Comparison of emergency department throughput and process times between male and female patients: A retrospective cohort investigation by the Reducing Disparities Increasing Equity in Emergency Medicine Study Group.

Introduction: Health equity for all patients is an important characteristic of an effective healthcare system. Bias has the potential to create inequities. In this study, we examine emergency department (ED) throughput and care measures for sex-based differences, including metrics such as door-to-room (DTR) and door-to-healthcare practitioner (DTP) times to look for potential signs of systemic bias.

Assessing the Generalizability of a Clinical Machine Learning Model Across Multiple Emergency Departments.

Objective: To assess the generalizability of a clinical machine learning algorithm across multiple emergency departments (EDs).

Patients And Methods: We obtained data on all ED visits at our health care system's largest ED from May 5, 2018, to December 31, 2019. We also obtained data from 3 satellite EDs and 1 distant-hub ED from May 1, 2018, to December 31, 2018.

Incorporating RTLS-Based Spatiotemporal Information in Studying Physical Activities of Clinical Staff.

Clinicians and staff who work in intense hospital settings such as the emergency department (ED) are under an extended amount of mental and physical pressure every day. They may spend hours in active physical pressure to serve patients with severe injuries or stay in front of a computer to review patients' clinical history and update the patients' electronic health records (EHR). Nurses on the other hand may stay for multiple consecutive days of 9-12 working hours.

A Comprehensive Departmental Care Review Model: Requirements, Structure, and Flow.

Background: The Institute of Medicine, the National Patient Safety Foundation, and The Joint Commission have advocated for increased systematic care review to inform future quality improvement. Developing a system to efficiently gather meaningful feedback, review care, and identify areas for improvement can take years to construct. Yet, these systems are vital to reducing future medical error.

Measuring Sensitivity and Precision of Real-Time Location Systems (RTLS): Definition, Protocol and Demonstration for Clinical Relevance.

The ability of a Real Time Location System (RTLS) to provide correct information in a clinical environment is an important consideration in evaluating the effectiveness of the technology. While past efforts describe how well the technology performed in a lab environment, the performance of such technology has not been specifically defined or evaluated in a practice setting involving workflow and movement. Clinical environments pose complexity owing to various layouts and various movements.

Trauma Activation Responsiveness: An RFID-enabled trauma flowsheet.

Manually documented trauma flow sheets contain critical information regarding trauma resuscitations in the emergency department (ED). The American College of Surgeons (ACS) has enforced certain thresholds on trauma surgeons' arrival time to the trauma bay. Due to the complex and fast-paced ED environment, this information can be easily overlooked or erroneously recorded, affecting compliance with ACS standards.

Unnecessary wait hours: a novel ED system-level metric.

Background: Emergency department (ED) operations leaders are under increasing pressure to make care delivery more efficient. Publicly reported ED efficiency metrics are traditionally patient centred and do not show situational or facility-based improvement opportunities. We propose the consideration of a novel metric, the 'Number of Unnecessary Waits (NUW)' and the corresponding 'Unnecessary Wait Hours (UWH)', to measure space efficiency, and we describe how we used NUW to evaluate operational changes in our ED.

Attitudes and Behavior of Health Care Workers Before, During, and After Implementation of Real-Time Location System Technology.

Objective: To assess how staff attitudes before, during, and after implementation of a real-time location system (RTLS) that uses radio-frequency identification tags on staff and patient identification badges and on equipment affected staff's intention to use and actual use of an RTLS.

Participants And Methods: A series of 3 online surveys were sent to staff at an emergency department with plans to implement an RTLS between June 1, 2015, and November 29, 2016. Each survey corresponded with a different phase of implementation: preimplementation, midimplementation, and postimplementation.

Patient-Care Team Contact Patterns Impact Treatment Length of Stay in the Emergency Department.

Real-time location systems (RTLS) has found extensive application in the healthcare setting, that is shown to improve safety, save cost, and increase patient satisfaction. More specifically, some studies have shown the efficacy of RTLS leading to an improved workflow in the emergency department. However, due to substantial implementation costs of such technologies, hospital administrators show reluctance in RTLS adoption.

Progression of Emergency Medicine Resident Patient Experience Scores by Level of Training.

Background: Patient satisfaction surveys are vital to measuring a patient's experience of care. How scores of patients managed by emergency medicine (EM) residents change as residents progress through training is not known.

Objectives: To evaluate whether EM residents' patient satisfaction scores improve as residency training progresses, similar to clinical skill improvement.

Ongoing and Focused Provider Performance Evaluations in Emergency Medicine: Current Practices and Modified Delphi to Guide Future Practice.

The Joint Commission requires ongoing and focused provider performance evaluations (OPPEs/FPPEs). The authors aim to describe current approaches in emergency medicine (EM) and identify consensus-based best practice recommendations. An online survey was distributed to leaders in EM to gain insight into current practices.

Characterization of emergency department abandonment using a real-time location system.

Background: Patients who present to emergency departments (EDs) for evaluation but are noted to have left without being seen (LWBS) are potentially at great risk. Governmental agencies, such as the Centers for Medicare and Medicaid, as well as hospitals and health organizations, are examining the factors which drive LWBS, including accurately quantifying patient tolerance to wait times and targeting interventions to improve patient tolerance to waiting.

Objective: Compare traditional methods of estimating time to LWBS with an objective method using a real-time location tracking system (RTLS); examine temporal factors associated with greater LWBS rates.

