scholarly journals MP04: Interim analysis of the impact of the Emergency Department Transformation System on ambulance offload delay

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S66
Author(s):  
S. Pawa ◽  
K. Van Aarsen ◽  
A. Dukelow ◽  
D. Lizotte ◽  
M. Zheng
Keyword(s):  
Emergency Department ◽  
Negative Impact ◽  
Positive Impact ◽  
Tertiary Care ◽  
Assessment Process ◽  
Hospital Length Of Stay ◽  
Initial Assessment ◽  
Hospital Inpatient ◽  
Chi Square Analysis ◽  
The Impact

Introduction: Emergency Department Systems Transformation (EDST) is a bundle of Toyota Production System based interventions implemented in two London, Canada tertiary care Emergency Departments (ED) between April 2014 and July 2016 to improve patient care by increasing value and reducing waste. Some of the 17 primary interventions included computerized physician order entry optimization, staff schedule realignment, physician scorecards, and a novel initial assessment process. Offload delays are associated with longer hospital length of stay and delayed admission, and may increase morbidity and mortality. Delays also result in fewer circulating ambulances in the community. CIHI sets a benchmark of 30 minutes as an acceptable offload target. It is possible that EDST may have impacted offload times. Methods: Middlesex-London EMS provided offload times. Data was collected from London Health Sciences Centre including daily ED visit volumes, ED occupancy, offload nursing hours, and site variation. A binomial logistic regression analysis was performed to determine the impact of interventions and confounding variables on the proportion of patients meeting CIHI benchmark. A chi-square analysis was done comparing proportion of patients meeting the benchmark in the first 3 months versus the last 3 months to identify overall impact of EDST to date. Results: Increased offload nursing hours had a positive impact (p<0.001) on the proportion of offload times meeting the CIHI benchmark while increased ED visit volume and hospital inpatient volume had a significant negative impact (p<0.001). At both ED sites, the proportion of patients meeting the offload target ranged from 58-83% over the timeframe. There was a significant increase in the proportion of patients meeting the benchmark from the first quarter to the last quarter (69.6% vs 75.0%; 95% CI 3.45% to 7.38%, p=0.000). Specific interventions had varying degrees of impact on offload times. Conclusion: The proportion of patients meeting the benchmark offload time varied over the study timeframe but significantly increased with EDST implementation. Offload times are one of many outcomes we aim to improve with EDST and it remains an ongoing process as new interventions continue to be implemented. Once transformation is complete, future studies will focus on the impact of EDST on all ED flow metrics, and patient and provider satisfaction.

scholarly journals P036: Interim analysis of the impact of the emergency department transformation system on flow metrics

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S69-S69
Author(s):  
A. Dukelow ◽  
K. Van Aarsen ◽  
C. MacDonald ◽  
V. Dagnone
Keyword(s):  
Emergency Department ◽  
Interim Analysis ◽  
Tertiary Care ◽  
Improve Patient Care ◽  
University Hospital ◽  
Assessment Process ◽  
Initial Assessment ◽  
High Acuity ◽  
Systems Transformation ◽  
The Impact

