Emergency Medicine

Convenient Care: Retail Clinics and Urgent Care Centers in New York State – United Hospital Fund – 2015

Posted on February 13, 2015. Filed under: Emergency Medicine |

Convenient Care: Retail Clinics and Urgent Care Centers in New York State – United Hospital Fund – 2015

“Urgent care centers and retail clinics—collectively known as “convenient care”—are a major market-driven development in ambulatory care, presenting both potential benefits and risks for the health care system. This Fund report presents an overview of convenient care nationally, and examines the distribution of these providers in New York State and their potential impact on two special populations—the medically underserved and children. It also offers five policy options the State could consider to establish consumer and public health protections, and considers the relationship of convenient care to broader health care restructuring.”

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Improving the Emergency Department Discharge Process: Environmental Scan Report – AHRQ – December 2014

Posted on December 10, 2014. Filed under: Emergency Medicine | Tags: , |

Improving the Emergency Department Discharge Process: Environmental Scan Report – AHRQ – December 2014

Prepared by: Johns Hopkins University, Armstrong Institute for Patient Safety and Quality

“Millions of patients visit hospital emergency departments (EDs) each year for a variety of injuries and ailments. It is crucial for these patients to receive appropriate preparation for their return home so that they can properly manage their recovery. ED discharge failure, such as ED return within 72 hours or more, carries significant clinical implications for patients, including unfinished treatments and progression of illness. But there is only limited understanding of such risk factors currently. This report presents the purpose, methods, and results of an environmental scan on existing literature in this area.”

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Reimbursement of urgent and emergency care: discussion document on options for reform – Monitor and NHS England – 19 August 2014

Posted on August 29, 2014. Filed under: Emergency Medicine |

Reimbursement of urgent and emergency care: discussion document on options for reform – Monitor and NHS England – 19 August 2014

This discussion paper is supported by the findings from Monitor’s research and analysis so far. It describes:

the case for reforming the urgent and emergency care payment approach
a suggested payment approach, including the supporting evidence and analysis
preliminary options for implementing a new payment approach to support improved delivery of urgent and emergency care
the next steps for Monitor and NHS England’s work”

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Transforming urgent and emergency care services in England: Update on the Urgent and Emergency Care Review – 15 August 2014

Posted on August 21, 2014. Filed under: Emergency Medicine |

Transforming urgent and emergency care services in England: Update on the Urgent and Emergency Care Review – 15 August 2014

 

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Focus on: A&E attendances – why are patients waiting longer? – QualityWatch – The Health Foundation & Nuffield Trust – July 2014

Posted on July 25, 2014. Filed under: Emergency Medicine | Tags: , |

Focus on: A&E attendances – why are patients waiting longer? – QualityWatch – The Health Foundation & Nuffield Trust – July 2014

Web page for the report

“Accident and emergency departments are facing unprecedented demand and making headlines by missing the high profile four-hour waiting time target. Our in-depth study looks at patterns of A&E activity, the nature of the increased demand and what has driven waiting times upwards.”

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Acute and emergency care: prescribing the remedy – The College of Emergency Medicine – 16 July 2014

Posted on July 22, 2014. Filed under: Acute Care, Emergency Medicine | Tags: |

Acute and emergency care: prescribing the remedy – The College of Emergency Medicine – 16 July 2014

“We are all too aware that the urgent and emergency care system has been under pressure for some time with increasing emergency admissions, rising levels of acuity and a lack of effective alternatives to the emergency department. This growing pressure is not sustainable and there is a risk that the quality of patient care will be compromised. Significant measures are needed to avoid an annual crisis and to build a resilient system which is fit for purpose.

Given the continuing challenges experienced by patients and those working in acute and emergency care services the College of Emergency Medicine convened an emergency summit with the Royal College of Paediatrics and Child Health, the Royal College of Physicians, the Royal College of Surgeons and the NHS Confederation. On 4th March 2014 key policy makers, opinion formers and leaders in acute healthcare were brought together to develop solutions to the challenges and to strengthen the system for future service demands.

Acute and emergency care – prescribing the remedy contains the consensus recommendations of this summit. The consensus nature of the proposals reflecting, the needs of patients whether ill or injured, the elderly and children is unique.

This report co-authored by the College of Emergency Medicine, Royal College of Paediatrics and Child Health, Royal College of Physicians and Royal College of Surgeons sets out 13 recommendations for Government, national bodies, commissioners, providers, professional bodies and clinicians, to take forward at local and national levels. Implementing these measures will help build an urgent and emergency care system that is sustainable and resilient to cope with future service demands.”

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Urgent and planned care: operational resilience and capacity planning for 2014/15 – Monitor, NHS England and NHS Trust Development Authority – 13 June 2014

Posted on June 17, 2014. Filed under: Emergency Medicine, Health Mgmt Policy Planning |

Urgent and planned care: operational resilience and capacity planning for 2014/15 – Monitor, NHS England and NHS Trust Development Authority – 13 June 2014

“This framework covers both urgent and planned care. It has been jointly produced by Monitor, NHS England, the NHS Trust Development Authority and ADASS (Association of Directors of Adult Social Services).

It sets out best practice requirements across planned and urgent and emergency care that local healthcare systems should reflect in their local plans, as well as providing information on more general requirements such as operational planning, patient experience and planning for higher dependency patient groups.”

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Time patients spent in emergency departments in 2012 and 2013 – National Health Performance Authority (NHPA) – 29 May 2014

Posted on May 29, 2014. Filed under: Emergency Medicine | Tags: , |

Time patients spent in emergency departments in 2012 and 2013 – National Health Performance Authority (NHPA) – 29 May 2014

 

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Accident & Emergency Performance: England 2013/14: national and regional data – Research Paper 14/22 – 14 April 2014

Posted on April 24, 2014. Filed under: Emergency Medicine |

Accident & Emergency Performance: England 2013/14: national and regional data – Research Paper 14/22 – 14 April 2014

“How many people attended accident and emergency departments in 2013/14? What was the pattern of A&E attendance across the year? Are different areas of England busier at different times of year? How do NHS trusts compare on key performance metrics such as the number of patients waiting for more than four hours?
In answering these questions, as well as others, this note provides an analysis of the Department of Health’s Weekly A&E Data from April 2013 to March 2014.”

 

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Violence in England and Wales in 2013: an Accident and Emergency perspective – Cardiff University – 23 April 2014

Posted on April 24, 2014. Filed under: Emergency Medicine, Violence |

Violence in England and Wales in 2013: an Accident and Emergency perspective – Cardiff University – 23 April 2014

News release: Serious violence in England and Wales drops 12% in 2013

“Numbers of people injured in serious violence dropped by 12% in 2013 compared to 2012, according to an England and Wales study by Cardiff University.

Overall, an estimated 234,509 people attended Emergency Departments (EDs), Minor Injury Units (MIUs) and Walk-in Centres in England and Wales for treatment following violence in 2013 – 32,780 fewer than in 2012.

The data was gathered from a scientific sample of 117 EDs, MIUs and Walk-in Centres in England and Wales. All are certified members of the National Violence Surveillance Network (NVSN).

Lead author of the study and Director of the Violence and Society Research Group at Cardiff University, Professor Jonathan Shepherd said: “The data show another significant year on year fall in serious violence across England and Wales. Apart from a 7% increase in 2008, levels of serious violence have fallen every year since 2001.

“Violence is falling in many Western countries and we don’t know all the reasons why,” said Professor Shepherd. “In England and Wales, the growth of multi-agency violence prevention involving police, the NHS and local authorities may well be a factor; violence has fallen more in regions where this is best organised. Another probable explanation is changes in alcohol habits. Binge drinking has become less frequent, and the proportion of youth who don’t drink alcohol at all has risen sharply. Also, after decades in which alcohol has become more affordable, since 2008 it has become less affordable. For people most prone to involvement in violence, those aged 18-30, falls in disposable income are probably an important factor.”

… continues on the site

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A Quality Framework and Suite of Quality Measures for the Emergency Department Phase of Acute Patient Care in New Zealand – NZ Ministry of Health – 28 March 2014

Posted on April 3, 2014. Filed under: Clin Governance / Risk Mgmt / Quality, Emergency Medicine |

A Quality Framework and Suite of Quality Measures for the Emergency Department Phase of Acute Patient Care in New Zealand – NZ Ministry of Health – 28 March 2014

“This publication suggests a quality framework including a common suite of measures. DHBs will be expected to use these measures to improve the acute patient journey, thereby improving patient experience.

Emergency departments and district health boards all currently monitor a range of different measures. The only mandatory common measure to date has been the Shorter stays in Emergency Departments health target. This publication provides a suite of common measures.

This publication is a product of the National Emergency Departments Advisory Group.”

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Ripping off the sticking plaster: Whole-system solutions for urgent and emergency care – NHS Confederation – 10 March 2014

Posted on March 13, 2014. Filed under: Emergency Medicine, Health Systems Improvement | Tags: |

Ripping off the sticking plaster: Whole-system solutions for urgent and emergency care – NHS Confederation – 10 March 2014

Extract from the Executive Summary

“In Emergency care: an accident waiting to happen? the NHS Confederation noted concerns from members that only sticking plaster solutions were being offered.

This follow-up report acts as a roadmap to the fundamental changes required to create a sustainable and high-quality urgent and emergency care system that can meet the needs of patients now and in the future. While this destination is clear, the public and politicians will need to recognise that the journey to get there may vary in each area, according to the resources, needs and priorities in different communities. As the NHS Confederation’s 2015 Challenge campaign sets out, we must ensure the health and care system has the freedom and flexibility it needs to develop solutions that will deliver the best possible outcomes for patients and the public.

The report draws on a review of the literature and evidence commissioned from the University of Sheffield’s School of Health and Related Research (ScHARR), and on the knowledge and experience of our members as shared through a programme of forum events, visits and steering group meetings.”

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Emergency admissions to hospital – House of Commons [UK] Committee of Public Accounts – 24 February 2014

Posted on March 5, 2014. Filed under: Emergency Medicine, Workforce |

Emergency admissions to hospital – House of Commons [UK] Committee of Public Accounts – 24 February 2014

No clear strategy for tackling lack of specialist A&E consultants – Parliament Commons Select Committee – 4 March 2014

“The Rt Hon Margaret Hodge MP, Chair of the Committee of Public Accounts, today said:

“Any attempt to improve emergency admissions services in the NHS is being completely stymied by the chronic shortage of specialist A&E consultants.

Nearly one fifth of consultant posts in emergency departments were either vacant or filled by locums in 2012.

There are also major problems in training enough doctors in emergency medicine. In 2012, only 18.5% of first year of higher training posts were filled.

What we found amazing is that neither the Department nor NHS England has a clear strategy to tackle the shortage of A&E consultants.

With many hospitals struggling to fill vacant posts for A&E consultants, there is too much reliance on temporary staff to fill gaps. This is expensive and just does not offer the same quality of service.”

… continues on the site

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Distance from home for emergency care [UK] – Quality Watch – February 2014

Posted on February 19, 2014. Filed under: Emergency Medicine | Tags: , |

Distance from home for emergency care [UK] – Quality Watch – February 2014

“How far away from home do people receive their emergency care, and how has this changed over the past decade? It is important that we have a clear picture of the distances involved in accessing emergency care in order to understand the impact of changes in hospital and A&E locations.”

