The emergency department of Lions Gate Hospital was studied both in regard to the patients' current visit to this facility and in regard to the patients' other sources of ambulatory medical care. The objectives of the study were: (1) to understand why patients seek care at Lions Gate's emergency department; (2) to discover how this facility fits into the patients' overall patterns of medical care; and (3) on the basis of the above data, to propose any appropriate changes in the organization of the emergency department. The study was conducted during 14 days in September, 1974; the sampling frame covered all hours of the day and all days of the week. Data were gathered by questionnaires administered in the emergency department, with 85.60 percent of the sample responding. The increase in demand for emergency department services has been attributed to a variety of factors. The present study determined that private physicians and their non-availability are the predominant factors contributing to emergency department usage at Lions Gate Hospital, indicating that this facility is substituting for the wider primary care system. Data pertaining to the patients' overall patterns of medical care provided further evidence that the emergency department has gained wide acceptance by the patients as a source of primary medical care. Moreover, the emergency department was identified as an important and continuing source of care in the medical care patterns of many of its patients. As a result of the above findings, it was recommended that future plans for either the modification or expansion of Lions Gate's emergency department should include the establishment within the department of a walk-in ambulatory clinic. The proposed ambulatory care department, consisting of an emergency centre and primary care clinic, would assist Lions Gate Hospital to fit its services to the medical care needs which its patients exhibit. / Business, Sauder School of / Graduate

No description available.

The purpose of this study is to gain information about the social service needs and demographic characteristics of patients admitted to Providence Hospital's emergency room during the hours a social worker is not available. The emergency room staff requested the information in order to utilize it in planning emergency room services

The problem of the study was to determine the status of bloodborne pathogen education for injection drug users in Indiana hospital emergency departments. The study was designed to answer the following research questions: (a) Do Indiana hospital emergency departments have written policies on bloodborne pathogen education for injection drug users? (b) To what extent do Indiana hospital emergency departments provide bloodborne pathogen education for injection drug users? and (c) What are the major barriers for Indiana hospital emergency departments in providing bloodborne pathogen education for injection drug users?A valid instrument was developed and sent to 110 Indiana hospital emergency department nurse managers. Forty-six instruments were returned for a response rate of 43.8%.The results indicated only three (7.1 %) responding hospital emergency departments had written bloodborne pathogen educational policies. Ten (20.8%) emergency departments provided some form of bloodborne pathogen education for injection drug users. Major barriers indicated for not providing patient education consisted of insufficient monetary resources, injection drug users denying a drug history, and emergency department nurses being unable to identify injection drug usage. / Department of Physiology and Health Science

Quality of health care delivered in the public sector remains a major challenge with diminishing resources to meet the increasing health care demands. Improvements in quality health care are identified in the Department of Health’s strategic framework as a key challenge. In order to improve quality, one needs to measure it. The patients’ views are important in identifying what is important to them. Inexpensive, easy to collect metrics need to be developed to measure quality of care. The study investigated perceptions of patients as a reflection of quality of care provided. The study also determined the key success factors in quality care in emergency departments and priorities of quality of care for improvement. A prospective study was conducted using one of Gauteng hospitals’ emergency departments as a case study. A structured questionnaire based on an overall care index focusing on specific dimensions of patients’ experience with health care was used to collect the data. Quantitative analysis was done using the Epi Info statistical package and the results summarised in frequency diagrams and tables. The findings indicate that waiting time is a major factor in perception of quality of health care. Although other hospitality issues in health care are important to patients, the degree to which they affect perception of quality of health care is difficult to determine because of the overwhelming influence of waiting time. It is recommended that priorities in addressing what users really want from health care should concentrate on strategies to shorten the waiting time. It is further recommended that a similar study be carried out in future once the waiting times have been improved considerably thus eliminating its excessive influence. This may highlight other variables important to the patients that may need to be improved in order to improve quality of care. / Dr. Susan Jennifer Armstrong

The purpose of this manual is to fill the void I encountered when I first began doing emergency room social work. After reading a mass of material on crisis theory, depression, suicide, psychiatric emergencies, etc., after having role played an emergency room crisis counselor, and after reviewing what seemed an infinite number of required hospital procedures, I began work as an emergency room social worker. The first few cases I encountered on my own were bewildering. When emergency room personnel would refer a patient to me with the prefatory remark: "This guy looks like he has real emotional problems. See what you can do”, I would nearly freeze as I wondered which form to fill out before seeing the patient, what questions to ask the patient, which theory to review before interviewing the patient. After the interview, I confronted the problem of deciding upon an appropriate referral, which forms to fill out, whom to confer with, etc. Frankly, the entire situation was pretty overwhelming to me.