Introduction: Emergency Department Systems Transformation (EDST) is a bundle of Toyota Production System based interventions implemented in two Canadian tertiary care Emergency Departments (ED) between June 2014 to July 2016. The goals were to improve patient care by increasing value and reducing waste. Longer times to physician initial assessment (PIA), ED length of stays (LOS) and times to inpatient beds are associated with increased patient morbidity and potentially mortality. Some of the 17 primary interventions included computerized physician order entry optimization, staff schedule realignment, physician scorecards and a novel initial assessment process ED access block has limited full implementation of EDST. An interim analysis was conducted to assess impact of interventions implemented to date on flow metrics. Methods: Daily ED visit volumes, boarding at 7am, time to PIA and LOS for non-admitted patients were collected from April 2014 -June 2016. Volume and boarding were compared from first to last quarter using an independent samples median test. Linear regression for each variable versus time was conducted to determine unadjusted relationships. PIA, LOS for non-admitted low acuity (Canadian Triage and Acuity Scale (CTAS) 4,5) and non-admitted high acuity (CTAS 1,2,3) patients were subsequently adjusted for volume and/or boarding to control for these variables using a non-parametric correlation. Results: Overall, median ED boarding decreased at University Hospital (UH) (14.0 vs 6.0, p<0.01) and increased at Victoria Hospital (VH) (17.0 vs 21.0, p<0.01) from first to last quarter. Median ED volume increased significantly at UH from first to last quarter (129.0 vs 142.0, p<0.01) but remained essentially unchanged at VH. 90th percentile LOS for non-admitted low acuity patients significantly decreased at UH (adjusted rs=-0.24, p<0.01) but did not significantly change at VH. For high acuity patients 90th percentile LOS significantly decreased at both hospitals (UH: adjusted rs=-0.23, p<0.01; VH: adjusted rs=-0.21, p<0.01). 90th percentile time to PIA improved slightly but significantly in both EDs (UH: adjusted rs=-0.10, p<0.01; VH: adjusted rs=-0.18, p<0.01). Conclusion: Persistent ED boarding impacted the ability to fully implement the EDST model of care. Partial EDST implementation has resulted in improvement in PIA at both LHSC EDs. At UH where ED boarding decreased, LOS metrics improved significantly even after controlling for boarding.

scholarly journals Emergency Department Referral Profile of Traumatic Brain Injury Records at a Tertiary Care Hospital of Pakistan

2021 ◽  
Author(s):  
Maria Khan ◽  
Uzair Yaqoob ◽  
Zair Hassan ◽  
Muhammad Muizz Uddin
Keyword(s):  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Road Traffic ◽  
Tertiary Care ◽  
Initial Assessment ◽  
Care Hospital ◽  
Mild Tbi ◽  
Epidemiological Characteristics ◽  
The Impact

Abstract Background: Traumatic Brain Injury (TBI) is the leading cause of morbidity and mortality all over the world and the impact is much worse in Pakistan. The objective here is to describe the epidemiological characteristics of patients with TBI in our country and to determine the immediate outcomes of patients with TBI after the presentation.Method: This was a cross-sectional study conducted at the Lady Reading Hospital, Peshawar, Pakistan. Data were extracted from the medical records from January 1st to December 31st, 2019. Patient age, sex, type of trauma, and immediate outcome of the referral to the Emergency Department were recorded. The severity of TBI was categorized based on Glasgow Coma Scale (GCS) in mild (GCS 13-15), moderate (GCS 9-12), and severe (GCS <8) classes. The Emergency Department referral profile was classified as admissions, disposed, detained and disposed, referred.Results: Out of 5047 patients, 3689 (73.1%) males and 1358 (26.9%) females. The most commonly affected age group was 0-10 years (25.6%) and 21-30 years (20.1%). Road Traffic accident was the predominant cause of injury (38.8%, n=1960) followed by fall (32.7%, n=1649). Most (93.6%, n=4710) of the TBIs were mild. After the full initial assessment and workup, and completing all first-aid management, the immediate outcome was divided into four, most frequent (67.2%, n=3393) of which was “disposed (discharged)”, and 9.3% (n=470) were admitted for further management.Conclusion: Our study represents a relatively commonplace picture of epidemiological data on the burden of TBI in Pakistan. As a large proportion of patients had a mild TBI, and there is a high risk of mild TBI being under-diagnosed, we warrant further investigation of mild TBI in population-based studies.

scholarly journals The Impact of an Automated Patient Digital Engagement Platform on Revisit Reduction

Iproceedings ◽  
10.2196/15091 ◽  
2019 ◽  
Vol 5 (1) ◽  
pp. e15091
Author(s):  
Adam Beck ◽  
Caroline Robinson
Keyword(s):  
Emergency Department ◽  
Patient Engagement ◽  
Information Exchange ◽  
Negative Impact ◽  
Statistical Significance ◽  
General Medicine ◽  
Inpatient Setting ◽  
Hospital Inpatient ◽  
Digital Platform ◽  
The Impact

