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https://www.readbyqxmd.com/read/29760848/code-help-can-this-unique-state-regulatory-intervention-improve-emergency-department-crowding
#1
Sean S Michael, John P Broach, Kevin A Kotkowski, D Eric Brush, Gregory A Volturo, Martin A Reznek
Introduction: Emergency department (ED) crowding adversely affects multiple facets of high-quality care. The Commonwealth of Massachusetts mandates specific, hospital action plans to reduce ED boarding via a mechanism termed "Code Help." Because implementation appears inconsistent even when hospital conditions should have triggered its activation, we hypothesized that compliance with the Code Help policy would be associated with reduction in ED boarding time and total ED length of stay (LOS) for admitted patients, compared to patients seen when the Code Help policy was not followed...
May 2018: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29748230/senior-doctor-triage-sdt-a-qualitative-study-of-clinicians-views-on-senior-doctors-involvement-in-triage-and-early-assessment-of-emergency-patients
#2
Maysam Ali Abdulwahid, Janette Turner, Suzanne M Mason
INTRODUCTION: Despite the focus during the last decade on introducing interventions such as senior doctor initial assessment or senior doctor triage (SDT) to reduce emergency department (ED) crowding, there has been little attempt to identify the views of emergency healthcare professionals on such interventions. The aim of this study was to gain an understanding of SDT from the perspective of emergency hospital staff. A secondary aim of this study was to develop a definition of SDT based on the interview findings and the available literature on this process...
May 10, 2018: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29747896/is-hallway-care-dangerous-an-observational-study
#3
Jeffrey A Rixe, James H Liu, Hudson A Breaud, Kerrie P Nelson, Patricia M Mitchell, James A Feldman
OBJECTIVES: In response to crowding the use of hallway beds has become an increasingly prevalent practice in Emergency Departments (EDs). There is limited research on whether caring for patients in hallways (HP) is associated with adverse outcomes. The goal of this study was to examine the effects of HP triage on 30 day outcomes for ED return, readmission, and mortality. METHODS: We performed a retrospective cohort study at an urban, academic ED comparing HPs (defined as HP for ≥30 min) to matched controls triaged to standard ED beds from 9/30/14 to 10/1/15...
April 6, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29729811/a-multicenter-program-to-implement-the-canadian-c-spine-rule-by-emergency-department-triage-nurses
#4
Ian G Stiell, Catherine M Clement, Maureen Lowe, Connor Sheehan, Jacqueline Miller, Sherry Armstrong, Brenda Bailey, Kerry Posselwhite, Jannick Langlais, Karin Ruddy, Susan Thorne, Alison Armstrong, Catherine Dain, Jeffrey J Perry, Christian Vaillancourt
STUDY OBJECTIVE: The Canadian C-Spine Rule has been widely applied by emergency physicians to safely reduce use of cervical spine imaging. Our objective is to evaluate the clinical effect and safety of real-time Canadian C-Spine Rule implementation by emergency department (ED) triage nurses to remove cervical spine immobilization. METHODS: We conducted this multicenter, 2-phase, prospective cohort program at 9 hospital EDs and included alert trauma patients presenting with neck pain or with cervical spine immobilization...
May 2, 2018: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/29704980/emergency-department-crowding-and-time-at-the-bedside-a-wearable-technology-feasibility-study
#5
Jessica Castner, Heidi Suffoletto
INTRODUCTION: ED crowding is a public health crisis, limiting quality and access to lifesaving care. The purpose of this study was to (1) evaluate the feasibility of radio-frequency identification tags to measure clinician-patient contact and (2) to test the relationship between ED occupancy and clinician-patient contact time. METHODS: In this 4-week observational study, radio-frequency identification tags were worn by emergency clinicians in a 21-bay urban teaching hospital emergency department...
April 25, 2018: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
https://www.readbyqxmd.com/read/29704977/outcomes-of-an-innovative-evidence-based-practice-project-building-a-difficult-access-team-in-the-emergency-department
#6
Madeleine Whalen, Barbara Maliszewski, Rebecca Sheinfeld, Heather Gardner, Diana Baptiste
PROBLEM: Difficult venous access is a common problem in health care-especially in the emergency setting-that relies on quick diagnostics to differentiate patient acuities and administer critical medications. The creation of a dedicated team to address difficult venous access (DVA) is a possible solution to the problems of delayed venous access, yet no studies have been published on implementing such a team in the emergency department. METHODS: This was a quasi-experimental study in an urban emergency department...
April 25, 2018: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
https://www.readbyqxmd.com/read/29573904/causes-of-emergency-department-overcrowding-and-blockage-of-access-to-critical-services-in-beijing-a-2-year-study
#7
Zhen Wang, Xiaying Xiong, Shuang Wang, Junguo Yan, Martin Springer, R P Dellinger
BACKGROUND: Emergency department (ED) overcrowding is a serious issue worldwide. OBJECTIVES: This study was done to evaluate the degree of overcrowding in local "teaching hospitals" in Beijing, and to ascertain the apparent root causes for the pervasive degree of overcrowding in these EDs. METHODS: This is a multicenter cross-sectional study. The studied population included all ED patients from 18 metropolitan teaching hospital EDs in Beijing for calendar years 2013 and 2014...
March 21, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29563151/emergency-department-overcrowding-a-survey-among-european-neurotrauma-centres
#8
Kimberley Bernadette Velt, Maryse Cnossen, Pleunie P M Rood, Ewout W Steyerberg, Suzanne Polinder, Hester F Lingsma
BACKGROUND: ED overcrowding is an increasing problem worldwide that may negatively affect quality of care and patient outcomes. We aimed to study ED overcrowding across European centres. METHODS: Questionnaires on structure and process of care, including crowding, were distributed to 68 centres participating in a large European study on traumatic brain injury (Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury). RESULTS: Of the 65 centres included in the analysis, 32 (49%) indicated that overcrowding was a frequent problem and 28 (43%) reported that patients were placed in hallways 'multiple times a day'; 27 (41%) stated that multiple times a day, there was no bed available when a patient needed to be admitted...
