Introduction of Wireless Buzzer to Improve Efficiency in Gynecology Triage (Preprint)

2020 ◽  
Author(s):  
Nicholas Mark Stansbury ◽  
Erin Nelson
Keyword(s):  
Medical Students ◽  
Nurse Practitioners ◽  
Nursing Staff ◽  
Internal Control ◽  
Patient Flow ◽  
Low Cost ◽  
Work Flow ◽  
Optimal Time ◽  
Nursing Experience ◽  
Asking Questions

BACKGROUND Current workflow in GYN triage has medical students interviewing patients after triage by nursing staff. The optimal time to initiate patient contact is unclear. This confusion has led to duplication of questions to patients, interruptions for nurses and fewer patient encounters for students. OBJECTIVE Determine if a restaurant-style buzzer can streamline workflow in gynecology (GYN) triage. METHODS A Plan-Do-Study-Act approach was used. Stakeholders were medical students, nurses, Nurse Practitioners and physicians. Factors contributing to workflow slowdown: students re-asking questions of patients, interruption of nursing staff, confusion about optimal patient flow. The net result was fewer interviews completed by students. The project was introduced during clerkship orientation. Buzzers were provided on weeks 1, 3, 5 of the rotation. Weeks 2, 4, 6 no buzzers were provided as an internal control. After each clerkship, students received a survey assessing key areas of waste and workflow disruption. A focus group with ten nurses was also conducted. RESULTS From February-July 2019, 30/45 surveys were completed (66%) 1. Very difficult/difficult to know when to begin the encounter: 90% without; 21.4% with buzzer p<.001 2. Students re-asking questions: very often/often 96.7% without; 14.8% with buzzer p<.001 3. Nursing staff interruptions: 76.7% very often/often without; 18.5% with buzzer p<.001 4. The odds of interviewing 5 or more patients per shift are ~10X greater using the buzzer χ²=14.2; p<.001 CONCLUSIONS The 10 nurses interviewed unanimously favored the use of the buzzer. Introduction of a simple, low-cost restaurant-style buzzer improved triage work-flow, student and nursing experience.

NURSING EXPERIENCE FOR MEDICAL STUDENTS

The Lancet ◽  
1949 ◽  
Vol 253 (6541) ◽  
pp. 83
Author(s):  
R.H. Carruthers ◽  
R.E. Richardson
Keyword(s):  
Medical Students ◽  
Nursing Experience

Separation or Synthesis: A Holistic Approach to Therapeutics

1996 ◽  
Vol 17 (8) ◽  
pp. 279-283
Author(s):  
Kathi J. Kemper
Keyword(s):  
Health Care ◽  
Nurse Practitioners ◽  
Low Cost ◽  
Self Regulation ◽  
Holistic Approach ◽  
Medical Settings ◽  
The Public ◽  
Specialized Health Care ◽  
Definition Of ◽  
Spiritual Healers

Over the past 50 years, health care has grown more complex and specialized. Health-care institutions now are staffed with an array of specialist physicians, social workers, psychologists, therapists, and nutritionists as well as general practitioners and nurses. The types of providers outside of the hospital are even more numerous and diverse: physicians; nurses; nurse practitioners; chiropractors; counselors; acupuncturists; herbalists; spiritual healers; and purveyors of nutritional supplements, aromatherapy, crystals, and more. Intent on distinguishing their "products," providers focus on differences, polarizing into distinct camps such as "mainstream or traditional" versus "alternative or unconventional." Although these dichotomies are simple, they also can mislead. The definition of "alternative" is very dependent on the definition "mainstream"; acupuncture may be an alternative in one setting, but it clearly is traditional within Asian communities. Therapies that once were considered unconventional, such as hypnosis and meditation, have moved into many mainstream medical settings. (See Sugarman article "Hypnosis: Teaching Children Self-regulation" in the January 1996 issue of Pediatrics in Review.) The public wants health care that is low-cost, safe, effective, and personalized. Practitioners of "natural" therapies often are viewed as more humanistic and less technological than busy physicians. According to one study, in 1990, alternative medical therapies were used by nearly one third of Americans.1

Managing patient flow with triage streaming to identify patients for Dutch emergency nurse practitioners

2012 ◽  
Vol 20 (2) ◽  
pp. 52-57 ◽  
Author(s):  
Christien van der Linden ◽  
Robert Lindeboom ◽  
Naomi van der Linden ◽  
Cees Lucas
Keyword(s):  
Nurse Practitioners ◽  
Patient Flow

scholarly journals The impact on patient flow after the integration of nurse practitioners and physician assistants in 6 Ontario emergency departments