Background Revisits within 30 days to an emergency department (ED), observation care unit, or inpatient setting following patient discharge continues to be a challenge, especially in urban settings. In addition to the consequences for the patient, these revisits have a negative impact on a health system’s finances in a value based care or global budget environment. Objective The objective was to evaluate the effectiveness of a customized automated digital patient engagement application (GetWell Loop) to prevent 30-day revisits after home discharge from an ED or hospital inpatient setting. Methods The LifeBridge Health Innovation Team collaborated with the GetWell Network to customize their patient engagement platform (GetWell Loop) with automated check-in questions and resources. An application link was emailed to adult patients discharged home from the ED. A retrospective study of ED visits for patients treated for general medicine and cardiology conditions (accounting for 24% of our adult ED discharges) between August 1, 2018, and December 31, 2018, was conducted using CRISP, Maryland’s state-designated health information exchange. We used this database to identify the index visits that experienced an emergency department visit, inpatient admission, or observation stay at any Maryland facility within 30 days of discharge. We also used data within GetWell Loop to track patient activation and engagement. The primary endpoint was a comparison of ED patients that experienced a 30-day revisit and who did or did not activate their GetWell Loop account. Secondary end points included overall activation rate and the rate of engagement as measured by the number of logins, alerts, and comments generated by patients through the platform. Statistical significance was calculated using the Fisher’s exact test with a P<.05. Results ED discharges who were treated for general medicine conditions (n=787) and activated their GetWell Loop account experienced a 30-day revisit rate of 18.9% compared to 25.2% who did not activate their account (P=.06). For patients treated for cardiology conditions (n=722), 10.5% of patients who activated their GetWell account experienced a 30-day revisit compared to 17.4% not activating their account (P=.02). During the course of this study, 26% of patients receiving an invite to use the digital platform activated their account (n=1652) logged in a total of 4006 times, generated 734 alerts, and submitted 297 open ended comments/questions. Conclusions These results indicate the potential value of digital health platforms to improve 30-day revisit rates. The strongest impact was observed amongst cardiology patients where the revisit rate is 39.8% lower for patients using GetWell Loop compared to general medicine patients where the relative difference is 25.2%. The results also indicate patients are willing to utilize a digital platform postdischarge to proactively engage in their own care. We attempted to control for potential selection bias that may impact this analysis given patient adoption and use of a digital platform by looking for differences in the subpopulations who did and did not activate the platform. LifeBridge Health is proving healthcare systems can leverage automated mobile platforms to successfully impact clinical outcomes at scale without compromising customer service and patient experience.

scholarly journals LO79: The impact of access block on consultation time in the emergency department

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S36-S37
Author(s):  
L. Carroll ◽  
M. Nemnom ◽  
E. Kwok ◽  
V. Thiruganasambandamoorthy
Keyword(s):  
Emergency Department ◽  
Performance Metrics ◽  
Tertiary Care ◽  
Initial Assessment ◽  
Inpatient Service ◽  
Care Hospital ◽  
Important Indicator ◽  
Consultation Request ◽  
The Impact ◽  
Consultation Time

Introduction: Access block (AB) is the most important indicator of Emergency Department (ED) crowding, but the impact of AB on consultation time has not been described. Our objectives were to determine if ED AB affects inpatient service consultation time, and operational and patient outcomes. Methods: We conducted a health records review of all ED patients referred and admitted at a university-affiliated tertiary care hospital over 60-days. A computational algorithm determined hourly ED AB at the time of consultation request, and observational cohorts were determined based on ED AB high (&gt;35% ED bed capacity occupied by admitted patients) or low (&lt;35%). The outcomes included total consultation time (TCT), ED physician initial assessment (PIA) time, ED length of stay (LOS), transfer time to inpatient bed (TTB), hospital LOS, return to ED (RTED) within 30 days, and 30-day mortality. Results: We included 2,871 patients (48% male; M = 63 years, IQR 45–78), and the low AB cohort were higher acuity (N = 1,692; 50.4% CTAS 1–2) than the high AB cohort (N = 1,179; 47.1% CTAS 1–2). Median TCT was not significantly different (low = 209min, high = 212min; p = 0.09), and there was no difference in consults completed within the 3-hour institutional time target (low = 41.1%, high = 40.9%; p = 0.89). Median ED PIA time was not significantly different (low = 66min, high = 68min; p = 0.08), however, patients seen within the funding-associated provincial ED PIA time target was significantly less during high AB (high = 82.2%, low = 89.2%; p &lt; 0.001). Median ED LOS was significantly longer during high AB (high = 12.1hr, low = 11.1hr; p = 0.009), but median hospital LOS was not different (high = 109.5hr, low = 112.4hr; p = 0.44). Median TTB was significantly longer during high AB (high = 8.0hr, low = 5.9hr; p = 0.0004). There was no difference in RTED visits (high = 12.4%, low = 10.6%; p = 0.15) or 30-day mortality (high = 8.4%, low = 9.2%; p = 0.51). Conclusion: In conclusion, consultation time is not affected by AB. However, boarding admitted patients in the ED impairs our ability to meet funding-associated performance metrics. Reducing boarding time should be an ED and hospital-wide priority, as it negatively impacts funding and delays patient care.

