Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Although many global health programs focus on providing clinical care or medical education, improving clinical operations can have a significant effect on patient care delivery, especially in developing health systems without high-level operations management. Lean manufacturing techniques have been effective in decreasing emergency department (ED) length of stay, patient waiting times, numbers of patients leaving without being seen, and door-to-balloon times for ST-elevation myocardial infarction in developed health systems, but use of Lean in low to middle income countries with developing emergency medicine (EM) systems has not been well characterized. ⋯ Lean manufacturing techniques can be successfully adapted for use in developing health systems. Lessons learned from this Lean project will aid future introduction of advanced operations management techniques in low- to middle-income countries.
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The objective was to determine child caregiver satisfaction with a nontraditional pediatric emergency department (ED) venue during the 2009 novel H1N1 influenza outbreak. ⋯ The MPERT facility alleviated patient volume surge and potentially prevented transmission during H1N1 outbreak. While these were health care provider goals, caregiver expectations were also met. Caregivers perceived MPERT as an acceptable alternative to receiving care in the regular ED, felt that physicians and nurses communicated well, and felt that medical care was good to excellent. Use of the MPERT did not negatively affect overall caregiver satisfaction with TCH. These findings suggest that families of pediatric patients are amenable to nontraditional ED venues during periods of ED crowding.
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Death in the emergency department (ED) is fairly common. Giving bad news can be difficult, but it is a skill that is vitally important for the emergency physician. ⋯ This reflection is about giving the news of the death of a family member over the telephone. Little literature addresses giving bad news over the telephone.