Healthcare quarterly (Toronto, Ont.)
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Shared decision-making has been called the crux of patient-centred care and identified as a key part of change for improved quality and safety in healthcare. However, it rarely happens, is hard to do and is not taught - for many reasons. Talking with patients about options is not embedded in the attitudes or communication skills training of most healthcare professionals. Information tools such as patient decision aids, personal health records and the Internet will help to shift this state, as will policy that drives patient and public involvement in healthcare delivery and training.
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Despite the release of a national report describing key markers of emergency department (ED) overcrowding, limited linear data using these markers have been published. We sought to report the degree and trends of ED overcrowding in a typical academic hospital and to highlight some of the key markers of ED patient flow and care. We conducted a prospective study in a large Canadian urban tertiary care teaching hospital that receives approximately 55,000 annual adult ED visits. ⋯ Semi-urgent and non-urgent admissions dropped from 11.5 to 7.4% and 3.2 to 1.8%, respectively. Admitted patients "boarding" in the ED increased from 70,955 hours in 2002 to 118,741 hours in 2007, while the number of emergent and urgent patients leaving without being seen increased by more than 400%. ED overcrowding in a tertiary care hospital is primarily a result of access block due to boarding admitted patients, a situation that poses serious risks to the majority of patients who have emergent or urgent conditions that cannot be managed appropriately in the waiting room.
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This study investigated the safety of discharge of seniors (aged 65 and over) from Quebec emergency departments (EDs) to the community. Data from a 2006 survey of key informants at 103 Quebec adult non-psychiatric EDs were linked to data on a sample of 172,927 seniors who were discharged home from one of the EDs during the period February 2004-January 2005. ⋯ A minority of EDs, regardless of their size and the characteristics of patients treated, systematically provided services to improve the safety of discharge. Resources and services need to be improved in EDs, particularly those that serve higher-risk populations (e.g., systematic approaches to the identification and management of high-risk seniors, with appropriate referrals to community services), in the hospital (e.g., increased accessibility to acute care beds) and in the community (e.g., increased accessibility to home care, outpatient geriatric assessment and primary medical care).
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Health Link Alberta is a model of successful regional integration. Launched as a single-region service in 2000, Health Link Alberta was rolled out as a province-wide service in 2003, operating as one service from two sites (Calgary and Edmonton). Provincial integration of Health Link Alberta was successful because it took the time to establish collaborative governance structures, build relationships with regional and provincial stakeholders, recognize and accommodate regional and local needs, and develop the processes and tools that it needed to deliver a quality, consistent and accessible service for all Albertans. Within three years, Health Link Alberta achieved 63% awareness and 46% utilization among all Alberta households.
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Implementing evidence is the basis for improving the organization of care, with the ultimate goal of achieving optimal patient outcomes. As implementing evidence can be a challenging task due to human and system barriers, we propose an innovative framework to facilitate knowledge translation at the bedside. This model is based on a problem-solving approach that was tested in the field of critical care. This method can be adapted to any healthcare environment as the problems encountered when trying to implement guidelines and protocols are common.