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Emergency department crowding: A point in time

ANNALS OF EMERGENCY MEDICINE 2003年第2期42卷 167-172页

作者： Schneider, SM Gallery, ME Schafermeyer, R Zwemer, FL Univ Rochester Dept Emergency Med Rochester NY 14642 USA Carolinas Med Ctr Charlotte NC 28203 USA Amer Coll Emergency Phys Dallas TX USA

Study objective: This is a pilot study designed to assess the feasibility of a point prevalence study to assess the degree of crowding in hospital emergency departments (EDs). In addition, we sought to measure the degree of physical crowding and personnel shortage in our sample. Methods: A mail survey was sent to a random sample of 250 EDs chosen from a database compiled by the American College of Emergency Physicians of 5,064 EDs in the United States. In addition to demographic information, respondents were asked to count the patients and staff in their EDs at 7 Pm local time on Monday March 12,, 2001 (index time). Results: The response rate was 36%. At the index time, there was an average of 1.1 patients per treatment space, and 52% of EDs reported more than 1 patient per treatment space. There was also evidence of personnel shortage, with a mean of 4.2 patients per registered nurse and 49% of EDs having each registered nurse caring for more than 4 patients. There was a mean of 9.7 patients per physician. Sixty-eight percent of EDs had each physician caring for more than 6 patients. There was crowding present in all geographic areas and all hospital types (teaching-nonteaching status of the hospital). Consistent with the crowded conditions, 11% of institutions were on ambulance diversion and not accepting new acute patients. Delays in transfer of admitted patients out of the ED contributed to the physical crowding. Twenty-two percent of patients in the ED were already admitted and were awaiting transfer to an inpatient bed;73% of EDs were boarding 2 or more inpatients. The amount of crowding quantified by this point prevalence study was confirmed by the amount of crowding reported for the previous week: 48% of EDs were boarding inpatients during the previous week for a mean of 8.9 hours, 4.2 days per week;31% had been on diversion;59% had been routinely using their halls for patients;38% had been doubling their rooms;and 47% had been using nonclinical space for pa

关键词：病床利用率/统计学和数值数据横断面研究拥挤急诊室医院/统计学和数值数据可行性研究卫生服务研究医院病床数/统计学和数值数据室内设计和家俱/统计学和数值数据住院时间/统计学和数值数据医务人员医院/供应和分配需求估价护理人员医院/供应和分配病人转诊/统计学和数值数据人员配备和时间安排/统计学和数值数据医生行政负责人试点项目前瞻性研究时间因素美国人类

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Public hospital resource allocations in El Salvador: accounting for the case mix of patients

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HEALTH POLICY AND PLANNING 1998年第3期13卷 296-310页

作者： Fiedler, JL Schmidt, RM Wight, JB Univ Richmond Richmond VA 23173 USA

National hospitals in developing countries command a disproportionate share of medical care budgets, justified on the grounds that they have a more difficult patient case mix and higher occupancy rates than decentralized district hospitals or clinics. This paper empirically tests the hypothesis by developing direct measures of the severity of patient illness, hospital case-mix and a resource intensity index for each of El Salvador's public hospitals. Based on an analysis of inpatient care staffing requirements, national hospitals are found to receive funding far in excess of what case-mix and case-load considerations would warrant. The findings suggest that significant system-wide efficiency gains can be realized by allocating hospital budgets on the bases of performance-related criteria which incorporate the case-mix approach developed here.

关键词：病床利用率/统计学和数值数据预算诊断相关患者组/分类诊断相关患者组/统计学和数值数据效率组织萨尔瓦多/流行病学卫生经费支出/统计学和数值数据卫生资源/分类卫生资源/利用卫生服务研究医院公立/经济学医院公立/组织和管理医院公立/利用年患病率人员配备和时间安排/统计学和数值数据疾病严重程度指数人类

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Use of a self-selected scheduling method in a large academic emergency medicine group

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ANNALS OF EMERGENCY MEDICINE 2003年第5期41卷 653-658页

作者： Binder, DS Crandall, CS Hauswald, M Univ New Mexico Dept Emergency Med Albuquerque NM 87131 USA

We describe a method for scheduling shifts in a large academic emergency medicine group. The method starts with a survey of the faculty to assign shift equivalent values to each of the 13 different shifts used during the week. A weekday day shift is assigned a value of 1.0, and the shifts range in value up to 2.1 units. Each faculty member is then assigned a shift allocation for the academic year equally divided among the various shift types. Faculty members can request reallocation of shift types on the basis of the individual shift equivalent values. Once the number of the different shifts are allocated as required by the schedule, a lottery is held whereby individual faculty members choose specific shifts in turn for the upcoming year. The lottery selection is done by the faculty members accessing a common server from their office computers during a specified period. The lottery process continues until all shifts are filled. The creation of shift equivalent values facilitates the initial allocation of shifts and subsequent trades between faculty members.

