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Johnston A, Wong A, Appo C, Eley R, Staib A. Modelling a two-stream emergency department segregation and admission system from COVID-19 early rapid antigen testing: A pilot study. Emerg Med Australas 2024; 36:283-287. [PMID: 38030404 DOI: 10.1111/1742-6723.14351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/01/2023] [Accepted: 11/06/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE Many factors influence patient flow through an ED, including streaming, treatment spaces and staff resources. This pilot study explored and compared real time patient flow using a single-stream system versus varying configurations of possible two-stream systems using computer simulation. METHODS Simulation modelling was used to assess the delay in treatment of a rapid-antigen-tested-based, two-stream model for patient flow through ED during the peak phase of the COVID pandemic. RESULTS Modelling two-stream configuration for all patients (minimum time to be seen for both COVID-positive and COVID-negative patients) showed that in the case study ED, a two-stream system and linked changes in bed configuration for managing the risks of infection can impact delays in treatment. CONCLUSIONS Data-driven modelling within specific clinical settings can inform the (in)efficiency of patient flow processes and help clinicians and managers make evidence-based decisions about patient transition through EDs. This can assist with reconfiguration of ED patient streaming particularly during periods of unique need, such as the recent COVID-19 pandemic.
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Affiliation(s)
- Amy Johnston
- Department of Emergency Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Andy Wong
- Department of Emergency Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- School of Mechanical, Medical and Process Engineering, Faculty of Engineering, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Casey Appo
- Department of Emergency Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Robert Eley
- Department of Emergency Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Andrew Staib
- Department of Emergency Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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2
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Berendsen Russell S, Seimon RV, Dixon E, Murphy M, Vukasovic M, Bohlken N, Taylor S, Cooper Z, Scruton J, Jain N, Dinh MM. Applying Sydney Triage to Admission Risk Tool (START) to improve patient flow in emergency departments: a multicentre randomised, implementation study. BMC Emerg Med 2024; 24:39. [PMID: 38454324 PMCID: PMC10921805 DOI: 10.1186/s12873-024-00956-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/26/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND To determine the effectiveness of applying the Sydney Triage to Admission Risk Tool (START) in conjunction with senior early assessment in different Emergency Departments (EDs). METHODS This multicentre implementation study, conducted in two metropolitan EDs, used a convenience sample of ED patients. Patients who were admitted, after presenting to both EDs, and were assessed using the existing senior ED clinician assessment, were included in the study. Patients in the intervention group were assessed with the assistance of START, while patients in the control group were assessed without the assistance of START. Outcomes measured were ED length of stay and proportion of patients correctly identified as an in-patient admission by START. RESULTS A total of 773 patients were evaluated using the START tool at triage across both sites (Intervention group n = 355 and control group n = 418 patients). The proportion of patients meeting the 4-hour length of stay thresholds was similar between the intervention and control groups (30.1% vs. 28.2%; p = 0.62). The intervention group was associated with a reduced ED length of stay when compared to the control group (351 min, interquartile range (IQR) 221.0-565.0 min versus 383 min, IQR 229.25-580.0 min; p = 0.85). When stratified into admitted and discharged patients, similar results were seen. CONCLUSION In this extension of the START model of care implementation study in two metropolitan EDs, START, when used in conjunction with senior early assessment was associated with some reduced ED length of stay.
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Affiliation(s)
- Saartje Berendsen Russell
- Emergency Department, RPA Green Light Institute, Royal Prince Alfred Hospital, Missenden Road, 2050, Camperdown, NSW, Australia.
| | - Radhika V Seimon
- Emergency Department, RPA Green Light Institute, Royal Prince Alfred Hospital, Missenden Road, 2050, Camperdown, NSW, Australia
| | - Emma Dixon
- Emergency Department, Westmead Hospital, Westmead, NSW, Australia
| | - Margaret Murphy
- Emergency Department, Westmead Hospital, Westmead, NSW, Australia
| | | | - Nicole Bohlken
- Emergency Department, Westmead Hospital, Westmead, NSW, Australia
| | - Sharon Taylor
- Emergency Department, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Zoe Cooper
- Emergency Department, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Jennifer Scruton
- Emergency Department, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Nitin Jain
- Emergency Department, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Michael M Dinh
- Emergency Department, RPA Green Light Institute, Royal Prince Alfred Hospital, Missenden Road, 2050, Camperdown, NSW, Australia
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Pearce S, Marr E, Shannon T, Marchand T, Lang E. Overcrowding in emergency departments: an overview of reviews describing global solutions and their outcomes. Intern Emerg Med 2024; 19:483-491. [PMID: 38041766 DOI: 10.1007/s11739-023-03477-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 10/30/2023] [Indexed: 12/03/2023]
Abstract
Emergency Department (ED) crowding is defined as a situation wherein the demands of emergency services overcome the ability of a department to provide high-quality care within an appropriate time frame. There is a need for solutions, as the harms of crowding impact patients, staff, and healthcare spending. An overview of ED crowding was previously published by our group, which outlines these global issues. The problem of overcrowding in emergency departments has emerged as a global public health concern, and several healthcare agencies have addressed the issue and proposed possible solutions at each level of emergency care. There is no current literature summarizing the extensive research on interventions and solutions, thus there is a need for data synthesis to inform policymakers in this field. The aim of this overview was to summarize the interventions at each level of emergency care: input, throughput, and output. The methodology was supported by the current PRIOR statement for an overview of reviews. The study summarized twenty-seven full-text systematic reviews, which encompassed three hundred and eight primary studies. The results of the summary displayed a requirement for increasing studies in input and output interventions, as these showed the best outcomes with regard to ED crowding metrics. Moreover, the results displayed heterogeneous results at each level of ED care; these reflected that generally solutions have not been matched to specific problems facing regional centres. Thus, individual factors need to be considered when implementing solutions in Emergency Departments.
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Affiliation(s)
- Sabrina Pearce
- University of Calgary, Cumming School of Medicine, Calgary, Canada.
- Alberta Health Services, Calgary, Canada.
| | - Erica Marr
- University of Calgary, Cumming School of Medicine, Calgary, Canada
- Alberta Health Services, Calgary, Canada
| | - Tara Shannon
- University of Calgary, Cumming School of Medicine, Calgary, Canada
- Alberta Health Services, Calgary, Canada
| | - Tyara Marchand
- University of Calgary, Cumming School of Medicine, Calgary, Canada
- Alberta Health Services, Calgary, Canada
| | - Eddy Lang
- University of Calgary, Cumming School of Medicine, Calgary, Canada
- Alberta Health Services, Calgary, Canada
- Department of Emergency Medicine, University of Calgary, Calgary, Canada
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Kilpatrick K, Tchouaket E, Savard I, Chouinard MC, Bouabdillah N, Provost-Bazinet B, Costanzo G, Houle J, St-Louis G, Jabbour M, Atallah R. Identifying indicators sensitive to primary healthcare nurse practitioner practice: A review of systematic reviews. PLoS One 2023; 18:e0290977. [PMID: 37676878 PMCID: PMC10484467 DOI: 10.1371/journal.pone.0290977] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/20/2023] [Indexed: 09/09/2023] Open
Abstract
AIM To identify indicators sensitive to the practice of primary healthcare nurse practitioners (PHCNPs). MATERIALS AND METHODS A review of systematic reviews was undertaken to identify indicators sensitive to PHCNP practice. Published and grey literature was searched from January 1, 2010 to December 2, 2022. Titles/abstracts (n = 4251) and full texts (n = 365) were screened independently by two reviewers, with a third acting as a tie-breaker. Reference lists of relevant publications were reviewed. Risk of bias was examined independently by two reviewers using AMSTAR-2. Data were extracted by one reviewer and verified by a second reviewer to describe study characteristics, indicators, and results. Indicators were recoded into categories. Findings were summarized using narrative synthesis. RESULTS Forty-four systematic reviews were retained including 271 indicators that were recoded into 26 indicator categories at the patient, provider and health system levels. Nineteen reviews were assessed to be at low risk of bias. Patient indicator categories included activities of daily living, adaptation to health conditions, clinical conditions, diagnosis, education-patient, mortality, patient adherence, quality of life, satisfaction, and signs and symptoms. Provider indicator categories included adherence to best practice-providers, education-providers, illness prevention, interprofessional team functioning, and prescribing. Health system indicator categories included access to care, consultations, costs, emergency room visits, healthcare service delivery, hospitalizations, length of stay, patient safety, quality of care, scope of practice, and wait times. DISCUSSION Equal to improved care for almost all indicators was found consistently for the PHCNP group. Very few indicators favoured the control group. No indicator was identified for high/low fidelity simulation, cultural safety and cultural sensitivity with people in vulnerable situations or Indigenous Peoples. CONCLUSION This review of systematic reviews identified patient, provider and health system indicators sensitive to PHCNP practice. The findings help clarify how PHCNPs contribute to care outcomes. PROSPERO REGISTRATION NUMBER CRD42020198182.
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Affiliation(s)
- Kelley Kilpatrick
- Susan E. French Chair in Nursing Research and Innovative Practice, Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de l’Est-de-l’Île-de-Montréal (CIUSSS-EMTL), Maisonneuve-Rosemont Hospital Site, Montréal, Québec, Canada
| | - Eric Tchouaket
- Department of Nursing, Université du Québec en Outaouais (UQO), St-Jérôme Campus, Saint-Jérôme, Québec, Canada
| | - Isabelle Savard
- Department of Nursing, Université du Québec en Outaouais (UQO), St-Jérôme Campus, Saint-Jérôme, Québec, Canada
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
| | - Maud-Christine Chouinard
- Faculté des Sciences Infirmières, Université de Montréal, Montréal, Québec, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l’Île-de-Montréal (CIUSSS-NIM), Montréal, Québec, Canada
| | - Naima Bouabdillah
- Department of Nursing, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | | | - Gina Costanzo
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
| | - Julie Houle
- Department of Nursing, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS-MCQ), Trois-Rivières, Québec, Canada
| | - Geneviève St-Louis
- Support and Development of Professional Practices in Nursing and Assistance Care and Infection Prevention Associate Directorate, Centre Intégré Universitaire de Santé et de Services Sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS-MCQ), Trois-Rivières, Québec, Canada
| | - Mira Jabbour
- Centre Intégré Universitaire de Santé et de Services Sociaux de l’Est-de-l’Île-de-Montréal (CIUSSS-EMTL), Maisonneuve-Rosemont Hospital Site, Montréal, Québec, Canada
| | - Renée Atallah
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
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Shaw V, Yu A, Parsons M, Olsen T, Walker C. Acute assessment services for patient flow assistance in hospital emergency departments. Cochrane Database Syst Rev 2023; 7:CD014553. [PMID: 37439227 PMCID: PMC10334694 DOI: 10.1002/14651858.cd014553.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
BACKGROUND Emergency departments (EDs) are facing serious and significant issues in the delivery of effective and efficient care to patients. Acute assessment services have been implemented at many hospitals internationally to assist in maintaining patient flow for identified groups of patients attending the ED. Identifying the risks and benefits, and optimal configurations of these services may be beneficial to those wishing to utilise an acute assessment service to improve patient flow. OBJECTIVES To assess the effects of acute assessment services on patient flow following attendance at a hospital ED. SEARCH METHODS We searched MEDLINE, CENTRAL, Embase and two trials registers on 24 September 2022 to identify studies. No restrictions were imposed on publication year, publication type, or publication language. SELECTION CRITERIA Studies eligible for inclusion were randomised trials and cluster-randomised trials with at least two intervention and two control sites. Participants were adults (as defined by study authors) receiving care either in the ED or the acute assessment service, where both were based in the hospital setting. The comparison was hospital-based acute assessment services with usual, ED-only care. The outcomes of this review were mortality at time point closest to 30 days, length of stay in the service (in minutes), and waiting time to see a doctor (in minutes). DATA COLLECTION AND ANALYSIS We followed the standard procedures of Cochrane Effective Practice and Organisation of Care for this review (https://epoc.cochrane.org/resources). MAIN RESULTS We identified a total of 5754 records in the search. Following assessment of 3609 de-duplicated records, none were found to be eligible for inclusion in this review. AUTHORS' CONCLUSIONS At present there are no randomised controlled trials exploring the effects of acute assessment services on patient flow in hospital-based emergency departments compared to usual, ED-only care.
