This document summarizes strategies for emergency department clinicians to improve efficiency and patient flow. It discusses organizing the ED to maximize situational awareness and relationships with staff. Clinicians are advised to start shifts strong by seeing patients quickly early on. Improving documentation, such as using templates and dictation, and playing well with others by understanding nursing roles are also covered. The document recommends focusing on value-added activities, avoiding distractions, and improving end-of-shift handoffs to finish shifts efficiently. Self-care strategies like recognizing personal stress levels and boundaries are also presented.
How to improve patient flow in emergency and ambulatory care, pop up uni, 10a...NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
We are all engaged in a hospital-wide a system of
patient flow or patient care. We are each part of the
whole. The emergency department is connected
to the ICU. The ICU is connected to the OR. The
discharge and discharge processes are connected
to our admission capabilities and capacity. It’s
like the “Dry Bones” song you learned as a child,
“The foot bone’s connected to the leg bone, the
leg bone’s connected to the knee bone, the knee
bone’s connected to the thigh bone” and so forth.
Overall flow, or “the system,” can only be improved
by applying several key strategic concepts to these
disparate but equal parts.
How to improve patient flow in emergency and ambulatory care, pop up uni, 10a...NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
We are all engaged in a hospital-wide a system of
patient flow or patient care. We are each part of the
whole. The emergency department is connected
to the ICU. The ICU is connected to the OR. The
discharge and discharge processes are connected
to our admission capabilities and capacity. It’s
like the “Dry Bones” song you learned as a child,
“The foot bone’s connected to the leg bone, the
leg bone’s connected to the knee bone, the knee
bone’s connected to the thigh bone” and so forth.
Overall flow, or “the system,” can only be improved
by applying several key strategic concepts to these
disparate but equal parts.
Increase quality, decrease stress in a hospital - Pieter E. Buwalda & Gijs An...commonsenseLT
Pieter E. Buwalda, Manager Hospital Operations Programs, Nij Smellinghe Hospital in Drachten (The Netherlands) &
Gijs Andrea, Consultant, implementor, trainer at House of TOC, Education Implementation Management Consultancy (The Netherlands) @ TOCICO International Public Sector Effectiveness Conference 2013 Vilnius
- How to improve the quality of healthcare services using managerial tools.
- How to improve the quality of care AND decrease the workload on nurses and doctors with the same amount of patients treated.
- How to decrease occupation of beds?
- How to decrease length of stay?
More information - http://pse.lt
Simulation modeling of pre/post bed needs for an Interventional PlatformSIMUL8 Corporation
Architect Frank Zilm discusses how simulation software was used to explore the implementation of an interventional platform concept, integrating surgery, cardiac procedures, interventional radiology and endoscopy services, at Saint Louis University Hospital.
Enhancing the performance of public healthcare systems: achieving more with e...commonsenseLT
Shimeon Pass, expert in Value Enhancement and implementation of advanced management concepts (Israel) @ TOCICO International Public Sector Effectiveness Conference 2013 Vilnius
- Dealing with the complexity of the full scale hospital.
- How can we better synchronize the in-coming stream of patients (from the ER to the internal medicine wards) with the release of patients from wards?
- How do we eliminate the wasted time of physicians and nurses?
- The complete kit concept in ORs, imaging clinics, admission processes and requests for expert opinion.
- Time-based control over the progress of the treatment plan.
- How do we eliminate unnecessary (and risky) waiting times of patients?
More information - http://pse.lt
Experience with the implementation of the WHO checklist and briefing in the operating theatre. Krishna Moorthy. IV Internacional Conference on Patient Safety. (Madrid, Ministry of Health and Consumer Affairs, 2008)
Presenter: Dr Paul Schmidt, Consultant Physician in Acute Medicine, Portsmouth Hospitals NHS Trust
Managing unscheduled care is high on the agenda of many health systems worldwide due to a focus on reducing hospitalizations, re-admission rates, and costs.
Guest speaker Dr Paul Schmidt, explored how simulation is being used to model a new operational strategy for unscheduled care at Portsmouth Hospitals NHS Trust, UK.
Using real life examples, we described an unscheduled care system in more detail including:
- Key challenges for unscheduled care operations
- Principles of a rational operational strategy (patient centered services, queues, lean principles etc.)
- Key stakeholder considerations (patient flow, bed capacity, staffing etc.)
