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Nahidi S, Forero R, McCarthy S, Man N, Gibson N, Mohsin M, Mountain D, Fatovich D, Fitzgerald G, Toloo G(S. Qualitative analysis of perceptions and experiences of emergency department staff in relation to implementation and outcomes of the Four‐Hour Rule/National Emergency Access Target in Australia. Emerg Med Australas 2018; 31:378-386. [DOI: 10.1111/1742-6723.13166] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 07/25/2018] [Accepted: 07/27/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Shizar Nahidi
- Simpson Centre for Health Services ResearchSouth Western Sydney Clinical School, The University of New South Wales Sydney New South Wales Australia
- Ingham Institute for Applied Medical Research Sydney New South Wales Australia
| | - Roberto Forero
- Simpson Centre for Health Services ResearchSouth Western Sydney Clinical School, The University of New South Wales Sydney New South Wales Australia
- Ingham Institute for Applied Medical Research Sydney New South Wales Australia
| | - Sally McCarthy
- Prince of Wales Clinical SchoolThe University of New South Wales Sydney New South Wales Australia
- Emergency Care InstituteAgency for Clinical Innovation Sydney New South Wales Australia
| | - Nicola Man
- Simpson Centre for Health Services ResearchSouth Western Sydney Clinical School, The University of New South Wales Sydney New South Wales Australia
- Ingham Institute for Applied Medical Research Sydney New South Wales Australia
| | - Nick Gibson
- School of Nursing and MidwiferyEdith Cowan University Perth Western Australia Australia
| | - Mohammed Mohsin
- Psychiatry Research and Teaching UnitSouth Western Sydney Local Health District Sydney New South Wales Australia
- School of PsychiatryFaculty of Medicine, The University of New South Wales Sydney New South Wales Australia
| | - David Mountain
- Emergency DepartmentSir Charles Gairdner Hospital Perth Western Australia Australia
- Division of Emergency Medicine, Faculty of Health and Medical SciencesThe University of Western Australia Perth Western Australia Australia
| | - Daniel Fatovich
- Division of Emergency Medicine, Faculty of Health and Medical SciencesThe University of Western Australia Perth Western Australia Australia
- Centre for Clinical Research in Emergency MedicineHarry Perkins Institute of Medical Research Perth Western Australia Australia
- Emergency DepartmentRoyal Perth Hospital Perth Western Australia Australia
| | - Gerard Fitzgerald
- School of Public Health and Social WorkQueensland University of Technology Brisbane Queensland Australia
| | - Ghasem (Sam) Toloo
- School of Public Health and Social WorkQueensland University of Technology Brisbane Queensland Australia
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Forero R, Man N, McCarthy S, Richardson D, Mohsin M, Toloo GS, FitzGerald G, Ngo H, Mountain D, Fatovich D, Celenza A, Gibson N, Xu F, Nahidi S, Hillman K. Impact of the National Emergency Access Target policy on emergency departments' performance: A time-trend analysis for New South Wales, Australian Capital Territory and Queensland. Emerg Med Australas 2018; 31:253-261. [PMID: 30043403 DOI: 10.1111/1742-6723.13142] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 05/30/2018] [Accepted: 06/13/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the impact of the Australian National Emergency Access Target (NEAT) policy introduced in 2012 on ED performance. METHODS A longitudinal cohort study of NEAT implementation using linked data, for 12 EDs across New South Wales (NSW), Australian Capital Territory (ACT) and Queensland (QLD) between 2008 and 2013. Segmented regression in a multi-level model was used to analyse ED performance over time before and after NEAT introduction. The main outcomes measures were ED length of stay ≤4 h, access block, number of ED presentations, short-stay admission (≤24 h), >24 h admissions, unplanned ED re-attendances within 7 days and 'left at own risk' (including 'did not wait for assessment'). RESULTS Two years after NEAT introduction, ED length of stay ≤4 h increased in NSW and QLD (odds ratio [OR] = 2.48 and 3.24; P < 0.001) and access block decreased (OR = 0.41 and 0.22; P < 0.001), but not in ACT (OR = 1.28; P > 0.05). ED presentations increased over time before and after NEAT introduction with a significant increase above the projected trend in NSW after NEAT (mean ratio = 1.07). Short-stay admissions increased in QLD (OR = 2.60), ACT (OR = 1.68) and NSW (OR = 1.35). Unplanned ED re-attendances did not change significantly. Those who left at their own risk decreased significantly in NSW and QLD (OR = 0.38 and 0.67). CONCLUSION ED presentations continued to increase over time in all jurisdictions. NSW and QLD, but not ACT, showed significant improvements in time-based measures. Significant increases in short-stay admissions suggest a strategic change in ED process associated with NEAT implementation. Rates of unplanned ED re-attendances and those leaving at their own risk showed no evidence for adverse effects from NEAT.
