Path Analysis Modeling Indicates Free Transport Increases Ambulance Use for Minor Indications
|
|
- Scott Baldric Henderson
- 6 years ago
- Views:
Transcription
1 Path Analysis Modeling Indicates Free Transport Increases Ambulance Use for Minor Indications Joseph Yuk Sang Ting, MBBS, B Med Sci 1, 2 and Allan M. Z. Chang, MBBS, PhD 3 1 Department of Emergency Medicine, Mater Public Adult Hospital, South Brisbane, Australia. 2 Division of Anesthesiology and Critical Care, School of Medicine, Southern Clinical School, Faculty of Health Sciences, University of Queensland, Brisbane, Australia. 3 Mater Research Support Center, Mater Health Services, South Brisbane, Australia. ABSTRACT Introduction. Clinically unnecessary ambulance transport is increasing, diverting limited resources from patients needing ambulance transport. It was anecdotally observed that inappropriate ambulance use increased after abolition of a direct patient cost for ambulance transport. Hypothesis. In July 2003, direct patient fees were abolished in favor of a universally applied ambulance levy, potentially leading to increased ambulance use by patients with low illness acuity and admission rates. Methods. The influence of age, illness acuity, and need for admission on ambulance use was assessed for 55,397 emergency department attendances in 2002 and Ambulance users were compared with nonusers in both years and attendances for 2002 compared with 2004 using chi-square test for two groups. Logistic regression provided a multivariate model leading to ambulance use. Path analysis modeling to assess interrelationships between factors associated with ambulance use was developed. Results. Ambulance users in both years were older, had more acute illness, and had greater need for admission compared with nonusers. The odds ratio (OR) of arrival by ambulance in 2004 compared with 2002 was 1.14 (95% confidence interval, [CI], 1.12 to 1.17). In 2002, ambulance users were older (OR, 1.42; 95% CI, 1.40 to 1.43), were more likely to need admission (OR, 2.28; 95% CI, 2.16 to 2.4) and had higher illness acuity (OR, 2.02; 95% CI, 1.94 to 2.09). There was a negative correlation between 2004 and illness acuity. Conclusions. Ambulance use increased in 2004 after patient transport fees were abolished. Increased use was associated with decreased age, clinical acuity, and admission need. Abolishing direct patient cost stimulates ambulance use, potentially including inappropriate transport. Path analysis to assess the effect of changed funding on ambulance use could be used to the influence of other locally relevant factors contributing to ambulance use. Keywords: ambulance use; path analysis; free patient transport. INTRODUCTION Understanding who, when, and for what an ambulance is used will help in developing a monitoring mechanism to reduce clinically unnecessary patient transport, thereby improving ambulance
2 utilization.[1] As far as we are aware, no surveillance mechanism has been developed to monitor the relative and interrelated contributions of clinical and demographic factors influencing ambulance use. Most ambulances are used to transport patients to the emergency department (ED) for assessment and treatment. The intersection between patients arriving by ambulance and the ED therefore provides a representative situation to examine the patterns of ambulance use by the public.[1, 2] A change in funding structure from direct patient cost to a universally applied ambulance levy in July 2003 resulted in anecdotal observations by ED and prehospital staff that more patients were being transported for minor conditions. It was surmised that ambulances that incurred no direct patient cost would be more prone to being inappropriately used, as reflected in the lesser acuity and admission need of those transported. To study this hypothesis, a path analysis model to quantify the contribution of patient clinical and demographic factors leading to request for an ambulance was developed. Clinically inappropriate ambulance use is a serious and widespread problem. Clinically unnecessary ambulance use varies widely in different localities, making comparisons difficult.[3, 4] In a retrospective review of 300 consecutive ambulance transports by emergency physicians in London, 15.7% were considered inappropriate,[5] while 36% of ambulance transports in Dublin were deemed inappropriate by emergency physicians.[6] In the United States, inappropriate ambulance use occurs in up to 47% of adult cases,[4] being influenced by health insurance and socioeconomic status.[4, 7] Inappropriate ambulance use increases response times to clinically urgent cases by diverting limited ambulance resources to nonurgent cases,[1, 8, 9] contributes to unsustainable demand,[1] is expensive[9] and lowers ambulance staff morale.[8] Demand for ambulance services, including that for inappropriate transport,[4] is increasing rapidly.[1] It is therefore important that ambulances are utilized by patients only when a clinical need exists.[10] Although ambulances should be provided primarily on the basis of clinical need,[11] there are no consistent prehospital[3, 12, 13] or hospital[3, 5, 7, 13] criteria defining clinical need and appropriate use[5, 8, 14] other than that for patients requiring resuscitation and those with suspected myocardial infarction, stroke, and other time-critical conditions.[15, 16] The goals of this study were 1) to determine whether an effectively free ambulance service incentivizes its use by patients with lower acuity and admission rates and 2) to develop a method for monitoring ambulance activity to achieve the first goal. The model should be capable of quantifying the influence of, and examining the interactions between, factors believed to affect ambulance use. METHODS Setting The Mater Health Services Research Ethics Committee determined that this was a quality assurance study and was therefore exempt from independent ethical review as specified by the National Health and Medical Research Council. The Mater Adult Public Hospital, an urban tertiary limited-trauma ED within 5 km of the central business district of Brisbane, provides free health care for adults and has an annual attendance of 28,000. The Mater Adult Public Hospital is within close proximity of a predominantly inner-city population, comprising high-density living, established older inner-city suburbs, and underprivileged homeless residents. It is the sole tertiary care provider for complications of early pregnancy for a catchment population of 750,000 in greater south Brisbane. One major trauma center and several peripheral public (free) hospitals serve greater south Brisbane. The Queensland Ambulance Service provides a comprehensive multitiered emergency transport and prehospital response service staffed by paramedics trained to different skill levels, the highest of which are airway, thoracostomy, and vascular access skills. Before July 2003, one third of Queenslanders were pensioners or their dependents covered under the State Government s Free Ambulance Transport for Pensioners policy, one third were ambulance subscribers, and the remaining one third possessed private health insurance with an ambulance component or had no coverage at all. Only those with no coverage (a portion of the last group) paid a fee for transport, which depended on urgency and distance to hospital. As such, more than two thirds of Queenslanders (pensioners, ambulance subscribers, and privately insured patients) were transported without incurring a fee before July After July 2003, all Queenslanders were transported at no direct cost with the introduction of a universally applied levy, the Community Ambulance Cover. Any change in ambulance use between 2002 and 2004 may be partly attributable to the abolition of fee for transport.
