Artykuły w czasopismach na temat „Emergency Department waiting room”
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Holm, Lydia, i Laura Fitzmaurice. "Emergency Department Waiting Room Stress". Pediatric Emergency Care 24, nr 12 (grudzień 2008): 836–38. http://dx.doi.org/10.1097/pec.0b013e31818ea04c.
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Chan, Y. Y., L. D. Richardson, S. B. Zaets, R. Nagurka, M. B. Brimacombe i S. R. Levine. "389: Stroke Education in the Emergency Department Waiting Room". Annals of Emergency Medicine 52, nr 4 (październik 2008): S161. http://dx.doi.org/10.1016/j.annemergmed.2008.06.416.
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Yvonne Chan, Yu-Feng, Roxanne Nagurka, Lynne D. Richardson, Sergey B. Zaets, Michael B. Brimacombe i Steven R. Levine. "Effectiveness of Stroke Education in the Emergency Department Waiting Room". Journal of Stroke and Cerebrovascular Diseases 19, nr 3 (maj 2010): 209–15. http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2009.04.009.
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Innes, Kelli, Doug Elliott, Virginia Plummer i Debra Jackson. "Emergency department waiting room nurses in practice: An observational study". Journal of Clinical Nursing 27, nr 7-8 (23.03.2018): e1402-e1411. http://dx.doi.org/10.1111/jocn.14240.
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Innes, Kelli, Debra Jackson, Virginia Plummer i Doug Elliott. "Emergency department waiting room nurse role: A key informant perspective". Australasian Emergency Nursing Journal 20, nr 1 (luty 2017): 6–11. http://dx.doi.org/10.1016/j.aenj.2016.12.002.
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Papa, Linda, David C. Seaberg, Elizabeth Rees, Kevin Ferguson, Richard Stair, Bruce Goldfeder i David Meurer. "Does a waiting room video about what to expect during an emergency department visit improve patient satisfaction?" CJEM 10, nr 04 (lipiec 2008): 347–54. http://dx.doi.org/10.1017/s1481803500010356.
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ABSTRACT Objective: We created an instructional waiting room video that explained what patients should expect during their emergency department (ED) visit and sought to determine whether preparing patients using this video would 1) improve satisfaction, 2) decrease perceived waiting room times and 3) increase calls to an outpatient referral line in an ambulatory population. Methods: This serial cross-sectional study took place over a period of 2 months before (control) and 2 months after the introduction of an educational waiting room video that described a typical patient visit to our ED. We enrolled a convenience sample of adult patients or parents of pediatric patients who were triaged to the ED waiting room; a research assistant distributed and collected the surveys as patients were being discharged after treatment. Subjects were excluded if they were admitted. The primary outcome was overall satisfaction measured on a 5-point Likert scale, and secondary outcomes included perceived waiting room time, and the number of outpatient referral-line calls. Results: There were 1132 subjects surveyed: 551 prevideo and 581 postvideo. The mean age was 38 years (standard deviation [SD] 18), 61% were female and the mean ED length of stay was 5.9 hours (SD 3.6). Satisfaction scores were significantly higher postvideo, with 65% of participants ranking their visit as either “excellent” or “very good,” compared with 58.1% in the prevideo group (p = 0.019); however, perceived waiting room time was not significantly different between the groups (p = 0.24). Patient calls to our specialty outpatient clinic referral line increased from 1.5 per month (95% confidence interval [CI] 0.58–2.42) to 4.5 per month (95% CI 1.19–7.18) (p = 0.032). After adjusting for possible covariates, the most significant determinants of overall satisfaction were perceived waiting room time (odds ratio [OR] 0.41, 95% CI 0.34–0.48) and having seen the ED waiting room video (OR 1.41, 95% CI 1.06–1.86). Conclusion: Preparing patients for their ED experience by describing the ED process of care through a waiting room video can improve ED patient satisfaction and the knowledge of outpatient clinic resources in an ambulatory population. Future studies should research the implementation of this educational intervention in a randomized fashion.
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Loso, Jennifer M., Stephanie L. Filipp, Matthew J. Gurka i Michael K. Davis. "Using Queue Theory and Load-Leveling Principles to Identify a Simple Metric for Resource Planning in a Pediatric Emergency Department". Global Pediatric Health 8 (styczeń 2021): 2333794X2094466. http://dx.doi.org/10.1177/2333794x20944665.
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Increased waiting time in pediatric emergency departments is a well-recognized and complex problem in a resource-limited US health care system. Efforts to reduce emergency department wait times include modeling arrival rates, acuity, process flow, and human resource requirements. The aim of this study was to investigate queue theory and load-leveling principles to model arrival rates and to identify a simple metric for assisting with determination of optimal physical space and human resource requirements. We discovered that pediatric emergency department arrival rates vary based on time of day, day of the week, and month of the year in a predictable pattern and that the hourly change in pediatric emergency department waiting room census may be useful as a simple metric to identify target times for shifting resources to better match supply and demand at no additional cost.
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Smalley, Courtney M., Erin L. Simon, Stephen W. Meldon, McKinsey R. Muir, Isaac Briskin, Steven Crane, Fernando Delgado, Bradford L. Borden i Baruch S. Fertel. "The impact of hospital boarding on the emergency department waiting room". Journal of the American College of Emergency Physicians Open 1, nr 5 (23.05.2020): 1052–59. http://dx.doi.org/10.1002/emp2.12100.
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Schabowski, S. L., J. Kirchoff, S. Hansen, M. Anderson i R. R. Roberts. "Testing a Model for an Emergency Department Waiting Room Educational Intervention". Annals of Emergency Medicine 46, nr 3 (wrzesień 2005): 25. http://dx.doi.org/10.1016/j.annemergmed.2005.06.097.
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Cabral, Catiane Zanin, Juliana Beirão de Almeida Guaragna, Fernanda Chaves Amantéa, Paulo Guilherme Markus Lopes, Alessandro Cumaru Pasqualotto, Claudia Ramos Rhoden i Sérgio Luís Amantéa. "Distribution of airborne respiratory pathogens in pediatric emergency department waiting room". Pediatric Pulmonology 56, nr 8 (29.06.2021): 2724–28. http://dx.doi.org/10.1002/ppul.25469.
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Ellis, Brittany, Michael Hartwick i Jeffrey J. Perry. "Register to donate while you wait: Assessing public opinions of the acceptability of utilizing the emergency department waiting room for organ and tissue donor registration". CJEM 21, nr 5 (14.05.2019): 622–25. http://dx.doi.org/10.1017/cem.2019.347.
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ABSTRACTObjectiveOur objectives were to identify barriers to the organ donation registration process in Ontario; and to determine the acceptability of using the emergency department (ED) waiting room to provide knowledge and offer opportunities for organ and tissue donor registration.MethodsWe conducted a paper based in-person survey over nine days in March and April 2017. The survey instrument was created in English using existing literature and expert opinion, pilot tested and then translated into French. Data was collected from patients and visitors in an urban academic Canadian tertiary care ED waiting room. All adults in the waiting room were approached to participate during study periods. We excluded patients who were too ill and required immediate treatment.ResultsThe number of attempted surveys was 324; 67 individuals (20.7%) declined participation. A total of 257 surveys were distributed and five were returned blank. This gave us a response rate of 77.8% with 252 completed surveys. The median age group was 51–60 years old with 55.9% female. Forty-six percent reported their religion as Christian and 34.1% did not declare a religious affiliation. 44.1% were already registered donors. Most participants agreed or were neutral that the ED waiting room was an acceptable place to provide information on donation, and for registration as an organ and tissue donor (83.3% and 82.1%, respectively).ConclusionsIndividuals waiting in the ED are generally supportive of using the waiting room for distributing information regarding organ and tissue donation, and to allow donor registration.
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Ellis, B., J. J. Perry i M. Hartwick. "P044: Register to donate while you wait: assessing public acceptability of utilizing the emergency department waiting room for organ and tissue donor registration". CJEM 20, S1 (maj 2018): S72. http://dx.doi.org/10.1017/cem.2018.242.