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Affiliation(s)
- Roberto Forero
- Simpson Centre for Health Services Research, The University of New South Wales, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
| | - Nicola Man
- Simpson Centre for Health Services Research, The University of New South Wales, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
| | - Sally McCarthy
- Emergency Department, Prince of Wales Hospital, Sydney, New South Wales, Australia.,Emergency Care Institute, Agency for Clinical Innovation, Sydney, New South Wales, Australia
| | - Drew Richardson
- Medical School, Australian National University, Canberra, Australian Capital Territory, Australia.,Emergency Department, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Mohammed Mohsin
- Psychiatry Research and Teaching Unit, South Western Sydney Local Health District, Sydney, New South Wales, Australia.,School of Psychiatry, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Ghasem Sam Toloo
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Gerry FitzGerald
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Hanh Ngo
- Division of Emergency Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - David Mountain
- Division of Emergency Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia.,Emergency Department, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Daniel Fatovich
- Division of Emergency Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia.,Emergency Department, Royal Perth Hospital, Perth, Western Australia, Australia.,Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
| | - Antonio Celenza
- Division of Emergency Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia.,Emergency Department, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Nick Gibson
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Fenglian Xu
- Simpson Centre for Health Services Research, The University of New South Wales, Sydney, New South Wales, Australia
| | - Shizar Nahidi
- Simpson Centre for Health Services Research, The University of New South Wales, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
| | - Ken Hillman
- Simpson Centre for Health Services Research, The University of New South Wales, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
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Fulbrook P, Jessup M, Kinnear F. Implementation and evaluation of a 'Navigator' role to improve emergency department throughput. ACTA ACUST UNITED AC 2017. [PMID: 28624270 DOI: 10.1016/j.aenj.2017.05.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Emergency department overcrowding impacts patients, staff, and quality of care, and there is government pressure to optimize throughput and reduce waiting times. One solution for improving patient flow is the emerging 'navigator' role: a nurse that supports staff in care delivery; facilitating efficient and timely patient movement through the emergency department. METHODS A 20-week project was implemented to evaluate an emergency department nurse navigator role. A controlled trial was used. The navigator worked on a week-on-week-off basis, eight hours per day, seven days per week. Time-based and cost-associated outcomes were compared. RESULTS Data from nearly 20,000 presentations during the trial period were analysed. All outcomes were improved during the ten weeks the Navigator was working. A slight improvement in National Emergency Access Target compliance was shown, with an average of 4.5min per presentation saved. The labour cost associated with the time saved was estimated to be $170,000. CONCLUSIONS The results from this study indicate that for a relatively small investment, complementary nursing roles such as the navigator can impact emergency department patient flow. However, further studies are required to determine optimisation of the role. RELEVANCE TO PRACTICE This study provides rigorous evidence of the effects of a nurse navigator role on emergency department throughput. Whilst positive outcomes were demonstrated, suggesting a whole-of-system benefit, the magnitude of effect on a per-presentation basis was relatively small. Further studies are required to demonstrate the clinical relevance of such roles.
