Demand for emergency care growing at more than 50,000 patients a month.

Relentless demand for services is driving up waiting times and exacerbating financial pressures in the NHS according to the latest monitoring report from The King's Fund.

Epidemiological Characteristics and Overall Burden of Accidental Injuries in Navarra, Spain: Epidemiology of Injuries in Children.

Injuries caused by accidents or violent situations in pediatric patients are a serious social problem where prevention plays a key role. The aim of this study was to describe the epidemiological situation of pediatric injuries in Spain. A prospective study of pediatric patients receiving care in the Emergency Service of the Complejo Hospitalario de Navarra due to for reasons of accidental injury was conducted. The study covered a period of 1 year and assessed a total of 16 variables. There were a total of 8,876 patients, of whom 56.4% were males. Traumatic injuries such as fractures and craniocerebral trauma were identified as the most frequent injuries, occurring as a result of injuries mainly in the home. In females, there was a decrease in the incidence of injuries related to age. There was a greater incidence at the end of the day, during the weekend, and in the months of March to October. The epidemiological profile of pediatric patients who met with accidents in Navarra, Spain, is described. The knowledge of the main areas and factors related to injuries allows us to improve preventive measures, which would contribute to better control in this region of Spain.

HIV Rapid Testing in a VA Emergency Department Setting: Cost Analysis at 5 Years.

OBJECTIVES: To conduct a comprehensive cost-minimization analysis to comprehend the financial attributes of the first 5 years of an implementation wherein emergency department (ED) registered nurses administered HIV oral rapid tests to patients. METHODS: A health science research implementation team coordinated with ED stakeholders and staff to provide training, implementation guidelines, and support to launch ED registered nurse-administered HIV oral rapid testing. Deidentified quantitative data were gathered from the electronic medical records detailing quarterly HIV rapid test rates in the ED setting spanning the first 5 years. Comprehensive cost analyses were conducted to evaluate the financial impact of this implementation. RESULTS: At 5 years, a total of 2,620 tests were conducted with a quarterly mean of 131 ± 81. Despite quarterly variability in testing rates, regression analysis revealed an average increase of 3.58 tests per quarter. Over the course of this implementation, Veterans Health Administration policy transitioned from written to verbal consent for HIV testing, serving to reduce the time and cost(s) associated with the testing process. CONCLUSIONS: Our data indicated salient health outcome benefits for patients with respect to the potential for earlier detection, and associated long-run cost savings.

Prioritizing the compensation mechanisms for nurses working in emergency department of hospital using fuzzy DEMATEL technique: a survey from Iran.

AIM AND BACKGROUND: Nursing professionals are the most important human resources that provide care in the Emergency Departments at hospitals. Therefore appropriate compensation for the services provided by them is considered as a priority. This study aims to identify and prioritize the factors affecting the compensation for services provided by the EDs nurses. METHODS: Twenty four nurses, hospital administrators, local and national health authorities participated in a cross sectional study conducted in 2012. The participants discussed on different compensation mechanisms for nurses' of EDs, in six groups according to Focus Group Discussion (FGD) technique, resulted in the adopted mechanisms. Opinions of the participants on the mechanisms were obtained via paired matrices using fuzzy logic. Decision Making Trial and Evaluation Laboratory (DEMATEL) technique was used for prioritizing the adopted mechanisms. FINDINGS: Among the compensation mechanisms for nurses of ED services, both Monthly fixed amounts (9.0382) and increasing the number of vacation days (9.0189) had highest importance. The lowest importance was given to the performance-based payment (8.9897). Monthly fixed amounts, increasing the number of vacation days, decreasing the working hours and performance-based payment were recognized as effective factors. Other mechanisms are prioritized as use of the facilities, increase in emergency tariff, job promotions, non-cash payments, continuing education, and persuasive years. CONCLUSION: According to the results, the nurses working in the EDS of the hospitals were more likely to receive non-cash benefits than cash benefits as compensation.

How Greek healthcare services are affected by the Euro crisis.

Greece's economic crisis is having a detrimental effect on the country's health service. Government cutbacks have forced hospitals to merge, reduced nurse-to-patient ratios and have led to pay cuts and poorer conditions for staff. Emergency nurses must work longer hours with fewer resources for less money, when emergency admissions in the public sector are rising as a result of the economic pressures on Greek society.

Cost-effectiveness of the SEN-concept: Specialized Emergency Nurses (SEN) treating ankle/foot injuries.