3 Data Collection Data for ED attendances in 2002 and 2004 were extracted using focused search algorithms from Emergency Department Information Systems, a computerized ED time-patient flow management system incorporating patient details, triage complaint, triage score, diagnostic tests, final diagnosis, and disposition. Measurements Patient age, time of arrival, and postcode were edited and categorized so that they more closely reflect parameters associated with ambulance use and are more compatible with analysis of frequencies. Personal data include age (categorized in decades) and gender. Environmental data include distance from hospital (postcodes were edited to within or greater than 10 km of hospital), time of arrival (edited to day [8 AM to 8 PM] or night [8 PM to 8 AM]), day of arrival (edited to weekday [Monday to Friday] or weekend [Saturday and Sunday]), and year of arrival (2002 or 2004). Clinical data include acuity, which is the reverse of the National Triage Score (NTS) (acuity = 6 NTS), whether the patient was discharged or admitted after ED assessment, and the primary diagnosis [28 aggregated International Classification of Diseases-10 diagnostic codes[17]). The NTS is a score from 1 to 5 of clinical urgency that determines the order of assessment by ED medical staff. A lower NTS requires more urgent assessment and treatment. The NTS has been validated in terms of clinical urgency, admission rates, and hospital outcome and has good interobserver and interinstitutional reliability.[17] It is widely used in Australasia and is one of the Australian Council on Health Care Standards Clinical Indicators for Emergency Medicine.[18] As the NTS signifies the priority for treatment, the term acuity (acuity = 6 NTS) reverses the scale so that a high-acuity score represents a lower NTS, with higher-acuity conditions requiring more urgent medical attention. Statistical Descriptions The Data A primary analysis was unable to demonstrate a relationship between aggregated diagnostic category and other parameters. A substantial proportion of cases did not have a diagnosis entry (3,184; 5.7% of all attendances), and the diagnostic categories were based on broad disease groupings that did not have an identifiable relationship with acuity of illness or with type of transport used. The categoryaggregated diagnostic groupings were therefore excluded from multivariate analysis. Statistical Method Because the study sample size was large and variables were easily categorized, demographic and other data were analyzed using frequency tables. Primary bivariate comparisons were performed using the chi-square test for two groups [19]: comparing data between 2002 and 2004 and comparing ambulance users with nonusers in both years. Logistic regression [20] was used to provide a multivariate model for ambulance use. Logistic regression is a rigorous and robust method to build multivariate models and for hypothesis testing. This is therefore the main method where factors believed to influence ambulance use are statistically tested for significance. Path analysis modeling, [21] incorporating linear regression coefficients, was used to examine the cascade of sequential events that led to ambulance use. This method allows partitioning of variances and permits the assumption that early variables sequentially affect those downstream in the cascade. Path analysis enables examination of complex interrelationships between variables that lead to request for an ambulance. The model uses three levels in a defined sequence. Personal and environmental factors influence acuity and need for admission, and together with them influence the use of ambulance.
4 Because acuity and need for admission are determined after patient arrival in the ED, they are used as surrogate measures of illness severity at the time of ambulance request. The model evaluates the strength of these interrelated influences on ambulance use. RESULTS Data from 55,397 ED attendances in 2002 and 2004 were compared, and the results are presented in Table 1. Patients arriving in 2004 had lower-acuity illness and were less likely to require admission. A higher proportion of patients in 2004 were years of age and living within 10 km of the hospital. These patients would be expected to be more capable of coming to the hospital independently, yet they used the ambulance more. TABLE 1. Comparison of Data Between 2002 and 2004, Including That Between Ambulance Users and Those Who Did Not Use the Ambulance Chi-square Power (1 ß) Day Weekday 20,116 (72.6) 19,872 (71.8) Weekend 7,611 (27.4) 7,798 (28.2) 3.66 (NS) 0.49 Time Day 19,706 (71.1) 19,373 (70.0) Night 8,021 (28.9) 8,297 (30.0) 7.39* > 0.99 Gender Female 15,514 (56.0) 15,554 (56.2) Male 12,211 (44.0) 12,111 (43.8) 0.39 (NS) 0.09 Age in decades 0 6 (0.0) 0 (0.0) 1 2,552 (9.2) 2,300 (8.3) 2 7,069 (25.5) 6,925 (25.0) 3 5,510 (19.9) 5,882 (21.3) 4 3,717 (13.4) 3,828 (13.8) 5 2,860 (10.3) 2,909 (10.5) 6 2,043 (7.4) 2,054 (7.4) 7 2,079 (7.5) 2,036 (7.4) 8 1,527 (5.5) 1,392 (5.0) (1.3) 329 (1.2) (0.0) 13 (0.0) Distance < 10 km 13,403 (48.3) 14,098 (51.0) > 10 Km 14,324 (51.7) 13,572 (49.0) > 0.99 Acuity (6 NTS %) 1 (6 5%) 1,907 (6.9) 2,324 (8.4) 2 (6 4%) 16,258 (58.6) 16,900 (61.1) 3 (6 3%) 8,074 (29.1) 7,239 (26.2) 4 (6 2%) 1,414 (5.1) 1,150 (4.2) 5 (6 1%) 74 (0.3) 57 (0.2) > 0.99 Disposition Discharged 21,142 (76.3) 21,305 (77.0) Admitted 6,585 (23.7) 6,365 (23.0) Transport Self 22,282 (81.2) 21,655 (78.5) Ambulance 5,151 (18.8) 5,927 (21.5) > 0.99 NS = not significant; NTS = National Triage Score, rated 1 to 5. *p < p < p <
5 Logistic regression coefficients were determined for the likelihood of ambulance use as it relates to age, acuity, and need for admission, among others. These are presented in Table 2 as adjusted odds ratios with 95% confidence intervals. All variables are assumed to have simultaneously influenced ambulance use. Ambulance users were significantly more likely to need admission, have an acute illness, arrive at night, belong to an older age group, live more than 10 km from the hospital, be female, and arrive in TABLE 2. Logistic Regression Analysis Modeling the Relationship Between Personal, Environmental, and Clinical Parameters and Ambulance Use Predictor Variable Adjusted Odds Ratio 95% Confidence Interval Correlation Coefficient Standard Error Z p- value Nighttime* < Older age group < Needs admission < > 10 km from < hospital Female < Acuity (6 NTS) < Weekend Year < Constant * * * < *Day-8 AM to 8 PM; night = 8 PM to 8 AM. NTS = National Triage Score, rated 1 to 5. The results of path analysis are presented in Figure 1, demonstrating only coefficients that are significant to p < All variables other than day of arrival have a statistically significant relationship with ambulance use (day of arrival was therefore excluded from the model). Ambulances were used more in both years by older patients (0.27), those who had more acute illness (0.17), those needing admission (0.16), those arriving at the ED at night (0.06), those living more than 10 km from the hospital (0.03), and females patients (0.02). Increased ambulance use in 2004 (0.04) was, however, associated with less acute illness ( 0.05) and living closer to the hospital ( 0.03). Correlations within each level exist within the path analysis model. Acuity and need for admission are related (0.36) because both reflect illness severity. Secondary influences reflecting interactions were also demonstrated. For instance, female patients (0.02), older patients (0.16), and those arriving at night (0.09) had more acute illnesses and required admission, with these in turn leading to increased ambulance use. DISCUSSION In our study, free ambulance transport was associated with increased clinically inappropriate transport as indicated by declining illness acuity, patient admission, and younger patient age, with the exception of young adult multitrauma victims. The latter issue was not specifically examined in the study. To our knowledge, this is the first attempt to develop an ambulance use path analysis model capable of demonstrating independent changes in clinical acuity, admission rate, patient age, and any other chosen factor(s) among ambulance users. The quantitative surveillance over time at our ED of these three clinical, demographic, and attendance characteristics, among others, led to the detection of increased nonurgent ambulance use following abolition of an ambulance transport fee. Previous studies[5, 6, 8, 12] have only measured rates of clinically inappropriate ambulance use as determined retrospectively by emergency clinicians.
