This document discusses creating a rapid admit unit to prevent emergency department overcrowding. It defines overcrowding and describes common strategies to address it, such as fast tracks and pulling patients to fill inpatient beds. A rapid admit unit can help by moving admitted patients out of the ED quickly. The document outlines how to plan and implement a rapid admit unit, including criteria for patient inclusion, staffing, equipment needs, and metrics to measure its success in reducing boarding times and left without being seen rates.
To address family history collection, interpretation, and application in busy primary care practices, NCHPEG has collaborated collaborating with the March of Dimes, Genetic Alliance, Harvard Partners, and the Health Resources and Services Administration to develop and evaluate a novel family history tool that focuses on prenatal and neonatal health. The tool helps to improve health outcomes for the female patient, fetus, and family by providing clinical decision support and educational resources for risk assessment based on family history. A set of screenshots and an overview of the module can be reviewed via this downloadable ppt.
Associate Professor Ian Scott - Princess Alexandra Hospital; University of Qu...Informa Australia
Associate Professor Ian Scott
Director
Internal Medicine & Clinical Epidemiology; Associate Professor of Medicine
Princess Alexandra Hospital; University of Queensland
Martin Utley, Director of the Clinical Operational Research Unit at University College London, reflects upon his involvement in the launch of specific tools to monitor care quality for paediatric cardiac surgery.
To address family history collection, interpretation, and application in busy primary care practices, NCHPEG has collaborated collaborating with the March of Dimes, Genetic Alliance, Harvard Partners, and the Health Resources and Services Administration to develop and evaluate a novel family history tool that focuses on prenatal and neonatal health. The tool helps to improve health outcomes for the female patient, fetus, and family by providing clinical decision support and educational resources for risk assessment based on family history. A set of screenshots and an overview of the module can be reviewed via this downloadable ppt.
Associate Professor Ian Scott - Princess Alexandra Hospital; University of Qu...Informa Australia
Associate Professor Ian Scott
Director
Internal Medicine & Clinical Epidemiology; Associate Professor of Medicine
Princess Alexandra Hospital; University of Queensland
Martin Utley, Director of the Clinical Operational Research Unit at University College London, reflects upon his involvement in the launch of specific tools to monitor care quality for paediatric cardiac surgery.
Paul Aylin, Co-Director of the Dr Foster Unit at Imperial College London, gives concrete examples of using a specific statistical model for monitoring care quality, cumulative sum (CUSUM).
Expediting Colonoscopy for Patients with + Faecal Occult Blood Test in a Publ...Cancer Institute NSW
Colon cancer is the commonest cancer in Australia. The Federal Gov. has recently accelerated the rollout of the National Bowel Cancer Screening Program to 2nd yearly after age 50 by 2018. We anticipate up to 1000 extra colonoscopies on the public system at NSLHD.
I gave this prezo to Auckland Regional Clinical IS Leadership Group on Feb 21, 2014. It shows how difficult it can be to deal with certain kinds of health information when developing systems by an impressive example (originally from Dr. Sam Heard). Therefore we need rigorous and scientific methods to tackle this - in this case using openEHR's multi-level modelling approach to create a single content model from which all health information exchange payload definitions will be derived. New Zealand's Interoperability Reference Architecture (HISO 10040) is underpinned by openEHR Archetypes to create this content model. The bottom line of the prezo is that almost every national programme starts health information standardisation from the wrong place; most of them are complex technical speficifications, like CDA, which are almost impossible for clinicians to comprehend and provide feedback. The process is flawed! Instead it should start from simple to understand representations, such as simple diagrams, mindmaps etc.and then handed over to techies once clinical validity and utility is agreed upon.That's the beauty of Archetype approach - great tooling and the Clinical Knowledge Manager (CKM) enable clinicians and other domain experts to collaborate and develop clinical models easily.
Providing actionable healthcare analytics at scale: Understanding improvement...Nuffield Trust
Thomas Woodcock, Improvement Science Fellow at Imperial College London, talks about the various measurement approaches and processes when working at large scale to assess care quality improvements.
Evaluating new models of care: Improvement Analytics UnitNuffield Trust
Martin Caunt, Improvement Analytics Unit Project Director and NHS England and Adam Steventon, Director of Data Analytics at The Health Foundation share insights into how they have approached evaluating new models of care.
