scholarly journals Clinical handover within the emergency care pathway and the potential risks of clinical handover failure (ECHO): primary research

2014 ◽  
Vol 2 (5) ◽  
pp. 1-144 ◽  
Author(s):  
Mark Sujan ◽  
Peter Spurgeon ◽  
Matthew Inada-Kim ◽  
Michelle Rudd ◽  
Larry Fitton ◽  
...  
Keyword(s):  
Emergency Care ◽  
Social Issues ◽  
Care Pathway ◽  
Patient Flow ◽  
Convenience Sample ◽  
Acute Medicine ◽  
Clinical Handover ◽  
Trade Offs ◽  
Organisational Factors

Background and objectivesHandover and communication failures are a recognised threat to patient safety. Handover in emergency care is a particularly vulnerable activity owing to the high-risk context and overcrowded conditions. In addition, handover frequently takes place across the boundaries of organisations that have different goals and motivations, and that exhibit different local cultures and behaviours. This study aimed to explore the risks associated with handover failure in the emergency care pathway, and to identify organisational factors that impact on the quality of handover.MethodsThree NHS emergency care pathways were studied. The study used a qualitative design. Risks were explored in nine focus group-based risk analysis sessions using failure mode and effects analysis (FMEA). A total of 270 handovers between ambulance and the emergency department (ED), and the ED and acute medicine were audio-recorded, transcribed and analysed using conversation analysis. Organisational factors were explored through thematic analysis of semistructured interviews with a purposive convenience sample of 39 staff across the three pathways.ResultsHandover can serve different functions, such as management of capacity and demand, transfer of responsibility and delegation of aspects of care, communication of different types of information, and the prioritisation of patients or highlighting of specific aspects of their care. Many of the identified handover failure modes are linked causally to capacity and patient flow issues. Across the sites, resuscitation handovers lasted between 38 seconds and 4 minutes, handovers for patients with major injuries lasted between 30 seconds and 6 minutes, and referrals to acute medicine lasted between 1 minute and approximately 7 minutes. Only between 1.5% and 5% of handover communication content related to the communication of social issues. Interview participants described a range of tensions inherent in handover that require dynamic trade-offs. These are related to documentation, the verbal communication, the transfer of responsibility and the different goals and motivations that a handover may serve. Participants also described the management of flow of patients and of information across organisational boundaries as one of the most important factors influencing the quality of handover. This includes management of patient flows in and out of departments, the influence of time-related performance targets, and the collaboration between organisations and departments. The two themes are related. The management of patient flow influences the way trade-offs around inner tensions are made, and, on the other hand, one of the goals of handover is ensuring adequate management of patient flows.ConclusionsThe research findings suggest that handover should be understood as a sociotechnical activity embedded in clinical and organisational practice. Capacity, patient flow and national targets, and the quality of handover are intricately related, and should be addressed together. Improvement efforts should focus on providing practitioners with flexibility to make trade-offs in order to resolve tensions inherent in handover. Collaborative holistic system analysis and greater cultural awareness and collaboration across organisations should be pursued.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

scholarly journals St. Vincent's Psychiatric Emergency Care Centre: an Evaluation of a Nurse-Led Service

2021 ◽  
Author(s):  
◽  
Caroline H Koia
Keyword(s):  
Mental Health ◽  
Emergency Care ◽  
Social Issues ◽  
Patient Flow ◽  
Rapid Assessment ◽  
Health Assessment ◽  
Psychiatric Emergency ◽  
Mental Health Nurses ◽  
Mental Health Assessment ◽  
Clinical Records