- Modeling approach
- Outcomes and Lessons
Increase quality, decrease stress in a hospital - Pieter E. Buwalda & Gijs An...commonsenseLT
Pieter E. Buwalda, Manager Hospital Operations Programs, Nij Smellinghe Hospital in Drachten (The Netherlands) &
Gijs Andrea, Consultant, implementor, trainer at House of TOC, Education Implementation Management Consultancy (The Netherlands) @ TOCICO International Public Sector Effectiveness Conference 2013 Vilnius
- How to improve the quality of healthcare services using managerial tools.
- How to improve the quality of care AND decrease the workload on nurses and doctors with the same amount of patients treated.
- How to decrease occupation of beds?
- How to decrease length of stay?
More information - http://pse.lt
Simulation modeling of pre/post bed needs for an Interventional PlatformSIMUL8 Corporation
Architect Frank Zilm discusses how simulation software was used to explore the implementation of an interventional platform concept, integrating surgery, cardiac procedures, interventional radiology and endoscopy services, at Saint Louis University Hospital.
Enhancing the performance of public healthcare systems: achieving more with e...commonsenseLT
Shimeon Pass, expert in Value Enhancement and implementation of advanced management concepts (Israel) @ TOCICO International Public Sector Effectiveness Conference 2013 Vilnius
- Dealing with the complexity of the full scale hospital.
- How can we better synchronize the in-coming stream of patients (from the ER to the internal medicine wards) with the release of patients from wards?
- How do we eliminate the wasted time of physicians and nurses?
- The complete kit concept in ORs, imaging clinics, admission processes and requests for expert opinion.
- Time-based control over the progress of the treatment plan.
- How do we eliminate unnecessary (and risky) waiting times of patients?
More information - http://pse.lt
Experience with the implementation of the WHO checklist and briefing in the operating theatre. Krishna Moorthy. IV Internacional Conference on Patient Safety. (Madrid, Ministry of Health and Consumer Affairs, 2008)
Presenter: Dr Paul Schmidt, Consultant Physician in Acute Medicine, Portsmouth Hospitals NHS Trust
Managing unscheduled care is high on the agenda of many health systems worldwide due to a focus on reducing hospitalizations, re-admission rates, and costs.
Guest speaker Dr Paul Schmidt, explored how simulation is being used to model a new operational strategy for unscheduled care at Portsmouth Hospitals NHS Trust, UK.
Using real life examples, we described an unscheduled care system in more detail including:
- Key challenges for unscheduled care operations
- Principles of a rational operational strategy (patient centered services, queues, lean principles etc.)
- Key stakeholder considerations (patient flow, bed capacity, staffing etc.)
- Modeling approach
- Outcomes and Lessons
Problems that you can solve with clinical rotation scheduling softwareRotation Manager
>> Allied Health and Nursing Problems That You Can Solve With Clinical Rotation Scheduling Software.
>> Simplifies the Scheduling Process.
>> Inaccurate Documentation And Mismanaged Clinical Rotations.
>> Solves Compliance Problems.
>> It Benefits All The Parties.
>> How To Organize an Effective Nursing Clinical Rotation Schedule.
>> Be Bold.
>> Have The Right Perspective.
>> Ask Questions.
>> Research what you don’t know.
>> Seek Learning Opportunities.
>> Practical Tips to Help You Excel During a Nursing Student Clinical Placement.
>> Visit The Facility Beforehand.
>> Keep Time.
>> Don’t Put Demands.
>> Take A Tour Of The Place.
>> Show Interest.
>> Be Ready To Do Any Work.
>> Don’t Be Afraid To Say No.
TOC 2011: Content as Application, presented by Reid SherlineSilverchair
Content as Application: Integrating Medical Books into the Healthcare Workflow. Presented at TOC 2011 by Reid Sherline, Vice President of Publishing for Wolters Kluwer Health, Professional and Education
An in-depth look into the life of a medical assistant. We explore the opportunity and growth potential for the health care industry and specifically for the career as a medical assistant.
Clinical DocumentationAt the IOP Paxcampus, my onl.docxbartholomeocoombs
Clinical Documentation
At the IOP Paxcampus, my only documentation is Client notes after shadowing Therapist in groups, or myself when I run group and I now am the trainee therapist on MONDAY’s only for women gender group where anything is discussed amongst women. Like PMS’ing while recovering, Relapse in/women when you are PMS’ing, codependency, depression, anxiety, fear. These notes have to be
Include a de-identified example of your documentation in this week’s paper (e.g., progress note, treatment plan).
