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Khan F, Popescu A, Chattergoon N, Fiumara F, Thandi N, Galeh H. Implementation of the admission transfer unit to reduce emergency department boarding: A quality improvement initiative. Healthc Manage Forum 2024:8404704241267317. [PMID: 39039840 DOI: 10.1177/08404704241267317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
Emergency Department (ED) boarding crowds the emergency department, strains resources, leads to higher hospital costs, and is associated with increased morbidity/mortality, a negative patient experience, and patient adverse events. The time Ontario patients wait in emergency departments for inpatient beds continues to rise, with the average time admitted patients spend in the ED increasing between 2015 and 2019 from 13.8 hours to 16.2 hours. As reported in this quality improvement initiative, one potential solution is to repurpose short-stay medical assessment units for complex admitted medicine patients using an objective patient selection tool. Objectively selecting admitted ED patients with the highest risk for adverse events and prioritizing them to move to a transitional unit advances safe quality patient care and decreases Time-to-Inpatient Bed (TIB). Results from this quality improvement initiative include reducing the organization's TIB by 13 hours.
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Affiliation(s)
- Faisal Khan
- William Osler Health System, Etobicoke, Ontario, Canada
| | | | | | | | | | - Hojat Galeh
- William Osler Health System, Etobicoke, Ontario, Canada
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Loke DE, Green KA, Wessling EG, Stulpin ET, Fant AL. Clinicians' Insights on Emergency Department Boarding: An Explanatory Mixed Methods Study Evaluating Patient Care and Clinician Well-Being. Jt Comm J Qual Patient Saf 2023; 49:663-670. [PMID: 37479591 DOI: 10.1016/j.jcjq.2023.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND The aim of this study was to describe clinicians' insights into the quality and safety of patient care delivered to emergency department (ED) boarding patients, as well as clinician safety and satisfaction related to ED boarding. METHODS This was a single-site, mixed methods sequential explanatory study. Quantitative data were obtained from a cross-sectional survey sent to ED attending physicians, resident physicians, advanced practice providers, and nurses. Semistructured focus group interviews with a subsample of participants sought to add depth to the interpretation of survey data and identify areas of improvement in boarding care. Chi-square and Wilcoxon rank sum tests were used to evaluate for response differences between groups. Qualitative data were thematically coded and analyzed. RESULTS A total of 94 questionnaires were obtained for a response rate of 34.1%. Clinicians reported that boarding highly contributed to the perception of burnout. All groups reported high rates of perceived verbal and/or physical abuse from boarding patients (86.8% of nurses, 41.1% of providers, p = 0.0002). A total of 39 clinicians participated in focus groups regarding boarding care, and six themes were identified, including patient safety concerns, lack of knowledge/resources/training, and poor communication. Key themes identified as possible solutions to improve care included standardization of care, proactive planning, and culture change. CONCLUSION Clinicians identified many concerns regarding patient safety and the quality of care delivered to boarding patients and identified several areas for improvement. Clinicians also felt that boarding negatively affected their satisfaction and safety.
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Emgård M, Mwangi R, Mayo C, Mshana E, Nkini G, Andersson R, Lepp M, Skovbjerg S, Muro F. Antibiotic use in children under 5 years of age in Northern Tanzania: a qualitative study exploring the experiences of the caring mothers. Antimicrob Resist Infect Control 2022; 11:130. [PMID: 36329551 PMCID: PMC9630810 DOI: 10.1186/s13756-022-01169-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/15/2022] [Indexed: 11/06/2022] Open
Abstract
Background Antimicrobial resistance is a serious threat to the global achievements in child health thus far. Previous studies have found high use of antibiotics in children in Northern Tanzania, but the experiences of the primary care-givers, who play a key role in accessing and administering antibiotics for the sick child, have remained largely unknown. Therefore, the aim of this study was to understand mothers’ conceptions of antibiotic use in their children, which is of importance when forming strategies to improve antibiotic use in the community. Method A qualitative study including eight focus group discussions with mothers of under-five children in Moshi urban and rural districts, Northern Tanzania, was performed during 2019. The discussions were recorded, transcribed verbatim, translated into English and analysed according to the phenomenographic approach. Findings Three conceptual themes emerged during analysis; (1) conceptions of disease and antibiotics, (2) accessing treatment and (3) administering antibiotics. Antibiotics were often perceived as a universal treatment for common symptoms or diseases in children with few side-effects. Although mothers preferred to attend a healthcare facility, unforeseen costs, long waits and lack of financial support from their husbands, posed barriers for healthcare seeking. However, pharmacies were perceived as a cheap and convenient option to access previously used or prescribed antibiotics. Some mothers sought advice from a trusted neighbour regarding when to seek healthcare, thus resembling the function of the community health worker. Conclusions To improve antibiotic use in children under 5 years of age in Northern Tanzania, the precarious situation that women often find themselves in as they access treatment for their sick children needs to be taken into consideration. It is necessary to improve structures, including the healthcare system, socioeconomic inequalities and promoting gender equality both in the household and in the public arena to reduce misuse of antibiotics. Meanwhile, equipping community health workers to support Tanzanian women in appropriate healthcare seeking for their children, may be a feasible target for intervention. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-022-01169-w.
