May 22, 2012
“Background: Emergency department (ED) utilization has dramatically increased in developed countries over the last twenty years. Because it has been associated with adverse outcomes, increased costs, and an overload on the hospital organization, several policies have tried to curb this growing trend. The aim of this study is to systematically review the effectiveness of organizational interventions designed to reduce ED utilization.
Posted in Journal Articles, READ Portal | Tagged with Emergency service, Evidence-based, Primary health care | No Comments
April 18, 2012
“Canada’s healthcare system faces mounting pressure as the population ages and the prevalence of chronic conditions continues to rise. The traditional focus on providing complex and chronic disease care within the acute setting is contributing to already existing pressures on wait times, alternate level of care days, and patient access and flow. In response to these challenges, and the recognition that the acute setting may not be optimal for providing patient-focused chronic care, many provincial health ministries and healthcare organizations are launching initiatives to better manage complex chronic conditions in the community and improve the patient care experience.
Recognizing the need to address this issue, the Canadian Health Services Research Foundation (CHSRF) engaged PricewaterhouseCoopers LLP (PwC) to conduct a National Health Leadership Survey on Ambulatory and Community Care to:
- Continue to help establish a channel for engagement with Health Leaders;
- Identify leaders and leading practices in ambulatory and community care;
- Identify integrated care interventions to improve care for patients with complex needs; and
- Gather insights for use in CHSRF’s programs and events.
In total, 53 health leaders, including general internal medicine practitioners, general practitioners and administrators representing all of the provinces and the combined territories responded and participated in the study. Numerous themes emanated throughout the health leader interviews, with consistency generally found across regions and roles (e.g., general internal medicine, general practitioner, executive).”
Posted in READ Portal, Reports & Papers | Tagged with Canada, Emergency service, Forecasting | No Comments
April 2, 2012
“ISSUE: Are there differences between Ontario’s primary care models in who they serve and how often their patients/clients go to the emergency department (ED)?
STUDY: This study examined patients/clients enrolled in: Community Health Centres (CHCs, a salaried model), Family Health Groups (FHGs, a blended fee-for-service model), Family Health Networks (FHNs, a blended capitation model), Family Health Organizations (FHOs, a blended capitation model), Family Health Teams (FHTs, an interprofessional team model composed of FHNs and FHOs), ‘Other’ smaller models combined, as well as those who did not belong to a model. Electronic record encounter data (for CHCs) and routinely collected health care administrative data were used to examine sociodemographic composition, patterns of morbidity and comorbidity (case mix) and ED use. ED visits rates were adjusted to account for differences in location and patient/client characteristics.
KEY FINDINGS
- Compared with the Ontario population, CHCs served populations that were from lower income neighbourhoods, had higher proportions of newcomers and those on social assistance, had more severe mental illness and chronic health conditions, and had higher morbidity and comorbidity. In both urban and rural areas, CHCs had ED visit rates that were considerably lower than expected.
- FHGs and ‘Other’ models had sociodemographic and morbidity profiles very similar to those of Ontario as a whole, but FHGs had a higher proportion of newcomers, likely reflecting their more urban location. Both urban and rural FHGs and ‘Other’ models had lower than expected ED visits.
- FHNs and FHTs had a large rural profile, while FHOs were similar to Ontario overall. Compared with the Ontario population, patients in all three models were from higher income neighbourhoods, were much less likely to be newcomers, and less likely to use the health system or have high comorbidity. ED visits were higher than expected in all three models.
- Those who did not belong to one of the models of care studied were more likely to be male, younger, make less use of the health system and have lower morbidity and comorbidity than those enrolled in a model of care. They had more ED visits than expected.”
Posted in READ Portal, Reports & Papers | Tagged with Canada, Emergency service, Indicators, Statistics & numerical data | No Comments
February 29, 2012
Emergency department (ED) overcrowding has been defined as “a situation where the demand for emergency services exceeds the ability to provide care in a reasonable amount of time.” 1 ED overcrowding is a serious and ongoing issue across Canada; in a 2006 survey of Canadian ED directors, 62% of respondents reported that overcrowding had been a major or severe problem in 2004 and 2005.
Short stay units (SSUs) have emerged as a potentially useful strategy for managing overcrowding in emergency departments. The theoretical benefit of SSUs is to “off-load” stable patients from the acute-care ED and to reduce the number of unnecessary hospital admissions. Typically, SSUs are focused on (1) expected short treatments such as blood transfusions; (2) further diagnostic investigations to finalize a medical diagnosis; and (3) safe discharge into the community, such as by involving a social worker. To prevent such units from being “dumping grounds,” most SSUs have strict inclusion/admission criteria. Part of the difficulty in evaluating the value of SSUs is terminology, since many terms have been used to describe such units (e.g., observation units, assessment units, and clinical decision units). Typically, however, SSUs are some type of extension of the ED whose overarching objective is to improve “the quality of medical care through extended observation and treatment, while reducing inappropriate admissions and healthcare costs.”
