Dissertations / Theses on the topic 'Emergency Department waiting room'
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1
Eckerberg, Maria. "Patient self-registration : Design of a digital tool for an emergency department." Thesis, Linköpings universitet, Institutionen för datavetenskap, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-140157.
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In this bachelor thesis, a prototype of a digital tool is designed, aimed at self-registering patient data in an emergency ward. Normally, patients not arriving by ambulance are treated in the order they enter the waiting room. Nurses performing the first examination—a triage—must ask the patient about their identity, previous medical history and similar questions, and enter this data into a new treatment case in the healthcare information system. It has been suggested that having the patient enter this data themselves would be beneficial, allowing nurses to concentrate on the medical issues. After gathering and analyzing data from observations and from interviews with the staff at a Swedish hospital, a prototype of a digital tool was designed, where patients step-by-step could enter the required data in the waiting room, thus saving valuable time in the triage. Benefits for the patient include receiving feedback about the number of persons ahead in line. The prototype was received favorably by test persons and by the staff, indicating that it could work as a model for a product to be put into work use.
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Van, Dreven Amber, and res cand@acu edu au. "Waiting: a critical experience." Australian Catholic University. School of Nursing, 2001. http://dlibrary.acu.edu.au/digitaltheses/public/adt-acuvp12.25072005.
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This study explores the experiences of relatives waiting. Often relatives wait for considerably long periods, especially in critical care areas, whilst their loved one, whose health status is unknown, receives care. To explore these experiences and to understand the symbolic meaning behind the participants stories, a grounded theory approach was utilised which is firmly rooted in the sociological theory of symbolic interactionism. A qualitative approach was employed in order to yield a rich description of the human experience often not found in quantitative studies (Jamerson, Scheibmeir, Bott, Crighton, Hinton and Kuckelman, 1996, p. 468). Similarly, the use of feminist principles to guide this study has facilitated a greater understanding of such issues as gender roles, language, power and hierarchy. Using grounded theory methodology, audio-taped interviews were conducted with six female relatives who were recruited using theoretical sampling. Simultaneous recruitment, data collection, analysis and literature review took place, as advocated and outlined by Barney Glaser and Anselm Strauss (1967). The overarching core category discovered using this approach which epitomises the waiting experience, is the balancing of both positive and negative aspects of the four codes identified. These four codes are -mothering, trust, flustered anxiety and institutional and medical power. Each code had negative aspects, such as being denied the felt need to mother the critically ill loved one, being asked to entrust the health of a loved one to people that relatives had never met, feelings of fluster and anxiety, and a perception that they would interfere with medial care if they were to be involved in their loved ones care. Conversely, each code could potentially have a positive aspect, such as being involved in the care of the loved one, feelings of relief once the care of the loved one was entrusted to professional health care providers, affiliating with other relatives who were waiting in similar circumstances, and receiving frequent information from staff. A final model was produced that illustrates the balance that many relatives aspire to when waiting in the Emergency Department waiting room. If the balance tips in favour of the negative aspects of the codes, a negative impact on the relatives feelings of well being can result.
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Burström, Lena, Bengt Starrin, Marie-Louise Engström, and Hans Thulesius. "Waiting management at the emergency department - a grounded theory study." Uppsala universitet, Centrum för klinisk forskning, Västerås, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-200118.
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Background: An emergency department (ED) should offer timely care for acutely ill or injured persons that require the attention of specialized nurses and physicians. This study was aimed at exploring what is actually going on at an ED. Methods: Qualitative data was collected 2009 to 2011 at one Swedish ED (ED1) with 53.000 yearly visits serving a population of 251.000. Constant comparative analysis according to classic grounded theory was applied to both focus group interviews with ED1 staff, participant observation data, and literature data. Quantitative data from ED1 and two other Swedish EDs were later analyzed and compared with the qualitative data. Results: The main driver of the ED staff in this study was to reduce non-acceptable waiting. Signs of non-acceptable waiting are physical densification, contact seeking, and the emergence of critical situations. The staff reacts with frustration, shame, and eventually resignation when they cannot reduce non-acceptable waiting. Waiting management resolves the problems and is done either by reducing actual waiting time by increasing throughput of patient flow through structure pushing and shuffling around patients, or by changing the experience of waiting by calming patients and feinting maneuvers to cover up. Conclusion: To manage non-acceptable waiting is a driving force behind much of the staff behavior at an ED. Waiting management is done either by increasing throughput of patient flow or by changing the waiting experience.
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Moreira, Kim-Sun. "Perfecting Patient Bed Flow in the Emergency Department." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4010.
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Emergency department (ED) crowding is a serious problem in the United States. Crowding in the ED can result in delays that may negatively affect patient outcomes and increase the cost of care. The purpose of this project was to understand strategies that can help to improve patient flow in the ED. The plan-to-do-study act model for process improvement influenced this project. Secondary data were collected for a 2-month period to determine the impact of workflow processes (patient boarding time in ED, surge capacity and workflow processes including the impact of ancillary departments) on the movement of admitted patients from the ED to the inpatient units. Descriptive statistics were used to provide numerical summaries, frequencies, and percentages for the identified variables. The findings were consistent with an increased length of stay and longer ED boarding of patients due to the workflow process. Resulting recommendations included standardized calls for report on admitted patients within 30 minutes, timely discharge of patients, collaboration with attending physicians to facilitate evaluation of patients and orders, modification of staffing roles to ensure adequate staff, and identification of staff transporters to ensure timely transport of patients to their rooms. The findings helped to inform the development of a Bed Utilization Policy. The policy has been shared with the organization with the recommendation to implement and further evaluate to help manage bed flow. Development of utilization strategies that contribute to facilitating throughput will promote positive social change by providing nurses with the tools to help prepare for and respond to unexpected increases in patient volume. Improving efficiency with flow can help to improve patient care, timeliness, and safety.
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Patvivatsiri, Lisa. "A Simulation-Based Approach for Optimal Nurse Scheduling in an Emergency Department." Thesis, Virginia Tech, 2003. http://hdl.handle.net/10919/43867.
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The purpose of this research is to determine an appropriate nurse staffing strategy for the Intermediate Care Unit (ICU) and the Critical Care Unit (CCU) of the Emergency Department at York Hospital in York, Pennsylvania. This strategy must adhere to certain administrative policies while keeping patient waiting times within allowable limits. Determining the proper number of resources in an emergency department is a difficult problem because while assistance must be provided without delay at any time, the available resources are restricted by the hospital budget. This research involves simulating the operations of the Emergency Department at York Hospital using the software package Arena 7.0 to evaluate how the system is impacted by various nurse staffing strategies. A microcomputer-based decision support system (DSS) for nurse scheduling that was first developed by Sitompul in 1991 has been implemented using Turbo Pascal 6.0 to generate twenty possible nurse staffing plans. The best alternative staffing plan has been evaluated by the simulation model to determine its effect on waiting times for patients. Specifically, patients are divided into five ESI levels, where ESI-1 patients are the most serious and ESI-5 patients are the least serious, and waiting times are provided for each patient type.
While the DSS approach is useful in generating specific working schedules that are acceptable to the nurses' requirements, it is limited when developing an overall staffing plan. Specifically, the DSS requires a user-defined ratio of nurses working the various shifts, and this ratio must remain constant throughout each month even if patient arrival rates are known to be time dependent. As an alternative approach, OptQuest for Arena was employed to search for an overall nurse staffing plan. After providing Arena with 50 DSS-generated schedules that satisfy the nurses' requirements, OptQuest was used to determine the best schedule for each nurse to follow in order to minimize the average waiting time in the system for patients. Although the average waiting time obtained by the OptQuest staffing plan decreased from the current staffing plan for all patient types, a paired-t comparison determined using Arena's Output Analyzer indicated no statistical difference (at the 95% confidence level) between the DSS and OptQuest scenarios, in terms of the average waiting time for ESI-1 and ESI-2 patients. Further analysis indicated that a system bottleneck occurred in the triage area of the emergency department during evening hours. After adding one additional triage nurse in the evening shift, the OptQuest-generated staffing plan was re-evaluated. The results indicate that the suggested staffing plan reduced the average waiting time in the current staffing plan by 34.33%, 32.73%, 47.87%, 54.92%, and 52.41% for ESI-1, ESI-2, ESI-3, ESI-4, and ESI-5 patients, respectively. In addition, the average waiting time of ESI-1, ESI-2, ESI-3, ESI-4, and ESI-5 patients for the suggested staffing plan was 19.27%, 19.36%, 39.37%, 48.55%, and 46.64%, respectively, less than for the staffing plan determined when using the DSS approach alone.Master of Science
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Hogan, Kerry-Anne. "Caring for adult patients who die in the emergency department: Reflections of emergency room nurses." Thesis, University of Ottawa (Canada), 2009. http://hdl.handle.net/10393/28088.
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Background. Emergency room nurses work in an area in which the workload is unpredictable and chaotic. Treatment measures are usually aggressive and the goal of care in the emergency department is to restore physiological stability in a sick or injured person. As treatment measures usually occur quickly and nurses care for many patients throughout their shifts, there is often a lack of time to establish relationships with patients and/or family members. In a situation when treatment is needed immediately, there may not be enough time to discuss advanced directives with patients and/or family members. Although most patients are seen, treated and sent home or are admitted and recover, more than 7000 lives end in Canadian emergency departments each year (CIHI, 2006).
Death in an emergency department is almost always considered a tragic event, regardless of whether the event was unexpected or expected. This view contrasts with the idealistic view of death occurring in a hospice or at home, free of pain and suffering and surrounded by loved ones. In an emergency department, treatment of critical illnesses and/or injuries begins immediately, leaving nurses or other members of the team little time to discuss advance directives or establish rapport with patients and/or family members.
Purpose. The purpose of this research study was to improve our understanding of the experience of emergency room nurses when caring for an adult who dies in the emergency department.
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Astralaga, Ingrid. "Emergency Room Nurse Perceptions of Emotional Intelligence." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5970.
