scholarly journals The impact of Coronavirus disease 19 on emergency volume in Northern Taiwan

2021 ◽  
Keyword(s):  
Emergency Department ◽  
Medical Staff ◽  
Geographical Location ◽  
Significant Decline ◽  
Chang Gung Memorial Hospital ◽  
Triage Category ◽  
Pandemic Planning ◽  
Before And After ◽  
The Impact ◽  
Northern Taiwan

The coronavirus disease 2019 (COVID-19) has changed the way communities and groups use the emergency department (ED). The purpose of this study is to evaluate changes in ED volume for different triage categories in three tertiary Chang Gung Memorial Hospital branches in Northern Taiwan before and after the spread of COVID-19. A decline of ED volume of about 20 to 25 percent was observed for all three branches during the study period. Statistically significant decline in total ED volume in all triage categories across the three branches was observed except triage category 1 for Keelung and triage category 5 for Linko. These exceptions were most likely due to the geographical location and proximity to other hospitals. The trends observed in this study regarding ED use during the COVID-19 pandemic period could better prepare resource management in hospitals, allocate medical staff, and may guide future pandemic planning.

scholarly journals P139: The impact of a pancreatitis admission algorithm on emergency department length of stay in a tertiary care academic hospital

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S114-S115
Author(s):  
A. Albina ◽  
F. Kegel ◽  
F. Dankoff ◽  
G. Clark
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Tertiary Care ◽  
Physician Satisfaction ◽  
Academic Hospital ◽  
Before And After ◽  
Potential Applicability ◽  
The Mean ◽  
Algorithm Implementation ◽  
The Impact

Background: Emergency department (ED) overcrowding is associated with a broad spectrum of poor medical outcomes, including medical errors, mortality, higher rates of leaving without being seen, and reduced patient and physician satisfaction. The largest contributor to overcrowding is access block – the inability of admitted patients to access in-patient beds from the ED. One component to addressing access block involves streamlining the decision process to rapidly determine which hospital service will admit the patient. Aim Statement: As of Sep 2011, admission algorithms at our institution were supported and formalised. The pancreatitis algorithm clarified whether general surgery or internal medicine would admit ED patients with pancreatitis. We hypothesize that this prior uncertainty delayed the admission decision and prolonged ED length of stay (LOS) for patients with pancreatitis. Our project evaluates whether implementing a pancreatitis admission algorithm at our institution reduced ED time to disposition (TTD) and LOS. Measures & Design: A retrospective review was conducted in a tertiary care academic hospital in Montreal for all adult ED patients diagnosed with pancreatitis from Apr 2010 to Mar 2014. The data was used to plot separate run charts for ED TTD and LOS. Serial measurements of each outcome were used to monitor change and evaluate for special cause variation. The mean ED LOS and TTD before and after algorithm implementation were also compared using the Student's t test. Evaluation/Results: Over four years, a total of 365 ED patients were diagnosed with pancreatitis and 287 (79%) were admitted. The mean ED LOS for patients with pancreatitis decreased following the implementation of an admission algorithm (1616 vs. 1418 mins, p = 0.05). The mean ED TTD was also reduced (1171 vs. 899 mins, p = 0.0006). A non-random signal of change was suggested by a shift above the median prior to algorithm implementation and one below the median following. Discussion/Impact: This project demonstrates that in a busy tertiary care academic hospital, an admission algorithm helped reduce ED TTD and LOS for patients with pancreatitis. This proves especially valuable when considering the potential applicability of such algorithms to other disease processes, such as gastrointestinal bleeding and congestive heart failure, among others. Future studies demonstrating this external applicability, and the impact of such decision algorithms on physician decision fatigue and within non-academic institutions, proves warranted.