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Affiliation(s)
- Paul Fulbrook
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Brisbane, Australia; Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Australia.
| | - Melanie Jessup
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Brisbane, Australia; Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Australia
| | - Frances Kinnear
- Department of Emergency Medicine, The Prince Charles Hospital, Brisbane, Australia
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Cheek JA, Braitberg G, Craig S, West A. Why do children present to emergency departments? Exploring motivators and measures of presentation appropriateness for children presenting to a paediatric emergency department. J Paediatr Child Health 2017; 53:451-457. [PMID: 28195435 DOI: 10.1111/jpc.13482] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 11/03/2016] [Accepted: 11/10/2016] [Indexed: 11/29/2022]
Abstract
AIM To compare the parental motivators and referring general practitioner's (GP's) reasons for advising emergency department (ED) attendance with the assessment of ED medical staff. To compare ED clinician opinion with other published methods that have attempted to define 'primary care suitable' presentations to the ED. METHODS A prospective observational study and series of surveys regarding the attendance of children presenting to a single tertiary paediatric ED. Surveys were distributed to the treating ED clinician, the child's parent/guardian, and the referring GP. Results between the three groups were analysed and compared. RESULTS There were a total of 1069 presentations during the study period. Six hundred (58.4%, 95% CI 55.3-61.4%) presentations were judged as 'ED appropriate' by the treating ED clinician. When compared with methods used to retrospectively judge whether ED patients are considered 'primary care suitable', ED clinicians disagree between 22.4 and 38.8% of the time. For patients who presented directly to ED, 85.6% did so for a medical reason, whilst 32.1% did so for a GP access reason. Being referred by a GP improved the ED clinicians' opinion of the appropriateness of the presentation (49.2 vs. 73.9%, P < 0.05). CONCLUSIONS We caution that many strategies attempting to 'solve' the issue of increasing ED attendances by paediatric patients have been driven by opinion, and a better understanding of the motivators that drive this behaviour is needed. We believe the solution to increasing utilisation of EDs by children must be a balanced approach that addresses community expectations and appropriately resources EDs.
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Affiliation(s)
- John A Cheek
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Monash Emergency Research Collaborative, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.,Paediatric Emergency Department, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - George Braitberg
- Department of Emergency Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Simon Craig
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Monash Emergency Research Collaborative, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.,Paediatric Emergency Department, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Adam West
- Monash Emergency Research Collaborative, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.,Paediatric Emergency Department, Monash Children's Hospital, Melbourne, Victoria, Australia
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5
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Unwin M, Kinsman L, Rigby S. Why are we waiting? Patients’ perspectives for accessing emergency department services with non-urgent complaints. Int Emerg Nurs 2016; 29:3-8. [DOI: 10.1016/j.ienj.2016.09.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 07/29/2016] [Accepted: 09/11/2016] [Indexed: 11/28/2022]
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Mason S, Knowles E, Boyle A. Exit block in emergency departments: a rapid evidence review. Emerg Med J 2016; 34:46-51. [PMID: 27789568 DOI: 10.1136/emermed-2015-205201] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 10/04/2016] [Accepted: 10/05/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Exit block (or access block) occurs when 'patients in the ED requiring inpatient care are unable to gain access to appropriate hospital beds within a reasonable time frame'. Exit block is an increasing challenge for Emergency Departments (EDs) worldwide and has been recognised as a major factor in leading to departmental crowding. This paper aims to identify empirical evidence, highlighting causes, effects and strategies to limit exit block. METHODS A computerised literature search was conducted of English language empirical evidence published between 2008 and 2014 using a combination of terms relating to exit block in ED. RESULTS 233 references were identified following the computerised search. Of these, 32 empirical articles of varying scientific quality were identified as relevant and results were presented under a number of headings. The majority of studies presented data relating to the impact of exit block on departments, patients and staff. A smaller number of articles evaluated interventions designed to reduce exit block. Evidence suggests that exit block is more likely to occur in more densely populated areas and less likely to occur in paediatric settings. Bed occupancy appears to be associated with exit block. Evidence supporting the impact of initiatives pointed towards increasing workforce and inpatient bed resources within the hospital setting to reduce block. CONCLUSIONS Further evidence is needed, especially within the NHS setting to increase the understanding around factors that cause exit block, and interventions that are shown to relieve it without compromising patient outcomes.
