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Emergency department overcrowding

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https://www.readbyqxmd.com/read/28418455/the-development-and-performance-of-after-hours-primary-care-in-the-netherlands-a-narrative-review
#1
Marleen Smits, Martijn Rutten, Ellen Keizer, Michel Wensing, Gert Westert, Paul Giesen
In many Western countries, hospital emergency departments are overcrowded, leading to the desire to strengthen primary care, particularly after hours. To achieve this goal, an increasing number of Western nations are reorganizing their after-hours primary care systems into large-scale primary care physician (PCP) cooperatives. This article provides an overview of the organization, performance, and development of PCP cooperatives in the Netherlands. The Dutch after-hours primary care system might offer opportunities for other countries facing problems with after-hours care and inappropriate emergency department visits...
April 18, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/28413420/overcrowding-in-emergency-departments-a-review-of-strategies-to-decrease-future-challenges
#2
REVIEW
Mohammad H Yarmohammadian, Fatemeh Rezaei, Abbas Haghshenas, Nahid Tavakoli
Emergency departments (EDs) are the most challenging ward with respect to patient delay. The goal of this study is to present strategies that have proven to reduce delay and overcrowding in EDs. In this review article, initial electronic database search resulted in a total of 1006 articles. Thirty articles were included after reviewing full texts. Inclusion criteria were assessments of real patient flows and implementing strategies inside the hospitals. In this study, we discussed strategies of team triage, point-of-care testing, ideal ED patient journey models, streaming, and fast track...
2017: Journal of Research in Medical Sciences: the Official Journal of Isfahan University of Medical Sciences
https://www.readbyqxmd.com/read/28396704/emergency-department-stay-associated-delirium-in-older-patients
#3
Marcel Émond, David Grenier, Jacques Morin, Debra Eagles, Valérie Boucher, Natalie Le Sage, Éric Mercier, Philippe Voyer, Jacques S Lee
BACKGROUND: Caring for older patients can be challenging in the Emergency Department (ED). A > 12 hr ED stay could lead to incident episodes of delirium in those patients. The aim of this study was to assess the incidence and impacts of ED-stay associated delirium. METHODS: A historical cohort of patients who presented to a Canadian ED in 2009 and 2011 was randomly constituted. Included patients were aged ≥ 65 years old, admitted to any hospital ward, non-delirious upon arrival and had at least a 12-hour ED stay...
March 2017: Canadian Geriatrics Journal: CGJ
https://www.readbyqxmd.com/read/28294011/we-must-not-repeat-the-mistakes-of-mid-staffs
#4
Sir Stephen Moss
These are exceptionally tough times for everyone providing care and treatment across NHS settings. Colleagues on the front line face unprecedented pressure day in, day out, without any respite and often with limited resources. As a nurse it distresses me greatly to see graphic images of older, frail patients waiting for long periods on trolleys in overcrowded emergency departments.
March 15, 2017: Nursing Standard
https://www.readbyqxmd.com/read/28279108/is-streaming-patients-a-good-idea
#5
Mandy Rumley-Buss
To reduce delays in patient care and overcrowding in emergency departments (EDs), suitable patients are often streamed away from the department or to separate areas in the department for specialist care.
March 10, 2017: Emergency Nurse: the Journal of the RCN Accident and Emergency Nursing Association
https://www.readbyqxmd.com/read/28275860/parameters-affecting-length-of-stay-in-a-pediatric-emergency-department-a-retrospective-observational-study
#6
Kevin D Hofer, Rotraud K Saurenmann
Prolonged emergency department (ED) length of stay (LOS) is used as a proxy for ED overcrowding and is associated with adverse outcomes of patients requiring therapy and reduced patient satisfaction. Our aim was to identify and quantify variables which affect ED-LOS. Patients admitted to the pediatric ED of a large regional Swiss hospital during a 1-year period were analyzed for LOS (in minutes). Predictor variables included patient-associated parameters (time of admission and discharge, ED occupancy, triage score, diagnosis, and demographic data) and external factors (weekday, time, and season)...
March 8, 2017: European Journal of Pediatrics
https://www.readbyqxmd.com/read/28274646/general-characteristics-and-activity-of-emergency-department-short-stay-units-in-spanish-hospitals
#7
Carles Ferré, Ferran Llopis, Francisco Javier Martín-Sánchez, Gonzalo Sempere, Pere Llorens, Carmen Navarro, Mikel Martínez-Ortiz, Antoni Juan
BACKGROUND: Emergency Department (ED) overcrowding mainly due to the lack of access to inpatient beds negatively affects safety and quality of care. Implementation of ED short-stay units (EDSSUs) may help to mitigate this situation. OBJECTIVES: To describe the general characteristics and evaluate the activity of EDSSUs in Spanish hospitals. METHODS: This is a cross-sectional study. A questionnaire was sent to coordinators responsible for the EDSSUs identified among Spanish hospitals appearing on the Ministry of Health Web page...
