Bottlenecks in the Emergency Department: the psychiatric clinicians' perspective

Abstract

Objective To ask psychiatric clinicians for their perspectives on the rate-limiting steps (RLS) in patient care in the Emergency Department (ED) and to compare them to the patient’s actual length of stay. Method Prospective cohort study of clinicians’ perspectives on the RLS among 1092 adult ED patients. Medical records were abstracted for ED time and other data. Results Clinicians identified five RLS: limited availability of staff, limited availability of beds after discharge, need for clinical stability, need for additional history and patient’s financial issues. The last RLS was the only one not associated with increased wait times in the ED. There were significant differences in the patterns of RLS by trainee status and hospital. For example, significantly higher proportions of trainees reported that RLS in patient care were due to the need for clinical stability and additional history and lack of bed availability. In contrast, non-trainee clinicians were more likely to cite problems with the availability of ED staff as an RLS. Conclusions Most of the RLS in patient care identified by clinicians were associated with actual increases in ED wait time for their patients. Next steps include asking clinicians for possible solutions to the delays their patients experience.

An Open Logic Approach to EPM

“…This algebra, by posting directly configurations in which a complex proposition is true, can explicitly represent all mental models, in the sense of Johnson-Laird [126], 2001) necessary for the apprehension of a proposition in all its complexity. In agreement to Morineau [127], we think that this algebra could represent a tool for assisting work activities that involve inductive reasoning, like problem-and case-based reasoning in medical diagnosis [128], and subject profiling in psychiatry and psychotherapy [129][130][131]. More specifically, from a biomedical engineering perspective, fault diagnosis task [132] and troubleshooting on logical networks [133] could be areas of application for reliable testing and validation of the presented EPM extension.…”

The doctor’s digital double: how warmth, competence, and animation promote adherence intention

“…Model x (Chang et al, 2012;Pickersgill, 2001;Sklar, 2013) as many countries are facing a shortage of physicians, nurses, and other healthcare professionals (Bodenheimer, Chen & Bennett, 2009;Bodenheimer & Smith, 2013;Colwill, Cultice & Kruse, 2008;Potempa, Redman & Landstrom, 2009). These shortages reduce opportunities for the clinical supervision of patients, allowing their nonadherence to increase negative health outcomes.…”

Effect of a Regional Dedicated Psychiatric Emergency Service on Boarding and Hospitalization of Psychiatric Patients in Area Emergency Departments

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