scholarly journals P121: Understanding health equity: a pilot project to collect socio-demographic information on emergency department patients at registration

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S119
Author(s):  
S. Vaillancourt ◽  
M. McGowan ◽  
C. Semprun ◽  
P. Hannam ◽  
G. Bandiera ◽  
...  
Keyword(s):  
Emergency Department ◽  
Data Collection ◽  
Large Scale ◽  
Capture Rate ◽  
Tertiary Care ◽  
Participation Rate ◽  
Pilot Project ◽  
Patient Data ◽  
Structured Interviews ◽  
Number Of Patients

Introduction: There is strong evidence that socio-economic factors such as income, housing and ethnicity are linked to health outcome disparities for emergency department (ED) patients. However, lack of real-time patient data has limited our ability to identify, understand and address health disparities. During a 14-week period, we assessed the feasibility and acceptability of the systematic collection of patient-level equity data in a busy tertiary care urban ED. Methods: We assessed feasibility by directly observing impact on registration time, percentage of patients on which data was collected, and ambulance patient data collection. We also assessed acceptability to patients, registration staff and clinicians through structured interviews of patients systematically sampled, focus group and surveys of registration staff and survey of clinicians. Results: Over the course of the study, equity data was collected on 2017 patients. Capture rate peaked in week 7 with 51% of eligible patients offered the equity questions and 30% answering. Average patient registration time increased from 215 seconds to 345 seconds (60%). Data collection with ambulance patients did not appear feasible. Patients (n=30) reported being comfortable with most questions except income (47% comfortable). 93% believed it could improve health services. However, a small number of patients voiced concern that the data could result in discrimination. Registration staff required sustained support and engagement, but some continued to feel uncomfortable with offering the questionnaire to some patients. Conclusion: Large scale collection of equity data is feasible but requires additional resources and sustained staff and patient support. Patient participation rate is likely to remain relatively low and is likely to underestimate disadvantaged groups. Data collection at multiple points within an institution may improve capture rate.

Patient perception regarding privacy and confidentiality: A study from the emergency department of a tertiary care hospital in Karachi, Pakistan

2021 ◽  
Vol 38 (ICON-2022) ◽  
Author(s):  
Syed Ghazanfar Saleem ◽  
Saima Ali ◽  
Nida Ghouri ◽  
Quratulain Maroof ◽  
Muhammad Imran Jamal ◽  
...  
Keyword(s):  
Emergency Department ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Patient Perception ◽  
Care Hospital ◽  
Structured Interviews ◽  
Privacy Concerns ◽  
Creative Commons ◽  
Privacy And Confidentiality ◽  
And Behavior

Background and Objective: Maintaining privacy and ensuring confidentiality with patients is paramount to developing an effective patient-provider relationship. This is often challenging in over-crowded Emergency Departments (EDs). This survey was designed to explore patients’ perceptions on maintenance of privacy and confidentiality and their subsequent interactions with providers in a busy tertiary care hospital in Karachi. Methods: Trained nursing staff conducted structured interviews with 571 patients who presented to The Indus Hospital (TIH) ED from January to December 2020. All patients were 14 years of age or older, could speak and understand Urdu, and provide informed consent. Patients were asked about their perceptions of privacy and confidentiality in the ED and whether this affected their interactions with providers. Results: Respondents were primarily men (64%) under the age of 45 (62%) presenting for the first time (49%). The majority of patients felt that privacy and confidentiality were maintained, however 10% of patients reported that they had rejected examination due to privacy concerns and 15% of patients reported that they had changed or omitted information provided to a provider due to confidentiality concerns. There was correlation between privacy and confidentiality concerns and patient-provider interactions (p<0.0001). Conclusions: Despite the often over-crowded and busy environment of the ED, patients generally felt that privacy and confidentiality were maintained. Given the correlation between perception and behavior and the importance of an effective patient-provider relationship, particularly in the acute setting when morbidity and mortality is high, initiatives that focus on maintaining privacy and confidentiality should be pursued. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5785 How to cite this:Saleem SG, Ali S, Ghouri N, Maroof Q, Jamal MI, Aziz T, et al. Patient perception regarding privacy and confidentiality: A study from the emergency department of a tertiary care hospital in Karachi, Pakistan. Pak J Med Sci. 2022;38(2):351-355.  doi: https://doi.org/10.12669/pjms.38.ICON-2022.5785 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals P151: Occupational therapy in the emergency department: sustaining results

