scholarly journals Management of non-urgent paediatric emergency department attendances by GPs: a retrospective observational study

2020 ◽  
Vol 71 (702) ◽  
pp. e22-e30
Author(s):  
Simon Leigh ◽  
Bimal Mehta ◽  
Lillian Dummer ◽  
Harriet Aird ◽  
Sinead McSorley ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Services ◽  
Waiting Times ◽  
Cost Effective ◽  
Treatment Costs ◽  
Antibiotic Prescribing ◽  
North West ◽  
Manchester Triage System ◽  
Care Models ◽  
The Impact

BackgroundNon-urgent emergency department (ED) attendances are common among children. Primary care management may not only be more clinically appropriate, but may also improve patient experience and be more cost-effective.AimTo determine the impact on admissions, waiting times, antibiotic prescribing, and treatment costs of integrating a GP into a paediatric ED.Design and settingRetrospective cohort study explored non-urgent ED presentations in a paediatric ED in north-west England.MethodFrom 1 October 2015 to 30 September 2017, a GP was situated in the ED from 2.00 pm until 10.00 pm, 7 days a week. All children triaged as ‘green’ using the Manchester Triage System (non-urgent) were considered to be ‘GP appropriate’. In cases of GP non-availability, children considered non-urgent were managed by ED staff. Clinical and operational outcomes, as well as the healthcare costs of children managed by GPs and ED staff across the same timeframe over a 2-year period were compared.ResultsOf 115 000 children attending the ED over the study period, a complete set of data were available for 13 099 categorised as ‘GP appropriate’; of these, 8404 (64.2%) were managed by GPs and 4695 (35.8%) by ED staff. Median duration of ED stay was 39 min (interquartile range [IQR] 16–108 min) in the GP group and 165 min (IQR 104–222 min) in the ED group (P<0.001). Children in the GP group were less likely to be admitted as inpatients (odds ratio [OR] 0.16; 95% confidence interval [CI] = 0.13 to 0.20) and less likely to wait >4 hours before being admitted or discharged (OR 0.11; 95% CI = 0.08 to 0.13), but were more likely to receive antibiotics (OR 1.42; 95% CI = 1.27 to 1.58). Treatment costs were 18.4% lower in the group managed by the GP (P<0.0001).ConclusionGiven the rising demand for children’s emergency services, GP in ED care models may improve the management of non-urgent ED presentations. However, further research that incorporates causative study designs is required.

scholarly journals To GP or not to GP: a natural experiment in children triaged to see a GP in a tertiary paediatric emergency department (ED)

2017 ◽  
Vol 27 (7) ◽  
pp. 521-528 ◽  
Author(s):  
Laurie Smith ◽  
Yajur Narang ◽  
Ana Belen Ibarz Pavon ◽  
Karl Edwardson ◽  
Simon Bowers ◽  
...  
Keyword(s):  
Emergency Department ◽  
Natural Experiment ◽  
Care Pathway ◽  
Waiting Times ◽  
Sensitivity Analyses ◽  
Antibiotic Prescribing ◽  
Paediatric Hospital ◽  
Paediatric Emergency Department ◽  
Paediatric Emergency ◽  
The Impact