6 FIGURE 1. Path analysis showing cascading and quantified influence of factors leading to ambulance use. More than two thirds of the community (ambulance subscribers, pensioners and their dependents, privately insured) were not affected by the introduction of the ambulance levy in July 2003 because they were already transported at no personal cost. Significantly increased ambulance use in 2004 would reasonably be assumed to have occurred in the one third of the community who, having previously been charged a fee for transport, now had this fee waived. This occurred despite decreased acuity and admission rates among ambulance users in Furthermore, younger patients and those living closer to the hospital used an ambulance more frequently in It is reasonable to surmise that when users do not incur fees for transport, they will use ambulances for less acute illnesses despite being more capable of getting to the hospital without assistance. On the other hand, charging transport fees and restricting eligibility risks ambulances not being used by clinically acute patients who cannot afford to pay a fee.[5, 8] The decline from 2002 to 2004 in this study of clinical acuity, admission rate, and age of ambulance users may represent an increase in unnecessary ambulance use. Although not seen in this study, such a trend would prompt correction by health system or public education interventions, such as improved ambulance dispatching triage systems and scene treatment for minor illnesses.[6, 8] Scarce ambulance resources could then be redirected to patients with greater clinical need for ambulance treatment and transport, that is, patients with high illness acuity, patients with need for admission, and older patients. Aside from being sicker, these patients are less mobile.[11] Additional factors, such as access to community health care, nonambulance private and public transport, and socioeconomic status, could be incorporated into the model, with both their individual and interrelated influence on ambulance use evaluated. As such, path analysis modeling may be useful for planning and improving ambulance services and as a tool for further prehospital and health systems research. Among ambulance users in both years and in decreasing magnitude of influence, older age, acuity, need for admission, nighttime arrival, and living more than 10 km from the hospital were each independently associated with increased ambulance use. Previous studies have demonstrated an association between older age, higher acuity, and admission rates with ambulance use.[6, 7, 22] Age older than 65 years, higher acuity, and admission to the hospital predicted ambulance use in a study of 10,229 patients transported to a Queensland hospital in [2] Older patients place high demands on ambulance services, EDs, and hospital beds.[2, 11, 23] The elderly have more acute illnesses, are more likely to be admitted,[23] and have reduced ability to use, and access to, non-ambulance transport.[2, 11] The combination of these factors with decreased physical and cognitive function in the elderly[8] leads to greater but more appropriate ambulance use in the elderly.[4, 6, 7]
7 As in this study, ambulance arrivals were more likely at night to a Montreal ED.[22] Reduced access to non-ambulance transport and primary health care at night may explain this finding. However, unlike in this study, time of arrival was found to not affect ambulance use in Ipswich Hospital,[2] 45 minutes by car from our hospital. This reflects wide variation in even local patterns of ambulance use. LIMITATIONS Increased ambulance use for less acute conditions in 2004 compared with 2002 was adjusted for other pre-specified variables, was of a large magnitude, and achieved significant p-values of at least < It is therefore unlikely that this change in ambulance use could be attributed to secular differences in disease presentation and population patterns, longer-term trends in the use of emergency services, and changes in health systems. This could be clarified by tracking ambulance activity over a longer period. Six-month periods before and after the introduction of the ambulance levy were excluded to reduce transitional effects of funding change. There are no reliable definitions or measures of appropriate ambulance use by a patient.[5, 8, 14] Broad criteria include whether treatment was potentially required en route to the hospital,[13] whether rapid transport to hospital was needed[3] and the reason for the patient requesting an ambulance.[12] Other studies use individual patient-based criteria such as ED assessment[7, 12] or diagnosis,[14] hospital diagnosis, and patient disposition to retrospectively determine whether transport was necessary.[6] This study focused on factors associated with ambulance use by an overall patient population rather than any individual. Because ambulances are requested by the patient (consumer controlled), the need for an ambulance as perceived by the patient invariably exists. A patient s perception of need frequently differs from medical opinion.[5, 8, 14] Our model cannot determine whether appropriate use of an ambulance has occurred from the patient s point of view. A patient s decision to call an ambulance for transport to the ED is influenced by personal circumstances and the health care resources the patient is able to access. Each patient has specific reasons for using an ambulance, and whether ambulance use is justified on that occasion for that patient is difficult to determine. These reasons include heightened perception of urgency, lack of access to alternative transport and primary care, the belief that arrival at the hospital by ambulance will hasten time to being seen, and, crucially, the personal financial cost of using an ambulance.[2, 5] Because this model is developed from ED attendances, it is unable to evaluate the effect on ambulance use of non hospital-based health resources such as primary health care facilities and afterhour general practice services, although this could be assessed in future models. CONCLUSIONS Ambulance use increased in 2004 after direct patient fees were abolished in favor of a universally applied ambulance levy. Increased ambulance use was associated with reductions in patient age, clinical acuity of conditions and need for admission. A change in ambulance funding, such as the removal of direct patient cost, stimulates ambulance use, potentially including inappropriate requests for transport. The path analysis model developed to study the effects on ambulance use of changes in ambulance funding structure may be used to determine influence of other locally relevant factors contributing to ambulance use. This may be conducted at one health care facility over time or comparison made between facilities at one point in time. Modeling the dynamics of ambulance use facilitates the assessment of appropriate ambulance use and the effect of interventions to improve ambulance utilization. ACKNOWLEDGEMENT The authors thank Dr. K. Humphrey for data abstraction and Dr. C. Foot, Dr. M.Y. Ling, and Dr. E. Merfield for their thoughtful appraisal of the manuscript. REFERENCES 1. Australian Institute for Primary Care Ambulance demand and funding project Faculty of Health Sciences, La Trobe University: Melbourne, Australia, (2004).