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Introduction: Our study objectives were to assess the acceptability of using the emergency department (ED) waiting room to provide knowledge on, and offer opportunities for organ and tissue donor registration; and to identify barriers to the donor registration process in Ontario. Methods: We conducted a paper based in-person survey over nine days for eight hour blocks in March and April 2017. The survey instrument was created in English using existing literature and expert opinion, pilot tested and then translated into French. The study collected data from patients and visitors in an urban academic Canadian tertiary care ED waiting room. All adults in the waiting room were approached to participate during the study periods. Individuals waiting in clinical care areas were excluded, as well as those who required immediate treatment. Results: The number of attempted surveys was 324; 67 individuals (20.7%) refused to partake. A total of 257 surveys were distributed and five were returned blank. This gave us a response rate of 77.8% with 252 completed surveys. The median age group was 51-60 years old with 55.9% female. Forty-six percent were Christian (46.0%) and 34.1% did not declare a religious affiliation. Nearly half of participants (44.1%) were registered organ donors. The majority of participants agreed or were neutral (83.3%) that the ED waiting room was an acceptable place to provide information on organ and tissue donation. Further, 82.1% agreed or were neutral that the ED was an acceptable place to register as an organ donor. Nearly half (47.2%) agreed that they would consider registering while in the ED waiting room. A number of barriers to registering as an organ and tissue donor were identified. The most common were: not knowing how to register (22.0%), a lack of time to register (21.1%), and having unanswered questions regarding organ and tissue donation (18.7%). Conclusion: Individuals waiting in the ED are supportive of using the ED waiting room for distributing information regarding organ and tissue donation, and facilitating organ and tissue donation registration. Developing such a practice could help to reduce some of the identified barriers, including a lack of time and having unanswered questions regarding donation.
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Calder-Sprackman, Samantha, Edmund S. H. Kwok, Renee Bradley, Jeffrey Landreville, Jeffrey J. Perry i Lisa A. Calder. "Availability of Emergency Department Wait Times Information: A Patient-Centered Needs Assessment". Emergency Medicine International 2021 (22.04.2021): 1–6. http://dx.doi.org/10.1155/2021/8883933.
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Introduction. Many Emergency Departments (ED) publish wait times; however, the patient perspective in what information is requested and the quantity of information to post is limited. Methods. We conducted a mixed-methods study at a tertiary care academic center. First, we conducted focus groups of 7 patients. We then generated themes following content analysis to create a patient survey. We administered in-person surveys to patients in ED waiting rooms at sites randomized for survey administration. We used preassigned shifts utilized for even patient perspective representation of the 24 hours-a-day/7 days-a-week service. We included waiting room patients over 18 years of age and excluded patients directly referred to a specialty service or who did not speak French or English. We analyzed survey data using descriptive statistics. Results. We identified nine dominant focus group themes: wait time definition, wait time notification, communication, education, patient expectations, utilization of the ED, patient behaviour, physical comfort, and patient empowerment. Of the 240 patient questionnaires administered, 81.3% of respondents wanted to know ED wait times before hospital arrival hospital and 90.8% wanted ED wait times posted in the waiting room. Website (46.7%) was the most popular choice for publishing wait times outside the ED. Within the ED, patients had no preference regarding display modality, if times were displayed (39.6%). Overall, 76.7% stated that their satisfaction with the ED would be improved if wait times were posted. Conclusion. ED patients strongly supported having access to wait time information. Patients believed having wait time information will have a positive impact on their overall ED satisfaction.
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Chan, Yu-Feng Yvonne, Lynne D. Richardson, Roxanne Nagurka, Ke Hao, Sergey B. Zaets, Michael B. Brimacombe, Susanne Bentley i Steven R. Levine. "Stroke Education in an Emergency Department Waiting Room: a Comparison of Methods". Health Promotion Perspectives 5, nr 1 (29.03.2015): 34–41. http://dx.doi.org/10.15171/hpp.2015.005.
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Kraus, Chadd K. "The emergency department waiting room: A barometer of hospital throughput and capacity?" Journal of the American College of Emergency Physicians Open 1, nr 5 (13.08.2020): 1060–61. http://dx.doi.org/10.1002/emp2.12217.
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Krebs, L., C. Villa-Roel, D. Ushko, G. Sandhar, H. Ruske, S. Couperthwaite, B. Holroyd, M. Ospina i B. Rowe. "P076: Do QR codes effectively engage patients in research while visiting the emergency department?" CJEM 21, S1 (maj 2019): S90—S91. http://dx.doi.org/10.1017/cem.2019.267.
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Introduction: Efforts to engage patients in research when presenting to emergency departments (EDs) have explored the utility of online tools; for example, through QR-based applications. It is unclear whether these are effective strategies for engaging patients in research activities while saving costs of in-person surveys. This study evaluated whether patients would participate in QR codes or short URL-linked surveys available in EDs across Alberta. Methods: A patient waiting room poster was developed as part of a stepped-wedge randomized controlled trial. The waiting room poster was introduced in 15 urban and regional Alberta EDs with a median annual volume of approximately 60,000. A QR-code and short URL were placed on the poster inviting patients to participate in an online survey and evaluate the poster's usefulness and acceptability. Additionally, written discharge instructions, which were part of the intervention materials, were distributed with QR-code and short URL link to surveys for patients to share their ED care experience. Patients were not prompted by any staff or research personnel to encourage use of the QR codes or the short URLs; however, a survey was conducted with ED waiting room patients in 3 urban EDs to ascertain whether they had downloaded a QR reader on their devices and the frequency of use of these applications. Results: Given the stepped-wedge nature of the study, these materials were available for a total of approximately 123 months (3 sites for 13 months, 4 sites for 10 months, 4 sites for 7 months, and 4 sites for 4 months). Over the study period, 15 patients accessed and completed the online survey linked to the QR code or the short URL placed on the posters. No patients completed the online surveys linked to the QR code or the short URL placed on the discharge instructions. The in-person survey conducted within the ED waiting room identified that 34% of respondents had a QR code reader downloaded on their phone (108/316). Of those with a QR reader, 33% reported using the reader at least once within the last 6 months. Conclusion: In this study, few patients downloaded QR readers on their electronic devices while in the ED waiting room. Without prompting, this appears to be an ineffective strategy for engaging patients in emergency medicine research. Other engagement strategies optimizing human resource investment are urgently needed to effectively conduct research in EDs.
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Acharya, Subhash Prasad, Dinesh Dharel, Smrity Upadhyaya, Nabin Khanal, Sandesh Dahal, Sumit Dahal i Karmapath Aryal. "Study of factors associated with waiting time for patients undergoing emergency surgery in a tertiary care centre in Nepal". Journal of Society of Anesthesiologists of Nepal 1, nr 1 (3.10.2015): 7–12. http://dx.doi.org/10.3126/jsan.v1i1.13582.
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Background: Emergency surgeries throughout the world are demanding earlier surgical times. In a developing country like Nepal this cannot be possible because of lot of factors. So we planned to study such factors that could interplay and increase the waiting time for emergency surgeries. Methods: A prospective observational study was conducted over 45 days and all patients diagnosed with general surgical and orthopedic emergencies were followed till they were operated. Results: Out of 1211 patients presenting to emergency department, 92 required emergency surgery. The mean age was 29.72 year and 76.1% of the patients were male. The mean time from presentation to the emergency department to the first surgical consultation was 170 minutes, from surgical consultation to decision of surgery was 28 minutes, from decision of surgery to transfer to operating room was 426 minutes, from arrival in operating room to anesthesia consultation was 18 minutes, and from anesthesia consultation to start of surgical incision was 75 minutes. The total average waiting time from arrival at emergency department to the start of surgery was 717 minutes. The factors were, viz., pre-occupancy of theatre (59.8%), special procedures/intervention required prior to surgery (23.9%), arrangement of logistics/finances by patient family (13%), arrangement of blood products (10.9%), consultations (9.8%), delay in giving consent by patients/family (5.4%), delay in arrangement of supplies (9.8%), and shift change of nursing staff (3.3%). Conclusion: This study shows that various preventable factors increases waiting times for emergency surgeries that should be minimized so that waiting times can be reduced.Journal of Society of Anesthesiologists 2014 1(1): 7-12
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Claassen, Cynthia A., i Gregory L. Larkin. "Occult suicidality in an emergency department population". British Journal of Psychiatry 186, nr 4 (kwiecień 2005): 352–53. http://dx.doi.org/10.1192/bjp.186.4.352.
