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https://www.readbyqxmd.com/read/28611876/effectiveness-of-resident-physicians-as-triage-liaison-providers-in-an-academic-emergency-department
#1
Victoria Weston, Sushil K Jain, Michael Gottlieb, Amer Aldeen, Stephanie Gravenor, Michael J Schmidt, Sanjeev Malik
INTRODUCTION: Emergency department (ED) crowding is associated with detrimental effects on ED quality of care. Triage liaison providers (TLP) have been used to mitigate the effects of crowding. Prior studies have evaluated attending physicians and advanced practice providers as TLPs, with limited data evaluating resident physicians as TLPs. This study compares operational performance outcomes between resident and attending physicians as TLPs. METHODS: This retrospective cohort study compared aggregate operational performance at an urban, academic ED during pre- and post-TLP periods...
June 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28589691/medical-scribes-have-no-impact-on-the-patient-experience-of-an-emergency-department
#2
William Dunlop, Lachlan Hegarty, Margaret Staples, Michele Levinson, Michael Ben-Meir, Katherine Walker
OBJECTIVE: We aimed to evaluate patient perceptions of medical scribes in the ED and to test for scribe impacts on ED Net Promoter Scores, Press Ganey Surveys and other patient-centred topics. METHODS: Exploratory semi-structured interviews were conducted in the ED during wait times after scribed consultations. Interview results were used to derive topics relating to scribes. Items addressing these topics from validated surveys were combined with items from widely used patient satisfaction questionnaires...
June 6, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/28571105/visualising-emergency-department-capacity-in-an-emergency-department-capacity-clock-a-novel-tool-to-assess-and-communicate-overcrowding-and-access-block
#3
Ohad Dar, Jacques Loubser
Hospital-wide engagement is required to alleviate the problem of ED crowding and its associated adverse effects. To this end, the article describes a novel visualisation termed 'the ED Capacity Clock', which can be formatted using business intelligence software. This radial diagram represents ED capacity and its consumption in a format that can be understood intuitively and at a glance. The ED Capacity Clock is designed to promote common understanding and discussion between relevant hospital services and also acts as an auditing tool to monitor processes implemented to alleviate ED crowding...
June 1, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/28535991/predictors-and-delays-associated-with-the-need-for-advanced-techniques-for-intravenous-access
#4
Michael D Witting, Siamak Moayedi, Latoya A Brown, Ammar Ismail
BACKGROUND: The need for advanced techniques for intravenous access (ATIVA) can lead to delays in care and contribute to emergency department (ED) crowding. OBJECTIVE: In this article, we estimate the delay and predictors associated with the need for ATIVA. METHODS: In this case-control study, we collected data from ED cases requiring ATIVA and control patients in whom i.v. access was gained by traditional inspection and palpation. We included two control groups-a random retrospective sample and a prospective limited convenience sample...
May 20, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28527642/depressive-symptoms-and-perceptions-of-ed-care-in-patients-evaluated-for-acute-coronary-syndrome
#5
Tara St Onge, Donald Edmondson, Emily Cea, Syed Husain, Bernard P Chang
INTRODUCTION: Posttraumatic stress disorder (PTSD) develops in 1 out of 8 survivors of acute coronary syndrome (ACS) events, and these persons have a doubling of risk for recurrent ACS and mortality. Overcrowding in the emergency department during ACS evaluation has been associated with increased risk for PTSD, and depressed patients have been found to be particularly vulnerable. Little is known about the mechanisms by which overcrowding increases PTSD risk in depressed patients. Our aim was to evaluate one possible mechanism, patient perception of crowding and care, in depressed and nondepressed ED patients evaluated for ACS...
May 17, 2017: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
https://www.readbyqxmd.com/read/28494475/impact-of-a-national-time-target-for-ed-length-of-stay-on-patient-outcomes
#6
Peter Jones, Susan Wells, Alana Harper, James Le Fevre, Joanna Stewart, Elana Curtis, Papaarangi Reid, Shanthi Ameratunga
AIM: The impact of national targets for emergency department (ED) length of stay (LOS) on patient care is unclear. This study aimed to determine the effect of New Zealand's six-hour time target (95% of ED patients discharged or admitted to hospital within six hours) on a range of quality indicators. METHODS: A nationwide observational study from 2006 to 2012 modelled differences in changes over time before and after target introduction in 2009. The observed model estimates in 2012 were compared to those predicted if pre-target trends had continued...