8 2. Clark, M J, Purdie, J, FitzGerald, G J, Bischoff, N G, and O Rourke, P K Predictors of demand for emergency prehospital care: an Australian study. Prehospital Disaster Med (1999), 14: Hauswald, M, and Jambrosic, M Denial of ambulance transport: can reviewers determine what is an emergency?. Prehosp Emerg Care (2004), 8: Richards, J R, and Ferrall, S J Inappropriate use of emergency medical services transport: comparison of provider and patient perspectives. Acad Emerg Med (1999), 6: Palazzo, F F, Warner, O J, Harron, M, and Sadana, A Misuse of London ambulance service: how much and why?. J Accid Emerg Med (1998), 15(6): Little, G F, and Barton, D Inappropriate use of the ambulance service. Eur J Emerg Med (1998), 5: Rucker, D W, Edwards, R A, Burstin, H R, O Neil, A C, and Brennan, T A Patient-specific predictors of ambulance use. Ann Emerg Med (1997), 29: Pennycook, A G, Makower, R M, and Morrison, W G Use of the emergency ambulance service to an inner city accident and emergency department a comparison of general practitioner and 999 calls. J R Soc Med (1991), 84: Marks, P J, Daniel, T D, Afolabi, O, Spiers, G, and Nguyen-Van-Tam, J S Emergency (999) calls to the ambulance service that do not result in the patient being transported to hospital: an epidemiological study. Emerg Med J (2002), 19: Coid, D R Measurement for management: report of a pilot project to quantify ambulance misuse for managers of a Fife hospital. Health Serv Manage Res (1989), 2: Clark, M J, and FitzGerald, G Older people s use of ambulance services: a population based analysis. J Accid Emerg Med (1999), 16: Wilson, S, Edwards, S, and Cooke, M W Inappropriate ambulance use is a retrospective diagnosis. J Accid Emerg Med (1999), 16: Hauswald, M Can paramedics safely decide which patients do not need ambulance transport or emergency department care?. Prehosp Emerg Care (2002), 6: Kost, S, and Arruda, J Appropriateness of ambulance transport to a suburban pediatric emergency department. Prehosp Emerg Care (1999), 3: Canto, J G, Zalenski, R J, Ornato, J P, et al. Use of emergency medical services in acute myocardial infarction and subsequent quality of care: observations from the National Registry of Myocardial Infarction. Circulation (2002), 106: Herlitz, J, Hjalmarson, A, Holmberg, S, Richterova, A, and Wennerblom, B Mortality and morbidity in suspected acute myocardial infarction in relation to ambulance transport. Eur Heart J (1987), 8: World Health Organization ICD-10: International Statistical Classification of Diseases and Related Health Problems,, 10th revision; World Health Organization: Geneva, Switzerland, ( ). 18. Jelinek, G A, and Little, M Inter-rater reliability of the national triage scale over 11,500 simulated occasions of triage. Emerg Med (1996), 8: Altman, D G Practical Statistics for Medical Research Chapman Hall: London, (1994): Foundation of Clinical Research: Applications to Practice,, 2nd ed.; Portney, L G, and Watkins, M P, Eds.; Prentice Hall: Upper Saddle River, NJ, (2000): Applied Multiple Regression/ Correlation Analysis for the Behavioral Sciences,, 2nd ed.; Cohen, J, and Cohen, P, Eds.; Lawrence Erlbaum Associates: NJ, (1983): Afilalo, J, Marinovich, A, Afilalo, M, et al. Impact of ambulance transportation on resource use in the emergency department. Acad Emerg Med (2004), 11: Stathers, G M, Delpech, V, and Raftos, J R Factors influencing the presentation and care of elderly people in the emergency department. Med J Aust (1992), 156:
Scottish Hospital Standardised Mortality Ratio (HSMR)
` 2016 Scottish Hospital Standardised Mortality Ratio (HSMR) Methodology & Specification Document Page 1 of 14 Document Control Version 0.1 Date Issued July 2016 Author(s) Quality Indicators Team Comments
More informationCause of death in intensive care patients within 2 years of discharge from hospital
Cause of death in intensive care patients within 2 years of discharge from hospital Peter R Hicks and Diane M Mackle Understanding of intensive care outcomes has moved from focusing on intensive care unit
More informationCase-mix Analysis Across Patient Populations and Boundaries: A Refined Classification System
Case-mix Analysis Across Patient Populations and Boundaries: A Refined Classification System Designed Specifically for International Quality and Performance Use A white paper by: Marc Berlinguet, MD, MPH
More informationRunning Head: READINESS FOR DISCHARGE
Running Head: READINESS FOR DISCHARGE Readiness for Discharge Quantitative Review Melissa Benderman, Cynthia DeBoer, Patricia Kraemer, Barbara Van Der Male, & Angela VanMaanen. Ferris State University
More informationEmergency admissions to hospital: managing the demand
Report by the Comptroller and Auditor General Department of Health Emergency admissions to hospital: managing the demand HC 739 SESSION 2013-14 31 OCTOBER 2013 4 Key facts Emergency admissions to hospital:
More informationBCEHS Resource Allocation Plan 2013 Review. Summary Report
BCEHS Resource Allocation Plan 2013 Review Summary Report November 2013 1 EXECUTIVE SUMMARY As the legislated authority to provide emergency health services in British Columbia, BC Emergency Health Services
More informationSouth Central Region EMS & Trauma Care Council Patient Care Procedures
South Central Region EMS & Trauma Care Council Patient Care s Table of Contents PCP #1 Dispatch PCP #2 Response Times PCP #3 Triage and Transport PCP #4 Inter-Facility Transfer PCP #5 Medical Command at
More informationMissed Nursing Care: Errors of Omission
Missed Nursing Care: Errors of Omission Beatrice Kalisch, PhD, RN, FAAN Titus Professor of Nursing and Chair University of Michigan Nursing Business and Health Systems Presented at the NDNQI annual meeting
More informationAmbulance Use Is Associated With Higher Self-rated Illness Seriousness: User Attitudes and Perceptions
ORIGINAL RESEARCH CONTRIBUTION Ambulance Use Is Associated With Higher Self-rated Illness Seriousness: User Attitudes and Perceptions Ghasem (Sam) Toloo, PhD, Gerry J. FitzGerald, MD, FACEM, FRACMA, Peter
More informationPatients Experience of Emergency Admission and Discharge Seven Days a Week
Patients Experience of Emergency Admission and Discharge Seven Days a Week Abstract Purpose: Data from the 2014 Adult Inpatients Survey of acute trusts in England was analysed to review the consistency
More informationEmergency care workload units: A novel tool to compare emergency department activity
Bond University epublications@bond Faculty of Health Sciences & Medicine Publications Faculty of Health Sciences & Medicine 10-1-2010 Emergency care workload units: A novel tool to compare emergency department
More informationThank you for joining us today!
Thank you for joining us today! Please dial 1.800.732.6179 now to connect to the audio for this webinar. To show/hide the control panel click the double arrows. 1 Emergency Room Overcrowding A multi-dimensional
More informationDo patients use minor injury units appropriately?
