Streamlining pathways for minor injuries in emergency departments through radiographer-led discharge

Rachuba, Sebastian; Knapp, Karen; Ashton, Lucy; Pitt, Martin

doi:10.1016/j.orhc.2018.03.001

Cited by 12 publications

(28 citation statements)

References 42 publications

(48 reference statements)

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“…Hand searching identified one article [ 4 , 11 , 25 ]. One study was located in the ORE [ 26 ]. A storyboard was identified through the PHE search [ 27 ].…”

Section: Resultsmentioning

confidence: 99%

Radiographer-led discharge for emergency care patients, requiring projection radiography of minor musculoskeletal injuries: a scoping review

Shepherd

Lourida²,

Meertens³

2022

BMC Emerg Med

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Background Pressure on emergency departments (EDs) from increased attendance for minor injuries has been recognised in the United Kingdom. Radiographer-led discharge (RLD) has potential for improving efficiency, through radiographers trained to discharge patients or refer them for treatment at the point of image assessment. This review aims to scope all RLD literature and identify research assessing the merits of RLD and requirements to enable implementation. Methods We conducted a scoping review of studies relating to RLD of emergency care patients requiring projection radiography of minor musculoskeletal (MSK) injuries. MEDLINE, Embase and CINAHL, relevant radiography journals and grey literature were searched. Articles were reviewed and the full texts of selected studies were screened against eligibility criteria. The data were extracted, collated and a narrative synthesis completed. Results Seven studies with varying study designs were included in the review. The small number of studies was possibly due to a generally low research uptake in radiography. The main outcome for four studies was reduced length of stay in ED, with recall and re-attendance to ED a primary outcome in one study and secondary outcome for two other studies. The potential for increased efficiency in the minor MSK pathway patient pathway and capacity for ED staff was recognised. Radiographers identified a concern regarding the risk of litigation and incentive of increased salary when considering RLD. The studies were broadly radiographer focussed, despite RLD spanning ED and Radiology. Conclusion There were a low number of RLD active radiographers, likely to be motivated individuals. However, RLD has potential for generalisability with protocol variations evident, all producing similar positive outcomes. Understanding radiography and ED culture could clarify facilitators for RLD to be utilised more sustainably into the future. Cost effectiveness studies, action research within ED, and cluster randomised controlled trial with process evaluation are needed to fully understand the potential for RLD. The cost effectiveness of RLD may provide financial support for training radiographers and increasing their salary, with potential future benefit of reduction in workload within ED. RLD implementation would require an inter-professional approach achieved by understanding ED staff and patient perspectives and ensuring these views are central to RLD implementation.

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“…Hand searching identified one article [ 4 , 11 , 25 ]. One study was located in the ORE [ 26 ]. A storyboard was identified through the PHE search [ 27 ].…”

Section: Resultsmentioning

confidence: 99%

Radiographer-led discharge for emergency care patients, requiring projection radiography of minor musculoskeletal injuries: a scoping review

Shepherd

Lourida²,

Meertens³

2022

BMC Emerg Med

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“…For instance, the use of hybrid approaches emerging from the combination of several prominent approaches is at the earlier stages and more contributions are then expected to increase the evidence base related to these applications. In particular, the use of combined interventions using simulation and lean manufacturing remains limited in the reported literature [113,115,116,166,176,216]. Likewise, researchers are advised to take into account the methodological trends regarding process improvement in emergency departments.…”

Section: Discussionmentioning

confidence: 99%

Methodological Approaches to Support Process Improvement in Emergency Departments: A Systematic Review

Ortíz‐Barrios

Alfaro-Saiz

2020

IJERPH

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The most commonly used techniques for addressing each Emergency Department (ED) problem (overcrowding, prolonged waiting time, extended length of stay, excessive patient flow time, and high left-without-being-seen (LWBS) rates) were specified to provide healthcare managers and researchers with a useful framework for effectively solving these operational deficiencies. Finally, we identified the existing research tendencies and highlighted opportunities for future work. We implemented the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology to undertake a review including scholarly articles published between April 1993 and October 2019. The selected papers were categorized considering the leading ED problems and publication year. Two hundred and three (203) papers distributed in 120 journals were found to meet the inclusion criteria. Furthermore, computer simulation and lean manufacturing were concluded to be the most prominent approaches for addressing the leading operational problems in EDs. In future interventions, ED administrators and researchers are widely advised to combine Operations Research (OR) methods, quality-based techniques, and data-driven approaches for upgrading the performance of EDs. On a different tack, more interventions are required for tackling overcrowding and high left-without-being-seen rates.

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“…Some of the solutions that have been implemented are defined as Fast Tracks [13], [14], or other solutions known as See and Treat [15]. Rachuba et al [16] show that diagnostic imaging services are essential to the diagnosis pathway for many patients.…”

Section: Related Workmentioning

confidence: 99%

An Intelligent Scheduling of Non-Critical Patients Admission for Emergency Department

Bruballa¹,

Wong²,

Rexachs³

et al. 2020

IEEE Access

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The combination of the progressive growth of an aging population, increased life expectancy and a greater number of chronic diseases all contribute significantly to the growing demand for emergency medical care, and thus, causing saturation in Emergency Departments (EDs). This saturation is usually due to the admission of non-urgent patients, who constitute a high percentage of patients in an ED. The Agentbased Model (ABM) is one of the most important tools that helps to study complex systems and explores the emergent behavior of this type of department. Its simulation more accurately reflects the complexity of the operation of real systems. Our proposal is the design of an ABM to schedule the access of these noncritical patients into an ED, which can be useful for the service management dealing with the actual growing demand for emergency care. We suppose that a relocation of these non-critical patients within the expected input pattern, provided initially by historical records, enables a reduction in waiting time for all patients, and therefore, it will lead to an improvement in the quality of service. It would also allow us to avoid long waiting times. This research offers the availability of relevant knowledge for Emergency Department managers in order to help them make decisions to improve the quality of the service, in anticipation of the expected growing demand of the service in the very near future. INDEX TERMS Agent-based modeling and simulation (ABMS), Emergency Department (ED), response capacity, decision support systems (SDS), length of stay (LoS).

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Streamlining pathways for minor injuries in emergency departments through radiographer-led discharge

Cited by 12 publications

References 42 publications

Radiographer-led discharge for emergency care patients, requiring projection radiography of minor musculoskeletal injuries: a scoping review

Radiographer-led discharge for emergency care patients, requiring projection radiography of minor musculoskeletal injuries: a scoping review

Methodological Approaches to Support Process Improvement in Emergency Departments: A Systematic Review

An Intelligent Scheduling of Non-Critical Patients Admission for Emergency Department

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