Background: The patient meets nurses in the emergency department that provide both nursing and has medical skills. The care that the patients are receiving should be individually adjusted. The care is shaped by the individual meeting with the patient according to the nursing theorist Orlando. There are large variations between the number of patients in an emergency department and it sets high demands on the staff, both physically and mentally. When the emergency department is highly loaded there is a priority for medical care and psycho-social and aesthetic aspects will have to wait. It´s often an impossibility to be able to sit down with the individual patient and talk for a while. Aim: The purpose of this study was to describe the patient´s perceptions of nurse’s treatment at an emergency department. Method: Ten scientific papers from the years 1999 – 2010 have been used in our literature review in which the similarities and differences are compared. Result: The result of the analysis resulted in three titles, environment affects the integrity, that patients well-being are satisfied and the nurse information affects patient’s experience. Conclusion: Whether the communication turned out well between patient and nurse influenced how the patient experienced the visit at the emergency department.

Aim: The aim of this study was to describe how patients with acute illness experience their given care in the emergency department. Method: A literature review of ten studies where differences and similarities were analyzed. These studies had been published between the years of 2000 and 2011. Results: The analysis showed a lack of sufficient care concerning patients’ subjective experiences. The researchers found three themes that specifically stood out when studies that had already been made were researched. These themes played an important role in care in the emergency department and insufficient attention to these from the staff could lead to a negative impact on patients’ experiences. The themes were: patients’ participation, patients’ need of communication and information and waiting period. The result showed that a lack in these presented themes could cause feelings of distress, frustration and irritation among patients. Because of this they often used different kinds of strategies to get more involved in their own caring process. Conclusion: The conclusion of this study was that there is a lack of resources within the emergency department where lack of personnel is the most forthcoming reason to patients’ negative experiences. There was however ways for the nurses to improve patients’ experiences within the emergency department by using Travelbee’s philosophy. This was to better interact and understand the patients’ lived experiences as a whole. Every patient is unique and by using proper communication, nurses can understand the patients’ whole life situation and by that, improve the quality of care.

INTRODUCTION: Oral health is a worldwide concern that affects people of every age, socioeconomic status, and ethnicity. Having good oral health is vital to overall health and well-being. Dental caries and periodontal diseases are preventable, but disparities exist in access to preventive care. Proper oral hygiene includes brushing with fluoride toothpaste, flossing, and regular dental visits. Adults without dental insurance may have financial obstacles to proper oral hygiene. Due to lack of dental care, adults without dental insurance may seek acute dental treatment in inappropriate settings, such as an emergency department. AIM: The purpose of this study was to examine if insurance status is associated with being dental and trauma patients presenting to Grady Memorial Hospital’s emergency department for care. METHODS: Data were obtained from Grady Memorial Hospital, Atlanta, GA for the years 2010-2013. Emergency department data for trauma and dental patients aged 20-64 years (n = 27,247) were extracted using ICD-9 codes and the age variable. Chi-square analyses were used to assess differences in insurance status between dental and trauma patients. Odds ratios from bivariate and multivariate analyses were used to determine associations between being a dental or trauma patient and selected independent variables. The model of best fit was determined using the stepwise logistic regression technique. RESULTS: Insurance status was significantly different between trauma and dental patients (p < .001). Approximately 78% of dental patients were uninsured, while about 57% of trauma patients were uninsured. Controlling for cofounders, being uninsured was statistically significant. Being uninsured was significantly associated with an increased likelihood of being a dental patient (OR: 2.58, 95% CI: [2.17,3.07], p < .001). DISCUSSION: The results from this study demonstrate that insurance status is a main reason why dental patients seek care in an emergency department. Dental patients are significantly more likely to be uninsured than trauma patients. This issue of lack of insurance coverage for dental patients must be addressed in order to decrease the current disparities in care. Further research is needed to determine if there are additional driving factors which contribute to the decision to visit an emergency department for dental care. Due to the disparities that exist in access to dental care, and the repercussions that occur from a lack of dental insurance, dental insurance coverage is a public health concern that needs to be given more attention.

An understanding of both the determinants of health care access and the implications of that access is of crucial importance because it enables us to learn about policies and institutions that are welfare enhancing in health outcomes. The first chapter of my dissertation explores how access to sanitaria aided in tuberculosis control in the time before antibiotics. Results indicate that access to an additional sanitaria bed reduced the death rate from tuberculosis for white residents by nearly .695 per 100,000 and had no impact for black residents. The next two chapters investigate the retail health clinic. First, I construct a choice model of clinic location that accounts for both demand and competition effects. I find that clinics are more likely to locate in areas that are populous, wealthy, educated, and white, and that they are less likely to locate in traditionally underserved communities. Second, I combine the results of my predictive model with data on ED visits to determine if clinics help direct patients away from receiving treatment at expensive emergency rooms. I find that access to retail clinics causes a substantial decrease in the number of ED visits for bronchitis and upper respiratory infections. The savings associated with retail clinic induced ED diversion is conservatively estimated to be at least $88 million in 2012 alone. In California, counterfactual analysis suggests that relaxing the barriers to clinic entry would result in $10.5 million in annual health care savings.

