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Davids J, Bohlken N, Brown M, Murphy M. What can be done about workplace wellbeing in emergency departments? 'There's no petrol for this Ferrari'. Int Emerg Nurs 2024; 75:101487. [PMID: 38936273 DOI: 10.1016/j.ienj.2024.101487] [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: 01/17/2024] [Revised: 05/27/2024] [Accepted: 06/12/2024] [Indexed: 06/29/2024]
Abstract
Workplace wellbeing encompasses all aspects of working life. Peak health organisations recognise that poor workplace wellbeing is costly, both to individuals and to the organisation, and the value in promoting healthy workplaces. Workplace wellbeing improves when its barriers are acknowledged and addressed, and protective factors are promoted. The Emergency Department (ED) is a place of intense and challenging activity, exacerbated by high workloads and overcrowding. This impacts negatively on patient care, staff safety and wellbeing. We held focus groups across four EDs to discuss barriers and enablers to wellbeing and found four core themes: Workplace Satisfaction; Barriers to Wellbeing; Organisational Culture that Prioritises Staff Wellbeing; Self-care and Self Compassion. From this, and existing literature, we collaboratively developed a contextualised staff wellbeing framework titled: 'Staff Wellbeing Good Practice Framework: From Surviving to Thriving, How to Protect your Wellbeing in the Emergency Department' that emphasises their values of Competence, Connection and Control.
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Affiliation(s)
- Jennifer Davids
- Western Sydney Local Health District, NSW Health, Australia.
| | - Nicole Bohlken
- Western Sydney Local Health District, NSW Health, Australia
| | | | - Margaret Murphy
- Western Sydney Local Health District, NSW Health, Australia; University of Sydney, Australia
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2
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Momesso T, Gokpinar B, Ibrahim R, Boyle AA. Effect of removing the 4-hour access standard in the ED: a retrospective observational study. Emerg Med J 2023; 40:630-635. [PMID: 37369563 DOI: 10.1136/emermed-2023-213142] [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: 02/06/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Time-based targets are used to improve patient flow and quality of care within EDs. While previous research often highlighted the benefits of these targets, some studies found negative consequences of their implementation. We study the consequences of removing the 4-hour access standard. METHODS We conducted a before and after, retrospective, observational study using anonymised, routinely collected, patient-level data from a single English NHS ED between April 2018 and December 2019. The primary outcomes of interest were the proportion of admitted patients, that is, the admission rate, the length of stay in the ED and ambulance handover times. We used interrupted time series models to study and estimate the impact of removing the 4-hour access standard. RESULTS A total of 169 916 attendances were included in the analysis. The interrupted time series models for the average daily admission rate indicate a drop from an estimated 35% to an estimated 31% (95% CI -4.1 to -3.9). This drop is only statistically significant for Majors (Ambulant) patients (from an estimated 38.3% to an estimated 31.4%) and, particularly, for short-stay admissions (from an estimated 18.1% to an estimated 12.8%). The models also show an increase in the average daily length of stay for admitted patients from an estimated 316 min to an estimated 387 min (95% CI 33.5 to 108.9), and an increase in the average daily length of stay for discharged patients from an estimated 222 min to an estimated 262 min (95% CI 6.9 to 40.4). CONCLUSION Lifting the 4-hour access standard reporting was associated with a drop in short-stay admissions to the hospital. However, it was also associated with an increase in the average length of stay in the ED. Our study also suggests that the removal of the 4-hour standard does not impact all patients equally. While certain patient groups such as those Majors (Ambulant) patients with less severe issues might have benefited from the removal of the 4-hour access standard by avoiding short-stay hospital admissions, the average length of stay in the ED seemed to have increased across all groups, particularly for older and admitted patients.
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Affiliation(s)
- Tomas Momesso
- UCL School of Management, University College London, London, UK
| | - Bilal Gokpinar
- UCL School of Management, University College London, London, UK
| | - Rouba Ibrahim
- UCL School of Management, University College London, London, UK
| | - Adrian A Boyle
- Emergency Department, Addenbrooke's Hospital Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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3
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Whitelock-Wainwright E, Koh JW, Whitelock-Wainwright A, Talic S, Rankin D, Gašević D. An exploration into physician and surgeon data sensemaking: a qualitative systematic review using thematic synthesis. BMC Med Inform Decis Mak 2022; 22:256. [PMID: 36171583 PMCID: PMC9520820 DOI: 10.1186/s12911-022-01997-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 09/12/2022] [Indexed: 11/10/2022] Open
Abstract
Providing electronic health data to medical practitioners to reflect on their performance can lead to improved clinical performance and quality of care. Understanding the sensemaking process that is enacted when practitioners are presented with such data is vital to ensure an improvement in performance. Thus, the primary objective of this research was to explore physician and surgeon sensemaking when presented with electronic health data associated with their clinical performance. A systematic literature review was conducted to analyse qualitative research that explored physicians and surgeons experiences with electronic health data associated with their clinical performance published between January 2010 and March 2022. Included articles were assessed for quality, thematically synthesised, and discussed from the perspective of sensemaking. The initial search strategy for this review returned 8,829 articles that were screened at title and abstract level. Subsequent screening found 11 articles that met the eligibility criteria and were retained for analyses. Two articles met all of the standards within the chosen quality assessment (Standards for Reporting Qualitative Research, SRQR). Thematic synthesis generated five overarching themes: data communication, performance reflection, infrastructure, data quality, and risks. The confidence of such findings is reported using CERQual (Confidence in the Evidence from Reviews of Qualitative research). The way the data is communicated can impact sensemaking which has implications on what is learned and has impact on future performance. Many factors including data accuracy, validity, infrastructure, culture can also impact sensemaking and have ramifications on future practice. Providing data in order to support performance reflection is not without risks, both behavioural and affective. The latter of which can impact the practitioner's ability to effectively make sense of the data. An important consideration when data is presented with the intent to improve performance.Registration This systematic review was registered with Prospero, registration number: CRD42020197392.
