1
|
Gola M, Johnson AA, La Milia DI, Cadeddu C, Bardini F, Bianconi B, Bisceglia R, Pumpo MD, Genovese C, Grieco A, Piras G, Guerra R, Damiani G, Favaretti C, Montagna MT, Capolongo S, Ricciardi W. Rethinking the Healthcare Facilities: The Role of the Buffer Space. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024; 17:24-37. [PMID: 38259242 DOI: 10.1177/19375867231222563] [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] [Indexed: 01/24/2024]
Abstract
OBJECTIVES A working group conducted a survey on the use of the principle of buffer space (BS), which in case of emergencies, could benefit healthcare settings. The aim of the preliminary investigation is to define new research lines in hospitals' functional design. BACKGROUND The global experience of the COVID-19 pandemic highlighted challenges faced by hospitals when responding promptly to emergencies, including spatial reorganization and suspension of ordinary medical activities for ensuring adequate management of the emergency surge of patients. METHODS The group designed questionnaires to be administered to healthcare staff and healthcare designers aimed at understanding varied conceptions and features of BSs. Content across the two surveys overlapped significantly, allowing for direct comparisons of responses, while also including tailored questions in relation to the respective experience and skills of the two groups of respondents. RESULTS 102 healthcare professionals and 56 designers took part to the survey. Analysis of the responses permitted for initial recommendations regarding BS typology including (a) proximity to the emergency department (ED), intensive care units (ICUs), and inpatient wards (IWs); (b) location within hospitals but separate from other medical areas; (c) need for independent access; (d) organizational and spatial features similar to ED, ICUs, and IWs; (e) existing as a fully flexible operational space; and (f) BS bed capacity to be approximately 12% of ED beds. CONCLUSIONS Although the analysis is related to the Italian context, the expansion of this preliminary research to alternate healthcare facilities and geographic areas is necessary for reaching a wide consensus by different professionals on this field. It serves as a starting point for future investigations regarding the implementation of BS in hospital settings.
Collapse
Affiliation(s)
- Marco Gola
- Design & Health Lab, Department of Architecture, Built environment and Construction engineering (DABC), Politecnico di Milano, Milan, Italy
| | | | - Daniele Ignazio La Milia
- Post graduate course "Hospital Healthcare Management" (II ed.), Advanced School of Economics and Management of Health Systems (ALTEMS), Rome, Italy
- Mediterranean Institute for Transplantation and Advanced Specialized Therapies ISMETT (IRCCS), Palermo, Italy
| | - Chiara Cadeddu
- Post graduate course "Hospital Healthcare Management" (II ed.), Advanced School of Economics and Management of Health Systems (ALTEMS), Rome, Italy
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Bardini
- Post graduate course "Hospital Healthcare Management" (II ed.), Advanced School of Economics and Management of Health Systems (ALTEMS), Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-medico, Rome, Italy
| | - Barbara Bianconi
- Post graduate course "Hospital Healthcare Management" (II ed.), Advanced School of Economics and Management of Health Systems (ALTEMS), Rome, Italy
- Azienda Usl Toscana Sud-Est, Arezzo, Italy
| | - Raffaella Bisceglia
- Post graduate course "Hospital Healthcare Management" (II ed.), Advanced School of Economics and Management of Health Systems (ALTEMS), Rome, Italy
- Università degli Studi di Perugia, Perugia, Italy
| | - Marcello Di Pumpo
- Post graduate course "Hospital Healthcare Management" (II ed.), Advanced School of Economics and Management of Health Systems (ALTEMS), Rome, Italy
- Azienda ULSS6 Euganea, Regione Veneto, Padova, Italy
| | - Cristina Genovese
- Post graduate course "Hospital Healthcare Management" (II ed.), Advanced School of Economics and Management of Health Systems (ALTEMS), Rome, Italy
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Postgraduate Medical School of Preventive Medicine and Hygiene, University of Messina, Messina, Italy
| | - Albino Grieco
- Post graduate course "Hospital Healthcare Management" (II ed.), Advanced School of Economics and Management of Health Systems (ALTEMS), Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Piras
- Post graduate course "Hospital Healthcare Management" (II ed.), Advanced School of Economics and Management of Health Systems (ALTEMS), Rome, Italy
- Asl n. 7 Sulcis, Carbonia SU, Italy
| | - Rocco Guerra
- ASL Bari, Bari, Italy
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Gianfranco Damiani
- Post graduate course "Hospital Healthcare Management" (II ed.), Advanced School of Economics and Management of Health Systems (ALTEMS), Rome, Italy
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlo Favaretti
- Post graduate course "Hospital Healthcare Management" (II ed.), Advanced School of Economics and Management of Health Systems (ALTEMS), Rome, Italy
- Centre on Leadership in Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Teresa Montagna
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Stefano Capolongo
- Design & Health Lab, Department of Architecture, Built environment and Construction engineering (DABC), Politecnico di Milano, Milan, Italy
| | - Walter Ricciardi
- Post graduate course "Hospital Healthcare Management" (II ed.), Advanced School of Economics and Management of Health Systems (ALTEMS), Rome, Italy
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
2
|