<p>Australia, like many other countries that adopted deinstitutionalisation is experiencing increased presentation at emergency departments (EDs) by patients with acute mental health and addiction needs. While different models of psychiatric emergency care have been utilised within EDs little is known about the effectiveness of the care provided or how they work on a day-to-day basis. Psychiatric Emergency Care Centres (PECCs) is one of these new initiatives. PECCs aim to improve patient flow in urban EDs by providing a rapid pathway to specialist mental health assessment and care. St Vincent hospital in Sydney opened a 6 bed PECC service in 2005. It is co-located with ED and staffed 24 hours a day by registered mental health nurses supported by psychiatric and emergency teams. The service has two components - a short term stay unit and an ED liaison role. The nurses work closely with community mental health teams, inpatient units, general practitioners, non-government agencies and other hospitals. This thesis evaluated the organisational and operational aspects of this PECC service using a processimpact evaluation. Documents, existing clinical records and interviews with nurses in the PECC and ED and with a consumer representative were used as data sources to describe the service and identify what was working well and what could be improved. The research found that the service has provided additional resources and collaboration between ED and mental health services. In addition the research found that PECC is an effective service catering to the needs of consumers and providing access to mental health specialist clinicians. Since PECC was established there has been an increase in assessments conducted within the ED and an increase in the numbers presenting to ED for mental health reasons from 2833 in 2006 to 4987 in 2008, but the number of admissions to PECC have remained relatively stable at 693 and 714. Aspects of the service that worked well included the rapid assessment and management of acutely unwell people by the PECC nurses. Aspects that were problematic concerned the ability of the service to address social issues and the management of people with behavioural, alcohol, substance intoxication or selfharm behaviours. Areas for enhancing the service include being more consumers responsive, increasing the skills and knowledge of staff and undertaking further research regarding the needs of people who use the service.</p>

scholarly journals St. Vincent's Psychiatric Emergency Care Centre: an Evaluation of a Nurse-Led Service

2021 ◽  
Author(s):  
◽  
Caroline H Koia
Keyword(s):  
Mental Health ◽  
Emergency Care ◽  
Social Issues ◽  
Patient Flow ◽  
Rapid Assessment ◽  
Health Assessment ◽  
Psychiatric Emergency ◽  
Mental Health Nurses ◽  
Mental Health Assessment ◽  
Clinical Records

<p>Australia, like many other countries that adopted deinstitutionalisation is experiencing increased presentation at emergency departments (EDs) by patients with acute mental health and addiction needs. While different models of psychiatric emergency care have been utilised within EDs little is known about the effectiveness of the care provided or how they work on a day-to-day basis. Psychiatric Emergency Care Centres (PECCs) is one of these new initiatives. PECCs aim to improve patient flow in urban EDs by providing a rapid pathway to specialist mental health assessment and care. St Vincent hospital in Sydney opened a 6 bed PECC service in 2005. It is co-located with ED and staffed 24 hours a day by registered mental health nurses supported by psychiatric and emergency teams. The service has two components - a short term stay unit and an ED liaison role. The nurses work closely with community mental health teams, inpatient units, general practitioners, non-government agencies and other hospitals. This thesis evaluated the organisational and operational aspects of this PECC service using a processimpact evaluation. Documents, existing clinical records and interviews with nurses in the PECC and ED and with a consumer representative were used as data sources to describe the service and identify what was working well and what could be improved. The research found that the service has provided additional resources and collaboration between ED and mental health services. In addition the research found that PECC is an effective service catering to the needs of consumers and providing access to mental health specialist clinicians. Since PECC was established there has been an increase in assessments conducted within the ED and an increase in the numbers presenting to ED for mental health reasons from 2833 in 2006 to 4987 in 2008, but the number of admissions to PECC have remained relatively stable at 693 and 714. Aspects of the service that worked well included the rapid assessment and management of acutely unwell people by the PECC nurses. Aspects that were problematic concerned the ability of the service to address social issues and the management of people with behavioural, alcohol, substance intoxication or selfharm behaviours. Areas for enhancing the service include being more consumers responsive, increasing the skills and knowledge of staff and undertaking further research regarding the needs of people who use the service.</p>

A Political Economy Model of a Research University

2009 ◽  
pp. 132-143
Author(s):  
K. Sonin ◽  
I. Khovanskaya
Keyword(s):  
Organizational Structure ◽  
Information Structure ◽  
Research University ◽  
Hiring Decisions ◽  
Voting Rules ◽  
Economy Model ◽  
Trade Offs ◽  
Political Economic ◽  
Optimal Incentives

Hiring decisions are typically made by committees members of which have different capacity to estimate the quality of candidates. Organizational structure and voting rules in the committees determine the incentives and strategies of applicants; thus, construction of a modern university requires a political structure that provides committee members and applicants with optimal incentives. The existing political-economic model of informative voting typically lacks any degree of variance in the organizational structure, while political-economic models of organization typically assume a parsimonious information structure. In this paper, we propose a simple framework to analyze trade-offs in optimal subdivision of universities into departments and subdepartments, and allocation of political power.

