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Quality and safety in emergency departments

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https://www.readbyqxmd.com/read/28528621/using-lean-to-rapidly-and-sustainably-transform-a-behavioral-health-crisis-program-impact-on-throughput-and-safety
#1
Margaret E Balfour, Kathleen Tanner, Paul J Jurica, Dawn Llewellyn, Robert G Williamson, Chris A Carson
BACKGROUND: Lean has been increasingly applied in health care to reduce waste and improve quality, particularly in fast-paced and high-acuity clinical settings such as emergency departments. In addition, Lean's focus on engagement of frontline staff in problem solving can be a catalyst for organizational change. In this study, ConnectionsAZ demonstrates how they applied Lean principles to rapidly and sustainably transform clinical operations in a behavioral health crisis facility. METHODS: A multidisciplinary team of management and frontline staff defined values-based outcome measures, mapped the current and ideal processes, and developed new processes to achieve the ideal...
June 2017: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/28499354/patient-and-care-characteristics-of-self-referrals-treated-by-the-general-practitioner-cooperative-at-emergency-care-access-points-in-the-netherlands
#2
Martijn Rutten, Fieke Vrielink, Marleen Smits, Paul Giesen
BACKGROUND: In the Netherlands, out-of-hours primary care is provided in general practitioner-cooperatives (GPCs). These are increasingly located on site and in collaboration with emergency departments of hospitals (ED). At such sites, also called emergency-care-access-points (ECAP), the GPC is generally responsible for the triage and treatment of self-referrals who used to attend the ED. To evaluate the effects and safety of this novel organisation, we studied the characteristics and the quality of care given by GPCs to self-referrals at ECAPs...
May 12, 2017: BMC Family Practice
https://www.readbyqxmd.com/read/28497924/real-life-efficacy-of-omalizumab-after-9-years-of-follow-up
#3
Francesco Menzella, Carla Galeone, Debora Formisano, Claudia Castagnetti, Patrizia Ruggiero, Anna Simonazzi, Luigi Zucchi
Omalizumab is frequently used as add-on treatment to inhaled corticosteroids (ICS) and long-acting β2-agonists in patients with suboptimal control of severe asthma. Patients with severe asthma will typically require chronic treatment, although due to the limited amount of data available there are still some concerns about the safety and efficacy of long-term therapy with omalizumab. Herein, in an extension of a previous 4-year study, we report disease-related outcomes of 8 patients with severe persistent allergic asthma who have been followed for a total of 9 years in a real-life setting...
July 2017: Allergy, Asthma & Immunology Research
https://www.readbyqxmd.com/read/28494994/predicting-return-visits-to-the-emergency-department-for-pediatric-patients-applying-supervised-learning-techniques-to-the-taiwan-national-health-insurance-research-database
#4
Ya-Han Hu, Chun-Tien Tai, Solomon Chih-Cheng Chen, Hai-Wei Lee, Sheng-Feng Sung
BACKGROUND AND OBJECTIVE: Return visits (RVs) to the emergency department (ED) consume medical resources and may represent a patient safety issue. The occurrence of unexpected RVs is considered a performance indicator for ED care quality. Because children are susceptible to medical errors and utilize considerable ED resources, knowing the factors that affect RVs in pediatric patients helps improve the quality of pediatric emergency care. METHODS: We collected data on visits made by patients aged ≤18years to EDs from the National Health Insurance Research Database...
June 2017: Computer Methods and Programs in Biomedicine
https://www.readbyqxmd.com/read/28478750/perception-survey-on-the-value-of-the-hospital-pharmacist-at-the-emergency-department
#5
Ángeles García-Martín, Charbel Maroun-Eid, Ainara Campino-Villegas, Belén Oliva-Manuel, Alicia Herrero-Ambrosio, Manuel Quintana-Díaz
OBJECTIVE: To determine the perception and evaluation of the Emergency pharmacist by the medical and nursing staff at the Emergency department. METHODS: A multicenter study based on a survey sent to the Spanish Society of Hospital Pharmacists (SEFH) for Emergency pharmacists (EPh) to distribute among the Emergency staff. Descriptive statistics were used, with a 95% confidence interval. RESULTS: 102 (12%) questionnaires were completed by 73 Emergency Physicians (71...