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The delivery of quality care has been a priority for the health care industry in the United States. Researchers have established positive correlations between the levels of emotional intelligence of registered nurses and their clinical performances. However, new evidence suggests the need to enhance the use of emotional intelligence (EI) in high-risk clinical units. With the intent to understand the use of EI, a phenomenological research approach was used to identify the emergency room nurse's understanding of EI. The Four-branch Model of Emotional Intelligence was used as the theoretical framework, while the research question identified the emergency room nurse's perception of EI. Eight emergency room nurses from two facilities participated in the study. The inclusion criteria consisted of emergency room nurses with one to ten years of experience, nurses that worked thirty-six hours or more per week, and were not in leadership roles. The data were collected through face-to-face interview sessions and analyzed using the Colaizzi's Method of Data Analysis. All participants reported unfamiliarity with the concept of EI. Nevertheless, evidence that indicated the presence of all elements of this concept such as the ability to perceive emotions, understand emotions, use emotions to enhance reasoning, and manage emotions, were apparent in the stories shared by the nurses. The results of the study indicated a potential influence toward positive social change at the organizational and professional level. The implementation of educational activities to improve the use of this concept and the modification of current health care policies to incorporate emotional intelligence as clinical competencies are actions that can influence positive social change.
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Li, Andrea (Andrea Shao-Yin). "Waveform-to-patient matching across room transfers in the emergency department." Thesis, Massachusetts Institute of Technology, 2018. http://hdl.handle.net/1721.1/119739.
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Thesis: M. Eng. in Computer Science, Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science, 2018.This electronic version was submitted by the student author. The certified thesis is available in the Institute Archives and Special Collections.
Cataloged from student-submitted PDF version of thesis.
Includes bibliographical references (pages 61-62).
In the emergency department (ED), patients are often continuously monitored for physiologic deterioration. Signals used include electrocardiograms (ECGs), blood pressure waveforms, and respiratory waveforms. Due to the fast-paced and ambulatory nature of care in the ED, patient location is not always synchronized with waveform collection. The aim of our work is to link disparate waveforms belonging to the same patient. We utilize approximate admission and discharge times available from the ED administration database to delineate patient stays. We then use waveform-derived features of the ECG to link together sequential signals which are separated by variable time delays. The ultimate goal is to construct an openly available database of ED records with linked waveforms to stimulate research in emergency medicine.
by Andrea Li.
M. Eng. in Computer Science
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Burström, Lena. "Patient Safety in the Emergency Department : Culture, Waiting, and Outcomes of Efficiency and Quality." Doctoral thesis, Uppsala universitet, Institutionen för kirurgiska vetenskaper, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-223987.
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The overall aim of this thesis was to investigate patient safety in the emergency department (ED) and to determine whether this varies according to patient safety culture, waiting, and outcomes of efficiency and quality variables. I: Patient safety culture was described in the EDs of two different hospitals before and after a quality improvement project. The questionnaire “Hospital Survey on Patient Safety Culture” was used to investigate the patient safety culture. The main finding was that the staff at both hospitals scored more positively in the dimension Team-work within hospital after implementing a new work model aimed at improving patient flow and patient safety in the ED. Otherwise, we found only modest improvements. II: Grounded theory was used to explore what happens in the ED from the staff perspective. Their main concern was reducing patients’ non-acceptable waiting time. Management of waiting was improved either by increasing the throughput of patient flow by structure pushing and by shuffling patients, or by changing the experience of waiting by calming patients and by feinting to cover up. III: Three Swedish EDs with different triage models were compared in terms of efficiency and quality. The median length of stay was 158 minutes for physician-led team triage compared with 243 and 197 minutes for nurse–emergency physician and nurse–junior physician triage, respectively. Quality indicators (i.e., patients leaving before treatment was completed, the rate of unscheduled return within 24 and 72 hours, and mortality rate within 7 and 30 days) improved under the physician-led team triage. IV: Efficiency and quality variables were compared from before (2008) to after (2012) a reorganization with a shift of triage model at a single ED. Time from registration to physician decreased by 47 minutes, and the length of stay decreased by 34 minutes. Several quality measures differed between the two years, in favour of 2012. Patients leaving before treatment was completed, unscheduled return within 24 and 72 hours, and mortality rate within 7 and 30 days all improved despite the reduced admission rate. In conclusion, the studies underscore the need to improve patient safety in the ED. It is important to the patient safety culture to reduce patient waiting because it dynamically affects both patients and staff. Physician-led team triage may be a suitable model for reducing patient waiting time and increasing patient safety.
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Egri, Erica. "USING SURROGATE MEASURES TO PREDICT PATIENT SATISFACTION IN THE EMERGENCY DEPARTMENT." Doctoral diss., University of Central Florida, 2007. http://digital.library.ucf.edu/cdm/ref/collection/ETD/id/3980.
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With healthcare organizations struggling to remain competitive and financially stable in a market where minimizing costs is a priority, hospital administrators feel the sense of urgency when it comes to keeping patients satisfied with services in order to expand volume and market share. The Emergency Department is considered the front door of a healthcare organization, and keeping its visitors satisfied in order to guarantee a future visit or a referral to a friend or family member is a must. While patient input on the services received in a healthcare facility is essential to improving quality of care, the costs associated with measuring, collecting and analyzing their feedback are remarkable. This research focuses on developing a linear regression model to predict patient satisfaction in the ED using surrogate measures related to patient's socio-demographic characteristics and visit characteristics. With a model of this kind, healthcare administrators can potentially eliminate survey costs while still being able to determine where the hospital stands in the eyes of the patient. Three modeling approaches were used to develop a multiple regression equation. Modeling approach 1 used monthly patient satisfaction scores as the dependent variable collected by a third-party survey organization. The goal of this model was to predict monthly patient satisfaction scores. Modeling approach 2 used patient satisfaction scores collected by the discharge registrar prior to the patient leaving the ED. The goal of this model was to predict patient satisfaction scores on a patient-by-patient basis. Modeling approach 3 used patient satisfaction scores collected by a third-party survey organization. The goal of this modeling approach was to predict patient satisfaction scores on a patient-by-patient basis. Each modeling approach developed in this study used its own survey tool. Though this study had limitations when it came to developing the models and validating the findings, results are very promising. Analysis shows that predicting average patient satisfaction scores on a monthly basis gives the most accurate results, with socio-demographic characteristics and visit characteristics explaining 96% of variation in monthly average patient satisfaction scores. Other model indicators, such as normality of residuals, predicted error, mean square error, and predicted R-square show that the model fits the data very well and has strong predictive ability. Models that attempted to predict patient satisfaction on a patient-by-patient basis appeared to be ineffective, with very large predicted errors and prediction intervals and low predictive ability.Ph.D.
Department of Industrial Engineering and Management Systems
Engineering and Computer Science
Industrial Engineering PhD
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Cyr, Julia Anne, and Julia Anne Cyr. "Evaluation of a Nurse Practitioner Led Program on Decreasing Emergency Room Visits." Diss., The University of Arizona, 2017. http://hdl.handle.net/10150/626651.
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Background: The overuse of the emergency department (ED) for non- critical patients has been associated with overcrowding and a rise in healthcare cost. Green Valley Fire Department (GVFD) has created a program, Fire-Based Urgent Medicals Service (FBUMS) with a nurse practitioner (NP). Patients can call 9-1-1 or the ""NP hotline"" and request to be seen by the NP instead of being immediately transported to the hospital via ambulance.
Purpose: The purpose of this project is to evaluate the impact of the nurse practitioner led FBUMS, on ED visits and ambulance transports.
Methods: A survey was mailed to all persons, age 18 and older, who were seen by the NP with FBUMS between February 2017 and March 2017. The survey asked about the reasons for contacting GVFD, the type of treatment received, and whether they went to ED after treatment.
Data analysis: Descriptive statistics including frequencies, percentages, means and standard deviations were used to analyze each of the answered survey questions in Microsoft Excel©.
Results: Surveys completed (n=42). The majority, 39 (92.9%) stated they did not receive care at the ED within 72 hours following their appointment with the NP, three (7.1%) stated they did. By dramatically decreasing transport to the hospital and associated ED treatment, it is estimated to have saved approximately $53,425 in ambulance costs and $54,210 in ED treatment for a total savings of $99,632.52.
Conclusion: A Fire-Based Urgent Medical Service led by a nurse practitioner decreased emergency room visits and ambulance transports.
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Cimona-Malua, T. C. "“Waiting time of patients who present at Emergency department of Saint Rita’s hospital, Limpopo Province, South Africa.”." Thesis, University of Limpopo (Medunsa Campus), 2010. http://hdl.handle.net/10386/539.
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Thesis (M. Med. (Family Medicine)) -- University of Limpopo (Medunsa Campus), 2010.Title: Waiting time of patients who present at Saint Rita’s hospital Emergency Department (ED), Limpopo province, South Africa. Objective: To determine the waiting time for stable patients who present at Saint Rita’s hospital ED, to determine where the longest time is spent by patients in ED and to identify the area of inefficient patients flow. Methods: A descriptive cross-sectional study was conducted in the ED of Saint Rita’s Regional hospital in the province of Limpopo, South Africa. During a one week period, Monday to Friday in July 2010, a daily random sample of 30 patients was monitored. The time In and Out of each step in the process of care was recorded. Waiting time was defined as the time from arrival of the patient in the ED until the start of the consultation by the Medical Officer. Time elapsed was calculated for various steps in care. Demographic data, diagnosis and acuity based on the SATS were obtained from patient’s record. Data capturing was done in window excel and data analysis done using the statistical software SPSS 17. Results: The mean waiting time for stable patients was 252.3 minutes. The mean EDLOS was 360 minutes for stable patients. Result show that 80% of patient attending Saint Rita’s ED are non-urgent (SATS: Green) cases. There was fluctuation of waiting times from Monday to Friday; with Monday having the longest waiting time and Tuesday the shortest waiting time. The waiting time for unstable patients (SATS: Red or Orange) is Zero minute. Patients spent the longest time waiting for registration (60 minutes) and for triage (57 min waiting for vitals and 28 minutes waiting for history taking). Interestingly the extremity of age: the youngest and oldest had lowest waiting time in ED. Areas of inefficient patient flow were registration and triage. Conclusion: This study has determined the waiting time for stable patients attending Saint Rita’s Regional Hospital ED. It has shown that waiting time in ED fluctuates with the day of the week. It has also shown that waiting time in ED varies with age of the patient and volume of patients in ED. Registration and triage have been identified as areas of inefficiency patients flow and recommendations for improvement have been formulated. Sustainability of the performance requires regular follow up from the hospital management.
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Wilson, Merna Akram. "Triage Template to Improve Emergency Department Flow." Kent State University / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=kent1622280768033809.
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Harrison, Pearl Alethea. "Knowledge and Attitudes of Emergency Room Nurses Regarding Palliative Care Patients." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5716.
