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emergency department crowding

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https://www.readbyqxmd.com/read/29330584/a-dedicated-neurologist-at-the-emergency-department-during-out-of-office-hours-decreases-patients-length-of-stay-and-admission-percentages
#1
M Christien van der Linden, Crispijn L van den Brand, Ido R van den Wijngaard, Roeline A Y de Beaufort, Naomi van der Linden, Korné Jellema
BACKGROUND: Emergency departments (EDs) worldwide face crowding, which hampers patient flow. In this study, the impact of a dedicated neurologist present at the ED on patient flow during out-of-office hours was assessed. METHODS: A cross-sectional, mixed methods study was undertaken at a Dutch ED, including a pre-post analysis of data of patients who had a primary neurological disease (n = 458) and staff surveys (n = 152). Descriptive statistics and content analysis were used for analyses...
January 12, 2018: Journal of Neurology
https://www.readbyqxmd.com/read/29280244/complex-systems-thinking-in-emergency-medicine-a-novel-paradigm-for-a-rapidly-changing-and-interconnected-health-care-landscape
#2
Matthew A Widmer, R Chad Swanson, Brian J Zink, Jesse M Pines
INTRODUCTION: The specialty of emergency medicine is experiencing the convergence of a number of transformational forces in the United States, including health care reform, technological advancements, and societal shifts. These bring both opportunity and uncertainty. 21ST CENTURY CHALLENGES: Persistent challenges such as the opioid epidemic, rising health care costs, misaligned incentives, patients with multiple chronic diseases, and emergency department crowding continue to plague the acute, unscheduled care system...
December 27, 2017: Journal of Evaluation in Clinical Practice
https://www.readbyqxmd.com/read/29207925/quantifying-emergency-department-crowding-comparison-between-two-scores
#3
Jérôme Jobé, Anne-Françoise Donneau, Béatrice Scholtes, Alexandre Ghuysen
INTRODUCTION: Emergency department (ED) crowding is a major international concern with a negative impact on both patient care and providers. Currently, there is no consensus regarding measure of crowding. Therefore, emergency physicians have to choose between numerous scoring systems, from simple to more complex. The aim of the present study was to compare the complex National Emergency Department Overcrowding Scale (NEDOCS) with the simple ED Occupancy rate (OR) determination. We further evaluated the correlation between these scores and a qualitative assessment of crowding...
December 5, 2017: Acta Clinica Belgica
https://www.readbyqxmd.com/read/29196487/application-of-time-series-analysis-in-modelling-and-forecasting-emergency-department-visits-in-a-medical-centre-in-southern-taiwan
#4
Wang-Chuan Juang, Sin-Jhih Huang, Fong-Dee Huang, Pei-Wen Cheng, Shue-Ren Wann
OBJECTIVE: Emergency department (ED) overcrowding is acknowledged as an increasingly important issue worldwide. Hospital managers are increasingly paying attention to ED crowding in order to provide higher quality medical services to patients. One of the crucial elements for a good management strategy is demand forecasting. Our study sought to construct an adequate model and to forecast monthly ED visits. METHODS: We retrospectively gathered monthly ED visits from January 2009 to December 2016 to carry out a time series autoregressive integrated moving average (ARIMA) analysis...
December 1, 2017: BMJ Open
https://www.readbyqxmd.com/read/29170337/40%C3%A2-ed-crowding-the-acceptability-of-dysfunction
#5
Karl Kavanagh, Darragh Shields, Paul Staunton
BACKGROUND: Crowding in the Emergency Department is internationally recognised as one of the greatest challenges to healthcare provision. Numerous studies have highlighted the ill-effects of crowding, including increased length of stay, mortality and cost per admission. Crowding is typically a manifestation of a hospital at full capacity and its main contributor is the practice of boarding patients in the ED. Therefore, a functioning flow system is advised to ease the burden. Different predictive tools/algorithms assess the degree of crowding...
