scholarly journals Lean management in a liaison psychiatry department: implementation, benefits and pitfalls

2019 ◽  
Vol 44 (1) ◽  
pp. 18-25
Author(s):  
Lauren Alexander ◽  
Susan Moore ◽  
Nigel Salter ◽  
Leonard Douglas
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Interpersonal Relations ◽  
Psychiatric Patients ◽  
Process Mapping ◽  
Lean Management ◽  
Liaison Psychiatry ◽  
Process Maps ◽  
Individual Interviews ◽  
Management Intervention

Aims and methodTo apply process mapping, a component of lean management, to a liaison psychiatry service of an emergency department. Lean management is a strategy that has been adapted to healthcare from business and production industries and aims to improve efficiency of a process. The process consisted of four stages: individual interviews with stakeholders, generation of process maps, allocation of goals and assessment of outcomes.ResultsThere was a significant reduction in length of stay of psychiatric patients in the emergency department (median difference: 1 h; P = 0.015). Five of the six goals were met successfully.Clinical implicationsThis article demonstrates a management intervention that successfully reduced length of stay in an emergency department. Further to the improvements in tangible (quantitative) outcomes, process mapping improved interpersonal relations between different disciplines. This paper may be used to guide similar quality improvement exercises in other areas of healthcare.

249 Waiting for Care: Differences in Emergency Department Length of Stay and Disposition Between Medical and Psychiatric Patients

2016 ◽  
Vol 68 (4) ◽  
pp. S97 ◽  
Author(s):  
S.C. Lippert ◽  
N. Jain ◽  
A. Nesper ◽  
J. Fahimi ◽  
E. Pirrotta ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Psychiatric Patients

Association of emergency department boarding times on hospital length of stay for patients with psychiatric illness

2021 ◽  
pp. emermed-2020-210610
Author(s):  
Daniel J Lane ◽  
Lauren Roberts ◽  
Shawn Currie ◽  
Rachel Grimminck ◽  
Eddy Lang
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Rate Ratio ◽  
Psychiatric Illness ◽  
Psychiatric Patients ◽  
A Priori ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Absolute Increase ◽  
Clinical Records

BackgroundExtended periods awaiting an inpatient bed in the emergency department (ED) may exacerbate the state of patients with acute psychiatric illness, increasing the time it takes to stabilise their acute problem in hospital. Therefore, we assessed the association between boarding time and hospital length of stay for psychiatric patients.MethodsED clinical records were linked to inpatient administrative records for all patients with a primary psychiatric diagnosis admitted to a Calgary, Alberta hospital between April 2014 and March 2018. The primary exposure was boarding time (admission decision to inpatient bed transfer), and primary outcome was inpatient length of stay. Confounders for this relationship, including indicators of illness severity, were selected a priori then the association was assessed using hierarchical Bayesian Poisson regression, which accounts for repeat observations of the same patient and differences between hospital sites. Changes in length of stay were measured using a rate ratio (ie, expected change in length of stay for each 1 hour increase in boarding time).ResultsA total of 19 212 admissions (14 261 unique patients) were included in the analysis. The average boarding time was 14 hours (range: 0–186 hours). Patients who were boarded for greater than 14 hours more frequently required a high-observation bed (14% vs 3.5%), received an antipsychotic (44% vs 14%) or received sedation (55% vs 33%) while in the ED. The probability that boarding time increased hospital length of stay (rate ratio: >1) was 92%, with a median increase for a patient boarded for 24 hours of 0.01 days.ConclusionBoarding in the ED was associated with a high probability of increasing the hospital length of stay for psychiatric patients; however, the absolute increase is minimal. Although slight, this signal for longer length of stay may be a sign of increased morbidity for psychiatric patients held in the ED.

Using Lean Management to Reduce Emergency Department Length of Stay for Medicine Admissions

2017 ◽  
Vol 26 (2) ◽  
pp. 91-96 ◽  
Author(s):  
Nazima Allaudeen ◽  
Anita Vashi ◽  
Julia S. Breckenridge ◽  
Farnoosh Haji-Sheikhi ◽  
Sarah Wagner ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Lean Management

A Retrospective Look at Length of Stay for Pediatric Psychiatric Patients in an Urban Emergency Department

2011 ◽  
Vol 27 (3) ◽  
pp. 170-173 ◽  
Author(s):  
Muhammad Waseem ◽  
Rahul Prasankumar ◽  
Krystal Pagan ◽  
Mark Leber
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Psychiatric Patients ◽  
Urban Emergency Department

scholarly journals Psychiatric patients at the emergency department: factors associated with length of stay and likelihood of hospitalization

2021 ◽  
Author(s):  
Enrica Marzola ◽  
Elisa Duranti ◽  
Carlotta De-Bacco ◽  
Enrico Lupia ◽  
Vincenzo Villari ◽  
...  
Keyword(s):  
Emergency Department ◽  
Suicidal Ideation ◽  
Length Of Stay ◽  
Alcohol Intoxication ◽  
Psychiatric Patients ◽  
Psychotic Symptoms ◽  
Psychiatric Evaluation ◽  
Real World Data ◽  
Related Factors ◽  
Clinical Conditions

