Modelling Waiting Times in an Emergency Department in Greece During the Economic Crisis

2018 ◽  
Vol 20 (4) ◽  
pp. 475-485 ◽  
Author(s):  
Panagiotis Manolitzas ◽  
Neophytos Stylianou
Keyword(s):  
Emergency Department ◽  
Economic Crisis ◽  
Emergency Departments ◽  
Waiting Times ◽  
Patient Dissatisfaction ◽  
Department Of Health ◽  
Physician Productivity ◽  
Pain And Suffering ◽  
Prolonged Pain ◽  
Improve Health

Overcrowding is one of the most common phenomenon at the emergency departments of the hospitals across the world. The aforementioned phenomenon causes many problems such as long waiting times for patients, increasing length of stay, patient dissatisfaction, ambulance diversions in some cities, prolonged pain and suffering, violence and miscommunication between the medical staff and the patients, patients leaving the emergency department without been seen and decreased physician productivity. This article analyses the problem of the increased waiting times in a Greek emergency department during the economic crisis. We use statistical models in order to reveal the factors that can lead to a decrease in waiting times. Our findings suggest that Greece’s Department of Health should standardize an uppermost waiting time for emergency departments which could help improve health care.

The 4-hour window: UK Government targets versus clinical priorities

2017 ◽  
Vol 41 (S1) ◽  
pp. S563-S564
Author(s):  
D. Cumming
Keyword(s):  
Emergency Department ◽  
United Kingdom ◽  
Public Hospital ◽  
Positive Response ◽  
Psychiatric Patients ◽  
Waiting Times ◽  
Adverse Outcomes ◽  
Department Of Health ◽  
Competing Interest ◽  
Image Position

IntroductionIn 2002, the Department of Health (United Kingdom) introduced a 4-hour target due to long waiting times. It is expected that 95% of patients who attend the A&E (Emergency) Department should be registered and admitted/discharged within 4 hours. Exceeding this is termed a “breach”.ObjectivesThe aim of this re-audit was to assess for a response following recommendations after an initial audit with concerning results. Forth Valley Royal is an acute public hospital in Central Scotland with 860 in-patient beds, covering a population of 300,000. It contains two general adult wards (42 beds), one IPCU (12 beds) and two Elderly wards (40 beds).MethodsReferral data was sourced across 4 consecutive months: April–July 2015 (initial audit) and October 2015–January 2016 (re-audit). These included all referrals from A&E to Psychiatry. Times were calculated for the 4 subprocesses listed in Table 1 below.Conclusion/discussionFollowing the initial audit, interventions such as training A&E staff to better manage psychiatric patients and encourage earlier referrals, led to a positive response in the re-audit (Subprocess 1). Breach rates reduced to 28% (from 35%) on re-audit. Less breaches (81% compared to 88%) were referred after 2-hours by A&E. Overall, the breach rates have reduced and they are less attributable to the A&E referring patients late. The outcome of patients leaving A&E without being seen by a psychiatrist was unknown – adverse outcomes would strengthen the debate to enforce the 4-hour window.Disclosure of interestThe author has not supplied his/her declaration of competing interest.Table 1Initial audit = 222 referrals (35% breach rate)Re-Audit = 348 referrals (28% breach rate)

scholarly journals The National Demonstration Hospitals Program

2000 ◽  
Vol 23 (4) ◽  
pp. 198 ◽  
Author(s):  
Amanda Alexander
Keyword(s):  
Best Practice ◽  
Waiting Times ◽  
Public Hospitals ◽  
Positive Health ◽  
Health Care Reforms ◽  
Family Services ◽  
Department Of Health ◽  
Two Phases ◽  
Improve Health ◽  
Improve Service Delivery

Fifty-five public hospitals in all Australian States and Territories participated in the first two phases of NationalDemonstration Hospitals Program (NDHP). The program was established in 1994 as part of a commitment by thethen Department of Health and Family Services to reduce waiting times and improve health outcomes for patients.The program uses a collaborative approach to assist public hospitals to improve service delivery and patient careoutcomes. Key results from Phases 1 and 2 of the NDHP have confirmed that identification of industry best practice,collaboration, knowledge sharing and innovation are key elements required to achieve positive health care reforms.

