1
|
Xu HG, Johnston ANB, Ray-Barruel G. Fast-Track Training in Emergency Department During the COVID-19 Pandemic: Evaluation of a Hybrid Education Model. Adv Emerg Nurs J 2024; 46:169-181. [PMID: 38736101 DOI: 10.1097/tme.0000000000000516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
INTRODUCTION Emergency department (ED) fast track (FT) for the ambulatory, minor injury patient cohort requires rapid patient assessment, treatment, and turnover, yet specific nursing education is limited. The study aimed to test the feasibility and staff satisfaction of an education program to expand nursing skills and knowledge of managing FT patients during the COVID-19 pandemic. METHODS This quasi-experimental study, including self-rating surveys and interviews, assessed the pre- and postimplementation of an education program for nurses working in FT in a metropolitan hospital ED in Australia. Hybrid (face-to-face and Teams) education sessions on 10 topics of staff-perceived limited knowledge were delivered over 8 months. RESULTS Participants demonstrated higher knowledge scores after the implementation of short online education sessions to cover the core facets of minor injury management. Overall staff satisfaction with the program was high. Interview discussions involved three key themes, including "benefits to staff learning," "positive impact on patient care and flow," and "preferred mode of delivery." CONCLUSIIONS Recorded education sessions on minor injury topics for nurses working in FT have proved effective, and this program has now become a core facet of ED education in our hospital.
Collapse
Affiliation(s)
- Hui Grace Xu
- Author Affiliations: Emergency Department, Queen Elizabeth II Jubilee Hospital, Coopers Plains, Queensland, Australia (Dr Xu) School of Nursing and Midwifery, Queensland University of Technology, Kelvin Grove, Queensland, Australia (Dr Xu) Centre of Clinical Nursing, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia (Drs Xu and Ray-Barruel) Emergency Department, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia (Dr Johnston) School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia (Dr Johnston) Herston Infectious Diseases Institute, Metro North Hospital and Health Service and University of Queensland Centre for Clinical Research, Herston, Queensland, Australia (Dr Ray-Barruel) School of Nursing and Midwifery, and Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia (Dr Ray-Barruel)
| | | | | |
Collapse
|
2
|
Mostafa R, El-Atawi K. Strategies to Measure and Improve Emergency Department Performance: A Review. Cureus 2024; 16:e52879. [PMID: 38406097 PMCID: PMC10890971 DOI: 10.7759/cureus.52879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 02/27/2024] Open
Abstract
Emergency Departments (EDs) globally face escalating challenges such as overcrowding, resource limitations, and increased patient demand. This study aims to identify and analyze strategies to enhance the structural performance of EDs, with a focus on reducing overcrowding, optimizing resource allocation, and improving patient outcomes. Through a comprehensive review of the literature and observational studies, the research highlights the effectiveness of various approaches, including triage optimization, dynamic staffing, technological integration, and strategic resource management. Key findings indicate that tailored strategies, such as implementing advanced triage protocols and leveraging telemedicine, can significantly reduce wait times and enhance patient throughput. Furthermore, evidence suggests that dynamic staffing models and the integration of cutting-edge diagnostic tools contribute to operational efficiency and improved quality of care. These strategies, when combined, offer a multifaceted solution to the complex challenges faced by EDs, promising better patient care and satisfaction. The study underscores the need for a comprehensive approach, incorporating both organizational and technological innovations, to address the evolving needs of emergency healthcare.
