Reducing Waiting Time for Community Rehabilitation Services: A Controlled Before-and-After Trial

Introduction: Mental health rehabilitation services provide essential support to people with complex and longer term mental health problems. They include inpatient services and community teams providing clinical input to people living in supported accommodation services. This systematic review included international studies evaluating the effectiveness of inpatient and community rehabilitation services.Methods: We searched six online databases for quantitative studies evaluating mental health rehabilitation services that reported on one or both of two outcomes: move-on to a more independent setting (i.e. discharge from an inpatient unit to the community or from a higher to lower level of supported accommodation); inpatient service use. The search was further expanded by screening references and citations of included studies. Heterogeneity between studies was too great to allow meta-analysis and therefore a narrative synthesis was carried out.Results: We included a total of 65 studies, grouped as: contemporary mental health rehabilitation services (n = 34); services for homeless people with severe mental health problems (n = 13); deinstitutionalization programmes (n = 18). The strongest evidence was for services for homeless people. Access to inpatient rehabilitation services was associated with a reduction in acute inpatient service use post discharge. Fewer than one half of people moved on from higher to lower levels of supported accommodation within expected timeframes.Conclusions: Inpatient and community rehabilitation services may reduce the need for inpatient service use over the long term but more high quality research of contemporary rehabilitation services with comparison groups is required.Review registration: This review was prospectively registered on PROSPERO (ID: CRD42019133579).

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Effect of emergency severity index implementation on the waiting time for patients to receive health services in the emergency department

Acta Facultatis Medicae Naissensis ◽

10.5937/afmnai2004369s ◽

2020 ◽

Vol 37 (4) ◽

pp. 369-380

Author(s):

Akbar Sarvari ◽

Hosein Habibzadeh ◽

Leyla Alilu ◽

Naser Sheikhi

Keyword(s):

Emergency Department ◽

Health Services ◽

Waiting Time ◽

Intervention Group ◽

Simple Random Sampling ◽

Severity Index ◽

Emergency Severity Index ◽

Post Intervention ◽

Before And After ◽

To Receive

The waiting time for patients in the emergency department to receive health services influences many processes in this department. This research aimed to determine the effect of implementation and deployment of emergency severity index (ESI) on the waiting time for patients to receive health services in the emergency department. This quasi-experimental study was performed on 736 patients who were referred to the emergency department of Imam Khomeini Hospital of Mahabad. For the ESI triage implementation, 368 patients were assigned to the pre-intervention group and 368 patients were selected for the post-intervention group, using a simple random sampling. Before and after the ESI triage implementation, the waiting time for patients to receive services was measured and recorded using a chronometer. For data analysis, Chi-square, Mann-Whitney and Kruskal-Wallis tests were used. Before and after the intervention, both groups were homogeneous in terms of demographic variables (p > 0.05). The results of Mann-Whitney test indicate that implementation of emergency severity index (ESI) has a positive effect on the decrease of average time intervals to provide health services, as well as on the entire length of stay in the emergency department (p < 0.05). Given the effect of the ESI triage implementation that reduced the waiting time for patients to receive health services, ESI is recommended for training nurses and other emergency staff.

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Exploring overcrowding trends in an inner city emergence department in the UK before and during COVID-19 epidemic

10.1101/2021.01.20.21250150 ◽

2021 ◽

Author(s):

J Panovska-Griffiths ◽

J Ross ◽

S Elkhodair ◽

C Baxter-Derrington ◽

C Laing ◽

...

Keyword(s):

Waiting Time ◽

Hospital Emergency ◽

Number Of Patients ◽

Before And After ◽

Ed Overcrowding ◽

University College London ◽

Flow Through ◽

Multifaceted Interventions ◽

The Uk ◽

The Impact

AbstractBackgroundWe compared impact of three pre-COVID-19 interventions and of the COVID-19 UK-epidemic and the first UK national lockdown on overcrowding within University College London Hospital Emergency Department (UCLH ED). The three interventions: target the influx of patients at ED (A), reduce the pressure on in-patients’ beds (B) and improve ED processes to improve the flow of patents out from ED (C).MethodsWe analysed the change in overcrowding metrics (daily attendances, the proportion of people leaving within four hours of arrival (four-hours target) and the reduction in overall waiting time) across three analysis. The first analysis used data 01/04/2017-31/12-2019 to calculate changes over a period of six months before and after the start of interventions A-C. The second and third analyses focused on evaluating the impact of the COVID-19 epidemic, comparing the first 10 months in 2020 and 2019, and of the first national lockdown (23/03/2020-31/05/2020).ResultsPre-COVID-19 all interventions led to small reductions in waiting time (17%, p<0.001 for A and C;9%, p=0.322 for B) but also to a small decrease in the number of patients leaving within four hours of arrival (6.6%,7.4%,6.2% respectively A-C,p<0.001).In presence of the COVID-19 pandemic, attendance and waiting time were reduced (40% and 8%;p<0.001), and the number of people leaving within four hours of arrival was increased (6%,p<0.001). During the first lockdown, there was 65% reduction in attendance, 22% reduction in waiting time and 8% increase in number of people leaving within 4 hours of arrival (p<0.001). Crucially, when the lockdown was lifted, there was an increase (6.5%,p<0.001) in the percentage of people leaving within four hours, together with a larger (12.5%,p<0.001) decrease in waiting time. This occurred despite the increase of 49.6%(p<0.001) in attendance after lockdown ended.ConclusionsThe mixed results pre-COVID-19 (significant improvements in waiting time with some interventions but not improvement in the four-hours target), may be due to a ‘spill-over effect’ where clogging up one part of the ED system affects other parts. Hence multifaceted interventions and a system-wide approach to improve the pathway of flow through the ED system is necessary.During 2020 and in presence of the COVID-19 epidemic, a shift in public behaviour with anxiety over attending hospitals and higher use of virtual consultations, led to notable drop in UCLH ED attendance and consequential curbing of overcrowding.Importantly, once the lockdown was lifted, although there was an increase in arrivals at UCLH ED, overcrowding metrics were reduced. Thus, the combination of shifted public behaviour and the restructuring changes during COVID-19 epidemic, maybe be able to curb future ED overcrowding, but longer timeframe analysis is required to confirm this.

