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emergency department crowding

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https://www.readbyqxmd.com/read/27913245/contextual-computing-a-bluetooth-based-approach-for-tracking-healthcare-providers-in-the-emergency-room
#1
Joshua Frisby, Vernon Smith, Stephen Traub, Vimla L Patel
Hospital Emergency Departments (EDs) frequently experience crowding. One of the factors that contributes to this crowding is the "door to doctor time", which is the time from a patient's registration to when the patient is first seen by a physician. This is also one of the Meaningful Use (MU) performance measures that emergency departments report to the Center for Medicare and Medicaid Services (CMS). Current documentation methods for this measure are inaccurate due to the imprecision in manual data collection...
November 29, 2016: Journal of Biomedical Informatics
https://www.readbyqxmd.com/read/27856953/door-to-imaging-time-for-acute-stroke-patients-is-adversely-affected-by-emergency-department-crowding
#2
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...
November 17, 2016: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/27833674/alternative-destination-transport-the-role-of-paramedics-in-optimal-use-of-the-emergency-department
#3
Michael M Neeki, Fanglong Dong, Leigh Avera, Tan Than, Rodney Borger, Joe Powell, Reza Vaezazizi, Richard Pitts
INTRODUCTION: Alternative destination transportation by emergency medical services (EMS) is a subject of hot debate between those favoring all patients being evaluated by an emergency physician (EP) and those recognizing the need to reduce emergency department (ED) crowding. This study aimed to determine whether paramedics could accurately assess a patient's acuity level to determine the need to transport to an ED. METHODS: We performed a prospective double-blinded analysis of responses recorded by paramedics and EPs of arriving patients' acuity level in a large Level II trauma center between April 2015 and November 2015...
November 2016: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27831655/emergency-department-crowding-and-hospital-bed-shortage-is-lean-a-smart-answer-a-systematic-review
#4
S Bucci, A G de Belvis, S Marventano, A C De Leva, M Tanzariello, M L Specchia, W Ricciardi, F Franceschi
OBJECTIVE: Emergency Departments (EDs) worldwide face the challenges of crowding, waiting times, and cost containment. This review aims to provide a synthesis of the current literature focused on how Lean Thinking Principles and tools can be applied in an ED to address overcrowding and hospital admissions. MATERIALS AND METHODS: Primary studies showing Lean interventions and implementation in ED visits, not requiring additional resources measuring specific outcomes (i...
October 2016: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/27789568/exit-block-in-emergency-departments-a-rapid-evidence-review
#5
REVIEW
Suzanne Mason, Emma Knowles, Adrian Boyle
BACKGROUND: Exit block (or access block) occurs when 'patients in the ED requiring inpatient care are unable to gain access to appropriate hospital beds within a reasonable time frame'. Exit block is an increasing challenge for Emergency Departments (EDs) worldwide and has been recognised as a major factor in leading to departmental crowding. This paper aims to identify empirical evidence, highlighting causes, effects and strategies to limit exit block. METHODS: A computerised literature search was conducted of English language empirical evidence published between 2008 and 2014 using a combination of terms relating to exit block in ED...
October 27, 2016: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/27776980/why-are-we-waiting-patients-perspectives-for-accessing-emergency-department-services-with-non-urgent-complaints
#6
Maria Unwin, Leigh Kinsman, Scott Rigby
[Background] Emergency departments world-wide report service demands which exceed resource availability. Themes such as crowding, non-urgent presentations, ambulance diversion and access block have been linked to complications in care, poorer patient outcomes, increased morbidity and staff burnout. People attending the emergency department with problems perceived as non-urgent are frequently attributed blame for increased service demand, yet little is known from the patients' perspective. [Method] This project utilised a descriptive cross-sectional waiting room survey of non-urgent patients to identify factors contributing to their decision making process to access ED services at a regional hospital in Tasmania, Australia...
October 21, 2016: International Emergency Nursing
https://www.readbyqxmd.com/read/27757231/emergency-department-crowding-in-singapore-insights-from-a-systems-thinking-approach
#7
Lukas K Schoenenberger, Steffen Bayer, John P Ansah, David B Matchar, Rajagopal L Mohanavalli, Sean Sw Lam, Marcus Eh Ong
OBJECTIVES: Emergency Department crowding is a serious and international health care problem that seems to be resistant to most well intended but often reductionist policy approaches. In this study, we examine Emergency Department crowding in Singapore from a systems thinking perspective using causal loop diagramming to visualize the systemic structure underlying this complex phenomenon. Furthermore, we evaluate the relative impact of three different policies in reducing Emergency Department crowding in Singapore: introduction of geriatric emergency medicine, expansion of emergency medicine training, and implementation of enhanced primary care...