Journal of Public Health Medicine Vol. 18, No. 2, pp. 152-156 Printed in Great Britain Do patients use minor injury units appropriately? Jeremy Dale and Brian Dolan Abstract Background This study aimed
More informationFleet and Marine Corps Health Risk Assessment, 02 January December 31, 2015
Fleet and Marine Corps Health Risk Assessment, 02 January December 31, 2015 Executive Summary The Fleet and Marine Corps Health Risk Appraisal is a 22-question anonymous self-assessment of the most common
More informationBIOSTATISTICS CASE STUDY 2: Tests of Association for Categorical Data STUDENT VERSION
STUDENT VERSION July 28, 2009 BIOSTAT Case Study 2: Time to Complete Exercise: 45 minutes LEARNING OBJECTIVES At the completion of this Case Study, participants should be able to: Compare two or more proportions
More informationavailable at journal homepage:
Australasian Emergency Nursing Journal (2009) 12, 16 20 available at www.sciencedirect.com journal homepage: www.elsevier.com/locate/aenj RESEARCH PAPER The SAPhTE Study: The comparison of the SAPhTE (Safe-T)
More informationIssue Brief. Non-urgent Emergency Department Use in Shelby County, Tennessee, May August 2012
Issue Brief May 2011 Non-urgent Emergency Department Use in Shelby County, Tennessee, 2009 Cyril F. Chang, Ph.D. Professor of Economics and Director of Methodist Le Bonheur Center for Healthcare Economics
More informationFrequently Asked Questions (FAQ) Updated September 2007
Frequently Asked Questions (FAQ) Updated September 2007 This document answers the most frequently asked questions posed by participating organizations since the first HSMR reports were sent. The questions
More informationTowards a national model for organ donation requests in Australia: evaluation of a pilot model
Towards a national model for organ donation requests in Australia: evaluation of a pilot model Virginia J Lewis, Vanessa M White, Amanda Bell and Eva Mehakovic Historically in Australia, organ donation
More informationProceedings of the 2016 Winter Simulation Conference T. M. K. Roeder, P. I. Frazier, R. Szechtman, E. Zhou, T. Huschka, and S. E. Chick, eds.
Proceedings of the 2016 Winter Simulation Conference T. M. K. Roeder, P. I. Frazier, R. Szechtman, E. Zhou, T. Huschka, and S. E. Chick, eds. IDENTIFYING THE OPTIMAL CONFIGURATION OF AN EXPRESS CARE AREA
More informationMedicare Spending and Rehospitalization for Chronically Ill Medicare Beneficiaries: Home Health Use Compared to Other Post-Acute Care Settings
Medicare Spending and Rehospitalization for Chronically Ill Medicare Beneficiaries: Home Health Use Compared to Other Post-Acute Care Settings Executive Summary The Alliance for Home Health Quality and
More informationThe Trauma System. Prevention Pre-hospital care and transport Acute hospital care Rehab Research
An Overview The Trauma System The Office of Emergency Medical Services & Trauma System (OEMSTS) is responsible for oversight of the trauma system. The ideal trauma system includes; Prevention Pre-hospital
More informationImpact of hospital nursing care on 30-day mortality for acute medical patients
JAN ORIGINAL RESEARCH Impact of hospital nursing care on 30-day mortality for acute medical patients Ann E. Tourangeau 1, Diane M. Doran 2, Linda McGillis Hall 3, Linda O Brien Pallas 4, Dorothy Pringle
More informationBarriers & Incentives to Obtaining a Bachelor of Science Degree in Nursing
Southern Adventist Univeristy KnowledgeExchange@Southern Graduate Research Projects Nursing 4-2011 Barriers & Incentives to Obtaining a Bachelor of Science Degree in Nursing Tiffany Boring Brianna Burnette
More informationRapid assessment and treatment (RAT) of triage category 2 patients in the emergency department
Trauma and Emergency Care Research Article Rapid assessment and treatment (RAT) of triage category 2 patients in the emergency department S. Hassan Rahmatullah 1, Ranim A Chamseddin 1, Aya N Farfour 1,
More informationTabletop Exercise on Mass Casualty Incident Triage, Does it Work?
Research Article imedpub Journals www.imedpub.com Health Science Journal DOI: 10.21767/1791-809X.1000566 Tabletop Exercise on Mass Casualty Incident Triage, Does it Work? Keebat Khan * Hamad General Hospital
More informationMeasure Information Form. Admit Decision Time to ED Departure Time for Admitted Patients Overall Rate
Last Updated: Version 4.4 Measure Set: Emergency Department Set Measure ID #: ED-2 Measure Information Form Set Measure ID# ED-2a ED-2b ED-2c Performance Measure Name Admit Decision Time to ED Departure
More informationThe Determinants of Patient Satisfaction in the United States
The Determinants of Patient Satisfaction in the United States Nikhil Porecha The College of New Jersey 5 April 2016 Dr. Donka Mirtcheva Abstract Hospitals and other healthcare facilities face a problem
More informationSpecifications Manual for National Hospital Inpatient Quality Measures Discharges (1Q17) through (4Q17)
Last Updated: Version 5.2a EMERGENCY DEPARTMENT (ED) NATIONAL HOSPITAL INPATIENT QUALITY MEASURES ED Measure Set Table Set Measure ID # ED-1a ED-1b ED-1c ED-2a ED-2b ED-2c Measure Short Name Median Time
More informationAnalyzing Readmissions Patterns: Assessment of the LACE Tool Impact
Health Informatics Meets ehealth G. Schreier et al. (Eds.) 2016 The authors and IOS Press. This article is published online with Open Access by IOS Press and distributed under the terms of the Creative
More informationPerformance Measurement of a Pharmacist-Directed Anticoagulation Management Service
Hospital Pharmacy Volume 36, Number 11, pp 1164 1169 2001 Facts and Comparisons PEER-REVIEWED ARTICLE Performance Measurement of a Pharmacist-Directed Anticoagulation Management Service Jon C. Schommer,
More informationWork- life Programs as Predictors of Job Satisfaction in Federal Government Employees
Work- life Programs as Predictors of Job Satisfaction in Federal Government Employees Danielle N. Atkins PhD Student University of Georgia Department of Public Administration and Policy Athens, GA 30602
More informationThe Medical Deputising Service Sector: An Industry Overview
The Medical Deputising Service Sector: An Industry Overview In Australia in recent years, community access to urgent after hours primary care has been a key focus of Government health care policy. The
