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Tenbensel T, Jones P, Chalmers LM, Ameratunga S, Carswell P. Gaming New Zealand's Emergency Department Target: How and Why Did It Vary Over Time and Between Organisations? Int J Health Policy Manag 2020; 9:152-162. [PMID: 32331495 PMCID: PMC7182144 DOI: 10.15171/ijhpm.2019.98] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 10/18/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Gaming is a potentially dysfunctional consequence of performance measurement and management systems in the health sector and more generally. In 2009, the New Zealand government initiated a Shorter Stays in Emergency Department (SSED) target in which 95% of patients would be admitted, discharged or transferred from an emergency department (ED) within 6 hours. The implementation of similar targets in England led to well-documented practices of gaming. Our research into ED target implementation sought to answer how and why gaming varies over time and between organisations. METHODS We developed a mixed-methods approach. Four organisation case study sites were selected. ED lengths of stay (ED LOS) were collected over a 6-year period (2007-2012) from all sites and indicators of target gaming were developed. Two rounds of surveys with managers and clinicians were conducted. Interviews (n=68) were conducted with clinicians and managers in EDs and the wider hospital in two phases across all sites. The interview data was used to develop explanations of the patterns of variation across time and across sites detected in the ED LOS data. RESULTS Our research established that gaming behaviour - in the form of 'clock-stopping' and decanting patients to short-stay units (SSUs) or observation beds to avoid target breaches - was common across all 4 case study sites. The opportunity to game was due to the absence of independent verification of ED LOS data. Gaming increased significantly over time (2009-2012) as the means to game became more available, usually through the addition or expansion of short-stay facilities attached to EDs. Gaming varied between sites, but those with the highest levels of gaming differed substantially in terms of organisational dynamics and motives. In each case, however, high levels of gaming could be attributed to the strategies of senior management more than to the individual motivations of frontline staff. CONCLUSION Gaming of New Zealand's ED target increased after the real benefits (in terms of process improvement) of the target were achieved. Gaming of ED targets could be minimised by eliminating opportunities to game through independent verification, or by monitoring and limiting the means and motivations to game.
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Affiliation(s)
- Tim Tenbensel
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Peter Jones
- Auckland District Health Board Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | - Shanthi Ameratunga
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Peter Carswell
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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Kuriyama A, Ikegami T, Kaihara T, Fukuoka T, Nakayama T. Validity of the Japan Acuity and Triage Scale in adults: a cohort study. Emerg Med J 2018. [PMID: 29535086 DOI: 10.1136/emermed-2017-207214] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The Japan Acuity and Triage Scale (JTAS) was developed based on Canadian Triage and Acuity Scale in 2012 and has been implemented in many Japanese EDs. We assessed the validity of JTAS by examining the association between JTAS triage levels and throughput and clinical outcomes in adult patients. METHODS We conducted a retrospective analysis of prospectively collected clinical data in the ED of a Japanese tertiary-care hospital. We included self-presenting patients who were ≥16 years of age and triaged between June 2013 and May 2014. We assessed the association between the triage level and overall admission and admission to the intensive care units (ICUs) with multivariable logistic regression analysis adjusted with patients' age and the time of visit and ED length of stay using the Kruskal-Wallis rank-sum test. We examined the predictive ability of JTAS for determining overall and ICU admission using receiver operating characteristic curves. RESULTS We included a total of 27 120 adult patients in our study. The OR for overall admission was greater with a higher triage level compared with the lowest urgency levels. ED length of stay was significantly longer with a higher JTAS level (p<0.001). The OR for ICU admission was greater in JTAS 1 (117.93 (95% CI 69.07 to 201.38)) and JTAS 2 (9.43 (95% CI 13.74 to 29.30)) compared with the lowest urgency levels. The areas under the curve for the predictive ability of JTAS for overall and ICU admission were 0.726 and 0.792, respectively. CONCLUSION Our study suggests an association of JTAS acuity with overall admission, ICU admission and ED length of stay, thereby demonstrating the predictive validity of JTAS.
