Developing Measures of Quality for the Emergency Department Management of Pediatric Suicide-Related Behaviors
Anne E. RhodesJennifer BethellAmanda S. NewtonJesmin AntonyLil TonmyrFarhan BhanjiDavid ChaulkSarah CurtisSerge GouinGary JoubertRobert D. PorterNorman SilverJennifer SpruytGraham C. ThompsonTroy Turner
6
Citation
17
Reference
10
Related Paper
Citation Trend
Abstract:
Objective Given the public health importance of suicide-related behaviors and the corresponding gap in the performance measurement literature, we sought to identify key candidate process indicators (quality of care measures) and structural measures (organizational resources and attributes) important for emergency department (ED) management of pediatric suicide-related behaviors. Methods We reviewed nationally endorsed guidelines and published research to establish an inventory of measures. Next, we surveyed expert pediatric ED clinicians to assess the level of agreement on the relevance (to patient care) and variability (across hospitals) of 42 candidate process indicators and whether 10 hospital and regional structural measures might impact these processes. Results Twenty-three clinicians from 14 pediatric tertiary-care hospitals responded (93% of hospitals contacted). Candidate process indicators identified as both most relevant to patient care (≥87% agreed or strongly agreed) and most variable across hospitals (≥78% agreed or strongly agreed) were wait time for medical assessment; referral to crisis intervention worker/program; mental health, psychosocial, or risk assessment requested; any inpatient admission; psychiatric inpatient admission; postdischarge treatment plan; wait time for first follow-up appointment; follow-up obtained; and type of follow-up obtained. Key hospital and regional structural measures (≥87% agreed or strongly agreed) were specialist staffing and type of specialist staffing in or available to the ED; regional policies, protocols, or procedures; and inpatient psychiatric services. Conclusions This study highlighted candidate performance measures for the ED management of pediatric suicide-related behaviors. The 9 candidate process indicators (covering triage, assessment, admission, discharge, and follow-up) and 4 hospital and regional structural measures merit further development.Keywords:
Staffing
Triage
Background and Aims Decision-making is the major component in triaging EDs patients. EDs Triage systems have applied different approaches to triaging intoxicated patients. Pros & Cons for these approaches need to be identified. Aim is to analysis management of intoxicated patients during various triage process. Methods Critical review includes five triage systems, Emergency Severity Index, Australasian Triage Scale, Canadian triage and Acuity Scale, Manchester Triage System and 5-tier Triage protocol. These systems have been analyzed via meta-synthesis in terms of evidence-based criteria, inclusiveness, specific application and practicability. Results General physiologic signs & symptoms were the gold standard for determining acuity in patients that have been applied by all triage systems. Conscious level, air way, respiratory status and circulation assessment were identified as major criteria in decision-making. 5-tier Triage protocol showed the most comprehensiveness characteristics to prioritizing intoxicated patients. Discussion Resources necessary for evidence-based performance to support nursing decisions in triaging intoxicated patients needs fundamentally to be developed. It`s necessary to develop National Triage Scale to approach intoxicated patients effectively.
Triage
Gold standard (test)
Cite
Citations (1)
Triage is the process of ordering
patients according to medical
priority. The overall objective is to do the
most good for the most people. Hospital triage involves identifying
and preferentially treating
life-threatening conditions. Ambulance triage systems
include colour-coded and 'priority-
based' systems. There is lack of uniformity and
continuity in triage processes in
South Africa. No definitive triage physiological
or algorithmic scoring system
is currently in use. A uniform national ambulance
and hospital-based system would
facilitate triage and treatment.
