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V Carvalho AS, Broekema B, Brito Fernandes Ó, Klazinga N, Kringos D. Acute care pathway assessed through performance indicators during the COVID-19 pandemic in OECD countries (2020-2021): a scoping review. BMC Emerg Med 2024; 24:19. [PMID: 38273229 PMCID: PMC10811879 DOI: 10.1186/s12873-024-00938-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic severely impacted care for non-COVID patients. Performance indicators to monitor acute care, timely reported and internationally accepted, lacked during the pandemic in OECD countries. This study aims to summarize the performance indicators available in the literature to monitor changes in the quality of acute care in OECD countries during the first year and a half of the pandemic (2020-July 2021) and to assess their trends. METHODS Scoping review. Search in Embase and MEDLINE (07-07-2022). Acute care performance indicators and indicators related to acute general surgery were collected and collated following a care pathway approach. Indicators assessing identical clinical measures were grouped under a common indicator title. The trends from each group of indicators were collated (increase/decrease/stable). RESULTS A total of 152 studies were included. 2354 indicators regarding general acute care and 301 indicators related to acute general surgery were included. Indicators focusing on pre-hospital services reported a decreasing trend in the volume of patients: from 225 indicators, 110 (49%) reported a decrease. An increasing trend in pre-hospital treatment times was reported by most of the indicators (n = 41;70%) and a decreasing trend in survival rates of out-of-hospital cardiac arrest (n = 61;75%). Concerning care provided in the emergency department, most of the indicators (n = 752;71%) showed a decreasing trend in admissions across all levels of urgency. Concerning the mortality rate after admission, most of the indicators (n = 23;53%) reported an increasing trend. The subset of indicators assessing acute general surgery showed a decreasing trend in the volume of patients (n = 50;49%), stability in clinical severity at admission (n = 36;53%), and in the volume of surgeries (n = 14;47%). Most of the indicators (n = 28;65%) reported no change in treatment approach and stable mortality rate (n = 11,69%). CONCLUSION This review signals relevant disruptions across the acute care pathway. A subset of general surgery performance indicators showed stability in most of the phases of the care pathway. These results highlight the relevance of assessing this care pathway more regularly and systematically across different clinical entities to monitor disruptions and to improve the resilience of emergency services during a crisis.
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Affiliation(s)
- Ana Sofia V Carvalho
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands.
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands.
| | - Bente Broekema
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Department of Pediatrics, Dijklander Hospital, Location Hoorn, Maelsonstraat 3, Hoorn, 1624 NP, The Netherlands
| | - Óscar Brito Fernandes
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Niek Klazinga
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Dionne Kringos
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
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Mamalelala TT. Quality emergency care (QEC) in resource limited settings: A concept analysis. Int Emerg Nurs 2022; 64:101198. [PMID: 35926319 DOI: 10.1016/j.ienj.2022.101198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/18/2022] [Accepted: 06/29/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Providing appropriate high-quality emergency care (QEC) commensurate with patients' needs is critical for continuity of care, patient safety, optimal clinical outcomes, reduced mortality, and patient satisfaction. This concept analysis aims to define and assist in understanding the concept of QEC in resource-limited settings. METHODS Quality emergency care concept analysis was conducted using Walker and Avant's approach. Several literature review methods and dictionaries were used to explore the QEC concept. RESULTS Immediate assessment, rapid diagnosis, and critical interventions are the attributes of QEC for life-threatening and time-sensitive conditions, leading to timely and safe care provision. DISCUSSION Nurses serve as the backbone for most emergency care centers such as primary care, emergency department, and even prehospital care. The first few hours following a potential life- or limb-threatening condition are vital. The emergency care rendered to patients can significantly affect treatment's overall outcome; therefore, quality emergency care is critical. CONCLUSION
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Affiliation(s)
- Tebogo T Mamalelala
- School of Nursing, University of Botswana, Botswana; School of Nursing, Rutgers, The State University of New Jersey, USA.
