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Overcrowding in emergency departments

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https://www.readbyqxmd.com/read/29455441/a-proactive-transfer-policy-for-critical-patient-flow-management
#1
Jaime González, Juan-Carlos Ferrer, Alejandro Cataldo, Luis Rojas
Hospital emergency departments are often overcrowded, resulting in long wait times and a public perception of poor attention. Delays in transferring patients needing further treatment increases emergency department congestion, has negative impacts on their health and may increase their mortality rates. A model built around a Markov decision process is proposed to improve the efficiency of patient flows between the emergency department and other hospital units. With each day divided into time periods, the formulation estimates bed demand for the next period as the basis for determining a proactive rather than reactive transfer decision policy...
February 17, 2018: Health Care Management Science
https://www.readbyqxmd.com/read/29438575/primary-care-professionals-providing-non-urgent-care-in-hospital-emergency-departments
#2
REVIEW
Daniela Gonçalves-Bradley, Jaspreet K Khangura, Gerd Flodgren, Rafael Perera, Brian H Rowe, Sasha Shepperd
BACKGROUND: In many countries emergency departments (EDs) are facing an increase in demand for services, long waits, and severe crowding. One response to mitigate overcrowding has been to provide primary care services alongside or within hospital EDs for patients with non-urgent problems. However, it is unknown how this impacts the quality of patient care and the utilisation of hospital resources, or if it is cost-effective. This is the first update of the original Cochrane Review published in 2012...
February 13, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29438126/sonographic-evaluation-and-monitoring-of-pneumoperitoneum-after-air-enema-reduction-for-intussusception
#3
Amy Z Zhou, Amy Toporowski, James W Tsung
Abdominal radiography and computed tomography scans are standard tests to diagnose pneumoperitoneum. With the growing availability of point-of-care ultrasound, pneumoperitoneum may be diagnosed in settings without easy access to radiography or computed tomography, such as in overcrowded emergency departments or resource-poor environments. The use of point-of-care ultrasound to diagnose or monitor pneumoperitoneum has been described in adult but not pediatric patients. We present a case of point-of-care ultrasound detection of pneumoperitoneum and monitoring for tension pneumoperitoneum, after failed air enema reduction for intussusception in an infant...
February 12, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29437310/suhcat-study-part-5-comparison-of-staff-and-chiefs-perceptions-of-emergency-department-quality-in-catalonia
#4
Javier Jacob, Emili Gené, Gilberto Alonso, Pere Rimbau, José Zorrilla, Francesc Casarramona, Cristina Netto, Pere Sánchez, Ricard Hernández, Xavier Escalada, Òscar Miró
OBJECTIVES: To study the perceptions of Catalan Society of Emergency Medicine (SoCMUE) members who staff hospital emergency departments regarding measures taken to cope with overcrowding, staff rest areas, and staff size. MATERIAL AND METHODS: Descriptive cross-sectional analysis of a survey sent to SoCMUE members. We compared opinions expressed by physicians and nurses in this survey and also compared them to opinions expressed by heads of departments in prior SUHCAT studies...
February 2018: Emergencias: Revista de la Sociedad Española de Medicina de Emergencias
https://www.readbyqxmd.com/read/29401740/primary-care-comprehensiveness-can-reduce-emergency-department-visits-and-hospitalization-in-people-with-hypertension-in-south-korea
#5
Nak-Jin Sung, Yong-Jun Choi, Jae-Ho Lee
Hypertension has been the leading risk factor contributing to cardiovascular morbidity and mortality, which needs comprehensive measures to manage and can be controlled effectively in primary care. In the health care context of South Korea, where specialists can see patients directly at their own community clinics and there has been no consensus on the definition of primary care, the authors used the nationally representative 2013 Korea Health Panel data, categorized adults (≥18 years) with hypertension by types of usual source of care (USC), and analyzed the association of having a comprehensive community clinic (i...
February 5, 2018: International Journal of Environmental Research and Public Health
https://www.readbyqxmd.com/read/29401351/emergency-department-waiting-times-in-an-israeli-children-s-hospital-during-times-of-military-conflict
#6
Itai Shavit, Oren Feldman
Introduction: During military conflicts in southern Israel, many families moved north, and hospitals and primary care clinics under threat of missile attacks referred their patients to hospitals outside the combat zone, causing overcrowding of the emergency departments (ED). The study objective is to examine the effect of military conflicts on ED waiting time in a children's hospital outside the combat zone. Materials and Methods: A retrospective cohort study of patients admitted between January 2011 and December 2015 was conducted...