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Affiliation(s)
- Victoria Shaw
- Department of Nursing, Toi Ohomai Institute of Technology, Rotorua, New Zealand
| | - An Yu
- Infrastructure and investment, Te Whatu Ora, Wellington, New Zealand
| | - Matthew Parsons
- Faculty of Health, The University of Waikato, Hamilton, New Zealand
| | - Tava Olsen
- Melbourne Business School, The University of Melbourne, Melbourne, Australia
| | - Cameron Walker
- Engineering Science, The University of Auckland, Auckland, New Zealand
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Cildoz M, Ibarra A, Mallor F. Acuity-based rotational patient-to-physician assignment in an emergency department using electronic health records in triage. Health Informatics J 2023; 29:14604582231167430. [PMID: 37068379 DOI: 10.1177/14604582231167430] [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: 04/19/2023]
Abstract
Emergency department (ED) operational metrics generated by a new acuity-based rotational patient-to-physician assignment (ARPA) algorithm are compared with those obtained with a simple rotational patient assignment (SRPA) system aimed only at an equitable patient distribution. The new ARPA method theoretically guarantees that no two physicians' assigned patient loads can differ by more than one, either partially (by acuity levels) or in total; whereas SRPA guarantees only the latter. The performance of the ARPA method was assessed in practice in the ED of the main public hospital (Hospital Compound of Navarra) in the region of Navarre in Spain. This ED attends over 140 000 patients every year. Data analysis was conducted on 9,063 ED patients in the SRPA cohort, and 8,892 ED patients in the ARPA cohort. The metrics of interest are related both to patient access to healthcare and physician workload distribution: patient length of stay; arrival-to-provider time; ratio of patients exceeding the APT target threshold; and range of assigned patients across physicians by priority levels. The transition from SRPA to ARPA is associated with improvements in all ED operational metrics. This research demonstrates that ARPA is a simple and useful strategy for redesigning front-end ED processes.
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Affiliation(s)
- Marta Cildoz
- Institute of Smart Cities, Public University of Navarre, Pamplona, Spain
| | | | - Fermin Mallor
- Institute of Smart Cities, Public University of Navarre, Pamplona, Spain
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Dinh MM, Bein KJ, Alkhouri H, Ní Bhraonáin S, Seimon RV. 24 hours - Life in the E.R.: A state-wide data linkage analysis of in-patients with prolonged emergency department length of stay in New South Wales, Australia. Emerg Med Australas 2023. [PMID: 36854419 DOI: 10.1111/1742-6723.14183] [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: 10/29/2022] [Revised: 12/22/2022] [Accepted: 01/29/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVE Describe the characteristics and predictors of mortality for patients who spend more than 24 h in the ED waiting for an in-patient bed and compare baseline clinical and demographic characteristics between tertiary and non-tertiary hospitals. METHODS This was a state-wide analysis data linkage analysis of adult (age >16 years) ED presentations across New South Wales from 2019 to 2020. Cases were included if their mode of separation from ED indicated admission to an in-patient unit including critical care ward and their ED length of stay was greater than or equal to 24 h. Cases were categorised by service-related groups based on principle diagnosis. RESULTS A total of 26 854 eligible cases were identified. The most common diagnosis groups were psychiatry, cardiology and respiratory. The odds ratio (OR) for 30-day all-cause mortality in admitted patients with an ED length of stay greater than 24 h were highest in those aged >75 years (OR 15.18, 95% confidence interval [CI] 9.99-23.07, P < 0.001), oncology (OR 10.45, 95% CI 7.93-13.77, P < 0.001) and haematology patients (OR 2.95, 95% CI 2.01-4.33, P < 0.001). CONCLUSION Interventions and models of care to address ED access block need to focus on mental health patients, older patients particularly those with cardiorespiratory illness and oncology and haematology patients for whom risk of mortality is disproportionately higher.
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Affiliation(s)
- Michael M Dinh
- Sydney Local Health District, RPA Green Light Institute for Emergency Care, Sydney, New South Wales, Australia
- Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Kendall J Bein
- Sydney Local Health District, RPA Green Light Institute for Emergency Care, Sydney, New South Wales, Australia
- Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Hatem Alkhouri
- Emergency Care Institute, Agency for Clinical Innovation, Sydney, New South Wales, Australia
- Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Sinéad Ní Bhraonáin
- Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Radhika V Seimon
- Sydney Local Health District, RPA Green Light Institute for Emergency Care, Sydney, New South Wales, Australia
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8
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Plint AC, Newton AS, Stang A, Cantor Z, Hayawi L, Barrowman N, Boutis K, Gouin S, Doan Q, Dixon A, Porter R, Joubert G, Sawyer S, Crawford T, Gravel J, Bhatt M, Weldon P, Millar K, Tse S, Neto G, Grewal S, Chan M, Chan K, Yung G, Kilgar J, Lynch T, Aglipay M, Dalgleish D, Farion K, Klassen TP, Johnson DW, Calder LA. How safe are paediatric emergency departments? A national prospective cohort study. BMJ Qual Saf 2022; 31:806-817. [PMID: 35853646 PMCID: PMC9606537 DOI: 10.1136/bmjqs-2021-014608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 06/02/2022] [Indexed: 12/21/2022]
Abstract
BACKGROUND Despite the high number of children treated in emergency departments, patient safety risks in this setting are not well quantified. Our objective was to estimate the risk and type of adverse events, as well as their preventability and severity, for children treated in a paediatric emergency department. METHODS Our prospective, multicentre cohort study enrolled children presenting for care during one of 168 8-hour study shifts across nine paediatric emergency departments. Our primary outcome was an adverse event within 21 days of enrolment which was related to care provided at the enrolment visit. We identified 'flagged outcomes' (such as hospital visits, worsening symptoms) through structured telephone interviews with patients and families over the 21 days following enrolment. We screened admitted patients' health records with a validated trigger tool. For patients with flags or triggers, three reviewers independently determined whether an adverse event occurred. RESULTS We enrolled 6376 children; 6015 (94%) had follow-up data. Enrolled children had a median age of 4.3 years (IQR 1.6-9.8 years). One hundred and seventy-nine children (3.0%, 95% CI 2.6% to 3.5%) had at least one adverse event. There were 187 adverse events in total; 143 (76.5%, 95% CI 68.9% to 82.7%) were deemed preventable. Management (n=98, 52.4%) and diagnostic issues (n=36, 19.3%) were the most common types of adverse events. Seventy-nine (42.2%) events resulted in a return emergency department visit; 24 (12.8%) resulted in hospital admission; and 3 (1.6%) resulted in transfer to a critical care unit. CONCLUSION In this large-scale study, 1 in 33 children treated in a paediatric emergency department experienced an adverse event related to the care they received there. The majority of events were preventable; most were related to management and diagnostic issues. Specific patient populations were at higher risk of adverse events. We identify opportunities for improvement in care.
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Affiliation(s)
- Amy C Plint
- Pediatric Emergency, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Amanda S Newton
- Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Antonia Stang
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Zach Cantor
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Lamia Hayawi
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Nick Barrowman
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Kathy Boutis
- Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Pediatrics and Child Health Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Serge Gouin
- Pediatric Emergency Department, CHU Sainte-Justine, Montreal, Québec, Canada
- Pediatrics, Université de Montreal, Montreal, Québec, Canada
| | - Quynh Doan
- Evidence to Innovations, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Dixon
- Stollery Children's Hospital, Edmonton, Alberta, Canada
- Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Robert Porter
- Janeway Children's Health and Rehabilitation Centre, St John's, Newfoundland and Labrador, Canada
- Pediatrics, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Gary Joubert
- Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
- Pediatrics, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Scott Sawyer
- Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
- Pediatric Emergency, Health Sciences Centre Winnipeg Children's Hospital, Winnipeg, Manitoba, Canada
| | - Tyrus Crawford
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Jocelyn Gravel
- Pediatric Emergency Department, CHU Sainte-Justine, Montreal, Québec, Canada
- Pediatrics, Université de Montreal, Montreal, Québec, Canada
| | - Maala Bhatt
- Pediatric Emergency, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Patrick Weldon
- Pediatric Emergency, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Kelly Millar
- Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Sandy Tse
- Pediatric Emergency, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Gina Neto
- Pediatric Emergency, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Simran Grewal
- Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
- Emergency Medicine, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Melissa Chan
- Emergency Medicine, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Kevin Chan
- Janeway Children's Health and Rehabilitation Centre, St John's, Newfoundland and Labrador, Canada
- Pediatrics, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Grant Yung
- Pediatric Emergency, Health Sciences Centre Winnipeg Children's Hospital, Winnipeg, Manitoba, Canada
| | - Jennifer Kilgar
- Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
- Pediatrics, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Tim Lynch
- Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
- Pediatrics, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Mary Aglipay
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Dale Dalgleish
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Ken Farion
- Pediatric Emergency, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Terry P Klassen
- Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
- Pediatrics and Child Health, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - David W Johnson
- Paediatrics, Alberta Health Services, Edmonton, Alberta, Canada
| | - Lisa A Calder
- Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Liao PH, Chu W, Ho CS. An Analysis of Waiting Time for Emergency Treatment and Optimal Allocation of Nursing Manpower. Healthcare (Basel) 2022; 10:healthcare10050820. [PMID: 35627957 PMCID: PMC9140927 DOI: 10.3390/healthcare10050820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/26/2022] [Accepted: 04/26/2022] [Indexed: 02/04/2023] Open
Abstract
Objective: Emergency care is the frontline of the healthcare system. Taiwanese typically seek emergency care when suffering from an acute or unknown illness, which leads to a large number of emergency patients and the related misallocation of nursing manpower, and the excessive workloads of emergency service providers have become serious issues for Taiwan’s medical institutions. Participants: This study conducted purposive sampling and recruited patients and nursing staffs from the emergency room of a medical center in New Taipei City as the research participants. Methods: This study applied the queueing theory and the derived optimal model to solve the problems of excessive workloads for emergency service providers and misallocation of nursing manpower, in an attempt to provide decision makers with more flexible resource allocation and process improvement suggestions. Results: This study analyzed the causes of emergency service overload and identified solutions for improving nursing manpower utilization. Conclusions: A wait-time model and the queueing theory were used to determine resource parameters for the optimal allocation of patient waiting times and to develop the best model for estimating nursing manpower.
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Affiliation(s)
- Pei-Hung Liao
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112, Taiwan; (P.-H.L.); (W.C.)
| | - William Chu
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112, Taiwan; (P.-H.L.); (W.C.)
- Department of Orthopedics, Cheng Hsin General Hospital, Taipei 112, Taiwan
| | - Chen-Shie Ho
- Department of Healthcare Administration, Asia Eastern University of Science and Technology, Taipei 112, Taiwan
- Correspondence: ; Tel.: +886-2-2822-7101 (ext. 3185)
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Rochat J, Ehrler F, Siebert JN, Ricci A, Garretas Ruiz V, Lovis C. Usability Testing of a Patient-Centered Mobile Health App for Supporting and Guiding the Pediatric Emergency Department Patient Journey: Mixed Methods Study. JMIR Pediatr Parent 2022; 5:e25540. [PMID: 35289754 PMCID: PMC8965675 DOI: 10.2196/25540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/18/2021] [Accepted: 12/21/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Patient experience in emergency departments (EDs) remains often suboptimal and can be a source of stress, particularly in pediatric settings. In an attempt to support patients and their families before, during, and after their visit to a pediatric ED, a mobile health (mHealth) app was developed by a multidisciplinary team based on patient-centered care principles. OBJECTIVE This study aims to evaluate the usability (effectiveness, efficiency, and satisfaction) of a new mHealth app, InfoKids, by potential end users through usability testing. METHODS The app was assessed through an in-laboratory, video-recorded evaluation in which participants had to execute 9 goal-oriented tasks, ranging from account creation to the reception of a diagnostic sheet at the end of the emergency care episode. Effectiveness was measured based on the task completion rate, efficiency on time on task, and user satisfaction according to answers to the System Usability Scale questionnaire. Think-aloud usability sessions were also transcribed and analyzed. Usability problems were rated for their severity and categorized according to ergonomic criteria. RESULTS A total of 17 parents participated in the study. The overall completion rate was 97.4% (149/153). Overall, they reported good effectiveness, with the task successfully completed in 88.2% (135/153) of cases (95% CI 83%-93%). Each task, with the exception of the first, created difficulties for some participants but did not prevent their completion by most participants. Users reported an overall good to excellent perceived usability of the app. However, ergonomic evaluation identified 14 usability problems occurring 81 time. Among these, 50% (7/14) were serious as their severity was rated as either major or catastrophic and indicated areas of improvements for the app. Following the suggested usability improvements by participants, mitigation measures were listed to further improve the app and avoid barriers to its adoption. CONCLUSIONS Usability of the InfoKids app was evaluated as good to excellent by users. Areas of improvement were identified, and mitigation measures were proposed to inform its development toward a universal app for all ED patients visiting a digitalized institution. Its contribution could also be useful in paving the way for further research on mobile apps aimed at supporting and accompanying patients in their care episodes, as research in this area is scarce.
