scholarly journals Emergency overcrowding and access block: A smaller problem than we think

CJEM ◽  
2018 ◽  
Vol 21 (2) ◽  
pp. 177-185 ◽  
Author(s):  
Grant D. Innes ◽  
Marco L.A. Sivilotti ◽  
Howard Ovens ◽  
Kirstie McLelland ◽  
Adam Dukelow ◽  
...  
Keyword(s):  
Emergency Care ◽  
Safety Concern ◽  
Cross Sectional Study ◽  
Or Efficiency ◽  
Average Delay ◽  
Cross Sectional ◽  
Hospital Access ◽  
High Acuity ◽  
Facility Level ◽  
Study Sites

ABSTRACTObjectivesEmergency department (ED) access block, the inability to provide timely care for high acuity patients, is the leading safety concern in First World EDs. The main cause of ED access block ishospital access blockwith prolonged boarding of inpatients in emergency stretchers. Cumulative emergency access gap, the product of the number of arriving high acuity patients and their average delay to reach a care space, is a novel access measure that provides a facility-level estimate of total emergency care delays. Many health leaders believe these delays are too large to be solved without substantial increases in hospital capacity. Our objective was to quantify cumulative emergency access blocks (the problem) as a fraction of inpatient capacity (the potential solution) at a large sample of Canadian hospitals.MethodsIn this cross-sectional study, we collated 2015 administrative data from 25 Canadian hospitals summarizing patient inflow and delays to ED care space. Cumulative access gap for high acuity patients was calculated by multiplying the number of Canadian Triage Acuity Scale (CTAS) 1-3 patients by their average delay to reach a care space. We compared cumulative ED access gap to available inpatient bed hours to estimate fractional access gap.ResultsStudy sites included 16 tertiary and 9 community EDs in 12 cities, representing 1.79 million patient visits. Median ED census (interquartile range) was 66,300 visits per year (58,700-80,600). High acuity patients accounted for 70.7% of visits (60.9%-79.0%). The mean (SD) cumulative ED access gap was 46,000 stretcher hours per site per year (± 19,900), which was 1.14% (± 0.45%) of inpatient capacity.ConclusionED access gaps are large and jeopardize care for high acuity patients, but they are small relative to hospital operating capacity. If access block were viewed as a “whole hospital” problem, capacity or efficiency improvements in the range of 1% to 3% could profoundly mitigate emergency care delays.

scholarly journals LO18: How big is emergency access block in Canadian hospitals?

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S33
Author(s):  
G. Innes ◽  
M. Sivilotti ◽  
H.J. Ovens ◽  
A. Chochinov ◽  
K. McLelland ◽  
...  
Keyword(s):  
Inpatient Care ◽  
Safety Concern ◽  
Or Efficiency ◽  
Average Delay ◽  
Convenience Sample ◽  
Hospital Administrators ◽  
Hospital Capacity ◽  
Hospital Access ◽  
Data Elements ◽  
Care Capacity

Introduction: Emergency department (ED) access block is the #1 safety concern in Canadian EDs. Its main cause is hospital access block, manifested by prolonged boarding of inpatients in EDs. Hospital administrators often believe this problem is too big to be solved and would require large increases in hospital capacity. Our objective was to quantify ED access gap by estimating the cumulative hours that CTAS 1-3 patients are blocked in waiting areas. This value, expressed as a proportion of inpatient care capacity, is an estimate of the bed hours a hospital would have to find in order to resolve ED access. Methods: A convenience sample of urban Canadian ED directors were asked to provide data summarizing their CTAS 1-3 inflow, the proportion triaged to nursed stretchers vs. RAZ or Intake areas, and time to care space. Total ED access gap was calculated by multiplying the number of CTAS 1-3 patients by their average delay to care space. Time to stretcher was captured electronically at participating sites, but time to RAZ or intake spaces was often not. In such cases, respondents provided time from triage to first RN or MD assessment in these areas. The primary outcome was total annual ED access block hours for emergent-urgent patients, expressed as a proportion of funded inpatient bed hours. Results: Directors of 40 EDs were queried. Six sites did not gather the data elements required. Of 34 remaining, 29 (85.3%) provided data, including 15 tertiary (T), 10 community (C) and 2 pediatric (P) sites in 12 cities. Mean census for the 3 ED types was 72,308 (T), 58,849 C) and 61,050 (P) visits per year. CTAS 1-3 patients accounted for 73.4% (T), 67.7% (C) and 66.2% (P) of visits in the 3 groups, and 34% (T), 46% (C) and 44% (P) of these patients were treated in RAZ or intake areas rather than staffed ED stretchers. Mean time to stretcher/RAZ care was 50/71 min (T), 46/62 min (C), and 37/59 min (P). Average ED access gap was 47,564 hrs (T), 37,222 hrs (C) and 35,407 hrs (P), while average inpatient bed capacity was 599 beds (5,243,486 hrs), 291 beds (2,545,875 hrs) and 150 beds (1,314,000 hrs) respectively. ED access gap as a proportion of inpatient care capacity was 0.93% for tertiary, 1.46% for community and 2.69% for pediatric centres. Conclusion: ED access gap is very large in Canadian EDs, but small compared to hospital operating capacity. Hospital capacity or efficiency improvements in the range of 1-3% could profoundly mitigate ED access block.

