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Emergency department throughput

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https://www.readbyqxmd.com/read/29447352/improvement-of-emergency-department-patient-flow-using-lean-thinking
#1
Miquel Sánchez, Montse Suárez, María Asenjo, Ernest Bragulat
Objective: To apply lean thinking in triage acuity level-3 patients in order to improve emergency department (ED) throughtput and waiting time. Design: A prospective interventional study. Setting: An ED of a tertiary care hospital. Participants: Triage acuity level-3 patients. Intervention(s): To apply lean techniques such as value stream mapping, workplace organization, reduction of wastes and standardization by the frontline staff...
February 13, 2018: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/29384780/effect-of-emergency-department-and-icu-occupancy-on-admission-decisions-and-outcomes-for-critically-ill-patients
#2
Kusum S Mathews, Matthew S Durst, Carmen Vargas-Torres, Ashley D Olson, Madhu Mazumdar, Lynne D Richardson
OBJECTIVES: ICU admission delays can negatively affect patient outcomes, but emergency department volume and boarding times may also affect these decisions and associated patient outcomes. We sought to investigate the effect of emergency department and ICU capacity strain on ICU admission decisions and to examine the effect of emergency department boarding time of critically ill patients on in-hospital mortality. DESIGN: A retrospective cohort study. SETTING: Single academic tertiary care hospital...
January 30, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29383053/taking-advantage-of-the-teachable-moment-a-review-of-learner-centered-clinical-teaching-models
#3
REVIEW
Sneha A Chinai, Todd Guth, Elise Lovell, Michael Epter
When working in a chaotic Emergency Department (ED) with competing priorities, clinical teaching may be sacrificed for the sake of patient flow and throughput. An organized, efficient approach to clinical teaching helps focus teaching on what the learner needs at that moment, incorporates regular feedback, keeps the department on track, and prevents over-teaching. Effective clinical teaching in a busy environment is an important skill for senior residents and faculty to develop. This review will provide a critique and comparison of seven structured teaching models to better prepare readers to seize the teachable moment...
January 2018: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29380730/hurry-up-it-s-quiet-in-the-emergency-department
#4
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/29367203/implementation-and-improvement-of-pediatric-asthma-guideline-improves-hospital-based-care
#5
David P Johnson, Donald H Arnold, James C Gay, Alison Grisso, Michael G O'Connor, Ellen O'Kelley, Paul E Moore
BACKGROUND: Standardized pediatric asthma care has been shown to improve measures in specific hospital areas, but to our knowledge, the implementation of an asthma clinical practice guideline (CPG) has not been demonstrated to be associated with improved hospital-wide outcomes. We sought to implement and refine a pediatric asthma CPG to improve outcomes and throughput for the emergency department (ED), inpatient care, and the ICU. METHODS: An urban, quaternary-care children's hospital developed and implemented an evidence-based, pediatric asthma CPG to standardize care from ED arrival through discharge for all primary diagnosis asthma encounters for patients ≥2 years old without a complex chronic condition...
January 24, 2018: Pediatrics
https://www.readbyqxmd.com/read/29352674/the-effect-of-vertical-split-flow-patient-management-on-emergency-department-throughput-and-efficiency
#6
John S Garrett, Colyn Berry, Hao Wong, Huanying Qin, Jeffery A Kline
BACKGROUND: To address emergency department overcrowding operational research seeks to identify efficient processes to optimize flow of patients through the emergency department. Vertical flow refers to the concept of utilizing and assigning patients virtual beds rather than to an actual physical space within the emergency department to care of low acuity patients. The aim of this study is to evaluate the impact of vertical flow upon emergency department efficiency and patient satisfaction...
January 11, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29335822/emergency-department-throughput-an-intervention
#7
Nowreen Haq, Rona Stewart-Corral, Eric Hamrock, Jamie Perin, Waseem Khaliq
Shortening emergency department (ED) boarding time and managing hospital bed capacity by expediting the inpatient discharge process have been challenging for hospitals nationwide. The objective of this study is was to explore the effect of an innovative prospective intervention on hospital workflow, specifically on early inpatient discharges and the ED boarding time. The intervention consisted of a structured nursing "admission discharge transfer" (ADT) protocol receiving new admissions from the ED and helping out floor nursing with early discharges...
