Article
Health Care Sciences & Services
Jalmari Tuominen, Teemu Koivistoinen, Juho Kanniainen, Niku Oksala, Ari Palomaki, Antti Roine
Summary: Emergency department crowding is a recognized threat to patient safety and is associated with increased mortality. This article presents the results of a prospective crowding early warning software that accurately predicts future service demand and potentially improves treatment outcomes. The software achieved high AUC scores for predicting next hour and 24-hour crowding using simple statistical models, and also successfully predicted afternoon crowding at 1 p.m.
JOURNAL OF MEDICAL SYSTEMS
(2023)
Article
Multidisciplinary Sciences
Bjorn af Ugglas, Per Lindmarker, Ulf Ekelund, Therese Djarv, Martin J. Holzmann
Summary: This study aimed to investigate the association between ED crowding and mortality, finding a significant association with 7-day mortality but not with 30-day mortality. Subgroup analysis by county showed mixed results, with a clear association only in one of the three counties.
Article
Emergency Medicine
Jens Wretborn, Hakan Starkenberg, Thoralph Ruge, Daniel B. Wilhelms, Ulf Ekelund
Summary: In this study conducted at four emergency departments in Sweden, a modified SEAL (mSEAL) model was derived and validated, showing strong correlation with crowding based on workload assessments. The mSEAL model demonstrated good discriminatory capacity in measuring crowding and can help policymakers and researchers target its causes and effects. Additionally, Occupancy Rate and NEDOCS were identified as good alternatives to measure crowding based on workload in Swedish emergency departments.
BMC EMERGENCY MEDICINE
(2021)
Article
Emergency Medicine
Qian Cheng, Nilay Tanik Argon, Christopher Scott Evans, Yufeng Liu, Timothy F. Platts-Mills, Serhan Ziya
Summary: This study developed a novel predictive model for emergency department hourly occupancy using SARIMAX model with external regressors, providing up to 4-hour ahead predictions. By including external regressors of current ED occupancy, average department-wide ESI, and ED boarding total, the 24-SARIMAX model outperformed other forecasting methods in predicting ED occupancy.
AMERICAN JOURNAL OF EMERGENCY MEDICINE
(2021)
Article
Public, Environmental & Occupational Health
Jens Wretborn, Daniel B. Wilhelms, Ulf Ekelund
Summary: A study in Sweden found that ED crowding measured by mSEAL or occupancy rate was not significantly associated with short-term mortality.
FRONTIERS IN PUBLIC HEALTH
(2023)
Letter
Emergency Medicine
Arshia P. Javidan, Kim Hansen, Ian Higginson, Peter Jones, Eddy Lang
Summary: The study developed a comprehensive guidance on the impacts, causes, and solutions related to ED crowding and access block through international collaboration. It highlighted that ED crowding is a multifactorial issue requiring systems-wide solutions, with access block being the predominant contributor in most parts of the world.
EMERGENCY MEDICINE JOURNAL
(2021)
Article
Emergency Medicine
Huiyin Ouyang, Junyan Wang, Zhankun Sun, Eddy Lang
Summary: This study evaluated the impact of emergency department (ED) crowding levels on patient admission decisions and outcomes. The findings showed a positive correlation between patient admission probability and ED census, as well as physician workload census, but an inverse correlation with boarder census. The results also revealed that the 7-day revisit probability of discharged patients was positively associated with boarder census. Insufficient physician staffing may lead to unnecessary patient admissions, and excessive boarding patients in the ED could result in unsafe discharges and increased 7-day revisit probability.
AMERICAN JOURNAL OF EMERGENCY MEDICINE
(2022)
Article
Pediatrics
Toni K. Gross, Natalie E. Lane, Nathan L. Timm, Comm Pediat Emergency Med
Summary: ED crowding occurs when the resources available cannot meet the demand for emergency services. It has negative impacts on patients, healthcare workers, and the community. To reduce ED crowding, it is important to improve the quality of care, patient safety, patient experience, and population health, while also reducing healthcare costs. Evaluating the causes, effects, and seeking solutions to ED crowding can be done through a conceptual framework addressing input, throughput, and output factors. Collaboration between ED leaders, hospital leadership, health system planners, policy decision makers, and pediatric care providers is necessary to address ED crowding. Proposed solutions in this policy statement aim to promote the medical home and ensure timely access to emergency care for children.