Mass Psychogenic Illness in Haraza Elementary School, Tigray, Northern Ethiopia: Investigation to the nature of an Episode.

2020 ◽  
Author(s):  
Kiros Fenta ◽  
Tewolde Wubayehu ◽  
Nega Mamo Bezabih ◽  
Yrgalem Meles ◽  
Goitom Mehari ◽  
...  
Keyword(s):  
Elementary School ◽  
Cross Sectional Study ◽  
Northern Ethiopia ◽  
Community Members ◽  
Cross Sectional ◽  
School Activities ◽  
Co Morbidity ◽  
Facility Level ◽  
Psychogenic Illness ◽  
Study Participants

Abstract Background Mass psychogenic illness has been documented for more than 600 years in a variety of culture, ethnic, and religious settings. The aim of this study was to assess the nature and characteristics of mass psychogenic illness in Tigray, Northern Ethiopia, Methods School based cross-sectional study was conducted in haraza elementary school from January –February, 2020. Students who were victims of an episode were subjects of the study. A total of twelve students were investigated using semi-structured questionnaire for quantitative study. Seven key informant interviews were conducted using guiding questionnaires. Quantitative data was analyzed using XL sheet while qualitative data was analyzed manually. Result the mean age of study participants was 14 years (SD±1.3). Majority (87%) were teenage female students. The incident was unspecified disease with psychiatric disorder, migraine and syncope with no plausible organic causes. An important feature of migraine and syncope was their co-morbidity with mass psychogenic illness. The community perceived that Evil-devil force and blaming as being an evil-eye were common causes for the occurrence of an episode. Conclusion lack of empirical knowledge and awareness about its management and prevention among community members and health professionals resulted exaggerated rumor that would perceived as newly emerging disease that affected school activities. Integrating MPI in PHEM package at health facility level, advocacy workshops for media and other relevant stakeholders will minimize its impact for the future.

scholarly journals How far is too far? A nationwide cross-sectional study for establishing optimal hospital access time for Korean pregnant women

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e031882 ◽  
Author(s):  
Mi Young Kwak ◽  
Seung Mi Lee ◽  
Hyun Joo Kim ◽  
Sang Jun Eun ◽  
Won Mo Jang ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Maternal Morbidity ◽  
Cross Sectional Study ◽  
Obstetric Complications ◽  
Access Time ◽  
Sectional Study ◽  
Cross Sectional ◽  
Hospital Access ◽  
Maternal Morbidity And Mortality ◽  
Delivery Unit

ObjectivesAccess to a delivery unit is a major factor in determining maternal morbidity and mortality. However, there is little information about the optimal access time to a delivery unit. This study aimed to establish the optimal hospital access time (OHAT) for pregnant women in South Korea.DesignNationwide cross-sectional study.SettingWe used the National Health Insurance System database of South Korea.ParticipantsWe analysed the data of 371 341 women who had experienced pregnancy in 2013.Primary and secondary outcome measuresAccess time to hospital was defined as the time required to travel from the patient’s home to the delivery unit. The incidence of obstetric complications was plotted against the access time to hospital. Change-point analysis was performed to identify the OHAT by determining a point wherein the incidence of obstetric complications changed significantly. As a final step, the risk of obstetric complications was compared by type among pregnant women who lived within the OHAT against those who lived outside the OHAT.ResultsThe OHAT associated with each adverse pregnancy outcomes were as follows: inadequate prenatal care, 41–50 min; preeclampsia, 51–60 min; placental abruption, 51–60 min; preterm delivery, 31–40 min; postpartum transfusion, 31–40 min; uterine artery embolisation, 31–40 min; admission to intensive care unit, 31–40 min; and caesarean hysterectomy, 31–40 min. Pregnant women who lived outside the OHAT had significantly higher risk for obstetric complications than those who lived within the OHAT.ConclusionsOur results showed that the OHAT for each obstetric complication ranged between 31 and 60 min. The Korean government should take the OHAT under consideration when establishing interventions for pregnant women who live outside OHAT to reduce maternal morbidity and mortality.

