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Healthcare Delivery Systems
Published in A. Ravi Ravindran , Paul M. Griffin , Vittaldas V. Prabhu , Service Systems Engineering and Management, 2018
A. Ravi Ravindran , Paul M. Griffin , Vittaldas V. Prabhu
Emergency Department (ED)—provides for the acute care (e.g., heart condition, a cut, a car accident, an asthma event). Entry to the ED can come from any of the three means mentioned previously. Typically, there is a triage that first evaluates and categorizes patients based on vitals such as blood pressure, temperature, and interview answers. A common method to prioritize patients in the ED is the Emergency Severity Index (https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/esi/esihandbk.pdf), which has five levels: 1—resuscitation (patient is dying), 2—emergent (patient isn’t dying, but shouldn’t wait for care), 3—urgent (patient isn’t dying or emergent, but has multiple vital signs in the “danger zone” and may require multiple resources such as imaging, laboratory, consult), 4—less urgent (patient isn’t dying or emergent and only requires a single resource), and 5—(nonurgent). Triage for the ED is typically performed by a triage nurse.
Specialist care in rural hospitals: From Emergency Department consultation to hospital discharge
Published in IISE Transactions, 2021
Michael G. Klein, Vedat Verter, Hughie F. Fraser, Brian G. Moses
In urban and rural hospitals alike, the Emergency Department (ED) is the main point of entry for acute care. Arguably more than with any other service, patients spend most of their time waiting (for a bed, physician, nurse, medication, consultations or tests). With most services, waiting creates patient dissatisfaction and impacts profits. Unfortunately, ED crowding also has serious effects: adverse outcomes including higher patient mortality and reduction in quality of care. The evidence includes a study of 25 community and teaching hospitals in Ontario, Canada demonstrating that ED crowding has a real impact on the time to deliver thrombolysis, with increased door-to-needle time for patients with suspected acute myocardial infarction (Schull et al., 2004). For reviews of the medical literature on the effect of ED crowding on quality of care, see Hoot and Aronsky (2008) and Bernstein et al. (2009).
Using a priority queuing approach to improve emergency department performance
Published in Journal of Management Analytics, 2020
Upon arrival at the emergency department, the patients register for the care and then go through a triage process where a chief physician determines the acuity level. Since the patients have heterogeneous injuries and diseases, the ED managers propose to classify the emergency care based on acuity of illness with four levels, which is a standard scale in many EDs (Cochran & Roche, 2009; Siddharthan et al., 1996). Level I (Resuscitation): primary trauma care (e.g. automobile accidents and life-threatening injuries).Level II (Emergent): critical care cases (e.g. respiratory distress, cardiac arrest).Level III (Urgent): non-critical and secondary care (e.g. wound checks, removal of sutures).Level IV (Non-emergency): non- primary care (e.g. minor infections of chronic illnesses).