scholarly journals Parents’ Involvement in High-Stakes Language Assessment A Review of Test Impact on Parent Behavior

2021 ◽  
Vol 14 (12) ◽  
pp. 55
Author(s):  
Jing Zhang
Keyword(s):  
Negative Impact ◽  
Positive Impact ◽  
High Stakes Testing ◽  
Language Assessment ◽  
Educational Background ◽  
Assessment Process ◽  
Future Research ◽  
High Stakes ◽  
The Impact ◽  
Test Impact

This paper reviews a total of 20 empirical research studies concerning parents&rsquo; behavior under the context of high-stakes language assessment, aiming to reveal the impact of the assessment on parents&rsquo; behavior. The results show that (1) parents are typically involved in high-stakes language assessment process; (2) their involvement practice includes general (such as hiring tutors for children) and extreme involvement behavior (such as participating in movement against high-stakes testing); (3) no unanimous conclusion is reached concerning the effectiveness of parents&rsquo; involvement in high-stakes language assessment; (4) multiple factors that affect parents&rsquo; involvement in high-stakes language assessment are identified, including parents&rsquo; perceptions of tests, their educational background, and the time they spend with their children. This study concludes that tests might influence the ways parents are involved in children&rsquo;s education. However, not all parents might be influenced by testing, and testing might have a positive impact on some parents but a negative impact on others. This synthesis has several practical implications. Firstly, it indicates that parents&rsquo; involvement behavior in the context of high-stakes language assessment deserves to be further investigated. Secondly, it points that various intervention programs should be provided for parents to help them better support their children&rsquo;s learning and test preparation. The paper also offers several suggestions for future research. &nbsp;

scholarly journals LO06: Effects of emergency department system transformation (EDST) on patient experience of emergency department visits

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S8-S8
Author(s):  
S. Danby ◽  
K. Van Aarsen ◽  
M. Columbus ◽  
A. Dukelow
Keyword(s):  
Emergency Department ◽  
Patient Experience ◽  
Tertiary Care ◽  
Emergency Department Visits ◽  
Assessment Process ◽  
Initial Assessment ◽  
System Transformation ◽  
Structured Interviews ◽  
Kappa Score ◽  
Perfect Agreement

