scholarly journals A Qualitative Study of the Theory Behind the Chairs: Balancing Lean-Accelerated Patient Flow With the Need for Privacy and Confidentiality in an Emergency Medicine Setting

10.2196/11714 ◽  
2019 ◽  
Vol 6 (1) ◽  
pp. e11714 ◽  
Author(s):  
Elaine Zibrowski ◽  
Lisa Shepherd ◽  
Richard Booth ◽  
Kamran Sedig ◽  
Candace Gibson
Keyword(s):  
Emergency Medicine ◽  
Qualitative Study ◽  
Patient Flow ◽  
Privacy And Confidentiality ◽  
The Chairs

scholarly journals A Qualitative Study of the Theory Behind the Chairs: Balancing Lean-Accelerated Patient Flow With the Need for Privacy and Confidentiality in an Emergency Medicine Setting (Preprint)

2018 ◽  
Author(s):  
Elaine Zibrowski ◽  
Lisa Shepherd ◽  
Richard Booth ◽  
Kamran Sedig ◽  
Candace Gibson
Keyword(s):  
Emergency Medicine ◽  
Qualitative Study ◽  
Health Care Professionals ◽  
Family Members ◽  
Value Added ◽  
Clinical Work ◽  
Patient Privacy ◽  
Privacy And Confidentiality ◽  
The Impact ◽  
The Chairs

BACKGROUND Many emergency departments (EDs) have used the Lean methodology to guide the restructuring of their practice environments and patient care processes. Despite research cautioning that the layout and design of treatment areas can increase patients’ vulnerability to privacy breaches, evaluations of Lean interventions have ignored the potential impact of these on patients’ informational and physical privacy. If professional regulatory organizations are going to require that nurses and physicians interact with their patients privately and confidentially, we need to examine the degrees to which their practice environment supports them to do so. OBJECTIVE This study explored how a Lean intervention impacted the ability of emergency medicine physicians and nurses to optimize conditions of privacy and confidentiality for patients under their care. METHODS From July to December 2017, semistructured interviews were iteratively conducted with health care professionals practicing emergency medicine at a single teaching hospital in Ontario, Canada. The hospital has 1000 beds, and approximately 128,000 patients visit its 2 EDs annually. In response to poor wait times, in 2013, the hospital’s 2 EDs underwent a Lean redesign. As the interviews proceeded, information from their transcripts was first coded into topics and then organized into themes. Data collection continued to theoretical sufficiency. RESULTS Overall, 15 nurses and 5 physicians were interviewed. A major component of the Lean intervention was the construction of a three-zone front cell at both sites. Each zone was outfitted with a set of chairs in an open concept configuration. Although, in theory, professionals perceived value in having the chairs, in practice, these served multiple, and often, competing uses by patients, family members, and visitors. In an attempt to work around limitations they encountered and keep patients flowing, professionals often needed to move a patient out from a front chair and actively search for another location that better protected individuals’ informational and physical privacy. CONCLUSIONS To our knowledge, this is the first qualitative study of the impact of a Lean intervention on patient privacy and confidentiality. The physical configuration of the front cell often intensified the clinical work of professionals because they needed to actively search for spaces better affording privacy and confidentiality for patient encounters. These searches likely increased clinical time and added to these patients’ length of stay. We advocate that the physical structure and configuration of the front cell should be re-examined under the lens of Lean’s principle of value-added activities. Future exploration of the perspectives of patients, family members, and visitors regarding the relative importance of privacy and confidentiality during emergency care is warranted.

scholarly journals A qualitative study of the barriers to procedural sedation practices in paediatric emergency medicine in the UK and Ireland

2016 ◽  
Vol 33 (8) ◽  
pp. 527-532 ◽  
Author(s):  
Siobhán McCoy ◽  
Mark D Lyttle ◽  
Stuart Hartshorn ◽  
Philip Larkin ◽  
Maria Brenner ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Qualitative Study ◽  
Procedural Sedation ◽  
Paediatric Emergency ◽  
Paediatric Emergency Medicine ◽  
The Uk

Just the Facts: how to teach emergency department flow management

CJEM ◽  
2020 ◽  
Vol 22 (4) ◽  
pp. 459-462
Author(s):  
Teresa M. Chan ◽  
Jonathan Sherbino ◽  
Arthur Welsher ◽  
Alexander Chorley ◽  
Alim Pardhan
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Patient Flow ◽  
Learning Objective ◽  
Waiting Room ◽  
Flow Management ◽  
Charge Nurse ◽  
Physician Office ◽  
Management Plans ◽  
Evening Shift

Even before starting your evening shift you know it's going to be busy. Ambulances are lined up in front of the hospital, and the charge nurse already seems stressed out. The senior Emergency Medicine (EM) resident is standing in the physician office, ready to start her shift as well. You have worked with her a few times during this rotation. She is competent, you trust in her management plans for all her individual patients. Together you both review the patient tracker: a variety of patient presentations ready to be seen, plus an additional 20 patients in the waiting room. Negotiating the learning objective for the shift, the resident indicates that she would like to work on more efficiently managing patient flow and the administration of the emergency department (ED). But…isn't that a skill you just learn from experience? You wonder what evidence-informed strategies might exist for training her for this next step.

scholarly journals An eLearning program to prepare residents for a rotation in pediatric emergency medicine: A qualitative study

2021 ◽  
pp. 102490792110449
Author(s):  
Arif Tyebally ◽  
Chaoyan Dong
Keyword(s):  
Emergency Medicine ◽  
Qualitative Study ◽  
Learning Styles ◽  
Instructional Methods ◽  
Clinical Work ◽  
Pediatric Emergency ◽  
Pediatric Emergency Medicine ◽  
Design Elements ◽  
Induction Program ◽  
Systematic Planning

Background: To meet ACGME-I (Accreditation Council for Graduate Medical Education–International) training and duty hour requirements, we converted our 3-week-long pediatric emergency medicine induction program to an eLearning program. Objectives: The study aimed to identify areas of the eLearning program residents perceived useful and the components that helped them prepare for clinical work. Methods: The qualitative study took place in a tertiary pediatric emergency department. Twenty-seven residents from family medicine, emergency medicine, and pediatric medicine participated in focus group discussions to explore how they perceived the eLearning program helped prepare them for work. The interviews were audio-recorded, and transcripts were analyzed and coded into categories and themes. Results: Four themes emerged from the data analysis: residents’ access to the eLearning program, instructional methods, eLearning design elements, and supplementary learning. Residents valued autonomy to control their pace of learning and use online features that matched their preferred learning styles. Design features such as the use of questions and quizzes helped stimulate learning, but attention had to be paid to the order of questions in the modules and the format of the questions. Written guidelines served as a good reference for learners and face-to-face sessions accompanying the eLearning program helped reinforce knowledge and offered opportunities to interact with faculty members to clarify questions. Conclusion: Systematic planning focusing on access, instructional methods, and design is essential when creating eLearning programs for residency training. eLearning programs can be enhanced by the incorporation of team-based learning and having accompanying written content to reference.

scholarly journals 143 Experts in Education Research: Advice to Emergency Medicine Education Researchers: A Qualitative Study

2017 ◽  
Vol 70 (4) ◽  
pp. S57
Author(s):  
D.P. Runde ◽  
J. Jordan ◽  
E. Fowlkes ◽  
S. Clarke ◽  
J. Kurth ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Education Research ◽  
Qualitative Study ◽  
Medicine Education
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