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Emergency department throughput

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https://www.readbyqxmd.com/read/28334556/impact-of-a-hospitalwide-quality-improvement-initiative-on-emergency-department-throughput-and-crowding-measures
#1
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/28325207/using-a-systematic-framework-of-interventions-to-improve-early-discharges
#2
Hemali Patel, Sasha Morduchowicz, Michelle Mourad
BACKGROUND: Late-afternoon hospital discharges can lead to admission bottlenecks and negatively affect the flow of patients needing hospital admission. Delays in discharge are a prevalent health care problem and have been linked to increased length of stay, lower patient satisfaction scores, and adverse outcomes. As a result, hospitals are placing a renewed emphasis on early discharge as a way to reduce admission delays and achieve optimal patient flow. This study shows that the Model for Improvement (MFI) is an effective approach for complex improvement efforts...
April 2017: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/28279543/emergency-department-holding-orders
#3
Stephen J Traub, M'Hamed Temkit, Soroush Saghafian
BACKGROUND: Holding orders help transition admitted emergency department (ED) patients to hospital beds. OBJECTIVE: To describe the effect of ED holding orders. METHODS: We conducted a single-site retrospective study of ward admissions from the ED to the hospital internal medicine (HIM) service over 2 years. Patients were classified based on whether the ED did (group 1) or did not (group 2) write holding orders; group 1 was subdivided into patients sent to the floor with only ED holding orders (group 1A) vs...
March 6, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28276106/provocative-ideas-on-human-placental-biology-a-prerequisite-for-prevention-and-treatment-of-neonatal-health-challenges
#4
REVIEW
Shilpi Sehgal, Shinjini Bhatnagar, S K Pallavi
A 2-day invite-only meeting on generating "Provocative Ideas on human placental research" was organized on 1-2 December 2015 at the Translational Health Science and Technology Institute, Faridabad. This meeting was sponsored by Department of Biotechnology, Ministry of Science and Technology, Govt. of India. The objectives of this meeting were the critical evaluation of placental physiology and its development. Special emphasis was placed on understanding the consequences and implications of placental development in sustenance of pregnancy and in pregnancy-associated complications such as preeclampsia, intrauterine growth restriction, and preterm birth...
March 9, 2017: American Journal of Reproductive Immunology: AJRI
https://www.readbyqxmd.com/read/28125429/which-indicators-to-include-in-a-crowding-scale-in-an-emergency-department-a-national-french-delphi-study
#5
Guilhem Noel, Camille Drigues, Gilles Viudes
BACKGROUND: Emergency department (ED) crowding is a serious international public health issue with a negative impact on quality of care. Despite two decades of research, there is no consensus on the indicators used to quantify crowding. The aim of our study was to select the most valid ED crowding indicators. MATERIALS AND METHODS: The Delphi method was used. Selected indicators originated from a literature review and propositions from FEDORU (National Emergency Department Observatory Network) workgroup...
January 25, 2017: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/28107348/predicting-length-of-stay-among-patients-discharged-from-the-emergency-department-using-an-accelerated-failure-time-model
#6
Chung-Hsien Chaou, Hsiu-Hsi Chen, Shu-Hui Chang, Petrus Tang, Shin-Liang Pan, Amy Ming-Fang Yen, Te-Fa Chiu
BACKGROUND: Emergency department (ED) crowding continues to be an important health care issue in modern countries. Among the many crucial quality indicators for monitoring the throughput process, a patient's length of stay (LOS) is considered the most important one since it is both the cause and the result of ED crowding. The aim of this study is to identify and quantify the influence of different patient-related or diagnostic activities-related factors on the ED LOS of discharged patients...
2017: PloS One
https://www.readbyqxmd.com/read/27942343/effects-of-a-general-practitioner-cooperative-co-located-with-an-emergency-department-on-patient-throughput
#7
Michiel J van Veelen, Crispijn L van den Brand, Resi Reijnen, M Christien van der Linden
BACKGROUND: In 2013 a General Practitioner Cooperative (GPC) was introduced at the Emergency Department (ED) of our hospital. One of the aims of this co-located GPC was to improve throughput of the remaining patients at the ED. To determine the change in patient flow, we assessed the number of self-referrals, redirection of self-referrals to the GPC and back to the ED, as well as ward and ICU admission rates and length of stay of the remaining ED population. METHODS: We conducted a four months' pre-post comparison before and after the implementation of a co-located GPC with an urban ED in the Netherlands...