December 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29170318/21%C3%A2-daily-dynamic-discharge-a-whole-system-solution-to-ed-crowding
#6
Jacques Kerr, Helen Maitland, Claire Bell, Julie White, Alan Hunter
INTRODUCTION: ED crowding is associated with increased mortality, poor staff and patient experience, an increased inpatient length of stay and poor compliance with the four-hour emergency access standard.1 Where crowding is caused by exit block, the focus needs to be on whole system patient management, reducing the temporal mismatch between admissions and discharges since at times of peak demand hospitals may become gridlocked until patients are discharged.In an attempt to tackle exit block, the Scottish Government Unscheduled Care Team have implemented the Daily Dynamic Discharge (DDD) approach, which aims to increase the number of inpatient discharges by 12 pm, thus enabling more timeous flow through the ED...
December 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29167033/nursing-perceptions-of-the-emergency-severity-index-as-a-triage-tool-in-the-united-arab-emirates-a-qualitative-analysis
#7
Binoy Mistry, Kamna S Balhara, Jeremiah S Hinson, Xavier Anton, Iman Yassin Othman, Maysoon Abdel Latif E'nouz, Norman Agustin Avila, Sophia Henry, Scott Levin, Sarah Stewart De Ramirez
INTRODUCTION: With emergency department crowding becoming an increasing problem across the globe, nursing triage to prioritize patients receiving care is ever more important. ESI is the most common triage system used in the United States and is increasingly used worldwide. This qualitative study that explores emergency nursing perceptions of the ESI identifies strengths, weaknesses, and barriers to implementation of the ESI internationally. METHODS: We conducted a cross-sectional qualitative analysis using semistructured interviews of 27 emergency triage nurses...
November 19, 2017: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
https://www.readbyqxmd.com/read/29115767/care-delays-in-patients-with-signs-and-symptoms-of-acute-myocardial-infarction
#8
Susan Sanders
AIM: More than six million patients with signs and symptoms suggestive of a heart attack present to emergency departments (EDs) in the US each year. Of those diagnosed with acute myocardial infarction (AMI), one third die in the acute phase. Rapid ED triage can reduce the mortality rate, yet there are still delays in patient care. The aim of this study is to explore the relationship between patient and nurse characteristics, patient presentations, delays in triage, and delays in obtaining electrocardiograms (ECGs) of patients with signs and symptoms of AMI...
October 12, 2017: Emergency Nurse: the Journal of the RCN Accident and Emergency Nursing Association
https://www.readbyqxmd.com/read/29110718/cardiac-patients-perceptions-of-neighboring-patients-risk-influence-on-psychological-stress-in-the-ed-and-subsequent-posttraumatic-stress
#9
Beatrice Konrad, David Hiti, Bernard P Chang, Jessica Retuerto, Jacob Julian, Donald Edmondson
BACKGROUND: As many as 12% of acute coronary syndrome (ACS) patients screen positive for post-traumatic stress disorder (PTSD) symptoms due to their cardiac event, and emergency department (ED) factors such as overcrowding have been associated with risk for PTSD. We tested the association of patients' perceptions of their proximity to a critically ill patient during ED evaluation for ACS with development of posttraumatic stress symptoms (PSS) in the month after hospital discharge. METHODS: Participants were enrolled in the REactions to Acute Care and Hospitalization (REACH) study during evaluation for ACS in an urban ED...
November 6, 2017: BMC Emergency Medicine
https://www.readbyqxmd.com/read/29095294/effect-of-crowding-on-length-of-stay-for-common-chief-complaints-in-the-emergency-department-a-strobe-cohort-study
#10
Linnéa Wickman, Per Svensson, Therese Djärv
Crowding in emergency departments (EDs) is associated with long lengths of stay (LOS); however, it is not known whether the effect is equal across different chief complaints.The aim of the study was to compare the effect of crowding on LOS in the 10 most common medical or surgical chief complaints in the ED.All adult visits to a university hospital ED on weekdays between 8 AM and 9 PM in 2012 (n = 19,200) were stratified based on chief complaint and triage priority. The ED bed occupancy rate was measured and crowding was defined as an occupancy rate over one...
