Increasing Throughput: Results from a 42-Hospital Collaborative to Improve Emergency Department Flow

Zocchi, Mark S.; McClelland, Mark; Pines, Jesse M.

doi:10.1016/s1553-7250(15)41070-0

Cited by 18 publications

(17 citation statements)

References 19 publications

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“…Similar to our findings, CL commitment has been found to be a key factor in improving patient flow in the ED [33–35]. For example, in a study conducted by Zocchi et al [35], leadership was found to be one of the fundamental elements in improving ED flow measures in hospitals. We found that the CNs and the DOCs play a vital role in maintaining information flow within their own and across other professions in the ED, and this finding is congruent with the results of a previous study that reviewed effective communication in CL [16].…”

Section: Discussionsupporting

confidence: 89%

“…These skills, except the latter, are components of the “Clinical leadership checklist” self-assessment tool outlined by McSherry and Pearce [4]. Similar to our findings, CL commitment has been found to be a key factor in improving patient flow in the ED [33–35]. For example, in a study conducted by Zocchi et al [35], leadership was found to be one of the fundamental elements in improving ED flow measures in hospitals.…”

Section: Discussionsupporting

confidence: 85%

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Actual clinical leadership: a shadowing study of charge nurses and doctors on-call in the emergency department

Husebø

Olsen

2019

Scand J Trauma Resusc Emerg Med

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BackgroundThe provision of safe, high quality healthcare in the Emergency Department (ED) requires frontline healthcare personnel with sufficient competence in clinical leadership. However, healthcare education curriculum infrequently features learning about clinical leadership, and there is an absence of experienced doctors and nurses as role models in EDs for younger and less experienced doctors and nurses. The purpose of this study was to explore the activities performed by clinical leaders and to identify similarities and differences between the activities performed by charge nurses and those performed by doctors on-call in the Emergency Department after completion of a Clinical Leadership course.MethodsA qualitative exploratory design was chosen. Nine clinical leaders in the ED were shadowed. The data were analyzed using a thematic analysis.ResultsThe analysis revealed seven themes: receiving an overview of the team and patients and planning the shift; ensuring resources; monitoring and ensuring appropriate patient flow; monitoring and securing information flow; securing patient care and treatment; securing and assuring the quality of diagnosis and treatment of patient; and securing the prioritization of patients. The last two themes were exclusive to doctors on-call, while the theme “securing patient care and treatment” was exclusive to charge nurses.ConclusionsCharge nurses and doctors on-call perform multitasking and complement each other as clinical leaders in the ED. The findings in this study provide new insights into how clinical leadership is performed by charge nurses and doctors on-call in the ED, but also the similarities and differences that exist in clinical leadership performance between the two professions. Clinical leadership is necessary to the provision of safe, high quality care and treatment for patients with acute health needs, as well as the coordination of healthcare services in the ED. More evaluation studies of this Clinical Leadership course would be valuable.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 85%

Actual clinical leadership: a shadowing study of charge nurses and doctors on-call in the emergency department

Husebø

Olsen

2019

Scand J Trauma Resusc Emerg Med

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“…These data are critically important for quality improvement and clinical education. 6 - 10 The Global Tracheostomy Collaborative (GTC), whose mission is to improve lives of individuals with tracheostomy, 4 has spearheaded data collection efforts and dissemination of best practice. 11 , 12 Yet, little is known about effectiveness of virtual approaches for engaging professionals of different disciplines.…”

Section: Introductionmentioning

confidence: 99%

Multidisciplinary Tracheostomy Quality Improvement in the COVID-19 Pandemic: Building a Global Learning Community

Swords

Bergman

Wilson-Jeffers

et al. 2020

Ann Otol Rhinol Laryngol

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Objectives: To report experience with a global multidisciplinary tracheostomy e-learning initiative Methods: An international multidisciplinary panel of experts convened to build a virtual learning community for tracheostomy care, comprising a web-based platform, five distance learning (interactive webinar) sessions, and professional discourse over 12 months. Structured pre- and post-webinar surveys were disseminated to global participants including otolaryngologists, intensivists, nurses, allied health professionals, and patients/caregivers. Data were collected on audio-visual fidelity, demographics, and pre- and post-tutorial assessments regarding experience and skill acquisition. Participants reported confidence levels for NICU, pediatric, adult, and family care, as well as technical skills, communication, learning, assessment, and subdomains. Results: Participants from 197 institutions in 22 countries engaged in the virtual education platform, including otolaryngologists, speech pathologists, respiratory therapists, specialist nurses, patients, and caregivers. Significant improvements were reported in communication ( P < .0001), clinical assessments ( P < .0001), and clinical governance ( P < .0001), with positive impact on pediatric decannulation ( P = .0008), adult decannulation ( P = .04), and quality improvement ( P < .0001). Respondents reported enhanced readiness to integrate knowledge into practice. Barriers included time zones, internet bandwidth, and perceived difficulty of direct clinical translation of highly technical skills. Participants rated the implementation highly in terms of length, ability for discussion, satisfaction, applicability to professional practice, and expertise of discussants (median scores: 4, 4, 4, 4 and 5 out of 5). Conclusions: Virtual learning has dominated the education landscape during COVID-19 pandemic, but few data are available on its effectiveness. This study demonstrated feasibility of virtual learning for disseminating best practices in tracheostomy, engaging a diverse, multidisciplinary audience. Learning of complex technical skills proved a hurdle, however, suggesting need for hands-on experience for technical mastery. While interactive videoconferencing via webinar affords an engaging and scalable strategy for sharing knowledge, further investigation is needed on clinical outcomes to define effective strategies for experiential online learning and virtual in-service simulations.

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“…Many hospitals are interested in quality improvement initiatives to optimize patient LOS and reduce costs. 5 Trauma centers in the United States regularly review their ED times as a quality measure, particularly in high-volume trauma centers. 6 Health care systems have identified modifiable variables that may impact patient ED LOS including hospital characteristics, 7 staffing limitations, [8][9][10][11] and ancillary support.…”

Section: Introductionmentioning

confidence: 99%

Predictors of Delayed Emergency Department Throughput Among Blunt Trauma Patients

Steren

Fleming

Zhou

et al. 2020

Journal of Surgical Research

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Increasing Throughput: Results from a 42-Hospital Collaborative to Improve Emergency Department Flow

Cited by 18 publications

References 19 publications

Actual clinical leadership: a shadowing study of charge nurses and doctors on-call in the emergency department

Actual clinical leadership: a shadowing study of charge nurses and doctors on-call in the emergency department

Multidisciplinary Tracheostomy Quality Improvement in the COVID-19 Pandemic: Building a Global Learning Community

Predictors of Delayed Emergency Department Throughput Among Blunt Trauma Patients

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