March 5, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28265341/diabetic-ketoacidosis-treatment-in-the-intensive-care-unit-or-general-medical-surgical-ward
#8
EDITORIAL
Yamely Mendez, Salim Surani, Joseph Varon
Diabetic ketoacidosis (DKA) is defined as an acute metabolic disorder, which is characterized by an increased presence of circulating ketones, and the development of ketoacidosis in the presence of hyperglycemia. This syndrome occurs as a result of insulin deficiency. Patients can be dramatically ill, however, with aggressive treatment, most patients recover rapidly. Despite being a low-risk condition, the development of acidosis, is one of the admission criteria to the intensive care unit (ICU) for these patients, in order to provide close monitoring, and recognize complications that could result from the use of aggressive therapy, such as continuous infusions if insulin...
February 15, 2017: World Journal of Diabetes
https://www.readbyqxmd.com/read/28241931/text-mining-approach-to-predict-hospital-admissions-using-early-medical-records-from-the-emergency-department
#9
Filipe R Lucini, Flavio S Fogliatto, Giovani J C da Silveira, Jeruza L Neyeloff, Michel J Anzanello, Ricardo de S Kuchenbecker, Beatriz D Schaan
OBJECTIVE: Emergency department (ED) overcrowding is a serious issue for hospitals. Early information on short-term inward bed demand from patients receiving care at the ED may reduce the overcrowding problem, and optimize the use of hospital resources. In this study, we use text mining methods to process data from early ED patient records using the SOAP framework, and predict future hospitalizations and discharges. DESIGN: We try different approaches for pre-processing of text records and to predict hospitalization...
April 2017: International Journal of Medical Informatics
https://www.readbyqxmd.com/read/28228344/emergency-department-return-visits-within-a-large-geographic-area
#10
Mimi Truong, Garth Meckler, Quynh H Doan
BACKGROUND: Return visits to the emergency department (RTED) contribute to overcrowding and may be a quality of care indicator. Previous studies focused on factors predicting returns to and from the same center. Little is known about RTEDs across a range of community and specialty hospitals within a large geographic area. OBJECTIVE: We sought to measure the frequency of pediatric RTEDs and describe their directional pattern across centers in a large catchment area...
February 19, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28207411/reporting-altered-test-results-in-hemolyzed-samples-is-the-cure-worse-than-the-disease
#11
Giuseppe Lippi, Gianfranco Cervellin, Mario Plebani
The management of laboratory data in unsuitable (hemolyzed) samples remains an almost unresolved dilemma. Whether or not laboratory test results obtained by measuring unsuitable specimens should be made available to the clinicians has been the matter of fierce debates over the past decades. Recently, an intriguing alternative to suppressing test results and recollecting the specimen has been put forward, entailing the definition and implementation of specific algorithms that would finally allow reporting a preanalytically altered laboratory value within a specific comment about its uncertainty of measurement...
February 16, 2017: Clinical Chemistry and Laboratory Medicine: CCLM
https://www.readbyqxmd.com/read/28173740/emergency-department-redirection-to-primary-care-a-prospective-evaluation-of-practice
#12
James A Bentley, Shobhan Thakore, William Morrison, Weijie Wang
Background and aim Non-urgent Emergency Department presentations contribute to overcrowding, which can adversely affect patient care. Redirecting patients to a more appropriate service is an option to help address this. We conducted a prospective evaluation of a major Scottish hospital's Emergency Department redirection policy to assess its safety. Methods and results Over two months, 620 patients triggered senior assessment for redirection with 444 (72%) redirected to primary care. Information on presentation was collected with subsequent management and outcome of redirection provided by the patient's general practitioner...
January 1, 2017: Scottish Medical Journal
https://www.readbyqxmd.com/read/28164140/epidemiology-of-pediatric-burns-and-future-prevention-strategies-a-study-of-475-patients-from-a-high-volume-burn-center-in-north-india
#13
Amol Dhopte, V K Tiwari, Pankaj Patel, Rahul Bamal
BACKGROUND: Pediatric burns have a long-term social impact. This is more apparent in a developing country such as India, where their incidence and morbidity are high. The aim of this study was to provide recent prospective epidemiological data on pediatric burns in India and to suggest future preventive strategies. METHODS: Children up to 18 years old admitted to the Department of Burns, Plastic & Maxillofacial Surgery, VMMC & Safdarjung Hospital, New Delhi, between January and December 2014 were included in the study...
2017: Burns and trauma
https://www.readbyqxmd.com/read/28151752/influences-on-emergency-department-length-of-stay-for-older-people
#14
Maryann Street, Mohammadreza Mohebbi, Debra Berry, Anthony Cross, Julie Considine
OBJECTIVE: The aim of this study was to examine the influences on emergency department (ED) length of stay (LOS) for older people and develop a predictive model for an ED LOS more than 4 h. METHODS: This retrospective cohort study used organizational data linkage at the patient level from a major Australian health service. The study population was aged 65 years or older, attending an ED during the 2013/2014 financial year. We developed and internally validated a clinical prediction rule...
