Emergency department (ED) crowding is a serious problem in the United States. Crowding in the ED can result in delays that may negatively affect patient outcomes and increase the cost of care. The purpose of this project was to understand strategies that can help to improve patient flow in the ED. The plan-to-do-study act model for process improvement influenced this project. Secondary data were collected for a 2-month period to determine the impact of workflow processes (patient boarding time in ED, surge capacity and workflow processes including the impact of ancillary departments) on the movement of admitted patients from the ED to the inpatient units. Descriptive statistics were used to provide numerical summaries, frequencies, and percentages for the identified variables. The findings were consistent with an increased length of stay and longer ED boarding of patients due to the workflow process. Resulting recommendations included standardized calls for report on admitted patients within 30 minutes, timely discharge of patients, collaboration with attending physicians to facilitate evaluation of patients and orders, modification of staffing roles to ensure adequate staff, and identification of staff transporters to ensure timely transport of patients to their rooms. The findings helped to inform the development of a Bed Utilization Policy. The policy has been shared with the organization with the recommendation to implement and further evaluate to help manage bed flow. Development of utilization strategies that contribute to facilitating throughput will promote positive social change by providing nurses with the tools to help prepare for and respond to unexpected increases in patient volume. Improving efficiency with flow can help to improve patient care, timeliness, and safety.

No description available.

The U.S. Department of Health and Human Services has declared the misuse of opioid prescription drugs as a public health emergency. The Affordable Care Act’s Medicaid expansion expanded the number of people with insurance and increased the demand for services related to substance abuse treatment. In the first part of this study, the researcher examines whether the Medicaid expansion reduced the likelihood of treatment delay. The second part of this study explores whether the length of stay for opioid use disorder treatment is significantly different in states that adopted Medicaid expansion versus states that did not. In both studies, the researcher analyzes administrative data from the Substance Abuse and Mental Health Services Administration to discover any treatment delays associated with the opioid treatments for the states that adopted the expansion versus the states that did not, and to determine whether there was a difference in the length of stay in the states that adopted the Medicaid versus the states that did not. A difference-in-difference approach is used in both studies to compare the states which adopted an optional Medicaid expansion to those non-adoption states. The evidence suggests that demand for opioid treatment services increased in expansion states as there is a decreased probability of obtaining treatment on the first day for initial requests for outpatient treatment. In addition, evidence suggests that Medicaid expansion increased the likelihood of staying longer in outpatient facilities, but not inpatient facilities. / Business Administration/Risk Management and Insurance

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23755号 / 医博第4801号 / 新制||医||1056(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 川上 浩司, 教授 小濱 和貴, 教授 平井 豊博 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

På Sveriges akutmottagningar ses att vistelsetiden ökar och att äldre över 65 år är de som står för nära hälften av alla akutbesök och mer än hälften av all sammanlagd vårdtid. Vistelsetiden inom sjukvården beskrivs med två begrepp, LOS som står för den totala vistelsetiden inom sjukhuset och ED LOS som beskriver vistelsetiden på akutmottagningen. Förlängd ED LOS och LOS drabbar äldre genom ökad förekomst av vårdskador och dödlighet. Skörhet är ett begrepp som används för att beskriva äldre som bedöms ha ökad risk att drabbas av sådana negativa konsekvenser. Sjuksköterskan på akutmottagningen har en nyckelfunktion inom patientsäkerhetsarbete och en viktig roll i att effektivisera patientflödet.  Syftet var att beskriva sjuksköterskeinitierade interventioner för sköra äldre på akutmottagning genom att undersöka vad som var gemensamt i interventionerna samt deras effekt på ED LOS och LOS.  En litteraturöversikt användes som metod. Datainsamlingen genomfördes via databassökningarna i PubMed och CINAHL. Femton vetenskapliga artiklar som beskrev sjuksköterskeinitierade interventioner som utfördes på akutmottagningar och som mätte ED LOS och LOS inkluderades i resultatet. Artiklarna kvalitetsgranskades och analyserades genom en integrerad analys.  I resultatet framkom tre huvudkategorier med sju tillhörande underkategorier som beskrev gemensamma fynd i interventionerna. Huvudkategorierna var kunskapens betydelse för interventionen, samverkan för den sköra äldre och identifiering, bedömning och behandling av sköra äldre. ED LOS och LOS presenterades i relation till huvudkategorier och underkategorier. ED LOS minskade i nio interventioner, ökade i två och hade ingen signifikant skillnad i två. LOS hade ingen signifikant skillnad i fem interventioner och minskade i tre.  Slutsatsen var att specialistsjuksköterskor har en viktig roll i att utveckla, implementera och leda interventioner för sköra äldre samt att samarbete mellan professioner och över organisationsgränser och införande av snabbspår var viktiga gemensamma faktorer i interventioner som minskade ED LOS och i viss mån LOS.

No description available.

The cost and duration of cardiovascular care was studied for 4,804 episodes of hospitalization in patients between 45 and 64 years of age. Men were more likely than women to be treated in urban medical centers for shorter, more expensive hospital care; women were more likely to be treated in rural hospitals for longer, less expensive care. Cost of treatment per day was not dependent on the type of insurance, but Medicaid claims (which represent low income patients) were associated with greater lengths of stay.

Urinary tract infections (UTI) in neonates are caused by many types of risk factors such as increased length of maternal labor, physiologic maternal conditions, prematurity, and decreased birth weight. Identification of potential risk factors for UTI in neonates can lead to rapid assessment and early interventions to treat urinary infection in the neonate before it transitions to a severe or life-threatening condition, such as a kidney infection or septicemia. The primary purpose of this literature review was to examine risk factors predisposing neonates to UTI. The secondary purpose was to identify if length of time to drug therapy used to treat UTI in neonates decreased complications and recurrence in the preterm infant. A comprehensive literature review was performed using research articles available from 2007 to 2021 regarding the factors influencing the occurrence of urinary tract infections in neonates. Databases used to search for articles include EBSCOhost databases, Medical Literature On-Line (Medline), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Google Scholar. Searches used a combination of the following terms: ‘UTI’, OR ‘urinary tract infection’, AND ‘neonates’, OR ‘infants’, ‘risk factors’. Of the articles reviewed, 15 met the inclusion criteria and answered the research questions. Two studies showed circumcision in male infants increases the risk of urinary tract infection in infants. Two studies revealed vesicourethral reflux in female infants compared to male infants increases the risk of UTIs. One article suggested women with longer labor (>24 hours) from onset had an increased likelihood of the newborn having a UTI within the first week of life. Preliminary data suggests there are significant precursors and risk factors that can be identified to diagnosis UTIs early and having them treated promptly. All the reviewed articles focused on collection of urine samples within hours of birth and physiologic findings of a UTI can decrease the length of stay and costs related to infection treatment. Antibiotic therapy being administered empirically due to rapid assessment of risk factors for UTI in the neonate decreases time to treatment by three to five days, which improves health outcomes. Rapid assessment and diagnosis of UTI is of value for preventable measures to be ordered sooner to avoid repeat and resistant UTIs in the neonate.

No description available.

No description available.