NO REFERENCES writing on paper like you work everyday
Answer Highlighted Questions in paper.
No References, make it personal.
Clinical Documentation IOP
Topic #3:
Clinical Documentation
What are your various documentation responsibilities at your site? Groups for Women only on Mondays with a Therapist shadowing me. Student shadowing the therapist on Wednesday and Friday.
What are some of the easiest aspects of documentation? Listening etc.
What are some of the difficult aspects of documentation? When clients leave the room for U/A or One-on-One Therapy Session etc.
Include a de-identified example of your documentation in this week’s paper (e.g., progress note, treatment plan). 1. give the topic of the group, 2.write a progress note, 3.write a summary from therapist professionally.
Meet with Supervisor once a week. Tuesday or Thursday sometimes after group if she has time.
1. To discuss what you are going to talk about in Monday meeting with clients, show her a plan on paper,
2. To discuss weakness and strengths.
Clinical Documentation IOP
Introduction
Clinical documentation is the process by which a patient’s medical or therapy process is noted down in terms of the diagnosis as well as the medication and healing process. At The PAX Campus, Intensive Out Patient, I have realized that clinical documentation has the following responsibilities like daily detailed group notes, based on my interactions:
The prompt is: "What are your various documentation responsibilities at your site?" What are some of the various documents you complete at your site? group notes, Group summary by Therapist (trainee), Emails etc.
First is that it enables the center to prepare in advance, whenever a patient is to be registered for an Outpatient program, I have realized that there is the need for the facility to understand whether they can handle the case successfully or efficiently. This, therefore, means that the referral source must send the information to assigned staff and hence they will review and give a feedback within a period of seven days. This procedure is referred to as Prior Authorization.
What are your documentation responsibilities at your site in reference to Prior Authorizations? None,I am still in training. What do you have to document? Group Notes How do you get the information? By taking notes, shadowing Group Therapist. From whom? How is it to be written? Professionally Hence this type of documentation enables.
"12 Steps to Better Healthcare" is filled with ideas that you can use right away to improve the efficiency and effectiveness of your healthcare organization. These steps can help you save time, money and lives, as you take part in the rebuilding of our healthcare system from the ground up.
A medical error is a preventable adverse effect of care, whether or not it is evident or harmful to the patient. This might include an inaccurate or incomplete diagnosis or treatment of a disease, injury, syndrome, behavior, infection, or other ailment.
Looking to improve your sales presence? Take a look at yourself from a Doctor's perspective! I have written these analogies as a self-reflection and wanted to share!
The Future of OB Hospitalist Programs: The Unexpected DeliverablesEmCare
You might expect that with an OB hospitalist onsite 24/7, hospitals are better equipped to manage obstetric and gynecologic care and emergencies, providing the ultimate in patient safety while reducing liability and risk. That’s true. But there are unexpected benefits as well.
Wayne L. Farley, Jr., D.O., FACOG, presents “The Future of OB Hospitalist Programs: The Unexpected Deliverables.” This webinar was September 21, 2016, hosted by Becker’s Hospital Review.
Alexander Strachan, Jr., MD, MBA, and Asim Usman, MD, of EmCare Hospital Medicine, discuss bundled payments for care improvement (BPCI) and how hospitalists are leading the charge.
Originally presented May 4, 2016, as a webinar in partnership with Becker's Hospital Review.
PowerPoint: Practical Approaches to Improving Patient Pre-Op PreparationEmCare
Michael Hicks, MD, MBA, FACHE, CEO of EmCare Anesthesia, and Lisa Kerich, PA-C, VP of Operations for EmCare Anesthesia, provide expert advice for improving the performance of your O.R. through an integrated, collaborative approach. Learn how Pre-Anesthesia Testing (PAT) clinics are being used successfully to improve patient readiness, surgeon satisfaction and financial performance.
Originally presented Sept. 17, 2015, as a webinar in partnership with Becker's Hospital Review.
Hardwiring Hospital-Wide Flow To Drive Competitive PerformanceEmCare
Thom Mayer, MD, FACEP, FAAP and Kirk Jensen, MD, MBA, FACEP, authors of “Hardwiring Flow” and “The Patient Flow Advantage, " share their secrets for streamlining processes, changing behaviors, and achieving sustainable advances in hardwiring flow throughout your hospital system.
