STRATEGI UNTUK MENGATASI KEPADATAN UNIT GAWAT DARURAT (UGD): TINJAUAN PUSTAKA

Latar Belakang: Unit gawat darurat (ED) sebagai pintu gerbang penanganan awal pasien dengan kegawatdarutatan berisiko mengalami Kepadatan. Tujuan literature review ini adalah untuk mencari strategi yang tepat untuk mengatasi kepadatan di ED. Metode yang digunakan yaitu pencarian pada electronic database seperti Pubmed, DOAJ, dan google scholar, menggunakan kata kunci Crowding AND Emergency Department, awal ditemukan 1160 artikel,15 artikel dimasukkan setelah melalui proses screening. Hasil review menyajikan penyebab kepadatan di ED, alat ukur, efek yang ditimbulkan, dan srategi penaganan kepadatan di ED. Kesimpulan, lama tinggal dan keterlambatan pemeriksaan penunjang mempengaruhi kepadatan, system informasi serta pengelompokan pasien dapat menurunkan kepadatan, National Emergency Department Overcrowding Scale (NEDOCS) direkomendasikan untuk mengukur skala kepadatan di ED.

EMS utilization predictors in a Mobile Integrated Health (MIH) program

Background The provision of unnecessary Emergency Medical Services care remains a challenge throughout the US and contributes to Emergency Department overcrowding, delayed services and lower quality of care. New EMS models of care have shown promise in improving access to health services for patients who do not need urgent care. The goals of this study were (1) to identify factors associated with EMS utilization (911) and (2) their effects on total EMS calls and transports in an MIH program. Methods The study sample included 110 MIH patients referred to the program or considered high-users of EMS services between November 2016 and September 2018. The study employed descriptive statistics and Poisson regressions to estimate the effects of covariates on total EMS calls and transports. Results The typical enrollee is a 60-year-old single Black male living with two other individuals. He has a PCP, takes 12 medications and is compliant with his treatment. The likelihood of calling and/or being transported by EMS was higher for males, patients at high risk for falls, patients with asthma/COPD, psychiatric or behavioral illnesses, and longer travel times to a PCP. Each prescribed medication increased the risk for EMS calls or transports by 4%. The program achieved clear reductions in 911 calls and transports and savings of more than 140,000 USD in the first month. Conclusions This study shows that age, marital status, high fall risk scores, the number of medications, psychiatric/behavioral illness, asthma/COPD, CHF, CVA/stroke and medication compliance may be good predictors of EMS use in an MIH setting. MIH programs can help control utilization of EMS care and reduce both EMS calls and transports.

EMS utilization predictors in a Mobile Integrated Health (MIH) program

Background. The provision of unnecessary Emergency Medical Services care remains a challenge throughout the US and contributes to Emergency Department overcrowding, delayed services and lower quality of care. New EMS models of care have shown promise in improving access to health services for patients who do not need urgent care. The goals of this study were 1) to identify factors associated with EMS utilization (911) and 2) their effects on total EMS calls and transports in an MIH program. Methods. The study sample included 110 MIH patients referred to the program or considered high-users of EMS services between November 2016-September 2018. The study employed descriptive statistics and Poisson regressions to estimate the effects of covariates on total EMS calls and transports. Results. The typical enrollee is a 60-year-old single Black male living with two other individuals. He has a PCP, takes 12 medications and is compliant with his treatment. The likelihood of calling and/or being transported by EMS was higher for males, patients at high risk for falls, patients with asthma/COPD, psychiatric or behavioral illnesses, and longer travel times to a PCP. Each prescribed medication increased the risk for EMS calls or transports by 4%. The program achieved clear reductions in 911 calls and transports and savings of more than 140,000 USD in the first month. Conclusions. This study shows that age, marital status, high fall risk scores, the number of medications, psychiatric/behavioral illness, asthma/COPD, CHF, CVA/stroke and medication compliance may be good predictors of EMS use in an MIH setting. MIH programs can help control utilization of EMS care and reduce both EMS calls and transports.

An Investigation of Risk Factors Affecting Short Term Mortality of Patients Referring to the Hospital Emergency Department