Problems of pathology related to the dermatovenerology field in the emergency hospital

2020 ◽  
pp. 45-52
Author(s):  
I. Barsukova ◽  
I. Bagretsova
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Emergency Care ◽  
Diagnostic Process ◽  
Emergency Hospital ◽  
New Models ◽  
Hospital Development

Development of a system for the delivery of emergency care in a hospital inevitably raises questions of its availability and quality. And, if the leading pathological syndrome which is a reason for hospitalization and posing a threat to the patient's life deserves priority attention, then the accompanying pathology often stays in the background. At the same time the accompanying pathology related to the field of dermatovenerology poses epidemiological threat. The aim of the study was to improve the organization of health care for patients with concomitant pathology related to dermatovenerology in an emergency hospital. Development of new models and principles of the organization of medical and diagnostic process, introduction of methods of express diagnostics is required; importance of a dermatovenerologist becomes obvious, it will increase the availability and quality of care for patients with dermatovenereological pathology in an emergency hospital.

scholarly journals Characterizing Color Quality, Damage to Artwork, and Light Intensity of Multi-Primary LEDs for Museums

Heritage ◽  
2021 ◽  
Vol 4 (1) ◽  
pp. 188-197
Author(s):  
Dorukalp Durmus
Keyword(s):  
Energy Efficiency ◽  
Appearance Model ◽  
Light Sources ◽  
Great Flexibility ◽  
Oil Paintings ◽  
Damage Reduction ◽  
Output Variability ◽  
Color Quality ◽  
Trade Offs

Light causes damage when it is absorbed by sensitive artwork, such as oil paintings. However, light is needed to initiate vision and display artwork. The dilemma between visibility and damage, coupled with the inverse relationship between color quality and energy efficiency, poses a challenge for curators, conservators, and lighting designers in identifying optimal light sources. Multi-primary LEDs can provide great flexibility in terms of color quality, damage reduction, and energy efficiency for artwork illumination. However, there are no established metrics that quantify the output variability or highlight the trade-offs between different metrics. Here, various metrics related to museum lighting (damage, the color quality of paintings, illuminance, luminous efficacy of radiation) are analyzed using a voxelated 3-D volume. The continuous data in each dimension of the 3-D volume are converted to discrete data by identifying a significant minimum value (unit voxel). Resulting discretized 3-D volumes display the trade-offs between selected measures. It is possible to quantify the volume of the graph by summing unique voxels, which enables comparison of the performance of different light sources. The proposed representation model can be used for individual pigments or paintings with numerous pigments. The proposed method can be the foundation of a damage appearance model (DAM).

Patient Flow or the Patient’s Journey? Exploring Health Care Providers’ Experiences and Understandings of Implementing a Care Pathway to Improve the Quality of Transitional Care for Older People

2021 ◽  
pp. 104973232110038
Author(s):  
Cecilie Fromholt Olsen ◽  
Astrid Bergland ◽  
Jonas Debesay ◽  
Asta Bye ◽  
Anne Gudrun Langaas
Keyword(s):  
Health Care ◽  
Older People ◽  
Health Care Providers ◽  
Transitional Care ◽  
Care Pathway ◽  
Patient Flow ◽  
Care Pathways ◽  
Care Providers ◽  
Patient Centered ◽  
Care For Older People

