Dissertations / Theses on the topic 'Emergency department'
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1
Riordan, Geraldine M. "Triage in Health Department of Western Australia accident and emergency departments." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 1995. https://ro.ecu.edu.au/theses/1182.
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A survey of triage systems used in Health Department of Western Australia accident and emergency departments was undertaken to examine differences in practices between departments with and without designated triage nurses (TNs). One questionnaire surveyed 93 nurses in seven departments with TNs, a similar second questionnaire surveyed 89 nurses in 16 departments without TNs, and a third questionnaire was used in a structured telephone interview of receptionists in hospitals without TNs. Data were analysed using frequencies, percentages, means, standard deviations and ranges with common themes identified for open ended questions. The study was guided by Donabedian's systems evaluation model. The structures and processes of triage within each department were examined in relation to the outcome standards recommended by the Australian Council on Healthcare Standards. The study results revealed that triage nurses were employed in all departments where patient attendances exceeded 300 per week and nursing staff coverage in the department was higher than five per day. Three departments had introduced triage on weekends only, and these departments had the lowest nurse-patient ratio of one nurse per day to 74 patients per week. The highest nurse-patient ratio was in departments with TNs (1-35). Conclusions drawn from the findings suggest that when receptionists are the first person to see patients, they triage patients using an unsatisfactory two category priority system. The average waiting time to see nursing staff is too long in departments without TNs, 7.6 minutes, as compared to 3. 7 minutes in department with TNs. Nursing staff perceived that triage systems could be improved by having only experienced staff as the triageur. The surveillance of patients entering the department is unsatisfactory as 81% of departments without TNs and 43% of departments with TNs are unable to provide nurse surveillance. The surveillance of the waiting room is similarly unsatisfactory in many departments. All triage areas are inadequate, as facilities for private conversation, hand washing and physical assessment are not always available. The majority of departments without TNs do not have a satisfactory triage priority category system in place. The average time taken by nursing staff to triage patients is an acceptable 3.2 minutes in departments with TNs, and 5.3 minutes in departments without TNs. The practice of redirecting patients away from the department could compromise patient safety as patients are redirected away from most departments by any level of staff employed in the department, without any written documentation kept or any written criteria for the redirection of these non-urgent patients. The practice of ordering investigations and treating minor problems without referring to a doctor could also compromise patient safety, as most departments do not have written policies and guidelines to cover this practice. Most departments offer an inadequate triage training program of preceptoring only. Recommendations are focused on the reviewing of existing triage practices to comply with the standards identified.
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Olsson, Thomas. "Risk Prediction at the Emergency Department." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-4632.
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Hunte, Garth Stephen. "Creating safety in an emergency department." Thesis, University of British Columbia, 2010. http://hdl.handle.net/2429/27485.
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Hospital emergency departments (EDs) are complex, high-hazard sociotechnical systems with distinction as sites of the highest proportion of preventable
patient harm. Patient safety is threatened by abbreviated and uneven care in an interrupted environment marked by uncertainty, multiple transitions over space and time, and mismatch between demand and resources.
Recommendations for reporting systems, standardization, and ‘safety culture’ are at the forefront of local, national, and international strategies to improve patient safety. British Columbia is currently implementing a provincial electronic Patient Safety Learning System to enhance reporting and learning, and to facilitate a culture of safety. However, the concept of ‘safety culture’, while popular and political, remains problematic and theoretically underspecified. Moreover, there is lack of clear evidence about
how emergency care providers conceptualize, make sense of, and learn from patient safety incidents, and limited evidence to guide an effective safety learning strategy for providers and staff in a busy ED.
In this multi-perspective, multi-method, practice-based ethnographic inquiry conducted at an inner city, tertiary care ED, I explore how ED practitioners and staff create safety in patient care in their everyday practice.
In this context, ‘safety’ is an emergent phenomenon of collective joint action, enacted dialogically by multiple actors, within a resilient system imbued with multiple social, cultural and political meanings. I claim that patient safety within an ED (and likely in other health care settings) is most
effectively created through dialogic storying, resilience, and phronesis.
I present an alternative account to the dominant “medical error” and bureaucratic “measure and manage” discourse, and propose an approach
to creating safety, including an open communicative space to facilitate sharing stories and learning about patient safety incidents, a safety action
team charged with systems analysis and empowered to enact change, and an inter-professional simulation learning environment to enhance dialogic sensemaking and innovation, that offers more to facilitate safety and resilience in everyday practice. I advocate for a pragmatic practice-based
account of patient harm within an ongoing reflective conversation about safety and performance, and for foresight and resilience in anticipating and responding to the complexities of everyday emergency care.
4
Feufel, Markus Alexander. "Bounded Rationality in the Emergency Department." Wright State University / OhioLINK, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=wright1249241698.
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Hickey, Michael. "Organ Donation in the Emergency Department." Thesis, Université d'Ottawa / University of Ottawa, 2021. http://hdl.handle.net/10393/42328.
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Hundreds of Canadians die each year while awaiting a vital organ transplant. Consistent with several countries in the world, the demand for organs for transplantation outweighs the supply. In Canada, citizens must actively register to enlist themselves as organ donors after death occurs. The aim of this thesis was to examine and evaluate the acceptability of an emergency department-based organ donation registration strategy. Secondarily, we identified the proportion of emergency physicians, nurses and clerks who are personally registered as organ donors. We conducted three self-administered surveys as well as an a priori sub-study to evaluate the effect of a prenotification letter on postal surveys of physicians. We discovered that key stakeholders in emergency departments are engaged in organ donation and feel that the emergency department is an acceptable place to promote organ donation registration. In addition, we identified several barriers to such a potential intervention which largely revolve around time and resource limitations.
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Hutson, Hendy Dionne. "Compassion Fatigue in Emergency Department Nurses." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2984.
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Compassion fatigue (CF) is a problem seen within healthcare institutions worldwide, especially critical care units and emergency departments (EDs). The problem identified in this quality improvement (QI) project was CF, experienced by nurses in the ED. The effects of CF cross nurse-patient boundaries and negatively impact a patient's expectations of having a quality care experience. The Iowa model's evidence-based team approach was used to guide the development of the education initiative for nurses on recognizing, preventing, and identifying methods of coping with CF in the ED. The outcome products for the project included an extensive review of the literature, a curriculum plan to educate ED nurses on CF, and a pretest/posttest to validate ED nurses knowledge about CF. The content of the project was measured by 2 master's-level prepared education experts using a dichotomous scale. The format evaluated content material using total scores of 1 for content (not met) and total scores of 2 for content (met). The average score was 2, which demonstrated the objectives for the education initiative were identified and the goals were met. The content experts also conducted content validation of each of the 14 pretest/posttest items using a 4-point Likert scale ranging from 1 (not relevant) to 4 (highly relevant) that resulted in a content validation index of 1.00, showing that the test items were covered in the curriculum. Recommendations were made for item construction improvement and omission of the Iowa model from the curriculum plan and pretest/posttest. The project promotes social change through the facilitation of patient satisfaction, quality of patient care, and prevention of CF on nursing staff.
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Chapnick, Marie. "Hourly Roudning in th Emergency Department." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3593.
