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.

scholarly journals Does accreditation of general practice promote patient-reported quality of care? A natural cluster randomised experiment

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e034465
Author(s):  
Helle Riisgaard ◽  
Frans Boch Waldorff ◽  
Merethe Kirstine Andersen ◽  
Line Bjørnskov Pedersen
Keyword(s):  
General Practice ◽  
Patient Satisfaction ◽  
Quality Of Care ◽  
General Practitioner ◽  
Outcome Measures ◽  
Negative Relationship ◽  
Secondary Outcome ◽  
Cluster Randomised ◽  
Patient Reported

ObjectiveTo investigate whether accreditation of general practice in Denmark promotes patient-reported quality of care and patient satisfaction.DesignA national cluster randomised case control study based on an online version of the Danish Patients Evaluate Practice questionnaire. Mixed effects ordered logit regression models taking account of clustering of patients in different municipalities were used in the analyses.SettingGeneral practice in Denmark.ParticipantsA representative sample of the Danish population.Primary and secondary outcome measuresThe primary outcome measure was patient-reported quality of care, and patient satisfaction with general practice and patient satisfaction with the general practitioner served as secondary outcome measures.ResultsIn total, 3609 respondents answered the survey. We found no statistically significant relationships between patient-reported quality of care and practice accreditation (2016: OR=0.89, 95% CI 0.73 to 1.07 and 2017: OR=0.85, 95% CI 0.71 to 1.02) and between patient satisfaction with the general practitioner and accreditation (2016: OR=0.93, 95% CI 0.76 to 1.13 and 2017: OR=0.86, 95% CI 0.70 to 1.04). However, there was a statistically significant negative relationship between patient satisfaction with the general practice and recent practice accreditation compared with satisfaction with practices not yet accredited (OR=0.81, 95% CI 0.67 to 0.97) but no significant relationship between patient satisfaction with the general practice and previous accreditation (OR=0.91, 95% CI 0.76 to 1.09).ConclusionAccreditation does not promote patient-reported quality of care or patient satisfaction. On the contrary, patient satisfaction with the general practice decreases when general practice is recently accredited.

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 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)

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

How does fast track affect quality of care in the emergency department?

2006 ◽  
Vol 13 (1) ◽  
pp. 32-35 ◽  
Author(s):  
Ayad Al Darrab ◽  
Jerome Fan ◽  
Christopher M.B. Fernandes ◽  
Rosanne Zimmerman ◽  
Rhonda Smith ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Of Care ◽  
Fast Track
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