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Affiliation(s)
- Akira Kuriyama
- Emergency and Critical Care Center, Kurashiki Central Hospital, Kurashiki, Japan.,Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Tetsunori Ikegami
- Emergency and Critical Care Center, Kurashiki Central Hospital, Kurashiki, Japan
| | - Toshie Kaihara
- Emergency and Critical Care Center, Kurashiki Central Hospital, Kurashiki, Japan
| | - Toshio Fukuoka
- Emergency and Critical Care Center, Kurashiki Central Hospital, Kurashiki, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
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Jewer J. Patients' intention to use online postings of ED wait times: A modified UTAUT model. Int J Med Inform 2018; 112:34-39. [PMID: 29500019 DOI: 10.1016/j.ijmedinf.2018.01.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 12/17/2017] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND As health care becomes more reliant on technology, a better understanding of the factors that contribute to acceptance and use of technology is now critical. The Unified Theory of Acceptance and Use of Technology (UTAUT) has been applied to study a variety of technologies in different settings, and it is one of the most cited theories in Information Systems (IS) research. However, there has been limited application of UTAUT to health IT and, in particular, to patients' IT use. OBJECTIVES The aim of this study is to adapt UTAUT to the context of patient acceptance and use of an Emergency Department (ED) wait-times website, and to empirically test the modified model and compare the results to those of the original UTAUT model. Specifically, it is proposed that there will be a significant relationship between facilitating conditions and behavioral intention. METHODS A survey of patients in the ED of a Canadian hospital was conducted, yielding 118 completed surveys, and subsequently analyzed using Partial least squares (PLS). RESULTS This study found that the modified UTAUT produced a substantial improvement in variance explained in behavioral intention compared to the original UTAUT (66% versus 46%). The modified-UTAUT model showed significant effects in performance expectancy (r = 0.302, p < 0.01) and facilitating conditions (r = 0.539, p < 0.001) on behavioral intention to use the website, while the effort expectancy impact was not significant. CONCLUSIONS This study provides empirical support for the modified-UTAUT in the context of patients' intention to use an ED wait times website. Some results of this study support prior research, while some differ, such as the non-significant relationship between effort expectancy and behavioral intention and the finding that performance expectancy is not the main driver of intention to use. As proposed, facilitating conditions - having the resources necessary to view the website and having the ability to find the website - were the most important factors influencing behavioral intention. UTAUT is a key theoretical advance in IS research and by modifying it to the context of patient use, we contribute to both IS and health research.
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Affiliation(s)
- Jennifer Jewer
- Faculty of Business Administration, Memorial University of Newfoundland, 300 Prince Phillip Drive, St. John's, NL, A1B 3X5, Canada.
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Tenbensel T, Chalmers L, Jones P, Appleton-Dyer S, Walton L, Ameratunga S. New Zealand's emergency department target - did it reduce ED length of stay, and if so, how and when? BMC Health Serv Res 2017; 17:678. [PMID: 28950856 PMCID: PMC5615466 DOI: 10.1186/s12913-017-2617-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 09/13/2017] [Indexed: 11/10/2022] Open
Abstract
Background In 2009, the New Zealand government introduced a hospital emergency department (ED) target – 95% of patients seen, treated or discharged within 6 h - in order to alleviate crowding in public hospital EDs. While these targets were largely met by 2012, research suggests that such targets can be met without corresponding overall reductions in ED length-of-stay (LOS). Our research explores whether the NZ ED time target actually reduced ED LOS, and if so, how and when. Methods We adopted a mixed-methods approach with integration of data sources. After selecting four hospitals as case study sites, we collected all ED utilisation data for the period 2006 to 2012. ED LOS data was derived in two forms-reported ED LOS, and total ED LOS - which included time spent in short-stay units. This data was used to identify changes in the length of ED stay, and describe the timing of these changes to these indicators. Sixty-eight semi-structured interviews and two surveys of hospital clinicians and managers were conducted between 2011 and 2013. This data was then explored to identify factors that could account for ED LOS changes and their timing. Results Reported ED LOS reduced in all sites after the introduction of the target, and continued to reduce in 2011 and 2012. However, total ED LOS only decreased from 2008 to 2010, and did not reduce further in any hospital. Increased use of short-stay units largely accounted for these differences. Interview and survey data showed changes to improve patient flow were introduced in the early implementation period, whereas increased ED resources, better information systems to monitor target performance, and leadership and social marketing strategies mainly took throughout 2011 and 2012 when total ED LOS was not reducing. Conclusions While the ED target clearly stimulated improvements in patient flow, our analysis also questions the value of ED targets as a long term approach. Increased use of short-stay units suggests that the target became less effective in ‘standing for’ improved timeliness of hospital care in response to increasing acute demand. As such, the overall challenges in managing demand for acute and urgent care in New Zealand hospitals remain. Electronic supplementary material The online version of this article (10.1186/s12913-017-2617-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tim Tenbensel
- Health Systems, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Private Bag, 92019, Auckland, 1142, New Zealand.
