The First View Concept

Hogan, Benedikt; Rasche, Christoph; Reinersdorff, Andrea Braun von

doi:10.1097/mej.0b013e32834bbd93

Cited by 21 publications

(3 citation statements)

References 9 publications

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“…In addition, while multiple studies and governing bodies, including the Institute of Medicine (IOM), 20 have suggested increased use of systems engineering and improvement science to combat this growing problem, only recently has the emergency medicine literature started to demonstrate the successes that many similarly complex industries discovered long ago. 21 – 24 Still, there remains significant opportunity to refine the use and application of these tools across EDs in an effort to continue to optimize care, especially with respect to streamlining processes and improving throughput, and thus creating much needed capacity. 25 – 30 For example, Lean methodologies, originally designed for use in process improvement in the manufacturing industry, represent one potential tool for use in improving systems of care and throughput in the ED.…”

Section: Introductionmentioning

confidence: 99%

Using Lean-Based Systems Engineering to Increase Capacity in the Emergency Department

White¹,

Chang²,

Grabowski³

et al. 2014

WestJEM

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IntroductionWhile emergency department (ED) crowding has myriad causes and negative downstream effects, applying systems engineering science and targeting throughput remains a potential solution to increase functional capacity. However, the most effective techniques for broad application in the ED remain unclear. We examined the hypothesis that Lean-based reorganization of Fast Track process flow would improve length of stay (LOS), percent of patients discharged within one hour, and room use, without added expense.MethodsThis study was a prospective, controlled, before-and-after analysis of Fast Track process improvements in a Level 1 tertiary care academic medical center with >95,000 annual patient visits. We included all adult patients seen during the study periods of 6/2010–10/2010 and 6/2011–10/2011, and data were collected from an electronic tracking system. We used concurrent patients seen in another care area used as a control group. The intervention consisted of a simple reorganization of patient flow through existing rooms, based in systems engineering science and modeling, including queuing theory, demand-capacity matching, and Lean methodologies. No modifications to staffing or physical space were made. Primary outcomes included LOS of discharged patients, percent of patients discharged within one hour, and time in exam room. We compared LOS and exam room time using Wilcoxon rank sum tests, and chi-square tests for percent of patients discharged within one hour.ResultsFollowing the intervention, median LOS among discharged patients was reduced by 15 minutes (158 to 143 min, 95%CI 12 to 19 min, p<0.0001). The number of patients discharged in <1 hr increased by 2.8% (from 6.9% to 9.7%, 95%CI 2.1% to 3.5%, p<0.0001), and median exam room time decreased by 34 minutes (90 to 56 min, 95%CI 31 to 38 min, p<0.0001). In comparison, the control group had no change in LOS (265 to 267 min) or proportion of patients discharged in <1 hr (2.9% to 2.9%), and an increase in exam room time (28 to 36 min, p<0.0001).ConclusionIn this single center trial, a focused Lean-based reorganization of patient flow improved Fast Track ED performance measures and capacity, without added expense. Broad multi-centered application of systems engineering science might further improve ED throughput and capacity.

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Section: Introductionmentioning

confidence: 99%

Using Lean-Based Systems Engineering to Increase Capacity in the Emergency Department

White¹,

Chang²,

Grabowski³

et al. 2014

WestJEM

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“…The nurse-to-patient ratio ranges from 1:3 to 1:5. Caregivers see patients on a first-view [ 22 ], on-site, 24/7 basis. Whether they work 8-, 10-, or 12-hour shifts, they all work in the same area, have access to the same patient volume, and see the same patient complaints.…”

Section: Methodsmentioning

confidence: 99%

Effectiveness of a Mobile App (PIMPmyHospital) in Reducing Therapeutic Turnaround Times in an Emergency Department: Protocol for a Pre- and Posttest Study

