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Lennon R, Krishnamohan A, Fitzpatrick L, Gillett M. CATCH IT: The Effect of Bladder Ultrasound in Decreasing the Time to Collect a Clean-Catch Urine Sample in the Nontoilet-Trained Child: A Randomized Control Trial. Pediatr Emerg Care 2024; 40:98-102. [PMID: 37011266 DOI: 10.1097/pec.0000000000002937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
OBJECTIVES Clean-catch urine is essential in the investigation of an unwell child but can unfortunately be difficult to obtain in nontoilet-trained children. To this end, we compared the difference in time taken to collect clean-catch urine in nontoilet-trained children via the use of point-of-care ultrasound and traditional methods. METHODS A single-center randomized controlled trial was conducted at an urban pediatric emergency department, recruiting 80 patients, of which 73 underwent data analyses. Participants were randomized to either the control arm, which consisted of the traditional "watch and wait" method of collecting a clean-catch sample, or to the intervention arm, which used point-of-care ultrasound to assess bladder volume and to stimulate the micturition reflex. The primary outcome measured was the mean time taken to collect a clean-catch urine sample. RESULTS Eighty patients (ultrasound, n = 41; standard care, n = 39) underwent randomization using a random number generator. Seven patients were removed from final analysis due to loss to follow-up for various reasons. Seventy-three patients (ultrasound, n = 37; standard care, n = 36) underwent statistical analysis. The ultrasound group had a median time to clean-catch urine of 40 minutes (interquartile range, 52) and mean time of 52 minutes (standard deviation, 42), and the control group had a median time of 55 minutes (interquartile range, 81), and mean time of 82 minutes (standard deviation, 90). This reached statistical significance (1-tail t test, P = 0.033). The baseline characteristics were similar between both groups for sex and age distribution; however, the mean ages were significantly different (2-tail t test, P = 0.049) with 8.4 months in the control group, and 12.3 months in the ultrasound group. CONCLUSIONS We found that there was a statistically and clinically significant reduction in mean time taken to collect clean-catch urine in nontoilet-trained children using point-of-care ultrasound compared with the traditional watch and wait method.
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Affiliation(s)
| | - Anirudh Krishnamohan
- From the Pediatric Emergency Department, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Lesley Fitzpatrick
- From the Pediatric Emergency Department, Royal North Shore Hospital, Sydney, NSW, Australia
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Berkowitz D, Cohen JS, McCollum N, Rojas CR, Chamberlain JM. Delays in treatment and disposition attributable to undertriage of pediatric emergency medicine patients. Am J Emerg Med 2023; 74:130-134. [PMID: 37826993 DOI: 10.1016/j.ajem.2023.09.054] [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: 07/13/2023] [Revised: 09/20/2023] [Accepted: 09/30/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Triage, the initial assessment and sorting of patients in the Emergency Department (ED), determines priority of evaluation and treatment. Little is known about the impact of undertriage, the underestimation of disease severity at triage, on clinical care in pediatric ED patients. We evaluate the impact of undertriage on time to disposition and treatment decisions in pediatric ED patients. METHODS This was a case control study of ED visits for patients <22 years of age, with an assigned Emergency Severity Index (ESI) score of 4 or 5, and associated hospital admission, nebulized treatment, supplemental oxygen, and/or intravenous (IV) line placement, between January 1, 2018, to June 30, 2022. Controls were sampled from a pool of patient visits with an ESI score of 3, matched by intervention, disposition, and date and hour of arrival. Primary outcome measures were time to order of intervention (nebulized treatment, oxygen administration, or IV placement) and time to disposition decision. A secondary outcome measure was return visits requiring admission or emergency intervention within 14 days of the index visit. Continuous variables (time to orders) were analyzed using Wilcoxon rank sum test and dichotomous outcomes (return visits) were compared using odds ratios with 95% confidence intervals. Analysis was performed with Python v3.10. RESULTS The final analysis included 7245 undertriaged patients. Undertriaged patients had longer times to orders for nebulized treatments, (p < 0.001) IV placement, (p < 0.001) and admission (p < 0.001) when compared to controls. There were no significant differences in time to supplemental oxygen delivery and time to discharge compared to controls. Undertriaged patients were more likely to experience a return visit requiring admission or emergency intervention (OR 3.74, 95% CI 3.32,4.22). CONCLUSIONS Undertriage in the pediatric ED is associated with delays in care and disposition decisions and increases likelihood of return visits.
