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https://www.readbyqxmd.com/read/28325207/using-a-systematic-framework-of-interventions-to-improve-early-discharges
#1
Hemali Patel, Sasha Morduchowicz, Michelle Mourad
BACKGROUND: Late-afternoon hospital discharges can lead to admission bottlenecks and negatively affect the flow of patients needing hospital admission. Delays in discharge are a prevalent health care problem and have been linked to increased length of stay, lower patient satisfaction scores, and adverse outcomes. As a result, hospitals are placing a renewed emphasis on early discharge as a way to reduce admission delays and achieve optimal patient flow. This study shows that the Model for Improvement (MFI) is an effective approach for complex improvement efforts...
April 2017: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/28290926/soldier-readiness-processing-time-for-a-new-paradigm-in-managing-musculoskeletal-injuries-after-deployment
#2
Daniel I Rhon, Kerrie J Golden, Amy J Trevino, Brian S Hatler
BACKGROUND: The drowning impact that musculoskeletal injuries (MSI) have on Soldier readiness, deployability, and escalating health care costs is growing. These injuries are associated with approximately 25 million lost duty days each year. The need to curb costs and improve efficacy and efficiency of health care delivery is pressing. This requires the consideration of new paradigms for clinical pathways and health care delivery processes. Soldiers returning from a deployment go through a screening process to ensure any medical, dental, and administrative issues are adequately addressed...
March 2017: Military Medicine
https://www.readbyqxmd.com/read/28283538/what-do-emergency-physicians-in-charge-do-a-qualitative-observational-study
#3
Ian Hosking, Adrian Boyle, Vazeer Ahmed, John Clarkson
INTRODUCTION: The emergency physician in charge role has developed in many large EDs to assist with patient flow. We aimed to describe and classify the problem-solving actions that this role requires. METHODS: We interviewed senior emergency physicians and performed iterative, qualitative observations, using continuous reflective inquiry, in a single centre. We reviewed and classified these approaches by consensus. RESULTS: Nine different problem-solving approaches were identified...
March 10, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28279543/emergency-department-holding-orders
#4
Stephen J Traub, M'Hamed Temkit, Soroush Saghafian
BACKGROUND: Holding orders help transition admitted emergency department (ED) patients to hospital beds. OBJECTIVE: To describe the effect of ED holding orders. METHODS: We conducted a single-site retrospective study of ward admissions from the ED to the hospital internal medicine (HIM) service over 2 years. Patients were classified based on whether the ED did (group 1) or did not (group 2) write holding orders; group 1 was subdivided into patients sent to the floor with only ED holding orders (group 1A) vs...
March 6, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28276090/the-content-and-meaning-of-administrative-work-a-qualitative-study-of-nursing-practices
#5
Lucie Michel, Mathias Waelli, Davina Allen, Etienne Minvielle
AIM: To investigate the content and meaning of nurses' administrative work. BACKGROUND: Nurses often report that administrative work keeps them away from bedside care. The content and meaning of this work remains insufficiently explored. DESIGN: Comparative case studies. METHOD: The investigation took place in 2014. It was based on 254 hours of observations and 27 interviews with nurses and staff in two contrasting units: intensive care and long term care...
March 9, 2017: Journal of Advanced Nursing
https://www.readbyqxmd.com/read/28241757/is-the-timing-of-radiological-intervention-and-treatment-day-associated-with-economic-outcomes-in-drg-financed-health-care-systems-a-case-study
#6
Christoph Napierala, Stefan Boes
BACKGROUND: In 2012, Switzerland has introduced a diagnosis related group (DRG) system for hospital financing to increase the efficiency and transparency of hospital services and to reduce costs. However, little is known about the efficiency of specific processes within hospitals. The objective of this study is to describe the relationship between timing of radiological interventions, in particular scan and treatment day, and the length of stay (LOS) compliance in a hospital. METHODS: This is a cross-sectional observational study based on administrative records of all DRG cases in a Swiss university hospital in 2013, enriched by data from the radiology information system and accounting details...
February 28, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28222904/the-2016-proposal-for-the-reorganisation-of-urgent-care-provision-in-belgium-a-political-struggle-to-co-locate-primary-care-providers-and-emergency-departments
#7
Koen Van den Heede, Wilm Quentin, Cécile Dubois, Stephan Devriese, Carine Van de Voorde
Internationally the number of emergency department (ED) visits is on the rise while evidence suggests that a substantial proportion of these patients do not require emergency care but primary care. This paper presents the Belgian 2016 proposal for the reorganisation of urgent care provision and places it into its political context. The proposal focused on re-designing patient flow aiming to reduce inappropriate ED visits by improving guidance of patients through the system. Initially policymakers envisaged, as cornerstone of the reform, to roll-out as standard model the co-location of primary care centres and EDs...