The purpose of this survey was to obtain information from hospital emergency room staff on each mental health admission during the period of December 15, 1977 to January 15, 1978. Mental health admissions were broadly defined to include those people who were experiencing an observable mental health difficulty, but who may have initially presented primary medical problems. At the request of Multnomah County Mental Health Division's Management Team, and with the approval of the Emergency Department Nurses Association (EDNA), questionnaires were distributed among 16 general hospitals in the Portland, Oregon, Tri-County area. These hospitals are located in Multnomah, Clackamas, and Washington Counties. This survey represents the first attempt (1) to obtain information on an area-wide basis, on emergency room (ER) treatment of mental health admissions; and (2) to ascertain the availability and use of community mental health resources. The collection of such information is important to planning for comprehensive mental health services and in improving the existing service delivery system.

Caregivers often associate fevers with permanent harm and bring children to emergency departments (EDs) unnecessarily. However, families using EDs for nonurgent complaints often have difficulty accessing quality primary care. Mutual misconceptions among caregivers and healthcare providers regarding nonurgent ED use are a barrier to implementing meaningful interventions. The purpose of this project was to identify dominant themes in caregivers’ narratives about bringing children to the ED for nonurgent fevers. Thirty caregivers were recruited in a pediatric ED for participation in qualitative semi-structured interview from August to November 2014. Interview transcripts were coded and analyzed for themes. Caregivers’ decisions to come to the ED revolved around their need for reassurance that children were not in danger. Several major themes emerged: caregivers came to the ED when they felt they had no other options; parents feared that fevers would result in seizures; caregivers frequently drew on family members and the internet for health information; and many families struggled to access their PCPs for sick care due to challenging family logistics. Reducing nonurgent ED utilization requires interventions at the individual and structural level. Individual-level interventions should empower caregivers to manage fevers and other common illnesses at home. However, such interventions may have limited impact on utilization outcomes among families with poor access to primary care. Afterhours primary care should be expanded to accommodate families with rigid work schedules and limited transportation resources.

This paper explains the increased use of hospital-based emergency facilities for primary care. The analysis identifies socio-demographic characteristics, individual resources and selected access variables which influence use of physician services or emergency rooms. The selection of variables is based on a model of facility use which has been derived from the literature on medical care. The results from the analysis concluded that socio-demographic characteristics are both directly and indirectly related to facility use, but there is no apparent association between health insurance as an individual resource and access variables, and use of health care services. Suggestions of further research ar:e proposed based upon a theoretical model of health care choice behavior. / Master of Urban Affairs

Objectives: This study has been conducted to determine the levels of inappropriate use of the A&E for conditions that could be treated by GPs, the nature of the morbidity pattern of those conditions, the reasons why primary care services were not being utilized, and also examined the validity (i.e. sensitivity and specificity) of patient classifications undertaken by nurses at the time of admission within this local context. Study design and setting: A cross sectional study was conducted over a one year period and subjects were randomly selected from four A&E departments located across the four principle geographic regions of Hong Kong by stratified, two-stage sampling. Main outcome measure: The gold standard in differentiating true emergency cases and GP cases was based on a retrospective record review conducted independently by a panel of emergency physicians. A random sub-sample of those classified as GP cases was interviewed and compared to a matched (via morbidity status) sample of primary care patients who had attended a hospitals' GOPC in order to determine factors distinguishing these two patient groups. Multiple Logistic Regression was used to distinguish the difference between GP cases and matched GOPC primary care patients on significance and odds ratios of the variables. The morbidity pattern according to ICPC was tabulated and analysed for the 'true' A&E cases and non-urgent cases. Sensitivity, specificity and positive predictive values were computed for both non-weighted and weighted conditions. Results: The level of GP cases was found to be 57% with a significant higher proportion of patients in younger age group, and late evening. The morbidity pattern of those top 10 diagnoses of non-urgent cases was very similar to the Hong Kong general practice morbidity pattern for self limiting conditions. Closure of the clinic was the main reason for GP cases attending A&E. Other major reasons were deterioration of symptoms, GPs' inability to diagnose efficiently and patients' wish to continue medical treatment in the same hospital. Affordability was the most pronounced reason for utilising the GOPC, but did not apply to the A&E GP patients. The most accurate weighted nurses' triage classification had the average sensitivity of 75%, specificity of 65.7%, and positive predictive value of 54%. The most accurate weighted patients' self-triage classification yielded a sensitivity of 43.3%, specificity of 49.2%, and a positive predictive value of 38.6%. Conclusion: The reasons for high level of utilisation of A&E services are complex and reflect problems of delivery of GP services. There is an urgent need for the GPs to set up a network system to provide out of hours services, and also for a better interfacing between primary and secondary care, and between public and private sectors, so that patients can be referred back to GPs. The design and measures chosen for this study will help provide A&E policy makers and planners with relevant information for better addressing practical solutions. / Albert Lee. / Source: Dissertation Abstracts International, Volume: 73-01, Section: B, page: . / Thesis (M.D.)--Chinese University of Hong Kong, 2004. / Includes bibliographical references (leaves 137-151). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Appendix 4 in Chinese.