Devkaran, S., Parsons, H., Van Dyke, M., Drennan, J., & Rajah, J. (2009). The impact of a fast track area on quality and effectiveness outcomes: A middle eastern emergency department perspective. BMC Emergency Medicine, 911-11 1p. doi:10.1186/1471-227X-9-11
There has long been an issue with overcrowding issues in emergency departments and fast track units have been used in order to reduce wait times, dissatisfaction of patients, and morbidity. The purpose of this study was to look at the impact a fast track unit has on wait times, length of stay, patients who leave without being seen, and mortality rates. The research question for this study is, can a fast track unit help to improve wait times, length of stay, patients who leave without
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being seen, and mortality rates? The hypothesis for this study is that fast track units can reduce wait times, length of stay, patients who leave without being seen, and mortality rates. The dependent variable for this study is the fast track unit, whereas the independent variables are the patient wait times, length of stay, patients who leave without being seen, and mortality rates. This study was completed using a conceptual framework since there was a specific concept that was being studied. Related literature is present in regards to use of fast track units to help reduce wait times and length of stay and also how overcrowding to led to patient dissatisfaction. The study used a non-randomized, quasi-experimental design with before and after data collected to determine the impact of a fast track area has in an emergency department. The sample for this study was of emergency department patients seen during the established study periods and the size was determined using an a priori power calculation. Extraneous variables were addressed by using a larger sample size than what had been used in similar studies, the fast track unit ran for 1 year to eliminate seasonal trends, and data was compared using acuity levels to be more precise. To collect the data used for the study, emergency department electronic patient medical records were used to insure reliability and validity was maintained by performing data checks for incomplete or missing data. The data for this study was collected retrospectively from emergency department patient medical records that had been opened prior to the fast track area and during the implementation of the fast track area, which was January 2005 to January 2006. The data analysis was completed using MedCalc for Windows version 9.20 along with a univariate descriptive analysis, bivariate analyses, and an independent sample t-test. There are many strengths to this study including sample size, length of the study, and prevention of extraneous variables; however, this study is still limited to emergency departments of the same size and who serve both pediatric and adult patients. Considine, J., Kropman, M., & Stergiou, H. (2010). Effect of clinician designation on emergency department fast track performance. Emergency Medicine Journal, 27(11), 838-842. doi:10.1136/emj.2009.083113 Fast track units have been used to help reduce emergency department patient wait times, length of stay, and overcrowding; however, who operates the fast track area can differ from facility to facility.
The purpose of this study is to look at the different clinical providers who operate the fast track area compared to fast track performance. The research question for this study is, which clinical provider has the best fast track performance? The hypothesis for this study could be, there is a difference in the fast track performance depending upon which clinical provider is operating the fast track area. The dependent variable is the clinical providers and the independent variable is the fast track performance. A conceptual framework was used with this study, since a specific concept was identified and sought to be defined. Related literature has been completed with different clinical providers operating the fast track area. A retrospective audit was completed of all patients seen by the fast track area during the study year of 2008. The setting used for this study was the Northern Hospital fast track unit and the sample size used for this study was 8714 records of patients seen by the fast track. To try to avoid extraneous variables this study was completed using data from one entire year and the fast track unit is open 24 hours a day/7 days a week to try to avoid any trends or abnormal data that could occur. The data was collected directly from the emergency department fast track documentation system in order to maintain reliability and validity of the information obtained. The data collection from the patient medical records included the patients age, time and date of visit, acuity level, length of stay in the emergency department, type of clinician who treated the patient, and disposition information. Data was analyzed using the SPSS version 15 along with the X2 and Kruskal-Wallis test. The strengths of this study include the fact that it was
completed over 1 year and used randomized patient information; however, the limitations are that this fast track runs over a 24-hour period unlike others and that there is a dedicated staff for the fast track unit used for this study. Quantitative studies use numbers to prove or disprove a hypothesis, so for me they are easier to rely on. It is important; however, to understand the limitations and weakness of each study since that can have a profound effect on the study results. I believe all three of these are good, well researched articles that provide me with information I will use in my own capstone proposal.
Monitoring staff levels is an important factor. Also leveling the flow of patients in and out institutions could help to reduce wide fluctuations in occupancy rates and prevent surges in patient visits that lead to overcrowding, poor handoffs, and delays in care. Studies show that overcrowding in areas such as the emergency rooms lead to adverse outcomes, because physicians and nurses having less time to focus on individual patients. One study found that for each additional patient with heart failure, pneumonia, or myocardial infarction assigned to a nurse, the odds of readmission increased between 6 percent and 9 percent (Hostetter and Klein, 2013). All of which costs the hospital money.
The challenges that all acute care hospitals and facilities faces are the demand for highly specialized services has increased. The US population is constantly aging and the elderly tend to need more acute care services. Because many people lack health insurance, they tend to use emergency rooms in the hospitals as their source of care. The increase demand in acute care prompted hospitals to expand their facility
...t them attain the services easily and at lower costs. In addition, these hospitals have the potential of managing effectively their cash flow. A fixed and proper payment system to the workers of the small health centers can m motivates them to avail quality services to the medical beneficiaries. Small hospitals can be able to have bonus payment in case they provide care in areas short of professional health. Hence, small hospital can implicate appropriately their method of payment. Conversely, there might be a risk possibility when it comes to accessing low amount due to the nature of the illness of the patients, the involvement of high cost of treatment amongst many other factors. In the vent that the overall health care costs are more than earlier anticipated, the hospital and the doctor shall receive less profits. This can have a negative impact on the hospital.
