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A conceptual model of emergency department crowding

ANNALS OF EMERGENCY MEDICINE 2003年第2期42卷 173-180页

作者： Asplin, BR Magid, DJ Rhodes, KV Solberg, LI Lurie, N Camargo, CA Reg Hosp Dept Emergency Med St Paul MN 55101 USA HealthPartners Res Fdn St Paul MN 55101 USA Univ Minnesota Sch Med Dept Emergency Med Minneapolis MN 55455 USA Univ Colorado Hlth Sci Ctr Div Emergency Med Denver CO USA Univ Colorado Hlth Sci Ctr Dept Prevent Med & Biometr Denver CO 80262 USA Univ Colorado Hlth Sci Ctr Clin Res Unit Colorado Permanente Med Grp Denver CO 80262 USA Univ Chicago Hosp Sect Emergency Med Chicago IL 60637 USA HealthPartners Res Fdn Minneapolis MN USA RAND Corp Arlington VA USA Harvard Univ Sch Med Channing Lab Dept Med Boston MA 02115 USA Massachusetts Gen Hosp Dept Emergency Med Boston MA 02114 USA

Emergency department (ED) crowding has become a major barrier to receiving timely emergency care in the United States. Despite widespread recognition of the problem, the research and policy agendas needed to understand and address ED crowding are just beginning to unfold. We present a conceptual model of ED crowding to help researchers, administrators, and policymakers understand its causes and develop potential solutions. The conceptual model partitions ED crowding into 3 interdependent components: input, throughput, and output. These components exist within an acute care system that is characterized by the delivery of unscheduled care. The goal of the conceptual model is to provide a practical framework on which an organized research, policy, and operations management agenda can be based to alleviate ED crowding.

关键词：急性病/治疗病床利用率/统计学和数值数据拥挤效率组织急诊室医院/组织和管理健康计划/组织和管理卫生政策卫生服务易得程度/组织和管理卫生服务研究住院时间/统计学和数值数据模型组织管理需求估价/组织和管理运筹学结果与过程评价(卫生保健)/组织和管理病人入院/统计学和数值数据病人出院/统计学和数值数据研究设计全面质量管理/组织和管理伤病员分拣/组织和管理美国

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Hospital trauma care in multiple-casualty incidents: A critical view

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ANNALS OF EMERGENCY MEDICINE 2001年第6期37卷 647-652页

作者： Hirshberg, A Holcomb, JB Mattox, KL Baylor Coll Med Dept Surg Houston TX 77030 USA Ben Taub Gen Hosp Joint Trauma Training Ctr Houston TX 77030 USA

During a multiple-casualty incident, a large casualty caseload adversely affects the quality of trauma care given to individual patients. From a trauma care perspective, the goal of the hospital emergency plan is to provide severely injured patients with a level of care that approximates the care given to similar patients under normal conditions. Therefore, the realistic admitting capacity of the hospital is determined primarily by the number of trauma teams that the hospital can recruit. Effective triage of these casualties is often not straightforward, with high over-triage rates. Simplified triage algorithms may be a practical alternative to more elaborate schemes. The concept of minimal acceptable care is the key to a staged management approach during a mass-casualty incident. Discrete-event computer simulation and war game tabletop exercises for key personnel are 2 new modalities that are supplementing the traditional mock disaster drill as effective planning and training tools.

关键词：算法计算机模拟决策树救灾计划/组织和管理急诊室医院/组织和管理策略实验性卫生保健公平提供/组织和管理医院病床数在职培训/组织和管理领导多处创伤/治疗医师的作用卫生保健质量创伤学/教育创伤学/组织和管理伤病员分拣/组织和管理工作负荷量人类

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Terrorism and the ethics of emergency medical care

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ANNALS OF EMERGENCY MEDICINE 2001年第6期37卷 642-646页

作者： Pesik, N Keim, ME Iserson, KV Ctr Dis Control & Prevent Natl Ctr Environm Hlth Atlanta GA 30341 USA Univ Arizona Coll Med Arizona Bioeth Program Tucson AZ USA Emory Univ Dept Emergency Med Atlanta GA 30322 USA

