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Ed overcrowding

Amy H Y Cheng, Neil G Barclay, Riyad B Abu-Laban
BACKGROUND: Observation units (OUs) have been shown to reduce emergency department (ED) lengths of stay (LOS) and admissions. Most published studies have been on OUs managing single complaints. OBJECTIVE: Our aim was to determine whether an OU reduces ED LOS and hospital admission rates for adults with a variety of presenting complaints. METHODS: We comparatively evaluated two hospitals in British Columbia, Canada (hereafter ED A and ED B) using a pre-post design...
September 26, 2016: Journal of Emergency Medicine
Mathias C Blom, Karin Erwander, Lars Gustafsson, Mona Landin-Olsson, Fredrik Jonsson, Kjell Ivarsson
BACKGROUND: Emergency department (ED) overcrowding is frequently described in terms of input- throughput and output. In order to reduce ED input, a concept called primary triage has been introduced in several Swedish EDs. In short, primary triage means that a nurse separately evaluates patients who present in the Emergency Department (ED) and either refers them to primary care or discharges them home, if their complaints are perceived as being of low acuity. The aim of the present study is to elucidate whether high levels of in-hospital bed occupancy are associated with decreased permeability in primary triage...
September 22, 2016: BMC Emergency Medicine
Ben Smith, Stephane Bouchoucha, Elizabeth Watt
OBJECTIVES: The aim in this study was to investigate the impact of overcrowding on the Australasian Triage Score's (ATS) time to treatment target and the National Emergency Access Target (NEAT) for patients who self-present to the Emergency Department (ED) with abdominal pain. BACKGROUND: The causes and effects of ED overcrowding have been well described in the literature. It is a widespread phenomenon throughout the world and it can cause serious harm to patients and have a negative impact on access to emergency care...
September 15, 2016: International Emergency Nursing
E Gedda, A Robbins, M Hentzien, A Giltat, V Pinel-Petit, J Souille, Y N'Guyen
INTRODUCTION: We assessed (i) the frequency of consultations for faintness in the Emergency department (ED) of a University hospital centre (UHC), (ii) clinical epidemiology and (iii) cost of faintness, taking a particular interest into the determining risk factors for hospitalization. METHODS: This epidemiological study has been conducted retrospectively, from data obtained for every patient having consulted for faintness in ED of Reims UHC (01/01/12-03/31/12)...
September 9, 2016: La Revue de Médecine Interne
Eduardo Santos, Daniela Cardoso, Paulo Queirós, Madalena Cunha, Manuel Rodrigues, João Apóstolo
The objective of this review is to identify the effects of emergency department (ED) overcrowding on admitted patient outcomes.More specifically, the questions are: does ED overcrowding increase the admitted patient's mortality? Does ED overcrowding increase the admitted patient's hospital length-of-stay? Does ED overcrowding increase the delay in door-to-needle time to treatment (time to antibiotic, time to thrombolysis and time to analgesic)?
May 2016: JBI Database of Systematic Reviews and Implementation Reports
Maria Paola Scapinello, Andrea Posocco, Irene De Ronch, Francesco Castrogiovanni, Gianluca Lollo, Guglielmo Sergi, Iginio Tomaselli, Loris Tonon, Marco Solmi, Stefano Traversa, Vincenzo Zambianco, Nicola Veronese
BACKGROUND: Out of hours (OOH) doctors could manage many cases limiting the inappropriate accesses to ED. However the possible determinants of referral to ED by OOH doctors are poorly studied. We aimed to characterize patients referred from the OOH to ED service in order to explore the gate-keeping role of OOH service for hospital emergency care and to facilitate future research in improving its cost-effectiveness. METHODS: A retrospective study was made through data collection of 5217 contacts in a local OOH service in the North-East of Italy (from 10/01/2012 to 03/31/2013)...