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Affiliation(s)
- Jessica Rochat
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Medical Information Sciences, University Hospitals of Geneva, Geneva, Switzerland
| | - Frédéric Ehrler
- Division of Medical Information Sciences, University Hospitals of Geneva, Geneva, Switzerland
| | - Johan N Siebert
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Arnaud Ricci
- Division of Medical Information Sciences, University Hospitals of Geneva, Geneva, Switzerland
| | - Victor Garretas Ruiz
- Division of Medical Information Sciences, University Hospitals of Geneva, Geneva, Switzerland
| | - Christian Lovis
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Medical Information Sciences, University Hospitals of Geneva, Geneva, Switzerland
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11
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Cleak H, Osborne SR, de Looze JWM. Exploration of clinicians’ decision-making regarding transfer of patient care from the emergency department to a medical assessment unit: A qualitative study. PLoS One 2022; 17:e0263235. [PMID: 35113942 PMCID: PMC8812931 DOI: 10.1371/journal.pone.0263235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 01/16/2022] [Indexed: 11/18/2022] Open
Abstract
Background Hospitals face immense pressures in balancing patient throughput. Medical assessment units have emerged as a commonplace response to improve the flow of medical patients presenting to the emergency department requiring hospital admission and to ease overcrowding in the emergency department. The aim of this study was to understand factors influencing the decision-making behaviour of key stakeholders involved in the transfer of care of medical patients from one service to the other in a large, tertiary teaching hospital in Queensland, Australia. Methods We used a qualitative approach drawing on data from focus groups with key informant health and professional staff involved in the transfer of care. A theoretically-informed, semi-structured focus group guide was used to facilitate discussion and explore factors impacting on decisions made to transfer care of patients from the emergency department to the medical assessment unit. Thematic analysis was undertaken to look for patterns in the data. Results Two focus groups were conducted with a total of 15 participants. Four main themes were identified: (1) we have a process—we just don’t use it; (2) I can do it, but can they; (3) if only we could skype them; and (4) why can’t they just go up. Patient flow relies on efficiency in two processes—the transfer of care and the physical re-location of the patient from one service to the other. The findings suggest that factors other than clinical reasoning are at play in influencing decision-making behaviour. Conclusions Acknowledgement of the interaction within and between professional and health staff (human factors) with the organisational imperatives, policies, and process (system factors) may be critical to improve efficiencies in the service and minimise the introduction of workarounds that might compromise patient safety.
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Affiliation(s)
- Helen Cleak
- School of Allied Health, Human Service and Sport, College of Science, Health & Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Sonya R. Osborne
- School of Nursing and Midwifery, Faculty of Health, Engineering and Sciences, Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Ipswich, Queensland, Australia
- * E-mail:
| | - Julian W. M. de Looze
- Department of Internal Medicine and Aged Care, Royal Brisbane and Women’s Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia
- School of Medicine, The University of Queensland, St. Lucia, Queensland, Australia
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12
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Patient Throughput Initiatives in Ambulatory Care Organizations during the COVID-19 Pandemic: A Systematic Review. Healthcare (Basel) 2021; 9:healthcare9111474. [PMID: 34828520 PMCID: PMC8624418 DOI: 10.3390/healthcare9111474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/20/2021] [Accepted: 10/27/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Ambulatory (outpatient) health care organizations continue to respond to the COVID-19 global pandemic using an array of initiatives to provide a continuity of care for both COVID-19 and non-COVID-19 patients. The purpose of this study is to systematically identify the facilitators and barriers experienced by outpatient health care organizations in an effort to maintain effective and efficient patient throughput during the pandemic. MATERIALS AND METHODS This study systematically reviewed articles focused on initiatives taken by ambulatory care organizations to maintain optimal outpatient throughput levels while balancing pandemic precautions, published during 2020. RESULTS Among the 30 articles that met the inclusion criteria, three initiatives healthcare organizations have taken to maintain throughput were identified: the use (and enhanced use) of telehealth, protocol development, and health care provider training. The research team also identified three barriers to patient throughput: lack of telehealth, lack of resources, and overall lack of knowledge. CONCLUSIONS To maintain patient throughput during the COVID-19 pandemic, healthcare organizations need to develop strategies such as the use of virtual consultation and follow-up, new guidelines to move patients along the care delivery value-chain, and ongoing training of providers. Additionally, the availability of required technology for telehealth, availability of resources, and adequate knowledge are vital for continuous patient throughput to ensure continuity of care during a pandemic.
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13
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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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14
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Development and Validation of Machine Learning Models to Predict Admission From Emergency Department to Inpatient and Intensive Care Units. Ann Emerg Med 2021; 78:290-302. [PMID: 33972128 DOI: 10.1016/j.annemergmed.2021.02.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 02/10/2021] [Accepted: 02/25/2021] [Indexed: 12/23/2022]
Abstract
STUDY OBJECTIVE This study aimed to develop and validate 2 machine learning models that use historical and current-visit patient data from electronic health records to predict the probability of patient admission to either an inpatient unit or ICU at each hour (up to 24 hours) of an emergency department (ED) encounter. The secondary goal was to provide a framework for the operational implementation of these machine learning models. METHODS Data were curated from 468,167 adult patient encounters in 3 EDs (1 academic and 2 community-based EDs) of a large academic health system from August 1, 2015, to October 31, 2018. The models were validated using encounter data from January 1, 2019, to December 31, 2019. An operational user dashboard was developed, and the models were run on real-time encounter data. RESULTS For the intermediate admission model, the area under the receiver operating characteristic curve was 0.873 and the area under the precision-recall curve was 0.636. For the ICU admission model, the area under the receiver operating characteristic curve was 0.951 and the area under the precision-recall curve was 0.461. The models had similar performance in both the academic- and community-based settings as well as across the 2019 and real-time encounter data. CONCLUSION Machine learning models were developed to accurately make predictions regarding the probability of inpatient or ICU admission throughout the entire duration of a patient's encounter in ED and not just at the time of triage. These models remained accurate for a patient cohort beyond the time period of the initial training data and were integrated to run on live electronic health record data, with similar performance.
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15
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Shaw VM, Yu A, Parsons M, Olsen T, Walker C. Acute assessment services for patient flow assistance in hospital emergency departments. Hippokratia 2021. [DOI: 10.1002/14651858.cd014553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Victoria M Shaw
- School of Nursing; The University of Auckland; Auckland New Zealand
| | - An Yu
- School of Nursing; The University of Auckland; Auckland New Zealand
| | - Matthew Parsons
- Faculty of Health; The University of Waikato; Hamilton New Zealand
| | - Tava Olsen
- Information Systems and Operations Management; The University of Auckland; Auckland New Zealand
| | - Cameron Walker
- Engineering Science; The University of Auckland; Auckland New Zealand
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16
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Boman E, Duvaland E, Gaarde K, Leary A, Rauhala A, Fagerström L. Implementation of advanced practice nursing for minor orthopedic injuries in the emergency care context: A non-inferiority study. Int J Nurs Stud 2021; 118:103910. [PMID: 33773309 DOI: 10.1016/j.ijnurstu.2021.103910] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 02/03/2021] [Accepted: 02/18/2021] [Indexed: 10/22/2022]
Abstract
AIMS To evaluate the implementation of advanced practice nursing for patients with minor orthopedic injuries, including comparison of outcomes in relation to advanced practice nurse versus standard (physician-led) care models. DESIGN A non-inferiority study was performed in an emergency department in Norway, where advanced practice nursing is in an initial stage of implementation. The non-inferiority design was chosen to test whether the new advanced practice nursing model does not compromise quality of care compared to the standard care model already in use. METHODS Patients with minor orthopedic injuries were assessed and treated by either advanced practice nursing or standard (physician-led) care models. Participating patients were assigned to the professional available at presentation. In the nursing model, registered nurses worked at an advanced level/applied advanced practice nursing following in-house-training. Senior orthopedic specialists evaluated the diagnostic and treatment accuracy in both models. Data were collected in a tool developed for this study, from May to October 2019. RESULTS In total, 335 cases were included, of which 167 (49.9%) were assessed and treated in the nursing model. Overall, correct diagnosis was found in 97.3% (n = 326) of the cases, and correct treatment was found in 91.3% (n = 306) of the cases. In comparison of missed diagnosis between advanced practice nurse and the standard (physician-led) care model showed inconclusive results (risk ratio: 0.29, 95% CI: 0.06-1.36). In comparison of treatment outcomes, the results showed that the advanced practice nursing model was non-inferior (risk ratio: 0.45, 95% CI: 0.21-0.97). CONCLUSION Advanced practice nursing care models can be used to diagnose and treat minor orthopedic injuries without compromising quality of care. Further implementation of the advanced practice nurse care model is encouraged.
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Affiliation(s)
- Erika Boman
- Department of Nursing and Health Sciences, University of South-Eastern, Norway, Drammen, Norway; Department of Nursing, Åland University of Applied Sciences, Mariehamn, Finland.
| | | | - Kim Gaarde
- Drammen Hospital, Vestre Viken HF, Drammen, Norway
| | - Alison Leary
- Department of Nursing and Health Sciences, University of South-Eastern, Norway, Drammen, Norway; School of Health and Social Care, London South Bank University, London, United Kingdom
| | - Auvo Rauhala
- Faculty of Education and Welfare Studies, Åbo Akademi University, Vaasa, Finland; Vaasa Central Hospital, Vaasa, Finland
| | - Lisbeth Fagerström
- Department of Nursing and Health Sciences, University of South-Eastern, Norway, Drammen, Norway; Faculty of Education and Welfare Studies, Åbo Akademi University, Vaasa, Finland
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17
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Lessons Learned From an Analysis of the Emergency Medical Services' COVID-19 Drive-Through Testing Facilities in Israel. Disaster Med Public Health Prep 2021; 16:2091-2096. [PMID: 33588964 PMCID: PMC8129685 DOI: 10.1017/dmp.2021.50] [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] [Indexed: 01/15/2023]
Abstract
One strategy for the containment of a pandemic is mass testing. Magen David Adom (MDA), the Israeli National Emergency Medical Services (EMS) Organization undertook this mission by operating a nationwide series of drive-through testing complexes. The objective of this study is to learn lessons from an analysis of these centers. Data from 198 stationary and mobile drive-through complexes from March 20, 2020, through October 17, 2020, were analyzed for temporal and geographic factors, and cost. Also, an operational improvement program was implemented and analyzed. A total of 931,074 patients were sampled in the MDA drive-through system: 46.9% in stationary complexes, and 53.1% in mobile complexes. The optimized cost per patient of home testing was estimated at 74.5 USD compared with 6.55 USD in the drive-through centers. An operational improvement program lowered the total sampling time from 128 s/patient to 98 s and decreased the total cost per patient from 6.55 USD to 6.27 USD. The EMS led drive-through complexes were cost-effective and efficient in performing large numbers of viral tests, especially when compared with home testing. Established concepts in clinical operations should be implemented to increase the number of persons that can be tested and decrease cost.