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Affiliation(s)
- Deena Berkowitz
- Division of Emergency Medicine, Children's National Hospital, Washington, DC, United States of America; The George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America.
| | - Joanna S Cohen
- Division of Pediatric Emergency Medicine, Johns Hopkins University, United States of America; Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Nichole McCollum
- Division of Emergency Medicine, Children's National Hospital, Washington, DC, United States of America; The George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America
| | - Christina R Rojas
- Division of Emergency Medicine, Children's National Hospital, Washington, DC, United States of America; The George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America
| | - James M Chamberlain
- Division of Emergency Medicine, Children's National Hospital, Washington, DC, United States of America; The George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America
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3
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Tsao H, Macdonald R, Dwyer D, Harper T, Rutz D, Sutherland J. Prolonged length of stay is associated with reduced hand hygiene compliance in the emergency department: A single centre retrospective study. Emerg Med Australas 2023; 35:213-217. [PMID: 36184077 DOI: 10.1111/1742-6723.14097] [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: 06/26/2022] [Revised: 09/09/2022] [Accepted: 09/14/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine whether patient flow factors in the ED such as prolonged length of stay are associated with hand hygiene (HH) compliance. METHODS We conducted a retrospective study at an urban district hospital utilising available data from January 2018 to December 2021. Compliance to the World Health Organization five moments of HH expressed as percentage of total moments observed were collated every 2 months. Patient flow measures including proportion of patients referred or discharged within 4 h (LOS4), proportion of patients with ED length of stay >24 h (LOS24) and total number of patient presentations, were obtained for each 2-month periods. The association between these patient flow measures and HH compliance was examined using Pearson's correlation (P < 0.05). RESULTS The results showed a moderate and significant association between rates of HH compliance and LOS24 (r = -0.48, P = 0.025). That is, lower proportion of patients with ED length of stay >24 h was associated with improved HH compliance. There was no significant correlation between HH compliance and LOS4 (r = 0.38, P = 0.085) or total number of ED presentations (r = -0.30, P = 0.17). CONCLUSIONS The findings show that prolonged ED length of stay may explain, at least partly, lower rates of HH compliance. Improvements in ED HH compliance should also include strategies that enhance patient flow.
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Affiliation(s)
- Henry Tsao
- Emergency Department, Redland Hospital, Brisbane, Queensland, Australia
| | - Rachel Macdonald
- Emergency Department, Redland Hospital, Brisbane, Queensland, Australia
| | - Damien Dwyer
- Emergency Department, Redland Hospital, Brisbane, Queensland, Australia
| | - Tracey Harper
- Infection Control, Redland Hospital, Brisbane, Queensland, Australia
| | - Dominik Rutz
- Emergency Department, Redland Hospital, Brisbane, Queensland, Australia
| | - John Sutherland
- Emergency Department, Redland Hospital, Brisbane, Queensland, Australia
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4
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Integrating Nurse Practitioner–Led Mental Health Care in Emergency Departments. J Nurse Pract 2023. [DOI: 10.1016/j.nurpra.2023.104557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
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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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Burke C, Dolan E, Faul J, Donohoe K, Ogbebor E, O'Carroll O, Tormey W. Delayed hospital discharges and the trolley crisis. Ir J Med Sci 2023; 192:11-14. [PMID: 35182289 DOI: 10.1007/s11845-022-02924-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/09/2021] [Indexed: 02/04/2023]
Abstract
We audited use of acute hospital beds in Connolly Hospital over a 3-month period (January-March 2020) which coincided with increased provision of step-down (nursing home) beds. Our results show both ineffective and inefficient baseline uses of these acute beds. Increased step-down beds improve patient care by reducing the trolley count, shortening average length of stay and reducing waiting lists. These data confirm that more step-down beds are a high priority for our Health Service to improve the effectiveness and efficiency of our hospitals i.e. better care at less cost.
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Affiliation(s)
- Conor Burke
- Department of Medicine, Connolly Hospital, Dublin 15, Blanchardstown, Ireland.