September 2016: Health Policy
Alessandra Buja, Roberto Toffanin, S Rigon, P Sandonà, T Carrara, G Damiani, V Baldo
BACKGROUND: A growing presence of inappropriate patients has been recognised as one of the main factors influencing emergency department (ED) overcrowding, which is a very widespread problem all over the world. On the other hand, out-of-hours (OOH) physicians must avoid delaying the diagnostic and therapeutic course of patients with urgent medical conditions. The aim of this study was to analyse the appropriateness of patient management by OOH services, in terms of their potentially inappropriate referral or non-referral of non-emergency cases to the ED...
2016: BMJ Open
Eva Fuentes, Jean-Francois Shields, Nandan Chirumamilla, Myriam Martinez, Haytham Kaafarani, Daniel Dante Yeh, Benjamin White, Michael Filbin, Christopher DePesa, George Velmahos, Jarone Lee
Emergency department (ED) overcrowding remains a significant problem in many hospitals, and results in multiple negative effects on patient care outcomes and operational metrics. We sought to test whether implementing a quality improvement project could decrease ED LOS for trauma patients requiring an ICU admission from the ED, specifically by directly admitting critically ill trauma patients from the ED CT scanner to an ICU bed. This was a retrospective study comparing patients during the intervention period (2013-2014) to historical controls (2011-2013)...
July 29, 2016: Internal and Emergency Medicine
K A Mol, B M Rahel, J G Meeder, B C A M van Casteren, P A Doevendans, M J M Cramer
Delays in patients suspected of acute coronary syndrome (ACS) should be kept as short as possible to reduce complications and mortality. In this review we discuss the substantial pre-hospital delays of ST-elevated myocardial infarction (STEMI) patients as well as non-STEMI patients. The pre-hospital delays include patient, doctor and emergency medical transport (EMT) delay. Patient delay is among the longest in the pre-hospital chain of ACS patients. Interventions as mass media campaigns or individual education programs have not yet shown much improvement...
October 15, 2016: International Journal of Cardiology
Jane E Hamilton, Pratikkumar V Desai, Nathan R Hoot, Robin E Gearing, Shin Jeong, Thomas D Meyer, Jair C Soares, Charles E Begley
STUDY OBJECTIVES: Behavioral health-related emergency department (ED) visits have been linked with ED overcrowding, an increased demand on limited resources and a longer length of stay due in part to patients being admitted to the hospital but waiting for an inpatient bed. The present study examines factors associated with the likelihood of hospital admission for ED patients with behavioral health conditions at 16 hospital-based EDs in a large urban area in the southern United States...
July 7, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Chip-Jin Ng, Pei-Ju Liao, Yu-Che Chang, Jen-Tze Kuan, Jih-Chang Chen, Kuang-Hung Hsu
Nonurgent emergency department (ED) patients are a controversial issue in the era of ED overcrowding. However, a substantial number of post-ED hospitalizations were found, which prompted for investigation and strategy management. The objective of this study is to identify risk factors for predicting the subsequent hospitalization of nonurgent emergency patients. This was a retrospective study of a database of adult nontrauma ED visits in a medical center for a period of 12 months from January 2013 to December 2013...
June 2016: Medicine (Baltimore)
Heather Boerner
No abstract text is available yet for this article.
May 2016: Physician Leadership Journal
Mohamed Afilal, Farouk Yalaoui, Frédéric Dugardin, Lionel Amodeo, David Laplanche, Philippe Blua
Emergency department (ED) have become the patient's main point of entrance in modern hospitals causing it frequent overcrowding, thus hospital managers are increasingly paying attention to the ED in order to provide better quality service for patients. One of the key elements for a good management strategy is demand forecasting. In this case, forecasting patients flow, which will help decision makers to optimize human (doctors, nurses…) and material(beds, boxs…) resources allocation. The main interest of this research is forecasting daily attendance at an emergency department...
