and the review team we was unable to find evidence that supports the alignment of nurse practitioner educational preparation and training with scope of clinical practice in United States emergency departments. Future research should seek to articulate the landscape of nurse practitioner academic preparation for specialty practice in the emergency department and to specifically examine the alignment of educational preparation with scope of practice and impact on clinical outcomes of patients seen in the emergency department.
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Bogh SB, Fløjstrup M, Möller S, Bech M, Johnsen SP, Henriksen DP, Mogensen CB, Lassen AT, Brabrand M. Intended and unintended changes in length of stay following reconfiguration of emergency care departments. Int J Qual Health Care 2021; 33:6101215. [PMID: 33449079 DOI: 10.1093/intqhc/mzab008] [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: 11/26/2020] [Revised: 01/04/2021] [Accepted: 01/13/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Danish health-care system has witnessed noticeable changes in the acute hospital care organization. The reconfiguration includes closing hospitals, centralizing acute care functions and investing in new buildings and equipment. OBJECTIVE To examine the impact on the length of stay (LOS) and the proportion of overnight stays for hospitalized acute care patients. METHODS This nationwide interrupted time series examined trend changes in LOS and overnight stay. Admissions were stratified based on admission time (weekdays/weekends and time of day), age and the level of co-morbidity. RESULTS In 2007-2016, the global average LOS declined 2.9% per year (adjusted time ratio [CI (confidence interval) 95%] 0.971 [0.970-0.971]). The reconfiguration was overall not associated with change in trend of LOS (time ratio [CI 95%] 1.001 [1.000-1.002]). When admissions were stratified for either weekdays or weekends, the reconfiguration was associated with reduction of the underlying downward trend for weekdays (time ratio [CI 95%] 1.004 [1.003-1.005]) and increased downward trend for weekend admissions (time ratio [CI 95%] 0.996 [0.094-0.098]). Admissions at night were associated with a 0.7% trend change in LOS (time ratio [CI 95%] 0.993 [0.991-0.996]). The reconfiguration was not associated with trend changes for overnight stays. CONCLUSION The nationwide reconfiguration of acute hospital care was overall not associated with change in trend for the registered LOS and no change in trend for overnight stays. However, the results varied according to hospitalization time, where admissions during weekends and nights after the reconfiguration were associated with shortened LOS.
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Affiliation(s)
- Søren Bie Bogh
- Odense Patient Exploratory Network (Open), Odense University Hospital, J.B. Winsløws Vej 9 A, 3. Sal, Odense 5000, Denmark.,Department of Clinical Research, University of Southern Denmark, Winsløwparken 19, 3. Sal, Odense 5000, Denmark
| | - Marianne Fløjstrup
- Department of Emergency Medicine, Hospital of South West Jutland, Finsensgade 35, Esbjerg 6700, Denmark.,Department of Regional Health Research, University of Southern Denmark, Winsløwparken 19, 3. Sal, Odense 5000, Denmark
| | - Sören Möller
- Odense Patient Exploratory Network (Open), Odense University Hospital, J.B. Winsløws Vej 9 A, 3. Sal, Odense 5000, Denmark.,Department of Clinical Research, University of Southern Denmark, Winsløwparken 19, 3. Sal, Odense 5000, Denmark
| | - Mickael Bech
- UCL University College, Niels Bohrs Alle 1, Odense 5230, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Mølleparkvej 10, Aalborg 9000, Denmark
| | - Daniel Pilsgaard Henriksen
- Clinical Pharmacology and Pharmacy, University of Southern Denmark, J.B. Winsløws Vej 19, 2 sal, Odense 5000, Denmark
| | - Christian Backer Mogensen
- Department of Regional Health Research, University of Southern Denmark, Winsløwparken 19, 3. Sal, Odense 5000, Denmark.,Focused Research Unit in Emergency Medicine, Hospital of Southern Denmark, Kresten Philipsens Vej 15, Aabenraa 6200, Denmark
| | - Annmarie Touborg Lassen
