scholarly journals Applying quality improvement principles to improve accident and emergency department overcrowding and flow in Rwanda: a case study

2015 ◽  
Vol 4 (5) ◽  
pp. 47 ◽  
Author(s):  
Jean Claude Byiringiro ◽  
Rex Wong ◽  
Caroline Davis ◽  
Jeffery Williams ◽  
Joseph Becker ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Success Factors ◽  
Low Cost ◽  
Post Intervention ◽  
Triage System ◽  
Accident And Emergency ◽  
Number Of Patients ◽  
Accident And Emergency Department ◽  
The Impact

Few case studies exist related to hospital accident and emergency department (A&E) quality improvement efforts in lowerresourced settings. We sought to report the impact of quality improvement principles applied to A&E overcrowding and flow in the largest referral and teaching hospital in Rwanda. A pre- and post-intervention study was conducted. A linked set of strategies included reallocating room space based on patient/visitor demand and flow, redirecting traffic, establishing a patient triage system and installing white boards to facilitate communication. Two months post-implementation, the average number of patients boarding in the A&E hallways significantly decreased from 28 (pre-intervention) to zero (post-intervention), p < .001. Foot traffic per dayshift hour significantly decreased from 221 people to 160 people (28%, p < .001), and non-A&E related foot traffic decreased from 81.4% to 36.3% (45% decrease, p < .001). One hundred percent of the A&E patients have been formally triaged since the implementation of the newly established triage system. Our project used quality improvement principles to reduce the number of patients boarding in the hallways and to decrease unnecessary foot traffic in the A&E department with little investment from the hospital. Key success factors included a collaborative multidisciplinary project team, strong internal champions, data-driven analysis, evidence-based interventions, senior leadership support, and rapid application of initial implementation learnings. Results to date show the application of quality improvement principles can help hospitals in resource-limited settings improve quality of care at relatively low cost.

Road Traffic Accident Related Morbidity as Seen in an Accident and Emergency Department

1981 ◽  
Vol 26 (2) ◽  
pp. 121-124 ◽  
Author(s):  
D. J. Galloway ◽  
A. R. Patel
Keyword(s):  
Emergency Department ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Young Male ◽  
Education Programme ◽  
Small Sample ◽  
Accident And Emergency ◽  
Number Of Patients ◽  
Accident And Emergency Department ◽  
Serious Injuries

This paper describes some of the findings of a prospective study of victims of road traffic accidents arriving at the Western Infirmary's Accident and Emergency Department over a period of 12 months. More than half the accidents occurred during leisure hours thus likely to stretch the resources of the hospital services. More than a third of the total number of patients were young male drivers. Serious injuries were significantly more often sustained among pedestrians who were often older. Victims of motor-cycle accidents less often escaped serious injuries. Blood ethanol studies on a small sample suggested that male pedestrians were often highly intoxicated. A public health education programme is regarded as a primary measure in preventing a large proportion of serious morbidity and mortality especially amongst pedestrians.

Cardiology referrals before and during the COVID-19 pandemic: a health service evaluation

2021 ◽  
pp. 1-6
Author(s):  
Chun Shing Kwok ◽  
Jessica Bennett ◽  
Sonia Curry ◽  
Debbie Jackson ◽  
Hayley Burke ◽  
...  
Keyword(s):  
Emergency Department ◽  
Healthcare Services ◽  
Tertiary Hospital ◽  
Service Evaluation ◽  
University Hospital ◽  
Accident And Emergency ◽  
Cardiac Assessment ◽  
Accident And Emergency Department ◽  
The Impact ◽  
Health Service Evaluation

Background/Aims The COVID-19 pandemic has resulted in unprecedented changes to healthcare services. This study aimed to evaluate the impact of the COVID-19 pandemic on referrals to cardiology services in a tertiary hospital. Methods Royal Stoke University Hospital has a cardiac assessment nurse team that provides rapid access to specialist cardiology opinion. All referrals are recorded on a database, which was used to determine how COVID-19 affected the number and types of referrals to cardiology during March–September 2019 and March–September 2020. Results A total of 12 447 referrals were made to the cardiac assessment nurse teams over the evaluation period. Compared to the average number of referrals across all months, there was a decline of 10.5%, 31.2% and 18.5% during March, April and May 2019 respectively. Comparing 2020 to 2019, there were more 999 calls (17.7% vs 15.7%) and accident and emergency referrals (46.5% vs 45.0%), and fewer interhospital referrals (16.0% vs 19.6%). In terms of advice provided for the 999 referrals, a greater number were advised to go to the accident and emergency department (10.5% vs 0%) and direct phone advice provided to those in other settings increased (11.7% vs 0.1%) in 2020. Conclusions The COVID-19 pandemic was associated with a reduction in the number of overall referrals to cardiology, while also demonstrating a shift towards more advice to attend the accident and emergency department for assessment or direct phone advice being provided about management in the community.

scholarly journals Impact of coronavirus disease 2019 on urgent referrals to secondary care otolaryngology: a prospective case series

2020 ◽  
pp. 1-4
Author(s):  
M S Osborne ◽  
E Bentley ◽  
A Farrow ◽  
J Chan ◽  
J Murphy
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Perceived Risk ◽  
Secondary Care ◽  
Case Series ◽  
Medical Setting ◽  
Accident And Emergency ◽  
Accident And Emergency Department ◽  
Prospective Case Series ◽  
The Impact

Abstract Objective As the novel coronavirus disease 2019 changed patient presentation, this study aimed to prospectively identify these changes in a single ENT centre. Design A seven-week prospective case series was conducted of urgently referred patients from primary care and accident and emergency department. Results There was a total of 133 referrals. Referral rates fell by 93 per cent over seven weeks, from a mean of 5.4 to 0.4 per day. Reductions were seen in referrals from both primary care (89 per cent) and the accident and emergency department (93 per cent). Presentations of otitis externa and epistaxis fell by 83 per cent, and presentations of glandular fever, tonsillitis and peritonsillar abscess fell by 67 per cent. Conclusion Coronavirus disease 2019 has greatly reduced the number of referrals into secondary care ENT. The cause for this reduction is likely to be due to patients’ increased perceived risk of the virus presence in a medical setting. The impact of this reduction is yet to be ascertained, but will likely result in a substantial increase in emergency pressures once the lockdown is lifted and the general public's perception of the coronavirus disease 2019 risk reduces.