This presentation is an abridged version of the webinar that Drs. Jensen and Mayer delivered July 9, 2015, in partnership with Becker's Hospital Review.
How one Hospital Shaved Off 88 Minutes from their ALOSEmCare
With goals of getting the right processes and staffing in place, the administration and staff at LewisGale Medical Center in Salem, Virginia put a priority on patient-centered process improvements that would shorten wait times and length of stay in the emergency department (E.D.). Here’s how they improved metrics including decreasing the ED ALOS by 45 percent.
Efficiency in the emergency department is always at the forefront of the minds of hospital leaders -- and for good reason. The infographic below reveals the true cost of inefficiency in the emergency department when it comes to patients who leave without treatment (LWOT) and why hospitals can't afford to leave this issue unaddressed.
OPERATIONAL INTEGRATION: CREATING A HIGH-PERFORMING HEALTHCARE ORGANIZATIONEmCare
What strategies are in your arsenal to combat and conquer the thorny challenges
of healthcare reform? Reducing costs? Improving quality, productivity and efficiency? Redesigning processes? Improving the patient experience? Transforming your organization from one that delivers episodic sick care to one that nurtures wellness and personal responsibility is daunting, but absolutely necessary. While consultants
have prospered by touting the “solution-of-the-day,” a handful of approaches have gained traction. One of those is clinical integration.
Learn how Methodist Richardson Achieved Fastest Total Patient Treatment Time ...EmCare
Methodist Richardson Medical Center (MRMC) and the Richardson Fire Department (RFD) were recognized by the American Heart Association for having the fastest total combined patient treatment time for cardiac events for the first quarter of 2011 for the state of Texas.
Learn how a shift in processes, leadership and culture to an integrated solution can put your hospital on track to achieve improved clinical outcomes, metrics and patient experiences, each of which can have a potentially dramatic financial impact.
[HOW TO] Create High Performance Emergency DepartmentsEmCare
EmCare’s latest White Paper on implementing a system-wide approach to providing emergency care. At Baylor Health Care System, the initiative has fostered the development of numerous approaches to managing the challenges faced by its emergency departments, including an innovative protocol to manage overcrowding at the system’s flagship facility.
Proven Techniques to Boost Lean Implementation in Your Emergency DepartmentEmCare
Six facilities of a national hospital chain located in the Southeast United States teamed up with EmCare® to review recent best practice publications, incorporate individual ideas, implement changes, modify processes and develop a standard best practice recommendation for efficient, quality ED care. The main goal was to satisfy the patient’s primary need in presenting to an ED – the desire to see a physician as soon as possible.
The concepts herein have been proven to work in various size and volume EDs. The following chart outlines the descriptions of the six facilities involved in this effort.
Much has been written in the business literature about managing the waiting experience. Federal Express has noted that “waiting is frustrating, demoralizing, agonizing, aggravating, annoying, time consuming, and incredibly expensive.” We intuitively know this from our own experience as well as from our patients. In this #ACEP13 presentation, Dr. Jensen gives practical tips to improve your patients' ED experience.
This Genesis Cup 2012 runner-up presentation by Medical Director, Harry "Tripp" Wingate, MD and Shayne Middleton, RN, RDCS describes the process used at EMH ED to “flip” the complaint to compliment ratio – a crude measure of customer service performance in a rural ED. The presentation details steps from training on AIDET to the key issues in providing effective feedback to ED staff. Special emphasis is given to the tricky issue of email communication and compliance with HIPAA. New web-based tools (WinZip.com and MyFax.com) for safe email communication are introduced to the audience with comments on benefits and usage.
In 2011, we took it upon ourselves to break down our patient care and examine it from the time the patient arrived (regardless of method) to the time they departed (again, regardless of method). Over the next year, we developed and implemented an end-to-end strategy of patient care and flow, where all decisions were under the scrutiny of what was deemed to be ‘patient-centric’. This process of self-improvement led us to develop a scalable, replicable template for hospitals of all shapes and sizes. Too often, patient flow hurdles and patient care problems are addressed solely through the vantage of individual departments at the expense of efficiency. Our presentation is the result of a personal, real-time experience.
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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
For Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #Girls
Fast and Efficient Practice: The Emergency Department Clinician on the Emergency Department Autobahn
1. WHITE PAPER
Fast and Efficient Practice:
The Emergency Department Clinician on the Emergency Department Autobahn
BY:
Kirk B. Jensen, MD, MBA, FACEP
Content
What Matters Most in Your ED?
