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Abstract
Emergency department (ED) operations reflect the intersection of factors external and internal to the ED itself, with unique problems posed by community and academic environments. ED crowding is primarily caused by a lack of inpatient beds for patients admitted through the ED. Changes to front-end operations, such as point-of-care testing and putting physicians in triage, can yield benefits in throughput, but require individual cost analyses. Balancing physician workloads can lead to substantial improvements in throughput. Observation pathways can reduce crowding while maintaining safety. Physician and nurse well-being is an underappreciated topic within operations, and demands close attention and further research.
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Aaronson EL, Yun BJ. Emergency department shifts and decision to admit: is there a lever to pull to address crowding? BMJ Qual Saf 2020; 29:443-445. [DOI: 10.1136/bmjqs-2019-010554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2019] [Indexed: 11/03/2022]
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Rasouli HR, Aliakbar Esfahani A, Abbasi Farajzadeh M. Challenges, consequences, and lessons for way-outs to emergencies at hospitals: a systematic review study. BMC Emerg Med 2019; 19:62. [PMID: 31666023 PMCID: PMC6822347 DOI: 10.1186/s12873-019-0275-9] [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: 01/08/2019] [Accepted: 10/09/2019] [Indexed: 11/10/2022] Open
Abstract
Background Emergency Department (ED) overcrowding adversely affects patients’ health, accessibility, and quality of healthcare systems for communities. Several studies have addressed this issue. This study aimed to conduct a systematic review study concerning challenges, lessons and way outs of clinical emergencies at hospitals. Methods Original research articles on crowding of emergencies at hospitals published from 1st January 2007, and 1st August 2018 were utilized. Relevant studies from the PubMed and EMBASE databases were assessed using suitable keywords. Two reviewers independently screened the titles, abstracts and the methodological validity of the records using data extraction format before their inclusion in the final review. Discussions with the senior faculty member were used to resolve any disagreements among the reviewers during the assessment phase. Results Out of the total 117 articles in the final record, we excluded 11 of them because of poor quality. Thus, this systematic review synthesized the reports of 106 original articles. Overall 14, 55 and 29 of the reviewed refer to causes, effects, and solutions of ED crowding, respectively. The review also included four articles on both causes and effects and another four on causes and solutions. Multiple individual patients and healthcare system related challenges, experiences and responses to crowding and its consequences are comprehensively synthesized. Conclusion ED overcrowding is a multi-facet issue which affects by patient-related factors and emergency service delivery. Crowding of the EDs adversely affected individual patients, healthcare delivery systems and communities. The identified issues concern organizational managers, leadership, and operational level actions to reduce crowding and improve emergency healthcare outcomes efficiently.
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Affiliation(s)
- Hamid Reza Rasouli
- Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| | - Ali Aliakbar Esfahani
- Marine Medicine Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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4
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A Retrospective Cohort Study of the Effect of Hospitalist-Directed Transfers on Patient Flow. J Gen Intern Med 2019; 34:1968-1970. [PMID: 31161569 PMCID: PMC6816622 DOI: 10.1007/s11606-019-05072-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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5
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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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Yoo J, Soh JY, Lee WH, Chang DK, Lee SU, Cha WC. Experience of Emergency Department Patients With Using the Talking Pole Device: Prospective Interventional Descriptive Study. JMIR Mhealth Uhealth 2018; 6:e191. [PMID: 30467105 PMCID: PMC6284145 DOI: 10.2196/mhealth.9676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 06/18/2018] [Accepted: 08/21/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Patient engagement is important. However, it can be difficult in emergency departments (EDs). OBJECTIVE The aim of this study was to evaluate the satisfaction of ED patients using a patient-friendly health information technology (HIT) device, the "Talking Pole," and to assess the factors relevant to their satisfaction. METHODS This study was conducted in May 2017 at the ED of a tertiary hospital. The "Talking Pole" is a smartphone-based device attached to a intravenous infusion pole with sensors. It is capable of sensing patient movement and fluid dynamics. In addition, it provides clinical information from electronic medical records to patients and serves as a wireless communication tool between patients and nurses. Patients and caregivers who entered the observation room of the ED were selected for the study. The "Talking Pole" devices were provided to all participants, regardless of their need for an intravenous pole upon admittance to the ED. After 2 hours, each participant was given an 18-item questionnaire created for this research, measured on a 5-point Likert scale, regarding their satisfaction with "Talking Pole." RESULTS Among 52 participants recruited, 54% (28/52) were patients and the remaining were caregivers. In total, 38% (20/52) were male participants; the average age was 54.6 (SD 12.9) years, and 63% (33/52) of the participants were oncology patients and their caregivers. The overall satisfaction rate was 4.17 (SD 0.79 ) points. Spearman correlation coefficient showed a strong association of "overall satisfaction" with "comparison to the previous visit" (ρ=.73 ), "perceived benefit" (ρ=.73), "information satisfaction" (ρ=.70), and "efficiency" (ρ=.70). CONCLUSIONS In this study, we introduced a patient-friendly HIT device, the "Talking Pole." Its architecture focused on enhancing information delivery, which is regarded as a bottleneck toward achieving patient engagement in EDs. Patient and caregiver satisfaction with the "Talking Pole" was positive in the ED environment. In particular, correlation coefficient results improved our understanding about patients' satisfaction, HIT devices, and services used in the ED.
