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Goyal N, Proper E, Lin P, Ahmad U, John-White M, O'Reilly GM, Craig SS. Using emergency department data to define a 'mental health presentation' - implications of different definitions on estimates of emergency department mental health workload. AUST HEALTH REV 2024; 48:342-350. [PMID: 38866423 DOI: 10.1071/ah24067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/22/2024] [Indexed: 06/14/2024]
Abstract
Objective This study aimed to describe and compare the proportion of patients classified as an emergency department (ED) mental health presentation under different definitions, including the Australian Institute of Health and Welfare (AIHW) definition. Methods This retrospective cohort study enrolled all patients that presented to the EDs of a multi-centre Victorian health service between 1 January 2020 and 30 June 2023. Varying definitions of a mental health presentation were applied to each ED attendance, applying the current AIHW definition (using selected diagnosis codes), broader diagnosis-based coding, the presenting complaint recorded at triage and whether the patient was seen by or referred to the emergency psychiatric service (EPS). The proportion of all ED presentations meeting each definition and any overlap between definitions were calculated. The agreement between each definition and the AIHW definition was evaluated using Kappa's coefficient. Results There were 813,078 presentations to ED of which 34,248 (4.2%) met the AIHW definition for a mental health presentation. Throughout the study, 45,376 (5.6%) patients were seen and/or referred to EPS, and 36,160 (4.4%) patients were allocated a mental health presenting complaint by triage staff. There was moderate interrater agreement between these definitions, with a kappa statistic (95% confidence interval) between the AIHW definition and a mental health presenting complaint recorded at triage of 0.58 (0.58-0.59) and between the AIHW definition and review by EPS of 0.58 (0.57-0.58). Conclusions The AIHW definition is a conservative measure of ED mental health presentations and may underestimate emergency psychiatry workload in Australian EDs.
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Affiliation(s)
- Nikita Goyal
- Department of Paediatrics, School of Clinical Sciences at Monash Health, Sub-Faculty of Clinical and Molecular Medicine, Monash University, Clayton, Vic, Australia
| | - Edmund Proper
- Department of Paediatrics, School of Clinical Sciences at Monash Health, Sub-Faculty of Clinical and Molecular Medicine, Monash University, Clayton, Vic, Australia
| | - Phyllis Lin
- Department of Paediatrics, School of Clinical Sciences at Monash Health, Sub-Faculty of Clinical and Molecular Medicine, Monash University, Clayton, Vic, Australia
| | - Usman Ahmad
- Department of Paediatrics, School of Clinical Sciences at Monash Health, Sub-Faculty of Clinical and Molecular Medicine, Monash University, Clayton, Vic, Australia
| | - Marietta John-White
- Department of Paediatrics, School of Clinical Sciences at Monash Health, Sub-Faculty of Clinical and Molecular Medicine, Monash University, Clayton, Vic, Australia
| | - Gerard M O'Reilly
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; and Emergency and Trauma Centre, Alfred Health, Melbourne, Vic, Australia; and National Trauma Research Institute, Alfred Health, Melbourne, Vic, Australia
| | - Simon S Craig
- Department of Paediatrics, School of Clinical Sciences at Monash Health, Sub-Faculty of Clinical and Molecular Medicine, Monash University, Clayton, Vic, Australia; and Paediatric Emergency Department, Monash Medical Centre, Clayton, Vic, Australia; and Clinical Sciences, Murdoch Children's Research Institute, Parkville, Vic, Australia
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Hetherington D, Wilson NJ, Dixon K, Murphy G. Emergency department Nurses' narratives of burnout: Changing roles and boundaries. Int Emerg Nurs 2024; 74:101439. [PMID: 38581856 DOI: 10.1016/j.ienj.2024.101439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 02/29/2024] [Accepted: 03/10/2024] [Indexed: 04/08/2024]
Abstract
PURPOSE Emergency department nurses work in rapidly changing environments, which can contribute to occupational stress. Emergency department nurses utilise diverse strategies to mediate the impact of stress on their daily lives. There is a paucity of qualitative research which explores emergency department nurses' experiences and perspectives of burnout. This study aimed to explore emergency department nurses' experiences of burnout. Further, the study considered how emergency nurses conceptualised burnout and the strategies they used to manage the professional and personal effects of burnout. PROCEDURES The COREQ research guidelines were used throughout the study from the design stage through to dissemination. Narrative inquiry was used as the underpinning theoretical framework. The researcher met individually with eight emergency department nurses from NSW hospitals to undertake a face-to-face semi-structured interview. An inductive approach was used to establish major themes within the narrative. FINDINGS Two major themes were established: experiencing conflicting emotions and trying to establish a personal sense of control. Emergency nurses felt passionate about their professional roles, yet encountered difficulties due to management structures, time constraints and a sense of underappreciation. The misalignment between their expectations and the reality of emergency department nursing, resulted in experiences of burnout such as dissatisfaction and frustrations at work. Consequently, these nurses adopted diverse strategies within both their professional and personal domains. PRINCIPAL CONCLUSIONS The conclusions of this study are transferable to a variety of acute health services. Health service management have a role to promote a positive workplace culture for nurses, which advocates for home life balance. This will support nurses to construct clear boundaries between professional identity and their personal lives.
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Affiliation(s)
- Debbie Hetherington
- Master of Research (MRes), School of Nursing and Midwifery, Western Sydney University, Australia.
| | - Nathan J Wilson
- School of Nursing and Midwifery, Western Sydney University, Australia.
| | - Kathleen Dixon
- School of Nursing and Midwifery, Western Sydney University, Australia.
| | - Gillian Murphy
- School of Nursing and Midwifery, Western Sydney University, Australia.
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Howland D, Cunniffe G, Morris S, Staunton P. An evaluation of the effectiveness of an advanced practice physiotherapist in the emergency department setting in Ireland. Ir J Med Sci 2024; 193:1533-1538. [PMID: 37982978 DOI: 10.1007/s11845-023-03567-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 11/01/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND One of the means of easing increased pressure on emergency care worldwide has been the development of advanced musculoskeletal physiotherapy practice in the emergency department setting. This model of care is in its infancy in Ireland. AIMS To evaluate the effectiveness of an advanced practice physiotherapist working as a primary contact clinician in the emergency department at St. James's Hospital, Dublin. METHODS A three-month retrospective chart review was undertaken for patients assigned the advanced practice physiotherapist as their primary clinician during their emergency department attendance. Three widely accepted measures of quality in emergency medicine were used to evaluate effectiveness, namely, time from attendance to discharge, time from triage to assessment, and unplanned reattendance within seven days. RESULTS A total of 129 patients were included in this study. Time from attendance to discharge was significantly less in the APP group (mean 208.5 min, standard deviation 122.4 min) than in the ED group (mean 377.1 min, standard deviation 314.7 min) (mean difference - 168.61 (95% C.I - 191.24- - 145.98)) (p < 0.001). Time from triage to assessment was significantly less in the APP group (mean 72.1 min, standard deviation 51.9 min) than in the ED group (mean 94.1 min, standard deviation 96.5 min) (mean difference - 22.08 (95% C.I - 31.28- - 12.89)) (p < 0.001). The unplanned reattendance rate was 3.9%. No adverse events were identified. CONCLUSIONS The findings of this study indicate that an advanced practice physiotherapist can provide a timely, effective, and safe service for patients attending the emergency department with musculoskeletal complaints in Ireland.
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Affiliation(s)
- David Howland
- School of Medicine, University College Dublin, Dublin, D04 V1W8, Ireland.
- Physiotherapy Department, St. James's Hospital, Dublin, D08 NHY1, Ireland.
| | - Gráinne Cunniffe
- School of Medicine, University College Dublin, Dublin, D04 V1W8, Ireland
| | - Seamus Morris
- School of Medicine, University College Dublin, Dublin, D04 V1W8, Ireland
| | - Paul Staunton
- Emergency Department, St. James's Hospital, Dublin, D08 NHY1, Ireland
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Lun T, Schiro J, Cailliau E, Tchokokam J, Liber M, de Jorna C, Martinot A, Dubos F. Randomized controlled open-label trial to evaluate prioritization software for the secondary triage of patients in the pediatric emergency department. Int J Emerg Med 2024; 17:53. [PMID: 38589780 PMCID: PMC11000356 DOI: 10.1186/s12245-024-00623-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/17/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND The continual increase in patient attendance at the emergency department (ED) is a worldwide health issue. The aim of this study was to determine whether the use of a secondary prioritization software reduces the patients' median length of stay (LOS) in the pediatric ED. METHODS A randomized, controlled, open-label trial was conducted over a 30-day period between March 15th and April 23rd 2021 at Lille University Hospital. Work days were randomized to use the patient prioritization software or the pediatric ED's standard dashboard. All time intervals between admission and discharge were recorded prospectively by a physician not involved in patient care during the study period. The study's primary endpoint was the LOS in the pediatric ED, which was expected to be 15 min shorter in the intervention group than in the control group. The secondary endpoints were specific time intervals during the stay in the pediatric ED and levels of staff satisfaction. RESULTS 1599 patients were included: 798 in the intervention group and 801 in the control group. The median [interquartile range] LOS was 172 min [113-255] in the intervention group and 167 min [108-254) in the control group (p = 0.46). In the intervention group, the time interval between admission to the first medical evaluation for high-priority patients and the time interval between the senior physician's final evaluation and patient discharge were shorter (p < 0.01). The median satisfaction score was 68 [55-80] (average). CONCLUSION The patients' total LOS was not significantly shorter on days of intervention. However, use of the electronic patient prioritization tool was associated with significant decreases in some important time intervals during care in the pediatric ED. CLINICALTRIALS gov: NCT05994196 Trial registration number: NCT05994196. Date of registration: August 16th, 2023.
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Affiliation(s)
- Thomas Lun
- Pediatric Emergency Unit & Infectious Diseases, Univ. Lille, CHU Lille, Lille, F-59000, France
| | | | | | - Julien Tchokokam
- Pediatric Emergency Unit & Infectious Diseases, Univ. Lille, CHU Lille, Lille, F-59000, France
| | - Melany Liber
- Pediatric Emergency Unit & Infectious Diseases, Univ. Lille, CHU Lille, Lille, F-59000, France
| | - Claire de Jorna
- Pediatric Emergency Unit & Infectious Diseases, Univ. Lille, CHU Lille, Lille, F-59000, France
| | - Alain Martinot
- Pediatric Emergency Unit & Infectious Diseases, Univ. Lille, CHU Lille, Lille, F-59000, France
- Univ. Lille, METRICS: Évaluation des technologies de santé et des pratiques médicales - ULR 2694, Lille, F-59000, France
| | - François Dubos
- Pediatric Emergency Unit & Infectious Diseases, Univ. Lille, CHU Lille, Lille, F-59000, France.
- Univ. Lille, METRICS: Évaluation des technologies de santé et des pratiques médicales - ULR 2694, Lille, F-59000, France.
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Almansour MA, Alhussain MN, Alsarhan MN. Awareness of Urgent Care Services Among Primary Healthcare Center Patients in Al-Ahsa, Saudi Arabia. Cureus 2024; 16:e57099. [PMID: 38681469 PMCID: PMC11053381 DOI: 10.7759/cureus.57099] [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: 03/28/2024] [Indexed: 05/01/2024] Open
Abstract
Background Urgent care clinics (UCCs) provide services for patients without the need to book an appointment in advance to treat acute diseases and injuries that do not need ED service and provide care for chronic conditions. This study aimed to assess the patients's level of awareness regarding UCCs in the Al-Ahsa region and provide information contributing to decision-makers' support about the urgent care services and their patterns of use within primary healthcare. Methods A descriptive cross-sectional study was conducted in the Al-Ahsa region from August 2023 to December 2023. A validated questionnaire was used. Cluster sampling was used to select three primary healthcare centers from four health sectors (southern cluster, middle cluster, northern cluster, and eastern cluster), and then simple random sampling was used to select participants. sample size calculated by Cochran's sample size formula, which estimated 377 participants. However, to accommodate a non-response rate of 10.0% and stronger statistical power and effect size, the final sample size was 469 participants. Data were analyzed by SPSS Statistics version 28 (IBM Corp. Released 2021. IBM SPSS Statistics for Windows, Version 28.0. Armonk, NY: IBM Corp.). Both descriptive and inferential statistics were used. A p-value ≤0.05 is considered statistically significant. Results Of the 469 participants in the study, more than half (54.8%) were aged between 18 and 38 years old, and more than half (54.8%) were male. More than half (67.4%) reported having no chronic diseases, whereas the most common chronic diseases reported were diabetes mellitus (11.9%) and hypertension (14.3%). Most of the participants (84.9%) weren't aware of UCCs. Among the participants who were aware of UCCs (n=71), 53.5% of them had visited a UCC in the last three months. The most common reasons for their visits were the common cold (40.8%), headaches (5.6%), and abdominal pain (5.6%). More than one-third of participants (38.6%) believed that UCCs provide services like those of the emergency center. According to patients' sex, there was a significant (0.031) difference in the awareness level; the highest was among females at 20.1% vs. 12.6%. Conclusion The study revealed that the majority of the participants were unaware of UCCs. Increasing patients' awareness of UCCs is necessary through different media to improve access to healthcare services and reduce overcrowding in the ED that is caused by non-urgent problems.
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Frith M, Randall S, Savira F, Swann J, White N, Giddy A, McLean K, Peeters A, Robinson S. Evaluation of the priority primary care centre program to reduce emergency department burden in regional Victoria, Australia: a mixed-method study. BMJ Open 2023; 13:e075773. [PMID: 37945302 PMCID: PMC10649696 DOI: 10.1136/bmjopen-2023-075773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 10/10/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION In Australia, the Victorian State Government has established a number of priority primary care centres (PPCCs) across the state to address the increasing demand for emergency departments (EDs). PPCCs are general practitioner-led, free-of-charge services that aim to provide care for conditions that require urgent attention but do not require the high-acuity care of an ED. This study aims to evaluate the implementation processes, outcomes and the impact of the PPCC on reducing ED demand within Barwon, Warrnambool and Grampians Health Services in the Western region of Victoria, Australia. METHODS AND ANALYSIS This is a convergent mixed-method study. Qualitative data collection will be undertaken through semistructured interviews to understand the experiences of PPCC patients, PPCC clinical staff, PPCC managerial and administrative staff and ED clinical staff. A documentary analysis will be conducted on the materials relating to the implementation of the PPCC. The quantitative component will involve interrupted time series analysis of de-identified administrative data, comprising ED presentation records and PPCC clinical records. Implementation science frameworks will be integrated throughout the study. The RE-AIM framework is a guide used for the planning and evaluation of programmes through five outcomes: reach, effectiveness, adoption, implementation and maintenance. The Consolidated Framework for Implementation Research will be integrated. ETHICS AND DISSEMINATION This study has received ethical approval from Deakin University HREC (Ref No. 2023-046) and Barwon Health HREC (Ref No. 94374). Findings will be disseminated as reports, presentations and peer-reviewed journal articles.
