scholarly journals Overcrowding in the Emergency Department and Patient Safety

2018 ◽  
Author(s):  
Donald Jeanmonod ◽  
Rebecca Jeanmonod
Keyword(s):  
Emergency Department ◽  
Patient Safety

Measuring Patient Safety in the Emergency Department

2014 ◽  
Vol 29 (4) ◽  
pp. 362-363 ◽  
Author(s):  
Santiago Tomas-Vecina ◽  
Manel R. Chanovas-Borrás ◽  
Fermí Roqueta-Egea ◽  
Tomas Toranzo-Cepeda
Keyword(s):  
Emergency Department ◽  
Patient Safety

Use of medical emergency call data as a marker of quality of emergency department care in the post-National Emergency Access Target era

2018 ◽  
Vol 42 (5) ◽  
pp. 607
Author(s):  
Lorraine Westacott ◽  
Judy Graves ◽  
Mohsina Khatun ◽  
John Burke
Keyword(s):  
Emergency Department ◽  
Patient Safety ◽  
Quality Of Care ◽  
Emergency Admission ◽  
Emergency Call ◽  
Medical Emergency ◽  
Negative Consequences ◽  
Model Of Care ◽  
Emergency Calls

Objectives Any new model of care should always be accompanied by rigorous monitoring to ensure that there are no negative consequences, especially any that impact upon patient safety. In 2013, ‘THERMoSTAT’ (Two- Hour Evaluation and Referral Model for Shorter Turnaround Times), an emergency department model of care developed by Royal Brisbane and Women’s Hospital staff was launched to gain efficiencies and improve hospital National Emergency Access Target (NEAT) compliance. The aim of this study was to trial the use of medical emergency call data as a novel marker of the quality of care delivered by our emergency department. Methods Incidence of medical emergency calls for hospital emergency admission patients for the 2 years pre- and 1 year post-THERMoSTAT were compared after standardising for overall hospital activity. Results During the study period, hospital activity increased 10%, and the emergency department experienced a total of 222 645 presentations, 68 000 (30.5%) of which converted into an admission. THERMoSTAT improved NEAT compliance by 17% (from 57.7% to 74.9%) with no change in any patient-safety indicators. A total of 8432 medical emergency calls were made on 5930 patients, 2831 of whom were emergency admissions. After adjusting for hospital activity, there was no change in the average number of patients per week who triggered a medical emergency call after the introduction of THERMoSTAT. These results were reproduced when data was analysed for: total number of inpatients triggering calls; emergency admission patients; and emergency admission patients within the first 24 h or first 4 h of admission. Conclusions This is the first report to investigate the correlation between inpatient medical emergency call incidence and emergency department model of care. Medical emergency call data showed significant promise as a measure of morbidity and as a more direct, objective, simple, quantitative and meaningful measure of patient safety. What is known about the topic? It is well established that extended emergency department lengths of stay are associated with poorer patient outcomes. The corollary of this is not always true however; shorter emergency department length of stay does not automatically translate into better care. Although the underlying philosophy of NEAT is to enhance patient care, there is a risk of negative consequences if NEAT is seen as an end in itself. Many of the commonly used emergency department key performance indicators focus on the timeliness of care and there is a scarcity of easily quantifiable markers that reliably reflect the quality of that care. What does this paper add? This study builds on the concept of medical emergency call incidence as a marker of safety and quality. It explores the utility of using the number of medical emergency calls made in the first few hours of an emergency admission as an indicator of the quality of care delivered by the emergency department. This is significant because it introduces a measure that has a focus that embraces more than the timeliness of care only. What are the implications for practitioners? If medical emergency call incidence in early emergency admissions can be proven to accurately reflect emergency department quality of care then it would provide an easily monitored, objective, quantitative and prompt measure that evaluates dimensions other than timeliness.

The Patient Safety Screener: Validation of a Brief Suicide Risk Screener for Emergency Department Settings

2015 ◽  
Vol 19 (2) ◽  
pp. 151-160 ◽  
Author(s):  
Edwin D. Boudreaux ◽  
Michelle L. Jaques ◽  
Kaitlyn M. Brady ◽  
Adam Matson ◽  
Michael H. Allen
Keyword(s):  
Emergency Department ◽  
Patient Safety ◽  
Suicide Risk

scholarly journals Ethical, legal and administrative implications of the use of video and audio recording in an emergency department in Ontario, Canada