Introduction: Emergency Department Systems Transformation (EDST) is a bundle of Toyota Production System based interventions partially implemented in two Canadian tertiary care Emergency Departments (ED) between June 2014- July 2016 with the goal to improve patient care by increasing value and reducing waste. Some of the 17 primary interventions included computerized physician order entry optimization, staff schedule realignment, physician scorecards and a novel initial assessment process. Some interventions have only been partially implemented due to persistent access block. This project was designed to examine the effect of partial EDST implementation on patient experience of emergency department visits. Patient satisfaction has been linked to improved patient outcomes, improved adherence to physician instruction, and improved provider satisfaction. Methods: Semi structured interviews were conducted over three distinct time periods (summer 2015, 2016 and 2017) to encompass progressive levels of EDST implementation. The interviews focused on the patients perceptions in each of 4 stages of their ED visit - Check-in, assessment, reassessment, and disposition. Patients were asked a list of positive (respected, listened to, supported, safe) and negative (in pain, worried, confused, frustrated) emotions frequently experienced and asked if they felt any of these emotions during their ED stay. Open ended questions were also asked about their overall visit. Descriptive statistics were calculated as differences in the proportion of patients feeling each emotion across timeframes. The open-ended question was coded by two reviewers as positive, negative or mixed. A kappa score was calculated to determine reviewer agreement. Results: 987 interviews were completed. In general, the proportion of patients feeling negative emotions remained consistent while positive emotions increased as EDST implementation progressed. For open-ended responses, the percentage of overtly positive experiences increased significantly from 2015 to 2017 (p=0.006), while overtly negative experiences did not significantly change. Reviewers agreed in the coding of the open-ended responses in 97.6% of surveys. The kappa score for reviewer agreement was 0.96 (95%CI 0.94-0.98) indicating almost perfect agreement. Conclusion: Partial implementation of EDST positively impacted patients experience of emergency department visits.

043 Sleep Restriction Affects Memory in Healthy Adults: Preliminary Findings

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A18-A19
Author(s):  
Molly Zimmerman ◽  
Christiane Hale ◽  
Adam Brickman ◽  
Lok-Kin Yeung ◽  
Justin Cochran ◽  
...  
Keyword(s):  
Working Memory ◽  
Negative Impact ◽  
Positive Impact ◽  
Healthy Adults ◽  
Task Demands ◽  
Sleep Restriction ◽  
Neuropsychological Function ◽  
Wake Time ◽  
Sleep Condition ◽  
The Impact

Abstract Introduction Sleep loss has a range of detrimental effects on cognitive ability. However, few studies have examined the impact of sleep restriction on neuropsychological function using an experimental design. The goal of this study was to examine the extent to which maintained insufficient sleep affects cognition in healthy adults compared to habitual adequate sleep. Methods This study used a randomized, crossover, outpatient sleep restriction design. Adults who regularly slept at least 7 h/night, verified by 2 weeks of screening with actigraphy, completed 2 phases of 6 weeks each: habitual sleep (&gt;7 h of sleep/night) or sleep restriction (habitual sleep minus 1.5 h) separated by a 6-week washout period. During the sleep restriction phase, participants were asked to delay their bedtime by 1.5 hours/night while maintaining their habitual wake time. Neuropsychological function was evaluated with the NIH Toolbox Cognition Battery at baseline (week 0) and endpoint (week 6) of each intervention phase. The NIH Toolbox evaluates a range of cognitive abilities, including attention, executive functioning, and working memory. General linear models with post hoc paired t-tests were used to assess demographically-adjusted test scores prior to and following each sleep condition. Results At the time of analyses, 16 participants were enrolled (age 34.5□14.5 years, 9 women), 10 of whom had completed study procedures. An interaction between sleep condition and testing session revealed that individuals performed worse on List Sorting, a working memory test, after sleep restriction but improved slightly after habitual sleep (p&lt;0.001). While not statistically reliable, the pattern of test results was similar on the other tests of processing speed, executive function, and attention. Conclusion In these preliminary results from this randomized experimental study, we demonstrated that sleep restriction has a negative impact while stable habitual adequate sleep has a positive impact on working memory, or the ability to temporarily hold information in mind while executing task demands. This finding contributes to our understanding of the complex interplay between different aspects of sleep quality (i.e., both sleep restriction as well as the maintenance of stable sleep patterns) on cognition and underscores the importance of routine sleep screening as part of medical evaluations. Support (if any):

scholarly journals Exploring the Relationship between Communication and Success of Construction Projects: The Mediating Role of Conflict

2021 ◽  
Vol 13 (8) ◽  
pp. 4513
Author(s):  
Summaira Malik ◽  
Muhammad Taqi ◽  
José Moleiro Martins ◽  
Mário Nuno Mata ◽  
João Manuel Pereira ◽  
...  
Keyword(s):  
Project Success ◽  
Negative Impact ◽  
Positive Impact ◽  
Construction Project ◽  
Project Team ◽  
Relationship Conflict ◽  
Team Members ◽  
Mediating Role ◽  
The Impact

