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Author: Mohammed Rashidul Anwar
Publisher:
ISBN:
Category :
Languages : en
Pages : 0
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Background: Several Canadian jurisdictions have launched interventions and strategies to address the complex, multi-dimensional problem of Emergency Department (ED) crowding. Still many of the health systems struggle with long waits. Initiatives that seem to display positive results in one site/system are often unable to show similar results in another. To make sense of such patterns, I drew on a form of theory-based evaluation, Realistic Evaluation (RE). My realist analysis focused on streaming-type interventions such as Fast-track/Minor Treatment Areas, Intake/Rapid Assessment Zones, and diverse types of Short-Stay Units, which separate the whole care process of patients into different streams (based on acuity and service needs) to improve patient flow. Objective- The purpose of this thesis was to identify relevant mechanisms and contextual factors to generate "middle-range theories" for streaming-based flow interventions. Methods- This thesis used the interview data collected for a larger project, "Patient Flow and Health Systems". These interviews were conducted with 300 key stakeholders who were involved in initiatives to improve flow, in one of the ten urban/mostly-urban health regions and zones of Western Canada. I undertook a realist analysis based on participants' explanations for (perceived) success and failure. This work was grounded in the Population-Capacity-Process model, which helped to categorize factors in a meaningful way. Findings- Essential design features of streaming-type interventions that might have led to their success included identification of a designated population (population), allocation of dedicated space and resources (capacity), and establishment of rapid cycle time (process). These supported key mechanisms: patients wait only for services they need, variability among patients is reduced, standardized care is provided, lag time between care steps is prevented and provider attitude change promotes prompt discharge. Critical context factors that might have impacted the interventions were lack of outflow sites and the possibility of demand outstripping capacity. An important finding of this study was that failure of interventions was more commonly attributed to design flaws (in particular, lack of dedicated space) than to context factors. Conclusion- This study helped generate "middle-range theories" which sought to explain the outcomes of diverse interventions that share a basic program theory. In this way, it was able to provide transferable lessons for stakeholders wishing to implement similar interventions elsewhere.
Author: Mohammed Rashidul Anwar
Publisher:
ISBN:
Category :
Languages : en
Pages : 0
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Book Description
Background: Several Canadian jurisdictions have launched interventions and strategies to address the complex, multi-dimensional problem of Emergency Department (ED) crowding. Still many of the health systems struggle with long waits. Initiatives that seem to display positive results in one site/system are often unable to show similar results in another. To make sense of such patterns, I drew on a form of theory-based evaluation, Realistic Evaluation (RE). My realist analysis focused on streaming-type interventions such as Fast-track/Minor Treatment Areas, Intake/Rapid Assessment Zones, and diverse types of Short-Stay Units, which separate the whole care process of patients into different streams (based on acuity and service needs) to improve patient flow. Objective- The purpose of this thesis was to identify relevant mechanisms and contextual factors to generate "middle-range theories" for streaming-based flow interventions. Methods- This thesis used the interview data collected for a larger project, "Patient Flow and Health Systems". These interviews were conducted with 300 key stakeholders who were involved in initiatives to improve flow, in one of the ten urban/mostly-urban health regions and zones of Western Canada. I undertook a realist analysis based on participants' explanations for (perceived) success and failure. This work was grounded in the Population-Capacity-Process model, which helped to categorize factors in a meaningful way. Findings- Essential design features of streaming-type interventions that might have led to their success included identification of a designated population (population), allocation of dedicated space and resources (capacity), and establishment of rapid cycle time (process). These supported key mechanisms: patients wait only for services they need, variability among patients is reduced, standardized care is provided, lag time between care steps is prevented and provider attitude change promotes prompt discharge. Critical context factors that might have impacted the interventions were lack of outflow sites and the possibility of demand outstripping capacity. An important finding of this study was that failure of interventions was more commonly attributed to design flaws (in particular, lack of dedicated space) than to context factors. Conclusion- This study helped generate "middle-range theories" which sought to explain the outcomes of diverse interventions that share a basic program theory. In this way, it was able to provide transferable lessons for stakeholders wishing to implement similar interventions elsewhere.