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Palliative care (PC) is the comprehensive management of patients diagnosed with terminal illness. Care for PC patients focuses on relieving symptoms. The purpose of this study was to determine the difference between pretest and posttest scores on the Frommelt Attitude towards the Care of the Dying (FATCOD) and the Palliative Care Quiz for Nurses (PCQN) after an educational intervention to emergency department (ED) nurses. The framework for this project was Bandura's social cognitive theory. The FATCOD was used to assess ED nurses' attitudes toward PC, and the PCQN was used to assess ED nurses' knowledge about PC prior to the educational program. The educational intervention was developed using evidence obtained from the literature review and guided by the PCQN. The program presented to the ED nurses covered the essentials of palliative care and the information and skills needed by the ED nurse caring for the PC patient. The FATCOD and the PCQN were then administered as a posttest. A total of 70 nurses from two ED units volunteered to take part in the project. Results of the PCQN pre- and posttest showed a significant difference (p < .05), and the FATCOD pre- and posttest showed no significant difference (p = .849). The results revealed that education significantly improved knowledge of PC for the ED nurses participating in the project. Attitudes about PC were not significantly changed after the education program. The project promotes positive social change by raising awareness of the need for PC educational opportunities for ED nurses. By improving PC in the ED, patients and their families may experience increased satisfaction with end-of-life care and improved quality of life.
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Walker, Andre. "A Guide for Delivering Evidence - Based Discharge Intructions for Emergency Department Patients." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/1452.
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Discharge instructions provided to patients discharged from the emergency department (ED) are often provided in a way that is neither clear nor concise. Patients are often discharged home without a clear understanding of their diagnosis, medications, reasons to return to the ED, follow-up instructions, or how to manage their care at home during their illness. Therefore, a guideline needed to be developed in order to help the ED staff provide clear and concise discharge instructions to patients discharged from the ED. The Ace Star Model of Knowledge Transformation was the foundation for the development of the evidence-based guideline. A formative group of 7 individuals was created to critique the initial draft of the guideline, and a final version of the guideline was then distributed to 10 medical professionals to aid in the approval and determination of the quality of the guideline. The data analysis from the formative group questionnaire, and the appraisal of guidelines for research and evaluation tool led to the recommendations for a guideline on the delivery of evidence-based discharge instructions. This project has implications for social change in practice by (a) increasing the awareness among medical professionals about the importance of their communication style on patient discharge and (b) allowing for more efficient communication to occur between them and their patients. The use of an evidence-based practice guideline for providing discharge instructions to patients discharged from the ED will allow improved quality of care to patients, efficient communication between the healthcare providers and patients, a positive impact for social change in practice, and a consistent and reliable method for patients to understand their discharge instructions in a way that is clear and concise.
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Coffey, Mary. "RELATIONAL COORDINATION: AN EXPLORATION OF NURSING UNITS, AN EMERGENCY DEPARTMENT AND IN-PATIENT TRANSFERS." VCU Scholars Compass, 2015. http://scholarscompass.vcu.edu/etd/3970.
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Emergency department (ED) crowding is a patient safety concern that has been increasing for more than a decade. Increased visits have resulted in ED crowding, longer wait times, ambulance diversions, and boarding of admitted patients (Hing & Bhuiya, 2012). Numerous factors affect ED crowding. Once various extraneous issues are resolved and a bed is available for a patient, it becomes the responsibility of nurses across unit boundaries to coordinate the patient transfer. This study applies Relational Coordination Theory (RCT) as a framework to provide nurses insight into the relational aspects of their work in the transfer of ED patients to inpatient beds. Relational coordination is a mutually reinforcing process of interaction between communication and relationships that is carried out for the purpose of task interaction. It is useful for coordinating work that is highly interdependent, uncertain, and time constrained (Gittell, 2002). Nurses work during ED transfers requires task interaction as they coordinate
their efforts. This study, guided by RCT, will examine relational and communication dynamics among nurses within their own units and across unit boundaries as they interact during ED transfers. A cross-sectional, descriptive design will explore the seven dimensions of Relational Coordination (RC) during ED admissions and explain nurses relational and communication dimensions that may influence ED boarding times. The results of this study provide new information and a sound theoretical model on which to base future research.
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Davis-Patrick, Daphne Marjorie. "An RN Sepsis Training Program That Supports Registered Nurses in the Emergency Room Setting." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3556.
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Sepsis is a severe blood stream infection that claim the lives of almost 220,000 Americans annually. Delayed patient treatment results in multi-organ failure, morbidity, mortality, and increased hospital length of stay. Timely sepsis management enables hospitals to have decreased expenses, increased patient survival, and judicious interventions. The problem addressed in this project was the lack of sepsis- training for registered nurses (RNs) working in the emergency department (ED) of a 628-bed hospital in the southeastern United States. Under the direction of the director of the ED, 269 patient charts were reviewed during 2014 to February 2015 for data related to a sepsis diagnosis. Data showed that 19.4% (n = 103) of patients diagnosed with sepsis had the sepsis order set implemented by the ED nurse. The purpose of this project was to create an educational sepsis-training program for ED nurses. The program included a 2-hour educational module on signs and symptoms of sepsis, including guidelines from the Surviving Sepsis Campaign and the Emergency Nurses' Association. Stetler's Model of Research Utilization and Benner's Novice to Expert conceptual frameworks supported the project. The director of professional practice provided formative feedback on module content and the program evaluation tool. Director feedback indicated that content was beneficial in educating ED nurses on the signs and symptoms of early sepsis recognition. The ED director has now mandated that all ED nurses take the training module and posttest. The project has the potential to improve early sepsis recognition by ED staff and to improve patient outcomes, thus promoting positive social change for patients, families, and nurses.
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Gibbs, Joy Jaylene. "Queueing Variables and Leave-Without-Treatment Rates in the Emergency Room." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/6207.
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Hospitals stand to lose millions of dollars in revenue due to patients who leave without treatment (LWT). Grounded in queueing theory, the purpose of this correlational study was to examine the relationship between daily arrivals, daily staffing, triage time, emergency severity index (ESI), rooming time, door-to-provider time (DTPT), and LWT rates. The target population comprised patients who visited a Connecticut emergency room between October 1, 2017, and May 31, 2018. Archival records (N = 154) were analyzed using multiple linear regression analysis. The results of the multiple linear regression were statistically significant, with F(9,144) = 2902.49, p < .001, and R2 = 0.99, indicating 99% of the variation in LWT was accounted for by the predictor variables. ESI levels were the only variables making a significant contribution to the regression model. The implications for positive social change include the potential for patients to experience increased satisfaction due to the high quality of care and overall improvement in public health outcomes. Hospital leaders might use the information from this study to mitigate LWT rates and modify or manage staffing levels, time that patients must wait for triage, room placement, and DTPT to decrease the rate of LWT in the emergency room.
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Wood, III John. "The Influence of Emergency Department Wait Times on Inpatient Satisfaction." Thesis, University of North Texas, 2019. https://digital.library.unt.edu/ark:/67531/metadc1609108/.
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Patient satisfaction dimensions have a wide ranging and significant impact on organizational performance in the healthcare industry. In addition, the Centers for Medicare and Medicaid Services Hospital Value Based Purchasing (HVBP) Program links patient satisfaction to Medicare reimbursement, putting millions of dollars at risk for health systems. A gap in the literature exists in the exploration of how a patient's experience in the emergency department affects their satisfaction with inpatient services. In a multiple regression analysis, the relationship between HVBP Patient Experience of Care and hospital level factors including emergency department wait times are explored. Results indicate a statistically significant relationship between hospital level factors and standardized measure of patient satisfaction with a moderate adjusted effect size (p= <.0001, R2 adjusted= 0.184). Emergency department wait times post physician admit orders were most salient in predicting patient satisfaction scores (rs2= 0.434, β= -0.334, p= <.001). Recommendations to improve emergency department wait times include focusing on key decision points and implementation of electronic systems to support the movement of admitted patients out of the emergency department as quickly as possible.
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Andersson, Sofia, and Anders Holmgren. "Patienters upplevelser av bemötande på akutmottagning : En litteraturöversikt." Thesis, Högskolan Väst, Institutionen för omvårdnad, hälsa och kultur, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:hv:diva-4186.
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Aim: The aim of this study was to describe how patients with acute illness experience their given care in the emergency department. Method: A literature review of ten studies where differences and similarities were analyzed. These studies had been published between the years of 2000 and 2011. Results: The analysis showed a lack of sufficient care concerning patients’ subjective experiences. The researchers found three themes that specifically stood out when studies that had already been made were researched. These themes played an important role in care in the emergency department and insufficient attention to these from the staff could lead to a negative impact on patients’ experiences. The themes were: patients’ participation, patients’ need of communication and information and waiting period. The result showed that a lack in these presented themes could cause feelings of distress, frustration and irritation among patients. Because of this they often used different kinds of strategies to get more involved in their own caring process. Conclusion: The conclusion of this study was that there is a lack of resources within the emergency department where lack of personnel is the most forthcoming reason to patients’ negative experiences. There was however ways for the nurses to improve patients’ experiences within the emergency department by using Travelbee’s philosophy. This was to better interact and understand the patients’ lived experiences as a whole. Every patient is unique and by using proper communication, nurses can understand the patients’ whole life situation and by that, improve the quality of care.
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McKay, Jennifer. "The Impact of Increased Number of Acute Care Beds to Reduce Emergency Room Wait Time." Thesis, Université d'Ottawa / University of Ottawa, 2015. http://hdl.handle.net/10393/33172.
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Reducing ED wait times is a top health care priority for the Ontario government and hospitals in Ontario are incentivised to meet provincial ED wait time targets.
In this study, we considered the costs and benefits associated with increasing the number of acute-care beds to reduce the time an admitted patient spends boarding in the ED. A shorter hospital LOS has often been cited as a potential benefit associated with shorter ED wait times. We derived a multivariable Cox regression model to examine this association.
We found no significant association between ED boarding times and the time to discharge. Using a Markov model, we estimated an increased annual operating cost of $2.1m to meet the prescribed wait time targets.
We concluded that increasing acute-care beds to reduce ED wait times would require significant funding from hospitals and would have no effect on total length of stay of hospitalized patients.
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Ferrand, Yann B. "Flexible Resource Utilization in Healthcare." University of Cincinnati / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1337289368.