January 1, 2018: Military Medicine
https://www.readbyqxmd.com/read/29380133/non-urgent-use-of-emergency-departments-populations-most-likely-to-overestimate-illness-severity
#7
Hans Andrews, Lawrence Kass
Patients' overestimation of their illness severity appears to contribute to the national epidemic of emergency department (ED) overcrowding. This study aims to elucidate which patient populations are more likely to have a higher estimation of illness severity (EIS). The investigator surveyed demographic factors of all non-urgent patients at an academic ED. The patients and physicians were asked to estimate the patients' illness severity using a 1-10 scale with anchors. The difference of these values was taken and compared across patient demographic subgroups using a 2-sample t-test...
January 29, 2018: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/29352674/the-effect-of-vertical-split-flow-patient-management-on-emergency-department-throughput-and-efficiency
#8
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/29249343/a-universal-deep-learning-approach-for-modeling-the-flow-of-patients-under-different-severities
#9
Shancheng Jiang, Kwai-Sang Chin, Kwok L Tsui
BACKGROUND AND OBJECTIVE: The Accident and Emergency Department (A&ED) is the frontline for providing emergency care in hospitals. Unfortunately, relative A&ED resources have failed to keep up with continuously increasing demand in recent years, which leads to overcrowding in A&ED. Knowing the fluctuation of patient arrival volume in advance is a significant premise to relieve this pressure. Based on this motivation, the objective of this study is to explore an integrated framework with high accuracy for predicting A&ED patient flow under different triage levels, by combining a novel feature selection process with deep neural networks...
February 2018: Computer Methods and Programs in Biomedicine
https://www.readbyqxmd.com/read/29226754/cardiac-troponins-25-years-on-the-stage-and-still-improving-their-clinical-value
#10
Aitor Alquézar-Arbé, Alessandro Sionis, Jorge Ordoñez-Llanos
Twenty-five years ago, non-isotopic immunoassays for measuring the cardiac specific isoforms of troponin I (cTnI) and T (cTnT) were developed. Both biomarkers radically changed the diagnosis, prognosis, and therapy indication of acute coronary syndromes (ACS) and, particularly, of myocardial infarction (MI). However, cardiac troponins (cTn) rapidly demonstrated their usefulness in other cardiac and non-cardiac conditions, a part of the ischemic coronary diseases. Consequently, the number of patients to be tested for cTn and the number of tests requested to clinical laboratories sharply increased...
December 11, 2017: Critical Reviews in Clinical Laboratory Sciences
https://www.readbyqxmd.com/read/29207925/quantifying-emergency-department-crowding-comparison-between-two-scores
#11
Jérôme Jobé, Anne-Françoise Donneau, Béatrice Scholtes, Alexandre Ghuysen
INTRODUCTION: Emergency department (ED) crowding is a major international concern with a negative impact on both patient care and providers. Currently, there is no consensus regarding measure of crowding. Therefore, emergency physicians have to choose between numerous scoring systems, from simple to more complex. The aim of the present study was to compare the complex National Emergency Department Overcrowding Scale (NEDOCS) with the simple ED Occupancy rate (OR) determination. We further evaluated the correlation between these scores and a qualitative assessment of crowding...
December 5, 2017: Acta Clinica Belgica
https://www.readbyqxmd.com/read/29196487/application-of-time-series-analysis-in-modelling-and-forecasting-emergency-department-visits-in-a-medical-centre-in-southern-taiwan
#12
Wang-Chuan Juang, Sin-Jhih Huang, Fong-Dee Huang, Pei-Wen Cheng, Shue-Ren Wann
OBJECTIVE: Emergency department (ED) overcrowding is acknowledged as an increasingly important issue worldwide. Hospital managers are increasingly paying attention to ED crowding in order to provide higher quality medical services to patients. One of the crucial elements for a good management strategy is demand forecasting. Our study sought to construct an adequate model and to forecast monthly ED visits. METHODS: We retrospectively gathered monthly ED visits from January 2009 to December 2016 to carry out a time series autoregressive integrated moving average (ARIMA) analysis...
December 1, 2017: BMJ Open
https://www.readbyqxmd.com/read/29175310/no-more-code-black-intervention-to-improve-inpatient-flow-at-a-large-public-hospital
#13
Charles E Coffey, Valda Carter, Eric Wei, Douglas Hutcheon, John P Gruen, Annie Anonas-Ternate, Rebecca Sandoval, Annie Marquez, Laura Sarff, Brad Spellberg
Code Black is a documentary movie, and now television series, whose name derives from a term used to describe critical hospital overcrowding resulting in dangerously inadequate patient flow. The Los Angeles County + University of Southern California (LAC+USC) Medical Center is a large, urban, public hospital with a long history of spending substantial amounts of time in Code Black-indeed the movie was created by a former Emergency Medicine resident at LAC+USC Medical Center. To change years of inadequate inpatient flow, we implemented time-limited cardiac monitoring criteria and empowered existing staff to enforce admission and downgrade criteria for our telemetry, step-down care unit, and intensive care units...