November 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29079371/impact-of-revised-triage-to-improve-throughput-in-an-ed-with-limited-traditional-fast-track-population
#11
Ryan M Gardner, Nathan A Friedman, Michael Carlson, Tamala S Bradham, Tyler W Barrett
BACKGROUND: Emergency department (ED) crowding is associated with patient safety concerns, increased patients left without being seen (LWBS), low patient satisfaction, and lost ED revenue. The objective was to measure the impact of a revised triage process on ED throughput. METHODS: This study took place at an urban, university-affiliated, adult ED with an annual census of 70,000 and admission rate of 34%. The revised triage approach included: identifying eligible patients at triage based on complaint, comorbidities, and illness acuity; and reallocating a nurse practitioner (NP) into our triage area...
January 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29076262/registered-nurses-own-experience-of-using-a-nurse-initiated-pain-protocol-based-on-their-working-experience
#12
L Sturesson, A-C Falk, J Ulfvarson, V Lindström
AIMS & OBJECTIVES: The aim of the study was to explore registered nurses' (RN) own experience of using the nurse-initiated pain protocol (NIPP) in the emergency department (ED) based on their working experience. BACKGROUND: Pain is known to be one of the most common symptoms among adult patients seeking care at the ED. Several strategies aiming to improve pain management have been developed. Despite some improvements in pain management by using NIPP, a large number of patients continue to have inadequate pain treatment when cared for in EDs...
October 27, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/29054574/concepts-antecedents-and-consequences-of-ambulance-ramping-in-the-emergency-department-a-scoping-review
#13
Chris Kingswell, Ramon Z Shaban, Julia Crilly
BACKGROUND: Patients arriving at the Emergency Department (ED) via ambulance can experience a delay in receiving definitive care. In Australia, this phenomenon is referred to as 'Ambulance Ramping', 'Patient Off Stretcher Time Delay' or 'Offload Delay'. As a direct consequence of crowding, and in the context of a worldwide increase in ED and ambulance usage, hospital and ambulance service function is hampered. The aim of this review was to synthesize the literature with respect to the conceptualisation, meaning, antecedents and consequences of Ambulance Ramping...
November 2017: Australasian Emergency Nursing Journal: AENJ
https://www.readbyqxmd.com/read/29038668/overcrowding-and-its-association-with-patient-outcomes-in-a-median-low-volume-emergency-department
#14
J Laureano Phillips, Bradford E Jackson, Elizabeth L Fagan, Steven E Arze, Brenton Major, Nestor R Zenarosa, Hao Wang
BACKGROUND: Crowding occurs commonly in high volume emergency departments (ED) and has been associated with negative patient care outcomes. We aim to assess ED crowding in a median-low volume setting and evaluate associations with patient care outcomes. METHODS: This was a prospective single-center study from November 14, 2016 until December 14, 2016. ED crowding was measured every 2 h by three different estimation tools: National Emergency Department Overcrowding Score (NEDOCS); Community Emergency Department Overcrowding Score (CEDOCS); and Severely-overcrowding Overcrowding and Not-overcrowding Estimation Tool (SONET) categorized under six different levels of crowding (not busy, busy, extremely busy, overcrowded, severely overcrowded, and dangerously overcrowded)...
November 2017: Journal of Clinical Medicine Research
https://www.readbyqxmd.com/read/29032791/deconstructing-the-4-h-rule-for-access-to-emergency-care-and-putting-patients-first
#15
Ian Scott, Clair Sullivan, Andrew Staib, Anthony Bell
Evidence suggests improved outcomes for patients requiring emergency admission to hospital are associated with improved emergency department (ED) efficiency and lower transit times. Factors preventing timely transfers of emergency patients to in-patient beds across the ED-in-patient interface are major causes for ED crowding, for which several remedial strategies are possible, including parallel processing of probable admissions, direct-to-ward admissions and single-point medical registrars for receiving and processing all referrals directed at specific speciality units...