I found your post interesting, having worked in an emergency department during my paramedic years. In my career as a nurse working in a clinic on occasion we must send a patient to the emergency department. I always call to speak with the charge nurse to provide report prior to just sending the patient, often I am on hold for greater than 15 minutes. This often results in the patient arriving at the ER before I can give report. Adding to this the charge nurse on more than one occasion is calling me on another line to ask why the patient it there! However, from past experience I do know how busy the ER can be at any given time.
Once the mandate was given to area hospitals not to divert MH patients, each hospital had to figure out how to deal with MH patients in their own organization. This entailed a safe environment for the MH patient, safety for the staff, and the ability to “board” MH patients in the ED. “Boarding” patients in ED’s became necessary because of the lack of inpatient MH beds in the State of Washington.
There has been a shortage of physicians, lack of inpatient beds, problems with ambulatory services, as well as not having proper methods of dealing with patient overflow, all in the past 10 years (Cummings & francescutti, 2006, p.101). The area of concern that have been worse...
middle of paper ... ... International Journal for Quality in Healthcare, 25(3), 261-269. Retrieved from http://intqhc.oxfordjournals.org/content/25/3/261.short Smedley, B., Stith, A., & Nelson, A. (2003). The 'Secondary' of the 'Secondary'.
Dimension1.2- “Clinical Effectiveness” takes part in better resource utilization; attempt to accomplish “more for less” through evidence based practice to improve the care. Providing effective and safe care is necessary in achieving the best clinical care outcome especially in an acute care hospital, and will help provide the best possible patient experience
According to the Centers for Disease Control and Prevention (CDC) (2012), the average time patients spend in the U.S. emergency department (ER) before they can see a doctor has increased to 25% between 2003-2009. The main cause of longer wait times (WT) in the ER is overcrowding. Overcrowding has been found to be closely related to both subjective and objective patient satisfaction (Miro’ et al, 2003). Longer wait times in the ED is such an important issue because its consequences are detrimental not only to the ER patients, but also to providers. As a health care provider, decreasing patients’ WT in the ED is essential, although challenging, to improve patient’s health outcomes and increase patients’ satisfaction. Although it is a very challenging issue to tackle, hospitals that have initiated some quality improvement (QI) strategies are experiencing some positive outcomes in that area of care. The outcomes are measured by decreased waiting times, improved patients’ clinical outcomes and increased patients’ satisfaction.
However, patients should register again and keep waiting for the specialist out-patient clinics. In light of the evidence, a streamlined process is being implemented so as to minimize the patient time. Based on the given reference, it is probable that services diminish the time externally. In fact, patients seem to be just waiting for help. Predictability :
Working in the emergency department can be easily described as fast placed and at times hectic. Being aware of resource management and learning to prioritize patients are skills that are required to be learned quickly. Once a basic understanding and knowledge of these skills are acquired, nurses are able to build off of them and adapt them however they see fit.
Being able to provide fast, appropriate, high-quality care in the emergency department (ED) setting can be complicated and should be the most valued goal by any healthcare organization. Organizations across the nation must be able to realize that the use of an open system for problem solving is the best approach to solving problems that are occurring with the organization. The use of system theory in the organization is to be able to clearly and concisely understand health care structures, processes, and outcomes along with the interactions that occur within the health care organization (Hayajneh, 2007). The purpose of the paper is to identify and describe a problem within a department of a healthcare
Understanding quality measurement is essential in improving quality. Teams need to be able to understand whether the changes being made are actually leading to improved care and improved outcomes. For data to have an impact on an improvement initiative, providers and staff must understand it, trust it, and use it. Health care organization must understand the measurement of quality provided by the Institute of Medicine (patient outcomes, patient satisfaction, compliance, efficiency, safe, timely, patient centered, and equitable. An organization cannot improve its performance if it does not know how it is performing. Measuring quality improvements is essential as it reflects the quality of care given by the providers and that by comparing performance
...d procedures are now being monitored to improve clinical processes. Ensuring that these processes are implemented in a timely, effective manner can also improve the quality of care given to patients. Management of the processes ensures accountability of the effectiveness of care, which, as mentioned earlier, improves outcomes. Lastly, providing reimbursements based on the quality of care and not the quantity also decreases the “wasting” and overuse of supplies. Providers previously felt the need to do more than necessary to meet a certain quota based on a quantity of supplies or other interventions used. Changing this goal can significantly decrease the cost of care due to using on the supplies necessary to provide effective, high-quality care. I look forward to this implementation of change and hope to see others encouraging an increase in high-quality healthcare.
Whether you are coming in to sit and wait for someone or you are the one who is having a procedure done safety and quality in any department of health is very important. Patient safety and quality of hospital care can affect hospital ratings.