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S110-S111
Author(s):  
J. Trenholm
Keyword(s):  
Emergency Department ◽  
Occupational Therapy ◽  
Hospital Admissions ◽  
Discharge Planning ◽  
Functional Decline ◽  
Pilot Project ◽  
Added Value ◽  
Functional Impairments ◽  
Chart Audit ◽  
Number Of Patients

Introduction: An emergency department visit may represent a sentinel event for someone who is older and frail, signalling a slide into dependence and functional decline. The gold standard for the treatment of frail older adults is a comprehensive geriatric assessment, involving consideration of multiple domains including mobility and function in activities of daily living. Despite this, when a chart audit was conducted in a Canadian metropolitan emergency department, none of the patients age 65 and older had a documented assessment of their function or mobility. In response, an occupational therapy program was implemented. The goals of this program were to reduce the number of unnecessary hospital admissions related to patient functional impairments, and to increase function, safety, and independence for patients upon discharge from the emergency department. Methods: The pilot project, which was completed in 2013, was evaluated using a mixed methods approach. Positive patient outcomes at that time included a reduction in avoidable admissions and better support for patients upon discharge from the emergency department. A survey of emergency department staff indicated that occupational therapy consultation added value to the diagnostic and discharge planning processes. However, due to changes in administrative priorities, several service redesigns were required. Multiple PDSA cycles were completed, and the development of a logic model guided and focused program development. Results: A reassessment of program objectives was conducted using 2015 data, which found that the number of patients seen by the occupational therapist remained the same, as did the percentage of patients discharged with support of occupational therapy intervention, such as provision of adaptive equipment or referral to community rehabilitation referrals. The percentage of patients discharged due to occupational therapy as a primary contributing factor rose slightly, and staff satisfaction with the program remained high. Conclusion: This evaluation proves that the provision of occupational therapy services in the emergency department is sustainable, benefits patients, and can be incorporated into the emergency department workflow and culture.

scholarly journals Enhancing Survey Participation among Foreign-Born Populations

2019 ◽  
Vol 53 ◽  
pp. 89-110 ◽  
Author(s):  
Anu Castaneda ◽  
Shadia Rask ◽  
Tommi Härkänen ◽  
Teppo Juntunen ◽  
Natalia Skogberg ◽  
...  
Keyword(s):  
General Population ◽  
Data Collection ◽  
Large Scale ◽  
Participation Rate ◽  
Migrant Health ◽  
Population Based ◽  
Health Examination ◽  
Foreign Born ◽  
Extra Effort ◽  
Scale Population

The Finnish Migrant Health and Wellbeing Study (Maamu) is the first large-scale population-based health examination survey among the foreign-born population in Finland, unique also at the European level. It provides information on wellbeing of three major foreign-born groups: Russian, Somali, and Kurdish. In data collection, extra effort was put into reaching the sampled persons (n=3,000), for example by recruiting bilingual personnel to carry out the data collection, reaching participation rates as high as 70%, 51%, and 63%, respectively. A comparison group of the general population was available from a general population survey. The main challenges in fieldwork included reaching sampled persons, supervision of the fieldwork personnel, and special linguistic or cultural needs. Our experiences show that participation rate can be improved by engaging the target groups in all stages of the survey process and using several recruitment strategies, ending up with succeeding in pointing out health inequalities in the population.

scholarly journals Acute pain management in patients with opiate maintenance treatment in primary care: a qualitative study

2020 ◽  
Author(s):  
morgane guillou landreat ◽  
Melia Baillot ◽  
Le Goff Delphine ◽  
Le Reste Jean Yves
Keyword(s):  
General Practice ◽  
Data Collection ◽  
Thematic Analysis ◽  
Acute Pain ◽  
Maintenance Treatment ◽  
Structured Interviews ◽  
Opiate Use ◽  
Number Of Patients ◽  
Data Collection Technique ◽  
Opiate Use Disorder

Abstract Background: Opiate use disorders are a worldwide disease. In the last 30 years, opiate maintenance treatment prescription changed patients’ and also changed physicians’ practice. General practitioners (GPs) have to deal with patients on OMT who are in acute pain. Both clinically and pharmacologically, the treatment of acute pain in patients with an opiate use disorder and an OMT(opiate maintenance treatment) differs from that given to patients with other conditions. As this situation is complex, it was important to explore whether GPs recognised this problem and whether they managed it effectively.Objective: To investigate how GPs identify and manage situations of acute pain in patients with opiate use disorders and OMT. Methods: semi-structured interviews were used as a data collection technique with a purposive sample of practising GPs. Data collection continued until saturation was reached. Analysis was undertaken using a thematic analysis method. Two independent researchers, working blind and pooling data, carried out the analysis. Results: The maximal variation of the sample and saturation of data were reached with 11 GPs. The thematic analysis resulted in 4 main themes: (1) the importance and difficulties of professional links , (2) the specific clinical reasoning , (3) the importance of the doctor-patient relationship and (4) the particular characteristics of OMT patients. Conclusion: The complexity of pain and opioid dependence represents significant challenges for GPs. It is hard to achieve a balance between pain relief and opiate use disorder treatment. These questions are particularly important in general practice, where the practitioner may feel insufficiently trained, and isolated. Existing protocols do not seem to be in line with general practice. The number of patients on OMT has increased since it was first marketed; GPs will increasingly have to deal with these situations and will have to issue their own recommendations.

