Addressing Emergency Department Issues Using Advanced Practice in Saudi Arabia

Rothwell, Siobhan; McIltrot, Kimberly; Khouri-Stevens, Zeina

doi:10.1016/j.nurpra.2017.11.006

Cited by 10 publications

(14 citation statements)

References 6 publications

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“…Several ‘within ED’ interventions and strategies identified in this review. These interventions were grouped under four common themes as follows: (1) area within ED staffed by PHCPs to manage lower acuity ED patients streamlined at triage, 29 (2) PHCPs located next to ED (sharing common triage with ED) to manage lower acuity ED patients streamed at triage as well as self-directed patients, 30 (3) PHCPs located at ED triage 31 to manage lower acuity ED patients and (4) PHCPs fully integrated within the ED to manage ED patients along with the ED team 32 ( online supplemental appendix table 6 ).…”

Section: Resultsmentioning

confidence: 99%

Interventions and strategies involving primary healthcare professionals to manage emergency department overcrowding: a scoping review

et al. 2021

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ObjectivesTo conduct a scoping review to identify and summarise the existing literature on interventions involving primary healthcare professionals to manage emergency department (ED) overcrowding.DesignA scoping review.Data sourcesA comprehensive database search of Medline (Ovid), EMBASE (Ovid), Cochrane Library (Wiley) and CINAHL (EBSCO) databases was conducted (inception until January 2020) using peer-reviewed search strategies, complemented by a search of grey literature sources.Eligibility criteriaInterventions and strategies involving primary healthcare professionals (PHCPs: general practitioners (GPs), nurse practitioners (NPs) or nurses with expanded role) to manage ED overcrowding.MethodsWe engaged and collaborated, with 13 patient partners during the design and conduct stages of this review. We conducted this review using the JBI guidelines. Two reviewers independently selected studies and extracted data. We conducted descriptive analysis of the included studies (frequencies and percentages).ResultsFrom 23 947 records identified, we included 268 studies published between 1981 and 2020. The majority (58%) of studies were conducted in North America and were predominantly cohort studies (42%). The reported interventions were either ‘within ED’ (48%) interventions (eg, PHCP-led ED triage or fast track) or ‘outside ED’ interventions (52%) (eg, after-hours GP clinic and GP cooperatives). PHCPs involved in the interventions were: GP (32%), NP (26%), nurses with expanded role (16%) and combinations of the PHCPs (42%). The ‘within ED’ and ‘outside ED’ interventions reported outcomes on patient flow and ED utilisation, respectively.ConclusionsWe identified many interventions involving PHCPs that predominantly reported a positive impact on ED utilisation/patient flow metrics. Future research needs to focus on conducting well-designed randomized controlled trials (RCTs) and systematic reviews to evaluate the effectiveness of specific interventions involving PHCPs to critically appraise and summarise evidence on this topic.

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Section: Resultsmentioning

confidence: 99%

Interventions and strategies involving primary healthcare professionals to manage emergency department overcrowding: a scoping review

et al. 2021

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“…Single OR-based approaches are also extensively used in Ajmi et al [83], Derni et al [87], Leo et al [153], Meng et al [152], Nezamoddini and Khasawneh [154], and Oueida et al [96]. Other non-hybrid methods that have been employed for tackling this ED deficiency are as follows: REACT [91], pivot nursing [92], process redesign [94,156], regression [157,158], nurse navigator [160], Iowa model of evidence-based practice [161], CQI [81,155], and ED dashboard/reporting [98]. Table 4 presents all the interventions focused on reducing overcrowding in EDs.…”

Section: Papers Focusing On Reducing the Waiting Timementioning

confidence: 99%

“…Another quality-improvement approach found to address the left-without-being-seen rates was CQI. In particular, Rothwell et al [155] struggled to manage this problem in an Arabic ED by implementing a 3-month quality improvement project including a new fast-track unit. A longer project is observed in Preyde et al [81] where a 6-month process improvement program was applied for reducing LWBS patients of a Canadian hospital ED.…”

Section: Papers Focusing On Diminishing the Number Of Patients Who Lementioning

confidence: 99%

Methodological Approaches to Support Process Improvement in Emergency Departments: A Systematic Review