The ED Physician Roles
Flow in the ED
Taking a Higher Look at the ED Clinician
and Clinical Work
Readings to Change Your Practice
To-Do’s
3. FAST AND EFFICIENT PRACTICE: THE EMERGENCY DEPARTMENT CLINICIAN ON THE EMERGENCY DEPARTMENT AUTOBAHN
Introduction................................................................................................................................................. 2
What Matters Most in Your Emergency Department?.................................................................................. 3
Flow and the Emergency Department.......................................................................................................... 4
Start Strong.................................................................................................................................................. 4
Organize the ED to Work Effectively With You and For You....................................................................... 4
Improve Documentation.............................................................................................................................. 5
Play Well with Others ................................................................................................................................. 6
Finish Strong................................................................................................................................................ 6
Taking a Higher Look at the ED Clinician and Clinical Work..................................................................... 6
Recommended Reading................................................................................................................................ 8
To Dos......................................................................................................................................................... 9
About the Author...................................................................................................................................... 10
References................................................................................................................................................. 11
Contact..................................................................................................................................................... 14
4. INTRODUCTION
Patient safety and satisfaction are the focus
within any emergency department. To streamline
navigation on the ED autobahn, i.e., flow, and
thus accomplish these goals most efficiently
can be accomplished by the consideration of
several factors and the application of several
key techniques.
2 |
5. FAST AND EFFICIENT PRACTICE: THE EMERGENCY DEPARTMENT CLINICIAN ON THE EMERGENCY DEPARTMENT AUTOBAHN
What Matters Most in Your
Emergency Department?
Most people would say it is taking care of your
patients; and this is true. But let us look a bit deeper.
While a fast, efficient, and effective emergency
department means greater patient safety and greater
patient satisfaction, you have to take care of your team
and you have to take care of yourself. Finding the
place where all three come together is the sweet spot
that we strive for. That is why it is critical to optimize
flow – important for your patients, your team and
yourself.
85 percent of their time waiting. We do not want to
cut down on the 15 percent of our time spent with
patients; we want to improve and streamline our
processes. We want to be fast at fast things and slow
at slow things. Fast and efficient is not about racing
through everything. We can only go as fast as the
slowest processes in the ED.
TRIAGE
PLACEMENT
TRIAGE AND REGISTRATION
MD
IN THE ED
CALL FOR BED OR DISCHARGE
TEST AND TREAT
EXIT ED
DISPOSITION DECISION
TO EXIT THE ED
ROOM UTILIZATION
There are opportunities to improve flow and
throughput throughout the life cycle of an emergency
department visit:
The three most important drivers of human behavior
are love, money and fear. There are days you show up
for work because you love it and wouldn’t want to be
anywhere else. There are days you show up because
you don’t want to let your team down. And there are
days you just want to earn your paycheck. Being a
good emergency physician means you need to think
through why you’re doing this and what it’s all about
for you.
There are three major dimensions to what an
Emergency Department physician does: Doctoring,
Deciding and Documenting. Patients spend 15
percent of their time receiving direct patient care and
• Leverage your clinical talent. Clinical talent
should be roving intellects engaged in value-added
activities at all times.
• Hire right (or repent at leisure)
• Optimize the physician, mid-level and nursing mix
and consider the use of scribes.
• Find the right clinical support mix for the team.
• Tailor the clinical hours and staff to the facility
and to patient flow.
• Have your A-team on the floor at all times.
The role of the clinical staff is to make diagnostic
and treatment decisions and to manage the team
and patient flow. Anything else is a non value-added
activity. To truly understand this, try this exercise in
your ED: take a 3 by 5 note card and write down in
five-minute intervals what you are actually doing for a
whole day or clinical shift (or only for one hour!) See
how much of your time is actually spent on valueadded activities, how much of what you did could and
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6. “We are what we repeatedly do.
Excellence is not an act, but a habit.”
~ Aristotle
should be done by a physician and only a physician
(substitute “mid-level practitioner” or “nurse” as the
situation requires), and how much of what you do or
did should or could have been offloaded to someone
else in your system or on your team, or perhaps,
should not have been done at all.
Flow and the
Emergency Department
• Start strong
• Organize the ED to work effectively
with you and for you
• Improve documentation
• Play well with others
• Finish strong
Start Strong
The first part of starting strong is getting prepared
before you start. Take a few moments to get organized
and mentally prepared. Bring your meals with you.
