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Hession M, Forero R, Man NW, Penza L, McDonald W. Gaming National Emergency Access Target performance using Emergency Treatment Performance definitions and emergency department short stay units. Emerg Med Australas 2019; 31:997-1006. [PMID: 30995691 DOI: 10.1111/1742-6723.13295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 03/14/2019] [Accepted: 03/20/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate potential gaming of the 4 h ED length of stay metric known as the National Emergency Access Target (NEAT) in Australia and Emergency Treatment Performance (ETP) in New South Wales (NSW). METHODS Descriptive statistical analysis was used to recalculate and compare the scores for NEAT and the NSW ETP using variations in the definitions of their measurement on 32 184 presentations during 2016. A computer simulation using a discrete event model illustrated the effect of the use of ED short stay beds on the ETP scores. RESULTS Using the timestamp of the intent to discharge a patient, called, 'ready for departure' instead of the time of a patient physically leaving the department, resulted in an apparent 6% performance improvement. A local interpretation of the NSW state definition of the 'transferred' patient resulted in the ETP for 'admitted' patients improving by 16%. The discrete event model demonstrated that without changing patient length of stay, ETP scores can be improved by optimising the time of the admit decision or increasing the number of ED short stay beds. CONCLUSIONS The opportunity of NEAT may be squandered unless gaming of the definitions and use of ED short stay beds is addressed. We argue that the longstanding issue of 'departure time' should be defined as 'physically leaving' the department, in accordance with the Australasian College for Emergency Medicine (ACEM) definition. Patient occupancy is a real measure of ED resource use and NSW and national recommendations should be adjusted. ACEM accreditation of EDs should include review of their application of NEAT definitions to ensure they truly reflect patient flow processes.
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Affiliation(s)
- Michael Hession
- Emergency Department, Blacktown Mount Druitt Hospital, Sydney, New South Wales, Australia.,School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Roberto Forero
- Simpson Centre for Health Services Research, South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
| | - Nicola W Man
- Simpson Centre for Health Services Research, South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.,School of Public Health and Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Luke Penza
- School of Computing, Engineering and Mathematics, Western Sydney University, Sydney, New South Wales, Australia.,Sax Institute, Sydney, New South Wales, Australia
| | - Wade McDonald
- Sax Institute, Sydney, New South Wales, Australia.,University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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van Galen LS, Lammers EMJ, Schoonmade LJ, Alam N, Kramer MHH, Nanayakkara PWB. Acute medical units: The way to go? A literature review. Eur J Intern Med 2017; 39:24-31. [PMID: 27843036 DOI: 10.1016/j.ejim.2016.11.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 11/01/2016] [Accepted: 11/02/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Acute healthcare chains in the Netherlands are increasingly under pressure because of rising emergency department (ED) admissions, relative bed shortages and government policy changes. In order to improve acute patient flow and quality of care through hospitals, an acute medical unit (AMU) might be a solution, as demonstrated in the UK. However, limited information is available concerning AMUs in the Netherlands. Therefore, the aims of this study were to METHODS: A systematic literature search was performed searching 3 electronic databases: PubMed, Cochrane and EMBASE. All 106 hospitals in the Netherlands were contacted, inquiring about the status of an ED, the AMU or future plans to start one. RESULTS The literature search resulted in 31 studies that met inclusion criteria. In general, these studies reported significant benefits on number of admissions, hospital length of stay (LOS), mortality, other wards and readmissions. Among the Dutch hospitals with an ED, 33 out of 93 implemented an AMU or similar ward, these are however organized heterogeneously. Following current trends, more AMUs are expected to be realized in the future. CONCLUSION In order to improve the current strain on the Dutch acute healthcare system, an AMU could potentially provide benefits. However, uniform guideline is warranted to optimize and compare quality of care throughout the Netherlands.