May 1, 2017: Farmacia Hospitalaria
https://www.readbyqxmd.com/read/28476345/the-perception-of-the-patient-safety-climate-by-professionals-of-the-emergency-department
#6
Mayara Carvalho Godinho Rigobello, Rhanna Emanuela Fontenele Lima de Carvalho, Juliana Magalhães Guerreiro, Ana Paula Gobbo Motta, Elizabeth Atila, Fernanda Raphael Escobar Gimenes
AIM: The aim of this study was to assess the patient safety climate from the perspective of healthcare professionals working in the emergency department of a hospital in Brazil. BACKGROUND: Emergency departments are complex and dynamic environments. They are prone to adverse events that compromise the quality of care provided and reveal the importance of patient safety culture and climate. METHODS: This was a quantitative, descriptive, cross-sectional study...
May 2, 2017: International Emergency Nursing
https://www.readbyqxmd.com/read/28460726/-input-data-collection
#7
Julie Duval
The quality and safety of nursing care depends notably on the collection of data. In Quebec, there is a tool which aims to improve the organisation of care in accident and emergency departments. Nurses are on the frontline in the initial assessment of the patient. Unfortunately, their recognition is not on a par with their responsibility.
May 2017: Revue de L'infirmière
https://www.readbyqxmd.com/read/28457743/the-information-needs-of-patients-receiving-procedural-sedation-in-a-hospital-emergency-department
#8
Sue Revell, Judy Searle, Shona Thompson
This research investigated the information needs of patients receiving ED procedural sedation to determine the best format to consistently deliver key information in a way acceptable to all involved. Of particular interest was the question concerning patients' need for receiving written information. A descriptive exploratory study gathered qualitative data through face-to-face interviews and focus groups involving patients, nurses and medical staff. Individual interviews were conducted with eight adult patients following procedural sedation...
April 27, 2017: International Emergency Nursing
https://www.readbyqxmd.com/read/28437795/effect-of-using-the-heart-score-in-patients-with-chest-pain-in-the-emergency-department-a-stepped-wedge-cluster-randomized-trial
#9
Judith M Poldervaart, Johannes B Reitsma, Barbra E Backus, Hendrik Koffijberg, Rolf F Veldkamp, Monique E Ten Haaf, Yolande Appelman, Herman F J Mannaerts, Jan-Melle van Dantzig, Madelon van den Heuvel, Mohamed El Farissi, Bernard J W M Rensing, Nicolette M S K J Ernst, Ineke M C Dekker, Frank R den Hartog, Thomas Oosterhof, Ghizelda R Lagerweij, Eugene M Buijs, Maarten W J van Hessen, Marcel A J Landman, Roland R J van Kimmenade, Luc Cozijnsen, Jeroen J J Bucx, Clara E E van Ofwegen-Hanekamp, Maarten-Jan Cramer, A Jacob Six, Pieter A Doevendans, Arno W Hoes
Background: The HEART (History, Electrocardiogram, Age, Risk factors, and initial Troponin) score is an easy-to-apply instrument to stratify patients with chest pain according to their short-term risk for major adverse cardiac events (MACEs), but its effect on daily practice is unknown. Objective: To measure the effect of use of the HEART score on patient outcomes and use of health care resources. Design: Stepped-wedge, cluster randomized trial...
May 16, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/28420688/can-a-partnership-between-general-practitioners-and-ambulance-services-reduce-conveyance-to-emergency-care
#10
Manuel Villarreal, Jonathan Leach, Kandala Ngianga-Bakwin, Jeremy Dale
BACKGROUND: Emergency services are facing increasing workload pressures, and new models of care are needed. We evaluate the impact of a service development involving a partnership between emergency ambulance crews and general practitioners (GPs) on reducing conveyance rates to the Hospital Emergency Department (ED). METHODS: The service model was implemented in the West Midlands of England. Call handlers identified patients with needs that could be addressed by a GP using locally agreed criteria...