Collapse
Affiliation(s)
- Reham Mostafa
- Department of Emergency Medicine, Al Zahra Hospital Dubai (AZHD), Dubai, ARE
| | - Khaled El-Atawi
- Pediatrics/ Neonatal Intensive Care Unit, Latifa Women and Children Hospital, Dubai, ARE
| |
Collapse
|
3
|
Kusters RWJ, Peters NALR, van Osch FHM, Simons PCG, Hulsbosch MHHM, Janzing HMJ, Barten DG. Primary care access to radiology: Characteristics of trauma patients referred to the emergency department. J Eval Clin Pract 2023; 29:101-107. [PMID: 35851516 PMCID: PMC10084186 DOI: 10.1111/jep.13738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/29/2022] [Accepted: 07/06/2022] [Indexed: 01/18/2023]
Abstract
RATIONALE, AIMS AND OBJECTIVES Low-urgent Emergency Department (ED) attendances are a known contributing factor to ED crowding. In the Netherlands, general practitioners (GPs) have direct access to radiology facilities during office hours. Patients with radiographically confirmed traumatic injuries are subsequently referred to the ED. We analysed these ED trauma patients' characteristics, provided treatments and ED discharge diagnoses to identify the possibility of alternative care pathways. METHODS Single-centre retrospective observational study of trauma patients referred to the ED by the radiology department during office hours (January 2017-December 2017). Data were obtained from patient records. Descriptive statistics were used to analyse the extracted data. RESULTS A total of 662 patients were included. The median age was 42 years (range: 1-100, interquartile range (IQR): 15-63) and patients presented to the ED with a median delay of 1 day (range: 0-112 days, IQR: 0-5). Most patients were referred for injuries involving the upper extremities (61.5%) and lower extremities (30%). A total of 48 additional diagnoses were made in the ED. The majority of injuries was classified as 'minor' (29.5%) or 'moderate' (68.3%) on the Abbreviated Injury Scale (AIS). The median length of stay in the ED was 65 min (range: 7-297 min, IQR: 43-102). CONCLUSION Most patients presented with low acuity injuries and often with a notable delay to the ED. This suggests that the majority of these patients do not necessarily need ED treatment, which may provide an opportunity to counter ED crowding.
Collapse
Affiliation(s)
- Renske W J Kusters
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, The Netherlands
| | | | - Frits H M van Osch
- Department of Clinical Epidemiology, VieCuri Medical Center, Venlo, The Netherlands.,Department of Epidemiology, Maastricht University, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - Petra C G Simons
- Department of Radiology, VieCuri Medical Center, Venlo, The Netherlands
| | - Mark H H M Hulsbosch
- Department of Orthopedic Surgery, VieCuri Medical Center, Venlo, The Netherlands
| | | | - Dennis G Barten
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, The Netherlands
| |
Collapse
|
4
|
Clinical Effect of Nursing Based on the Kano Model in Emergency Multiple Injuries. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:3586290. [PMID: 35873622 PMCID: PMC9303145 DOI: 10.1155/2022/3586290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/24/2022] [Indexed: 11/17/2022]
Abstract
Multiple injury refers to the injury of two or more anatomical parts of the body caused by mechanical injury factors. Even if only one injury exists alone, it can endanger limbs or lives. Therefore, nursing plays an important role in its treatment. Here, we investigated the application and clinical effect of nursing based on the Kano model in emergency multiple injuries. A case-control study was designed, where 48 patients with multiple injuries in the emergency department were divided into the control group to perform routine care and 48 patients were divided into the study group to carry on nursing based on the Kano model. The first-aid indexes, success rate of rescue, inflammatory response indicators, satisfaction rate of nursing, incidence of adverse events, and prognosis were compared between the two groups. A monofactor analysis showed that the emergency response time, admission time, and emergency department rescue time were shorter in the study group than those in the control group, indicating a higher success rate of rescue with nursing based on the Kano model. For the immunity of patients, the scores of mental states and the serum levels of inflammatory factors were lower in the study group than those in the control group. In addition, the rate of nursing satisfaction and good prognosis in the study group was significantly higher than those in the control group, and the incidence of adverse events was significantly lower than that in the control group. These results indicated that nursing based on the Kano model in patients with emergency multiple injuries can reduce the body inflammatory reaction, reduce the risk of adverse events, improve the prognosis of patients, and obtain high patient satisfaction.