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Affiliation(s)
- Madison Frith
- Deakin Health Economics, Deakin University, Institute for Health Transformation, Burwood, Victoria, Australia
| | - Sean Randall
- Deakin Health Economics, Deakin University, Institute for Health Transformation, Burwood, Victoria, Australia
| | - Feby Savira
- Deakin Health Economics, Deakin University, Institute for Health Transformation, Burwood, Victoria, Australia
| | - Jamie Swann
- Health Analytics and Research, Western Victorian Primary Health Network, Ballarat, Victoria, Australia
| | - Naomi White
- Regional Parnterships and Public Health, Western Victorian Primary Health Network, Ballarat, Victoria, Australia
| | - Andrew Giddy
- Strategy and Engagement, Western Victorian Primary Health Network, Ballarat, Victoria, Australia
| | - Kirsty McLean
- Emergency Nursing, Grampians Health Ballarat, Ballarat, Victoria, Australia
| | - Anna Peeters
- Institute of Health Transformation, Deakin University, Melbourne, Victoria, Australia
| | - Suzanne Robinson
- Deakin Health Economics, Deakin University, Institute for Health Transformation, Burwood, Victoria, Australia
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Khattak FA, Saba M, Hakim M, Khan A, Aleem S, Afaq S, Ullah A, Rahim A, Haq ZU. Patient Satisfaction and Utilization of Ambulance Services in Prehospital Services at a Tertiary Care Hospital: A Cross-Sectional Study in Peshawar, Khyber Pakhtunkhwa, Pakistan. Air Med J 2023; 42:239-245. [PMID: 37356883 DOI: 10.1016/j.amj.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE Patients reporting to emergency departments frequently use different ambulance services; therefore, the measurement of patient satisfaction is relevant to encouraging those services to meet patient expectations. The aim of this study was to determine the patients' satisfaction and utilization of different ambulance services at a tertiary health care hospital in Peshawar relating to prehospital services. METHODS This cross-sectional study was conducted at Lady Reading Hospital, Peshawar, Khyber Pakhtunkhwa, Pakistan, from July 2019 to January 2020 using a consecutive sampling technique with a total sample size of 378. The patients reporting to the emergency department using any ambulance service were included in this study. Different types of ambulance services were used as an outcome variable. Proportions were compared for the categoric variables using the chi-square test, whereas the 1-way analysis of variance test was used to determine the mean response time and age. Results were considered significant at a P value ≤ .050. All analyses were completed using SPSS version 20 (IBM Corp, Armonk, NY). RESULTS Of the total 378 study participants, approximately 166 (43.9%) used Rescue 1122 services, 99 (26.2%) used private ambulance services, and 44 (11.6%) used public ambulance services. Road traffic accidents were the most common complaint by 98 (25.9%, P < .003) participants. The mean response time for Rescue 1122 was 13.2 ± 18 minutes followed by the Chippa Foundation (private) at 17.8 ± 20 minutes (P < .005). Males (n = 254) were the predominant users of all services. Participants from the urban region (n = 112) used Rescue 1122, whereas the public ambulance service was used only by 31 patients (P < .005). Among all the ambulance services, 19 (61.3%) participants were not satisfied with the Chippa service regarding vehicle cleanliness, whereas participants were highly satisfied with Rescue 1122. CONCLUSION Overall, the patients were more satisfied with the services provided by the Rescue 1122 ambulances compared with all other ambulance services.
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Affiliation(s)
- Farhad Ali Khattak
- Research Cell, Khyber College of Dentistry, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Mehwish Saba
- Health Department, Nowshera, Khyber Pakhtunkhwa, Pakistan
| | - Muhammad Hakim
- Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Asad Khan
- College of Medical Technology, Bacha Khan Medical College, Mardan, Pakistan
| | - Saima Aleem
- Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Saima Afaq
- Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Khyber Pakhtunkhwa, Pakistan; Department of Epidemiology and Biostatistics, School of Public Health Faculty of Medicine, Imperial College, London, United Kingdom.
| | - Abid Ullah
- Sarhad University of Science and Technology, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Abid Rahim
- Sardar Begum Dental College & Hospital, Gandhara University, Peshawar, Pakistan
| | - Zia Ul Haq
- Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Khyber Pakhtunkhwa, Pakistan
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Curtis K, Dinh MM, Shetty A, Kourouche S, Fry M, Considine J, Li L, Lung T, Shaw T, Lam MK, Murphy M, Alkhouri H, Aggar C, Russell SB, Seimon RV, Hughes JA, Varndell W, Shaban RZ. The Emergency nurse Protocols Initiating Care-Sydney Triage to Admission Risk Tool (EPIC-START) trial: protocol for a stepped wedge implementation trial. Implement Sci Commun 2023; 4:70. [PMID: 37340486 DOI: 10.1186/s43058-023-00452-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 06/04/2023] [Indexed: 06/22/2023] Open
Abstract
INTRODUCTION Emergency department (ED) overcrowding is a global problem and a threat to the quality and safety of emergency care. Providing timely and safe emergency care therein is challenging. To address this in New South Wales (NSW), Australia, the Emergency nurse Protocol Initiating Care-Sydney Triage to Admission Risk Tool (EPIC-START) was developed. EPIC-START is a model of care incorporating EPIC protocols, the START patient admission prediction tool, and a clinical deterioration tool to support ED flow, timely care, and patient safety. The aim of this study is to evaluate the impact of EPIC-START implementation across 30 EDs on patient, implementation, and health service outcomes. METHODS AND ANALYSIS This study protocol adopts an effectiveness-implementation hybrid design (Med Care 50: 217-226, 2012) and uses a stepped-wedge cluster randomised control trial of EPIC-START, including uptake and sustainability, within 30 EDs across four NSW local health districts spanning rural, regional, and metropolitan settings. Each cluster will be randomised independently of the research team to 1 of 4 dates until all EDs have been exposed to the intervention. Quantitative and qualitative evaluations will be conducted on data from medical records and routinely collected data, and patient, nursing, and medical staff pre- and post-surveys. ETHICS AND DISSEMINATION Ethical approval for the research was received from the Sydney Local Health District Research Ethics Committee (Reference Number 2022/ETH01940) on 14 December 2022. TRIAL REGISTRATION Australian and New Zealand Clinical trial, ACTRN12622001480774p. Registered on 27 October 2022.
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Affiliation(s)
- Kate Curtis
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, NSW, Australia.
- Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Crown St, Wollongong, NSW, Australia.
| | - Michael M Dinh
- New South Wales Institute of Trauma and Injury Management, Chatswood, Australia
- Sydney Medical School, The University of Sydney, Camperdown, Australia
- RPA Green Light Institute for Emergency Care, Sydney Local Health District, Camperdown, Australia
| | - Amith Shetty
- System Sustainability and Performance, NSW Ministry of Health, St Leonards, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Sarah Kourouche
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, NSW, Australia
| | - Margaret Fry
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, NSW, Australia
- Sydney Faculty of Health, University of Technology, Ultimo, NSW, Australia
- Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Julie Considine
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Experience in the Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- Centre for Quality and Patient Safety Research - Eastern Health Partnership, Box Hill, VIC, Australia
| | - Ling Li
- Macquarie University, Sydney, Australia
| | - Thomas Lung
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Timothy Shaw
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Mary K Lam
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Margaret Murphy
- Western Sydney Local Health District, North Parramatta, NSW, 2145, Australia
| | - Hatem Alkhouri
- Agency for Clinical Innovation, NSW Emergency Care Institute, St Leonards, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Christina Aggar
- Nothern NSW Local Health District, Southern Cross University, Lismore, Australia
| | | | - Radhika V Seimon
- RPA Green Light Institute for Emergency Care, Sydney Local Health District, Camperdown, Australia
| | - James A Hughes
- School of Nursing, Centre for Healthcare Transformation, Brisbane, QUT, Australia
| | - Wayne Varndell
- Prince of Wales Hospital Emergency Department, Randwick, Australia
- Faculty of Health, University of Technology Sydney, Ultimo, Australia
- College of Emergency Nursing Australasia (CENA), Hobart, Australia
| | - Ramon Z Shaban
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, NSW, Australia
- Faculty of Medicine and Health, Sydney Institute for Infectious Diseases, The University of Sydney, Camperdown, NSW, 2006, Australia
- Communicable Diseases Branch, Public Health Unit, Centre for Population Health, Western Sydney Local Health District, North Parramatta, NSW, 2141, Australia
- New South Wales Biocontainment Centre, Western Sydney Local Health District and New South Wales Health, Westmead, NSW, 2145, Australia
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Mills B, Hill M, Miles A, Smith E, Afrifa-Yamoah E, Reid D, Rogers S, Sim M. Calling an ambulance for non-emergency medical situations: Results of a cross-sectional online survey from an Australian nationally representative sample. Emerg Med Australas 2023; 35:133-141. [PMID: 36113863 PMCID: PMC10087376 DOI: 10.1111/1742-6723.14086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/10/2022] [Accepted: 08/24/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To investigate the Australian general public's perception of appropriate medical scenarios that warrants a call to an emergency ambulance. METHODS An online survey asked participants to identify the likely medical treatment pathway they would take for 17 hypothetical medical scenarios. The number and type of non-emergency scenarios (n = 8) participants incorrectly suggested were appropriate to place a call for an emergency ambulance were calculated. Participants included Australian residents (aged >18 years) who had never worked as an Australian registered medical doctor, nurse or paramedic. RESULTS From a sample of 5264 participants, 40% suggested calling an emergency ambulance for a woman in routine labour was appropriate. Other medical scenarios which were most suggested by participants to warrant an emergency ambulance call was 'Lego in ear canal' (11%), 'Older person bruising' (8%) and 'Flu' (7%). Women, people aged 56+ years, those without a university qualification, with lower household income and with lower emotional wellbeing were more likely to suggest calling an emergency ambulance was appropriate for non-emergency scenarios. CONCLUSIONS Although emergency healthcare system (EHS) capacity not increasing at the same rate as demand is the biggest contributor to EHS burden, non-urgent medical situations for which other low-acuity healthcare pathways may be appropriate does play a small role in adding to the overburdening of the EHS. This present study outlines a series of complaints and demographic characteristics that would benefit from targeted educational interventions that may aid in alleviating ambulance service attendances to low-acuity callouts.
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Affiliation(s)
- Brennen Mills
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Michella Hill
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Alecka Miles
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Erin Smith
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Eben Afrifa-Yamoah
- School of Science, Edith Cowan University, Perth, Western Australia, Australia
| | - David Reid
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Shane Rogers
- School of Arts and Humanities, Edith Cowan University, Perth, Western Australia, Australia
| | - Moira Sim
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
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Crilly J, Huang Y, Krahe M, Wilhelms D, Ekelund U, Hörlin E, Hayes J, Keijzers G. Research priority setting in emergency care: A scoping review. J Am Coll Emerg Physicians Open 2022; 3:e12852. [PMID: 36518881 PMCID: PMC9742830 DOI: 10.1002/emp2.12852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 09/13/2022] [Accepted: 10/26/2022] [Indexed: 12/14/2022] Open
Abstract
Objective Priority areas for emergency care research are emerging and becoming ever more important. The objectives of this scoping review were to (1) provide a comprehensive overview of published emergency care priority-setting studies by collating and comparing priority-setting methodology and (2) describe the resulting research priorities identified. Methods The Joanna Briggs Institute methodological framework was used. Inclusion criteria were peer-review articles available in English, published between January 1, 2008 and March 31, 2019 and used 2 or more search terms. Five databases (Scopus, AustHealth, EMBASE, CINAHL, and Ovid MEDLINE) were searched. REporting guideline for PRIority SEtting of health research (REPRISE) criteria were used to assess the quality of evidence of included articles. Results Forty-five studies were included. Fourteen themes for emergency care research were considered within 3 overarching research domains: emergency populations (pediatrics, geriatrics), emergency care workforce and processes (nursing, shared decision making, general workforce, and process), and emergency care clinical areas (imaging, falls, pain management, trauma care, substance misuse, infectious diseases, mental health, cardiology, general clinical care). Variation in the reporting of research priority areas was evident. Priority areas to drive the global agenda for emergency care research are limited given the country and professional group-specific context of existing studies. Conclusion This comprehensive summary of generated research priorities across emergency care provides insight into current and future research agendas. With the nature of emergency care being inherently broad, future priorities may warrant population (eg, children, geriatrics) or subspecialty (eg, trauma, toxicology, mental health) focus and be derived using a rigorous framework and patient engagement.