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SummaryThe prevalence and severity of suicidal ideation was established in a patient sample seeking emergency treatment for non-psychiatric reasons. Using a computerised mental health screening panel, data were collected from waiting-room patients during randomised shifts over a 45-day period. Of 1590 screened patients, 185 (11.6%) acknowledged suicidal ideation and 31 (2%) reported planning to kill themselves. Almost all of those with suicidal ideation (97%) acknowledged symptoms consistent with mood, anxiety and/or substance-related disorders. Structured medical record review revealed that 25 of the 31 patients planning suicide were undetected during their index visit, and that 4 attempted suicide within 45 days of the visit. All survived.
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Calder-Sprackman, S. M., E. S. Kwok, R. Bradley, J. Landreville i L. A. Calder. "P019: Understanding patient perceptions of emergency department wait time publication: a mixed-methods needs assessment". CJEM 18, S1 (maj 2016): S84. http://dx.doi.org/10.1017/cem.2016.195.
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Introduction: Many emergency departments (EDs) have begun publishing wait times. This study seeks to develop an understanding of patients’ needs with respect to publishing ED wait times, which, to our knowledge, has not been described in the literature. Methods: We conducted a two-stage mixed methods study at a dual campus tertiary care academic center. First, we held focus group discussions comprising of 7 patient advocacy hospital committee members. Themes generated from focus group discussions were then utilized to create a patient survey. Focus groups were analyzed using content theme analysis. Hospital sites for survey administration were randomized and pre-assigned shifts were established to ensure a balance of weekdays, weekends, days, evenings, and overnights. All adult patients (age >18) in the waiting room were eligible, but excluded if they were directly referred to a specialty service or did not speak French or English. Survey data was analyzed using descriptive statistics. Results: We found 9 dominant focus group themes: definition of wait time, wait time posting, lack of communication, education in waiting room, patient expectations, utilization of the ED, patient behavior, physical comfort, and patient empowerment. Of the 240 patient questionnaires administered, 81.3% (195) wanted to know ED wait times before arrival to hospital and 90.8% (217) wanted ED wait times posted in the ED waiting room. The most popular choice for publishing wait times outside the ED was a website (46.7%) whereas, within the ED, patients were not particular about the specific display modality as long as times were displayed (39.6%). Overall, 76.7% (184) stated their satisfaction with the ED would be improved if wait times were posted. Conclusion: ED patients we surveyed strongly supported both the idea of having access to wait time information prior to arrival, as well as physical display of wait times in the waiting room.
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Hamrock, Eric, Kerrie Paige, Jennifer Parks, James Scheulen i Scott Levin. "Relieving emergency department crowding: Simulating the effects of improving patient flow over time". Journal of Hospital Administration 4, nr 1 (9.12.2014): 43. http://dx.doi.org/10.5430/jha.v4n1p43.
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Background: Emergency Departments (ED) are challenged with excess demand for services and inadequate system capacity.Crowding at two independent EDs within a health system prompted an examination of the potential effects of improving patientthroughput. The objective of this study was to determine the effects of reducing ED dwell time on temporal patterns of patientflow and demand for ED resources.Methods: Separate discrete event simulation (DES) models were developed for the EDs of a 1,000-bed urban medical centerand a 560-bed community medical center using patient flow information. These models characterized the effects of reducingpatient dwell time on ED care area census (i.e., staffing needs), waiting room census, total length of stay (LOS) and waiting time. Dwell time was defined as the time interval from when a patient entered the main ED care area to when the patient exited the ED by discharge or hospital admission. Total LOS is defined as the entire time interval from ED from arrival to exit (includingwaiting time).Results: DES results for each site demonstrate how natural patient arrivals and common hospital admission processes generatecommon temporal patterns of decreased crowding. Improving flow translates to most substantial reductions in waiting timeand waiting room census during evening hours (17:00 to 22:00 hours). Significant effects on ED care area census and staffingdemands are lagged, not occurring until overnight hours (2:00 to 8:00 hours). We reduced patient dwell time in 5% incrementswithin the urban ED (16.2 min) and community ED (13.5 min) from 5% to 15%. For example, a 10% decrease in dwell timeat the urban ED (32.4 min) and community ED (27.0 min) resulted in respective decreases in evening waiting room census by49% (10.8 patients) and 26% (3.5 patients) during evening hours and ED care area census by 16% (3.6 patients) and 11% (2.0patients) overnight.Conclusions: DES results suggest that increasing ED efficiency will most significantly decrease delays experienced by eveningarrivals and provide opportunities to decrease care area census and reduce staff overnight.
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Sapto Putro, Wasis, i Sodikin Sodikin. "The correlation between response time and waiting time on patients’ satisfaction at the emergency departement". Proceedings Series on Health & Medical Sciences 1 (10.12.2020): 142–45. http://dx.doi.org/10.30595/pshms.v1i.52.
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Fast and accurate services are essential in the Emergency Departement (ED). Services in the emergency room will be hampered if it is are full of patients. If this is not managed well, the right services cannot be implemented. In turn, it will have a bad effect on patient satisfaction. To analyze the correlation between response time and waiting time with patient satisfaction during service at the Emergency Department of the Banyumas Regional General Hospital.This research is quantitative research. The sampling technique in this study used purposive sampling of 96 respondents. The statistical test used is the chi square test.Most respondents percieved the responding time in ER is fast; most of them also rated that the waiting time in ER is short. Most of them are also satisfied with ER services. The chi square test results in p value of <0.05 for each variable. It means there is a relationship between response time and waiting time with patient satisfaction during service at the Emergency Department of Banyumas Regional General Hospital.Response time and waiting time are related to patient satisfaction during service at the Emergency Department of Banyumas Regional General Hospital.
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Benning, Stephen D., Stephany M. Molina, Emily A. Dowgwillo, Christopher J. Patrick, Karen F. Miller i Alan B. Storrow. "Psychopathy in the Medical Emergency Department". Journal of Personality Disorders 32, nr 4 (sierpień 2018): 482–96. http://dx.doi.org/10.1521/pedi_2017_31_308.
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Psychopathy is a personality disorder representing an admixture of a fearless and dominant temperament with an impulsive and antisocial orientation. A sample of 1,026 participants in the waiting room of the medical emergency department of a city hospital exhibited levels of fearless dominance similar to university undergraduates and federal inmates; their levels of impulsive antisociality fell between those of federal and state inmates. Both psychopathy factors were correlated with male gender, younger age, and more frequent average alcohol consumption. Fearless dominance was associated with agentic success (e.g., being employed, higher household income), fewer psychological problems, and less use of psychotropic medications, including anxiolytics. Impulsive antisociality was negatively related to both agentic and communal (e.g., ever being married) success and positively correlated with substance use and self-reported bipolar, ADHD, and psychotic psychiatric conditions. Further, only impulsive antisociality was associated with presenting to the emergency department for physical injury or psychological disturbance.
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Nanda, Upali, Cheryl Chanaud, Michael Nelson, Xi Zhu, Robyn Bajema i Ben H. Jansen. "Impact of Visual Art on Patient Behavior in the Emergency Department Waiting Room". Journal of Emergency Medicine 43, nr 1 (lipiec 2012): 172–81. http://dx.doi.org/10.1016/j.jemermed.2011.06.138.
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Stang, Antonia S., Stephen B. Freedman, Angelo Mikrogianakis, Graham C. Thompson, Janie Williamson i David W. Johnson. "Parental experiences and preferences as participants in pediatric research conducted in the emergency department". CJEM 20, nr 3 (4.05.2017): 409–19. http://dx.doi.org/10.1017/cem.2017.22.