Providing actionable healthcare analytics at scale: Insights from the Nationa...Nuffield Trust
Christopher Boulton, Falls and Fragility Fracture Audit Programme Manager at the Royal College of Physicians and Rob Wakeman, Clinical Lead for Orthopaedic Surgery at the National Hip Fracture Database talk about what they have learned by analysing the national hip fracture database.
A Standards-based Approach to Development of Clinical Registries - Initial Le...Koray Atalag
This is the prezo I presented at HINZ 2014 conference.
Gestational diabetes has implications for both mother and child with risk of complications during pregnancy, and type 2 diabetes later in life. This paper presents the initial lessons learned from the development of a clinical registry. The aims of the Registry are: 1) 100% successful diabetes screening within 3 months of delivery; 2) Annual type 2 diabetes screening; 3) Early warning in subsequent pregnancies.
We have employed the openEHR standard which underpins our national interoperability reference architecture to represent the dataset and also to build the web-based registry system. Use of this rigorous methodology to tackle health information is expected to ensure semantic consistency of Registry data and maximise interoperability with other Sector projects. The development work has been facilitated by the ability to transform the dataset automatically into software code – ensuring clinical requirements accurately translated into technical terms.
Dataset has been finalised, registry system has been developed and deployed for pilot implementation. Data entry is underway for participants after consenting.
This registry is expected to increase the screening of women leading to earlier detection of diabetes. It should provide a valuable picture of the condition and is intended for extension and wider roll-out after evaluation.
Introduction of the NZ Health IT Plan enables better gout management - Reflections of an early adopter. Presented by Peter Gow, Counties Manukau DHB, at HINZ 2014, 12 November 2014, 11.37am, Plenary Room
Predictors of MDT review and the impact on lung cancer survival for HNELHD re...Cancer Institute NSW
Review by a Multidisciplinary Team (MDT) has been shown to lead to increased rates of surgical resection, radiotherapy, chemotherapy and timeliness of care. Most recently, the Victorian lung cancer patterns of care study have found that MDT review is an independent predictor of lung cancer survival.
Paul Aylin, Co-Director of the Dr Foster Unit at Imperial College London, gives concrete examples of using a specific statistical model for monitoring care quality, cumulative sum (CUSUM).
Expediting Colonoscopy for Patients with + Faecal Occult Blood Test in a Publ...Cancer Institute NSW
Colon cancer is the commonest cancer in Australia. The Federal Gov. has recently accelerated the rollout of the National Bowel Cancer Screening Program to 2nd yearly after age 50 by 2018. We anticipate up to 1000 extra colonoscopies on the public system at NSLHD.
I gave this prezo to Auckland Regional Clinical IS Leadership Group on Feb 21, 2014. It shows how difficult it can be to deal with certain kinds of health information when developing systems by an impressive example (originally from Dr. Sam Heard). Therefore we need rigorous and scientific methods to tackle this - in this case using openEHR's multi-level modelling approach to create a single content model from which all health information exchange payload definitions will be derived. New Zealand's Interoperability Reference Architecture (HISO 10040) is underpinned by openEHR Archetypes to create this content model. The bottom line of the prezo is that almost every national programme starts health information standardisation from the wrong place; most of them are complex technical speficifications, like CDA, which are almost impossible for clinicians to comprehend and provide feedback. The process is flawed! Instead it should start from simple to understand representations, such as simple diagrams, mindmaps etc.and then handed over to techies once clinical validity and utility is agreed upon.That's the beauty of Archetype approach - great tooling and the Clinical Knowledge Manager (CKM) enable clinicians and other domain experts to collaborate and develop clinical models easily.
Providing actionable healthcare analytics at scale: Understanding improvement...Nuffield Trust
Thomas Woodcock, Improvement Science Fellow at Imperial College London, talks about the various measurement approaches and processes when working at large scale to assess care quality improvements.
Evaluating new models of care: Improvement Analytics UnitNuffield Trust
Martin Caunt, Improvement Analytics Unit Project Director and NHS England and Adam Steventon, Director of Data Analytics at The Health Foundation share insights into how they have approached evaluating new models of care.