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Affiliation(s)
- Julia Crilly
- Department of Emergency MedicineGold Coast Hospital and Health ServiceQueenslandGold CoastAustralia
- School of Nursing and MidwiferyGriffith UniversityGold CoastQueenslandAustralia
- Menzies Health Institute QueenslandGriffith UniversityGold CoastQueenslandAustralia
| | - Ya‐Ling Huang
- Department of Emergency MedicineGold Coast Hospital and Health ServiceQueenslandGold CoastAustralia
- School of Nursing and MidwiferyGriffith UniversityGold CoastQueenslandAustralia
- Faculty of Health (Nursing)Southern Cross UniversityQueenslandGold CoastAustralia
| | - Michelle Krahe
- Office of the Pro Vice Chancellor (Indigenous)Griffith UniversityMeadowbrookQueenslandAustralia
| | - Daniel Wilhelms
- Department of Emergency MedicineLocal Health Care ServicesCentral ÖstergötlandLinköpingSweden
- Department of Biomedical and Clinical SciencesLinköping UniversitySweden
| | - Ulf Ekelund
- Department of Clinical SciencesFaculty of MedicineLund UniversityLundSweden
| | - Erika Hörlin
- Department of Emergency MedicineLocal Health Care ServicesCentral ÖstergötlandLinköpingSweden
- Department of Biomedical and Clinical SciencesLinköping UniversitySweden
| | - Jessica Hayes
- Department of Emergency MedicineGold Coast Hospital and Health ServiceQueenslandGold CoastAustralia
- School of Nursing and MidwiferyGriffith UniversityGold CoastQueenslandAustralia
| | - Gerben Keijzers
- Department of Emergency MedicineGold Coast Hospital and Health ServiceQueenslandGold CoastAustralia
- Faculty of Health Sciences and MedicineBond UniversityGold CoastQueenslandAustralia
- School of MedicineGriffith UniversityGold CoastQueenslandAustralia
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11
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Willson KA, Lim D, Toloo G, FitzGerald G, Kinnear FB, Morel DG. Potential role of general practice in reducing emergency department demand: A qualitative study. Emerg Med Australas 2022; 34:717-724. [PMID: 35306746 PMCID: PMC9790648 DOI: 10.1111/1742-6723.13964] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/27/2022] [Accepted: 02/28/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To inform local, state and national strategies intended to reduce demand for ED care, the present study aimed to identify key factors influencing the current provision of acute care within primary healthcare (PHC) and explore the policy and system changes potentially required. METHODS Semi-structured interviews with key stakeholders were audio-recorded, transcribed verbatim and analysed through content and thematic approaches incorporating the Walt and Gilson health policy framework. RESULTS Eleven interviews were conducted. Five key considerations were highlighted, namely the barriers and enablers for general practitioners (GPs) in providing acute care, barriers to patient use of PHC instead of ED, suggestions for new PHC models and improvements for current ED models. Additionally, economic issues relating to clinic funding and GP remuneration, complexities of state or federal funding and management of urgent care centres (UCC) were identified. Potential policy changes included GP clinics incorporating emergency appointments, GP triage, further patient streaming and changes to the ED medical workforce model, as well as linking hospitals with PHC clinics. Suggested system changes included improving rapid access to non-GP specialists, offering qualifications for urgent care within PHC, developing integrated information technology systems and educating patients regarding appropriate healthcare system pathways. CONCLUSION The present study suggested that while PHC has the potential to attenuate the demands for ED services, a whole-of-system approach focusing on realignment of priorities and integrated changes are needed.
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Affiliation(s)
- Katie A Willson
- College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia
| | - David Lim
- College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia,School of Health SciencesWestern Sydney UniversitySydneyNew South WalesAustralia
| | - Ghasem‐Sam Toloo
- School of Public Health and Social Work, Centre for Healthcare Transformation, Faculty of HealthQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Gerry FitzGerald
- School of Public Health and Social WorkQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Frances B Kinnear
- Emergency ServicesThe Prince Charles HospitalBrisbaneQueenslandAustralia,Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
| | - Douglas G Morel
- Emergency DepartmentRedcliffe HospitalBrisbaneQueenslandAustralia
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12
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Jheng JC, Tseng YT, Wang TH, Chen LF, Chung JY. Using neutrophil to lymphocyte ratio to predict discharge among geriatric patients with influenza infection in emergency department. Medicine (Baltimore) 2022; 101:e30261. [PMID: 36042631 PMCID: PMC9410611 DOI: 10.1097/md.0000000000030261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 07/12/2022] [Accepted: 07/15/2022] [Indexed: 11/26/2022] Open
Abstract
The neutrophil-to-lymphocyte ratio (NLR) is used to predict the prognosis of various diseases, such as coronavirus disease 2019, community-acquired pneumonia, bacteremia, and endocarditis. However, NLR has never been reported to predict patient discharge in geriatric patients with influenza infection. This retrospective case-control study enrolled geriatric patients (≥65 years) with influenza virus infection who visited the emergency department of a medical center between January 01, 2010 and December 31, 2015. Demographic data, vital signs, past histories, influenza subtypes, outcomes, and disposition were analyzed. The optimal NLR cut-off value to predict patient discharge was determined using the Youden index. We also evaluated the accuracy of NLR in predicting patient discharge using logistic regression and receiver operating characteristic analysis. The study included 409 geriatric patients in the emergency department with a mean age of 79.5 years and an approximately equal sex ratio. NLR was significantly lower in the discharged group than in the nondischarged group (5.8 ± 3.7 vs 9.7 ± 8.4). Logistic regression revealed that patients with NLR ≤ 6.5 predicted discharge with an odds ratio of 3.62. The Hosmer-Lemeshow goodness-of-fit test was calculated as 0.36, and the adjusted area under the receiver operating characteristic was 0.75. The negative predictive value of NLR ≤ 6.5, to predict patient discharge, was 91.8%. NLR ≤ 6.5 is a simple and easy-to-obtain laboratory tool to guide the physicians to discharge geriatric patients with influenza infection in the crowded emergency department.
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Affiliation(s)
- Jing-Cheng Jheng
- Department of Emergency Medicine, National Yang-Ming University Hospital, I-Lan, Taiwan
| | - Yen-Ting Tseng
- Department of Emergency Medicine, National Yang-Ming University Hospital, I-Lan, Taiwan
| | - Te-Hao Wang
- Department of Emergency Medicine, National Yang-Ming University Hospital, I-Lan, Taiwan
| | - Li-Fu Chen
- Department of Emergency Medicine, National Yang-Ming University Hospital, I-Lan, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jui-Yuan Chung
- Department of Emergency Medicine, Cathay General Hospital, Taipei, Taiwan
- School of Medicine, Fu Jen Catholic University, Taipei, Taiwan
- School of Medicine, National Tsing Hua University, Hsinchu, Taiwan
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13
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Schäfer I, Menzel A, Herrmann T, Oltrogge JH, Lühmann D, Scherer M. Patient satisfaction with computer-assisted structured initial assessment facilitating patient streaming to emergency departments and primary care practices: results from a cross-sectional observational study accompanying the DEMAND intervention in Germany. BMC PRIMARY CARE 2022; 23:213. [PMID: 35999511 PMCID: PMC9397153 DOI: 10.1186/s12875-022-01825-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 08/13/2022] [Indexed: 11/23/2022]
Abstract
Background Patient numbers in emergency departments are on the rise. The DEMAND intervention aims to improve the efficacy of emergency services by computer-assisted structured initial assessment assigning patients to emergency departments or primary care practices. The aims of our study were to evaluate patient satisfaction with this intervention and to analyse if reduced patient satisfaction is predicted by sociodemographic data, health status or health literacy. Methods We conducted a cross-sectional patient survey in emergency departments and co-located primary care practices. Each intervention site was planned to participate for two observation periods, each with a duration of one full week. Study participants were recruited by the local staff. The patients filled out a written questionnaire during their waiting time. Patient satisfaction was assessed by agreement to four statements on a four point Likert scale. Predictors of patient satisfaction were identified by multilevel, multivariable logistic regression models adjusted for random effects at the intervention site level. Results The sample included 677 patients from 10 intervention sites. The patients had a mean age of 38.9 years and 59.0% were women. Between 67.5% and 55.0% were fully satisfied with aspects of the intervention. The most criticised aspect was that the staff showed too little interest in the patients’ personal situation. Full satisfaction (“clearly yes” to all items) was reported by 44.2%. Reduced patient satisfaction (at least one item rated as “rather yes”, “rather no”, “clearly no”) was predicted by lower age (odds ratio 0.79 for ten years difference, 95% confidence interval 0.67/0.95, p = 0.009), presenting with infections (3.08,1.18/8.05,p = 0.022) or injuries (3.46,1.01/11.82,p = 0.048), a higher natural logarithm of the symptom duration (1.23,1.07/1.30,p = 0.003) and a lower health literacy (0.71 for four points difference, 0.53/0.94,p = 0.019). Conclusions The patients were for the most part satisfied with the intervention. Assessment procedures should be evaluated a) regarding if all relevant patient-related aspects are included; and whether patient information can be improved b) for patients with strong opinions about cause, consequences and treatment options for their health problem; and c) for patients who have problems in the handling of information relevant to health and healthcare. Trial registration German Clinical Trials Register (https://www.drks.de/drks_web/setLocale_EN.do) no. DRKS00017014. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01825-5.
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Ioannou P, Karakonstantis S, Kofteridis DP. Admissions in a medical ward and factors independently associated with mortality. Eur J Intern Med 2022; 98:117-118. [PMID: 34961673 DOI: 10.1016/j.ejim.2021.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/18/2021] [Accepted: 12/20/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Petros Ioannou
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, Heraklion, Crete, Greece.
| | - Stamatis Karakonstantis
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Diamantis P Kofteridis
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, Heraklion, Crete, Greece
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15
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Collyer TA, Athanasopoulos G, Srikanth V, Tiruvoipati R, Matthews C, Mcinnes N, Menon S, Dowling J, Braun G, Krivitsky TA, Cooper H, Andrew NE. Impact of COVID-19 lockdowns on hospital presentations and admissions in the context of low community transmission: evidence from time series analysis in Melbourne, Australia. J Epidemiol Community Health 2022; 76:341-349. [PMID: 34782421 PMCID: PMC8595051 DOI: 10.1136/jech-2021-217010] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 11/02/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Melbourne, Australia, successfully halted exponential transmission of COVID-19 via two strict lockdowns during 2020. The impact of such restrictions on healthcare-seeking behaviour is not comprehensively understood, but is of global importance. We explore the impact of the COVID-19 pandemic on acute, subacute and emergency department (ED) presentations/admissions within a tertiary, metropolitan health service in Melbourne, Australia, over two waves of community transmission (1 March to 20 September 2020). METHODS We used 4 years of historical data and novel forecasting methods to predict counterfactual hospital activity for 2020, assuming absence of COVID-19. Observed activity was compared with forecasts overall, by age, triage category and for myocardial infarction and stroke. Data were analysed for all patients residing in the health service catchment area presenting between 4 January 2016 and 20 September 2020. RESULTS ED presentations (n=401 805), acute admissions (n=371 723) and subacute admissions (n=15 676) were analysed. Substantial departures from forecasted presentation levels were observed during both waves in the ED and acute settings, and during the second wave in subacute. Reductions were most marked among those aged >80 and <18 years. Presentations persisted at expected levels for urgent conditions, and ED triage categories 1 and 5, with clear reductions in categories 2-4. CONCLUSIONS Our analyses suggest citizens were willing and able to present with life-threatening conditions during Melbourne's lockdowns, and that switching to telemedicine did not cause widespread spill-over from primary care into ED. During a pandemic, lockdowns may not inhibit appropriate hospital attendance where rates of infectious disease are low.
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Affiliation(s)
- Taya A Collyer
- Peninsula Clinical School, Monash University Faculty of Medicine, Nursing and Health Sciences, Frankston, Victoria, Australia
- National Centre for Healthy Aging, Frankston, Victoria, Australia
| | - George Athanasopoulos
- Department of Econometrics and Business Statistics, Monash University Faculty of Business and Economics, Caulfield East, Victoria, Australia
| | - Velandai Srikanth
- Peninsula Clinical School, Monash University Faculty of Medicine, Nursing and Health Sciences, Frankston, Victoria, Australia
- National Centre for Healthy Aging, Frankston, Victoria, Australia
- Peninsula Health, Frankston Hospital, Frankston, Victoria, Australia
| | - Ravindranath Tiruvoipati
- Peninsula Clinical School, Monash University Faculty of Medicine, Nursing and Health Sciences, Frankston, Victoria, Australia
- Peninsula Health, Frankston Hospital, Frankston, Victoria, Australia
| | - Chris Matthews
- Peninsula Health, Frankston Hospital, Frankston, Victoria, Australia
| | - Nicholas Mcinnes
- Peninsula Health, Frankston Hospital, Frankston, Victoria, Australia
| | - Shyaman Menon
- Peninsula Health, Frankston Hospital, Frankston, Victoria, Australia
| | - Jonathan Dowling
- Peninsula Health, Frankston Hospital, Frankston, Victoria, Australia
| | - Gary Braun
- Peninsula Health, Frankston Hospital, Frankston, Victoria, Australia
| | - Timur A Krivitsky
- Peninsula Health, Frankston Hospital, Frankston, Victoria, Australia
| | - Helen Cooper
- Peninsula Health, Frankston Hospital, Frankston, Victoria, Australia
| | - Nadine E Andrew
- Peninsula Clinical School, Monash University Faculty of Medicine, Nursing and Health Sciences, Frankston, Victoria, Australia
- National Centre for Healthy Aging, Frankston, Victoria, Australia
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Nonurgent Visits to the Pediatric Emergency Department before and during the First Peak of the COVID-19 Pandemic. Int J Pediatr 2022; 2022:7580546. [PMID: 35242194 PMCID: PMC8886764 DOI: 10.1155/2022/7580546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 02/03/2022] [Indexed: 11/28/2022] Open
Abstract
Background Nonurgent visits in pediatric Emergency Departments are a growing burden. In order to find predictors for those nonurgent visits, we performed a retrospective analysis of unscheduled visits at the Pediatric Emergency Department of the University Hospital of Bonn, Germany, in the year 2017. Additionally, we compared these findings to unscheduled visits during the first peak of the worldwide pandemic of the Coronavirus disease 2019, to see if there would be an effect on nonurgent pediatric Emergency Department attendances. Methods For our retrospective cohort study, we analyzed more than 5.000 visits at the pediatric Emergency Department of the University Hospital of Bonn, Germany, before and during the first peak of the ongoing worldwide pandemic of the Coronavirus disease 2019, particularly with regard to their urgency. Data included gender, age, zip code, urgency, and preexisting conditions. Results Our study shows that more than half of unscheduled pediatric Emergency Department visits (69%) at the University Hospital in Bonn are for nonurgent reasons, with short living distance being a factor to present children to a pediatric Emergency Department, even with minor complaints. During the first peak of the pandemic of the Coronavirus disease 2019, nonurgent visits decreased significantly, potentially due to hesitation to attend a pediatric Emergency Department with minor issues, fearing an infection with SARS-CoV-2 at the hospital. Conclusion Many people use pediatric Emergency Departments for nonemergency complaints. In order to address the reasons for nonurgent visits to pediatric Emergency Departments and to prevent parents from doing so, further studies and targeted education concepts for parents are needed.
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Cleak H, Osborne SR, de Looze JWM. Exploration of clinicians’ decision-making regarding transfer of patient care from the emergency department to a medical assessment unit: A qualitative study. PLoS One 2022; 17:e0263235. [PMID: 35113942 PMCID: PMC8812931 DOI: 10.1371/journal.pone.0263235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 01/16/2022] [Indexed: 11/18/2022] Open
Abstract
Background Hospitals face immense pressures in balancing patient throughput. Medical assessment units have emerged as a commonplace response to improve the flow of medical patients presenting to the emergency department requiring hospital admission and to ease overcrowding in the emergency department. The aim of this study was to understand factors influencing the decision-making behaviour of key stakeholders involved in the transfer of care of medical patients from one service to the other in a large, tertiary teaching hospital in Queensland, Australia. Methods We used a qualitative approach drawing on data from focus groups with key informant health and professional staff involved in the transfer of care. A theoretically-informed, semi-structured focus group guide was used to facilitate discussion and explore factors impacting on decisions made to transfer care of patients from the emergency department to the medical assessment unit. Thematic analysis was undertaken to look for patterns in the data. Results Two focus groups were conducted with a total of 15 participants. Four main themes were identified: (1) we have a process—we just don’t use it; (2) I can do it, but can they; (3) if only we could skype them; and (4) why can’t they just go up. Patient flow relies on efficiency in two processes—the transfer of care and the physical re-location of the patient from one service to the other. The findings suggest that factors other than clinical reasoning are at play in influencing decision-making behaviour. Conclusions Acknowledgement of the interaction within and between professional and health staff (human factors) with the organisational imperatives, policies, and process (system factors) may be critical to improve efficiencies in the service and minimise the introduction of workarounds that might compromise patient safety.