scholarly journals Modeling, Assessment and Design of an Emergency Department of a Public Hospital through Discrete-Event Simulation

2021 ◽  
Vol 11 (2) ◽  
pp. 805
Author(s):  
Alexandre Castanheira-Pinto ◽  
Bruno S. Gonçalves ◽  
Rui M. Lima ◽  
José Dinis-Carvalho
Keyword(s):  
Emergency Department ◽  
Simulation Model ◽  
Emergency Departments ◽  
Patient Flow ◽  
Waiting Times ◽  
Discrete Event ◽  
Analytical Description ◽  
Northern Region ◽  
Optimized Design ◽  
Initial State

Emergency departments in hospitals are having many difficulties in achieving the performance levels required by health regulators and society. The waiting times as well as the total throughput time are examples of performance indicators that emergency departments need to improve in order to provide a better service to the community. To achieve improvement of performance, the present paper shows a methodology to assist the design process of an emergency department using simulation techniques. In this study, the emergency department of a hospital located in the northern region of Portugal was considered to test the proposed simulation technique. The emergency department initial state was assessed, in terms of patient flow, as well as the human resources needed at every stage of the service. In order to understand in depth the process that a patient goes through during an emergency episode, a comprehensive study was performed on the hospital database. This allowed the analytical description of an emergency episode, which was further used as an input to the simulation model. After developing the simulation model with the information obtained by the hospital’s database, a validation stage was performed. Finally, in order to achieve an optimized design for the emergency department several variant scenarios were considered and evaluated. This methodology proved to be very useful in determining an optimized operation for complex, and non-linear systems.

Triage scales, used in inpatient emergency departments (review article)

2021 ◽  
Vol 7-8 (217-218) ◽  
pp. 45-52
Author(s):  
Nurgul Kulmanova ◽  
◽  
Muhtar Saduov ◽  
Keyword(s):  
Emergency Department ◽  
Emergency Departments ◽  
Treatment Effectiveness ◽  
Negative Impact ◽  
Medical Condition ◽  
Waiting Times ◽  
Relevant Literature ◽  
Medical Personnel ◽  
Severity Index ◽  
Emergency Severity Index

The article describes different types of sorting scales used in inpatient emergency departments in different countries. Triage scales are designed to optimize patient waiting times according to the severity of their medical condition in order to treat the most intense symptom as quickly as possible and reduce the negative impact on the prognosis of a long delay before starting treatment. The aim of the study is to analyze the literature data describing the scales for triage in the emergency department, their comparative characteristics, and assessment of their reliability and reliability. Material and methods. An online literature research was conducted in databases such as Pubmed, Web of Science and Scopus, as well as on-line publications in Russian and English languages. The following terms were used to search for relevant literature sources: emergency department, triage, emergency severity index. A total of 813 literary sources were found, 37 of which were selected for further analysis. Inclusion criteria: studies performed in people, published in English, Russian, as well as full versions of articles. Exclusion criteria: summary of reports, newspaper publications, personal messages. Results and discussion. Analysis of the literature data allows us to judge a variety of approaches and systems of medical sorting of patients requiring emergency medical care, especially in cases of mass disasters and injuries. Analysis of existing sorting scales has shown that these scales are fivestep and adapted to the region and the health system, but there is no single universal scale. Conclusion. The introduction of structured triage by specially trained medical personnel in the emergency Department helps to accurately identify patients whose lives are at risk, especially during periods of insufficient treatment effectiveness. Therefore, five-level triage systems are recommended by national and international societies of emergency medicine. Keywords: triage, system triage, emergency severity index, emergency department.

scholarly journals Patient Satisfaction in a University Hospital Emergency Department in Turkey

