Development of an easy-to-use tool for the assessment of emergency department physical design

Physical design of the emergency department [ED] has an important effect on its role and function. To date, no guidelines have been introduced to set the standards for the construction of EDs in Iran. In this study, we aim to devise an easy-to-use tool based on the available literature and expert opinion for the quick and effective assessment of EDs in regards to their physical design. For this purpose, based on current literature on emergency design, a comprehensive checklist was developed. Then, this checklist was analyzed by a panel consisting of heads of three major EDs and contradicting items were decided. 178 crude items were derived from available literature. The Items were categorized in to three major domains of Physical space, Equipment, and Accessibility. The final checklist approved by the panel consisted of 163 items categorized into six domains. Each item was phrased as a "Yes or No" question for ease of analysis, meaning that the criterion is either met or not

Knowledge of emergency medicine residents in relation to prevention of tetanus

Knowledge of emergency medicine residents about the management of patients suspected of having tetanus-favoring wounds is very important due to their responsibility for the treatment of such patients. The aim of the present study was to evaluate this knowledge and making sure of the adequacy of instructions they have received in relation to prevention of tetanus. A reliable and reproducible questionnaire was used to evaluate knowledge of all the emergency medicine residents in Imam Hussein Hospital in Tehran, Iran, about conditions favoring tetanus [9 questions] and proper interventions in such conditions [12 questions]. The questionnaires were completed and scored as poor and good. The Mann-Whitney U test was used to analyze data. Statistical significance was set at P<0.05. In the present study, 73 emergency medicine residents were evaluated [45.2% male]. Knowledge of 31 [42.5%] residents in relation to conditions favoring tetanus and 41 [56.2%] residents in correct therapeutic interventions was in good level. The most frequent incorrect answer was related to diabetic ulcers and wounds in patients with sepsis. There was an increase in scores of conditions favoring tetanus [P<0.001] and correct therapeutic interventions [P=0.001] with an increase in educational years. However, age [P=0.64], gender [P=0.31], job experience [P=0.38] and participation in educational courses [P=0.67] had no effect on the knowledge level of emergency medicine residents. According to the findings of the pre-sent study, the knowledge of emergency medicine residents about correct management of patients suspected of tetanus was low, which emphasizes the necessity of providing further instructions on prevention of tetanus in wound management

Utilization of failure mode and effects analysis [FMEA] method in increasing the revenue of emergency department; a prospective cohort study

The balance between revenue and cost of an organization/system is essential to maintain its survival and quality of services. Emergency departments [ED] are one of the most important parts of health care delivery system. Financial discipline of EDs, by increasing the efficiency and profitability, can directly affect the quality of care and subsequently patient satisfaction. Accordingly, the present study attempts to investigate failure mode and effects analysis [FMEA] method in identifying the problems leading to the loss of ED revenue and offer solutions to help fix these problems. This prospective cohort study investigated the financial records of ED patients and evaluated the effective errors in reducing the revenue in ED of Imam Hossein hospital, Tehran, Iran, from October 2007 to November 2009. The whole department was divided into one main system and six subsystems, based on FMEA. The study was divided into two phases. In the first phase, the problems leading to the loss of revenue in each subsystem were identified and weighted into four groups using risk priority number [RPN], and the solutions for fixing them were planned. Then, in the second phase, discovered defects in the first phase were fixed according to their priority. Finally, the impact of each solution was compared before and after intervention using the repeated measure ANOVA test. 100 financial records of ED patients were evaluat-ed during the first phase of the study. The average of ED revenue in the six months of the first phase was 73.1 +/- 3.65 thousand US dollars/month. 12 types of errors were detected in the predefined subsystems. ED reve-nue rose from 73.1 to 153.1, 207.06, 240, and 320 thousand US dollars/month after solving first, second, third, and fourth priority problems, respectively [337.75% increase in two years] [p<0.001]. 111.0% increase in the ED revenue after solving of first priority problems revealed that they were extremely indispensable in decreasing the revenue [p<0.0001]. The findings of the present study revealed that FMEA could be considered as an efficient model for increasing the revenue of emergency department. According to this model, not recording the services by the nursing unit, and lack of specific identifying code for the patients moving from ED to any other department, were the two first priority problems in decreasing our ED revenue

Emergency department performance indexes before and after establishment of emergency medicine

Emergency department performance index [EPI] greatly influences the function of other hospital's units and patient satisfaction. Recently, the Iranian Ministry of Health has defined specific national EPI containing five indexes. In the present study the performance indexes of emergency department [ED] in one educational hospital has been assessed before and after establishment of emergency medicine. In the present cross-sectional study the ED of Shohadaye Tajrish Hospital, Tehran, Iran was assessed during one-year period from March 2012 to February 2013. The study was divided into two six-month periods of before and after establishment of emergency medicine. Five performance indexes including: the percentage of patients were disposed during 6-hour, left the ED in a 12-hour, had unsuccessful cardiopulmonary resuscitations [CPR], discharged against medical advice, and the mean time of triage were calculated using data of department of medical records on daily patients' files. Then, Mann-Whitney U test was used to make comparisons at P<0.05. The average triage time decreased from 6.04 minutes in the first six months to 1.5 minutes in the second six months [P=0.06]. The percentage of patients leaving the ED in a 12-hour decreased from 97.3% to 90.4% [P=0.004]. However, the percentage of disposed patients during 6-hour [P=0.2], unsuccessful CPR [P=0.34] and discharged against medical advice [P=0.42] did not differ between the two periods. It seems that establishment of emergency medicine could be able to improve ED performances indexes such as time to triage and leave in a 12-hour period