| | - Linda Chalmers
- Nursing Development Unit, Auckland City Hospital, Private Bag 92024, Auckland, 1142, New Zealand
| | - Peter Jones
- Adult Emergency Department, Auckland City Hospital, Private Bag 92024, Auckland, 1142, New Zealand
| | - Sarah Appleton-Dyer
- Health Systems, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Private Bag, 92019, Auckland, 1142, New Zealand
| | - Lisa Walton
- Health Systems, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Private Bag, 92019, Auckland, 1142, New Zealand
| | - Shanthi Ameratunga
- Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Private Bag, 92019, Auckland, 1142, New Zealand
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McDevitt J, Melby V. An evaluation of the quality of Emergency Nurse Practitioner services for patients presenting with minor injuries to one rural urgent care centre in the UK: a descriptive study. J Clin Nurs 2014; 24:523-35. [DOI: 10.1111/jocn.12639] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Joe McDevitt
- Urgent Care and Treatment Centre; Tyrone County Hospital; Omagh UK
| | - Vidar Melby
- School of Nursing; University of Ulster; Magee Campus; Derry UK
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Bukhari H, Albazli K, Almaslmani S, Attiah A, Bukhary E, Najjar F, Qari A, Sulaimani N, Lihyani AA, Alhazmi A, Maghrabi HA, Alyasi O, Albarqi S, Eldin AS. Analysis of Waiting Time in Emergency Department of Al-Noor Specialist Hospital, Makkah, Saudi Arabia. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ojem.2014.24012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Weber EJ, Mason S, Freeman JV, Coster J. Implications of England's Four-Hour Target for Quality of Care and Resource Use in the Emergency Department. Ann Emerg Med 2012; 60:699-706. [DOI: 10.1016/j.annemergmed.2012.08.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 07/31/2012] [Accepted: 08/06/2012] [Indexed: 10/27/2022]
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Huang EPC, Liu SSH, Fang CC, Chou HC, Wang CH, Yen ZS, Chen SC. The impact of adding clinical assistants on patient waiting time in a crowded emergency department. Emerg Med J 2012; 30:1017-9. [PMID: 23175705 DOI: 10.1136/emermed-2012-201611] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Emergency department (ED) crowding causes prolonged waiting times. OBJECTIVE To evaluate the potential benefit of introducing clinical assistants to a busy and crowded ED. METHODS This was a retrospective cohort study at an urban, academic tertiary medical centre. We introduced one clinical assistant to each ED shift. The main task of clinical assistants was managing the flow of incoming ED patients. The case group consisted of all adult non-trauma emergency patients during the case period from 1 September to 30 November 2008. The first control group consisted of all adult non-trauma emergency patients between 1 June and 31 August 2008 and the second control group consisted of all patients treated between 1 September and 30 November 2007. The primary outcome was the 'waiting time', defined as the time from triage to the time of the first medical order entered into the computer system. The secondary outcome was the number of adult non-trauma emergency patients who left the ED without being seen. RESULTS There were 12 257 cases and 25 950 controls. The mean and median waiting times were significantly shorter in the case group. The mean waiting time of the case group was 20.86 min, which was 4.51 min (17.8%) shorter than that of the first control group and 7.41 min (26.2%) shorter than that of the second control group. The median waiting time of the case group was also significantly shorter than those of the control groups. The number of the patients who left without being seen was significantly smaller in the case period. CONCLUSIONS In a busy and crowded ED, the introduction of clinical assistants to an existing emergency health service effectively reduces patient waiting times and decreases the number of patients leaving without being seen.
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Affiliation(s)
- Edward Pei-Chuan Huang
- Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, , Taipei, Taiwan
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Time Patients Spend in the Emergency Department: England's 4-Hour Rule—A Case of Hitting the Target but Missing the Point? Ann Emerg Med 2012; 59:341-9. [DOI: 10.1016/j.annemergmed.2011.08.017] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 08/12/2011] [Accepted: 08/19/2011] [Indexed: 11/18/2022]
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Boyle A, Beniuk K, Higginson I, Atkinson P. Emergency department crowding: time for interventions and policy evaluations. Emerg Med Int 2012; 2012:838610. [PMID: 22454772 PMCID: PMC3290817 DOI: 10.1155/2012/838610] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 10/13/2011] [Indexed: 11/17/2022] Open
Abstract
This paper summarises the consequences of emergency department crowding. It provides a comparison of the scales used to measure emergency department crowding. We discuss the multiple causes of crowding and present an up-to-date literature review of the interventions that reduce the adverse consequences of crowding. We consider interventions at the level of an individual hospital and a policy level.