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18
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Abdu B, Akolkar S, Picking C, Boura J, Piper M. Factors Associated with Delayed Paracentesis in Patients with Spontaneous Bacterial Peritonitis. Dig Dis Sci 2021; 66:4035-4045. [PMID: 33274417 PMCID: PMC8510927 DOI: 10.1007/s10620-020-06750-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 11/25/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM In patients with spontaneous bacterial peritonitis (SBP), studies show that delayed paracentesis (DP) is associated with worse outcomes and mortality. We aimed to assess the rate of DP in the community setting and associated factors with early versus delayed paracentesis. METHODS Patients hospitalized with SBP were retrospectively studied between 12/2013 and 12/2018. DP was defined as paracentesis performed > 12 h from initial encounter. Data collected included: patient factors (i.e., age, race, symptoms, history of SBP, MELD) and physician factors (i.e., admission service, shift times, providers ordering and performing paracentesis). Logistic regression analysis was performed to assess for factors associated with DP. RESULTS DP occurred 82% of the time (n = 97). The most significant factors in predicting timing of paracentesis were ordering physician [emergency department (ED) physician was associated with early paracentesis (57% vs 8%, p < 0.001) and specialty of physician performing paracentesis (interventional radiology was associated with DP (88% vs 48%, p < 0.001)]. Younger patients were more likely to receive early paracentesis. In regression analysis, the factor most associated with early paracentesis was when the order was made by the ED provider (OR 0.07, 95% CI 0.02-0.22). No differences were observed in patients with prior history of SBP, abdominal pain, encephalopathy, or creatinine level. CONCLUSIONS Studies have suggested that DP is associated with increased mortality in patients with SBP. Despite this, DP is common in the community setting and is influenced by ordering physician and specialty of physician performing paracentesis. Future efforts should assess interventions to improve this important quality indicator.
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Affiliation(s)
- Backer Abdu
- Department of Gastroenterology and Internal Medicine, Providence-Providence Park Hospital, Michigan State University College of Human Medicine, 16001 W Nine Mile Rd, Southfield, MI 48075 USA
| | - Shalaka Akolkar
- Department of Gastroenterology and Internal Medicine, Providence-Providence Park Hospital, Michigan State University College of Human Medicine, 16001 W Nine Mile Rd, Southfield, MI 48075 USA
| | - Christopher Picking
- Department of Gastroenterology and Internal Medicine, Providence-Providence Park Hospital, Michigan State University College of Human Medicine, 16001 W Nine Mile Rd, Southfield, MI 48075 USA
| | - Judith Boura
- Department of Gastroenterology and Internal Medicine, Providence-Providence Park Hospital, Michigan State University College of Human Medicine, 16001 W Nine Mile Rd, Southfield, MI 48075 USA
| | - Marc Piper
- Department of Gastroenterology and Internal Medicine, Providence-Providence Park Hospital, Michigan State University College of Human Medicine, 16001 W Nine Mile Rd, Southfield, MI 48075 USA
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19
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Delayed flow is a risk to patient safety: A mixed method analysis of emergency department patient flow. Int Emerg Nurs 2020; 54:100956. [PMID: 33360361 DOI: 10.1016/j.ienj.2020.100956] [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: 12/06/2019] [Revised: 10/10/2020] [Accepted: 11/25/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Increasing emergency department (ED) demand and crowding has heightened focus on the need for better understanding of patient flow. AIM This study aimed to identify input, throughput and output factors contributing to ED patient flow bottlenecks and extended ED length of stay (EDLOS). METHOD Concurrent nested mixed method study based on retrospective analysis of attendance data, patient flow observational data and a focus group in an Australian regional ED. RESULTS Analysis of 89 013 ED presentations identified increased EDLOS, particularly for patients requiring admission. Mapping of 382 patient journeys identified delays in time to triage assessment (0-39 mins) and extended waiting room stays (0-348 mins). High proportions of patients received care outside ED cubicles. Four qualitative themes emerged: coping under pressure, compromising care and safety, makeshift spaces, and makeshift roles. CONCLUSION Three key findings emerged: i) hidden waits such as extended triage-queuing occur during the input phase; ii) makeshift spaces are frequently used to assess and treat patients during times of crowding; and iii) access block has an adverse effect on output flow. Data suggests arrival numbers may not be a key predictor of EDLOS. This research contributes to our understanding of ED crowding and patient flow, informing service delivery and planning.
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20
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Oberlin M, Andrès E, Behr M, Kepka S, Le Borgne P, Bilbault P. [Emergency overcrowding and hospital organization: Causes and solutions]. Rev Med Interne 2020; 41:693-699. [PMID: 32861534 DOI: 10.1016/j.revmed.2020.05.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 04/14/2020] [Accepted: 05/05/2020] [Indexed: 10/23/2022]
Abstract
Emergency Department (ED) overcrowding is a silent killer. Thus, several studies in different countries have described an increase in mortality, a decrease in the quality of care and prolonged hospital stays associated with ED overcrowding. Causes are multiple: input and in particular lack of access to lab test and imaging for general practitioners, throughput and unnecessary or time-consuming tasks, and output, in particular the availability of hospital beds for unscheduled patients. The main cause of overcrowding is waiting time for available beds in hospital wards, also known as boarding. Solutions to resolve the boarding problem are mostly organisational and require the cooperation of all department and administrative levels through efficient bed management. Elderly and polypathological patients wait longer time in ED. Internal Medicine, is the ideal specialty for these complex patients who require time for observation and evaluation. A strong partnership between the ED and the internal medicine department could help to reduce ED overcrowding by improving care pathways.
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Affiliation(s)
- M Oberlin
- Structure d'urgences, Hôpitaux Universitaires de Strasbourg, 1 place de l'hôpital, 67000 Strasbourg, France.
| | - E Andrès
- Service de Médecine Interne, Diabète et Maladies métaboliques, Hôpitaux Universitaires de Strasbourg, Clinique Médicale B - HUS, 1 porte de l'Hôpital, 67000 Strasbourg, France; Unité INSERM EA 3072 « Mitochondrie, Stress oxydant et Protection musculaire », Faculté de Médecine - Université de Strasbourg, 4 rue Kirschleger, 67085 Strasbourg, France
| | - M Behr
- Structure d'urgences, Hôpitaux Universitaires de Strasbourg, 1 place de l'hôpital, 67000 Strasbourg, France
| | - S Kepka
- Structure d'urgences, Hôpitaux Universitaires de Strasbourg, 1 place de l'hôpital, 67000 Strasbourg, France
| | - P Le Borgne
- Structure d'urgences, Hôpitaux Universitaires de Strasbourg, 1 place de l'hôpital, 67000 Strasbourg, France; Unité INSERM UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), Faculté de Médeine - Université de Strasbourg, 4 rue Kirschleger, 67085 Strasbourg, France
| | - P Bilbault
- Structure d'urgences, Hôpitaux Universitaires de Strasbourg, 1 place de l'hôpital, 67000 Strasbourg, France; Unité INSERM UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), Faculté de Médeine - Université de Strasbourg, 4 rue Kirschleger, 67085 Strasbourg, France
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21
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Sharma S, Rafferty AM, Boiko O. The role and contribution of nurses to patient flow management in acute hospitals: A systematic review of mixed methods studies. Int J Nurs Stud 2020; 110:103709. [PMID: 32745787 DOI: 10.1016/j.ijnurstu.2020.103709] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 06/16/2020] [Accepted: 06/25/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Increased overcrowding in the emergency department is a potential threat to the quality and safety of patient care. Innovative ways are needed to explore overcrowding, the variables affecting patient flow and interventions necessary for future flow improvement. AIMS AND OBJECTIVES The aim of this review is to explore nurses' role(s) and their contribution to maintaining patient flow in acute hospitals through emergency departments. METHODOLOGY A systematic review of mixed studies (qualitative, quantitative and mixed-method) using narrative synthesis was undertaken. Five major databases-PubMed, CINHAL, BNI, ASSIA and SCOPUS-were searched to identify appropriate primary and secondary studies. Selected studies were critically appraised with a modified CASP tool. Data extraction and analysis was undertaken using narrative synthesis. RESULTS In total, 34 articles (31 primary studies and three systematic reviews) met the inclusion criteria. This systematic review is informed by studies from several countries, including the UK, US, Australia, Canada, and the Netherlands. The qualitative arm of this review explored both the role and function of nurses, as well as their experiences and perspectives of the patient flow process, while the quantitative arm investigated nurses' contribution to patient flow in terms of length of stay (LOS), triage time, and other associated performance data. FINDINGS Nurses' contribution to patient flow spanned their operational, strategic, and expanded roles. Strategic and expanded nursing roles offered the possibility of reducing LOS, triage time, and ED crowding in addition to improving the experience of patients and staff. Nurses in operational roles deployed experiential knowledge pertaining to several invisible aspects of patient flow challenges thereby facilitating decision-making for strategic flow improvement. The experiential knowledge and skills of these nursing roles are central to the success of flow-related interventions. However, the effects of emotional labour (e.g. conflicts, frustrations) of patient flow processes on nurses are significant and may have unaccounted for transaction costs and consequences that need acknowledging in order to be addressed by managers and policy makers. CONCLUSIONS AND RECOMMENDATIONS Policy-makers and senior managers need to capitalise on nurses' experiential knowledge and skills to enhance the strategic design and development of flow management in acute hospitals. Recommendations from this review have potential to deploy those skills and knowledge in flow improvement.
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Affiliation(s)
- Shrawan Sharma
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, England, United Kingdom; London North West University Healthcare NHS Trust Harrow, HA1 3UJ London, England, United Kingdom.
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, England, United Kingdom
| | - Olga Boiko
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, England, United Kingdom
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22
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Vainieri M, Panero C, Coletta L. Waiting times in emergency departments: a resource allocation or an efficiency issue? BMC Health Serv Res 2020; 20:549. [PMID: 32552829 PMCID: PMC7298831 DOI: 10.1186/s12913-020-05417-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 06/09/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In recent years, the flow of patients to the Emergency Departments (ED) of Western countries has steadily increased, thus generating overcrowding and extended waiting times. Scholars have identified four main causes for this phenomenon, related to: continuity of primary care services; availability of specific clinical pathways for chronic patients; ED's personnel endowment; organization of the ED. This study aims at providing a logical diagnostic framework to support managers in investigating specific solutions to be applied to their EDs to cope with high ED waiting times. The framework is based on the ED waiting times and ED admission rate matrix. It was applied to the Tuscan EDs as illustrative example. METHODS To provide the factors to be analyzed once the EDs are positioned into the matrix, a list of issues has been identified. The matrix was applied to Tuscan EDs. Data were collected from the Tuscan performance evaluation system, integrated with specific data on Tuscan EDs' personnel. The Tuscan EDs matrix, the descriptive statistics for each quadrant and the Spearman's rank correlation analysis among waiting times, admission rates and a set of performance indicators were conducted to help managers to read the phenomena that they need to investigate. RESULTS The combined reading of the correlations and waiting times-admission rates matrix shows that there are no optimal rules for all the EDs in managing admission rates and waiting times, but solutions have to be found considering mixed and personalized strategies. CONCLUSIONS The waiting times-admission rates matrix provides a tool able to support managers in detecting the problems related to the management of ED services. In particular, using this matrix, healthcare managers could be facilitated in the identification of possible solutions for their specific situation.
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Affiliation(s)
- Milena Vainieri
- Associate Professor at Management and Health Laboratory, Institute of Management, Scuola Superiore Sant’Anna, Pisa, Italy
| | - Cinzia Panero
- Post-doctoral researcher at Università degli studi di Genova, Genoa, Italy
| | - Lucrezia Coletta
- PhD candidate, Management and Health Laboratory, Institute of Management, Scuola Superiore Sant’Anna, Pisa, Italy
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Austin EE, Blakely B, Tufanaru C, Selwood A, Braithwaite J, Clay-Williams R. Strategies to measure and improve emergency department performance: a scoping review. Scand J Trauma Resusc Emerg Med 2020; 28:55. [PMID: 32539739 PMCID: PMC7296671 DOI: 10.1186/s13049-020-00749-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/27/2020] [Indexed: 11/15/2022] Open
Abstract
Background Over the last two decades, Emergency Department (ED) crowding has become an increasingly common occurrence worldwide. Crowding is a complex and challenging issue that affects EDs’ capacity to provide safe, timely and quality care. This review aims to map the research evidence provided by reviews to improve ED performance. Methods and findings We performed a scoping review, searching Cochrane Database of Systematic Reviews, Scopus, EMBASE, CINAHL and PubMed (from inception to July 9, 2019; prospectively registered in Open Science Framework https://osf.io/gkq4t/). Eligibility criteria were: (1) review of primary research studies, published in English; (2) discusses a) how performance is measured in the ED, b) interventions used to improve ED performance and their characteristics, c) the role(s) of patients in improving ED performance, and d) the outcomes attributed to interventions used to improve ED performance; (3) focuses on a hospital ED context in any country or healthcare system. Pairs of reviewers independently screened studies’ titles, abstracts, and full-texts for inclusion according to pre-established criteria. Discrepancies were resolved via discussion. Independent reviewers extracted data using a tool specifically designed for the review. Pairs of independent reviewers explored the quality of included reviews using the Risk of Bias in Systematic Reviews tool. Narrative synthesis was performed on the 77 included reviews. Three reviews identified 202 individual indicators of ED performance. Seventy-four reviews reported 38 different interventions to improve ED performance: 27 interventions describing changes to practice and process (e.g., triage, care transitions, technology), and a further nine interventions describing changes to team composition (e.g., advanced nursing roles, scribes, pharmacy). Two reviews reported on two interventions addressing the role of patients in ED performance, supporting patients’ decisions and providing education. The outcomes attributed to interventions used to improve ED performance were categorised into five key domains: time, proportion, process, cost, and clinical outcomes. Few interventions reported outcomes across all five outcome domains. Conclusions ED performance measurement is complex, involving automated information technology mechanisms and manual data collection, reflecting the multifaceted nature of ED care. Interventions to improve ED performance address a broad range of ED processes and disciplines.