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Affiliation(s)
- Junsang Yoo
- Department of Digital Health, Samsung Advanced Institute of Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Ji Yeong Soh
- Department of Digital Health, Samsung Advanced Institute of Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Wan Hyoung Lee
- Creative Laboratory, Samsung Electronics, Suwon, Republic of Korea
| | - Dong Kyung Chang
- Department of Digital Health, Samsung Advanced Institute of Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea.,Department of Gastroenterology, Samsung Medical Center, Seoul, Republic of Korea.,Health Information Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Se Uk Lee
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Won Chul Cha
- Department of Digital Health, Samsung Advanced Institute of Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea.,Health Information Center, Samsung Medical Center, Seoul, Republic of Korea.,Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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7
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Lee N, Ahn Y, Kim Y, Lee J, Cho K, Hwang SY, Shin T, Ha Y, Kim Y, Hong C. Holiday Fast-Track Reduced Medical Cost and Length of Emergency Department Stay: Preliminary Report from a Single Secondary Care Hospital. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791502200202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction The aims of this study were to compare the effect of a Holiday Fast-Track (HFT) unit on medical costs and emergency department (ED) length of stay (LOS) associated with low acuity patients attended during the same timeframe in two consecutive years in a single secondary care hospital ED. Methods Two groups (non-HFT vs. HFT), before and after the fast-track unit was implemented, were compared. The HFT unit was operated to improve the flow of low acuity patients, which were defined as the patients classified as level 4 or 5 by the modified Canadian Triage and Acuity Scale. Data were collected from March 1 to April 30, 2011 for the non-HFT group and during the same period in 2012 for the HFT group. Results A total of 894 (431 for non-HFT period and 463 for HFT period) patients of acuity level 4 or 5 visited the ED during the study period. Compared to the non-HFT group, the ED LOS of the HFT group decreased by 27 min and 3.5 min in the patients with acuity levels 4 and 5, respectively (p=0.005 and p=0.003, respectively). Furthermore, total medical costs and laboratory fees were also reduced significantly in the HFT group (p<0.001, p=0.038). However, there was no difference in the other variables between those two groups. Conclusions The HFT system decreases the medical costs and LOS in low acuity patients visiting the ED of a secondary care hospital. (Hong Kong j.emerg.med. 2015;22:84-92)
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Affiliation(s)
- Nk Lee
- Samsung Changwon Hospital, Department of Nursing Medicine, Sungkyunkwan University School of Medicine, South Korea
| | - Yr Ahn
- Samsung Changwon Hospital, Department of Nursing Medicine, Sungkyunkwan University School of Medicine, South Korea
| | - Yh Kim
- Samsung Changwon Hospital, Department of Nursing Medicine, Sungkyunkwan University School of Medicine, South Korea
| | - Jh Lee
- Samsung Changwon Hospital, Department of Nursing Medicine, Sungkyunkwan University School of Medicine, South Korea
| | - Kw Cho
- Samsung Changwon Hospital, Department of Nursing Medicine, Sungkyunkwan University School of Medicine, South Korea
| | | | - Ty Shin
- Bundang Jesaeng General Hospital, Department of Emergency Medicine, Daejin Medical Center, South Korea
| | - Yr Ha
- Bundang Jesaeng General Hospital, Department of Emergency Medicine, Daejin Medical Center, South Korea
| | - Ys Kim
- Bundang Jesaeng General Hospital, Department of Emergency Medicine, Daejin Medical Center, South Korea