Collapse
|
5
|
Machine learning-based triage to identify low-severity patients with a short discharge length of stay in emergency department. BMC Emerg Med 2022; 22:88. [PMID: 35596154 PMCID: PMC9123815 DOI: 10.1186/s12873-022-00632-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 04/14/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Overcrowding in emergency departments (ED) is a critical problem worldwide, and streaming can alleviate crowding to improve patient flows. Among triage scales, patients labeled as "triage level 3" or "urgent" generally comprise the majority, but there is no uniform criterion for classifying low-severity patients in this diverse population. Our aim is to establish a machine learning model for prediction of low-severity patients with short discharge length of stay (DLOS) in ED. METHODS This was a retrospective study in the ED of China Medical University Hospital (CMUH) and Asia University Hospital (AUH) in Taiwan. Adult patients (aged over 20 years) with Taiwan Triage Acuity Scale level 3 were enrolled between 2018 and 2019. We used available information during triage to establish a machine learning model that can predict low-severity patients with short DLOS. To achieve this goal, we trained five models-CatBoost, XGBoost, decision tree, random forest, and logistic regression-by using large ED visit data and examined their performance in internal and external validation. RESULTS For internal validation in CMUH, 33,986 patients (75.9%) had a short DLOS (shorter than 4 h), and for external validation in AUH, there were 13,269 (82.7%) patients with short DLOS. The best prediction model was CatBoost in internal validation, and area under the receiver operating cha racteristic curve (AUC) was 0.755 (95% confidence interval (CI): 0.743-0.767). Under the same threshold, XGBoost yielded the best performance, with an AUC value of 0.761 (95% CI: 0.742- 0.765) in external validation. CONCLUSIONS This is the first study to establish a machine learning model by applying triage information alone for prediction of short DLOS in ED with both internal and external validation. In future work, the models could be developed as an assisting tool in real-time triage to identify low-severity patients as fast track candidates.
Collapse
|
6
|
Hospital Access Block: A Scoping Review. J Emerg Nurs 2022; 48:430-454. [DOI: 10.1016/j.jen.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/17/2022] [Accepted: 03/02/2022] [Indexed: 11/30/2022]
|
7
|
Feral-Pierssens AL, Morris J, Marquis M, Daoust R, Cournoyer A, Lessard J, Berthelot S, Messier A. Safety assessment of a redirection program using an electronic application for low-acuity patients visiting an emergency department. BMC Emerg Med 2022; 22:71. [PMID: 35488215 PMCID: PMC9052637 DOI: 10.1186/s12873-022-00626-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 04/01/2022] [Indexed: 11/25/2022] Open
Abstract
Background Emergency departments (EDs) are operating at or above capacity, which has negative consequences on patients in terms of quality of care and morbi-mortality. Redirection strategies for low-acuity ED patients to primary care practices are usually based on subjective eligibility criteria that sometimes necessitate formal medical assessment. Literature investigating the effect of those interventions is equivocal. The aim of the present study was to assess the safety of a redirection process using an electronic clinical support system used by the triage nurse without physician assessment. Methods A single cohort observational study was performed in the ED of a level 1 academic trauma center. All low-acuity patients redirected to nearby clinics through a clinical decision support system (February–August 2017) were included. This system uses different sets of medical prerequisites to identify patients eligible to redirection. Data on safety and patient experience were collected through phone questionnaires on day 2 and 10 after ED visit. The primary endpoint was the rate of redirected patients returning to any ED for an unexpected visit within 48 h. Secondary endpoints were the incidence of 7-day return visit and satisfaction rates. Results A total of 980 redirected low-acuity patients were included over the period: 18 patients (2.8%) returned unexpectedly to an ED within 48 h and 31 patients (4.8%) within 7 days. No hospital admission or death were reported within 7 days following the first ED visit. Among redirected patients, 81% were satisfied with care provided by the clinic staff. Conclusion The implementation of a specific electronic-guided decision support redirection protocol appeared to provide safe deferral to nearby clinics for redirected low-acuity patients. EDs are pivotal elements of the healthcare system pathway and redirection process could represent an interesting tool to improve the care to low-acuity patients.