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The Affordable Care Act of 2010 increased the number of patients seen in a northeast, urban trauma emergency department by 34%. This created a problem as it occurred simultaneously with a nursing shortage. Consequently, patient satisfaction scores fell below the national average benchmark. The rate patients left the emergency department without being seen was 2.6% higher than the national average and patient fall rates increased by 20%. A review of the literature to search for solutions led to the support of an hourly rounding project and an educational workshop promoting proactive nurse behaviors as a way to address the quality and safety gap. The goal of this scholarly project was to develop this evidence based, theory supported project and to conduct a formative and summative evaluation by an expert review panel in order to achieve consensus before implementation. An executive team was formed and led through the process of development of a detailed hourly rounding protocol and workshop, which will be implemented at the facility at a later time. A 10 member expert panel was formed. The panel members consented to participate in an explanatory session, to review all project materials, and to complete an anonymous 20 question survey tool. The panel also consented to review any changes made to materials as part of a summative evaluation. Descriptive analysis of the formative data demonstrated a 90% overall agreement that the workshop was comprehensive and covered key concepts within 5 categories. Minor requested revisions were made in response to formative results. The summmative review demonstrated 100% consensus on the revisions. This project will bring about social change by engaging nurses in proactively caring for patients in a safe and efficient manner.
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Lawrence, Michelle Candice. "Compassion Fatigue in Emergency Department Nurses." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7815.
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Compassion fatigue (CF) is defined as a sudden onset of the inability to experience feelings or compassion for others that is triggered by a nurse's inability to separate his/her feelings of stress and anxiety associated with caring for patients who have suffered from a traumatic event. The practice problem addressed in this doctoral project was the lack of knowledge of emergency department nurses (EDNs) related to CF in the work setting, resulting in a negative impact on a nurse's ability to provide quality care to patients. The purpose of the project was to present an educational program on how to recognize, prevent, and manage CF. Framed within Stamm's theoretical model of compassion satisfaction and CF, the project was guided by the steps within the Walden University Manual for Staff Education Project and the practice question addressed whether the literature would support an evidence-based educational program on CF for EDNs. The evaluation/validation for the project included an evaluation of the curriculum by the three content experts (in which learning objectives were deemed met), content validation of the pre-/post-test items by the content experts (all test items were deemed relevant to the learning objectives, with the validity index scale analysis at 1.00), and finally, a paired t test to determine knowledge gained from pre- to post-test that resulted in a significant (p < 0.0001) improvement in knowledge. A potential positive social change resulting from the project is a healthy work environment where EDNs understand and reduce their risks for CF, which may ultimately promote optimal patient care and improved health outcomes.
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Gunnarsdóttir, Oddný. "Users of a hospital emergency department : Diagnoses and mortality of those discharged home from the emergency department." Thesis, Nordic School of Public Health NHV, 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:norden:org:diva-3323.
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Objectives – To ascertain the annual number of users who were discharged home after visits to the emergency department, grouped by age, gender and number of visits during the calendar year, and to assess whether an increasing number of visits to the department predicted a higher mortality. Methods – This is a retrospective cohort study, at the emergency department of Landspitali University Hospital, Reykjavik capital city area, Iceland. During the years of 1995 to 2001 19259 users visited the emergency department, and were discharged home and they were follow-up for cause specific mortality through a national registry. Standardised mortality ratio, with expected number based on national mortality rates was calculated and hazard ratios according to number of visits per calendar year using time dependent multivariate regression analysis were computed. Results – The annual increase of visits to the emergency department among the patients discharged home was seven to 14 per cent per age group during the period 1995 to 2001, with a highest increase among older men. The most common discharge diagnosis was the category Symptoms, signs and abnormal clinical and laboratory findings not elsewhere classified. When emergency department users were compared with the general population, the standardised mortality ratio was 1.81 for men and 1.93 for women. Among those attending the emergency department two times, and three or more times in a calendar year, the mortality rate was higher than among those coming only once in a year. The causes of death which led to the highest mortality among frequent users of the emergency department were neoplasm, ischemic heart diseases, and the category external causes, particularly drug intoxication, suicides and probable suicides. Conclusions – The mortality of users of the emergency department who had been discharged home turned out to be higher than that of the general population. Frequent users of the emergency department had a higher mortality than those visiting the department no more than once in a year. Since the emergency department serves general medicine and surgery patients, not injuries, the high mortality due to drug intoxication, suicide and probable suicide is notable. Further studies are needed into the diagnosis at discharge of those frequently using emergency departments, in an attempt to understand and possibly prevent this mortalityISBN 91-7997-128-8
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Han, Chin-Yen. "Emergency department nurses' experience of implementing discharge planning for emergency department patients in Taiwan : a phenomenographic study." Thesis, Queensland University of Technology, 2008. https://eprints.qut.edu.au/17003/1/Chin-Yen_Han_Thesis.pdf.
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During recent reforms to the Taiwanese health care system, discharge planning for hospital patients has become an issue of great concern as a result of shorter hospital stays, increased health care costs and a greater emphasis on community care. There are around five million patients visiting in emergency departments (ED) per year in Taiwan with up to 85% of these, 4,250,000 emergency patients, discharged directly from the emergency department. This significant number of ED visits highlights the need to implement discharge planning in the ED. ED nurses are not only responsible for providing appropriate assessments of a patient's future care needs but also for implementing effective discharge planning as a legal obligation; discharge planning is also a patient's right in Taiwan. For ED nurses to function effectively in the role of discharge planner, it is important that they have a comprehensive understanding of implementing discharge planning. To date, no published research focuses on nurses' experience of implementing discharge planning in the ED in Taiwan. This study is the first step in identifying the experience and understanding of nurses in implementing discharge planning in the ED in Taiwan and may have implications worldwide.
The purpose of this study was to identify and describe the experience and understanding of the qualitatively different ways in which ED nurses’ experience of implementing discharge planning for emergency patients in Taiwan. In order to identify and describe the experience of implementing discharge planning, the qualitative approach of a phenomenography was chosen. Thirty-two ED nurses in Taiwan who matched the participant selection criteria were asked to describe their experience and understanding of the implementation of discharge planning in the ED. Semi-structured interviews were audio-taped and later transcribed verbatim. The data analysis process focused on identifying and describing ways ED nurses’ experience and understanding of implementing discharge planning in the ED. There were two major outcomes of this study: six categories of description and an outcome space. These six categories of description revealed the experience and understanding of implementing discharge planning in the ED. An outcome space portraying the logical relations between the categories of description was identified.
The six categories of description were implementing discharge planning as ‘getting rid of my patients’; implementing discharge planning as completing routines; implementing discharge planning as being involved in patient education; implementing discharge planning as professional accountability; implementing discharge planning as autonomous practice; implementing discharge planning as demonstrating professional nursing care in ED. The outcome space mapped the three levels of hierarchical relationship between these six categories of description. The referential meaning of implementing discharge planning was the commitment to providing discharge services in the ED.
The results of this research contribute to describing the nurses’ experience in the implementation of the discharge planning process in the emergency nursing field, in order to provide accurate and effective care to patients discharged from the ED. This study also highlights key insights into the provision of discharge services both in Taiwan and World-wide.
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Han, Chin-Yen. "Emergency department nurses' experience of implementing discharge planning for emergency department patients in Taiwan : a phenomenographic study." Queensland University of Technology, 2008. http://eprints.qut.edu.au/17003/.