More informationLong-Stay Alternate Level of Care in Ontario Mental Health Beds
Health System Reconfiguration Long-Stay Alternate Level of Care in Ontario Mental Health Beds PREPARED BY: Jerrica Little, BA John P. Hirdes, PhD FCAHS School of Public Health and Health Systems University
More informationAMBULANCE diversion policies are created
36 AMBULANCE DIVERSION Scheulen et al. IMPACT OF AMBULANCE DIVERSION POLICIES Impact of Ambulance Diversion Policies in Urban, Suburban, and Rural Areas of Central Maryland JAMES J. SCHEULEN, PA-C, MBA,
More informationImpact of Scribes on Performance Indicators in the Emergency Department
CLINICAL PRACTICE Impact of Scribes on Performance Indicators in the Emergency Department Rajiv Arya, MD, Danielle M. Salovich, Pamela Ohman-Strickland, PhD, and Mark A. Merlin, DO Abstract Objectives:
More informationSAFE STAFFING GUIDELINE
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Guideline title SAFE STAFFING GUIDELINE SCOPE 1. Safe staffing for nursing in accident and emergency departments Background 2. The National Institute for
More informationA Brief Analysis of Trends in Prehospital Care Services and a Vision for the Future Article No
PROFESSIONALISM A Brief Analysis of Trends in Prehospital Care Services and a Vision for the Future Article No. 990082 Mark S. Chilton Head, Academic Services Monash University Centre for Ambulance and
More informationEvaluation of the Threshold Assessment Grid as a means of improving access from primary care to mental health services
Evaluation of the Threshold Assessment Grid as a means of improving access from primary care to mental health services Report for the National Co-ordinating Centre for NHS Service Delivery and Organisation
More informationQuality Assessment of the Philadelphia Emergency Medical Services System and the Call Center. By Katherine Lynn Waser May 2009
Quality Assessment of the Philadelphia Emergency Medical Services System and the 3-1-1 Call Center By Katherine Lynn Waser May 2009 A Community Based Master s Project presented to the faculty of Drexel
More informationSatisfaction and Experience with Health Care Services: A Survey of Albertans December 2010
Satisfaction and Experience with Health Care Services: A Survey of Albertans 2010 December 2010 Table of Contents 1.0 Executive Summary...1 1.1 Quality of Health Care Services... 2 1.2 Access to Health
More informationEPSRC Care Life Cycle, Social Sciences, University of Southampton, SO17 1BJ, UK b
Characteristics of and living arrangements amongst informal carers in England and Wales at the 2011 and 2001 Censuses: stability, change and transition James Robards a*, Maria Evandrou abc, Jane Falkingham
More informationThe Glasgow Admission Prediction Score. Allan Cameron Consultant Physician, Glasgow Royal Infirmary
The Glasgow Admission Prediction Score Allan Cameron Consultant Physician, Glasgow Royal Infirmary Outline The need for an admission prediction score What is GAPS? GAPS versus human judgment and Amb Score
More information3M Health Information Systems. 3M Clinical Risk Groups: Measuring risk, managing care
3M Health Information Systems 3M Clinical Risk Groups: Measuring risk, managing care 3M Clinical Risk Groups: Measuring risk, managing care Overview The 3M Clinical Risk Groups (CRGs) are a population
More informationTRIAGE SYSTEMS FOR TRAUMA CARE
Indep Rev July-Aug 2014;16(7-9) IR-333 TRIAGE SYSTEMS FOR TRAUMA CARE Awais Shuja FRCS (Ed), FCPS Assistant Professor of Surgery Independent Medical College, Faisalabad. Correspondence Address: Awais Shuja
More informationResponses of pharmacy students to hypothetical refusal of emergency hormonal contraception
Responses of pharmacy students to hypothetical refusal of emergency hormonal contraception Author Hope, Denise, King, Michelle, Hattingh, Laetitia Published 2014 Journal Title International Journal of
More informationThe Hashemite University- School of Nursing Master s Degree in Nursing Fall Semester
The Hashemite University- School of Nursing Master s Degree in Nursing Fall Semester Course Title: Statistical Methods Course Number: 0703702 Course Pre-requisite: None Credit Hours: 3 credit hours Day,
More informationHealthcare Conflicts: Resolution Mode Choices of Doctors & Nurses in a Tertiary Care Teaching Institute
International Journal of scientific research and management (IJSRM) Volume Issue Pages 3-1 Website: www.ijsrm.in ISSN (e): 31-31 Healthcare Conflicts: Resolution Mode Choices of Doctors & Nurses in a Tertiary
More informationBoarding Impact on patients, hospitals and healthcare systems
Boarding Impact on patients, hospitals and healthcare systems Dan Beckett Consultant Acute Physician NHSFV National Clinical Lead Whole System Patient Flow Project Scottish Government May 2014 Important
More informationORIGINAL RESEARCH ABSTRACT
ORIGINAL RESEARCH Assessing call demand and utilization of a secondary triage emergency communication nurse system for low acuity calls transferred from an emergency dispatch system Mark Conrad Fivaz,
More informationORIGINAL ARTICLE. Evaluating Popular Media and Internet-Based Hospital Quality Ratings for Cancer Surgery
ORIGINAL ARTICLE Evaluating Popular Media and Internet-Based Hospital Quality Ratings for Cancer Surgery Nicholas H. Osborne, MD; Amir A. Ghaferi, MD; Lauren H. Nicholas, PhD; Justin B. Dimick; MD MPH
More informationCritique of a Nurse Driven Mobility Study. Heather Nowak, Wendy Szymoniak, Sueann Unger, Sofia Warren. Ferris State University
Running head: CRITIQUE OF A NURSE 1 Critique of a Nurse Driven Mobility Study Heather Nowak, Wendy Szymoniak, Sueann Unger, Sofia Warren Ferris State University CRITIQUE OF A NURSE 2 Abstract This is a
More informationTracking Functional Outcomes throughout the Continuum of Acute and Postacute Rehabilitative Care
Tracking Functional Outcomes throughout the Continuum of Acute and Postacute Rehabilitative Care Robert D. Rondinelli, MD, PhD Medical Director Rehabilitation Services Unity Point Health, Des Moines Paulette
More informationRacial disparities in ED triage assessments and wait times