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Emergency Overcrowding Impact on the Quality of Care of Patients Presenting with Acute Stroke. ADVANCED JOURNAL OF EMERGENCY MEDICINE 2017; 2:e3. [PMID: 31172066 PMCID: PMC6548098 DOI: 10.22114/ajem.v0i0.25] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Introduction: Emergency overcrowding is defined as when the amount of care required for patients overcomes the available amount. This can cause delays in delivering critical care in situations like stroke. Objective: The aim of this study was to assess the possible impact of emergency department (ED) crowding on the quality of care for acute stroke patients. Methods: In this cross-sectional prospective study, all patients with symptoms of acute stroke presenting to the ED of educational hospitals were enrolled. All patients were assessed and examined by the emergency medicine (EM) residents on shift and a questionnaire was filled out for them. The amount of time that passed from the first triage to performing the required interventions and delivering health services were recorded by the triage nurse. ED crowding was measured by the occupancy rate. Then, the correlation between all of the variables and ED crowding level were calculated. Results: The average daily bed occupancy rate was 184.9 ± 54.3%. The median time passed from the first triage to performing the interventions were as follows: the first EM resident visit after 34 min, the first neurologic visit after 138 min, head CT after 134 min, ECG after 104 min and ASA administration after 210 min. There was no statistically significant relationship between the ED occupancy rate and the time elapsed before different required health services in the management of stroke patients either throughout an entire day or during each 8-hour interval (p > 0.05). Conclusion: In the current study, the ED occupancy rate was not significantly correlated with the time frame associated with management of admitted acute stroke patients.
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Paek SH, Kim DK, Lee JH, Kwak YH. The Impact of Middle East Respiratory Syndrome Outbreak on Trends in Emergency Department Utilization Patterns. J Korean Med Sci 2017; 32:1576-1580. [PMID: 28875599 PMCID: PMC5592169 DOI: 10.3346/jkms.2017.32.10.1576] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 06/24/2017] [Indexed: 12/14/2022] Open
Abstract
Changes occurred in the patterns of utilization of emergency medical services during the Middle East respiratory syndrome (MERS) outbreak. The purpose of this study was to analyze the patterns of adult and pediatric patients who visited the emergency department (ED) during the outbreak. This retrospective study was conducted by analyzing changes in the patterns of visits among adult and pediatric patients in the ED at one tertiary teaching hospital in Korea. The study was performed from June 1, 2013 to July 31, 2015. The MERS outbreak period was from June 1 to July 31, 2015, and we compared that period to the same periods in 2013 and 2014. We compared and analyzed the patients' characteristics, emergency severity index (ESI) level at the visit, cause of visit, diagnosis, final dispositions, injury/non-injury, length of stay at the ED (EDLOS), and hospitalization rate. A total of 9,107 patients visited the ED during this period. Of these patients, 2,572 (28.2%) were pediatric patients and 6,535 (71.8%) were adult patients. The most common cause of an ED visit was fever (adult patients: 21.6%, pediatric patients: 56.2%). The proportion of non-urgent visits involving an ESI level of 4 or 5 and the EDLOS decreased significantly in pediatric and adult patients in comparison to that during the past two years. This change was significant in pediatric patients. Among adult patients, the rate of injury decreased, whereas it increased among pediatric patients. During the MERS outbreak period, pediatric ED visits due to non-urgent cases decreased significantly and there were more pronounced differences in ED utilization patterns in pediatric patients than in adult patients.
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Affiliation(s)
- So Hyun Paek
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Emergency Medicine, Kangwon National University, Graduate School of Medicine, Chuncheon, Korea
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.
