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"Patient flow"

Manuel de la Matta
It is universally accepted that deep sedation involves more risks than light-to-moderate sedation. Deep sedation for endoscopic explorations is normally provided by anesthesiologists in Spain and in most countries of the European Unión. The present debate about deep sedation-anesthesia states goes beyond the topic of cardiovascular and respiratory adverse events, and targets the cognitive consequences and global increased mortality of uncontrolled sedation states, especially in specific fragile populations...
October 19, 2016: Revista Española de Enfermedades Digestivas
Paul Richard Edwin Jarvis
Emergency departments (ED) face significant challenges in delivering high quality and timely patient care on an ever-present background of increasing patient numbers and limited hospital resources. A mismatch between patient demand and the ED's capacity to deliver care often leads to poor patient flow and departmental crowding. These are associated with reduction in the quality of the care delivered and poor patient outcomes. A literature review was performed to identify evidence-based strategies to reduce the amount of time patients spend in the ED in order to improve patient flow and reduce crowding in the ED...
June 2016: Clin Exp Emerg Med
Gang-Xi Lin, Yin-Ling Yang, Denise Kudirka, Colleen Church, Collin K K Yong, Fiona Reilly, Qi-Yi Zeng
BACKGROUND: Pediatric emergency rooms (PERs) in Chinese hospitals are perpetually full of sick and injured children because of the lack of sufficiently developed community hospitals and low access to family physicians. The aim of this study was to evaluate the clinical value of a new five-level Chinese pediatric emergency triage system (CPETS), modeled after the Canadian Triage System and Acuity Scale. METHODS: In this study, we compared CPETS outcomes in our PER relative to those of the prior two-level system...
2016: Chinese Medical Journal
Alexander K Leung, Shawn D Whatley, Dechang Gao, Marko Duic
OBJECTIVE: To study the operational impact of process improvements on emergency department (ED) patient flow. The changes did not require any increase in resources or expenditures. METHODS: This was a 36-month pre- and post-intervention study to evaluate the effect of implementing process improvements at a community ED from January 2010 to December 2012. The intervention comprised streamlining triage by having patients accepted into internal waiting areas immediately after triage...
October 17, 2016: CJEM
Annetje C P Guédon, M Paalvast, F C Meeuwsen, D M J Tax, A P van Dijke, L S G L Wauben, M van der Elst, J Dankelman, J J van den Dobbelsteen
Operating Room (OR) scheduling is crucial to allow efficient use of ORs. Currently, the predicted durations of surgical procedures are unreliable and the OR schedulers have to follow the progress of the procedures in order to update the daily planning accordingly. The OR schedulers often acquire the needed information through verbal communication with the OR staff, which causes undesired interruptions of the surgical process. The aim of this study was to develop a system that predicts in real-time the remaining procedure duration and to test this prediction system for reliability and usability in an OR...
December 2016: Journal of Medical Systems
David A Pegues, Jennifer Han, Cheryl Gilmar, Brooke McDonnell, Steven Gaynes
OBJECTIVE To evaluate the impact of no-touch terminal room no-touch disinfection using ultraviolet wavelength C germicidal irradiation (UVGI) on C. difficile infection (CDI) rates on inpatient units with persistently high rates of CDI despite infection control measures. DESIGN Interrupted time-series analysis with a comparison arm. SETTING 3 adult hematology-oncology units in a large, tertiary-care hospital. METHODS We conducted a 12-month prospective valuation of UVGI. Rooms of patients with CDI or on contact precautions were targeted for UVGI upon discharge using an electronic patient flow system...
October 6, 2016: Infection Control and Hospital Epidemiology
Fonda G Robinson, Larry L Cunningham, Sharon P Turner, John Lindroth, Deborah Ray, Talib Khan, Audrey Yates
The term "lean production," also known as "Lean," describes a process of operations management pioneered at the Toyota Motor Company that contributed significantly to the success of the company. Although developed by Toyota, the Lean process has been implemented at many other organizations, including those in health care, and should be considered by dental schools in evaluating their clinical operations. Lean combines engineering principles with operations management and improvement tools to optimize business and operating processes...
