| 1. |
- Ekström, Andreas, et al.
(författare)
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Forecasting emergency department visits using internet data
- 2015
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Ingår i: Annals of Emergency Medicine. - : Elsevier. - 0196-0644 .- 1097-6760. ; 65:4, s. 436-442.e1
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Tidskriftsartikel (refereegranskat)abstract
- STUDY OBJECTIVE: Using Internet data to forecast emergency department (ED) visits might enable a model that reflects behavioral trends and thereby be a valid tool for health care providers with which to allocate resources and prevent crowding. The aim of this study is to investigate whether Web site visits to a regional medical Web site, the Stockholm Health Care Guide, a proxy for the general public's concern of their health, could be used to predict the ED attendance for the coming day.METHODS: In a retrospective, observational, cross-sectional study, a model for forecasting the daily number of ED visits was derived and validated. The model was derived through regression analysis, using visits to the Stockholm Health Care Guide Web site between 6 pm and midnight and day of the week as independent variables. Web site visits were measured with Google Analytics. The number of visits to the ED within the region was retrieved from the Stockholm County Council administrative database. All types of ED visits (including adult, pediatric, and gynecologic) were included. The period of August 13, 2011, to August 12, 2012, was used as a training set for the model. The hourly variation of visits was analyzed for both Web site and the ED visits to determine the interval of hours to be used for the prediction. The model was validated with mean absolute percentage error for August 13, 2012, to October 31, 2012.RESULTS: The correlation between the number of Web site visits between 6 pm and midnight and ED visits the coming day was significant (r=0.77; P<.001). The best forecasting results for ED visits were achieved for the entire county, with a mean absolute percentage error of 4.8%. The result for the individual hospitals ranged between mean absolute percentage error 5.2% and 13.1%.CONCLUSION: Web site visits may be used in this fashion to predict attendance to the ED. The model works both for the entire region and for individual hospitals. The possibility of using Internet data to predict ED visits is promising.
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| 2. |
- Liu, Jenny, et al.
(författare)
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Can interprofessional teamwork reduce patient throughput times? : A longitudinal single-centre study of three different triage processes at a Swedish emergency department
- 2018
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 8:4
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Tidskriftsartikel (refereegranskat)abstract
- Objective To determine the impact on emergency department (ED) throughput times and proportion of patients who leave without being seen by a physician (LWBS) of two triage interventions, where comprehensive nurse-led triage was first replaced by senior physician-led triage and then by interprofessional teamwork. Design Single-centre before-and-after study. Setting Adult ED of a Swedish urban hospital. Participants Patients arriving on weekdays 08: 00 to 21: 00 during three 1-year periods in the interval May 2012 to November 2015. A total of 185 806 arrivals were included. Interventions Senior physicians replaced triage nurses May 2013 to May 2014. Interprofessional teamwork replaced the triage process on weekdays 08: 00 to 21: 00 November 2014 to November 2015. Main outcome measures Primary outcomes were the median time to physician (TTP) and the median length of stay (LOS). Secondary outcome was the LWBS rate. Results The crude median LOS was shortest for teamwork, 228 min (95% Cl 226.4 to 230.5) compared with 232 min (95% Cl 230.8 to 233.9) for nurse-led and 250 min (95% Cl 248.5 to 252.6) for physician-led triage. The adjusted LOS for the teamwork period was 16 min shorter than for nurse-led triage and 23 min shorter than for physician-led triage. The median TTP was shortest for physician-led triage, 56 min (95% Cl 54.5 to 56.6) compared with 116 min (95% Cl 114.4 to 117.5) for nurse-led triage and 74 min (95% Cl 72.7 to 74.8) for teamwork. The LWBS rate was 1.9% for nurse-led triage, 1.2% for physician-led triage and 3.2% for teamwork. All outcome measure differences had two-tailed p values< 0.01. Conclusions Interprofessional teamwork had the shortest length of stay, a shorter time to physician than nurse-led triage, but a higher LWBS rate. Interprofessional teamwork may be a useful approach to reducing ED throughput times.