Report –  developed in partnership by the Nuffield Trust and the Health Foundation

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The Diseconomies of Queue Pooling: An Empirical Investigation of Emergency Department Length of Stay – Harvard Business School – 31 January 2014

Posted on February 3, 2014. Filed under: Emergency Medicine, Health Systems Improvement |

The Diseconomies of Queue Pooling: An Empirical Investigation of Emergency Department Length of Stay – Harvard Business School – 31 January 2014

Executive summary”

“Improving efficiency and customer experience are key objectives for managers of service organizations including hospitals. In this paper, the authors investigate queue management, a key operational decision, in the setting of a hospital emergency department. Specifically, they explore the impact on throughput time depending on whether an emergency department uses a pooled queuing system (in which a physician is assigned to a patient once the patient is placed in an emergency department bed) or a dedicated queuing system (in which physicians are assigned to specific patients at the point of triage). The authors measured throughput time based on individual patients’ length of stay in the emergency department, starting with arrival to the emergency department and ending with a bed request for admission to the hospital or the discharge of a patient to home or to an outside facility. The findings show that, on average, the use of a dedicated queuing system decreased patients’ lengths of stay by 10 percent. This represented a 32-minute reduction in length of stay—a meaningful time-savings for the emergency department and patients alike. The authors argue that physicians in the dedicated queuing system had both the incentive and ability to make sure their patients’ care progressed efficiently, so that patients in the waiting room could be treated sooner than they otherwise would have. Key concepts include:”

… continues on the site

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Costing seven day services: The financial implications of seven day services for acute emergency and urgent services and supporting diagnostics – Healthcare Financial Management Association (HFMA) – 17 December 2013

Posted on December 24, 2013. Filed under: Acute Care, Diagnostics, Emergency Medicine, Health Economics | Tags: |

Costing seven day services: The financial implications of seven day services for acute emergency and urgent services and supporting diagnostics – Healthcare Financial Management Association (HFMA) – 17 December 2013

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Emergency Medicine: Background to HEE proposals to address workforce shortages – NHS Health Education England – December 2013

Posted on December 19, 2013. Filed under: Emergency Medicine, Workforce | Tags: |

Emergency Medicine: Background to HEE proposals to address workforce shortages – NHS Health Education England – December 2013

“The Health Education England Board has today agreed joint proposals from HEE and The College of Emergency Medicine (CEM) to address workforce shortages in emergency medicine.

The proposals and recommendations are for improvements in the future workforce of emergency departments to ensure that patients receive consistent, high quality, safe and effective care.”

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10 priorities for the A&E Crisis – College of Emergency Medicine – 6 November 2013

Posted on December 17, 2013. Filed under: Emergency Medicine |

10 priorities for the A&E Crisis – College of Emergency Medicine – 6 November 2013

The College has published ’10 priorities for resolving the crisis in Emergency Departments’ which clearly sets out what action needs to be taken to address the current crisis in A&E. The College through its Members is playing its part and we are working in 5 key areas. However, this crisis cannot be solved by us alone, we need urgent action by all stakeholders to work with us to provide a stable long term future for A&E services whilst tackling the short term immediate pressures. This is why we have identified 5 priorities for us and 5 for the Government and NHS leadership to grasp to address this crisis. Our proposals are the collective view of practicing Emergency Physicians; they represent cost-effective solutions to ensure we can deliver safe patient care.

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Reducing violence and aggression in A&E: Through a better experience – report by Frontier Economics for the Design Council – November 2013

Posted on December 17, 2013. Filed under: Emergency Medicine, Hosp Design Planning Architecture, Violence |

Reducing violence and aggression in A&E: Through a better experience – report by Frontier Economics for the Design Council – November 2013

A&E departments urged to implement proven design solutions that improve patient experience and save money – Design Council [UK] – 28 November 2013

“Today, Design Council and Frontier Economics published evidence that Accident & Emergency departments could improve patient experience, increase staff wellbeing and save money by implementing a new, proven design solution created by studio PearsonLloyd. Based on this evidence, Design Council recommends that other Trusts adopt the designs.

The two-pronged solution called ‘A Better A&E’ incorporates a ‘Guidance Solution’ – signage to guide and reassure patients, and a ‘People Solution’ – a programme to support staff in their interactions with frustrated, aggressive and sometimes violent patients through communications training and reflective practices.

The solutions have been implemented at two pilot Trusts – St George’s Healthcare NHS Trust in London and University Hospital Southampton NHS Foundation Trust (UHS). The implementation has been rigorously evaluated over the last year. Key findings show:”

… continues on the site

A Better A&E

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Transforming urgent and emergency care services in England: Urgent and Emergency Care Review. End of phase 1 report – NHS England – 13 November 2013

Posted on December 12, 2013. Filed under: Emergency Medicine | Tags: |

Transforming urgent and emergency care services in England: Urgent and Emergency Care Review. End of phase 1 report – NHS England – 13 November 2013

“The National Medical Director of NHS England today proposes a fundamental shift in provision of urgent care, with more extensive services outside hospital and patients with more serious or life threatening conditions receiving treatment in centres with the best clinical teams, expertise and equipment.”

… continues on the site

 

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Focus on Accident and Emergency, December 2013 – The Health and Social Care Information Centre (HSCIC) [UK] – 3 December 2013

Posted on December 6, 2013. Filed under: Emergency Medicine |

Focus on Accident and Emergency, December 2013 – The Health and Social Care Information Centre (HSCIC) [UK] – 3 December 2013

full text

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Targeting Waiting Times – NZ Ministry of Health – 13 November 2013

Posted on November 27, 2013. Filed under: Emergency Medicine | Tags: |

Targeting Waiting Times – NZ Ministry of Health – 13 November 2013

“This publication looks at how district health boards and their staff are working to achieve the three health targets focused on patient access:

Shorter stays in emergency departments
Improved access to elective surgery
Shorter waits for cancer treatment.

Meeting the health targets requires whole-of-system improvements that span not just the hospital but primary and community providers as well.

The nine case studies in the booklet describe some of the initiatives, innovations, organisations and people that have contributed to sector improvements made in these health targets.”

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Emergency Department Patient Deaths Memphis VA Medical Center Memphis, Tennessee – Healthcare Inspection – Dept of Veterans Affairs, Office of Inspector General – 23 October 2013

Posted on November 5, 2013. Filed under: Emergency Medicine, Health Informatics, Patient Safety |

Emergency Department Patient Deaths Memphis VA Medical Center Memphis, Tennessee – Healthcare Inspection – Dept of Veterans Affairs, Office of Inspector General – 23 October 2013

Deaths at VA hosptial blamed on poor EHR use – Government Health IT – 1 November 2013

“Three recent deaths at the Memphis VA Medical Center emergency department could probably have been prevented with better communication, documentation and layout design, according to an investigation by the Veterans Administration Inspector General.

After receiving an anonymous complaint describing potential inadequate care incidents at the Memphis VA Medical Center’s 22 bed ED, the VA OIG reviewed committee minutes, relevant documents, and the electronic health records of the patients, and largely substantiated the claims, finding physicians missing nurse notes and EHR alerts, and a poor ED design leaving some patients only partly monitored.”

… continues on the site

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The marginal rate for emergency admissions: What you said, what we did, what has and still needs to be done – NHS Confederation – 21 October 2013

Posted on October 23, 2013. Filed under: Emergency Medicine | Tags: |

The marginal rate for emergency admissions: What you said, what we did, what has and still needs to be done – NHS Confederation – 21 October 2013

Full text of the report

“Proposed changes to the way urgent and emergency care services are funded have recognised NHS concerns about current implementation of the marginal rate for emergency admissions and responded to calls for a more transparent, clear and effective system.”

 

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Australian hospital statistics 2012-13: emergency department care – AIHW – 18 October 2013

Posted on October 22, 2013. Filed under: Emergency Medicine | Tags: |

Australian hospital statistics 2012-13: emergency department care – AIHW – 18 October 2013

“In 2012-13: – There were more than 6.7 million presentations to public hospital emergency departments – 73% of patients received treatment within an appropriate time for their urgency (triage) category – 67% of patients spent 4 hours or less in the emergency department – 1.8 million patients were admitted to the hospital from the emergency department, and 36% of these were admitted within 4 hours.”

ISSN 1036-613X; ISBN 978-1-74249-505-7; Cat. no. HSE 142; 68pp.

Media release: Emergency department waiting times fall

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Government Response to the House of Commons Health Select Committee report into urgent and emergency services [England] – 10 October 2013

Posted on October 14, 2013. Filed under: Emergency Medicine |

Government Response to the House of Commons Health Select Committee report into urgent and emergency services [England] – 10 October 2013

“The government agrees with many of the Committee’s recommendations. The response outlines how the health system is responding to the pressures on urgent and emergency care by such measures as providing an additional £500 million for this winter and the next, the forthcoming vulnerable older people’s plan work and NHS England’s review of urgent and emergency care.”

 

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Focus on preventable admissions: Trends in emergency admissions for ambulatory care sensitive conditions, 2001 to 2013 – The Health Foundation – October 2013

Posted on October 14, 2013. Filed under: Chronic Disease Mgmt, Emergency Medicine | Tags: |

Focus on preventable admissions: Trends in emergency admissions for ambulatory care sensitive conditions, 2001 to 2013 – The Health Foundation – October 2013

“This QualityWatch report, published in partnership with the Nuffield Trust, explores patterns of emergency admissions across England for people with ambulatory care sensitive conditions.

For many years, clinicians, managers and policy-makers have tried various strategies to reduce hospital admissions, but rates have continued to increase. A particular focus has been on patients with conditions where timely access to high quality primary and preventive care can avoid the need for hospital admission in most cases.

These conditions are known as ambulatory care sensitive (ACS). Aggregate rates of emergency admissions for ACS conditions are commonly used to measure how well the health system is preventing unplanned hospital use. We were interested to understand how these rates varied across areas, and how they have changed over time – particularly in relation to the recent financial constraints introduced in the NHS.”

… continues on the site

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Acute care toolkit 7: Acute oncology on the acute medical unit – Royal College of Physicians – October 2013

Posted on October 2, 2013. Filed under: Acute Care, Emergency Medicine, Oncology | Tags: |

Acute care toolkit 7: Acute oncology on the acute medical unit – Royal College of Physicians – October 2013

“Advances in cancer management continue to improve patient outcomes, but this has been accompanied by a steady increase in emergency admissions with disease- or treatment-related complications. The acute medical unit (AMU) currently shoulders much of this burden. Providing efficient and excellent care to this complex patient group in a busy AMU presents a key challenge. A good working partnership between the AMU and acute oncology service (AOS) can result in a significant improvement in patient care together with opportunities for admission avoidance and early discharge.”

Press release – Promoting better care for cancer patients with urgent medical problems

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Leaving Against Medical Advice: Characteristics Associated With Self-Discharge – Canadian Institute for Health Information (CIHI) – 1 October 2013

Posted on October 2, 2013. Filed under: Clin Governance / Risk Mgmt / Quality, Emergency Medicine, Medicine | Tags: , |

Leaving Against Medical Advice: Characteristics Associated With Self-Discharge – Canadian Institute for Health Information (CIHI) – 1 October 2013

“People who leave the hospital or an emergency department against medical advice tend to do so before their treatment is complete and often end up returning within a short time frame.

A new study from the Canadian Institute for Health Information (CIHI) shows that, compared with people who completed their treatment, those who left inpatient care against medical advice were more than twice as likely to be readmitted to hospital within a month and three times as likely to visit an emergency department within a week.

Leaving Against Medical Advice: Characteristics Associated With Self-Discharge also found that more than three out of five people who left inpatient care and returned to an emergency department within a week were admitted to inpatient care upon their return.”

