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https://www.readbyqxmd.com/read/29115767/care-delays-in-patients-with-signs-and-symptoms-of-acute-myocardial-infarction
#1
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
#2
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
#3
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-emergency-department-with-limited-traditional-fast-track-population
#4
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...
October 7, 2017: 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
#5
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
#6
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
#7
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
#8
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
#9
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/28950856/new-zealand-s-emergency-department-target-did-it-reduce-ed-length-of-stay-and-if-so-how-and-when
#10
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
#11
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
#12
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
https://www.readbyqxmd.com/read/28924304/nedocs-vs-subjective-evaluation-%C3%A2-is-the-health-personnel-of-the-emergency-department-aware-of-its-overcrowding
#13
Mauricio Garcia-Romero, Claudia Geraldine Rita-Gáfaro, Jairo Quintero-Manzano, Anderson Bermon Angarita
INTRODUCTION: An emergency department (ED) is considered to be "overcrowded" when the number of patients exceeds its treatment capacity and it does not have the conditions to meet the needs of the next patient to be treated. This study evaluates overcrowding in the emergency department of a hospital in Colombia. OBJECTIVE: To compare the objective NEDOCS scale with a subjective evaluation by ED health staff in order to evaluate the differences between the two. METHODS: The NEDOCS scale was applied and a subjective overcrowding survey was administered to the medical staff and the charge nurse on duty 6 times per day (6:00 a...
June 30, 2017: Colombia Médica: CM
https://www.readbyqxmd.com/read/28900665/-questionnaire-for-the-utilization-of-the-emergency-department-implications-for-the-patient-survey
#14
J Frick, M Möckel, M Schmiedhofer, J Searle, B Erdmann, M Erhart, A Slagman
BACKGROUND: For several years, Emergency Departments (ED) in Germany have observed increasing patient numbers, resulting in ED crowding. This leads to the question of whether patients with nonurgent conditions could also receive adequate treatment in primary care. Our objective was to develop a quantitative questionnaire to investigate in a larger patient group the reasons for this and to describe the implications for a patient survey in the ED. METHODS: The development of the questionnaire was based on a literature search and the results of the qualitative EPICS-2 study...
September 12, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/28898330/-analysis-of-crowding-in-an-adult-emergency-department-of-a-tertiary-university-hospital
#15
Diego Hernán Giunta, Ana Soledad Pedretti, Cristina María Elizondo, María Florencia Grande Ratti, Fernán González Bernaldo de Quiros, Gabriel Darío Waisman, Hector José Peroni, Bernardo Martínez
BACKGROUND: Crowding in Emergency Departments (ED), results from the imbalance between the simultaneous demand for health care and the ability of the system to respond. The NEDOCS scale (National Emergency Department Crowding Scale) measures the degree of crowding in an ED. AIM: To describe ED Crowding characteristics, using the NEDOCS scale, in an Argentinean hospital. MATERIAL AND METHODS: A retrospective cohort study was conducted with all adult patient consultations between July 2013 and July 2014 at the ED of Hospital Italiano de Buenos Aires...
May 2017: Revista Médica de Chile
https://www.readbyqxmd.com/read/28874952/duration-of-mechanical-ventilation-in-the-emergency-department
#16
Lauren B Angotti, Jeremy B Richards, Daniel F Fisher, Jeffrey D Sankoff, Todd A Seigel, Haitham S Al Ashry, Susan R Wilcox
INTRODUCTION: Due to hospital crowding, mechanically ventilated patients are increasingly spending hours boarding in emergency departments (ED) before intensive care unit (ICU) admission. This study aims to evaluate the association between time ventilated in the ED and in-hospital mortality, duration of mechanical ventilation, ICU and hospital length of stay (LOS). METHODS: This was a multi-center, prospective, observational study of patients ventilated in the ED, conducted at three academic Level I Trauma Centers from July 2011 to March 2013...
August 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28865753/developing-an-emergency-department-crowding-dashboard-a-design-science-approach
#17
Niels Martin, Jochen Bergs, Dorien Eerdekens, Benoît Depaire, Sandra Verelst
BACKGROUND: As an emergency department (ED) is a complex adaptive system, the analysis of continuously gathered data is valuable to gain insight in the real-time patient flow. To support the analysis and management of ED operations, relevant data should be provided in an intuitive way. AIM: Within this context, this paper outlines the development of a dashboard which provides real-time information regarding ED crowding. METHODS: The research project underlying this paper follows the principles of design science research, which involves the development and study of artifacts which aim to solve a generic problem...
August 30, 2017: International Emergency Nursing
https://www.readbyqxmd.com/read/28844764/hospital-strategies-for-reducing-emergency-department-crowding-a-mixed-methods-study
#18
Anna Marie Chang, Deborah J Cohen, Amber Lin, James Augustine, Daniel A Handel, Eric Howell, Hyunjee Kim, Jesse M Pines, Jeremiah D Schuur, K John McConnell, Benjamin C Sun
STUDY OBJECTIVE: Emergency department (ED) crowding and patient boarding are associated with increased mortality and decreased patient satisfaction. This study uses a positive deviance methodology to identify strategies among high-performing, low-performing, and high-performance improving hospitals to reduce ED crowding. METHODS: In this mixed-methods comparative case study, we purposively selected and recruited hospitals that were within the top and bottom 5% of Centers for Medicare & Medicaid Services case-mix-adjusted ED length of stay and boarding times for admitted patients for 2012...
August 25, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28833779/patient-and-system-factors-related-to-missed-opportunities-for-screening-in-an-electronic-medical-record-driven-opt-out-hiv-screening-program-in-the-emergency-department
#19
Janet Lin, Sara Baghikar, Cammeo Mauntel-Medici, Sara Heinert, Daven Patel
OBJECTIVE: Emergency departments (EDs) have implemented HIV screening using a variety of strategies. This study investigates how specific patient and health system factors in the ED impact who is and is not screened in a combined targeted and nontargeted, electronic medical record (EMR)-driven, opt-out, HIV screening program. METHODS: This was a retrospective, cross-sectional study of ED visits where patients were determined eligible for HIV screening by an EMR algorithm between November 18, 2014, and July 15, 2015...
August 18, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28780916/assessing-and-improving-hospital-mass-casualty-preparedness-a-no-notice-exercise
#20
Daniel A Waxman, Edward W Chan, Francesca Pillemer, Timothy Wj Smith, Mahshid Abir, Christopher Nelson
In recent years, mass-casualty incidents (MCIs) have become more frequent and deadly, while emergency department (ED) crowding has grown steadily worse and widespread. The ability of hospitals to implement an effective mass-casualty surge plan, immediately and expertly, has therefore never been more important. Yet, mass-casualty exercises tend to be highly choreographed, pre-scheduled events that provide limited insight into hospitals' true capacity to respond to a no-notice event under real-world conditions...
August 7, 2017: Prehospital and Disaster Medicine
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