2016: SAGE Open Medicine
https://www.readbyqxmd.com/read/27752619/improving-emergency-department-patient-flow
#8
Paul Richard Edwin Jarvis
Emergency departments (ED) face significant challenges in delivering high quality and timely patient care on an ever-present background of increasing patient numbers and limited hospital resources. A mismatch between patient demand and the ED's capacity to deliver care often leads to poor patient flow and departmental crowding. These are associated with reduction in the quality of the care delivered and poor patient outcomes. A literature review was performed to identify evidence-based strategies to reduce the amount of time patients spend in the ED in order to improve patient flow and reduce crowding in the ED...
June 2016: Clinical and Experimental Emergency Medicine
https://www.readbyqxmd.com/read/27749799/making-improvements-in-the-ed-does-ed-busyness-affect-time-to-antibiotics-in-febrile-pediatric-oncology-patients-presenting-to-the-emergency-department
#9
Christopher A Benner, Erika Mora, Emily Mueller, F Jacob Seagull, Kelly Walkovich, Kaleena Johnson, Schuyler Halverson, Ed Rothman, George Hucks, John G Younger, Michele M Nypaver
OBJECTIVES: Febrile neutropenic pediatric patients are at heightened risk for serious bacterial infections, and rapid antibiotic administration (in <60 minutes) improves survival. Our objectives were to reduce the time-to-antibiotic (TTA) administration and to evaluate the effect of overall emergency department (ED) busyness on TTA. METHODS: This study was a quality improvement initiative with retrospective chart review to reduce TTA in febrile children with underlying diagnosis of cancer or hematologic immunodeficiency who visited the pediatric ED...
October 4, 2016: Pediatric Emergency Care
https://www.readbyqxmd.com/read/27724978/the-copenhagen-triage-algorithm-a-randomized-controlled-trial
#10
Rasmus Bo Hasselbalch, Louis Lind Plesner, Mia Pries-Heje, Lisbet Ravn, Morten Lind, Rasmus Greibe, Birgitte Nybo Jensen, Lars S Rasmussen, Kasper Iversen
BACKGROUND: Crowding in the emergency department (ED) is a well-known problem resulting in an increased risk of adverse outcomes. Effective triage might counteract this problem by identifying the sickest patients and ensuring early treatment. In the last two decades, systematic triage has become the standard in ED's worldwide. However, triage models are also time consuming, supported by limited evidence and could potentially be of more harm than benefit. The aim of this study is to develop a quicker triage model using data from a large cohort of unselected ED patients and evaluate if this new model is non-inferior to an existing triage model in a prospective randomized trial...
October 10, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/27706871/what-cognitive-psychology-tells-us-about-ed-physician-decision-making-and-how-to-improve-it
#11
Jesse M Pines
In this issue of Academic Emergency Medicine, Patterson et al. report a link between two measures of emergency department (ED) crowding -ED census and physician load - to hospital admission decisions. Disposition appeared to change based on both the degree of ED crowding and how many total patients the physician making the admission decision was carrying at the time. This translated to important swings: an average admission rate of 35% with an empty waiting room and zero patient load which increased to 40% with 12 patients waiting or physician was carrying 16 ED patients...
October 5, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27704323/comparison-of-emergency-department-crowding-scores-a-discrete-event-simulation-approach
#12
Virginia Ahalt, Nilay Tanık Argon, Serhan Ziya, Jeff Strickler, Abhi Mehrotra
According to American College of Emergency Physicians, emergency department (ED) crowding occurs when the identified need for emergency services exceeds available resources for patient care in the ED, hospital, or both. ED crowding is a widely reported problem and several crowding scores are proposed to quantify crowding using hospital and patient data as inputs for assisting healthcare professionals in anticipating imminent crowding problems. Using data from a large academic hospital in North Carolina, we evaluate three crowding scores, namely, EDWIN, NEDOCS, and READI by assessing strengths and weaknesses of each score, particularly their predictive power...
October 4, 2016: Health Care Management Science
https://www.readbyqxmd.com/read/27682023/fear-vulnerability-and-sacrifice-drivers-of-emergency-department-use-and-implications-for-policy
#13
Anastasia Hudgins, Kristin L Rising
Patients' existential fears of unknowns associated with illness and unusual bodily signs and symptoms are common, but unexamined drivers to the emergency department (ED). This paper examines a May 2015 case study of a 51-year-old low-income, recently insured, African American man in Philadelphia (USA) who had two recent ED visits for evaluation of frequent headaches and described fear of being at risk for a stroke. Through ethnographic methods and anthropological analyses we find that fear of failing to fulfill social roles due to a potentially debilitating illness, and fear of burdening family members with medical bills resulting from doctor's visits affect this man's patterns of health-seeking behaviors...
