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Emergency medicine crowding

Matthew A Widmer, R Chad Swanson, Brian J Zink, Jesse M Pines
INTRODUCTION: The specialty of emergency medicine is experiencing the convergence of a number of transformational forces in the United States, including health care reform, technological advancements, and societal shifts. These bring both opportunity and uncertainty. 21ST CENTURY CHALLENGES: Persistent challenges such as the opioid epidemic, rising health care costs, misaligned incentives, patients with multiple chronic diseases, and emergency department crowding continue to plague the acute, unscheduled care system...
December 27, 2017: Journal of Evaluation in Clinical Practice
Andrew Guy, Ross Prager, Sheila Turris, Adam Lund
Mass gatherings attract large crowds and can strain the planning and health resources of the community, city, or nation hosting an event. Mass-Gatherings Health (MGH) is an evolving niche of prehospital care rooted in emergency medicine, emergency management, public health, and disaster medicine. To explore front-line issues related to data quality in the context of mass gatherings, the authors draw on five years of management experience with an online, mass-gathering event and patient registry, as well as clinical and operational experience amassed over several decades...
June 2017: Prehospital and Disaster Medicine
Matt S Friedman, Alex Plocki, Antonios Likourezos, Illya Pushkar, Andrew N Bazos, Christian Fromm, Benjamin W Friedman
Mass-Gathering Medicine studies have identified variables that predict greater patient presentation rates (PPRs) and transport to hospital rates (TTHRs). This is a descriptive report of patients who presented for medical attention at an annual electronic dance music festival (EDMF). At this large, single EDMF in New York City (NYC; New York, USA), the frequency of patient presentation, the range of presentations, and interventions performed were identified. This descriptive report examined consecutive patients who presented to the medical tent of a summertime EDMF held at an outdoor venue with an active, mobile, bounded crowd...
February 2017: Prehospital and Disaster Medicine
Magnus Hjortdahl, Peder Halvorsen, Mette Bech Risør
OBJECTIVE: Health authorities want to increase general practitioner (GP) participation in emergency medicine, but the role of the GP in this context controversial. We explored GPs' attitudes toward emergency medicine and call outs. DESIGN: Thematic analysis of focus group interviews. SETTING: Four rural casualty clinics in Norway. PARTICIPANTS: GPs with experience ranging from one to 32 years. RESULTS: The GPs felt that their role had changed from being the only provider of emergency care to being one of many...
December 2016: Scandinavian Journal of Primary Health Care
Lukas K Schoenenberger, Steffen Bayer, John P Ansah, David B Matchar, Rajagopal L Mohanavalli, Sean Sw Lam, Marcus Eh Ong
OBJECTIVES: Emergency Department crowding is a serious and international health care problem that seems to be resistant to most well intended but often reductionist policy approaches. In this study, we examine Emergency Department crowding in Singapore from a systems thinking perspective using causal loop diagramming to visualize the systemic structure underlying this complex phenomenon. Furthermore, we evaluate the relative impact of three different policies in reducing Emergency Department crowding in Singapore: introduction of geriatric emergency medicine, expansion of emergency medicine training, and implementation of enhanced primary care...
2016: SAGE Open Medicine
Jesse M Pines
No abstract text is available yet for this article.
January 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Anna Marie Chang, Amber Lin, Rongwei Fu, K John McConnell, Benjamin Sun
OBJECTIVE: The Institute of Medicine identified emergency department (ED) crowding as a critical threat to patient safety. We assess the association between changes in publicly reported ED length of stay (LOS) and changes in quality-of-care measures in a national cohort of hospitals. METHODS: Longitudinal analysis of 2012 and 2013 data from the American Hospital Association (AHA) Survey, Center for Medicare and Medicaid Services (CMS) Cost Reports, and CMS Hospital Compare...
February 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
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
Wonpil Im, Jie Liang, Arthur Olson, Huan-Xiang Zhou, Sandor Vajda, Ilya A Vakser
Computational modeling is essential for structural characterization of biomolecular mechanisms across the broad spectrum of scales. Adequate understanding of biomolecular mechanisms inherently involves our ability to model them. Structural modeling of individual biomolecules and their interactions has been rapidly progressing. However, in terms of the broader picture, the focus is shifting toward larger systems, up to the level of a cell. Such modeling involves a more dynamic and realistic representation of the interactomes in vivo, in a crowded cellular environment, as well as membranes and membrane proteins, and other cellular components...
July 31, 2016: Journal of Molecular Biology
Mark Hauswald
No abstract text is available yet for this article.
July 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Yan Li, Chen Li, Jun Xu, Hui Zhang, Liangliang Zheng, Dongqi Yao, Yangyang Fu, Huadong Zhu, Shubin Guo, Zhong Wang, Joseph Walline, Xuezhong Yu
BACKGROUND: Emergency department (ED) enlargement became a trend with its development. However, there came some problems such as ED overcrowding and increasing medical disputes. Here we did a survey about the development tendency of EDs in 3A grade hospitals in China, analysed the problems we facing and rendered some solutions combining some special characteristics in China. METHODS: We randomly selected 17 3A grade general hospitals from 12 provinces from the 50 members of Chinese College of Emergency Physician...