Full textAbstract:
During recent reforms to the Taiwanese health care system, discharge planning for hospital patients has become an issue of great concern as a result of shorter hospital stays, increased health care costs and a greater emphasis on community care. There are around five million patients visiting in emergency departments (ED) per year in Taiwan with up to 85% of these, 4,250,000 emergency patients, discharged directly from the emergency department. This significant number of ED visits highlights the need to implement discharge planning in the ED. ED nurses are not only responsible for providing appropriate assessments of a patient's future care needs but also for implementing effective discharge planning as a legal obligation; discharge planning is also a patient's right in Taiwan. For ED nurses to function effectively in the role of discharge planner, it is important that they have a comprehensive understanding of implementing discharge planning. To date, no published research focuses on nurses' experience of implementing discharge planning in the ED in Taiwan. This study is the first step in identifying the experience and understanding of nurses in implementing discharge planning in the ED in Taiwan and may have implications worldwide.
The purpose of this study was to identify and describe the experience and understanding of the qualitatively different ways in which ED nurses’ experience of implementing discharge planning for emergency patients in Taiwan. In order to identify and describe the experience of implementing discharge planning, the qualitative approach of a phenomenography was chosen. Thirty-two ED nurses in Taiwan who matched the participant selection criteria were asked to describe their experience and understanding of the implementation of discharge planning in the ED. Semi-structured interviews were audio-taped and later transcribed verbatim. The data analysis process focused on identifying and describing ways ED nurses’ experience and understanding of implementing discharge planning in the ED. There were two major outcomes of this study: six categories of description and an outcome space. These six categories of description revealed the experience and understanding of implementing discharge planning in the ED. An outcome space portraying the logical relations between the categories of description was identified.
The six categories of description were implementing discharge planning as ‘getting rid of my patients’; implementing discharge planning as completing routines; implementing discharge planning as being involved in patient education; implementing discharge planning as professional accountability; implementing discharge planning as autonomous practice; implementing discharge planning as demonstrating professional nursing care in ED. The outcome space mapped the three levels of hierarchical relationship between these six categories of description. The referential meaning of implementing discharge planning was the commitment to providing discharge services in the ED.
The results of this research contribute to describing the nurses’ experience in the implementation of the discharge planning process in the emergency nursing field, in order to provide accurate and effective care to patients discharged from the ED. This study also highlights key insights into the provision of discharge services both in Taiwan and World-wide.
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Phelps, Joy Leatrice Barnes. "Virginia Emergency Department Physician Knowledge of the Emergent Treatment of Avulsed Teeth." VCU Scholars Compass, 2008. http://scholarscompass.vcu.edu/etd/845.
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Purpose: The purpose of this study was to determine the knowledge and treatment protocols for physicians in Virginia emergency departments in regards to the emergent treatment of avulsed teeth.Methods: Using a cross sectional survey design, an 8-item questionnaire regarding the treatment of avulsed teeth was emailed to 75 emergency department chairpersons in Virginia. After 30 days, a reminder paper copy of the questionnaire was mailed and an email reminder with the on-line link was sent. After 60 days the study was closed. Comparisons were made using chi-square analysis based on percentages to test for significance. Results: The response rate was 52 % (n = 39). There were no associations between physician knowledge of the treatment of avulsed teeth and whether there was a protocol for treatment, an in-house dental team, or an on-call dentist available. Conclusion: Most of the physicians have some knowledge of the treatment of avulsed teeth; however further training would help ensure appropriate treatment.
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Indig, Devon National Drug & Alcohol Research Centre Faculty of Medicine UNSW. "Detection of alcohol-related emergency department presentations." Publisher:University of New South Wales. National Drug & Alcohol Research Centre, 2009. http://handle.unsw.edu.au/1959.4/43684.
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People who consume alcohol at risky levels are at an increased risk of presenting to the emergency department (ED). There are a variety of methods used for detection of alcohol-related ED presentations but little guidance about the relative strengths and weaknesses for each method. This research compared and contrasted multiple detection methods for alcohol-related ED presentations and also examined the characteristics of ED patients identified as risky drinkers on a brief self-report screen compared with those detected as having an alcohol-related ED presentation. The first study, a population health survey, found that high risk drinking, high psychological distress and current smoking were all significantly associated (both independently and when combined) with a greater likelihood of presenting to an ED in the last year. The second study involved electronically searching three years of ED nursing triage text data (N=263,937) for alcohol-related terms and found that over 5% of ED presentations were related to alcohol. The third study involved comparing a number of detection methods for alcohol-related ED presentations. It found that nearly a fifth (19%) of ED presentations were detected to be alcohol-related. The strongest method was a medical records audit (72%), followed by patient self-report (67%), nursing triage text (49%) then diagnostic codes (10%). Over a fourth of ED patients were identified as risky drinkers (28%), however, just over half (51%) of these did not present to the ED for an alcohol-related reason. Among alcohol-related ED presentations, nearly a third (31%) were not identified as risky drinkers. In a survey of ED staff, it was found that management of alcohol-related problems was not routine, and many staff appeared to lack the confidence to fully and appropriately manage ED patients with alcohol-related problems. In summary, not all patients who have an alcohol-related ED presentation usually drink at risky levels, nor do all risky drinkers present to the ED for an alcohol-related reason. Using a variety of detection methods for alcohol-related problems in the ED is recommended to enhance the impact of any intervention strategies. ED staff require additional training, resources and support to enhance their management of patients with alcohol-related problems.
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Shah, Jalpa. "Factors associated with higher emergency department utilization." Thesis, California State University, Long Beach, 2015. http://pqdtopen.proquest.com/#viewpdf?dispub=1586168.
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The purpose of this study was to analyze the factors associated with higher Emergency Department (ED) visits in the United States. Higher ED utilization contributes in a major way to costs in the healthcare industry. Unnecessary utilization of emergency department causes medication errors, poor patient satisfaction, lower quality and higher cost. This study analyzed the data from National Hospital Ambulatory Medical Care Survey (NHAMCS) collected in 2010, which involved a sample size of 34,936 ED visits nationwide. The variables in this study included age, ethnicity, type of coverage and gender differences. The result showed that Medicaid population has a higher number of ED visits than other types of insurance coverage; white population shows maximum ED visits than other race types; males visits ED more than females and infants has higher ED rate than other age groups. More research is needed to develop health policies to limit the non-urgent ED visits.
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Chang, Josh (Josh Woolim). "Cost accounting system for an emergency department." Thesis, Massachusetts Institute of Technology, 2015. http://hdl.handle.net/1721.1/98979.
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Thesis: M.B.A., Massachusetts Institute of Technology, Sloan School of Management, 2015. In conjunction with the Leaders for Global Operations Program at MIT.Thesis: S.M., Massachusetts Institute of Technology, Engineering Systems Division, 2015. In conjunction with the Leaders for Global Operations Program at MIT.
Cataloged from PDF version of thesis.
Includes bibliographical references (pages 113-114).
In 2011, Michael Porter and Robert Kaplan - the godfather of modern managerial accounting and professor at Harvard Business School - said "There is an almost complete lack of understanding of how much it costs to deliver patient care, much less how those costs compare with the outcomes achieved." They also stated "U.S. healthcare costs exceed 17% of GDP and continue to rise" and "a fundamental source of escalating costs is the system by which those costs are measured" [1] In 2015, Beth Israel Deaconess Medical Center (BIDMC), a Harvard teaching hospital, and MIT's Leaders for Global Operations program partnered to address this cost measurement issue for BIDMC's Emergency Department (ED). The joint team developed a cost accounting model and implemented it as a software system. Using the resulting system as a ruler for measuring cost of each patient visit, the ED is now able to assess cost of each visit, identify leverage points for cost reduction, and discover best practices from its own data. Most importantly, the ED is now making informed cost improvement decisions and can measure the impact of changes. This paper documents in detail how we developed the cost accounting model and implemented the cost accounting system at the BIDMC ED, so that other emergency departments may be able to benefit.
by Josh Chang.
