Implementation of an Opioid Detoxification Management Pathway Reduces Emergency Department Length of Stay

Bellew, Shawna D.; Collins, Sean P.; Barrett, Tyler W.; Russ, Stephan; Jones, Ian D.; Slovis, Corey M.; Self, Wesley H.

doi:10.1111/acem.13457

Cited by 4 publications

(4 citation statements)

References 11 publications

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“…The techniques included here can serve as a methodological framework supporting interventions undertaken by healthcare administrators, ED managers, health authorities, and practitioners involved in the strategic and tactic decision levels of the emergency care system. These terms are also familiar for these stakeholders as evidenced in Elamir [14] (lean), Rotteau et al [15] (continuous quality improvement), Cheng et al [16] (regression), Ashour and Kremer [17] (simulation), Feng et al [18] (optimization), Bellew et al [19] (critical pathways), Youseffi and Ferreira [20] (decision making), Nezamoddini and Khasawneh [21] (integer programming), Bish et al [22] (queuing), Blick [23] (2013) (six sigma), Azadeh et al [24] (fuzzy logic), Acuna et al [25] (game theory), Sorrentino [26], and Saghafian et al [27] (operational research) where real applications have been fully reported before the pandemic era with the participation of different healthcare workers, especially those from the managerial dependencies. Additionally, we performed a manual search taking into account the references related to the reviewed manuscripts.…”

Section: Search Strategy and Information Sourcesmentioning

confidence: 99%

Process Improvement Approaches for Increasing the Response of Emergency Departments against the COVID-19 Pandemic: A Systematic Review

Ortíz‐Barrios

Coba-Blanco

Alfaro-Saiz

et al. 2021

IJERPH

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The COVID-19 pandemic has strongly affected the dynamics of Emergency Departments (EDs) worldwide and has accentuated the need for tackling different operational inefficiencies that decrease the quality of care provided to infected patients. The EDs continue to struggle against this outbreak by implementing strategies maximizing their performance within an uncertain healthcare environment. The efforts, however, have remained insufficient in view of the growing number of admissions and increased severity of the coronavirus disease. Therefore, the primary aim of this paper is to review the literature on process improvement interventions focused on increasing the ED response to the current COVID-19 outbreak to delineate future research lines based on the gaps detected in the practical scenario. Therefore, we applied the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to perform a review containing the research papers published between December 2019 and April 2021 using ISI Web of Science, Scopus, PubMed, IEEE, Google Scholar, and Science Direct databases. The articles were further classified taking into account the research domain, primary aim, journal, and publication year. A total of 65 papers disseminated in 51 journals were concluded to satisfy the inclusion criteria. Our review found that most applications have been directed towards predicting the health outcomes in COVID-19 patients through machine learning and data analytics techniques. In the overarching pandemic, healthcare decision makers are strongly recommended to integrate artificial intelligence techniques with approaches from the operations research (OR) and quality management domains to upgrade the ED performance under social-economic restrictions.

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Section: Search Strategy and Information Sourcesmentioning

confidence: 99%

Process Improvement Approaches for Increasing the Response of Emergency Departments against the COVID-19 Pandemic: A Systematic Review

Ortíz‐Barrios

Coba-Blanco

Alfaro-Saiz

et al. 2021

IJERPH

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“…OR-based studies addressing long LOS are evidenced in Chan et al [91], Derni et al [87], Liu et al [95], and Oueida et al [86,96]. Apart from the aforementioned single techniques, less popular methods like critical pathways [88,89,97], pivot nursing [92], and process redesign [94] were also used by some practitioners and researchers to diminish the total burden produced by long ED-LOS. Table 3 presents all the papers aiming at shortening the door-to-physician time in EDs.…”

Section: Papers Focusing On Reducing the Extended Losmentioning

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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“…CPs tend to be used in time-sensitive situations, such as acute coronary syndrome and acute stroke in adult EDs [6,7] . Many studies have shown meaningful improvements in patient safety and outcomes, such as door-to-needle time, ED length of stay (LOS), and complication rates, owing to multidisciplinary cooperation that involve CPs [6–9] . A handful of studies has previously examined the effectiveness of certain CP programs in pediatric EDs [10,11] .…”

Section: Introductionmentioning

confidence: 99%

“…[6,7] Many studies have shown meaningful improvements in patient safety and outcomes, such as door-to-needle time, ED length of stay (LOS), and complication rates, owing to multidisciplinary cooperation that involve CPs. [6][7][8][9] A handful of studies has previously examined the effectiveness of certain CP programs in pediatric EDs. [10,11] Although intussusception is a time-sensitive disease in pediatric EDs, few previous studies have examined the role of CPs in its diagnosis and treatment, focusing primarily on management.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of the implementation of pediatric intussusception clinical pathway

et al. 2021

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Intussusception is common among children at the pediatric emergency department (ED) with acute abdomen. Diagnosis and treatment delay remain a challenge. This study aimed to evaluate the impact of intussusception clinical pathways (CPs) implementation, including bedside point-of-care ultrasonography, on patient management in a pediatric ED. In January 2017, an intussusception management protocol was implemented for children with symptoms of intussusception. We retrospectively examined the charts of patients diagnosed with intussusception during the preprotocol (January 2015 to December 2016) and postprotocol (January 2017 to January 2019) periods and compared their outcomes. A total of 106 and 108 patients were included in the preprotocol and postprotocol groups, respectively. After CP implementation, the median door-to-ultrasonography time decreased from 66.5 (range: 13, 761) to 54 (20, 191) minutes; meanwhile, door-to-reduction time decreased from 121.5 (37, 1077) to 80.5 (40, 285) minutes; the median ED length of stay decreased from 440 to 303.5 minutes; and finally, admission rate increased from 18.9% to 40.7% ( P < .01). There was no between-group difference in the rates of complications, readmission, emergency surgery, or reduction failure. The implementation of an intussusception CP decreased time-to-diagnosis, time-to-treatment, and ED length of stay estimates among children screened using point-of-care ultrasonography. The present findings suggest that the implementation of an intussusception CP may improve the efficiency of time and resource use.

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Implementation of an Opioid Detoxification Management Pathway Reduces Emergency Department Length of Stay

Abstract: Implementation of an opioid detoxification management pathway reduced EDLOS, reduced utilization of resources, and increased the proportion of patients prescribed medications for symptom relief.

Cited by 4 publications

References 11 publications

Process Improvement Approaches for Increasing the Response of Emergency Departments against the COVID-19 Pandemic: A Systematic Review

Process Improvement Approaches for Increasing the Response of Emergency Departments against the COVID-19 Pandemic: A Systematic Review

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

Effectiveness of the implementation of pediatric intussusception clinical pathway

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