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Affiliation(s)
- Adrian Boyle
- Emergency Department, Cambridge University Foundation Hospitals NHS Trust, Hills Road, Cambridge CB2 2QQ, UK
| | - Kathleen Beniuk
- Engineering Design Centre, Cambridge University, Cambridge CB2 1PZ, UK
| | - Ian Higginson
- Emergency Department, Plymouth Hospitals NHS Trust, Derriford Road, Crownhill, Plymouth, Devon PL6 8DH, UK
| | - Paul Atkinson
- Emergency Department, St John Regional Hospital, New Brunswick, Canada
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Schull MJ, Guttmann A, Leaver CA, Vermeulen M, Hatcher CM, Rowe BH, Zwarenstein M, Anderson GM. Prioritizing performance measurement for emergency department care: consensus on evidence-based quality of care indicators. CAN J EMERG MED 2012; 13:300-9, E28-43. [PMID: 21955411 DOI: 10.2310/8000.2011.110334] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The evaluation of emergency department (ED) quality of care is hampered by the absence of consensus on appropriate measures. We sought to develop a consensus on a prioritized and parsimonious set of evidence-based quality of care indicators for EDs. METHODS The process was led by a nationally representative steering committee and expert panel (representatives from hospital administration, emergency medicine, health information, government, and provincial quality councils). A comprehensive review of the scientific literature was conducted to identify candidate indicators. The expert panel reviewed candidate indicators in a modified Delphi panel process using electronic surveys; final decisions on inclusion of indicators were made by the steering committee in a guided nominal group process with facilitated discussion. Indicators in the final set were ranked based on their priority for measurement. A gap analysis identified areas where future indicator development is needed. A feasibility study of measuring the final set of indicators using current Canadian administrative databases was conducted. RESULTS A total of 170 candidate indicators were generated from the literature; these were assessed based on scientific soundness and their relevance or importance. Using predefined scoring criteria in two rounds of surveys, indicators were coded as "retained" (53), "discarded" (78), or "borderline" (39). A final set of 48 retained indicators was selected and grouped in nine categories (patient satisfaction, ED operations, patient safety, pain management, pediatrics, cardiac conditions, respiratory conditions, stroke, and sepsis or infection). Gap analysis suggested the need for new indicators in patient satisfaction, a healthy workplace, mental health and addiction, elder care, and community-hospital integration. Feasibility analysis found that 13 of 48 indicators (27%) can be measured using existing national administrative databases. DISCUSSION A broadly representative modified Delphi panel process resulted in a consensus on a set of 48 evidence-based quality of care indicators for EDs. Future work is required to generate technical definitions to enable the uptake of these indicators to support benchmarking, quality improvement, and accountability efforts.
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Affiliation(s)
- Michael J Schull
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
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Coevolution of Patients and Hospitals: How Changing Epidemiology and Technological Advances Create Challenges and Drive Organizational Innovation. J Healthc Manag 2012. [DOI: 10.1097/00115514-201201000-00005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mason S. Keynote address: United Kingdom experiences of evaluating performance and quality in emergency medicine. Acad Emerg Med 2011; 18:1234-8. [PMID: 22168184 DOI: 10.1111/j.1553-2712.2011.01237.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Demand for emergency care is rising throughout the western world and represents a major public health problem. Increased reliance on professionalized health care by the public means that strategies need to be developed to manage the demand safely and in a way that is achievable and acceptable to both consumers of emergency care, but also to service providers. In the United Kingdom, strategies have previously been aimed at managing demand better and included introducing new emergency services for patients to access, extending the skills within the existing workforce, and more recently, introducing time targets for emergency departments (EDs). This article will review the effect of these strategies on demand for care and discuss the successes and failures with reference to future plans for tackling this increasingly difficult problem in health care.
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Affiliation(s)
- Suzanne Mason
- School of Health and Related Research, University of Sheffield, UK.