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Affiliation(s)
- L S van Galen
- VU University Medical Centre, Section Acute Medicine, Department of Internal Medicine, Amsterdam, The Netherlands
| | - E M J Lammers
- VU University Medical Centre, Section Acute Medicine, Department of Internal Medicine, Amsterdam, The Netherlands
| | - L J Schoonmade
- VU University Medical Centre, Medical Library, VU University, Amsterdam, The Netherlands
| | - N Alam
- VU University Medical Centre, Section Acute Medicine, Department of Internal Medicine, Amsterdam, The Netherlands
| | - M H H Kramer
- VU University Medical Centre, Section Acute Medicine, Department of Internal Medicine, Amsterdam, The Netherlands
| | - P W B Nanayakkara
- VU University Medical Centre, Section Acute Medicine, Department of Internal Medicine, Amsterdam, The Netherlands.
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Effectiveness of Emergency Medicine Wards in reducing length of stay and overcrowding in emergency departments. Int Emerg Nurs 2013; 22:116-20. [PMID: 24080095 DOI: 10.1016/j.ienj.2013.08.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 08/14/2013] [Accepted: 08/17/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study aims to evaluate the effectiveness of an Emergency Medicine Ward (EMW) in reducing the length of stay (LOS) in the emergency department, length of hospitalization, emergency medical admission rate, and the hospital bed occupancy rate. METHODS This study is a cross-sectional, observational study with a retrospective, quantitative record review conducted at the EMW of a regional acute hospital in Hong Kong from January 2009 to June 2009. RESULTS During the study, a retrospective audit was conducted on 1834 patient records. The five main groups of patients admitted into EMW suffered from cardiac disease (26.5%), pneumonia (19.6%), dizziness (16.2%), Chronic Obstructive Pulmonary Disease (12.3%), and gastroenteritis (7.9%). The mean LOS in the EMW was 1.27 days (SD=0.59). The average emergency medical admission rate within the six-month period was significantly reduced relative to that before the EMW became operational (January 2008 to June 2008). Clinically, the medical in-patient bed occupancy was significantly reduced by 6.2%. The average LOS during in-patient hospitalization after the EMW was established decreased to 4.13 days from the previous length of 5.16 days. CONCLUSIONS EMWs effectively reduce both the LOS during in-patient hospitalization and the avoidable medical admission rate.
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Forero R, Hillman KM, McCarthy S, Fatovich DM, Joseph AP, Richardson DB. Access block and ED overcrowding. Emerg Med Australas 2012; 22:119-35. [PMID: 20534047 DOI: 10.1111/j.1742-6723.2010.01270.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Prospective and retrospective access block hospital intervention studies from 1998 to 2008 were reviewed to assess the evidence for interventions around access block and ED overcrowding, including over 220 documents reported in Medline and data extracted from The State of our Public Hospitals Reports. There is an estimated 20-30% increased mortality rate due to access block and ED overcrowding. The main causes are major increases in hospital admissions and ED presentations, with almost no increase in the capacity of hospitals to meet this demand. The rate of available beds in Australia reduced from 2.6 beds per 1000 (1998-1999) to 2.4 beds per 1000 (2002-2007) in 2002, and has remained steady at between 2.5-2.6 beds per 1000. In the same period, the number of ED visits increased over 77% from 3.8 million to 6.74 million. Similarly, the number of public hospital admissions increased at an average rate of 3.4% per year from 3.7 to 4.7 million. Compared with 1998-1999 rates, the number of available beds in 2006-2007 is thus similar (2.65 vs 2.6 beds per 1000), but the number of ED presentations has almost doubled. All patient groups are affected by access block. Access block interventions may temporarily reduce some of the symptoms of access block, but many measures are not sustainable. The root cause of the problem will remain unless hospital capacity is addressed in an integrated approach at both national and state levels.
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Affiliation(s)
- Roberto Forero
- Simpson Centre for Health Services Research Affiliated with The Australian Institute of Health Innovation, University of New South Wales, Kensington, New South Wales, Australia.