A Time-Driven Activity-Based Costing Analysis of Emergency Department Scribes.

Objective: To apply time-driven activity-based costing (TDABC) methodology to determine emergency medicine physician documentation costs with and without scribes.

Methods: This was a prospective observation cohort study in a large academic emergency department. Two research assistants with experience in physician-scribe interactions and ED workflow shadowed attending physicians for a total of 64 hours in the adult emergency department.

Clinical Policy: Critical Issues in the Evaluation and Management of Emergency Department Patients With Suspected Non-ST-Elevation Acute Coronary Syndromes.

This clinical policy from the American College of Emergency Physicians addresses key issues in the evaluation and management of patients with suspected non-ST-elevation acute coronary syndromes. A writing subcommittee conducted a systematic review of the literature to derive evidence-based recommendations to answer the following clinical questions: (1) In adult patients without evidence of ST-elevation acute coronary syndrome, can initial risk stratification be used to predict a low rate of 30-day major adverse cardiac events? (2) In adult patients with suspected acute non-ST-elevation acute coronary syndrome, can troponin testing within 3 hours of emergency department presentation be used to predict a low rate of 30-day major adverse cardiac events? (3) In adult patients with suspected non-ST-elevation acute coronary syndrome in whom acute myocardial infarction has been excluded, does further diagnostic testing (eg, provocative, stress test, computed tomography angiography) for acute coronary syndrome prior to discharge reduce 30-day major adverse cardiac events? (4) Should adult patients with acute non-ST-elevation myocardial infarction receive immediate antiplatelet therapy in addition to aspirin to reduce 30-day major adverse cardiac events? Evidence was graded and recommendations were made based on the strength of the available data.

Time Motion Analysis: Impact of Scribes on Provider Time Management.

Background: Scribes are unlicensed professionals trained in medical data entry. Limited data exist on the impact of scribes on provider time management in the emergency department (ED). Time-motion analysis is a tool utilized in business to capture detailed movements and durations to task completion.

Consequences of the 48-h rule: A lens into the psychiatric patient flow through an emergency department.

Objective: Psychiatric patient boarding in emergency department (ED) is a severe and growing problem. In July 2013, Minnesota implemented a law requiring jailed persons committed to state psychiatric facilities be transferred within 48-h of commitment. This study aims to quantify the effect of this law on a large ED's psychiatric patient flow.

Clinical care review systems in healthcare: a systematic review.

Background: Clinical care review is the process of retrospectively examining potential errors or gaps in medical care, aiming for future practice improvement. The objective of our systematic review is to identify the current state of care review reported in peer-reviewed publications and to identify domains that contribute to successful systems of care review.

Methods: A librarian designed and conducted a comprehensive literature search of eight electronic databases.

Physician, Interrupted: Workflow Interruptions and Patient Care in the Emergency Department.

Background: It is unclear how workflow interruptions impact emergency physicians at the point of care.

Objectives: Our study aimed to evaluate interruption characteristics experienced by academic emergency physicians.

Methods: This prospective, observational study collected interruptions during attending physician shifts.

Contact tracing with a real-time location system: A case study of increasing relative effectiveness in an emergency department.

Background: Contact tracing is the systematic method of identifying individuals potentially exposed to infectious diseases. Electronic medical record (EMR) use for contact tracing is time-consuming and may miss exposed individuals. Real-time location systems (RTLSs) may improve contact identification.

Temporal Trends in Epinephrine Dispensing and Allergy/Immunology Follow-up Among Emergency Department Anaphylaxis Patients in the United States, 2005-2014.

Background: Anaphylaxis is a potentially life-threatening allergic reaction; measures including prescription of an epinephrine autoinjector (EAI) and allergy/immunology (A/I) follow-up may prevent future morbidity.

Objective: The objective of this study was to evaluate trends in outpatient management of anaphylaxis by studying EAI dispensing and A/I follow-up among patients seen in the emergency department (ED) for anaphylaxis from 2005 through 2014.

Methods: We analyzed administrative claims data from the OptumLabs Data Warehouse database using an expanded International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code algorithm.

Impact of Scribes on Billed Relative Value Units in an Academic Emergency Department.

Background: Scribe use throughout health care is becoming more common. There is limited peer-reviewed literature supporting this emerging role in health care despite rapid uptake of the role.

Objectives: Our study assesses impact of scribes on relative value units (RVUs) in adult and pediatric emergency departments (EDs).

Impact of scribes on emergency department patient throughput one year after implementation.

Objectives: Assess the impact of scribes on an academic emergency department's (ED) throughput one year after implementation.

Methods: A prospective cohort design compared throughput metrics of patients managed when scribes were and were not a part of the treatment team during pre-defined study hours in a tertiary academic ED with both an adult and pediatric ED. An alternating-day pattern one year following scribe implementation ensured balance between the scribe and non-scribe groups in time of day, day of week, and patient complexity.

Does gender bias in cardiac stress testing still exist? A videographic analysis nested in a randomized controlled trial.

Objectives: Despite a high prevalence of coronary heart disease in both genders, studies show a gender disparity in evaluation whereby women are less likely than men to undergo timely or comprehensive cardiac investigation. Using videographic analysis, we sought to quantify gender differences in provider recommendations and patient evaluations.

Methods: We analyzed video recordings from our Chest Pain Choice trial, a single center patient-level randomized trial in which emergency department patients with chest pain being considered for cardiac stress testing were randomized to shared decision-making or usual care.