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Karlsson, Christina, and Wendela Bensdorp-Redestam. "Är det min tur snart? : Väntans betydelse för den äldre patienten på akutmottagningen." Thesis, Högskolan i Halmstad, Sektionen för hälsa och samhälle (HOS), 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:hh:diva-26013.
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Antalet äldre människor ökar i samhället och står för en allt mer växande grupp patienter som behöver vård på akutmottagningen. Väntetiden på akutmottagningar runt om i landet blir allt längre. Det är ett välkänt faktum att äldre människor påverkas av att vänta länge på en akutmottagning, då deras allmäntillstånd lätt kan försämras på grund av det biologiska åldrandet och grundsjukdomar som gör dem skörare. Syftet med studien var att beskriva äldre patienters upplevelser av väntan vid besök på akutmottagningen. En litteraturstudie utfördes där resultatet baserades på tio vetenskapliga artiklar. Resultatet av denna litteraturöversikt delades in i fyra teman: att bli sedd, att bekräftas i sitt lidande, att vara delaktig som patient och att se patientens hela situation. Behovet hos den äldre att bli bekräftad, att få information och omvårdnad ökade när väntetiden blev lång på akutmottagningen. En ökad medvetenhet hos sjuksköterskan behövs kring den äldre akut sjuka patientens utsatta situation på akutmottagningen. Genom ökad kunskap och medvetenhet kan dessa patienternas behov av omsorg och omvårdnad mötas så deras lidande minskar under väntan på akutmottagningen. Behov av fortsatt forskning kring förbättringar avseende miljön och omhändertagandet av den äldre patienten på akutmottagningen finns vilket även behöver belysas inom grundutbildningen till sjuksköterska.The number of elderly people is constantly increasing in the community and represents a growing group of patients who need care in the emergency department. The waiting time in the emergency deparments in Sweden tends to become longer. It’s a wellknown fact that older people are affected when they have to wait for a long time. Their general condition could easily detoriate as they are more vulnerable due to biological aging and medical conditions. The aim of the study was to describe older patient’s experiences of waiting in the emergency department. The study was conducted as a literature review and was based on ten scientific articles. The result of this literature review was divided into four themes: to be seen, to be acknowledged in their suffering, to participate as a patient and to see the patient’s entire situation. The older patient’s need to be acknowledged, information and care increased when the waiting time become long. For the nurse, an increased awareness of the older acutely ill patients situation in the emergency department is needed. With more knowledge and awareness, these patients’ needs could be taken care of and their suffering during the waiting time could be reduced. Continued research is needed to improve the environment and care of the older patient and should also be emphasized in nursing education.
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Tran, Quoc Huy Martin, and Carl Ronström. "Mapping and Visualisation of the Patient Flow from the Emergency Department to the Gastroenterology Department at Södersjukhuset." Thesis, KTH, Medicinteknik och hälsosystem, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-279605.
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The Emergency department at Södersjukhuset currently suffers from very long waiting times. This is partly due to problems within visualisation and mapping of patient data and other information that is fundamental in the handling of patients at the Emergency department. This led to a need in the creation of improvement suggestions to the visualisation of the patient flow between the Emergency department and the Gastroenterology department at Södersjukhuset. During the project, a simulated graphical user interface was created with the purpose of mimicking Södersjukhusets current patient flow. This simulated user interface would visualise the patient flow between the Emergency department and the Gastroenterology department. Additionally, a patient symptoms estimation algorithm was implemented to guess the likelihood of a patient being admitted to a department. The result shows that there are many possible improvements to Södersjukhusets current hospital information system, TakeCare, that would facilitate the care coordinators work and in turn lower the waiting times at the Emergency department.Akutmottagningen på Södersjukhuset har i dagsläget väldigt långa väntetider. Detta beror till viss del utav problem inom visualiseringen och kartläggning av patient data och annan fundamental information för att hantera patienter på akutmottagningen. Detta ledde till att det finns ett behov att skapa förbättringsförslag på visualiseringen av patientflödet mellan akutmottagningen och gastroenterologiavdelningen på Södersjukhuset. Under projektets gång skapades ett simulerat användargränssnitt med syfte att efterlikna Södersjukhusets nuvarande patientflöde. Denna lösning visualiserar patientflödet mellan akutmottagningen och gastroenterologiavdelningen. Dessutom implementerades en enkel sorteringsalgoritm som kan bedöma sannolikheten om en patient skall bli inlagd på en avdelning. Resultatet visar att det finns flera möjliga förbättringar i Södersjukhusets nuvarande elektroniska journalsystemet, TakeCare, som skulle underlätta vårdkoordinatorernas arbete och därmed sänka väntetiderna på akutmottagningen.
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Al, Essa Fares Mohammed. "Approaches and solutions to hospital emergency department overcrowding including failure mode and effect analysis as a risk assessment technique of real-time locating system." Thesis, University of Exeter, 2013. http://hdl.handle.net/10871/16063.
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Emergency Departments (ED) are highly dynamic environments comprising complex multi-dimensional patient-care processes. In recent decades, there has been increased pressure to improve ED services, while taking into account various aspects such as clinical quality, operational efficiency, and cost performance. Overcrowding has become a major barrier to receiving a proper and timely emergency care in many acute hospitals throughout the world. Patients often face long waiting times to be seen and treated. Those who require admission may even wait longer. The scope of this research is to focus on ED factors that lead to overcrowding and their management. Technology is being cited as one of the management tools, specifically the utilization of Radio Frequency Identification (RFID) for tracking patients as their journey progresses through an ED. Like any technology, RFID has potential and pitfalls. The author chose to use Failure Mode and Effect Analysis (FMEA) as a tool to explore the possible failures of RFID technology as it is utilized in one of the ED in Riyadh Military Hospital (RMH). This particular ED has been used as a case study to explore those failures and, with the use of FMEA, propose a set of recommendations to address those failures and improve the design and implementation of RFID. The experience of RMH-ED was explored through interviews and a survey in which 100 participants took part. The survey touched upon various aspects of this experience. This was due to the various roles of the surveyed staff who were involved with this technology. These roles ranged from front line clinical staff to administrative staff, management staff and technical support staff. Data analysis showed convincing evidence of the positive impact RFID had on managing ED overcrowding. However, and as expected, there are some pitfalls and failures that FMEA helped identifying and suggested potential solutions to them. RFID is a small link in the chain of other technological innovations and solutions. It is by no means capable of solving the problems associated with ED overcrowding by itself. Most of the search carried out by the author identified large variation in approaches to dealing with the issue of ED overcrowding. Those ranged from applying more human resources to altering the pathways of managing patients journey through healthcare system to applying more intermediate layers of management to ease the pressure of the Emergency departments. Other approaches included some aspects of technology such as development of early warning systems that have not been widely adopted and remained as isolated efforts.
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Venables, Heather. "In emergency department patients requiring resuscitation room care, can Renal Resistive Index measurements predict the development of acute kidney injury?" Thesis, University of Bath, 2019. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.767596.
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PURPOSE: Doppler renal resistive index (RRI) has emerged in the last decade as a useful prognostic indicator for transient (fluid responsive) and persistent acute kidney injury (AKI). The determinants of RRI are largely systemic and recent studies confirm that RRI measurement could also be a useful early marker for sub-clinical AKI and post procedural AKI risk. This study aimed to determine the feasibility of RRI measurement in an Emergency Department (ED) resuscitation room setting using a pointofcare ultrasound system. METHODS: In this prospective single centre study, RRI measurement was attempted in 20 non-consecutive patients (meeting the inclusion criteria) by a single expert sonographer. RRI measurements were evaluated against context specific feasibility criteria and target outcomes. RESULTS: 20 patients (11 male, 9 female) were recruited to the study. Age of patients ranged from 33 years to 91 years (mean 62.3 years). Adequate visualisation of both kidneys was achieved in 60% of patients (n=12). In patients where it was not possible to achieve adequate views of both kidneys (n=8), limiting technical factors were shortness of breath (SOB) (n=6), high BMI (n=2). At least one measurement of RRI was achieved in 70% of patients (n=14). However, in 9 of these patients (64.3%) the Doppler spectral traces achieved were substandard and did not meet the measurement criteria for RRI as specified in the study protocol. In 30% of patients (n=6) no usable spectral trace was achieved and it was not possible to measure RRI. SOB was noted as a technical difficulty in 60% of patients (n=12) including three for whom RRI measurements were achieved. In 9 patients (45%) SOB was recorded as the primary reason for failure to acquire a usable Doppler trace. All criteria for RRI measurements were met in only 3 patients (15%). CONCLUSION: Measurement of RRI was not feasible in patients requiring resuscitation room care using a current point of care ultrasound system. If RRI is to play a useful role in this high priority patient group, adaptation of the available technology is required to mitigate the problem of image blur due to patient breathing movement.
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Robayo, Rubilin. "Faktorer som påverkar patienters upplevelser av vistelsen på akutmottagningen." Thesis, Sophiahemmet Högskola, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:shh:diva-2174.
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Omhändertagandet av personer som är i behov av vård skall vara lika för alla med ett respektfullt bemötande. Patienter bör få individanpassad vård tillsammans med ett omhändertagande som innebär personligt bemötande på individens villkor. Behandling och kommunikation är nyckelfaktorer för att möta vården med att förebygga ohälsa och lidande hos patienter. Inom akutmottagningar omhändertas människor som är i akut behov av vård vilket kan innebära att de patienter som söker akuthjälp och får låg prioritet i triage-systemet kan vänta länge på vård. Ett bemötande inom sjukvården bör vara anpassat med hänsyn till lika villkor för alla människor. Hög arbetsbelastning ses på akutmottagningar i hela världen. Orsaker till detta kan bero på att det faktiska antalet personer som besöker vården ökar eller att patienter söker akutvård istället för primärvård. En annan orsak som kan bidra till höga belastningen på akutmottagning kan vara att patienter ofta inte känner till, eller litar på, andra vårdgivare. Patienter som uppsöker akutvård bör få information om hur de kan vända sig till andra vårdgivare där de kan få hjälp. Syftet var att beskriva faktorer som påverkar upplevelsen av vistelsen för patienter på en akutmottagning. Metoden var en litteraturbaserad studie i form av en litteraturöversikt baserad på 16 vetenskapligt granskade artiklar med kvantitativ och kvalitativ ansats. Resultatet var att kommunikation, information, väntetiden, bemötande och tillfredsställdes var faktorer som påverkar patienters upplevelse av vistelse på akutmottagning. Klar och tydlig kommunikation, ett gott bemötande och att ge information angående t.ex. eventuell väntetid kan bidra till en ökad tillfredsställelse hos patienten under vistelsen på akutmottagningen.
