Emergency Department Escalation in Theory and Practice: A Mixed-Methods Study Using a Model of Organizational Resilience

Back, Jonathan; Ross, Alastair; Duncan, Myanna; Jaye, Peter; Henderson, Katherine; Anderson, Janet

doi:10.1016/j.annemergmed.2017.04.032

Cited by 59 publications

(91 citation statements)

References 23 publications

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“…The methods used to study RHC varied in the studies: seven were qualitative [29,30,27,28,23,24,31], and four used mixed methods [22,21,25,26]. The methods used in the studies published in books, however, were mainly qualitative [32-34, 36, 37, 39-43, 45-47, 35] except two studies that used mixed methods [38,44].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Reconciling the gap between Work-as-imagined (WAI) and Work-as-done (WAD) to enhance safety by learning from everyday clinical work instead of focusing only on adverse events [27,29,30,32,36,39,46,47,38,41,43].…”

Section: Risk Of Biasmentioning

confidence: 99%

“…Instead, escalation processes were adapted to manage pressures informally [29]. Further studies are needed to co-design interventions to develop more realistic and useful escalation policies.…”

Section: Modelsmentioning

confidence: 99%

“…Effective team working structure between doctors, nurses and patient flow-coordinator roles to enhance the ability to expedite patient transfer to manage crowding in an emergency department [29].…”

Section: Quasi Modelsmentioning

confidence: 99%

“…Experienced health care professionals may teach novices how the health care system works and how to perform work. Managing different situations and cases will provide health care professionals with knowledge and experience that allows development of the resilient behaviours of anticipating, learning, monitoring and responding when facing similar situations [29,31,33,40,45]. Another example to build resilience is in-situ simulation training and debriefings, which provide opportunities for experts and novices to understand practice and adapt to routine and unexpected situations [24,40,41,47].…”

Section: Quasi Modelsmentioning

confidence: 99%

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Resilient Health Care: a systematic review of conceptualisations, study methods and factors that develop resilience.

Iflaifel

Lim

Ryan

et al. 2019

Preprint

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Background Traditional approaches to safety management in health care have focused primarily on counting errors and understanding how things go wrong. Resilient Health Care (RHC) provides an alternative complementary perspective of learning from incidents and understanding how, most of the time, work is safe. The aim of this review was to identify how RHC was conceptualised, described and interpreted, to describe the methods used to study, and to identify factors that develop RHC. Methods Electronic searches of PubMed, Scopus and Cochrane databases were performed to identify relevant peer-reviewed studies, and a hand search for studies published in books that explained how RHC as a concept was interpreted, methods used to study, and factors to develop RHC. Studies were evaluated independently by two researchers. Data was synthesised using a deductive thematic approach. Results Twenty-seven studies were included; they shared similar descriptions of RHC which was the ability to adjust its functioning prior to, during, or following events and thereby sustain required operations under both expected and unexpected conditions. Qualitative methods such as observations and interviews were used to study RHC. Models for studying RHC currently exist and were in the early stages of implementation. Effective team relationships, trade-offs and healthcare ‘resilience’ training of health care professionals were factors used to develop RHC. Conclusions Although there was consistency in the conceptualisation of RHC, methods used to study and factors to develop RHC, further research should focus on operationalising RHC assessment methods and developing, testing and evaluating interventions for developing RHC.

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Section: Study Characteristicsmentioning

confidence: 99%

Section: Risk Of Biasmentioning

confidence: 99%

Section: Modelsmentioning

confidence: 99%

Section: Quasi Modelsmentioning

confidence: 99%

Section: Quasi Modelsmentioning

confidence: 99%

See 3 more Smart Citations

Resilient Health Care: a systematic review of conceptualisations, study methods and factors that develop resilience.

Iflaifel

Lim

Ryan

et al. 2019

Preprint

View full text Add to dashboard Cite

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All in a day's work: Towards improved understanding of safety leadership during regular safety‐related tasks in mining

Donovan

Salmon

Horberry

et al. 2020

Hum Ftrs & Erg Mfg Svc

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This article examines safety leadership during regular safety‐related tasks conducted across a mining work system. Applying a systems‐thinking methodology, a modified version of the critical decision method (CDM) interview technique was used to examine decision‐making and behavior in association with five safety‐related tasks executed across the work system; hazard identification, inspections, standard operating procedure development, task observation and return to work coordination activities. Data were mapped onto Rasmussen's risk management framework to explore the characteristics of safety leadership decision‐making and behavior which occurred across the work system to support successful task execution. Vertical integration was present and was associated with a core set of decision‐making elements and leadership behaviors that facilitated the communication and exchange of information within and across the work system in association with tasks executed. In addition, different profiles of decision‐making characteristics and behavioral engagement were evident at different system levels, which indicated variability in safety leadership was required to support successful task execution across the work system. Task type was found to influence safety leadership, with structured tasks demonstrating less intensive decision‐making and behavioral engagement requirements than unstructured tasks. The findings add to the knowledge base on safety leadership through improved understanding of the concept, its occurrence across tasks and work system levels, and the factors which influence it to support safe system functioning. Future research endeavors and practical implications are discussed.

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Determining the optimal capacity and occupancy rate in a hospital: A theoretical model using queuing theory and marginal cost analysis

Maaz

Papanastasiou

2020

Manage Decis Econ

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We model the hospital as seeking to balance the costs to itself in providing care, as well as the societal cost of people waiting for care. We use queuing theory to show that the optimal capacity and the corresponding optimal occupancy rate are dependent on the marginal cost of expanding capacity, the marginal cost of waiting, and the rates of patient arrival and discharge. Therefore, a universal occupancy target is unfounded. As well, the model shows that increasing capacity to respond to increased patient influxes is inadequate, suggesting that the health care system must explore alternate responses to burgeoning patient populations.

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Emergency Department Escalation in Theory and Practice: A Mixed-Methods Study Using a Model of Organizational Resilience

Abstract: Formal escalation actions and their implementation in practice differed and varied in their effectiveness. Monitoring how escalation works in practice is essential in understanding whether and how escalation policies help to manage workload.

Cited by 59 publications

References 23 publications

Resilient Health Care: a systematic review of conceptualisations, study methods and factors that develop resilience.

Resilient Health Care: a systematic review of conceptualisations, study methods and factors that develop resilience.

All in a day's work: Towards improved understanding of safety leadership during regular safety‐related tasks in mining

Determining the optimal capacity and occupancy rate in a hospital: A theoretical model using queuing theory and marginal cost analysis

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