February 17, 2017: Health Policy
https://www.readbyqxmd.com/read/28212907/improving-preoperative-throughput
#8
Jennifer Franklin, Tony Franklin
Preoperative throughput is an important piece in achieving the perioperative goal for first case on time starts. An inefficient preoperative (preop) department can delay surgery starts and impact the patient flow throughout the day. Research is abundant in applying lean six sigma principles in the operating room, however there are minimal studies that specifically apply these tools in the preop. The perioperative process includes the preop, operating room, and the postoperative departments. All areas have to run like a well-oiled machine to improve performance and achieve positive outcomes...
February 2017: Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses
https://www.readbyqxmd.com/read/28210350/use-of-physician-in-triage-model-in-the-management-of-abdominal-pain-in-an-emergency-department-observation-unit
#9
John R Marshall, Robert Katzer, Shahram Lotfipour, Bharath Chakravarthy, Siri Shastry, Jessica Andrusaitis, Craig L Anderson, Erik D Barton
INTRODUCTION: Given the nationwide increase in emergency department (ED) visits it is of paramount importance for hospitals to find efficient ways to manage patient flow. The purpose of this study was to determine whether there is a significant difference in success rates, length of stay (LOS), and other demographic factors in two cohorts of patients admitted directly to an ED observation unit (EDOU) under an abdominal pain protocol by a physician in triage (bypassing the main ED) versus those admitted via the traditional pathway (evaluated and treated in the main ED prior to EDOU admission)...
February 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28196748/up-regulation-of-cx3cr1-on-tonsillar-cd8-positive-cells-in-patients-with-iga-nephropathy
#10
Ryuki Otaka, Miki Takahara, Seigo Ueda, Toshihiro Nagato, Kan Kishibe, Kenichiro Nomura, Akihiro Katada, Tatsuya Hayashi, Yasuaki Harabuchi
Although tonsillectomy are used as therapeutic options to prevent chronic renal failure in IgA nephropathy (IgAN) patients, the relationship between IgAN and tonsils is not fully proved by basic research. Recently, circulating CX3CR1-positive cells were reportedly involved in promoting hematuria in patients with IgAN. In this study, we focused on the expression of CX3CR1 in tonsillar mononuclear cells in IgAN patients. Immunohistological analysis revealed greater distribution of CX3CR1-positive cells in the inter-follicular area of tonsils in IgAN patients than in non-IgAN patients...
February 11, 2017: Human Immunology
https://www.readbyqxmd.com/read/28195936/two-models-to-conduct-nonphysician-led-exercise-stress-testing-in-low-to-intermediate-risk-patients
#11
Adam Scott, Mark Whitman, Alice McDonald, Meghan Webster, Carly Jenkins
BACKGROUND: Exercise stress testing (EST) is a noninvasive procedure that aids the diagnosis and prognosis of a range of cardiac pathologies. Reduced access is recognized as a limiting factor in enabling early access to treatment or safe and appropriate discharge. Increased accessibility can be achieved by utilizing nonphysician health practitioners to supervise tests. To implement nonphysician-led EST in clinical environments, there is a need for the development and administration of feasible and effective models...
March 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/28188202/progressive-prediction-of-hospitalisation-in-the-emergency-department-uncovering-hidden-patterns-to-improve-patient-flow
#12
Yuval Barak-Corren, Shlomo Hanan Israelit, Ben Y Reis
INTRODUCTION: One of the factors contributing to ED crowding is the lengthy delay in transferring an admitted patient from the ED to an inpatient department (ie, boarding time). An earlier start of the admission process using an automatic hospitalisation prediction model could potentially shorten these delays and reduce crowding. METHODS: Clinical, operational and demographic data were retrospectively collected on 80 880 visits to the ED of Rambam Health Care Campus in Haifa, Israel, from January 2011 to January 2012...
February 10, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28185509/developing-an-advanced-nurse-practitioner-approach-to-clinical-assessments
#13
Caroline Prescott, Nick Stackhouse
Emergency departments (EDs) often experience reduced patient flow, which results in low capacity, increased congestion and delays in patient care. Advanced nurse practitioners (ANPs) possess the skills required to relieve these pressures and enhance care delivery. This article describes how introducing ANP-led rapid assessment triage in an ED has enabled these practitioners to use advanced practice skills in assessment and intervention, and to request early diagnostic processes to improve patient flow. The system enables the ANPs to identify high-acuity patients who can be cared for in the ED without the need for admission, while ensuring their safety, rapid assessment and timely interventions...
February 10, 2017: Emergency Nurse: the Journal of the RCN Accident and Emergency Nursing Association
https://www.readbyqxmd.com/read/28185492/avoiding-hospital-admission-in-copd-impact-of-a-specialist-nursing-team
#14
Karen Cox, Susan C Macleod, Caroline J Sim, Arwel W Jones, Jacqui Trueman
Chronic obstructive pulmonary disease (COPD) is a common, preventable and incurable disease. The costs of caring for patients with COPD is estimated to be more than £800 million a year for acute hospital admissions alone ( Department of Health, 2012 ). The hospital-at-home model is increasingly being adopted for COPD patients following British Thoracic Society (BTS) guidelines for the delivery of hospital admission-avoidance schemes ( BTS, 2007 ). The aim of this case-note review was to evaluate the safety and effectiveness of a specialist nurse-led acute respiratory assessment service working with COPD patients in the community...