2016: World Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27856140/impact-of-scribes-on-emergency-department-patient-throughput-one-year-after-implementation
#8
Heather A Heaton, David M Nestler, Christine M Lohse, Annie T Sadosty
OBJECTIVES: Assess the impact of scribes on an academic emergency department's (ED) throughput one year after implementation. METHODS: A prospective cohort design compared throughput metrics of patients managed when scribes were and were not a part of the treatment team during pre-defined study hours in a tertiary academic ED with both an adult and pediatric ED. An alternating-day pattern one year following scribe implementation ensured balance between the scribe and non-scribe groups in time of day, day of week, and patient complexity...
November 5, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27818014/utilizing-six-sigma-lean-strategies-to-expedite-emergency-department-ct-scan-throughput-in-a-tertiary-care-facility
#9
Devon Klein, Vandana Khan
No abstract text is available yet for this article.
January 2017: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/27791449/lean-intervention-improves-patient-discharge-times-improves-emergency-department-throughput-and-reduces-congestion
#10
Michael J Beck, Davin Okerblom, Anika Kumar, Subhankar Bandyopadhyay, Lisabeth V Scalzi
OBJECTIVE: To determine if a lean intervention improved emergency department (ED) throughput and reduced ED boarding by improving patient discharge efficiency from a tertiary care children's hospital. METHODS: The study was conducted at a tertiary care children's hospital to study the impact lean that changes made to an inpatient pediatric service line had on ED efficiency. Discharge times from the general pediatrics' service were compared to patients discharged from all other pediatric subspecialty services...
December 2016: Hospital Practice (Minneapolis)
https://www.readbyqxmd.com/read/27663766/ed-triage-pain-protocol-reduces-time-to-receiving-analgesics-in-patients-with-painful-conditions
#11
Aaron Nathan Barksdale, Jeff Lee Hackman, Karen Williams, Matt Christopher Gratton
BACKGROUND: Studies suggest that collaborative nursing protocols initiated in triage improve emergency department (ED) throughput and decrease time to treatment. OBJECTIVE: The objective of the study is to determine if an ED triage pain protocol improves time to provision of analgesics. METHODS: Retrospective data abstracted via electronic medical record of patients at a safety net facility with 67 000 annual adult visits. Patients older than 18 years who presented to the ED between March 1, 2011, and May 31, 2013, with 1 of 6 conditions were included: back pain, dental pain, extremity trauma, sore throat, ear pain, or pain from an abscess...
December 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27658897/systematic-identification-and-management-of-barriers-to-vascular-surgery-patient-discharge-time-of-day
#12
Gaurav Sharma, Danny Wong, Dean J Arnaoutakis, Samir K Shah, Alice O'Brien, Stanley W Ashley, C Keith Ozaki
OBJECTIVE: Length of stay fails to completely capture the clinical and economic effects of patient progression through the phases of inpatient care, such as admission, room placement, procedures, and discharge. Delayed hospital throughput has been linked to increased time spent in the emergency department and postanesthesia care unit, delayed time to treatment, increased in-hospital mortality, decreased patient satisfaction, and lost hospital revenue. We identified barriers to vascular surgery inpatient care progression and instituted defined measures to positively impact standardized metrics...
January 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/27658706/primary-triage-nurses-do-not-divert-patients-away-from-the-emergency-department-at-times-of-high-in-hospital-bed-occupancy-a-retrospective-cohort-study
#13
Mathias C Blom, Karin Erwander, Lars Gustafsson, Mona Landin-Olsson, Fredrik Jonsson, Kjell Ivarsson
BACKGROUND: Emergency department (ED) overcrowding is frequently described in terms of input- throughput and output. In order to reduce ED input, a concept called primary triage has been introduced in several Swedish EDs. In short, primary triage means that a nurse separately evaluates patients who present in the Emergency Department (ED) and either refers them to primary care or discharges them home, if their complaints are perceived as being of low acuity. The aim of the present study is to elucidate whether high levels of in-hospital bed occupancy are associated with decreased permeability in primary triage...
September 22, 2016: BMC 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
#14
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/27603225/effect-of-lean-processes-on-surgical-wait-times-and-efficiency-in-a-tertiary-care-veterans-affairs-medical-center
#15
Nakul P Valsangkar, Andrew C Eppstein, Rick A Lawson, Amber N Taylor
Importance: There are an increasing number of veterans in the United States, and the current delay and wait times prevent Veterans Affairs institutions from fully meeting the needs of current and former service members. Concrete strategies to improve throughput at these facilities have been sparse. Objective: To identify whether lean processes can be used to improve wait times for surgical procedures in Veterans Affairs hospitals. Design, Setting, and Participants: Databases in the Veterans Integrated Service Network 11 Data Warehouse, Veterans Health Administration Support Service Center, and Veterans Information Systems and Technology Architecture/Dynamic Host Configuration Protocol were queried to assess changes in wait times for elective general surgical procedures and clinical volume before, during, and after implementation of lean processes over 3 fiscal years (FYs) at a tertiary care Veterans Affairs medical center...