Providing actionable healthcare analytics at scale: Insights from the Nationa...Nuffield Trust
Christopher Boulton, Falls and Fragility Fracture Audit Programme Manager at the Royal College of Physicians and Rob Wakeman, Clinical Lead for Orthopaedic Surgery at the National Hip Fracture Database talk about what they have learned by analysing the national hip fracture database.
A Standards-based Approach to Development of Clinical Registries - Initial Le...Koray Atalag
This is the prezo I presented at HINZ 2014 conference.
Gestational diabetes has implications for both mother and child with risk of complications during pregnancy, and type 2 diabetes later in life. This paper presents the initial lessons learned from the development of a clinical registry. The aims of the Registry are: 1) 100% successful diabetes screening within 3 months of delivery; 2) Annual type 2 diabetes screening; 3) Early warning in subsequent pregnancies.
We have employed the openEHR standard which underpins our national interoperability reference architecture to represent the dataset and also to build the web-based registry system. Use of this rigorous methodology to tackle health information is expected to ensure semantic consistency of Registry data and maximise interoperability with other Sector projects. The development work has been facilitated by the ability to transform the dataset automatically into software code – ensuring clinical requirements accurately translated into technical terms.
Dataset has been finalised, registry system has been developed and deployed for pilot implementation. Data entry is underway for participants after consenting.
This registry is expected to increase the screening of women leading to earlier detection of diabetes. It should provide a valuable picture of the condition and is intended for extension and wider roll-out after evaluation.
Introduction of the NZ Health IT Plan enables better gout management - Reflections of an early adopter. Presented by Peter Gow, Counties Manukau DHB, at HINZ 2014, 12 November 2014, 11.37am, Plenary Room
Predictors of MDT review and the impact on lung cancer survival for HNELHD re...Cancer Institute NSW
Review by a Multidisciplinary Team (MDT) has been shown to lead to increased rates of surgical resection, radiotherapy, chemotherapy and timeliness of care. Most recently, the Victorian lung cancer patterns of care study have found that MDT review is an independent predictor of lung cancer survival.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
1. Creating a Rapid Admit Unit
to Prevent Overcrowding
and Provide Safe Passage
for Patients
Marie Hankinson, PhDc, RN
2. Objectives
I. Define Emergency Department Overcrowding
II. When to Create a Rapid Admit Unit
III. Describe the Benefits of Creating a Rapid
Admit Unit
IV. Describe Metrics to Measure Your
Program Success
3. Definition of ED Overcrowding
“A situation in which the
identified need for emergency
services outstrips available
resources in the ED”
ACEP Crowding Resources Task Force, 2002. Retrieved
from http://www.acep.org/workarea/downloadasset.aspx?id
=8872
4. Common Strategies to Decompress
the Emergency Department
• Code Purple
• Fast Track
• Hallway Beds
• Pull till Full
• Advanced
Nursing
Interventions
• Rapid Medical
Evaluation
(RME)
• Bedside
Registration
5. Front End Flow Tactics
RME- Clinician in Triage
• Midlevel Provider in
Triage
• MD in Triage
• Intake Team
Fast Track Low Acuity
• Super- Track ( ESI 5’s
+ Simple 4’s)
• Fast- Track ( ESI 5’s,
4’s & simple 3’s)
6. Boarding Patients
ED patients who need to be admitted are
“boarded” until inpatient beds become
available. The practice of “boarding” patients
creates safety and negative consequences
such as increasing LWBS, patient
walkouts, adverse events, errors, mortality
rates and diversion of ambulances.
7. Causes of ED Overcrowding
In 2006, the Institute Of Medicine (IOM)
described emergency care in America at the
“breaking point”.
The most common documented factor for
ED Overcrowding is scarcity of beds for
patients admitted through the ED.
Studies consistently tell us that inpatient
occupancy is positively associated with
patient waiting in the ED.
8. Key Drivers of ED Overcrowding
• Lack of staffed inpatient beds
• Lack of ICU and Critical Care beds
• Shortage of hospital or ED Staff
• Shortage of specialist physicians willing to take
ED call
• Inability to cover specific specialties and
having to transfer patients to other facilities.