M.B.A.
S.M.
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Lojo, Matthew. "Measuring Nurse Competence in the Emergency Department." Scholarly Commons, 2020. https://scholarlycommons.pacific.edu/uop_etds/3670.
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Background: “Nurses provide essential care to the millions of people who are hospitalized each year as a result of illness or injury” (Smith, 2012, p. 172). The Institute of Medicine reported approximately 44,000-98,000 patients die annually resulting from a medical error, and health care errors ranked among the top 10 for the leading causes of death in the United States (Smith, 2012).
Problem: Nurse competence impacts safe and quality nursing, and several research studies investigated the measurement of nurse competence among nurses in various nursing settings (Flinkman et al., 2016). However, a review of the research revealed limited studies in the emergency department (ED) setting and in the United States (O’Leary, 2012).
Method: This study implemented a quantitative nonexperimental research design using the combination of an instrumental case study and a cross-sectional survey for this study’s sample. An Internet-based SurveyMonkey questionnaire collected data on nurse competence from registered nurses (RNs) working in the ED at a San Francisco Bay Area hospital. Part I of the questionnaire integrated Meretoja, Isoaho, and Leino-Kilpi’s (2004) Nurse Competence Scale (NCS) consisting of 73 closed-ended clinical indicators divided into seven competence areas. Participants rated their level of competence and frequency of use for each clinical indicator. Part II of the questionnaire obtained background information about participants. A total of 21 out of 110 potential participants completed the survey.
Results: The data analysis using Statistical Package for Social Sciences (SPSS) provided descriptive and nonparametric correlation statistics. Descriptive statistics described survey respondents. The least and most competent areas were ensuring quality and managing situations, respectively. The most frequent length of nursing experience was at least 60 months and the most frequent number of hours worked was at least 65 hours per 2-week period. Nonparametric correlation statistics, including Kendell’s tau-b and Spearman’s rho, identified significant relationships. A significant relationship existed between the frequency of using clinical skills and level of competence for four of the seven competence areas. A significant relationship existed between the background factor of experience, both as an RN and an ED RN, and level of competence for many clinical indicators. A significant relationship existed between the background factor of hours worked and level of competence for one clinical indicator.
Conclusion: Despite the small sample size of 21 survey respondents, this study revealed findings consistent with the existing research on nurse competence. This study offers implications and recommendations for practice relative to nurse competence, nurse competence assessment, and transitions to new settings of nursing practice to support the nursing profession and safe and quality nursing.
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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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Jones, Nicole Maria, and Nicole Maria Jones. "VAP Prevention Knowledge in the Emergency Department." Diss., The University of Arizona, 2017. http://hdl.handle.net/10150/624492.
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Introduction: Ventilator associated pneumonia (VAP) is a prevalent hospital acquired infection that patients have a risk of developing after being intubated. The mortality rate of intubated patients is estimated between 30-50 percent. Furthermore, it is estimated that VAP occurs in 10-30 percent of all intubated patients. Numerous studies have linked VAP protocols and evidence based guidelines initiated in the intensive care unit (ICU) to a decrease in the prevalence of VAP. However, limited research exists on VAP prevention protocols implemented in the emergency department (ED). Early implementation of VAP bundles and protocols are linked to a decrease in the prevalence of VAP.
Purpose: Evaluate the knowledge of interdisciplinary staff members on VAP, and the VAP prevention protocol in the emergency department.
Setting: The setting of the DNP project is a 61-bed level one trauma emergency department at a Banner University Medical Center, serving approximately 77,000 patients a year.
Results: The average score VAP survey was a 71.6%, with majority of the respondents unable to identify the correct patient diagnosed with VAP. The major barriers identified by the survey included lack of education, availability of the necessary supplies, proper orders to be imputed by providers, patient availability, lack of time and/or supplies, and RN ratios.
Discussion: The results of the survey show majority of the registered nurses are not familiar with the protocol, but suggest they do implement the protocol on those patients who are intubated in the ED. Thus, there are still gaps in the full implementation of the VAP protocol and there is a need further improvement in the care of patients who are intubated in the ED.
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Khlifi, Abdmalek S. "Etiological characterization of emergency department acute poisoning." [Tampa, Fla] : University of South Florida, 2008. http://purl.fcla.edu/usf/dc/et/SFE0002475.
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Zhao, Lijuan. "Advanced Triage Protocols in the Emergency Department." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3649.
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Overcrowded emergency departments (EDs) are a major problem in the United States resulting in inefficiency in operation and performance. A Southern California hospital ED was the site for this project because it had operated over its maximum capacity during the last decade. Advanced triage protocols integrating standard order sets were implemented to improve quality of care; however, no evaluation of the protocols had been done. The purpose of this project was to evaluate the effect of the advanced triage protocols. Two project questions determined whether advanced triage protocols reduced ED length of stay (LOS), number of patients who left without being seen (LWBS), and improved patient experience. The Lean Principles and the Plan-Do-Study-Act Model for Improvement were used to guide the project. A pre- and post-implementation design found that ED LOS had a significant 17-minute decrease for ESI Level 3 patients (225.7 -± 8.6 minutes vs. 208.8 -± 6.9 minutes, p = .002), and significant 13- minute decrease for ESI Level 4 patients (146.5 -± 1.6 minutes vs. 133.5 -± 1.5 minutes, p =.001). For the ED rate of patients who LWBS, no statistically significant difference was seen between pre- and post- implementation (41/575, 7.13% vs. 46/611, 7.52%). Satisfaction scores were improved by more than 10% after implementation. The advanced triage protocols enhanced front-end throughput operations and patient experience within the ED by allowing triage nurses to initiate orders and begin pain medication. Delivering timely and efficient care to meet various patients' needs has the potential for a positive social change through improved health care outcomes; perception of care; and trust between patients, providers, and the health care system.
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Sekandari, Zohib, and Shahin Saleh. "Emergency Department Triage Prediction of Emergency Severity Index using Machine Learning Models." Thesis, KTH, Skolan för elektroteknik och datavetenskap (EECS), 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-259402.
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Study Objective: The emergency department (ED) in the United States strongly rely on subjective assessment of patients. This study seeks to evaluate an electronic triage system based on machine learning models that can predict the patients emergency severity index (ESI). Methods: A dataset containing 560 486 patients triage data was investigated.Three different machine learning models was tested and evaluated. A crossvalidation table and a confusion matrix was conducted from each of the models. The precision rate, recall rate and f1-score were calculated and reported. Result: The Gradient Boosting model returned an accuracy rate of 68%. The random forest model returned an accuracy rate of 66%. The Gaussian Naive Bayesmodel returned an accuracy rate of 25%. Conclusion: The model that best predicted the ESI-level is the GradientBoosting model. Further testing is needed with better computational power since we could not train our model with the whole dataset.Syfte: Akutmottagningen i USA förlitar sig kraftigt på en subjektiv värdering av patienter. Denna studie söker efter att evaluera ett elektronisk triage systembaserad på maskininlärningsmodeller som kan förutse patienters ESI. Metod: Ett data set som innehåller 560 486 patienters triage data har undersökts. Tre olika maskininlärningsmodeller har testats och evaluerats. En cross validation tabell och en confusion matrix har skapats för varje modell. Precision, recall och f1 värde har kalkylerats och rapporterats. Resultat: Gradient Boosting modellen har returnerat ett accuracy värde av 68%. Random Forest modellen har returnerat ett accuracy värde av 66%. Gaussian Naive Bayes modellen har returnerat ett accuracy värde av 25%. Slutsats: Modellen som har bäst förutsett ESI nivåerna är Gradient Boostingmodellen. Flera tester behövs med starkare beräkningskraft då vi inte kunde träna vår modell med hela datasetet.