January 15, 2018: Internal and Emergency Medicine
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
#8
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/29298247/the-effect-of-early-knowledge-of-respiratory-syncytial-virus-positivity-on-medical-decision-making-and-throughput-time-within-the-pediatric-emergency-department
#9
Jessica Schnell, Lisa Schroeder, Kelly Sinclair, Lina Patel, Denise Dowd
OBJECTIVE: The aim of this study was to evaluate whether early knowledge of respiratory syncytial virus (RSV) positivity by rapid triage-based testing protocol improved emergency department (ED) throughput time and decreased ED ancillary testing and antibiotic administration. METHODS: A retrospective cohort study was performed of ED patients aged 2 to 12 months, presenting November 1 to March 31 for the years 2008-2013. Included patients presented with fever and upper respiratory tract symptoms...
January 2, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29249008/secondary-imaging-for-suspected-appendicitis-after-equivocal-ultrasound-time-to-disposition-of-mri-compared-to-ct
#10
James F Martin, David J Mathison, Paul C Mullan, Hansel J Otero
PURPOSE: The purpose of this study was to compare MRI to CT as a secondary imaging modality for children age 5 years and older with suspected appendicitis after an equivocal abdominal ultrasound in terms of (1) the time to ED disposition decision, (2) surgery consultation rate, and (3) imaging test accuracy. METHODS: We retrospectively studied children with suspected appendicitis and equivocal ultrasound results who underwent MR or CT as secondary imaging in a pediatric emergency department over two-consecutive 9-month periods...
December 16, 2017: Emergency Radiology
https://www.readbyqxmd.com/read/29239230/impact-of-a-scribe-program-on-patient-throughput-physician-productivity-and-patient-satisfaction-in-a-community-based-emergency-department
#11
Waqas Shuaib, John Hilmi, Joshua Caballero, Ijaz Rashid, Hashim Stanazai, Alan Ajanovic, Alex Moshtaghi, Ahmed Amari, Kerolos Tawfeek, Anjit Khurana, Hesham Hasabo, Abdulrehman Baqais, Ahmed A Mattar, Theodore J Gaeta
Previous literature on the impact of scribe programs varies and has mostly been reported from academic institutions or other clinics. We report the implementation of the scribe program in the emergency room of a community hospital and its impact on patient throughput, physician productivity, and patient satisfaction. We performed a quasi-experimental, before-and-after study measuring patient throughput metrics, physician productivity, and patient satisfaction. The intervention measuring the scribe implementation was divided into pre- and post-implementation periods...
March 1, 2017: Health Informatics Journal
https://www.readbyqxmd.com/read/29126559/outcomes-of-a-simplified-ultrasound-guided-intravenous-training-course-for-emergency-nurses
#12
Sarah Feinsmith, Ryan Huebinger, Michael Pitts, Emily Baran, Sheila Haas
INTRODUCTION: Various medical or anatomical conditions can lead to difficult intravenous access (DIVA) in the emergency department. It was hypothesized that developing an emergency nurse-training program could reduce IV attempts in the emergency department, improving throughput and patient care. METHODS: Emergency nurses completed a 4-hour ultrasound-guided intravenous (USGIV) access course and achieved competency after 10 successful supervised USGIV insertions on patients...
November 7, 2017: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
https://www.readbyqxmd.com/read/29079371/impact-of-revised-triage-to-improve-throughput-in-an-ed-with-limited-traditional-fast-track-population
#13
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/28943077/evaluation-of-an-evidence-based-throat-pain-protocol-to-reduce-left-without-being-seen-length-of-stay-and-antibiotic-prescribing
#14
Deanna Settelmeyer
BACKGROUND: Increasing numbers of people are seeking unscheduled medical care in United States' emergency departments, which contributes to delayed throughput and increased patient length of stay. Implementation of nurse-initiated protocols, such as those for throat pain, initiates early diagnostic testing, optimizes patient throughput strategies, and promotes adherence to clinic practice guidelines for an additional segment of patients. AIM: To evaluate the effect of an evidence-based throat-pain protocol...
