scholarly journals Ambulance diversion and ED overcrowding

CJEM ◽  
2002 ◽  
Vol 4 (04) ◽  
pp. 244
Author(s):  
Sue Ieraci
2018 ◽  
Vol 35 (7) ◽  
pp. 447-448 ◽  
Author(s):  
Kimberley Bernadette Velt ◽  
Maryse Cnossen ◽  
Pleunie P M Rood ◽  
Ewout W Steyerberg ◽  
Suzanne Polinder ◽  
...  

BackgroundED overcrowding is an increasing problem worldwide that may negatively affect quality of care and patient outcomes. We aimed to study ED overcrowding across European centres.MethodsQuestionnaires on structure and process of care, including crowding, were distributed to 68 centres participating in a large European study on traumatic brain injury (Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury).ResultsOf the 65 centres included in the analysis, 32 (49%) indicated that overcrowding was a frequent problem and 28 (43%) reported that patients were placed in hallways ‘multiple times a day’; 27 (41%) stated that multiple times a day, there was no bed available when a patient needed to be admitted. Ambulance diversion rarely occurred in the participating centres.ConclusionSimilar to reports from other parts of the world, ED crowding appears to be a considerable problem in Europe. More research is needed to determine effective ways to reduce overcrowding.


Author(s):  
Patrick Bodenmann ◽  
Miriam Kasztura ◽  
Madison Graells ◽  
Elodie Schmutz ◽  
Oriane Chastonay ◽  
...  

Frequent users of emergency departments (FUED; ≥ 5 ED visits/year) commonly cumulate medical, social, and substance use problems requiring complex and sustained care coordination often unavailable in ED. This study aimed to explore ED healthcare providers’ challenges related to FUED care to gain insight into the support and resources required to address FUED complex needs. An online survey was sent to all general adult emergency services within Switzerland (N = 106). Participants were asked to indicate the extent to which they perceived that FUED represented a problem and to describe the main challenges encountered. In total, 208 physicians and nurses from 75 EDs (70.7%) completed the survey. Among the 208 participants, 134 (64%) reported that FUED represented a challenge and 133 described 1 to 5 challenges encountered. A conventional content analysis yielded 4 main categories of perceived challenges. Negative consequences in the ED secondary to FUED’s presence (eg, ED overcrowding, staff helplessness, and fatigue) was the most frequently reported challenge, followed by challenges related to FUEDs’ characteristics (eg, mental health and social problems) leading to healthcare complexity. The third most frequently encountered challenge was related to the ED inappropriateness and inefficiency to address FUEDs’ needs. Finally, challenges related to the lack of FUED healthcare network were the least often mentioned. ED healthcare providers experience a wide range of challenges related to FUED care. These findings suggest that currently EDs nor their staff are equipped to address FUEDs’ complex needs.


BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e041553
Author(s):  
Enrico de Koning ◽  
Tom E Biersteker ◽  
Saskia Beeres ◽  
Jan Bosch ◽  
Barbra E Backus ◽  
...  

IntroductionEmergency department (ED) overcrowding is a major healthcare problem associated with worse patient outcomes and increased costs. Attempts to reduce ED overcrowding of patients with cardiac complaints have so far focused on in-hospital triage and rapid risk stratification of patients with chest pain at the ED. The Hollands-Midden Acute Regional Triage—Cardiology (HART-c) study aimed to assess the amount of patients left at home in usual ambulance care as compared with the new prehospital triage method. This method combines paramedic assessment and expert cardiologist consultation using live monitoring, hospital data and real-time admission capacity.Methods and analysisPatients visited by the emergency medical services (EMS) for cardiac complaints are included. EMS consultation consists of medical history, physical examination and vital signs, and ECG measurements. All data are transferred to a newly developed platform for the triage cardiologist. Prehospital data, in-hospital medical records and real-time admission capacity are evaluated. Then a shared decision is made whether admission is necessary and, if so, which hospital is most appropriate. To evaluate safety, all patients left at home and their general practitioners (GPs) are contacted for 30-day adverse events.Ethics and disseminationThe study is approved by the LUMC’s Medical Ethics Committee. Patients are asked for consent for contacting their GPs. The main results of this trial will be disseminated in one paper.DiscussionThe HART-c study evaluates the efficacy and feasibility of a prehospital triage method that combines prehospital patient assessment and direct consultation of a cardiologist who has access to live-monitored data, hospital data and real-time hospital admission capacity. We expect this triage method to substantially reduce unnecessary ED visits.