… continues on the site

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Emergency Department Use 2011/12: Key findings of the New Zealand Health Survey – Ministry of Health – 12 September 2013

Posted on September 13, 2013. Filed under: Emergency Medicine |

Emergency Department Use 2011/12: Key findings of the New Zealand Health Survey – Ministry of Health – 12 September 2013

“The emergency department (ED) use report presents key findings from the continuous New Zealand Health Survey 2011/12 about ED use at public hospitals. This report focuses on differences in ED use over the past year for adults and children across population groups. It also reports on reasons for attending EDs, and whether respondents thought that they could have been treated by a medical centre, if one had been available, rather than by an ED. Patient experience of waiting times in ED is also presented.”

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What evidence is there on the clinical and cost effectiveness of major trauma centres, as the core component of a trauma service, compared with standard care for adults with major trauma? – Healthcare Improvement Scotland – 19 July 2013

Posted on August 2, 2013. Filed under: Emergency Medicine | Tags: , |

What evidence is there on the clinical and cost effectiveness of major trauma centres, as the core component of a trauma service, compared with standard care for adults with major trauma? – Healthcare Improvement Scotland – 19 July 2013

Major trauma centres as the core component of a trauma service: Technologies scoping report 17

“In response to an enquiry from the National Planning Forum

The following questions were scoped:
1. What evidence is there that adults with major trauma have better outcomes if cared for in a major trauma centre, as the core component of a trauma service, compared with standard care?

2. What is the evidence for the cost effectiveness of trauma centres, as the core component of a trauma service, compared with standard care for adults with major trauma?”

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Latest emergency department data shows big improvements for some – National Health Performance Authority – 25 July 2013

Posted on July 30, 2013. Filed under: Emergency Medicine, Health Mgmt Policy Planning | Tags: |

Latest emergency department data shows big improvements for some – National Health Performance Authority – 25 July 2013 – Media release

Media backgrounder

 

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Nine out of 10 emergency visits take 7.5 hours or less [Canada] – Canadian Institute for Health Information – 20 June 2013

Posted on June 21, 2013. Filed under: Emergency Medicine | Tags: , |

Nine out of 10 emergency visits take 7.5 hours or less [Canada] – Canadian Institute for Health Information – 20 June 2013

“Nine out of 10 hospital emergency department (ED) visits were 7.5 hours or less in 2011–2012. The median (average) time spent—from time of registration to time the patient left the ED—was 2.4 hours, according to the Canadian Institute for Health Information (CIHI). This information is based on available data covering more than half of the ED visits in Canada, including all of those in Ontario, Alberta and Yukon.

Complex patients can expect to spend more than twice as long in the ED as minor/uncomplicated patients. Nine out of 10 of the complex patients spent 10.5 hours or less in the ED in 2011–2012. In comparison, 9 out of 10 of the minor/uncomplicated patients spent 4.2 hours or less in the ED.”

… continues

 

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Access to Primary Care and Visits to Emergency Departments in England: A Cross-Sectional, Population-Based Study – PLoS One 12 June 2013

Posted on June 18, 2013. Filed under: Emergency Medicine, General Practice, Primary Hlth Care |

Access to Primary Care and Visits to Emergency Departments in England: A Cross-Sectional, Population-Based Study – PLoS One 12 June 2013

“Background

The number of visits to hospital emergency departments (EDs) in England has increased by 20% since 2007-08, placing unsustainable pressure on the National Health Service (NHS). Some patients attend EDs because they are unable to access primary care services. This study examined the association between access to primary care and ED visits in England.”

Citation: Cowling TE, Cecil EV, Soljak MA, Lee JT, Millett C, et al. (2013) Access to Primary Care and Visits to Emergency Departments in England: A Cross-Sectional, Population-Based Study. PLoS ONE 8(6): e66699. doi:10.1371/journal.pone.0066699

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Emergency Care and Emergency Services 2013 – View from the frontline – Foundation Trust Network [UK] – 5 June 2013

Posted on June 18, 2013. Filed under: Acute Care, Emergency Medicine |

Emergency Care and Emergency Services 2013 – View from the frontline – Foundation Trust Network [UK] – 5 June 2013

“The FTN has surveyed its members operating at the frontline on the urgent and emergency care pathway.Our survey shows that acute, ambulance,community and mental health have different perspectives but there are also some clear common messages. We share some of our initial findings here.”

Media release

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High quality care for all, now and for future generations: transforming urgent and emergency care services in England – June 2013

Posted on June 18, 2013. Filed under: Acute Care, Emergency Medicine | Tags: |

High quality care for all, now and for future generations: transforming urgent and emergency care services in England – June 2013
Emerging Principles from the Urgent and Emergency Care Review

The evidence base

News announcement: NHS England asks patients, the public and staff to help shape the future of urgent and emergency care

 

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The Evolving Roles of Emergency Departments – RAND – May 2013

Posted on May 20, 2013. Filed under: Emergency Medicine | Tags: |

The Evolving Roles of Emergency Departments – RAND – May 2013

“This brief summarizes a RAND analysis of the role of that hospital emergency departments may come to play in either contributing to or reducing the rising costs of health care.”

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The drive for quality – How to achieve safe, sustainable care in our Emergency Departments – College of Emergency Medicine [UK] – 14 May 2013

Posted on May 17, 2013. Filed under: Clin Governance / Risk Mgmt / Quality, Emergency Medicine | Tags: |

The drive for quality – How to achieve safe, sustainable care in our Emergency Departments – College of Emergency Medicine [UK] – 14 May 2013

“Emergency care systems in the UK & Ireland are facing their biggest challenge in well over a decade as they aim to cope with unsustainable workloads and a lack of sufficient numbers of middle grade doctors and Consultants in Emergency Medicine to deliver consistent quality care. Both the Care Quality Commission and NHS England have recognised the scale of the crisis and the need for urgent action.

In this report, the first of its kind, The College calls for fundamental change in the way we design, fund and run our emergency care systems. Ten recommendations are made across 4 domains that must be considered and adopted by national policy makers, commissioners, clinicians and Trust Boards in order to return our systems to stability and help deliver the quality of care that our patients expect when they seek our help in an emergency. ”

… continues on the site

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NHS England: Improving A&E Performance – 9 May 2013

Posted on May 14, 2013. Filed under: Emergency Medicine | Tags: |

NHS England: Improving A&E Performance – 9 May 2013

Letter on the plan above:

Extract:

“we have agreed a national recovery and improvement plan to secure the timeliness of treatment for our patients. This plan is attached and describes the actions expected of Area Directors to facilitate a local partnership approach and system plan.”

 

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American Hospital Association Issue Brief: Sicker, more complex patients are driving up intensity of ED care – May 2013

Posted on May 9, 2013. Filed under: Emergency Medicine | Tags: |

American Hospital Association Issue Brief: Sicker, more complex patients are driving up intensity of ED care – May 2013

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Urgent care services – NHS London Programmes

Posted on May 7, 2013. Filed under: Emergency Medicine |

Urgent care services – NHS London Programmes

“Due to inconsistencies in existing work and a lack of a standardised approach to the provision of urgent care services across the capital, quality standards for urgent care services across London have been developed [February 2013]. The London quality standards apply to all urgent care services (both adult and paediatric) with the exclusion of GP in-hours and out-of-hours services.

A multi-disciplinary clinical expert panel was established to develop the quality standards, and was jointly-chaired by Dr Agnelo Fernandes, General Practitioner, NHS Croydon and Dr Andrew Hobart, Consultant in Emergency Medicine, South London Healthcare NHS Trust. The clinical expert panel consisted of a range of disciplines including general practitioners, nursing, adult and paediatric emergency medicine consultants, and a representative from the London Ambulance Service. The quality and safety programme patient panel also informed the development of the London quality standards to ensure the patient voice was heard throughout.

The quality standards for urgent care cover areas including governance, the timeframe for initial clinical assessment and decision, minimum staffing levels, access to diagnostics, advice from other specialties and patient experience.
During the development of the standards, wider engagement has taken place and feedback on the standards has been sought from mental health professionals, the NHS London 111 Board, and cluster urgent care groups from across London.

The standards have been reviewed by the London Clinical Senate and the London Clinical Commissioning Council and aim support the commissioning of high-quality and safe urgent care services, consistently across the capital.”

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Health Building Note 15-01: Accident & Emergency Departments Planning and Design Guidance [UK] – 23 April 2013

Posted on April 29, 2013. Filed under: Emergency Medicine | Tags: |

Health Building Note 15-01: Accident & Emergency Departments Planning and Design Guidance [UK] – 23 April 2013

“Sets out the strategic background, uncertainties and evidence base for decision-making in the design and planning of A&E departments.

This updated guidance provides information on how to approach a new build or redesign an A&E department. It is specifically aimed at senior emergency clinicians and designers given their important role in making a new build successful.

This guidance replaces HBN 22 published in 2005.”

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Urgent and Emergency Care: A review for NHS South of England – The Kings Fund – March 2013

Posted on April 26, 2013. Filed under: Emergency Medicine | Tags: |

Urgent and Emergency Care: A review for NHS South of England – The Kings Fund – March 2013

Can we keep up with the demand for urgent and emergency care? – King’s Fund – 24 April 2013

“The urgent and emergency care system is under severe pressure. Performance on a number of important indicators, including the four-hour wait and ambulance handover targets, is heading in the wrong direction. Demand is growing and calls for work to be shifted out of hospital look oddly out of line with a system that cannot even constrain, let alone reduce, the rate of increase in many places. Our recent study for NHS South of England raises some questions about the management of urgent and emergency care and identifies some important lessons.

The methods for running a hospital in the face of high levels of variable demand are now quite well understood. They are, however, based on an assumption that capacity and demand are in balance – which may not always be the case. For example, it may be necessary to make major changes to consultants’ job plans to provide 18-24 hour cover, seven days a week. These methods are also hard to implement and need continuous monitoring and maintenance. The key to success is to ensure that patients flow quickly through the hospital and are discharged rapidly. This may have been made more difficult by attempts to improve efficiency and utilisation, and close beds, which have left hospitals running at high levels of occupancy and with reduced ability to respond to fluctuations in demand or to discharge patients.”

… continues on the site

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Service resdesign case study: Providing specialist emergency care in Northumbria – NHS Confederation – 27 March 2013

Posted on April 9, 2013. Filed under: Emergency Medicine | Tags: , |

Service resdesign case study: Providing specialist emergency care in Northumbria – NHS Confederation – 27 March 2013

“This case study is part of a series designed to share good practice and lessons learned by local NHS organisations involved in major reviews of local health services.

This case study features the establishment of Northumbria Healthcare NHS Foundation Trust’s new urgent and emergency care facility, that culminated from several years’ strategic planning, and a comprehensive programme of engagement with staff and the local community.”

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Hurry Up and Wait: Differential Impacts of Congestion, Bottleneck Pressure, and Predictability on Patient Length of Stay – Harvard Business School Working Paper – released 1 March 2012

Posted on March 5, 2013. Filed under: Emergency Medicine | Tags: |

Hurry Up and Wait: Differential Impacts of Congestion, Bottleneck Pressure, and Predictability on Patient Length of Stay – Harvard Business School Working Paper – released 1 March 2012

Authors: Jaeker Berry, Jillian, and Anita L. Tucker

“High work load, from high inventory levels, impacts unit processing times, but prior operations management studies have found conflicting results regarding direction. Thus, it is difficult to predict inventory’s effects on productivity a priori, inhibiting effective capacity management in high load systems. We categorize load into in-process inventory (congestion) and incoming inventory, decomposing the latter into its levels of bottleneck (BN) pressure and predictability, and quantify the magnitudes and directions of change on processing times. Using data from 283 hospitals, we find (1) high congestion increases a patient’s hospital stay up to 28%, indicating inefficiencies from overloaded resources; (2) a patient stays up to 11.7% longer if there is a high load of incoming low BN pressure patients, consistent with the slowdown associated with “social loafing”; (3) a patient’s stay is up to 10.2% shorter when there is a high incoming load of predictable patients, consistent with workload smoothing.”