October 2016: Journal of Dental Education
Thomas Monks, David Worthington, Michael Allen, Martin Pitt, Ken Stein, Martin A James
BACKGROUND: Mathematical capacity planning methods that can take account of variations in patient complexity, admission rates and delayed discharges have long been available, but their implementation in complex pathways such as stroke care remains limited. Instead simple average based estimates are commonplace. These methods often substantially underestimate capacity requirements. We analyse the capacity requirements for acute and community stroke services in a pathway with over 630 admissions per year...
September 29, 2016: BMC Health Services Research
Erin L Caruana, Suzanne S Kuys, Jane Clarke, Sandra G Bauer
PURPOSE: This study determined the impact of a pragmatic 6-day physiotherapy service on length of stay, functional independence, gait and balance in people undergoing inpatient rehabilitation, compared to a 5-day service. METHOD: A prospective cohort study with historical comparison was undertaken in a mixed inpatient rehabilitation unit. Intervention period participants (2011) meeting inclusion criteria were eligible for a 6-day physiotherapy service. All other participants, including the historical cohort (2010) received usual care (5-day physiotherapy)...
August 16, 2016: Disability and Rehabilitation
Jun-Yi Zhu, Jian-Gang Ren, Wei Zhang, Feng-Qin Wang, Yu Cai, Ji-Hong Zhao, Gang Chen, Yi-Fang Zhao
OBJECTIVES: To determine the basic biochemical features of microparticles (MP) in patients with venous malformation (VM) of the head and neck. METHODS: MP were isolated from peripheral venous blood of VM patients or healthy subjects and from lesional fluid of VM patients. Flow cytometry and real-time polymerase chain reaction were employed to determine the concentration, cellular origin and RNA expression of obtained MP. A functional coagulation test was applied to measure the coagulant activity of MP...
September 26, 2016: Oral Diseases
Taj Ali Khan, Kalsoom Kalsoom, Asif Iqbal, Huma Asif, Hazir Rahman, Syed Omar Farooq, Hassan Naveed, Umar Nasir, Muhammad Usman Amin, Mubashir Hussain, Hamid Nawaz Tipu, Andrei Florea
Chronic granulomatous disease (CGD) is a primary immunodeficiency caused by mutations in the five structural genes (CYBB, CYBA, NCF1, NCF2, and NCF4) that typically results in a decrease in function or inability to generate a respiratory burst, leading to defective killing of pathogens, including fungi and intracellular bacteria. Mutations in CYBB, encoding the gp91phox (also known as NOX2) result in X-linked CGD account for approximately 65% of CGD cases. Here, we aimed the characterization of a novel missense mutation c...
September 23, 2016: Microbial Pathogenesis
Gaurav Sharma, Danny Wong, Dean J Arnaoutakis, Samir K Shah, Alice O'Brien, Stanley W Ashley, C Keith Ozaki
OBJECTIVE: Length of stay fails to completely capture the clinical and economic effects of patient progression through the phases of inpatient care, such as admission, room placement, procedures, and discharge. Delayed hospital throughput has been linked to increased time spent in the emergency department and postanesthesia care unit, delayed time to treatment, increased in-hospital mortality, decreased patient satisfaction, and lost hospital revenue. We identified barriers to vascular surgery inpatient care progression and instituted defined measures to positively impact standardized metrics...
September 19, 2016: Journal of Vascular Surgery
Allen M Medway, Werner T W de Riese, Cornelia S de Riese, Joehassin Cordero
INTRODUCTION: When considering quality improvement of healthcare practices, patient flow, wait time, and satisfaction are important factors to monitor. Patient wait time can affect satisfaction with the care received, and it can be dependent on many different factors. The purpose of this study was to investigate the impact of patients' arrival times to his/her appointment (early vs. on time vs. late) on patients' wait times and satisfaction. METHODS: 171 patients in an otolaryngology outpatient clinic completed surveys that asked them to record wait times in various areas of the clinic and to provide a satisfaction level for these wait times...
September 2016: Healthcare
Linda Furness, Alison C Pighills, Wendy Ducat, Anna Tynan
Expansion of occupational therapy education programs has resulted in increased student numbers and demand on clinicians to host clinical placements while also maintaining the delivery of high-quality, safe clinical services to patients. Much of the research about innovative placement models, including student contributions to service delivery, has been conducted in metropolitan areas. Therefore, there is a need to develop models that are suited to regional settings that face diversity of caseload, more generalised occupational therapy roles and variations in patient flow...