| | - Jin Hee Lee
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young Ho Kwak
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
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Ahn JY, Ryoo HW, Park J, Kim JK, Lee MJ, Kim JY, Shin SD, Cha WC, Seo JS, Kim YA. New Intervention Model of Regional Transfer Network System to Alleviate Crowding of Regional Emergency Medical Center. J Korean Med Sci 2016; 31:806-13. [PMID: 27134506 PMCID: PMC4835610 DOI: 10.3346/jkms.2016.31.5.806] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 01/15/2016] [Indexed: 11/20/2022] Open
Abstract
Emergency department (ED) crowding is a serious problem in most tertiary hospitals in Korea. Although several intervention models have been established to alleviate ED crowding, they are limited to a single hospital-based approach. This study was conducted to determine whether the new regional intervention model could alleviate ED crowding in a regional emergency medical center. This study was designed as a "before and after study" and included patients who visited the tertiary hospital ED from November 2011 to October 2013. One tertiary hospital and 32 secondary hospitals were included in the study. A transfer coordinator conducted inter-hospital transfers from a tertiary hospital to a secondary hospital for suitable patients. A total of 1,607 and 2,591 patients transferred from a tertiary hospital before and after the study, respectively (P < 0.001). We found that the median ED length of stay (LOS) decreased significantly from 3.68 hours (interquartile range [IQR], 1.85 to 9.73) to 3.20 hours (IQR, 1.62 to 8.33) in the patient group after implementation of the Regional Transfer Network System (RTNS) (P < 0.001). The results of multivariate analysis showed a negative association between implementation of the RTNS and ED LOS (beta coefficient -0.743; 95% confidence interval -0.914 to -0.572; P < 0.001). In conclusion, the ED LOS in the tertiary hospital decreased after implementation of the RTNS.
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Affiliation(s)
- Jae Yun Ahn
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hyun Wook Ryoo
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jungbae Park
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jong Kun Kim
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Mi Jin Lee
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jong-yeon Kim
- Department of Preventive Medicine, Catholic University of Daegu College of Medicine, Daegu, Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Won Chul Cha
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun Seok Seo
- Department of Emergency Medicine, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Seoul, Korea
| | - Young Ae Kim
- Public Health and Welfare Bureau, Daegu Metropolitan City Hall, Daegu, Korea
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Cha WC, Song KJ, Cho JS, Singer AJ, Shin SD. The Long-Term Effect of an Independent Capacity Protocol on Emergency Department Length of Stay: A before and after Study. Yonsei Med J 2015; 56:1428-36. [PMID: 26256991 PMCID: PMC4541678 DOI: 10.3349/ymj.2015.56.5.1428] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 10/25/2014] [Accepted: 11/13/2014] [Indexed: 11/27/2022] Open
Abstract
PURPOSE In this study, we determined the long-term effects of the Independent Capacity Protocol (ICP), in which the emergency department (ED) is temporarily used to stabilize patients, followed by transfer of patients to other facilities when necessary, on crowding metrics. MATERIALS AND METHODS A before and after study design was used to determine the effects of the ICP on patient outcomes in an academic, urban, tertiary care hospital. The ICP was introduced on July 1, 2007 and the before period included patients presenting to the ED from January 1, 2005 to June 31, 2007. The after period began three months after implementing the ICP from October 1, 2007 to December 31, 2010. The main outcomes were the ED length of stay (LOS) and the total hospital LOS of admitted patients. The mean number of monthly ED visits and the rate of inter-facility transfers between emergency departments were also determined. A piecewise regression analysis, according to observation time intervals, was used to determine the effect of the ICP on the outcomes. RESULTS During the study period the number of ED visits significantly increased. The intercept for overall ED LOS after intervention from the before-period decreased from 8.51 to 7.98 hours [difference 0.52, 95% confidence interval (CI): 0.04 to 1.01] (p=0.03), and the slope decreased from -0.0110 to -0.0179 hour/week (difference 0.0069, 95% CI: 0.0012 to 0.0125) (p=0.02). CONCLUSION Implementation of the ICP was associated with a sustainable reduction in ED LOS and time to admission over a six-year period.
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Affiliation(s)
- Won Chul Cha
- Department of Emergency Medicine, Samsung Medical Center, Seoul, Korea
| | - Kyoung Jun Song
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Sung Cho
- Department of Emergency Medicine, Gachon University Gil Hospital, Seoul, Korea
| | - Adam J Singer
- Department of Emergency Medicine, Stony Brook University, NY, USA
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea.
