Patient flow within UK emergency departments

Mohiuddin, S. et al. (2017) BMJ Open. 7:e015007

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Objectives: Overcrowding in the emergency department (ED) is common in the UK as in other countries worldwide. Computer simulation is one approach used for understanding the causes of ED overcrowding and assessing the likely impact of changes to the delivery of emergency care. However, little is known about the usefulness of computer simulation for analysis of ED patient flow. We undertook a systematic review to investigate the different computer simulation methods and their contribution for analysis of patient flow within EDs in the UK.

 

Conclusions: We found that computer simulation can provide a means to pretest changes to ED care delivery before implementation in a safe and efficient manner. However, the evidence base is small and poorly developed. There are some methodological, data, stakeholder, implementation and reporting issues, which must be addressed by future studies.

Read the full article here

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A & E performance: The view of NHS Providers

Following recent media coverage of NHS accident and emergency department performance, NHS Providers has published NHS Providers view on NHS A&E performance and linked media coverage

This briefing sets out facts about current A&E performance without underplaying the real pressures facing providers.

The briefing hihghlights the following:

  • Very few trusts are performing well, as measured by meeting the seeing 95% of A&E patients within the four-hour standard. We expect overall NHS performance for last week against the standard to be between 70 and 80%.
  • The vast majority of trusts are coping with the demand, in terms of avoiding persistently long trolley and 12-hour waits but some are struggling to do so.
  • There is a small number of trusts who are failing to cope with the demand and who have seen persistently large trolley and 12-hour waits. These tend to have lasted for short periods as corrective management action kicks in. Clearly, any incident of unavoidable harm is unacceptable and trusts are doing all they can to avoid them.

Read the full briefing here

Validity of the Manchester Triage System in patients with sepsis presenting at the ED

Gräff, I. et al. Emergency Medicine Journal. Published Online: 19 December 2016

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Background: The Manchester Triage System (MTS) does not have a specific presentational flow chart for sepsis. The goal of this investigation was to determine adequacy of acuity assignment for patients with sepsis presenting at the ED and triaged using the MTS.

 

Conclusions: The MTS has some weaknesses regarding priority levels in emergency patients with septic illness. Overall, target key symptoms (discriminators) which aim at identifying systemic infection and ascertaining vital parameters are insufficiently considered.

Read the full abstract here

Packaging Patients and Handing Them Over

Nugus, P. et al. Annals of Emergency Medicine. Published online: December 11 2016

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Study objective: Communication is commonly understood by health professional researchers to consist of relatively isolated exchanges of information. The social and organizational context is given limited credit. This article examines the significance of the environmental complexity of the emergency department (ED) in influencing communication strategies and makes the case for adopting a richer understanding of organizational communication.

 

Conclusion: This study shows that handoff of patients from the ED to other hospital departments is a complex communication process that involves more than a series of “checklistable” information exchanges. Clinicians must learn to use both negotiation and persuasion to achieve objectives.

Read the full abstract here

Sharp rise in ‘trolley waits’ for hospital beds in England

More than one in 10 patients in England face long delays for a hospital bed after emergency admission. | Story via BBCThe Guardian

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There has been a sharp rise in “trolley waits” – the length of time people wait for a hospital bed in England after being admitted in an emergency, figures show. Figures show 473,453 patients waited more than four hours for a hospital bed – a fivefold increase since 2010-11.

Data analysed by the BBC shows 473,453 patients waited more than four hours between October 2015 and September 2016 – almost a fivefold increase since 2010-11.

Read more via The Guardian

Additional link: BBC News: Hospital ‘trolley waits’ show sharp rise

The Sydney Triage to Admission Risk Tool to predict Emergency Department Disposition

Dinh, M.M. et al. BMC Emergency Medicine. Published online: 3 December 2016

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Background: Disposition decisions are critical to the functioning of Emergency Departments. The objectives of the present study were to derive and internally validate a prediction model for inpatient admission from the Emergency Department to assist with triage, patient flow and clinical decision making.

Conclusion: By deriving and internally validating a risk score model to predict the need for in-patient admission based on basic demographic and triage characteristics, patient flow in ED, clinical decision making and overall quality of care may be improved. Further studies are now required to establish clinical effectiveness of this risk score model.

Read the full article here

Delayed transfers of care continue to worsen

Hazel, W. HSJ. Published online: 10 November 2016

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  • Delayed transfers of care reach highest level with 196,246 delayed days in September
  • NHS England figures show demand up and performance in most areas down
  • NHS Providers warn demands “only likely to increase as we move into winter”

According to performance statistics for September, released on Thursday, 196,246 delayed days occurred in the month compared to 188,340 in August – previously the highest level since monthly data started being collected six years ago.

The NHS England figures show a continued increase in demand and a deterioration of performance in most areas.

Accident and emergency attendances were 4.9 per cent higher than in September 2015, and emergency admissions were 2.6 per cent higher than the previous year.

In September 90.6 per cent of patients were admitted, transferred or discharged from A&E within four hours of arrival, against a target of 95 per cent.

Read the full article here