April 18, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28412951/understanding-discharge-communication-behaviours-in-a-pediatric-emergency-care-context-a-mixed-methods-observation-study-protocol
#11
Janet A Curran, Andrea Bishop, Amy Plint, Shannon MacPhee, Roger Zemek, Jill Chorney, Mona Jabbour, Stephen Porter, Scott Sawyer
BACKGROUND: One of the most important transitions in the continuum of care for children is discharge to home. Optimal discharge communication between healthcare providers and caregivers (e.g., parents or other guardians) who present to the emergency department (ED) with their children is not well understood. The lack of policies and considerable variation in practice regarding discharge communication in pediatric EDs pose a quality and safety risk for children and their parents. METHODS: The aim of this mixed methods study is to better understand the process and structure of discharge communication in a pediatric ED context to contribute to the design and development of discharge communication interventions...
April 17, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28409062/improved-availability-and-quality-of-care-with-epilepsy-nurse-practitioners
#12
Chloe E Hill, Bethany Thomas, Kimberly Sansalone, Kathryn A Davis, Judy A Shea, Brian Litt, Nabila Dahodwala
BACKGROUND: This study investigated the quality of care delivered by nurse practitioner (NP)-physician teams employed to expand clinic appointment availability for patients with epilepsy. METHODS: We performed a retrospective observational cohort study of patients with epilepsy presenting to the Penn Epilepsy Center for a new patient appointment in 2014. During this time, patients were seen either by an NP-physician team care model or a more traditional physician-only care model...
April 2017: Neurology. Clinical Practice
https://www.readbyqxmd.com/read/28402017/asthma-education-for-school-staff
#13
REVIEW
Kayleigh M Kew, Robin Carr, Tim Donovan, Morris Gordon
BACKGROUND: Teachers and school staff should be competent in managing asthma in schools. Demonstrated low levels of asthma knowledge mean that staff may not know how best to protect a child with asthma in their care, or may fail to take appropriate action in the event of a serious attack. Education about asthma could help to improve this knowledge and lead to better asthma outcomes for children. OBJECTIVES: To assess the effectiveness and safety of asthma education programmes for school staff, and to identify content and attributes underpinning them...
April 12, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28394084/personalised-asthma-action-plans-for-adults-with-asthma
#14
REVIEW
Timothy L Gatheral, Alison Rushton, David Jw Evans, Caroline A Mulvaney, Nathan R Halcovitch, Gemma Whiteley, Fiona Jr Eccles, Sally Spencer
BACKGROUND: A key aim of asthma care is to empower each person to take control of his or her own condition. A personalised asthma action plan (PAAP), also known as a written action plan, an individualised action plan, or a self-management action plan, contributes to this endeavour. A PAAP includes individualised self-management instructions devised collaboratively with the patient to help maintain asthma control and regain control in the event of an exacerbation. A PAAP includes baseline characteristics (such as lung function), maintenance medication and instructions on how to respond to increasing symptoms and when to seek medical help...
April 10, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28388818/enhancing-quality-of-provider-practices-for-older-adults-in-the-emergency-department-equipped
#15
Melissa Stevens, Susan N Hastings, Alayne D Markland, Ula Hwang, William Hung, Ann E Vandenberg, William Bryan, Dewayne Cross, James Powers, Gerald McGwin, Noor Fattouh, William Ho, Carolyn Clevenger, Camille P Vaughan
EQUiPPED is a multicomponent quality improvement initiative combining education, electronic clinical decision support, and individual provider feedback to influence prescribing and improve medication safety for older adults. The objective here was to evaluate the effectiveness and sustainability of EQUiPPED to reduce the use of potentially inappropriate medications (PIMs), as defined by the American Geriatrics Society 2012 Beers Criteria, prescribed to older Veterans at the time of emergency department (ED) discharge...
