scholarly journals 1089 Unscheduled care presentations for children in gloucestershire during the SARS-CoV-2 pandemic

2021 ◽  
Author(s):  
Louisa Jackson ◽  
Imelda Bennet ◽  
Clare Freebrey ◽  
Becky Teare
Keyword(s):  
Unscheduled Care

scholarly journals Evaluation of an unscheduled care model delivered by advanced nurse practitioners in a primary-care setting

2019 ◽  
Vol 24 (8) ◽  
pp. 696-709
Author(s):  
Calum F Leask ◽  
Heather Tennant
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Care Setting ◽  
Primary Care Setting ◽  
Home Visits ◽  
Rejection Rate ◽  
Service Level ◽  
Average Score ◽  
Unscheduled Care ◽  
Viable Solution

Background Considering new models of delivery may help reduce increasing pressures on primary care. One potentially viable solution is utilising Advanced Practitioners to deliver unscheduled afternoon visits otherwise undertaken by a General Practitioner (GP). Aims Evaluate the feasibility of utilising an Advanced Nurse Practitioner (ANP) to deliver unscheduled home visits on behalf of GPs in a primary care setting. Methods Following a telephone request from patients, ANPs conducted unscheduled home visits on behalf of GPs over a six-month period. Service-level data collected included patient-facing time and outcome of visits. Practice staff and ANPs participated in mind-mapping sessions to explore perceptions of the service. Results There were 239 accepted referrals (total visiting time 106.55 hours). The most common outcomes for visits were ‘medication and worsening statement given’ (107 cases) and ‘self-care advice’ (47 cases). GPs were very satisfied with the service (average score 90%), reporting reductions in stress and capacity improvements. Given the low referral rejection rate, ANPs discussed the potential to increase the number of practices able to access this model, in addition to the possibility of utilising other practitioners (such as paramedics or physiotherapists) to deliver the same service. Conclusions It appears delivering unscheduled care provision using an ANP is feasible and acceptable to GPs.

Medicaid member perspectives on innovation in prenatal care delivery: A call to action from pregnant people using unscheduled care

Healthcare ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 100456
Author(s):  
Eloho E. Akpovi ◽  
Tamala Carter ◽  
Shreya Kangovi ◽  
Sindhu K. Srinivas ◽  
Judith A. Bernstein ◽  
...  
Keyword(s):  
Prenatal Care ◽  
Care Delivery ◽  
Call To Action ◽  
Unscheduled Care

Telehealth Facilitates Value-Based Care in Emergency Department Settings

2021 ◽  
pp. 256-261
Author(s):  
Deborah Ann Mulligan ◽  
Krista Drobac ◽  
Robert Shesser
Keyword(s):  
Value Chain ◽  
Hospital Admissions ◽  
Leadership Role ◽  
Emergency Physicians ◽  
Coordinated Care ◽  
Care Needs ◽  
Unscheduled Care ◽  
Value Based Care

Spurred by the COVID-19 pandemic, the health care industry is increasingly aware of benefits emergency physicians could contribute to value-based care. The use of emergency telehealth—to reduce the number of hospital admissions, readmissions, and missed outpatient follow-up appointments—will play an increasing role in the shift to value-based care paradigms. Although certain legal, regulatory, and reimbursement challenges remain, the COVID-19 outbreak should stimulate lawmakers and regulatory agencies to promulgate further measures that facilitate widespread adoption of telemedicine, which will inevitably extend into emergency care. Emergency physicians should play a leadership role in the development and implementation of coordinated care before, during, and after acute unscheduled care needs of patients. Coordinated care is a recognized role of emergency telehealth in the value chain. For emergency telehealth to be effective, it must be appropriately integrated into standard practice of emergency medicine.

Document Management Mechanism for Holistic Emergency Healthcare

2014 ◽  
Vol 9 (2) ◽  
pp. 1-15 ◽  
Author(s):  
M. Poulymenopoulou ◽  
F. Malamateniou ◽  
G. Vassilacopoulos
Keyword(s):  
Patient Information ◽  
Emergency Care ◽  
Point Of Care ◽  
Document Management ◽  
Management Mechanism ◽  
Emergency Case ◽  
Holistic View ◽  
Unscheduled Care ◽  
Care Processes ◽  
Timely Access

A number of recent studies have showed that early and specialized pre-hospital patient management contributes significantly to emergency case survival. Along with the deployment and availability of appropriate emergency care resources, this also requires the availability of timely and relevant patient information to emergency medical service professionals. However, current healthcare information systems are characterized by heterogeneity and fragmentation, hindering emergency care professionals to have access to holistic or integrated patient information from the various organizations that participate in emergency care processes where and when needed. At the same time, many e-health programs have been undertaken worldwide in the area of emergency and unscheduled care with the objective to facilitate sharing of electronic patient information that may be considered important for the delivery of high quality emergency care and, hence, need to be readily available. In this vein, this paper takes a holistic view of the information needed in emergency healthcare and focuses on developing an appropriate tool for providing timely access to holistic care information by authorized users while retaining existing investments. Thus, a special purpose document management mechanism (DMM) is proposed that facilitates creating standardized XML documents from existing healthcare systems and that enables access to such documents at the point of care. For illustrative purposes, the mechanism has been incorporated into a prototype, cloud-based holistic EMS system.