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Yuwanich, Nuttapol. "Occupational stress among Thai emergency department nurses : Development and validation of an instrument for measuring stressors in emergency departments." Doctoral thesis, Mälardalens högskola, Akademin för hälsa, vård och välfärd, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:mdh:diva-36691.
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Working at an emergency department has some characteristics, which may generate stress. In this thesis, the stressors for emergency nurses were evaluated and an instrument was developed for measuring their impact. In order to gain a deeper understanding regarding the occupational stress among emergency nurses, a descriptive qualitative design with semi-structured interviews were used in two studies (I, II), one at a private and the other at a public hospital in Thailand. Three main categories of stressors were identified, related to the activity at the emergency departments, to human factors and to perceived consequences of these factors. Nurses in both private and public hospitals frequently experienced occupational stress, which influenced their psychophysiological health, and resulted in incomplete nursing care. Since no validated instrument had been published for measuring stressors in emergency nurses’ workplace, a scoping literature review was performed and a questionnaire for this purpose was developed, based on the review and the results from the interviews (I and II). The questionnaire was validated (III) and the influence of socio-economic factors were evaluated (IV). Four-hundred and five emergency nurses in Thailand completed a questionnaire containing 59 items. The responses were analyzed using 1) item generation, 2) content and face validity and test-retest reliability and 3) evaluation of the internal consistency and construct validity of the instrument. An exploratory factor analysis was performed on 200 of these responses and a confirmatory factor analysis on the remaining 205. The analysis provided a final four-factor solution with 25 items distributed among the factors Life and death situations, Patients’ and families’ actions and reactions, Technical and formal support, and Conflicts. The statistical evaluation (Cronbach’s alpha and intra-class correlation coefficient) indicated good homogeneity and stability. The type of organization, educational level and average income were associated with stressor related to Life and Death situations. Stressor related to Patients’ and families’ actions and reactions was predicted by educational level. While sociodemographic variables had no influence on stressor related to Technical and formal support and Conflicts. Future research regarding patient safety should focus on both emergency nurses’ and patients’ perspectives regarding consequences of occupational stress related to patient safety. Different perspectives may create a knowledge-base which can be used to develop guidelines or protocols aiming at reducing nurses’ stress and prevent its consequence, such as poor patient safety.
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Reid, Tracey. "The impact of physician communication skills on continuity of care and emergency department use by regular emergency department users." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape8/PQDD_0028/MQ50865.pdf.
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Reid, Tracey. "The impact of physician communication skills on continuity of care and emergency department use by regular emergency department users /." Thesis, McGill University, 1998. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=21629.
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Regular use of the emergency department is associated with a patient's inability to identify a regular primary care physician. Continuity of the physician-patient relationship is largely determined by patient satisfaction, which in turn is influenced by the physician's communication and interpersonal skills. The objective of this study was to estimate the relationship between the communication competency of newly licensed family physicians and the ambulatory health care utilization behaviour of their regular emergency department users. It was hypothesized that physicians with higher levels of competency in patient communication would be the providers of a greater proportion of their patients' ambulatory care than physicians with poorer communication abilities. Consequently, these patients would rely on the emergency department for a smaller proportion of their ambulatory care than patients of physicians with lower levels of communication competency.In total, 474 newly licensed family physicians and 42 113 regular ED user patients were included in the study population. Analysis was conducted at the level of the physician and patients were attributed to the practice populations of the first study physician they saw. (Abstract shortened by UMI.)
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Stang, Antonia. "Emergency department conditions associated with the number of patients who leave a pediatric emergency department prior to physician assessment." Thesis, McGill University, 2010. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=86630.
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As emergency department (ED) waiting times and volumes increase, substantial numbers of patients LWBS (leave after registration but prior to physician assessment). The objective of this study was to identify ED conditions reflecting patient input, throughput and output associated with the number of patients who LWBS in a pediatric setting. Multivariate analysis was used to examine the impact of variables describing the timing of patient arrival and ED conditions including patient acuity, volume and waiting times on the number of patients who LWBS. During the study period there were 138,361 patient visits; 11,055 (7.99%) of patients LWBS. The throughput variables, time from triage to physician assessment (rate ratio 2.11 (95% CI 2.01-2.21)) and time from registration to triage (rate ratio 1.55 (95% CI 1.25 - 1.90)) had the largest impact on the number of patients who LWBS. Interventions designed to decrease the number of patients who LWBS should focus on improving ED throughput.Avec l'augmentation du débit et du temps d'attente dans les services des urgences, un nombre élevé de patients ayant rempli les formulaires d'accueil quittent avant d'avoir été vus par un médecin. Cette étude avait pour but de déterminer les conditions du service des urgences reflétant l'inscription, le temps de prise en charge ainsi que le débit de patients, et ayant un lien avec le nombre de personnes qui, dans un milieu pédiatrique, quittent avant d'avoir vu un médecin. Une analyse multivariée a été utilisée afin d'examiner l'effet de variables décrivant le moment de l'arrivée du patient et les conditions qui prévalent au service des urgences (y compris l'acuité des patients, le volume de patients et le délai d'attente), sur le nombre de personnes qui quittent sans avoir été examinés. Un total de 138,361 patients se sont présentés à l'urgence au cours de l'étude et 11,055 (7,99%) ont quitté avant d'avoir vu un médecin. Les résultats de l'étude révèlent que les variables liées au temps de prise en charge, soit le délai entre le moment du triage et l'examen du médecin (ratio des taux = 2,11; intervalle de confiance [IC] de 95% : 2,01 - 2,21) et le délai entre l'inscription et le triage (ratio des taux = 1,55; IC de 95% : 1,25 - 1,90) exercent la plus grande influence sur le nombre de patients quittant avant d'avoir été vus par un médecin. Les interventions visant à réduire le nombre de départs prématurés devraient être orientées en vue d'améliorer le temps de prise en charge dans les services d'urgence.
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Shaffer, Claire. "EMERGENCY DEPARTMENT CROWDING: EXPLORING BIAS AND BARRIERS TO EQUITABLE ACCESS OF EMERGENCY CARE." Master's thesis, Temple University Libraries, 2018. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/487771.
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Urban BioethicsM.A.