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Affiliation(s)
- Elizabeth E Austin
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
| | - Brette Blakely
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Catalin Tufanaru
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Amanda Selwood
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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24
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Sim MA, Lee SH, Phan PH, Lateef A. Quality improvement at an acute medical unit in an Asian Academic Center: A mixed methods study of nursing work dynamics. Nurs Outlook 2020; 68:169-183. [PMID: 32044102 DOI: 10.1016/j.outlook.2019.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 09/07/2019] [Accepted: 09/18/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The acute medical unit (AMU) provides early specialist care to emergency department patients before inpatient admission. The workflows and skills for successful AMU nursing comprise a hybrid of internal and emergency medicine. PURPOSE To understand nursing work dynamics in the AMU. METHODS AMU at a 1,250-bed tertiary academic center in Singapore with 14,000 ED presentations monthly. Retrospective mixed methods study using focus group discussions and surveys. Fifteen nurses across three focus group discussions. Thirty-two physicians and 54 nurses responded to a validated questionnaire. FINDINGS Focus group discussions transcripts content analyzed by two researchers. Survey items factor analyzed and attitudinal differences between AMU physicians and nurses, and among nurses compared using Student's t- and one-way ANOVA tests. DISCUSSION AMU nursing staff faced obstacles of inadequate patient information, emergency department onboarding, unbalanced workload, and coworker conflicts, which led to them to develop processes and checklists to manage patient information, patient expectations, and teamwork. CONCLUSION AMU nursing requires a combination of specialist internal medicine and emergency medicine skills. Training should familiarize nurse workforce with managing patient expectations and multidisciplinary teamwork.
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Affiliation(s)
- Ming Ann Sim
- National University Health System, Singapore, The Republic of Singapore
| | | | | | - Aisha Lateef
- National University of Singapore, Singapore, The Republic of Singapore
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25
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Boman E, Duvaland E, Gaarde K, Leary A, Fagerström L. Implementation of advanced practice nursing for orthopaedic patients in the emergency care context – A study protocol for outcome studies. J Adv Nurs 2020; 76:1069-1076. [DOI: 10.1111/jan.14299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 10/15/2019] [Accepted: 12/10/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Erika Boman
- Department of Nursing and Health Sciences University of South‐Eastern Norway Drammen Norway
- Department of Nursing Åland University of Applied Sciences Mariehamn Finland
| | | | - Kim Gaarde
- Drammen Hospital Vestre Viken HF Drammen Norway
| | - Alison Leary
- Department of Nursing and Health Sciences University of South‐Eastern Norway Drammen Norway
- School of Health and Social Care London South Bank University London UK
| | - Lisbeth Fagerström
- Department of Nursing and Health Sciences University of South‐Eastern Norway Drammen Norway
- Faculty of Education and Welfare Studies Åbo Akademi University Vaasa Finland
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26
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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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27
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Ebker-White A, Bein KJ, Berendsen Russell S, Dinh MM. The Sydney triage to admission risk tool (START) to improve patient flow in an emergency department: a model of care implementation pilot study. BMC Emerg Med 2019; 19:79. [PMID: 31805874 PMCID: PMC6896669 DOI: 10.1186/s12873-019-0290-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 11/12/2019] [Indexed: 11/18/2022] Open
Abstract
Background The Sydney Triage to Admission Risk Tool (START) is a validated clinical analytics tool designed to estimate the probability of in-patient admission based on Emergency Department triage characteristics. Methods This was a single centre pilot implementation study using a matched case control sample of patients assessed at ED triage. Patients in the intervention group were identified at triage by the START tool as likely requiring in-patient admission and briefly assessed by an ED Consultant. Bed management were notified of these patients and their likely admitting team based on senior early assessment. Matched controls were identified on the same day of presentation if they were admitted to the same in-patient teams as patients in the intervention group and same START score category. Outcomes were ED length of stay and proportion of patients correctly classified as an in-patient admission by the START tool. Results One hundred and thirteen patients were assessed using the START-based model of care. When compared with matched control patients, this intervention model of care was associated with a significant reduction in ED length of stay [301 min (IQR 225–397) versus 423 min (IQR 297–587) p < 0.001] and proportion of patients meeting 4 h length of stay thresholds increased from 24 to 45% (p < 0.001). Conclusion In this small pilot implementation study, the START tool, when used in conjunction with senior early assessment was associated with a reduction in ED length of stay. Further controlled studies are now underway to further examine its utility across other ED settings.
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Affiliation(s)
- Anja Ebker-White
- Emergency Department, Royal Prince Alfred Hospital, Missenden Road, Camperdown NSW, Sydney, 2050, Australia
| | - Kendall J Bein
- Emergency Department, Royal Prince Alfred Hospital, Missenden Road, Camperdown NSW, Sydney, 2050, Australia.,RPA Green Light Institute, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW, 2050, Australia
| | - Saartje Berendsen Russell
- Emergency Department, Royal Prince Alfred Hospital, Missenden Road, Camperdown NSW, Sydney, 2050, Australia.,RPA Green Light Institute, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW, 2050, Australia
| | - Michael M Dinh
- Emergency Department, Royal Prince Alfred Hospital, Missenden Road, Camperdown NSW, Sydney, 2050, Australia. .,RPA Green Light Institute, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW, 2050, Australia.
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28
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Dupuy AM, Bargnoux AS, Andreeva A, Zins C, Kuster N, Badiou S, Cristol JP. Analytical performances of a novel point-of-care procalcitonin assay. Pract Lab Med 2019; 18:e00145. [PMID: 31720356 PMCID: PMC6838538 DOI: 10.1016/j.plabm.2019.e00145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 11/25/2022] Open
Abstract
Objectives We report the analytical performances of a new point-of-care (POC) procalcitonin (PCT) fluorescence immunoassay that uses the AFIAS-6© system from Boditech and its concordance with results of the standard method Kryptor Compact plus from the central laboratory. Design and methods: Analytical performances including imprecision studies, limit of blank (LoB), limit of detection (LoD) and limit of quantification (LOQ) were determined. The method comparison was performed using plasma vs. whole blood for Kryptor CompactPlus© vs. AFIAS-6©, respectively. Results The total imprecision was far from the CV of 4.5% claimed by the manufacturer and close to 10%, for levels of PCT at 0.4 and 8.3 μg/L. The LoD of this novel PCT assay was found to close to the LoD provided by the manufacturer at 0.04 μg/L. The LOQ was higher than that claimed by the manufacturer (0.1 vs 0.002, respectively). The equation of linearity in the lower range was found to be y = 1.056x - 0.039 with r2 = 0.993 with a mean recovery percentage of 86 ± 15%. Correlation studies showed a good correlation between PCT measurements using plasma on Kryptor system and on corresponding whole blood with POC reaching a bias of -0.04 in the range from 0.02 to 2 μg/L. Conclusion The novel PCT assay on AFIAS-6© is an acceptable POC alternative for the diagnosis and management of sepsis at EDs to improve the flow of patients, as results are consistent with those of the standard PCT Kryptor Compact Plus© assay, despite its higher imprecision.
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Affiliation(s)
- Anne Marie Dupuy
- Laboratoire de Biochimie et Hormonologie, CHU Montpellier, Univ Montpellier 1, Montpellier, F-34295, cédex 5, France
| | - Anne Sophie Bargnoux
- Laboratoire de Biochimie et Hormonologie, PhyMedExp, Université de Montpellier, INSERM, CNRS, CHU de Montpellier, France
| | - Aneta Andreeva
- Laboratoire de Biochimie et Hormonologie, CHU Montpellier, Univ Montpellier 1, Montpellier, F-34295, cédex 5, France
| | - Charlie Zins
- Laboratoire de Biochimie et Hormonologie, CHU Montpellier, Univ Montpellier 1, Montpellier, F-34295, cédex 5, France
| | - Nils Kuster
- Laboratoire de Biochimie et Hormonologie, PhyMedExp, Université de Montpellier, INSERM, CNRS, CHU de Montpellier, France
| | - Stéphanie Badiou
- Laboratoire de Biochimie et Hormonologie, PhyMedExp, Université de Montpellier, INSERM, CNRS, CHU de Montpellier, France
| | - Jean Paul Cristol
- Laboratoire de Biochimie et Hormonologie, PhyMedExp, Université de Montpellier, INSERM, CNRS, CHU de Montpellier, France
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The impact of a multimodal intervention on emergency department crowding and patient flow. Int J Emerg Med 2019; 12:21. [PMID: 31455260 PMCID: PMC6712614 DOI: 10.1186/s12245-019-0238-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 08/15/2019] [Indexed: 11/16/2022] Open
Abstract
Objective The objective of this study is to assess the impact of a multimodal intervention on emergency department (ED) crowding and patient flow in a Dutch level 1 trauma center. Methods In this cross-sectional study, we compare ED crowding and patient flow between a 9-month pre-intervention period and a 9-month intervention period, during peak hours and overall (24/7). The multimodal intervention included (1) adding an emergency nurse practitioner (ENP) and (2) five medical specialists during peak hours to the 24/7 available emergency physicians (EPs), (3) a Lean programme to improve radiology turnaround times, and (4) extending the admission offices’ openings hours. Crowding is measured with the modified National ED OverCrowding Score (mNEDOCS). Furthermore, radiology turnaround times, patients’ length of stay (LOS), proportion of patients leaving without being seen (LWBS) by a medical provider, and unscheduled representations are assessed. Results The number of ED visits were grossly similar in the two periods during peak hours (15,558 ED visits in the pre-intervention period and 15,550 in the intervention period) and overall (31,891 ED visits in the pre-intervention period vs. 32,121 in the intervention period). During peak hours, ED crowding fell from 18.6% (pre-intervention period) to 3.5% (intervention period), radiology turnaround times decreased from an average of 91 min (interquartile range 45–256 min) to 50 min (IQR 30–106 min., p < 0.001) and LOS reduced with 13 min per patient from 167 to 154 min (p < 0.001). For surgery, neurology and cardiology patients, LOS reduced significantly (with 17 min, 25 min, and 8 min. respectively), while not changing for internal medicine patients. Overall, crowding, radiology turnaround times and LOS also decreased. Less patients LWBS in the intervention period (270 patients vs. 348 patients, p < 0.001) and less patients represented unscheduled within 1 week after the initial ED visit: 864 (2.7%) in the pre-intervention period vs. 645 (2.0%) patients in the intervention period, p < 0.001. Conclusions In this hospital, a multimodal intervention successfully reduces crowding, radiology turnaround times, patients’ LOS, number of patients LWBS and the number of unscheduled return visits, suggesting improved ED processes. Further research is required on total costs of care and long-term effects.