Get there early. Work hard early in your shift; it sets
the tone for the rest of your day. Let’s say your goal is
4 |
to see 20 patients in a 10 hour shift at an average of
two-plus patients an hour. Many times you can get
five to ten patients started within the first hour. The
less “batch and queue” you have, the better off service
delivery is for everybody.
Organize the ED to Work
Effectively With You and For You
You are the captain of your ship.
Position yourself near a place where the patients
and their charts enter the emergency department.
This is called situational awareness. Good situational
awareness means you will know when patients are
coming in to the ED, when family members are
arriving, and who needs what kind of treatment.
Putting yourself where you can keep your eyes on
the entire emergency department is powerful and
effective.
Evaluate patients as the charts are
“put into the rack.”
Find the flow that works for you. Put your hands and
eyes on the charts or carry a patient log. It allows you
7. FAST AND EFFICIENT PRACTICE: THE EMERGENCY DEPARTMENT CLINICIAN ON THE EMERGENCY DEPARTMENT AUTOBAHN
to organize your day and have the information you
need when you need it.
Develop good relationships with your attending
physicians and call them early.
Make the unit clerk your best friend.
Get the family members involved early.
A good unit clerk (unit coordinator) knows exactly
what is going on in the ED at all times. They can keep
you and your ED humming. They can remind you of
the chest X ray you wanted, the surgical consultant
that you need, the hours when Dr. Smith is in the
hospital or outside the hospital. The unit clerk and the
charge nurse are far and away your most important
allies when it comes to keeping the ER running
smoothly and effectively.
They play a critical role in the relationship. They
can be a valuable source of information. They will
certainly play a role in your disposition plans.
Sign out safely and effectively.
Personally sign out to your patients when you go offshift. Let them know that you are leaving and you are
handing over the patient’s care to your partner. It’s the
right thing to do – it’s good for you, your patients,
Recognize what you can do by and for yourself.
Don’t batch charts. Seeing patients one at a time is
seldom the most effective approach. On the other
hand, batching five or six charts isn’t either. It’s like
the “pig going through the proverbial python.”
Batching loads up and temporarily overloads your
system and your processes. Figure out what the
optimal blend is for you and your department.
Usually it’s two or three charts or patients at a time.
Avoid serial workups.
Sit down.
and your team.
Patients think that you spend twice as much time with
them when you sit down. It’s easy on your knees, it’s
easy on your back, it puts you at eye level with your
patients, and it doubles the amount of time they think
you have been spending with them.
No counting down.
Ask the key questions right up front – don’t wait until
the end of your patient encounter. Engage family
members as well.
Improve Documentation
There will be days you show up in the ER and are
counting down from the first hour. It happens. But
we are professionals, and professionals perform even
when they don’t feel like it.
“I just don’t understand why an emergency department
physician would go to all that trouble to do the work and
not take the few extra minutes to get paid for it.”
~ Mel Gotlieb
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8. Documentation is important. It may not be the
most mentally rewarding thing you do but it can be
the most financially rewarding thing that you do.
Write succinctly and legibly. Bad writing can lead to
inadequate records and even medical errors. Hire a
scribe. Once you’ve used a scribe, you will probably
never want to go back to your previous ways of
delivering patient care. Other ways of improving
your documentation include utilizing templates for
routine charting work, using dictation for important
to make their lives easier and/or better. Then actually
listen and adjust your behavior accordingly.
To knock it completely out of the park, spend 2-4
hours working in triage. You only have to do this once
at the hospital you are working in and it will last you
the rest of your career. You are “the doc who worked
triage,” the doc who “understands what it’s really like.”
Spend 4-8 hours actually working as a nurse. It will
significantly change your point of view as to how your
ER actually works – and it really sets you up with the
nursing staff.
Finish Strong
parts of the history and physical exam, and organizing
discharge instructions.
Play Well with Others
It is critically important to your work and
performance to work effectively with your nursing
staff. Learn their names. Know their individual and
team practice patterns. Invite them in as part of your
team, learn how they work, understand their hopes
and fears – these are all vital to your success and
effectiveness.
If you really want to be the emergency department
physician of the year, ask your nurses what you can do
6 |
Know your best practices for end of shift
management. This means you probably shouldn’t
batch charts. Be careful with handoffs. You do not
want to stop seeing patients four hours before the end
of your shift, and at the same time, you want to hand
off as few patients as possible. Treat your colleagues
the way you would like to be treated.