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Affiliation(s)
- Emma Whitelock-Wainwright
- Faculty of Information Technology, Centre for Learning Analytics (CoLAM), Monash University, Melbourne, Australia
- Practice Analytics, DHCRC, Sydney, Australia
| | - Jia Wei Koh
- Faculty of Information Technology, Centre for Learning Analytics (CoLAM), Monash University, Melbourne, Australia
- Practice Analytics, DHCRC, Sydney, Australia
| | | | - Stella Talic
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
- Practice Analytics, DHCRC, Sydney, Australia
| | - David Rankin
- Clinical Governance and Informatics, Cabrini Health, Melbourne, Australia
- Practice Analytics, DHCRC, Sydney, Australia
| | - Dragan Gašević
- Faculty of Information Technology, Centre for Learning Analytics (CoLAM), Monash University, Melbourne, Australia
- Practice Analytics, DHCRC, Sydney, Australia
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Bouda Abdulai AS, Mukhtar F, Ehrlich M. United States' Performance on Emergency Department Throughput, 2006 to 2016. Ann Emerg Med 2021; 78:174-190. [PMID: 33865616 DOI: 10.1016/j.annemergmed.2021.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 10/30/2020] [Accepted: 01/07/2021] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE Studies of early data found that US emergency departments (EDs) were characterized by prolonged patient waiting, long visit times, frequent and prolonged boarding (ie, patients kept waiting in ED hallways or other space outside the ED on admission to the hospital), and patients leaving without receiving or completing treatment. We sought to assess recent trends in ED throughput nationally. METHODS This was a retrospective cross-sectional analysis of data from the National Hospital Ambulatory Medical Care Survey from 2006 to 2016. We used survey-weighted generalized linear models to assess changes over time. The primary outcome variables were the number of visits, wait time to consult a physician, length of visit (time from arrival to leaving for home or hospital ward), boarding time, the proportion of patients leaving without being seen, the proportion treated within recommended waiting times, and the proportion dispositioned within 4, 6, and 8 hours. RESULTS Between 2006 and 2016, the number of ED visits increased from 119.2 million to 145.6 million. During this period, annual median wait time decreased from 31 minutes (interquartile range 14 to 67) to 17 minutes (interquartile range 6 to 45). The proportion of patients who left without being seen declined from 2.0% (95% confidence interval [CI] 1.7% to 2.4%) to 1.1% (95% CI 0.8% to 1.4%). The proportion treated by a qualified practitioner within recommended waiting times increased from 75.5% (95% CI 72.7% to 78.3%) to 80.8% (95% CI 77.2% to 84.4%). Overall, there was no statistically significant change in median length of visit. However, over time, decreased proportions of the sickest patients were discharged within 4, 6, and 8 hours, whereas increased proportions of low-acuity patients were discharged within 4 hours. The distribution of patient boarding time remained fairly unchanged from 2009 to 2015, with a median of approximately 75 minutes. CONCLUSION Overall, there was improvement in ED timeliness from 2006 to 2016. However, we observed a decrease in the proportion of the sickest patients discharged within 8 hours of arrival, although this may be due to increased ancillary testing or specially consultation over time.
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Affiliation(s)
- Abubakar Sadiq Bouda Abdulai
- Martin Tuchman School of Management, New Jersey Institute of Technology, Newark, NJ; New Jersey Innovation Institute Healthcare Delivery Systems iLab, Newark, NJ.
| | - Fahad Mukhtar
- Department of Behavioral Health, St. Elizabeths Hospital, Washington, DC
| | - Michael Ehrlich
- Martin Tuchman School of Management, New Jersey Institute of Technology, Newark, NJ
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Walker K, Honan B, Haustead D, Mountain D, Gangathimmaiah V, Forero R, Mitchell R, Martini E, Tesch G, Bissett I, Jones P. Review article: Have emergency department time-based targets influenced patient care? A systematic review of qualitative literature. Emerg Med Australas 2021; 33:202-213. [PMID: 33622021 DOI: 10.1111/1742-6723.13747] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 12/01/2022]
Abstract
Time-based targets for ED length of stay were introduced in England in 2000, followed by the rest of the UK, Canada, Ireland, New Zealand, and Australia after ED crowding was associated with poor quality of care and increased mortality. This systematic review evaluates qualitative literature to see if ED time-based targets have influenced patient care quality. We included 13 studies from four countries, incorporating 617 interviews. We conclude that time-based targets have impacted on the quality of emergency patient care, both positively and negatively. Successful implementation depends on whole hospital resourcing and engagement with targets.