scholarly journals Utilisation and Perceptions of Cervical Cancer Screening Services

2020 ◽  
Vol 22 (1) ◽  
Author(s):  
Mercy Kokuro ◽  
Abigail Kusi-Amponsah Diji
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Sampling Technique ◽  
Healthcare Services ◽  
Cross Sectional Study ◽  
Reproductive Age ◽  
Cross Sectional ◽  
Screening Services ◽  
Study Sites

Cervical cancer is the second most frequently diagnosed and the fourth commonest cause of cancer death among women worldwide. Even though cervical cancer is preventable, its screening rate has been reported to be low in Ghana. To the best of our knowledge, no study has focused on the utilisation and perceptions of cervical cancer among women in their reproductive age in Ghana. The present study aimed at assessing the utilisation and perceptions of cervical cancer screening services among women who seek reproductive healthcare services. A descriptive cross-sectional study was carried out among women aged 18 years and above. Using a two-stage sampling technique, 369 participants were selected from 2 out of 4 eligible study sites. Data on the perceptions and utilisation of cervical cancer screening services were collected following ethical approval. The data were collected using both English and Twi versions of the questionnaire. The data were descriptively and inferentially analysed. A few of the participants had been previously screened for cervical cancer (n = 69; 18.7%), while a greater proportion of the participants appropriately perceived the screening benefits (> 70%), and an equally greater percentage of them harboured negative perceptions which prevented them from engaging in such endeavours (> 80%). Significant differences in perception were, however, observed in two-fifths of the studied areas (6/14) among the screened and unscreened participants. Cervical cancer screening services were not utilised by the majority of the participating women. Screening was associated with socio-demographic characteristics such as marital status, parity, education, and employment status. Inappropriate perceptions on cervical cancer screening may account for the low utilisation of cervical cancer screening. Therefore, all-inclusive health education on the benefits of cervical cancer screening for both women and men should be a priority for stakeholders and all health organisations.

scholarly journals Evaluating capacity at three government referral hospital emergency units in the Kingdom of Eswatini using the WHO Hospital Emergency Unit Assessment Tool

2020 ◽  
Author(s):  
Jennifer Pigoga ◽  
Anjni Patel Joiner ◽  
Phindile Chowa ◽  
Jennifer Luong ◽  
Masitsela Mhlanga ◽  
...  
Keyword(s):  
Emergency Care ◽  
Assessment Tool ◽  
Care Delivery ◽  
Cross Sectional Study ◽  
Referral Hospital ◽  
Emergency Unit ◽  
Hospital Emergency ◽  
Cross Sectional ◽  
Middle Income ◽  
Entry Points

Abstract Background The Kingdom of Eswatini, a lower-middle income nation of 1.45 million in southern Africa, has recently identified emergency care as a key strategy to respond to the national disease burden. We aimed to evaluate the current capacity of hospital emergency care areas using the WHO Hospital Emergency Unit Assessment Tool (HEAT) at government referral hospitals in Eswatini. Methods We conducted a cross-sectional study of three government referral hospital emergency care areas using HEAT in May 2018. This standardised tool assists healthcare facilities to assess the emergency care delivery capacity in facilities and support in identifying gaps and targeting interventions to strengthen care delivery within emergency care areas. Senior-level emergency care area employees, including senior medical officers and nurse matrons, were interviewed using the HEAT. Results All sites provided some level of emergency care 24 hours a day, seven days a week, though most had multiple entry points for emergency care. Only one facility had a dedicated area for receiving emergencies and a dedicated resuscitation area; two had triage areas. Facilities had limited capacity to perform signal functions (life-saving procedures that require both skills and resources). Commonly reported barriers included training deficits and lack of access to supplies, medications, and equipment. Sites also lacked formal clinical management and process protocols (such as triage and clinical protocols). Conclusions The HEAT highlighted strengths and weaknesses of emergency care delivery within hospitals in Eswatini and identified specific causes of these system and service gaps. In order to improve emergency care outcomes, multiple interventions are needed, including training opportunities, improvement in supply chains, and implementation of clinical and process protocols for emergency care areas. We hope that these findings will allow hospital administrators and planners to develop effective change management plans.

