Ethnicity, Spatial Segregation and Length of Stay in Emergency Medicine Departments: The Case of Israel

The present paper examines the sources of disparities between Arabs and Jews and between residents of the periphery and residents of the urban center in the length of stay (LOS) in emergency departments (ED) in Israeli hospitals. Israel is a society where all residents are covered by National Health Insurance and have equal access to emergency medicine; thus, no disparities in emergency treatment are expected. Data were obtained from the 2015 “Survey of Satisfaction with Hospitalization in Emergency Medicine Departments” in Israel. The analysis reveals that LOS is considerably shorter for Arabs than for Jews and among residents of the periphery than residents of the urban center. After considering patterns of residential segregation (as well as socio-demographic attributes and indicators of the medical condition) and controlling for perceived waiting time (triage), the LOS disparity between Arabs and Jews vanishes. The findings lead to the conclusion that disparities in LOS in Israeli EDs do not stem from differential treatment by the medical staff but can be fully attributed to patterns of spatial segregation. Differential allocation of medical resources by the state to urban-center regions, compared to peripheral regions, seems to be the source of LOS disparities in emergency departments in Israeli hospitals.

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Effectiveness of Emergency Medicine Wards in reducing length of stay and overcrowding in emergency departments

International Emergency Nursing ◽

10.1016/j.ienj.2013.08.003 ◽

2014 ◽

Vol 22 (2) ◽

pp. 116-120 ◽

Cited By ~ 18

Author(s):

Shuk Man Lo ◽

Kenny Tze Ying Choi ◽

Eliza Mi Ling Wong ◽

Larry Lap Yip Lee ◽

Richard Sai Dat Yeung ◽

...

Keyword(s):

Emergency Medicine ◽

Length Of Stay ◽

Emergency Departments

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Predictive factors for prolonged hospitalisation in acute pyelonephritis patients admitted to the emergency medicine ward

Hong Kong Journal of Emergency Medicine ◽

10.1177/10249079211000976 ◽

2021 ◽

pp. 102490792110009

Author(s):

Howard Tat Chun Chan ◽

Ling Yan Leung ◽

Alex Kwok Keung Law ◽

Chi Hung Cheng ◽

Colin A Graham

Keyword(s):

Emergency Department ◽

Emergency Medicine ◽

Length Of Stay ◽

Acute Pyelonephritis ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Prolonged Length ◽

Reactive Protein ◽

Prolonged Hospital ◽

Emergency Medicine Ward

Background: Acute pyelonephritis is a bacterial infection of the upper urinary tract. Patients can be admitted to a variety of wards for treatment. However, at the Prince of Wales Hospital in Hong Kong, they are managed initially in the emergency medicine ward. The aim of the study is to identify the risk factors that are associated with a prolonged hospital length of stay. Methods: This was a retrospective cohort study conducted in Prince of Wales Hospital. The study recruited patients who were admitted to the emergency medicine ward between 1 January 2014 and 31 December 2017. These patients presented with clinical features of pyelonephritis, received antibiotic treatment and had a discharge diagnosis of pyelonephritis. The length of stay was measured and any length of stay over 72 h was considered to be prolonged. Results: There were 271 patients admitted to the emergency medicine ward, and 118 (44%) had a prolonged hospital length of stay. Univariate and multivariate analyses showed that the only statistically significant predictor of prolonged length of stay was a raised C-reactive protein (odds ratio 1.01; 95% confidence 1.01–1.02; p < 0.0001). Out of 271 patients, 261 received antibiotics in the emergency department. All 10 patients (8.5%) who did not receive antibiotics in emergency department had a prolonged length of stay (p = 0.0002). Conclusion: In this series of acute pyelonephritis treated in the emergency medicine ward, raised C-reactive protein levels were predictive for prolonged length of stay. Patients who did not receive antibiotics in the emergency department prior to emergency medicine ward admission had prolonged length of stay.

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P033: Procedural skills training in emergency medicine physicians within the Edmonton zone: a needs assessment

CJEM ◽

10.1017/cem.2020.240 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S76-S76

Author(s):

R. Schonnop ◽

B. Stauffer ◽

A. Gauri ◽

D. Ha

Keyword(s):