ObjectiveTo evaluate the impact of integrating a general practitioner (GP) into a tertiary paediatric emergency department (ED) on admissions, waiting times and antibiotic prescriptions.DesignRetrospective cohort study.SettingAlder Hey Children’s NHS Foundation Trust, a tertiary paediatric hospital in Liverpool, UK.ParticipantsFrom October 2014, a GP was colocated within the ED, from 14:00 to 22:00 hours, 7 days a week. Children triaged green on the Manchester Triage System without any comorbidities were classed as ‘GP appropriate’. The natural experiment compared patients triaged as ‘GP appropriate’ and able to be seen by a GP between 14:00 and 22:00 hours (GP group) to patients triaged as ‘GP appropriate’ seen outside of the hours when a GP was available (ED group). Intention-to-treat (ITT) analysis was used to assess the main outcomes.Results5223 patients were designated as ‘GP appropriate’—18.2% of the total attendances to the ED over the study period. There were 2821 (54%) in the GP group and 2402 (46%) in the ED group. The median duration of stay in the ED was 94 min (IQR 63–141) for the GP group compared with 113 min (IQR 70–167) for the ED group (p<0.0005). Using the ITT analysis equivalent, we demonstrated that the GP group were less likely to: be admitted to hospital (2.2% vs 6.5%, OR 0.32, 95% CI 0.24 to 0.44), wait longer than 4 hours (2.3% vs 5.1%, OR 0.45, 95% CI 0.33 to 0.61) or leave before being seen (3.1% vs 5.7%, OR 0.53, 95% CI 0.41 to 0.70), but more likely to receive antibiotics (26.1% vs 20.5%, OR 1.37, 95% CI 1.10 to 1.56). Sensitivity analyses yielded similar results.ConclusionsIntroducing a GP to a paediatric ED service can significantly reduce waiting times and admissions, but may lead to more antibiotic prescribing. This study demonstrates a novel, potentially more efficient ED care pathway in the current context of rising demand for children’s emergency services.

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.

Validating the primary provider theory in emergency medicine

2008 ◽  
Vol 21 (2) ◽  
pp. 120-130 ◽  
Author(s):  
Joseph S. Guarisco ◽  
Stefoni A. Bavin
Keyword(s):  
Emergency Department ◽  
Patient Satisfaction ◽  
Pay For Performance ◽  
Medical Center ◽  
Waiting Times ◽  
Emergency Department Visits ◽  
Business Success ◽  
Content Type ◽  
The Impact

PurposeThe purpose of this paper is to provide a case study testing the Primary Provider Theory proposed by Aragon that states that: disproportionate to any other variables, patient satisfaction is distinctly and primarily linked to physician behaviors and secondarily to waiting times.Design/methodology/approachThe case study began by creating incentives motivating physicians to reflect and improve behaviors (patient interactions) and practice patterns (workflow efficiency). The Press Ganey Emergency Department Survey was then utilized to track the impact of the incentive programs and to ascertain any relationship between patient satisfaction with the provider and global patient satisfaction with emergency department visits by measuring patient satisfaction over an eight quarter period.FindingsThe findings were two‐fold: firstly, the concept of “pay for performance” as a tool for physician motivation was valid; and secondly, the impact on global patient satisfaction by increases in patient satisfaction with the primary provider was significant and highly correlated, as proposed by Aragon.Practical implicationsThese findings can encourage hospitals and physician groups to place a high value on the performance of primary providers of patient care, provide incentives for appropriate provider behaviors through “pay for performance” programs and promote physician understanding of the links between global patient satisfaction with physician behaviors and business growth, malpractice reduction, and other key measures of business success.Originality/valueThere are no other case studies prior to this project validating the Primary Provider Theory in an urban medical center; this project adds to the validity and credibility of the theory in this setting.

scholarly journals Robust capacity planning for accident and emergency services

2020 ◽  
Vol 54 (6) ◽  
pp. 1757-1773
Author(s):  
Elvan Gökalp
Keyword(s):  
Capacity Planning ◽  
Emergency Services ◽  
Simulation Optimization ◽  
Patient Flow ◽  
Waiting Times ◽  
Model Parameters ◽  
Planning Problem ◽  
Accident And Emergency ◽  
Number Of Patients ◽  
The Impact

Accident and emergency departments (A&E) are the first place of contact for urgent and complex patients. These departments are subject to uncertainties due to the unplanned patient arrivals. After arrival to an A&E, patients are categorized by a triage nurse based on the urgency. The performance of an A&E is measured based on the number of patients waiting for more than a certain time to be treated. Due to the uncertainties affecting the patient flow, finding the optimum staff capacities while ensuring the performance targets is a complex problem. This paper proposes a robust-optimization based approximation for the patient waiting times in an A&E. We also develop a simulation optimization heuristic to solve this capacity planning problem. The performance of the approximation approach is then compared with that of the simulation optimization heuristic. Finally, the impact of model parameters on the performances of two approaches is investigated. The experiments show that the proposed approximation results in good enough solutions.