| | - Eamon Dolan
- Department of Medicine, Connolly Hospital, Dublin 15, Blanchardstown, Ireland
| | - John Faul
- Department of Medicine, Connolly Hospital, Dublin 15, Blanchardstown, Ireland
| | - Kevin Donohoe
- Department of Medicine, Connolly Hospital, Dublin 15, Blanchardstown, Ireland
| | - Estella Ogbebor
- Department of Medicine, Connolly Hospital, Dublin 15, Blanchardstown, Ireland
| | - Orla O'Carroll
- Department of Medicine, Connolly Hospital, Dublin 15, Blanchardstown, Ireland
| | - William Tormey
- Department of Medicine, Connolly Hospital, Dublin 15, Blanchardstown, Ireland
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Wessman T, Ärnlöv J, Carlsson AC, Ekelund U, Wändell P, Melander O, Ruge T. The association between length of stay in the emergency department and short-term mortality. Intern Emerg Med 2022; 17:233-240. [PMID: 34110561 PMCID: PMC8841314 DOI: 10.1007/s11739-021-02783-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/31/2021] [Indexed: 11/25/2022]
Abstract
The detrimental effects of increased length of stay at the emergency department (ED-LOS) for patient outcome have been sparsely studied in the Swedish setting. Our aim was to further explore the association between ED-LOS and short-term mortality in patients admitted to the EDs of two large University hospitals in Sweden. All adult patients (> 18 years) visiting the ED at the Karolinska University Hospital, Sweden, from 1/1/2010 to 1/1/2015 (n = 639,385) were retrospectively included. Logistic regression analysis was used to determine association between ED-LOS and 7- and 30-day mortality rates. All patients were triaged according to the RETTS-A into different levels of medical urgency and subsequently separated into five quintiles of ED-LOS. Mortality rate was highest in highest triage priority level (7-day mortality 5.24%, and 30-day mortality 9.44%), and decreased by lower triage priority group. For patients with triage priority levels 2-4, prolonged ED-LOS was associated with increased mortality, especially for lowest priority level, OR for priority level 4 and highest quintile of ED-LOS 30-day mortality 1.49 (CI 95% 1.20-1.85). For patients with highest triage priority level the opposite was at hand, with decreasing mortality risk with increasing quintile of ED-LOS for 7-day mortality, and lower mortality for the two highest quintile of ED-LOS for 30-day mortality. In patients not admitted to in-hospital care higher ED-LOS was associated with higher mortality. Our data suggest that increased ED-LOS could be associated with slightly increased short-term mortality in patients with lower clinical urgency and dismissed from the ED.
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Affiliation(s)
- Torgny Wessman
- grid.4514.40000 0001 0930 2361Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
- grid.411843.b0000 0004 0623 9987Emergency Department, Skåne University Hospital, Malmö, Sweden
| | - Johan Ärnlöv
- grid.4714.60000 0004 1937 0626Division for Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- grid.411953.b0000 0001 0304 6002School of Health and Social Studies, Dalarna University, Falun, Sweden
| | - Axel Carl Carlsson
- grid.4714.60000 0004 1937 0626Division for Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
| | - Ulf Ekelund
- grid.4514.40000 0001 0930 2361Department of Clinical Sciences Lund, Emergency Medicine, Faculty of Medicine, Lund University, Lund, Sweden
| | - Per Wändell
- grid.4714.60000 0004 1937 0626Division for Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Olle Melander
- grid.4514.40000 0001 0930 2361Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
- grid.411843.b0000 0004 0623 9987Emergency Department, Skåne University Hospital, Malmö, Sweden
| | - Toralph Ruge
- grid.4514.40000 0001 0930 2361Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
- grid.411843.b0000 0004 0623 9987Emergency Department, Skåne University Hospital, Malmö, Sweden
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Burgess L, Ray-Barruel G, Kynoch K. Association between emergency department length of stay and patient outcomes: A systematic review. Res Nurs Health 2021; 45:59-93. [PMID: 34932834 DOI: 10.1002/nur.22201] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 11/16/2021] [Accepted: 11/27/2021] [Indexed: 11/09/2022]
Abstract
In this review, we investigate associations between time spent in the emergency department (ED) and patient reported outcomes. ED staff provide initial assessment, treatment and referral to patients presenting with an acute status to the hospital 24 h a day. ED length of stay, including ED boarding, and treatment received in the ED may affect patient outcomes. In this review we considered published studies that explored the association of ED length of stay of individuals of any age with their subsequent outcomes, including mortality and inpatient length of stay (IPLOS). Joanna Briggs Institute methods for systematic reviews of association were followed. Search strategies were developed to identify studies published in English since 2000 for inclusion. Two reviewers assessed the studies for inclusion and methodological quality and extracted data independently. In total, 34 studies were included in the review, including one case-control, one analytical cross-sectional, and 32 retrospective cohort studies, with a total sample size of 2,308,840 patients. Overall, there were variable associations of time spent in the ED and mortality, IPLOS, time-to-treatment and adverse events. However, findings indicated that older people are at risk for longer ED stays. They may also experience higher mortality. Specific focus should be placed upon elderly people in the ED, to reduce their exposure to the ED environment where possible and to implement focused initiatives that address their specific and complex treatment needs. We conclude that the diversity of individual settings and health systems will require locally defined and relevant solutions to locally identified issues.