Triage
Cite
Citations (0)
Background: We sought to increase resident/fellow involvement in patient safety and healthcare quality improvement initiatives by identifying and reporting opportunities for improvement. We wanted to enhance residents9 attention to quality and safety lapses, whether resulting in patient harm or near misses, and to promote collaboration between GME and patient safety/quality improvement personnel. Methods: The quality improvement team met with all 40 residency and fellowship programs individually to educate them regarding the patient safety/quality improvement reporting process and incident follow-up. Every resident/fellow in each program was then requested to identify a perceived patient safety concern and complete a patient safety/quality improvement report. Patient safety/quality improvement staff reviewed all submitted reports and provided feedback 1 month later at resident meetings. Results: Prior to the beginning of the educational sessions in January 2014, only 6 patient safety/quality improvement reports were completed by residents and fellows from January–June 2013, and 8 reports were completed from July–December 2013. However, in the January–June 2014 time frame, 55 reports were completed, and the number increased to 117 in the July–December 2014 time frame. The educational intervention yielded a 12-fold increase in medical error reports submitted by residents. Conclusions: This project encouraged discussion about medical error reporting and resulted in more involvement by residents in quality committees. Also, in cooperation with the quality improvement team, changes were made to the online patient safety/quality improvement reporting form to include an optional data field identifying the status of the individual submitting the report (resident, nurse, etc) so even when reporting anonymously, residents can be identified as residents.
Near miss
Cite
Citations (0)
Triage
Emergency nursing
Cite
Citations (93)
This chapter on mass casualty triage outlines the fundamentals of providing care in humanitarian settings, including overall guidance to clinical care, key aspects of patient triage, including the rationing of care based on priority for treatment, and approaches for paediatrics. It clarifies the differences between medical triage and mass casualty triage, describes the process of balancing needs with the resources available, recognizing situations where large numbers of patients overwhelm resources, and discusses triage models and organization, triage teams, and triage algorithms.
Triage
Mass-casualty incident
Mass Casualty
Cite
Citations (0)
Triage
Cite
Citations (3)
To triage, to triage to buy an apt gig; Home again, home again, diagnosed thingamajig. To triage, to triage to buy an apt doc; Home again, home again, diagnosed thingamabob. To triage, to triage a gallop a trot; To buy some granite to put in the plot. One million, three million coverage supplied, If he hadn’t been killed, he must have died.
Triage
Cite
Citations (1)
Triage
Emergency nursing
Identification
Cite
Citations (5)
Cite
Citations (7)
The triage system currently recommended by the Association of Emergency Physicians (ACEP) and Emergency Nurses Association (ENA) is a five levels triage, Emergency Severity Index (ESI) due to more structured, concise, and clear. Cibabat Hospital used a relatively new triage of four modified levels of the Australian Triage Scale (ATS) which accuracy and time triage have not been evaluated. The purpose of this study was to compare the four level triage of modification of ATS and five levels of ESI triage based on accuracy and time triage. The researcher used a quantitative quasi-experimental design with samples of triage activities totaling 38 in the control group and 38 intervention groups, using accidental sampling techniques. Univariate analysis consisted of frequency distribution for nurse characteristics, time triage and accuracy, bivariate analysis used the Mann-Whitney test. The results showed there were no differences, triage modification of ATS with ESI triage in accuracy (p-0.488), and length of triage (p-0.488) ESI triage accuracy was in the expected triage category (76.3%), under triage (13.2%), and over triage (10.5%). Triage modified ATS, expected triage (73.7%), under triage (18.4%), and over triage (7.9%). ESI triage has more expected and less under triage than ATS modification triage. Under triage caused prolong waiting times, unexpected risks, increases morbidity and mortality. Based on the length of time, ESI triage averaged 167 seconds, triage modification of ATS an average of 183 seconds. ESI flowchrat is easier to understand because is simple, has slight indicators in each category. Conclusion of this study is there is no significant difference in the level of accuracy and duration of triage. However, based on data distribution, ESI triage gives more expected triage decisions, less under triage and 16 seconds faster. Suggestions given to the Cibabat Hospital, can use ESI triage as an alternative triage assessment option because easy to use, structured, simple, and clear.
Triage
Cite
Citations (3)