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Affiliation(s)
- Matilda Emgård
- grid.8761.80000 0000 9919 9582Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ,grid.8761.80000 0000 9919 9582Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden ,grid.1649.a000000009445082XDepartment of Paediatrics, Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, Gothenburg, Region Västra Götaland Sweden
| | - Rose Mwangi
- grid.412898.e0000 0004 0648 0439Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Sokoine Road, Moshi, Tanzania
| | - Celina Mayo
- grid.415218.b0000 0004 0648 072XDepartment of Community Health, Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania
| | - Ester Mshana
- grid.412898.e0000 0004 0648 0439Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Sokoine Road, Moshi, Tanzania
| | - Gertrud Nkini
- grid.412898.e0000 0004 0648 0439Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Sokoine Road, Moshi, Tanzania
| | - Rune Andersson
- grid.8761.80000 0000 9919 9582Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ,grid.8761.80000 0000 9919 9582Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden ,grid.1649.a000000009445082XDepartment of Clinical Microbiology, Sahlgrenska University Hospital, Gothenburg, Region Västra Götaland Sweden
| | - Margret Lepp
- grid.8761.80000 0000 9919 9582Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ,grid.446040.20000 0001 1940 9648Østfold University College, Halden, Norway ,grid.1022.10000 0004 0437 5432School of Nursing and Midwifery, Griffith University, Gold Coast, QLD Australia ,grid.477237.2Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway ,grid.8570.a0000 0001 2152 4506Faculty of Medicine, Public Health & Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Susann Skovbjerg
- grid.8761.80000 0000 9919 9582Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ,grid.8761.80000 0000 9919 9582Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden ,grid.1649.a000000009445082XDepartment of Clinical Microbiology, Sahlgrenska University Hospital, Gothenburg, Region Västra Götaland Sweden
| | - Florida Muro
- grid.412898.e0000 0004 0648 0439Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Sokoine Road, Moshi, Tanzania ,grid.415218.b0000 0004 0648 072XDepartment of Community Health, Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania
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Rantala A, Nordh S, Dvorani M, Forsberg A. The Meaning of Boarding in a Swedish Accident & Emergency Department: A Qualitative Study on Patients' Experiences of Awaiting Admission. Healthcare (Basel) 2021; 9:healthcare9010066. [PMID: 33445751 PMCID: PMC7828189 DOI: 10.3390/healthcare9010066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/04/2021] [Accepted: 01/10/2021] [Indexed: 01/10/2023] Open
Abstract
The number of in-hospital beds in Sweden has decreased during recent decades, resulting in the smallest number (2.2 available beds/1000 inhabitants) within the European Union. At the same time, the number of patients attending Accident and Emergency (A&E) departments has increased, resulting in overcrowding and boarding. The aim of this study was to explore the meaning of being subjected to boarding at an A&E department, as experienced by patients. A phenomenological-hermeneutic approach was chosen to interpret and understand the meaning of boarding at A&E. The study was carried out at a hospital in the south of Sweden. Seventeen participants with a mean age of 64 years (range: 35-86 years) were interviewed. The thematic structural analysis covers seven themes: Being in a state of uncertainty, Feeling abandoned, Fearing death, Enduring, Adjusting to the circumstances, Being a visitor in an unsafe place, and Acknowledging the staff, all illustrating that the participants were in a state of constant uncertainty and felt abandoned with no guidance or support from the clinicians. The conclusion is that the situation where patients are forced to wait in A&E, i.e., boarding, violates all conditions for professional ethics, presumably causing profound ethical stress in the healthcare professionals involved. Thus, boarding should be avoided.