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The Effect of a Clinical Practice Guideline for Acute Pelvic Pain on Length of Stay in the Emergency Department. Adv Emerg Nurs J 2015. [PMID: 26218488 DOI: 10.1097/tme.0000000000000070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Length of stay (LOS) is a key measure of emergency department (ED) efficiency and a marker of overcrowding. The use of clinical practice guidelines (CPGs) has been shown to decrease the time spent in the ED. The objective of this study was to determine whether the utilization of a CPG for evaluation of acute pelvic pain in the ED would reduce patient LOS. This before-and-after study was conducted at a large urban Level II ED over the course of 2 years. A retrospective review of 134 electronic patient records: 67 charts prior to protocol implementation; 67 after implementation of a CPG for the evaluation of acute pelvic pain. Length of stay was based on the time from triage to discharge. The before-and-after protocol groups were compared using an independent-samples t test. Length of stay was actually increased in the protocol group (n = 67, M = 5:16, SD = 4:14 [hr:min]; p = 0.092). The use of diagnostic imaging was associated with longer LOS, varying with the specific imaging performed. Because of financial restructuring, the radiology unit reduced the availability of in-house sonography to 9:00 a.m.-5:00 p.m., Monday through Friday, which also possibly affected the LOS. Of significance was the willingness of the health care providers to utilize the CPG (86%). Time of day, availability of in-house ultrasound, and individual provider judgment influence ED LOS and subsequent imaging performed. Future research is necessary to determine how these and other factors can be incorporated into a model for predicting LOS, reducing provider disparities, and ensuring patient safety.
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Ro YS, Shin SD, Song KJ, Cha WC, Cho JS. Triage-based resource allocation and clinical treatment protocol on outcome and length of stay in the emergency department. Emerg Med Australas 2015; 27:328-35. [PMID: 26075591 DOI: 10.1111/1742-6723.12426] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The present study aimed to determine the relationship between the triage-based resource allocation and clinical treatment (TRACT) protocol and mortality and length of stay (LOS) in ED. METHODS This before-and-after study was conducted in an adult, tertiary, teaching hospital ED from August 2008 to July 2012. Patients who were younger than 18 years of age, who were dead on arrival and whose triage information was not available were excluded. TRACT was implemented in August 2010, and the Emergency Severity Index (ESI) was used for triage. Primary and secondary outcomes were ED mortality and ED LOS. Multivariate logistic regression models for ED mortality and multivariable general linear models on the ED LOS were used to compare the before- and after-intervention periods. RESULTS For the 155 563 visits over study period, the ED mortality rate was 0.2%, and the ED LOS was 4.6 h (median). The adjusted odds ratios (95% confidence intervals [CIs]) of the TRACT protocol on ED mortality were 0.69 (0.54-0.88) for total patients, 0.42 (0.30-0.59) for ESI 1, 1.04 (0.66-1.65) for ESI 2 and 1.45 (0.76-2.75) for ESI 3 group. The adjusted coefficients (95% CIs) of the TRACT on the ED LOS were -88.1 (-96.9 ∼ -79.2) min for all patients, -44.9 (-72.0 ∼ -17.9) min for ESI level 2 and -104.3 (-114.7 ∼ -94.0) min for ESI level 3. CONCLUSIONS The TRACT protocol decreased the ED mortality in ESI 1 group and reduced the ED LOS in ESI levels 2 and 3 groups.
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Affiliation(s)
- Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kyoung Jun Song
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Won Chul Cha
- Department of Emergency Medicine, Samsung Medical Center, Seoul, Korea
| | - Jin Sung Cho
- Department of Emergency Medicine, Gachon University Gil Hospital, Gyeonggi, Korea
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Abstract
Emergency departments (ED) worldwide have experienced dramatic increases in crowding over the past 20 years that now have reached critical levels. One consequence of ED crowding has been the routine use of ED hallways for patient care. This includes ED patients who are awaiting care but are considered unstable to remain in the waiting room, patients who are undergoing active medical and trauma treatment, and patients who have been stabilized but await transfer to an inpatient bed (boarding) or another institution. Compared with licensed hospital or standard ED beds, care in ED hallways results in increased patient morbidity and mortality, as well as patient and staff dissatisfaction. Complications experienced by hallway patients include unrecognized sudden respiratory arrest or unstable cardiac arrhythmias, delay in time-sensitive procedures and laboratory testing, delay in receiving important medications, excessive or unrelieved pain, overall increased length of stay, increased disability, and exposure to traumatic psychological events. While much has been published on the general problems of ED crowding, only recently have studies focused exclusively on the issues of providing care in ED hallways. This review summarizes the current issues, challenges, and solutions for hallway care.