scholarly journals Using the Past to Prepare for the Future: A 2018 Pilot Study to Improve the Hospital Response for Mass Casualties via a Multi-Dimensional Approach

2019 ◽  
Vol 34 (s1) ◽  
pp. s176-s176
Author(s):  
George W. Contreras ◽  
Kevin Pohlman ◽  
Jenna Mandel-Ricci ◽  
David Markenson ◽  
Michael Reilly
Keyword(s):  
Emergency Department ◽  
New York ◽  
Large Scale ◽  
New York State ◽  
Physician Assistants ◽  
Disaster Medicine ◽  
Mass Casualties ◽  
Clinical Role ◽  
Number Of Patients ◽  
Short Period

Introduction:Recent mass shooting events remind us of the importance of hospitals’ preparedness to manage a large number of patients in a short period of time. While prehospital systems triage for field interventions and priority of transport, they were not designed to triage for the scarce resources of a hospital. Therefore, upon arrival to hospital, clinicians must then quickly determine how to best assess and provide life-saving interventions based on their limited resources.Methods:In collaboration with the Greater New York Hospital Association (GNYHA), the Center for Disaster Medicine at New York Medical College piloted an interactive and intensive eight-hour course at four New York State hospitals that covered critical areas such as: current literature on Mass Casualty Events and Triage, review of hospital emergency management, hospital-based triage principles, a MCI exercise in the emergency department, a surge capacity tabletop exercise, and use of ultrasound. While targeted towards physicians to foster team-based care and learning, nurses, physician assistants, and hospital administrators also participated in the pilot course.Results:Sixty persons from four hospitals participated in the pilot phase. Preliminary findings post-training reveal the following: 58% of participants expressed greater confidence in distinguishing between emergency department triage and triage during disasters; 59% of participants expressed greater confidence in performing initial triage of victims; 49% of participants expressed greater confidence in describing the use of ultrasound-guided triage; and 95% of participants reported an enhancement in their ability to perform their clinical role.Discussion:Preliminary findings reiterate the ongoing need for hospitals to provide training to their staff in the unique aspects of hospital triage and surge management using tools specifically designed in order to be prepared for the rapid influx of a large number of patients. A multipronged training model is a positive approach to help hospitals prepare for large-scale disasters.

scholarly journals (A22) Impact of Karachi Terrorist Bombing on an Emergency Department of a Tertiary Care Hospital

2011 ◽  
Vol 26 (S1) ◽  
pp. s6-s7
Author(s):  
H. Waseem ◽  
S. Shahbaz ◽  
J. Razzak
Keyword(s):  
Emergency Department ◽  
Tertiary Care Hospital ◽  
Wound Care ◽  
Tertiary Care ◽  
Care Facility ◽  
Care Hospital ◽  
Disaster Plan ◽  
Tertiary Care Facility ◽  
Number Of Patients ◽  
The Government

ObjectivesThe objective of this study was to collect epidemiological injury data on patients presenting to the emergency department of a tertiary care hospital after the bombing on 29 December 2009.MethodsThis was a retrospective review of the medical records of the victims that were brought to a tertiary care hospital. Bombing victims were described as requiring acute care due to the direct effect of the bombing.ResultsThe results are derived from a sample size of 198 bomb blast victims, most of which were first transported to government hospitals by private cars rather than ambulances. After the government announced free treatment, there was a wave of patients, among which, most were stable and already had received some form of treatment. Approximately 5–6 patients who had life-threatening injuries were brought directly to the tertiary care facility and needed surgical intervention. The lack of security in the emergency department could have lead to another terrorist activity. There were no procedures done in the field as there is lack of emergency medical services training in Pakistan, but in the hospital most of the interventions included intravenous (IV) lines, wound care, and laceration repair. The most common treatments included the administration of IV fluids, antibiotics, and analgesia. Radiographs of specific sites and trauma series were used to rule out bone injuries. There was lack of documentation in most of the medical charts.ConclusionsThe emergency department was overwhelmed with the number of patients that it received. Therefore, an updated disaster plan and regular disaster drills are required. Rapid and accurate triage could minimize mortality among bombing survivors significantly. The majority of patients were discharged home.

