Review article: Has the implementation of time‐based targets for emergency department length of stay influenced the quality of care for patients? A systematic review of quantitative literature

2021 ◽  
Author(s):  
Peter Jones ◽  
Daniel Haustead ◽  
Katie Walker ◽  
Bridget Honan ◽  
Vinay Gangathimmaiah ◽  
...  
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Quality Of Care ◽  
Length Of Stay ◽  
Review Article

scholarly journals Has the implementation of time-based-targets for emergency department length-of-stay influenced the quality of care for patients? A systematic review of qualitative literature

2021 ◽  
Author(s):  
Katie Walker ◽  
Bridget Honan ◽  
Daniel Haustead ◽  
David Mountain ◽  
Vinay Gangathimmaiah ◽  
...  
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Quality Of Care ◽  
Length Of Stay ◽  
Cochrane Library ◽  
Research Approach ◽  
Successful Implementation ◽  
The Impact ◽  
Qualitative Literature

abstractBackgroundTime-based-targets for emergency department length-of-stay were introduced in England in 2000; followed by Canada, Ireland, New Zealand, and Australia after emergency department crowding was associated with poor quality of care and increased mortality.ObjectivesThe aim of the systematic review was to evaluate qualitative literature to investigate how implementing time-based-targets for emergency department length-of-stay has influenced the quality of care of patients.MethodsSystematic review of qualitative studies that described knowledge, attitudes to or experiences regarding a time-based-target for emergency department length-of-stay. Searches were conducted in Cochrane library, Medline, Embase, CInAHL, Emerald, ABI/Inform, and Informit. Individual studies were evaluated using the Critical Appraisal Skills Programme tool. Individual study findings underwent thematic analysis. Confidence in findings was assessed using the Confidence in the Evidence from Reviews of Qualitative research approach.ResultsThe review included thirteen studies from four countries, incorporating 617 interviews. Themes identified were: quality of care, access block and overcrowding, patient experience, staff morale and workload, intrahospital and interdepartmental relationships, clinical education and training, gaming, and enablers and barriers to achieving targets. The confidence in findings is moderate or high for most themes. More patient and junior doctor perspectives are needed.ConclusionsEmergency time-based-targets have impacted on the quality of emergency patient care. The impact can be both positive and negative and successful implementation depends on whole hospital resourcing and engagement with targets.FundingThe Australasian College for Emergency Medicine provided administrative support for the study, no funding was received.RegistrationPROSPERO CRD42019107755 (prospective)

A Recent Systematic Review on Simulation Modeling and Emergency Departments

2019 ◽  
pp. 1232-1264
Author(s):  
Soraia Oueida ◽  
Seifedine Kadry ◽  
Pierre Abi Char
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Patient Satisfaction ◽  
Quality Of Care ◽  
Simulation Modeling ◽  
Recommended Care ◽  
Recent Systematic Review ◽  
Increase Patient Satisfaction ◽  
System Review

Healthcare, being a complex and huge system, suffers from low quality of care delivered to arriving patients. The quality of care depends on the patient's condition and the availability of hospital's resources. Therefore, many authors have studied the problems faced by such systems and emphasized in their articles the importance of a system review for better performance. In healthcare, different departments interact with each other in order to deliver a certain service to arriving patients and provide the recommended care. In particular, the emergency department (ED) is proven to be the busiest unit of the hospital; thus, the exiting problems and recommended solutions are highlighted in this study by a literature systematic review. The main goal of this article is to study the problems that EDs face nowadays and how simulation modeling can interfere in order to alleviate these problems, propose corresponding solutions and increase patient satisfaction.

scholarly journals A systematic review of the impact of nurse practitioners on cost, quality of care, satisfaction and wait times in the emergency department

CJEM ◽  
2007 ◽  
Vol 9 (04) ◽  
pp. 286-295 ◽  
Author(s):  
Alix J.E. Carter ◽  
Alecs H. Chochinov
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Patient Satisfaction ◽  
Quality Of Care ◽  
Nurse Practitioners ◽  
Census Data ◽  
Medical Community ◽  
Wait Times ◽  
The Impact

ABSTRACT Introduction: US emergency personnel cared for 106% more patients in 1990 than they did in 1980, and national emergency department census data show that 60%–80% of those patients presented with non-urgent or minor medical problems. The hiring of nurse practitioners (NPs) is one proposed solution to the ongoing overcrowding and physician shortage facing emergency departments (EDs). Methods: We conducted a systematic review of MEDLINE and Cinahl to find articles that discussed NPs in the ED setting, looking specifically at 4 key outcome measures: wait times, patient satisfaction, quality of care and cost effectiveness. Results: Although some questions remain, a review of the literature suggests that NPs can reduce wait times for the ED, lead to high patient satisfaction and provide a quality of care equal to that of a mid-grade resident. Cost, when compared with resident physicians, is higher; however, data comparing to the hiring additional medical professionals is lacking. Conclusion: The medical community should further explore the use of NPs, particularly in fast track areas for high volume departments. In rural areas, NPs could supplement overextended physicians and allow health centres to remain open when they might otherwise have to close. These strategies could improve access to care and patient satisfaction for selected urban and rural populations as well as make the best use of limited medical resources.