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Affiliation(s)
- Luke Burgess
- Emergency Department, QEII Jubilee Hospital, Coopers Plains, Queensland, Australia
| | - Gillian Ray-Barruel
- School of Nursing and Midwifery Griffith University, Nursing Services, QEII Jubilee Hospital, Coopers Plains, Queensland, Australia
| | - Kathryn Kynoch
- Mater Health and Queensland Centre for Evidence Based Nursing and Midwifery: a Joanna Briggs Centre of Excellence, Mater Misericordiae Limited, South Brisbane, Queensland, Australia.,Australian Centre for Health Services Innovation (AusHSI) and School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
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Curtis K, Sivabalan P, Bedford DS, Considine J, D'Amato A, Shepherd N, Fry M, Munroe B, Shaban RZ. Implementation of a structured emergency nursing framework results in significant cost benefit. BMC Health Serv Res 2021; 21:1318. [PMID: 34886873 PMCID: PMC8655998 DOI: 10.1186/s12913-021-07326-y] [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: 06/10/2021] [Accepted: 11/17/2021] [Indexed: 12/02/2022] Open
Abstract
Background Patients are at risk of deterioration on discharge from an emergency department (ED) to a ward, particularly in the first 72 h. The implementation of a structured emergency nursing framework (HIRAID) in regional New South Wales (NSW), Australia, resulted in a 50% reduction of clinical deterioration related to emergency nursing care. To date the cost implications of this are unknown. The aim of this study was to determine any net financial benefits arising from the implementation of the HIRAID emergency nursing framework. Methods This retrospective cohort study was conducted between March 2018 and February 2019 across two hospitals in regional NSW, Australia. Costs associated with the implementation of HIRAID at the study sites were calculated using an estimate of initial HIRAID implementation costs (AUD) ($492,917) and ongoing HIRAID implementation costs ($134,077). Equivalent savings per annum (i.e. in less patient deterioration) were calculated using projected estimates of ED admission and patient deterioration episodes via OLS regression with confidence intervals for incremental additional deterioration costs per episode used as the basis for scenario analysis. Results The HIRAID-equivalent savings per annum exceed the costs of implementation under all scenarios (Conservative, Expected and Optimistic). The estimated preliminary savings to the study sites per annum was $1,914,252 with a payback period of 75 days. Conservative projections estimated a net benefit of $1,813,760 per annum by 2022–23. The state-wide projected equivalent savings benefits of HIRAID equalled $227,585,008 per annum, by 2022–23. Conclusions The implementation of HIRAID reduced costs associated with resources consumed from patient deterioration episodes. The HIRAID-equivalent savings per annum to the hospital exceed the costs of implementation across a range of scenarios, and upscaling would result in significant patient and cost benefit.
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Affiliation(s)
- Kate Curtis
- Susan Wakil School of Nursing, Faculty of Medicine and Health, University of Sydney, Office 169, RC Mills Building, Camperdown, NSW, Australia. .,Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Crown St, Wollongong, NSW, Australia. .,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia. .,George Institute for Global Health, University of NSW, Kensington, Australia. .,Faculty of Medicine and Health, University of Wollongong, Wollongong, NSW, Australia.
| | - Prabhu Sivabalan
- Business School, University of Technology Sydney, Sydney, NSW, Australia
| | - David S Bedford
- Performance Analysis for Transformation in Healthcare (PATH) Group, UTS Business School, Ultimo, NSW, Australia
| | - Julie Considine
- Deakin University, School of Nursing and Midwifery, Geelong, NSW, Australia.,Deakin University, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Geelong, Victoria, Australia.,Centre for Quality and Patient Safety Research - Eastern Health Partnership, Box Hill, Victoria, Australia
| | - Alfa D'Amato
- Performance Analysis for Transformation in Healthcare (PATH) Group, UTS Business School, Ultimo, NSW, Australia.,System Financial Performance, NSW Ministry of Health, North Sydney, NSW, Australia
| | - Nada Shepherd
- Illawarra Shoalhaven Local Health District, Warrawong, NSW, Australia
| | - Margaret Fry
- Susan Wakil School of Nursing, Faculty of Medicine and Health, University of Sydney, Office 169, RC Mills Building, Camperdown, NSW, Australia.,School of Nursing and Midwifery, University of Technology Sydney, Sydney, NSW, Australia.,Research & Practice Development Unit, Northern Sydney Local Health District, St Leonards, Sydney, NSW, Australia
| | - Belinda Munroe
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia.,Illawarra Shoalhaven Local Health District, Warrawong, NSW, Australia
| | - Ramon Z Shaban
- Susan Wakil School of Nursing, Faculty of Medicine and Health, University of Sydney, Office 169, RC Mills Building, Camperdown, NSW, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Westmead, NSW, Australia.,Division of Infectious Diseases and Sexual Health, Westmead Hospital and the New South Wales Biocontainment Centre, Western Sydney Local Heath District and New South Wales Ministry of Health, Westmead, NSW, Australia
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10
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Wand T, Collett G, Keep J, Cutten A, Stack A, White K. Mental Health Nurses' Experiences of Working in the Emergency Department of Two Rural Australian Settings. Issues Ment Health Nurs 2021; 42:893-898. [PMID: 33979236 DOI: 10.1080/01612840.2021.1913773] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Providing effective mental health care in Emergency Departments (ED) is a fundamental expectation, as EDs increasingly become the first point of contact with health services for people in mental distress. As part of a larger multi-site translational research project this study explored the experiences, perspectives and recommendations of mental health liaison nurses (MHLN) employed in the EDs of two rural hospitals in New South Wales, Australia. Participants identified numerous benefits associated with embedding the MHLNs within the ED team. Some challenges associated with changing thinking and practice were recognised and recommendations for improving ED mental health care provided.