2005 ◽  
Vol 48 (1) ◽  
pp. 59-62 ◽  
Author(s):  
Cuma Yildirim ◽  
Hasan Koçoğlu ◽  
Sıtkı Göksu ◽  
Nurullah Gunay ◽  
Haluk Savas
Keyword(s):  
Emergency Department ◽  
Patient Satisfaction ◽  
Quality Of Care ◽  
Quality Care ◽  
Waiting Times ◽  
Adult Patients ◽  
University Hospital ◽  
Patient Dissatisfaction ◽  
Insurance Carrier

Objective: Patient satisfaction, an indicator of the quality of care provided by emergency department (ED) personnel, is a significant issue for EDs. The purpose of this study was to identify factors associated with patient satisfaction and dissatisfaction, and to describe demographic characteristics of those surveyed in a university hospital ED. Methods: All adult patients who consecutively presented to the ED between 8:00 a.m. and 5:00 p.m. on weekdays were included in the study. Patients were asked to complete a questionnaire prior to discharge. The questionnaire asked about the attitude, politeness, and efficiency of the medical and ancillary staff, the reason for preferring our centre and reasons for dissatisfaction. Results: Two-hundred and forty-five adult patients presenting to our ED were included in this study. Forty-five percent of patients preferred our ED because of the previous perception of higher quality of care, informed by other people previously treated in this ED unit, and 35% because of restrictions by their health insurance carrier. The main causes of patient dissatisfaction were lengthy waiting times (27%). Conclusion: As a result, lengthy waiting time was the major reason for patient dissatisfaction, and high quality care together with insurance restrictions were the main reasons for preference of this university hospital ED.

scholarly journals Association of Emergency Department Waiting Times With Patient Experience in Admitted and Discharged Patients

2021 ◽  
Vol 8 ◽  
pp. 237437352110114
Author(s):  
Andrew Nyce ◽  
Snehal Gandhi ◽  
Brian Freeze ◽  
Joshua Bosire ◽  
Terry Ricca ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Patient Experience ◽  
Waiting Times ◽  
Hospital Length ◽  
Short Length ◽  
Hospital Length Of Stay ◽  
Patient’S Experience ◽  
Discharged Patients ◽  
The Impact

Prolonged waiting times are associated with worse patient experience in patients discharged from the emergency department (ED). However, it is unclear which component of the waiting times is most impactful to the patient experience and the impact on hospitalized patients. We performed a retrospective analysis of ED patients between July 2018 and March 30, 2020. In all, 3278 patients were included: 1477 patients were discharged from the ED, and 1680 were admitted. Discharged patients had a longer door-to-first provider and door-to-doctor time, but a shorter doctor-to-disposition, disposition-to-departure, and total ED time when compared to admitted patients. Some, but not all, components of waiting times were significantly higher in patients with suboptimal experience (<100th percentile). Prolonged door-to-doctor time was significantly associated with worse patient experience in discharged patients and in patients with hospital length of stay ≤4 days. Prolonged ED waiting times were significantly associated with worse patient experience in patients who were discharged from the ED and in inpatients with short length of stay. Door-to-doctor time seems to have the highest impact on the patient’s experience of these 2 groups.

scholarly journals 140. Symptoms and Situations Predispose Patients to Use Antibiotics Without Medical Advice

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S200-S200
Author(s):  
Michael Hansen ◽  
Barbara Trautner ◽  
Roger Zoorob ◽  
George Germanos ◽  
Osvaldo Alquicira ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Emergency Departments ◽  
Primary Care Clinic ◽  
Antibiotic Use ◽  
Safety Net ◽  
Care Clinic ◽  
Primary Care Clinics ◽  
Primary Care Patients ◽  
Emergency Department Patients