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Factors associated with overcrowded emergency rooms in Thailand: a medical school setting. Emerg Med Int 2014; 2014:576259. [PMID: 25328708 PMCID: PMC4195257 DOI: 10.1155/2014/576259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 09/10/2014] [Accepted: 09/14/2014] [Indexed: 12/04/2022] Open
Abstract
Background. Overcrowding in the emergency department (ED) is a significant public health problem in the US, Europe, and Asia. Factors associated with prolonged length of stay in Thailand are still limited. Methods. This study was conducted at the ED, Ramathibodi Hospital, Mahidol University, Thailand, during July 2011. We selected 300 patients (5.77%) from a total of 5,202 who visited the ED during the study period by simple random sampling. Charts were retrospectively reviewed baseline characteristics, clinical factors, and duration of ED stay. Multivariate logistic regression analyses were performed to identify independent factors for an ED stay more than or equal to 8 hours. Results. We excluded 33 patients (11%) due to incomplete data or stroke fast track enrollment. In total, 267 patients were in the analysis and 53 patients (19.85%) had an ED visit time more than or equal to 8 hours. The number of rounds of blood testing and the type of insurance were associated with prolonged ED stay of more than or equal to 8 hours. Conclusion. ED physicians may need to consider appropriate investigations to shorten the length of stay in the ED.
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Cha WC, Lee SC, Shin SD, Song KJ, Sung AJ, Hwang SS. Regionalisation of out-of-hospital cardiac arrest care for patients without prehospital return of spontaneous circulation. Resuscitation 2012; 83:1338-42. [DOI: 10.1016/j.resuscitation.2012.03.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 02/14/2012] [Accepted: 03/15/2012] [Indexed: 10/28/2022]
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Gender differences in emergency stroke care and hospital outcome in acute ischemic stroke: a multicenter observational study. Am J Emerg Med 2012; 31:178-84. [PMID: 23000320 DOI: 10.1016/j.ajem.2012.07.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 07/01/2012] [Accepted: 07/04/2012] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND We aimed to investigate the effect of gender difference on the accessibility to emergency care, hospital mortality and disability in acute stroke care. METHODS This study was performed on a single-tiered basic emergency medical service with a comprehensive national health insurance. Demographic variables, risk factors, elapsed time intervals, performing diagnosis and treatment options, hospital mortality, and modified Rankin Scale of acute ischemic stroke during 2008 were collected. We modeled the multivariate regression analysis for gender differences on the accessibility, hospital mortality, and disability. The adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated adjusting for potential risk factors. RESULTS The total number of patients was 6635. The time from symptom onset to emergency department (ED) arrival and to computed tomography or magnetic resonance imaging scan and from ED arrival to computed tomography or magnetic resonance imaging scan was significantly longer in women. No significant difference was found in either the time to intravenous thrombolysis or in the number of patients who received intravenous thrombolysis, anti-platelet therapy, anti-coagulation, or operation. The hospital mortality rate was higher in women (3.9%) than in men (2.9%) (P = .03). The increased disability was significantly higher in women (67.8%) than in men (65.1%) (P = .02). The hospital mortality and increased disability showed a non-significant difference between the 2 genders in the adjusted model (OR, 1.10; 95% CI, 0.74-1.64) and (OR, 1.11; 95% CI, 0.96-1.28), respectively. CONCLUSION The adjusted model for risk factors showed no significant difference on hospital mortality and disability between the 2 genders for stroke patients.
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Jeong J, Shin SD, Kim H, Hong YC, Hwang SS, Lee EJ. The effects of celebrity suicide on copycat suicide attempt: a multi-center observational study. Soc Psychiatry Psychiatr Epidemiol 2012; 47:957-65. [PMID: 21656079 DOI: 10.1007/s00127-011-0403-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Accepted: 05/23/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND The effect of celebrity suicides on copycat suicide attempts is not well known. Our objective was to determine the association between celebrity suicide and copycat suicide attempts. METHODS We conducted a retrospective multicenter observational time series analysis. Celebrity suicides were selected by an operational definition via three nationwide television news internet sites from January 2005 to December 2008. The reference week was defined as the week preceding date of suicide notification to the public. Then two pre-event weeks and four post-event weeks were analyzed for suicide attempts. We derived a prediction model for suicide attempt visits for each ED for these seven observational weeks using a General Additive Model with data from the National Emergency Department Information System (NEDIS) database. We calculated the mean excess visit (EV = observed visit - expected visit) and mean excess visit ratio (EVR = EV/expected visit). We tested the mean EV and EVR between reference weeks versus the observational weeks using independent t test and repeated measures ANOVA. RESULTS Five celebrity suicides occurred during the study period. Total number of ED visits was 5,453,441 in the 85 EDs over the 4-year period, and suicide attempt or self-injury occurred in 27,605. The mean excess visit for each observational interval per ED was less than 0.1 during pre-event periods but increased to 0.695 in the second post-event week. EVs were significantly higher in the first to the third post-event weeks (p = 0.02, p < 0.01, p = 0.03, respectively) compared to reference week. The mean EVRs were significantly higher (=0.215) in the second post-week intervals compared with the reference week (p = 0.03). Mean EVs and mean EVRs showed significant increase in the post event period compared with the observational period (p = 0.001 in EV, p = 0.021 in EVR). CONCLUSION From a prediction model using a 4-year nationwide ED database, ED visits for suicide attempts or self injury increased following the announcements of celebrity suicides.