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Affiliation(s)
- Andreas Rantala
- Department of Health Sciences, Lund University, SE-221 00 Lund, Sweden;
- Emergency Department, Helsingborg General Hospital, SE-251 87 Helsingborg, Sweden;
- Centre of Interprofessional Cooperation within Emergency Care (CICE), Linnaeus University, SE-251 95 Växjö, Sweden
- Correspondence:
| | - Sören Nordh
- Emergency Department, Helsingborg General Hospital, SE-251 87 Helsingborg, Sweden;
| | - Mergime Dvorani
- Premedic AB, Ambulance Service Hässleholm, SE-281 25 Hässleholm, Sweden;
| | - Anna Forsberg
- Department of Health Sciences, Lund University, SE-221 00 Lund, Sweden;
- Department of Cardiothoracic Surgery, Skåne University Hospital, SE-224 42 Lund, Sweden
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Fann WC, Lee BO, Hsiao CT, Chuan YS, Kuo CY. Do Emergency Nurses Spend Enough Time on Nursing Activities? The Relationship Between Actual and Expected Patient Care Nursing Time. J Acute Med 2019; 9:161-171. [PMID: 32995246 DOI: 10.6705/j.jacme.201912_9(4).0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background The overcrowded environments of emergency departments (EDs) lead to increased clinical workloads for nurses and infl uences the quality of patient care. This study aimed to evaluate whether the quality of patient care meets the expectations of emergency nurses in Taiwan by measuring the amount of time nurses spend on patient care activities. Methods The direct observation study was conducted in one suburban academic hospital with approximately 80,000 annual ED visits. This study observed emergency nurses and the time they spent on their nursing activities. The directly measured times and nurse expected patient care nursing times were compared. Results For all 88 types of nursing activities recorded, each measured nursing time was less than the expected nursing time. On average, the measured nursing time was 82% less than the expected nursing time (2.0 ± 0.3 minutes vs. 11.6 ± 1.5 minutes, p < 0.01). Among the 88 types of nursing activities recorded, the average measured time spent on 76 types (86%) was less than 3 minutes. The nursing activity on which the longest time was spent was cerebrospinal fl uid study nursing (7 minutes). The most frequent nursing activity was documentation. Conclusion The nursing time spent on patient-care activities in EDs was much less than the nurses expected. The results may provide a basis for nursing quality measurements and manpower calculations for EDs.
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Affiliation(s)
- Wen-Chih Fann
- Chiayi Chang Gung Memorial Hospital Department of Emergency Medicine Chiayi Taiwan
| | - Bih-O Lee
- Chiayi Chang Gung Memorial Hospital Department of Nursing Chiayi Taiwan.,Chang Gung University of Science and Technology, Taoyuan Taiwan
| | - Cheng-Ting Hsiao
- Chiayi Chang Gung Memorial Hospital Department of Emergency Medicine Chiayi Taiwan.,Chang Gung University School of Traditional Chinese Medicine Taoyuan Taiwan
| | - Yu-Shan Chuan
- Chiayi Chang Gung Memorial Hospital Department of Nursing Chiayi Taiwan
| | - Chiu-Ya Kuo
- Chiayi Chang Gung Memorial Hospital Department of Nursing Chiayi Taiwan.,Chang Gung University of Science and Technology, Taoyuan Taiwan
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Karlberg Traav M, Forsman H, Eriksson M, Cronqvist A. First line nurse managers' experiences of opportunities and obstacles to support evidence-based nursing. Nurs Open 2018; 5:634-641. [PMID: 30338109 PMCID: PMC6178359 DOI: 10.1002/nop2.172] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 05/20/2018] [Accepted: 05/30/2018] [Indexed: 11/30/2022] Open
Abstract
AIM The aim was to explore first line nurse managers' experiences of opportunities and obstacles to support evidence-based nursing. DESIGN A qualitative study with a phenomenographical approach. METHOD Data were collected through focus group interviews with 15 first line nurse managers' in four settings. RESULTS The results are presented in four categories of description headed: Manage the everyday work vs. evidence-based nursing; Uncertainties about evidence-based nursing and nursing research; Time as a reality, as an approach; and Shaping awareness-towards an active approach to evidence-based nursing. The overarching category of description has been formulated as follows: The internal relation-how active leadership influences evidence-based nursing. The outcome space is presented as: The individual path-how to make vision and reality become a working entity around evidence-based nursing.
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Affiliation(s)
- Malin Karlberg Traav
- Department of Health Care ScienceErsta Sköndal Bräcke University CollegeStockholmSweden
- Faculty of Medicine and Health, School of Health SciencesÖrebro UniversityÖrebroSweden
| | - Henrietta Forsman
- School of Education, Health and Social StudiesDalarna UniversityFalunSweden
| | - Mats Eriksson
- Faculty of Medicine and Health, School of Health SciencesÖrebro UniversityÖrebroSweden
| | - Agneta Cronqvist
- Department of Health Care ScienceErsta Sköndal Bräcke University CollegeStockholmSweden
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