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Edin, Caroline, and Sara Mälby. "Faktorer på akutmottagningen som är av betydelse för patientens tillfredställelse av vården : - en litteraturstudie." Thesis, Högskolan i Gävle, Avdelningen för hälso- och vårdvetenskap, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-14122.
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Syfte: Att beskriva faktorer av betydelse för patienttillfredsställelse på akutmottagningen.Metod: En litteraturstudie med beskrivande design. Data baserades på 13 artiklar sökta i databasen PubMed.Resultat: Totalt identifierades sju faktorer av betydelse för patienttillfredsställelsen av vården på akutmottagningen. Faktorerna var patientens bakgrund, vårdpersonalens bemötande, information, kommunikation, triageprocessen, väntetid och miljö. Resultatet visade att den viktigaste faktorn som hade betydelse för patientens tillfredställelse på akutmottagningen var väntetiden, ovissheten kring denna och triageprocessens påverkan.Slutsats: Faktorerna visade sig vara viktiga var för sig och ännu viktigare i kombination med varandra. Om patienterna var missnöjda med en faktor påverkade det ofta tillfredställelsen av de andra faktorerna under besöket på akutmottagningen. Väntetiden tyder sig vara den mest betydande faktorn för patienttillfredsställelse i kombination med att triagesystemet påverkade hur länge patienterna faktiskt väntade på akutmottagningen. Forskning finns om vilka faktorer som var betydande för patienterna på akutmottagningen, ändå var patienterna fortsatt otillfredsställda och ovetande på akutmottagningen. Ytterligare forskning behövs kring samband mellan faktorer som är betydande för patienttillfredsställelsen på akutmottagningen och specifikt triagesystemets betydelse för väntetider och patienttillfredsställelse. Även forskning om triagesystemet är ett fungerande system, då samband visats med väntetider.Aim: To describe the factors of patient satisfaction in the emergency department. Method: A literature review with descriptive design. The data was based on 13 articles searched in the PubMed database.Result: In total, seven factors of patient satisfaction of care were identified in the emergency department. The factors were the patient's background, health professional response, information, communication, the triage process, waiting time and the environment. The result showed that the main factor that had an impact on patient satisfaction in the emergency department was waiting time, the uncertainty surrounding this and the impact of the triageprocess. Conclusion: The factors shown to be important in itself, and more importantly, in combination with each other. If patients were dissatisfied with one factor it often affected the satisfaction of the other factors during the visit to the emergency department. The waiting time suggest being the most significant factor for patient satisfaction and the triage system affected how long the patients actually waited in the emergency department. Research exists on what factors that are significant for patients in the emergency department. Yet patients continued to be unsatisfied and unaware in the emergency department. Further research is needed about the relationship between the factors that are important for patient satisfaction in the emergency department and specific the triage system's impact on waiting times and patient satisfaction. Also research on the triage system as a functioning system, as association showed to waiting times.
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Carlsson, Lena. "Väntetidsrelaterad frustration på akutmottagningen." Thesis, Högskolan i Borås, Institutionen för Vårdvetenskap, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-16521.
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Aim: The aim of this study was to describe what nurses experienced in connection with waiting time related frustration among patients and relatives in the emergency department and also what strategies nurses use to manage waiting time related frustration.Background: The numbers of emergency department visits are increasing and lead to waiting times which can cause frustration among patients and relatives, a frustration that nurses encounter in their everyday work and need strategies to deal with.Methods: This is a descriptive qualitative study. Interviews are conducted with five nurses, transcribed and analyzed by qualitative content analysis.Findings: The nurses feel inadequate and powerless when they meet patients and relatives frustration. In order to deal with patients and relatives frustration, they use the strategy of participation, which implies to involve and meet patients and relatives needs for information and to be seen. In order to prevent themselves becoming frustrated they use adaptability, by creating an inner calm, not take it personally and to distance themselves from the frustration.Conclusion: The result highlights the importance of managing the activity to reduce waiting time related frustration, for example through reflection and working for reducing waiting times. Further research is also needed.Program: Magisterprogram i vårdvetenskap med inriktning mot akutsjukvård
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Haglunds, Eriksson Marie, and Rebecka Massey. "Patientens väntan på akutmottagningen : en litteraturstudie." Thesis, Högskolan Väst, Avdelningen för omvårdnad - grundnivå, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:hv:diva-14032.
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Background: Overcrowding and long waiting times are common in emergency departments. Organizational problems, staff- and hospital bed shortages leads to long waiting times. A consequence of the long waiting time is that patients' leave without being seen. Aim: The aim of this study was to understand patient's experiences of waiting at the emergency department. Method: This is a literature study based on qualitative articles. Ten qualitative articles were included in this study. Results: The findings in this study revealed three main themes; Being a patient, Meeting with healthcare and The environment at the emergency department. The patients' experience feelings of lack of control, abandonment, frustration and develop different strategies to deal with the waiting time. Patients' describe how they feel ignored and lacking information about waiting times and treatment. The emergency department environment affects the patient's experience during the waiting period. Conclusion: Improvement measures are needed to improve the environment at the Emergency department to make waiting time easier. The waiting time experience is improved when nurses are present and available to provide support.
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Mahapatra, Arun Kiran. "Investigation of noise in hospital emergency departments." Thesis, Georgia Institute of Technology, 2011. http://hdl.handle.net/1853/45842.
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The hospital sound environment is complex. Emergency Departments (EDs), in particular, have proven to be hectic work environments populated with diverse sound sources. Medical equipment, alarms, and communication events generate noise that can interfere with staff concentration and communication. In this study, sound measurements and analyses were conducted in six hospitals total: three civilian hospitals in Atlanta, Georgia and Dublin, Ohio, as well as three Washington, DC-area hospitals in the Military Health System (MHS). The equivalent, minimum, and maximum sound pressure levels were recorded over twenty-four hours in several locations in each ED, with shorter 15-30 minute measurements performed in other areas. Acoustic descriptors, such as spectral content, level distributions, and speech intelligibility were examined. The perception of these acoustic qualities by hospital staff was also evaluated through subjective surveys. It was found that noise levels in both work areas and patient rooms were excessive. Additionally, speech intelligibility measurements and survey results show that background noise presents a significant obstacle in effective communication between staff members and patients. Compared to previous studies, this study looks at a wider range of acoustic metrics and the corresponding perceptions of staff in order to form a more precise and accurate depiction of the ED sound environment.
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Brisenheim, Therese, and Ylva Hagsköld. "Patienters upplevelser av att vårdas på en akutmottagning : -en litteraturöversikt." Thesis, Högskolan Dalarna, Omvårdnad, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:du-20930.
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Bakgrund: Vårdpersonalen på en akutmottagning har stora krav på sig, ansvar för många patienter och måste fatta många egna beslut, ibland med mycket kort betänketid. Vårdpersonalen möter många olika patienter med olika problem och personligheter, och måste bemöta varje patient så att denne känner sig bekräftad och sedd. Syfte: Syftet med litteraturöversikten är att undersöka patienters upplevelse av att vårdas på en akutmottagning. Metod: Artiklar till arbetet har söks i olika databaser. Aktuella artiklar har lästs och relevanta fynd har markerats, för att analyseras och sammanställa ett resultat. Resultat: Analysen resulterade i tre underrubriker: Information, Bemötande och Vårdmiljö, med uppdelning av positiva och negativa upplevelser. Många patienter var nöjda med vården, men hade låga förväntningar från början. Patienterna har förstående för personalens tuffa arbetsmiljö, men önskade att få bättre information om väntetid och undersökningar. De tyckte att väntetiden var för lång, och kände sig ofta ensamma och övergivna. Slutsats: Mycket behöver förändras för att patienterna ska få en mer positiv upplevelse av akuten. Detta arbeta kan hjälpa till att belysa vilka punkter som vården måste arbeta extra mycket med för att patienterna ska känna sig trygga, exempelvis bättre information om väntetider och ett bemötande där sjusköterskan ser hela patienten.Background: The demands and expectations on a nurse in the emergency room are high. They are responsible for many patients and have to make many decisions on their own, sometimes with very short reflection time. They face a wide variety of patients with different problems and personalities, each requiring their own method of approach and interaction in order for him or her to feel acknowledged. Aim: The aim of the literature review is to examine patient's experiences of being cared for in an emergency room. Method: Articles for the work has been searched in different databases. Articles in-question has been read and the relevant finding has been highlighted, to analyze and compile the results. Results: The analysis resulted in three subheadings: Information, Treatment and Care environment, with sectioning of positive and negative experiences. Many patients were satisfied with the care, but had low expectations from the start. Conclusion: There is much that needs to be changed to allow patients to have a more positive experience of the emergency room. Care units must work harder with to ensure that patients will feel secure and safe, for example, better information on waiting times and a treatment where the nurse sees the whole patient.
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Sunhede, Magdalena, and Nina Sandberg. "Patienters upplevelser av ett akutmottagningsbesök." Thesis, Uppsala University, Department of Public Health and Caring Sciences, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-112508.
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The pressure is getting tougher on Accident and Emergency departments. Therefore it is crucial to study how the patient’s perceive their visit to the Emergency department. Knowledge about this enables improvement of routines, patient participation and patient safety. The purpose of the study was to investigate patient’s experiences of their visit at the Emergency department.
A descriptive design was used. Patients (n=91) who visited the Emergency department at Uppsala University Hospital during two weeks in October 2009, answered a questionnaire. The questionnaire consisted of 13 questions about the visit, waiting time and information.
The result showed that most of the patients found that the waiting time was acceptable and they perceived that the staff was competent and professional. On the other hand most patients perceived that they did not receive enough information of the prioritization of the patients in the Emergency department and information about expected waiting time.
The study result shows that one part of the patient didn´t get information about expecting waiting time and the order of priority and the conclusion was that the study shows that the majority of the patients perceived their Emergency department visit as positive.
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AL-Mhana, Rania, and Muthana Shaghi. "ÄLDRE MULTISJUKA PATIENTER PÅ AKUTEN : Ur äldre patienters perspektiv." Thesis, Mälardalens högskola, Akademin för hälsa, vård och välfärd, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:mdh:diva-41404.
