International journal of emergency medicine
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Computerized physician order entry (CPOE) systems are designed to increase safety and improve quality of care; however, their impact on efficiency in the ED has not yet been validated. This study examined the impact of CPOE on process times for medication delivery, laboratory utilization and diagnostic imaging in the early, late and control phases of a regional ED-CPOE implementation. ⋯ Regional implementation of CPOE afforded important efficiencies in time to medication delivery for high acuity ED patients. Increased times observed for laboratory and radiology results may reflect system issues outside of the emergency department and as a result of potential confounding may not be a reflection of CPOE impact.
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⋯ This paper describes the determination of variations in the ED care process and patient flow among EP's and internists by an observational instrument. A pilot study with the instrument showed variations in the patient care process and patient flow among the two groups at the LUMC ED.
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Ambulance offload delay (AOD) has been recognized by the National Association of EMS Physicians (NAEMSP) as an important quality marker. AOD is the time between arrival of a patient by EMS and the time that the EMS crew has given report and moved the patient off of the EMS stretcher, allowing the EMS crew to begin the process of returning to service. The AOD represents a potential delay in patient care and a delay in the availability of an EMS crew and their ambulance for response to emergencies. This pilot study was designed to assess the AOD at a university hospital utilizing direct observation by trained research assistants. ⋯ The median AOD was considered significant and raised concerns related to patient care and EMS system resource availability. The NEDOCS score had a positive correlation with AOD and should be further investigated as a potential marker for determining diversion status or for destination decision-making by EMS personnel.
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Overcrowding in the emergency department (ED) is an increasing problem worldwide. In The Netherlands overcrowding is not a major issue, although some urban hospitals struggle with increased throughput. In 2004, Weiss et al. created the NEDOCS tool (National Emergency Department Over Crowding Study), a web-based instrument to measure objective overcrowding with scores between 0 (not busy at all) to above 181 (disaster). In this study we tried to validate the accuracy of the NEDOCS tool by comparing this with the subjective feelings of the ED nurse and emergency physician (EP) in an inner city hospital in The Netherlands. ⋯ The NEDOCS tool is a reasonably good tool to quantify the subjective feelings of overcrowding. When overcrowding is encountered and immediately recognised, specific measures can be taken to guarantee the timely provision of necessary medical care to the patients in the ED at that time. However, possibly more accurate agreements could be obtained as approximately 20% of the surveys were not completed because of perceived crowdedness. An important limitation is that only 3% of the NEDOCS is scored as overcrowded, so no conclusions can be drawn about the agreement for higher categories of overcrowding. It is suggested to repeat the study in a busier period. As the triage category was not taken into account in the formula, a high workload with only a few patients giving high scores in subjective overcrowding in spite of a low NEDOCS score could have led to lower agreements. Incorporating the triage category in the NEDOCS tool possibly will lead to better agreement, but further research is needed to assess this idea.
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The development of sepsis risk prediction models and treatment guidelines has largely been based on patients presenting in the emergency department (ED) with severe sepsis or septic shock. Therefore, in this study we investigated which patient characteristics might identify patients with an adverse outcome in a heterogeneous group of patients presenting with uncomplicated sepsis to the emergency department (ED). ⋯ Non-survivors of uncomplicated sepsis had on average a higher abbreviated MEDS score, a lower hemoglobin (Hb) and more often used β-blockers compared to survivors. Early identification of these factors might contribute to optimization of sepsis treatment for this patient category and thereby prevent disease progression to severe sepsis or septic shock.