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Affiliation(s)
- Helen Cleak
- School of Allied Health, Human Service and Sport, College of Science, Health & Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Sonya R. Osborne
- School of Nursing and Midwifery, Faculty of Health, Engineering and Sciences, Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Ipswich, Queensland, Australia
- * E-mail:
| | - Julian W. M. de Looze
- Department of Internal Medicine and Aged Care, Royal Brisbane and Women’s Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia
- School of Medicine, The University of Queensland, St. Lucia, Queensland, Australia
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They Told Me "This Isn't a Hotel": Young People's Experiences and Perceptions of Care When Presenting to the Emergency Department with Suicide-Related Behaviour. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031377. [PMID: 35162409 PMCID: PMC8834737 DOI: 10.3390/ijerph19031377] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/10/2022] [Accepted: 01/15/2022] [Indexed: 11/16/2022]
Abstract
In Australia, the number of young people presenting to the emergency department with mental health concerns, in particular, suicidal behaviour (defined here as suicidal ideation, thoughts, intent and attempts) is increasing. Little is known about the experiences of Australian young people who present to hospital emergency departments with suicidal behaviour. In this qualitative study, we conducted a series of focus groups with 55 young people aged 16–25 years, with a view to developing a framework for youth suicide prevention for Western Australia. The data were analysed using a general inductive analysis approach. We explored the experiences and perceptions of the care and management of 35 young people presenting to Western Australian hospital emergency departments. Participants described a range of negative experiences relating to the emergency department environment, staff attitudes and their treatment by staff. We argue that adapting ED practices and approaches to young people presenting with suicidal thoughts and behaviours based on these findings will result in lower rates of repeated presentations and admissions to hospital and lower rates of suicide attempts and deaths by suicide.
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Yao LH, Leung KC, Tsai CL, Huang CH, Fu LC. A Novel Deep Learning-Based System for Triage in the Emergency Department Using Electronic Medical Records: Retrospective Cohort Study. J Med Internet Res 2021; 23:e27008. [PMID: 34958305 PMCID: PMC8749584 DOI: 10.2196/27008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/21/2021] [Accepted: 10/26/2021] [Indexed: 12/15/2022] Open
Abstract
Background Emergency department (ED) crowding has resulted in delayed patient treatment and has become a universal health care problem. Although a triage system, such as the 5-level emergency severity index, somewhat improves the process of ED treatment, it still heavily relies on the nurse’s subjective judgment and triages too many patients to emergency severity index level 3 in current practice. Hence, a system that can help clinicians accurately triage a patient’s condition is imperative. Objective This study aims to develop a deep learning–based triage system using patients’ ED electronic medical records to predict clinical outcomes after ED treatments. Methods We conducted a retrospective study using data from an open data set from the National Hospital Ambulatory Medical Care Survey from 2012 to 2016 and data from a local data set from the National Taiwan University Hospital from 2009 to 2015. In this study, we transformed structured data into text form and used convolutional neural networks combined with recurrent neural networks and attention mechanisms to accomplish the classification task. We evaluated our performance using area under the receiver operating characteristic curve (AUROC). Results A total of 118,602 patients from the National Hospital Ambulatory Medical Care Survey were included in this study for predicting hospitalization, and the accuracy and AUROC were 0.83 and 0.87, respectively. On the other hand, an external experiment was to use our own data set from the National Taiwan University Hospital that included 745,441 patients, where the accuracy and AUROC were similar, that is, 0.83 and 0.88, respectively. Moreover, to effectively evaluate the prediction quality of our proposed system, we also applied the model to other clinical outcomes, including mortality and admission to the intensive care unit, and the results showed that our proposed method was approximately 3% to 5% higher in accuracy than other conventional methods. Conclusions Our proposed method achieved better performance than the traditional method, and its implementation is relatively easy, it includes commonly used variables, and it is better suited for real-world clinical settings. It is our future work to validate our novel deep learning–based triage algorithm with prospective clinical trials, and we hope to use it to guide resource allocation in a busy ED once the validation succeeds.
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Affiliation(s)
- Li-Hung Yao
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan
| | - Ka-Chun Leung
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan
| | - Chu-Lin Tsai
- Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chien-Hua Huang
- Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Li-Chen Fu
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan
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Chow A, Keng B, Guo H, Aung AH, Huang Z, Weng Y, Ang H. Sociodemographic and clinical factors, visit expectations and driving factors for emergency department attendance for uncomplicated upper respiratory tract infection. Emerg Med J 2021; 39:427-435. [PMID: 34949598 DOI: 10.1136/emermed-2021-211718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 12/14/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Upper respiratory tract infections (URTIs) account for substantial non-urgent ED attendances. Hence, we explored the reasons for such attendances using a mixed-methods approach. METHODS We interviewed adult patients with URTI who visited the second busiest adult ED in Singapore from June 2016 to November 2018 on their expectations and reasons for attendance. A structured questionnaire, with one open-ended question was used. Using the Andersen's Behavioural Model for Healthcare Utilisation, the topmost reasons for ED attendances were categorised into (1) contextual predisposing factors (referral by primary care physician, family, friends or coworkers), (2) contextual enabling factors (convenience, accessibility, employment requirements), (3) individual enablers (personal preference and trust in hospital-perceived care quality and efficiency) and (4) individual needs (perceived illness severity and non-improvement). Multivariable multinomial logistic regression was used to assess associations between sociodemographic and clinical factors, patient expectations for ED visits and the drivers for ED attendance. RESULTS There were 717 patients in the cohort. The mean age of participants was 40.5 (SD 14.7) years, 61.2% were males, 66.5% without comorbidities and 40.7% were tertiary educated. Half had sought prior medical consultation (52.4%) and expected laboratory tests (55.7%) and radiological investigations (46.9%). Individual needs (32.8%) and enablers (25.1%) were the main drivers for ED attendance. Compared with ED attendances due to contextual enabling factors, attendances due to other drivers were more likely to be aged ≥45 years, had prior medical consultation and expected radiological investigations. Having a pre-existing medical condition (adjusted OR (aOR) 1.78, 95% CI 1.05 to 3.04) and an expectation for laboratory tests (aOR 1.64, 95% CI 1.01 to 2.64) were associated with individual needs while being non-tertiary educated (aOR 2.04, 95% CI 1.22 to 3.45) and having pre-existing comorbidities (aOR 1.79, 95% CI 1.04 to 3.10) were associated with individual enablers. CONCLUSIONS Meeting individual needs of perceived illness severity or non-improvement was the topmost driver of ED visits for URTI, while contextual enabling factors such as convenience was the lowest. Patients' sociodemographic and clinical factors and visit expectations influence their motivations for ED attendances. Addressing these factors and expectations can alleviate the overutilisation of ED services.
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Affiliation(s)
- Angela Chow
- Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore .,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Bryan Keng
- Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore
| | - Huiling Guo
- Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore
| | - Aung Hein Aung
- Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore
| | - Zhilian Huang
- Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore
| | - Yanyi Weng
- Department of Emergency Medicine, Tan Tock Seng Hospital, Singapore
| | - Hou Ang
- Department of Emergency Medicine, Tan Tock Seng Hospital, Singapore
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Brain D, Johnson D, Hocking J, Chang AT. The economic impact of rostering junior doctors to triage to assist nursing staff in the early part of the patient journey through the emergency department. PLoS One 2021; 16:e0261303. [PMID: 34919596 PMCID: PMC8682888 DOI: 10.1371/journal.pone.0261303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 11/30/2021] [Indexed: 11/18/2022] Open
Abstract
Objective This study aims to determine whether redeploying junior doctors to assist at triage represents good value for money and a good use of finite staffing resources. Methods We undertook a cost-minimisation analysis to produce new evidence, from an economic perspective, about the costs associated with reallocating junior doctors in the emergency department. We built a decision-analytic model, using a mix of prospectively collected data, routinely collected administrative databases and hospital costings to furnish the model. To measure the impact of uncertainty on the model’s inputs and outputs, probabilistic sensitivity analysis was undertaken, using Monte Carlo simulation. Results The mean costs for usual care were $27,035 (95% CI $27,016 to $27,054), while the mean costs for the new model of care were $25,474, (95% CI $25,453 to $25,494). As a result, the mean difference was -$1,561 (95% CI -$1,533 to -$1,588), with the new model of care being a less costly approach to managing staffing allocations, in comparison to the usual approach. Conclusion Our study shows that redeploying a junior doctor from the fast-track area of the department to assist at triage provides a modest reduction in cost. Our findings give decision-makers who seek to maximise benefit from their finite budget, support to reallocate personnel within the ED.
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Affiliation(s)
- David Brain
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, School of Public Health & Social Work, Queensland University of Technology (QUT), Brisbane, Australia
- * E-mail:
| | - David Johnson
- Hervey Bay Hospital Emergency Department, Wide Bay Hospital and Health Service, Queensland Health, Queensland, Australia
| | - Julia Hocking
- Office for Research, Griffith University, Brisbane, Australia
| | - Angela T. Chang
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, School of Public Health & Social Work, Queensland University of Technology (QUT), Brisbane, Australia
- Centre for Allied Health Research, Royal Brisbane and Women’s Hospital, Brisbane, Australia
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Schäfer I, Menzel A, Oltrogge JH, Slagman A, Möckel M, Lühmann D, Scherer M. Is subjectively perceived treatment urgency of patients in emergency departments associated with self-reported health literacy and the willingness to use the GP as coordinator of treatment? Results from the multicentre, cross-sectional, observational study PiNo Bund. BMJ Open 2021; 11:e053110. [PMID: 34819288 PMCID: PMC8614139 DOI: 10.1136/bmjopen-2021-053110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Aim of this study was to analyse if subjectively perceived treatment urgency of patients in emergency departments is associated with self-reported health literacy and the willingness to use the general practitioner (GP) as coordinator of treatment. DESIGN A multicentre, cross-sectional, observational study. SETTING Emergency departments in five hospitals. Each hospital was visited 14 times representing two 8-hour shifts on each day of the week. Calendar dates were randomly assigned. PARTICIPANTS All patients of legal age registered at the emergency department or hospital reception desk. Exclusion criteria included immediate or very urgent need of treatment, high level of symptom burden and severe functional impairments in terms of hearing, vision and speech. We conducted standardised personal interviews. Additionally, clinical data were extracted from patient records. PRIMARY AND SECONDARY OUTCOME MEASURES Our target variable was subjectively perceived treatment urgency. Predictor variables included age, sex, education, health-related quality of life (EuroQol Five-Dimension Scale, value set UK), anxiety and depression (Hospital Anxiety and Depression Scale), somatic symptoms (Patient Health Questionnaire, 15 items version), self-reported health literacy (European Health Literacy Questionnaire, 16 questions version) and the commitment to the GP (Fragebogen zur Intensität der Hausarztbindung, 'F-HaBi'). Data were analysed by multilevel, multivariable linear regression adjusted for random effects at the hospital level. RESULTS Our sample comprised 276 patients with a mean age of 50.1 years and 51.8% women. A low treatment urgency (defined as 0-5 points on a Numerical Rating Scale) was reported by 111 patients (40.2%). In the final model, lower subjective treatment urgency was associated with male sex (β=0.84; 95% CI 0.11/1.57, p=0.024), higher health-related quality of life (-2.27 to -3.39/-1.15, p<0.001), lower somatic symptoms score (0.09, 0.004/0.17, p=0.040), higher anxiety score (-0.13 to -0.24/-0.01, p=0.027) and lower commitment to the GP (0.08, 0.01/0.14, p=0.029). CONCLUSIONS A lower level of subjectively perceived treatment urgency was predicted by a lower willingness to use the GP as coordinator of treatment. Self-reported health literacy did not predict the patients' urgency rating.
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Affiliation(s)
- Ingmar Schäfer
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Agata Menzel
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Hendrik Oltrogge
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Slagman
- Department of Emergency and Acute Medicine, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Martin Möckel
- Department of Emergency and Acute Medicine, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Dagmar Lühmann
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Scherer
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Duwalage KI, Burkett E, White G, Wong A, Thompson MH. Retrospective identification of latent subgroups of emergency department patients: A machine learning approach. Emerg Med Australas 2021; 34:252-262. [PMID: 34614544 DOI: 10.1111/1742-6723.13875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/05/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This research aims to (i) identify latent subgroups of ED presentations in Australian public EDs using a data-driven approach and (ii) compare clinical, socio-demographic and time-related characteristics of ED presentations broadly using the subgroups. METHODS We examined presentations to four public hospital EDs in Queensland from 2009 to 2014. An unsupervised machine learning algorithm, Clustering Large Applications, was used to cluster ED presentations. RESULTS There were six subgroups common across the EDs, primarily distinguishable by age, and subsequently by triage category, ED length of stay, arrival mode, departure status and several time-related attributes. Around 10% to 30% of the total presentations had high resource utilisation, with half of these from older patients (55+ years). ED resource utilisation per population was highest among the oldest cohort (75+ years). Children and young adults more frequently presented to the ED outside general-practitioner hours, mostly on Sundays. Older persons were more likely to present at any time, rather than specific hours, days or seasons. ED service performance measured against commonly used access-target indicators were rarely satisfied for older people and frequently satisfied for children. CONCLUSION Clustering Large Applications is effective in finding latent groups in large-scale mixed-type data, as demonstrated in the present study. Six types of ED presentations were identified and described using clinically relevant characteristics. The present study provides evidence for policy makers in Australia to develop alternative ED models of care tailored around the care needs of the differing groups of patients and thereby supports the sustainable delivery of acute healthcare.