The threat of domestic and international terrorism involving weapons of mass destruction-terrorism (WMD-T) has become an increasing public health concern for US citizens. WMD-T events may have a major effect on many societal sectors but particularly on the health care delivery system. Anticipated medical problems might include the need for large quantities of medical equipment and supplies, as well as capable and unaffected health care providers. In the setting of WMD-T, triage may bear little resemblance to the standard approach to civilian triage. To address these issues to the maximum benefit of our patients, we must first develop collective forethought and a broad-based consensus that these decisions must reach beyond the hospital emergency department. Critical decisions like these should not be made on an individual case-by-case basis. Physicians should never be placed in a position of individually deciding to deny treatment to patients without the guidance of a policy or protocol. Emergency physicians, however, may easily find themselves in a situation in which the demand for resources clearly exceeds supply. It is far this reason that emergency care providers, personnel, hospital administrators, religious leaders, and medical ethics committees need to engage in bioethical decisionmaking before an acute bioterrorist event.

关键词：算法决策树急诊室医院/标准急诊处理/标准伦理学医学卫生保健公平提供/组织和管理组织方针病人辩护病人遴选医师的作用恐怖主义伤病员分拣/组织和管理美国人类

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Interobserver agreement in emergency department triage

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ANNALS OF EMERGENCY MEDICINE 2003年第2期41卷 191-195页

作者： Nakagawa, J Ouk, S Schwartz, B Schriger, DL Univ Calif Los Angeles Sch Med Ctr Emergency Med Los Angeles CA USA Univ Calif San Diego Sch Med San Diego CA USA Kaiser Permanente San Diego CA USA

Study objectives: We measure the interobserver reliability of the triage process, examine the effect of vital signs on the triage process, and provide a context for the prior observation of poor interobserver agreement between in-person and telephonic interviews. Methods: We performed a prospective observational study using a randomized crossover design at a university teaching hospital emergency department. Patients were eligible if they spoke English, were not presenting for a reevaluation, and were unlikely to be harmed by the delay created by a second triage interview. Every eligible patient underwent 2 independent, sequential, in-person ED intake interviews conducted by experienced ED triage nurses. After taking a history, each nurse chose 1 of 5 hypothetic triage designations (ED by 911, ED within 2 hours, see a physician within 8 hours, see a physician within 24 hours, or home care-see a physician in >24 hours) and, after being told the patient's vital signs, again selected a designation. Results: Three hundred sixty-three patients presented during the study period: 113 were ineligible, 34 were missed by the investigators, and 15 refused to participate. Nineteen nurses participated in the triage of the 201 study patients. Agreement between 2 in-person designations made without knowledge of vital signs was poor (percent agreement 53%;kappa=0.30;tau(b)=0.50). Knowledge of vital signs did not improve agreement (percent agreement 49%;kappa=0.25;tau(b)=0.45). Conclusion: There was poor interobserver agreement between certified triage nurses using a 5-item triage scale designed for telephonic triage. These findings suggest that only a small portion of the poor interobserver agreement observed in a prior study of telephonic versus in-person triage can be attributed to the use of the telephone.

关键词：交叉研究急诊室医院/组织和管理医院大学/组织和管理洛杉矶护理人员医院观察者偏差前瞻性研究电话伤病员分拣/组织和管理伤病员分拣/标准人类

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Quality management activities in the obstetric triage setting

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JOURNAL OF NURSE-MIDWIFERY 1999年第6期44卷 592-599页

作者： Ament, L Yale Univ Nurse Midwifery Specialty New Haven CT USA

Quality management is the umbrella under which quality assurance, quality improvement, and peer review reside. Although quality assurance monitors structure, process, and outcomes, quality improvement shrives to continually improve care. Ongoing communication among team members and utilization of ancillary resources facilitates an effective quality management program in obstetric (OB) triage. This article describes the components of an OB triage quality management program and its relationship to risk management. (C) 1999 by the American College of Nurse-Midwives.

