Simulating competition dynamics for hospital admissions provides prospective planning (ie, decision making) information and demonstrates how interventions to increase inpatient throughput will have a much greater effect on higher priority surgical admissions compared with ED admissions.

In 2006, JCAHO defined the second of its National Patient Safety goals as to "Improve the effectiveness of communication among caregivers". The SBAR protocol gives practical guidelines for person-toperson communication but may not be appropriate in its current form for more complex contexts. This paper presents a case study showing communication processes in one ICU and illustrates important principles of complex clinical communication. The case study is based on observational and interview data from a bedside nurse, a charge nurse, a resident and a fellow over 12 hours each in a major trauma ICU. Artefacts were also collected and annotated. Five types of interconnected communication events are described in the sequence in which they occur. Each communication event is described in terms of its purpose, participants, process, and support tools. Four principles are defined.

Objectives Rapid risk stratification and timely treatment are critical to favorable outcomes for acute coronary syndrome (ACS) patients. Our objective was to identify patient and system factors that influence time-dependent quality indicators (QIs) for unstable angina (UA)/non-ST elevation Myocardial Infarction (NSTEMI) patients in the emergency department (ED). Methods A retrospective, cohort study was conducted over a 42-month period of all patients aged 24 years or older suspected of having ACS as defined by receiving an electrocardiogram (ECG) and at least one cardiac biomarker test. Cox regression was used to model the effects of patient characteristics, ancillary service utilization, staffing provisions, equipment availability and ED and hospital crowding on ACS QIs. Results ED adherence rates to national standards for ECG read out time and biomarker turn-around-time were 42% and 37%, respectively. Cox regression models revealed that chief complaints without chest pain and the timing of stress testing and medication administration were associated with the most significant delays. Conclusions Patient and system factors both significantly influenced QI times in this UA/NSTEMI cohort. These results illustrate both the complexity of diagnosing NSTEMI patients and the competing effects of clinical and system factors on patient flow through the ED.

No abstract

No abstract