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Evidence driven strategies for meeting hospital performance targets – CSIRO – 25 February 2013

Posted on March 5, 2013. Filed under: Emergency Medicine, Health Mgmt Policy Planning | Tags: , , , |

Evidence driven strategies for meeting hospital performance targets – CSIRO – 25 February 2013

“The most visible challenge facing our healthcare system is overcrowding in hospitals, which has been labelled an ‘international crisis’ [1]. Overcrowding and long emergency waiting periods have a significant impact on the quality of patient care and patient experience.

National Emergency Access Targets (NEAT) introduced by the Federal Government in 2011, will require hospitals to ensure that 90% of all patients arriving at emergency departments are seen and admitted or discharged within four hours by 2015[2].

Our health services research team is helping hospitals meet these emergency access targets, whilst solving the challenge of overcrowding and system bottlenecks.

This report gives an overview of the patient flow modelling research currently being undertaken at CSIRO. It outlines how CSIRO’s analytics, optimisation and operational decision support tools can help give hospitals a better understanding of what they could do to meet these targets.”

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Australian hospital statistics: national emergency access and elective surgery targets 2012 – AIHW – 28 February 2013

Posted on February 28, 2013. Filed under: Emergency Medicine, Surgery | Tags: , , |

Australian hospital statistics: national emergency access and elective surgery targets 2012 – AIHW – 28 February 2013

“This report presents 2012 data for performance indicators in the National Partnership Agreement on Improving Public Hospital Services. Included are measures of the extent to which states and territories met targets for emergency department lengths of stay of 4 hours or less and for lengths of time spent waiting for elective surgery.

ISSN 1036-613X; ISBN 978-1-74249-405-0; Cat. no. HSE 131; 20pp”

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Update on Emergency Department Visits Involving Energy Drinks: A Continuing Public Health Concern – The Substance Abuse and Mental Health Services Administration (SAMHSA) [US] – 10 January 2013

Posted on January 17, 2013. Filed under: Alcohol & Drug Dep., Emergency Medicine, Public Hlth & Hlth Promotion | Tags: |

Update on Emergency Department Visits Involving Energy Drinks: A Continuing Public Health Concern – The Substance Abuse and Mental Health Services Administration (SAMHSA) [US] – 10 January 2013 [The DAWN report – drug abuse warning network]

“The number of emergency department (ED) visits involving energy drinks doubled from 10,068 visits in 2007 to 20,783 visits in 2011

Energy drinks are flavored beverages containing high amounts of caffeine and typically other additives, such as vitamins, taurine, herbal supplements, creatine, sugars, and guarana, a plant product containing concentrated caffeine. These drinks are sold in cans and bottles and are readily available in grocery stores, vending machines, convenience stores, and bars and other venues where alcohol is sold. These beverages provide high doses of caffeine that stimulate the central nervous system and cardiovascular system. The total amount of caffeine in a can or bottle of an energy drink varies from about 80 to more than 500 milligrams (mg), compared with about 100 mg in a 5-ounce cup of coffee or 50 mg in a 12-ounce cola.1 Research suggests that certain additives may compound the stimulant effects of caffeine. Some types of energy drinks may also contain alcohol, producing a hazardous combination; however, this report focuses only on the dangerous effects of energy drinks that do not have alcohol.”

… continues on the site

 

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Zero tolerance – Making ambulance handover delays a thing of the past – NHS Confederation – 6 December 2012

Posted on January 4, 2013. Filed under: Emergency Medicine | Tags: , |

Zero tolerance – Making ambulance handover delays a thing of the past – NHS Confederation – 6 December 2012

“Making ambulance handover delays a thing of the past

Nobody wants to see ambulances stacked up outside hospitals waiting to hand over patients. Not paramedics, not emergency department doctors and nurses, not hospital managers, ambulance service controllers, commissioners
or politicians – and least of all patients.

Handing over a patient from an ambulance to an ED is expected to take no more than 15 minutes. But as the National Audit Office highlighted in its review of ambulance services in June 2011, only around 80 per cent of handovers meet this expectation.”

… continues

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Accident and emergency 2012 – Care Quality Commission – 7 December 2012

Posted on January 4, 2013. Filed under: Emergency Medicine | Tags: |

Accident and emergency 2012 – Care Quality Commission – 7 December 2012

“Read the results of our latest survey which asked people about their experiences of accident and emergency (A&E) departments in 2012.”

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Hospital Performance: Time patients spent in emergency departments in 2011–12 – National Health Performance Authority – December 2012

Posted on January 2, 2013. Filed under: Emergency Medicine | Tags: , |

Hospital Performance: Time patients spent in emergency departments in 2011–12 – National Health Performance Authority – December 2012

ISSN: 2201-3091
ISBN: 978-1-74241-823-0
Online ISBN: 978-1-74241-824-7

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Cancer patients in crisis: responding to urgent needs – Royal College of Physicians (RCP), Royal College of Radiologists (RCR) – 21 November 2012

Posted on November 22, 2012. Filed under: Emergency Medicine, Oncology, Radiology | Tags: , |

Cancer patients in crisis: responding to urgent needs – Royal College of Physicians (RCP), Royal College of Radiologists (RCR) – 21 November 2012

full report 

“Emergency admissions for patients with cancer remain problematic despite the development of acute oncology. There is more that could be done to improve their care and subsequent experiences and outcomes.

Patients and their carers often have a lack of information about what to expect and who to contact when their condition suddenly worsens and requires urgent medical attention – this is often referred to as a crisis.  Cancer management is complex and involves a number of teams and there has been little emphasis on planning for potential problems.  More proactive care would ensure that patients, their carers and health professionals are better equipped to respond when a person becomes acutely unwell.

When admitted to hospital there is a need to improve decision-making, coordination of care and communication between professionals and – crucially – with patients themselves. In unplanned and urgent situations, patients themselves may receive confusing or conflicting information or feel less able to assert their concerns and wishes. Too often patients receive fragmented care. Patients are often seen by multiple healthcare professionals and sometimes multiple medical specialties during an admission.

This results in some patients being treated suboptimally, especially where the cancer diagnosis clouds other considerations in their management. Others, especially nearing the end of life, may undergo repeated investigations and interventions that are not to their benefit. Some admissions, especially among patients already approaching the end of life, may be avoidable.

This new report Cancer patients in crisis: responding to urgent needs from the Royal College of Physicians (RCP) and Royal College of Radiologists (RCR), including a foreword from Professor Sir Mike Richards, national clinical director for cancer, provides decision making tools to health professionals working in hospitals and the community, to help improve the care of cancer patients in crisis. It also proposes  standards of good practice in each care setting which should reduce risk and improve outcomes.

Patient and carer representative members of the working party have led on the development of an innovative planning wallet for patients. This is intended to encourage timely discussions about unexpected problems at any point in  a patient’s journey. It will prompt patients to seek and keep to hand important information and help to facilitate forward planning regarding their care.”

… continues on the media release site

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Patient Reported Experience Measure (PREM) for urgent and emergency care – Royal College of Paediatrics and Child Health – October 2012

Posted on October 31, 2012. Filed under: Child Health / Paediatrics, Emergency Medicine, Patient Participation |

Patient Reported Experience Measure (PREM) for urgent and emergency care – Royal College of Paediatrics and Child Health – October 2012

“PREMs for urgent and emergency care is a tool developed by the RCPCH with Picker Institute Europe to measure the experience of paediatric patients 0-16 years in all urgent and emergency care settings including; GP practices, out-of-hours centres, A&E departments and the ambulance service.”

… continues

The Development of a Patient Reported Experience Measure for Paediatrics Patients (0-16 years) in Urgent and Emergency Care: Research Report – October 2012  Final Report

Final Urgent and Emergency Care PREM tools

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Driving improvements in A&E services – Foundation Trust Network [UK] – 24 October 2012

Posted on October 25, 2012. Filed under: Emergency Medicine |

Driving improvements in A&E services – Foundation Trust Network [UK] – 24 October 2012

“A&E departments are a beacon to patients in need of emergencymedical care.These departments offer guaranteed access 24 hours a day seven days aweek to patientswith a range of health needs.The volume and complexity of patients continues to increase and NHS providers of these services are facedwith significant challenges and cost pressures.

To meet these challenges acute trusts are implementing initiatives to deliver safe, timely and high quality clinical care inA&E.This FTNBenchmarking study brings together 11 acute trustswithA&E services ranging frommajor specialist trauma centres to primary-care-led urgent care centres.Using comparable and validated information on their services these trusts shared best practice and developed action plans to improve their services.”

… continues on the site

Media release

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Australian hospital statistics 2011-12: emergency department care – AIHW – 28 September 2012

Posted on September 28, 2012. Filed under: Emergency Medicine, Health Mgmt Policy Planning | Tags: |

Australian hospital statistics 2011-12: emergency department care – AIHW – 28 September 2012

“In 2011-12: – there were more than 6.5 million presentations to public hospital emergency departments – 72% of patients received treatment within an appropriate time for their urgency (triage) category – almost two-thirds of patients stayed in the emergency department for 4 hours or less, and 90% had left within 8 hours and 30 minutes.”

ISSN 1036-613X; ISBN 978-1-74249-356-5; Cat. no. HSE 126; 56pp

Media release: About two-thirds of Australia’s emergency department visits are completed within 4 hours

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A Critical Essay on the Deployment of an ED Clinical Information System – Systemic Failure or Bad Luck? [Cerner FirstNet] – University of Sydney – 2009

Posted on August 20, 2012. Filed under: Emergency Medicine, Health Informatics | Tags: |

A Critical Essay on the Deployment of an ED Clinical Information System – Systemic Failure or Bad Luck? [Cerner FirstNet]
Professor Jon Patrick, Health Information Technology Research Laboratory, School of Information Technologies, University of Sydney

“This essay is about the effectiveness and impact of Cerner FirstNet in NSW  hospitals. The need for a systemic study became clear during work that was being undertaken at a number of NSW hospitals when clinicians and administrators constantly expressed their dissatisfaction even hostility to FirstNet, to the point of often refusing to use it. As such, this essay aims at unravelling issues that are obscure and not normally associated so that a clearer picture of relationships and their interactions can be evaluated.”

… continues on the site

3.    A study of an Enterprise Health information System. (released 4th March 2011)

“This is a study into the roll-out of Cerner FirstNet into EDs in NSW. The original study was issued in Dec 2009 (Part 3.1). This has been added to with a new study in 2010 consisting of discussions with 7 ED Directors (Part 3.2), discussions with software experts who do performance evaluations on Cerner sites (Part 3.3), and reviews of Entity-Relationship Diagrams (Part 3.4), Schema descriptions and data tables from customer installations (Part 3.5 & 3.6). All this information is coalesced to establish a much more detailed picture of a Cerner installation (Part 3.7). A number of weaknesses are identified in the design and implementation and risk assessments are recommended for organisations using this software or intending to use it. Regulations that might minimise the risks to users of health software are recommended (Part 3.8). An alternative architecture and method for constructing clinical information systems is presented (Part 3.9). I would like to acknowledge the postgraduates who assisted in collecting the data and colleagues who offered advice and edited the written materials.

The bibliographical citation for this report is:

Patrick, J. A Study of a Health Enterprise Information System. School of Information Technologies, University of Sydney. Technical Report TR673, 2011, pp 190.