CJEM ◽  
2009 ◽  
Vol 11 (05) ◽  
pp. 455-461 ◽  
Author(s):  
James Ducharme ◽  
Robert J. Alder ◽  
Cindy Pelletier ◽  
Don Murray ◽  
Joshua Tepper
Keyword(s):  
Health Care ◽  
Nurse Practitioners ◽  
Emergency Departments ◽  
Patient Flow ◽  
Physician Assistants ◽  
Wait Times ◽  
Care Providers ◽  
Lengths Of Stay ◽  
Left Without Being Seen ◽  
The Impact

ABSTRACT Objective: We sought to assess the impact of the integration of the new roles of primary health care nurse practitioners (NPs) and physician assistants (PAs) on patient flow, wait times and proportions of patients who left without being seen in 6 Ontario emergency departments (EDs). Methods: We performed a retrospective review of health records data on patient arrival time, time of initial assessment by a physician, time of discharge from the ED and discharge status. Results: Whether a PA or NP was directly involved in the care of patients or indirectly involved by being on duty, the wait times, lengths of stay and proportion of patients who left without being seen were significantly reduced. When a PA or NP were directly involved in patients' care, patients were 1.6 (95% confidence interval [CI] 1.3–2.1, p &lt; 0.05) and 2.1 (95% CI 1.6–2.8, p &lt; 0.05) times more likely to be seen within the wait time benchmarks, respectively. Lengths of stay were 30.3% (95% CI 21.6%–39.0%, p &lt; 0.01) and 48.8% (95% CI 35.0%–62.7%, p &lt; 0.01) lower when PAs and NPs, respectively, were involved. When PAs and NPs were not on duty, the proportion of patients who left without being seen were 44% (95% CI 31%–63%, p &lt; 0.01) and 71% (95% CI 53%–96%, p &lt; 0.05), respectively. Conclusion: The addition of PAs or NPs to the ED team can improve patient flow in medium-sized community hospital EDs. Given the ongoing shortage of physicians, use of alternative health care providers should be considered. These results require validation, as their generalizability to other locations or types of EDs is not known.

PP19 Primary care streaming in emergency departments- contexts and mechanisms associated with perceived effectiveness outcomes: a realist evaluation

2021 ◽  
Vol 38 (9) ◽  
pp. A9.1-A9
Author(s):  
Michelle Edwards ◽  
Alison Cooper ◽  
Freya Davies ◽  
Andrew Carson Stevens ◽  
Adrian Edwards ◽  
...  
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Emergency Departments ◽  
Patient Flow ◽  
Care Service ◽  
Realist Evaluation ◽  
Primary Care Service ◽  
Evaluation Methodology ◽  
Service Development ◽  
Service Models

BackgroundRecent policy has encouraged emergency departments (EDs) to deploy nurses to stream patients from the ED front door to GPs working in a separate GP service operating within or alongside an ED. We aimed to describe mechanisms relating to effectiveness of streaming in different primary care service models identified in EDs. We explored perceptions of whether patients were perceived to be appropriately streamed to emergency care, primary care, other hospital services or community primary care services; and effects on patient flow (waiting times and length of stay in the ED); and safe streaming outcomes.MethodsWe used realist evaluation methodology to explore perceived streaming effectiveness. We visited 13 EDs with different primary care service models (purposively selected across England & Wales; 8 streamed primary care patients to a primary care clinician) and carried out observations of triage/streaming and patient flow and interviews with key members of staff (consultants, GPs, nurses). Field notes and audio-recorded interviews were transcribed and analysed by creating context, mechanism and outcome configurations to refine and develop theories relating to streaming effectiveness.ResultsWe identified five contexts (nurses’ knowledge and experience, streaming guidance, teamwork and communication, operational management and strategic management) that facilitated mechanisms that influenced the effectiveness of streaming (streaming to an appropriate service, patient flow, delivering safe care). We integrated a middle range psychological theory (cognitive continuum theory) with our findings to recommend a focus for training nurses in streaming and service improvements.ConclusionsWe identified key mechanisms relating to the effectiveness of primary care streaming in different models of service. We recommend a collaborative approach to service development, guidance and training (including input from ED clinicians and primary care clinicians) and a range of training strategies that are suitable for less experienced junior nurses and more experienced senior nurses and nurse practitioners.

Simulating Difficult Nurse Patient Relationships

2012 ◽  
pp. 141-156
Author(s):  
Peter Kandlbinder ◽  
Scott Brunero
Keyword(s):  
Mental Illness ◽  
General Hospital ◽  
Design Process ◽  
Nursing Staff ◽  
Low Cost ◽  
Hospital Setting ◽  
Improve Patient Care ◽  
Patient Behaviour ◽  
Patient Relationships ◽  
Improve Patient

Difficult nurse-patient relationships are an area where general nurses can improve their knowledge, confidence and skill. This chapter describes a user-centred approach used to create a low-cost e-simulation of a commonly occurring case of manipulative patient behaviour. This e-simulation required nurses to focus on specific problems, gain understanding about the possible causes, and use empathetic understanding of what was needed to improve patient care. Specific examples from our experience of including nurses from the very beginning of the design process illustrate how everyday technology can provide an authentic experience of difficult nurse-patient behaviours to prepare general nursing staff who are facing a higher incidence of mental illness in patients that are now in the general hospital setting.