September 20, 2016: Social Science & Medicine
https://www.readbyqxmd.com/read/27678127/the-influence-of-emergency-department-crowding-on-the-efficiency-of-care-for-acute-stroke-patients
#14
Ming-Ta Tsai, Yung-Lin Yen, Chih-Min Su, Chih-Wei Hung, Chia-Te Kung, Kuan-Han Wu, Hsien-Hung Cheng
OBJECTIVE: To investigate the impact of emergency department (ED) crowding (number of ED patients) and number of ED staff on the efficiency of the ED care process for acute stroke patients. DESIGN: Retrospective cohort study conducted from 1 May 2008 to 31 December 2013. SETTING: Largest primary stroke center (3000-bed tertiary academic hospital) in southern Taiwan. PARTICIPANTS: Patients aged 18-80 years presenting to the ED with acute stroke symptoms ≤3 h from symptom onset (n = 1142)...
September 27, 2016: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/27640877/associations-of-emergency-department-length-of-stay-with-publicly-reported-quality-of-care-measures
#15
Anna Marie Chang, Amber Lin, Rongwei Fu, K John McConnell, Benjamin Sun
OBJECTIVE: The Institute of Medicine identified emergency department (ED) crowding as a critical threat to patient safety. We assess the association between changes in publicly reported ED length-of-stay (LOS) and changes in quality-of-care measures in a national cohort of hospitals. METHODS: Longitudinal analysis of 2012 and 2013 data from the American Hospital Association (AHA) Survey, Center for Medicare and Medicaid Services (CMS) Cost Reports, and CMS Hospital Compare...
September 19, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27637406/can-triage-nurses-accurately-predict-patient-dispositions-in-the-emergency-department
#16
Danette Alexander, Lincoln Abbott, Qiuping Zhou, Ilene Staff
: Contemporary emergency departments experience crowded conditions with poor patient outcomes. If triage nurses could accurately predict admission, one theoretical intervention to reduce crowding is to place patients in the admission cue on arrival to the emergency department. The purpose of this study was to determine if triage nurses could accurately predict patient dispositions. METHODS: This prospective study was conducted in a tertiary academic hospital's emergency department using a data collection tool embedded in the ED electronic information system...
November 2016: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
https://www.readbyqxmd.com/read/27625737/the-medical-duty-officer-an-attempt-to-mitigate-the-ambulance-at-hospital-interval
#17
Megan H Halliday, Andrew J Bouland, Benjamin J Lawner, Angela C Comer, Daniel C Ramos, Mark Fletcher
INTRODUCTION: A lack of coordination between emergency medical services (EMS), emergency departments (ED) and systemwide management has contributed to extended ambulance at-hospital times at local EDs. In an effort to improve communication within the local EMS system, the Baltimore City Fire Department (BCFD) placed a medical duty officer (MDO) in the fire communications bureau. It was hypothesized that any real-time intervention suggested by the MDO would be manifested in a decrease in the EMS at-hospital time...
September 2016: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27625726/increased-30-day-emergency-department-revisits-among-homeless-patients-with-mental-health-conditions
#18
Chun Nok Lam, Sanjay Arora, Michael Menchine
INTRODUCTION: Patients with mental health conditions frequently use emergency medical services. Many suffer from substance use and homelessness. If they use the emergency department (ED) as their primary source of care, potentially preventable frequent ED revisits and hospital readmissions can worsen an already crowded healthcare system. However, the magnitude to which homelessness affects health service utilization among patients with mental health conditions remains unclear in the medical community...
September 2016: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27605653/emergency-department-length-of-stay-for-psychiatric-visits-was-significantly-longer-than-for-nonpsychiatric-visits-2002-11
#19
Jane M Zhu, Astha Singhal, Renee Y Hsia
Despite increases in the use of emergency department (EDs) for mental health care, there are limited data on whether psychiatric patients disproportionately contribute to ED crowding. We conducted a retrospective analysis using a national database of ED visits in the period 2002-11 to describe trends in median and ninetieth-percentile length-of-stay for patients with psychiatric versus nonpsychiatric primary diagnoses. Psychiatric patients who visited the ED were transferred to another facility at six times the rate of nonpsychiatric patients...
September 1, 2016: Health Affairs
https://www.readbyqxmd.com/read/27541701/the-impact-of-patient-centered-medical-homes-on-safety-net-clinics
#20
Li-Hao Chu, Michael Tu, Yuan-Chi Lee, Neeraj Sood
OBJECTIVES: To evaluate the impact of moving to a patient-centered medical home (PCMH) model in safety net clinics in a managed Medicaid plan. STUDY DESIGN: Quasi-experimental, difference-in-differences design. METHODS: The study examined whether the PCMH model reduced emergency department (ED) use and whether the growth in the seniors and people with disabilities (SPDs) population crowds out lower-cost populations. The study compared 7 PCMH safety net clinics (22,870 members) in late 2011 in the greater Los Angeles area with 110 general safety net clinics (143,530 members) between January 2011 and December 2013...
August 2016: American Journal of Managed Care
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