Establishment of a multidisciplinary concussion program: impact of standardization on patient care and resource utilization

2014 ◽  
Vol 13 (1) ◽  
pp. 82-89 ◽  
Author(s):  
Sara Anne Wilkins ◽  
Chevis N. Shannon ◽  
Steven T. Brown ◽  
E. Haley Vance ◽  
Drew Ferguson ◽  
...  
Keyword(s):  
Emergency Department ◽  
Retrospective Study ◽  
Resource Utilization ◽  
Media Coverage ◽  
Public Awareness ◽  
Return To Play ◽  
Management Protocol ◽  
Before And After ◽  
Multiple Variables ◽  
The Impact

Object Recent legislation and media coverage have heightened awareness of concussion in youth sports. Previous work by the authors' group defined significant variation of care in management of children with concussion. To address this variation, a multidisciplinary concussion program was established based on a uniform management protocol, with emphasis on community outreach via traditional media sources and the Internet. This retrospective study evaluates the impact of standardization of concussion care and resource utilization before and after standardization in a large regional pediatric hospital center. Methods This retrospective study included all patients younger than 18 years of age evaluated for sports-related concussion between January 1, 2007, and December 31, 2011. Emergency department, sports medicine, and neurosurgery records were reviewed. Data collected included demographics, injury details, clinical course, Sports Concussion Assessment Tool-2 (SCAT2) scores, imaging, discharge instructions, and referral for specialty care. The cohort was analyzed comparing patients evaluated before and after standardization of care. Results Five hundred eighty-nine patients were identified, including 270 before standardization (2007–2011) and 319 after standardization (2011–2012). Statistically significant differences (p < 0.0001) were observed between the 2 groups for multiple variables: there were more girls, more first-time concussions, fewer initial presentations to the emergency department, more consistent administration of the SCAT2, and more consistent supervision of return to play and return to think after adoption of the protocol. Conclusions A combination of increased public awareness and legislation has led to a 5-fold increase in the number of youth athletes presenting for concussion evaluation at the authors' center. Establishment of a multidisciplinary clinic with a standardized protocol resulted in significantly decreased institutional resource utilization and more consistent concussion care for this growing patient population.

scholarly journals Admission Decisions Made by Emergency Physicians Can Reduce the Emergency Department Length of Stay for Medical Patients

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Yuri Choi ◽  
Jinwoo Jeong ◽  
Byoung-Gwon Kim
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Policy Change ◽  
Control Period ◽  
Medical Patients ◽  
Emergency Physicians ◽  
Before And After ◽  
Negative Effect ◽  
Admission Decisions ◽  
The Impact

Background. Emergency department (ED) overcrowding is a worldwide problem that poses a threat to patient safety by causing treatment delays and increasing mortality. Consultations are common and important in the emergency medicine profession and are associated with longer ED length of stay (LOS). The purpose of this study was to evaluate the impact of admission decisions by emergency physicians without consultations on the ED LOS and other quality indicators. Methods. The study was a retrospective observational study comparing the ED LOS of patients admitted to the internal medicine (IM) department before and after the policy change regarding admission decisions that was implemented in October 2016. During and after the policy change, emergency physicians decided how to arrange for and treat medical patients by processing their admission and providing follow-up care without consultations. The ED LOS and other indicators of patients admitted to the IM department were compared between the study period (January to June 2017) and the control period (January to June 2016). Results. The median ED LOS of patients admitted to the IM department decreased from 673 (IQR: 347–1,369) minutes in the control period to 237 (IQR: 166–364) minutes in the study period. There were no significant differences in the interdepartmental transfer rate or in-hospital mortality between the two periods. Conclusions. The admission decisions regarding medical patients made by emergency physicians without specialty consultations reduced the ED LOS without a significant negative effect on mortality or hospital LOS.

scholarly journals The impact of computerized provider order entry on emergency department flow

CJEM ◽  
2016 ◽  
Vol 18 (4) ◽  
pp. 264-269 ◽  
Author(s):  
Andrew Gray ◽  
Christopher M.B. Fernandes ◽  
Kristine Van Aarsen ◽  
Melanie Columbus
Keyword(s):  
Emergency Department ◽  
Patient Safety ◽  
Improve Patient Safety ◽  
Patient Flow ◽  
Wait Time ◽  
Order Entry ◽  
Computerized Provider Order Entry ◽  
Left Without Being Seen ◽  
Before And After ◽  
The Impact