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Affiliation(s)
- Timothy Wand
- Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, NSW, Australia.,Emergency Department, Royal Prince Alfred Hospital Sydney Local Health District, NSW, Australia
| | - Gemma Collett
- Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Joel Keep
- Illawarra Shoalhaven Mental Health Service, NSW, Australia
| | - Alexa Cutten
- Hunter New England Local Health District, NSW, Australia
| | - Amanda Stack
- Western NSW Local Health District, NSW, Australia
| | - Kathryn White
- Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, NSW, Australia
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11
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Bein KJ, Berendsen Russell S, Ní Bhraonáin S, Seimon RV, Dinh MM. Does volume or occupancy influence emergency access block? A multivariate time series analysis from a single emergency department in Sydney, Australia during the COVID-19 pandemic. Emerg Med Australas 2021; 33:343-348. [PMID: 33387421 DOI: 10.1111/1742-6723.13717] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/09/2020] [Accepted: 12/17/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study aims to determine whether ED presentation volume or hospital occupancy had a greater impact on ED performance before and during the COVID-19 health response at a tertiary referral hospital in Sydney, Australia. METHODS Single centre time series analysis using routinely collected hospital and ED data from January 2019 to September 2020. The primary outcome was ED access block measured by emergency treatment performance (ETP; i.e. percentage of patients who were discharged or transferred to a ward from ED within 4 h of ED arrival time). Secondary outcomes were hospital occupancy, elective theatre cases and ambulance ramping. Multivariate time series analysis was performed using vector autoregression, to model effects of changes in various endogenous and correlated variables on ETP. RESULTS There was an increase in ETP, drop in ED presentations and decrease in hospital occupancy between April and June 2020. Elective surgery and hospital occupancy had significant effects up to 2 days prior on ETP, while there were no significant effects of either ED or ambulance presentations on ETP. Hospital occupancy itself increased with ED presentations after 2-4 days and decreased with elective surgery after 1 day. Shocks (a one standard deviation increase) in hospital occupancy had a peak impact nearly two times greater compared to ED presentations (-1.43, 95% confidence interval -1.92, -0.93 vs -0.73, 95% confidence interval -1.21, -0.25). CONCLUSION The main determinants of the reduction of ED overcrowding and access block during the pandemic were associated with reductions in hospital occupancy and elective surgery levels, and more research is required to assess more complex associations beyond the scope of this manuscript.
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Affiliation(s)
- Kendall J Bein
- RPA Green Light Institute for Emergency Care, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Saartje Berendsen Russell
- RPA Green Light Institute for Emergency Care, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Sinéad Ní Bhraonáin
- RPA Green Light Institute for Emergency Care, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Radhika V Seimon
- RPA Green Light Institute for Emergency Care, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Michael M Dinh
- RPA Green Light Institute for Emergency Care, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
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12
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Dinh MM, Berendsen Russell S. Overcrowding kills: How COVID‐19 could reshape emergency department patient flow in the new normal. Emerg Med Australas 2020. [DOI: 10.1111/1742-6723.13700] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Michael M Dinh
- The RPA Green Light Institute for Emergency Care Royal Prince Alfred Hospital Sydney New South Wales Australia
| | - Saartje Berendsen Russell
- The RPA Green Light Institute for Emergency Care Royal Prince Alfred Hospital Sydney New South Wales Australia
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