scholarly journals Emergency department front-end split-flow experience: ‘physician in intake’

2019 ◽  
Vol 8 (4) ◽  
pp. e000817 ◽  
Author(s):  
Sean S Michael ◽  
Daniel Bickley ◽  
Kelly Bookman ◽  
Richard Zane ◽  
Jennifer L Wiler
Keyword(s):  
Emergency Department ◽  
Cross Section ◽  
Medication Administration ◽  
National Sample ◽  
Intake Process ◽  
Front End ◽  
Unscheduled Care ◽  
Before And After ◽  
Single Centre Study ◽  
Discharged Patients

BackgroundEmergency department (ED) crowding is a critical problem in the delivery of acute unscheduled care. Many causes are external to the ED, but antiquated operational traditions like triage also contribute. A physician intake model has been shown to be beneficial in a single-centre study, but whether this solution is generalisable is not clear. We aimed to characterise the current state of front-end intake models in a national sample of EDs and quantify their effects on throughput measures.MethodsWe performed a descriptive mixed-method analysis of ED process changes implemented by a cross section of self-selecting institutions who reported 2 years of demographic/operational data and structured process descriptions of any ‘new front-end processes to replace traditional nurse-based triage’.ResultsAmong 25 participating institutions, 19 (76%) provided data. While geographically diverse, most were urban, academic adult level 1 trauma centres. Thirteen (68%) reported implementing a new intake process. All were run by attending emergency physicians, and six (46%) also included advanced practice providers. Daily operating hours ranged from 8 to 16 (median 12, IQR 10.25–15.85), and the majority performed labs, imaging and medication administration and directly discharged patients. Considering each site’s before-and-after data as matched pairs, physician-driven intake was associated with mean decreases in arrival-to-provider time of 25 min (95% CI 13 to 37), ED length of stay 36 min (95% CI 12 to 59), and left before being seen rate 1.2% (95% CI 0.6% to 1.8%).ConclusionsIn this cross section of primarily academic EDs, implementing a physician-driven front-end intake process was feasible and associated with improvement in operational metrics.

First principles

2016 ◽  
Keyword(s):  
First Principles ◽  
Infection Prevention ◽  
Ethical Issues ◽  
Care Delivery ◽  
Advanced Practice ◽  
Unscheduled Care ◽  
Major Incidents ◽  
Difficult Situations ◽  
Care History ◽  
Legal And Ethical Issues

This chapter provides an overview of basic nursing practice as it relates to emergency nursing, including: teamwork, health promotion, injury prevention, infection prevention, dealing with patients with learning disabilities, models of unscheduled care, delivery, triage, documentation, the handover of care, history taking, advanced practice, early warning scores, major incidents and terrorism, legal and ethical issues, and dealing with difficult situations.

scholarly journals High-Cost, High-Need Users of Acute Unscheduled HIV Care: A Cross-Sectional Study

2020 ◽  
Vol 7 (2) ◽  
Author(s):  
Conor Grant ◽  
Colm Bergin ◽  
Sarah O’Connell ◽  
John Cotter ◽  
Clíona Ní Cheallaigh
Keyword(s):  
Emergency Department ◽  
Hospital Admissions ◽  
High Volume ◽  
Cross Sectional Study ◽  
Emergency Department Visits ◽  
Hiv Care ◽  
Psychiatric Disease ◽  
Cross Sectional ◽  
Unscheduled Care ◽  
Cumulative Length

Abstract Background High-cost, high-need users are defined as patients who accumulate large numbers of emergency department visits and hospital admissions that might have been prevented by relatively inexpensive early interventions and primary care. This phenomenon has not been previously described in HIV-infected individuals. Methods We analyzed the health records of HIV-infected individuals using scheduled or unscheduled inpatient or outpatient health care in St James’s Hospital, Dublin, Ireland, from October 2014 to October 2015. Results Twenty-two of 2063 HIV-infected individuals had a cumulative length of stay >30 days in the study period. These individuals accrued 99 emergency department attendances and 1581 inpatient bed days, with a direct cost to the hospital of >€1 million during the study period. Eighteen of 22 had potentially preventable requirements for unscheduled care. Two of 18 had a late diagnosis of HIV. Sixteen of 18 had not been successfully engaged in outpatient HIV care and presented with consequences of advanced HIV. Fourteen of 16 of those who were not successfully engaged in care had ≥1 barrier to care (addiction, psychiatric disease, and/or homelessness). Conclusions A small number of HIV-infected individuals account for a high volume of acute unscheduled care. Intensive engagement in outpatient care may prevent some of this usage and ensuing costs.

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