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Brammen D, Greiner F, Kulla M, Otto R, Schirrmeister W, Thun S, Drösler SE, Pollmanns J, Semler SC, Lefering R, Thiemann VS, Majeed RW, Heitmann KU, Röhrig R, Walcher F. [AKTIN - The German Emergency Department Data Registry - real-time data from emergency medicine : Implementation and first results from 15 emergency departments with focus on Federal Joint Committee's guidelines on acuity assessment]. Med Klin Intensivmed Notfmed 2020; 117:24-33. [PMID: 33346852 PMCID: PMC7750913 DOI: 10.1007/s00063-020-00764-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/03/2020] [Accepted: 10/20/2020] [Indexed: 12/02/2022]
Abstract
Hintergrund Die Notfallversorgung befindet sich im Umbruch. In Notaufnahmen werden Patienten ausgehend von Symptomen und Dringlichkeit versorgt; dies bildet sich jedoch in den etablierten Routinedaten der gesetzlichen Sozialversicherung nicht ab. Ziel des AKTIN-Projekts war der Aufbau einer datenschutzkonformen Registerinfrastruktur zur Nutzung von klinischen Routinedaten aus Notaufnahmen. Methoden Über eine standardisierte Schnittstelle werden aus den verschiedenen Dokumentationssystemen kontinuierlich Daten der Notaufnahmebehandlung in ein lokales Data Warehouse exportiert. Dort stehen sie sowohl für lokale Nutzungen, wie interne Berichte und Qualitätsmanagement, als auch gleichzeitig datenschutzkonform für multizentrische Auswertungen zur Verfügung. Anhand der Registerpopulation wird die Ersteinschätzung sowie die Erhebung von Vitalparametern in Abhängigkeit von Vorstellungsgründen für einen 12-Monats-Zeitraum analysiert. Ergebnisse Für den Zeitraum 04/2018 bis 03/2019 wurden 436.149 gültige Fälle aus 15 Notaufnahmen übermittelt. In 86,0 % der Fälle ist eine Ersteinschätzung dokumentiert. Diese fand in 70,5 % innerhalb von 10 min nach Ankunft des Patienten statt. In 10 Kliniken wird regelhaft (82,3 %) ein Vorstellungsgrund erfasst. Die Erfassung von Vitalparametern variiert plausibel zwischen den Vorstellungsgründen. Schlussfolgerung Das AKTIN-Notaufnahmeregister bietet einen zeitnahen Einblick in das Versorgungsgeschehen der Notaufnahmen ohne zusätzlichen Dokumentationsaufwand und unabhängig vom primären IT-System, Kostenträger, Fallart und Abrechnungsmodus. Die Vorgaben des Gemeinsamen Bundesausschusses zur Ersteinschätzung werden weitgehend umgesetzt. Durch die Etablierung von standardisierten Vorstellungsgründen werden symptombasierte Analysen und Gesundheitssurveillance ermöglicht. Zusatzmaterial online Die Onlineversion dieses Beitrags (10.1007/s00063-020-00764-2) enthält die Abb. S1 und S2. Beitrag und Zusatzmaterial stehen Ihnen auf www.springermedizin.de zur Verfügung. Bitte geben Sie dort den Beitragstitel in die Suche ein, das Zusatzmaterial finden Sie beim Beitrag unter „Ergänzende Inhalte“. ![]()
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Affiliation(s)
- D Brammen
- Universitätsklinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland.
- Universitätsklinik für Anästhesiologie und Intensivtherapie, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland.