May 2016: Journal of Thoracic Disease
K Asish, Varun Suresh
BACKGROUND AND AIMS: Tertiary care teaching hospitals remain referral centres for victims of trauma and mass casualty. Often specialists from various disciplines manage these crowded casualty areas. These age old casualty areas are being replaced, throughout the country by Emergency Medicine Departments (EMDs), presumed to be better planned to confront a crisis. We aimed to gather basic data contributive in setting up of an EMD at a tertiary care teaching hospital from the lessons learned from functioning existent systems...
February 2016: Indian Journal of Anaesthesia
Chih-Long Pan, Chin-Fu Chang, Chun-Wen Chiu, Chih-Hsien Chi, Zhong Tian, Jyh-Horng Wen, Jet-Chau Wen
This research focuses on developing an improved and robust measurement for emergency department (ED) performance and a criterion standard for global use via kinetic analysis. Based on kinetic approach, the input-throughput-output conceptual model of ED crowding is compared to the procedure of enzyme catalysis. All in average, the retented patients in EDs are defined as substrate (S), whereas the patients who depart the EDs as product (P). Therefore, the average ED departure velocity (V) can be presented as (P)divided by a given time (t) of the ED length of stay (LOS)...
March 2016: Medicine (Baltimore)
James Ahn, Andrew Golden, Alyssa Bryant, Christine Babcock
INTRODUCTION: In the face of declining bedside teaching and increasing emergency department (ED) crowding, balancing education and patient care is a challenge. Dedicated shifts by teaching residents (TRs) in the ED represent an educational intervention to mitigate these difficulties. We aimed to measure the perceived learning and departmental impact created by having TR. METHODS: TRs were present in the ED from 12 pm-10 pm daily, and their primary roles were to provide the following: assist in teaching procedures, give brief "chalk talks," instruct junior trainees on interesting cases, and answer clinical questions in an evidence-based manner...
March 2016: Western Journal of Emergency Medicine
Finlay A McAlister, Jeffrey A Bakal, Rhonda J Rosychuk, Brian H Rowe
OBJECTIVE: The General Internal Medicine (GIM) Care Transformation Initiative implemented at one of four teaching hospitals in the same city resulted in improved efficiency of in-hospital care. Whether it had beneficial effects upstream in the emergency department (ED) is unclear. METHODS: Controlled before-after study of ED length of stay (LOS) and crowding metrics for the intervention site (n = 108,951 visits) compared to the three other teaching hospitals (controls, n = 300,930 visits)...
June 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Samuel Locoh-Donou, Guofen Yan, Thomas Berry, Robert O'Connor, Mark Sochor, Nathan Charlton, William Brady
This study was conducted to identify the event characteristics of mass gatherings that predict patient presentation rates held in a southeastern US university community. We conducted a retrospective review of all event-based emergency medical services (EMS) records from mass gathering patient presentations over an approximate 23 month period, from October 24, 2009 to August 27, 2011. All patrons seen by EMS were included. Event characteristics included: crowd size, venue percentage filled seating, venue location (inside/outside), venue boundaries (bounded/unbounded), presence of free water (i...
August 2016: Internal and Emergency Medicine
Shammi Ramlakhan, Hasan Qayyum, Derek Burke, Ruth Brown
The patient safety movement has been active for over a decade, but the issue of patient safety in emergency care and the emergency department (ED) has only recently been brought into the forefront. The ED environment has traditionally been considered unsafe, but there is little data to support this assertion. This paper reviews the literature on patient safety and highlights the challenges associated with using the current evidence base to inform practice due to the variability in methods of measuring safety...
April 2016: Emergency Medicine Journal: EMJ
Anita Sabzghabaei, Majid Shojaee, Hossein Alimohammadi, Hojjat Derakhshanfar, Parvin Kashani, Shohreh Nassiriabrishamchi
INTRODUCTION: Creating a calm and stress-free environment affects education significantly. The effects of the emergency department overcrowding (EDO) on the training of emergency medicine residents (EMR) is a highly debated subject. Therefore, this study aimed to evaluate the effect of EDO on efficiency of EMR's education. METHODS: In this cross-sectional study, the effects of overcrowding on EMR's education in the resuscitation room and acute care unit. Data collection was done using a questionnaire, which was filled out by the second year EMRs...
2015: Emergency (Tehran, Iran)
Jonathan Sherbino, Nikita Joshi, Michelle Lin
BACKGROUND: In health professionals' education, senior learners play a key role in the teaching of junior colleagues. OBJECTIVE: We describe an online discussion about residents as teachers to highlight the topic and the online journal club medium. METHODS: In January 2015, the Journal of Graduate Medical Education (JGME) and the Academic Life in Emergency Medicine blog facilitated an open-access, online, weeklong journal club on the JGME article "What Makes a Great Resident Teacher? A Multicenter Survey of Medical Students Attending an Internal Medicine Conference...
September 2015: Journal of Graduate Medical Education
Brian Schwartz, Sarah Nafziger, Andrew Milsten, Jeffrey Luk, Arthur Yancey
Mass gatherings are heterogeneous in terms of size, duration, type of event, crowd behavior, demographics of the participants and spectators, use of recreational substances, weather, and environment. The goals of health and medical services should be the provision of care for participants and spectators consistent with local standards of care, protection of continuing medical service to the populations surrounding the event venue, and preparation for surge to respond to extraordinary events. Pre-event planning among jurisdictional public health and EMS, acute care hospitals, and event EMS is essential, but should also include, at a minimum, event security services, public relations, facility maintenance, communications technicians, and the event planners and organizers...
2015: Prehospital Emergency Care
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