Abstract Background Use of antibiotics without a prescription (non-prescription use) contributes to antimicrobial resistance. Non-prescription use includes obtaining and taking antibiotics without a prescription, taking another person’s antibiotics, or taking one’s own stored antibiotics. We conducted a quantitative survey focusing on the factors that impact patients’ decisions to use non-prescription antibiotics. Methods We surveyed patients visiting public safety net primary care clinics and private emergency departments in a racially/ethnically diverse urban area. Surveys were read aloud to patients in Spanish and English. Survey domains included patients’ perspectives on which syndromes require antibiotic treatment, their perceptions of health care, and their access to antibiotics without a prescription. Results We interviewed 190 patients, 122 from emergency departments (64%), and 68 from primary care clinics (36%). Overall, 44% reported non-prescription antibiotic use within the past 12 months. Non-prescription use was higher among primary care clinic patients (63%) than the emergency department patients (39%, p = 0.002). The majority felt that antibiotics would be needed for bronchitis (78%) while few felt antibiotics would be needed for diarrhea (30%) (Figure 1). The most common situation identified “in which respondents would consider taking antibiotics without contacting a healthcare provider was “got better by taking this antibiotic before” (Figure 2). Primary care patients were more likely to obtain antibiotics without prescription from another country than emergency department patients (27% vs. 13%, P=0.03). Also, primary care patients were more likely to report obstacles to seeking a doctor’s care, such as the inability to take time off from work or transportation difficulties, but these comparisons were not statistically significant. Figure 1. Patients’ agreement that antibiotics would be needed varied by symptom/syndrome. Figure 2. Situations that lead to non-prescription antibiotic use impacted the two clinical populations differently Conclusion Non-prescription antibiotic use is a widespread problem in the two very different healthcare systems we included in this study, although factors underlying this practice differ by patient population. Better understanding of the factors driving non-prescription antibiotic use is essential to designing patient-focused interventions to decrease this unsafe practice. Disclosures All Authors: No reported disclosures

Finding the path of least resistance: Locally adapting the MITIGATE toolkit in emergency departments and urgent care centers

2021 ◽  
pp. 1-3
Author(s):  
Joanne Huang ◽  
Zahra Kassamali Escobar ◽  
Todd S. Bouchard ◽  
Jose Mari G. Lansang ◽  
Rupali Jain ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Antimicrobial Stewardship ◽  
Emergency Departments ◽  
Urgent Care ◽  
Complex Data ◽  
University Of Washington ◽  
Primary Care Clinics ◽  
Urgent Care Centers ◽  
The University

Abstract The MITIGATE toolkit was developed to assist urgent care and emergency departments in the development of antimicrobial stewardship programs. At the University of Washington, we adopted the MITIGATE toolkit in 10 urgent care centers, 9 primary care clinics, and 1 emergency department. We encountered and overcame challenges: a complex data build, choosing feasible outcomes to measure, issues with accurate coding, and maintaining positive stewardship relationships. Herein, we discuss solutions to challenges we encountered to provide guidance for those considering using this toolkit.

scholarly journals A Structured Curriculum for Interprofessional Training of Emergency Medicine Interns

2019 ◽  
Vol 21 (1) ◽  
pp. 149-151 ◽  
Author(s):  
Ashley Rider ◽  
Tiffany Anaebere ◽  
Mariko Nomura ◽  
David Duong ◽  
Charlotte Wills
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Interprofessional Education ◽  
Hospital Setting ◽  
Scope Of Practice ◽  
Registered Nursing ◽  
Interprofessional Training ◽  
Before And After ◽  
Team Based Care ◽  
Improve Health

Interprofessional education (IPE) has been shown to improve health outcomes and patient satisfaction. IPE is now represented in the Accreditation Council for Graduate Medical Education’s emergency medicine (EM) milestones given the team-based nature of EM. The Highland Allied Health Rotation Program (H-AHRP) was developed by residents to enhance and standardize IPE for EM residents in a single hospital setting. H-AHRP was incorporated into the orientation month for interns starting in the summer of 2016. EM interns were paired with emergency department preceptors in registered nursing (RN), respiratory therapy (RT), pharmacy (PH), laboratory (LAB), and social work (SW) in either a four-hour shadowing experience (RN, RT, PH) or lecture-based overview (LAB, SW). We conducted a survey before and after the program. Overall, the EM interns reported an improved understanding of the scope of practice and day-to-day logistics after working with the preceptors. They found the program helpful to their future as physicians and would recommend it to other residencies. The H-AHRP program allows for the early incorporation of IPE into EM training, enhances interns’ understanding of both the scope and logistics of their colleagues, and is a well-received effort at improving team-based care.

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