Posted in Journal Articles, READ Portal | Tagged with Emergency service, Process improvement | No Comments
January 30, 2012
“Patients who are discharged from a hospital emergency department sometimes have a poor understanding of how they should care for themselves once they get home, says a new review of more than 50 studies. In an article published in January’s Annals of Emergency Medicine, researchers recommend that doctors provide instructions verbally, in writing and with a visual demonstration whenever possible.
“It doesn’t happen as systematically as I would want it to,” said one of the co-authors, Dr. Stephen Porter of the Hospital for Sick Children in Toronto. In pediatrics, for example, he said a lot of medications come in liquid form. Only a minority of parents can figure out a complex dosing question without help, but doctors don’t necessarily show each patient exactly the dose that needs to be given.”
Read about the article on the Canadian Free Press, or visit the Annals of Emergency Medicine, at http://www.annemergmed.com/article/S0196-0644%2811%2901762-8/fulltext, to see the full article. As this is a subscription resource, contact your institution’s librarian for information on how to access it.
Posted in Journal Articles, READ Portal | Tagged with Emergency service, Outpatient care, Safety | No Comments
September 2, 2011
Temporary staff members working in a hospital’s fast-paced emergency department are twice as likely as permanent employees to be involved in medication errors that harm patients, new Johns Hopkins research suggests.
Results of the research raise serious issues related to temporary nursing staff in particular because they already are a substantial and growing part of the health care workforce owing to the national nursing shortage. These fill-ins are used to plug holes in both short-term and long-term work schedules, and are seen as a cheaper alternative to permanent hires. They tend to earn more per hour, but don’t receive benefits.
Posted in Mass Media Articles, READ Portal | Tagged with Emergency service, Health human resources, Safety | No Comments
September 1, 2011
“For years, studies have shown that health outcomes — like recovery from heart attacks or procedures requiring time in intensive-care units — for patients who are rushed to emergency rooms at night or on weekends aren’t as good as for those who are treated during so-called working hours. But a recent study in the Archives of Surgery found that outcomes for injured patients in Pennsylvania are remarkably similar when comparing weekdays with weeknights, and that they are actually slightly better on weekends compared with weekdays. It was one of the first to demonstrate that for trauma, there is no “night-weekend effect” whatsoever, at least in Pennsylvania, which has a well-developed trauma system.”
The reason for this is that Pennsylvania has a “smart system design and strict standards on the treatment of trauma patients. Trauma systems are planned so that patients are taken or quickly transferred to hospitals that specialize in treating serious injuries. And there are explicit criteria for designating such centers as, for example, a Level 1 trauma center that can handle sick, injured patients.”
Posted in Mass Media Articles, READ Portal | Tagged with Access to care, Emergency service, Safety | No Comments
August 9, 2011
“Hospitals are tackling a dangerous and costly side effect of emergency-room overcrowding and long wait times: the growing number of patients who get fed up and leave without treatment.
To speed patients through the system, emergency rooms are adopting so-called lean-management principles pioneered by such companies as Toyota Motor Corp. to increase efficiency, cut costs and provide better service.
That means streamlining the traditional methods of triage and reserving beds for only the sickest patients, abandoning the longstanding rule that every patient gets a bed. It also means staffing the ER with less-costly providers such as nurse practitioners and physician’s assistants, so more expensive ER doctors can focus on care and not on paperwork, test ordering and discharge plans.”
Posted in Mass Media Articles, READ Portal | Tagged with Emergency service, Patient-centered care, Process improvement, Wait lists | No Comments
February 18, 2011
Emergency-department (ED) overcrowding is common in countries across the globe. Patients must often wait hours before being seen by a doctor and far longer before being transferred to a hospital bed. The result is not merely inconvenience but rather a degradation of the entire experience—quality of care suffers, patients’ safety is endangered, staff morale is impaired, and the cost of care is increased.
Posted in READ Portal, Reports & Papers | Tagged with Emergency service, Trauma centers | 1 Comment
November 11, 2010
Early treatment with rt-PA is critical for favorable outcome of acute stroke. However, only a very small proportion of stroke patients receive this treatment, as most arrive at hospital too late to be eligible for rt-PA therapy.
Posted in Journal Articles, READ Portal | Tagged with Efficiency, Emergency service, Mortality rates, Safety | No Comments