October 16, 2017: Australian Health Review: a Publication of the Australian Hospital Association
https://www.readbyqxmd.com/read/28992161/the-role-of-patient-perception-of-crowding-in-the-determination-of-real-time-patient-satisfaction-at-emergency-department
#16
Hao Wang, Jeffrey A Kline, Bradford E Jackson, Richard D Robinson, Matthew Sullivan, Marcus Holmes, Katherine A Watson, Chad D Cowden, Jessica Laureano Phillips, Chet D Schrader, JoAnna Leuck, Nestor R Zenarosa
Objective: To evaluate the associations between real-time overall patient satisfaction and Emergency Department (ED) crowding as determined by patient percepton and crowding estimation tool score in a high-volume ED. Design: A prospective observational study. Setting: A tertiary acute hospital ED and a Level 1 trauma center. Participants: ED patients. Intervention(s): Crowding status was measured by two crowding tools [National Emergency Department Overcrowding Scale (NEDOCS) and Severely overcrowded-Overcrowded-Not overcrowded Estimation Tool (SONET)] and patient perception of crowding surveys administered at discharge...
October 1, 2017: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/28958418/planning-for-the-future-emergency-department-presentation-patterns-in-tasmania-australia
#17
Claire Morley, Jim Stankovich, Gregory Peterson, Leigh Kinsman
BACKGROUND: Emergency department crowding and associated adverse outcomes are major issues in health care systems worldwide. The Australian government has highlighted the need to analyse emergency presentations to inform system redesign. OBJECTIVE: To describe the profile of emergency department presentations by Tasmanian residents to emergency departments over four years, and examine regional variations. METHOD: A retrospective analysis of emergency department data for Tasmania's public hospitals over four financial years, 2010-11 to 2013-14, was undertaken...
September 22, 2017: International Emergency Nursing
https://www.readbyqxmd.com/read/28950856/new-zealand-s-emergency-department-target-did-it-reduce-ed-length-of-stay-and-if-so-how-and-when
#18
Tim Tenbensel, Linda Chalmers, Peter Jones, Sarah Appleton-Dyer, Lisa Walton, Shanthi Ameratunga
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...
September 26, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28941074/towards-a-best-measure-of-emergency-department-crowding-lessons-from-current-australasian-practice
#19
Peter Jones, Susan Wells, Shanthi Ameratunga
OBJECTIVE: Despite extensive literature, how crowding in EDs should be measured is still debated. The present study aimed to describe crowding metrics used in Australasia, what they were used for, the perceived extent and frequency of crowding and the challenges faced when trying to measure crowding. METHODS: A survey of ED clinical directors was undertaken between December 2014 and July 2015. Free-text responses were categorised and thematically coded. Quantitative data were analysed descriptively and with logistic regression...
September 23, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/28929984/developing-a-hospital-disaster-preparedness-plan-for-mass-casualty-incidents-lessons-learned-from-the-downtown-beirut-bombing
#20
Mazen El Sayed, Ali F Chami, Eveline Hitti
Mass casualty incidents (MCIs) are becoming more frequent worldwide, especially in the Middle East where violence in Syria has spilled over to many neighboring countries. Lebanon lacks a coordinated prehospital response system to deal with MCIs; therefore, hospital preparedness plans are essential to deal with the surge of casualties. This report describes our experience in dealing with an MCI involving a car bomb in an urban area of downtown Beirut, Lebanon. It uses general response principles to propose a simplified response model for hospitals to use during MCIs...
September 20, 2017: Disaster Medicine and Public Health Preparedness
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