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Bakgrund: Antalet äldre patienter som söker vård till akutmottagningen har ökat med åren. De flesta sökande av dessa äldre patienter är multisjuka, vilket innebär att de äldre patienterna har minst två sjukdomar. Sjuksköterskor upplever stress och frustration i sitt arbete på akutmottagningen på grund av tidsbrist och brist i kompetenser samt erfarenhet. Syfte: Att beskriva äldre multisjuka patienters upplevelser av att bli vårdade på akutmottagningen. Metod: En systematisk litteraturstudie med beskrivande syntes baserad på 10 kvalitativa vetenskapliga artiklar. Resultat: Resultatdelen presenteras utifrån två teman med sina respektive subteman. Första temat är ”Positiva upplevelser”, som inkluderar två subteman” Att uppleva tillfredsställelse och bli sedd och respekterad” och ” Att uppleva trygghet och tillit”. Andra tema är ”Negativa upplevelser” som inkluderar två subteman ”Att uppleva sig övergiven” och ”Att uppleva brist på trygghet och tillit”. Slutsats: Äldre multisjuka patienter har en stark önskan om att uppleva trygghet och sjuksköterskans närvaro. Att sjukvårdspersonalen är professionella och säkra i sin yrkesroll leder till att äldre patienter känner sig trygga, sedda och respekterade. När sjukvårdspersonalen inte har tillräckliga kunskaper och erfarenheter om de äldre patienternas hälsotillstånd leder det till att de äldre patienterna upplevde sig övergivna, otrygga samt en minskad tillit till sjukvårdspersonalen.Background: The number of older patients who require and seek the emergency department is increasing every year. Most of them have multiple diseases, which means that the older patients have at least two diseases. The nurses encounter a lot of stress and frustration while working at the emergency department because there is always shortage of time but also because they might have a lack in their knowledge, certain competence skills or experience. Aim: To describe the experiences of older patients with multiple diseases to be cared at the emergency department. Method: A systematic literature study with descriptive synthesis based on 10 qualitative scientific articles. Results: The result is presented based on two themes with two subthemes, respectively. The first theme is "Positive Experiences", which includes two subthemes "Experiencing satisfaction, being seen and respected" and "Experiencing security and trust". The second theme is "Negative Experiences", which includes two subthemes "Experiencing abandonment" and "Experiencing lack of security and trust". Conclusion: Older patients with multiple diseases have a strong desire for staff presence and safety. The fact that healthcare personnel are professional and safe in their occupational role leads to older patients feeling safe, seen and respected. When healthcare personnel do not have sufficient knowledge and experience about the older patients’ health condition, older patients experience abandonment, insecurity and reduced confidence in healthcare personnel.
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Bakaki, Paul Mugeni. "MEDICAID ENROLLMENT PATTERNS AND SERVICE UTILIZATION OF EPILEPSY PATIENTS IN OHIO." Case Western Reserve University School of Graduate Studies / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=case1365162793.
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Jardine, Kaitlyn. "The psychology of waiting: designing for satisfaction in emergency department waiting environments." 2017. http://hdl.handle.net/1993/32086.
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This practicum project investigates current emergency department waiting room models and explores how the psychology of waiting can be applied to positively influence the waiting experience. This culmination of research, coupled with concepts of evidence-based design (EBD), precedent research and regional site visits result in an understanding of emergency department waiting that challenges current emergency department design. This knowledge led to the formulation of a theoretical framework and hypothetical design proposal that aims to uncover, identify, and integrate design concepts known to influence emergency department waiting environment satisfaction.February 2017
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Medeiros, Joshua. "Improving waiting times in the Emergency Department." Thesis, 2016. https://hdl.handle.net/2144/19424.
Full textAbstract:
Waiting times in the Emergency Department cause considerable delays in care and in patient satisfaction. There are many moving parts to the ED visit with multiple providers delivering care for a single patient. Factors that have been shown to delay care in the ED have been broken down into input factors such as triaging, throughput factors during the visit, and output factors, which include discharge planning and available inpatient beds for admitted patients. Research has shown that throughput factors are an area of interest to decrease time spent in the ED that will lead to decrease waiting room times. In this Quality Improvement project, we will develop a systematic check in system with ED providers that will allow providers to identify any outstanding issues that may be delaying care or discharge. We hypothesize that this system will increase throughput in the ED by resolving any lab, radiology, or treatments that were overlooked. Reviewing the results of this QI project will allow us to see if we were effective in our timing of scheduled check-ins. Ultimately, this will reduce time spent in the waiting room by allowing more patients to be seen. In the era of the Affordable Care Act, more patients have access to affordable healthcare and will increase volume in the ED. This check-in system will allow more patients to be seen smoothly and in a timely manner that will improve and increase patient care and satisfaction in the ED.
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Tranquada, Sara Patrícia Fernandes. "Hospital hero: a game for reducing stress and anxiety of children while waiting in emergency room." Master's thesis, 2014. http://hdl.handle.net/10400.13/831.
Full textAbstract:
This report tells a story which started as an idea that came to us to fight the battle-cry feeling commonly known as stress and anxiety. Before creating the solution of the idea, we first need to understand the feelings underneath and its effects on our well-being.
Throughout the course of our lives, we experience states of weakness and fear. These feelings can arise, for instance, while we are in an emergency room.
Needless to say, how much it would have imaginable effects on children, who are
unfamiliar to such environments. We ran through a serious of scenarios to find
the most suitable solution, among them the study of interaction with positive
expressions by Dr. Baldwin, proved to be a valued resource. It was reduced due to
its length and to be suitable to our public audience.
The game was then created in order to reduce or even eliminate the stress and anxiety of children. Since the game was initially released, some modifications had been made but the original idea - interaction with positive expressions – remained.
When the time came, we asked children to play one of the two versions of the game while waiting in the emergency room. This not only created a diversion for them but also a learning experience as it displayed some hospital equipment.
The difference between the two versions is that one provides expressions, while the other does not. After all our hard work, we felt rewarded because the project proved its
worth and we would see that in the expressions on children’s faces while they
played. Most importantly, their anxiety level numbers were significantly reduced
during that short period of time.Agência regional para o Desenvolvimento da Investigação Tecnologia e Inovação
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Liu, Min-Ling, and 劉敏玲. "Perceived waiting times, actual waiting times and their relations to satisfaction of patients of the emergency department in a medical center." Thesis, 2001. http://ndltd.ncl.edu.tw/handle/71495702719461445190.
Full textAbstract:
碩士國立臺灣大學
醫療機構管理研究所
89
Abstract─ The objective of this study was to explore perceived waiting time, actual waiting time and their relations to satisfaction of patients of the emergency department (ED). We hope to provide management priority of ED patient care to improve the quality of the ED service according to patients’ opinions and demands. We used “time motion study” to measure ED patient’s actual waiting time and gathered both perceived waiting time and satisfaction toward ED services from the questionnaires. In addition, we adopted an “intervention” to explore its effects on satisfaction. In this study, a simple random sampling was used for the emergency patients at a medical center. For our investigation we analyzed 196 samples gathered from 2000/01/08 to 2000/01/28. The result of this study are shown as follow: 1. Over one half of the triage patients were category III (55.6%), followed by category II (40.3%). Most of them are internal medicine patients and discharged in one day. There were significantly differences between perceived and actual waiting time. The longer the waiting time was, the larger the difference between actual and perceived time. Patient satisfaction caused by perceived waiting time was significantly higher than that caused by actual waiting time. 2. ED patients spent most time on waiting laboratory test results, followed by waiting x-ray test reports and on waiting to see the consulting doctor. The longer the waiting times were, the lower the satisfactions. Therefore, these three kinds of waiting times should be our first priority to improve the ED services. 3. Three of the patient characteristics (time of arrival, mode of arrival and disease pattern) were significantly associated with the waiting time of the ED. The characteristics of patients, such as sex, age, education, disease pattern, time of arrival and mode of arrival, were significantly associated with satisfaction. 4. The intervention during waiting laboratory test results could only reduce the time from specimen collection to login it, but it couldn’t speed up the laboratory testing time. Their satisfactions were the same as without intervention. However, the intervention shortened the waiting time for x-ray test results and significantly improved satisfactions. This study suggest that (1) It’s necessary to treat major and minor disease in separate rooms to meet the demand of minor disease patients, and to provide the information of waiting times for all patients to decrease dissatisfaction. (2) The ED information system should be established. They will help doctors to deal with the patient’s reports in time and save the patient’s waiting time.
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Chang, Hsing-Ming. "Waiting-line problems with priority assignment, and its application on hospital emergency department wait-time." 2011. http://hdl.handle.net/1993/4974.
Full textAbstract:
The aim of this thesis is to first give a brief review of waiting line problems which often is a subject related to queueing theory. Simple counting processes such as the Poisson process and the duration of service time of each customer being exponentially distributed are often taught in a undergraduate or graduate stochastic process course. In this thesis, we will continue discussing such waiting line problems with priority assignment on each customer. This type of queueing processes are called priority queueing models.
Patients requiring ER service are triaged and the order of providing service to patients more than often reflects early symptoms and complaints than final diagnoses. Triage systems used in hospitals vary from country to country and region to region. However, the goal of using a triage system is to ensure that the sickest patients are seen first. Such wait line system is much comparable to a priority queueing system in our study. The finite Markov chain imbedding technique is very effective in obtaining the waiting time distribution of runs and patterns. Applying this technique, we are able to obtain the probability distribution of customer wait time of priority queues. The results of this research can be applied directly when studying patient wait time of emergency medical service. Lengthy ER wait time issue often is studied from the view of limited spacing and complications in hospital administration and allocation of resources. In this thesis, we would like to study priority queueing systems by mathematical and probabilistic modeling.
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Piccolo, Christian. ""How long before I see a doctor?" An analysis of triage-to-doctor waiting times in an emergency department in a Johannesburg private hospital." Thesis, 2013.