Collapse
Affiliation(s)
- Anne-Laure Feral-Pierssens
- Hôpital du Sacré-Cœur de Montréal, CIUSSS-NIM, 5400 boulevard Gouin Ouest, Montréal, Québec, H4J 1C5, Canada. .,CR-CSIS, Sherbrooke University, Longueuil, Québec, Canada. .,Health Educations and Promotion Laboratory (LEPS EA3412), University Sorbonne Paris Nord, Bobigny, France. .,SAMU 93 - Emergency Department, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Bobigny, France.
| | - Judy Morris
- Hôpital du Sacré-Cœur de Montréal, CIUSSS-NIM, 5400 boulevard Gouin Ouest, Montréal, Québec, H4J 1C5, Canada.,Département médecine de famille et médecine d'urgence, Université de Montréal, Montréal, Québec, Canada
| | - Martin Marquis
- Hôpital du Sacré-Cœur de Montréal, CIUSSS-NIM, 5400 boulevard Gouin Ouest, Montréal, Québec, H4J 1C5, Canada
| | - Raoul Daoust
- Hôpital du Sacré-Cœur de Montréal, CIUSSS-NIM, 5400 boulevard Gouin Ouest, Montréal, Québec, H4J 1C5, Canada.,Département médecine de famille et médecine d'urgence, Université de Montréal, Montréal, Québec, Canada
| | - Alexis Cournoyer
- Hôpital du Sacré-Cœur de Montréal, CIUSSS-NIM, 5400 boulevard Gouin Ouest, Montréal, Québec, H4J 1C5, Canada.,Département médecine de famille et médecine d'urgence, Université de Montréal, Montréal, Québec, Canada.,Hôpital Maisonneuve-Rosemont, CIUSSS-EIM, Montréal, Québec, Canada.,Corporation d'Urgences-santé, Montréal, Québec, Canada
| | - Justine Lessard
- Hôpital du Sacré-Cœur de Montréal, CIUSSS-NIM, 5400 boulevard Gouin Ouest, Montréal, Québec, H4J 1C5, Canada.,Département médecine de famille et médecine d'urgence, Université de Montréal, Montréal, Québec, Canada
| | - Simon Berthelot
- Département de médecine familiale et de médecine d'urgence, Université Laval, Québec, Canada.,Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
| | - Alexandre Messier
- Hôpital du Sacré-Cœur de Montréal, CIUSSS-NIM, 5400 boulevard Gouin Ouest, Montréal, Québec, H4J 1C5, Canada.,Département médecine de famille et médecine d'urgence, Université de Montréal, Montréal, Québec, Canada
| |
Collapse
|
8
|
Kłosiewicz T, Szkudlarek W, Węglewska M, Konieczka P, Zalewski R, Podlewski R, Sowińska A, Puślecki M. Dynamics of the Third Wave of COVID-19 from the Perspective of the Emergency Department in a Large Regional Hospital—Single Center Observational Study. Healthcare (Basel) 2021; 10:healthcare10010018. [PMID: 35052182 PMCID: PMC8775057 DOI: 10.3390/healthcare10010018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/19/2021] [Accepted: 12/20/2021] [Indexed: 12/21/2022] Open
Abstract
Background: The outbreak of the Coronavirus Disease 2019 (COVID-19) pandemic has caused many significant social and economic changes. The consecutive waves of the epidemic in various countries have had dissimilar courses depending on the methods used to combat it. The aim of this study was to determine the dynamics of the third wave of COVID-19 from the perspective of emergency departments (ED). Methods: This was a retrospective review of medical records from ED. The authors have identified the most frequent symptoms. Prognostic factors have been chosen—prognostic scales, length of stay (LOS)—and a number of resources required have been calculated. Results: As the time passed, there were fewer patients and they presented mild symptoms. A statistically significant difference was observed in the median of blood oxygenation measurement (p = 0.00009), CRP level (p = 0.0016), and admission rate. Patients admitted to the hospital required more resources at ED. LOS was shorter in patients discharged home (p < 0.0001). Conclusions: The blood oxygen saturation (SPO2) and CPR levels can be helpful in decision-making regarding medical treatment. The fast-track for patients in good clinical condition may shorten the duration of stay in ED, and reduce the number of required resources.
