Analysis of the Literature on Emergency Department Throughput

Introduction: The purpose of this paper was to review and analyze all the literature concerning ED patient throughput. The secondary goal was to determine if certain factors would significantly alter patients’ ED throughput.Methods: A MEDLINE search was performed from 1966 to 2007 using the terms “turnaround,” “emergency departments,” “emergency medicine,” “efficiency,” “throughput,” “overcrowding” and “crowding.” Studies were graded using a scale of one to four based on the ACEP paper quality criteria. Inclusion criteria were English language and at least a level four or better on the quality scale. An analysis of successful procedures and techniques was performed.Results: Literature search using the key terms found 29 articles on turnaround times, 129 on ED efficiency, 3 on throughput, 64 on overcrowding and 52 on crowding. Twenty-six articles were found to meet the inclusion criteria. There were three level I studies, thirteen level II studies, five level III studies and five level IV studies. The studies were categorized into five areas: determinants (7), laboratories processes (4), triage process (3), academic responsibilities (2), and techniques (10). Few papers used the same techniques or process to examine or reduce patient throughput precluding a meta-analysis.Conclusions: An analysis of the literature was difficult because of varying study methodologies and less than ideal quality. EDs with combinations of low inpatient census, in-room registration, point of care testing and an urgent care area demonstrated increased patient throughput. [WestJEM. 2009;10:104-109.

Completeness and Accuracy of Emergency Medical Information on the Web: Update 2008

<p>Introduction: Reliable and accurate Web-based health information is extremely valuable when applied to emergency medical diagnoses. With this update we seek to build upon on the 2004 study by determining whether the completeness and accuracy of emergency medical information available online has improved over time.</p> <p>Methods: The top 15 healthcare information sites, as determined by internet traffic, were reviewed between February 4, 2008, and February 29, 2008. Standard checklists were created from information provided by American Stroke Association, American Heart Association, National Institutes of Health, and American College of Emergency Physicians to evaluate medical content on each of the Web sites for 4 common emergency department diagnoses: myocardial infarct, stroke, influenza, and febrile child. Each Web site was evaluated for descriptive information, completeness, and accuracy. Data were sorted for total medical checklist items, certification and credentialing, and medical items by topic.</p> <p>Results: Three of the 15 sites were excluded because of a lack of medical information on the selected topics. Completeness of sites ranged from 46% to 80% of total checklist items found. The median percentage of items found was 72. Two sites, MSN Health and Yahoo!Health, contained the greatest amount of medical information, with 98 of 123 checklist items found for each site. All Web sites but 1, Healthology.com, contained greater than 50% of aggregated checklist items, and the majority (ie, 7 of 12) contained greater than 70%. Healthology.com was the least complete Web site, containing 57 of 123 items. No significant correlation was found between credentialing and completeness of site (correlation coefficient = -0.385) or credentialing and site popularity (correlation coefficient = 0.184).</p> <p>Conclusion: This study indicates that the completeness and accuracy of online emergency medical information available to the general public has improved over the past 6 years. Overall, health Web sites studied contained greater than 70% of aggregated medical information on 4 common emergency department diagnoses, and 4 sites examined advanced from 2002 to 2008. [West J Emerg Med. 2011;12(4):448–454.]</p

Emergency physician stress and morbidity

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/27251/1/0000259.pd

Medical Evaluation and Triage of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA Medical Evaluation Workgroup

Numerous medical and psychiatric conditions can cause agitation; some of these causes are life threatening. It is important to be able to differentiate between medical and nonmedical causes of agitation so that patients can receive appropriate and timely treatment. This article aims to educate all clinicians in nonmedical settings, such as mental health clinics, and medical settings on the differing levels of severity in agitation, basic triage, use of de-escalation, and factors, symptoms, and signs in determining whether a medical etiology is likely. Lastly, this article focuses on the medical workup of agitation when a medical etiology is suspected or when etiology is unclear

Analysis of the Literature on Emergency Department Throughput

Introduction: The purpose of this paper was to review and analyze all the literature concerning ED patient throughput. The secondary goal was to determine if certain factors would significantly alter patients’ ED throughput.Methods: A MEDLINE search was performed from 1966 to 2007 using the terms “turnaround,” “emergency departments,” “emergency medicine,” “efficiency,” “throughput,” “overcrowding” and “crowding.” Studies were graded using a scale of one to four based on the ACEP paper quality criteria. Inclusion criteria were English language and at least a level four or better on the quality scale. An analysis of successful procedures and techniques was performed.Results: Literature search using the key terms found 29 articles on turnaround times, 129 on ED efficiency, 3 on throughput, 64 on overcrowding and 52 on crowding. Twenty-six articles were found to meet the inclusion criteria. There were three level I studies, thirteen level II studies, five level III studies and five level IV studies. The studies were categorized into five areas: determinants (7), laboratories processes (4), triage process (3), academic responsibilities (2), and techniques (10). Few papers used the same techniques or process to examine or reduce patient throughput precluding a meta-analysis.Conclusions: An analysis of the literature was difficult because of varying study methodologies and less than ideal quality. EDs with combinations of low inpatient census, in-room registration, point of care testing and an urgent care area demonstrated increased patient throughput. [WestJEM. 2009;10:104-109.

Care of Psychiatric Patients: The Challenge to Emergency Physicians

Psychiatric patients frequently present to the emergency department (ED) for care when they are in crisis. Recent studies demonstrate about 10% of all ED patients present with psychiatric illness.1 However, this is not an adequate estimate of the number of patients because many of these patients do not have a psychiatric diagnosis. Two recent studies have demonstrated that 45% of adults and 40% of pediatric patients who present to the ED with non-psychiatric complaints have undiagnosed mental illness.2-3 These studies did not determine whether these psychiatric illnesses affected the patients’ presentation. The purpose of this article is to discuss disparity and challenges in caring for these patients

Completeness and Accuracy of Emergency Medical Information on the Web: Update 2008

Introduction: Reliable and accurate Web-based health information is extremely valuable when applied to emergency medical diagnoses. With this update we seek to build upon on the 2004 study by determining whether the completeness and accuracy of emergency medical information available online has improved over time.Methods: The top 15 healthcare information sites, as determined by internet traffic, were reviewed between February 4, 2008, and February 29, 2008. Standard checklists were created from information provided by American Stroke Association, American Heart Association, National Institutes of Health, and American College of Emergency Physicians to evaluate medical content on each of the Web sites for 4 common emergency department diagnoses: myocardial infarct, stroke, influenza, and febrile child. Each Web site was evaluated for descriptive information, completeness, and accuracy. Data were sorted for total medical checklist items, certification and credentialing, and medical items by topic.Results: Three of the 15 sites were excluded because of a lack of medical information on the selected topics. Completeness of sites ranged from 46% to 80% of total checklist items found. The median percentage of items found was 72. Two sites, MSN Health and Yahoo!Health, contained the greatest amount of medical information, with 98 of 123 checklist items found for each site. All Web sites but 1, Healthology.com, contained greater than 50% of aggregated checklist items, and the majority (ie, 7 of 12) contained greater than 70%. Healthology.com was the least complete Web site, containing 57 of 123 items. No significant correlation was found between credentialing and completeness of site (correlation coefficient = -0.385) or credentialing and site popularity (correlation coefficient = 0.184).Conclusion: This study indicates that the completeness and accuracy of online emergency medical information available to the general public has improved over the past 6 years. Overall, health Web sites studied contained greater than 70% of aggregated medical information on 4 common emergency department diagnoses, and 4 sites examined advanced from 2002 to 2008. [West J Emerg Med. 2011;12(4):448–454.