AbstractObjectivesComputerized provider order entry (CPOE) has been established as a method to improve patient safety by avoiding medication errors; however, its effect on emergency department (ED) flow remains undefined. We examined the impact of CPOE implementation on three measures of ED throughput: wait time (WT), length of stay (LOS), and the proportion of patients that left without being seen (LWBS).MethodsWe conducted a retrospective cohort study of all ED patients of 18 years and older presenting to London Health Sciences Centre during July and August 2013 and 2014, before and after implementation of a CPOE system. The three primary variables were compared between time periods. Subgroup analyses were also conducted within each Canadian Triage and Acuity Scale (CTAS) level (1–5) individually, as well as for admitted patients only.ResultsA significant increase in WT of 5 minutes (p=0.036) and LOS of 10 minutes (p=0.001), and an increase in LWBS from 7.2% to 8.1% (p=0.002) was seen after CPOE implementation. Admitted patients’ LOS increased by 63 minutes (p<0.001), the WT of CTAS 3 and 5 patients increased by 6 minutes (p=0.001) and 39 minutes (p=0.005), and LWBS proportion increased significantly for CTAS 3–5 patients, from 24.3% to 42.0% (p<0.001) for CTAS 5 patients specifically.ConclusionsCPOE implementation detrimentally impacted all patient flow throughput measures that we examined. The most striking clinically relevant result was the increase in LOS of 63 minutes for admitted patients. This raises the question as to whether the potential detrimental effects to patient safety of CPOE implementation outweigh its benefits.

scholarly journals Impacts of school closure due to COVID-19 on the mobility trend of Japanese citizens

2021 ◽  
Author(s):  
Nguyen Hai Nam ◽  
Anh PN Nguyen ◽  
Bao-Tran Do Le ◽  
Abdelrahman Gamil Gad ◽  
Abdelrahman Sherif Mohamed Abdelnae Abdalla ◽  
...  
Keyword(s):  
Control Measure ◽  
Significant Decline ◽  
School Closure ◽  
After School ◽  
Median Percentage ◽  
Before And After ◽  
Before School ◽  
The Moment ◽  
The Impact ◽  
Staying At Home

School closure was the only main control measure that Japan took into action from late February to late March in 2020. Accurate evaluation of how Japanese citizens responded to the impact of school closure remains a challenge. Data from the Google COVID-19 Community Mobility Report was used to analyze the mobility trend of Japanese citizens regarding six categories, including retail and recreation, grocery and pharmacy, parks, transit stations, workplace, and residential. The median percentage of mobility in all 47 prefectures of Japan was calculated during five periods of time, including one week before school closure, one week, two weeks, three weeks, and four weeks after school closure. There was a significant decline in the mobility trend of transit stations, grocery and pharmacy, parks, retail and recreation, and workplace at the moment after school closure compared to the prior period. Inversely, the mobility trend in staying at home remarkably increased following the implementation of school closure. Our study determined a significant change in the mobility trend of Japanese citizens before and after school closure. These data reflected the responsibility and the consciousness of Japanese citizens in mitigating COVID-19.

scholarly journals The Impact of the “Muslim Ban” Executive Order on Healthcare Utilization in Minneapolis-St. Paul, Minnesota

2020 ◽  
Author(s):  
Elizabeth A. Samuels ◽  
Lilla Orr ◽  
Elizabeth B. White ◽  
Altaf Saadi ◽  
Aasim I. Padela ◽  
...  
Keyword(s):  
United States ◽  
Primary Care ◽  
Emergency Department ◽  
Healthcare Utilization ◽  
The United States ◽  
Emergency Department Visits ◽  
Executive Order ◽  
Before And After ◽  
Muslim Majority ◽  
The Impact