Author: Arshya Feizi
Publisher:
ISBN:
Category :
Languages : en
Pages : 0
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Addressing hospital emergency department (ED) overcrowding is a critical challenge for many healthcare systems worldwide. Many hospitals (including our partner hospital) have been experimenting with innovative patient flow designs to address this challenge. A promising new design is to separate patients who can be served vertically (e.g., on a regular chair as opposed to horizontally on an ED bed) and route them to a different area termed the Vertical Processing Pathway (VPP) unit. While this can potentially increase operational efficiency by removing the burden caused by a main ED bottleneck--lack of bed availability--it can degrade performance if patients that are routed to the VPP unit need to be sent back to be served in an ED bed, or if some patients that could have been served in the VPP unit end up occupying an ED bed. Successful implementation of this design, thus, significantly depends on understanding which patients should be routed to the VPP unit and when.To assist our partner hospital and other EDs, we develop a machine learning model trained on large-scale data capable of providing a personalized risk score for each arriving patient on whether or not they will eventually need an ED bed. We then feed these risk scores to an analytical model of patient flow to characterize the optimal protocol for utilizing the VPP unit. We find that the optimal protocol depends not only on the predicted risk scores but also on the machine learning model's accuracy as well as some of the main ED characteristics (e.g., patient arrival intensity and congestion level). To gain deeper insights, we make use of simulation analyses calibrated with hospital data and compare the performance of our recommended VPP-based patient streaming design with more traditional ED flow approaches such as “fast track” or “physician in triage.” Our results suggest that following the VPP design under our recommended protocol can bring several advantages to EDs, allowing them to significantly improve their operations.
Author: Soroush Saghafian
Publisher:
ISBN:
Category :
Languages : en
Pages : 0
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Crisis level overcrowding conditions in Emergency Departments (ED's) have led hospitals to seek out new patient flow designs to improve both responsiveness and safety. One approach that has attracted attention and experimentation in the emergency medicine community is a system in which ED beds and care teams are segregated and patients are "streamed" based on predictions of whether they will be discharged or admitted to the hospital. In this paper, we use a combination of analytic and simulation models to determine whether such a streaming policy can improve ED performance, where it is most likely to be effective, and how it should be implemented for maximum performance. Our results suggest that the concept of streaming can indeed improve patient flow, but only in some situations. First, ED resources must be shared across streams rather than physically separated. This leads us to propose a new "virtual-streaming" patient flow design for ED's. Second, this type of streaming is most effective in ED's with (1) a high percentage of admitted patients, (2) longer care times for admitted patients than discharged patients, (3) a high day-to-day variation in the percentage of admitted patients, (4) long patient boarding times (e.g., caused by hospital "bed-block"), and (5) high average physician utilization. Finally, to take full advantage of streaming, physicians assigned to admit patients should prioritize upstream (new) patients, while physicians assigned to discharge patients should prioritize downstream (old) patients.
Author: Shanshan Qiu
Publisher:
ISBN:
Category : Hospitals
Languages : en
Pages : 132
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ABSTRACT IMPROVING EMERGENCY DEPARTMENT PATIENT FLOW THROUGH NEAR REAL-TIME ANALYTICS This dissertation research investigates opportunities for developing effective decision support models that exploit near real-time (NRT) information to enhance the "operational intelligence" within hospital Emergency Departments (ED). Approaching from a systems engineering perspective, the study proposes a novel decision support framework for streamlining ED patient flow that employs machine learning, statistical and operations research methods to facilitate its operationalization. ED crowding has become the subject of significant public and academic attention, and it is known to cause a number of adverse outcomes to the patients, ED staff as well as hospital revenues. Despite many efforts to investigate the causes, consequences and interventions for ED overcrowding in the past two decades, scientific knowledge remains limited in regards to strategies and pragmatic approaches that actually improve patient flow in EDs. Motivated by the gaps in research, we develop a near real-time triage decision support system to reduce ED boarding and improve ED patient flow. The proposed system is a novel variant of a newsvendor modeling framework that integrates patient admission probability prediction within a proactive ward-bed reservation system to improve the effectiveness of bed coordination efforts and reduce boarding times for ED patients along with the resulting costs. Specifically, we propose a cost-sensitive bed reservation policy that recommends optimal bed reservation times for patients right during triage. The policy relies on classifiers that estimate the probability that the ED patient will be admitted using the patient information collected and readily available at triage or right after.