November 21, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/29170337/40%C3%A2-ed-crowding-the-acceptability-of-dysfunction
#14
Karl Kavanagh, Darragh Shields, Paul Staunton
BACKGROUND: Crowding in the Emergency Department is internationally recognised as one of the greatest challenges to healthcare provision. Numerous studies have highlighted the ill-effects of crowding, including increased length of stay, mortality and cost per admission. Crowding is typically a manifestation of a hospital at full capacity and its main contributor is the practice of boarding patients in the ED. Therefore, a functioning flow system is advised to ease the burden. Different predictive tools/algorithms assess the degree of crowding...
December 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29170318/21%C3%A2-daily-dynamic-discharge-a-whole-system-solution-to-ed-crowding
#15
Jacques Kerr, Helen Maitland, Claire Bell, Julie White, Alan Hunter
INTRODUCTION: ED crowding is associated with increased mortality, poor staff and patient experience, an increased inpatient length of stay and poor compliance with the four-hour emergency access standard.1 Where crowding is caused by exit block, the focus needs to be on whole system patient management, reducing the temporal mismatch between admissions and discharges since at times of peak demand hospitals may become gridlocked until patients are discharged.In an attempt to tackle exit block, the Scottish Government Unscheduled Care Team have implemented the Daily Dynamic Discharge (DDD) approach, which aims to increase the number of inpatient discharges by 12 pm, thus enabling more timeous flow through the ED...
December 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29169818/introduction-of-a-horizontal-and-vertical-split-flow-model-of-emergency-department-patients-as-a-response-to-overcrowding
#16
Gregory Wallingford, Nikita Joshi, Patrice Callagy, Jamie Stone, Ian Brown, Sam Shen
INTRODUCTION: ED overcrowding is an issue that is affecting every emergency department and every hospital. The inability to maintain patient flow into and out of the emergency department paralyzes the ability to provide effective and timely patient care. Many solutions have been proposed on how to mitigate the effects of ED overcrowding. Solutions involve either hospital-wide initiatives or ED-based solutions. In this article, the authors seek to describe and provide metrics for a patient flow methodology that targets ESI 3 patients in a vertical flow model...
November 20, 2017: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
https://www.readbyqxmd.com/read/29169003/growing-old-in-the-emergency-department
#17
P Liston, G Conyngham, M Brady, P J Byrne, P Gilligan
The research team were concerned that older patients requiring emergency admission seemed to wait longer for a hospital bed, and as such were disproportionately affected by Emergency Department overcrowding. To investigate this theory and explore any changes over time, a ten year dataset (2005-2014 inclusive) was extracted from the information systems at Beaumont Hospital, Dublin. This research examines the changing age profile of ED patients, identifies the relationship between age and the total time spent in the Emergency Department (Patient Experience Time (PET)), and examines the public belief that EDs are busiest in winter when reports of overcrowding and elderly patients waiting on trolleys get most media attention...
August 12, 2017: Irish Medical Journal
https://www.readbyqxmd.com/read/29137906/can-different-physicians-providing-urgent-and-non-urgent-treatment-improve-patient-flow-in-emergency-department
#18
Flora Fei-Fei Yau, Tsung-Cheng Tsai, Yan-Ren Lin, Kuan-Han Wu, Yuan-Jhen Syue, Chao-Jui Li
BACKGROUND: Emergency Department (ED) overcrowding is a worldwide problem, and it might be caused by prolonged patient stay in the ED. This study tried to analyze if different practice models influence patient flow in the ED. MATERIALS AND METHODS: A retrospective, 1-year cohort study was conducted across two EDs in the largest healthcare system in Taiwan. A total of 37,580 adult non-trauma patients were involved in the study. The clinical practice between two ED practice models was compared...
November 6, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29115072/emergency-department-visits-can-be-reduced-by-having-a-regular-doctor-for-adults-with-diabetes-mellitus-secondary-analysis-of-2013-korea-health-panel-data
#19
Clara Lee, Nak Jin Sung, Hyeong Seok Lim, Jae Ho Lee
Chronic diseases pose a major challenge to population health worldwide. Diabetes is a major chronic disease that is managed overwhelmingly in primary care. There is an increasing recognition of the role that primary care physicians play to achieve high-quality care for patients with diabetes. By analyzing 2013 Korean Health Panel data, the authors aimed to determine the current status of having a regular doctor (RD) for adults (aged 18 years or older) with diabetes. In addition, the association of having a RD with the experience of emergency department (ED) visits was determined in this study...
December 2017: Journal of Korean Medical Science
https://www.readbyqxmd.com/read/29110718/cardiac-patients-perceptions-of-neighboring-patients-risk-influence-on-psychological-stress-in-the-ed-and-subsequent-posttraumatic-stress
#20
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
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