Collapse
Affiliation(s)
- Tomasz Kłosiewicz
- Department of Medical Rescue, Faculty of Health Sciences, Poznan University of Medical Sciences, 60-608 Poznan, Poland; (R.Z.); (R.P.); (M.P.)
- Correspondence: ; Tel.: +48-668956969
| | - Weronika Szkudlarek
- Students’ Scientific Circle of Emergency Medicine, Department of Medical Rescue, Faculty of Health Sciences, Poznan University of Medical Sciences, 60-608 Poznan, Poland; (W.S.); (M.W.)
| | - Magdalena Węglewska
- Students’ Scientific Circle of Emergency Medicine, Department of Medical Rescue, Faculty of Health Sciences, Poznan University of Medical Sciences, 60-608 Poznan, Poland; (W.S.); (M.W.)
| | - Patryk Konieczka
- Department of Emergency Medicine, Faculty of Health Sciences, Poznan University of Medical Sciences, 60-608 Poznan, Poland;
| | - Radosław Zalewski
- Department of Medical Rescue, Faculty of Health Sciences, Poznan University of Medical Sciences, 60-608 Poznan, Poland; (R.Z.); (R.P.); (M.P.)
| | - Roland Podlewski
- Department of Medical Rescue, Faculty of Health Sciences, Poznan University of Medical Sciences, 60-608 Poznan, Poland; (R.Z.); (R.P.); (M.P.)
| | - Anna Sowińska
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, 60-608 Poznan, Poland;
| | - Mateusz Puślecki
- Department of Medical Rescue, Faculty of Health Sciences, Poznan University of Medical Sciences, 60-608 Poznan, Poland; (R.Z.); (R.P.); (M.P.)
- Department of Cardiac Surgery and Transplantology, Medical Faculty, Poznan University of Medical Sciences, 61-848 Poznan, Poland
| |
Collapse
|
9
|
Jesus APSD, Batista REA, Campanharo CRV, Lopes MCBT, Okuno MFP. Evaluation of the Manchester Triage System quality indicator: service time. Rev Gaucha Enferm 2021; 42:e20200371. [PMID: 34878015 DOI: 10.1590/1983-1447.2021.20200371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 06/24/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to verify the conformity of the time interval between the end of the risk classification and the beginning of medical care with that recommended by the Manchester protocol and to relate the times of care and the risk categories with the outcome. METHOD Cross-sectional, retrospective, and analytical study. The t test, the analysis of variance and the generalized linear model were used. RESULTS The average time for medical care in the red and orange categories was 3 and 39.5 minutes, respectively. Death outcome was associated with the red category, with an average time to start the classification of 5.5 minutes and an average length of stay of 2.3 hours. CONCLUSION The waiting time for medical care in the high priority categories was longer than recommended, which suggests the need to continuously monitor the system. Shorter waiting times for classification and permanence were related to the red category and the outcome of death.