Article
Biology
Jason-Alexander Hoerauf, Cora Rebecca Schindler, Nils Muhlenfeld, Julian Zabel, Philipp Stoermann, Ingo Marzi, Nicolas Soehling, Rene Danilo Verboket
Summary: Every year, the number of patients in German emergency departments increases, leading to a greater workload for the staff. This study focuses on a university-based trauma surgery emergency department and analyzes the characteristics and reasons for patients' visits. To reduce the number of patients in emergency rooms, outpatient emergency institutions need to be expanded and promoted effectively.
Article
Health Care Sciences & Services
Fengbao Guo, Yan Qin, Hailong Fu, Feng Xu
Summary: This study aimed to determine the impact of the COVID-19 pandemic on the length of stay and prognosis of patients in the resuscitation area. The study found that the length of stay was significantly prolonged during the COVID-19 period, but there was no significant difference in mortality. Patients in different departments were affected differently, with no significant increase in length of stay for emergency neurology.
BMC HEALTH SERVICES RESEARCH
(2022)
Editorial Material
Emergency Medicine
Arshia P. Javidan, Kim Hansen, Ian Higginson, Peter Jones, Eddy Lang
Summary: The research aims to explore the international impacts, causes, and solutions of ED crowding and access block, using a task force composed of emergency physicians representing 15 countries. The results show that access block is the predominant contributor to ED crowding, requiring systemic solutions.
EMERGENCY MEDICINE AUSTRALASIA
(2021)
Article
Health Care Sciences & Services
Lindsay Allen, Cong T. Gian, Kosali Simon
Summary: This study found that Medicaid expansion was associated with increased emergency department wait times, indicating a possible worsening of ED crowding post-expansion. Future research should focus on uncovering the mechanisms through which insurance expansion led to increased ED wait times to inform policy decisions.
HEALTH SERVICES RESEARCH
(2022)
Article
Emergency Medicine
Yosef Berlyand, Martin S. Copenhaver, Benjamin A. White, Sayon Dutta, Joshua J. Baugh, Susan R. Wilcox, Brian J. Yun, Ali S. Raja, Jonathan D. Sonis
Summary: This study aimed to investigate the impact of ED crowding on the experience of discharged patients. The findings revealed that patients who arrived at a crowded ED and were ultimately discharged were more likely to have negative patient experience. Length of stay, leaving against medical advice/without being seen, and the number of ED care areas visited by a patient were associated with an increase in detractor likelihood.
WESTERN JOURNAL OF EMERGENCY MEDICINE
(2023)
Article
Health Care Sciences & Services
Marian Amissah, Sudakshina Lahiri
Summary: The limitations of process improvement efforts in addressing bottlenecks in emergency departments are mainly due to the lack of accurate real system models. This research used a detailed process modeling approach to analyze the bottlenecks in a Level-1 emergency department of a teaching hospital in the UK. The study identified Majors as the most crowded area and proposed solutions such as reducing repeat tests, informed alerting, and considering operational complexity. Additionally, this study mapped the care processes in Majors for the first time.
Article
Medicine, General & Internal
Ji Hwan Lee, Ji Hoon Kim, Incheol Park, Hyun Sim Lee, Joon Min Park, Sung Phil Chung, Hyeon Chang Kim, Won Jeong Son, Yun Ho Roh, Min Joung Kim
Summary: The study showed that the boarding restriction protocol effectively reduced ED crowding by decreasing the accumulation of boarding patients in the ED. It resulted in a decrease in ED occupancy rate, length of stay, and boarding time, while treatment time increased.