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| 3. |
- Liu, Jenny, et al.
(författare)
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Interprofessional teamwork versus fast track streaming in an emergency department - An observational cohort study of two strategies for enhancing the throughput of orthopedic patients presenting limb injuries or back pain
- 2019
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Ingår i: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 14:7, s. -16
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Tidskriftsartikel (refereegranskat)abstract
- Objective To compare two strategies, interprofessional teams versus fast track streaming, for orthopedic patients with limb injuries or back pain, the most frequent orthopedic complaints in an emergency department. Methods An observational before-and-after study at an adult emergency department from May 2012 to Nov 2015. Patients who arrived on weekdays from 8 am to 9 pm and presented limb injury or back pain during one year of each process were included, so that 11,573 orthopedic presentations were included in the fast track period and 10,978 in the teamwork period. Similarly, another 11,020 and 10,760 arrivals presenting the six most frequent non-orthopedic complaints were included in the respective periods, altogether 44,331 arrivals. The outcome measures were the time to physician (TTP) and length of stay (LOS). The LOS was adjusted for predictors, including imaging times, by using linear regression analysis. Results The overall median TTP was shorter in the teamwork period, 76.3 min versus 121.0 min in the fast track period (-44.7 min, 95% confidence interval (CI): -47.3 to -42.6). The crude median LOS for orthopedic presentations was also shorter in the teamwork period, 217.0 min versus 230.0 min (-13.0 min, 95% CI: -18.0 to -8.0), and the adjusted LOS was 22.8 min shorter (95% CI: -26.9 to -18.7). For non-orthopedic presentations, the crude median LOS did not differ significantly between the periods (2.0 min, 95% CI: -3.0 to 7.0). However, the adjusted LOS was shorter in the teamwork period (-20.1 min, 95% CI: -24.6 to -15.7). Conclusions The median TTP and LOS for orthopedic presentations were shorter in the teamwork period. For non-orthopedic presentations, the TTP and adjusted LOS were also shorter in the teamwork period. Therefore, interprofessional teamwork may be an alternative approach to improve the patient flow in emergency departments.
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| 4. |
- Muntlin, Åsa, Docent, 1971-, et al.
(författare)
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Teamwork – a way to improve patient perceptions of the quality of care in an emergency department : an intervention study with follow-up
- 2016
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Ingår i: European Journal for Person Centered Healthcare. - : University of Buckingham Press. - 2052-5648 .- 2052-5656. ; 4:3, s. 509-519
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Tidskriftsartikel (refereegranskat)abstract
- Rationale, aims and objectives: Targeted interventions are suggested for improving patient perceptions of the emergency care they have received. However, organizational changes are another way of addressing these issues. Structured evaluation of such changes is warranted. The overall aim was to investigate how organizational changes aimed to support multi-professional teamwork in the emergency department (ED) could affect patients’ perceptions of the quality of care.Method: The introduction of multi-professional teamwork in an emergency department at a Swedish university hospital was evaluated using an intervention study design. Weeks with standard procedure were interchanged with and compared to, intervention weeks over a 4-week period and follow-up after 1.5 years. In total, 203 patients completed the questionnaire “Quality from the Patient’s Perspective (QPP)”. Results: Of 4 dimensions, 3 (medical-technical, identity-oriented approach and socio-cultural atmosphere) showed increasing improvements from the control phase to follow-up. Seven of 22 items concerning quality of care in the emergency department improved significantly from baseline to intervention and to follow-up. The number of areas in need of improvement was dramatically reduced in the intervention phase compared to the control phase and overall the results were sustained 1.5 years later. Significant differences between the study phases in patient perceptions of waiting time were also noted.Conclusion: Multi-professional teamwork has previously been related to improved patient safety and lead time efficiency. Findings show that it may also be related to improvements in patients’ perceptions of quality of care in the emergency department. Emphasizing this relationship may enhance the patient-centered care approach of emergency departments.
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