The success of a construction project is a widely discussed topic, even today, and there exists a difference of opinion. The impact of communication and conflict on project success is an important, but least addressed, issue in literature, especially in the case of underdeveloped countries. Miscommunication and conflict not only hinder the success of a project but also may lead to conflicts. The focus of this paper was to examine the impact of communication on project success with the mediating role of conflict. By using SPSS, demographics, descriptive statistics and correlation were determined. Smart PLS version 3.0 was used for confirmatory factor analysis (CFA), internal accuracy and validity estimates, hypothesis checking and mediation testing. The results showed that formal communication has a negative impact on the success of a construction project, resulting in conflicts among project team members, whereas informal communication and communication willingness have a positive impact on project success because people tend to know each other, and trust is developed. Task, process and relationship conflicts were used as mediating variables. It was found that task conflict effects the relations positively because project team members suggest different ways to do a certain task, and, hence, project success is achieved. On the contrary, process conflict and relationship conflict have a negative impact on communication and project success. Both of these conflicts lead to miscommunication, and project success is compromised. Hence, it is the responsibility of the project manager to enhance communication among project team members and to reduce the detrimental effects of process and relationship conflict on project success.

scholarly journals Association of Emergency Department Waiting Times With Patient Experience in Admitted and Discharged Patients

2021 ◽  
Vol 8 ◽  
pp. 237437352110114
Author(s):  
Andrew Nyce ◽  
Snehal Gandhi ◽  
Brian Freeze ◽  
Joshua Bosire ◽  
Terry Ricca ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Patient Experience ◽  
Waiting Times ◽  
Hospital Length ◽  
Short Length ◽  
Hospital Length Of Stay ◽  
Patient’S Experience ◽  
Discharged Patients ◽  
The Impact

Prolonged waiting times are associated with worse patient experience in patients discharged from the emergency department (ED). However, it is unclear which component of the waiting times is most impactful to the patient experience and the impact on hospitalized patients. We performed a retrospective analysis of ED patients between July 2018 and March 30, 2020. In all, 3278 patients were included: 1477 patients were discharged from the ED, and 1680 were admitted. Discharged patients had a longer door-to-first provider and door-to-doctor time, but a shorter doctor-to-disposition, disposition-to-departure, and total ED time when compared to admitted patients. Some, but not all, components of waiting times were significantly higher in patients with suboptimal experience (<100th percentile). Prolonged door-to-doctor time was significantly associated with worse patient experience in discharged patients and in patients with hospital length of stay ≤4 days. Prolonged ED waiting times were significantly associated with worse patient experience in patients who were discharged from the ED and in inpatients with short length of stay. Door-to-doctor time seems to have the highest impact on the patient’s experience of these 2 groups.

scholarly journals Environmental Regulation, Environmental Awareness and Environmental Governance Satisfaction

2021 ◽  
Vol 13 (7) ◽  
pp. 3960
Author(s):  
Meng-Meng Geng ◽  
Ling-Yun He
Keyword(s):  
Environmental Regulation ◽  
Environmental Governance ◽  
Negative Impact ◽  
Positive Impact ◽  
Subjective Evaluation ◽  
Environmental Awareness ◽  
General Social Survey ◽  
Probit Model ◽  
The People ◽  
The Impact

It is a problem worth thinking about whether the government’s environmental regulation policies can meet the residents’ requirements for environmental quality, and benefit the people. The study of the public’s subjective evaluation can more intuitively judge whether the government’s environmental regulation has realized “ecological benefits for the people”. Based on the data of the Chinese General Social Survey (CGSS) in 2013, this paper studied the impact of environmental regulation and environmental awareness on environmental governance satisfaction by an ordered probit model. The study found that environmental regulation has a significant positive impact on environmental governance satisfaction, while environmental awareness has a significant negative impact on environmental governance satisfaction. We also found that when public environmental awareness is taken into account, the positive relationship between environmental regulation and environmental governance satisfaction is affected. The robustness test proved this conclusion.

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