YONSEI MEDICAL JOURNAL
(2022)
Article
Psychology, Clinical
Vanessa W. S. Ng, Le Gao, Esther W. Chan, Ho Ming Edwin Lee, Joseph F. Hayes, David P. J. Osborn, Timothy H. Rainer, Kenneth K. C. Man, Ian C. K. Wong
Summary: This study examined the association between pharmacological treatment and the risk of emergency room admissions due to traumatic injuries among patients with bipolar disorder. The analysis found that there was an increased risk of traumatic injuries before treatment, but the risk decreased after treatment initiation and returned to baseline during maintenance treatment. However, the risk increased again after treatment cessation.
PSYCHOLOGICAL MEDICINE
(2023)
Article
Geriatrics & Gerontology
Tracey England, Sally Brailsford, Dave Evenden, Andrew Street, Laia Maynou, Suzanne M. Mason, Louise Preston, Christopher Burton, James Van Oppen, Simon Conroy
Summary: The rising demand for emergency and urgent care, as well as sub-optimal outcomes for older people, highlight the need for effective interventions. This study utilizes a system dynamics computer simulation model to explore a range of evidence-based interventions and their impact on patient outcomes. The results suggest that implementing these interventions can lead to reductions in hospital admissions, readmissions, and hospital-related deaths for older patients.
Article
Public, Environmental & Occupational Health
Susan Baxter, Matthew Franklin, Annette Haywood, Tony Stone, Monica Jones, Suzanne Mason, Kamil Sterniczuk
Summary: This study aimed to explore the potential of real-world data in informing public health decision-making. The research identified key factors and obstacles that affect data sharing, and emphasized the need for improved communication with the public about data usage. The study suggests actions to unlock the potential of real-world data for public health benefit.
Article
Emergency Medicine
Laia Maynou, Andrew Street, Christopher Burton, Suzanne M. Mason, Tony Stone, Graham Martin, James van Oppen, Simon Conroy
Summary: This study examined the quality of care for older patients in the emergency department (ED) and identified age, previous attendance, and attending out of hours as predictors for outcomes such as long waits, hospital admission, and reattendance.
EMERGENCY MEDICINE JOURNAL
(2023)
Article
Toxicology
Rex Pui Kin Lam, Chi Keung Chan, Man Li Tse, Eric Ho Yin Lau, Zonglin Dai, Matthew Sik Hon Tsui, Timothy Hudson Rainer
Summary: The objective of this study was to establish a clinical prediction score for predicting major effect or death in acute metamfetamine toxicity. The MASCOT score, based on six independent predictors, was derived and validated, showing high discriminatory performance. This score allows for quick risk stratification in acute metamfetamine toxicity.
CLINICAL TOXICOLOGY
(2023)
Letter
Emergency Medicine
Daniel Romeu, Elspeth Guthrie, Suzanne M. Mason
EMERGENCY MEDICINE JOURNAL
(2023)
Article
Emergency Medicine
Rex Pui Kin Lam, Chi Keung Chan, Man Li Tse, Eric Ho Yin Lau, Matthew Sik Hon Tsui, Timothy Hudson Rainer
Summary: This study aimed to characterize the trends, drug use pattern, clinical presentations, and health services utilization of acute methamphetamine toxicity presenting to emergency departments in Hong Kong. The findings highlight the significant impact of methamphetamine on physical and mental health in Hong Kong.
HONG KONG JOURNAL OF EMERGENCY MEDICINE
(2023)
Article
Multidisciplinary Sciences
Abraham Ka-chung Wai, Teddy Tai-loy Lee, Sunny Ching-long Chan, Crystal Ying Chan, Edmond Tsz-fung Yip, Luke Yik-fung Luk, Joshua Wing-kei Ho, Kevin Wang-leong So, Omar Wai-kiu Tsui, Man-lok Lam, Shi-yeow Lee, Tafu Yamamoto, Chak-kwan Tong, Man-sing Wong, Eliza Lai-yi Wong, Timothy Hudson Rainer
Summary: This study evaluates the association between antivirals and various clinical outcomes in high-risk COVID-19 patients during an Omicron outbreak. The use of Nirmatrelvir-Ritonavir or Molnupiravir was associated with significantly lower all-cause mortality, respiratory mortality, and sepsis incidence compared to no antiviral use. These findings suggest the potential benefits of antiviral treatment in COVID-19 patients.