3.0  Part 0 – Executive Summary
3.1  Part 1 – A Critical Essay on the Deployment of an ED ClinicalInformation System ‐ Systemic Failure or Bad Luck?   First published here in Oct 2009, revised Dec 2009.
3.2  Part 2 – Discussions with ED Directors: Are we on the right track?
3.3  Part 3 – Discussions with Software Performance Experts.
3.4  Part 4 – Conceptual Data Modelling.
3.5  Part 5 – Database Relational Schema and Data Tables.
3.6  Part 6 – Coalescing the Analyses of the ER Diagrams, Relational Schemata and Data Tables.
3.7  Part 7 – The Integrated Assessment.
3.8  Part 8 – Future HIT Regulation Proposals.
3.9  Part 9 – Ockham’s Razor of Design. Published at the IHI conference, Nov 2010 Washington.
Download the whole study Parts 3.0 to 3.9 (12.3MB)
3.10 Over the last few days there has been considerable interest from the press and colleagues on the future pathways that are indicated by this report. I have composed a number of strategies that we need to implement to move onto the next phase of e-Health in the state. The list is intended to be brief as a full case for its justification will require a longer  essay. The proposals developed in this statement are not altogether my own but collected from the many people I have spoken to and worked with over the last few years.
The Future Pathways for e-Health in NSW
3.11  Analysis of FirstNet Problems defined by ED Directors
3.12 Revision of Conclusions and New Recommendations (released 15th April 2011). New information has been provided since the first release of the report above (4th March 2011) which paints a much more serious picture of the issues with the roll-out of Firstnet in NSW. This new evidence requires re-evaluation and revisions of the previous conclusions and recommendations.”

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Explaining variation in use of emergency hospital beds by patients over 65 – The King’s Fund – 9 August 2012

Posted on August 10, 2012. Filed under: Aged Care / Geriatrics, Emergency Medicine | Tags: , |

Explaining variation in use of emergency hospital beds by patients over 65 – The King’s Fund – 9 August 2012

Blog discussion on the paper

“Summary

This paper explores factors that might be driving the significant variation in use of hospital beds by patients over 65 admitted as an emergency.  It considers the contribution made by patient-based (demand-side) factors, hospital (supply-side) factors, the availability of community services and resources, and broader system relationships (how care systems and staff work together and relate to each other) in driving the observed variation in length of stay and rate of admission. Its conclusions are based on new analysis by The King’s Fund of Hospital Episode Statistics (HES) and local population -based data.”

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Metropolitan Emergency Department Access Initiative: A Report on Ambulance Ramping in Metropolitan Hospitals – Queensland Health – July 2012

Posted on August 3, 2012. Filed under: Emergency Medicine |

Metropolitan Emergency Department Access Initiative: A Report on Ambulance Ramping in Metropolitan Hospitals – Queensland Health – July 2012

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NIH creates Office of Emergency Care Research – 31 July 2012

Posted on August 2, 2012. Filed under: Emergency Medicine, Knowledge Translation, Research | Tags: , |

NIH creates Office of Emergency Care Research – 31 July 2012

“Will coordinate and foster research and training in the emergency setting

To help improve health outcomes of patients who require emergency care, the National Institutes of Health has created a new Office of Emergency Care Research (OECR). The office is a focal point for basic, clinical and translational emergency care research and training across NIH.

“NIH has supported research to advance emergency care for years; however, now we have a single office to coordinate and foster our activities in this arena,” said NIH Director Francis S. Collins, M.D., Ph.D. “The NIH Office of Emergency Care Research will focus on speeding diagnosis and improving care for the full spectrum of conditions that require emergency treatment.”

Although OECR will not fund grants, it will foster innovation and improvement in emergency care and in the training of future researchers in this field by:”

… continues on the site

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Dispelling Myths About Emergency Department Use – Robert Wood Johnson Foundation [US] – July 2012

Posted on August 2, 2012. Filed under: Emergency Medicine | Tags: |

Dispelling Myths About Emergency Department Use – Robert Wood Johnson Foundation [US] – July 2012

“Majority of Medicaid Visits Are for Urgent or More Serious Symptoms

Contrary to conventional wisdom that Medicaid patients often use hospital emergency departments (EDs) for routine care, the majority of ED visits by nonelderly Medicaid patients are for symptoms suggesting urgent or more serious medical problems, according to a national study released by the Center for Studying Health System Change.

This research brief, funded by the Robert Wood Johnson Foundation, looks at the two kinds of information from such visits that generally are used to explain ED use—patients’ symptoms as assessed by ED triage staff to determine how quickly patients need evaluation, and patients’ diagnoses after evaluation by a physician.

While nonelderly Medicaid patients do use EDs at higher rates than nonelderly privately insured patients, the percentage of those visits that were for nonurgent symptoms is not considerably higher than the rate for their privately insured counterparts. The authors found that about 10 percent of nonelderly Medicaid patient ED visits were for nonurgent symptoms, compared with about 7 percent of ED visits by privately insured nonelderly people in 2008. In contrast, slightly more than half of both Medicaid and private insurance visits were categorized as emergent—needing immediate—or urgent—attention within an hour.”

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ACT Auditor General’s report on Emergency Department Performance Information – July 2012

Posted on July 3, 2012. Filed under: Emergency Medicine | Tags: , |

ACT Auditor General’s report on Emergency Department Performance Information – July 2012

“This report presents the results of a performance audit that examined the circumstances associated with the alleged manipulation and misreporting of Emergency Department performance information at the Canberra Hospital.”

Media Release

ABC News Report – More than one fudged hospital data: audits

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The Silver Book. Quality Care for Older People with Urgent and Emergency Care Needs – University of Leicester, Department of Cardiovascular Sciences

Posted on June 22, 2012. Filed under: Acute Care, Aged Care / Geriatrics, Emergency Medicine | Tags: |

The Silver Book. Quality Care for Older People with Urgent and Emergency Care Needs – University of Leicester, Department of Cardiovascular Sciences

“Executive summary

Despite the majority of urgent care being delivered in the primary care setting, an increasing number of older people are attending emergency departments and accessing urgent health and social care services. This is partly related to the demographic shift that has resulted in a rapid increase in the number of older people, but may also be due to lower thresholds for accessing urgent care. Over the next 20 years, the number of people aged 85 and over is set to increase by two-thirds, compared with a 10 per cent growth in the overall population. Recent national reports including from Patient UK, Care Quality Commission, NCEPOD and the  Health Service Ombudsman highlighted major deficiencies in the care of older people in acute hospitals ranging from issues around privacy and dignity to  peri-operative care. Older people are admitted to hospital more frequently, have longer length of stay and occupy more bed days in acute hospitals compared to other patient groups. There is a pressing need to change how we care for older people with urgent care needs, to improve quality, outcomes and efficiency. Emergency departments need to be supported to deliver the right care for these patients, as no one component of the health and social care systems can manage this challenge in isolation; implementation of improved care for older people requires a whole system approach.

Important factors in primary care that impact on the use of urgent care services include a timely primary care response and ready access to general practitioners. More community based services with a rapid response time may reduce the need to access secondary care. There needs to be better communication between ‘in-hours’ and out of hours services. The ambulance service has a key role to play and can be an important contributor in doing things differently – for example, referring non-conveyed patients directly to urgent care, community and primary care services, including falls services.

Attendance at the Emergency Department is associated with a high risk of admission for older people, so the nature of the service and the environment in which it is provided needs to change to reflect the changing nature of health care in the 21st century, the bulk of which relates to older people, and increasingly frail older people. Dedicated teams delivering comprehensive geriatric assessment can support this, but in themselves are not sufficient to realise whole system change. Services in all settings including health and social care need to improve their communication and handover, and greater use of the voluntary sector is to be encouraged. In acute medical units, greater use of geriatric liaison services should increase the proportion of older people able to be managed in the community setting.”

… continues on the site

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All-Cause Readmission to Acute Care and Return to the Emergency Department – Canadian Institute for Health Information – 14 June 2012

Posted on June 18, 2012. Filed under: Clin Governance / Risk Mgmt / Quality, Emergency Medicine | Tags: , , , |

All-Cause Readmission to Acute Care and Return to the Emergency Department – Canadian Institute for Health Information – 14 June 2012

“One in 12 patients readmitted to Canadian hospitals within 30 days
Study examines who is returning and why

June 14, 2012—Soon after their discharge from hospital, more than 180,000 Canadians were readmitted to acute care in 2010, reveals a study from the Canadian Institute for Health Information (CIHI). In those jurisdictions where detailed emergency department (ED) data was available—Alberta, Ontario and Yukon—nearly 1 in 10 acute care patients returned to the ED within seven days of hospital discharge. The study, All-Cause Readmission to Acute Care and Return to the Emergency Department, included more than 2.1 million hospitalizations across the country. It looked at surgical, medical, pediatric and obstetric patients to better understand who returned to acute care after discharge and for what clinical reason.

“Better understanding of the factors influencing readmission rates is an important step for improving the quality of care for Canadians,” says Jeremy Veillard, Vice President of Research and Analysis at CIHI. “Although readmissions cannot always be avoided, research suggests that in many cases they may be prevented.”

Reasons for readmission varied by patient group”

… continues

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Is achieving Ontario’s Emergency Department length of stay performance targets associated with improved patient outcomes following discharge? – February 2012

Posted on June 12, 2012. Filed under: Clin Governance / Risk Mgmt / Quality, Emergency Medicine | Tags: |

Is achieving Ontario’s Emergency Department length of stay performance targets associated with improved patient outcomes following discharge? – February 2012

Michael Schull, Astrid Guttmann, Marian Vermeulan, Therese Stukel, & Dorina Simeonov. (2012).  Institute for Clinical Evaluative Sciences.

Extract:

“Background:
Wait time targets are controversial since some claim that the push for improved efficiency could compromise patient safety. On the other hand, spending long hours waiting for care in an ED has itself been shown to have safety risks. We tested the question of whether ED patients, who arrived during a shift when a greater percentage of all ED patients seen on that shift met their respective MOHLTC ED LOS targets, had a lower risk of mortality or hospital admission in the 7 days following ED discharge. We looked only at outcomes among patients discharged from the ED, since subsequent outcomes among admitted patients could be due to in-patient, as opposed to ED, care.  …

Policy recommendations:
Achieving MOHLTC ED wait time targets was associated with a reduced risk of death or hospitalization after ED discharge among both high and low acuity patients. This study provides empirical support for ED LOS targets as a means to improve patient outcomes. ED wait times performance should continue to be monitored. Consideration should be given to providing incentives for EDs to achieve 95% compliance with ED wait time targets, since this was generally associated with the best outcomes.”

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Volume, Flow, and Safety Issues in the ED – HealthLeaders Media Intelligence [US] – May 2012

Posted on June 1, 2012. Filed under: Emergency Medicine, Patient Safety | Tags: |

Volume, Flow, and Safety Issues in the ED – HealthLeaders Media Intelligence [US] – May 2012

By Joe Cantlupe

“Contributing forces, from the primary care shortage to the rise in the uninsured, are adding to overcrowded emergency departments and deep concerns about patient safety. Hospital leaders, uncertain about their systems’ preparedness, as well as how healthcare reform will further affect the flow of patients, are strategizing to reduce congestion, cut wait times, and improve care coordination.

As health systems try to improve their EDs, healthcare leaders are watching the financial framework with caution. About 80% say they expect their ED revenue margins will worsen as a result of healthcare reform and 78% say their reimbursement also will get worse. View the data from the most recent HealthLeaders Media Intelligence Report, Volume, Flow, and Safety Issues in the ED, in this slideshow.”

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Cool Technology of the Week: Emergency Medical Services run sheets – Life as a Healthcare CIO – 18 May 2012

Posted on May 21, 2012. Filed under: Emergency Medicine, Health Informatics |

Cool Technology of the Week: Emergency Medical Services run sheets – Life as a Healthcare CIO – 18 May 2012

“I’ve often been asked how Emergency Medical Services (EMS) run sheets can be automatically integrated to emergency department information systems so that the transition of care between the ambulance and the hospital is seamless.