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ABSTRACTObjectiveTo determine parental experiences and preferences regarding the conduct of pediatric research in an emergency department (ED) setting.MethodsWe conducted a cross-sectional study of parents of children ages 0 – 14 years who visited the ED of a tertiary care children’s hospital. Parents completed a Web-based survey designed to assess perceptions regarding: 1) background/training of research personnel, 2) location and timing of research discussions, and 3) factors influencing their consent/refusal decision.ResultsParents totalling 339 were approached, and 227 (67%) surveys were completed. Overall, 87% (197/227; 95% confidence interval [CI] 83, 92) reported they would be comfortable being approached by a university student to discuss research. This proportion did not change when stratified by the child’s gender, illness severity, or season of visit. Whereas only 37% (84/227; 95% CI 31, 43) of respondents would be comfortable being approached in the waiting room, 68% (154/227; 95% CI 62, 75) would be comfortable if approached in a separate area of the main waiting room. The majority reported comfort with follow-up via email (83%; 188/227; 95% CI 78, 88) or telephone (80%; 182/227; 95% CI 75, 85); only 51% (116/227; 95% CI 44, 57) would be comfortable with a scheduled follow-up visit in the hospital. Participants identified potential complications or side effects as the most common reason for declining consent (69%; 157/227; 95% CI 63, 75).ConclusionsThe majority of parents are comfortable being approached by trained university students, preferably in a separate area of an ED waiting room, and email and telephone follow-ups are preferred over a scheduled re-visit.
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Calder-Sprackman, S., E. Klar, A. Rocker i E. S. H. Kwok. "MP27: Publishing emergency department wait times in the waiting room: implementation and evaluation of a co-designed patient centered solution". CJEM 20, S1 (maj 2018): S50. http://dx.doi.org/10.1017/cem.2018.181.
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Introduction: Patients in our ED were dissatisfied with their waiting experience, which resulted in patient anxiety and complaints. In 8 months, we aimed to (1) improve patient satisfaction with the ED waiting experience from triage to physician initial assessment by a 15% improvement in patients who rate their experience very good/excellent on a Likert Scale, and (2) improve patient knowledge of ED wait time by a 50% increase in understanding on a Likert Scale. Methods: We co-designed a display with ED patients to notify those in the waiting room of their wait process and wait time. The intervention was selected after root cause diagnostics including: Fishbone exercise, Pareto Diagram, and Driver Diagram. The display was co-designed with ED patients and improved via PDSA cycles to establish information displayed and how to incorporate it into the waiting experience. After co-design, a low-fidelity display was piloted in the waiting room. Results: A family of measures were evaluated using patient/provider surveys and hospital data metrics. Outcome measures were (1) percentage of patients who rated their ED experience as very good/excellent on a Likert scale, and (2) patients who had a clear/very clear understanding of their wait time on a Likert scale. Process measures were the percentage of patients who (1) looked at the wait time display, and (2) felt they could communicate their wait time to others. Balancing measures were clerk/nurse satisfaction and self-reported interruptions of patients asking wait time. Outcomes were tracked using statistical process charts and run charts. Following display implementation, patient rating of their ED experience and patient understanding of wait time showed positive improvement. Clerks/nurses were also more satisfied with their jobs and self-reported interruptions decreased. Conclusion: A low-fidelity wait time display co-designed with patients improved patient satisfaction and understanding of ED wait times. We plan to develop an automated electronic display that resembles the low-fidelity display and evaluate the impact of the intervention on the established measures. This intervention has the potential to be sustainable, feasible for other EDs, and require minimal upkeep costs.
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Morphet, Julia, Debra Griffiths, Virginia Plummer, Kelli Innes, Robyn Fairhall i Jill Beattie. "At the crossroads of violence and aggression in the emergency department: perspectives of Australian emergency nurses". Australian Health Review 38, nr 2 (2014): 194. http://dx.doi.org/10.1071/ah13189.
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Objective Violence is widespread in Australian emergency departments (ED) and most prevalent at triage. The aim of the present study was to identify the causes and common acts of violence in the ED perceived by three distinct groups of nurses. Methods The Delphi technique is a method for consensus-building. In the present study a three-phase Delphi technique was used to identify and compare what nurse unit managers, triage and non-triage nurses believe is the prevalence and nature of violence and aggression in the ED. Results Long waiting times, drugs and alcohol all contributed to ED violence. Triage nurses also indicated that ED staff, including security staff and the triage nurses themselves, can contribute to violence. Improved communication at triage and support from management to follow up episodes of violence were suggested as strategies to reduce violence in the ED Conclusion There is no single solution for the management of ED violence. Needs and strategies vary because people in the waiting room have differing needs to those inside the ED. Participants agreed that the introduction and enforcement of a zero tolerance policy, including support from managers to follow up reports of violence, would reduce violence and improve safety for staff. Education of the public regarding ED processes, and the ED staff in relation to patient needs, may contribute to reducing ED violence. What is known about the topic? Violence is prevalent in Australian healthcare, and particularly in emergency departments (ED). Several organisations and government bodies have made recommendations aimed at reducing the prevalence of violence in healthcare but, to date, these have not been implemented consistently, and violence continues. What does this paper add? This study examined ED violence from the perspective of triage nurses, nurse unit managers and non-triage nurses, and revealed that violence is experienced differently by emergency nurses, depending on their area of work. Triage nurses have identified that they themselves contribute to violence in the ED by their style of communication. Nurse unit managers and non-triage nurses perceive that violence is the result of drugs and alcohol, as well as long waiting times. What are the implications for practitioners? Strategies to reduce violence must address the needs of patients and staff both within the ED and in the waiting room. Such strategies should be multifaceted and include education of ED consumers and staff, as well as support from management to respond to reports of violence.
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Varney, S. M., T. E. Vargas, R. L. Pitotti i V. S. Bebarta. "447: Patient Perceptions of Leaving an Emergency Department Waiting Room Before Seeing a Physician". Annals of Emergency Medicine 56, nr 3 (wrzesień 2010): S144—S145. http://dx.doi.org/10.1016/j.annemergmed.2010.06.490.
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Zhao, Yuancheng, Qingjin Peng, Trevor Strome, Erin Weldon, Michael Zhang i Alecs Chochinov. "Bottleneck detection for improvement of Emergency Department efficiency". Business Process Management Journal 21, nr 3 (1.06.2015): 564–85. http://dx.doi.org/10.1108/bpmj-06-2014-0060.
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Purpose – The purpose of this paper is to introduce a method of the bottleneck detection for Emergency Department (ED) improvement using benchmarking and design of experiments (DOE) in simulation model. Design/methodology/approach – Four procedures of treatments are used to represent ED activities of the patient flow. Simulation modeling is applied as a cost-effective tool to analyze the ED operation. Benchmarking provides the achievable goal for the improvement. DOE speeds up the process of bottleneck search. Findings – It is identified that the long waiting time is accumulated by previous arrival patients waiting for treatment in the ED. Comparing the processing time of each treatment procedure with the benchmark reveals that increasing the treatment time mainly happens in treatment in progress and emergency room holding (ERH) procedures. It also indicates that the to be admitted time caused by the transfer delay is a common case. Research limitations/implications – The current research is conducted in the ED only. Activities in the ERH require a close cooperation of several medical teams to complete patients’ condition evaluations. The current model may be extended to the related medical units to improve the model detail. Practical implications – ED overcrowding is an increasingly significant public healthcare problem. Bottlenecks that affect ED overcrowding have to be detected to improve the patient flow. Originality/value – Integration of benchmarking and DOE in simulation modeling proposed in this research shows the promise in time-saving for bottleneck detection of ED operations.
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Ahmed, Reshma, Nihar Sultana, Saieda Farzana, Begum Sharifa Akhtar, SM Ziauddin i Md Golam Rubby. "Management of the services of emergency department in a specialized hospital a cross sectional study". Update Dental College Journal 6, nr 1 (13.08.2016): 15–20. http://dx.doi.org/10.3329/updcj.v6i1.29215.