January 1, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/27564093/dedicated-pediatricians-in-emergency-department-shorter-waiting-times-and-lower-costs
#16
Manuel Rocha Melo, Manuel Ferreira-Magalhães, Filipa Flor-Lima, Mariana Rodrigues, Milton Severo, Luis Almeida-Santos, Alberto Caldas-Afonso, Pedro Pita Barros, António Ferreira
BACKGROUND: Dedicated pediatricians in emergency departments (EDs) may be beneficial, though no previous studies have assessed the related costs and benefits/harms. We aimed to evaluate the net benefits and costs of dedicated emergency pediatricians in a pediatric ED. METHODS: Cost-consequences analysis of visits to a pediatric ED of a tertiary hospital. Two pediatric ED Medical Teams (MT) were compared: MT-A (May-September 2012), with general pediatrics physicians only; and MT-B (May-September 2013), with emergency dedicated pediatricians...
2016: PloS One
https://www.readbyqxmd.com/read/27527398/initiating-diagnostic-studies-on-patients-with-abdominal-pain-in-the-waiting-room-decreases-time-spent-in-an-emergency-department-bed-a%C3%A2-randomized-controlled-trial
#17
Tomer Begaz, David Elashoff, Tristan R Grogan, David Talan, Breena R Taira
STUDY OBJECTIVE: The effect of clinician screening of patients in the emergency department (ED) waiting room is unclear. This study aims to determine the effect of initiating laboratory and imaging studies from the ED waiting room on time in a bed, total ED time, and likelihood of patients leaving before completion of service. METHODS: This was a prospective, randomized, controlled trial evaluating 1,659 nonpregnant adults with a chief complaint of abdominal pain, conducted in a public hospital ED when all ED beds were occupied and patients were in the waiting room awaiting definitive evaluation...
March 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/27524106/efficiency-in-the-emergency-department-a-complex-relationship-between-throughput-rates-and-staff-perceptions
#18
Ulrica von Thiele Schwarz, Henna Hasson, Åsa Muntlin Athlin
INTRODUCTION: It is well known that emergency departments (EDs) suffer from crowding and throughput challenges, which make the ED a challenging workplace. However, the interplay between the throughput of patients and how staff experience work is seldom studied. The aim of this study was to investigate whether staff experience of work (efficiency, work-related efforts and rewards, and quantity and quality of work) differs between days with low and high patient throughput rates. METHOD: Throughput times were collected from electronic medical records and staff (n=252 individuals, mainly nurses) ratings in daily questionnaires over a total of six weeks...
November 2016: International Emergency Nursing
https://www.readbyqxmd.com/read/27478347/emergency-department-crowding-disparity-a-nationwide-cross-sectional-study
#19
Won Chul Cha, Ki Ok Ahn, Sang Do Shin, Jeong Ho Park, Jin Sung Cho
In this study, we evaluated national differences in emergency department (ED) crowding to identify factors significantly associated with crowding in institutes and communities across Korea. This was a cross-sectional nationwide observational study using data abstracted from the National Emergency Department Information System (NEDIS). We calculated mean occupancy rates to quantify ED crowding status and divided EDs into three groups according to their occupancy rates (cutoffs: 0.5 and 1.0). Factors potentially related to ED crowding were collected from the NEDIS...
August 2016: Journal of Korean Medical Science
https://www.readbyqxmd.com/read/27450391/impact-of-scribes-on-patient-throughput-in-adult-and-pediatric-academic-eds
#20
Heather A Heaton, David M Nestler, Derick D Jones, Christine M Lohse, Deepi G Goyal, Jeffrey S Kallis, Annie T Sadosty
OBJECTIVES: Assess the impact of scribes on an academic emergency department's (ED) patient-specific throughput. METHODS: Study design, setting, participants: A prospective cohort design compared throughput metrics of patients managed when scribes were and were not a part of the treatment team during pre-defined study hours in a tertiary academic ED with both an adult and pediatric ED. INTERVENTION: Eight scribes were hired and trained on-site by a physician with experience in scribe implementation...
October 2016: American Journal of Emergency Medicine
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