September 16, 2016: Australian Health Review: a Publication of the Australian Hospital Association
Hui Jin Toh, Zhen Yu Lim, Philip Yap, Terence Tang
INTRODUCTION: Prolonged stay in acute hospitals increases the risks of hospital-acquired infections in older patients, and disrupts patient flow and access to care due to bed shortages. Therefore, factors associated with prolonged length of stay (pLOS) among older patients (aged over 78 years) in a tertiary hospital were investigated to identify potentially modifiable risk factors that could help direct interventions to reduce pLOS. METHODS: During a three-month period from January 2013 to March 2013, 72 patients with pLOS (length of stay [LOS] ≥ 21 days) were identified and compared to 281 randomly selected control patients (LOS < 21 days) for demographic and clinical variables using univariate and multivariate logistic regression analyses...
September 9, 2016: Singapore Medical Journal
Robert L Kerner, Kathleen Gallo, Michael Cassara, John DʼAngelo, Anthony Egan, John Galbraith Simmons
Simulation in multiple contexts over the course of a 10-week period served as a core learning strategy to orient experienced clinicians before opening a large new urban freestanding emergency department. To ensure technical and procedural skills of all team members, who would provide care without on-site recourse to specialty backup, we designed a comprehensive interprofessional curriculum to verify and regularize a wide range of competencies and best practices for all clinicians. Formulated under the rubric of systems integration, simulation activities aimed to instill a shared culture of patient safety among the entire cohort of 43 experienced emergency physicians, physician assistants, nurses, and patient technicians, most newly hired to the health system, who had never before worked together...
October 2016: Simulation in Healthcare: Journal of the Society for Simulation in Healthcare
Luca Carenzo, Francesco Ragozzino, Davide Colombo, Federico Lorenzo Barra, Francesco Della Corte, Pier Luigi Ingrassia
OBJECTIVE: Hospitals play a pivotal role as basic healthcare providers during mass casualty incidents (MCIs). Radiological studies and emergency laboratory test are of high importance for the management of hospital patients. However, it is known that during these events, they can generate significant bottlenecks. Appropriate request of such tests is of utmost importance to not generate delays in the patient flow. The aim of this paper is to describe a software designed to increase the realism of hospital-based MCI training through a realistic reproduction of radiology and laboratory departments...
September 3, 2016: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
Chiara Lodi
No abstract text is available yet for this article.
September 2016: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
Thomas M Gregory, Thomas Bihel, Pierre Guigui, Jérôme Pierrart, Benjamin Bouyer, Baptiste Magrino, Damien Delgrande, Thibault Lafosse, Jaber Al Khaili, Antoine Baldacci, Guillaume Lonjon, Sébastien Moreau, Laurent Lantieri, Jean-Marc Alsac, Jean-Baptiste Dufourcq, Jean Mantz, Philippe Juvin, Philippe Halimi, Richard Douard, Olivier Mir, Emmanuel Masmejean
BACKGROUND: On November 13th, 2015, terrorist bomb explosions and gunshots occurred in Paris, France, with 129 people immediately killed, and more than 300 being injured. This article describes the staff organization, surgical management, and patterns of injuries in casualties who were referred to the Teaching European Hospital Georges Pompidou. METHODS: This study is a retrospective analysis of the pre-hospital response and the in-hospital response in our referral trauma center...
October 2016: Injury
Zdenka Navratilova, Eva Novosadova, Michael Hagemann-Jensen, Susanna Kullberg, Vitezslav Kolek, Johan Grunewald, Martin Petrek
BACKGROUND: Sarcoidosis is characterised by up-regulation of cytokines and chemokine ligands/receptors and proteolytic enzymes. This pro-inflammatory profile is regulated post-transcriptionally by RNA-binding proteins (RBPs). We investigated in vivo expression of six RBPs (AUF1, HuR, NCL, TIA, TIAR, PCBP2) and two inhibitors of proteolytic enzymes (RECK, PTEN) in pulmonary sarcoidosis and compared it to the expression in four control groups of healthy individuals and patients with other respiratory diseases: chronic obstructive pulmonary disease (COPD), asthma and idiopathic interstitial pneumonias (IIPs)...
2016: PloS One
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