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Emergency department is one of the most important part of the hospital and also vulnerable to criticism. The reputation of a hospital rests to a large extent on the service of emergency department. A descriptive type of cross sectional study was conducted at Emergency Department (ED) of National Institute of Cardiovascular Diseases Hospital (NICVD), Dhaka to assess different aspects of the service management of ED which includes opinion regarding different services, reception facilities, overall management of ED, waiting time for the patients to be attended by a doctor, required time for completion of emergency treatment, suggestions of service receivers for further improvement of ED of the hospital. A total of 121 patients or patient attendance and 39 health personnel were interviewed by a structured questionnaire and a checklist was utilized for availability of equipments and drugs in ED. The collected data were processed and analyzed meticulously with the help of SPSS (Version 21) software on the basis of different variables. According to Standard Operating Procedure (SOP) all instruments were present, 15 emergency drugs had been listed, out of them Inj. Streptokinase, antiseptic liquid were not available at that time in the ED of the hospital. The study revealed that out of 160 respondents the mean age was 40.3 ± 5.81 years, opinion about different services provided in ED more than two third found satisfied, only 18.1 % service receivers mentioned about the waiting time at ED to be seen by a doctor was ?3 minutes, more than half (54.5 %) required 20-30 minutes for completion of emergency treatment, different suggestions were suggested for further improvement of ED like increase number of wheel chair, stretcher, ambulance, to supply required medicine from the hospital, separate ECG room for female patients, waiting room for patients attendance etc. However, specific problems identified by different stakeholders need to be critically appraised by the authority to improve the services further.Update Dent. Coll. j: 2016; 6 (1): 15-20
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Molalign Takele, Goitom, Negash Abreha Weldesenbet, Nahom Girmay, Habtamu Degefe i Rigbe Kinfe. "Assessment patient satisfaction towards emergency medical care and its determinants at Ayder comprehensive specialized hospital, Mekelle, Northern Ethiopia". PLOS ONE 16, nr 1 (7.01.2021): e0243764. http://dx.doi.org/10.1371/journal.pone.0243764.
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Background As the healthcare industry shifts toward patient-centered models, providers will need to fully understand patient satisfaction and how they affect their practices. This study aimed to assess patient satisfaction towards the emergency medical care and factors associated with at Ayder specialized comprehensive hospital, Emergency room, Mekelle, Ethiopia. Methods An institution-based cross-sectional study was conducted from March 1–30, 2019. A systematic random sampling method was used to enroll 299 study participants. Data were collected using a standard Brief Emergency Department Patient Satisfaction Scale questionnaire by trained data collectors. Data was entered into EpiData 3.1 then exported and analyzed by SPSS version 22. Binary and multiple logistic regression were used to assess the factors associated with patient satisfaction. Where the p-value of <0.05 was considered significant. Results A total of 299 participants were enrolled in the study with a response rate of 99.3%. On overall patient satisfaction score majority (81.9%) of them were satisfied with the emergency medical care provided. The satisfaction rate towards emergency staff courtesy, emergency room environment, physician care satisfaction, general patient satisfaction, and patient family satisfaction was 80.3%, 37.5%, 75.9%, 70.9%, and 49.8% respectively. Those who arrived during the morning time of the day tend to be satisfied more with the emergency services (AOR = 4.8, 95% CI: 2.08, 11.4), while having low educational status (able to read and write) (AOR = 0.12, 95% CI: 0.03, 0.50) and waiting time till seen by a doctor (AOR = 1.3, 95% CI: 1.003, 1.4) was found to affect patient satisfaction negatively. Conclusions The total patient satisfaction score towards emergency medical care was found to be good. The hospital management and emergency room staff should act on the identified factors especially on minimizing the patients waiting time to improve the quality of care in the emergency department.
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Trikhacheva, Anna, Michael Page, Holly Gault, Rose Ochieng, Bradley E. Barth, Chad M. Cannon, Olga Shakhnovich i Kimberly K. Engelman. "Dental-related Emergency Department Visits and Community Dental Care Resources for Emergency Room Patients". Kansas Journal of Medicine 8, nr 2 (18.05.2015): 61–72. http://dx.doi.org/10.17161/kjm.v8i2.11521.
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BACKGROUND: The number and cost of dental-related visits to Emergency Departments (ED) is a significant issue nationwide. A better understanding of the treatment provided to ED patients presenting with dental complaints and community dental resources is needed. METHODS: A three-tiered approach included: 1) a 12-month retrospective chart review for dental-related ICD-9 visit codes at an urban academic ED in Kansas City; 2) surveys of 30 providers at the same ED regarding the dental patient process and treatment; and 3) telephone surveys of 16 Kansas City area safety net clinics regarding service access. RESULTS: Out of 49,276 ED visits, 676 were related to dental conditions (70 were repeat dental ED visits). Most patients were female (54%), white (45%), age 20-39 (65%), and self-pay (56%). The most prevalent codes utilized were dental disorder not otherwise specified (NOS; 57%), periapical abscess (22%), and dental caries NOS (15%). Nearly all providers (97%) felt comfortable seeing patients with dental complaints. Chart review indicated that patients received a dental screen/exam during 80% of the encounters, with medication provided to 90% of the patients. Over two-thirds of the providers (N = 23/30) regularly prescribed antibiotics and pain medications for their ED dental patients. ED providers performed dental procedures in 63% of the patient cases. The most common procedures included dental blocks (N = 16 providers) and incision and drainage (N = 4 providers). Only two of the 16 safety net clinics provided comprehensive dental care, almost all (94%) clinics required patients to call to schedule an appointment, and there was a two to six month waiting period for 31% of the clinics. CONCLUSION: The limited scope of dental treatment in the ED, coupled with poor availability of safety-net dental resources, may result in dental exacerbations and suboptimal patient clinical outcomes. The enhancement of safety-net dental service accessibility is crucial to reducing dental ED visits and improving dental health, particularly among low-income, self-pay populations.
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Lindenau-Stockfisch, Verena, Julia Searle i Martin Möckel. "POCT in Emergency Rooms: One Key Factor for Process Streamlining with Lean Management". Conference Papers in Medicine 2013 (26.05.2013): 1–6. http://dx.doi.org/10.1155/2013/143985.
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Overcrowding is a common problem in Emergency Departments (ED) worldwide and has a negative impact on patient satisfaction and, more importantly, patient safety. So, the Emergency Department of the secondary-care hospital Paul Gerhardt Stift in Wittenberg, Germany, was faced with increasing numbers of patients. Lean management was introduced to analyse, optimise, and standardise ED processes. Consequently, a project group concentrated on “cycling muda” which is to identify waste and cost drivers along a representative patient path using one suitable Lean tool: mapping the current state in a value stream. As a result, it became clear that both patients and staff suffered from immense waiting times that lead to risky patient care and employee frustration. By subsequently eliminating the waste drivers and designing a high-quality patient flow process creating standards supported by state-of-the-art technology, the hospital’s ED turned into a streamlined department with reduced waiting times offering employees a satisfactory and modern workplace where patients benefit from first-class care.
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Innes, Kelli, Debra Jackson, Virginia Plummer i Doug Elliott. "Care of patients in emergency department waiting rooms - an integrative review". Journal of Advanced Nursing 71, nr 12 (30.06.2015): 2702–14. http://dx.doi.org/10.1111/jan.12719.
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Ding, Ru, Melissa L. McCarthy, Jeffrey S. Desmond, Jennifer S. Lee, Dominik Aronsky i Scott L. Zeger. "Characterizing Waiting Room Time, Treatment Time, and Boarding Time in the Emergency Department Using Quantile Regression". Academic Emergency Medicine 17, nr 8 (29.07.2010): 813–23. http://dx.doi.org/10.1111/j.1553-2712.2010.00812.x.
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Chan, Teresa M., Jonathan Sherbino, Arthur Welsher, Alexander Chorley i Alim Pardhan. "Just the Facts: how to teach emergency department flow management". CJEM 22, nr 4 (13.05.2020): 459–62. http://dx.doi.org/10.1017/cem.2020.32.
