Impact of an emergency medicine residency program on the quality of care in an urban community hospital emergency department

ABSTRACTObjectives:To examine the effect of severe acute respiratory syndrome (SARS) on visits to a community hospital emergency department (ED) during the early stage of the Toronto outbreak in 2003 and for the same period in 2004. We focused on visits for respiratory illness (SARS-like symptoms) and different age groups.Methods:This study is a retrospective review of ED discharge diagnoses obtained from a computerized database, examining the 4-week period starting March 28 for the years 2001-2004. We obtained the discharge diagnosis, age and visit date for each ED patient during the relevant time intervals, then compared visit data from 2003 and 2004 with a baseline derived from the average number of visits during 2001 and 2002. We constructed groupings based on age and respiratory-illness symptoms.Results:During the SARS outbreak in 2003, ED visits declined by 21% (95% confidence interval [CI], 18%–24%) over the 4-week study period. The greatest reduction was for combined infant and toddler visits (69%; 95% CI, 58%–79%); these did not recover the following year. However, during the SARS outbreak there was a large increase in the number of visits for respiratory illnesses in adults (61%; 95% CI, 46%–75%) and in teenagers (132%; 95% CI, 82%–182%).Conclusions:During the SARS outbreak, total ED visits fell. The relative decline was most notable for infants and toddlers. By contrast, there was an increase in respiratory illness–related visits for adults and teenagers. In 2004, the year following the SARS outbreak, visit patterns shifted toward baseline levels, but ED visits by infants and toddlers remained depressed.

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How to improve quality of care in overcrowded emergency departments? Development and evaluation of a virtual research environment. (Preprint)

10.2196/preprints.13993 ◽

2019 ◽

Author(s):

Charles-Henri Houze Cerfon ◽

Christine Vaissié ◽

Laurent Gout ◽

Bruno Bastiani ◽

Sandrine Charpentier ◽

...

Keyword(s):

Emergency Department ◽

Emergency Medicine ◽

Quality Of Care ◽

Simulated Patients ◽

Emergency Physicians ◽

Research Environment ◽

Significant Difference ◽

Ed Overcrowding ◽

Virtual Research Environment

BACKGROUND Despite wide literature on ED overcrowding, scientific knowledge on emergency physicians’ cognitive processes coping with overcrowding is limited. OBJECTIVE We sought to develop and evaluate a virtual research environment that will allow us to study the effect of physicians’ strategies and behaviours on quality of care in the context of emergency department overcrowding. METHODS A simulation-based observational study was conducted over two stages: the development of a simulation model and its evaluation. A research environment in Emergency Medicine combining virtual reality and simulated patients has been designed and developed. Then, twelve emergency physicians took part in simulation scenarios and had to manage thirteen patients during a 2-hour period. The study outcome was the authenticity of the environment through realism, consistency and mastering. The realism was the resemblance perceived by the participants between virtual and real Emergency Department. The consistency of the scenario and the participants’ mastering of the environment was expected for 90% of the participants. RESULTS The virtual emergency department was considered realistic with no significant difference from the real world concerning facilities and resources except for the length of time of procedures that was perceived to be shorter. 100% of participants deemed that patient information, decision-making and managing patient flow were similar to real clinical practice. The virtual environment was well-mastered by all participants over the course of the scenarios. CONCLUSIONS The new simulation tool, Virtual Research Environment in Emergency Medicine has been successfully designed and developed. It has been assessed as perfectly authentic by emergency physicians compared to real EDs and thus offers another way to study human factors, quality of care and patient safety in the context of ED overcrowding.

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