Ortíz‐Barrios

Alfaro-Saiz

2020

IJERPH

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The most commonly used techniques for addressing each Emergency Department (ED) problem (overcrowding, prolonged waiting time, extended length of stay, excessive patient flow time, and high left-without-being-seen (LWBS) rates) were specified to provide healthcare managers and researchers with a useful framework for effectively solving these operational deficiencies. Finally, we identified the existing research tendencies and highlighted opportunities for future work. We implemented the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology to undertake a review including scholarly articles published between April 1993 and October 2019. The selected papers were categorized considering the leading ED problems and publication year. Two hundred and three (203) papers distributed in 120 journals were found to meet the inclusion criteria. Furthermore, computer simulation and lean manufacturing were concluded to be the most prominent approaches for addressing the leading operational problems in EDs. In future interventions, ED administrators and researchers are widely advised to combine Operations Research (OR) methods, quality-based techniques, and data-driven approaches for upgrading the performance of EDs. On a different tack, more interventions are required for tackling overcrowding and high left-without-being-seen rates.

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“…More recently, Sánchez et al (2018) Derni et al (2019), Leo et al (2016), Meng et al (2017), Nezamoddini and Khasawneh (2016), and Oueida et al (2018b. Other non-hybrid methods that have been employed for tackling this ED deficiency are as follows: REACT (Chan et al, 2005), pivot nursing (Christensen et al 2016), process redesign (DeFlitch et al, 55 2015Spaite et al, 2002), regression (Doupe et al, 2018;Eiset et al, 2019), nurse navigator (Fulbrook et al, 2017) Iowa model of evidence-based practice (Popovich et al, 2012), CQI (Preyde et al, 2012;Rothwell et al, 2018), and ED dashboard/reporting (Stone-Griffith et al, 2012).…”

Section: Papers Focusing On Reducing the Waiting Timementioning

confidence: 99%

“…Another quality-improvement approach found to address the left-without-beingseen rates was CQI. In particular, Rothwell et al (2018) struggled to manage this problem in an Arabic ED by implementing a 3-month quality improvement project including a new fast-track unit. A longer project is observed in Preyde et al (2012) where a 6-month process improvement program was applied for reducing LWBS patients of a Canadian hospital ED.…”

Section: Papers Focusing On Tackling the Overcrowdingmentioning

confidence: 99%

Redesigning the Barranquilla's public emergency care network to improve the patient waiting time

Barrios¹,

Ángel²

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Waiting time is one of the most critical measures in the satisfaction of patients admitted within emergency departments. Therefore, hospitals and governmental organizations should jointly aim to provide timely attention at reasonable costs. In the case of Barranquilla's Pubic Emergency Service Network, composed by 8 Points of care (POCs) and 2 hospitals, the trend evidences a continuous growing of the waiting time with a rate of 3,08 min/semester and a 93,13% likelihood of serving patients after waiting for more than 30 minutes. This is an unmistakable symptom of 12 average with a standard deviation of 81,6 min before being served by the emergency care unit. On the other hand, based on the reported literature, it is highly suggested to combine Operations Research (OR) methods, quality-based techniques, and data-driven approaches for addressing this problem. In this sense, a methodology based on collateral payment models, Discrete-event simulation, and Lean Six Sigma was proposed and validated resulting in a redesigned network whose average waiting time may diminish between 6,71 min and 9,08 min with an average profit US$29,980/node. Lately, a model comprising of 8 criteria and 35 sub-criteria was designed for evaluating the overall performance of emergency departments. The model outcomes revealed the critical role of Infrastructure (Global weight = 21,5%) in ED performance and the interactive nature of Patient Safety (C + R = 12,771).

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Addressing Emergency Department Issues Using Advanced Practice in Saudi Arabia

Cited by 10 publications

References 6 publications

Interventions and strategies involving primary healthcare professionals to manage emergency department overcrowding: a scoping review

Interventions and strategies involving primary healthcare professionals to manage emergency department overcrowding: a scoping review

Methodological Approaches to Support Process Improvement in Emergency Departments: A Systematic Review

Redesigning the Barranquilla's public emergency care network to improve the patient waiting time

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