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Guttmann A, Schull MJ, Vermeulen MJ, Stukel TA. Association between waiting times and short term mortality and hospital admission after departure from emergency department: population based cohort study from Ontario, Canada. BMJ 2011; 342:d2983. [PMID: 21632665 PMCID: PMC3106148 DOI: 10.1136/bmj.d2983] [Citation(s) in RCA: 413] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
OBJECTIVE To determine whether patients who are not admitted to hospital after attending an emergency department during shifts with long waiting times are at risk for adverse events. DESIGN Population based retrospective cohort study using health administrative databases. Setting High volume emergency departments in Ontario, Canada, fiscal years 2003-7. PARTICIPANTS All emergency department patients who were not admitted (seen and discharged; left without being seen). OUTCOME MEASURES Risk of adverse events (admission to hospital or death within seven days) adjusted for important characteristics of patients, shift, and hospital. RESULTS 13,934,542 patients were seen and discharged and 617,011 left without being seen. The risk of adverse events increased with the mean length of stay of similar patients in the same shift in the emergency department. For mean length of stay ≥ 6 v <1 hour the adjusted odds ratio (95% confidence interval) was 1.79 (1.24 to 2.59) for death and 1.95 (1.79 to 2.13) for admission in high acuity patients and 1.71 (1.25 to 2.35) for death and 1.66 (1.56 to 1.76) for admission in low acuity patients). Leaving without being seen was not associated with an increase in adverse events at the level of the patient or by annual rates of the hospital. CONCLUSIONS Presenting to an emergency department during shifts with longer waiting times, reflected in longer mean length of stay, is associated with a greater risk in the short term of death and admission to hospital in patients who are well enough to leave the department. Patients who leave without being seen are not at higher risk of short term adverse events.
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Affiliation(s)
- Astrid Guttmann
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
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Emptying the Corridors of Shame: Organizational Lessons From England's 4-Hour Emergency Throughput Target. Ann Emerg Med 2011; 57:79-88.e1. [DOI: 10.1016/j.annemergmed.2010.08.013] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Revised: 07/24/2010] [Accepted: 08/06/2010] [Indexed: 11/21/2022]
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Coleman P, Nicholl J. Consensus methods to identify a set of potential performance indicators for systems of emergency and urgent care. J Health Serv Res Policy 2010; 15 Suppl 2:12-8. [PMID: 20354114 DOI: 10.1258/jhsrp.2009.009096] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To identify a comprehensive set of indicators to enable Primary Care Trust (PCT) commissioners in England and other NHS decision-makers to monitor the performance of systems of emergency and urgent care for which they are responsible. METHODS Using a combination of Delphi RAND methods in three successive rounds of consultation and nominal group review, we canvassed expert opinion on 70 potential indicators as good measures of system performance. The two Delphi panels consisted of senior clinicians and researchers, and urgent care leads and commissioners in PCTs and Strategic Health Authorities (SHAs). The indicators were formatted into a questionnaire according to whether they were outcome, process, structure, or equity-based measures. Participants scored each indicator on a Likert scale of 1-9 and had the opportunity to consider their scores informed by the group scores and feedback. The questionnaire was refined after each round. To ensure that the indicators rated most highly by the Delphi panels covered all dimensions of performance, the results of the Delphi were reviewed by a nominal group consisting of two researchers and three clinicians from the local health services research network (LHSR). RESULTS Overall, the process yielded 16 candidate indicators. It also produced a core set of serious, emergency and urgent care-sensitive conditions (defined as conditions whose exacerbations should be managed by a well-performing system without admission to an inpatient bed), for use with the indicators. CONCLUSIONS System-wide measures to monitor performance across multiple services should encourage providers to work for patient benefit in an integrated way. They will also assist commissioners to monitor and improve emergency and urgent care for their local populations. The indicators are now being calculated using routinely available data, and tested for their responsiveness to capture change over time.
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Affiliation(s)
- Patricia Coleman
- Medical Care Research Unit, University of Sheffield, Sheffield, UK.
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Vivanti AP, McDonald CK, Palmer MA, Sinnott M. Malnutrition associated with increased risk of frail mechanical falls among older people presenting to an emergency department. Emerg Med Australas 2009; 21:386-94. [DOI: 10.1111/j.1742-6723.2009.01223.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Chung SH, Hwang JI. Patient characteristics associated with length of stay in emergency departments. HEALTH POLICY AND MANAGEMENT 2009. [DOI: 10.4332/kjhpa.2009.19.3.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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