Diagnostic anticipation to reduce emergency department length of stay: a retrospective cohort study in Ferrara University hospital, Italy

Strada, Andrea; Bolognesi, Niccolò; Manzoli, Lamberto; Valpiani, Giorgia; Morotti, Chiara; Bravi, Francesca; Bentivegna, Roberto; Forini, Elena; Pesci, Antonella; Stefanati, Armando; Ruscio, Eugenio Di; Carradori, Tiziano

doi:10.1186/s12913-020-05472-3

Cited by 3 publications

(1 citation statement)

References 16 publications

(25 reference statements)

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“…According to this study, crowding is significantly associated with prolonged EDLOS. This result is consistent with the study conducted in Sweden [ 47 ], Norway [ 40 ], USA [ 74 ], Italy [ 75 ], and Southern Ethiopia [ 8 ]. Many studies showed that crowding is a global challenge that affects emergency health care services and prolong EDLOS.…”

Section: Discussionsupporting

confidence: 92%

Prolonged length of stay and its associated factors at adult emergency department in amhara region comprehensive specialized hospitals, northwest Ethiopia

et al. 2023

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Background Prolonged length of stay at the emergency department interferes with the main goal of emergency care and results in adverse patient outcomes like nosocomial infection, dissatisfaction, morbidity, and mortality. Despite this, little is known about the length of stay and the factors that influence it in Ethiopia’s emergency department. Methods An institution-based cross-sectional study was conducted on 495 patients admitted at Amhara region comprehensive specialized hospitals emergency department from May 14 to June 15/2022. A systematic random sampling was employed to select study participants. A pretested structured interview-based questionnaire was used to collect data by using Kobo toolbox software. SPSS version 25 was used for data analysis. Bi-variable logistic regression analysis was carried out to select variables with P-value < 0.25. The significance of association was interpreted using an Adjusted Odds Ratio with a 95% confidence interval. Variables with P-value < 0.05 in the multivariable logistic regression analysis were inferred to be significantly associated with length of stay. Result Out of 512 enrolled participants, 495 were participated with a response rate of 96.7%. The prevalence of prolonged length of stay in the adult emergency department was 46.5% (95%CI: 42.1, 51.1). Lack of insurance (AOR: 2.11; 95% CI: 1.22, 3.65), non-communicative presentation (AOR: 1.98; 95% CI: 1.07, 3.68), delayed consultation (AOR: 9.5; 95% CI: 5.00, 18.03), overcrowding (AOR: 4.98; 95% CI: 2.13, 11.68), and shift change experience (AOR: 3.67; 95% CI: 1.30, 10.37) were significantly associated with prolonged length of stay. Conclusion The result of this study is found to be high based on Ethiopian target emergency department patient length of stay. Lack of insurance, presentation without communication, delayed consultation, overcrowding, and shift change experience were significant factors for prolonged emergency department length of stay. Therefore, interventions like expansion of organizational setup are needed to decrease the length of stay to an acceptable level.

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Section: Discussionsupporting

confidence: 92%

Prolonged length of stay and its associated factors at adult emergency department in amhara region comprehensive specialized hospitals, northwest Ethiopia

et al. 2023

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The Lived Experiences of Discharged Patients on Quality Care in a Crowded Emergency Department

Abordo,

F. Benabaye,

Lyn F. Bombeza

et al. 2024

International Journal of Innovative Science and Research Techno

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Background and Aim: In the Philippines, the problem of overcrowding in emergency rooms causes serious negative effects to delivering quality care to patients. The study aims to investigate the lived experiences of discharged patients from a crowding emergency rooms revealing the difficulties that patients encounter and offer critical insights to improve the standard of care and emergency department flow.  Method: This qualitative study employed a phenomenological approach, using semi-structured interviews to gather data from 16 participants who had recently been discharged from an overcrowded emergency department in Iligan City, Lanao del Norte. The interviews were conducted in the local dialect, Bisaya, and were analyzed using Colaizzi's method for qualitative data analysis.  Results: The findings reveal key themes that emerged from the participants' responses; the stress and anxiety, the environmental stressors such as noise, overcrowding, lack of privacy, the Specific spaces like triage, examination rooms, and waiting areas, the technological environment, particularly equipment quality, the Extended waiting periods, rapid treatment progression, sudden discharge and contrasting temporal experiences. Lastly, human connection amidst chaos and feeling understood and cared for with kindness.  Conclusion: The findings emphasize the need for improved patient flow management, enhanced environmental design, and a patient-centered approach to care delivery to prioritize patient comfort, reduce distress, and promote better outcomes especially for patients. It also shows how nurses care compassionately with patients amidst piling responsibilities in crowding emergency department.

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Nurse-Driven Protocols for Abdominal Pain in the Emergency Department

Schmidt¹

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Practice Problem: Emergency department (ED) crowding hinders the opportunity to deliver safe, quality care to abdominal pain patients and detrimentally affects clinical outcomes. Leadership of a rural community ED recognized a comparable issue by introducing a nurse-driven protocol (NDP) to reduce patient length of stay (LOS) and the rate of patients who leave the department prior to physician evaluation. PICOT: The PICOT question that guided this project was: For adult patients in an emergency department, how does a nurse-driven protocol for abdominal pain compared to no protocol use affect the LOS and left without being seen (LWBS) rate over 10 weeks? Evidence: Fourteen studies were identified and supported evidence of effective NDP use for reducing the LOS and LWBS rate amongst abdominal pain patients. Improved clinical outcomes, enhanced operational efficiencies, increased patient and staff satisfaction, and NDP utility in multiple disease states were themes recognized in the literature. Intervention: The evidence-based NDP empowered ED nurses to obtain laboratory diagnostic data and implement nursing interventions within a facility-approved protocol designed to improve throughput by decreasing the time from patient presentation to obtaining medical disposition. Outcome: A pre and post-implementation design found a clinically significant mean reduction of 28-minutes in LOS with the use of the NDP. Overall LWBS was reduced from 5.2 to 2.3 percent and found to be statistically significant. Conclusion: Implementation of an ED abdominal pain NDP was effective in decreasing ED LOS and LWBS. Emergency nurses reported a sense of empowerment with the use of the NDP.

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Diagnostic anticipation to reduce emergency department length of stay: a retrospective cohort study in Ferrara University hospital, Italy

Cited by 3 publications

References 16 publications

Prolonged length of stay and its associated factors at adult emergency department in amhara region comprehensive specialized hospitals, northwest Ethiopia

Prolonged length of stay and its associated factors at adult emergency department in amhara region comprehensive specialized hospitals, northwest Ethiopia

The Lived Experiences of Discharged Patients on Quality Care in a Crowded Emergency Department

Nurse-Driven Protocols for Abdominal Pain in the Emergency Department

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