July 2016: Journal of Medical Systems
Kittiyaporn Wiwatcharagoses, Kwanchanog Lueweeravong
BACKGROUND: Chronic Obstructive Pulmonary Disease with acute exacerbation (AECOPD) is a condition, which frequently results in patients visiting the emergency department (ED). Recently, many studies have reported new factors, which cause AECOPD-patients (AECOPDs) to require urgent hospital admission. OBJECTIVE: To determine the crucial factors of AECOPDs that are associated with patients who visit the ED being admitted to Rajavithi Hospital. MATERIAL AND METHOD: This retrospective cross-sectional study was performed from May 1, 2011 to June 30, 2013...
February 2016: Journal of the Medical Association of Thailand, Chotmaihet Thangphaet
Alexander Kutz, Jonas Florin, Pierre Hausfater, Devendra Amin, Adina Amin, Sebastian Haubitz, Antoinette Conca, Barbara Reutlinger, Pauline Canavaggio, Gabrielle Sauvin, Maguy Bernard, Andreas Huber, Beat Mueller, Philipp Schuetz
INTRODUCTION: In overcrowded emergency department (ED) care, short time to start effective antibiotic treatment has been evidenced to improve infection-related clinical outcomes. Our objective was to study factors associated with delays in initial ED care within an international prospective medical ED patient population presenting with acute infections. METHODS: We report data from an international prospective observational cohort study including patients with a main diagnosis of infection from three tertiary care hospitals in Switzerland, France and the United States (US)...
2016: PloS One
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
Chao-Jui Li, Yuan-Jhen Syue, Yan-Ren Lin, Hsien-Hung Cheng, Fu-Jen Cheng, Tsung-Cheng Tsai, Kuan-Fu Chen, Chien-Hung Lee
OBJECTIVE: CT, an important diagnostic tool in the emergency department (ED), might increase the ED length of stay (LOS). Considering the issue of ED overcrowding, it is important to evaluate whether CT use delays or facilitates patient disposition in the ED. DESIGN: A retrospective 1-year cohort study. SETTING: 5 EDs within the same healthcare system dispersed nationwide in Taiwan. PARTICIPANTS: All adult non-trauma patients who visited the 5 EDs from 1 July 2011 to 30 June 2012...
2016: BMJ Open
Roshana Shrestha, Samita Pant, Ashis Shrestha, Kabita Hada Batajoo, Rashmi Thapa, Sumana Vaidya
BACKGROUND: Pain in the emergency department (ED) is common but undertreated. The objective of this study was to examine the efficacy and safety of intranasal (IN) ketamine used as an analgesic for patients with acute injury with moderate to severe pain. METHODS: This study was a cross sectional, observational study of patients more than 8 years old experiencing moderate to severe pain [visual analog score (VAS) >50 mm]. The initial dose of IN ketamine was 0...
2016: World Journal of Emergency Medicine
Emogene S Aldridge, Ian R Rogers, Paul M Bailey, Jeremy R Rogers
OBJECTIVE: To evaluate the effect of a sudden and sustained decrease in patient presentations on waiting times and other measures of workload and flow following the opening of a large, greenfields ED adjacent to our own. METHOD: A descriptive study involving all patients presenting to a private urban district hospital ED for two 60 day periods, immediately before and after the opening of the tertiary hospital ED. Changes in median waiting time, case-mix distribution, method of arrival, total admissions and total waiting time were compared pre-opening and post-opening...
June 2016: Emergency Medicine Australasia: EMA
(no author information available yet)
In an effort to strengthen patient safety, leadership at the University of Kentucky HealthCare (UKHC) decided to replace its traditional approach to root cause analysis (RCA) with a process based on swarm intelligence, a concept borrowed from other industries. Under this process, when a problem or error is identified, staff quickly hold a swarm--a meeting in which all those involved in the incident or problem quickly evaluate why the issue occurred and identify potential solutions for implementation. A pillar of the swarm concept is a mandate that there be no punishments or finger-pointing during the swarms...
March 2016: ED Management: the Monthly Update on Emergency Department Management
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