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Nicholls D, Gaynor N, Shafiei T, Bosanac P, Farrell G. Mental health nursing in emergency departments: the case for a nurse practitioner role. J Clin Nurs 2011; 20:530-6. [PMID: 21219526 DOI: 10.1111/j.1365-2702.2010.03504.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES This paper aims to explore the effectiveness of the mental health nurse practitioner role in the emergency department in the context of the growing use of special units or segregated areas to manage particular kinds of mental health presentations, often complicated by substance use. BACKGROUND In recent years, there has been a significant increase in mental health presentations to emergency departments, often complicated by substance abuse. Emergency departments have introduced a variety of mechanisms to address this growing problem. With the introduction of mental health nurse practitioners, opportunities arise to reconsider these mechanisms. DESIGN Discursive paper. METHODS In this discursive paper, contemporary practices are described in relation to 'special care areas', 'psychiatric emergency centres' and 'short-stay units'. The mental health nurse practitioner role in training and capacity building is also explored and the notion of 'locational processes' described. Rather than being presented as an alternative to short-stay units, the mental health nurse practitioner role is explored in its potential to enhance mental health nursing practice in a sometimes difficult clinical environment. RESULTS The paper provides evidence from literature and practice that the clinical outcome for consumers is enhanced through the mental health nurse practitioner role. CONCLUSIONS It is argued that the introduction of the mental health nurse practitioner role in the emergency department leads to increased staff competence and confidence in interacting with those presenting with mental health issues. The mental health nurse practitioner role also addresses the serious problem of stigma associated with those with a mental health issue. RELEVANCE TO CLINICAL PRACTICE It is expected that those presenting with mental health issues to the emergency department will benefit through the increased assessment and management skills of staff.
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Affiliation(s)
- Daniel Nicholls
- University of Western Sydney, Penrith South DC, New South Wales, Australia.
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Jelinek GA, Weiland T, Mackinlay C. The Emergency Medicine Capacity Assessment Study: Perceived resource requirements to support a major increase in intern numbers in Australian emergency departments. Emerg Med Australas 2011; 23:76-83. [DOI: 10.1111/j.1742-6723.2010.01377.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pines JM, Isserman JA, Szyld D, Dean AJ, McCusker CM, Hollander JE. The effect of physician risk tolerance and the presence of an observation unit on decision making for ED patients with chest pain. Am J Emerg Med 2010; 28:771-9. [DOI: 10.1016/j.ajem.2009.03.019] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2009] [Revised: 03/13/2009] [Accepted: 03/19/2009] [Indexed: 10/19/2022] Open
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Testing a Swedish Version of the Consumer Emergency Care Satisfaction Scale in an Emergency Department and 2 Observation Wards. J Nurs Care Qual 2010; 25:266-73. [DOI: 10.1097/ncq.0b013e3181c986d2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Cameron PA, Joseph AP, McCarthy SM. Access block can be managed. Med J Aust 2009; 190:364-8. [DOI: 10.5694/j.1326-5377.2009.tb02449.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Accepted: 01/27/2009] [Indexed: 11/17/2022]
Affiliation(s)
- Peter A Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC
| | - Anthony P Joseph
- Royal North Shore Hospital, Sydney, NSW
- Faculty of Medicine, University of Sydney, Sydney, NSW
| | - Sally M McCarthy
- Prince of Wales Hospital, Sydney, NSW
- Australasian College for Emergency Medicine, Melbourne, VIC
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Affiliation(s)
- George A Jelinek
- Sir Charles Gairdner Hospital, University of Western Australia, Hospital Avenue, Nedlands, WA, 6009.
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Browne GJ. Emergency department observation wards. Med J Aust 2001. [DOI: 10.5694/j.1326-5377.2001.tb143298.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Gary J Browne
- The New Children's HospitalPQ Box 3515ParramattaNSW2124
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