9. Behavorial Health Patients
• 5-8% of ED volume
• Shortages of Mental Health Care
Bad news is that we have a lack of studies
that can explain the impact on ED
Overcrowding!
10. ED Overcrowding
Reduces
• Health Care Quality
• Patient Safety
• Patient Mortality
• Failure to receive
antibiotics and
analgesic medications
• Adverse events such as
hospital acquired
pneumonia and
pulmonary embolisms.
Research
• Use existing capacity
more efficiently.
• Improve internal
processes.
• Resources
Joint Commission
IHI
RWJF Urgent Matters
ACEP
11. When is a Rapid Admit Unit
Needed?
• ED is overcrowded
• Boarding patients
• Long waits for inpatient beds
• Patient satisfaction decreases
• LWBS numbers increase
• Staff satisfaction decreases
12. How to Sell The Idea
• Holdover hours
• Capacity/Code Purple status
• LWBS
• Satisfaction
• Identify and optimize/profitize an area with
low utilization
13. What is and isn’t a Rapid
Admit Unit?
• Not an Observation Unit.
• Clearly delineates responsibility
for patient care between the
emergency department
physicians and admitting
physician.
14. What is Needed to Create a
Rapid Admit Unit?
• Support from administrative team
• Support from Medical Staff
• Physical space outside the ED
• Determine number of beds
• Staffing
• Skill mix
• Orientation
15. Involve Other Departments
• Finance
• How will you charge these patients?
• Dietary
• Pharmacy
• Environmental
• Security
• Volunteers
• Hospital operators
• Admitting
• #1 department to involve: IT
17. Inclusion/Exclusion Criteria
Types of patients
• Medical/ telemetry
• Direct admits
• ICU patients
• Isolation
• Geriatric Patients
• Pediatric Patients
• Hours of service
18. Standards of Care
• Admission procedures
• Transfer / Discharge procedures
• Documentation guidelines
• Customer Service Guidelines
19. Quality Monitors
• Types of patients
• Levels of service
• Satisfaction ( both inpatient and
emergency)
• Incident reports
• Staff feedback
• LWBS
• Door to Doc Time
21. Measuring Success
• Decrease ED wait times
• Decrease LWBS
• Improve Patient Satisfaction
• Improve Staff Satisfaction
• Reduce Medical Errors
• Improve Quality and Safety
22. 2011 ED Patients Triaged, Not Seen
25
35
21
36
39
27
28
35
38 38
21
8
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec
Numberofpatients
GOOD
23. 2011 Total ED VISITS
4140
3943
4493
3916
3875 3787 3785 3723 3657
3776
4071
4226
3693 3620
3921
3485 3415
3104
3259 3192 3112
3334 3332
3582
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec
Numberofpatients
GOOD
TOTAL TARGET
24. Metrics to Measure Success
• Reduction of patient boarding in the ED
• Decrease the Time to Admit Orders
• Improve Patient Satisfaction
• Improve Staff Satisfaction
• Reduction of LWBS
25. Elements of Performance (EP)
Publication of the Joint Commission in
December 2012.
• Standards LD.04.03.11 and PC.01.01.01
are revised standards that address an
increased focus on the importance of
patient flow in hospitals.
• Go into effect January 1, 2013, with two
exceptions: LD.04.03.11, EP’s 6 and 9 will
be effective January 1, 2014.
26. LD.04.03.11
The hospital manages the flow of patients
throughout the hospital.
• EP 1. The hospital has the processes to support
the flow of patients throughout the hospital.
• EP 2. The hospital plans for the care of admitted
patients who are in temporary bed locations, such
as the post anesthesia care unit or emergency
department.
• EP 3. The hospital plans for the care of patients
placed in overflow locations.
• EP 4. Criteria guide decisions to initiate
ambulance diversion.
27. LD.04.03.11 continued
EP 5. The hospital measures and sets goals for the components
of the patient flow process including:
• The available supply of beds
• The throughput of areas where patients receive
care, treatment and services ( such as inpatient
units, laboratory, operating rooms, telemetry, radiology and
PACU).
• The safety of areas where patients receive care, treatment
and services.
• The effeciency of the nonclinical services that support patient
care and treatment ( such as housekeeping and
transportation).
• Access to support services ( such as case management and
social work).