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Even before starting your evening shift you know it's going to be busy. Ambulances are lined up in front of the hospital, and the charge nurse already seems stressed out. The senior Emergency Medicine (EM) resident is standing in the physician office, ready to start her shift as well. You have worked with her a few times during this rotation. She is competent, you trust in her management plans for all her individual patients. Together you both review the patient tracker: a variety of patient presentations ready to be seen, plus an additional 20 patients in the waiting room. Negotiating the learning objective for the shift, the resident indicates that she would like to work on more efficiently managing patient flow and the administration of the emergency department (ED). But…isn't that a skill you just learn from experience? You wonder what evidence-informed strategies might exist for training her for this next step.
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Sari, Milda Aprilian, Susi Erianti i Erna Marni. "FAKTOR-FAKTOR YANG BERHUBUNGAN DENGAN WAITING TIME PADA PASIEN TRIAGE KUNING". Jurnal Keperawatan Abdurrab 4, nr 1 (7.07.2020): 14–25. http://dx.doi.org/10.36341/jka.v4i1.1240.
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Abstrak
Waiting time diartikan rentang waktu kedatangan pasien emergency yang diukur mulai dari pasien datang sampai ditransfer keruangan lain. Penumpukan pasien (overcrowded) merupakan masalah yang sering terjadi di Instalasi Gawat Darurat yang dapat menyebabkan waktu tunggu yang lama. Waktu tunggu yang baik dapat meningkatkan mutu pelayanan dan kepuasan yang lebih kepada pasien. Tujuan penelitian ini untuk mengetahui faktor-faktor yang berhubungan dengan waiting time pada pasien triage kuning di IGD RSUD Arifin Achmad Provinsi Riau. Desain yang digunakan dalam penelitian ini adalah observasional analitik dengan pendekatan cross sectional. Sampel dalam penelitian ini adalah pasien yang masuk IGD pada triage kuning dengan teknik pengambilan sampel menggunakan concecutive sampling sebanyak 85 responden. Instrumen penelitian menggunakan lembar observasi dan metode Check List. Hasil bivariat dengan uji chi-square didapatkan bahwa dari empat faktor yang dianalisa terdapat faktor yang berhubungan dengan waiting time adalah waktu kembalinya hasil pemeriksaan laboratorium. Sedangkan faktor-faktor yang tidak berhubungan dengan waiting time pada pasien triage kuning yaitu rasio perbandingan perawat dengan pasien pershift, sarana prasarana, dan adminstrasi. Diharapkan kepada pihak manajemen RSUD Arifin Achmad Provinsi Riau untuk terus mengontrol performa pelayanan pada pemeriksaan penunjang yaitu waktu tunggu kembalinya hasil pemeriksaan laboratorium agar tidak melebihi standar yang telah ditetapkan oleh rumah sakit sehingga dapat mengurangi waktu boarding pasien yang memanjang.
Kata kunci: Pasien triage kuning, Waiting Time
Factors Associated with Yellow Triage Patients’ Waiting Time
Abstract
Waiting time refers to time span of emergency patients has to spend, starting from patient’s arrival to patient being transferred to another room. Overcrowding is a common problem faced at emergency department causing longer waiting time for patients. Shorter waiting time can improve quality of service and patients’ level of satisfaction. This study was aimed to determine factors associated with yellow triage patients’ waiting time at emergency department of Arifin Achmad General Hospital of Riau Province. This observational-analytic study was carried out using cross sectional approach. Samples of this study were patients entering Emergency Department with yellow triage category, with 85 respondents who were recruited using consecutive sampling technique. Observation sheet and check list method were used as the study instruments. The result of univariate and bivariate analyses using Chi-square test showed that of all four analyzed factors associated with patient waiting time, the most significantly related one was waiting time for laboratory test results. In contrast, the least related factors were nurse-patient ratio per shift, facilities and infrastructures, and administration procedure. It is expected that the management of Arifin Achmad General Hospital of Riau Province to maintain control of the service performance on supporting examination, especially waiting time for the laboratory test result, which will reduce the amount of patient boarding time which keeps extending.
Keywords: Yellow triage patient, Waiting Time
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Gunnarsson, Ronny, Paul Cullen, Clare Heal i Jennifer Banks. "Effect of promoting current local research activities on large monitors on the population’s interest in health-related research: a randomised controlled trial". BMJ Open 9, nr 8 (sierpień 2019): e028714. http://dx.doi.org/10.1136/bmjopen-2018-028714.
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ObjectiveThe objectives of this study were threefold: to estimate people’s interest in health-related research, to understand to what extent people appreciate being actively informed about current local health-related research and to investigate whether their interest can be influenced by advertising local current health-related research using large TV monitors.DesignRandomised controlled trial using a stepped wedge design.SettingThe emergency department waiting room at two public hospitals in northern Queensland, Australia.ParticipantsWaiting patients and their accompanying friends and relatives in the emergency department waiting room not requiring immediate medical attention.InterventionsA TV monitor advertising local current health-related research.Main outcome measuresOR for the effect of intervention on changing the interest in health-related research compared with a control group while adjusting for gender, age and socioeconomic standard.ResultsThe intervention significantly increased the short-term interest in health-related research with an OR of 1.3 (1.1–1.7, p=0.0063). We also noted that being female and being older was correlated to a higher interest in health-related researchConclusionsThis study found that proactive information significantly increased the general populations’ interest in health-related research. There are reasonable set up costs involved but the costs for maintaining the system were very low. Hence, it seems reasonable that research-active organisations should give much higher priority to this type of activity.Trial registration numberACTRN12617001085369
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Cembrowicz, S. P., i J. P. Shepherd. "Violence in the Accident and Emergency Department". Medicine, Science and the Law 32, nr 2 (kwiecień 1992): 118–22. http://dx.doi.org/10.1177/106002809203200205.
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Crimes of violence are recorded increasingly frequently, including those involving health professionals. We reviewed records of violent incidents kept for a major Accident and Emergency Department over a ten-year period. Details were recorded in a Violent Incident Book by all grades of A/E staff, and separate records were kept by hospital security officers. A total of 407 incidents were recorded. Numbers, rank and sex of staff assaulted, types of assault, injuries received, weapons used and characteristics and disposal of perpetrators were recorded. Many were young males who had been drinking: others were regular attenders, of whom three subsequently died and one convicted of murder. Nurses and male doctors appeared to be at the greatest risk of assault and receptionists at the least risk. Recording of violent incidents and subsequent prosecution seemed inconsistent, and may have reflected the lack of a code of practice in this area. Suggestions are made about preventing, predicting and dealing with violence, and its aftermath, in the A and E department, including the use of security officers and closed circuit television, waiting room design, the recognition of body language and signs of alcohol or substance intoxication. The importance of staff support after an assault is emphasized, including immediate and long-term counselling, provision of legal advice, criminal or civil court action, victim support schemes and the workings of the Criminal Injuries Compensation Board. Free legal advice for staff assaulted at work should be included in the terms of service of NHS staff.
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Saha, Arup Kumar, Shaik Abdullah Al Mamun, Diti Rani Das, Wahedul Alam Almajidi, Most Shahana Afroge Khan, SM Sadequl Hasan i Farhana Nasrin. "The Evaluation of Cardiac Emergency Management in National Institute of Cardiovascular Diseases Hospital, Dhaka, Bangladesh". Bangladesh Journal of Dental Research & Education 2, nr 2 (26.08.2013): 52–57. http://dx.doi.org/10.3329/bjdre.v2i2.16245.