Negotiate pain medicine needs yourself. Do not
expect the nurse to do it.
Check for allergies.
When you are seeing patients who have a medical
background, ask them, “What do you think is wrong?
What do you want me to check for? What treatments
do you need or want or expect?”
Address service complaints immediately and on the
spot. It’s easier, quicker and better for everyone in the
long run.
9. The “Swiss Cheese” Model
Hazzards
Other holes due to latent conditions
Successive layers of defenses
Taking a Higher Look at the ED
Clinician and Clinical Work
Ask yourself: are you really superman or superwoman?
Or can you aim for just being somebody with the
“right stuff.” Somebody who can take on the mission
and carry it through with equanimity, decisiveness,
grace and humor?
Take care of yourself.
Taking care of yourself is vitally important. If you
don’t, who else is going to do it? Know your stress
tolerance levels. Know your behaviors. When you
know how you behave under stress and stressful
situations you understand how to better mitigate
the effects of stress – on yourself and on your
relationships.
Remember the importance of the other things in
your life.
Eat, sleep, exercise, and nurture your relationships.
Learn to juggle well. Know what drives you, whether
it’s love, money, fear or something else. Learn
the importance of the little things that make you
operationally effective and the importance of the big
things like taking care of yourself and taking care of
your team, as well as taking care of your patients.
Learn not to think too much.
As Henry Ford once said, “Thinking is the hardest
work there is, which is the probable reason why so
few people engage in it.” Your goal as an emergency
physician or an emergency clinician in training was
to actually get to the point where you did not have to
think too much. Lucian Leape, in his article “Error
in Medicine,” points out that the more expert you
are, the less you really have to think. It’s more about
pattern recognition. When you really have to think,
it’s intense and time-consuming. What we consider
thinking is often just selecting the appropriate
diagnostic and treatment pattern from our memory,
then making sure that the selected pattern is
successfully executed and that it works as planned.
Multitasking makes you stupid.
A study at Carnegie Mellon University found that
doing several things at once reduces the brain power
a person can devote to each task. Sometimes we don’t
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10. have a choice. Sometimes we have to multitask. But
understand the consequences. Teenagers can drive a
car, dial a cell phone and IM simultaneously faster
than adults can, but they can’t recognize the danger up
ahead as well as your mature and savvy brain can (the
one focused primarily on driving, situation awareness,
and threat recognition, not the teenage brain totally
absorbed with a cell phone, talking with passengers,
and instant messaging). Learn where, when, and how
you can control or limit your need to multitask.
Be familiar with James Reason’s operational model
for institutional error, or the “Swiss cheese” model for
error. (See above)
It is seldom one “mistake” or one “slip” that gets you
in trouble. It is the summation of a number of small
errors that will most often get you into trouble.
Avoid interruptions.
A study from the University of Illinois found that
it takes on average 16 minutes and 33 seconds for
a worker interrupted by email to get back to what
he or she was doing. Think through the number
of interruptions that you experience. Emergency
department doctors are interrupted 9.7 times per
hour while office physicians are interrupted 4 times
per hour. It is amazing that we do as well as we do. In
fact, the only reason clinical and operational outcomes
aren’t worse is that you are so good at what you do. It
helps make up for all of this – the interruptions, the
multi-tasking, and the continuous partial attention
paid to multiple patients.
8 |
Recommended Reading
Patrick Croskerry, MD, PhD. has written eloquently
on error management, thinking and what we can do
in the ER to optimize what we do. I would urge you
take the time to review some of these references.
Read the book “The Goal” by Eli Goldratt. It’s a
novel that delineates the Theory of Constraints. After
you read this, you will not walk into an ER without
thinking about the theory of constraints. You won’t
stand in line, walk into a lecture hall, or wait for a
cup of coffee at Starbucks without thinking about the
theory of constraints, dependent events, statistical
fluctuations and how someone could make this
process (and your life) a bit better.
Spend an hour reading the article “Error in Medicine”
by Lucien Leape. It can positively change your life and
your outlook.
“The Psychology of Waiting” by David Maister
(davidmaister.com) will take you through the eight
principles of waiting, what people experience and
think while they are waiting and what you can do. A
cardiology friend who read it ten years ago went back
home to his work and changed his office cardiology
practice. He did not add staff, he did not redo the
building, he did not rank and yank, hire and fire.
He simply changed his processes based on this one
article – and his patient satisfaction survey results
went from worst to first. This is powerful material.
