Healthcare quarterly (Toronto, Ont.)
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Despite the release of a national report describing key markers of emergency department (ED) overcrowding, limited linear data using these markers have been published. We sought to report the degree and trends of ED overcrowding in a typical academic hospital and to highlight some of the key markers of ED patient flow and care. We conducted a prospective study in a large Canadian urban tertiary care teaching hospital that receives approximately 55,000 annual adult ED visits. ⋯ Semi-urgent and non-urgent admissions dropped from 11.5 to 7.4% and 3.2 to 1.8%, respectively. Admitted patients "boarding" in the ED increased from 70,955 hours in 2002 to 118,741 hours in 2007, while the number of emergent and urgent patients leaving without being seen increased by more than 400%. ED overcrowding in a tertiary care hospital is primarily a result of access block due to boarding admitted patients, a situation that poses serious risks to the majority of patients who have emergent or urgent conditions that cannot be managed appropriately in the waiting room.
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Many people assume that quality improvement (QI) projects pose no ethical issues in relation to participants or their rights. However, members of the Alberta Research Ethics Community Consensus Initiative (ARECCI) submit that all projects that generate knowledge, including QI projects, can create risks to participants that need to be identified, assessed and addressed in the context of the kind of project. ⋯ In this article, we use a case example to illustrate potential ethical issues raised by a QI project, and argue for an ethics review approach that is distinct from that used with research projects. We propose six considerations with guidelines to help assess (and ultimately minimize and mitigate) the risk for participants in QI projects and assist in the appropriate ethical management of these projects.
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This study investigated the safety of discharge of seniors (aged 65 and over) from Quebec emergency departments (EDs) to the community. Data from a 2006 survey of key informants at 103 Quebec adult non-psychiatric EDs were linked to data on a sample of 172,927 seniors who were discharged home from one of the EDs during the period February 2004-January 2005. ⋯ A minority of EDs, regardless of their size and the characteristics of patients treated, systematically provided services to improve the safety of discharge. Resources and services need to be improved in EDs, particularly those that serve higher-risk populations (e.g., systematic approaches to the identification and management of high-risk seniors, with appropriate referrals to community services), in the hospital (e.g., increased accessibility to acute care beds) and in the community (e.g., increased accessibility to home care, outpatient geriatric assessment and primary medical care).
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In a project funded by the Ontario Ministry of Health and Long-Term Care, MedEmerg facilitated the introduction of three new providers into six emergency departments. A managed change process that included team development was carried out. ⋯ While overall the project was a success, lessons learned included the need for physician buy-in, communication, planning for unintended consequences and management of expectations. The project emphasized the importance of a managed process, including team development, in the implementation of change.