Background and Objective: One of the causes of short-term mortality in patients is the lower quality of services provided by hospital emergency departments. Given the particular importance of the hospital emergency system and the presence of numerous problems, as well as short term mortality rates in hospitals, this study aimed to investigate the risk factors affecting short term mortality of patients presenting to the Emergency Department at Nemazi Hospital in Shiraz, Fars province in 2019.Methods: This is a retrospective study with a case control-analytical design. The sample size was 768 subjects. In the present study, the emergency department overcrowding was measured by the NEDOCS (National Emergency Department Overcrowding Scale) criterion. The severity of the disease was also evaluated based on the level of the triage of patients through the Emergency Severity Index (ESI) system and vital signs.Results: With each year increase in age, the chance of short-term mortality increases by 0.8%. People with O2 sat% <90% are 7.3 times more likely to experience short term mortality in an emergency department compared to people with O2 sat%> 90%. A significant relationship was noted between short term mortality and SBP (systolic blood pressure) in the hospital's emergency department. It was also found out that as the triage score increases, short term mortality decreases significantly. As hospital stay increases, the chance of the patients' mortality decreases by 0.5%.Conclusion: The percentage of arterial blood oxygen saturation, systolic blood pressure, respiration rate per minute, triage score, the way the patient arrives at the hospital, working shifts, hospitalization duration, age, and comorbidities were regarded as the risk factors for short term mortality. Therefore, promoting professional knowledge and skills of nurses and physicians in the hospitals' emergency department and up-to-dating and reviewing emergency protocols as well as similar research can greatly help reduce short term mortality in the hospital's emergency department.

Emergency Department Overcrowding: A Retrospective Spatial Analysis and the Geocoding of Accesses. A Pilot Study in Rome

The overcrowding of first aid facilities creates considerable hardship and problems which have repercussions on patients’ wellbeing, the time needed for a diagnosis, and on the quality of the assistance. The basic objective of this contribution, based on the data collected by the Hospital Policlinico Umberto I in Rome (Lazio region, Italy), is to carry out a territorial screening of the municipality using GIS applications and spatial analyses aimed at reducing—in terms of triage—code white (inappropriate) attendances, after having identified the areas of greatest provenance of improperly used emergency room access. Working in a GIS environment and using functions for geocoding, we have tested an experimental model aimed at giving a close-up geographical-sanitary look at the situation: recognizing the territorial sectors in Rome which contribute to amplifying the Policlinico Umberto I emergency room overcrowding; leading up to an improvement of the situation; promoting greater awareness and knowledge of the services available on the territory, a closer relationship between patient and regular doctor (general practitioner, GP) or Local Healthcare Unit and a more efficient functioning of the emergency room. In particular, we have elaborated a “source” map from which derive all the others and it is a dot map on which all the codes white have been geolocalized on a satellite image through geocoding. We have produced three sets made up of three digital cartographic elaborations each, constructed on the census sections, the census areas and the sub-municipal areas, according to data aggregation, for absolute and relative values, and using different templates. Finally, following the same methodology and steps, we elaborated another dot map about all the codes red to provide another kind of information and input for social utility. In the near future, this system could be tested on a platform that spatially analyzes the emergency department (ED) accesses in near-real-time in order to facilitate the identification of critical territorial issues and intervene in a shorter time to regulate the influx of patients to the ED.

Validation of the National Emergency Department Overcrowding Score (NEDOCS) in a UK non-specialist emergency department

IntroductionEmergency department (ED) crowding has significant adverse consequences, however, there is no widely accepted tool to measure it. This study validated the National Emergency Department Overcrowding score (NEDOCS) (range 0–200 points), which uses routinely collected ED data.MethodsThis prospective single-centre study sampled data during four periods of 2018. The outcome against which NEDOCS performance was assessed was a composite of clinician opinion of crowding (physician and nurse in charge). Area under thereceiver operating characteristic curves (AUROCs) and calibration plots were produced. Six-hour stratified sampling was added to adjust for temporal correlation of clinician opinion. Staff inter-rater agreement and NEDOCS association with opinion of risk, safety and staffing levels were collected.ResultsFrom 905 sampled hours, 448 paired observations were obtained, with the ED deemed crowded 18.5% of the time. Inter-rater agreement between staff was moderate (weighted kappa 0.57 (95% CI 0.56 to 0.60)). AUROC for NEDOCS was 0.81 (95% CI 0.77 to 0.86). Adjusted for temporal correlation, AUROC was 0.80 (95% CI 0.73 to 0.88). At a cut-off of 100 points sensitivity was 75.9% (95% CI 65.3% to 84.6%), specificity 72.1% (95% CI 67.1% to 76.6%), positive predictive value 38.2% (95% CI 30.7% to 46.1%) and negative predictive value 92.9% (95% CI 89.3% to 95.6%). NEDOCS underpredicted clinical opinion on Calibration assessment, only partially correcting with intercept updating. For perceived risk of harm, safety and insufficient staffing, NEDOCS AUROCs were 0.71 (95% CI 0.61 to 0.82), 0.71 (95% CI 0.63 to 0.80) and 0.70 (95% CI 0.64 to 0.76), respectively.ConclusionsNEDOCS demonstrated good discriminatory power for clinical perception of crowding. Prior to implementation, determining individual unit ED cut-off point(s) would be important as published thresholds may not be generalisable. Future studies could explore refinement of existing variables or addition of new variables, including acute physiological data, which may improve performance.