scholarly journals P117: A pilot program of physician at triage conducted at a tertiary care hospital improved measures of emergency department throughput and provides a potential solution for emergency department overcrowding

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S98-S98
Author(s):  
J. D. Powell ◽  
A. Hughes ◽  
R. Scott ◽  
N. Balfour ◽  
G. McInnes ◽  
...  
Keyword(s):  
Emergency Department ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Initial Assessment ◽  
Administrative Database ◽  
Care Hospital ◽  
Potential Solution ◽  
Process Measures ◽  
Emergency Department Overcrowding ◽  
Number Of Patients

Introduction: Emergency Department Overcrowding (EDOC) is a multifactorial issue that leads to Access Block for patients needing emergency care. Identified as a national problem, patients presenting to a Canadian Emergency Department (ED) at a time of overcrowding have higher rates of admission to hospital and increased seven-day mortality. Using the well accepted input-throughput-output model to study EDOC, current research has focused on throughput as a measure of patient flow, reported as ED length of stay (LOS). In fact, ED LOS and ED beds occupied by inpatients are two “extremely important indicators of EDOC identified by a 2005 survey of Canadian ED directors. One proposed solution to improve ED throughput is to utilize a physician at triage (PAT) to rapidly assess newly arriving patients. In 2017, a pilot PAT program was trialed at Kelowna General Hospital (KGH), a tertiary care hospital, as part of a PDSA cycle. The aim was to mitigate EDOC by improving ED throughput by the end of 2018, to meet the national targets for ED LOS suggested in the 2013 CAEP position statement. Methods: During the fiscal periods 1-6 (April 1 to September 7, 2017) a PAT shift occurred daily from 1000-2200, over four long weekends. ED LOS, time to inpatient bed, time to physician initial assessment (PIA), number of British Columbia Ambulance Service (BCAS) offload delays, and number of patients who left without being seen (LWBS) were extracted from an administrative database. Results were retrospectively analyzed and compared to data from 1000-2200 of non-PAT trial days during the trial periods. Results: Median ED LOS decreased from 3.8 to 3.4 hours for high-acuity patients (CTAS 1-3), from 2.1 to 1.8 hours for low-acuity patients (CTAS 4-5), and from 9.3 to 8.0 hours for all admitted patients. During PAT trial weekends, there was a decrease in the average time to PIA by 65% (from 73 to 26 minutes for CTAS 2-5), average number of daily BCAS offload delays by 39% (from 2.3 to 1.4 delays per day), and number of patients who LWBS from 2.4% to 1.7%. Conclusion: The implementation of PAT was associated with improvements in all five measures of ED throughput, providing a potential solution for EDOC at KGH. ED LOS was reduced compared to non-PAT control days, successfully meeting the suggested national targets. PAT could improve efficiency, resulting in the ability to see more patients in the ED, and increase the quality and safety of ED practice. Next, we hope to prospectively evaluate PAT, continuing to analyze these process measures, perform a cost-benefit analysis, and formally assess ED staff and patient perceptions of the program.

scholarly journals P025: Are we ready for a gunman in the emergency department? A qualitative study of staff perceptions of risk and readiness to respond

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S65-S66
Author(s):  
M. McGowan ◽  
K. Dainty ◽  
B. Seaton ◽  
S. Gray
Keyword(s):  
Emergency Department ◽  
Data Collection ◽  
Workplace Violence ◽  
Tertiary Care ◽  
Active Shooter ◽  
Tertiary Care Centre ◽  
Primary Methods ◽  
Staff Members ◽  
Qualitative Interview Study ◽  
The Impact