- Department of Clinical Research, University of Southern Denmark, Winsløwparken 19, 3. Sal, Odense 5000, Denmark.,Department of Emergency Medicine, Odense University Hospital, J. B. Winsløws Vej 4, Odense 5000, Denmark
| | - Mikkel Brabrand
- Department of Emergency Medicine, Hospital of South West Jutland, Finsensgade 35, Esbjerg 6700, Denmark.,Department of Regional Health Research, University of Southern Denmark, Winsløwparken 19, 3. Sal, Odense 5000, Denmark.,Department of Emergency Medicine, Odense University Hospital, J. B. Winsløws Vej 4, Odense 5000, Denmark
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Patey C, Norman P, Araee M, Asghari S, Heeley T, Boyd S, Hurley O, Aubrey-Bassler K. SurgeCon: Priming a Community Emergency Department for Patient Flow Management. West J Emerg Med 2019; 20:654-665. [PMID: 31316707 PMCID: PMC6625694 DOI: 10.5811/westjem.2019.5.42027] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 05/21/2019] [Accepted: 05/17/2019] [Indexed: 11/11/2022] Open
Abstract
Introduction Canadian emergency departments (ED) are struggling to provide timely emergency care. Very few studies have assessed attempts to improve ED patient flow in the rural context. We assessed the impact of SurgeCon, an ED patient-management protocol, on total patient visits, patients who left without being seen (LWBS), length of stay for departed patients (LOSDep), and physician initial assessment time (PIA) in a rural community hospital ED. Methods We implemented a set of commonly used methods for increasing ED efficiency with an innovative approach over 45 months. Our intervention involved seven parts comprised of an external review, Lean training, fast track implementation, patient-centeredness approach, door-to-doctor approach, performance reporting, and an action-based surge capacity protocol. We measured key performance indicators including total patient visits (count), PIA (minutes), LWBS (percentage), and LOSDep (minutes) before and after the SurgeCon intervention. We also performed an interrupted time series (ITS) analysis. Results During the study period, 80,709 people visited the ED. PIA decreased from 104.3 (±9.9) minutes to 42.2 (±8.1) minutes, LOSDep decreased from 199.4 (±16.8) minutes to 134.4(±14.5) minutes, and LWBS decreased from 12.1% (±2.2) to 4.6% (±1.7) despite a 25.7% increase in patient volume between pre-intervention and post-intervention stages. The ITS analysis revealed a significant level change in PIA - 19.8 minutes (p<0.01), and LWBS - 3.8% (0.02), respectively. The change over time decreased by 2.7 minutes/month (p< 0.001), 3.0 minutes/month (p<0.001) and 0.4%/month (p<0.001) for PIA, LOSDep, and LWBS, after the intervention. Conclusion SurgeCon improved the key wait-time metrics in a rural ED in a country where average wait times continue to rise. The SurgeCon platform has the potential to improve ED efficiency in community hospitals with limited resources.
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Affiliation(s)
- Christopher Patey
- Memorial University of Newfoundland, Discipline of Family Medicine, St. John's, Newfoundland.,Eastern Health, Carbonear Institute for Rural Research and Innovation by the Sea, Carbonear General Hospital, Carbonear, Newfoundland
| | - Paul Norman
- Eastern Health, Carbonear Institute for Rural Research and Innovation by the Sea, Carbonear General Hospital, Carbonear, Newfoundland
| | - Mehdee Araee
- Memorial University of Newfoundland, Discipline of Family Medicine, St. John's, Newfoundland
| | - Shabnam Asghari
- Memorial University of Newfoundland, Discipline of Family Medicine, St. John's, Newfoundland
| | - Thomas Heeley
- Memorial University of Newfoundland, Discipline of Family Medicine, St. John's, Newfoundland
| | - Sarah Boyd
- Memorial University of Newfoundland, Discipline of Family Medicine, St. John's, Newfoundland
| | - Oliver Hurley
- Memorial University of Newfoundland, Discipline of Family Medicine, St. John's, Newfoundland
| | - Kris Aubrey-Bassler
- Memorial University of Newfoundland, Discipline of Family Medicine, St. John's, Newfoundland
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