The National Report Card on the State of Emergency Medicine

Epstein, Stephen K.; Burstein, Jonathan L.; Case, Randall B.; Gardner, Angela F.; Herman, Steven D.; Hirshon, Jon Mark; Jermyn, John; McKay, Mary Pat; Mitchiner, James C.; Sullivan, William P.; Wagner, Mary Jo; Beer, Susan; Tiberi, Laura; Price, Craig; Cunningham, Ron; Wilkerson, Dean; Bromley, Marilyn; Geist, Marjorie; Gore, Laura; Singh, Cynthia A.; Wheeler, Gordon E.; Gleason, Stacy; Decker, Jennifer; Gwinner, Valerie M.; Schwalberg, Renee

doi:10.1016/j.annemergmed.2008.10.028

Cited by 32 publications

(11 citation statements)

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“…According to the National Report Card on the State of Emergency Medicine Hospitals, “It is the inescapable conclusion of numerous studies: hospitals are crowded, emergency departments are backed up, ambulance diversions are common, and patients are facing longer waits.” 27 Adding complexity to this already challenging situation is the continual rise in ED patient volume and tightening operating budgets. 1–2,14–15 It is critical to identify more efficient ways to respond to this increasing demand given existing or potentially even more limited resources.…”

Section: Discussionmentioning

confidence: 99%

“…Discrete-event simulation (DES) can be used to estimate statistical performance measures of complex systems without disrupting actual care delivery environments. 17–27 As such, DES is a powerful tool that can be used to evaluate operational strategies without the costly step of implementing each possible solution. We demonstrate the value of DES to model flexible capacity strategies so as to select the optimal change to make in our ED.…”

Section: Introductionmentioning

confidence: 99%

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The Flex Track: Flexible Partitioning Between Low- and High-Acuity Areas of an Emergency Department

Laker

Froehle

Lindsell

et al. 2014

Annals of Emergency Medicine

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Study Objective EDs with both low- and high-acuity treatment areas often have fixed allocation of resources, regardless of demand. We demonstrate the utility of discrete-event simulation to evaluate flexible partitioning between low- and high-acuity ED areas to identify the best operational strategy for subsequent implementation. Methods A discrete-event simulation was used to model patient flow through a 50-bed, urban, teaching ED that handles 85,000 patient visits annually. The ED has historically allocated ten beds to a Fast Track for low-acuity patients. We estimated the effect of a Flex Track policy, which involved switching up to five of these Fast Track beds to serving both low- and high-acuity patients, on patient waiting times. When the high-acuity beds were not at capacity, low-acuity patients were given priority access to flexible beds. Otherwise, high-acuity patients were given priority access to flexible beds. Wait times were estimated for patients by disposition and emergency severity index (ESI) score. Results A Flex Track policy using three flexible beds produced the lowest mean patient waiting of 30.9 (95% CI 30.6–31.2) minutes. The typical Fast Track approach of rigidly separating high- and low–acuity beds produced a mean patient wait time of 40.6 (95% CI 40.2–50.0) minutes, 31% higher than the three-bed Flex Track. A completely flexible ED, where all beds can accommodate any patient, produced mean wait times of 35.1 (95% CI 34.8–35.4) minutes. The results from the three-bed Flex Track scenario were robust, performing well across a range of scenarios involving higher and lower patient volumes and care durations. Conclusion Using discrete-event simulation, we have shown that adding some flexibility into bed allocation between low- and high-acuity can provide substantial reductions in overall patient waiting and a more efficient ED.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Flex Track: Flexible Partitioning Between Low- and High-Acuity Areas of an Emergency Department

Laker

Froehle

Lindsell

et al. 2014

Annals of Emergency Medicine

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“…22,23 Several studies have shown that ED crowding is associated with delays in delivery of timely emergency care, 24 such as delays in antibiotic administration in community-acquired pneumonia 25 and thrombolysis delays in myocardial infarction. 26 In the present study, a longer average patient wait time may serve as a proxy measure for a crowded ED and, therefore, is associated with delays in SC treatment.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with delayed use or nonuse of systemic corticosteroids in emergency department patients with acute asthma