| | - F Greiner
- Universitätsklinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland
| | - M Kulla
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
| | - R Otto
- Universitätsklinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland
| | - W Schirrmeister
- Universitätsklinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland
| | - S Thun
- Competence Center eHealth, Hochschule Niederrhein, Krefeld, Deutschland
| | - S E Drösler
- Fachbereich Gesundheitswesen, Hochschule Niederrhein, Krefeld, Deutschland
| | - J Pollmanns
- Fachbereich Gesundheitswesen, Hochschule Niederrhein, Krefeld, Deutschland
| | - S C Semler
- TMF - Technologie- und Methodenplattform für die vernetzte medizinische Forschung e. V., Berlin, Deutschland
| | - R Lefering
- Institut für Forschung in der Operativen Medizin (IFOM), Universität Witten/Herdecke, Köln, Deutschland
| | - V S Thiemann
- Abteilung Medizinische Informatik, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland
| | - R W Majeed
- Institut für Medizinische Informatik, Medizinische Fakultät, RWTH Aachen, Aachen, Deutschland
| | - K U Heitmann
- Heitmann Consulting and Services, Hürth, Deutschland
- hih - health innovation hub, Bundesministerium für Gesundheit, Berlin, Deutschland
| | - R Röhrig
- Institut für Medizinische Informatik, Medizinische Fakultät, RWTH Aachen, Aachen, Deutschland
| | - F Walcher
- Universitätsklinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland
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Schneider A, Wehler M, Weigl M. Provider interruptions and patient perceptions of care: an observational study in the emergency department. BMJ Qual Saf 2018; 28:296-304. [PMID: 30337495 DOI: 10.1136/bmjqs-2018-007811] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 08/15/2018] [Accepted: 09/07/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND Interruptions are endemic in healthcare work environments. Yet, they can have positive effects in some instances and negative in others, with their net effect on quality of care still poorly understood. We aimed to distinguish beneficial and detrimental forms of interruptions of emergency department (ED) providers using patients' perceptions of ED care as a quality measure. METHODS An observational design was established. The study setting was an interdisciplinary ED of an academic tertiary referral hospital. Frequencies of interruption sources and contents were identified in systematic expert observations of ED physicians and nurses. Concurrently, patients rated overall quality of care, ED organisation, patient information and waiting times using a standardised survey. Associations were assessed with hierarchical linear models controlling for daily ED workload. Regression results were adjusted for multiple testing. Additionally, analyses were computed for ED physicians and nurses, separately. RESULTS On 40 days, 160 expert observation sessions were conducted. 1418 patients were surveyed. Frequent interruptions initiated by patients were associated with higher overall quality of care and ED organisation. Interruptions relating to coordination activities were associated with improved ratings of ED waiting times. However, interruptions containing information on previous cases were associated with inferior ratings of ED organisation. Specifically for nurses, overall interruptions were associated with superior patient reports of waiting time. CONCLUSIONS Provider interruptions were differentially associated with patient perceptions of care. Whereas coordination-related and patient-initiated interruptions were beneficial to patient-perceived efficiency of ED operations, interruptions due to case-irrelevant communication were related to inferior patient ratings of ED organisation. The design of resilient healthcare systems requires a thorough consideration of beneficial and harmful effects of interruptions on providers' workflows and patient safety.
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Affiliation(s)
- Anna Schneider
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich
| | - Markus Wehler
- Department of Emergency Medicine and Department of Medicine IV, Klinikum Augsburg, Augsburg, Germany
| | - Matthias Weigl
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich
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Schluck G, Wu W, Whyte J, Abbott L. Emergency department arrival times in Florida heart failure patients utilizing Fisher-Rao curve registration: A descriptive population-based study. Heart Lung 2018; 47:458-464. [PMID: 29907362 DOI: 10.1016/j.hrtlng.2018.05.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 05/26/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Emergency room utilization and hospital readmission rates are disproportionately high for heart failure patients (HF). Emergency department (ED) utilization is intimately intertwined with hospital readmissions. OBJECTIVE Describe the arrival time distribution of HF patients presenting to the ED. METHOD The study analyzed heart failure discharge data from the Florida State Emergency Department Database and the Florida State Inpatient Database from the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality. Data were treated as a Poisson process and analyzed using functional data analysis tools. RESULTS HF arrivals are multi-modal with the largest peak arrival time in the middle of the day as well as a smaller peak in the early morning hours, especially in rural areas. CONCLUSIONS The arrival pattern has minor differences in rural and urban areas. HF clinic appointments should be established in the early morning hours when these patients utilize the ED.
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Affiliation(s)
- Glenna Schluck
- College of Nursing, Florida State University, 98 Varsity Way, PO Box 3064310, Tallahassee, FL 32306-4310.
| | - Wei Wu
- Department of Statistics, College of Arts and Sciences, Florida State University, Tallahassee, FL
| | - James Whyte
- College of Nursing, Florida State University, Tallahassee, FL
| | - Laurie Abbott
- College of Nursing, Florida State University, Tallahassee, FL
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