March 21, 2018: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29538401/impact-of-the-four-hour-rule-in-western-australian-hospitals-trend-analysis-of-a-large-record-linkage-study-2002-2013
#9
Hanh Ngo, Roberto Forero, David Mountain, Daniel Fatovich, Wing Nicola Man, Peter Sprivulis, Mohammed Mohsin, Sam Toloo, Antonio Celenza, Gerard Fitzgerald, Sally McCarthy, Ken Hillman
BACKGROUND: In 2009, the Western Australian (WA) Government introduced the Four-Hour Rule (FHR) program. The policy stated that most patients presenting to Emergency Departments (EDs) were to be seen and either admitted, transferred, or discharged within 4 hours. This study utilised de-identified data from five participating hospitals, before and after FHR implementation, to assess the impact of the FHR on several areas of ED functioning. METHODS: A state (WA) population-based intervention study design, using longitudinal data obtained from administrative health databases via record linkage methodology, and interrupted time series analysis technique...
2018: PloS One
https://www.readbyqxmd.com/read/29474392/characterising-non-urgent-users-of-the-emergency-department-ed-a-retrospective-analysis-of-routine-ed-data
#10
Colin O'Keeffe, Suzanne Mason, Richard Jacques, Jon Nicholl
BACKGROUND: The pressures of patient demand on emergency departments (EDs) continue to be reported worldwide, with an associated negative impact on ED crowding and waiting times. It has also been reported that a proportion of attendances to EDs in different international systems could be managed in settings such as primary care. This study used routine ED data to define, measure and profile non-urgent ED attendances that were suitable for management in alternative, non-emergency settings...
2018: PloS One
https://www.readbyqxmd.com/read/29473738/surface-charge-modulates-protein-protein-interactions-in-physiologically-relevant-environments
#11
Alex J Guseman, Shannon L Speer, Gerardo M Perez Goncalves, Gary J Pielak
Protein-protein interactions are fundamental to biology yet are rarely studied under physiologically relevant conditions where the concentration of macromolecules can exceed 300 g/L. These high concentrations cause cosolute-complex contacts that are absent in dilute buffer. Understanding such interactions is important because they organize the cellular interior. We used 19 F nuclear magnetic resonance, the dimer-forming A34F variant of the model protein GB1, and the cosolutes bovine serum albumin (BSA) and lysozyme to assess the effects of repulsive and attractive charge-charge dimer-cosolute interactions on dimer stability...
March 20, 2018: Biochemistry
https://www.readbyqxmd.com/read/29438575/primary-care-professionals-providing-non-urgent-care-in-hospital-emergency-departments
#12
REVIEW
Daniela Gonçalves-Bradley, Jaspreet K Khangura, Gerd Flodgren, Rafael Perera, Brian H Rowe, Sasha Shepperd
BACKGROUND: In many countries emergency departments (EDs) are facing an increase in demand for services, long waits, and severe crowding. One response to mitigate overcrowding has been to provide primary care services alongside or within hospital EDs for patients with non-urgent problems. However, it is unknown how this impacts the quality of patient care and the utilisation of hospital resources, or if it is cost-effective. This is the first update of the original Cochrane Review published in 2012...
February 13, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29380730/hurry-up-it-s-quiet-in-the-emergency-department
#13
E Ter Avest, B T Onnes, T van der Vaart, M J Land
INTRODUCTION: Emergency department (ED) crowding is a contemporary problem. Solutions are multiple, but often involve a lengthy implementation process and/or substantial funding. Therefore, it is important that in the meanwhile, we aim to identify simple strategies, focussing on optimising efficiency of the available resources, which can be adopted in the ED here and now. METHODS: We made a careful analysis of inflow, throughput and outflow data of all 24,823 patients visiting the ED of a large teaching hospital in the year 2015, and looked in more detail at the 10 days with the longest average throughput times...
January 2018: Netherlands Journal of Medicine
https://www.readbyqxmd.com/read/29370946/retrospective-chart-review-of-the-triage-algorithm-for-psychiatric-screening-taps-for-patients-who-present-to-emergency-departments-with-psychiatric-chief-complaints
#14
Jennifer Schieferle Uhlenbrock, John Hudson, Judy Prewitt, Julie A Thompson, Katherine Pereira
INTRODUCTION: There is a growing number of mental health illnesses (MHIs) in the nation and no standardization of the medical screening examination (MSE) in the emergency department. Many health care organizations are at the tipping point of discarding a battery of laboratory workups. A triage tool-specific to psychiatric chief complaints and cost effective-is needed for the emergency department. METHODS: A nonexperimental, retrospective overlay of the Triage Algorithm for Psychiatric Screening (TAPS) onto previous psychiatric patients' records was performed to determine the sensitivity and specificity of the TAPS in ruling out acute medical illness...
January 19, 2018: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
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
#15
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...
March 2018: Journal of Neurology
https://www.readbyqxmd.com/read/29207925/quantifying-emergency-department-crowding-comparison-between-two-scores
#16
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
#17
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-ed-crowding-the-acceptability-of-dysfunction
#18
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-daily-dynamic-discharge-a-whole-system-solution-to-ed-crowding
#19
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/29115767/care-delays-in-patients-with-signs-and-symptoms-of-acute-myocardial-infarction
#20
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
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