Tsai

Rowe

Sullivan

et al. 2009

Annals of Allergy, Asthma & Immunology

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Background Little is known about factors associated with systemic corticosteroid (SC) use in emergency department (ED) patients with acute asthma. Objective To determine the patient and system factors associated with delayed use or nonuse of SCs in the ED. Methods We analyzed the asthma component of the National Emergency Department Safety Study. Patients with acute asthma in 62 urban EDs in 23 US states between 2003 and 2006 were identified. The primary outcome measure was the pattern of SC use in the ED, which was categorized as timely use (≤60 minutes), delayed use (>60 minutes), or nonuse. Multinomial logistic regression was performed to identify factors associated with delayed use or nonuse of SCs. Results A total of 2,559 of 3,798 patients with acute asthma (67.4%) received SCs. Of these, the median door-to-SC time was 62 minutes (interquartile range, 35–100 minutes), with 1,319 patients (51.5%) having delayed SC treatment. Nonuse of SCs was largely explained by markers of asthma exacerbations (never intubated for asthma, lower respiratory rate, and higher oxygen saturation). In contrast, in addition to these factors, delayed SC treatment was associated with age of 40 years or older, female sex, longer duration of symptoms, ED presentation between 8 AM and 11:59 PM, and ED with a longer average patient wait time. Conclusions Physicians in the ED seem to appropriately administer SCs to higher-acuity asthmatic patients; however, the additional nonmedical factors represent opportunities to improve the timeliness of SC treatment in the ED.

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“…In several countries, the use of diagnostic ultrasound in the ED has, for many years, been a well-integrated part of the initial investigation of the acute patient. In countries like England, Ireland and the United States, ultrasound diagnostics is an educational element for all physicians who complete training that will lead to a permanent position in an ED [ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…The current North American guidelines for emergency medical ultrasound published by the American College of Emergency Physicians (ACEP) and the international consensus document from the International Federation for Emergency Medicine (IFEM) have classified emergency medical ultrasound in different organ-specific core areas [ 1 , 4 ]. There is a big difference in how far the research has come within these areas, but within the most well-studied areas, there is solid evidence that emergency medical ultrasound improves the initial diagnostics and treatment and in certain groups of patients may improve outcome while maximizing patient satisfaction with a hospital visit [ 5 – 9 ].…”

Section: Introductionmentioning

confidence: 99%

Physicians using ultrasound in Danish emergency departments are mostly summoned specialists

Nielsen

Lauridsen

Laursen

et al. 2015

Scand J Trauma Resusc Emerg Med

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BackgroundEmergency ultrasound is a relatively new diagnostic discipline. It is used as an extension of the clinical examination and is ideal in the setting of acute illness. The objective of this study was to investigate how many Emergency Departments (EDs) in Denmark have implemented emergency ultrasound. We also wanted to give an idea of how many and which physicians have adopted ultrasound as a diagnostic tool so far.MethodsThe study was a cross-sectional, descriptive, multicenter survey that included all physician staffed EDs in Denmark. An Internet based questionnaire was distributed by e-mail to all heads of department. Those departments who responded that ultrasound was available in their department were included in the second part of the study where all physicians working in the ED were contacted and asked to complete a second questionnaire.ResultsAll 28 eligible EDs participated in the first part of the study (Response rate: 100 %). 25 EDs (89 %, 95 % CI: 85-93) had ultrasound equipment available. Questionnaires were distributed to 1,872 physicians in these departments and 561 responded (Response rate: 30 %, 95 % CI: 28-32). Overall 257 (46 %, 95 % CI: 42-50) were users of emergency ultrasound and 304 were non-users (54 %, 95 % CI: 50-58). The largest group with 146 respondents (25 %, 95 % CI: 21-29) were anaesthetists with merely consult duty in the ED. When looking exclusively on physicians with on-call duty in the ED, thus excluding anaesthetists, only 146 (35 %, 95 % CI: 30-40) were users of ultrasound while 269 (65 %, 95 % CI: 60-70) were non-users. There was a considerable difference regarding age, level of training, and medical specialty between users and non-users. Users were mainly anaesthetists and attending physicians from other departments. The majority of non-users were young physicians with on call duty in the ED.ConclusionsWe have found that although almost all Danish EDs have ultrasound equipment available, few physicians working in the ED seem to have adopted the tool. Emergency Ultrasound is mainly performed by specialists who are summoned to the ED in case of severe acute illness and not by those physicians who comprise the backbone of the ED around the clock.

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The National Report Card on the State of Emergency Medicine

Cited by 32 publications

References 0 publications

The Flex Track: Flexible Partitioning Between Low- and High-Acuity Areas of an Emergency Department

The Flex Track: Flexible Partitioning Between Low- and High-Acuity Areas of an Emergency Department

Factors associated with delayed use or nonuse of systemic corticosteroids in emergency department patients with acute asthma

Physicians using ultrasound in Danish emergency departments are mostly summoned specialists

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