scholarly journals The Impact of the Lisbon Football Derby on the Profile of Emergency Department Admissions

2014 ◽  
Vol 27 (6) ◽  
pp. 700 ◽  
Author(s):  
André Almeida ◽  
Mónica Eusébio ◽  
Jaime Almeida ◽  
Matteo Boattini
Keyword(s):  
Emergency Department ◽  
Time Frame ◽  
Subsequent Increase ◽  
Manchester Triage System ◽  
Sports Events ◽  
Period Data ◽  
Global Increase ◽  
Time Frames ◽  
The Impact ◽  
Urgency Level

<p lang="en-US" style="margin-bottom: 0.35cm; line-height: 200%;" class="western"><span style="font-family: Arial,sans-serif;"><span style="font-size: small;"><strong>Background:</strong> Variations in emergency department admissions have been reported to happen as a result of major sports events. The work presented assessed changes in volume and urgency level of visits to a major Emergency Department in Lisbon during and after the city’s football derby.<br /><strong>Material and Methods:</strong> Volume of attendances and patient urgency level, according to the Manchester Triage System, were retrospectively analyzed for the 2008-2011 period. Data regarding 24-hour periods starting 45 minutes before kick-off was collected, along with data from similar periods on the corresponding weekdays in the previous years, to be used as controls. Data samples were organized according to time frame (during and after the match), urgency level, and paired accordingly.<br /><strong>Results: </strong>A total of 14 relevant periods (7 match and 7 non-match) were analyzed, corresponding to a total of 5861 admissions. During the match time frame, a 20.6% reduction (p = 0.06) in the total number of attendances was found when compared to non-match days. MTS urgency level sub-analysis only showed a statistically significant reduction (26.5%; p = 0.05) in less urgent admissions (triage levels green-blue). Compared to controls, post-match time frames showed a global increase in admissions (5.6%; p = 0.45), significant only when considering less urgent ones (18.9%; p = 0.05).<br /><strong>Discussion:</strong> A decrease in the total number of emergency department attendances occurred during the matches, followed by a subsequent increase in the following hours. These variations only reached significance among visits triaged green-blue.<br /><strong>Conclusion:</strong> During major sports events an overall decrease in emergency department admissions seems to take place, especially due to a drop in visits associated with less severe conditions.<br /><strong>Keywords:</strong> Emergency Service, Hospital; Triage; Sports; Soccer; Portugal.</span></span></p>

MARINE MONITORING: CHRONIC OR ACUTE PROBLEMS

1992 ◽  
Vol 32 (1) ◽  
pp. 413
Author(s):  
Peter Farrell ◽  
John Yeates
Keyword(s):  
Environmental Impact ◽  
Impact Assessment ◽  
Environmental Impact Assessment ◽  
Oil And Gas ◽  
Cost Effective ◽  
Scientific Validity ◽  
North West ◽  
Regulatory Authorities ◽  
Census Methods ◽  
The Impact

A mosaic-like compendium of information on the marine biotic environment of the North West Shelf has been compiled from a number of different sources. The areas most valued coincide with those most vulnerable to disturbance. Regulatory authorities require some form of impact assessment to be carried out by oil and gas explorers and producers as a condition of operation. Considerable expenditure is incurred annually by these companies in complying with these requirements, but current assessment methods do not always consider the scale of possible impacts nor the scientific validity of the results. Despite acceptance, and therefore implied approval of these assessments by the regulatory authorities, adjustments should be made to the current methodology to improve the cost effectiveness of the assessments and to improve the scientific validity of the results.Design of environmental impact assessment of exploration and production operations should consider the relative weighting given to potential acute versus chronic impacts. Prediction of possible impacts enables quantifiable relevant parameters for impact assessment to be identified. Monitoring of indicator species is a cost-effective method of detecting acute effects. Community census methods can be used to detect chronic effects.Statistical analysis of data is a vital, yet frequently ignored, aspect of environmental impact assessment, as is the depositing of voucher specimens for future reference. Statistical analysis can be based on either changes in the difference between specific parameters at the impact and control sites, or comparison of variance between sites over time. Decisions regarding sample area and number of sample replicates should be made based on the required precision of the assessment.