It’s been challenging to do in the past because data was not available electronically from EMS and we lacked an architecture to transmit the information.

In Boston, both problems have been solved.

BIDMC now receives electronic run sheets from each Boston EMS ambulance run, in near real time.

Boston EMS uses the SafetyPad mobile application  to capture patient history electronically during the ambulance run.”

… continues on the site

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Standards for Children and Young People in Emergency Care Settings 3rd ed – Royal College of Paediatrics and Child Health – 3 May 2012

Posted on May 4, 2012. Filed under: Child Health / Paediatrics, Emergency Medicine | Tags: |

Standards for Children and Young People in Emergency Care Settings 3rd ed – Royal College of Paediatrics and Child Health – 3 May 2012

“Developed by the Intercollegiate Committee for Standards for Children and Young People in Emergency Care Settings, this revised edition provides healthcare professionals, providers and service planners with measurable and auditable standards of care applicable to all urgent and emergency care settings in the UK.

The 2012 edition reflects changes in the way care is delivered: there is a new chapter focusing on mental health and substance misuse and the document takes a ‘pathway’ approach to aid a multi-professional workforce. Most importantly, this edition shifts from making recommendations to setting standards, giving healthcare professionals the guidance they need to provide the best service for children and young people along the care pathway.”

Media release:  New standards set for emergency care of children and young people – Royal College of Paediatrics and Child Health – 3 May 2012

“From mental health, substance and alcohol abuse to major incidents involving serious injury or death, thousands of children and young people pass through the NHS each day needing emergency care.  Now, a new series of standards set out minimum requirements for how children in emergency settings should be treated – covering areas from service design and environment to staff training and safeguarding.

The standards appear in the third edition of a publication formerly known as the ‘Red Book’, which is widely used by healthcare professionals in the UK to improve care of children in emergency settings. This latest edition, renamed ‘Standards for children and young people in emergency care settings’, is unique in containing not only guidance, but also specific standards against which healthcare providers can be measured.

The standards have been developed by the Intercollegiate Committee for Standards for Children and Young People in Emergency Care Settings led by the Royal College of Paediatrics and Child Health and are designed to help service planners overcome some of the key challenges in emergency healthcare – including the impact of the European Working Time Directive which sets maximum daily and weekly working hours and increased public expectation of immediate access to care.”

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Benchmark of out of hours. An overview across the services. Report from the Primary Care Foundation – 19 April 2012

Posted on April 24, 2012. Filed under: Emergency Medicine, General Practice, Primary Hlth Care | Tags: , |

Benchmark of out of hours. An overview across the services. Report from the Primary Care Foundation – 19 April 2012

Prepared by Henry Clay

[Urgent care in general practice – benchmark report from April 2012]

Using data to Improve Care: A new national benchmark for Out of Hours services

“The Department of Health were keen to drive reliable comparisons of performance across out of hours services in England, building on the established national quality requirements, but breaking new ground in measuring outcomes as well as process.  Following a competitive tender, the Primary Care Foundation were appointed in November 2007 to develop a benchmark of out of hours services that would be seen as credible by commissioners and providers alike and would serve as a basis for service improvement.  The overall aim was to make accurate comparisons across different services so that providers and commissioners were in a position to recognise and take action to improve care for their patients.”

… continues

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Ensuring Access to After-Hours Care – Commonwealth Fund – 4 April 2012

Posted on April 24, 2012. Filed under: Emergency Medicine, Health Mgmt Policy Planning, Health Systems Improvement | Tags: |

Ensuring Access to After-Hours Care – Commonwealth Fund – 4 April 2012

by David Squires

“Urgent care needs are not confined to weekdays and work hours. Nonetheless, patients often have difficulty accessing care after hours without going to the emergency department, which in many circumstances can be an inappropriate and inefficient use of health care resources. Ensuring that patients have timely access to the appropriate level of care on nights and weekends has the potential to reduce unnecessary emergency department use; it can also ensure that patients receive patient-centered, efficient care.

According to past Commonwealth Fund International Surveys, after-hours care is particularly difficult to obtain in the U.S. without going to the emergency department. In recent years, several countries, including the Netherlands, Denmark, and Germany, have sought to expand access to after-hours care—often by transitioning from the traditional approach, in which practices designate someone to be “on-call,” to group-based or regional approaches. As the U.S. seeks to strengthen primary care, particularly through the development of patient-centered medical homes, it has a great deal to learn from these international models.”

… continues on the site

Looks at:
The Netherlands
Denmark
Germany

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Regionalized Emergency Medical Care Services: Phase 1 2012 Final Report – National Quality Forum [US] – April 2012

Posted on April 10, 2012. Filed under: Emergency Medicine | Tags: |

Regionalized Emergency Medical Care Services: Phase 1 2012 Final Report  – National Quality Forum [US] – April 2012

“The concept of “regionalization” has been identified as a potential method for improving emergency medical care through efficient resource utilization. NQF convened a workgroup, including a Steering Committee of national experts, staff from the U.S. Department of Health and Human Services, and a team from the University of North Carolina at Chapel Hill, to develop a framework to guide measurement of regionalized emergency care systems (REMCS).”   44 p.

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Models of Care Managing Emergency Department Attendances Review – NHS East of England Evidence Adoption Centre – 17 March 2012

Posted on April 5, 2012. Filed under: Emergency Medicine |

Models of Care Managing Emergency Department Attendances Review – NHS East of England Evidence Adoption Centre – 17 March 2012

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Comparison of Primary Care Models in Ontario by Demographics, Case Mix and Emergency Department Use, 2008/09 to 2009/10 – Institute for Clinical Evaluative Sciences – March 2012

Posted on April 4, 2012. Filed under: Emergency Medicine, Primary Hlth Care | Tags: |

Comparison of Primary Care Models in Ontario by Demographics, Case Mix and Emergency Department Use, 2008/09 to 2009/10 – Institute for Clinical Evaluative Sciences – March 2012

Glazier, R.H., Zagorski, B.M., & Rayner, J.

“ISSUE
Are there differences between Ontario’s primary care models in who they serve and how often their patients/clients go to the emergency department (ED)?
STUDY
This study examined patients/clients enrolled in: Community Health Centres (CHCs, a salaried model), Family Health Groups (FHGs, a blended fee-for-service model), Family Health Networks (FHNs, a blended capitation model), Family Health Organizations (FHOs, a blended capitation model), Family Health Teams (FHTs, an interprofessional team model composed of FHNs and FHOs), ‘Other’ smaller models combined, as well as those who did not belong to a model. Electronic record encounter data (for CHCs) and routinely collected health care administrative data were used to examine sociodemographic composition, patterns of morbidity and comorbidity (case mix) and ED use. ED visits rates were adjusted to account for differences in location and patient/client characteristics.”

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Data briefing: Emergency hospital admissions for ambulatory care-sensitive conditions. Identifying the potential for reductions – King’s Fund – 3 April 2012

Posted on April 4, 2012. Filed under: Chronic Disease Mgmt, Emergency Medicine, Primary Hlth Care | Tags: |

Data briefing: Emergency hospital admissions for ambulatory care-sensitive conditions. Identifying the potential for reductions – King’s Fund – 3 April 2012

“Summary

Ambulatory care-sensitive conditions (ACSCs) are conditions for which effective management and treatment should limit emergency admission to hospital. Nevertheless, ACSCs currently account for more than one in six emergency hospital admissions in England. These emergency admissions cost the NHS £1.42 billion each year.

High levels of admissions for ACSCs often indicate poor co-ordination between the different elements of the health care system, in particular between primary and secondary care. An emergency admission for an ACSC is a sign of the poor overall quality of care, even if the ACSC episode itself is managed well.

This data briefing considers patterns of admissions for ACSCs in terms of age, sex, condition, socioeconomic group and local authority area. The authors analyse these patterns and assess the potential for reducing emergency admissions for ACSCs, highlighting the disease areas and patient groups where the greatest reduction can be achieved.

The briefing concludes that the number of emergency hospital admissions for ACSCs could be reduced by:

18 per cent (potentially saving £238 million) if all local authorities performed at the level of the best-performing local authorities
8 per cent (potentially saving £96 million)  if each local authority improved their service to the level of the next best  local authorities
11 per cent (potentially saving £136 million) if the poorer (than the average) performing local authorities performed at the level of the better (than the average) ones.

This briefing highlights for commissioners the opportunities for improving the quality of care and saving costs that reducing emergency hospital admissions for ACSCs presents. To realise the potential savings, changes will be needed in the management and prevention of these conditions.”

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The effectiveness and safety of emergency department short stay units: a rapid review – Open Medicine, Vol 6, No 1 (2012)

Posted on March 2, 2012. Filed under: Emergency Medicine |

The effectiveness and safety of emergency department short stay units: a rapid review
Kristin J Konnyu, Edmund Kwok, Becky Skidmore, David Moher
Open Medicine, Vol 6, No 1 (2012)

“Emergency department (ED) overcrowding has been defined as “a situation where the demand for emergency services exceeds the ability to provide care in a reasonable amount of time.” 1 ED overcrowding is a serious and ongoing issue across Canada; in a 2006 survey of Canadian ED directors, 62% of respondents reported that overcrowding had been a major or severe problem in 2004 and 2005.1

Short stay units (SSUs) have emerged as a potentially useful strategy for managing overcrowding in emergency departments. The theoretical benefit of SSUs is to “off-load” stable patients from the acute-care ED and to reduce the number of unnecessary hospital admissions. Typically, SSUs are focused on (1) expected short treatments such as blood transfusions; (2) further diagnostic investigations to finalize a medical diagnosis; and (3) safe discharge into the community, such as by involving a social worker. To prevent such units from being “dumping grounds,” most SSUs have strict inclusion/admission criteria. Part of the difficulty in evaluating the value of SSUs is terminology, since many terms have been used to describe such units (e.g., observation units, assessment units, and clinical decision units). Typically, however, SSUs are some type of extension of the ED whose overarching objective is to improve “the quality of medical care through extended observation and treatment, while reducing inappropriate admissions and healthcare costs.”2”

…continues

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Review of the Quality of Care and Safety of Patients Requiring Access to Emergency Department Care and Cancer Surgery and the Role and Process of Physician Advocacy – Health Care Quality Council of Alberta – 22 February 2012

Posted on March 2, 2012. Filed under: Clin Governance / Risk Mgmt / Quality, Emergency Medicine, Patient Safety | Tags: |

Review of the Quality of Care and Safety of Patients Requiring Access to Emergency Department Care and Cancer Surgery and the Role and Process of Physician Advocacy – Health Care Quality Council of Alberta – 22 February 2012

News release

Backgrounder

Executive summary

Full report

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Emergency Severity Index, Version 4 – Agency for Healthcare Research and Quality [US] – December 2011

Posted on February 9, 2012. Filed under: Emergency Medicine | Tags: , |

Emergency Severity Index, Version 4 – Agency for Healthcare Research and Quality [US] – December 2011

“The Emergency Severity Index (ESI) is a five-level emergency department (ED) triage algorithm that provides clinically relevant stratification of patients into five groups from 1 (most urgent) to 5 (least urgent) on the basis of acuity and resource needs. The Agency for Healthcare Research and Quality (AHRQ) funded initial work on the ESI.”

Gilboy N, Tanabe P, Travers DA, Rosenau AM, Eitel DR. Emergency Severity Index, Version 4: Implementation Handbook. AHRQ Publication No. 12-0014, December 2011. Agency for Healthcare Research and Quality, Rockville, MD.