3 Reducing frequent attenders to the emergency department at west suffolk hospital

2020 ◽  
Vol 96 (1132) ◽  
pp. 119.3-120
Author(s):  
Fiona Huang ◽  
Yusef Kiberu ◽  
Sreejib Das
Keyword(s):  
Emergency Department ◽  
Care Plan ◽  
Liaison Psychiatry ◽  
Post Intervention ◽  
Significance Level ◽  
Frequent Attenders ◽  
Number Of Patients ◽  
Wide Range ◽  
The Impact ◽  
Multi Disciplinary Team

IntroductionPatients who repeatedly attend the emergency department (ED) often have underlying complex social, psychological and chronic medical issues which are difficult to address in the emergency/acute medicine environment alone. Their attendances not only present a burden to the ED, but also can be a sign that the patient’s primary issue has been insufficiently addressed. At West Suffolk Hospital, we are trialling an approach to reduce frequency of ED attendances in a specific cohort of patients identified as being frequent attenders. In order to do this, we are using a multi-disciplinary approach including psychiatry services and ED clinicians.MethodsOur cohort of frequent attenders were identified as patients presenting more than 4 times to ED between March 2017 to April 2018. Exclusion criteria was if the patient is under 18 years old, has known long term medical conditions and known safeguarding concerns. With collaborative working by the emergency medicine clinician and liaison psychiatry, a letter was sent to 38 patients in May 2018, identifying them as frequent attenders and inviting them to a tailored multi-disciplinary team meeting. Initially we are assessing the impact of the letter, so 6 months after the letters were sent out, we assessed patient attendances again. 2 patients were excluded due to moving out of area and being in prison. Paired sample for means t-test was used to compare attendances pre- and post-intervention.ResultsThere were a wide range of presenting complaints to ED, most of which were psychiatric related – overdose, deliberate self harm, alcohol/drug related. The intervention letter improved the attendance rate the most in this cohort, whereas it had a negligible effect on attendances with physical complaints. The average fall in attendance was 33% in the 6 months post patients receiving the intervention letter. This reached significance level with p=0.039.ConclusionsSending frequent attender patients a letter and putting in place a care plan could significantly reduce Emergency Department attendances. However there were a small number of patients, making it difficult to assess the efficacy of our intervention especially when adjusting for patient relocation.We are hoping to disseminate the locally trialed strategy region wide across East Anglia, providing many more data points. We can also implement the model not just in patients with psychiatric background, but also patients with chronic medical problems too with additions to the multi-disciplinary team as per the needs of the patient.

scholarly journals Use of Audiobooks as an Environmental Distractor to Decrease State Anxiety in Children Waiting in the Pediatric Emergency Department: A Pilot and Feasibility Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Leah I. Stein Duker ◽  
Anita R. Schmidt ◽  
Phung K. Pham ◽  
Sofronia M. Ringold ◽  
Alan L. Nager
Keyword(s):  
Emergency Department ◽  
State Anxiety ◽  
Low Cost ◽  
Pediatric Emergency ◽  
Control Group ◽  
Pediatric Emergency Department ◽  
Post Intervention ◽  
Paired Samples ◽  
Before And After ◽  
The Impact

Objectives: Anxiety and anticipatory stressors are commonly experienced by children visiting the Pediatric Emergency Department (PED), but little research exists that addresses the efficacy of interventions to decrease this stress. This one-sample pretest-postest pilot study gathered preliminary data on the feasibility and effectiveness of utilizing audiobooks to reduce fear and state anxiety in children in the PED.Methods: Participants were 131 children in kindergarten through 8th grade (M = 9.4 years, 54% female), triaged urgent or emergent, presenting to the PED. Participants self-reported fear (Children's Fear Scale) and state anxiety (modified State-Trait Anxiety Inventory for Children; mSTAIC) before and after listening to an age-appropriate audiobook (two options). Data regarding patient experience were also collected. Paired samples t-test was used to examine pre–post intervention changes in fear and state anxiety.Results: Significant, albeit small, improvements in fear and the mSTAIC states of nervous, calm, happy, and relaxed were found after use of the audiobook (Cohen's dz = 0.22–0.35). Small, yet significant correlations were found between child age/grade level and improvements in fear and in the mSTAIC states of scared and relaxed, suggesting that the audiobook was more beneficial for older participants. Over 60% of participants liked the audiobook content “a lot” as well as enjoyed listening to the audiobook “a lot.” Without prompting, 15% of participants requested to listen to an additional audiobook.Conclusions: Listening to an audiobook is feasible and could be effective in decreasing fear and state anxiety for children during a waiting period in the PED. The technology is low-cost, simple, and portable. The results of this study should be interpreted with prudence due to the lack of a control group and results that, although significant, were modest based on effect size conventions; future studies should explore the impact of audiobooks on patient stress with an expanded sample size and control group.

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