Placing Emergency Department Crowding on the Decision Agenda

Bradley, Victoria

doi:10.1016/j.jen.2005.04.007

Cited by 38 publications

(29 citation statements)

References 50 publications

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“…20 As many hospitals face situations with decreased inpatient capacity resulting in "bed block," 21 management of chest pain in the ED can possibly decrease in-hospital admissions for evaluation of chest pain. 22 However, the pressures of ED overcrowding 21,[23][24][25][26][27][28] mean that ED resources can become stretched due to the lengthy and costly evaluations of chest pain patients in order to "rule out" ACS.…”

Section: Discussionmentioning

confidence: 99%

Validation of the new Vancouver Chest Pain Rule in Asian chest pain patients presenting at the emergency department

Ong

Ying

Yap

et al. 2016

CJEM

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Objectives: The new Vancouver Chest Pain (VCP) Rule recommends early discharge for chest pain patients who are at low risk of developing acute coronary syndrome (ACS), and thus can be discharged within 2 hours of arrival at the emergency department (ED). This study aimed to assess the performance of the new VCP Rule for Asian patients presenting with chest pain at the ED. Methods: This prospective cohort study involved patients attended to at the ED of a large urban centre. Patients of at least 25 years old, presenting with stable chest pain and a non-diagnostic ECG, and with no history of active coronary artery disease were included in the study. The main outcome measures were cardiac events, angioplasty, or coronary artery bypass within 30 days of enrolment. Results: The study included 1690 patients from 27 August 2000 to 1 May 2002, with 661 patients fulfilling the VCP criteria. Of those for early discharge, 24 had cardiac events and 13 had angioplasty or bypass at 30 days, compared to 91 and 41, respectively, for those unsuitable for discharge. This gave the rule a sensitivity of 78.1% for cardiac events, including angioplasty and bypass. Specificity was 41.0%, and negative predictive value (NPV) was 94.4%. Conclusion: We found the new VCP Rule to have moderate sensitivity and poor specificity for adverse cardiac events in our population. With an NPV of less than 100%, this means that a small proportion of patients sent home with early discharge would still have adverse cardiac events. RÉSUMÉObjectifs: Selon la nouvelle règle de Vancouver sur la douleur thoracique, il est recommandé que les patients qui présentent des douleurs thoraciques mais qui connaissent un faible risque de syndrome coronarien aigu puissent être renvoyés peu de temps après leur arrivée au service des urgences (SU), soit dans les deux heures suivantes. L'étude visait à évaluer la performance de la nouvelle règle de Vancouver chez des patients d'origine asiatique présentant des douleurs thoraciques, au SU. Méthode: Il s'agit d'une étude de cohorte, prospective, à laquelle ont participé des patients traités dans un SU d'un important centre urbain. Ont été sélectionnés des patients âgés d'au moins 25 ans, qui présentaient une douleur thoracique stable mais chez qui l'ECG s'est révélé non concluant et qui n'avaient pas d'antécédents de coronaropathie active. Les principaux critères d'évaluation consistaient en la survenue d'événements cardiaques ou encore en la réalisation d'une angioplastie ou d'un pontage coronarien dans les 30 jours suivant l'inclusion dans l'étude. Résultats: Au total, 1690 patients ont participé à l'étude, du 27 août 2000 au 1 er mai 2002, dont 661 répondaient aux critères de la nouvelle règle de Vancouver. Parmi ceux qui ont été renvoyés peu de temps après leur arrivée, 24 ont subi un événement cardiaque et 13 autres, une angioplastie ou un pontage coronarien au bout de 30 jours contre 91 et 41 respectivement parmi ceux qui n'étaient pas en état de quitter l'hôpital. Ainsi, la sensibilité de la règle s'est étab...

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Section: Discussionmentioning

confidence: 99%

Validation of the new Vancouver Chest Pain Rule in Asian chest pain patients presenting at the emergency department

Ong

Ying

Yap

et al. 2016

CJEM

View full text Add to dashboard Cite

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“…Those often needing the most services, for example the chronically ill and the poor, have less access (Furler et al 2002;Siminski et al 2008a;Siminski et al 2008b;Suruda et al 2005). Bradley (2005) suggests that 50% of patients attending ED have access barriers to alternative forms of health care, although Lega and Mengoni (2008) argue that many patients who access ED erroneously believe that their condition is serious. Bradley (2005) also suggests that non-urgent usage is a contributing factor to ED overcrowding and inefficiency that leads to deleterious health outcomes for Insert table 2 here Table 2 provides a cross reference of the numbers of residents per GPs in each postcode area of highest ED use for primary care, rates of attendance, and SEIFA IRSD scores to obtain ED services.…”

Section: Triangulation and Rigour Of Qualitative Datamentioning

confidence: 99%

Using mixed methods to analyse barriers to primary paediatric health access

Parry

Willis

2013

International Journal of Multiple Research Approaches

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“…Segundo Bradley (2005) e Fávero (1975, a falta de leitos de que os hospitais em geral carecem tem como origem principal a superlotação das emergências, o mau uso dos recursos financeiros e a não utilização adequada da estrutura de leitos existente, agravada pelo desperdício da relação conflituosa entre o sistema público e o privado.…”

Section: Introductionunclassified

Aplicação da TOC em uma estrutura hospitalar de grande porte: O uso da metodologia em um processo sistêmico nos serviços de internação

Araujo

2013

RGSS

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Placing Emergency Department Crowding on the Decision Agenda

Cited by 38 publications

References 50 publications

Validation of the new Vancouver Chest Pain Rule in Asian chest pain patients presenting at the emergency department

Validation of the new Vancouver Chest Pain Rule in Asian chest pain patients presenting at the emergency department

Using mixed methods to analyse barriers to primary paediatric health access

Aplicação da TOC em uma estrutura hospitalar de grande porte: O uso da metodologia em um processo sistêmico nos serviços de internação

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