关键词：危险处理哨点监测伤病员分拣/方法伤病员分拣/组织和管理伤病员分拣/标准美国

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Midwifery triage and management of trauma and second/third trimester bleeding

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JOURNAL OF NURSE-MIDWIFERY 1999年第5期44卷 439-448页

作者： Tillett, J Hanson, L Univ Wisconsin Nurse Midwifery Ctr Sch Med Sinai Samaritan Med Ctr Milwaukee WI 53201 USA Marquette Univ Coll Nursing Nurse Midwifery Program Milwaukee WI 53233 USA

Trauma affects approximately 8% of all pregnancies, and bleeding affects nearly 5% of gestations. These two conditions are potentially life-threatening and require immediate management by the midwife. Trauma in pregnancy is commonly caused by motor vehicle accidents, falls, and assault. Although abruption resulting from trauma is a rare occurrence, injury caused by domestic violence: is associated with the greatest risk of obstetric complications. Bleeding in pregnancy has a number of etiologies. Midwives are well-prepared to safely and competently make a differential diagnosis of bleeding in the second and third trimesters. A sequence for midwifery triage of clients who present to the emergency room/triage area for trauma and bleeding is presented. Considerations for stabilization, history, physical examinations, diagnostic testing, initial management, and follow-up are described. Practical considerations for midwifery services incorporating provisions for triage into their caseloads are also provided. (C) 1999 by the American College of Nurse-Midwives.

关键词：助产士妊娠并发症/诊断妊娠并发症/护理妊娠中期妊娠末期伤病员分拣/方法伤病员分拣/组织和管理子宫出血/诊断子宫出血/病因学子宫出血/护理创伤和损伤/并发症创伤和损伤/诊断创伤和损伤/护理女(雌)性人类妊娠

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An update on NHS direct

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Accident and emergency nursing 2000年第3期8卷 160-164页

作者： Royle, J. NHS Direct Bolton United Kingdom

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The utilization of nurse-midwives as providers of obstetric triage services - Results of a national survey

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JOURNAL OF NURSE-MIDWIFERY 1999年第5期44卷 431-438页

作者： Angelini, DJ Brown Univ Sch Med Women & Infants Hosp Dept OB GYNNurse Midwifery Sect Providence RI 02912 USA

Obstetric triage services are rapidly advancing, and the concept is becoming a popular practice pattern. As more pregnant women are evaluated in ambulatory settings, especially in high volume obstetric tertiary centers, it is now realized more and more that labor and other complaints cannot be addressed solely in labor and delivery units, nor are most of these complaints solely labor related. This article presents the results of a national survey designed to discover what contributions nurse-midwives are making to obstetric triage services. In addition, the results provide initial benchmark data on obstetric triage components against which other midwifery services can address practice issues. (C) 1999 by the American College of Nurse-Midwives.

关键词：产房助产士病人入院妊娠并发症/诊断妊娠并发症/护理伤病员分拣/组织和管理伤病员分拣/统计学和数值数据美国女(雌)性人类妊娠

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An A&E nurse's fast-track for potential miscarriage patients

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Accident and Emergency Nursing 2000年第1期8卷 9-12页

作者： Wilson, Wendy Accident and Emergency Department Norfolk and Norwich Hospital Norwich NR1 3SR Brunswick Road United Kingdom

When women present at A&E with vaginal bleeding, it is possible that they are miscarrying, and very likely that they are distressed physically and psychologically. This paper outlines the development and auditing of a fast-track protocol for these women, in response to the author's being unable to help them in the A&E department as quickly as she would have wished. © 2000 Harcourt Publishers Ltd.

关键词：流产自然/诊断流产自然/治疗算法临床方案决策树急症护理/组织和管理急诊室医院护理质量审核时间因素伤病员分拣/组织和管理女(雌)性人类

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Medical assessment units in the West Midlands region: A nursing perspective

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Accident and Emergency Nursing 2000年第4期8卷 196-200页

作者： Wood, Ian Department of Nursing and Midwifery Keele University Keele Staffordshire ST5 5BG 59 The Covert United Kingdom

Within a 'whole system' approach to the management of acute medical referrals, many hospitals have introduced Medical Assessment Units (MAUs) to improve the care of acutely ill patients by assessing their need for hospital admission or discharge. This paper gives details of a research study designed to investigate the extent of MAU provision in the West Midlands Region, how these Units are organized and the nature of nursing roles within them. Results indicate that MAUs are organized and managed in different ways according to the likely length of patient stay. Likewise, nursing roles vary depending upon the context in which the nurses are working. © 2000 Harcourt Publishers Ltd.

关键词：临床工作能力/标准急症护理/组织和管理英格兰医院专科病房/组织和管理职务说明护理估计/组织和管理护理评价研究护理人员医院/教育护理人员医院/组织和管理病人入院方案评价问卷调查公费医疗伤病员分拣/组织和管理人类

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