Author:
Publisher:
ISBN:
Category :
Languages : en
Pages : 24
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Introduction: Emergency departments are overburdened with mental health patients who lack adequate access to behavioral health resources. The influx of patients has led to an increased length of stay in the emergency department for patients who are being evaluated for mental health concerns. Overcrowding can lead to delays in treatment, undesirable medical events, and patient mortality. Crisis Intervention Team (CIT) models bring law enforcement, mental health providers, emergency departments, and individuals with mental illness together to improve care for patients in crisis. They have been instrumental in identifying patients in crisis and transporting them to a Crisis Intervention Team Assessment Center (CITAC), an integral link in CIT programs. Methods: A retrospective chart review was done pre- and post-implementation of a Crisis Intervention Team Assessment Center in a 54 bed Emergency Department. Results: Implementation of a Crisis Intervention Team Assessment Center in the emergency department may increase emergency department length of stay. Chi-square found no statistical significance between time to disposition and age, gender, type of insurance, or restraint usage. The presence of a police officer trained in de-escalating mental health patients may decrease the need for physical restraints for patients in crisis. Discussion: The behavioral health system is lacking preventative resources needed to stabilize many mental health patients. Behavioral health patients in crisis have an increased length of stay in the emergency department. Implementing a team trained to efficiently evaluate and treat a patient in crisis is essential to ensure the patient's safety.
Author: Barbara Cook Overton
Publisher: Rowman & Littlefield
ISBN: 1498567460
Category : Language Arts & Disciplines
Languages : en
Pages : 281
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Unintended Consequences of Electronic Medical Records: An Emergency Room Ethnography argues that while electronic medical records (EMRs) were supposed to improve health care delivery, EMRs’ unintended consequences have affected emergency medicine providers and patients in alarming ways. Higher healthcare costs, decreased physician productivity, increased provider burnout, lower levels of patient satisfaction, and more medical mistakes are just a few of the consequences Barbara Cook Overton observes while studying one emergency room’s EMR adoption. With data collected over six years, Overton demonstrates how EMRs harm health care organizations and thrust providers into the midst of incompatible rule systems without appropriate strategies for coping with these challenges, thus robbing them of agency. Using structuration theory and its derivatives to frame her analysis, Overton explores the ways providers communicatively and performatively receive and manage EMRs in emergency rooms. Scholars of communication and medicine will find this book particularly useful.
Author:
Publisher:
ISBN:
Category : Hospitals
Languages : en
Pages : 92
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"Emergency Departments (EDs) are experiencing increasing pressure due to rising patient presentations and emergency admissions in the face of a delay in access to available inpatient beds and other resources to meet this demand. This mismatch places pressure upon the public health system to provide equitable and timely access to emergency care. The National Health Reform Agreement on Improving Public Hospital Services includes the National Emergency Access Target (NEAT) to improve emergency service accessibility. This requires ED patients to be admitted, referred for treatment of discharged within four hours. For most EDs and hospitals, meeting this targe requires significant redesign of the current process. ... Currently patients are often assessed later in the ED journey by a senior medical officer, which delays, decision-making and disposition. The ED senior assessment and streaming (ED SAS) model enables earlier senior medical input and aims to reduce ED total length of stay ... . A detailed implementation tool is supplied with this model of care ... ."--Executive summary.
Author:
Publisher:
ISBN: 9781897257289
Category : Hospitals
Languages : en
Pages : 29
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Author: Institute of Medicine
Publisher: National Academies Press
ISBN: 0309141613
Category : Medical
Languages : en
Pages : 130
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Book Description
In 2006, the Institute of Medicine (IOM) released a series of three books on the Future of Emergency Care in the United States Health System. These reports contained recommendations that called on the federal government and private stakeholders to initiate changes aimed at improving the emergency care system. Three years later, in May 2009, the IOM convened a workshop to examine the progress to date in achieving these objectives, and to help assess priorities for future action. The May 2009 workshop, summarized in this volume, brought stakeholders and policy makers together to discuss which among the many challenges facing emergency care are most amenable to coordinated federal action. The workshop sought to foster information exchange among federal officials involved in advancing emergency care and key stakeholder groups from around the country.
Author: Institute of Medicine
Publisher: National Academies Press
ISBN: 0309147964
Category : Medical
Languages : en
Pages : 131
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Book Description
In 2006, the Institute of Medicine (IOM) released a series of three books on the Future of Emergency Care in the United States Health System. These reports contained recommendations that called on the federal government and private stakeholders to initiate changes aimed at improving the emergency care system. Three years later, in May 2009, the IOM convened a workshop to examine the progress to date in achieving these objectives, and to help assess priorities for future action. The May 2009 workshop, summarized in this volume, brought stakeholders and policy makers together to discuss which among the many challenges facing emergency care are most amenable to coordinated federal action. The workshop sought to foster information exchange among federal officials involved in advancing emergency care and key stakeholder groups from around the country.