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30
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Stowell JR, Pugsley P, Jordan H, Akhter M. Impact of Emergency Department Phlebotomists on Left-Before-Treatment-Completion Rates. West J Emerg Med 2019; 20:681-687. [PMID: 31316710 PMCID: PMC6625689 DOI: 10.5811/westjem.2019.5.41736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 03/11/2019] [Accepted: 05/11/2019] [Indexed: 11/15/2022] Open
Abstract
Introduction The emergency department (ED) serves as the primary access point to the healthcare system. ED throughput efficiency is critical. The percentage of patients who leave before treatment completion (LBTC) is an important marker of department efficiency. Our study aimed to assess the impact of an ED phlebotomist, dedicated to obtaining blood specimen collection on waiting patients, on LBTC rates. Methods This study was conducted as a retrospective observational analysis over approximately 18 months (October 5, 2015–March 31, 2017) for patients evaluated by a triage provider with a door-to-room (DtR) time of > 20 minutes (min). LBTC rates were compared in 10-min DtR increments for when the ED phlebotomist collected the patient’s specimen vs not. Results Of 71,942 patient encounters occurring during the study period, 17,349 (24.1%) met study inclusion criteria. Of these, 1842 (10.6%) had blood specimen collection performed by ED phlebotomy. The overall LBTC rate for encounters included in the analysis was 5.26% (95% confidence interval [CI], 4.94%–5.60%). Weighting the LBTC rates for each 10-min DtR interval using the fixed effects model led to an overall LBTC rate of 2.74% (95% CI, 2.09%–3.59%) for patient encounters with ED phlebotomist collection vs 5.31% (95% CI, 4.97%–5.67%) in those which did not, yielding a relative reduction of 48% (95% CI, 34%–63%). The effect of the phlebotomist on LBTC rates increased as DtR times increased. The difference in the rate of the rise of LBTC percentages, per 10-min interval, was 0.50% (95% CI, 0.19%–0.81%) higher for non-ED phlebotomist encounters vs phlebotomist encounters. Conclusion ED phlebotomy demonstrated a significant reduction in ED LBTC rates. Further, as DtR times increased, the impact of ED phlebotomy became increasingly significant. Adult EDs with increased rates of LBTC patient encounters may want to consider the implementation of ED phlebotomy.
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Affiliation(s)
- Jeffrey R Stowell
- University of Arizona College of Medicine-Phoenix, Department of Emergency Medicine, Phoenix, Arizona.,Maricopa Integrated Health System, Department of Emergency Medicine, Phoenix, Arizona.,Creighton University School of Medicine, Department of Emergency Medicine, Omaha, Nebraska
| | - Paul Pugsley
- Maricopa Integrated Health System, Department of Emergency Medicine, Phoenix, Arizona
| | - Heather Jordan
- Maricopa Integrated Health System, Department of Emergency Medicine, Phoenix, Arizona
| | - Murtaza Akhter
- University of Arizona College of Medicine-Phoenix, Department of Emergency Medicine, Phoenix, Arizona.,Maricopa Integrated Health System, Department of Emergency Medicine, Phoenix, Arizona.,Creighton University School of Medicine, Department of Emergency Medicine, Omaha, Nebraska
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Characteristics of Non-Emergent Visits in Emergency Departments: Profiles and Longitudinal Pattern Changes in Taiwan, 2000-2010. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16111999. [PMID: 31195627 PMCID: PMC6603954 DOI: 10.3390/ijerph16111999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 05/26/2019] [Accepted: 06/04/2019] [Indexed: 11/17/2022]
Abstract
An increasing number of emergency department (ED) visits have posed a challenge to health systems in many countries, but an understanding of non-emergent ED visits has remained limited and contentious. This retrospective study analyzed ED visits using three representative cohorts from routine data to explore the profiles and longitudinal pattern changes of non-emergent ED visits in Taiwan. Systematic-, personal-, and ED visit-level data were analyzed using a logistic regression model. Average marginal effects were calculated to compare the effects of each factor. The annual ED visit rate increased up to 261.3 per 1000 population in 2010, and a significant one-third of visits were considered as non-emergent. The rapidly growing utilization of ED visits underwent a watershed change after cost-sharing payments between patients and medical institutions were increased in 2005. In addition to cohort effects resulting from cost-sharing payment changes, all factors were significantly associated with non-emergent ED visits with different levels of impact. We concluded that non-emergent ED visits were associated with multifaceted factors, but the change to cost-sharing payment, being female, younger age, and geographical residence were the most predictive factors. This information would enhance the implementation of evidence-based strategies to optimize ED use.
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Triage to Observation: A Quality Improvement Initiative for Chest Pain Patients Presenting to the Emergency Department. Crit Pathw Cardiol 2019; 18:75-79. [PMID: 31094733 DOI: 10.1097/hpc.0000000000000175] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the impact of a rapid admission protocol for chest pain patients presenting to the emergency department (ED) on ED length-of-stay (LOS). In this study, ED LOS was defined as the time from triage check-in until the time the patient physically leaves the ED. The purpose of this quality improvement study was to decrease ED crowding. METHODS This is a single-center prospective cohort study performed as a quality improvement initiative. This study implemented a rapid admission protocol for patients who were at moderate risk for a major adverse cardiac event based on the HEART score. When a patient presented to the ED through triage with a chief complaint of chest pain, this protocol allowed the provider-in-triage (PIT) to identify eligible patients for potential rapid admission to the hospital's clinical decision unit (CDU). The PIT would complete a rapid medical screening examination, initiate the patient's workup, and call the CDU providers to further evaluate the patient. By identifying these patients early, the lengthy ED chest pain workup contributing to longer ED LOS could then be completed in the CDU. RESULTS The total number of patients seen in the ED over the study period was 34,251. The total number of patients admitted to the CDU during the study period was 1,442. The PIT identified 13 patients for rapid admission to the CDU during the study period. These patients had a statistically significant reduction in ED LOS (P < 0.001). ED LOS was also adjusted to identify delays in patient movement resulting in a statistically significant difference (P < 0.001). CONCLUSION Implementation of a rapid admission protocol for chest pain patients at moderate risk for a major adverse cardiac event resulted in a reduction in ED LOS. Adjusted ED LOS was also significant, highlighting a delay in patient movement from the ED to the CDU indicating continued barriers affecting ED holding times.
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Vandyk AD, Kaluzienski M, Goldie C, Stokes Y, Ross-White A, Kronick J, Gilmour M, MacPhee C, Graham ID. Interventions to improve emergency department use for mental health reasons: protocol for a mixed-methods systematic review. Syst Rev 2019; 8:84. [PMID: 30944033 PMCID: PMC6446265 DOI: 10.1186/s13643-019-1008-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 03/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Healthcare resources are limited and unnecessary, and inappropriate emergency department use is now a highly visible healthcare priority. Individuals visiting the emergency department for mental health-related reasons are often amongst the most frequent presenters. In response, researchers and clinicians have created interventions to streamline emergency department use and several primary studies describe the effects of these interventions. Yet, no consensus exists on the optimal approach, and information on the quality of development, effectiveness, acceptability, and economic considerations is hard to find. The purpose of this study is to systematically review interventions designed to improve appropriate use of the emergency department for mental health reasons. METHOD A mixed-method systematic review using Joanna Briggs Methodology. Search combining electronic databases (EMBASE, MEDLINE, PsycINFO, CINAHL, HealthSTAR, PROQUEST, Cumulative Index to Nursing and Allied Health) and secondary searches (grey literature and hand search with consultation). Two independent reviewers will screen titles and abstracts using predetermined eligibility criteria and a third reviewer will resolve conflicts. Full texts will also be screened by two independent reviews and conflicts resolved in a consensus meeting with a third reviewer. A pilot-tested data extraction form will be used to retrieve data relevant to the study objectives. We will assess the quality and of all included studies. Data describing interventions will be summarized using logic models and reported narratively. Quality of development will be assessed using the Oxford Implementation Index. For data on intervention effectiveness, we will assess statistical heterogeneity and conduct a meta-analysis using a random effects method, if appropriate. For interventions that cannot be pooled, we will report outcomes narratively and descriptively. Qualitative data on acceptability will be synthesized using meta-aggregation and an economic evaluation of interventions will be done. The reporting of this protocol follows the PRISMA-P statement. DISCUSSION Using a combined systematic review methodology and integrated knowledge translation plan, the project will provide decision makers with concrete evidence to support the implementation and evaluation of interventions to improve emergency department use for mental health reasons. These interventions reflect widespread priorities in the area of mental health care. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018087430.
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Affiliation(s)
- Amanda Digel Vandyk
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Mark Kaluzienski
- Department of Psychiatry and Psychiatric Emergency Services, The Ottawa Hospital, Ottawa, Canada
| | | | - Yehudis Stokes
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Amanda Ross-White
- Clinical Outreach Services Librarian, Queen’s University, Kingston, Canada
| | | | | | - Colleen MacPhee
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario Canada
- Community Mental Health Crisis Services, The Ottawa Hospital, Ottawa, Ontario Canada
| | - Ian D. Graham
- School of Epidemiology and Public Health, School of Nursing (cross-appointed), University of Ottawa, Ottawa, Canada
- Centre for Practice-Changing Research, The Ottawa Hospital Research Institute, Ottawa, Canada
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Goh WP, Han HF, Segara UC, Baird G, Lateef A. Acute medical unit: experience from a tertiary healthcare institution in Singapore. Singapore Med J 2019; 59:510-513. [PMID: 30386857 DOI: 10.11622/smedj.2018124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Singapore's healthcare system is under strain from the rising demands of an increasing and ageing population, resulting in delayed specialist care for patients presenting to the emergency department and requiring admission. Acute assessment units have been developed elsewhere but are not well established in local healthcare. Our institution extended our acute medical team to form an acute medical unit (AMU), in which focused internist-led teams are stationed on site to rapidly assess and re-triage patients. All patients (excluding those with very complex conditions) are admitted to the AMU and managed by internists who provide holistic, patient-centric care with better ownership, improved efficiency and less fragmentation. Patients can receive timely access to medical interventions and stable patients can benefit from early supported discharge, anchored by the nursing, allied health and transitional care teams. Given the ageing patient population with multiple comorbidities, this integrated model with exceptional outcomes is highly suitable for Singapore.
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Affiliation(s)
- Wei-Ping Goh
- University Medicine Cluster, National University Hospital, Singapore
| | - Hui Fen Han
- Clinical Operations, Woodlands Health Campus, Singapore
| | | | - Geraldine Baird
- University Medicine Cluster, National University Hospital, Singapore
| | - Aisha Lateef
- University Medicine Cluster, National University Hospital, Singapore.,Department of Medicine, NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Bell A, Toloo GS, Crilly J, Burke J, Williams G, McCann B, FitzGerald G. Emergency department models of care in Queensland: a multisite cross-sectional study. AUST HEALTH REV 2019; 43:363-370. [DOI: 10.1071/ah17233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 03/26/2018] [Indexed: 11/23/2022]
Abstract
Objective
The acuity and number of presentations being made to emergency departments (EDs) is increasing. In an effort to safely and efficiently manage this increase and optimise patient outcomes, innovative models of care (MOC) have been implemented. What is not clear is how these MOC reflect the needs of patients or relate to each other or to ED performance. The aim of this study was to describe ED MOC in Queensland, Australia.
Methods
Situated within a larger mixed-methods study, the present study was a cross-sectional study. In early 2015, leaders (medical directors and nurse managers) from public hospital EDs in Queensland were invited to complete a survey detailing ED activity, staffing profiles, treatment space, MOC and National Emergency Access Target (NEAT) performance. Routinely collected ED information system data was also used.
Results
Twenty of the 27 EDs invited participated in the study (response rate 74%). An extensive array of MOC were identified that were categorised into those that facilitate input, throughput and output from the ED. There was no consistent evidence as to the relative effectiveness of these MOC in achieving ED performance benchmarks, such as NEAT performance.
Conclusion
There is considerable variability in the MOC used throughout EDs in Queensland. A more complete analysis of the relative effectiveness of different MOC either in isolation or as part of a comprehensive approach would help inform more consistent MOC in Queensland EDs.
What is known about the topic?
MOC in any given ED are implemented in response to factors such as the geographical location of the hospital, hospital-specific characteristics and service profile, staffing profile and patient demographic profile. In the era of time-based targets, they may also serve to address a particular aspect of flow in the face of rising ED demand. Although many of the MOC attempt to deal with flow in a linear fashion, target specific phases of the ED journey or address particular patient cohorts, what is clear is that not all EDs are shaped and formed the same.
What does this paper add?
The study provides a comprehensive description of the varied models of care operating within Queensland public hospital EDs and how they relate to ED performance. A basic taxonomy of contemporary ED MOC is necessary to allow comparison between departments and inform decisions regarding safety, efficiency and cost-effectiveness.
What are the implications to practitioners?
A contemporary understanding of the presence and profile of ED MOC that currently exist within a network of hospitals and health services is important for managers, clinicians and patients to inform decision-making regarding the safety, clinical effectiveness and cost-effectiveness of these models. This understanding can also inform where and how further improvements in care delivery can progress.