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Preventing emergency readmissions to hospital. A scoping review – RAND – 2012

Posted on February 3, 2012. Filed under: Emergency Medicine, Patient Journey, Patient Safety | Tags: , , |

Preventing emergency readmissions to hospital. A scoping review – RAND – 2012

by Ellen Nolte, Martin Roland, Susan Guthrie, Laura Brereton

“The report reviews the evidence and potential for use of ’emergency readmissions within 28 days of discharge from hospital’ as an indicator within the NHS Outcomes Framework. It draws on a rapid review of systematic reviews, complemented by a synopsis of work in four countries designed to better understand current patterns of readmissions and the interpretation of observed patterns. Reviewed studies suggest that between 5 percent and 59 percent of readmissions may be avoidable. Studies are highly heterogeneous, but based on the evidence reviewed, about 15 percent up to 20 percent may be considered reasonable although previous authors have advised against producing a benchmark figure for the percentage of readmissions that can be avoided. The majority of published studies focus on clinical factors associated with readmission. Studies are needed of NHS organisational factors which are associated with readmission or might be altered to prevent readmission.

The introduction of new performance indicators always has the potential to produce gaming. Observers from the USA cite experience which suggests hospitals might increase income by admitting less serious cases, thus simultaneously increasing their income and reducing their rate of readmission. There is also the possibility that there may be some shift in coding of admissions between ’emergency’ and ‘elective’ depending on the incentives. If hospitals are performance managed on the basis of readmission rates, it would be reasonable to expect that some behaviour of this type would occur.”

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Four Hour Rule Program. Progress and Issues Review – WA Health – December 2011

Posted on January 27, 2012. Filed under: Emergency Medicine, Health Mgmt Policy Planning, Health Systems Improvement | Tags: , , |

Four Hour Rule Program. Progress and Issues Review – WA Health – December 2011

by Professor Bryant Stokes AM
ISBN: 978-1-921841-04-0

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Improving Patient Flow and Reducing Emergency Department Crowding. A Guide for Hospitals – AHRQ – October 2011

Posted on January 11, 2012. Filed under: Emergency Medicine | Tags: , |

Improving Patient Flow and Reducing Emergency Department Crowding. A Guide for Hospitals – AHRQ – October 2011

AHRQ = US Agency for Healthcare Research and Quality
 
“This guide presents step-by-step instructions that can be used by hospitals in planning and implementing patient flow improvement strategies to ease emergency department crowding.

Contents
Acknowledgments
Executive Summary
Section 1. The Need to Address Emergency Department Crowding
Section 2. Forming a Patient Flow Team
Section 3. Measuring Emergency Department Performance
Section 4. Identifying Strategies
Section 5. Preparing to Launch
Section 6. Facilitating Change and Anticipating Challenges
Section 7. Sharing Results
References
Appendix A: Guide to Online Resources Successfully Used by Hospitals to Improve Patient Flow
Appendix B: Implementation Plan Template
Appendix C: Example Implementation Plan
Appendix D: Additional Readings”

McHugh, M., Van Dyke, K., McClelland M., Moss D. Improving Patient Flow and Reducing Emergency Department Crowding: A Guide for Hospitals. (Prepared by the Health Research & Educational Trust, an affiliate of the American Hospital Association, under contract 290-200-600022, Task Order No. 6). AHRQ Publication No. 11(12)-0094, October 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/ptflow/

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Data briefing: Emergency bed use. What the numbers tell us – King’s Fund – December 2011

Posted on January 4, 2012. Filed under: Emergency Medicine | Tags: , , |

Data briefing: Emergency bed use. What the numbers tell us – King’s Fund – December 2011

“Summary

The NHS will need to find £20 billion in productivity improvements by 2015 to avoid reducing quality and making significant cuts to services. The acute sector is already receiving less for treating patients and so is under particular pressure to make those improvements. Could reducing the use of hospital beds for emergency admissions help?

Hospital beds are used for emergency admissions and elective admissions, but bed use for elective admissions has fallen significantly in recent years – although they account for 55 per cent of admissions, they occupy less that 30 per cent of overall bed days. So reducing bed use for emergency admissions offers the most potential for savings. Our new data briefing explores the figures in more detail and identifies the groups of emergency patients with the greatest scope for reductions in bed use.”

… continues

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Australian hospital statistics 2010-2011: emergency department care and elective surgery waiting times – AIHW – 30 November 2011

Posted on November 30, 2011. Filed under: Emergency Medicine, Surgery | Tags: |

Australian hospital statistics 2010-2011: emergency department care and elective surgery waiting times – AIHW – 30 November 2011

‘Australian hospital statistics 2010-11: emergency department care and elective surgery waiting times’ presents information relating to emergency department care in major public hospitals and public hospital elective surgery waiting times for the period 1 July 2010 to 30 June 2011. In 2010-11: over 6.2 million emergency department presentations were provided by major public hospitals, with 70% of patients receiving treatment within an appropriate time for their urgency (triage category); about 621,000 patients were admitted to Australian public hospitals from waiting lists for elective surgery, with 50% of patients admitted within 36 days.

ISSN 1036-613X; ISBN 978-1-74249-262-9; Cat. no. HSE 115; 88pp.

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Reducing violence and aggression in A&E – Design Council [UK] – November 2011

Posted on November 18, 2011. Filed under: Emergency Medicine, Violence | Tags: |

Reducing violence and aggression in A&E – Design Council [UK] – November 2011

“According to the National Audit Office, violence and aggression towards frontline hospital staff is estimated to cost the NHS at least £69 million a year in staff absence, loss of productivity and additional security. We know designers have what it takes to develop new systems that help reduce violence and aggression in A&E and commissioned a multi-disciplinary design team lead by PearsonLloyd to develop solutions.

Solutions
The Reducing violence and aggression in A&E design team have developed prototype solutions including:”

… continues

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Adult emergency services: Acute medicine and emergency general surgery – LondonHealth Programmes – September 2011 reports

Posted on September 22, 2011. Filed under: Emergency Medicine, Health Mgmt Policy Planning, Surgery | Tags: |

Adult emergency services: Acute medicine and emergency general surgery – LondonHealth Programmes – September 2011 reports
 
Adult emergency services: Case for change 
 
Adult emergency services: Case for change summary 
 
Adult emergency services: Commissioning standards 
 
Adult emergency services: Survey of current arrangements 
 
Media commentary:
 
BBC London hospitals: Hundreds die ‘due to weekend staffing’  – 21 Sept 2011
“Stark” differences in consultant hours at weekends were identified Hundreds of people die every year in London due to a lack of hospital consultants available at weekends, according to NHS London.

Guardian
Don’t go to A&E this weekend; you may die. The Patient from hell reads a report, which claims that 520 emergency patients die in London every year due to understaffed out-of-hours care

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New figures showing the quality of A&E services have been published for the first time today – NHS – 26 August 2011

Posted on August 30, 2011. Filed under: Clin Governance / Risk Mgmt / Quality, Emergency Medicine |

New figures showing the quality of A&E services have been published for the first time today – NHS – 26 August 2011

Provisional Accident & Emergency Quality Indicators for England. Experimental Statistics by provider for April 2011

“The publication was ordered by Health Secretary Andrew Lansley to give patients and the NHS a more rounded view of the quality of A&E services. The eight clinical quality indicators measure more than the single standard introduced under the previous government which showed the percentage of patients being seen within four hours.

Although the number of patients being seen within four hours remains a key measure of A&E performance, the new figures being published today also include:

• The proportion of patients who left A&E without being seen
• The proportion of patients who had to attend A&E again within the week after their first attendance
• The time it takes to initial assessment.

All the measures were developed jointly by Professor Matthew Cooke, the National Clinical Director for Emergency Care, together with senior clinicians in the College of Emergency Medicine and the Royal College of Nursing.”

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Communicating in hospital emergency departments – University of Technology Sydney – August 2011

Posted on August 10, 2011. Filed under: Emergency Medicine | Tags: |

Communicating in hospital emergency departments – University of Technology Sydney – August 2011

Communication for Health in Emergency Contexts 

“Summary:
Ineffective communication has been identified as the major cause of critical incidents in public hospitals (NSW Health, 2005a). Critical incidents are adverse events leading to avoidable patient harm. This project, by examining spoken interactions between health-care practitioners and patients in hospital emergency departments identified and analysed causes of misunderstandings and breakdowns.”

ABC report on the project – 10 August 2011 

UTS Newsroom report

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Urgent and Emergency Care Clinical Audit Toolkit – UK – 30 March 2011

Posted on April 14, 2011. Filed under: Clin Governance / Risk Mgmt / Quality, Emergency Medicine, General Practice |

Urgent and Emergency Care Clinical Audit Toolkit – UK – 30 March 2011

With Forewords from:
Royal College of General Practitioners
The College of Emergency Medicine
London Ambulance Service
Department of Health
Royal College of Paediatrics and Child Health

Extract from the introduction:

“This report comprises the evaluation of a six month project undertaken by the Royal College of General Practitioners (RCGP) and The College of Emergency Medicine (CEM). RCGP and CEM have worked closely with a wide range of Urgent Care providers and representatives throughout the course of the project.

The overarching aim of the project has been to work towards the creation of a universal clinical audit toolkit, applicable across a wide range of urgent and emergency care situations, and one which supports the implementation of a system of routine clinical audit along all urgent care pathways. Current urgent care provision pathways are often fragmented and complex, resulting in confusing care journeys for the many patients experiencing them. This situation is further complicated by the increasing plethora of organisations offering urgent care, and the wide range of professionals involved in the provision of that care.”

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NHS emergency planning guidance: planning for the management of burn-injured patients in the event of a major incident: interim strategic national guidance – 5 April 2011

Posted on April 14, 2011. Filed under: Disaster Management, Emergency Medicine | Tags: |

NHS emergency planning guidance: planning for the management of burn-injured patients in the event of a major incident: interim strategic national guidance – 5 April 2011
Author: Department of Health

“This guidance gives best practice guidance to National Health Service (NHS) organisations in planning, preparing and responding to incidents and emergencies that give rise to burn injuries regardless of cause, source or nature. This includes chemical, biological and radiological incidents. The principles apply regardless of the number of patients being treated. The guidance covers adults and children.”

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Emergency Surgery: Standards for unscheduled surgical care – Royal College of Surgeons – 7 April 2011

Posted on April 13, 2011. Filed under: Emergency Medicine, Surgery | Tags: |

Emergency Surgery: Standards for unscheduled surgical care – Royal College of Surgeons – 7 April 2011

“Emergency patients account for half the NHS surgical workload but mortality and complication rates vary widely; these are the problems identified in new standards for emergency surgery care published today by the Royal College of Surgeons [RCS]. The RCS estimates that the care of emergency surgery patients comprises 40-50 per cent of surgical work and in general surgery alone account for 14,000 admissions a year to intensive care in England and Wales, at a costs of at least £88m* and mortality rates of 25 per cent. The report demonstrates that there is a lack of detailed outcome measurement for emergency surgery patients – which is preventing hospitals from understanding how they can improve.

Surgeons believe that dedicated operating theatre time for emergency cases; better care for highrisk patients before and after surgery; and greater availability of consultants would save lives and shorten hospital stays for emergency patients.”