28. LD.04.03.11 continued.
Effective January 1, 2014
• EP 6. The hospital measures and sets
goals for mitigating and managing the
boarding of patients who come through the
emergency department.
– it is recommended that boarding timeframes
not exceed 4 hours in the interest of patient safety
and quality of care.
29. Conclusion – putting it all together!
• Create your project team.
• Assess and map your current process.
• Define your guiding principles:
“design a rapid admit unit.”
• Develop initial draft and solicit feedback
from staff members.
• Implement and Evaluate the plan.
• Sustain and Continue to Improve!
30. Next Steps
• Evaluate other processes. Involve other
departments Such as Admitting, Customer
Service, Inpatient Nursing Units.
• Sustain the Gains! Share data immediately
and regularly.
• Continue to assess the process. Measure
different aspects of this process to
eliminate boarding times.
32. References
• Amarasingham, R., Swanson, T. S., Treichler, D. B., Amarasingham, S. N., & Reed, W. G. (2010). A rapid
admission protocol to reduce emergency department boarding times. Quality and Safety in Health
Care, 19, 200-204. doi:10.1136/qshc.2008.031641
• Burley, G., Bendyk, H., & Whelchel, C. (2007). Managing the storm: an emergency department capacity
strategy. Journal for Healthcare Quality, 29, 19-28. doi: 10.1111/j.1945-1474.2007.tb00171.x
• DeLia, D., & Cantor, J. C. (2009, July 17). Emergency department utilization and capacity (Research
Synthesis Report. No. 17). Princeton, NJ: Robert Wood Johnson Foundation. Retrieved from
http://www.rwjf.org/pr/product.jsp?id=45929
• Liew, D., Liew, D., & Kennedy, M. P. (2003). Emergency department length of stay independently predicts
excess inpatient length of stay. Medical Journal of Australia, 179, 524- 526. Retrieved from
http://www.mja.com.au
• Liu, S. W., Thomas, S. H., Gordon, J. A., & Weissman, J. (2005). Frequency of adverse events and errors
among patients boarding in the emergency department. Academic Emergency Medicine, 12(Suppl. 1),49-
50. doi:10.1111/j.1553-2712.2005.tb03828.x
• Richardson, D. B. (2006). Increase in patient mortality at 10 days associated with emergency department
overcrowding. Medical Journal of Australia, 184, 213-216. Retrieved from http://www.mja.com.au
• Viccellio, P. (n.d.). Our environment: The silent issue (PowerPoint presentation). Retrieved January
22, 2013, from http://www.hospitalovercrowding.com
• Weiss, S. J., Ernst, A. A., Derlet, R., King, R., Bair, A., & Nick, T. G. (2005). Relationship between the
National ED Overcrowding Scale and the number of patients who leave without being seen in an
academic emergency department. American Journal of Emergency Medicine, 23, 288-294. doi:10.1016/
j.ajem.2005.02.034
Super Track is located in or near triage for the purpose of promptly treating patients who require very low resource utilization. Both of these programs are models for low acuity patients.
Increase in ED visits
Lack of clinical staff
Where are our researchers?
Changed initial caps in bullet list entries, turned around phrasing in third and fourth bullet items
Safety/ Quality / Capture Costs by patients not LWBS or patients going to other hospitals / IT is the new JC regs!Removed the question mark, changed capitals, fiddled text of last item
Not an extension of the EDNot run by ED MD
Orientation. Staff need to know how to document on inpatient/ charges/ familiar with the area/ Protocols/
beds? Curtains? IV poles and stuff? Blood pressure cuffs? THERMOMETERS? Linen
Patients on dripsChanged capital letters
How are you going to treat these patients?Who manages/is responsible for ensuring people follow these procedures?
Start tracking these/ Get your IT department to generate a report for you. Daily census and LOS. What kind of patietns are you admittinf, what units? Age groups etc. This information can assist your administrative team to see where the gridlocks are…
We had no additional costs. We got approval for 2 temporary nurses to staff the unit. We used Relief staff both secretary and EMT’s to work as ancillary/ transporters etc. We had a job description for each staff.
With more patients using our emergency services we need to be creative and find ways to better manage our services.
Fixed all the entries, resequenced into alpha order, changed capital letters