Racial disparities in ED triage assessments and wait times Jordan Bleth, James Beal PhD, Abe Sahmoun PhD June 2, 2017 Outline Background Purpose Methods Results Discussion Limitations Future areas of study
More informationPredicting use of Nurse Care Coordination by Patients in a Health Care Home
Predicting use of Nurse Care Coordination by Patients in a Health Care Home Catherine E. Vanderboom PhD, RN Clinical Nurse Researcher Mayo Clinic Rochester, MN USA 3 rd Annual ICHNO Conference Chicago,
More informationMeasuring healthcare service quality in a private hospital in a developing country by tools of Victorian patient satisfaction monitor
ORIGINAL ARTICLE Measuring healthcare service quality in a private hospital in a developing country by tools of Victorian patient satisfaction monitor Si Dung Chu 1,2, Tan Sin Khong 2,3 1 Vietnam National
More informationSTEMI Receiving Center Designation Process
PURPOSE STEMI Receiving Center Designation Process Rev. 2-6-2013 To define requirements for designation of a hospital as a ST-elevation myocardial infarction (STEMI) receiving center for the Austin-Travis
More informationIssue Brief From The University of Memphis Methodist Le Bonheur Center for Healthcare Economics
Issue Brief From The University of Memphis Methodist Le Bonheur Center for Healthcare Economics August 4, 2011 Non-Urgent ED Use in Tennessee, 2008 Cyril F. Chang, Rebecca A. Pope and Gregory G. Lubiani,
More informationA comparison of two measures of hospital foodservice satisfaction
Australian Health Review [Vol 26 No 1] 2003 A comparison of two measures of hospital foodservice satisfaction OLIVIA WRIGHT, SANDRA CAPRA AND JUDITH ALIAKBARI Olivia Wright is a PhD Scholar in Nutrition
More informationA Survey of Sepsis Treatment Protocols in West Virginia Critical Access Hospitals
A Survey of Sepsis Treatment Protocols in West Virginia Critical Access Hospitals Joshua Dunn, Pharm.D. Anne Teichman, Pharm.D. School of Pharmacy University of Charleston Charleston WV Corresponding author:
More informationEmergency department overcrowding, mortality and the 4-hour rule in Western Australia. Abstract. Methods
Research Gary C Geelhoed FRACP, FACEM, MD, Director, 1 and Professor, 2 Nicholas H de Klerk BSc, MSc, PhD, Head of Biostatistics and Bioinformatics 3,4 1 Emergency Department, Princess Margaret Hospital
More informationChapter 1, Part 2 EMS SYSTEMS EMS System A comprehensive network of personnel, equipment, and established to deliver aid and emergency medical care
1 3 4 5 6 7 8 9 10 11 1 Chapter 1, Part EMS SYSTEMS EMS System A comprehensive network of personnel, equipment, and established to deliver aid and emergency medical care to the community. IN-HOSPITAL COMPONENTS
More informationBurnout in ICU caregivers: A multicenter study of factors associated to centers
Burnout in ICU caregivers: A multicenter study of factors associated to centers Paolo Merlani, Mélanie Verdon, Adrian Businger, Guido Domenighetti, Hans Pargger, Bara Ricou and the STRESI+ group Online
More informationSupplementary Online Content
Supplementary Online Content Kaukonen KM, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012.
More informationPERCEPTION STUDY ON INFORMATION, EDUCATION AND COMMUNICATION IN A TERTIARY CARE HOSPITAL,CHENNAI.
African Journal of Science and Research,2016,(5)4:14-18 ISSN: 2306-5877 Available Online: http://ajsr.rstpublishers.com/ PERCEPTION STUDY ON INFORMATION, EDUCATION AND COMMUNICATION IN A TERTIARY CARE
More informationQuality of Care of Medicare- Medicaid Dual Eligibles with Diabetes. James X. Zhang, PhD, MS The University of Chicago
Quality of Care of Medicare- Medicaid Dual Eligibles with Diabetes James X. Zhang, PhD, MS The University of Chicago April 23, 2013 Outline Background Medicare Dual eligibles Diabetes mellitus Quality
More informationDANNOAC-AF synopsis. [Version 7.9v: 5th of April 2017]
DANNOAC-AF synopsis. [Version 7.9v: 5th of April 2017] A quality of care assessment comparing safety and efficacy of edoxaban, apixaban, rivaroxaban and dabigatran for oral anticoagulation in patients
More informationEvaluation of an independent, radiographer-led community diagnostic ultrasound service provided to general practitioners
Journal of Public Health VoI. 27, No. 2, pp. 176 181 doi:10.1093/pubmed/fdi006 Advance Access Publication 7 March 2005 Evaluation of an independent, radiographer-led community diagnostic ultrasound provided
More informationThe following policy was adopted by the San Luis Obispo County EMS Agency and will become effective March 1, 2012 at 0800 hours.
SLO County Emergency Medical Services Agency Bulletin 2012-02 PLEASE POST New Trauma System Policies and Procedures February 9, 2012 To All SLO County EMS Providers and Training Institutions: The following
More informationPublication Year: 2013
THE INITIAL ASSESSMENT PROCESS ST. JOSEPH'S HEALTHCARE HAMILTON Publication Year: 2013 Summary: The Initial Assessment Process (IAP) was developed collaboratively by the emergency physicians, nursing,
More informationANALYSIS OF SPECIALIST MEDICAL RESCUE TEAM INTERVENTIONS IN SOKOLÓW COUNTY IN 2016
ORIGINAL ARTICLE Disaster and Emergency Medicine Journal 2017, Vol. 2, No. 3, 107 111 DOI: 10.5603/DEMJ.2017.0023 Copyright 2017 Via Medica ISSN 2451 4691 ANALYSIS OF SPECIALIST MEDICAL RESCUE TEAM INTERVENTIONS
More informationFactors that Impact Readmission for Medicare and Medicaid HMO Inpatients
The College at Brockport: State University of New York Digital Commons @Brockport Senior Honors Theses Master's Theses and Honors Projects 5-2014 Factors that Impact Readmission for Medicare and Medicaid
More informationCDU. Clinical Decision Unit Ward for
CDU Clinical Decision Unit Ward for Can t Observational Decide Medicine Unit What are observation medicine units? Observation medicine delivers intensive shortterm assessment, observation or therapy to
More informationThe Amb Score. A pilot study to develop a scoring system to identify which emergency medical referrals would be suitable for Ambulatory Care.
The Amb Score A pilot study to develop a scoring system to identify which emergency medical referrals would be suitable for Ambulatory Care. Les Ala 1, Jennifer Mack 2, Rachel Shaw 2, Andrea Gasson 1 1.