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Moskop JC, Geiderman JM, Marshall KD, McGreevy J, Derse AR, Bookman K, McGrath N, Iserson KV. Another Look at the Persistent Moral Problem of Emergency Department Crowding. Ann Emerg Med 2018; 74:357-364. [PMID: 30579619 DOI: 10.1016/j.annemergmed.2018.11.029] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/23/2018] [Accepted: 11/19/2018] [Indexed: 11/16/2022]
Abstract
This article revisits the persistent problem of crowding in US hospital emergency departments (EDs). It begins with a brief review of origins of this problem, terms used to refer to ED crowding, proposed definitions and measures of crowding, and causal factors. The article then summarizes recent studies that document adverse moral consequences of ED crowding, including poorer patient outcomes; increased medical errors; compromises in patient physical privacy, confidentiality, and communication; and provider moral distress. It describes several organizational strategies implemented to relieve crowding and implications of ED crowding for individual practitioners. The article concludes that ED crowding remains a morally significant problem and calls on emergency physicians, ED and hospital leaders, emergency medicine professional associations, and policymakers to collaborate on solutions.
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Affiliation(s)
- John C Moskop
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC.
| | - Joel M Geiderman
- Ruth and Harry Roman Emergency Department, Department of Emergency Medicine, and Center for Healthcare Ethics, Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Kenneth D Marshall
- Department of Emergency Medicine and Department of History and Philosophy of Medicine, University of Kansas Health System, Kansas City, KS
| | - Jolion McGreevy
- Department of Emergency Medicine, Mount Sinai School of Medicine, New York, NY, and Center for Bioethics, Harvard Medical School, Boston, MA
| | - Arthur R Derse
- Center for Bioethics and Medical Humanities, Institute for Health and Society, and Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Kelly Bookman
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Norine McGrath
- Department of Emergency Medicine and John J. Lynch, MD, Center for Ethics, Medstar Washington Medical Center, Washington, DC
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DeAnda R. Stop the Bottleneck: Improving Patient Throughput in the Emergency Department. J Emerg Nurs 2018; 44:582-588. [DOI: 10.1016/j.jen.2018.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 03/21/2018] [Accepted: 05/11/2018] [Indexed: 11/26/2022]
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Scott I, McGavigan A, Ferson M, Woolley I, Burt MG, Russell A, Bridgman P, Ting J, Blacker D, Bonomo Y, Martin J, Szer J. Selected state of the art research in internal medicine, 2017. Intern Med J 2018; 48:619-623. [PMID: 29898274 DOI: 10.1111/imj.13820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 03/26/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Ian Scott
- Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Andrew McGavigan
- Cardiology, Flinders Medical Centre, Adelaide, South Australia, Australia.,School of Medicine, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Mark Ferson
- Public Health Unit, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Ian Woolley
- Infectious Diseases, Monash Medical Centre, Melbourne, Victoria, Australia.,Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Morton G Burt
- Southern Adelaide Diabetes and Endocrine Services, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Anthony Russell
- Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Paul Bridgman
- Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Joseph Ting
- Department of Emergency Medicine, Mater Hospital, Brisbane, Queensland, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - David Blacker
- Neurology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Yvonne Bonomo
- Addiction Medicine, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Jennifer Martin
- Clinical Pharmacology, Newcastle University, Newcastle, New South Wales, Australia
| | - Jeff Szer
- Bone Marrow Transplant Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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De Freitas L, Goodacre S, O’Hara R, Thokala P, Hariharan S. Interventions to improve patient flow in emergency departments: an umbrella review. Emerg Med J 2018; 35:626-637. [DOI: 10.1136/emermed-2017-207263] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 05/28/2018] [Accepted: 06/03/2018] [Indexed: 01/08/2023]
Abstract
ObjectivesPatient flow and crowding are two major issues in ED service improvement. A substantial amount of literature exists on the interventions to improve patient flow and crowding, making it difficult for policymakers, managers and clinicians to be familiar with all the available literature and identify which interventions are supported by the evidence. This umbrella review provides a comprehensive analysis of the evidence from existing quantitative systematic reviews on the interventions that improve patient flow in EDs.MethodsAn umbrella review of systematic reviews published between 2000 and 2017 was undertaken. Included studies were systematic reviews and meta-analyses of quantitative primary studies assessing an intervention that aimed to improve ED throughput.ResultsThe search strategy yielded 623 articles of which 13 were included in the umbrella review. The publication dates of the systematic reviews ranged from 2006 to 2016. The 13 systematic reviews evaluated 26 interventions: full capacity protocols, computerised provider order entry, scribes, streaming, fast track and triage. Interventions with similar characteristics were grouped together to produce the following categories: diagnostic services, assessment/short stay units, nurse-directed interventions, physician-directed interventions, administrative/organisational and miscellaneous. The statistical evidence from 14 primary randomised controlled trials (RCTs) was evaluated to determine if correlation or clustering of observations was considered. Only the fast track intervention had moderate evidence to support its use but the RCTs that assessed the intervention did not use statistical tests that considered correlation.ConclusionsOverall, the evidence supporting the interventions to improve patient flow is weak. Only the fast track intervention had moderate evidence to support its use but correlation/clustering was not taken into consideration in the RCTs examining the intervention. Failure to consider the correlation of the data in the primary studies could result in erroneous conclusions of effectiveness.
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Boman E, Ösp Egilsdottir H, Levy-Malmberg R, Fagerström L. Nurses’ understanding of a developing nurse practitioner role in the Norwegian emergency care context: A qualitative study. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/2057158518783166] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In Norway the nurse practitioner (NP) role is still in its infancy. To succeed with implementation of this new role stakeholder involvement is important, and there should be an explicit need for change. The aim of this study was to explore registered nurses’ understanding of how the NP role could contribute to meeting patients’ needs for care in the emergency care context, and nurses’ perceptions about the implementation process. The study is a qualitative interview study. The interviews were analysed by means of qualitative content analysis. Two themes presented themselves: the NP role being an autonomous role suitable for non-urgent patients, and the NP role being diffuse as well as a threat to colleagues and organizational structures. The results indicate that the NP role can make a valuable contribution to meet current challenges in the emergency care context. However, for successful implementation, the management team plays an important role in leading change and engaging co-workers to be part of the process. In further research, it is recommended to evaluate the forthcoming implementation process and, later on, to evaluate the outcomes of NP practice in the emergency care context in Norway.
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Affiliation(s)
- Erika Boman
- Department of Nursing and Health Sciences, University of South-Eastern Norway, Drammen, Norway
- Department of Nursing, Åland University of Applied Sciences, Mariehamn, Finland
| | - H. Ösp Egilsdottir
- Department of Nursing and Health Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Rika Levy-Malmberg
- Department of Nursing and Health Sciences, University of South-Eastern Norway, Drammen, Norway
- Department of Nursing, University of Applied Sciences, Novia, Vaasa, Finland
| | - Lisbeth Fagerström
- Department of Nursing and Health Sciences, University of South-Eastern Norway, Drammen, Norway
- Faculty of Education and Welfare Studies, Åbo Akademi University, Vaasa, Finland
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Varndell W, Fry M, Elliott D. Quality and impact of nurse-initiated analgesia in the emergency department: A systematic review. Int Emerg Nurs 2018; 40:46-53. [PMID: 29885907 DOI: 10.1016/j.ienj.2018.05.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/27/2018] [Accepted: 05/28/2018] [Indexed: 11/26/2022]
Abstract
AIM This paper reports a systematic literature review evaluating the impact and quality of pain management associated with nurse initiated analgesia in patients presenting to the emergency department (ED). BACKGROUND Pain is a major presenting complaint for individuals attending the ED. Timely access to effective analgesia continues to be a global concern in the ED setting; emergency nurses are optimally positioned to improve detection and management of pain. DESIGN Systematic review. DATABASES AND DATA TREATMENT Four databases - CINAHL, EMBASE, Medline, ProQuest - the Cochrane Library and the National Institute of Clinical Excellence were searched from date of inception to December 2017; with no language restrictions applied. Studies were identified using predetermined inclusion criteria. Data were extracted and summarised and underwent evaluation using published valid criteria. RESULTS Twelve articles met inclusion, comprising a wide range of analgesics and administration routes to manage mild to severe pain. Overall study quality was high; 7 studies included a form of comparison group. Patient outcome measures included time to analgesia (n = 12; 100%), change in pain score (n = 6; 50.0%); adverse events (n = 6; 50.0%); patient satisfaction (n = 5; 41.7%) and documenting pain assessment (n = 2; 16.7%). CONCLUSION Nurse-initiated analgesia was associated with safe, timely and effective pain relief.
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Affiliation(s)
- Wayne Varndell
- Clinical Nurse Consultant, Prince of Wales Hospital Emergency Department, Randwick, NSW 2031, Australia; Faculty of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia.
| | - Margaret Fry
- Faculty of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia; Level 7 Kolling Building, Royal North Shore Hospital, St Leonards, NSW 2065, Australia.
| | - Doug Elliott
- Faculty of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia.
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Liu J, Masiello I, Ponzer S, Farrokhnia N. Can interprofessional teamwork reduce patient throughput times? A longitudinal single-centre study of three different triage processes at a Swedish emergency department. BMJ Open 2018; 8:e019744. [PMID: 29674366 PMCID: PMC5914774 DOI: 10.1136/bmjopen-2017-019744] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To determine the impact on emergency department (ED) throughput times and proportion of patients who leave without being seen by a physician (LWBS) of two triage interventions, where comprehensive nurse-led triage was first replaced by senior physician-led triage and then by interprofessional teamwork. DESIGN Single-centre before-and-after study. SETTING Adult ED of a Swedish urban hospital. PARTICIPANTS Patients arriving on weekdays 08:00 to 21:00 during three 1-year periods in the interval May 2012 to November 2015. A total of 185 806 arrivals were included. INTERVENTIONS Senior physicians replaced triage nurses May 2013 to May 2014. Interprofessional teamwork replaced the triage process on weekdays 08:00 to 21:00 November 2014 to November 2015. MAIN OUTCOME MEASURES Primary outcomes were the median time to physician (TTP) and the median length of stay (LOS). Secondary outcome was the LWBS rate. RESULTS The crude median LOS was shortest for teamwork, 228 min (95% CI 226.4 to 230.5) compared with 232 min (95% CI 230.8 to 233.9) for nurse-led and 250 min (95% CI 248.5 to 252.6) for physician-led triage. The adjusted LOS for the teamwork period was 16 min shorter than for nurse-led triage and 23 min shorter than for physician-led triage. The median TTP was shortest for physician-led triage, 56 min (95% CI 54.5 to 56.6) compared with 116 min (95% CI 114.4 to 117.5) for nurse-led triage and 74 min (95% CI 72.7 to 74.8) for teamwork. The LWBS rate was 1.9% for nurse-led triage, 1.2% for physician-led triage and 3.2% for teamwork. All outcome measure differences had two-tailed p values<0.01. CONCLUSIONS Interprofessional teamwork had the shortest length of stay, a shorter time to physician than nurse-led triage, but a higher LWBS rate. Interprofessional teamwork may be a useful approach to reducing ED throughput times.
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Affiliation(s)
- Jenny Liu
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Italo Masiello
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Sari Ponzer
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Nasim Farrokhnia
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
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Ferreira GE, Traeger AC, Maher CG. Review article: A scoping review of physiotherapists in the adult emergency department. Emerg Med Australas 2018; 31:43-57. [DOI: 10.1111/1742-6723.12987] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 03/02/2018] [Accepted: 03/13/2018] [Indexed: 12/29/2022]
Affiliation(s)
- Giovanni E Ferreira
- School of Public Health, Sydney Medical School; The University of Sydney; Sydney New South Wales Australia
| | - Adrian C Traeger
- School of Public Health, Sydney Medical School; The University of Sydney; Sydney New South Wales Australia
| | - Chris G Maher
- School of Public Health, Sydney Medical School; The University of Sydney; Sydney New South Wales Australia
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Digel Vandyk A, Young L, MacPhee C, Gillis K. Exploring the Experiences of Persons Who Frequently Visit the Emergency Department for Mental Health-Related Reasons. QUALITATIVE HEALTH RESEARCH 2018; 28:587-599. [PMID: 29231128 DOI: 10.1177/1049732317746382] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In this qualitative study, the experiences of persons who frequently visit the emergency department (ED) for mental health-related reasons were explored. Interpretive Description guided the design, and data were collected through interviews with 10 adults who made 12+ ED visits within a 1-year time frame (2015). Thematic analysis was used to analyze data inductively. The participants' experiences were described with the help of three themes emerging from the data: The Experience, The Providers, and Protective Factors. The participants felt compelled to come to hospital. For them, every visit was necessary, and dismissal of their needs by staff was interpreted as disrespect and prejudice. We noted differences in ED utilization patterns according to psychiatric diagnosis, and more research is needed to explore the phenomenon of frequent use by particular patient populations. Furthermore, health care providers implementing interventions designed to improve emergency care should consider tailored approaches rather than a one-size-fits-all strategy.