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Affiliation(s)
- Kalpani I Duwalage
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.,Centre for Data Science, Queensland University of Technology, Brisbane, Queensland, Australia.,ARC Centre of Excellence for Mathematical and Statistical Frontiers, Melbourne, Victoria, Australia
| | - Ellen Burkett
- Emergency Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Queensland Government Clinical Excellence Division, Healthcare Improvement Unit, Brisbane, Queensland, Australia
| | - Gentry White
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.,Centre for Data Science, Queensland University of Technology, Brisbane, Queensland, Australia.,ARC Centre of Excellence for Mathematical and Statistical Frontiers, Melbourne, Victoria, Australia
| | - Andy Wong
- Emergency Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - M Helen Thompson
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.,Centre for Data Science, Queensland University of Technology, Brisbane, Queensland, Australia
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24
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Osborne S, Cleak H, White N, Lee X, Deacon A, de Looze JWM. Effectiveness of clinical criteria in directing patient flow from the emergency department to a medical assessment unit in Queensland, Australia: a retrospective chart review of hospital administrative data. BMC Health Serv Res 2021; 21:527. [PMID: 34051765 PMCID: PMC8164739 DOI: 10.1186/s12913-021-06537-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 05/17/2021] [Indexed: 11/13/2022] Open
Abstract
Background Medical Assessment Units (MAUs) have become a popular model of acute medical care to improve patient flow through timely clinical assessment and patient management. The purpose of this study was to determine the effectiveness of a consensus-derived set of clinical criteria for patient streaming from the Emergency Department (ED) to a 15-bed MAU within the highly capacity-constrained environment of a large quaternary hospital in Queensland, Australia. Methods Clinically coded data routinely submitted for inter-hospital benchmarking purposes was used to identify the cohort of medical admission patients presenting to the ED in February 2016 (summer) and June 2016 (winter). A retrospective review of patient medical records for this cohort was then conducted to extract MAU admission data, de-identified patient demographic data, and clinical criteria. The primary outcome was the proportion of admissions that adhered to the MAU admission criteria. Results Of the total of 540 included patients, 386 (71 %) patients were deemed to meet the MAU eligibility admission criteria. Among patients with MAU indications, 66 % were correctly transferred (95 % CI: 61 to 71) to the MAU; this estimated sensitivity was statistically significant when compared with random allocation (p-value < 0.001). Transfer outcomes for patients with contraindications were subject to higher uncertainty, with a high proportion of these patients incorrectly transferred to the MAU (73 % transferred; 95 % CI: 50 to 89 %; p-value = 0.052). Conclusions Based on clinical criteria, approximately two-thirds of patients were appropriately transferred to the MAU; however, a larger proportion of patients were inappropriately transferred to the MAU. While clinical criteria and judgement are generally established as the process in making decisions to transfer patients to a limited-capacity MAU, our findings suggest that other contextual factors such as bed availability, time of day, and staffing mix, including discipline profile of decision-making staff during ordinary hours and after hours, may influence decisions in directing patient flow. Further research is needed to better understand the interplay of other determinants of clinician decision making behaviour to inform strategies for improving more efficient use of MAUs, and the impact this has on clinical outcomes, length of stay, and patient flow measures in MAUs.
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Affiliation(s)
- Sonya Osborne
- School of Nursing and Midwifery, Centre for Health Research, Institute of Resilient Regions, University of Southern Queensland, 4305, Ipswich, Queensland, Australia. .,Australian Centre for Health Services Innovation, School of Public Health and Social Work, Queensland University of Technology, Queensland, 4059, Kelvin Grove, Australia.
| | - Helen Cleak
- Department of Community and Clinical Health, La Trobe University, 3086, Melbourne, Victoria, Australia
| | - Nicole White
- Australian Centre for Health Services Innovation, School of Public Health and Social Work, Queensland University of Technology, Queensland, 4059, Kelvin Grove, Australia
| | - Xing Lee
- Australian Centre for Health Services Innovation, School of Public Health and Social Work, Queensland University of Technology, Queensland, 4059, Kelvin Grove, Australia
| | - Anthony Deacon
- Department of Internal Medicine and Aged Care, Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, 4029, Herston, Queensland, Australia.,School of Medicine, The University of Queensland, 4067, St. Lucia, Queensland, Australia.,School of Electrical Engineering and Computer Science, Queensland University of Technology, Queensland, 4059, Kelvin Grove, Australia
| | - Julian W M de Looze
- Department of Internal Medicine and Aged Care, Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, 4029, Herston, Queensland, Australia.,School of Medicine, The University of Queensland, 4067, St. Lucia, Queensland, Australia
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25
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Therapeutic Applications of Stem Cells and Extracellular Vesicles in Emergency Care: Futuristic Perspectives. Stem Cell Rev Rep 2021; 17:390-410. [PMID: 32839921 PMCID: PMC7444453 DOI: 10.1007/s12015-020-10029-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Regenerative medicine (RM) is an interdisciplinary field that aims to repair, replace or regenerate damaged or missing tissue or organs to function as close as possible to its physiological architecture and functions. Stem cells, which are undifferentiated cells retaining self-renewal potential, excessive proliferation and differentiation capacity into offspring or daughter cells that form different lineage cells of an organism, are considered as an important part of the RM approaches. They have been widely investigated in preclinical and clinical studies for therapeutic purposes. Extracellular vesicles (EVs) are the vital mediators that regulate the therapeutic effects of stem cells. Besides, they carry various types of cargo between cells which make them a significant contributor of intercellular communication. Given their role in physiological and pathological conditions in living cells, EVs are considered as a new therapeutic alternative solution for a variety of diseases in which there is a high unmet clinical need. This review aims to summarize and identify therapeutic potential of stem cells and EVs in diseases requiring acute emergency care such as trauma, heart diseases, stroke, acute respiratory distress syndrome and burn injury. Diseases that affect militaries or societies including acute radiation syndrome, sepsis and viral pandemics such as novel coronavirus disease 2019 are also discussed. Additionally, featuring and problematic issues that hamper clinical translation of stem cells and EVs are debated in a comparative manner with a futuristic perspective. Graphical Abstract.
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Knights E, Gorman V, Mitra B, Gray R. Emergency department nurse call back: A quality improvement project. Int Emerg Nurs 2021; 56:101001. [PMID: 33848792 DOI: 10.1016/j.ienj.2021.101001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 02/18/2021] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Early detection of clinical deterioration after discharge from the Emergency Department may facilitate timely intervention and improve patient outcomes. METHODS A quality improvement project to evaluate nurse call back offered to all patients within 72 h of discharge to community (usual residence) from an Emergency Department. All patients of all ages that were assessed, managed by a physician and discharged to their home from an Emergency Department were eligible. A standard algorithm and flow chart was used for all call backs. Call back refers to the follow up phone call by a Registered Nurse from the Emergency Department following patient discharge. The aim of call back is to enhance the early recognition of deteriorating patients. Project outcomes were the proportion of patients who were contacted by phone by a nurse post discharge and the proportion of patients that met deterioration criteria. The project was conducted over a six month period. RESULTS There were 1139 patients eligible. Call back was attempted for 893 patients of which 716 (80%) were contacted. Deterioration was identified in 34 of 716 (5%) patients, two were advised to attend their general practitioner, and 32 were directed to present to an Emergency Department. Of the 32 recalled patients, 26 represented to the original Emergency Department and 12 were admitted following the call back, an admission rate of 46% (95% CI:28.7-64.5) of those that represented. CONCLUSIONS It was feasible to implement a nurse call back in an Emergency Department. Nurse call back has the potential to reduce times to re-presentation of an emergency, thereby mitigating adverse events, preventing complications. Further evaluation is warranted.
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Affiliation(s)
- Emily Knights
- Northpark Private Hospital, 10 Greenhills Road, Bundoora, Melbourne, Australia; School of Nursing and Midwifery, La Trobe University, Corner Plenty Road and Kingsbury Drive, Bundoora, Melbourne, Australia
| | - Vanessa Gorman
- The Royal Womens Hospital, 20 Flemington Road, Parkville, Melbourne, Australia
| | - Biswadev Mitra
- Northpark Private Hospital, 10 Greenhills Road, Bundoora, Melbourne, Australia; School of Public Health & Preventive Medicine, Monash University, Wellington Road, Clayton, Melbourne, Australia
| | - Richard Gray
- School of Nursing and Midwifery, La Trobe University, Corner Plenty Road and Kingsbury Drive, Bundoora, Melbourne, Australia.
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Sadka N, Lee V, Ryan A. Purpose, Pleasure, Pace and Contrasting Perspectives: Teaching and Learning in the Emergency Department. AEM EDUCATION AND TRAINING 2021; 5:e10468. [PMID: 33796807 PMCID: PMC7995923 DOI: 10.1002/aet2.10468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 05/02/2020] [Accepted: 05/04/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Teaching and learning in the clinical setting are vital for the training and development of emergency physicians. Increasing service provision and time pressures in the emergency department (ED) have led to junior trainees' perceptions of a lack of teaching and a lack of support during clinical shifts. We sought to explore the perceptions of learners and supervisors in our ED regarding teaching within this diverse and challenging context. METHODS Nine ED physicians and eight ED trainees were interviewed to explore perceptions of teaching in the ED. Clinical teaching was described as "on-the-floor" teaching during work shifts. We used a validated clinical teaching assessment instrument to help pilot and develop some of our interview questions, and data were analyzed using qualitative thematic analysis. RESULTS We identified three major themes in our study: 1) the strong sense of purpose and the pleasure gained through teaching and learning interactions, despite both groups being unsure of each other's engagement and enthusiasm; 2) contrasting perspectives of teaching with registrars holding a traditional knowledge transmission view, yet shared perspectives of teacher as being ED consultants; and 3) the effect of patient acuity and volume, which both facilitated learning until a critical point of busyness beyond which service provision pressures and staffing limitations were perceived to negatively impact learning. CONCLUSIONS The ED is a complex and fluid working and learning environment. We need to develop a shared understanding of teaching and learning opportunities in the ED, which helps all stakeholders move beyond learning as knowledge acquisition and sees the potential for learning from teachers of a multitude of professional backgrounds.
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Affiliation(s)
- Nancy Sadka
- From theEmergency Medicine TrainingAustin HealthHeidelbergVictoriaAustralia
| | - Victor Lee
- From theEmergency Medicine TrainingAustin HealthHeidelbergVictoriaAustralia
| | - Anna Ryan
- and theMelbourne Medical SchoolUniversity of MelbourneMelbourneVictoriaAustralia
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Trivedi S, Littmann J, Stempien J, Kapur P, Bryce R, Betz M. A Comparison Between Computer-Assisted Self-Triage by Patients and Triage Performed by Nurses in the Emergency Department. Cureus 2021; 13:e14002. [PMID: 33884243 PMCID: PMC8053390 DOI: 10.7759/cureus.14002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background and objective Emergency departments (EDs) often find the number of arriving patients exceeding their capacity and find it difficult to triage them in a timely manner. The potential risk to the safety of patients awaiting assessment by a triage professional has led some hospitals to consider implementing patient self-triage, such as using kiosks. Published studies about patient self-triage are scarce and information about patients’ ability to accurately assess the acuity of their condition or predict their need to be hospitalized is limited. In this study, we aimed to compare computer-assisted patient self-triage scores versus the scores assigned by the dedicated ED triage nurse (TN). Methods This pilot study enrolled patients presenting to a tertiary care hospital ED without ambulance transport. They were asked a short series of simple questions based on an algorithm, which then generated a triage score. Patients were asked whether they were likely to be admitted to the hospital. Patients then entered the usual ED system of triage. The algorithm-generated triage score was then compared with the Canadian Triage and Acuity Scale (CTAS) score assigned by the TN. Whether the patients actually required hospital admission was determined by checking their medical records. Results Among the 492 patients enrolled, agreement of triage scores was observed in 27%. Acuity was overestimated by 65% of patients. Underestimation of acuity occurred in 8%. Among patients predicting hospitalization, 17% were admitted, but the odds ratio (OR) for admission was 3.4. Half of the patients with cardiorespiratory complaints were correct in predicting the need for hospitalization. Conclusion The use of a short questionnaire by patients to self-triage showed limited accuracy, but sensitivity was high for some serious medical conditions. The prediction of hospitalization was more accurate with regard to cardiorespiratory complaints.
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Affiliation(s)
- Sachin Trivedi
- Emergency Medicine, Royal University Hospital, University of Saskatchewan, Saskatoon, CAN
| | | | - James Stempien
- Emergency Medicine, University of Saskatchewan, Saskatoon, CAN
| | - Puneet Kapur
- Emergency Medicine, Jim Pattison Children's Hospital, University of Saskatchewan, Saskatoon, CAN
| | - Rhonda Bryce
- Clinical Research Support Unit, University of Saskatchewan, Saskatoon, CAN
| | - Martin Betz
- Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, CAN
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Ferreira GE, Herbert R, Machado GC, Richards B, Harris IA, O'Keeffe M, Zadro JR, Maher CG. Low back pain presentations to New South Wales emergency departments: Trends over time and geographical variation. Emerg Med Australas 2021; 33:868-874. [PMID: 33618430 DOI: 10.1111/1742-6723.13745] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine whether rates of ED presentations because of low back pain (LBP) have increased from 2016 to 2019 in New South Wales and map the geographical distribution of ED presentations because of LBP across New South Wales. METHODS We sourced data from the New South Wales Emergency Department Records for Epidemiology. We included all ED presentations aged 15 years and older with a diagnosis of LBP to the 178 public EDs across New South Wales from 1 January 2016 to 31 December 2019. We calculated the ratio (95% confidence interval) between the 2016 and 2019 age-standardised rates to determine whether an increase in the rate of ED LBP presentations has occurred. To assess geographical variation, we aggregated presentations by their home postcode. We calculated age-standardised rates per 100 000 person year for each of those areas using data from 2016 to 2019. RESULTS We included 188 275 LBP presentations for patients aged 15 years or older. Their mean (standard deviation) age was 51.3 (20.0) years. From 2016 to 2019, we observed a 5.3% increase in the age-adjusted LBP ED presentation rates (age-standardised ratio 1.05, 95% confidence interval 1.04-1.06). We found a 20-fold variation in LBP ED age-standardised presentation rates across the different local government areas of New South Wales. Higher rates were mostly observed in rural and regional areas. CONCLUSIONS The demand for ED services because of LBP has increased in New South Wales over time, and we observed a 20-fold variation in presentation rates across different regions.
