A Pragmatic Randomized Evaluation of a Nurse-Initiated Protocol to Improve Timeliness of Care in an Urban Emergency Department

Douma, Matthew J.; Drake, Claire A.; O'Dochartaigh, Domhnall; Smith, Katherine E.

doi:10.1016/j.annemergmed.2016.06.019

Cited by 32 publications

(42 citation statements)

References 21 publications

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“…Les articles retenusp r é sentaientd ifférents devisd e recherche, dontune revue systématique de la littératureet trois essais cliniques randomisés( tableau I). La majorité des articles sélectionnés étaient rédigéspard es auteurs nord-américains :neuf articles étaient américains [17][18][19][20][21][22][23][24] et cinq étaient canadiens [25][26][27][28][29][30]. Les autres articles étaient issus de la Chine [31],del' A ustralie [32][33][34], de la Suède [35], des Pays-Bas [36] et de Singapour [37].…”

Section: Caractéristiques Méthodologiques Des Articlesunclassified

“…Neuf articles portaientsur l'administration d'un analgésique [19,24,25,[31][32][33][35][36][37], un sur les antiémétiques [20] et un sur lescorticostéroïdes [29]. Six articles présentaient des ordonnances collectivespermettant l'initiation de différents examensd iagnostiques et l'administration d'un analgésique en fonctiond'une raison de consultation principale :septicémie [18], dyspnée [21], problème génito-urinaire [21], douleur abdominale [21,23,25,28], douleur à la hanche [25], douleur thoracique [21,25,30] et saignementsv aginaux [ 25]. Ces examens diagnostiques étaient desradiographies,des électrocardiogrammes, des analyses d'urine, des bilans sanguins et, conséquemment,l'installationd'un accèsintraveineux.…”

Section: Les Ordonnances Collectives éTudiéesunclassified

“…L' ordonnancecollective relative à la prescription d'examens diagnostiquespar les infirmièresdèsl'arrivéedes patients au triaged ansl es départements d'urgence permettait de réduire le délai de 79 à 257 minutes avant les radiographies et les résultatsd ebilans sanguins [ 25,28]. Néanmoins, Thompson et coll.…”

Section: L'efficienceunclassified

“…Articles retenus n=23 [19,24,25,[31][32][33][35][36][37]. L' administration de médicaments dèsletriage par lesinfirmièresaentraîné un soulagement cliniquement pertinent pour les patients durant leur séjoura ud é partement d'urgence, carles patients ont rapporté une diminution de l'intensité de la douleur [31,35,36].…”

Section: Articles Retenus àPartir Des Bases De Données N=3103unclassified

“…Lesinfirmièresont noté que l'utilisationdes ordonnances collectivesl eur ap ermis d'utiliser leurj ugement clinique pour déterminer la pertinence de leur application en fonction du délai d'attente [ 34]e td el ' é tatc liniqued u patient [21]. La majorité desinfirmièressedisaient satisfaites et bienadaptées à cettenouveller esponsabilité qui augmentait leur autonomie [25,27,37]. Toutefois, certaines infirmièresr apportaient que les ordonnances collectives ajoutaient des responsabilités à leur travail actuel, telles quelesuivi des résultatsd'examens des patients et le suivi des résultatsanormaux chez lespatientsqui sortent avant de voir le médecin [23,25,27].…”

Section: La Sécuritéunclassified

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Les ordonnances collectives et la qualité des soins au triage des urgences : synthèse des connaissances

Lacroix¹,

Silva²

2018

Santé Publique

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Section: Caractéristiques Méthodologiques Des Articlesunclassified

Section: Les Ordonnances Collectives éTudiéesunclassified

Section: L'efficienceunclassified

Section: Articles Retenus àPartir Des Bases De Données N=3103unclassified

Section: La Sécuritéunclassified

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Les ordonnances collectives et la qualité des soins au triage des urgences : synthèse des connaissances

Lacroix¹,

Silva²

2018

Santé Publique

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Emergency department provider in triage: assessing site‐specific rationale, operational feasibility, and financial impact

Franklin

Somand

et al. 2021

JACEP Open

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Emergency department (ED) crowding is recognized as a critical threat to patient safety, while sub‐optimal ED patient flow also contributes to reduced patient satisfaction and efficiency of care. Provider in triage (PIT) programs—which typically involve, at a minimum, a physician or advanced practice provider conducting an initial screening exam and potentially initiating treatment and diagnostic testing at the time of triage—are frequently endorsed as a mechanism to reduce ED length of stay (LOS) and therefore mitigate crowding, improve patient satisfaction, and improve ED operational and financial performance. However, the peer‐reviewed evidence regarding the impact of PIT programs on measures including ED LOS, wait times, and costs (as variously defined) is mixed. Mechanistically, PIT programs exert their effects by initiating diagnostic work‐ups earlier and, sometimes, by equipping triage providers to directly disposition patients. However, depending on local contextual factors—including the co‐existence of other front‐end interventions and delays in ED throughput not addressed by PIT—we demonstrate how these features may or may not ultimately translate into reduced ED LOS in different settings. Consequently, site‐specific analysis of the root causes of excessive ED LOS, along with mechanistic assessment of potential countermeasures, is essential for appropriate deployment and successful design of PIT programs at individual EDs. Additional motivations for implementing PIT programs may include their potential to enhance patient safety, patient satisfaction, and team dynamics. In this conceptual article, we address a gap in the literature by demonstrating the mechanisms underlying PIT program results and providing a framework for ED decision‐makers to assess the local rationale for, operational feasibility of, and financial impact of PIT programs.

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Preventative measures taken against hypothermia in selected Durban hospitals’ emergency centres and operating theatres

Nel

Hardcastle

2017

African Journal of Emergency Medicine

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IntroductionHypothermia is common in emergency general surgical patients. It is known to be associated with major complications in multiple organ systems. It is also easily preventable with the use of safe and cost-effective equipment. However, by observation, it appears that this equipment is used too infrequently thus resulting in unnecessary harm to patients.MethodsThis descriptive, observational, cross-sectional study was conducted in two arms to evaluate both emergency centres and operating theatres in the major state hospitals in Durban. It was conducted as an audit as well as a questionnaire-based study, to ascertain the availability of equipment used to prevent hypothermia and also how appropriately the equipment was being used.ResultsThere was good availability of equipment in both the operating theatres and the emergency centres. However it was being used very poorly, particularly in emergency centres (41% of responses deemed not beneficial to patients versus 29% from operating theatres; 39% of answers beneficial versus 54% from operating theatres). Institutions with hypothermia-prevention protocols scored significantly better than those without a protocol (59% versus 25% beneficial; p = 0.01).ConclusionIn the field of hypothermia prevention, there was sufficient equipment to result in optimal patient care. However there appears to be a lack of knowledge amongst health care providers, resulting in suboptimal use of this equipment. Protocolised management may provide a solution to this problem and improve patient outcomes.

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A Pragmatic Randomized Evaluation of a Nurse-Initiated Protocol to Improve Timeliness of Care in an Urban Emergency Department

Cited by 32 publications

References 21 publications

Les ordonnances collectives et la qualité des soins au triage des urgences : synthèse des connaissances

Les ordonnances collectives et la qualité des soins au triage des urgences : synthèse des connaissances

Emergency department provider in triage: assessing site‐specific rationale, operational feasibility, and financial impact

Preventative measures taken against hypothermia in selected Durban hospitals’ emergency centres and operating theatres

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