The Relationship Between Emergency Department Crowding and Patient Outcomes: A Systematic Review

Abstract Objective Exponential increases in rehabilitation intensity in skilled nursing facilities (SNFs) motivated recent changes in Medicare reimbursement policies, which remove financial incentives for providing more minutes of physical therapy, occupational therapy, and speech therapy. Yet there is concern that SNFs will reduce therapy provision and patients will experience worse outcomes. The purpose of this systematic review was to synthesize current evidence on the relationship between therapy intensity and patient outcomes in SNFs. Methods PubMed, Medline, Scopus, Embase, CINAHL, PEDro, and COCHRANE databases were searched. English-language studies published in the United States between 1998 and February 14, 2020, examining the relationship between therapy intensity and community discharge, hospital readmission, length of stay (LOS), and functional improvement for short-stay SNF patients were considered. Data extraction and risk of bias were performed using the American Academy of Neurology (AAN) Classification of Evidence scale for causation questions. AAN criteria were used to assess confidence in the evidence for each outcome. Results Eight observational studies met inclusion criteria. There was moderate evidence that higher intensity therapy was associated with higher rates of community discharge and shorter LOS. One study provided very low-level evidence of associations between higher intensity therapy and lower hospital readmissions after total hip and knee replacement. There was low-level evidence indicating higher intensity therapy is associated with improvements in function. Conclusions This systematic review concludes, with moderate confidence, that higher intensity therapy in SNFs leads to higher community discharge rates and shorter LOS. Future research should improve quality of evidence on functional improvement and hospital readmissions. Impact This systematic review demonstrates that patients in SNFs may benefit from higher intensity therapy. Because new policies no longer incentivize intensive therapy, patient outcomes should be closely monitored to ensure patients in SNFs receive high-quality care.

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Abstract P274: Relationship Between Stroke Quality Metrics and Patient Outcomes: A Systematic Review

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.4.suppl_2.ap274 ◽

2011 ◽

Vol 4 (suppl_2) ◽

Author(s):

Carol J Parker ◽

Mathew J Reeves

Keyword(s):

Systematic Review ◽

Acute Care ◽

Patient Outcomes ◽

Stroke Care ◽

Evidence Base ◽

Quality Metrics ◽

Care Quality ◽

Stroke Recurrence ◽

The Impact ◽

The Relationship

Background: Stroke quality metrics play an increasingly important role in quality improvement efforts and policies, but the relationship between quality metrics and patient-orientated outcomes are not well described. We conducted a systematic review of observational hospital-based studies examining this relationship. Methods: We searched MEDLINE and EMBASE for studies published before December 31, 2010 that examined the relationship between 2 or more stroke quality metrics and patient-oriented outcomes in acute stroke admissions. Outcomes included mortality, length of stay, discharge to home, functional status, and stroke recurrence. Results: A total of 470 hits were identified. After screening the titles and abstracts, 27 studies underwent full review, and 14 were deemed eligible. Given the variation in study characteristics, quality metrics, and outcomes utilized, it was not possible to generate summary estimates describing the relationship between quality metric compliance and patient-oriented outcomes. Evidence of a positive relationship between quality metrics and improved patient outcomes was limited by the lack of high quality studies. Four of the 14 studies found a statistically significant relationship between increased compliance with acute care quality metrics and improved patient-oriented outcomes. Two studies failed to find an association between acute care measures and improved outcomes, but did find statistically significant positive relationships between compliance with post-acute rehabilitation measures and improved patient outcomes. Five other studies reported mixed findings, while the remaining three found no relationships. Conclusions: We found a limited evidence-base addressing the impact of compliance on stroke quality metrics and patient-oriented outcomes. Generation of data clarifying the relationship between compliance with stroke quality metrics and stroke-related outcomes should be prioritized so that the current investments undertaken to improve stroke care can be sustained.