关键词：医学科学研究中心急诊室医院/统计学和数值数据全体教工医学院校/统计学和数值数据人员配备和时间安排/统计学和数值数据工作负荷量/统计学和数值数据人类

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A study of the workforce in emergency medicine: 1999

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ANNALS OF EMERGENCY MEDICINE 2002年第1期40卷 3-15页

作者： Moorhead, JC Gallery, ME Hirshkorn, C Barnaby, DP Barsan, WG Conrad, LC Dalsey, WC Fried, M Herman, SH Hogan, P Mannle, TE Packard, DC Perina, DG Pollack, CV Rapp, MT Rorrie, CC Schafermeyer, RW Oregon Hlth Sci Univ Dept Emergency Med Portland OR 97201 USA Amer Coll Emergency Phys Irvine CA USA Lewin Grp Falls Church VA USA Mt Sinai Sch Med Dept Emergency Med New York NY USA Univ Michigan Dept Emergency Med Ann Arbor MI 48109 USA St Joseph Hosp Dept Emergency Med Denver CO USA Robert Wood Johnson Univ Hosp Dept Emergency Med New Brunswick NJ USA Amer Coll Emergency Phys Washington DC USA Wesley Long Moses Cone Hosp Dept Emergency Med Greensboro NC USA Baylor Univ Med Ctr Dept Emergency Med Dallas TX USA Univ Virginia Hlth Sci Ctr Dept Emergency Med Charlottesville VA USA Penn Hosp Dept Emergency Med Philadelphia PA 19107 USA Washington Univ Sch Med & Hlth Dept Emergency Med Washington DC USA Carolinas Med Ctr Dept Emergency Med Charlotte NC 28203 USA

Study objective: We estimate the total number of physicians practicing clinical emergency medicine during a specified period, describe certain characteristics of those individuals to estimate the total number of full-time equivalents (FTEs) and the total number of individuals needed to staff those FTEs, and compare the data collected with those data collected in 1997. Methods: Data were gathered from a survey of a random sample of 2,153 hospitals drawn from a population of 5,329 hospitals reported by the American Hospital Association as having, or potentially having, an emergency department. The survey instrument addressed items such as descriptive data on the institution, enumeration of physicians in the ED, and the total number of physicians working during the period from June 6 to June 9, 1999. Demographic data on the individuals were also collected. Results: A total of 940 hospitals responded (a 44% return rate). These hospitals reported that a total of 6,719 physicians were working during the specified period, or an average of 7.85 persons scheduled per institution. The physicians were scheduled for a total of 347,702 hours. The average standard for FrE was 40 clinical hours per week. This equates to 4,346 FTEs or 5.29 FTEs per institution. The ratio of persons to FrEs was 1.48:1. With regard to demographics, 83% of the physicians were men, and 82% were white. Their average age was 42.6 years. As for professional credentials, 42% were emergency medicine residency trained, and 58% were board certified in emergency medicine;50% were certified by the American Board of Emergency Medicine. Conclusion: Given that there are 5,064 hospitals with EDs and given that the data indicate that there are 5.35 FTEs per ED, the total number of FTEs is projected to be 27,067 (SE=500). Given further that the data indicate a physician/FTE ratio of 1.47:1, we conclude that there are 39,746 persons (SE=806) needed to staff those FTEs. When adjusted for persons working at more than on

关键词：美国医院协会证明/统计学和数值数据急救医学/教育急诊室医院实习医师和住院医师职务/统计学和数值数据医务人员医院/标准医务人员医院/供应和分配人员配备和时间安排/统计学和数值数据专业场所/统计学和数值数据前瞻性研究薪金和附加福利/统计学和数值数据美国工作负荷量/统计学和数值数据成年人女(雌)性人类男(雄)性中年人

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Demographic analysis and needs assessment of rural emergency departments in New Mexico (DANARED-NM)

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ANNALS OF EMERGENCY MEDICINE 2002年第4期39卷 456-457页

作者： Sklar, D Spencer, D Alcock, J Cameron, S Saiz, M Univ New Mexico Hlth Sci Ctr Dept Emergency Med Albuquerque NM 87131 USA

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Speech and language therapy caseloads in seven districts in the UK.