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Emergency department is one of the most important part of the hospital and also vulnerable to criticism. The reputation of a hospital rests to a large extent on the service of emergency department. The sudden and unexpected nature on the emergency produces panic and psychological disturbances to the relatives, which must be valued and borne in mind during organization and management of services. A descriptive type of cross sectional study was conducted at Emergency Department of National Institute of Cardiovascular Hospital, Dhaka to evaluate the existing facilities, waiting time for the patients for receiving treatment, emergency referral rate and availability of health personnel, overall management and patients suggestion to improve the services of the emergency department. A total of 150 patients were interviewed by a structured questionnaire and a checklist was utilized for equipments and drugs. It was observed that the mean age 49.49 years. About 38.7% patients were attended by doctor within 6-10 minutes. Shifting of the patients form emergency department to another hospital was 12%. 87.3% patients were satisfied with time to complete treatment. In emergency department 69.3% patients were satisfied with reception facility, 89.3% patients were satisfied with given treatment, 92% patients were satisfied with doctors service and 74% patients were satisfied with the service of the support staff. About 90% patients were satisfied with overall management. The findings of cardiac emergency services obtained through check-list were fairly comparable with the opinions expressed by the patients. For further management of emergency department patients gave suggestion for arrangement of waiting room and toilet facility, X-ray and other laboratory facility for emergency patient should be made available for all the duty shift, drugs should be supply adequately and on regular basis. They suggested for augmentation of the equipments, drugs and security and other facilities and recruitment of some trained service providers. According to the patients the Emergency Department is well-studded to manage most of the cardiac emergencies. However, specific problems identified by different stakeholders need to be critically appraised by the authority to improve the services further.DOI: http://doi.dx.org/10.3329/bjdre.v2i2.16245 Bangladesh Journal of Dental Research & Education Vol.2(2) 2012: 52-57
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Krebs, L., C. Villa-Roel, D. Ushko, G. Sandhar, H. Ruske, S. Couperthwaite, B. Holroyd, M. Ospina i B. Rowe. "P147: Your emergency department journey: piloting a patient poster explaining the emergency department care process". CJEM 21, S1 (maj 2019): S117. http://dx.doi.org/10.1017/cem.2019.338.
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Introduction: Qualitative research with emergency department (ED) patients in Alberta has revealed that some patients have limited understanding of the ED care process and that this increases the anxiety, frustration and confusion experienced throughout their visit. The objective of this study was to design, implement, and test the usefulness of a poster explaining the ED care process. Methods: As part of a stepped-wedge ED intervention trial in Alberta, a 4′ x 3′ poster portraying the patient ED care process was developed and posted in 15 study site waiting rooms. Trained research assistants approached patients in 3 urban ED waiting areas and invited them to complete a short paper-based survey on the acceptability and usefulness of the poster. Results are reported as proportions. Results: A total of 316 patients agreed to participate in this study. Approximately half of the participants were male and 60% were between the ages of 17 and 49. The majority of participants identified themselves as white (72%) and nearly half (49%) were accompanied by someone. A third (37%) of patients had read the wall poster prior to being approached to complete the survey. Most patients (62%) who had not read it prior to being approached hadn't noticed the poster or couldn't see it because of its location. Once patients reviewed the poster, the vast majority (92%) reported completely or largely understanding the information and most (84%) found it at least moderately helpful in preparing them for their ED journey. Approximately 45% of respondents agreed that they learned something new about the ED care process by reading the poster and 20% wanted additional information added to the poster; largely, wait time estimates (53% of responses). Conclusion: Placing posters in the ED is one method for equipping patients for their ED care process; however, this study revealed the potential limited utility of this engagement method by the small number of patients who noticed the poster and read the information. Location and content (e.g., time estimates) were identified as key factors for implementation. Condition-specific guides may need to supplement general ED process guides to better prepare patients for their individual ED journey and to actively engage them in their ED care.
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Tolia, Vaishal, Eddie Castillo i David Guss. "EDTITRATE (Emergency Department Telemedicine Initiative to Rapidly Accommodate in Times of Emergency)". Journal of Telemedicine and Telecare 23, nr 4 (8.06.2016): 484–88. http://dx.doi.org/10.1177/1357633x16648535.
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Objective Emergency Department (ED) patient volumes are unpredictable, which can result in service delays and patients leaving without care. We initiated a programme of emergency physician (EP) telepresence in the ED with the objectives of assessing feasibility, safety, patient and provider acceptance, and throughput time. Methods This was a prospective convenience study. Patients presenting to the ED during operation of the study who were planned for placement in the waiting room were considered for enrolment. A faculty EP conducted patient evaluations via telepresence with confirmatory evaluation by the onsite faculty EP prior to disposition. Patient care was either taken to completion by the telemedicine EP or initiated and handed off to the onsite team. Measures included patient demographics, triage class (ESI 1–5), throughput time and a single question satisfaction survey (rating 1–5, 5 most favourable) completed by patients, registered nurses and EPs. Patients were called within 3 days and the electronic health record reviewed at 7 days looking for unscheduled visits and adverse events. Results In total, 130 patients were enrolled. Mean triage class was 3.9 with a median throughput of 150 minutes (IQR = 116.5, 206). Non-telemedicine patients during the same time period with similar triage classes had a median throughput of 287 minutes (IQR = 199, 408). Mean satisfaction scores were: patient 4.91, nurse 4.75, onsite EP 4.47 and telemedicine EP 4.79. There was one potential misdiagnosis and no adverse events. Conclusion Patient evaluation by EP via telepresence is feasible, safe, readily accepted by patients and providers and associated with reduced throughput time.
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Varney, Shawn M., Toni E. Vargas, Rebecca L. Pitotti i Vikhyat S. Bebarta. "Reasons Military Patients With Primary Care Access Leave an Emergency Department Waiting Room Before Seeing a Provider". Southern Medical Journal 105, nr 10 (październik 2012): 538–42. http://dx.doi.org/10.1097/smj.0b013e318268cd18.
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Richards, John R., M. Christien van der Linden i Robert W. Derlet. "Providing Care in Emergency Department Hallways: Demands, Dangers, and Deaths". Advances in Emergency Medicine 2014 (25.12.2014): 1–7. http://dx.doi.org/10.1155/2014/495219.
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Emergency departments (ED) worldwide have experienced dramatic increases in crowding over the past 20 years that now have reached critical levels. One consequence of ED crowding has been the routine use of ED hallways for patient care. This includes ED patients who are awaiting care but are considered unstable to remain in the waiting room, patients who are undergoing active medical and trauma treatment, and patients who have been stabilized but await transfer to an inpatient bed (boarding) or another institution. Compared with licensed hospital or standard ED beds, care in ED hallways results in increased patient morbidity and mortality, as well as patient and staff dissatisfaction. Complications experienced by hallway patients include unrecognized sudden respiratory arrest or unstable cardiac arrhythmias, delay in time-sensitive procedures and laboratory testing, delay in receiving important medications, excessive or unrelieved pain, overall increased length of stay, increased disability, and exposure to traumatic psychological events. While much has been published on the general problems of ED crowding, only recently have studies focused exclusively on the issues of providing care in ED hallways. This review summarizes the current issues, challenges, and solutions for hallway care.
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Clouston, R., M. Howlett, D. Canales, J. Fraser, D. Sohi, S. Lee i P. Atkinson. "P119: Emergency department census is useful as a real-time measure of crowding". CJEM 22, S1 (maj 2020): S108. http://dx.doi.org/10.1017/cem.2020.325.
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Introduction: Crowding is associated with poor patient outcomes in emergency departments (ED). Measures of crowding are often complex and resource-intensive to score and use in real-time. We evaluated single easily obtained variables to establish the presence of crowding compared to more complex crowding scores. Methods: Serial observations of patient flow were recorded in a tertiary Canadian ED. Single variables were evaluated including total number of patients in the ED (census), in beds, in the waiting room, in the treatment area waiting to be assessed, and total inpatient admissions. These were compared with Crowding scores (NEDOCS, EDWIN, ICMED, three regional hospital modifications of NEDOCS) as predictors of crowding. Predictive validity was compared to the reference standard of physician perception of crowding, using receiver operator curve analysis. Results: 144 of 169 potential events were recorded over 2 weeks. Crowding was present in 63.9% of the events. ED census (total number of patients in the ED) was strongly correlated with crowding (AUC = 0.82 with 95% CI = 0.76 - 0.89) and its performance was similar to that of NEDOCS (AUC = 0.80 with 95% CI = 0.76 - 0.90) and a more complex local modification of NEDOCS, the S-SAT (AUC = 0.83, 95% CI = 0.74 - 0.89). Conclusion: The single indicator, ED census was as predictive for the presence of crowding as more complex crowding scores. A two-stage approach to crowding intervention is proposed that first identifies crowding with a real-time ED census statistic followed by investigation of precipitating and modifiable factors. Real time signalling may permit more standardized and effective approaches to manage ED flow.
