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- Cheng, I, et al.
(författare)
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Factors associated with failure of emergency wait-time targets for high acuity discharges and intensive care unit admissions
- 2018
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Ingår i: CJEM. - : Springer Science and Business Media LLC. - 1481-8043 .- 1481-8035. ; 20:1, s. 112-124
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveOntario established emergency department length-of-stay (EDLOS) targets but has difficulty achieving them. We sought to determine predictors of target time failure for discharged high acuity patients and intensive care unit (ICU) admissions.MethodsThis was a retrospective, observational study of 2012 Sunnybrook Hospital emergency department data. The main outcome measure was failing to meet government EDLOS targets for high acuity discharges and ICU emergency admissions. The secondary outcome measures examined factors for low acuity discharges and all admissions, as well as a run chart for 2015 – 2016 ICU admissions. Multiple logistic regression models were created for admissions, ICU admissions, and low and high acuity discharges. Predictor variables were at the patient level from emergency department registries.ResultsFor discharged high acuity patients, factors predicting EDLOS target failure were having physician initial assessment duration (PIAD)>2 hours (OR 5.63 [5.22-6.06]), consultation request (OR 10.23 [9.38-11.14]), magnetic resonance imaging (MRI) (OR 19.33 [12.94-28.87]), computed tomography (CT) (OR 4.24 [3.92-4.59]), and ultrasound (US) (OR 3.47 [3.13-3.83]). For ICU admissions, factors predicting EDLOS target failure were bed request duration (BRD)>6 hours (OR 364.27 [43.20-3071.30]) and access block (AB)>1 hour (OR 217.27 [30.62-1541.63]). For discharged low acuity patients, factors predicting failure for the 4-hour target were PIAD>2 hours (OR 15.80 [13.35-18.71]), consultation (OR 20.98 [14.10-31.22]), MRI (OR 31.68 [6.03-166.54]), CT (OR 16.48 [10.07-26.98]), and troponin I (OR 13.37 [6.30-28.37]).ConclusionSunnybrook factors predicting failure of targets for high acuity discharges and ICU admissions were hospital-controlled. Hospitals should individualize their approach to shortening EDLOS by analysing its patient population and resource demands.
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- Beygui, F, et al.
(författare)
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Pre-hospital management of patients with chest pain and/or dyspnoea of cardiac origin. A position paper of the Acute Cardiovascular Care Association (ACCA) of the ESC
- 2020
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Ingår i: European heart journal. Acute cardiovascular care. - : Oxford University Press (OUP). - 2048-8734 .- 2048-8726. ; 9:1_SUPPL1_suppl, s. 59-81
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Tidskriftsartikel (refereegranskat)abstract
- Chest pain and acute dyspnoea are frequent causes of emergency medical services activation. The pre-hospital management of these conditions is heterogeneous across different regions of the world and Europe, as a consequence of the variety of emergency medical services and absence of specific practical guidelines. This position paper focuses on the practical aspects of the pre-hospital treatment on board and transfer of patients taken in charge by emergency medical services for chest pain and dyspnoea of suspected cardiac aetiology after the initial assessment and diagnostic work-up. The objective of the paper is to provide guidance, based on evidence, where available, or on experts’ opinions, for all emergency medical services’ health providers involved in the pre-hospital management of acute cardiovascular care.
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- Cheng, I, et al.
(författare)
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Cost-effectiveness of a physician-nurse supplementary triage assessment team at an academic tertiary care emergency department
- 2016
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Ingår i: CJEM. - : Springer Science and Business Media LLC. - 1481-8043 .- 1481-8035. ; 18:3, s. 191-204
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveThe purpose of this study was to evaluate the cost-effectiveness of physician-nurse supplementary triage assistance team (MDRNSTAT) from a hospital and patient perspective.MethodsThis was a cost-effectiveness evaluation of a cluster randomized control trial comparing the MDRNSTAT with nurse-only triage in the emergency department (ED) between the hours of 0800 and 1500. Cost was MDRNSTAT salary. Revenue was from Ontario’s Pay-for-Results and patient volume-case mix payment programs. The incremental cost-effectiveness ratio was based on MDRNSTAT cost and three consequence assessments: 1) per additional patient-seen; 2) per physician initial assessment (PIA) hour saved; and 3) per ED length of stay (EDLOS) hour saved. Patient opportunity cost was determined. Patient satisfaction was quantified by a cost-benefit ratio. A sensitivity analysis extrapolating MDRNSTAT to different working hours, salary, and willingness-to-pay data was performed.ResultsThe added cost of the MDRNSTAT was $3,597.27 [$1,729.47 to ∞] per additional patient-seen, $75.37 [$67.99 to $105.30] per PIA hour saved, and $112.99 [$74.68 to $251.43] per EDLOS hour saved. From the hospital perspective, the cost-benefit ratio was 38.6 [19.0 to ∞] and net present value of –$447,996 [–$435,646 to –$459,900]. For patients, the cost-benefit ratio for satisfaction was 2.8 [2.3 to 4.6]. If MDRNSTAT performance were consistently implemented from noon to midnight, it would be more cost-effective.ConclusionsThe MDRNSTAT is not a cost-effective daytime strategy but appears to be more feasible during time periods with higher patient volume, such as late morning to evening.
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- Mattsson, Janet, 1967-, et al.
(författare)
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Clinical judgement of pain in the non-verbal child at the Paediatric Intensive Care Unit
- 2011
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Konferensbidrag (refereegranskat)abstract
- Background: The aim of this study was to explore PICU nurses’ experiences of clinical judgment of pain in critically ill non-verbal children. The alleviation of children’s pain has been investigated from various perspectives but undertreated pain remains a problem in the Paediatric Intensive Care Unit with empirical evidence pointing towards the role of nurses and their pain judgment process.Summary of work: A phenomenographic method containing interviews was of seventeen experienced PICU nurses. Three categories emerged, describing nurses’ experiences of clinical judgment of pain from diverse perspective and levels of understanding.Summary of results: The findings are hierarchically ordered A, B, C, with A as the most elaborate level of understanding. (A), named Knowledge orientation, takes various aspects of pain in consideration and relates it to theoretical as well as experiential knowledge. (B), called Investigating orientation is focused on the specific child and this child’s specific pain cues, requiring the parent’s engagement. In (C) Practical orientation the judgment process is unsystematic, building on experiential knowledge.Conclusions: This study puts forward that the clinical judgment process has direct implications for how nurses take contextual factors, the child’s condition and the parents’ perceptions into consideration when judging the severity and intensity of the child’s pain, and by extension the child’s pain alleviation.Take-home messages: Increased awareness on nurses’ judgment processes benefits nursing care and nurses becomes more aware of how their judgment process directly affects the alleviation of pain. Finding ways of applying theoretical and experiential knowledge ineveryday care is proposed to systematically facilitate this
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