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Affiliation(s)
- Suzanne Mason
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Emma Knowles
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Knowles E, Mason SM, Smith C. Factors associated with exit block and impact on the emergency department. Emerg Med J 2016; 34:61-62. [PMID: 26873731 DOI: 10.1136/emermed-2015-205202] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 12/21/2015] [Accepted: 12/29/2015] [Indexed: 11/03/2022]
Abstract
We used routinely available data to identify the likelihood of exit block within type 1 EDs across acute trusts in England. While the findings are based on exploratory work and should be treated with caution, some patterns appeared to emerge from the data and require further exploration. NHS Trusts at risk of exit block were more likely to be large trusts, located in larger catchment areas, having higher admission rates and inpatient bed occupancy and higher levels of patients leaving the ED without being seen or reattending. Some of the factors identified may well be symptomatic of exit block rather than causal, while other factors may be acting as proxies for differences in casemix, social deprivation or ability to access alternative urgent care services.
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Affiliation(s)
- Emma Knowles
- Medical Care Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Suzanne M Mason
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Craig Smith
- The Medical School, University of Sheffield, Sheffield, UK
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Gilfillan C, Newnham E, Nagappan R, Evans J, Compton J. A 7-day team-based model of care in general medicine: implementation and outcomes at 12 months. Intern Med J 2016; 46:79-85. [DOI: 10.1111/imj.12913] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 09/07/2015] [Accepted: 09/15/2015] [Indexed: 11/27/2022]
Affiliation(s)
- C. Gilfillan
- Eastern Health Clinical School; Monash University; Melbourne Victoria Australia
- Department of Medicine; Eastern Health; Melbourne Victoria Australia
| | - E. Newnham
- Department of Medicine; Eastern Health; Melbourne Victoria Australia
| | - R. Nagappan
- Department of Medicine; Eastern Health; Melbourne Victoria Australia
| | - J. Evans
- Department of Quality, Planning and Innovation; Eastern Health; Melbourne Victoria Australia
| | - J. Compton
- Northern Hospital; Northern Health; Melbourne Victoria Australia
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Morphet J, Innes K, Griffiths DL, Crawford K, Williams A. Resident transfers from aged care facilities to emergency departments: can they be avoided? Emerg Med Australas 2015; 27:412-8. [PMID: 26095333 PMCID: PMC4745031 DOI: 10.1111/1742-6723.12433] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2015] [Indexed: 11/17/2022]
Abstract
Objective Residents from aged care facilities make up a considerable proportion of ED presentations. There is evidence that many residents transferred from aged care facilities to EDs could be managed by primary care services. The present study aimed to describe the characteristics of residents transferred from residential aged care facilities to EDs, and to evaluate the appropriateness and cost of these presentations. Methods A retrospective review of ED records was undertaken for residents transferred from residential aged care facilities to two EDs in Melbourne, Victoria, in 2012. Data examined included residents' mode and time of arrival to ED, presenting complaint, triage category, procedures within ED, diagnosis, length of stay, and disposition. Data were examined against a previously established tool to identify resident transfers that might be ‘potentially avoidable’. Results There were 2880 resident transfers included in the sample, of which 408 transfers were randomly selected for scrutiny of documentation. Seventy‐one residents (17.4%) were identified as being potentially avoidable transfers. Conclusion Many resident transfers might have been avoided with better primary care services in place. Future strategies to improve resident care might include aged care staff skill mix and the availability of outreach or primary care services.