Find full textAbstract:
A research report presented to the
Division of Emergency Medicine,
Faculty of Health Sciences,
University of the Witwatersrand
In partial fulfilment of the degree
Master of Science in Medicine (Emergency Medicine)Background: Private health care emergency departments (EDs) are vital components of health care systems and have become increasingly popular due to their accessibility, convenience and proficiency. This popularity has led to overcrowding which in turn has led to increased patient waiting times. Lengthy waiting times have been shown to be a common cause of patient dissatisfaction. Patients, however, often overestimate the passage of time which results in unwarranted dissatisfaction. Study objectives: The purpose of this study was to establish the actual waiting times experienced by patients from the time of triage to first doctor contact at the Dogwood Hospital Emergency Department. Design: A retrospective cross-sectional descriptive study was undertaken at the Dogwood Hospital Emergency Department from 1 st January 2009 to the 30th August 2009. All patients (adults and children) of all priority who sought medical attention at the Dogwood Hospital ED were included in the study. Main Results: Priority 3 patients waited the longest out of all patients, particularly on weekday mornings. Overall this study revealed that for 70% of patients the triage-to-doctor waiting time was less than 1 hour. Almost 24% of patients waited between one and two hours and about six percent waited more than two hours. Conclusions: Most patients in this study were seen by a doctor within the target times set by the South African Triage Group (SATG). Numerous studies suggest that patients believe that the acceptable triage-to-doctor waiting time is approximately one hour. In this study 30% of patients waited longer than one hour.
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Wang, Li-Hsiang, and 王麗香. "The Difference of Patient Needs Among Patients,Caregiver and Nurse in The Observation Room of Emergency Department." Thesis, 2001. http://ndltd.ncl.edu.tw/handle/70707027712337080177.
Full textAbstract:
碩士長庚大學
護理學研究所
89
Abstract The observation room in emergency department handles patient care between emergency treatments and hospital management. The number of observed patient in this setting was incremental due to the high incidence of hospitalization. Patient faced disease-related and environment induced stresses and anxieties, their needs were more urgent to be satisfied. The purpose of this cross-sectional comparison study was to explore the different point of view of patient need through the eyes of patients themselves, their caregivers and their primary nurse. Also, the related factors of these variations will be explored. Patients and their caregiver were selected by simple random sampling method while the primary nurses were selected by purposive sampling method. All subjects were selected from a medical center around the northern part of Taiwan. A total of 130-paired patients-caregivers and 32 nurses were interviewed. Self-designed questionnaires “Patient needs in observation room of emergency department” was identified as valid and reliable by expert validity and cronbach alph. Another instrument is Chinese version of Health locus of control. Descriptive analysis, t-test, Anova test, Anova repeated measure and Pearson’s Correlation coefficient were performed for data analysis. The results showed：(1).Patients demand needs disease-related information. Caregivers indicated patients demand disease-related and care-related information. Nurse indicated patients demand all four dimensions of information. (2). All these three samples regarded care-related information were one acquired most and mental support was the least one in general. (3). Patients were satisfied with mental supports and environment-related needs. Caregivers and nurses both believed that patients’ satisfaction level of these needs is between “satisfaction” and “dissatisfaction”. (4). Comparison among these three groups indicated that there is no difference in disease-related information. However, nurses overestimated patients’ needs, acquirement and satisfaction in the other three dimensions of patients’ needs. (5). Caregivers overestimated patients’ needs, acquirement and the satisfaction in mental supports dimension of patients needs. (6). The significant related factors of patients’ needs included: age of patient, marital status, education, experiences of emergency admission in study hospital and other hospitals, transference from other hospital, type of department, and triage degree. Also, age of caregiver, marital status, education, health locus of control, duration of being a caregiver, lived with patient or not, and relationship with patient have impact on the variation of assessment. Age of nurse, marital status, seniority of nursing and emergency nursing, religion, and education are another set of factors that affect results of assessment. All these findings can facilitate nurses to be aware of patients’ needs in observation room in emergency department, which in turn, provide some directions of strategies to improve quality of care. Keyword: need, satisfaction, observation room of emergency department
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Yang, Jie. "Simulation modeling for the impact of triage liaison physician on emergency department to reduce overcrowding." 2017. http://hdl.handle.net/1993/31963.
Full textAbstract:
Emergency department (ED) overcrowding has been a common complaint in Emergency Medicine in Canada for many years. Its adverse effects of prolonged waiting times cause patient dissatisfaction and unsafety. Previous studies indicate that adding a physician in triage (PIT) can increase accuracy and efficiency in the initial process of patient evaluation. However, the scientific evidence of the PIT impact on ED is far away from sufficient before its widespread implementation. This research is to search solutions using PIT to identify areas of improvement for the ED patient flow, based upon a validated discrete-event simulation (DES) model. As an efficient decision-making tool, the DES model also helps to develop an understanding of the current ED performance and quantitatively test various design alternatives for ED operations.February 2017
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Kliewer, Sandra Sharon. "Emergency room referrals to a geriatric outreach team: the analysis of referral reasons." 2010. http://hdl.handle.net/1993/4058.
Full textAbstract:
The purpose of this study was to explore the referrals that were generated from one hospital emergency room to a community outreach team. This study used a specific geriatric program assessment team in Winnipeg, Manitoba, Canada as the community outreach team.
Malcolm Payne’s description of Task Centered Casework and Crisis Intervention and Irene Pollin’s Medical Crisis Counseling served as the theoretical structure and design to gain an understanding of the reasons geriatric patients were referred to the GPAT on discharge.
This study aimed to answer three research questions:
1) What is the emergency room medical team’s main reason for referral to a geriatric outreach team?
2) Are the referrals received from the emergency room medical team clearly identifying psychosocial issues as areas for examination by an outreach team?
3) Are psychosocial issues identified only after an outreach team clinician completed a comprehensive assessment?
This study revealed that out of the 209 referrals to geriatric program assessment team, the highest number of times referred was for functional decline. It revealed that the emergency room medical team saw functional decline as a valid reason to have the geriatric program assessment team assess the individual in their home settings to ensure that any functional issue be addressed and possible adaptations made in a timely manner to avoid the reverberation that one ailment can set off. The second most common reason for referring to the geriatric program assessment team was for social issues. Forty percent of the referrals identified that there were concerns in relation to social issues which clearly identifies that the emergency room medical team identified psychosocial issues as an area for further examination.
And finally, the findings show psychosocial issues were not identified only after an outreach team clinician completed a comprehensive assessment, but that both appear cognizant of the interplay between medical issues and social issues.
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Salam, Lialoma. "Predictors of Emergency Room Visits or Acute Hospital Admissions Prior to Death among Hospice Palliative Care Clients in the Community." Thesis, 2012. http://hdl.handle.net/10012/6914.
Full textAbstract:
Background: The demand for hospice palliative care (HPC) services is expected to grow due to the increasing number of seniors living into advanced old age, the changing nature of death, and the changing family structure. HPC is a philosophy of care that aims to relieve suffering and improve the quality of life for clients with life-threatening illnesses or end of life issues. The goals of HPC are not only to ameliorate clients’ symptoms but also to reduce unneeded or unwanted medical interventions such as emergency room visits or hospitalizations (ERVH). Hospitals are considered a setting ill-prepared for end of life issues. Therefore, use of such acute care services has to be considered an indicator of poor quality end of life care. It is important to understand the factors that contribute to ERVH in order to determine how to minimize the number of avoidable hospital visits.
Objectives: The objectives of this study were to report the proportion of palliative home care clients with ERVH, describe the characteristics of clients with ERVH, and identify the predisposing, enabling, and need-for-care variables associated with ERVH.
Methods: Analysis of secondary data was performed on a palliative home care dataset from the Hamilton Community Care Access Centre (CCAC). All palliative home care clients receiving services from the Hamilton branch were assessed using the interRAI Palliative Care (interRAI PC), which is a comprehensive, standardized instrument. One assessment for each client assessed between April 2008 and July 2010 was used, for a final sample size of 764.
Results: Half of the palliative home care clients had one or more ERVH. Visits to the emergency department by time of the day and day of the week were relatively stable. Logistic regression and Cox regression analyses showed that wish to die at home and advance care directives are protective against ERVH. Unstable health, identified by a Changes in Health End stage disease and Signs and Symptoms scale (CHESS) score of 3 or higher, was associated with reduced odds of ERVH, while infections such as prior pneumonia and prior urinary tract infections increased odds of ERVH.
Conclusions: Predisposing characteristics (i.e., wish to die at home and advance care directives) are nearly as important as need variables (i.e., CHESS and prior urinary tract infection) in determining ERVH among palliative home care clients, which challenges the assumption that need variables are the most important determinants of ERVH. There was a lack of significant association between many assessed needs and ERVH, perhaps due to the fluctuating health status among such clients and the stability of measurements. Ongoing assessment of palliative home care clients is essential in reducing ERVH, as reassessments at specified intervals will allow care and service plans to be adjusted with clients’ changing health needs and end of life preferences.
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Jiahe, Wei, and Li Xuyang. "The occupational stress of nurses and their coping strategies : Nurses in Intensive care unit, Operating room, Emergency department as exampleA descriptive literature review." Thesis, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-27357.
Full text
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Pinto, Sofia Isabel Fernandes. "O lugar da formação contínua na atuação da equipa da sala de emergência nos cuidados à pessoa em situação critica." Master's thesis, 2021. http://hdl.handle.net/1822/74235.
Full textAbstract:
Relatório de estágio de mestrado da Pessoa em Situação criticaNo âmbito do Estágio do Mestrado em Enfermagem da Pessoa em Situação Crítica, da Escola Superior de Enfermagem da Universidade do Minho em consórcio com a Escola Superior de Enfermagem da Universidade de Trás-os-Montes e Alto Douro, decorrido num Serviço de urgência foi realizado o presente relatório. Este relatório para além de descrever e refletir sobre as atividades e competências desenvolvidas também descreve o projeto de intervenção desenvolvido no serviço ao longo do estágio, no âmbito da temática “O lugar da formação continua na atuação da equipa da sala de emergência nos cuidados à pessoa em situação critica”. A formação em contexto de urgência influencia direta e favoravelmente os níveis de desempenho dos enfermeiros perante emergências tais como peri-paragem/PCR. A continua e constante formação de qualidade diminui consideravelmente os riscos para o doente no sentido em que diminui o caos em que se pode tornar o serviço de urgência perante situações de life saving em que os profissionais de saúde concretamente os enfermeiros pelas mais variadas razões não estejam devidamente preparados para atuar em conformidade com a situação, por falta de formação complementar ou prática. A finalidade principal deste trabalho é detetar as lacunas existentes nas equipas alocadas à sala de emergência e trabalhar essas “falhas” com o intuito de melhorar a confiança e desempenho dos enfermeiros perante situações de emergência e assegurar a prestação de cuidados de alta qualidade, diminuindo assim o caos e a perda de controlo que se podem instalar devido à falta de formação/conhecimento de atuação. O plano de ação implementado passou pela aplicação de uma grelha de observação, direcionada aos aspetos que a mesma pretende observar objetivamente nos enfermeiros do serviço de urgência/emergência do Hospital em análise antes e após a ministração de formação de acordo com as guedlines. Após a análise dos resultados, o objetivo mediante os resultados obtidos e as ilações retiradas, foi organizar e ministrar uma formação com o intuito de melhorar os níveis de qualidade da prestação de cuidados de enfermagem ao doente crítico. Dos 6 casos abrangidos em contexto de sala de emergência cerca de 80% dos casos cumpriram com os itens observados na grelha. Quando observados os procedimentos realizados pelos enfermeiros, verifica-se que estes adaptam a sua prática clínica às suas aprendizagens e experiências pessoais, embora cumpram os protocolos instituídos. Conseguem seguir os algoritmos preconizados, mas gerem o cenário dentro das suas próprias experiências inclusive, com métodos de trabalho adequados às suas equipas. Constata-se assim que o facto de existirem equipas previamente formadas em suporte avançado de vida e, consequentemente na abordagem ao doente critico favorece os níveis de desempenho dos enfermeiros, melhorando e assegurando consideravelmente a segurança do doente critico.