2020 ◽  
Vol 7 (1) ◽  
pp. 224-230
Author(s):  
Stuart L Douglas ◽  
Andrew McRae ◽  
Lisa Calder ◽  
Melanie de Wit ◽  
Marco L A Sivilotti ◽  
...  
Keyword(s):  
Emergency Department ◽  
Patient Safety ◽  
Quality Improvement ◽  
Clinical Research ◽  
Audio Recording ◽  
Current Context ◽  
Regulatory Barriers ◽  
Video And Audio

While video and audio recording (VAR) of patients is well described for clinical research, its application to quality improvement in the emergency department has thus far been limited and hindered by potential obstacles. We believe this technology holds promise to incite marked systems improvement but only if deployed in a thoughtful and principled manner. Experts in clinical, regulatory, legal, quality improvement, patient safety and ethical domains collaborated to articulate the salient considerations and challenges to implementation of a VAR programme. We describe this implementation using the lens of legislation and other principles specific to our current context. The landscape of ethical, legal and regulatory barriers and a case example of how a VAR programme has been implemented in an emergency department in Ontario, Canada are outlined. The potential to harness VAR data to drive quality and to improve safety is remarkable. Articulating the most contentious issues and illustrating how they can be addressed may guide others hoping to implement similar VAR programmes.

scholarly journals Learning from Patient Safety Incidents in the Emergency Department: A Systematic Review

2020 ◽  
Vol 58 (2) ◽  
pp. 234-244 ◽  
Author(s):  
Sara Amaniyan ◽  
Bjørn Ove Faldaas ◽  
Patricia A. Logan ◽  
Mojtaba Vaismoradi
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Patient Safety ◽  
Patient Safety Incidents

scholarly journals Assessment and improvement of junior doctor handover in the emergency department

2020 ◽  
Vol 9 (3) ◽  
pp. e001032
Author(s):  
Mark Sykes ◽  
Jack Garnham ◽  
Pablo Martin Kostelec ◽  
Hazel Hall ◽  
Anu Mitra
Keyword(s):  
Emergency Department ◽  
Patient Safety ◽  
Standard Operating Procedure ◽  
Baseline Survey ◽  
Junior Doctors ◽  
Improvement Strategy ◽  
Essential Components ◽  
Improvement Strategies ◽  
National Patient ◽  
Handover Process

IntroductionEffective handover between junior doctors is widely accepted as essential for patient safety. The British Medical Association in association with the National Health Service (NHS) National Patient Safety Agency and NHS Modernisation Agency have produced clear guidance regarding the contents and setting for a safe and efficient handover. We aimed to understand current junior doctor’s opinions on the handover process in a London emergency department (ED), with subsequent assessment, and any necessary improvement, of handover practices within the department.MethodsIn a London ED, a baseline survey was completed by the senior house officer (SHO) cohort to gauge current opinions of the existing handover process. Concurrently, a blinded prospective audit of handover practises was conducted. Multiple improvement strategies were subsequently implemented and assessed via Plan–Do–Study–Act (PDSA) cycles. A standard operating procedure was initially introduced and ‘rolled out’ throughout the department. This intervention was followed by development of an electronic handover note to ease completion of a satisfactory handover. Additional surveys were conducted to continually assess SHO opinion on how the handover process was developing. The final improvement strategy was formal handover teaching at the SHO induction.ResultsBaseline audit and SHO survey highlighted several opportunities for improvement. 5 handover components were deemed essential: (1) documented handover note; (2) doctor’s names; (3) history of presenting complaint; (4) ED actions; and (5) ongoing plan. The frequency of these components saw significant improvement by completion of the final PDSA. Following SHO rotation, all of the essential components fell, only to recover after the next improvement strategy.ConclusionsJunior doctors in a London ED were not satisfied with the current SHO handover process, and handover practices were not adequate. While the rotational nature of the SHO cohort makes sustained change challenging, implementation of thoughtful and realistic improvement strategies can significantly improve handover quality.

scholarly journals Stress Testing the Resuscitation Room: Latent Threats to Patient Safety Identified During Interprofessional In Situ Simulation in a Canadian Academic Emergency Department

2019 ◽  
Vol 4 (3) ◽  
pp. 254-261 ◽  
Author(s):  
George Mastoras ◽  
Cari Poulin ◽  
Larry Norman ◽  
Brian Weitzman ◽  
Anita Pozgay ◽  
...  
Keyword(s):  
Emergency Department ◽  
Patient Safety ◽  
Stress Testing ◽  
In Situ Simulation ◽  
Resuscitation Room

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.

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