scholarly journals Search for the Occurrence of Clostridium difficile and Clostridium perfringens in Pigs Within Zaria and Environs, in Kaduna State, Nigeria

2020 ◽  
Vol 64 (2) ◽  
pp. 11-19
Author(s):  
E. C. Maaji ◽  
S. N. G. Kia ◽  
M. Bello
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Clostridium Perfringens ◽  
Management Practices ◽  
Egg Yolk ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Pig Management ◽  
Study Sites ◽  
Associated Risk Factors

AbstractAnimals have been known to be the main study subjects when investigating the epidemiology of zoonotic Gram-positive Clostridium difficile and Clostridium perfringens. This cross-sectional study was aimed at determining the occurrence of C. difficile and C. perfringens in pigs as well as the associated risk factors within Zaria and environs, in Kaduna State of Nigeria. A pre-sampling survey led to the selection of Shika, Samaru and Ungwan Mangu in the pig farming communities of Zaria and environs in Kaduna North as the study sites. Rectal swabs from 132 pigs were obtained and anaerobically cultured in fluid thioglycolate and further grown on reinforced clostridia agar. The colonies obtained were sub-cultured in Clostridium difficile moxalactam norfloxacin agar and reinforced clostridia agar containing egg yolk tellurite. C. difficile was not detected. However, C. perfringens was detected at a prevalence of 16.7 % (22/132). Isolates were tested for their susceptibility to 13 antimicrobials. Only 1 isolate (4.55 %) demonstrated susceptibility to vancomycin, gentamicin, chloramphenicol and erythromycin. Of the bivariate analyses of the risk factors studied, only the type of piggery and pig management were statistically significant (P < 0.05) for C. perfringens. Therefore, it should be recognized that there is a need for pig farmers to be enlightened about this pathogen and its prevention through good management practices and hygiene.

scholarly journals Knowledge, Attitude and Practice of First Aid and Emergency Care among the Classes Educated in Aurangabad, Maharashtra

2020 ◽  
pp. 1-6
Author(s):  
Rohit Jacob ◽  
Manjiri Naik
Keyword(s):  
High School Students ◽  
Emergency Care ◽  
Small Firms ◽  
Age Groups ◽  
Real Life ◽  
First Aid ◽  
Cross Sectional Study ◽  
School Students ◽  
Cross Sectional ◽  
Care Training

Aims: To find an association between educational qualification of the participant and knowledge of first aid and emergency care. To understand the common misconceptions of First Aid practices among the educated class of Aurangabad. To conduct a seminar cum workshop session for the educated class of Aurangabad. Study Design: Cross sectional study with a sample size of 700 participants. The candidates were provided with a questionnaire and a seminar demonstrating First aid and Emergency care was conducted post-questionnaire. Place and Duration of Study: The study was conducted among the educated class in the city of Aurangabad between October 2018 to February 2019. Methodology: The candidates were selected from different schools, colleges, small firms, church gatherings and hotel staff. Data was collected using a self-administered pre – tested questionnaire. Based on the scores obtained in each condition, the overall knowledge was graded as good, moderate and poor. A seminar was conducted post questionnaire and the improvement in their knowledge was tested. Results: Out of 700 candidates included in the study, 110(15.7%) were school going children, 60 (8.6%) were high school students, 50(7.1%) were college students, 280(40%) were graduates and 200(28.6%) were post graduates. 410(58.7%) had poor knowledge about First Aid and Emergency Care and only a mere 39(5.6%) had good knowledge about First Aid and Emergency Care. 105 candidates (15%) of the candidates believed that applying hot compresses relieves an ankle sprain. 77 candidates (11%) of the candidates believed that inducing vomiting is initial modality of management in a patient who accidentally ingested acid. Conclusion: Initiation of First aid and Emergency care training programs among all age groups still remains an enigma. Conducting such workshops on First aid and Emergency Care among communities can make the citizens competitive enough to provide first aid independently and spontaneously in real life situations.

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