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Affiliation(s)
| | | | - Colleen MacPhee
- 3 Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- 4 The Ottawa Hospital, Ottawa, Ontario, Canada
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Mazza D, Pearce C, Joe A, Turner LR, Brijnath B, Browning C, Shearer M, Lowthian J. Emergency department utilisation by older people in metropolitan Melbourne, 2008–12: findings from the Reducing Older Patient’s Avoidable Presentations for Emergency Care Treatment (REDIRECT) study. AUST HEALTH REV 2018; 42:181-188. [DOI: 10.1071/ah16191] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 12/26/2016] [Indexed: 11/23/2022]
Abstract
Objective Older patients are over-represented in emergency departments (ED), with many presenting for conditions that could potentially be managed in general practice. The aims of the present study were to examine the characteristics of ED presentations by older patients and to identify patient factors contributing to potentially avoidable general practitioner (PAGP)-type presentations. Methods A retrospective analysis was performed of routinely collected data comprising ED presentations by patients aged ≥70 years at public hospitals across metropolitan Melbourne from January 2008 to December 2012. Presentations were classified according to the National Healthcare Agreement definition for PAGP-type presentations. Presentations were characterised according to patient demographic and clinical factors and were compared across PAGP-type and non-PAGP-type groups. Results There were 744 519 presentations to the ED by older people, of which 103 471 (13.9%) were classified as PAGP-type presentations. The volume of such presentations declined over the study period from 20 893 (14.9%) in 2008 to 20 346 (12.8%) in 2012. External injuries were the most common diagnoses (13 761; 13.3%) associated with PAGP-type presentations. Sixty-one per cent of PAGP-type presentations did not involve either an investigation or a procedure. Patients were referred back to a medical officer (including a general practitioner (GP)) in 58.7% of cases. Conclusion Older people made a significant number of PAGP-type presentations to the ED during the period 2008–12. A low rate of referral back to the primary care setting implies a potential lost opportunity to redirect older patients from ED services back to their GPs for ongoing care. What is known about the topic? Older patients are increasingly attending EDs, with a proportion attending for problems that could potentially be managed in the general practice setting (termed PAGP-type presentations). What does this paper add? This study found that PAGP-type presentations, although declining, remain an important component of ED demand. Patients presented for a wide array of conditions and during periods that may indicate difficulty accessing a GP. What are the implications for practitioners? Strategies to redirect PAGP-type presentations to the GP setting are required at both the primary and acute care levels. These include increasing out-of-hours GP services, better triaging and appointment management in GP clinics and improved communication between ED clinicians and patients’ GPs. Although some strategies have been implemented, further examination is required to assess their ongoing effectiveness.
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Tenbensel T, Chalmers L, Jones P, Appleton-Dyer S, Walton L, Ameratunga S. New Zealand's emergency department target - did it reduce ED length of stay, and if so, how and when? BMC Health Serv Res 2017; 17:678. [PMID: 28950856 PMCID: PMC5615466 DOI: 10.1186/s12913-017-2617-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 09/13/2017] [Indexed: 11/10/2022] Open
Abstract
Background In 2009, the New Zealand government introduced a hospital emergency department (ED) target – 95% of patients seen, treated or discharged within 6 h - in order to alleviate crowding in public hospital EDs. While these targets were largely met by 2012, research suggests that such targets can be met without corresponding overall reductions in ED length-of-stay (LOS). Our research explores whether the NZ ED time target actually reduced ED LOS, and if so, how and when. Methods We adopted a mixed-methods approach with integration of data sources. After selecting four hospitals as case study sites, we collected all ED utilisation data for the period 2006 to 2012. ED LOS data was derived in two forms-reported ED LOS, and total ED LOS - which included time spent in short-stay units. This data was used to identify changes in the length of ED stay, and describe the timing of these changes to these indicators. Sixty-eight semi-structured interviews and two surveys of hospital clinicians and managers were conducted between 2011 and 2013. This data was then explored to identify factors that could account for ED LOS changes and their timing. Results Reported ED LOS reduced in all sites after the introduction of the target, and continued to reduce in 2011 and 2012. However, total ED LOS only decreased from 2008 to 2010, and did not reduce further in any hospital. Increased use of short-stay units largely accounted for these differences. Interview and survey data showed changes to improve patient flow were introduced in the early implementation period, whereas increased ED resources, better information systems to monitor target performance, and leadership and social marketing strategies mainly took throughout 2011 and 2012 when total ED LOS was not reducing. Conclusions While the ED target clearly stimulated improvements in patient flow, our analysis also questions the value of ED targets as a long term approach. Increased use of short-stay units suggests that the target became less effective in ‘standing for’ improved timeliness of hospital care in response to increasing acute demand. As such, the overall challenges in managing demand for acute and urgent care in New Zealand hospitals remain. Electronic supplementary material The online version of this article (10.1186/s12913-017-2617-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tim Tenbensel
- Health Systems, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Private Bag, 92019, Auckland, 1142, New Zealand.
| | - Linda Chalmers
- Nursing Development Unit, Auckland City Hospital, Private Bag 92024, Auckland, 1142, New Zealand
| | - Peter Jones
- Adult Emergency Department, Auckland City Hospital, Private Bag 92024, Auckland, 1142, New Zealand
| | - Sarah Appleton-Dyer
- Health Systems, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Private Bag, 92019, Auckland, 1142, New Zealand
| | - Lisa Walton
- Health Systems, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Private Bag, 92019, Auckland, 1142, New Zealand
| | - Shanthi Ameratunga
- Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Private Bag, 92019, Auckland, 1142, New Zealand
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Lateef A, Lee SH, Fisher DA, Goh WP, Han HF, Segara UC, Sim TB, Mahadehvan M, Goh KT, Cheah N, Lim AYT, Phan PH, Merchant RA. Impact of inpatient Care in Emergency Department on outcomes: a quasi-experimental cohort study. BMC Health Serv Res 2017; 17:555. [PMID: 28806942 PMCID: PMC5557060 DOI: 10.1186/s12913-017-2491-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 08/01/2017] [Indexed: 11/24/2022] Open
Abstract
Background Hospitals around the world are faced with the issue of boarders in emergency department (ED), patients marked for admission but with no available inpatient bed. Boarder status is known to be associated with delayed inpatient care and suboptimal outcomes. A new care delivery system was developed in our institution where boarders received full inpatient care from a designated medical team, acute medical team (AMT), while still residing at ED. The current study examines the impact of this AMT intervention on patient outcomes. Methods We conducted a retrospective quasi-experimental cohort study to analyze outcomes between the AMT intervention and conventional care in a 1250-bed acute care tertiary academic hospital in Singapore. Study participants included patients who received care from the AMT, a matched cohort of patients admitted directly to inpatient wards (non-AMT) and a sample of patients prior to the intervention (pre-AMT group). Primary outcomes were length of hospital stay (LOS), early discharges (within 24 h) and bed placement. Secondary outcomes included unplanned readmissions within 3 months, and patient’s bill size. χ2- and Mann-Whitney U tests were used to test for differences between the cohorts on dichotomous and continuous variables respectively. Results The sample comprised of 2279 patients (1092 in AMT, 1027 in non-AMT, and 160 in pre-AMT groups). Higher rates of early discharge (without significant differences in the readmission rates) and shorter LOS were noted for the AMT patients. They were also more likely to be admitted into a ward allocated to their discipline and had lower bill size compared to non AMT patients. Conclusions The AMT intervention improved patient outcomes and resource utilization. This model was noted to be sustainable and provides a potential solution for hospitals’ ED boarders who face a gap in inpatient care during their crucial first few hours of admissions while waiting for an inpatient bed. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2491-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Aisha Lateef
- University Medicine Cluster, National University Hospital, 1E Kent Ridge Road, Singapore, 119074, Singapore. .,Yong Loo Lin School of Medicine, National University of Singapore, 12 Science Drive 2, Singapore, 117549, Singapore.
| | - Soo Hoon Lee
- Yong Loo Lin School of Medicine, National University of Singapore, 12 Science Drive 2, Singapore, 117549, Singapore.,The Johns Hopkins Carey Business School, 100 International Drive, Baltimore, MD, 21202, USA.,Strome College of Business, Old Dominion University, 2027 Constant Hall, Norfolk, VA, 23529, USA
| | - Dale Andrew Fisher
- University Medicine Cluster, National University Hospital, 1E Kent Ridge Road, Singapore, 119074, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, 12 Science Drive 2, Singapore, 117549, Singapore
| | - Wei-Ping Goh
- University Medicine Cluster, National University Hospital, 1E Kent Ridge Road, Singapore, 119074, Singapore
| | - Hui Fen Han
- University Medicine Cluster, National University Hospital, 1E Kent Ridge Road, Singapore, 119074, Singapore
| | - Uma Chandra Segara
- Emergency Medicine Department, National University Hospital, 1E Kent Ridge Road, Singapore, 119074, Singapore
| | - Tiong Beng Sim
- Emergency Medicine Department, National University Hospital, 1E Kent Ridge Road, Singapore, 119074, Singapore
| | - Malcolm Mahadehvan
- Emergency Medicine Department, National University Hospital, 1E Kent Ridge Road, Singapore, 119074, Singapore
| | - Khean Teik Goh
- National University Hospital, 1E Kent Ridge Road, Singapore, 119074, Singapore
| | - Noel Cheah
- National University Hospital, 1E Kent Ridge Road, Singapore, 119074, Singapore
| | - Aymeric Y T Lim
- Yong Loo Lin School of Medicine, National University of Singapore, 12 Science Drive 2, Singapore, 117549, Singapore.,Department of Hand and Reconstructive Microsurgery, National University Hospital, 1E Kent Ridge Road, Singapore, 119074, Singapore
| | - Phillip H Phan
- Yong Loo Lin School of Medicine, National University of Singapore, 12 Science Drive 2, Singapore, 117549, Singapore.,Carey Business School & Department of Medicine, Johns Hopkins University, 100 International Drive, Baltimore, MD, 21202, USA
| | - Reshma A Merchant
- University Medicine Cluster, National University Hospital, 1E Kent Ridge Road, Singapore, 119074, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, 12 Science Drive 2, Singapore, 117549, Singapore
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A systematic review of the impact of nurse-initiated medications in the emergency department. ACTA ACUST UNITED AC 2017; 20:53-62. [PMID: 28462830 DOI: 10.1016/j.aenj.2017.04.001] [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] [Received: 01/30/2017] [Revised: 03/16/2017] [Accepted: 04/03/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Nurse-initiated medications are one of the most important strategies used to facilitate timely care for people who present to Emergency Departments (EDs). The purpose of this paper was to systematically review the evidence of nurse-initiated medications to guide future practice and research. METHODS A systematic review of the literature was conducted to locate published studies and Grey literature. All studies were assessed independently by two independent reviewers for relevance using titles and abstracts, eligibility dictated by the inclusion criteria, and methodological quality. RESULTS Five experimental studies were included in this review: one randomised controlled trial and four quasi-experimental studies conducted in paediatric and adult EDs. The nurse-initiated medications were salbutamol for respiratory conditions and analgesia for painful conditions, which enabled patients to receive the medications quicker by half-an-hour compared to those who did not have nurse-initiated medications. The intervention had no effect on adverse events, doctor wait time and length of stay. Nurse-initiated analgesia was associated with increased likelihood of receiving analgesia, achieving clinically-relevant pain reduction, and better patient satisfaction. CONCLUSION Nurse-initiated medications are safe and beneficial for ED patients. However, randomised controlled studies are required to strengthen the validity of results.
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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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Nurse Staffing and Hospital Characteristics Predictive of Time to Diagnostic Evaluation for Patients in the Emergency Department. J Emerg Nurs 2017; 43:138-144. [DOI: 10.1016/j.jen.2016.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 04/14/2016] [Accepted: 07/14/2016] [Indexed: 11/18/2022]
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