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Affiliation(s)
- Julia Morphet
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Kelli Innes
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Debra L Griffiths
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Kimberley Crawford
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Allison Williams
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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El-Eid GR, Kaddoum R, Tamim H, Hitti EA. Improving hospital discharge time: a successful implementation of Six Sigma methodology. Medicine (Baltimore) 2015; 94:e633. [PMID: 25816029 PMCID: PMC4554014 DOI: 10.1097/md.0000000000000633] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Delays in discharging patients can impact hospital and emergency department (ED) throughput. The discharge process is complex and involves setting specific challenges that limit generalizability of solutions. The aim of this study was to assess the effectiveness of using Six Sigma methods to improve the patient discharge process. This is a quantitative pre and post-intervention study. Three hundred and eighty-six bed tertiary care hospital. A series of Six Sigma driven interventions over a 10-month period. The primary outcome was discharge time (time from discharge order to patient leaving the room). Secondary outcome measures included percent of patients whose discharge order was written before noon, percent of patients leaving the room by noon, hospital length of stay (LOS), and LOS of admitted ED patients. Discharge time decreased by 22.7% from 2.2 hours during the preintervention period to 1.7 hours post-intervention (P < 0.001). A greater proportion of patients left their room before noon in the postintervention period (P < 0.001), though there was no statistical difference in before noon discharge. Hospital LOS dropped from 3.4 to 3.1 days postintervention (P < 0.001). ED mean LOS of patients admitted to the hospital was significantly lower in the postintervention period (6.9 ± 7.8 vs 5.9 ± 7.7 hours; P < 0.001). Six Sigma methodology can be an effective change management tool to improve discharge time. The focus of institutions aspiring to tackle delays in the discharge process should be on adopting the core principles of Six Sigma rather than specific interventions that may be institution-specific.
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Affiliation(s)
- Ghada R El-Eid
- From the Executive Hospital Administrator (GRE-D); Assistant Professor of Clinical Anesthesiology (RK); Associate Professor Department of Internal Medicine (HT); and Assistant Professor of Clinical Emergency Medicine, Department of Emergency Medicine, American University of Beirut Faculty of Medicine, Beirut, Lebanon (EAH)
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Nagree Y, Gosbell A, McCarthy S, Moore K, Mountain D. Determining the true burden of general practice patients in the emergency department: getting closer. Emerg Med Australas 2014; 25:487-90. [PMID: 24308612 DOI: 10.1111/1742-6723.12163] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Yusuf Nagree
- Emergency, Fremantle Hospital, Fremantle, Western Australia, Australia; School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Nedlands, Western Australia, Australia
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12
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Griffiths D, Morphet J, Innes K, Crawford K, Williams A. Communication between residential aged care facilities and the emergency department: a review of the literature. Int J Nurs Stud 2014; 51:1517-23. [PMID: 24996849 DOI: 10.1016/j.ijnurstu.2014.06.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 06/06/2014] [Accepted: 06/06/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Western countries have encountered an increase in elderly patients transferred from residential aged care facilities to emergency departments. This patient cohort frequently experiences impaired physical and cognitive function. Emergency department staff require important clinical and personal patient information to provide quality care. International studies show that documentation and handover deficiencies are common. OBJECTIVE The purpose of this literature review was to explore transitional communication practices, and to consider the specific patient information deemed essential for the management of residents in the emergency department. METHODS A literature review was conducted to examine the studies exploring the documentation accompanying elderly people who were transferred from residential aged care facilities to emergency departments. Scopus, OVID Medline and Cinahl Plus data bases were searched using combinations of the following key words: 'nursing home', 'long-term care', 'skilled nursing facility', 'aged care facility', 'communication', 'documentation', 'emergency department', 'emergency room', 'hospital', 'acute', 'transfer', and 'transition'. Additional data was located with the use of Google Scholar. Review of titles and exclusion of duplicates identified 69 relevant studies. These 69 papers were independently reviewed by three members of the research team for eligibility for inclusion in the review, and seven papers were retained. RESULTS There is currently no consensus regarding what information is essential when residents are transferred from aged care facilities to emergency departments, and practices vary. Key information which should accompany the resident has been reported by various authors and include the reason for transfer, past medical history, current medications, cognitive function and advance directives. Some authors also suggest that facility contact details are essential. Without agreement by key stakeholders as to what constitutes 'essential transfer information', clinical practices will continue to vary and resident care will be affected. CONCLUSION This paper identifies frequent communication deficits in the information provided to the emergency department from aged care facilities. There is an imperative to identify suitable items of information which health care professionals agree are essential. Future research should focus on methods to improve the transfer of information between facilities, including consensus regarding what information is essential transfer data.
