A Rapid Medical Screening Process Improves Emergency Department Patient Flow During Surge Associated With Novel H1N1 Influenza Virus

Fagbuyi, Daniel B.; Brown, Kathleen M.; Mathison, David J.; Kingsnorth, Jennifer; Morrison, Sephora; Saidinejad, Mohsen; Greenberg, Jeff; Knapp, Michael; Chamberlain, James M.

doi:10.1016/j.annemergmed.2010.08.026

Cited by 34 publications

(27 citation statements)

References 12 publications

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“…50 EDs experience predictable seasonal increases in volumes related to influenza and other winter viruses. 51 In addition, they have reported rapid increases of up to 100 percent related to novel H1N1 influenza 52 and up to 40 percent in reaction to media reports about streptococcal infections. 53,54 Under the terms of the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985, EDs are the only providers required by law to treat any person requesting a medical evaluation.…”

Section: Increases In Volume and Overcrowdingmentioning

confidence: 99%

Emergency Care For Children In The United States

2013

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A formal emergency care system for children in the United States began in the 1980s with the establishment of specialized training programs in academic children's hospitals. The ensuing three decades have witnessed the establishment of informal regional networks for clinical care and a federally funded research consortium that allows for multisite research on evidence-based practices. However, pediatric emergency care suffers from problems common to emergency departments (EDs) in general, which include misaligned incentives for care, overcrowding, and wide variation in the quality of care. In pediatric emergency care specifically, there are problems with low-volume EDs that have neither the experience nor the equipment to treat children, poor adherence to clinical guidelines, lack of resources for mental health patients, and a lack of widely accepted performance metrics. We call for policies to address these issues, including providing after-hours care in other settings and restructuring payment and reimbursement policies to better address patients' needs.

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Section: Increases In Volume and Overcrowdingmentioning

confidence: 99%

Emergency Care For Children In The United States

2013

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“…According to four studies,9 12–14 revisits could be reduced by providing consistent verbal and written discharge information regarding the natural history of disease13 and temperature measurement/treatment 14. In contrast, other studies concluded that the provision of safety-net advice did not affect the number of revisits 15 16. We found conflicting evidence for the association between educational interventions at the ED and parental recall of discharge instructions or revisits 16–24.…”

Section: Resultsmentioning

confidence: 76%

Tools for ‘safety netting’ in common paediatric illnesses: a systematic review in emergency care

et al. 2015

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ContextFollow-up strategies after emergency department (ED) discharge, alias safety netting, is often based on the gut feeling of the attending physician.ObjectiveTo systematically identify evaluated safety-netting strategies after ED discharge and to describe determinants of paediatric ED revisits.Data sourcesMEDLINE, Embase, CINAHL, Cochrane central, OvidSP, Web of Science, Google Scholar, PubMed.Study selectionStudies of any design reporting on safety netting/follow-up after ED discharge and/or determinants of ED revisits for the total paediatric population or specifically for children with fever, dyspnoea and/or gastroenteritis. Outcomes included complicated course of disease after initial ED visit (eg, revisits, hospitalisation).Data extractionTwo reviewers independently assessed studies for eligibility and study quality. As meta-analysis was not possible due to heterogeneity of studies, we performed a narrative synthesis of study results. A best-evidence synthesis was used to identify the level of evidence.ResultsWe summarised 58 studies, 36% (21/58) were assessed as having low risk of bias. Limited evidence was observed for different strategies of safety netting, with educational interventions being mostly studied. Young children, a relevant medical history, infectious/respiratory symptoms or seizures and progression/persistence of symptoms were strongly associated with ED revisits. Gender, emergency crowding, physicians’ characteristics and diagnostic tests and/or therapeutic interventions at the index visit were not associated with revisits.ConclusionsWithin the heterogeneous available evidence, we identified a set of strong determinants of revisits that identify high-risk groups in need for safety netting in paediatric emergency care being related to age and clinical symptoms. Gaps remain on intervention studies concerning specific application of a uniform safety-netting strategy and its included time frame.

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“…ED management can optimize supply and demand by proactively planning for these peak periods with increased staffing and surge space allowances. 101,102 Computer modeling of patient flow has been used successfully to predict the effects of physician staffing patterns on patient throughput in a pediatric ED. 103 …”

Section: Innovative Staffing Modelsmentioning

confidence: 99%

Best Practices for Improving Flow and Care of Pediatric Patients in the Emergency Department

Barata¹,

Brown²,

Fitzmaurice³

et al. 2015

Pediatrics

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This report provides a summary of best practices for improving flow, reducing waiting times, and improving the quality of care of pediatric patients in the emergency department. CURRENT STATUS AND NEEDS ED Use and ED Crowding in the United StatesApproximately 800 000 children seek care in the emergency department (ED) each day in the United States. Additionally, it is estimated that 3.4% of US children use EDs as their source for sick care. The vast majority (92%) of these children are seen in community EDs, with a smaller percentage seen in pediatric EDs. The increase in ED utilization has saturated the capacity of EDs and emergency medical services in many communities. Increases in patient volume and decreases in resources, including fragmentation of resources and shortage of critical subspecialists, have resulted in EDs facing crowding and ambulance diversion.The need for emergency medical services outstrips the available resources on a daily basis. This mismatch is reflected by the considerable increase in the number of patients visiting EDs. In 1993, 90.3 million patients visited EDs; in 2003 that number increased to 113.9 million patients. Approximately 21% of these patients were younger than 15 years. Despite the increase in ED visits, the number of hospitals decreased by 703, the number of hospital beds decreased by 198 000, and the number of EDs decreased by 425.

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A Rapid Medical Screening Process Improves Emergency Department Patient Flow During Surge Associated With Novel H1N1 Influenza Virus

Cited by 34 publications

References 12 publications

Emergency Care For Children In The United States

Emergency Care For Children In The United States

Tools for ‘safety netting’ in common paediatric illnesses: a systematic review in emergency care

Best Practices for Improving Flow and Care of Pediatric Patients in the Emergency Department

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