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The relationship between healthcare workers’ attachment styles and patient outcomes: a systematic review

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzy034 ◽

2018 ◽

Vol 30 (5) ◽

pp. 332-343 ◽

Cited By ~ 1

Author(s):

Chizu Mimura ◽

Ian J Norman

Keyword(s):

Systematic Review ◽

Patient Outcomes ◽

Attachment Styles ◽

Healthcare Workers ◽

The Relationship

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The relationship between cannabis use and patient outcomes in medication-based treatment of opioid use disorder: A systematic review

Clinical Psychology Review ◽

10.1016/j.cpr.2020.101939 ◽

2020 ◽

Vol 82 ◽

pp. 101939

Author(s):

Stephanie Lake ◽

Michelle St. Pierre

Keyword(s):

Systematic Review ◽

Patient Outcomes ◽

Opioid Use Disorder ◽

Cannabis Use ◽

Opioid Use ◽

The Relationship

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143 EMF Radio-Frequency Time and Motion Study: The Relationship of Emergency Department Crowding, Physical Workspace, and Patient-Provider Contact

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2012.06.120 ◽

2012 ◽

Vol 60 (4) ◽

pp. S52 ◽

Cited By ~ 1

Author(s):

J. Castner ◽

H. Suffoletto

Keyword(s):

Emergency Department ◽

Radio Frequency ◽

Emergency Department Crowding ◽

Time And Motion Study ◽

Time And Motion ◽

Motion Study ◽

Relationship Of ◽

The Relationship

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The relationship between the nursing practice environment and five nursing‐sensitive patient outcomes in acute care hospitals: A systematic review

Nursing Open ◽

10.1002/nop2.828 ◽

2021 ◽

Author(s):

Tamer Al‐ghraiybah ◽

Jenny Sim ◽

Luise Lago

Keyword(s):

Systematic Review ◽

Acute Care ◽

Patient Outcomes ◽

Nursing Practice ◽

Acute Care Hospitals ◽

Practice Environment ◽

Nursing Practice Environment ◽

The Relationship

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MP05: Diagnostic accuracy of point of care ultrasound in undifferentiated hypotension presenting to the emergency department: a systematic review

CJEM ◽

10.1017/cem.2019.140 ◽

2019 ◽

Vol 21 (S1) ◽

pp. S43-S44 ◽

Cited By ~ 1

Author(s):

L. Richardson ◽

O. Loubani ◽

P. Atkinson

Keyword(s):

Systematic Review ◽

Emergency Department ◽

Full Article ◽

Diagnostic Accuracy ◽

Patient Outcomes ◽

Primary Outcome ◽

Point Of Care ◽

Initial Assessment ◽

Point Of Care Ultrasound ◽

Strong Conclusion

Introduction: Undifferentiated hypotension remains one of the most life-threatening presentations to emergency departments (ED) around the world. An accurate and rapid initial assessment is essential, as shock carries a high mortality with multiple unique etiologies and management plans. Point of care ultrasound (PoCUS) has emerged as a promising tool to improve these diagnostic and management challenges, yet its reliability in this setting remains unclear. Methods: We performed a systematic review of Medline, EMBASE, CINAHL, Cochrane, and clinicaltrials.gov databases from inception to June 8, 2018. Databases were reviewed by two independent researchers and all languages were included. The methodological quality of included studies were evaluated using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Our primary outcome was diagnostic accuracy of PoCUS in hypotension, with secondary outcomes including patient outcomes and changes to management. Results: Our literature search revealed 5345 articles after duplicates were removed, leaving 235 articles for full article review. Following full article review, 9 studies remained and were included in the systematic review. There were 2 randomized control trials, 6 prospective cohort trials, and 1 retrospective cohort trial. For our primary outcome of diagnostic accuracy, eight studies were included; we extracted Kappa values ranging from 0.70 to 0.971, pooled sensitivity ranging from 69% to 88%, and pooled specificity ranging from 88% to 96%. Four studies reported on management change including results reporting shorter time to disposition, change in diagnostic test ordering (18% to 31%), change in consultation (13.6%), change in admission location (12%) and change in management plan (25% to 40%). Only one study reported on patient outcomes, which revealed no survival or length of stay benefit. Conclusion: When assessing for the diagnostic accuracy of PoCUS in the setting of undifferentiated hypotension presenting to the emergency department, we found fair consistency between PoCUS and final diagnosis with high Kappa values, fair to good pooled sensitivities, and good to excellent specificities. There was no strong evidence indicating improved outcomes. However, the large amount of heterogeneity amongst studies has limited our ability to make a strong conclusion except that future research should focus on a uniform study design and patient focused outcomes.

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