The emergency department (ED) has often been considered the safety net of the American healthcare system. It earned this distinction because every person in the United States has access to a medical screening exam and stabilization at an ED regardless of their ability to pay. Unfortunately, over the past several decades, decreasing numbers of EDs and inpatient beds, coupled with increasing rates of ED usage, has led to crowding of EDs across the country. Crowding leads to unsafe conditions that may increase morbidity and mortality for patients, or cause patients to leave the ED without being evaluated by a physician. Essentially, crowding causes a barrier for patients to access their right to emergency evaluation. The problem of crowding is most pronounced in large urban communities, and these already frequently underserved patients suffer the most from the crowding burden. The main cause of crowding seems to be the boarding of admitted patients in the ED, however many often cite high rates of non-urgent patients presenting to the ED as a cause of crowding. Some have even suggested diverting non-urgent patients to help solve the problem of crowding. I became interested in this topic due to crowding concerns and initiatives to decrease the number of patients who left without being seen at my own institution. As I reviewed relevant research, I became aware of my own misconceptions and noted a trend of literature suggesting non-urgent patients are not the cause of crowding. Drawing on research from many different sources, paired with evaluation based on principles in bioethics, I have come to several conclusions. I believe the systematic diversion of non-urgent patients is unsafe, and that the unequal burden of ED crowding on urban communities represents an unjust barrier in access to care. We must continue to carefully research the demographics of patients frequently presenting to EDs to avoid perpetuating stereotypes about which types of patients are responsible for crowding. We should also look for ways to ease the crowding burden in urban communities. Additionally, we should take a qualitative assessment of our individual communities to determine if there are any particular reasons in our community that people choose to use the ED rather than other healthcare options. I believe these suggestions can be an important addition to the efforts already in motion to help reduce ED crowding and provide equitable access to emergency medical evaluation.
Temple University--Theses
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Dover, Saunya. "Emergency Department use: Why do patients choose the Emergency Department for medical care and how much does it really cost?" Thesis, University of Ottawa (Canada), 2010. http://hdl.handle.net/10393/28805.
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Background: It is important to understand Canadians' expectations of health care services and the costs of delivering care in the Emergency Department (ED) in order to continue to provide health care in a sustainable manner.
Objectives: To examine the reasons patients present to the ED, and to conduct a cost analysis to compare the costs of seeking care in the ED versus a primary care setting.
Methodology: We surveyed patients (n=606) triaged to the cubicles of the ED of The Ottawa Hospital, Civic Campus. The survey asked about their perceived urgency level and their patterns of health service use. Patient surveys were accompanied by physician surveys to assess each patient's level of urgency from a medical perspective. We performed bivariate analysis and logistic regression on survey variables of interest. We also conducted a cost analysis to determine the costs of providing non-urgent care in the ED.
Results: Both a presenting symptom of a musculoskeletal injury (OR=2.93, CI 1.42-6.04) and having heard of TeleHealth Ontario (OR=2.08, CI1.08-4.03) were significantly associated with non-urgent ED use from the patient perspective. We also found that non-urgent ED visits cost an average of $248.75, which is significantly more costly than a primary care visit.
Implications: Our results provide insights regarding patient factors influencing ED use and relative costs of non-urgent ED visits versus outpatient family doctor visits. However, additional work may be required to identify non-medical factors influencing patient motivations for seeking care in the ED.
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Godek, Paul A. "Emergency supplemental appropriations : a Department of Defense perspective." Thesis, Monterey, Calif. : Springfield, Va. : Naval Postgraduate School ; Available from National Technical Information Service, 2000. http://handle.dtic.mil/100.2/ADA387504.
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Stickney, Remington Bigelow, and Remington Bigelow Stickney. "Transitional Care of Elderly Frequent Emergency Department Users." Diss., The University of Arizona, 2017. http://hdl.handle.net/10150/626348.
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Background: Frequent ED users are generally over the age of 65 years, Medicare beneficiaries, sicker and have more health issues than non-frequent users. Elderly patients suffer a 20% mortality rate upon admission and a 30% decrease in activities of daily living (ADL) after discharge. Transitional care programs (TCP) decrease ED visits and readmission rates, improves ADLs, and increases event-free survival.
Purpose: To evaluate the need of an ED TCP in the ED. Aims are to assess ED providers’, nurses’ and managers’ perceptions of elderly frequent ED users’ discharge needs, resources, and potential role of a TCP.
Methods: Conducted within one community based ED in Tucson, Arizona. Survey content determined by a review of the literature focused upon elderly transitional care. Recruitment of nurses, providers, and managers following verbal consent. Inclusion criteria: willingness to participate in a 10-minute survey and work two shifts a month minimum within the ED. The survey is comprised of 19 questions focused on patient needs, current resources and the role of a TCP. Surveys were followed by a 5-minute post-survey session to review questions regarding content. Questions structured using a Likert scale format and categorical answers. Data analyzed using descriptive statistics. A needs assessment (NA) executive summary was presented to the ED staff and management.
Results: One hundred providers, nurses, and managers completed the survey of which 79% were female, 73% registered nurses, 14% physicians, and 10% advanced practice providers. The majority of respondents believed elderly patients are discharged unsafely, additional resources were needed, more time was spend caring for elderly patients, and TCPs were a viable supportive option. “What is a transitional care team (TCT)?” was the most asked question during question and answer session.
Implications: This NA revealed providers’, nurses’, and managers’ perceptions of elderly frequent ED user needs and the role of a TCP. Concerns identified are consistent with the literature. This NA provided information about ED staff perceptions of elderly frequent users and addressed transitional care while laying the groundwork for the potential future implementation of a TCP initiated in the ED.
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Duffy, Brianne Michelle. "Identification of stressors related to emergency department employment." Honors in the Major Thesis, University of Central Florida, 2003. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/315.
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This item is only available in print in the UCF Libraries. If this is your Honors Thesis, you can help us make it available online for use by researchers around the world by following the instructions on the distribution consent form at http://library.ucf.edu/Systems/DigitalInitiatives/DigitalCollections/InternetDistributionConsentAgreementForm.pdf You may also contact the project coordinator, Kerri Bottorff, at kerri.bottorff@ucf.edu for more information.Bachelors
Health and Public Affairs
Nursing
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Bush, Burman Randi M. "Identifying drug-seeking behaviors in the emergency department." Honors in the Major Thesis, University of Central Florida, 2011. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/352.
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Pain is the leading cause of Emergency Department (ED) visits making it one of the primary concerns of the emergency medical field. The experience of pain is subjective and unique to every individual making it difficult to effectively manage. As a result, the subjective nature of pain is also commonly associated with drug-seekers often claiming to have pain simply to receive narcotics to support their addiction. There have been numerous studies completed to determine how to effectively recognize drug-seeking. This integrative literature review will identify the common behaviors that have been seen as indicators of drug-seeking in the ED. The evidence collected from articles published between 2001 and 2011 examined the use of assessment tools, drug screening, and prescription monitoring programs for distinguishing drug-seekers. The evidence did not identify a specific evaluation tool used to recognize drug-seekers; however, the research did suggested that using these techniques can help to identify drug-seeking behavior allowing emergency medical staff to effectively manage pain in the ED.B.S.N.
Bachelors
Nursing
Nursing
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Maas, Christine C. "Emergency department utilization patterns in patients with diabetes." Thesis, California State University, Long Beach, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=1526926.