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Journal of management in medicine 1999年第1期13卷 23-32页

作者： van der Gaag, A. McLoone, P. Reid, D. Department of Speech and Language Therapy University of Strathclyde Scotland United Kingdom

This paper provides managers and clinicians with an analysis of routine data collected by seven speech and language therapy services in the UK. Managers in seven districts in the UK of varying size and location were asked to provide information on referrals, waiting times and attendances during the six month period, and to give a breakdown of the types of intervention offered and type of clients seen. These data were aggregated and comparisons were made with existing data on speech and language therapy services. The results revealed considerable variations in prevalence, staffing ratios and client management practices. The implications for service planning are discussed.

关键词：人员配备和时间安排/统计学和数值数据转诊和会诊/利用言语疗法/组织和管理言语疗法/统计学和数值数据公费医疗/利用时间和运动研究预约名单工作负荷量/统计学和数值数据男(雄)性

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Human resources management practices and patient satisfaction in home health care

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Home Health Care Services Quarterly 1994年第1期15卷 43-56页

作者： Dansky, Kathryn H. Brannon, Diane Wangsness, Sally Department of Health Policy and Administration The Pennsylvania State University University Park Pennsylvania PA 16802 United States The Pennsylvania State University University Park PA 16802 United States

Patient satisfaction is an important issue for home health providers. This study tested the influence of organizational factors, particularly human resource management practices, on quality of care, as measured by patient satisfaction. Six hundred ninety-six patients of thirteen home health agencies were surveyed to test the influence of organizational factors on five dimensions of patient satisfaction. Organizational variables included size of the agency, staffing characteristics, educational preparation of RNs, continuing education, and compensation. We found that full-time staffing, the number of BSN-prepared RNs, and percent of budget allocated to benefits all predicted high patient satisfaction scores. © 1994 Taylor & Francis Group, LLC.

关键词：数据收集家庭保健机构/组织和管理俄亥俄病人满意度/统计学和数值数据宾夕法尼亚人员管理/标准人员配备和时间安排/标准人员配备和时间安排/统计学和数值数据卫生保健质量/标准卫生保健质量/统计学和数值数据薪金和附加福利/统计学和数值数据人员开发/标准人员开发/统计学和数值数据

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What to do about the nursing shortage

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Hospital Topics 1989年第4期67卷 8-20页

作者： Roberts, Marc J. Harvard University School of Public Health and Kennedy School of Government Boston MA United States Rush Presbyterian St. Luke’s Medical Center Chicago IL United States Columbia University New York NY United States The Curran Group Chicago IL United States

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关键词：数据收集教育护理就业/统计学和数值数据医院市区/人力护理部医院/人力护理人员医院/供应和分配人员管理/统计学和数值数据人员配备和时间安排/统计学和数值数据规划技术社会经济因素美国女(雌)性人类男(雄)性

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Have I been here before?

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The British journal of theatre nursing : NATNews : the official journal of the National Association of Theatre Nurses 1998年第7期8卷 41-42页

作者： Baxter, B. Northwick Park and St Mark's Hospitals. United Kingdom

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Physician Staffing of Small Rural Hospital Emergency Departments: Rapid Change and Escalating Cost

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The Journal of Rural Health 1992年第3期8卷 171-177页

作者： Williamson, Harold A. Rosenblatt, Roger A. Hart, L. Gary Department of Family Medicine School of Medicine University of Washington Seattle United States

We surveyed all 37 rural Washington state hospitals with fewer than 100 beds to determine how rural emergency departments are staffed by physicians and to estimate rural hospital payments for emergency department physician services. Only five hospital emergency departments (14%) were still covered by the traditional rotation of local practitioners and billed on a fee‐for‐service basis. Ten hospitals (27%) paid local private practitioners to provide emergency department coverage. Twelve other hospitals (32%) hired visiting emergency department physicians to cover only weekends or evenings. The remaining 10 rural emergency departments (27%) were staffed entirely by external contract physicians. Thus, 86 percent of rural hospitals contracted for emergency department coverage, and 59 percent obtained some or all of this service from nonlocal physicians. Most of the 32 hospitals with some form of contracted services have changed to this emergency department coverage in the last few years. The cost of these services is high, particularly for the smallest hospitals that have fewer than eight emergency department visits per day and pay physician wages of nearly $100 per patient visit. Emergency staffing responsibility has shifted from local practitioners to the hospital administrators because of rural physician scarcity and a desire to improve quality and convenience. The cost of these changes may further undermine the economic viability of the smaller rural hospitals. Copyright © 1992, Wiley Blackwell. All rights reserved

关键词：合同业务/经济学成本及成本分析/统计学和数值数据急诊室医院/经济学急诊室医院/人力急诊室医院/利用医院病床数 100张以下医院乡村/经济学医院乡村/人力人员配备和时间安排/经济学人员配备和时间安排/统计学和数值数据薪金和附加福利/统计学和数值数据华盛顿人类

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