AbstractObjectiveDetermine whether the 2017 “Muslim Ban” Executive Order impacted healthcare utilization by people born in Order-targeted nations living in the United States.MethodsWe conducted a retrospective cohort study of people living in Minneapolis-St. Paul, MN in 2016-2017 who were: 1) born in Order-targeted nations, 2) born in Muslim-majority nations not listed in the Order, and 3) born in the United States and non-Latinx. Primary outcomes were: 1) primary care visits, 2) missed primary care appointments, 3) primary care diagnoses for stress-responsive conditions, 4) emergency department visits, and 5) emergency department visits for stress-responsive diagnoses. We evaluated visit trends before and after Order issuance using linear regression and differences between study groups using a difference-in-difference analyses.ResultsIn early 2016, primary care visits and stress-responsive diagnoses increased among individuals from Muslim majority nations. Following the Order, there was an immediate increase in emergency department visits among individuals from Order-targeted nations.ConclusionsIncreases in healthcare utilization among people born in Muslim majority countries before and after the “Muslim Ban” likely reflect elevated cumulative stress including the impact of the Order.

scholarly journals Development of the Concept of Circular Supply Chain Management—A Systematic Review

Processes ◽  
2021 ◽  
Vol 9 (10) ◽  
pp. 1740
Author(s):  
Péter Lengyel ◽  
Attila Bai ◽  
Zoltán Gabnai ◽  
Othman Mohammad Ahmed Mustafa ◽  
Péter Balogh ◽  
...  
Keyword(s):  
Systematic Review ◽  
Supply Chain ◽  
Supply Chain Management ◽  
Geographical Location ◽  
Systematic Analysis ◽  
Chain Management ◽  
Subject Characteristic ◽  
Before And After ◽  
Number Of Publications ◽  
The Impact

This systematic review presents the most important characteristics and trends of research in circular supply chain management (CSCM), taking into account the impact of COVID. In addition, the similarities and differences between the basic concepts often used as synonyms for sustainability are also presented. First, the sample database (39,000 records) was based on a search containing publications’ titles regarding supply chain management (SCM). After narrowing the topic from SCM towards CSCM, the considered paper characteristics were expanded, including abstract and author keywords, to get a manageable number of samples for the systematic analysis (6095 documents) and the most accurate results possible. The analysis’ base sample was divided into two periods (before and after 2012) due to a significant increase and change in the number of publications, their subject, characteristic journals and geographical location. Sustainability has emerged since 2012, while a circular approach emerged after 2017 with a significant share of research, mainly thanks to relevant EU policies. Although the role of the US has been decisive in the field, the European research bases of previous years have increasingly been replaced by Far Eastern dominance. Currently, CSCM’s most important journal is the International Journal of Supply Chain Management (Elsevier), but most articles on the impact of COVID have been published in Sustainability (MDPI). More effective policy implementation and the fight against COVID in the development of supply chains are also likely to spread the circular economic model in the future.

scholarly journals Multimorbidity Clustering of the Emergency Department Patient Flow: Impact Analysis of New Unscheduled Care Clinics

2020 ◽  
Author(s):  
Adrien Wartelle ◽  
Farah Mourad-Chehade ◽  
Farouk Yalaoui ◽  
Hélène Questiaux ◽  
Thomas Monneret ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Departments ◽  
Patient Flow ◽  
Temporal Trends ◽  
Healthcare Delivery ◽  
Period Effect ◽  
Care Services ◽  
Unscheduled Care ◽  
Before And After ◽  
The Impact

Abstract Background: In France, the number of admissions to emergency departments doubled between 1996 and 2016, leading to overcrowding. To cope with the resultant overcrowding, redirecting patients to new healthcare services is a viable solution, to spread demand more evenly across available healthcare delivery points, and render care more efficient. The goal of this study was to analyse the impact of opening new unscheduled care services on variations in patient attendance at a large emergency department. Methods: We performed a before-and-after study investigating the use of unscheduled care services in the Aube Department (Eastern France), focusing on emergency department attendance of Troyes Hospital. We applied a hierarchical clustering based on co-occurrence of diagnoses, to divide the population into different multimorbidity profiles and study their temporal trends. A multivariate logistic regression model was constructed to adjust the period effect for appropriate confounders. Results: In total, 120,718 visits to the emergency department were recorded over a 24-month period (2018-2019), and 14 clusters were identified accounting for 94.76% of all visits. The before-and-after analysis showed a decrease of 57.95 visits per week in 7 specific clusters, while the consumption of unscheduled health care services increased by 328.12 visits per week.Conclusions: Using an innovative and reliable methodology to evaluate changes in patient flow through the emergency department, our results could help to inform public health policy regarding the implementation of unscheduled care services, to ease pressure on emergency departments.