scholarly journals Are reductions in emergency department length of stay associated with improvements in quality of care? A difference-in-differences analysis

2015 ◽  
Vol 25 (7) ◽  
pp. 489-498 ◽  
Author(s):  
Marian J Vermeulen ◽  
Astrid Guttmann ◽  
Therese A Stukel ◽  
Ashif Kachra ◽  
Marco L A Sivilotti ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Of Care ◽  
Length Of Stay ◽  
Difference In Differences

scholarly journals Impact of the implementation of a fast-track on emergency department length of stay and quality of care indicators in the Champagne-Ardenne region: a before–after study

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e026200 ◽  
Author(s):  
Jan Chrusciel ◽  
Xavier Fontaine ◽  
Arnaud Devillard ◽  
Aurélien Cordonnier ◽  
Lukshe Kanagaratnam ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Of Care ◽  
Length Of Stay ◽  
Outcome Measures ◽  
Fast Track ◽  
Secondary Outcome ◽  
Large Hospital ◽  
Intervention Hospital ◽  
Hospital Bed

ObjectivesWe aimed to evaluate the effect of the implementation of a fast-track on emergency department (ED) length of stay (LOS) and quality of care indicators.DesignAdjusted before–after analysis.SettingA large hospital in the Champagne-Ardenne region, France.ParticipantsPatients admitted to the ED between 13 January 2015 and 13 January 2017.InterventionImplementation of a fast-track for patients with small injuries or benign medical conditions (13 January 2016).Primary and secondary outcome measuresProportion of patients with LOS ≥4 hours and proportion of access block situations (when patients cannot access an appropriate hospital bed within 8 hours). 7-day readmissions and 30-day readmissions.ResultsThe ED of the intervention hospital registered 53 768 stays in 2016 and 57 965 in 2017 (+7.8%). In the intervention hospital, the median LOS was 215 min before the intervention and 186 min after the intervention. The exponentiated before–after estimator for ED LOS ≥4 hours was 0.79; 95% CI 0.77 to 0.81. The exponentiated before–after estimator for access block was 1.19; 95% CI 1.13 to 1.25. There was an increase in the proportion of 30 day readmissions in the intervention hospital (from 11.4% to 12.3%). After the intervention, the proportion of patients leaving without being seen by a physician decreased from 10.0% to 5.4%.ConclusionsThe implementation of a fast-track was associated with a decrease in stays lasting ≥4 hours without a decrease in access block. Further studies are needed to evaluate the causes of variability in ED LOS and their connections to quality of care indicators.

A Recent Systematic Review on Simulation Modeling and Emergency Departments

2017 ◽  
Vol 2 (1) ◽  
pp. 40-68
Author(s):  
Soraia Oueida ◽  
Seifedine Kadry ◽  
Pierre Abi Char
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Patient Satisfaction ◽  
Quality Of Care ◽  
Simulation Modeling ◽  
Recommended Care ◽  
Recent Systematic Review ◽  
Increase Patient Satisfaction ◽  
System Review

Healthcare, being a complex and huge system, suffers from low quality of care delivered to arriving patients. The quality of care depends on the patient's condition and the availability of hospital's resources. Therefore, many authors have studied the problems faced by such systems and emphasized in their articles the importance of a system review for better performance. In healthcare, different departments interact with each other in order to deliver a certain service to arriving patients and provide the recommended care. In particular, the emergency department (ED) is proven to be the busiest unit of the hospital; thus, the exiting problems and recommended solutions are highlighted in this study by a literature systematic review. The main goal of this article is to study the problems that EDs face nowadays and how simulation modeling can interfere in order to alleviate these problems, propose corresponding solutions and increase patient satisfaction.

scholarly journals Associations of Emergency Department Length of Stay With Publicly Reported Quality‐of‐care Measures

2017 ◽  
Vol 24 (2) ◽  
pp. 246-250 ◽  
Author(s):  
Anna Marie Chang ◽  
Amber Lin ◽  
Rongwei Fu ◽  
K. John McConnell ◽  
Benjamin Sun
Keyword(s):  
Emergency Department ◽  
Quality Of Care ◽  
Length Of Stay
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