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Diabetes is one of the most prevalent diseases in America, and the associated costs place a heavy burden on our health care system. This study was undertaken to provide information on emergency service utilization and hospitalization among people with diabetes in the United States. The hypotheses were that adults with diabetes visit the emergency department (ED) more than those without diabetes, that persons with diabetes who present in the ED are hospitalized more than those without diabetes and that more patients with diabetes present in the ED within 1 week of hospital discharge than those without diabetes. To test these hypotheses, secondary data from the 2010 National Hospital Ambulatory Medical Care Survey was analyzed. The results indicate that adults with diabetes did utilize the ED more than those without diabetes, and that patients with diabetes were admitted to the hospital through the ED more than those without diabetes. Furthermore, persons with diabetes presented within 1 week of hospital discharge more than those without diabetes.
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Benner, Myron, and L. Lee Glenn. "Measurement Validity of Pediatric Emergency Department Rapid Triage." Digital Commons @ East Tennessee State University, 2012. https://dc.etsu.edu/etsu-works/7481.
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Excerpt: The study by Doyle et al1 concluded that “Implementing rapid triage and fast track guidelines can affect nurse-sensitive patient outcomes related to safety and care delivery in a pediatric emergency department,” but the support for the conclusions was weak because of 2 shortcomings: (1) the authors did not use a side-by-side control group, and (2) the findings can be explained by the Hawthorne effect.
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Ferguson, Craig James. "Diagnosing acute heart failure in the Emergency Department." Thesis, Manchester Metropolitan University, 2014. http://e-space.mmu.ac.uk/582262/.
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Background: Acute, decompensated heart failure is a serious and common presentation in patients attending Emergency Departments. Diagnosis of this condition in this environment can be challenging. Main Objective: To assess the diagnostic utility of variables related to the diagnosis of decompensated heart failure in the Emergency Department setting. To create a Clinical Decision Rule to facilitate the diagnosis of decompensated heart failure in the Emergency Department setting. Methods: A systematic review and meta-analysis of literature related to the diagnosis of acute heart failure in the Emergency Department was performed to assess and rank the diagnostic utility of all potential predictor variables. Bivariate meta-analysis was performed where appropriate to provide summary statistics for variable utility. A diagnostic study performed in a single, urban Emergency Department to allow multivariable analysis of the data to derive a Clinical Decision Rule. Logistic regression, Random Forest analysis and CART analysis were used in the analysis. Results: 44 papers were included in the systematic review providing data on 41 potential diagnostic variables. A history of heart failure, clinical opinion of heart failure, natriuretic peptide levels and the findings of cardiomegaly, pulmonary oedema or cephalisation of vessels on the chest x-ray had the greatest diagnostic utility. 105 patients were recruited in the diagnostic study and 62 potential variables were assessed against a reference standard of two cardiologists opinions. Cardiothoracic ratio, natriuretic peptide levels, the presence of pulmonary oedema, clinical impression of heart failure and urea levels were found to be the best performing variables. Two or more of these variables, using selected cut-off values for continuous variables, had a specificity of nearly 100% for definite or possible heart failure. Different cut-off values could be used with these variables to provide high sensitivity for this condition. Conclusion: The clinical and investigative findings with the greatest diagnostic utility for the acutely dyspnoeic patient with heart failure have been identified and can be used to rule in heart failure.
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Ortiz, Alicia. "Using Health Literacy to Improve Emergency Department Discharge." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3716.
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Patients with limited health literacy often fail to understand verbal and written discharge instructions, and they frequently return to the emergency department (ED) for care. Patients returning to the ED and 30-day readmission rate are core quality performance measures. The purpose of this project was to decrease repeat visits and readmissions to the ED by implementing components of health literacy programs within the ED on patient education and written discharge instructions. Change implementation consisted of (a) use of teach back method (b) modifying medical terminology to language that patient could understand (c) limiting use of words with more than three syllables and (d) discouraging nursing practice of copying and pasting other completed clinician notes in discharge notes. Following the tenets of the logic model and Watson's caring theory, ED nurses (n=45) at a veteran's healthcare facility participated in the modification of the ED discharge note design. A retrospective quantitative design was used to obtain data from 5,474 records related to each patient's language preference, educational level, and the readability index of the discharge note pre-and post-modification of the note. The comparative analysis of the descriptive statistics before and after modification of the discharge note indicated a decrease of 1.75% in the readability index of the discharge note, a 24% decrease in return visits within 30 days and a 40% decrease in readmission rate within 30 days. Healthcare costs and health disparities associated with health literacy decrease if patients comprehend discharge instructions. Understanding verbal and written discharge instructions correlates with healthy communities. Health literacy policies and technological innovation can promote health literacy and research on health literacy.
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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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Rogers, Ruthie Waters. "Implementing Relationship Based Care in an Emergency Department." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/363.
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When patients and families come to the emergency department seeking medical attention, they come in with many mixed emotions and thoughts. The fast paced, rapid turnover of patients and the chaotic atmosphere may leave patients who visit the emergency department with the perception that staff is uncaring. The purpose of this project was to implement a patient care delivery model, relationship-based care, in the emergency department. The model is comprised of several caring theories including Jean Watson's model of human care and Kristen Swanson's middle range theory of caring. The main goals of the project were to help staff enhance the patient and caregiver interaction, strengthen co-worker relationships, and gain appreciation of the importance of self-care. The intervention was an educational workshop about the relationship-based care model. Eight participants were consented, given a preassessment survey, educated about the model, and then given a postassessment survey. Prior to education, 83% of participants believed strongly that patients and families need to feel cared for during an emergency department visit; this increased to 100% posteducation. Perception about the importance of coworkers' relationships being trusting went from 38% to 50% and the importance of caring for one's self increased from 63% to 100%. It was recommended that the model be implemented in all emergency departments and all staff educated in its use as a way to promote social change through intentional focus on caring in every patient interaction.
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Duwalage, Kalpani I. "Statistical modelling of public hospital emergency department presentations." Thesis, Queensland University of Technology, 2022. https://eprints.qut.edu.au/228610/1/Kalpani%20Ishara_Duwalage_Thesis.pdf.
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This thesis used statistical methods to investigate and more accurately forecast Australian emergency department presentations to four major public hospital EDs in South-East Queensland, Australia. The findings of this thesis assist Australian EDs in understanding trends in ED presentations, which can subsequently lead to reductions in presentations and improvement in the sustainability of the health system. This thesis further demonstrates the benefits of various statistical modelling methods over conventional methods in extracting more useful and accurate information from complex ED data.
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Spiro, Joshua. "Quantitative Factors Correlated with Increased Length of Stay for Adult Patients Presenting to the Emergency Department with Abdominal and Pelvic Pain." Thesis, The University of Arizona, 2017. http://hdl.handle.net/10150/623541.
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A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.Abdominal/pelvic pain is one of the most common reasons that patients present to hospital emergency departments (ED). With 129.8 million emergency department visits per year nationally, efficient triage and admission of these patients from the ED is essential. At the New York Methodist Hospital (NYMH) ED, patients presenting with abdominal/pelvic pain are evaluated based on a series of factors such as pain scores, past medical history, physical exam, and laboratory tests. Depending on these factors, clinicians observe, evaluate, and treat their patients requiring varying lengths of stay in the emergency department before either being discharged or admitted to the hospital. Physicians must weigh the benefits and risks of each evaluation they perform knowing that their resources may be needed more urgently by other patients. Determine the quantitative factors correlated with an increased length of stay for adults presenting to the emergency department with abdominal or pelvic pain. Increases in factors such as age, pain, BMI, and vital signs will correlate with an increased length of stay in the emergency department as well as an increased rate of admission to the hospital. Data regarding the above factors were abstracted from a sample of adult patients (n=347) presenting to the New York Methodist hospital emergency department from June 1st, 2013 to May 31st, 2014. The review of patients presenting to the emergency department with abdominal/pelvic pain demonstrated that patients with lengths of stay greater than four hours had a significantly higher value for age, weight, BMI, and blood pressure compared to those with lengths of stay less than four hours. Additionally, patients that were admitted to the hospital had a statistically significantly higher value for age, pain scores, systolic blood pressure, and heart rate. The identification of factors associated with longer lengths of stay provides the first step in identifying how to improve patients’ access to care in a more time efficient manner. Understanding what factors account for delays in care and discharge will allow for more efficient allocation of time and resources to the patients that need it most.