Introduction: Hospital-based gun violence is devastatingly traumatic for everyone present and recent events in Cobourg, Ontario underscore that an active shooter inside the emergency department (ED) is an imminent threat. In June 2016, the Ontario Hospital Association (OHA) added Code Silver to the list of standardized emergency preparedness colour codes and advised member hospitals to develop policies and train staff on how best to respond. Given that EDs are particularly susceptible to opportunistic breach by an active shooter, the impact of a Code Silver on ED functioning and staff members may be particularly acute. We hypothesized that there may not be a simple, one-size-fits-all-hospital-staff solution about how best to prepare EDs to respond to Code Silver. In order to inform and support future staff training initiatives related to Code Silver and other disaster situations in hospitals, we sought to investigate staff perspectives and behaviour related to personal safety at work and, in particular, an active shooter. Methods: We undertook a qualitative interview study of multi-disciplinary ED staff (MDs, RNs, clericals, allied health, administrators) at a single tertiary care centre in Toronto. The primary methods for data collection were in-depth qualitative interviews and focus groups. Participants were recruited using stakeholder and maximum variation sampling strategies. Data collection and analysis were concurrent and standard thematic analysis techniques were employed. Results: Sixteen (16) staff members participated in interviews and 40 participated in small focus group discussions. Data analysis revealed workplace violence and personal health risks have been normalized as expected, acceptable features of everyday life at work in the ED given that patients are perceived to be sick people in need of help that ED staff are trained for and prepared to provide. In contrast, weapons and active shooters challenge the boundaries of professional responsibility and readiness to respond to Code Silver is perceived by staff as a fallacy. Conclusion: Knowledge from this study gives us crucial insight into important areas for targeted training and opportunities for knowledge translation on the topic of implementing Code Silver in EDs across the country. Future interventions must include how to overcome normalization of workplace violence in the ED setting and negotiating competing professional obligations during crisis situations. Attention to these are crucial if we are to truly keep our staff safe during these traumatic events.

scholarly journals Clinical Profile of Stroke Patients Presenting to the Emergency Department of a Major Stroke Centre in Oman

2021 ◽  
Author(s):  
Hasina A. Al Harthi ◽  
Ammar Al Kashmiri ◽  
Lubna M. Zakaryia ◽  
Jawad A. Al-Lawati ◽  
Omar M. Najem ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Heart Diseases ◽  
Tertiary Care ◽  
Public Health Problem ◽  
Large Artery ◽  
Care Hospital ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Number Of Patients

Objectives: Stroke is a significant public health problem and one of the important preventable non-communicable diseases. Preventive stroke programs are yet to be properly established in Oman, with a better focus on increasing awareness among those who are currently at risk. This study was conducted to describe the characteristics of stroke presenting to a tertiary care hospital in Oman. Methods: This was a cross-sectional hospital-based study. Included 193 stroke cases which were prospectively recruited from the Emergency Department of a tertiary-level hospital. Data was collected from November 2017 to April 2018. Results: The total number of patients was 193. 82.9% of strokes were ischemic strokes. 58% were male. The mean age of stroke patients was 61.05 years. Risk factors included hypertension (72.5%) and diabetes mellitus (54.4%). Dyslipidemia, atrial fibrillation and ischemic heart diseases were not particularly prevalent in our population. 24.4% of ischemic strokes had large artery atherosclerosis and 21.9% had small vessel occlusion. Significantly more patients had lower Glasgow Coma Scale (GCS), required ICU admission and had in-hospital deaths in hemorrhagic stroke compared to ischemic stroke. Conclusions: This study provides essential stroke characteristics data specific to Oman’s population. Most of the information obtained conforms with that described internationally and similar preventive strategies can be implemented. The information can be utilized by health administrators in planning resource allocation. Further research is needed to explore rehabilitation aspects and long-term outcomes. Keywords: Stroke; Ischemic; Hemorrhagic; Young Stroke; Risk Factors; Thrombolysis; Epidemiology; Oman.

scholarly journals Nurses and physicians’ perception of the care of oncology patients in the emergency department

2020 ◽  
Vol 73 (suppl 6) ◽  
Author(s):  
Silvana Bastos Cogo ◽  
Ariele Priebe Reisdorfer ◽  
Jéssica Luíza Beck ◽  
Tais Falcão Gomes ◽  
Aline Gomes Ilha ◽  
...  
Keyword(s):  
Emergency Department ◽  
Data Collection ◽  
General Hospital ◽  
Descriptive Study ◽  
Qualitative Approach ◽  
Comprehensive Care ◽  
Structured Interviews ◽  
Oncology Patients ◽  
Nurses And Physicians

ABSTRACT Objectives: to understand nurses’ and physicians’ perceptions of the care of people with cancer admitted to an emergency department of a general hospital. Methods: descriptive study with a qualitative approach. Data collection took place from September to November 2017 through semi-structured interviews in which participated 12 professionals from the emergency department, including nurses and physicians. The data were analyzed using Minayo’s operative proposal. Results: three categories emerged: 1) The person with cancer from nurses and physicians’ perspective; 2) Comprehensive care of people with cancer or deconfiguration in the emergency department?; and 3) The context of the emergency department and the repercussions on the care of people with cancer. Final Considerations: we identified that the care provided to people with cancer in the emergency department is carried out differently regarding the overall population due to the disease’s particularities, which lead us to reflect on the quality and humanization of care.

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