Impact of emergency physician-provided patient education about alternative care venues.

Objectives: Interventions that focus on educating patients appear to be the most effective in directing healthcare utilization to more appropriate venues. We sought to evaluate the effects of mailed information and a brief scripted educational phone call from an emergency physician (EP) on subsequent emergency department (ED) utilization by low-risk adults with a recent treat-and-release ED visit.

Study Design: Patients were randomized into 3 groups for post-ED follow-up: EP phone call with mailed information, mailed information only, and no educational intervention.

Informed consent documentation for lumbar puncture in the emergency department.

Introduction: Informed consent is a required process for procedures performed in the emergency department (ED), though it is not clear how often or adequately it is obtained by emergency physicians. Incomplete performance and documentation of informed consent can lead to patient complaints, medico-legal risk, and inadequate education for the patient/guardian about the procedure. We undertook this study to quantify the incidence of informed consent documentation in the ED setting for lumbar puncture (LP) and to compare rates between pediatric (<18 years) and adult patients.

Reduction of admit wait times: the effect of a leadership-based program.

Objectives: Prolonged admit wait times in the emergency department (ED) for patients who require hospitalization lead to increased boarding time in the ED, a significant cause of ED congestion. This is associated with decreased quality of care, higher morbidity and mortality, decreased patient satisfaction, increased costs for care, ambulance diversion, higher numbers of patients who leave without being seen (LWBS), and delayed care with longer lengths of stay (LOS) for other ED patients. The objective was to assess the effect of a leadership-based program to expedite hospital admissions from the ED.

Physician e-mail and telephone contact after emergency department visit improves patient satisfaction: a crossover trial.

Study Objective: Enhancing emergency department (ED) patient satisfaction has wide-ranging benefits. We seek to determine how postvisit patient-physician contact by e-mail or telephone affects patients' satisfaction with their emergency physician.

Methods: We undertook this crossover study from May 1, 2010, to June 30, 2010, at 2 community EDs.

Ambulance diversion reduction and elimination: the 3-2-1 plan.

Background: The diversion of ambulances from their intended emergency departments (EDs) occurs frequently, compromising patient care. Previously, we reduced ambulance diversion (AD) by 74% in a large urban area with 17 EDs.

Objectives: In this follow-up program, we sought to further reduce and eliminate AD by progressively reducing the duration of each AD event.

Facilitating follow-up after emergency care using an appointment assignment system.

Many emergency department (ED) patients require urgent follow-up in primary care. The most effective way to help patients obtain their needed after-visit care is to secure the appointment on their behalf prior to their departure from the ED. This study describes the development, implementation, and outcomes of an appointment assignment system that facilitates patient follow-up at two community hospitals in an integrated healthcare system.

Outpatient management of deep venous thrombosis: 2 models of integrated care.

Objective: To describe and evaluate the impact, effectiveness, and safety of 2 models of outpatient deep venous thrombosis (DVT) management.

Study Design: Observational health-records survey conducted in 2 community hospitals using a comparative design.

Methods: The model centered around the emergency department (ED) was studied from April 15, 1997, through December 31, 1999; the decentralized model was studied from July 15, 2002, through March 15, 2004.

Ambulance diversion reduction: the Sacramento solution.

Purpose: The diversion of ambulances away from their intended emergency departments (EDs) in the United States has become commonplace and may compromise patient care. Although ambulance diversion resulting from ED overcrowding has been well described in the literature, little is known about how to reduce the incidence of ambulance diversion on a regional level. We describe the development, implementation, and impact of a region-wide program to reduce ambulance diversion.

Team assignment system: expediting emergency department care.

Study Objective: We designed and implemented an emergency department (ED) team assignment system, each team consisting of 1 emergency physician, 2 nurses, and usually 1 technician. Patients were assigned in rotation upon arrival to a specific team that was responsible for their care. We monitored the time from arrival to physician assessment, percentage of patients who left without being seen by a physician, and patient satisfaction before and after team assignment system implementation.