35 Online randomised controlled trial to improve clinical estimates of survival (ORACLES): study design

2018 ◽  
Vol 8 (3) ◽  
pp. 373.1-373 ◽  
Author(s):  
Linda Oostendorp ◽  
Nicola White ◽  
Priscilla Harries ◽  
Sarah Yardley ◽  
Christopher Tomlinson ◽  
...  
Keyword(s):  
Palliative Care ◽  
Medical Students ◽  
Randomised Controlled Trial ◽  
Care Pathway ◽  
Low Cost ◽  
Controlled Trial ◽  
Online Training ◽  
List Type ◽  
More Care ◽  
Randomised Controlled

IntroductionClinicians often struggle to recognise whether palliative care patients are imminently dying.1 2 A previous study identified the factors that expert palliative care doctors (with demonstrated prognostic skills) had used to judge the probability of patients dying within 72 hours.Aim and methodsTo evaluate whether an online training resource can teach medical students to formulate survival estimates for palliative care patients that are more similar to experts’ estimates. In this online randomised controlled trial we will recruit 128 students in the penultimate/final year of medical school. Participants are asked to review three series of vignettes describing patients referred to palliative care and provide estimates (0%–100%) about the probability that patients will die within 72 hours. After the first series of vignettes students in the intervention arm are given access to the training resource showing how experts weighted the various symptoms/signs. Participants are asked to complete a second series of vignettes and then a third series after two weeks to assess if any effect has been maintained.ResultsStudents’ survival estimates will be correlated with experts’ estimates to determine the baseline level of agreement and any changes following the intervention. The primary outcome will be the survival estimates provided in the second series of vignettes. Secondary outcomes include the estimates provided at the follow-up the weighting of symptoms/signs and levels of discrimination and consistency.ConclusionThis study will provide evidence about whether a brief low-cost online training resource can influence how medical students make prognostic decisions in an experimental setting.References. Neuberger J. More care less pathway: A review of the liverpool care pathway.Department of Health2013. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/212450/Liverpool_Care_Pathway.pdf [Accessed: 30thMay 2018]. White N, Reid F, Harris A, Harries P, Stone P. A systematic review of predictions of survival in palliative care: How accurate are clinicians and who are the experts?PLoS One25 August 2016;11(8):e0161407. Available from: http://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0161407&type=printable [Accessed: 30th May 2018]

scholarly journals Emergency department resource optimisation for improved performance: a review

2019 ◽  
Vol 15 (S1) ◽  
pp. 253-266 ◽  
Author(s):  
Kazi Badrul Ahsan ◽  
M. R. Alam ◽  
Doug Gordon Morel ◽  
M. A. Karim
Keyword(s):  
Nurse Practitioners ◽  
Patient Flow ◽  
Demand Management ◽  
Discrete Event ◽  
Healthcare Services ◽  
Models Of Care ◽  
Analytical Models ◽  
Fast Tracking ◽  
Advantages And Disadvantages ◽  
Modelling Techniques

AbstractEmergency departments (EDs) have been becoming increasingly congested due to the combined impacts of growing demand, access block and increased clinical capability of the EDs. This congestion has known to have adverse impacts on the performance of the healthcare services. Attempts to overcome with this challenge have focussed largely on the demand management and the application of system wide process targets such as the “four-hour rule” intended to deal with access blocks. In addition, EDs have introduced various strategies such as “fast tracking”, “enhanced triage” and new models of care such as introducing nurse practitioners aimed at improving throughput. However, most of these practices require additional resources. Some researchers attempted to optimise the resources using various optimisation models to ensure best utilisation of resources to improve patient flow. However, not all modelling approaches are suitable for all situations and there is no critical review of optimisation models used in hospital EDs. The aim of this article is to review various analytical models utilised to optimise ED resources for improved patient flow and highlight benefits and limitations of these models. A range of modelling techniques including agent-based modelling and simulation, discrete-event simulation, queuing models, simulation optimisation and mathematical modelling have been reviewed. The analysis revealed that every modelling approach and optimisation technique has some advantages and disadvantages and their application is also guided by the objectives. The complexity, interrelationships and variability of ED-related variables make the application of standard modelling techniques difficult. However, these models can be used to identify sources of flow obstruction and to identify areas where investments in additional resources are likely to have most benefit.

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