May 12, 2017: New Zealand Medical Journal
https://www.readbyqxmd.com/read/28493626/why-do-people-choose-emergency-and-urgent-care-services-a-rapid-review-utilizing-a-systematic-literature-search-and-narrative-synthesis
#7
Joanne E Coster, Janette K Turner, Daniel Bradbury, Anna Cantrell
OBJECTIVES: Rising demand for emergency and urgent care services are well documented, as are the consequences, for example, ED crowding, increased costs, pressure on services and waiting times. Multiple factors have been suggested to explain why demand is increasing, including an aging population, rising number of people with multiple chronic conditions and behavioural changes relating to how people choose to access health services. The aim of this systematic mapping review is to bring together published research from urgent and emergency care settings to identify drivers that underpin patient decisions to access urgent and emergency care...
May 11, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28483037/effect-of-the-4-h-target-on-time-to-ecg
#8
James A Hughes, C J Cabilan, Caitlin Young, Andrew Staib
Objectives The aim of this study was to assess the relationship between compliance with time-based Emergency Department (ED) targets (known as NEAT) and the time taken to collect an electrocardiogram (TTE) in patients presenting with chest pain.Methods This was a pilot descriptive retrospective cohort study completed in a large inner city tertiary ED. Patients who presented with active or recent chest pain between July 2014 and June 2015 were eligible for inclusion. Pregnant patients, inter-hospital transfers, and traumatic chest pain were excluded...
May 9, 2017: Australian Health Review: a Publication of the Australian Hospital Association
https://www.readbyqxmd.com/read/28467124/building-capacity-in-healthcare-by-re-examining-clinical-services-in-paramedicine
#9
Walter Tavares, Ian Drennan, Kelly Van Diepen, Michael Abanil, Natalie Kedzierski, Chris Spearen, Norm Barrette, Mathew Mercuri
OBJECTIVES: Emergency departments (ED) continue to be overburdened, leading to crowding and elevated risk of negative clinical outcomes. Extending clinical services to paramedics may support efforts to improve ED burdens by promoting health care access and capacity during times of patient crisis. The objective of this study was to identify the clinical course and most responsible diagnosis of patients transported by paramedic services to local EDs to then evaluate impact of various augmented 9-1-1/paramedic clinical service models on the need for additional ED services...
May 3, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28456336/a-full-capacity-protocol-allows-for-increased-emergency-patient-volume-and-hospital-admissions
#10
Erin Willard, Elizabeth F Carlton, Lindsay Moffat, Bradley E Barth
Our hospital was encountering problems with ED crowding. We sought to determine the impact of implementing a full-capacity protocol to respond to anticipated or actual crowding conditions. Our full-capacity protocol is based on collaboration among multiple hospital units. METHODS: We completed a quality improvement initiative using a pre/post analysis of all ED patient encounters after implementing a full-capacity protocol with a corresponding period from the prior year. The principal outcomes measured were patient volume, admission rate, patient left without being seen (LWBS) rate, length of stay, and ambulance diversion hours...
April 26, 2017: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
https://www.readbyqxmd.com/read/28435492/applying-systems-engineering-reduces-radiology-transport-cycle-times-in-the-emergency-department
#11
Benjamin A White, Brian J Yun, Michael H Lev, Ali S Raja
INTRODUCTION: Emergency department (ED) crowding is widespread, and can result in care delays, medical errors, increased costs, and decreased patient satisfaction. Simultaneously, while capacity constraints on EDs are worsening, contributing factors such as patient volume and inpatient bed capacity are often outside the influence of ED administrators. Therefore, systems engineering approaches that improve throughput and reduce waste may hold the most readily available gains. Decreasing radiology turnaround times improves ED patient throughput and decreases patient waiting time...
April 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28382879/frequent-users-of-the-pediatric-emergency-department
#12
Jade Seguin, Esli Osmanlliu, Xun Zhang, Virginie Clavel, Harley Eisman, Robert Rodrigues, Maryam Oskoui
OBJECTIVES: Emergency department (ED) crowding is associated with increased morbidity and mortality. Its etiology is multifactorial, and frequent ED use (defined as more or equal to five visits per year) is a major contributor to high patient volumes. Our primary objective is to characterize the frequent user population. Our secondary objective is to examine risk factors for frequent emergency use. METHODS: We conducted a retrospective cohort study of pediatric emergency department (PED) visits at the Montreal Children's Hospital using the Système Informatique Urgence (SIURGE), electronic medical record database...
April 6, 2017: CJEM
https://www.readbyqxmd.com/read/28378942/effects-of-a-hospital-wide-intervention-on-emergency-department-crowding-and-quality-a-prospective-study
#13
Drew B Richardson, Kate Brockman, Angela Abigail, Gregory J Hollis
OBJECTIVE: The objective of this study was to determine the impact of a management-supported, multimodal, hospital-wide intervention on ED crowding and quality measures. METHODS: This is a prospective descriptive study of the first 20 weeks of the intervention, with 3 years of historical controls. The study was conducted in a 600 bed adult/paediatric tertiary hospital with 80 000 ED presentations annually. ED information system data were collected on all presentations in matched 20 week periods...