Internationally, the implementation of care pathways is a common strategy for making transitional care for older people more effective and patient-centered. Previous research highlights inherent tensions in care pathways, particularly in relation to their patient-centered aspects, which may cause dilemmas for health care providers. Health care providers’ understandings and experiences of this, however, remain unclear. Our aim was to explore health care providers’ experiences and understandings of implementing a care pathway to improve transitional care for older people. We conducted semistructured interviews with 20 health care providers and three key persons, along with participant observations of 22 meetings, in a Norwegian quality improvement collaborative. Through a thematic analysis, we identified an understanding of the care pathway as both patient flow and the patient’s journey and a dilemma between the two, and we discuss how the negotiation of conflicting institutional logics is a central part of care pathway implementation.

scholarly journals Palliative care and complex chronic conditions since the perspective of healthcare professionals

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Doñate-Martínez ◽  
L Llop ◽  
J Garcés
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
Early Identification ◽  
Chronic Conditions ◽  
Healthcare Professionals ◽  
Care Pathway ◽  
Holistic View ◽  
Complex Chronic Conditions ◽  
Symptom Intensity

Abstract Background According to the WHO, palliative care (PC) is applicable early in the course of illness together with other curative therapies. Early PC has demonstrated beneficial effects on quality of life and symptom intensity among cancer patients. However, PC is not as early integrated on the care pathway of complex chronic conditions (CCC). This abstract presents barriers and needs identified to effectively implement early PC on CCC performed under the EU-funded InAdvance project (ref.: 825750). Methods Semi-structured interviews were performed with 16 healthcare professionals (HPs) from primary care and hospital settings working with older patients with CCC in Valencia (Spain). Results Interviews reported that main needs identified to provide early PC are: (a) coordinated strategies between multi-setting HPs to an early identification of CCC patients in need of PC; (b) adequate resources to attend patients' PC needs from a holistic view, i.e. psychosocial and spiritual needs; and (c) early integration of basic PC at primary care teams. The main barriers identified were: (a) stereotypes associated to the traditional PC approach; (b) poor knowledge from HPs of the PC holistic approach; and (c) lack of specific protocols or pathways for CCC in need of PC. Conclusions Specific skills and resources are the most relevant needs to effectively provide early PC among patients with CCC. First, it is urgent to demystify the negative culture-related vision of PC that is commonly associated to sedation and last days of a person's life. Also, multidisciplinary HPs require specific training to identify and provide early PC tailored to CCC. And, it is required a strategic and multi-setting organizational approach with fluent information flow and coordinated roles. Key messages Healthcare expenditure would be considerably reduced, especially at hospital and emergency units, with an early identification of patients with CCC in need of PC. Empowering primary HPs in PC would improve the quality of care of patients with CCC.

scholarly journals Public Administration and Governance for the SDGs: Navigating between Change and Stability

2021 ◽  
Vol 13 (11) ◽  
pp. 5914
Author(s):  
Louis Meuleman
Keyword(s):  
Public Administration ◽  
Policy Development ◽  
Governance Reform ◽  
Policy Coherence ◽  
Sector Reform ◽  
Eu Member States ◽  
Trade Offs ◽  
Strategic Policy ◽  
Research And Policy

This article highlights four key reform challenges regarding the quality of public administration and governance (PAG), aimed at increasing ‘SDG-readiness’ at all levels of administration, in a nexus characterized by complexity, volatility, pluriformity and uncertainty. Based on others’ research into how EU Member States institutionalize the implementation of the SDGs, a critical review of SDG-governance approaches, as well as a review paper on the management of the SDGs, it is concluded that that four priority areas could guide research and policy development to accelerate implementation of the 2030 Agenda. Firstly, to recognize that creating an effective public administration and governance is an important strategic policy area. Secondly, to begin with mission-oriented public administration and governance reform for SDG implementation, replacing the efficiency-driven public sector reform of the past decades. Thirdly, to apply culturally sensitive metagovernance to design, define and manage trade-offs and achieving synergies between SDGs and their targets. Fourthly, to start concerted efforts to improve policy coherence with a mindset beyond political, institutional, and mental ‘silos’.

Sign in / Sign up

Export Citation Format

Share Document