An evaluation of the activities of nurses and pediatricians in a university outpatient department

Modeling emergency department operations using advanced computer simulation systems

We developed a computer simulation model of emergency department operations using simulation software. This model uses multiple levels of preemptive patient priority; assigns each patient to an individual nurse and physician; incorporates all standard tests, procedures, and consultations; and allows patient service processes to proceed simultaneously, sequentially, repetitively, or a combination of these. Selected input data, including the number of physicians, nurses, and treatment beds, and the blood test turnaround time, then were varied systematically to determine their simulated effect on patient throughput time, selected queue sizes, and rates of resource utilization. Patient throughput time varied directly with laboratory service times and inversely with the number of physician or nurse servers. Resource utilization rates varied inversely with resource availability, and patient waiting time and patient throughput time varied indirectly with the level of patient acuity. The simulation can be animated on a computer monitor, showing simulated patients, specimens, and staff members moving throughout the ED. Computer simulation is a potentially useful tool that can help predict the results of changes in the ED system without actually altering it and may have implications for planning, optimizing resources, and improving the efficiency and quality of care.

Time study of patient movement through the emergency department: sources of delay in relation to patient acuity

A continuous observation time study was used to track 1,568 patients through various stages of emergency department care in order to identify sources of delay. Patients initially were assigned to one of four categories of decreasing acuity, and flow profiles were compared for each category. Patients with lowest acuity level experienced long delays in moving through the ED, although the actual evaluation and treatment time was brief. Urinalyses, procedures, radiographs, and blood tests had an increasing impact on treatment times (45 minutes, 63 minutes, 65 minutes, and 126 minutes, respectively, compared to 31 minutes with no tests or procedures). Patients of increasing acuity moved more quickly, but with a longer evaluation and treatment time. The most critical patients moved most quickly but with a brief evaluation and treatment time due to a rapid disposition from the ED or death. This relationship suggests an emergency care system that is oriented toward the efficient care of high-acuity patients but that is less effective for low-acuity patients. This occurs despite the fact that low-acuity patients comprise the vast majority of the ED census, and represent a group for whom delay is a frequent source of patient dissatisfaction.

A short-term intensive training program for pediatric nurse practitioners

A pediatric nurse practitioner course has been described in which 30 nurse trainees spent six seeks in an intensive training program followed by six months of preceptorship with a pediatrician in their own agency. This short but intensive program had advantages of permitting the PNP student to retain her health care agency position during the intensive part of the program and of assuring her a position as a PNP once the course was completed. Evaluation of the students by written and practical examinations indicated that they had made significant gains in their knowledge and understanding of pediatrics and in their ability to evaluate and refer patients and to provide well-child care and maternal counseling.