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Affiliation(s)
- Giovanni E Ferreira
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Rob Herbert
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia.,Neuroscience Research Australia, The University of New South Wales, Sydney, New South Wales, Australia
| | - Gustavo C Machado
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Bethan Richards
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Ian A Harris
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia.,Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.,Orthopaedic Department, South Western Sydney Local Health District, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Mary O'Keeffe
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Joshua R Zadro
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Chris G Maher
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
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Hellawell HN, Kyriacou H, Sumal AS. Twelve tips to maximise medical student learning during emergency medicine placements. MEDICAL TEACHER 2021; 43:148-151. [PMID: 32521189 DOI: 10.1080/0142159x.2020.1774531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Placements in the emergency department provide medical students with countless clinical and practical learning opportunities. However, medical education may not always be optimised for students in this busy, potentially overwhelming environment. Prior knowledge of how to make the most of emergency medicine placements helps to facilitate student learning and enjoyment. In this article, the authors compiled twelve tips based on the relevant literature and their experiences on emergency attachments. These tips will better prepare medical students for their emergency medicine placements and ensure that they experience the full benefits of working in the emergency department.
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Affiliation(s)
- Holly N Hellawell
- School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Harry Kyriacou
- School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Anoop S Sumal
- School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
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Kok MR, Tuson M, Yap M, Turlach B, Boruff B, Vickery A, Whyatt D. Impact of the modifiable areal unit problem in assessing determinants of emergency department demand. Emerg Med Australas 2021; 33:794-802. [PMID: 33517585 DOI: 10.1111/1742-6723.13727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 12/22/2020] [Accepted: 01/01/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine the impact of the modifiable areal unit problem (MAUP) in an investigation of factors associated with ED demand in Perth, Western Australia, in 2016. Furthermore, to advocate a means of avoiding this impact. METHODS ED presentations were classified as: urgent medical, non-urgent medical, urgent trauma or non-urgent trauma. In each group, sex-stratified, age-adjusted multivariate associations with socio-economic status and distance to the nearest ED and general practitioner (GP) were estimated. Modelling was undertaken using different sets of spatial units: Australian Bureau of Statistics (ABS) Statistical Areas Level 1 (SA1s) and numerous aggregate-level zonations of SA1s (ABS SA2s and others). RESULTS Estimates obtained using the different units often varied widely: for seven (30%) of 24 strata defined by combinations of sex, ED type and covariate, the smallest and largest effect sizes differed in terms of direction; further, for 11 (65%) of the remaining 17 strata, the largest effect size was at least twice as high as the smallest. This demonstrates the MAUP's impact and that analyses based on a single set of spatial units are unreliable. To resolve the observed variation, we highlight the SA1-level estimates. CONCLUSIONS When formulating interventions targeting reduced ED utilisation, policy planners should be guided by evidence based on analysis of appropriate spatial units. This ideal is undermined by the widespread lack of acknowledgement of the MAUP in studies examining drivers of ED demand using spatially aggregated data. To avoid the MAUP, only estimates obtained through examining a minimal geographic unit should be relied upon.
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Affiliation(s)
- Mei Ruu Kok
- Division of General Practice, Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Matthew Tuson
- Division of General Practice, Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia.,Department of Mathematics and Statistics, Faculty of Engineering and Mathematical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Matthew Yap
- Division of General Practice, Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Berwin Turlach
- Department of Mathematics and Statistics, Faculty of Engineering and Mathematical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Bryan Boruff
- Department of Geography, Faculty of Arts, Business, Law and Education, The University of Western Australia, Perth, Western Australia, Australia.,UWA School of Agriculture and Environment, Faculty of Science, The University of Western Australia, Perth, Western Australia, Australia
| | - Alistair Vickery
- Division of General Practice, Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - David Whyatt
- Division of General Practice, Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
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O'Donnell R, Savaglio M, Skouteris H, Banaszak-Holl J, Moranl C, Morris H, Vicary D, Ayton D. The Effectiveness of Transition Interventions to Support Older Patients From Hospital to Home: A Systematic Scoping Review. J Appl Gerontol 2020; 40:1628-1636. [PMID: 33155499 DOI: 10.1177/0733464820968712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Interventions supporting older adults' transition from hospital to home can address geriatric needs. Yet this evidence base is fragmented. This review describes transitional interventions that provide pre- and post-discharge support for older adults and evaluates their implementation and effectiveness in improving health and well-being. METHOD Articles were included if they examined the extent to which transitional interventions were effective in improving health and well-being outcomes and reducing hospital readmission rates among older adults. RESULTS Twenty studies met the inclusion criteria. Four types of interventions were identified: education-based (10/20); goal-oriented (4/20); exercise (4/20); and social support interventions (2/20). Education and goal-oriented interventions were effective in improving health and well-being outcomes. The impact of interventions on mitigating hospital readmissions was inconclusive. Only five studies examined implementation. DISCUSSION Older adults transitioning from hospital to home would benefit from tailored education and goal-oriented interventions that promote their capacity for self-care.
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Affiliation(s)
| | | | - Helen Skouteris
- Monash University, Clayton, Victoria, Australia.,Warwick University, Coventry, UK
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Middleton PM, Moore N, Ren S. Lost bed capacity in emergency departments: A descriptive analysis and data visualisation exploration. Emerg Med Australas 2020; 33:310-315. [PMID: 33051981 DOI: 10.1111/1742-6723.13633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 08/10/2020] [Accepted: 08/17/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To map utilisation of bed resources within an ED over time, in order to determine the proportions of patient stay spent receiving emergency care versus non-emergent care. To produce visualisations that effectively convey this bed utilisation. METHODS This was a retrospective cohort study using routinely collected administrative data, derived from the ED electronic health record (FirstNet; Cerner, North Kansas City, MO, USA), on all patients presenting to a single tertiary-level ED during a 1-month period and who were triaged to an acute area bed in order to undergo their emergency care. Resuscitation, subacute, fast track and paediatric area patients were excluded from analysis as firstly, in our institution the acute area processing appears to contribute most to barriers to patient flow and secondly, using acute area patients allowed us to approximate standardisation of acuity. Lost bed capacity (LBC) was defined as the time spent in an ED bed after an emergency clinician indicated that they were ready to depart the ED, as recorded in the electronic medical record. RESULTS The overall proportion of time spent in an ED bed after completion of emergency care was 38.5% (interquartile range 21.8-47.2%). This time differed significantly between 'discharged' (1 min), 'admitted-ward' (72 min) and 'admitted-critical care' (110 min) groups. This was clearly revealed in our novel LBC heatmaps. CONCLUSIONS A considerable proportion of ED length of stay is because of patients remaining in an ED bed after their emergency care is concluded. Absolute time is much greater for admitted patients than for discharged patients, and therefore efforts to reduce LBC are likely to reduce overall ED length of stay. LBC heatmaps may provide an intuitively useful, potentially automated tool to understand these problems.
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Affiliation(s)
- Paul M Middleton
- South Western Emergency Research Institute, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Nicholas Moore
- South Western Emergency Research Institute, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Shiquan Ren
- South Western Emergency Research Institute, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
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Cai X, Wu J, Chen J, Sun J, Li P. The "two-step four-level + " pediatric triage method in a medical center in Southern China. J SPEC PEDIATR NURS 2020; 25:e12305. [PMID: 32702207 DOI: 10.1111/jspn.12305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 06/04/2020] [Accepted: 07/09/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Because the quality of medical resources is extremely uneven across China, it is nearly impossible to implement a unified emergency triage program. The aim of the study is to examine triage using the "two-step four-level+ " triage model in a hospital in Southern China, with an emphasis on hand, foot, and mouth disease. DESIGN AND METHODS This was a retrospective study of all patients seen in the pediatric emergency room (ER) between January 1, 2012 and December 31, 2018, at the Guangzhou Women and Children's Medical Center. The "two-step and four-level+ " was manually implemented in 2012, and an electronic triage system was developed and applied since 2015. Emergency quality control indicators were analyzed. RESULTS There were 645,473 patients triaged at the pediatric ER between January 1, 2015 and December 31, 2018. After the first step, 17,444 patients were classified as unstable, including 6546 (1.01%) Level I patients, 10,898 (1.69%) Level II patients, 210,368 (32.5%) Level III patients, and 417,661 (64.8%) Level IV patients. After triage implementation, the stay time of the patient in the pediatric ER decreased each year (all p < .05) and shortened to 20.3 ± 2.2 h in 2018. Compared with 2012-2014, the mortality of 2015-2018 decreased by 21.1%, the rate of unexpected resuscitation was 0%, and the complaints of overcrowding decreased (all p < .05). PRACTICE IMPLICATIONS This "two-step four-level+ " triage method can improve the medical care quality of pediatric ER in China.
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Affiliation(s)
- Xian Cai
- Department of Pediatric Emergency, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jinxia Wu
- Department of Pediatric Emergency, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jiechan Chen
- Department of Pediatric Emergency, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jing Sun
- Department of Pediatric Emergency, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Peiqing Li
- Department of Pediatric Emergency, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
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Ayton D, O'Donnell R, Vicary D, Bateman C, Moran C, Srikanth VK, Lustig J, Banaszak-Holl J, Hunter P, Pritchard E, Morris H, Savaglio M, Parikh S, Skouteris H. Psychosocial volunteer support for older adults with cognitive impairment: development of MyCare Ageing using a codesign approach via action research. BMJ Open 2020; 10:e036449. [PMID: 32994233 PMCID: PMC7526312 DOI: 10.1136/bmjopen-2019-036449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Older adults with cognitive impairment are vulnerable to frequent hospital admissions and emergency department presentations. The aim of this study was to use a codesign approach to develop MyCare Ageing, a programme that will train volunteers to provide psychosocial support to older people with dementia and/or delirium in hospital and at home when discharged from hospital. SETTING Melbourne, Victoria, Australia. RESEARCH DESIGN This study adopts an action research methodology. We report on two co-design workshops with keystakeholders: Workshop 1: identification of components from three existing programmes to inform the development of the MyCare Ageing program logic and, Workshop 2: identification of implementation strategies. PARTICIPANTS The key stakeholders and workshop participants included clinicians (geriatricians, nurses and allied health), hospital staff (volunteer coordinators and hospital executives), Baptcare staff, a consumer, researchers and implementation experts and project staff. RESULTS Workshop 1 identified the components from three existing programmes-the Volunteer Dementia and Delirium Care programme, Home-Start and MyCare for inclusion in MyCare Ageing. In workshop 2, the p implementation plan was developed taking into consideration hospital-specific processes, training and support needs of volunteers and safety and risk management processes. DISCUSSION AND CONCLUSION The codesign process was successfully applied to develop the MyCare Ageing programme to provide volunteer support to patients with dementia and/or delirium in hospital and their transition home. MyCare Ageing is an innovative programme that meets an identified need from hospitals and consumers to support patients with dementia and/or delirium to improve psychosocial outcomes on discharge from hospital.
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Affiliation(s)
- Darshini Ayton
- Monash Centre for Health Research and Implementation, Monash University, Melboune, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Renée O'Donnell
- Monash Centre for Health Research and Implementation, Monash University, Melboune, Victoria, Australia
| | - Dave Vicary
- Victoria Family & Community Services Service & Operations, Baptcare, Melbourne, Victoria, Australia
| | - Catherine Bateman
- Southern New South Wales Local Health District, Queanbeyan, New South Wales, Australia
| | - Chris Moran
- Peninsula Clinical School, Monash University, Frankston, Victoria, Australia
| | - Velandai K Srikanth
- Peninsula Clinical School, Monash University, Frankston, Victoria, Australia
| | - Julie Lustig
- Rehabilitation and Aged Care Services, Monash Health, Clayton, Victoria, Australia
| | - Jane Banaszak-Holl
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Peter Hunter
- Rehabilitation, Aged and Community Care, Alfred Health, Melbourne, Victoria, Australia
| | - Elizabeth Pritchard
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Heather Morris
- Monash Centre for Health Research and Implementation, Monash University, Melboune, Victoria, Australia
| | - Melissa Savaglio
- Monash Centre for Health Research and Implementation, Monash University, Melboune, Victoria, Australia
| | - Seema Parikh
- Department of Aged Care Services, Alfred Health, Melbourne, Victoria, Australia
| | - Helen Skouteris
- Monash Centre for Health Research and Implementation, Monash University, Melboune, Victoria, Australia
- University of Warwick, Coventry, West Midlands, UK
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Driesen BEJM, Merten H, Wagner C, Bonjer HJ, Nanayakkara PWB. Unplanned return presentations of older patients to the emergency department: a root cause analysis. BMC Geriatr 2020; 20:365. [PMID: 32962646 PMCID: PMC7510142 DOI: 10.1186/s12877-020-01770-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 09/10/2020] [Indexed: 12/02/2022] Open
Abstract
Background In line with demographic changes, there is an increase in ED presentations and unplanned return presentations by older patients (≥70 years). It is important to know why these patients return to the ED shortly after their initial presentation. Therefore, the aim of this study was to provide insight into the root causes and potential preventability of unplanned return presentations (URP) to the ED within 30 days for older patients. Methods A prospective observational study was conducted from February 2018 to November 2018 in an academic hospital in Amsterdam. We included 83 patients, aged 70 years and older, with an URP to the ED within 30 days of the initial ED presentation. Patients, GPs and doctors at the ED were interviewed by trained interviewers and basic administrative data were collected in order to conduct a root cause analysis using the PRISMA-method. Results One hundred fifty-one root causes were identified and almost half (49%) of them were disease-related. Fifty-two percent of the patients returned to the ED within 7 days after the initial presentation. In 77% of the patients the URP was related to the initial presentation. Patients judged 17% of the URPs as potentially preventable, while doctors at the ED judged 25% and GPs 23% of the URPs as potentially preventable. In none of the cases, there was an overall agreement from all three perspectives on the judgement that an URP was potentially preventable. Conclusion Disease-related factors were most often identified for an URP and half of the patients returned to the ED within 7 days. The majority of the URPs was judged as not preventable. However, an URP should trigger healthcare workers to focus on the patient’s process of care and their needs and to anticipate on potential progression of disease. Future research should assess whether this may prevent that patients have to return to the ED.