Collapse
Affiliation(s)
- Ana Paula Santos de Jesus
- Universidade Federal do Recôncavo da Bahia (UFRB), Centro de Ciências da Saúde. Santo Antônio de Jesus, Bahia, Brasil
| | - Ruth Ester Assayag Batista
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Enfermagem. São Paulo, São Paulo, Brasil
| | | | | | - Meiry Fernanda Pinto Okuno
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Enfermagem. São Paulo, São Paulo, Brasil
| |
Collapse
|
10
|
Lahiri K, Indrasena BSH, Aylott J. Unprecedented times in the emergency department: are "board rounds" and leadership the missing links to improve patient flow? Leadersh Health Serv (Bradf Engl) 2021; ahead-of-print. [PMID: 34786901 DOI: 10.1108/lhs-06-2021-0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE National Health Service (NHS) Emergency Department (ED) attendances are at the second highest level ever recorded, (RCEM, 2021a) and as they soar, performance plummets, putting patient safety at risk (RCEM, 2021b). Managing patient flow in the ED is critical to reduce patient safety incidents and crowding, however, this needs effective leadership (Jensen and Crane, 2014). This paper aims to introduce an innovative form of managing patient flow in ED, which is a two hourly "Board Rounds", providing a managed process to pull patients through the system meeting pre-determined time critical standards and preventing patient harm. Board Rounds combined with effective leadership can play a contributory role preventing crowding in the ED. DESIGN/METHODOLOGY/APPROACH An evaluation of two hourly ED Board Rounds was undertaken using the hospitals' ED Board Round Standard Operating Procedure to develop a series of short questions. As leadership is the responsibility of all clinicians (Darzi, 2008; Moscrop, 2012), a separate survey was undertaken for clinicians of all grades and managers to self-assess their own leadership styles using the Path-Goal Leadership Theory (House and Mitchell, 1974; Indvik, 1985; Northhouse, 2013). Findings were reported to the team to explore ideas for improvement not only to develop more effective leadership in the ED but also to raise awareness of how to optimise leadership in Board Rounds. FINDINGS In total, 27 (n = 27) clinicians and managers reported support for a 2 hourly Board Round, for a period of 15 min, in both minor and major injuries departments in ED. A multi-disciplinary Board meeting, led by the lead nurse with support from the Emergency Physician in Charge, was preferred, locating it at the nurse's station. A validated Path-Goal Leadership survey instrument was returned (n = 24). The findings reveal that leaders and managers are using a high level of the directive leadership style, where there is more potential to use the supportive, participative and achievement approaches to leadership. RESEARCH LIMITATIONS/IMPLICATIONS This was a small sample, returned from a Hospital ED located in a semi-rural location, department requiring "improvement" from the Health Regulator. This research would benefit from being undertaken in a medium/large NHS ED department to identify if the findings report on a wider leadership culture in the NHS ED. The implications for this study are that improvement interventions such as a "Board Round" can be usefully evaluated alongside a review of leadership styles and approaches to understand the wider implications for continuous improvement and change in the ED. ORIGINALITY/VALUE NHS EDs are facing unprecedented challenges and require innovative evidence-based solutions combined with leadership at this time. The evidence base for improving patient flow is limited, however, this study provides some initial findings on the positive perception and experience of staff to Board Rounds. Board Rounds combined with leadership has the potential to contribute to the wider strategy to prevent crowding in ED. This paper is the first of its kind to evaluate perceptions of Board Rounds in the ED and to engage clinicians and managers in a self-assessment of their own leadership styles to reflect on optimum leadership styles for use in ED.