It can be wonderfully effective for you and your
Emergency Department.
11. TO DOS
Discuss your practice profile with a couple of trusted colleagues.
ASK:
– How do you practice?
– What works?
– What could work better?
– What doesn’t work so well?
– What’s it like for you or for the team when I am in the ER?
Have your work patterns observed by a trusted colleague or nurse.
Become a student of others.
– Observe the people who are good or the people whose practices
you admire.
– Spend part of a shift tagging along with them.
– Always look for ways to get better at what you do
(CQI for the individual clinician).
Take a course or two.
Emulate Benjamin Franklin. Ben Franklin worked on one trait a
week. Know your weaknesses and work on one every week.
Remember, we are emergency clinicians.
We can do this.
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14. • Fitzsimmons J., and M. Fitzsimmons. 2006.
Service Management: Operations, Strategy,
Information Technology. 5th ed. Boston:
McGraw-Hill.
• Goldratt, E. 1986. The Goal. Great Barrington:
North River Press.
• Langley GJ, Nolan KM, Nolan TW. The
Foundation of Improvement. Silver Spring, MD:
API Publishing, 1992)
• Institute for Healthcare Improvement (IHI).
Optimizing Patient Flow: Moving Patients
Smoothly Through Acute Care Settings.
Innovation Series 2003.
• “Bursting at the Seams: 2004. Improving Patient
Flow to Help America’s Emergency Departments.”
Urgent Matters Learning Network Whitepaper.
www.gwhealthpolicy.org accessed September 17,
2005.
• Building the Clockwork ED: Best Practices
for Eliminating Bottlenecks and Delays in the
ED. HWorks. An Advisory Board Company.
Washington D.C. 2000.
• Bazarian J. J., and S. M. Schneider, et al. Do
Admitted Patients Held in the Emergency
Department Impair Throughput of Treat and
Release Patients? Acad Emerg Med. 1996; 3(12):
1113-1118.
• Full Capacity Protocol. www.viccellio.com/
overcrowding.htm
12 |
• Kelley, M.A. The Hospitalist: A New Medical
Specialty. Ann Intern Med. 1999; 130:373-375.
• Holland, L., L. Smith, et al. 2005. “Reducing
Laboratory Turnaround Time Outliers Can
Reduce Emergency Department Patient Length of
Stay.” Am J Clin Pathol 125 (5): 672-674.
• Husk, G., and D. Waxman. 2004. “Using Data
from Hospital Information Systems to Improve
Emergency Department Care.” SAEM 11(11):
1237-1244.
• Green LV, Soares J, Giglio JF, et al. Using
queuing theory to increase the effectiveness of
emergency department provider staffing. Academic
Emergency Medicine. 2006. Jan;13(1):61-8.
• Aiken L, Clarke S, Sloane D. Hospital Nurse
Staffing and Patient Mortality, Nurse Burnout, and
Job Dissatisfaction, JAMA, 2002;288(16);19871993.
• Lardner R. Effective shift handover: a literature
review. Health and Safety Executive. June 1996.
Offshore technology report-OTO 96 003.
Available at: http://www.npsf.org/download/
Focus2004Vol7No2.pdf. Accessed February 3,
2006
• Wears RL, Perry SJ, et al. Shift changes among
emergency physicians: best of times, worst of
times. Proceedings of the Human Factors and
Ergonomics Society 47th Annual Meeting;
October 13-17, 2003; Denver, CO.
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• ACEP Patient Safety Task Force. Patient Safety in
the Emergency Department. Dallas, TX: American
College of Emergency Physicians; 2001.
• The Effect of Hospital Occupancy on Emergency
Department Length of Stay and Patient
Disposition. Acad Emerg Med 2003; 10: 127-133
• Perry S. Transitions in care: studying safety in
emergency department signovers. Focus Patient
Safety. 2004;7:1-3. Available at: http://www.npsf.
org/download/Focus2004Vol7No2.pdf. Accessed
February 3, 2006
• Croskerry P. Critical thinking and decisionmaking: avoiding the perils of thin-slicing. Ann
Emerg Med. 2006;48:720-722. Abstract
• Schull et al. Emergency Department Contributors
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Annals of Emergency Medicine 41:4 April 2003;
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• Richardson. The Access Block Effect: Relationship
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Abstract
• Kachalia A, Gandhi TK, Puopolo AL, et al.
Missed and delayed diagnoses in the emergency
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