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Affiliation(s)
- Debra Griffiths
- School of Nursing and Midwifery, Monash University, P.O. Box 527, Frankston 3199, Australia.
| | - Julia Morphet
- School of Nursing and Midwifery, Monash University, P.O. Box 527, Frankston 3199, Australia
| | - Kelli Innes
- School of Nursing and Midwifery, Monash University, P.O. Box 527, Frankston 3199, Australia
| | - Kimberley Crawford
- School of Nursing and Midwifery, Monash University, P.O. Box 527, Frankston 3199, Australia
| | - Allison Williams
- School of Nursing and Midwifery, Monash University, P.O. Box 527, Frankston 3199, Australia
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13
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Blom MC, Jonsson F, Landin-Olsson M, Ivarsson K. The probability of patients being admitted from the emergency department is negatively correlated to in-hospital bed occupancy - a registry study. Int J Emerg Med 2014; 7:8. [PMID: 24499660 PMCID: PMC3917619 DOI: 10.1186/1865-1380-7-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 01/10/2014] [Indexed: 11/18/2022] Open
Abstract
Background The association between emergency department (ED) overcrowding and poor patient outcomes is well described, with recent work suggesting that the phenomenon causes delays in time-sensitive interventions, such as resuscitation. Even though most researchers agree on the fact that admitted patients boarding in the ED is a major contributing factor to ED overcrowding, little work explicitly addresses whether in-hospital occupancy is associated to the probability of patients being admitted from the ED. The objective of the present study is to investigate whether such an association exists. Methods Retrospective analysis of data on all ED visits to Helsingborg General Hospital in southern Sweden between January 1, 2011, and December 31, 2012, was undertaken. The fraction of admitted patients was calculated separately for strata of in-hospital occupancy <95%, 95–100%, 100–105%, and >105%. Multivariate models were constructed in an attempt to take confounding factors, e.g., presenting complaints, age, referral status, triage priority, and sex into account. Subgroup analysis was performed for each specialty unit within the ED. Results Overall, 118,668 visits were included. The total admitted fraction was 30.9%. For levels of in-hospital occupancy <95%, 95–100%, 100–105%, and >105% the admitted fractions were 31.5%, 30.9%, 29.9%, and 28.7%, respectively. After taking confounding factors into account, the odds ratio for admission were 0.88 (CI 0.84–0.93, P >0.001) for occupancy level 95–100%, 0.82 (CI 0.78–0.87, P >0.001) for occupancy level 100–105%, and 0.74 (CI 0.67–0.81, P >0.001) for occupancy level >105%, relative to the odds ratio for admission at occupancy level <95%. A similar pattern was observed upon subgroup analysis. Conclusions In-hospital occupancy was significantly associated with a decreased odds ratio for admission in the study population. One interpretation is that patients who would benefit from inpatient care instead received suboptimal care in outpatient settings at times of high in-hospital occupancy. A second interpretation is that physicians admit patients who could be managed safely in the outpatient setting, in times of good in-hospital bed availability. Physicians thereby expose patients to healthcare-associated infections and other hazards, in addition to consuming resources better needed by others.
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Affiliation(s)
- Mathias C Blom
- IKVL, Lund University, IKVL/Sektion I-II, Akutmedicin, Hs 32, EA-blocket, plan 2, Universitetssjukhuset, 221 85 Lund, Sweden.