Collapse
Affiliation(s)
- Kaushik Lahiri
- Emergency Department, Scunthorpe General Hospital, North Lincolnshire and Goole NHS Foundation Trust, Scunthorpe, UK
| | | | - Jill Aylott
- Institute for Quality Improvement, World Academy of Medical Leadership, Sheffield, UK
| |
Collapse
|
11
|
Prediction of hospitalization using artificial intelligence for urgent patients in the emergency department. Sci Rep 2021; 11:19472. [PMID: 34593930 PMCID: PMC8484275 DOI: 10.1038/s41598-021-98961-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/17/2021] [Indexed: 11/10/2022] Open
Abstract
Timely assessment to accurately prioritize patients is crucial for emergency department (ED) management. Urgent (i.e., level-3, on a 5-level emergency severity index system) patients have become a challenge since under-triage and over-triage often occur. This study was aimed to develop a computational model by artificial intelligence (AI) methodologies to accurately predict urgent patient outcomes using data that are readily available in most ED triage systems. We retrospectively collected data from the ED of a tertiary teaching hospital between January 1, 2015 and December 31, 2019. Eleven variables were used for data analysis and prediction model building, including 1 response, 2 demographic, and 8 clinical variables. A model to predict hospital admission was developed using neural networks and machine learning methodologies. A total of 282,971 samples of urgent (level-3) visits were included in the analysis. Our model achieved a validation area under the curve (AUC) of 0.8004 (95% CI 0.7963–0.8045). The optimal cutoff value identified by Youden's index for determining hospital admission was 0.5517. Using this cutoff value, the sensitivity was 0.6721 (95% CI 0.6624–0.6818), and the specificity was 0.7814 (95% CI 0.7777–0.7851), with a positive predictive value of 0.3660 (95% CI 0.3586–0.3733) and a negative predictive value of 0.9270 (95% CI 0.9244–0.9295). Subgroup analysis revealed that this model performed better in the nontraumatic adult subgroup and achieved a validation AUC of 0.8166 (95% CI 0.8199–0.8212). Our AI model accurately assessed the need for hospitalization for urgent patients, which constituted nearly 70% of ED visits. This model demonstrates the potential for streamlining ED operations using a very limited number of variables that are readily available in most ED triage systems. Subgroup analysis is an important topic for future investigation.
Collapse
|
12
|
Singh S, Koirala B, Thami R, Thapa A, Thapa B, Kayastha A, Dahal P. Length of Stay in the Emergency Department during COVID-19 Pandemic in a Tertiary Care Hospital: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2021; 59:490-493. [PMID: 34508425 PMCID: PMC8673464 DOI: 10.31729/jnma.6281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/12/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: Emergency Department overcrowding has become worsening problem internationally which may affect patient, emergency department efficiency and quality of care and this may lead to increased risk of in-hospital mortality, higher costs, medical errors and longer times to treatment. With this pandemic COVID-19 likely to go on for months, if not a year or longer, the Emergency Department should be prepared for large influx of patients infected with COVID-19. The aim of this study is to find-out the length of stay in emergency department during COVID-19 pandemic at a tertiary care hospital in Nepal. Methods: This is a descriptive cross-sectional study conducted in the Emergency Department of Kanti Children's Hospital. Ethical clearance was obtained from Institutional review committee-Kanti Children's Hospital. Data collection was done from the emergency records from July 23, 2020 to July 29, 2020. The calculated sample size was 211. The data thus obtained was entered in Statistical Package for the Social Science software version 20 and necessary calculations were done. Results: The median length of stay in emergency department was found to be 1.75 hours (Interquartile range 0 to 30 hours). Conclusions: Definitive management starts in respective wards and Intensive Care Units. During COVID-19, with longer emergency stay, chances of cross-infection increases, and the health workers serving in emergency department will be at risks. So guidelines for shorter emergency stay should be implemented.