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Lyros, Ioannis, Pavi Elpida, Apostolos I. Tsolakis, Makou Margarita i Kyriopoulos John. "Satisfaction with Orthodontic Care Provided in a University Orthodontic Clinic". Open Dentistry Journal 13, nr 1 (28.02.2019): 67–75. http://dx.doi.org/10.2174/1874210601913010067.
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Objective: To evaluate patients’ satisfaction with their orthodontic care at the Department of Orthodontics of University of Athens. Materials and Methods: The study sample comprised of 100 individuals whose orthodontic treatment had been completed during the period May to October 2010. A questionnaire was designed and piloted before the telephone interviews were carried out. Questions concerned socio-demographic characteristics, reason for seeking care at the Dental School, level of satisfaction with treatment outcome, fees paid for treatment, and various aspects of organisation of care provision, assessed on 1-very dissatisfied to 5-very satisfied Likert type items. Results: Satisfaction score was particularly high as far as treatment outcome (53% were “very satisfied” and 31% were “satisfied”), dentist’s response to an emergency (81% were “very satisfied”), and personnel’s behavior at initial examination (81% were “very satisfied”) were concerned. Factors appearing to require improvement were the waiting time from initial examination to the beginning of treatment, the waiting room and the duration of treatment. Overall satisfaction was found to be significantly associated with total duration of treatment, fees paid by patients, treatment outcome, the behaviour of personnel who conducted first clinical examination, and dentist’s response to an emergency. Overall satisfaction was confirmed as the vast majority of patients (97%) would recommend the Orthodontic Clinic. Conclusion: While the Orthodontics Clinic enjoys overall highly satisfied patients, there is scope for improvement of organizational aspects of care provision like the waiting time between the initial examination and the beginning of treatment, the waiting room and the duration of treatment.
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Papa, L., E. Rees, K. Ferguson, B. Goldfeder, D. Meurer, J. Light, R. Stair, M. Willett, C. Luetke i D. Seaberg. "Does Preparing Patients for Their Emergency Department Experience Through a Waiting Room Video About Process of Care Improve Their Satisfaction?" Annals of Emergency Medicine 46, nr 3 (wrzesień 2005): 23–24. http://dx.doi.org/10.1016/j.annemergmed.2005.06.090.
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Schreyer, Kraftin, Saloni Malik, Andrea Blome i Joseph D’Orazio. "A Case Report of a Novel Harm Reduction Intervention Used to Detect Opioid Overdose in the Emergency Department". Clinical Practice and Cases in Emergency Medicine 4, nr 4 (18.09.2020): 548–50. http://dx.doi.org/10.5811/cpcem.2020.7.47936.
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Introduction: As over 130 people die daily from opioid overdose in the United States, harm reduction strategies have become increasingly important. Because public restrooms are a common site for opioid overdose, emergency department waiting room restrooms (EDWRR) should be considered especially high-risk areas. Case Report: We present the case of a patient found after a presumed opioid overdose in our EDWRR. Staff were alerted to his condition by a reverse motion detector (RMD), and rapidly treated him with naloxone. Conclusion: The RMD is a novel intervention that can save lives and should be considered in EDs with a high incidence of opioid overdose.
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Vella, K., A. Hall, J. van Merrienboer i A. Szulewski. "LO56: Measuring cognitive load on shift: Application of cognitive load theory during clinical work in the emergency department". CJEM 21, S1 (maj 2019): S28. http://dx.doi.org/10.1017/cem.2019.99.
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Introduction: By virtue of the nature of their work, emergency medicine physicians and residents experience high cognitive load and stress, which are known to affect physician performance and patient outcomes. However, the contribution of cognitive load has not previously been measured during the clinical work of emergency physicians. The objectives of this study were to measure cognitive load and stress in emergency physicians and residents during clinical work, evaluate the relative contribution of multiple factors on cognitive load, and to determine the effect of experience on these results. Methods: This observational study was conducted at an academic Canadian Urgent Care Centre from July to August 2018. Emergency medicine residents and staff physicians completed a survey while on shift to evaluate measures of cognitive load and acute stress. Patient acuity and the number of active patients for each physician, hours worked and patients in the waiting room were recorded. Correlational analyses and multivariable linear regression were performed to evaluate the effect of each predictor on measures of overall cognitive load. Results: A total of 131 questionnaires were completed by 42 physicians (87 questionnaires from 26 staff physicians and 44 questionnaires from 16 residents). Results showed that staff physicians carried a significantly higher patient load compared to residents (p < 0.001). There were no differences in mean overall cognitive load (p = 0.25), acute stress (p = 0.17) or measured subcomponents of cognitive load between the two groups. Perceived case difficulty and acute stress were strong predictors of overall cognitive load, while level of distraction did not correlate with the other outcomes. The number of patients in the waiting room predicted acute stress in staff physicians, while the number of higher acuity patients was a significant predictor in residents. Conclusion: Measures of overall cognitive load and acute stress were strongly correlated in the clinical setting. Different factors affect cognitive load and acute stress in staff physicians compared to residents. Appreciating these differences may help medical educators understand the cognitive challenges faced by learners in a clinical context, and aid in the design of cognitive and educational strategies to help mitigate these challenges and reduce stress.
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Clouston, R. V., M. Howlett, G. Stoica, J. Fraser i P. R. Atkinson. "LO52: Combination of easily measurable real time variables to predict ED crowding". CJEM 19, S1 (maj 2017): S45—S46. http://dx.doi.org/10.1017/cem.2017.114.
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Introduction: Almost every domain of quality is reduced in crowded emergency departments (ED), with significant challenges around the definition, measurement and interventions for ED crowding. We wished to determine if a combination of 3 easily measurable variables could perform as well as standard tools (NEDOCS score and a NEDOCS-derived LOCAL tool) in predicting ED crowding at a tertiary hospital with 57,000 visits per year. Methods: Over a 2-week period, we recorded ED crowding predictor variables and calculated NEDOCS and LOCAL scores. These were compared every 2 hours to a reference standard Physician Visual Analog Scale (range 0 to 10) impression of crowding to determine if any combination of variables outperformed NEDOCS and LOCAL (crowded=5 or greater). Five numeric variables performed well under univariate analysis: i) Total ED Patients; ii) Patients in ED beds + Waiting Room; iii) Boarded Patients; iv) Waiting Room Patients; v) Patients in beds To Be Seen. These underwent multivariate, log regression with stratification and bootstrapping to account for incomplete data and seasonal and daily effect. Results: 143 out of a possible 168 observations were completed. Two different combinations of 3 variables outperformed NEDOCS and LOCAL. The most powerful combination was: Boarded Patients; plus Waiting Room Patients; plus Patients in beds To Be Seen, with Sensitivity 81% and Specificity 76% (r=0.844, β=0.712, p<0.0001, strong positive correlation). This compared favourably with NEDOCS and LOCAL, each with Sensitivity 71% and Specificity 64%[PA1] (r=0.545 and r=0.640 respectively). We will also present a sensitivity and specificity analysis of all combinations of predictor variables, using various reference standard cut-offs for crowding. Conclusion: A combination of 3 easily measurable ED variables (Boarded Patients; plus Waiting Room Patients; plus Patients in beds To Be Seen) performed better than the validated NEDOCS tool and a NEDOCS-derived LOCAL score at predicting ED crowding. Work is on going to design a simple tool that can predict crowding in real time and facilitate early interventions. Correlation with ED system and clinical outcomes should be studied in different ED environments.
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Scheuermeyer, Frank Xavier, Jim Christenson, Grant Innes, Barb Boychuk, Eugenia Yu i Eric Grafstein. "Safety of Assessment of Patients With Potential Ischemic Chest Pain in an Emergency Department Waiting Room: A Prospective Comparative Cohort Study". Annals of Emergency Medicine 56, nr 5 (listopad 2010): 455–62. http://dx.doi.org/10.1016/j.annemergmed.2010.03.043.
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