Emergency Medicine ◽

Emergency Departments ◽

Continuing Professional Development ◽

Skills Training ◽

Procedural Skill ◽

Cross Sectional Survey ◽

Procedural Skills ◽

Cross Sectional ◽

Health Region ◽

Perceived Importance

Introduction: Procedural skills are a key component of an emergency physician's practice. The Edmonton Zone is a health region that comprises twelve tertiary, urban community and rural community emergency departments (EDs) and represents over three hundred emergency physicians. This study describes the current attitudes toward procedural skill competency, current procedural skill practices, and the role for educational skills training sessions among emergency medicine physicians within a geographical health region. Methods: Multicenter descriptive cross-sectional survey of all emergency medicine physicians working at 12 emergency departments within the Edmonton Zone in 2019 (n = 274). The survey underwent several phases of systematic review; including item generation and reduction, pilot testing, and clinical sensibility testing. Survey items addressed current procedural skill performance frequency, perceived importance and confidence, current methods to maintain competence, barriers and facilitating factors to participation in a curriculum, preferred teaching methods, and desired frequency of practice for each procedural skill. Results: Survey response rate was 53.6%. Variability in frequency of performed procedures was apparent across the type of hospital sites. For majority of skills, there was a significantly positive correlation between the frequency at which a skill was performed and the perceived confidence performing said skill. There was inconsistency and no significant correlation with perceived importance, perceived confidence, or frequency performing a given skill and the desired frequency of training for that skill. Course availability (76.2%) and time (72.8%) are the most common identified barriers to participation in procedural skills training. Conclusion: This study summarized the current emergency department procedural skill practices and attitudes toward procedural skill competency and an educational curriculum among emergency medicine physicians in Edmonton. This represents a step towards targeted continuing professional development in the growing realm of competency-based medical education.

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Correlates of Length of Stay and Boarding in Florida Emergency Departments for Patients With Psychiatric Diagnoses

Psychiatric Services ◽

10.1176/appi.ps.201500283 ◽

2016 ◽

Vol 67 (11) ◽

pp. 1169-1174 ◽

Cited By ~ 10

Author(s):

Joseph L. Smith ◽

Alessandro S. De Nadai ◽

Eric A. Storch ◽

Barbara Langland-Orban ◽

Etienne Pracht ◽

...

Keyword(s):

Length Of Stay ◽

Emergency Departments ◽

Psychiatric Diagnoses

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Pediatric Emergency Medicine: A Developing Subspecialty

PEDIATRICS ◽

10.1542/peds.84.2.336 ◽

1989 ◽

Vol 84 (2) ◽

pp. 336-342

Author(s):

Marilyn Li ◽

M. Douglas Baker ◽

Leland J. Ropp

Keyword(s):

Emergency Medicine ◽

Emergency Care ◽

Emergency Departments ◽

Life Support ◽

Pediatric Emergency ◽

Advanced Trauma Life Support ◽

Full Time ◽

Pediatric Emergency Medicine ◽

Pediatric Hospitals ◽

Pediatric Emergency Care

Questionnaires were sent to 245 North American institutions with pediatric residency programs. There was a 69% response rate. Pediatric emergency care is provided in three types of facilities: emergency departments in pediatric hospitals, separate pediatric emergency departments or combined pediatric and adult emergency departments, in multidisciplinary hospitals. There are at least 262 pediatricians practicing full-time pediatric emergency medicine. The majority work in pediatric emergency departments, an average of 30.7 clinical hours per week. There are 27 pediatric emergency medicine programs with 46 fellows in training and 117 full-time positions available for emergency pediatricians throughout North America. Varying qualifications for these positions include board eligibility in pediatrics, certification in Basic Life Support or Advanced Trauma Life Support, and a fellowship in pediatric emergency medicine. The demonstrated need for pediatricians, preferably trained in emergency care, clearly indicates that pediatric emergency medicine is a rapidly developing subspecialty of Pediatrics that will be an attractive career choice for future pediatricians.

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Emergency medicine training demographics of physicians working in rural and regional southwestern Ontario emergency departments

CJEM ◽

10.1017/s1481803500015487 ◽

2007 ◽

Vol 9 (06) ◽

pp. 449-452 ◽

Cited By ~ 4

Author(s):

Munsif Bhimani ◽

Gordon Dickie ◽

Shelley McLeod ◽

Daniel Kim

Keyword(s):

Emergency Medicine ◽

Family Medicine ◽

Residency Training ◽

Emergency Departments ◽

Training Programs ◽

Family Physicians ◽

Demographic Information ◽

Trauma Resuscitation ◽

Curriculum Content

ABSTRACT Objectives: We sought to determine the emergency medicine training demographics of physicians working in rural and regional emergency departments (EDs) in southwestern Ontario. Methods: A confidential 8-item survey was mailed to ED chiefs in 32 community EDs in southwestern Ontario during the month of March 2005. This study was limited to nonacademic centres. Results: Responses were received from 25 (78.1%) of the surveyed EDs, and demographic information on 256 physicians working in those EDs was obtained. Of this total, 181 (70.1%) physicians had no formal emergency medicine (EM) training. Most were members of the College of Family Physicians of Canada (CCFPs). The minimum qualification to work in the surveyed EDs was a CCFP in 8 EDs (32.0%) and a CCFP with Advanced Cardiac and Trauma Resuscitation Courses (ACLS and ATLS) in 17 EDs (68.0%). None of the surveyed EDs required a CCFP(EM) or FRCP(EM) certification, even in population centres larger than 50 000. Conclusion: The majority of physicians working in southwestern Ontario community EDs graduated from family medicine residencies, and most have no formal EM training or certification. This information is of relevance to both family medicine and emergency medicine residency training programs. It should be considered in the determination of curriculum content and the appropriate number of residency positions.

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