April 7, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28356887/pre-test-and-post-test-applications-to-shape-the-education-of-phlebotomists-in-a-quality-management-program-an-experience-in-a-training-hospital
#16
Güzin Aykal, Mustafa Keşapli, Özgür Aydin, Hatice Esen, Ayşenur Yeğin, Faruk Güngör, Necat Yilmaz
BACKGROUND: After the introduction of modern laboratory instruments and information systems, preanalytic phase is the new field of battle. Errors in preanalytical phase account for approximately half of total errors in clinical laboratory. The objective of this study was to share an experience of an education program that was believed to be successful in decreasing the number of rejected samples received from the Emergency Department (ED). METHODS: An education program about laboratory procedures, quality requirements in the laboratory, patient and health-care worker safety was planned by the quality team to be performed on 36 people who were responsible for sample collection in the ED...
September 2016: Journal of Medical Biochemistry
https://www.readbyqxmd.com/read/28339735/triage-quality-control-is-missing-tools-a-new-observation-technique-for-ed-quality-improvement
#17
Tomi Malmström, Veli-Pekka Harjola, Paulus Torkki, Salla Kumpulainen, Raija Malmström
Objective: Correct assessment of patient urgency is critical to ensuring patient safety in emergency departments (EDs). Although significant time and effort have been devoted to developing triage systems, less attention has been paid to the development of quality control. The aim of this study is to introduce and test observation technique, which enables identifying of patient groups at risk of erroneous assessment in triage. The introduced technique is aimed to be less laborious to use than existing triage quality control methods...
April 1, 2017: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/28302375/risk-factors-for-unplanned-transfer-to-the-intensive-care-unit-after-emergency-department-admission
#18
Lena M Boerma, Eef P J Reijners, Roger A P A Hessels, Martijn A A V Hooft
INTRODUCTION: Unplanned Intensive Care Unit (ICU) admission has been used as a surrogate marker of adverse events, and is used by the Australian Council of Healthcare Accreditation as a reportable quality indicator. If we can identify independent variables predicting deterioration which require ICU transfer within 24h after emergency department (ED) admission, direct ICU admission should be considered. This may improve patient safety and reduce adverse events by appropriate disposition of patients presenting to the ED...
March 12, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28289051/paediatric-early-warning-systems-for-detecting-and-responding-to-clinical-deterioration-in-children-a-systematic-review
#19
Veronica Lambert, Anne Matthews, Rachel MacDonell, John Fitzsimons
OBJECTIVE: To systematically review the available evidence on paediatric early warning systems (PEWS) for use in acute paediatric healthcare settings for the detection of, and timely response to, clinical deterioration in children. METHOD: The electronic databases PubMed, MEDLINE, CINAHL, EMBASE and Cochrane were searched systematically from inception up to August 2016. Eligible studies had to refer to PEWS, inclusive of rapid response systems and teams. Outcomes had to be specific to the identification of and/or response to clinical deterioration in children (including neonates) in paediatric hospital settings (including emergency departments)...
March 13, 2017: BMJ Open
https://www.readbyqxmd.com/read/28274646/general-characteristics-and-activity-of-emergency-department-short-stay-units-in-spanish-hospitals
#20
Carles Ferré, Ferran Llopis, Francisco Javier Martín-Sánchez, Gonzalo Sempere, Pere Llorens, Carmen Navarro, Mikel Martínez-Ortiz, Antoni Juan
BACKGROUND: Emergency Department (ED) overcrowding mainly due to the lack of access to inpatient beds negatively affects safety and quality of care. Implementation of ED short-stay units (EDSSUs) may help to mitigate this situation. OBJECTIVES: To describe the general characteristics and evaluate the activity of EDSSUs in Spanish hospitals. METHODS: This is a cross-sectional study. A questionnaire was sent to coordinators responsible for the EDSSUs identified among Spanish hospitals appearing on the Ministry of Health Web page...
March 5, 2017: Journal of Emergency Medicine
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