Hurricane Impact on Emergency Services and Use of Telehealth to Support Prehospital Care

2019 ◽  
Vol 14 (1) ◽  
pp. 39-43
Author(s):  
David M. French ◽  
Greg A. Hall ◽  
Todd McGeorge ◽  
Michael Haschker ◽  
Joseph G. Brazeal ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Management ◽  
Emergency Services ◽  
Health Care Systems ◽  
Prehospital Care ◽  
Storm Duration ◽  
Care Systems ◽  
Hurricane Impact ◽  
State And Local ◽  
The Impact

ABSTRACTThe impact of hurricanes on emergency services is well-known. Recent history demonstrates the need for prehospital and emergency department coordination to serve communities during evacuation, storm duration, and cleanup. The use of telehealth applications may enhance this coordination while lessening the impact on health-care systems. These applications can address triage, stabilization, and diversion and may be provided in collaboration with state and local emergency management operations through various shelters, as well as during other emergency medical responses.

scholarly journals Antibiotic prescribing in the paediatric emergency department and the impact of education

2014 ◽  
Vol 50 (11) ◽  
pp. 932-933 ◽  
Author(s):  
Despoina Gkentzi ◽  
Rohana Ramachandran ◽  
Elisabeth Day ◽  
Lazarus Anguvaa ◽  
Malcolm Borg ◽  
...  
Keyword(s):  
Emergency Department ◽  
Antibiotic Prescribing ◽  
Paediatric Emergency Department ◽  
Paediatric Emergency ◽  
The Impact

scholarly journals Improving patient waiting times and quality of care by arranging access to notes from a neighbouring trust

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S175-S176
Author(s):  
Georgios Basdanis ◽  
Cormac Fenton
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Quality Of Care ◽  
Median Time ◽  
Discharge Planning ◽  
Waiting Times ◽  
Clinical Information ◽  
North West ◽  
Time Required

AimsWe aim to improve waiting times in the Emergency Department and improve the overall quality of care of out-of-area patients by arranging for the liaison team to have access to the electronic notes system of a neighbouring trust.MethodSt Thomas’ Hospital is located in south London, right opposite the City of Westminster. As a result, approximately 20% of patients we see in mental health liaison are from that locality. Given that they belong to a different trust, we do not have access to their notes, which leads to a delay in trying to establish whether they are known to local mental health services. Often, staff are reluctant to divulge information. When information is shared, it is often late and/or incomplete. We approached the Chief Clinical Information Officer and Head of Information Governance from Central and North West London (CNWL) NHS Foundation Trust. We held weekly meetings which included both IT departments. Our IT had to install the electronic notes application (SystmOne) on our computers and open relevant firewall ports. The information is access through an NHS Smartcard, therefore CNWL had to authorise read-only Smartcard profiles for every member of the liaison team. A quick reference guide was created for all staff that would be using the new application. The system went live on 21 January 2021.ResultWe audited patient outcomes in December 2020 and February 2021 for initial comparison. In December 2020, the median time from referral to discharge was 6 hours 35 minutes. 25% of patients were admitted and 17% discharged with HTT. In February 2021, the median time from referral to discharge was 3 hours 19 minutes. 16% of patients were admitted and 5% discharged with HTT.ConclusionIt is likely that by reducing the time required for collateral information, overall waiting times in the emergency department will be reduced. Clinicians are likely to feel more confident in their discharge planning if they have access to all clinical notes and previous risk assessments, which might in turn reduce referrals to HTT or admission. There should be further attempts by neighbouring NHS trusts, especially in London, to ensure access to their electronic notes system in order to reduce waiting times and improve the quality of patient care. We have already been approached for more information by a trust in North London who are interested in establishing access to a neighbouring trust's notes.

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