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Affiliation(s)
- Babiche E J M Driesen
- Department of Emergency Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands. .,Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam, 1081 BT, The Netherlands.
| | - Hanneke Merten
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam, 1081 BT, The Netherlands
| | - Cordula Wagner
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam, 1081 BT, The Netherlands.,Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118-124, Utrecht, 3513 CR, The Netherlands
| | - H Jaap Bonjer
- Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands
| | - Prabath W B Nanayakkara
- Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands
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Connell CJ, Endacott R, Cooper S. The prevalence and management of deteriorating patients in an Australian emergency department. Australas Emerg Care 2020; 24:112-120. [PMID: 32917577 DOI: 10.1016/j.auec.2020.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/22/2020] [Accepted: 07/30/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Complex human and system factors impact the effectiveness of Rapid Response Systems (RRS). Emergency Department (ED) specific RRS are relatively new and the factors associated with their effectiveness are largely unknown. This study describes the period prevalence of deterioration and characteristics of care for deteriorating patients in an Australia ED and examine relationships between system factors and escalation of care. METHODS A retrospective medical record audit of all patients presenting to an Australian ED in two weeks. RESULTS Period prevalence of deterioration was 10.08% (n=269). Failure to escalate care occurred in nearly half (n=52, 47.3%) of the patients requiring a response (n=110). Appropriate escalation practices were associated with where the patient was being cared for (p=0.01), and the competence level of the person documenting deterioration (p=0.005). Intermediate competence level nurses were nine times more likely to escalate care than novices and experts (p=0.005). While there was variance in escalation practice related to system factors, these associations were not statistically significant. CONCLUSION The safety of deteriorating ED patients may be improved by informing care based on the escalation practices of staff with intermediate ED experience and competence levels.
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Affiliation(s)
- Clifford J Connell
- Monash Nursing and Midwifery, Monash University, PO Box 527, Frankston, VIC 3199, Australia.
| | - Ruth Endacott
- Monash Nursing and Midwifery, Monash University, PO Box 527, Frankston, VIC 3199, Australia; School of Nursing and Midwifery, University of Plymouth, Drake Circus, Plymouth PL4 8AA, United Kingdom.
| | - Simon Cooper
- School of Nursing and Health Professions, Federation University, Gippsland Campus, Churchill, VIC 3842, Australia.
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Johnston ANB, Cabilan CJ, Galbraith S, Mason D, Farma C, Kunst E, Taurima K. What impact does Magnet designation have on emergency department nurses' outcomes? A scoping review. Int Emerg Nurs 2020; 52:100908. [PMID: 32827933 DOI: 10.1016/j.ienj.2020.100908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/31/2020] [Accepted: 08/05/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Amy N B Johnston
- Emergency Department, Princess Alexandra Hospital, 4102 Brisbane, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, 4067 Brisbane, Australia.
| | - C J Cabilan
- Emergency Department, Princess Alexandra Hospital, 4102 Brisbane, Australia. http://orcid.org//0000-0001-8465-8026
| | - Sue Galbraith
- Emergency Department, Princess Alexandra Hospital, 4102 Brisbane, Australia
| | - Dale Mason
- Emergency Department, Princess Alexandra Hospital, 4102 Brisbane, Australia
| | - Charandeep Farma
- School of Nursing, Midwifery and Social Work, University of Queensland, 4067 Brisbane, Australia
| | - Elicia Kunst
- School of Nursing, Southern Cross University, Bilinga 4225, QLD, Australia. http://orcid.org/0000-0002-2609-8347
| | - Karen Taurima
- Emergency Department, Princess Alexandra Hospital, 4102 Brisbane, Australia
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Yaghmaei E, Ehwerhemuepha L, Feaster W, Gibbs D, Rakovski C. A multicenter mixed-effects model for inference and prediction of 72-h return visits to the emergency department for adult patients with trauma-related diagnoses. J Orthop Surg Res 2020; 15:331. [PMID: 32795327 PMCID: PMC7427714 DOI: 10.1186/s13018-020-01863-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/04/2020] [Indexed: 11/10/2022] Open
Abstract
Objective Emergency department (ED) return visits within 72 h may be a sign of poor quality of care and entail unnecessary use of healthcare resources. In this study, we compare the performance of two leading statistical and machine learning classification algorithms, and we use the best performing approach to identify novel risk factors of ED return visits. Methods We analyzed 3.2 million ED encounters with at least one diagnosis under “injury, poisoning and certain other consequences of external causes” and “external causes of morbidity.” These encounters included patients 18 years or older from across 128 emergency room facilities in the USA. For each encounter, we calculated the 72-h ED return status and retrieved 57 features from demographics, diagnoses, procedures, and medications administered during the process of administration of medical care. We implemented a mixed-effects model to assess the effects of the covariates while accounting for the hierarchical structure of the data. Additionally, we investigated the predictive accuracy of the extreme gradient boosting tree ensemble approach and compared the performance of the two methods. Results The mixed-effects model indicates that certain blunt force and non-blunt trauma inflates the risk of a return visit. Notably, patients with trauma to the head and patients with burns and corrosions have elevated risks. This is in addition to 11 other classes of both blunt force and non-blunt force traumas. In addition, prior healthcare resource utilization, patients who have had one or more prior return visits within the last 6 months, prior ED visits, and the number of hospitalizations within the 6 months are associated with increased risk of returning to the ED after discharge. On the one hand, the area under the receiver characteristic curve (AUROC) of the mixed-effects model was 0.710 (0.707, 0.712). On the other hand, the gradient boosting tree ensemble had a lower AUROC of 0.698 CI (0.696, 0.700) on the independent test model. Conclusions The proposed mixed-effects model achieved the highest known AUC and resulted in the identification of novel risk factors. The model outperformed one of the leading machine learning ensemble classifiers, the extreme gradient boosting tree in terms of model performance. The risk factors we identified can assist emergency departments to decrease the number of unplanned return visits within 72 h.
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Affiliation(s)
- Ehsan Yaghmaei
- CHOC Children's, Orange, CA, 92868, USA.,Schmid College of Science & Technology, Chapman University, Orange, CA, USA
| | - Louis Ehwerhemuepha
- CHOC Children's, Orange, CA, 92868, USA. .,Schmid College of Science & Technology, Chapman University, Orange, CA, USA.
| | | | | | - Cyril Rakovski
- Schmid College of Science & Technology, Chapman University, Orange, CA, USA
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Castriotta L, Giangreco M, Cogliati-Dezza MG, Spanò M, Atrigna E, Ehrenfreund C, Rosolen V, Paoletti F, Barbone F. Measuring the impact of a social programme on healthcare: a 10-year retrospective cohort study in Trieste, Italy. BMJ Open 2020; 10:e036857. [PMID: 32709652 PMCID: PMC7413194 DOI: 10.1136/bmjopen-2020-036857] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Poor social conditions are strong determinants of poor health but positive health and healthcare changes caused by social interventions are difficult to demonstrate. In 2006, in Trieste (Italy), a social intervention known as 'Habitat Microaree' (HM) project was implemented in eight deprived neighbourhoods. In 2016, an observational study was launched to assess the impact of the HM project on healthcare. DESIGN Retrospective cohort study. SETTING The eight geographically defined neighbourhoods of Trieste involved in the 2006 HM project, accounting for a total of 11 380 residents. PARTICIPANTS Participants were all residents in the intervention areas. By means of a propensity score based on deprivation index, age, sex, Charlson index and drug utilisation, a non-participating, comparison group was defined. INTERVENTION The community-based intervention consisted of facilitating access to social services and outpatient healthcare facilities, coordinating intersectoral public services and specifically planning hospital discharge. These services were not provided in other areas of the city. OUTCOME MEASURES Hospital admissions and emergency department access. RESULTS We followed 16 256 subjects between 2008 and 2015. Living in microareas was associated with an HR for first hospital admission, for all causes, of 0.95 (95% CI 0.91 to 0.99); while the HR for urgent admissions in females was 0.92 (95% CI 0.85 to 1.00). The HR for psychiatric disorders, in females, was 0.39 (95%CI 0.18 to 0.82); in particular, the HR for psychosis was 0.15 (95% CI 0.05 to 0.51). The HR for acute respiratory diseases in females was 0.44 (95% CI 0.21 to 0.95). In males, the HR for genitourinary diseases and heart diseases were 0.65 (95% CI 0.42 to 1.01) and 0.72 (95% CI 0.54 to 0.97), respectively. Concerning urgent multiple admissions, the OR for fractures in females was 0.75 (95% CI 0.58 to 0.97). CONCLUSION In the study period, the effects on healthcare appear evident, especially in females.
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Affiliation(s)
- Luigi Castriotta
- Istituto di Igiene ed Epidemiologia Clinica, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Manuela Giangreco
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo" - Trieste, Trieste, Italy
| | | | - Marco Spanò
- Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Enrico Atrigna
- Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | | | - Valentina Rosolen
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo" - Trieste, Trieste, Italy
| | - Flavio Paoletti
- Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Fabio Barbone
- Department Medical Area - DAME, Università degli Studi di Udine, Udine, Italy
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Gomes JCP, Dias RD, de Barros JV, Velasco IT, Jacob Filho W. The growing impact of older patients in the emergency department: a 5-year retrospective analysis in Brazil. BMC Emerg Med 2020; 20:47. [PMID: 32527325 PMCID: PMC7291438 DOI: 10.1186/s12873-020-00341-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 05/25/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The average age of the global population is rising at an increasing rate. There is a disproportional increase in Emergency Department (ED) visits by older people worldwide. In the Brazilian health system, complex and severely ill patients and those requiring specialized urgent procedures are referred to tertiary level care. As far as we know, no other study in Latin America has analyzed the impact of demographic changes in tertiary ED attendance. AIM To describe the sociodemographic characteristics and outcomes of tertiary Brazilian ED users. METHODS Design: Observational cross-sectional analytic study. SETTING Emergency Department, tertiary university hospital, São Paulo, Brazil. PARTICIPANTS patients aged 18 years or older attending a tertiary ED (2009-2013). The primary outcomes were hospitalization and mortality; the secondary outcome was ICU admission. Age was categorized as 'young adults' (18-39y), 'adults' (40-59y), 'young-older adults' (60-79y), and 'old-older adults' (80-109y). Other variables included sex, reason for attendance, time of ED visit, mode of presentation, type of hospitalization, main procedure, length of hospital stay (LOS) and length of ICU stay (ICU-LOS). We calculated descriptive statistics, built generalized linear mixed models for each outcome and estimated Odds Ratios (95% CI) for the independent categorical variables. The significance level was 5% with Bonferroni correction. RESULTS Older age-groups represented 26.6% of 333,028 ED visits, 40.7% of admissions, 42.7% of ICU admissions and 58% of all deaths. Old-older patients accounted for 5.1% of ED visits, 9.5% of admissions and 10.1% of ICU admissions. Hospitalization, ICU admission and mortality rates increased with older age in both sexes. LOS and ICU-LOS were similar across age-groups. The proportions of visits and admissions attributed to young adults decreased annually, while those of people aged 60 or over increased. The ORs for hospitalization, ICU admission and mortality associated with the old-older group were 3.49 (95% CI = 3.15-3.87), 1.27 (1.15-1.39) and 5.93 (5.29-6.66) respectively, with young adults as the reference. CONCLUSIONS In tertiary ED, age is an important risk factor for hospitalization and mortality, but not for ICU admission. Old-older people are at the greatest risk and demand further subgroup stratification.
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Affiliation(s)
- João Carlos Pereira Gomes
- Emergency Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av Dr. Enéas Carvalho de Aguiar, 255, 5° andar, s.5023, São Paulo, SP, CEP: 05403-010, Brazil.
| | - Roger Daglius Dias
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, MA, USA
| | - Jacson Venancio de Barros
- Department of Information Technology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Irineu Tadeu Velasco
- Emergency Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av Dr. Enéas Carvalho de Aguiar, 255, 5° andar, s.5023, São Paulo, SP, CEP: 05403-010, Brazil
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Wilson Jacob Filho
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
- Division of Geriatrics, Department of Internal Medicine, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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The impact of improved access to after-hours primary care on emergency department and primary care utilization: A systematic review. Health Policy 2020; 124:812-818. [PMID: 32513447 DOI: 10.1016/j.healthpol.2020.05.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 11/23/2022]
Abstract
Access to after-hours primary care is problematic in many developed countries, leading patients to instead visit the emergency department for non-urgent conditions. However, emergency department utilization for conditions treatable in primary care settings may contribute to emergency department overcrowding and increased health system costs. This systematic review examines the impact of various initiatives by developed countries to improve access to after-hours primary care on emergency department and primary care utilization. We performed a systematic review on the impact of improved access to after-hours primary and searched CINAHL, EMBASE, MEDLINE, and Scopus. We identified 20 studies that examined the impact of improved access to after-hours primary care on ED utilization and 6 studies that examined the impact on primary care utilization. Improved access to after-hours primary care was associated with increased primary care utilization, but had a mixed effect on emergency department utilization, with limited evidence of a reduction in non-urgent and semi-urgent emergency department visits. Although our review suggests that improved access to after-hours primary care may limit emergency department utilization by shifting patient care from the emergency department back to primary care, rigorous research in a given institutional context is required before introducing any initiative to improve access to after-hours primary care.
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Moore N, Middleton PM, Ren S. Lost capacity in emergency departments and its economic implications: A simulation study and economic analysis. Emerg Med Australas 2020; 32:974-979. [PMID: 32431066 DOI: 10.1111/1742-6723.13526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/03/2020] [Accepted: 04/06/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the effect of lost bed capacity (LBC) on the overall capacity of an ED, and to estimate the costs attributable to excess stay in the ED beyond that required for actual emergency care. METHODS This was a retrospective simulation and health economic evaluation, using data from a single-centre tertiary level ED. Data from all patients who presented to the ED during a 1-month period and triaged to receive an acute bed in order to undergo their emergency care were included. The main outcomes measured were the change in overall ED length of stay, and costs attributable to LBC, in both discharged and admitted patients. RESULTS Overall daily median ED length of stay decreased by 182 min (95% confidence interval 165-198; P < 0.01) in the simulated cohort when LBC was removed. Within the admitted cohort, the median cost attributable to LBC was AUD$202.99 (95% confidence interval $186.50-$216.70) per patient. We estimate the cost of an ED bed to be AUD$164.59 per hour. CONCLUSIONS A substantial amount of ED length of stay is due to patients remaining in the ED for time after their emergency care is concluded. This likely represents a substantial overall monetary cost to the Australian healthcare system.