April 5, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/28366243/a-systematic-approach-to-evaluation-of-performance-deficiencies-in-ed-triage
#14
Mark R Reinhardt
PROBLEM: Increasing ED crowding has resulted in greater demand and longer time-to-triage and time-to-provider wait times, making accurate triage more important than ever before to avoid poor patient outcomes and possible hospital liability. In one case, a 75-year-old patient presenting with chest pain became unconscious in the ED waiting area after initial registration but before triage. Although resuscitation was attempted, the patient did not survive. Continuous assessment and improvement are needed to streamline the triage process and improve accuracy and efficiency...
March 30, 2017: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
https://www.readbyqxmd.com/read/28355651/-perception-of-the-emergency-department-for-outpatient-care-in-a-rural-region-in-saxony-anhalt-a-qualitative-survey-of-patients-and-general-practitioners
#15
Martina Schmiedhofer, Julia Searle, Anna Slagman, Johann Frick, Stephan Ruhla, Martin Möckel
Background The increasing number of low-acuity visits to Emergency Departments (ED) is an important issue in Germany and contributes to ED crowding. A sustainable solution needs deeper knowledge of patients' underlying rationales. Methods To explore patients' motives we conducted 31 semi-structured face-to-face interviews with low-acuity ED patients in a rural region in Saxony-Anhalt. Subsequently we interviewed 12 General Practitioners (GP)s about their perspectives on patients visiting ED with low-acuity conditions and referring patients to ED...
May 2017: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/28334556/impact-of-a-hospitalwide-quality-improvement-initiative-on-emergency-department-throughput-and-crowding-measures
#16
James D Melton, Fred Blind, A Brad Hall, Maureen Leckie, April Novotny
BACKGROUND: This pre- and postintervention analysis evaluates the impact of a systemwide, comprehensive, executively supported quality improvement (QI) project on emergency department (ED) throughput measures and crowding in a large nonacademic community hospital. METHODS: The two primary endpoints used to assess the impact of the project were (1) the percentage of all patients who were door-in to door-out in less than three hours and (2) the percentage of patients who left without being seen (LWBS)...
December 2016: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/28282406/applicability-of-the-modified-emergency-department-work-index-medwin-at-a-dutch-emergency-department
#17
Steffie H A Brouns, Klara C H van der Schuit, Patricia M Stassen, Suze L E Lambooij, Jeanne Dieleman, Irene T P Vanderfeesten, Harm R Haak
BACKGROUND: Emergency department (ED) crowding leads to prolonged emergency department length of stay (ED-LOS) and adverse patient outcomes. No uniform definition of ED crowding exists. Several scores have been developed to quantify ED crowding; the best known is the Emergency Department Work Index (EDWIN). Research on the EDWIN is often applied to limited settings and conducted over a short period of time. OBJECTIVES: To explore whether the EDWIN as a measure can track occupancy at a Dutch ED over the course of one year and to identify fluctuations in ED occupancy per hour, day, and month...
2017: PloS One
https://www.readbyqxmd.com/read/28272257/suspected-infection-in-afebrile-patients-are-they-septic
#18
Fernanda de Souza Martins, Gisele Giuliane Guedes, Thiago Martins Santos, Marco A de Carvalho-Filho
We prospectively evaluated afebrile patients admitted to an emergency department (ED), with suspected infection and only tachycardia or tachypnea.The white blood cell count (WBC) was obtained, and patients were considered septic if leukocyte count was >12,000 μL-1 or <4000 μL-1 or with >10% of band forms. Clinical data were collected to examine whether sepsis could be predicted.Seventy patients were included and 37 (52.86%) met sepsis criteria. Self-measured fever showed an odds ratio (OR) of 5...
March 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28228344/emergency-department-return-visits-within-a-large-geographic-area
#19
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/28202338/a-new-strategy-for-emergency-department-crowding-high-turnover-utility-bed-intervention
#20
I-Hsin Lee, Chung-Ting Chen, Yi-Tzu Lee, Yueh-Shuang Hsu, Chia-Ling Lu, Hsien-Hao Huang, Teh-Fu Hsu, Chorng-Kuang How, David Hung-Tsang Yen, Ueng-Cheng Yang
BACKGROUND: This study applied a new strategy, termed high-turnover utility bed intervention, to offer early admission chances for emergency department (ED) patients and alleviate ED crowding. METHODS: This before-and-after observational cohort study was conducted at the ED of an urban tertiary hospital. On January 1, 2012, 14 utility beds were prepared exclusively for ED patient use. A strict 48-hour course limit for each patient was formulated to govern these high-turnover beds...
May 2017: Journal of the Chinese Medical Association: JCMA
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