2010 ◽  
Vol 22 (2) ◽  
pp. 119-135 ◽  
Author(s):  
Roberto Forero ◽  
Kenneth M Hillman ◽  
Sally McCarthy ◽  
Daniel M Fatovich ◽  
Anthony P Joseph ◽  
...  
Keyword(s):  

2021 ◽  

Background: Emergency department (ED) overcrowding and overuse are global healthcare problems. Despite that substantial pieces of literature have explored quality parameters to monitor the patients’ safety and quality of care in the ED, to the best of our knowledge, no reasonable patient-to-ED staff ratios were established. Objectives: This study aimed to find the association between unexpected emergency department cardiac arrest (EDCA) and the patient-to-ED staff ratio. Methods: A retrospective cohort study was conducted in a medical center in Taiwan. Non-trauma patients (age > 18) who visited the ED from January 1, 2016 to November 30, 2018 were included. The total number of patients in ED, number of patients waiting for boarding, length of stay over 48 hours, and physician/nurse number in ED were collected and analyzed. The primary outcome was the association of each parameter with the incidence of EDCA. Results: A total of 508 patients were included. The total number of patients in ED ( > 361, RR: 1.54; 95% CI {1.239-1.917}), ED occupancy rate (> 280, RR: 1.54; 95% CI {1.245-1.898}), ED bed occupancy rate (> 184, RR: 1.63; 95% CI {1.308-2.034}), number of patients waiting for boarding (> 134, RR: 1.45; 95% CI {1.164-1.805}), number of patients in ED with length of stay over 48 hours (> 36, RR: 1.27; 95% CI {1.029-1.558}) and patient-to-nurse ratio (> 8.5, adjusted RR: 1.33; 95% CI {1.054-1.672}) had significant associations with higher incidence of EDCA. However, the patient-to-physician ratio was not associated with EDCA incidence. Discussions: Regarding loading parameters, the patient-to-nurse ratio is more representative than the patient-to-physician ratio as regards association with higher EDCA incidence. Conclusions: A higher patient-to-nurse ratio (> 8.5) was associated with an increment in the incidence of EDCA. Our findings provide a basis for setting different thresholds for different ED settings to adjust ED staff and develop individually tailored approaches corresponding to the level of ED overcrowding.


2019 ◽  
Author(s):  
Charles-Henri Houze Cerfon ◽  
Christine Vaissié ◽  
Laurent Gout ◽  
Bruno Bastiani ◽  
Sandrine Charpentier ◽  
...  

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.


2019 ◽  
Vol 1 (2) ◽  
pp. 19-31
Author(s):  
Kalaivani S ◽  
Shalini Dhiman ◽  
Rajagopal T.K.P.

Emergency Department (ED) boarding –the inability to transfer emergency patients to inpatient beds- is a key factor contributing to ED overcrowding. This paper presents a novel approach to improving hospital operational efficiency and, therefore, to decreasing ED boarding. Using the historic data of 15,000 patients, admission results and patient information are correlated in order to identify important admission predictor factors. For example, the type of radiology exams prescribed by the ED physician is identified as among the most important predictors of admission. Based on these  factors, a  real-time prediction  model is  developed which  is able  to correctly predict  the  admission  result  of  four  out  of  every  five  ED  patients.  The  proposed admission  model  can  be  used  by inpatient  units  to  estimate  the  likelihood  of ED patients’ admission, and consequently, the number of incoming patients from ED in the near future. Using  similar prediction models,  hospitals can evaluate their short-time needs for inpatient care more accurately Emergency Department (ED) boarding – the inability to transfer emergency patients to inpatient beds- is a key factor contributing to ED overcrowding. This paper presents a novel approach to improving hospital operational efficiency and, therefore, to decreasing ED boarding. Using the historic data of 15,000 patients, admission results and patient information are correlated in order to identify important admission predictor factors. For example, the type of radiology exams prescribed by the ED physician is identified as among the most important predictors of admission. The proposed admission model can be used by inpatient units to estimate the likelihood of ED patients’ admission, and consequently, the number of incoming patients from ED in the near future. Using similar prediction models, hospitals can evaluate their short-time needs for inpatient care more accurately. We use three algorithms to build the predictive models: (1) logistic regression, (2) decision trees, and Analytic tools (accuracy=80.31%, AUC-ROC=0.859) than the decision tree accuracy=80.06%, AUC-ROC=0.824) and the logistic regression model (accuracy=79.94%, AUC-ROC=0.849). Drawing on logistic regression, we identify several factors related to hospital admissions including hospital site, age, arrival mode, triage category, care group, previous admission in the past month, and previous admission in the past year. From a different perspective, the research focuses on mobility data instead of personal data in general using Structural Equation Modelling analysis method. Based on this research finding, we identified an unexplored factor that can be used to predict the intention to disclose mobility data, and the result also confirmed that context aspects such as demographics and different personal data categories.


Author(s):  
Abey Kuruvilla ◽  
Suraj M. Alexander ◽  
Xiaolin Li

This research effort is undertaken to determine the impact that one hospital’s diversion status has on other hospitals in a region and the strength of these interactions. The conditional probability of one hospital going on diversion given that another is already on diversion is evaluated. Based on this analysis, the strength of interactions among the hospitals is established. Through statistical analyses of historical data, the strength of the mutual effects of diversion among a collection of hospitals is determined. These effects are mutual if one hospital’s diversion status affected another’s, then the reverse was also true. The intensity of these interactions between hospitals is varied, some being stronger than others. The model illustrates an approach to studying the cascading effects of diversion among hospitals in a region. This is important, because the status of any hospital in a region can signal the likelihood of impending diversion in every other hospital in the region. This allows actions that might prevent the occurrence of diversion or mitigate the cascading effects of Emergency Medical Systems diversion.


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