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Hintzen, Calliandra. "A DOUBLE‐BLINDED RANDOMIZED TRIAL OF IV IBUPROFEN AND MORPHINE COMBINATION THERAPY IN PATIENTS PRESENTING TO THE EMERGENCY DEPARTMENT WITH RENAL COLIC." Thesis, The University of Arizona, 2015. http://hdl.handle.net/10150/528194.
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A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.Renal stones (or “calculi”) are a relatively common condition, affecting up to 12 percent of people during their lifetime. Typical presentation of renal calculi is acute, intermittent flank pain, termed “renal colic”, which may radiate to the groin. Pain may be accompanied by hematuria, nausea, or vomiting.1 Acute renal colic is a common cause for presentation to the Emergency Department, accounting for an estimated 1 million emergency room visits annually in the United States.2 The severe pain associated with renal calculi requires immediate analgesia, and effective analgesia is associated with improved functional capacity after drug administration.3 In this trial, we compare the efficacy of IV ketorolac vs. IV ibuprofen for pain control in patients with renal colic in a three‐armed double‐blind prospective trial. Patients were randomized to one of three treatment groups, receiving parenteral infusions of either IV ibuprofen + morphine, IV ketorolac + morphine, or morphine monotherapy. Outcome of drug administration was measured by patients’ self‐assessment of pain on a verbal scale at 15 mins, 30 mins, 60 min, and 120 min after drug administration. We hypothesized that IV ibuprofen would provide effective, non‐opioid pain relief in the emergency setting and might have a lower incidence of adverse effects than ketorolac. Need for rescue analgesia (with 4 mg morphine) was observed as an indirect measure of analgesic efficacy. A total of 11 patients completed the study. There was no significant difference in area under the curve of pain score in any of the three treatment arms (p>0.4). The ibuprofen group demonstrated consistent improvement in pain over the course of 120 min of study, with 100% of the patients in that arm demonstrating downtrending pain scores. Though the sample size was too small to identify a statistically significant difference in need for rescue medication, there was a trend toward increased opioid in the ibuprofen group, with 50% of those participants receiving rescue analgesia with morphine. The sample size of this pilot study is inadequate to fully assess the analgesic efficacy of IV ibuprofen for renal colic. A trend toward improved pain control in the ibuprofen group was observed, with 100% of the patients in the ibuprofen arm reporting decreased pain after 120 minutes (as compared to 66% in the ketorolac arm and 75% in the placebo arm). Further study of efficacy and need for rescue analgesia is warranted.
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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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Thompson, June D. Grimes Richard M. "Factors determining the use of universal precautions by emergency department nurses /." See options below, 1994. http://proquest.umi.com/pqdweb?did=741486321&sid=1&Fmt=2&clientId=68716&RQT=309&VName=PQD.
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Dansby, Benjamin W. "An Informed Emergency: Improving Patient Comfort And Comprehension In And After The Emergency Department." Kent State University / OhioLINK, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=kent1276367591.
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Wood, Robert D. "Emergency Department Nurses' Suggestions for Improving End-of-Life Care." BYU ScholarsArchive, 2012. https://scholarsarchive.byu.edu/etd/3259.
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Introduction: Death is not an uncommon outcome for patients who seek immediate care in an emergency department. Although death is common in the emergency department there is little literature regarding end-of-life care in the emergency department. The purpose of this research study is to determine what changes emergency nurses would suggest to improve end-of-life care for dying patients and their families in emergency departments.
Background: A national, geographically dispersed, random sample of 1000 emergency nurses were sent a questionnaire entitled, "Emergency Nurses' Perceptions of End-of-Life Care." Inclusion criteria included nurses who were members of the Emergency Nurses Association, could read English, worked in an emergency department, and had cared for at least one emergency patient at the end-of-life.
Results: There was an overwhelming consistency in recommended changes to improve care of the dying emergency department patient by the nurses participating in the study. Five major themes were identified: 1) increasing the amount of time emergency nurses have to care for dying patients and their families; 2) consistently allowing family presence during resuscitation; 3) providing a comfortable patient room; 4) providing for more privacy at the end-of-life; and 5) providing a family grief room.
Conclusion: The emergency department will continue to be the primary access point for dying patients to receive medical and nursing care. Implementing changes based on emergency nurse recommendations may dramatically improve the experience for the dying patient as well as their family members.
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Neal, Pamela S. "Comparison of domestic violence outcomes among emergency department nurses." Huntington, WV : [Marshall University Libraries], 2002. http://www.marshall.edu/etd/descript.asp?ref=127.
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Brim, Carla B. "A descriptive analysis of non-urgent emergency department utilization." Online access for everyone, 2006. http://www.dissertations.wsu.edu/Thesis/Spring2006/c%5Fbrim%5F040606.pdf.
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Kapur, Atul Kumar. "Emergency department treatment of clinically stable paroxysmal atrial fibrillation." Thesis, University of Ottawa (Canada), 2002. http://hdl.handle.net/10393/6228.
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Introduction. Optimal management of paroxysmal atrial fibrillation (PAF), a common presenting complaint in emergency departments (EDs), remains undetermined. Methods. Six month prospective observational study at three EDs. Patients had clinically stable PAF for less than 48 hours. Conservative (rate control) and aggressive (pharmacologic and/or electrical cardioversion) treatment were analyzed. Results. 169 patients were analyzed, 32 treated conservatively and 137 aggressively. 83.9% of aggressively treated patients converted in the ED, 8.0% were admitted, and 52.3% stayed in sinus rhythm for four weeks. The corresponding proportions for conservative treatment were 34.4%, 37.5%, and 30.0%. There were 15 ED complications (2 rate control, 4 pharmacologic, and 9 electrical), two required admission (one pharmacologic and one electrical). No thromboembolism occurred by four-week follow-up. Conclusions. The results of this study---the first prospective study of ED treatment of PAF---will be used to plan a randomized controlled trial which will compare the two treatments.
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Colantonio, David A. "Troponin modifications, from animal model to the Emergency Department." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2002. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/MQ65612.pdf.
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Al-Tayyib, Alia Abdul-Hamid Miller William C. "Undiagnosed chlamydial and gonococcal infections in an emergency department." Chapel Hill, N.C. : University of North Carolina at Chapel Hill, 2007. http://dc.lib.unc.edu/u?/etd,958.
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Thesis (Ph. D.)--University of North Carolina at Chapel Hill, 2007.Title from electronic title page (viewed Dec. 18, 2007). "... in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Epidemiology, School of Public Health." Discipline: Epidemiology; Department/School: Public Health.
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Knott, Jonathan Charles. "Management of mental health patients in the emergency department /." Connect to thesis, 2006. http://eprints.unimelb.edu.au/archive/00002656.
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