Emergency medicine clinics of North America
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Quality assurance (QA) of care in the emergency department encompasses activities ensuring that the care provided meets applicable standards. Health care delivery is complex and many factors affect quality of care. Thus, quantification of health care quality is challenging, especially with regard to attribution of outcomes to various factors contributing to such care. A critical component of the process of QA is determination of quality health care and the concept of (unjustified) deviation from the reference applicable standard of care.
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This article introduces a clinical audience to the process of emergency department (ED) design, particularly relating to academic EDs. It explains some of the major terms, processes, and key decisions that clinical staff will experience as participants in the design process. Topics covered include an overview of the planning and design process, issues related to determining needed patient capacity, the impact of patient flow models on design, and a description of several common ED design types and their advantages and disadvantages.
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Emerg. Med. Clin. North Am. · Aug 2020
ReviewQueuing Theory and Modeling Emergency Department Resource Utilization.
Queueing theory is a discipline of applied mathematics that studies the behavior of lines. Queueing theory has successfully modeled throughput in a variety of industries, including within the emergency department (ED). ⋯ Utilization is a measure of the throughput of a process relative to demand, and provides a quick means of comparing the demand for certain resources. Although there have been some significant successes in applying queueing theory to EDs, the field remains underused within ED operations.
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Emergency medicine is a high-risk area of medical practice, with a high rate of preventable adverse events. This is multifactorial, hinging on the myriad system and processes issues that complicate emergency care. ⋯ Health care professionals and leaders within emergency medicine can implement solutions aimed at cultivating a strong safety culture, creating processes and system-based approaches to improve patient safety. This article provides an overview of the evidence-based approaches to improve patient safety and communication.
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Emerg. Med. Clin. North Am. · Aug 2020
ReviewAlternative Dispositions for Emergency Department Patients.
Alternatives to inpatient admission have been shown to be safe and effective for a variety of clinical conditions and can help relieve emergency department (ED) and inpatient crowding. Evidence-based alternatives include use of rapid ED follow-up clinics, observation units, and home hospital programs. Use of accelerated diagnostic pathways and shared decision making can help support clinicians and patients in appropriately choosing an alternative disposition to traditional inpatient admission. However, many institutions struggle to fully embrace possible alternative depositions because of challenges of patient access, clinician and patient comfort with diagnostic uncertainty, and perceived medicolegal risks.