scholarly journals Improving emergency department efficiency by patient streaming to outcomes-based teams

2007 ◽  
Vol 31 (1) ◽  
pp. 16 ◽  
Author(s):  
Anne-Maree Kelly ◽  
Michael Bryant ◽  
Lisa Cox ◽  
Damien Jolley
Keyword(s):  
Emergency Department ◽  
Task Analysis ◽  
Waiting Times ◽  
Time Data ◽  
Lean Thinking ◽  
Process Redesign ◽  
Median Increase ◽  
Triage Category ◽  
Before And After ◽  
Before And After Study

Objective: To describe the process and results of a process redesign based on task analysis and lean thinking approaches aimed at improving emergency department (ED) efficiency. Methods: Before-and-after study comparing 12- month periods before and after the process redesign for total episodes of ambulance bypass, waiting times (overall and by triage category) and total ED time (overall and by triage category). Time data were analysed using non-parametric methods. Results: The years were broadly comparable, with the exception that there was an 8.4% increase in total hours of care delivered (a marker of ED workload) in the year after the change. Episodes of ambulance bypass reduced by 55% (120 v 54). There were statistically significant waiting times reductions for triage categories 3 and 5 (median reductions 5 and 11 minutes respectively). There was an increase in total ED time for triage category 3 (median increase 7 min) and a decrease for categories 4 and 5 (median reduction 14 and 18 min, respectively). Conclusion: ED process redesign based on task analysis and lean thinking approaches can result in improved ED efficiency.

Privileging pharmacists improves time to patient notification in the microbiological test review process for patients discharged from the emergency department

2020 ◽  
Vol 77 (Supplement_1) ◽  
pp. S19-S24
Author(s):  
Steven M Loborec ◽  
Jose A Bazan ◽  
Nicole V Brown ◽  
Mary Beth Shirk ◽  
Trisha A Jordan
Keyword(s):  
Emergency Department ◽  
Medical Center ◽  
Academic Medical Center ◽  
Test Results ◽  
Infectious Disease Physician ◽  
Microbiological Test ◽  
Test Review ◽  
Academic Medical ◽  
Before And After ◽  
The Impact

Abstract Purpose Results of a study evaluating the impact of privileging pharmacists to manage microbiologic test results for patients discharged from the emergency department (ED) are reported. Methods This was a single-center, retrospective pre-post study that was conducted at an urban academic medical center. Patients discharged from the ED with a subsequent positive microbiologic test result before and after privileging of an ED specialty practice pharmacist (ED-SPP) to manage the results independently were screened for inclusion. Time to patient notification of a required change in antimicrobial therapy was compared between groups. Numbers of erroneous interventions before and after pharmacist privileging were compared to assess the safety of implementation. Results One hundred seventy-eight positive microbiologic test results (n = 92 pre- and n = 86 postimplementation) were included. The median time to patient notification in the pre-implementation group was 23.6 hours (range, 12.4-93 hours) and in the postimplementation group was 14.9 hours (range, 2.5-27.9 hours; P = 0.0023). As determined by the board-certified infectious disease physician, 1.1% of reviewed microbiologic test results (1 of 92) was erroneous prior to implementation of pharmacist privileging compared with 2.3% (2 of 86) after implementation (P = 0.6105). Conclusion Privileging ED-SPPs to assess microbiologic test results improved the time to patient notification with no statistical difference in the number of erroneous interventions between groups. These findings demonstrate the benefit of clinical privileging and provide support for expansion of this role to other ED-SPPs.

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