Ehrler¹,

Tuor²,

Rey³

et al. 2023

JMIR Res Protoc

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Background Delays in reviewing issued laboratory results in emergency departments (EDs) can adversely affect efficiency and quality of care. One opportunity to improve therapeutic turnaround time could be to provide real-time access to laboratory results on mobile devices available to every caregiver. We developed a mobile app named “Patients In My Pocket in my Hospital” (PIMPmyHospital) to help ED caregivers automatically obtain and share relevant information about the patients they care for including laboratory results. Objective This pre- and posttest study aims to explore whether the implementation of the PIMPmyHospital app impacts the timeliness with which ED physicians and nurses remotely access laboratory results while actively working in their real-world environment, including ED length of stay, technology acceptance and usability among users, and how specific in-app alerts impact on its effectiveness. Methods This single-center study of nonequivalent pre- and posttest comparison group design will be conducted before and after the implementation of the app in a tertiary pediatric ED in Switzerland. The retrospective period will cover the previous 12 months, and the prospective period will cover the following 6 months. Participants will be postgraduate residents pursuing a ≤6-year residency in pediatrics, pediatric emergency medicine fellows, and registered nurses from the pediatric ED. The primary outcome will be the mean elapsed time in minutes from delivery of laboratory results to caregivers’ consideration by accessing them either through the hospital’s electronic medical records or through the app before and after the implementation of the app, respectively. As secondary outcomes, participants will be queried about the acceptance and usability of the app using the Unified Theory of Acceptance and Use of Technology model and the System Usability Scale. ED length of stay will be compared before and after the implementation of the app for patients with laboratory results. The impact of specific alerts on the app, such as a flashing icon or sound for reported pathological values, will be reported. Results Retrospective data collection gathered from the institutional data set will span a 12-month period from October 2021 to October 2022, while the 6-month prospective collection will begin with the implementation of the app in November 2022 and is expected to cease at the end of April 2023. We expect the results of the study to be published in a peer-reviewed journal in late 2023. Conclusions This study will show the potential reach, effectiveness, acceptance, and use of the PIMPmyHospital app among ED caregivers. The findings of this study will serve as the basis for future research on the app and any further development to improve its effectiveness. Trial Registration: ClinicalTrials.gov NCT05557331; https://clinicaltrials.gov/ct2/show/NCT05557331 Trial Registration ClinicalTrials.gov NCT05557331; https://clinicaltrials.gov/ct2/show/NCT05557331 International Registered Report Identifier (IRRID) PRR1-10.2196/43695

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“…The study was conducted in the ED of the Katharinenhospital Stuttgart which is an adult tertiary referral and major trauma hospital in South-Western Germany It provides interdisciplinary emergency treatment for 100-120 patients per day. The center adopts the First View Concept 14 , in which an emergency registrar/consultant sees each patient in an interdisciplinary approach. The center has 23 treatment rooms with central monitoring, one resuscitation rooms, one wound and one plaster room.…”

Section: Methodsmentioning

confidence: 99%

Improving emergency department patient-doctor conversation through an artificial intelligence symptom taking tool: an action-oriented design pilot study

Scheder-Bieschin

Bluemke²,

Buijzer³

et al. 2020

Preprint

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IMPORTANCECommunication between patients and healthcare professionals is frequently challenging in the crowded emergency department (ED), with few opportunities to develop rapport or empathy. Digital tools for patients and physicians have been proposed as helpful but their utility is not established.OBJECTIVETo evaluate a patient-facing digital symptom and history taking, as well as handover tool in the waiting room.DESIGNA two-phase, questionnaire-based quality improvement study. Phase I observations guided iterative improvement, which was then further evaluated in Phase II.SETTINGED of a German tertiary referral and major trauma hospital providing interdisciplinary treatment for an average of 120 patients daily.PARTICIPANTSAll patients who were willing/able to provide consent, excluding patients: (i) with severe injury/illness requiring immediate treatment; (ii) with traumatic injury; (iii) incapable of completing a health assessment; or, (iv) under 18 years old. Of 1699 patients presenting to the ED, 815 were eligible based on triage level. With available recruitment staff, 135 were approached, of whom 81 were included in the study.INTERVENTION/OBSERVATIONPatients entered information into the tool, which generated a handover report to be accessed via a clinician dashboard. All users completed evaluation questionnaires. Clinicians were trained to observationally assess the tool as a prototype, without relying upon it for clinical care.MAIN OUTCOMES AND MEASURESPatient and clinician Likert scale ratings of tool performance.RESULTSRespondents were strongly positive in endorsing the tool’s usefulness in facilitating conversation (75% of patients, 73% physicians, 100% nurses). Nurses judged the tool as potentially time saving, whilst physicians assessed it as time saving only in some ED medical specialisms (e.g. Surgery). Patients understood the tool questions and reported high usability. The proportion of patients, physicians and nurses who would recommend the tool was 78%, 53% and 76%.CONCLUSIONS AND RELEVANCEThe system has clear potential to improve patient-HCP interaction and make efficiency savings in the ED. Future research and development will extend the range of patients for which the history collection has clinical utility.Key PointsQuestionCan a patient-facing digital symptom and clinical history taking tool provide conversational support, aid in symptom taking, facilitate record keeping, and lead to improved rapport between patients, physicians and nurses in the emergency department (ED)?FindingsAcceptability was high, with improved rapport experienced 90% of the time for patients, 73% for physicians and 100% for nurses. Nurses assessed the tool as having workflow benefit through potential time saving. Physicians assessed the current tool design as providing time saving in certain ED medical specialisms including Surgery.MeaningThe patient-facing tool for symptom and history taking provided meaningful conversation support and showed potential for efficiency savings, however, further research and testing is required before time savings can be consistently delivered to ED clinicians across the range of relevant ED medical specialisms.

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The First View Concept

Cited by 21 publications

References 9 publications

Using Lean-Based Systems Engineering to Increase Capacity in the Emergency Department

Using Lean-Based Systems Engineering to Increase Capacity in the Emergency Department

Effectiveness of a Mobile App (PIMPmyHospital) in Reducing Therapeutic Turnaround Times in an Emergency Department: Protocol for a Pre- and Posttest Study

Improving emergency department patient-doctor conversation through an artificial intelligence symptom taking tool: an action-oriented design pilot study

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