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Affiliation(s)
- Katie Walker
- Emergency Department, Cabrini Institute, Melbourne, Victoria, Australia.,School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Bridget Honan
- Central Australian Retrieval Service, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Daniel Haustead
- Emergency Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - David Mountain
- Emergency Department, Sir Charles Gardner Hospital, Perth, Western Australia, Australia
| | - Vinay Gangathimmaiah
- Emergency Department, The Townsville Hospital, Townsville, Queensland, Australia
| | - Roberto Forero
- South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Rob Mitchell
- Emergency Department, Alfred Hospital, Melbourne, Victoria, Australia
| | | | - Greg Tesch
- Nephrology Department, Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Ian Bissett
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Peter Jones
- School of Medicine, The University of Auckland, Auckland, New Zealand
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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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7
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Man NWY, Forero R, Ngo H, Mountain D, FitzGerald G, Toloo GS, McCarthy S, Mohsin M, Fatovich DM, Bailey P, Bosley E, Carney R, Lai HMX, Hillman K. Impact of the Four-Hour Rule policy on emergency medical services delays in Australian EDs: a longitudinal cohort study. Emerg Med J 2020; 37:793-800. [PMID: 32669320 DOI: 10.1136/emermed-2019-208958] [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: 07/23/2019] [Revised: 05/26/2020] [Accepted: 05/29/2020] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Delayed handover of emergency medical services (EMS) patients to EDs is a major issue with hospital crowding considered a primary cause. We explore the impact of the 4-hour rule (the Policy) in Australia, focusing on ambulance and ED delays. METHODS EMS (ambulance), ED and hospital data of adult patients presenting to 14 EDs from 2002 to 2013 in three jurisdictions were linked. Interrupted time series 'Before-and-After' trend analysis was used for assessing the Policy's impact. Random effects meta-regression analysis was examined for associations between ambulance delays and Policy-associated ED intake, throughput and output changes. RESULTS Before the Policy, the proportion of ED ambulances delayed increased between 1.1% and 1.7% per quarter across jurisdictions. After Policy introduction, Western Australia's increasing trend continued but Queensland decreased by 5.1% per quarter. In New South Wales, ambulance delay decreased 7.1% in the first quarter after Policy introduction. ED intake (triage delay) improved only in New South Wales and Queensland. Each 1% ambulance delay reduction was significantly associated with a 0.91% reduction in triage delay (p=0.014) but not ED length of stay ≤4 hours (p=0.307) or access-block/boarding (p=0.605) suggesting only partial improvement in ambulance delay overall. CONCLUSION The Policy was associated with reduced ambulance delays over time in Queensland and only the immediate period in New South Wales. Associations may be due to local jurisdictional initiatives to improve ambulance performance. Strategies to alleviate ambulance delay may need to focus on the ED intake component. These should be re-examined with longer periods of post-Policy data.
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Affiliation(s)
- Nicola Wing Young Man
- Simpson Centre for Health Services Research, South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia.,National Drug and Alcohol Research Centre, University of New South Wales, Randwick, New South Wales, Australia
| | - Roberto Forero
- Simpson Centre for Health Services Research, South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia .,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Hanh Ngo
- Division of Emergency Medicine, Faculty of Health and Medical Services, University of Western Australia, Perth, Western Australia, Australia
| | - David Mountain
- Division of Emergency Medicine, Faculty of Health and Medical Services, University of Western Australia, Perth, Western Australia, Australia.,Emergency Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Gerard FitzGerald
- School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Ghasem Sam Toloo
- School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Sally McCarthy
- Emergency Department, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Prince of Wales Clinical School, University of New South Wales, Randwick, New South Wales, Australia
| | - Mohammed Mohsin
- Psychiatry Research and Teaching Unit, Liverpool Hospital, Liverpool, New South Wales, Australia.,School of Psychiatry, Faculty of Medicine, University of New South Wales, Randwick, New South Wales, Australia
| | - Daniel M Fatovich
- Division of Emergency Medicine, Faculty of Health and Medical Services, University of Western Australia, Perth, Western Australia, Australia.,Emergency Medicine, Royal Perth Hospital, Centre for Clinical Research in Emergency Medicine, Perth, Western Australia, Australia
| | - Paul Bailey
- St John Ambulance Western Australia, Perth, Western Australia, Australia
| | - Emma Bosley
- Queensland Ambulance Service, Brisbane, Queensland, Australia
| | - Rosemary Carney
- New South Wales Ambulance Service, Rozelle, New South Wales, Australia
| | - Harry Man Xiong Lai
- New South Wales Ambulance Service, Rozelle, New South Wales, Australia.,Discipline of Psychiatry, University Of Sydney, Sydney, New South Wales, Australia
| | - Ken Hillman
- Simpson Centre for Health Services Research, South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
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