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Affiliation(s)
- Joo Jeong
- Department of Emergency Medicine, Seoul National University College of Medicine, 101 Daehakro, Chongno-Gu, Seoul, 110-744, Korea.
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Huang YC, Lin MS, Lin HH. Comparison of emergency physicians and internists regarding core measures of care for admitted emergency department boarders with pneumonia. J Acute Med 2012. [DOI: 10.1016/j.jacme.2012.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kim MJ, Park JM, Je SM, You JS, Park YS, Chung HS, Chung SP, Lee HS. Effects of a short text message reminder system on emergency department length of stay. Int J Med Inform 2012; 81:296-302. [DOI: 10.1016/j.ijmedinf.2012.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 10/20/2011] [Accepted: 01/01/2012] [Indexed: 10/14/2022]
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Ciambrone RM, Zavotsky KE, Souto K, Baron K, Joseph VD, Johnson JE, Mastro KA. Redesign of an urban academic emergency department: action research can make a difference. J Emerg Nurs 2012; 38:531-6. [PMID: 22245398 DOI: 10.1016/j.jen.2011.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 11/01/2011] [Accepted: 11/05/2011] [Indexed: 10/14/2022]
Affiliation(s)
- Regina M Ciambrone
- Emergency Services, Robert Wood Johnson University Hospital, New Brunswick, NJ 08903, USA
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Ahn KO, Shin SD, Hwang SS, Oh J, Kawachi I, Kim YT, Kong KA, Hong SO. Association between deprivation status at community level and outcomes from out-of-hospital cardiac arrest: a nationwide observational study. Resuscitation 2010; 82:270-6. [PMID: 21146280 DOI: 10.1016/j.resuscitation.2010.10.023] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 10/19/2010] [Accepted: 10/28/2010] [Indexed: 11/18/2022]
Abstract
STUDY OBJECTIVES We sought to examine the association between area deprivation and outcomes of out-of-hospital cardiac arrest in Korea. METHODS Data were obtained from the emergency medical service (EMS) system. A nationwide OHCA cohort database from January 2006 to December 2007 was constructed via hospital chart review and ambulance run sheet data. We enrolled all EMS-assessed OHCA victims and excluded cases without available hospital outcome data or residential address. The Carstairs index was used to categorize districts according to level of deprivation into five quintiles, from (Q1, the least deprived) to (Q5, the most deprived). Main outcomes were survival to hospital discharge, survival to admission, and return of spontaneous circulation (ROSC). RESULTS 34,227 patients were included. Initial rhythm, witnessed status, attempted bystander cardiopulmonary resuscitation (CPR), CPR by EMS, CPR in the emergency department (ED), and elapsed time interval significantly varied according to area deprivation level (p < 0.001). OHCA outcomes were consistently worse in the most deprived areas. The adjusted OR (95% CI) for survival to hospital discharge was 0.58 (0.45-0.77) in the most deprived areas compared to the least deprived areas. CONCLUSION Community deprivation was strongly associated with survival among out-of-hospital cardiac arrest patients in Korea.
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Affiliation(s)
- Ki Ok Ahn
- Center for Education and Training of EMS and Rescue, Seoul Fire Academy, Seoul, Republic of Korea.
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Schneider SM, Asplin BR. Global crowding: opportunities for regionalization in emergency care. Acad Emerg Med 2009; 16:1333-1334. [PMID: 20053256 DOI: 10.1111/j.1553-2712.2009.00606.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sandra M Schneider
- Department of Emergency Medicine University of Rochester Rochester, NY Department of Emergency Medicine Mayo Clinic College of Medicine Rochester, MN
| | - Brent R Asplin
- Department of Emergency Medicine University of Rochester Rochester, NY Department of Emergency Medicine Mayo Clinic College of Medicine Rochester, MN
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