Articles: emergency-services.
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Emerg Med Australas · Feb 2015
Age and admission times as predictive factors for failure of admissions to discharge-stream short-stay units.
Discharge-stream emergency short-stay units (ESSU) improve ED and hospital efficiency. Age of patients and time of hospital presentations have been shown to correlate with increasing complexity of care. We aim to determine whether an age and time cut-off could be derived to subsequently improve short-stay unit success rates. ⋯ Patients >70 years of age have higher rates of failure after admission to discharge-stream ESSU. Although in appropriately selected discharge-stream patients, no age group or time-band of presentation was associated with increased failure rate beyond the stipulated KPI.
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To review the result of the implementation of treatment protocol for post-chemotherapy sepsis in haematological malignancy patients. ⋯ Implementation of the protocol can effectively shorten the door-to-antibiotic time to meet the international standard of care in neutropenic sepsis patients. The compliance rate was also high. We proved that effective implementation of the protocol is feasible in a busy emergency department through excellent teamwork between nurses, pharmacists, and emergency physicians.
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To quantify the rate of preventable duplication of imaging studies in the Emergency Department. Previously, to estimate potential savings from the Health Information Exchange, figures used to be based on expert opinion, as the actual rate of redundant imaging is unknown. ⋯ We used two EDs to quantify the rate of preventable duplicate CT scans ordered. Our results demonstrate that only 0.4% of CT scans performed in our EDs are preventable duplicates. Our rate of preventable duplicate studies was much lower than what experts and emergency practitioners suspected, which suggests that potential cost savings from elimination of preventable duplicates may also be much lower than currently estimated.
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Emerg Med Australas · Feb 2015
Redesigning emergency patient flow with timely quality care at the Alfred.
The 4 h National Emergency Access Target was introduced in 2011. The Alfred Hospital in Melbourne implemented a hospital-wide clinical service framework, Timely Quality Care (TQC), to enhance patient experience and care quality by improving timeliness of interventions and investigations through the emergency episode and admission to discharge in 2012. We evaluated TQC's effect on achieving the National Emergency Access Target and associated safety and quality indicators. ⋯ TQC resulted in improvement in timeliness of care for emergency patients without compromising safety and quality. Success is attributed to effective engagement of stakeholders with a hospital-wide approach to redesigning the care pathway and establishing a new set of principles that underpin care from the time of ED arrival.
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The objective was to describe transfers out of hospital-based emergency departments (EDs) in the United States and to identify different characteristics of sending and receiving hospitals, travel distance during transfer, disposition on arrival to the second hospital, and median number of transfer partners among sending hospitals. ⋯ Among high-transfer conditions in U.S. EDs, patients are often transferred great distances, more commonly to large teaching hospitals with greater resources. The large number of transfer partners indicates a possible lack of stable transfer relationships between U.S. hospitals.