Should Emergency Department Attendances be Used With or Instead of Readmission Rates as a Performance Metric?

Medical Care ◽  
2019 ◽  
Vol 57 (1) ◽  
pp. e1-e8 ◽  
Author(s):  
Kate Honeyford ◽  
Paul Aylin ◽  
Alex Bottle
Keyword(s):  
Emergency Department ◽  
Readmission Rates ◽  
Performance Metric ◽  
A Performance

Abstract WP252: Reduction in Stroke Readmission Rates After Implementing an Emergency Department-based Transient Ischemic Attack Observation Unit

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Lori Fayas ◽  
Kathy Polum ◽  
Heather Stanko
Keyword(s):  
Emergency Department ◽  
Comprehensive Evaluation ◽  
Recurrent Stroke ◽  
Retrospective Chart Review ◽  
Rapid Evaluation ◽  
Observation Unit ◽  
Readmission Rates ◽  
Community Based ◽  
Ischemic Attack ◽  
Work Up

Background and Purpose —Diagnosis and treatment of transient ischemic attacks (TIAs) is often delayed by lack of access to immediate comprehensive evaluation of the underlying etiology. Early initiation of treatment can reduce the risk of early recurrent stroke by up to 80%. Up to 40% of people who have experienced a TIA will go on to have a stroke. The purpose of this review was to determine the efficacy of an Emergency Department (ED)-based TIA observation unit using a standardized TIA protocol designed to provide rapid evaluation and treatment of patients presenting with TIA in reducing the rates of readmission with stroke to a community-based hospital. Methods —We did a retrospective chart review of all patients discharged from Bellin Hospital with a diagnosis of stroke before implementing a standardized TIA protocol in our ED-based TIA observation unit (July to December 2010) and after implementation of the TIA observation unit (November 2011 to April 2012). We identified the patients in these cohorts who had previously been evaluated in the ED with signs or symptoms of stroke in the 6 months prior to admission and compared their stroke readmission rates. Patients who received evaluation through the TIA observation unit from November 2011 to April 2012 were monitored for readmission for stroke in the 6 months after evaluation. Results —Prior to use of the TIA observation unit, 7 of 51 (13.7%) patients discharged with a diagnosis of stroke had been seen in the ED in the previous 6 months with stroke-like symptoms. After implementation of the TIA observation unit, 7 of 119 (5.9%) patients discharged with a diagnosis of stroke had been seen in the ED, a 57.1% reduction in stroke readmission at 6 months. Of these, 4 (57.1%) had not completed the work-up during their previous ED visit. 122 patients underwent evaluation using the TIA observation unit. Of these, only 3 (2.5%) patients were readmitted for stroke in the next 6 months. 16 of these 122 (13.1%) patients were diagnosed with stroke during their TIA work-up. Conclusions —Rapid evaluation and treatment of TIA through an ED-based TIA observation unit substantially reduces the risk of readmission for stroke.

scholarly journals Validation of phlebotomy performance metrics developed as part of a proficiency-based progression initiative to mitigate wrong blood in tube

2020 ◽  
pp. postgradmedj-2019-137254
Author(s):  
Noirin O’Herlihy ◽  
Sarah Griffin ◽  
Patrick Henn ◽  
Robert Gaffney ◽  
Mary Rose Cahill ◽  
...  
Keyword(s):  
Construct Validity ◽  
Performance Metrics ◽  
Working Environment ◽  
Modified Delphi ◽  
Video Recordings ◽  
Performance Metric ◽  
Large Teaching Hospital ◽  
Wide Range ◽  
The Mean ◽  
A Performance

AimsThe purpose of this study was to (1) characterise the procedure of phlebotomy, deconstruct it into its constituent parts and develop a performance metric for the purpose of training healthcare professionals in a large teaching hospital and to (2) evaluate the construct validity of the phlebotomy metric and establish a proficiency benchmark.MethodBy engaging with a multidisciplinary team with a wide range of experience of preanalytical errors in phlebotomy and observing video recordings of the procedure performed in the actual working environment, we defined a performance metric. This was brought to a modified Delphi meeting, where consensus was reached by an expert panel. To demonstrate construct validity, we used the metric to objectively assess the performance of novices and expert practitioners.ResultsA phlebotomy metric consisting of 11 phases and 77 steps was developed. The mean inter-rater reliability was 0.91 (min 0.83, max 0.95). The expert group completed more steps of the procedure (72 vs 69), made fewer errors (19 vs 13, p=0.014) and fewer critical errors (1 Vs 4, p=0.002) than the novice group.ConclusionsThe metrics demonstrated construct validity and the proficiency benchmark was established with a minimum observation of 69 steps, with no critical errors and no more than 13 errors in total.

scholarly journals A Performance Metric for Co-optimization of Day-Ahead Dispatch and Reserves in Electric Microgrids

2019 ◽  
Author(s):  
Mayank Panwar ◽  
Rob Hovsapian ◽  
Robin Roche ◽  
Sid Suryanarayanan
Keyword(s):  
Performance Metric ◽  
A Performance
Sign in / Sign up

Export Citation Format

Share Document