SCIENTIFIC REPORTS
(2023)
Review
Biochemistry & Molecular Biology
Qianyun Li, Lingyun Zhao, Ching Long Chan, Yilin Zhang, See Wai Tong, Xiaodan Zhang, Joshua Wing Kei Ho, Yaqing Jiao, Timothy Hudson Rainer
Summary: This study evaluated the potential of blood biomarkers for the early diagnosis of ischemic stroke and identified potential biomarkers and biological pathways for further investigation. The study generated two shortlists of biomarkers and identified five key biological processes associated with ischemic stroke, providing valuable insights for better understanding and diagnosing this condition.
INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES
(2023)
Review
Multidisciplinary Sciences
Yaqing Jiao, Cindy See Wai Tong, Timothy H. Rainer
Summary: Clinicians need reliable outcome predictors to improve the prognosis of septic patients. Mouse models are widely used in sepsis research for novel prognostic biomarker discovery, but current models and biomarker platforms do not achieve sufficient clinical performance for use in humans.
Article
Health Care Sciences & Services
Qihao Wu, Sunny Ching-long Chan, Teddy Tai-loy Lee, Kevin Wang-leong So, Omar Wai-kiu Tsui, Yong-Hong Kuo, Timothy Hudson Rainer, Abraham Ka-chung Wai
Summary: The fifth wave of COVID-19 outbreaks in Hong Kong from January to March 2022 has seen the highest number of confirmed cases and deaths compared to previous waves. Severe hospital boarding in various Emergency Departments was observed. A retrospective cohort study was conducted to identify factors associated with hospital boarding during the Omicron surge. The study found that admissions from elderly homes with a lag of 6 days and medical patients with a lag of 4 days were significantly associated with prolonged admission waiting time and increased number of boarding patients, respectively.
JOURNAL OF MEDICAL SYSTEMS
(2023)
Article
Health Care Sciences & Services
Abraham Ka -Chung Wai, Crystal Ying Chan, Annie Wai-Ling Cheung, Kailu Wang, Sunny Ching -Long Chan, Teddy Tai -Loy Lee, Luke Yik-Fung Luk, Edmond Tsz-Fung Yip, Joshua Wing-Kei Ho, Omar Wai-Kiu Tsui, Kelly Wing -Yin Cheung, Shiyeow Lee, Chak-kwan Tong, Tafu Yamamoto, Timothy Hudson, Eliza Lai-Yi Wong
Summary: This study aims to evaluate the clinical and cost effectiveness of Molnupiravir and Nirmatrelvir-ritonavir in reducing mortality in patients with mild-to-moderate COVID-19. The study found that the use of these antiviral drugs in high-risk patients in Hong Kong was associated with reduced all-cause mortality and significant cost savings.
LANCET REGIONAL HEALTH-WESTERN PACIFIC
(2023)
Meeting Abstract
Surgery
Amal Azhar Anwer, Shahab Hajibandeh, Ahmed Kotb, Louis Evans, Emily Sams, Shahin Hajibandeh, Thomas Satyadas
BRITISH JOURNAL OF SURGERY
(2022)
Meeting Abstract
Surgery
Shahab Hajibandeh, Shahin Hajibandeh, Louis Evans, Bethany Miller, Jennifer Waterman, Andrew Maw
BRITISH JOURNAL OF SURGERY
(2022)
Meeting Abstract
Surgery
Amal Azhar Anwer, Shahab Hajibandeh, Shahin Hajibandeh, Jennifer Waterman, Bethany Miller, Louis Evans, Andrew Maw
BRITISH JOURNAL OF SURGERY
(2022)