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Benefits of satellite lab in the reduction of chemotherapy waiting time.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e18218 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e18218-e18218

Author(s):

Abdullah Ahmed Bany Hamdan ◽

Jesusa Christine Tamani ◽

Sheena Peethambaran ◽

Isamme Alfayyad ◽

Richard Erlandez ◽

...

Keyword(s):

Patient Care ◽

Waiting Time ◽

Positive Impact ◽

Turnaround Time ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Base Line ◽

Oncology Patients ◽

Mean Waiting Time ◽

Before And After

e18218 Background: Oncology patients need to receive their course of treatment in a timely manner. Increasing the efficiency of laboratory testing could potentially improve hospital operations and thus have a positive impact on patient care. One way of doing this is by initiating an installation of a satellite laboratory. The purpose of this study is to determine the advantages of having a satellite laboratory in an oncology unit. Moreover, it shall also try to determine whether the presence of satellite laboratory will help reduce the chemotherapy waiting time of oncology patients. Methods: This study utilized experimental study design in order to analyze and compare Laboratory Turnaround time (TAT) and the chemotherapy waiting time before and after establishment of satellite laboratory. The samples taken as base line data was 150 and compared to samples taken from 2013-2015. The population of this study included patients in Comprehensive Cancer Center of King Fahad Medical City diagnosed with cancer and received chemotherapy regardless of their age and sex. Results: Laboratory Mean TAT decrease significantly from 1 hour and 30 minutes in 2012 to 43 minutes, 43 minutes, and 37 minutes in 2013, 2014 and 2015 respectively. Also chemotherapy Mean waiting time decreased from 2012 base line of 252 to 164 minutes in 2013, 115 minutes in 2014 and 146 minutes in 2015. The chemotherapy waiting time shows a decreasing pattern as the laboratory time decrease from 2013 to 2015. This shows that there is a decrease in the chemotherapy time and turnaround time before and after the intervention. We also have identified that there is a direct relationship between the reduction of turnaround time and chemotherapy waiting time. Conclusions: The need to structure how we deliver patient care specifically to cancer patient is an important drive for quality improvement. Basing on the result of the project and with the increase in patient satisfaction rate, it can be concluded that it is possible to reduce patients’ mean chemotherapy waiting time by applying more efficient process, which is the installation of satellite laboratory.

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Variation in access to community rehabilitation services and length of stay in hospital following a hip fracture: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2014-005469 ◽

2014 ◽

Vol 4 (9) ◽

pp. e005469-e005469 ◽

Cited By ~ 9

Author(s):

J. Neuburger ◽

K. A. Harding ◽

R. J. D. Bradley ◽

D. A. Cromwell ◽

C. L. Gregson

Keyword(s):

Hip Fracture ◽

Length Of Stay ◽

Cross Sectional Study ◽

Rehabilitation Services ◽

Sectional Study ◽

Cross Sectional ◽

Community Rehabilitation

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Effects of Traffic Calming Measures on Pedestrian and Motorist Behavior

Transportation Research Record Journal of the Transportation Research Board ◽

10.3141/1705-05 ◽

2000 ◽

Vol 1705 (1) ◽

pp. 26-31 ◽

Cited By ~ 25

Author(s):

Herman F. Huang ◽

Michael J. Cynecki

Keyword(s):

Waiting Time ◽

Vehicle Traffic ◽

Slowing Down ◽

Traffic Calming ◽

Before And After

By slowing down vehicle traffic, shortening crossing distances, and enhancing motorist and pedestrian visibility, traffic calming treatments may benefit pedestrians who are crossing the street. The effects of selected traffic calming treatments on pedestrian and motorist behavior were evaluated at both intersection and midblock locations. Before and after data were collected in Cambridge, Massachusetts (bulbouts and raised intersection), Corvallis, Oregon (pedestrian refuge island), Seattle, Washington (bulbouts), and Sacramento, California (refuge islands). The key findings include that none of the treatments had a significant effect on the percentage of pedestrians for whom motorists yielded, the treatments usually did not have a significant effect on average pedestrian waiting time, and refuge islands often served to channelize pedestrians into marked crosswalks. The raised intersection in Cambridge also increased the percentage of pedestrians who crossed in the crosswalk. While traffic calming devices have the potential for improving the pedestrian environment, these devices by themselves do not guarantee that motorists will slow down or yield to pedestrians.

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