The purpose of this Doctor of Nursing Practice (DNP) final project is to develop a business plan and care model for implementing a fast track area (FTA) in a rural emergency department (ED). The short term goal for this project is to create a business plan and the long term goals are to create a new care model to decrease wait times and lengths of stay, as well as increasing patient satisfaction in a rural emergency department. This project will provide background knowledge pertaining to ED overcrowding, identification of key stakeholders and justification for a fast track area with definitions of pertinent terminology used throughout the project. This business plan will incorporate data collection and results from Platte County Memorial Hospital in Wheatland, Wyoming. Limitations to and proposals for future research will be addressed at the end of the project.

In an emergency department (ED), information flow is of high value, as the ability to react quickly directly affects the patients’ well being. One of the gaps in the information flow is in the order tracking process. This paper focuses on modelling the feedback in this process from the order being issued until it has been fulfilled. We address this problem using discrete-event simulation. Additionally, we use the mathematical theory of communication to evaluate the information con- tent in the current and proposed systems. We perform computational tests on these models to compare their performance. Experimental results show that the problem can be effectively modelled using our approach and the effects of feedback on the physician decision-making can be better understood. The results indicate that additions of as little as one point of feedback have practically significant effects on the amount of time that an order spends in the system.

No description available.

Emergency department(ED) is one of the busiest clinical units in Winnipeg Victoria Gen-eral Hospital (VGH) which faces the challenge of patients’ long waiting-time as increas-ing healthcare demand and limited resources. This research investigates the critical factors of the ED operation to enhance the operational efficiency using simulation modeling and optimization. The contribution of this research is the integration of simulation and optimization for the performance improvement of ED operations. Discrete-events simula-tion (DES) methodology provides a cost-effective tool to analyse the performance of the ED operations and evaluates the potential alternatives. Design of experiments (DOE) and Scatter search (SS) of model optimization are proposed to search the ED potential capaci-ty for waiting-time reduction. The patient-flow is accelerated along with the waiting-time reduction, which results in better efficient patient throughput in the ED. A specific strate-gy is suggested to improve the ED operation based on the simulation model.

In an emergency department (ED), information flow is of high value, as the ability to react quickly directly affects the patients’ well being. One of the gaps in the information flow is in the order tracking process. This paper focuses on modelling the feedback in this process from the order being issued until it has been fulfilled. We address this problem using discrete-event simulation. Additionally, we use the mathematical theory of communication to evaluate the information con- tent in the current and proposed systems. We perform computational tests on these models to compare their performance. Experimental results show that the problem can be effectively modelled using our approach and the effects of feedback on the physician decision-making can be better understood. The results indicate that additions of as little as one point of feedback have practically significant effects on the amount of time that an order spends in the system.

Die Zentrale Notaufnahme (ZNA) dient als Eintrittsstelle für alle ungeplanten Notfallpatienten eines Krankenhauses. Im Rahmen der Prozesssteuerung kommt der ZNA mit der Priorisierung der Behandlung (Ersteinschätzung), der zielgerichteten Diagnostik und Therapie sowie der Entscheidung über ambulanten Verbleib und stationäre Aufnahme der Patienten eine große Bedeutung zu. In Abhängigkeit von der Struktur und Organisationsform einer ZNA erfolgt bei bereits im ambulanten Bereich behandelten Patienten die Zuordnung zur weiterbehandelnden Fachdisziplin innerhalb des Krankenhauses auf Basis der Überweisungs- bzw. Einweisungsscheinen. Der auf dem Einweisungsschein dokumentierten Einweisungsdiagnose wird als Zuordnungskriterium bei der Prozesssteuerung im klinischen Alltag daher eine tragende Rolle zuteil. Die prospektive, monozentrische Untersuchung zeigt, dass Einweisungsdiagnosen durch niedergelassene Hausärzte und ambulante Versorgungeinrichtungen einer gewissen Unschärfe unterliegen: Nach Ende der Behandlung in der ZNA wurden bei 57,8% der Patienten die Einweisungsdiagnose als zutreffend, bei 23,6% als teilweise zutreffend und bei 18,6% als nicht-zutreffend dokumentiert. Bei Patienten mit teilweise bzw. nicht-zutreffender Einweisungsdiagnose fand sich eine 3-fach bzw. eine 6,5-fach höhere Konsilrate im Vergleich zu Patienten mit zutreffender Einweisungsdiagnose (p<0,05). Patienten mit zutreffender Einweisungsdiagnose wiesen eine signifikant kürzere Verweildauer im Vergleich zu denen mit teilweiser oder nicht-zutreffender Einweisungsdiagnose auf. Die Konsilrate in der ZNA stieg bei Nichtübereinstimmung der 3 Einweisungsdiagnose mit der in der ZNA gestellten Diagnose bis auf das 6,5-fache an [36 Konsile (7,9%) bei 453 Patienten mit zutreffender vs. 75 Konsile (51%) bei 146 Patienten mit nicht-zutreffender Einweisungsdiagnose] und auch die Verweildauer in der ZNA nahm signifikant zu (MW±SD: 192±108 min bei zutreffender vs. 258±138 min bei nicht-zutreffender Einweisungsdiagnose). Die vorliegenden Untersuchungsergebnisse zeigen, dass in der ZNA durch geeignete Maßnahmen (z. B. Ersteinschätzungssysteme, Behandlungspfade, „Standard Operation Procedure“) ein organisiertes und strukturiertes Vorgehen gewährleistet sein muss, um eine Fehlsteuerung mit Verlängerung der Patientenverweildauer und einer Erhöhung der Konsilrate mit höheren Kosten, einer höheren Personalbelastung und möglicherweise negativen Folgen für den Patienten bei nicht-zutreffender Einweisungsdiagnose zu vermeiden.