AbstractEmergency department (ED) care for psychiatric patients is currently understudied despite being highly utilized. Therefore, we aimed to analyze psychiatric patients' length of stay (LOS) and LOS-related factors at the ED and to investigate and quantify the likelihood of being hospitalized after an emergency psychiatric evaluation. Charts of 408 individuals who sought help at the ED were retrospectively assessed to identify patients' sociodemographic and clinical data upon ED admission and discharge. All interventions performed at the ED (e.g., medications, hospitalization, clinical advice at discharge) were collected as well. The LOS for psychiatric patients was relatively short (6.5 h), and substance/alcohol intoxication was the main factor impacting LOS. Upon ED arrival, hospitalized patients were mostly men, most often had a yellow/severe triage code, and most often had a positive history of psychiatric illness, psychotic symptoms, euphoric mood, or suicidal ideation. Manic symptoms and suicidal ideation were the conditions most frequently leading to hospitalization. Given the paucity of real-world data on psychiatric patients’ LOS and outcomes in the ED context, our findings show that psychiatric patients are evaluated in a reasonable amount of time. Their hospitalization is mostly influenced by clinical conditions rather than predisposing (e.g., age) or system-related factors (e.g., mode of arrival).

scholarly journals Emergency department junior medical staff's knowledge, skills and confidence with psychiatric patients: a survey

2012 ◽  
Vol 36 (5) ◽  
pp. 186-188 ◽  
Author(s):  
Jacqueline Therese Gordon
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Emergency Services ◽  
Psychiatric Patients ◽  
Medical Emergency ◽  
Junior Doctors ◽  
Mental Health Training ◽  
Liaison Psychiatry ◽  
Health Training ◽  
Mental Health Patients

Aims and methodTo determine knowledge, skills and confidence of junior medical emergency department staff in managing mental health patients. Over a 2-year period new emergency department junior doctors were given a questionnaire to complete early on in their post and prior to any mental health training. The questionnaire asked about knowledge, confidence, concerns and skills in the management of mental health patients in accident and emergency services.ResultsMore than half of the 32 doctors surveyed said they lacked knowledge, skills and confidence when assessing mental health patients.Clinical implicationsThe survey has demonstrated a need for mental health training of new doctors working in the emergency department. Effective training for such doctors can be offered by a liaison psychiatry service. This should be embedded in their teaching programme and be continually responsive to their perceived training needs.

Weekday Psychiatry Faculty Rounds on Emergency Department Psychiatric Patients Reduces Length of Stay

2013 ◽  
Vol 20 (5) ◽  
pp. 498-502 ◽  
Author(s):  
Howard Blumstein ◽  
Amy H. Singleton ◽  
Charles W. Suttenfield ◽  
Brian C. Hiestand
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Psychiatric Patients

scholarly journals National Trends in Emergency Department Care Processes for Acute Myocardial Infarction in the United States, 2005 to 2015

2020 ◽  
Vol 9 (20) ◽  
Author(s):  
Akshay Pendyal ◽  
Craig Rothenberg ◽  
Jean E. Scofi ◽  
Harlan M. Krumholz ◽  
Basmah Safdar ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Emergency Department ◽  
Length Of Stay ◽  
Real World ◽  
The United States ◽  
Emergency Department Care ◽  
Care Processes ◽  
Ed Visits

Background Despite investments to improve quality of emergency care for patients with acute myocardial infarction (AMI), few studies have described national, real‐world trends in AMI care in the emergency department (ED). We aimed to describe trends in the epidemiology and quality of AMI care in US EDs over a recent 11‐year period, from 2005 to 2015. Methods and Results We conducted an observational study of ED visits for AMI using the National Hospital Ambulatory Medical Care Survey, a nationally representative probability sample of US EDs. AMI visits were classified as ST‐segment–elevation myocardial infarction (STEMI) and non‐STEMI. Outcomes included annual incidence of AMI, median ED length of stay, ED disposition type, and ED administration of evidence‐based medications. Annual ED visits for AMI decreased from 1 493 145 in 2005 to 581 924 in 2015. Estimated yearly incidence of ED visits for STEMI decreased from 1 402 768 to 315 813. The proportion of STEMI sent for immediate, same‐hospital catheterization increased from 12% to 37%. Among patients with STEMI sent directly for catheterization, median ED length of stay decreased from 62 to 37 minutes. ED administration of antithrombotic and nonaspirin antiplatelet agents rose for STEMI (23%–31% and 10%–27%, respectively). Conclusions National, real‐world trends in the epidemiology of AMI in the ED parallel those of clinical registries, with decreases in AMI incidence and STEMI proportion. ED care processes for STEMI mirror evolving guidelines that favor high‐intensity antiplatelet therapy, early invasive strategies, and regionalization of care.

Effect of Undertriage on the Outcomes of Cancer Patients with Febrile Neutropenia, Sepsis, and Septic Shock

2021 ◽  
pp. 105477382199968
Author(s):  
Anas Alsharawneh
Keyword(s):  
Emergency Department ◽  
Septic Shock ◽  
Length Of Stay ◽  
Febrile Neutropenia ◽  
Cancer Patients ◽  
Emergency Setting ◽  
Extended Length ◽  
Life Threatening ◽  
Sepsis And Septic Shock ◽  
Timely Treatment

Sepsis and neutropenia are considered the primary life-threatening complications of cancer treatment and are the leading cause of hospitalization and death. The objective was to study whether patients with neutropenia, sepsis, and septic shock were identified appropriately at triage and receive timely treatment within the emergency setting. Also, we investigated the effect of undertriage on key treatment outcomes. We conducted a retrospective analysis of all accessible records of admitted adult cancer patients with febrile neutropenia, sepsis, and septic shock. Our results identified that the majority of patients were inappropriately triaged to less urgent triage categories. Patients’ undertriage significantly prolonged multiple emergency timeliness indicators and extended length of stay within the emergency department and hospital. These effects suggest that triage implementation must be objective, consistent, and accurate because of the several influences of the assigned triage scoring on treatment and health outcomes.

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