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Ed overcrowding

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https://www.readbyqxmd.com/read/29605480/emergency-department-boarding-and-adverse-hospitalization-outcomes-among-patients-admitted-to-a-general-medical-service
#1
Kito Lord, Vivek Parwani, Andrew Ulrich, Emily B Finn, Craig Rothenberg, Beth Emerson, Alana Rosenberg, Arjun K Venkatesh
OBJECTIVE: Overcrowding in the emergency department (ED) has been associated with patient harm, yet little is known about the association between ED boarding and adverse hospitalization outcomes. We sought to examine the association between ED boarding and three common adverse hospitalization outcomes: rapid response team activation (RRT), escalation in care, and mortality. METHOD: We conducted an observational analysis of consecutive patient encounters admitted from the ED to the general medical service between February 2013 and June 2015...
March 20, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29601462/incident-reporting-to-improve-patient-safety-the-effects-of-process-variance-on-pediatric-patient-safety-in-the-emergency-department
#2
Karen J OʼConnell, Kathy N Shaw, Richard M Ruddy, Prashant V Mahajan, Richard Lichenstein, Cody S Olsen, Tomohiko Funai, Stephen Blumberg, James M Chamberlain
OBJECTIVE: Medical errors threaten patient safety, especially in the pediatric emergency department (ED) where overcrowding, multiple handoffs, and workflow interruptions are common. Errors related to process variance involve situations that are not consistent with standard ED operations or routine patient care. SETTING/PARTICIPANTS: We performed a planned subanalysis of the Pediatric Emergency Care Applied Research Network incident reporting data classified as process variance events...
April 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29573904/causes-of-emergency-department-overcrowding-and-blockage-of-access-to-critical-services-in-beijing-a-2-year-study
#3
Zhen Wang, Xiaying Xiong, Shuang Wang, Junguo Yan, Martin Springer, R P Dellinger
BACKGROUND: Emergency department (ED) overcrowding is a serious issue worldwide. OBJECTIVES: This study was done to evaluate the degree of overcrowding in local "teaching hospitals" in Beijing, and to ascertain the apparent root causes for the pervasive degree of overcrowding in these EDs. METHODS: This is a multicenter cross-sectional study. The studied population included all ED patients from 18 metropolitan teaching hospital EDs in Beijing for calendar years 2013 and 2014...
March 21, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29563151/emergency-department-overcrowding-a-survey-among-european-neurotrauma-centres
#4
Kimberley Bernadette Velt, Maryse Cnossen, Pleunie P M Rood, Ewout W Steyerberg, Suzanne Polinder, Hester F Lingsma
BACKGROUND: ED overcrowding is an increasing problem worldwide that may negatively affect quality of care and patient outcomes. We aimed to study ED overcrowding across European centres. METHODS: Questionnaires on structure and process of care, including crowding, were distributed to 68 centres participating in a large European study on traumatic brain injury (Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury). RESULTS: Of the 65 centres included in the analysis, 32 (49%) indicated that overcrowding was a frequent problem and 28 (43%) reported that patients were placed in hallways 'multiple times a day'; 27 (41%) stated that multiple times a day, there was no bed available when a patient needed to be admitted...
March 21, 2018: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29538401/impact-of-the-four-hour-rule-in-western-australian-hospitals-trend-analysis-of-a-large-record-linkage-study-2002-2013
#5
Hanh Ngo, Roberto Forero, David Mountain, Daniel Fatovich, Wing Nicola Man, Peter Sprivulis, Mohammed Mohsin, Sam Toloo, Antonio Celenza, Gerard Fitzgerald, Sally McCarthy, Ken Hillman
BACKGROUND: In 2009, the Western Australian (WA) Government introduced the Four-Hour Rule (FHR) program. The policy stated that most patients presenting to Emergency Departments (EDs) were to be seen and either admitted, transferred, or discharged within 4 hours. This study utilised de-identified data from five participating hospitals, before and after FHR implementation, to assess the impact of the FHR on several areas of ED functioning. METHODS: A state (WA) population-based intervention study design, using longitudinal data obtained from administrative health databases via record linkage methodology, and interrupted time series analysis technique...
2018: PloS One
https://www.readbyqxmd.com/read/29523559/incidence-of-delirium-in-the-canadian-emergency-department-and-its-consequences-on-hospital-length-of-stay-a-prospective-observational-multicentre-cohort-study
#6
Marcel Émond, Valérie Boucher, Pierre-Hugues Carmichael, Philippe Voyer, Mathieu Pelletier, Émilie Gouin, Raoul Daoust, Simon Berthelot, Marie-Eve Lamontagne, Michèle Morin, Stéphane Lemire, Thien Tuong Minh Vu, Alexandra Nadeau, Marcel Rheault, Lucille Juneau, Natalie Le Sage, Jacques Lee
OBJECTIVE: We aim to determine the incidence of delirium and describe its impacts on hospital length of stay (LOS) among non-delirious community-dwelling older adults with an 8-hour exposure to the emergency department (ED) environment. DESIGN: This is a prospective observational multicentre cohort study (March-July 2015). Patients were assessed two times per day during their entire ED stay and up to 24 hours on hospital ward. SETTING: The study took place in four Canadian EDs...
March 8, 2018: BMJ Open
https://www.readbyqxmd.com/read/29438575/primary-care-professionals-providing-non-urgent-care-in-hospital-emergency-departments
#7
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/29417732/the-sydney-triage-to-admission-risk-tool-start-a-prospective-validation-study
#8
Anja A Ebker-White, Kendall J Bein, Michael M Dinh
OBJECTIVE: The present study aims to prospectively validate the Sydney Triage to Admission Risk Tool (START) to predict ED disposition. METHODS: This was a prospective validation study at two metropolitan EDs in Sydney, Australia. Consecutive triage encounters were observed by a trained researcher and START scores calculated. The primary outcome was patient disposition (discharge or inpatient admission) from the ED. Multivariable logistic regression was used to estimate area under curve of receiver operator characteristic (AUC ROC) for START scores as well as START score in combination with other variables such as frailty, general practitioner referral, overcrowding and major medical comorbidities...
February 8, 2018: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29401740/primary-care-comprehensiveness-can-reduce-emergency-department-visits-and-hospitalization-in-people-with-hypertension-in-south-korea
#9
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
#10
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
#11
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
#12
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
#13
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
#14
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...
November 2017: Critical Reviews in Clinical Laboratory Sciences
https://www.readbyqxmd.com/read/29207925/quantifying-emergency-department-crowding-comparison-between-two-scores
#15
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
#16
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/29170337/40-ed-crowding-the-acceptability-of-dysfunction
#17
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-daily-dynamic-discharge-a-whole-system-solution-to-ed-crowding
#18
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
#19
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
#20
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
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