February 1, 2017: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/28139312/impact-of-an-emergency-short-stay-unit-on-emergency-department-performance-of-poisoned-patients
#15
Michael A Downes, James K Balshaw, Tracy M Muscat, Nicole Ritchie, Geoffrey K Isbister
OBJECTIVES: This was a before and after study which sought to assess the impact of opening an ED short stay unit (ESSU) on the ED performance of poisoned patients. METHODS: Data was collected from two groups of adult patients presenting to an ED with a tertiary referral inpatient Toxicology unit from the 2009 and 2012 calendar years, to assess the impact of the ESSU. The toxicology unit clinical database and hospital electronic medical records were interrogated for demographic, clinical and hospital flow details of presentations...
January 26, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28108139/emergency-department-waiting-room-nurse-role-a-key-informant-perspective
#16
Kelli Innes, Debra Jackson, Virginia Plummer, Doug Elliott
BACKGROUND: Emergency departments have become overcrowded with increased waiting times. Strategies to decrease waiting times include time-based key performance indicators and introduction of a waiting room nurse role. The aim of the waiting room nurse role is to expedite care by assessing and managing patients in the waiting room. There is limited literature examining this role. METHODS: This paper presents results of semi-structured interviews with five key informants to explore why and how the waiting room nurse role was implemented in Australian emergency departments...
February 2017: Australasian Emergency Nursing Journal: AENJ
https://www.readbyqxmd.com/read/28065392/mapping-the-process-of-emergency-care-at-a-teaching-hospital-in-ghana
#17
Emily Aaronson, Elizabeth Mort, Samara Soghoian
Emergency Department (ED) overcrowding has become a global concern as the number of countries with formalized emergency care systems has expanded, and the burden of trauma and non-communicable diseases in low and middle-income countries increased. In light of this, the international Emergency Medicine literature has outlined the need for operational projects in low and middle income countries which focus on the process of care. Despite this, there is limited published literature describing these types of projects...
January 3, 2017: Healthcare
https://www.readbyqxmd.com/read/27973563/frequent-use-of-emergency-departments-by-the-elderly-population-when-continuing-care-is-not-well-established
#18
Jacopo M Legramante, Laura Morciano, Francesca Lucaroni, Francesco Gilardi, Emanuele Caredda, Alessia Pesaresi, Massimo Coscia, Stefano Orlando, Antonella Brandi, Germano Giovagnoli, Vito N Di Lecce, Giuseppe Visconti, Leonardo Palombi
INTRODUCTION: The elderly, who suffer from multiple chronic diseases, represent a substantial proportion of Emergency Department (ED) frequent users, thus contributing to ED overcrowding, although they could benefit from other health care facilities, if those were available. The aim of this study was to evaluate and characterize hospital visits of older patients (age 65 or greater) to the ED of a university teaching hospital in Rome from the 1st of January to the 31st of December 2014, in order to identify clinical and social characteristics potentially associated with "elderly frequent users"...
2016: PloS One
https://www.readbyqxmd.com/read/27885343/qualitative-inquiry-into-challenges-experienced-by-registered-general-nurses-in-the-emergency-department-a-study-of-selected-hospitals-in-the-volta-region-of-ghana
#19
Confidence Alorse Atakro, Jerry Paul Ninnoni, Peter Adatara, Janet Gross, Michael Agbavor
Registered General Nurses (RGNs) play crucial roles in emergency departments (EDs). EDs in Ghana are primarily staffed by RGNs who have had no additional formal education in emergency care. Additionally, basic, master's, or doctoral level nursing education programs provide limited content on the complexities of emergency nursing. Nurses in EDs are affected by many challenges such as growing patient population, financial pressures, physical violence, verbal abuse, operational inefficiencies, overcrowding, and work overload...
2016: Emergency Medicine International
https://www.readbyqxmd.com/read/27856953/door-to-imaging-time-for-acute-stroke-patients-is-adversely-affected-by-emergency-department-crowding
#20
Martin A Reznek, Evangelia Murray, Marguerite N Youngren, Natassia T Durham, Sean S Michael
BACKGROUND AND PURPOSE: National guidelines call for door-to-imaging time (DIT) within 25 minutes for suspected acute stroke patients. Studies examining factors that affect DIT have focused primarily on stroke-specific care processes and patient-specific factors. We hypothesized that emergency department (ED) crowding is associated with longer DIT. METHODS: We conducted a retrospective investigation of 1 year of consecutive patients in our prospective Code Stroke registry, which included all ED stroke team activations...
January 2017: Stroke; a Journal of Cerebral Circulation
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