As part of the Internship of the Master's Degree in Nursing of the Critical Person, from the Higher School of Nursing at the University of Minho in consortium with the Higher School of Nursing at the University of Trás-os-Montes and Alto Douro, which took place in an emergency service, it was carried out this report. This report, in addition to describing and reflecting on the activities and skills developed, also describes the intervention project developed in the service throughout the internship, under the theme “The place of training continues in the performance of the emergency room team in caring for the person in critical situation ”. Training in an emergency context directly and favorably influences the performance levels of nurses in the face of emergencies such as peri-stop / CRP. The continuous and constant quality training reduces considerably the risks for the patient in the sense that it reduces the chaos in which the emergency service can become in the face of life saving situations in which health professionals, specifically nurses, for the most varied reasons are not properly prepared to act in accordance with the situation, due to lack of complementary or practical training. The main purpose of this work is to detect the gaps in the teams allocated to the emergency room and work on these “failures” in order to improve nurses' confidence and performance in emergency situations and ensure the provision of high quality care, thus reducing the chaos and loss of control that can be installed due to lack of training / knowledge of performance. The implemented action plan included the application of an observation grid, directed to the aspects that it intends to observe objectively in the nurses of the urgency / emergency service of the hospital under analysis before and after the training in accordance with the guedlines. After analyzing the results, the objective, based on the results obtained and the lessons learned, was to organize and provide training in order to improve the levels of quality in the provision of nursing care to critically ill patients. Of the 6 cases covered in the emergency room context, about 80% of the cases complied with the items observed in the grid. When observing the procedures performed by nurses, it appears that they adapt their clinical practice to their learning and personal experiences, although they comply with the established protocols. They manage to follow the recommended algorithms, but manage the scenario within their own experiences, including working methods appropriate to their teams. It can be seen that the fact that there are teams previously trained in advanced life support and, consequently in the approach to the critical patient, favors the performance levels of nurses, improving and ensuring considerably the safety of the critical patient.
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Gonçalves, Filipe da Silva. "Predictive analysis in healthcare." Master's thesis, 2018. http://hdl.handle.net/10071/17295.
Full textAbstract:
The Emergency departments (ED) are the major entry point to the healthcare system.
With the growing demand due to the increase of life expectancy and the greater number
of diseases, it is mandatory for the ED’s to have a more efficient resource management
in order to try and provide the best experience possible to its patients. If the resource
demand is greater than the resources available, then ED crowding occurs. This
phenomenon leads to several problems that affect the patient experience, like longer
waiting times, lack of beds, patients in hallways, etc.
One of the ways to improve patient satisfaction is through patient waiting time
prediction, since it would allow for a better resource management in the ED and providing
patients with a waiting time estimation on the triage increases patient satisfaction. The
author collaborated with a Portuguese hospital near Lisbon using real ED data and built
a prototype to predict the ED waiting time. The researcher complemented the ED original
dataset with external data like weather information, DGS Announcements and number of
football games, to try to find the most accurate model.
To perform the prediction, the Naïve Bayes (NB) and Random Forest (RF) algorithms
were applied in three different scenarios: the first one only with data from the original
dataset, the second one where the number of football games and DGS announcements
attributes were added and finally, a third one with the same dataset as the previous
scenario but added weather information (temperature, wind, humidity and precipitation).
The RF algorithm was the one with the best performance, especially in the third scenario.
For this reason, the author used the RF algorithm with the variable inputs from the third
scenario to perform the predictions on the prototype. The author concluded that the
external data attributes added in both second and third scenarios were not the most
important attributes for the waiting times, being the most important variables, the triage
colors, disease category.As urgências dos hospitais são o maior ponto de entrada para o sistema de saúde. Com o aumento da esperança média de vida e o aumento do número de doenças, aumentou a necessidade e a procura dos serviços de saúde, levando a que seja importante que as urgências dos hospitais consigam fazer uma gestão eficiente dos seus recursos de forma a proporcionar a melhor experiência possível aos seus utentes. Se a procura por recursos nas urgências dos hospitais for superior aos recursos disponíveis, ocorre um fenómeno de concentração excessiva de pessoas nas urgências, o que pode causar vários problemas como por exemplo tempos de espera mais longos, falta de camas, utentes nos corredores, o que acaba por afetar a satisfação dos utentes. Uma forma de aumentar a satisfação dos utentes é através da previsão do tempo de espera nas urgências do hospital, visto que ajuda a administração do hospital a fazer uma melhor gestão dos recursos disponíveis e oferecer uma previsão do tempo de espera aos utentes leva a maior satisfação. O autor desenvolveu em conjunto com um hospital Português perto de Lisboa, usando dados reais, um protótipo que permite fazer a previsão do tempo de espera nas urgências do hospital. Para complementar os dados providenciados pelo hospital, o autor adicionou alguns atributos como informação do estado meteorológico por dia (temperatura, humidade, precipitação e vento), anúncios da Direção-Geral de Saúde (DGS) e o número de jogos de futebol das duas principais equipas de Lisboa (Sporting CP e SL Benfica) por dia. O autor aplicou os algoritmos Naive Bayes e Random Forest em três cenários diferentes: o primeiro em que apenas se utilizam os dados originais providenciados pelo hospital, o segundo em que se adicionam os atributos dos anúncios da DGS e o número de jogos de futebol e o terceiro em que para além dos atributos do cenário anterior, se adicionou os atributos relativos ao estado meteorológico do dia mencionados anteriormente. O algoritmo com melhor performance foi o Random Forest, principalmente no terceiro cenário, fator que levou a que este tenha sido o modelo escolhido para ser utilizado no protótipo. Depois de fazer as previsões do tempo de espera e analisar os resultados, podese concluir que para além do algoritmo Random Forest apresentar melhores resultados para a previsão do tempo de espera nas urgências, tendo em conta o tipo de dados fornecido, os atributos externos adicionados posteriormente e que não pertenciam ao conjunto de dados original providenciado pelo hospital, não são dos atributos que mais afetam os tempos de espera, sendo que os atributos que têm mais importância para os tempos de espera das urgências são a cor de triagem e a categoria da doença.
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Rivas, Olivares Fernando Miguel. "Un modèle global et intégré de la performance : application à l’urgence d’un hôpital au Mexique." Thèse, 2011. http://hdl.handle.net/1866/7050.
Full textAbstract:
À cause de la nature complexe et non linéaire de leurs opérations, les salles d’urgence (SU) constituent des entités organisationnelles uniques dans le domaine de la santé. Les SU subissent des pressions accrues résultant des dynamiques des sociétés contemporaines et de leurs systèmes de santé, et font face ainsi à des défis uniques comme l’engorgement. Contrairement aux croyances dominantes sur le phénomène, le présent travail de recherche établit que ce problème est en réalité une manifestation de pauvre performance systémique plutôt qu’une faillite opérationnelle. Alors, pour les SU, la
performance organisationnelle relève une importance incontestable. En effet, l’étude de la performance organisationnelle est un sujet de recherche qui intéresse de nombreux chercheurs des services de santé. Il s’agit, néanmoins, d’un concept historiquement difficile à définir à cause de son caractère complexe, multidimensionnel et paradoxal. Le modèle EGIPSS, basé sur la théorie de l’action sociale de Parsons, est capable de saisir cette complexité et constitue un cadre conceptuel robuste et
exhaustif, pouvant s’adapter à des contextes divers. Ce mémoire adopte le modèle EGIPSS pour présenter un outil global et intégré d’évaluation de la performance organisationnelle de la salle d’urgences de l’Hôpital Général Régional 46 à Guadalajara, au Mexique. Cet instrument est conçu pour prendre en compte spécifiquement les particularités propres des SU, ainsi que les caractéristiques organisationnelles uniques de l'Hôpital Général Régional 46. Enfin, le développement de ce projet de mémoire contribue aux efforts d’amélioration continue de la performance de cet établissement, et enrichit les
connaissances sur les urgences en tant qu’unités organisationnelles.Because of the complex, nonlinear nature of their operations, emergency rooms (ER) represent unique organizational entities in healthcare. ERs suffer from increased pressures as the result of current social and health care system dynamics, and thus face distinctive challenges like the crowding phenomenon. Contrary to the prevailing thought among researchers, the present work establishes that crowding is a manifestation of poor performance rather than one of operational failure. Therefore, organizational performance is of indisputable importance to emergency rooms. Indeed, the study of performance is a current subject among health services researchers. It is, however, a concept that has been historically difficult to define because of its complex, multidimensional and paradoxical nature. The EGIPSS model, based on Parson’s Social Action Theory, is capable of seizing this complexity and constitutes a solid and comprehensive framework, capable of adapting to different contexts. This thesis adopts the EGIPSS model in order to present a global and integral tool for the evaluation of the organizational performance of the emergency room at Regional General Hospital 46 in Guadalajara, Mexico. This instrument is conceived to specifically address the particularities of ERs, as well as the unique organizational characteristics of Regional General Hospital 46 and the Mexican Health System. Thus, the development of this thesis project contributes to the continuous performance improvement efforts of this institution, and adds to the knowledge of emergency rooms as complex organizations.