February 9, 2017: British Journal of Nursing: BJN
https://www.readbyqxmd.com/read/28173689/evaluation-of-geographic-indices-describing-health-care-utilization
#15
Agnus M Kim, Jong Heon Park, Sungchan Kang, Yoon Kim
Objectives: The accurate measurement of geographic patterns of health care utilization is a prerequisite for the study of geographic variations in health care utilization. While several measures have been developed to measure how accurately geographic units reflect the health care utilization patterns of residents, they have been only applied to hospitalization and need further evaluation. This study aimed to evaluate geographic indices describing health care utilization. Methods: We measured the utilization rate and four health care utilization indices (localization index, outflow index, inflow index, and net patient flow) for eight major procedures (coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty, surgery after hip fracture, knee replacement surgery, caesarean sections, hysterectomy, computed tomography scans, and magnetic resonance imaging scans) according to three levels of geographic units in Korea...
January 2017: Journal of Preventive Medicine and Public Health, Yebang Ŭihakhoe Chi
https://www.readbyqxmd.com/read/28166772/challenges-uncertainties-and-perceived-benefits-of-providing-weekend-allied-health-services-a-managers-perspective
#16
Deb Mitchell, Lisa O'Brien, Anne Bardoel, Terry Haines
BACKGROUND: Health services that operate 7 days per week are under pressure to show the increased cost of providing weekend services can be measured in improved patient outcomes. The evidence for weekend allied health services in acute medical and surgical wards is weak and there is wide variation between the services offered at different hospitals. METHODS: This qualitative study was undertaken during a multi-site stepped wedge randomised controlled trial involving twelve acute medical and surgical wards from two Australian hospitals, in which weekend allied health services were removed before being reinstated with a stakeholder driven model...
February 6, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28152943/applying-value-stream-mapping-to-improve-patient-flow-and-satisfaction
#17
Rob Kenney, Katherine Glass, Emily Elizabeth Monteleone, Brian James Bolwell
244 Background: Value Stream Mapping (VSM) is a tool commonly used in manufacturing environments to analyze the current state process and to design an improved future state. VSM is a dynamic visual management tool that can be applied in the context of clinical activities to identify value-added (VA) and non-value added (NVA) activities along the spectrum of patient care. A VSM was created for the Breast Cancer Program to identify improvement opportunities in patient quality, flow, and communication across disciplines...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152931/timeliness-of-care-delivery-for-lung-cancer-patients-in-a-vertically-integrated-health-care-system
#18
Erin Elizabeth Hahn
127 Background: A Kaiser Permanente Southern California (KPSC) organizational goal is to achieve optimal timeliness of cancer care delivery. The purpose of this report is to present a process used for a multi-disciplinary physician led performance improvement exercise at the at the Los Angeles Medical Center and share initial learnings. METHODS: A CME approved Performance Improvement (PI) program to examine timeliness of care delivery for newly diagnosed patients with lung cancer was created for physicians...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152808/ambulatory-redesign-strategies-for-quality-improvement-in-patient-care
#19
Catherine A Lyons, Nancy Smith, Maureen McGlennon, Terri L Parker, Carolyn Truini, Maureen Major-Campos, Jill Lacy, Karen Michaels, Vanna Dest, Richard Lisitano, Kerin B Adelson, Rogerio Lilenbaum
85 Background: Growing outpatient volume poses patient flow challenges, making it difficult to accommodate the complexities of academic medical practice. Volume increases create operational inefficiencies like delays in lab turnaround time (TAT) and limited rooming capacity resulting in delays in patient access and reduced provider productivity. These bottlenecks negatively impact patient satisfaction. METHODS: Four multidisciplinary teams assessed barriers to patient flow in the lab, rooming and scheduling process...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152786/first-line-treatment-of-metastatic-nsclc-mnsclc-patients-without-actionable-mutations-in-u-s-community-oncology-clinical-practice
#20
Ashwini Arunachalam, Thomas A Burke, Xiting Cao, Amy P Abernethy, David Paul Carbone
307 Background: Benchmarking high quality care requires defining optimally effective practice patterns. As first step, contemporary real-world practice must be detailed. The purpose of this study is to describe patient flow from diagnosis of mNSCLC to initiation of anti-cancer drug therapy in patients without known EGFR/ALK genomic tumor aberrations; the characteristics and first-line (1L) anti-cancer treatment of these patients, including induction and maintenance therapy. METHODS: Retrospective database cohort study using data from an oncology EHR system, representing 17% of incident cancer cases from US community setting...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
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