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Meek R, Morphet J, Hood K, Leech M, Sandry K. Effect of interprofessional student-led beds on emergency department performance indicators. Emerg Med Australas 2013; 25:427-34. [DOI: 10.1111/1742-6723.12118] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Robert Meek
- Department Emergency Medicine; Monash Health; Melbourne Victoria Australia
- Monash University; Melbourne Victoria Australia
| | - Julia Morphet
- School of Nursing and Midwifery; Monash University; Melbourne Victoria Australia
| | - Kerry Hood
- School of Nursing and Midwifery; Monash University; Melbourne Victoria Australia
| | - Michelle Leech
- Monash University; Melbourne Victoria Australia
- Department of Medicine; Monash Health; Melbourne Victoria Australia
| | - Kate Sandry
- Department Emergency Medicine; Monash Health; Melbourne Victoria Australia
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15
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Fry M, Horvat L, Roche M, Fong J, Plowes J. The prevalence and triage characteristics of patients presenting with infection to one tertiary referral hospital. ACTA ACUST UNITED AC 2013; 15:127-32. [PMID: 22947685 DOI: 10.1016/j.aenj.2012.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 06/04/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND Globally, severe infection and or sepsis is a problem that is costing billions of dollars, using hundreds of hospital beds, and often results in patient death. Any infection can potentially develop a sepsis health trajectory if left unrecognised and unmanaged. METHODS We conducted a 12 month retrospective descriptive exploratory study. Our research explored the prevalence and triage characteristics of patients presenting with infection to one tertiary referral hospital. Electronic medical records were reviewed to identify patients that had a primary diagnosis related to infection. RESULTS The study identified that 16% (n=7756) of adult presentations had a discharge diagnosis related to infection. A significant difference (X(2)=297.83, df=4, p≤.001) in Triage Code allocation for the infection group was identified compared with the non-infection patient group. Thirty-nine percent (n=3027) of patients with infections were admitted to hospital. Of the patients (n=1930; 4%) admitted to a critical care area, 6% (n=122) had a primary diagnosis related to infection. Of the ED deaths (n=81), 12% (n=10) had a primary diagnosis related to infection. CONCLUSION The study provides a detailed analysis of the prevalence and triage characteristics of patients with infection presenting to one ED. Further research is needed to identify strategies to improve the triage nurse's recognition of severe infection and consistency of urgency code allocation to prevent patient deterioration.
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Affiliation(s)
- Margaret Fry
- Faculty of Nursing, Midwifery and Health, University of Technology, Sydney, Australia.
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Managing the wait: Clinical initiative nurses’ perceptions of an extended practice role. ACTA ACUST UNITED AC 2012; 15:202-10. [DOI: 10.1016/j.aenj.2012.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 09/13/2012] [Accepted: 10/17/2012] [Indexed: 11/23/2022]
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Patel H, Celenza A, Watters T. Effect of nurse initiated X-rays of the lower limb on patient transit time through the emergency department. ACTA ACUST UNITED AC 2012; 15:229-34. [DOI: 10.1016/j.aenj.2012.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Revised: 07/16/2012] [Accepted: 07/17/2012] [Indexed: 11/17/2022]
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Ye L, Zhou G, He X, Shen W, Gan J, Zhang M. Prolonged length of stay in the emergency department in high-acuity patients at a Chinese tertiary hospital. Emerg Med Australas 2012; 24:634-40. [PMID: 23216724 DOI: 10.1111/j.1742-6723.2012.01588.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVE ED overcrowding is a worldwide issue, with most evidence coming from developed countries. Until now, little was known about this subject in China. The aim of this study was to investigate the situation of prolonged lengths of stay (LOS) in the ED for high-acuity patients in a Chinese tertiary hospital and to identify associated factors. METHODS A retrospective study was performed in a Chinese tertiary hospital from 1 January to 31 December 2010. The primary outcomes were ED LOS and associated factors in overall high-acuity patients. Multivariate Cox regression analysis was used. RESULTS In this consecutive study period, 7966 high-acuity patients presenting to the ED were triaged to the resuscitation room. The median LOS in the ED for these patients was 10.6 h (IQR, 3.1-23.1 h). In the multivariate analysis, the most significant factor associated with prolonged LOS was boarding for more than 2 h (OR, 4.29; 95% CI, 4.03-4.57). Patients requiring emergency operation or intensive care unit admission experienced a shorter LOS (OR, 0.56 and 0.76; 95% CI, 0.53-0.60 and 0.71-0.81, respectively). Older patients, night shift arrivals, non-spring visitors, general internal medicine patients and patients leaving without receiving advanced therapy had longer LOS. CONCLUSIONS We found an excessive LOS in the resuscitation room in this tertiary hospital. The most significant reason for prolonged LOS was boarding block. Shortage of inpatient beds and reluctance of the wards to admit these patients might be the primary reasons for extremely long boarding.