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Affiliation(s)
- Nicholas Moore
- South Western Emergency Research Institute, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Paul M Middleton
- South Western Emergency Research Institute, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Shiquan Ren
- South Western Emergency Research Institute, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
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Hansen K, Boyle A, Holroyd B, Phillips G, Benger J, Chartier LB, Lecky F, Vaillancourt S, Cameron P, Waligora G, Kurland L, Truesdale M. Updated framework on quality and safety in emergency medicine. Emerg Med J 2020; 37:437-442. [PMID: 32404345 PMCID: PMC7413575 DOI: 10.1136/emermed-2019-209290] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/03/2020] [Accepted: 02/08/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Quality and safety of emergency care is critical. Patients rely on emergency medicine (EM) for accessible, timely and high-quality care in addition to providing a 'safety-net' function. Demand is increasing, creating resource challenges in all settings. Where EM is well established, this is recognised through the implementation of quality standards and staff training for patient safety. In settings where EM is developing, immense system and patient pressures exist, thereby necessitating the availability of tiered standards appropriate to the local context. METHODS The original quality framework arose from expert consensus at the International Federation of Emergency Medicine (IFEM) Symposium for Quality and Safety in Emergency Care (UK, 2011). The IFEM Quality and Safety Special Interest Group members have subsequently refined it to achieve a consensus in 2018. RESULTS Patients should expect EDs to provide effective acute care. To do this, trained emergency personnel should make patient-centred, timely and expert decisions to provide care, supported by systems, processes, diagnostics, appropriate equipment and facilities. Enablers to high-quality care include appropriate staff, access to care (including financial), coordinated emergency care through the whole patient journey and monitoring of outcomes. Crowding directly impacts on patient quality of care, morbidity and mortality. Quality indicators should be pragmatic, measurable and prioritised as components of an improvement strategy which should be developed, tailored and implemented in each setting. CONCLUSION EDs globally have a remit to deliver the best care possible. IFEM has defined and updated an international consensus framework for quality and safety.
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Affiliation(s)
- Kim Hansen
- Emergency Department, Prince Charles Hospital, Chermside, Queensland, Australia .,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Adrian Boyle
- Emergency Department, Addenbrooke's Hospital, Cambridge, Cambridgeshire, UK
| | - Brian Holroyd
- Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Emergency Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
| | - Georgina Phillips
- Emergency Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Jonathan Benger
- Academic Department of Emergency Care, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Lucas B Chartier
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Emergency Department, University Health Network, Toronto, Ontario, Canada
| | - Fiona Lecky
- Health Services Research, University of Sheffield, Sheffield, UK.,Emergency Department /TARN, Salford Royal Hospitals NHS Foundation Trust, Salford, UK
| | | | - Peter Cameron
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia.,Emergency Department, Alfred Hospital, Melbourne, Victoria, Australia
| | - Grzegorz Waligora
- Emergency Department, Wroclaw Medical University, Wroclaw, Dolnoslaskie, Poland
| | - Lisa Kurland
- Medical Sciences, Orebro Universitet, Orebro, Sweden
| | - Melinda Truesdale
- Emergency Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Emergency Department, Royal Women's Hospital, Parkville, Victoria, Australia
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Sarıyer G, Ataman MG, Kızıloğlu İ. Analyzing Main and Interaction Effects of Length of Stay Determinants in Emergency Departments. Int J Health Policy Manag 2020; 9:198-205. [PMID: 32563220 PMCID: PMC7306116 DOI: 10.15171/ijhpm.2019.107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 10/30/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Measuring and understanding main determinants of length of stay (LOS) in emergency departments (EDs) is critical from an operations perspective, since LOS is one of the main performance indicators of ED operations. Therefore, this study analyzes both the main and interaction effects of four widely-used independent determinants of ED-LOS. METHODS The analysis was conducted using secondary data from an ED of a large urban hospital in Izmir, Turkey. Between-subject factorial analysis of variance (ANOVA) was used to test the main and interaction effects of the corresponding factors. P values <.05 were considered statistically significant. RESULTS While the main effect of gender was insignificant, age, mode of arrival, and clinical acuity had significant effects, whereby ED-LOS was significantly higher for the elderly, those arriving by ambulance, and clinically-categorized high-acuity patients. Additionally, there was an interaction between the age and clinical acuity in that, while ED-LOS increased with age for high acuity patients, the opposite trend occurred for low acuity patients. When ED-LOS was modeled using gender, age, and mode of arrival, there was a significant interaction between age and mode of arrival. However, this interaction was not significant when the model included age, mode of arrival, and clinical acuity. CONCLUSION Significant interactions exist between commonly used ED-LOS determinants. Therefore, interaction effects should be considered in analyzing and modelling ED-LOS.
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Affiliation(s)
- Gorkem Sarıyer
- Department of Business Administration, Yaşar University, İzmir, Turkey
| | | | - İlker Kızıloğlu
- Department of General Surgery, Çiğli Regional Training Hospital, İzmir, Turkey
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46
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Jiang L, Ye L, Dai M, Zhou J, Li Q. Use Andersen's behavior model to explain non-urgent visits in emergency department: A single center study in southwest China. Int Emerg Nurs 2020; 52:100845. [PMID: 32205107 DOI: 10.1016/j.ienj.2020.100845] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/26/2019] [Accepted: 01/13/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Non-urgent ED visit was an important contributor of emergency overcrowding. Previous studies showed that patients make non-urgent ED visits for many reasons and their ED use patterns may be influenced by many factors. However, seldom studies were theory-based research aimed to offer a systemic insight regarding this question. METHODS This was a cross-sectional study conducted in the ED of a tertiary hospital in China guided by Andersen's behavior model of health service use. Patients triaged as non-urgent were surveyed using a self-administrated questionnaire to investigate the reasons for ED presentation and associated factors influenced their ED use patterns. RESULTS Perceived severity of illness and urgent treatment need (374, 68.6%), accessible problems to alternative services (144, 26.4%) and referral by medical staffs (134, 24.6%) were most commonly reported reasons for ED presentation. Alternative service attempt before ED presentation was determined by two predisposing factors: education level (OR = 0.638, P < 0.05) and use of nearest medical institution (OR = 1.588, P < 0.05). Prior non-urgent ED use was explained by both predisposing and need factors. They were: nationality (OR = 3.057, P < 0.01), type of health problems (OR = 1.641, P < 0.01) and self-rated health status (OR = 0.769, P < 0.01). CONCLUSION Patients' perceived need of emergency care played an extremely important role in driving ED use although several factors were identified. Future studies aim to decrease non-urgent ED use in China may firstly gain success from patient education programs.
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Affiliation(s)
- Lingjun Jiang
- Department of Emergency Medicine/Institute of Disaster Medicine, West China Hospital, Sichuan University, China; West China School of Nursing, West China Hospital, Sichuan University, China
| | - Lei Ye
- Department of Emergency Medicine/Institute of Disaster Medicine, West China Hospital, Sichuan University, China.
| | - Min Dai
- Department of Emergency Medicine/Institute of Disaster Medicine, West China Hospital, Sichuan University, China
| | - Jing Zhou
- Department of Emergency Medicine/Institute of Disaster Medicine, West China Hospital, Sichuan University, China
| | - Qin Li
- Department of Emergency Medicine/Institute of Disaster Medicine, West China Hospital, Sichuan University, China
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Jones NR, Shanahan M, Dobbins T, Degenhardt L, Montebello M, Gisev N, Larney S. Reductions in emergency department presentations associated with opioid agonist treatment vary by geographic location: A retrospective study in New South Wales, Australia. Drug Alcohol Rev 2020; 38:690-698. [PMID: 31577058 DOI: 10.1111/dar.12976] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/19/2019] [Accepted: 07/22/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIMS It is not known if the reduction in ED use during periods of OAT occurs across urgent and low acuity presentations. We aimed to compare the incidence and costs of urgent and low acuity ED presentations of people with opioid use disorder (OUD) in and out of opioid agonist treatment (OAT). DESIGN AND METHODS This was a retrospective cohort study (N=24,875), using linked administrative health data from New South Wales (NSW), Australia. Urgent and low acuity ED incidence and associated costs were calculated for periods in and out of OAT. GEE models estimated the adjusted incidence rate ratio (IRR) for ED presentations. Average costs per person-day were calculated with bootstrap confidence intervals. RESULTS Incidence of urgent presentations was lower in OAT compared to out of OAT [IRR (95%CI): 0.65 (0.61-0.69)]. In major cities, low acuity presentations were lower during OAT compared to timeout of OAT [IRR (95%CI): 0.82 (0.70-0.96)], in regional/remote areas, low acuity presentations were higher during OAT [IRR (95%CI): 2.65 (1.66-4.21)]. In major cities, average costs for low acuity presentations in OAT were 28% lower atA$0.50 (95%CI: A$0.48-A$0.52) and A$0.69 (95%CI: A$0.66-A$0.71) out of OAT, but 103% higher in regional/remote NSW, at A$2.12 (95%CI: A$1.91-A$2.34) in OAT and A$1.04 (95%CI: A$0.91-A$1.16) out of OAT. DISCUSSION AND CONCLUSIONS OAT was associated with reductions in urgent ED presentations and associated costs among people with OUD. Geographical variation was evident for low acuity ED presentations, highlighting the need to increase access to OAT in regional/remote areas.
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Affiliation(s)
- Nicola R Jones
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Marian Shanahan
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Timothy Dobbins
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Mark Montebello
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.,Northern Sydney Local Health District, Sydney, Australia
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Sarah Larney
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
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48
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The Impact of Mass Gatherings on Emergency Department Patient Presentations with Communicable Diseases Related to Syndromic Indicators: An Integrative Review. Prehosp Disaster Med 2020; 35:206-211. [PMID: 32070453 DOI: 10.1017/s1049023x20000151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Mass-gathering events (MGEs) are commonly associated with a higher than average rate of morbidity. Spectators, workers, and the substantial number of MGE attendees can increase the spread of communicable diseases. During an MGE, emergency departments (EDs) play an important role in offering health care services to both residents of the local community and event attendees. Syndromic indicators (SIs) are widely used in an ED surveillance system for early detection of communicable diseases. AIM This literature review aimed to develop an understanding of the effect of MGEs on ED patient presentations with communicable diseases and their corresponding SIs. METHOD An integrative literature review methodology was used. Online databases were searched to retrieve relevant academic articles that focused on MGEs, EDs, and SIs. Inclusion/exclusion criteria were applied to screen articles. The Standard Quality Assessment Criteria for Evaluating Primary Research (QualSyst) assessment tool was used to assess the quality of included papers. RESULTS Eleven papers were included in this review; all discussed the impact of an MGE on patient presentations with communicable diseases at EDs/hospitals. Most included studies used the raw number of patients who presented or were admitted to EDs/hospitals to determine impact. Further, the majority of studies focused on either respiratory infections (n = 4) or gastrointestinal infections (n = 2); two articles reported on both. Eight articles mentioned SIs; however, such information was limited. The quality of evidence (using QualSyst) ranged from 50% to 90%. CONCLUSIONS Limited research exists on the impact of MGEs on ED presentations with communicable diseases and related SIs. Recommendations for future MGE studies include assessing differences in ED presentations with communicable diseases regarding demographics, clinical characteristics, and outcomes before, during, and after the event. This would benefit health care workers and researchers by offering more comprehensive knowledge for application into practice.
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d'Etienne JP, Zhou Y, Kan C, Shaikh S, Ho AF, Suley E, Blustein EC, Schrader CD, Zenarosa NR, Wang H. Two-step predictive model for early detection of emergency department patients with prolonged stay and its management implications. Am J Emerg Med 2020; 40:148-158. [PMID: 32063427 DOI: 10.1016/j.ajem.2020.01.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 01/20/2020] [Accepted: 01/27/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To develop a novel model for predicting Emergency Department (ED) prolonged length of stay (LOS) patients upon triage completion, and further investigate the benefit of a targeted intervention for patients with prolonged ED LOS. MATERIALS AND METHODS A two-step model to predict patients with prolonged ED LOS (>16 h) was constructed. This model was initially used to predict ED resource usage and was subsequently adapted to predict patient ED LOS based on the number of ED resources using binary logistic regressions and was validated internally with accuracy. Finally, a discrete event simulation was used to move patients with predicted prolonged ED LOS directly to a virtual Clinical Decision Unit (CDU). The changes of ED crowding status (Overcrowding, Crowding, and Not-Crowding) and savings of ED bed-hour equivalents were estimated as the measures of the efficacy of this intervention. RESULTS We screened a total of 123,975 patient visits with final enrollment of 110,471 patient visits. The overall accuracy of the final model predicting prolonged patient LOS was 67.8%. The C-index of this model ranges from 0.72 to 0.82. By implementing the proposed intervention, the simulation showed a 12% (1044/8760) reduction of ED overcrowded status - an equivalent savings of 129.3 ED bed-hours per day. CONCLUSIONS Early prediction of prolonged ED LOS patients and subsequent (simulated) early CDU transfer could lead to more efficiently utilization of ED resources and improved efficacy of ED operations. This study provides evidence to support the implementation of this novel intervention into real healthcare practice.
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Affiliation(s)
- James P d'Etienne
- Department of Emergency Medicine, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.
| | - Yuan Zhou
- Department of Industrial, Manufacturing, and Systems Engineering, The University of Texas at Arlington, 701 S. Nedderman Dr., Arlington, TX 760199, USA.
| | - Chen Kan
- Department of Industrial, Manufacturing, and Systems Engineering, The University of Texas at Arlington, 701 S. Nedderman Dr., Arlington, TX 760199, USA.
| | - Sajid Shaikh
- Department of Information Technology, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.
| | - Amy F Ho
- Department of Emergency Medicine, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.
| | - Eniola Suley
- Department of Industrial, Manufacturing, and Systems Engineering, The University of Texas at Arlington, 701 S. Nedderman Dr., Arlington, TX 760199, USA.
| | - Erica C Blustein
- Department of Emergency Medicine, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.
| | - Chet D Schrader
- Department of Emergency Medicine, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA; Integrative Emergency Services, 4835 LBJ Fwy Suite 900, Dallas, TX 75244, USA.
| | - Nestor R Zenarosa
- Department of Emergency Medicine, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA; Integrative Emergency Services, 4835 LBJ Fwy Suite 900, Dallas, TX 75244, USA.
| | - Hao Wang
- Department of Emergency Medicine, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA; Integrative Emergency Services, 4835 LBJ Fwy Suite 900, Dallas, TX 75244, USA.
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50
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Duwalage KI, Burkett E, White G, Wong A, Thompson MH. Forecasting daily counts of patient presentations in Australian emergency departments using statistical models with time‐varying predictors. Emerg Med Australas 2020; 32:618-625. [DOI: 10.1111/1742-6723.13481] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 01/29/2020] [Accepted: 01/30/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Kalpani I Duwalage
- School of Mathematical Sciences, Queensland University of Technology Brisbane Queensland Australia
| | - Ellen Burkett
- Emergency DepartmentPrincess Alexandra Hospital Brisbane Queensland Australia
- Healthcare Improvement UnitClinical Excellence Queensland Brisbane Queensland Australia
| | - Gentry White
- School of Mathematical Sciences, Queensland University of Technology Brisbane Queensland Australia
| | - Andy Wong
- Emergency DepartmentPrincess Alexandra Hospital Brisbane Queensland Australia
| | - Mery H Thompson
- School of Mathematical Sciences, Queensland University of Technology Brisbane Queensland Australia
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