Samadbeik M, Staib A, Boyle J, Khanna S, Bosley E, Bodnar D, Lind J, Austin JA, Tanner S, Meshkat Y, de Courten B, Sullivan C. Patient flow in emergency departments: a comprehensive umbrella review of solutions and challenges across the health system. BMC Health Serv Res 2024; 24:274. [PMID: 38443894 PMCID: PMC10913567 DOI: 10.1186/s12913-024-10725-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 02/14/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Globally, emergency departments (EDs) are overcrowded and unable to meet an ever-increasing demand for care. The aim of this study is to comprehensively review and synthesise literature on potential solutions and challenges throughout the entire health system, focusing on ED patient flow. METHODS An umbrella review was conducted to comprehensively summarise and synthesise the available evidence from multiple research syntheses. A comprehensive search strategy was employed in four databases alongside government or organisational websites in March 2023. Gray literature and reports were also searched. Quality was assessed using the JBI critical appraisal checklist for systematic reviews and research syntheses. We summarised and classified findings using qualitative synthesis, the Population-Capacity-Process (PCP) model, and the input/throughput/output (I/T/O) model of ED patient flow and synthesised intervention outcomes based on the Quadruple Aim framework. RESULTS The search strategy yielded 1263 articles, of which 39 were included in the umbrella review. Patient flow interventions were categorised into human factors, management-organisation interventions, and infrastructure and mapped to the relevant component of the patient journey from pre-ED to post-ED interventions. Most interventions had mixed or quadruple nonsignificant outcomes. The majority of interventions for enhancing ED patient flow were primarily related to the 'within-ED' phase of the patient journey. Fewer interventions were identified for the 'post-ED' phase (acute inpatient transfer, subacute inpatient transfer, hospital at home, discharge home, or residential care) and the 'pre-ED' phase. The intervention outcomes were aligned with the aim (QAIM), which aims to improve patient care experience, enhance population health, optimise efficiency, and enhance staff satisfaction. CONCLUSIONS This study found that there was a wide range of interventions used to address patient flow, but the effectiveness of these interventions varied, and most interventions were focused on the ED. Interventions for the remainder of the patient journey were largely neglected. The metrics reported were mainly focused on efficiency measures rather than addressing all quadrants of the quadruple aim. Further research is needed to investigate and enhance the effectiveness of interventions outside the ED in improving ED patient flow. It is essential to develop interventions that relate to all three phases of patient flow: pre-ED, within-ED, and post-ED.
Collapse
Affiliation(s)
- Mahnaz Samadbeik
- Faculty of Medicine, Centre for Health Services Research, The University of Queensland, Brisbane, Australia.
- Faculty of Medicine, Queensland Digital Health Centre, The University of Queensland, Brisbane, QLD, 4072, Australia.
| | - Andrew Staib
- Princess Alexandra Hospital, Brisbane, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Justin Boyle
- The Australian E-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
| | - Sankalp Khanna
- The Australian E-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
| | - Emma Bosley
- Queensland Ambulance Service, Queensland Government, Brisbane, Australia
| | - Daniel Bodnar
- Queensland Ambulance Service, Queensland Government, Brisbane, Australia
| | - James Lind
- Gold Coast University Hospital, Gold Coast, Australia
| | - Jodie A Austin
- Faculty of Medicine, Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Faculty of Medicine, Queensland Digital Health Centre, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Sarah Tanner
- Faculty of Medicine, Queensland Digital Health Centre, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Yasaman Meshkat
- Faculty of Medicine, Queensland Digital Health Centre, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Barbora de Courten
- Faculty of Medicine, Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Faculty of Medicine, Queensland Digital Health Centre, The University of Queensland, Brisbane, QLD, 4072, Australia
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
| | - Clair Sullivan
- Faculty of Medicine, Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Faculty of Medicine, Queensland Digital Health Centre, The University of Queensland, Brisbane, QLD, 4072, Australia
- Department of Health, Metro North Hospital and Health Service, Brisbane, Australia
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
| |
Collapse
|
3
|
Wu L, Kong X. COVID-19 pandemic: ethical issues and recommendations for emergency triage. Front Public Health 2023; 11:1160769. [PMID: 37213643 PMCID: PMC10196018 DOI: 10.3389/fpubh.2023.1160769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/07/2023] [Indexed: 05/23/2023] Open
Abstract
The current epidemic of Coronavirus Disease 2019 (COVID-19) has become a public health event worldwide. Through ethical analysis of a series of epidemic prevention phenomena and epidemic prevention measures taken by the Chinese (and other countries) government and medical institutions during the COVID-19 pandemic, this paper discusses a series of ethical difficulties in hospital emergency triage caused by the COVID-19, including the autonomy limitation of patients and waste of epidemic prevention resources due to over-triage, the safety problem of patients because of inaccurate feedback information from intelligent epidemic prevention technology, and conflicts between individual interests of patients and public interests due to the "strict" implementation of the pandemic prevention and control system. In addition, we also discuss the solution path and strategy of these ethical issues from the perspective of system design and implementation based on the Care Ethics theory.
Collapse
|
4
|
Casagranda I, Gola M, Bellone A, Coen D, Brambilla A, Guiddo G, Paolillo C, Lerza R, Capolongo S, Boeri S. Challenges of the next generation hospitals: Rethinking the Emergency Department. EMERGENCY CARE JOURNAL 2022. [DOI: 10.4081/ecj.2022.10840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The COVID 19 outbreak dramatically highlighted the inadequacy of the Emergency Department (ED) settings in dealing with events that can acutely affect a wide range of population. The immediate urgency to create strictly distinct pathways became also a strategic aspect for reducing possible sources of contagion inside the hospital.1 This need has often clashed with inadequate structural conditions of the hospital: in fact, the rigidity of many EDs is due to the hospital typology and its localization (affected by functional program);2,3 and it prevents them from being quickly adapted to new needs in the case of maxi-emergencies.4 In several recent international projects, the presence of a multifunctional space and/or a buffer area guarantees different scenarios in relation to the healthcare/emergency needs.5 [...]
Collapse
|