September 21, 2017: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
https://www.readbyqxmd.com/read/28935285/is-the-pelvic-examination-still-crucial-in-patients-presenting-to-the-emergency-department-with%C3%A2-vaginal-bleeding-or-abdominal-pain-when-an-intrauterine-pregnancy-is-identified-on-ultrasonography-a-randomized-controlled-trial
#15
RANDOMIZED CONTROLLED TRIAL
Judith A Linden, Benjamin Grimmnitz, Laura Hagopian, Alan H Breaud, Breanne K Langlois, Kerrie P Nelson, Lauren L Hart, James A Feldman, Jeremy Brown, Marc Reid, Elise Desormeau, Patricia M Mitchell
STUDY OBJECTIVE: We determine whether omitting the pelvic examination in emergency department (ED) evaluation of vaginal bleeding or lower abdominal pain in ultrasonographically confirmed early intrauterine pregnancy is equivalent to performing the examination. METHODS: We conducted a prospective, open-label, randomized, equivalence trial in pregnant patients presenting to the ED from February 2011 to November 2015. Patients were randomized to no pelvic examination versus pelvic examination...
December 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28925587/lessons-learned-from-the-development-and-parameterization-of-a-computer-simulation-model-to-evaluate-task-modification-for-healthcare-providers
#16
Parastu Kasaie, W David Kelton, Rachel M Ancona, Michael J Ward, Craig M Froehle, Michael S Lyons
Computer simulation is a highly advantageous method for understanding and improving healthcare operations with a wide variety of possible applications. Most computer-simulation studies in emergency medicine have sought to improve allocation of resources to meet demand, or to assess the impact of hospital and other system policies on emergency department (ED) throughput. These models have enabled essential discoveries that can be used to improve the general structure and functioning of EDs. Theoretically, computer simulation could also be used to examine the impact of adding or modifying specific provider tasks...
September 19, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28802868/development-and-implementation-of-an-ultrasound-guided-peripheral-intravenous-catheter-program-for-emergency-nurses
#17
Courtney Edwards, Jodi Jones
PROBLEM: Emergency medical care often necessitates placement of peripheral intravenous (PIV) catheters. When traditional methods for obtaining PIV access are not successful, ultrasound guidance is a rescue technique for peripheral vascular placement that improves the quality of patient care. METHODS: The aim of this training program was to develop a process where emergency nurses would be competent to perform ultrasound guided PIV to improve the quality of patient care delivered while reducing throughput time...
August 9, 2017: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
https://www.readbyqxmd.com/read/28712608/a-custom-developed-emergency-department-provider-electronic-documentation-system-reduces-operational-efficiency
#18
Joshua Feblowitz, Sukhjit S Takhar, Michael J Ward, Ryan Ribeira, Adam B Landman
STUDY OBJECTIVE: Electronic health record implementation can improve care, but may also adversely affect emergency department (ED) efficiency. We examine how a custom, ED provider, electronic documentation system (eDoc), which replaced paper documentation, affects operational performance. METHODS: We analyzed retrospective operational data for 1-year periods before and after eDoc implementation in a single ED. We computed daily operational statistics, reflecting 60,870 pre- and 59,337 postimplementation patient encounters...
November 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28704269/the-impact-of-medical-specialist-staffing-on-emergency-department-patient-flow-and-satisfaction
#19
M Christien van der Linden, Roeline A Y de Beaufort, Sven A G Meylaerts, Crispijn L van den Brand, Naomi van der Linden
OBJECTIVE: The aim of this study was to describe the impact of additional medical specialists, non-emergency physicians (non-EPs), performing direct supervision or a combination of direct and indirect supervision at an EP-led emergency department (ED), on patient flow and satisfaction. PATIENTS AND METHODS: An observational, cross-sectional, three-part study was carried out including staff surveys (n=379), a before and after 16-week data collection using data of visits during the peak hours (n=5270), and patient questionnaires during 1 week before the pilot and during week 5 of the pilot...
July 12, 2017: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/28693348/calm-interventions-behavioral-health-crisis-assessment-linkage-and-management-improve-patient-care
#20
Natalie A Lester, Laura R Thompson, Kendal Herget, Julie A Stephens, John V Campo, Eric J Adkins, Thomas E Terndrup, Susan Moffatt-Bruce
Emergency departments (EDs) have seen rising numbers of patients in psychiatric crises, patient boarding, and throughput delays. This study describes and evaluates the impact of a Crisis Assessment Linkage and Management (CALM) service designed to manage behavioral health crises. A year-to-year comparison was performed before (n = 2211 ED visits) and after implementation of CALM (n = 2387). CALM was associated with reductions in median ED and hospital length of stay (LOS) from 9.5 to 7.3 hours and 46.2 to 31...
January 2018: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
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