More informationInteragency Council on Intermediate Sanctions
Interagency Council on Intermediate Sanctions October 2011 Timothy Wong, ICIS Research Analyst Maria Sadaya, Judiciary Research Aide Hawaii State Validation Report on the Domestic Violence Screening Instrument
More informationPatient Safety Assessment in Slovak Hospitals
1236 Patient Safety Assessment in Slovak Hospitals Veronika Mikušová 1, Viera Rusnáková 2, Katarína Naďová 3, Jana Boroňová 1,4, Melánie Beťková 4 1 Faculty of Health Care and Social Work, Trnava University,
More informationCommunity health centers and primary care access and quality for chronically-ill patients a case-comparison study of urban Guangdong Province, China
Shi et al. International Journal for Equity in Health (2015) 14:90 DOI 10.1186/s12939-015-0222-7 RESEARCH Community health centers and primary care access and quality for chronically-ill patients a case-comparison
More informationE m e rgency Health S e r v i c e s Syste m M o d e r n i zation
E m e rgency Health S e r v i c e s Syste m M o d e r n i zation Briefing Paper on Legislative Amendments to the Ambulance Act July 2017 Enhancing Emergency Services in Ontario (EESO) Ministry of Health
More information2018 Optional Special Interest Groups
2018 Optional Special Interest Groups Why Participate in Optional Roundtable Meetings? Focus on key improvement opportunities Identify exemplars across Australia and New Zealand Work with peers to improve
More informationAging in Place: Do Older Americans Act Title III Services Reach Those Most Likely to Enter Nursing Homes? Nursing Home Predictors
T I M E L Y I N F O R M A T I O N F R O M M A T H E M A T I C A Improving public well-being by conducting high quality, objective research and surveys JULY 2010 Number 1 Helping Vulnerable Seniors Thrive
More informationEXECUTIVE SUMMARY. 1. Introduction
EXECUTIVE SUMMARY 1. Introduction As the staff nurses are the frontline workers at all areas in the hospital, a need was felt to see the effectiveness of American Heart Association (AHA) certified Basic
More informationCHAPTER 3. Research methodology
CHAPTER 3 Research methodology 3.1 INTRODUCTION This chapter describes the research methodology of the study, including sampling, data collection and ethical guidelines. Ethical considerations concern
More informationLinkage between the Israeli Defense Forces Primary Care Physician Demographics and Usage of Secondary Medical Services and Laboratory Tests
MILITARY MEDICINE, 170, 10:836, 2005 Linkage between the Israeli Defense Forces Primary Care Physician Demographics and Usage of Secondary Medical Services and Laboratory Tests Guarantor: LTC Ilan Levy,
More informationCHAPTER 5 AN ANALYSIS OF SERVICE QUALITY IN HOSPITALS
CHAPTER 5 AN ANALYSIS OF SERVICE QUALITY IN HOSPITALS Fifth chapter forms the crux of the study. It presents analysis of data and findings by using SERVQUAL scale, statistical tests and graphs, for the
More informationNHS Ambulance Services
Report by the Comptroller and Auditor General NHS England NHS Ambulance Services HC 972 SESSION 2016-17 26 JANUARY 2017 4 Key facts NHS Ambulance Services Key facts 1.78bn the cost of urgent and emergency
More informationNavy and Marine Corps Public Health Center. Fleet and Marine Corps Health Risk Assessment 2013 Prepared 2014
Navy and Marine Corps Public Health Center Fleet and Marine Corps Health Risk Assessment 2013 Prepared 2014 The enclosed report discusses and analyzes the data from almost 200,000 health risk assessments
More informationPredicting Transitions in the Nursing Workforce: Professional Transitions from LPN to RN
Predicting Transitions in the Nursing Workforce: Professional Transitions from LPN to RN Cheryl B. Jones, PhD, RN, FAAN; Mark Toles, PhD, RN; George J. Knafl, PhD; Anna S. Beeber, PhD, RN Research Brief,
More informationComputer assisted assessment and advice for non-serious 999 ambulance service callers: the potential impact on ambulance despatch
178 PREHOSPITAL CARE Computer assisted assessment and advice for non-serious 999 ambulance service callers: the potential impact on ambulance despatch J Dale, J Higgins, S Williams, T Foster, H Snooks,
More informationOP ED-THROUGHPUT GENERAL DATA ELEMENT LIST. All Records
Material inside brackets ( [ and ] ) is new to this Specifications Manual version. HOSPITAL OUTPATIENT QUALITY MEASURES ED-Throughput Set Measure ID # OP-18 OP-20 OP-22 Measure Short Name Median Time from
More informationPhysician Use of Advance Care Planning Discussions in a Diverse Hospitalized Population
J Immigrant Minority Health (2011) 13:620 624 DOI 10.1007/s10903-010-9361-5 BRIEF COMMUNICATION Physician Use of Advance Care Planning Discussions in a Diverse Hospitalized Population Sonali P. Kulkarni
More informationGill Schierhout 2*, Veronica Matthews 1, Christine Connors 3, Sandra Thompson 4, Ru Kwedza 5, Catherine Kennedy 6 and Ross Bailie 7
Schierhout et al. BMC Health Services Research (2016) 16:560 DOI 10.1186/s12913-016-1812-9 RESEARCH ARTICLE Open Access Improvement in delivery of type 2 diabetes services differs by mode of care: a retrospective
More informationIncreased mortality associated with week-end hospital admission: a case for expanded seven-day services?
Increased mortality associated with week-end hospital admission: a case for expanded seven-day services? Nick Freemantle, 1,2 Daniel Ray, 2,3,4 David Mcnulty, 2,3 David Rosser, 5 Simon Bennett 6, Bruce
More informationProcess and definitions for the daily situation report web form
Process and definitions for the daily situation report web form November 2017 The daily situation report (sitrep) indicates where there are pressures on the NHS around the country in areas such as breaches
More informationSame day emergency care: clinical definition, patient selection and metrics
Ambulatory emergency care guide Same day emergency care: clinical definition, patient selection and metrics Published by NHS Improvement and the Ambulatory Emergency Care Network June 2018 Contents 1.
More informationResearcher: Dr Graeme Duke Software and analysis assistance: Dr. David Cook. The Northern Clinical Research Centre
Real-time monitoring of hospital performance: A practical application of the hospital and critical care outcome prediction equations (HOPE & COPE) for monitoring clinical performance in acute hospitals.
More informationICU Research Using Administrative Databases: What It s Good For, How to Use It
ICU Research Using Administrative Databases: What It s Good For, How to Use It Allan Garland, MD, MA Associate Professor of Medicine and Community Health Sciences University of Manitoba None Disclosures
More informationAs part. findings. appended. Decision
Council, 4 December 2012 Revalidation: Fitness to practisee data analysis Executive summary and recommendations Introduction As part of the programme of work looking at continuing fitness to practise and
More informationNebraska Final Report for. State-based Cardiovascular Disease Surveillance Data Pilot Project
Nebraska Final Report for State-based Cardiovascular Disease Surveillance Data Pilot Project Principle Investigators: Ming Qu, PhD Public Health Support Unit Administrator Nebraska Department of Health
More informationAppendix. We used matched-pair cluster-randomization to assign the. twenty-eight towns to intervention and control. Each cluster,
Yip W, Powell-Jackson T, Chen W, Hu M, Fe E, Hu M, et al. Capitation combined with payfor-performance improves antibiotic prescribing practices in rural China. Health Aff (Millwood). 2014;33(3). Published
More informationWith healthcare spending continuing to increase while
Predictive Factors of Discharge Navigation Lag Time CHARLES WALKER, MD; SAYEH BOZORGHADAD, BS; LEAH SCHOLTIS, PA-C; CHUNG-YIN SHERMAN, CRNP; JAMES DOVE, BA; MARIE HUNSINGER, RN, BSHS; JEFFREY WILD, MD;
More information