Collapse
Affiliation(s)
- Suraj Singh
- Kanti Children's Hospital, Maharajganj, Kathmandu, Nepal
| | - Bibek Koirala
- Kanti Children's Hospital, Maharajganj, Kathmandu, Nepal
| | - Rabin Thami
- Kanti Children's Hospital, Maharajganj, Kathmandu, Nepal
| | - Anupama Thapa
- Kanti Children's Hospital, Maharajganj, Kathmandu, Nepal
| | - Bijay Thapa
- Kanti Children's Hospital, Maharajganj, Kathmandu, Nepal
| | - Anuj Kayastha
- Kanti Children's Hospital, Maharajganj, Kathmandu, Nepal
| | - Priyanka Dahal
- Kanti Children's Hospital, Maharajganj, Kathmandu, Nepal
| |
Collapse
|
13
|
Bogh SB, Fløjstrup M, Möller S, Bech M, Johnsen SP, Henriksen DP, Mogensen CB, Lassen AT, Brabrand M. Intended and unintended changes in length of stay following reconfiguration of emergency care departments. Int J Qual Health Care 2021; 33:6101215. [PMID: 33449079 DOI: 10.1093/intqhc/mzab008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/04/2021] [Accepted: 01/13/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Danish health-care system has witnessed noticeable changes in the acute hospital care organization. The reconfiguration includes closing hospitals, centralizing acute care functions and investing in new buildings and equipment. OBJECTIVE To examine the impact on the length of stay (LOS) and the proportion of overnight stays for hospitalized acute care patients. METHODS This nationwide interrupted time series examined trend changes in LOS and overnight stay. Admissions were stratified based on admission time (weekdays/weekends and time of day), age and the level of co-morbidity. RESULTS In 2007-2016, the global average LOS declined 2.9% per year (adjusted time ratio [CI (confidence interval) 95%] 0.971 [0.970-0.971]). The reconfiguration was overall not associated with change in trend of LOS (time ratio [CI 95%] 1.001 [1.000-1.002]). When admissions were stratified for either weekdays or weekends, the reconfiguration was associated with reduction of the underlying downward trend for weekdays (time ratio [CI 95%] 1.004 [1.003-1.005]) and increased downward trend for weekend admissions (time ratio [CI 95%] 0.996 [0.094-0.098]). Admissions at night were associated with a 0.7% trend change in LOS (time ratio [CI 95%] 0.993 [0.991-0.996]). The reconfiguration was not associated with trend changes for overnight stays. CONCLUSION The nationwide reconfiguration of acute hospital care was overall not associated with change in trend for the registered LOS and no change in trend for overnight stays. However, the results varied according to hospitalization time, where admissions during weekends and nights after the reconfiguration were associated with shortened LOS.
Collapse
Affiliation(s)
- Søren Bie Bogh
- Odense Patient Exploratory Network (Open), Odense University Hospital, J.B. Winsløws Vej 9 A, 3. Sal, Odense 5000, Denmark.,Department of Clinical Research, University of Southern Denmark, Winsløwparken 19, 3. Sal, Odense 5000, Denmark
| | - Marianne Fløjstrup
- Department of Emergency Medicine, Hospital of South West Jutland, Finsensgade 35, Esbjerg 6700, Denmark.,Department of Regional Health Research, University of Southern Denmark, Winsløwparken 19, 3. Sal, Odense 5000, Denmark
| | - Sören Möller
- Odense Patient Exploratory Network (Open), Odense University Hospital, J.B. Winsløws Vej 9 A, 3. Sal, Odense 5000, Denmark.,Department of Clinical Research, University of Southern Denmark, Winsløwparken 19, 3. Sal, Odense 5000, Denmark
| | - Mickael Bech
- UCL University College, Niels Bohrs Alle 1, Odense 5230, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Mølleparkvej 10, Aalborg 9000, Denmark
| | - Daniel Pilsgaard Henriksen
- Clinical Pharmacology and Pharmacy, University of Southern Denmark, J.B. Winsløws Vej 19, 2 sal, Odense 5000, Denmark
| | - Christian Backer Mogensen
- Department of Regional Health Research, University of Southern Denmark, Winsløwparken 19, 3. Sal, Odense 5000, Denmark.,Focused Research Unit in Emergency Medicine, Hospital of Southern Denmark, Kresten Philipsens Vej 15, Aabenraa 6200, Denmark
| | - Annmarie Touborg Lassen
- Department of Clinical Research, University of Southern Denmark, Winsløwparken 19, 3. Sal, Odense 5000, Denmark.,Department of Emergency Medicine, Odense University Hospital, J. B. Winsløws Vej 4, Odense 5000, Denmark
| | - Mikkel Brabrand
- Department of Emergency Medicine, Hospital of South West Jutland, Finsensgade 35, Esbjerg 6700, Denmark.,Department of Regional Health Research, University of Southern Denmark, Winsløwparken 19, 3. Sal, Odense 5000, Denmark.,Department of Emergency Medicine, Odense University Hospital, J. B. Winsløws Vej 4, Odense 5000, Denmark
| |
Collapse
|