…continues on the site

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A study of an Enterprise Health information System – NSW Cerner FirstNet NSW EDs- 4 March 2011

Posted on March 15, 2011. Filed under: Emergency Medicine, Health Informatics |

A study of an Enterprise Health information System – NSW Cerner FirstNet NSW EDs- 4 March 2011

“This is a study into the roll-out of Cerner FirstNet into EDs in NSW. The original study was issued in Dec 2009 (Part 3.1). This has been added to with a new study in 2010 consisting of discussions with 7 ED Directors (Part 3.2), discussions with software experts who do performance evaluations on Cerner sites (Part 3.3), and reviews of Entity-Relationship Diagrams (Part 3.4), Schema descriptions and data tables from customer installations (Part 3.5 & 3.6). All this information is coalesced to establish a much more detailed picture of a Cerner installation (Part 3.7). A number of weaknesses are identified in the design and implementation and risk assessments are recommended for organisations using this software or intending to use it. Regulations that might minimise the risks to users of health software are recommended (Part 3.8). An alternative architecture and method for constructing clinical information systems is presented (Part 3.9). I would like to acknowledge the postgraduates who assisted in collecting the data and colleagues who offered advice and edited the written materials.”

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NHS joins forces with designers to tackle violence and aggression in A and E departments – 26 February 2011

Posted on February 28, 2011. Filed under: Emergency Medicine, Violence | Tags: , |

NHS joins forces with designers to tackle violence and aggression in A and E departments – 26 February 2011

Reducing violence and aggression in A&E by design – Design Council

“Can you develop solutions that reduce the human and financial costs of violence and aggression in hospital Accident and Emergency (A&E) departments?

According to the National Audit Office, violence and aggression towards frontline hospital staff is estimated to cost the NHS at least £69 million a year in staff absence, loss of productivity and additional security.

Reducing violence and aggression in A&E by design challenges multi-disciplinary ‘design and make’ teams to improve the experience of A&E departments and make them safer for staff, patients and visitors. To participate in this open innovation challenge designers and architects need to team up with fabricators, building contractors, manufacturers, service producers and other specialist consultancies.”  … continues

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Reforming urgent and emergency care performance management – UK Department of Health – 17 December 2010

Posted on February 15, 2011. Filed under: Clin Governance / Risk Mgmt / Quality, Emergency Medicine | Tags: , |

Reforming urgent and emergency care performance management – UK Department of Health – 17 December 2010

“In line with the Government’s commitment, outlined in Equity and excellence: liberating the NHS, to hold the NHS to account against clinically credible and evidence-based outcome measures, the Department of Health is developing some clinical quality indicators for urgent and emergency care.  They will be consistent with the NHS Outcomes Framework.  The first sets of clinical quality indicators, for A&E and ambulance services, were announced on 17 December 2010 and will start being used from April 2011.  In the meantime, existing standards and requirements remain in place.”

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Emergency Communications: Broadband and the Future of 911 – Congressional Research Service – 22 December 2010

Posted on February 4, 2011. Filed under: Disaster Management, Emergency Medicine, Health Informatics | Tags: , |

Emergency Communications: Broadband and the Future of 911 – Congressional Research Service – 22 December 2010
Linda K. Moore Specialist in Telecommunications Policy

“Summary
Today’s 911 system is built on an infrastructure of analog technology that does not support many of the features that most Americans expect to be part of an emergency response. Efforts to splice newer, digital technologies onto this aging infrastructure have created points of failure where a call can be dropped or misdirected, sometimes with tragic consequences. Callers to 911, however, generally assume that the newer technologies they are using to place a call are matched by the same level of technology at the 911 call centers, known as Public Safety Answering Points (PSAPs). However, this is not always the case. To modernize the system to provide the quality of service that approaches the expectations of its users will require that the PSAPs, and state, local, and possibly federal emergency communications authorities invest in new technologies. As envisioned by most stakeholders, these new technologies—collectively referred to as Next Generation 911 or NG9-1-1—should incorporate Internet Protocol (IP) standards. An IP-enabled emergency communications network that supports 911 will facilitate interoperability and system resilience; improve connections between 911 call centers; provide more robust capacity; and offer flexibility in receiving and managing calls. The same network can also serve wireless broadband communications for public safety and other emergency personnel, as well as other purposes.

Recognizing the importance of providing effective 911 service, Congress has passed three major bills supporting improvements in the handling of 911 emergency calls.”  …continues on the site

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Australian hospital statistics 2009-10: emergency department care and elective surgery waiting times – AIHW – 30 November 2010

Posted on January 25, 2011. Filed under: Emergency Medicine, Health Mgmt Policy Planning, Surgery | Tags: , |

Australian hospital statistics 2009-10: emergency department care and elective surgery waiting times – AIHW – 30 November 2010

“Australian hospital statistics 2009-10: emergency department care and elective surgery waiting times presents information relating to emergency department care in major public hospitals and public hospital elective surgery waiting times for the period 1 July 2009 to 30 June 2010. In 2009-10: almost 6 million emergency department presentations were provided by major public hospitals, with 70% of patients receiving treatment within an appropriate time for their urgency (triage category); about 610,000 patients were admitted to Australian public hospitals from waiting lists for elective surgery, with 50% of patients admitted within 36 days. *Please note: from 2009-10, the data for the Albury Base Hospital was reported by the Victorian Department of Health as part of the Albury Wodonga Health Service. The Albury Wodonga Health Service was formed by the integration of Wodonga Regional Health Service in Victoria and acute services at the Albury Base Hospital in New South Wales. Data for Albury Base Hospital are therefore now included in statistics for Victoria whereas they were formerly reported by, and included in statistics for New South Wales.”

Authored by AIHW.

Published 30 November 2010; ISSN 1036-613X; ISBN-13 978-1-74249-094-6; AIHW cat. no. HSE 93; 68pp

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Accident and Emergency attendances in England (experimental statistics) 2009-10 – January 2011

Posted on January 20, 2011. Filed under: Emergency Medicine | Tags: |

Accident and Emergency attendances in England (experimental statistics) 2009-10 – January 2011

“Large number of [NHS] A&E visits require no actual treatment, new report suggests

A large number of visits to NHS accident and emergency departments in England end with the patient just needing advice and no actual treatment, a new NHS Information Centre report suggests today.

Of 10.3 million A&E visits 5 in 2009/10 with a valid treatment code recorded, about two in five – around 3.9 million – ended with the patient receiving guidance or advice only. During the same period nearly one in eight – 1.2 million – were recorded as requiring neither advice nor treatment.

The report, Accident and Emergency attendances in England (experimental statistics) 2009-10, covers 15.6 million records submitted by NHS A&E departments, minor injury clinics and walk-in centres in 2009-10, representing about three quarters of known activity and covering 172 of 263 providers in England.

The report also shows that, of the 15.6 million attendances, around half a million patients were recorded as leaving A&E before being treated.”

…continues on the site

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Avoiding hospital admissions: What does the research evidence say? – King’s Fund – 16 December 2010

Posted on January 14, 2011. Filed under: Acute Care, Emergency Medicine | Tags: |

Avoiding hospital admissions: What does the research evidence say? – King’s Fund – 16 December 2010

“Summary:  Emergency admissions to hospital are costly to the NHS and also cause disruption to planned health care. Considerable efforts have been made within the health service to reduce emergency admissions, but few primary care trusts have been successful, with some primary care trusts recording an increase.

In order to successfully reduce avoidable emergency admissions, we need to fully understand which interventions are the most effective. The King’s Fund commissioned this review of research evidence to establish which interventions work in avoiding emergency or unplanned hospital admissions.”  … continues

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The Patient Journey Through Emergency Care in Nova Scotia: A Prescription for New Medicine – October 2010

Posted on October 29, 2010. Filed under: Emergency Medicine |

The Patient Journey Through Emergency Care in Nova Scotia: A Prescription for New Medicine – October 2010

Dr. John Ross, provincial advisor on emergency care, makes 26 recommendations in his report: The Patient Journey Through Emergency Care in Nova Scotia: A Prescription for New Medicine.

The recommendations focus on improvements that can be made in:

Smaller hospitals
Larger hospitals
Funding and emergency care standards
Emergency Health Services (EHS)
Care for seniors
Care for people with mental illness

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Where Do Americans Get Acute Care? Not at Their Doctor’s Office – RAND – 2010

Posted on September 9, 2010. Filed under: Acute Care, Emergency Medicine | Tags: |

Where Do Americans Get Acute Care? Not at Their Doctor’s Office – RAND – 2010

 By: Arthur Lodge Kellermann, Emily R. Carrier, Stephen R. Pitts, Eugene C. Rich
Pages: 2
Document Number: RB-9556
Year: 2010

Less than half of acute care visits in the United States involve a patient’s personal physician. Emergency physicians, who comprise only 4 percent of doctors, handle 28 percent of all acute care encounters and nearly all after-hours and weekend care.
Full Document (pdf)
(File size < 0.1 MB, < 1 minute modem, < 1 minute broadband)

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Evaluating the Reliability of Emergency Response Systems for Large-Scale Incident Operations – RAND – 2010

Posted on August 23, 2010. Filed under: Disaster Management, Emergency Medicine | Tags: |

Evaluating the Reliability of Emergency Response Systems for Large-Scale Incident Operations – RAND – 2010
 
By: Brian A. Jackson, Kay Sullivan Faith, Henry H. Willis    224 p.
ISBN/EAN: 9780833050052

“The ability to measure emergency preparedness — to predict the likely performance of emergency response systems in future events — is critical for policy analysis in homeland security. Yet it remains difficult to know how prepared a response system is to deal with large-scale incidents, whether it be a natural disaster, terrorist attack, or industrial or transportation accident. This research draws on the fields of systems analysis and engineering to apply the concept of system reliability to the evaluation of emergency response systems. The authors describe a method for modeling an emergency response system; identifying how individual parts of the system might fail; and assessing the likelihood of each failure and the severity of its effects on the overall response effort. The authors walk the reader through two applications of this method: a simplified example in which responders must deliver medical treatment to a certain number of people in a specified time window, and a more complex scenario involving the release of chlorine gas. The authors also describe an exploratory analysis in which they parsed a set of after-action reports describing real-world incidents, to demonstrate how this method can be used to quantitatively analyze data on past response performance. The authors conclude with a discussion of how this method of measuring emergency response system reliability could inform policy discussion of emergency preparedness, how system reliability might be improved, and the costs of doing so.”

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Implementing trauma systems: key issues for the NHS – Ambulance Service Network, NHS Confederation – 2010

Posted on August 20, 2010. Filed under: Emergency Medicine | Tags: , |

Implementing trauma systems: key issues for the NHS – Ambulance Service Network, NHS Confederation – 2010

Table of contents
Executive summary
Introduction
Section 1: Changing the trauma pathway
Section 2: Trauma systems – evidence analysis and discussion
Conclusion
References
Appendix

Extract from the summary:
“Trauma is the main cause of death in the first four decades of life and a leading cause of disability. Following a series of high-profile reports it is recognised that, while emergency care has improved, treatment for victims of major injury could be improved and coordinating trauma services is now a priority for the NHS. There is significant variation in outcomes across the system. Better organisation of care could ensure consistently higher standards of care. Evidence suggests that introducing trauma systems can reduce mortality rates by around 10 per cent, more efficiently use the £300-400m spending on emergency care for major injuries and contribute to reducing the estimated £3.3bn – £3.7bn annual economic cost of trauma.”

…continues

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Trends in emergency admissions in England 2004-2009: is greater efficiency breeding inefficiency? – 5 July 2010 – Nuffield Trust

Posted on July 8, 2010. Filed under: Emergency Medicine | Tags: |

Trends in emergency admissions in England 2004-2009: is greater efficiency breeding inefficiency? – 5 July 2010 – Nuffield Trust

“Approximately 35% of all admissions in the NHS in England are classified as emergency admissions, costing approximately £11 billion a year. Admitting a patient to hospital as an emergency case is costly and frequently preventable, yet the number of emergency admissions to hospitals has been rising for some time. This briefing paper examines the rise in emergency hospital admissions in England from 2004/05 to 2008/09 and tries to identify the possible explanations.”

Download full publication pdf

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