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Affiliation(s)
- Ligang Ye
- Department of Emergency Medicine, Second Affiliated Hospital, School of Medicine and Institute of Emergency Medicine, Zhejiang University, Hangzhou, China
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19
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Pre-hospital pain management patterns and triage nurse documentation. Int Emerg Nurs 2012; 20:83-7. [DOI: 10.1016/j.ienj.2011.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Revised: 06/27/2011] [Accepted: 07/01/2011] [Indexed: 11/20/2022]
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Pines JM, Hilton JA, Weber EJ, Alkemade AJ, Al Shabanah H, Anderson PD, Bernhard M, Bertini A, Gries A, Ferrandiz S, Kumar VA, Harjola VP, Hogan B, Madsen B, Mason S, Ohlén G, Rainer T, Rathlev N, Revue E, Richardson D, Sattarian M, Schull MJ. International perspectives on emergency department crowding. Acad Emerg Med 2011; 18:1358-70. [PMID: 22168200 DOI: 10.1111/j.1553-2712.2011.01235.x] [Citation(s) in RCA: 386] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The maturation of emergency medicine (EM) as a specialty has coincided with dramatic increases in emergency department (ED) visit rates, both in the United States and around the world. ED crowding has become a public health problem where periodic supply and demand mismatches in ED and hospital resources cause long waiting times and delays in critical treatments. ED crowding has been associated with several negative clinical outcomes, including higher complication rates and mortality. This article describes emergency care systems and the extent of crowding across 15 countries outside of the United States: Australia, Canada, Denmark, Finland, France, Germany, Hong Kong, India, Iran, Italy, The Netherlands, Saudi Arabia, Catalonia (Spain), Sweden, and the United Kingdom. The authors are local emergency care leaders with knowledge of emergency care in their particular countries. Where available, data are provided about visit patterns in each country; however, for many of these countries, no national data are available on ED visits rates or crowding. For most of the countries included, there is both objective evidence of increases in ED visit rates and ED crowding and also subjective assessments of trends toward higher crowding in the ED. ED crowding appears to be worsening in many countries despite the presence of universal health coverage. Scandinavian countries with robust systems to manage acute care outside the ED do not report crowding is a major problem. The main cause for crowding identified by many authors is the boarding of admitted patients, similar to the United States. Many hospitals in these countries have implemented operational interventions to mitigate crowding in the ED, and some countries have imposed strict limits on ED length of stay (LOS), while others have no clear plan to mitigate crowding. An understanding of the causes and potential solutions implemented in these countries can provide a lens into how to mitigate ED crowding in the United States through health policy interventions and hospital operational changes.
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Affiliation(s)
- Jesse M Pines
- Center for Health Care Quality, George Washington University, Washington, DC, USA.
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New PW, Cameron PA, Olver JH, Stoelwinder JU. Inpatient subacute care in Australia: perceptions of admission and discharge barriers. Med J Aust 2011; 195:538-41. [DOI: 10.5694/mja10.11361] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Peter W New
- Rehabilitation and Aged Care Services, Medical Program, Southern Health, Melbourne, VIC
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC
- Epworth HealthCare, Monash University, Melbourne, VIC
| | - Peter A Cameron
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC
| | - John H Olver
- Epworth HealthCare, Monash University, Melbourne, VIC
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A systematic review of the impact of afterhours care models on emergency departments, ambulance and general practice services. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.aenj.2011.09.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Jones PG, Olsen S. Point prevalence of access block and overcrowding in New Zealand emergency departments in 2010 and their relationship to the ‘Shorter Stays in ED’ target. Emerg Med Australas 2011; 23:587-92. [DOI: 10.1111/j.1742-6723.2011.01451.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Nagree Y, Mountain D, Cameron P, Fatovich D, McCarthy S. Determining the true burden of general practice patients in the emergency department: The need for robust methodology. Emerg Med Australas 2011; 23:116-9. [DOI: 10.1111/j.1742-6723.2011.01399.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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