Safety of a rapid diagnostic protocol with accelerated stress testing.

Background: Most patients at low to intermediate risk for an acute coronary syndrome (ACS) receive a 12- to 24-hour "rule out." Recently, trials have found that a coronary computed tomographic angiography-based strategy is more efficient. If stress testing were performed within the same time frame as coronary computed tomographic angiography, the 2 strategies would be more similar.

Impact of physician-assisted triage on timing of antibiotic delivery in patients admitted to the hospital with community-acquired pneumonia (CAP).

Background: Time to antibiotic delivery in patients with diagnosis of pneumonia is a publicly reported quality measure.

Objective: We aim to describe the impact of emergency department (ED) physician-assisted triage (PAT) on The Joint Commission (TJC) and Centers for Medicare and Medicaid Services (CMS) pneumonia core quality measures of timing to antibiotic delivery.

Methods: Retrospective case series studies of patients admitted to the hospital through the ED with diagnosis of community-acquired pneumonia were identified over a period of 48 months.

Emergency medicine: an operations management view.

Operations management (OM) is the science of understanding and improving business processes. For the emergency department (ED), OM principles can be used to reduce and alleviate the effects of crowding. A fundamental principle of OM is the waiting time formula, which has clear implications in the ED given that waiting time is fundamental to patient-centered emergency care.

Cancellation of scheduled procedures as a mechanism to generate hospital bed surge capacity-a pilot study.

Background: The ability to generate hospital beds in response to a mass-casualty incident is an essential component of public health preparedness. Although many acute care hospitals' emergency response plans include some provision for delaying or cancelling elective procedures in the event of an inpatient surge, no standardized method for implementing and quantifying the impact of this strategy exists in the literature. The aim of this study was to develop a methodology to prospectively emergency plan for implementing a strategy of delaying procedures and quantifying the potential impact of this strategy on creating hospital bed capacity.

Administrative challenges to regionalization.

The ideal emergency care system delivers the right care to the right patient at the right time and yields appropriate patient outcomes at a sustainable overall cost. Transforming the current system of emergency care into the Institute of Medicine's vision of a coordinated, regionalized, and accountable emergency care system requires careful consideration of administrative challenges and barriers. Left unaddressed, certain processes, systems, and structures may prevent integration efforts or threaten long-term viability.