BACKGROUND: Emergency Departments (EDs) are confronted with progressive overcrowding. As a consequence, the workload for ED physicians increases and waiting times go up with the risk of unnecessary complications and patient dissatisfaction. To cope with these problems, Specialized Emergency Nurses (SENs), regular ED-nurses receiving a short, injury-specific course, were trained to assess and treat minor injuries according to a specific protocol. METHODS: An economic evaluation was conducted alongside a randomized controlled trial comparing House Officers (HOs) and SENs in their assessment of ankle and foot injuries. Cost prices were established for all parts of healthcare utilization involved. Total costs of health care utilization were computed per patient in both groups. Cost-effectiveness was investigated by comparing the difference in total cost between groups with the difference in sensitivity and specificity between groups in diagnosing fractures and severe sprains. Finally, cost-effectiveness ratios were calculated and presented on a cost-effectiveness plane. RESULTS: No significant differences were seen between treatment groups for any of the health care resources assessed. However, the waiting times for both first assessment by a treatment officer and time spent waiting between hearing the diagnosis and final treatment were significantly longer in the HO group. There was no statistically significant difference in costs between groups. The total costs were euro 186 (SD euro 623) for patients in the SEN group and euro 153 (SD euro 529) for patients in the HO group. The difference in total costs was euro 33 (95% CI: - euro 84 to euro 155). The incremental cost-effectiveness ratio was euro 27 for a reduction of one missed diagnosis and euro 18 for a reduction of one false negative. CONCLUSION: Considering the benefits of the SEN-concept in terms of decreased workload for the ED physicians, increased patient satisfaction and decreased waiting times, SENs appear to be a useful solution to the problem of ED crowding.

Effectiveness of emergency care practitioners working within existing emergency service models of care.

BACKGROUND: An emergency care practitioner (ECP) is a generic practitioner drawn mainly from paramedic and nursing backgrounds. ECPs receive formal training and extended clinical skills to equip them to work as an integral part of the healthcare team working within and across traditional boundaries of emergency and unplanned care. Currently, ECPs are working in different healthcare settings in the UK. OBJECTIVES: (1) To evaluate appropriateness, satisfaction and cost of ECPs compared with the usual service available in the same healthcare setting, (2) to increase understanding of what effect, if any, ECPs are having on delivery of health services locally and (3) to evaluate whether ECP working yields cost savings. METHODS: Using a mixed-methods approach, data were collected quantitatively and qualitatively from three different types of health provider setting where ECPs are operational, in three areas of England. Data were collected by sending two questionnaires to each patient eligible to be seen by an ECP, at 3 and 28 days after presentation; telephone interviews were conducted with a sample of staff that included ECPs, other health professionals and stakeholders (eg, managers) in each of the three settings; and routine data were analysed to provide a perspective on costs. RESULTS: After adjusting for age, sex, presenting complaint and service model, some differences in the processes of care between the ECPs and the usual providers in the three settings were observed. Overall, ECPs carried out fewer investigations, provided more treatments and were more likely to discharge patients home than the usual providers. Patients were satisfied with the care received from ECPs, and this was consistent across the three different settings. It was found that ECPs are working in different settings across traditional professional boundaries and are having an impact on reconfiguring how those services are delivered locally. Costs information (based on one site only) indicated that ECP care may be cost effective in that model of ECP working. CONCLUSION: Care provided by ECPs appears to reduce the need for subsequent referral to other emergency and unscheduled care services in a large proportion of cases. We found no evidence that the care provided by an ECP was less appropriate than the care by the usual providers for the same type of health problem.

A dramaturgical analysis of shift report patterns with cost implications: a case study.

This secondary analysis uses Goffman's stage drama to explore the roles of registered nurses in videotaped reports in a hospital. Each report was a performance by the charge nurse which affected the climate, interactions, and duration of the report.

The evolution of the emergency care practitioner role in England: experiences and impact.

BACKGROUND: The emergency care practitioner (ECP) is a generic practitioner who combines extended nursing and paramedic skills. The "new" role emerged out of changing workforce initiatives intended to improve staff career opportunities in the National Health Service and ensure that patients' health needs are assessed appropriately. OBJECTIVE: To describe the development of ECP Schemes in 17 sites, identify criteria contributing to a successful operational framework, analyse routinely collected data and provide a preliminary estimate of costs. METHODS: There were three methods used: (a) a quantitative survey, comprising a questionnaire to project leaders in 17 sites, and analysis of data collected routinely; (b) qualitative interpretation based on telephone interviews in six sites; and (c) an economic costing study. RESULTS: Of 17 sites, 14 (82.5%) responded to the questionnaire. Most ECPs (77.4%) had trained as paramedics. Skills and competencies have been extended through educational programmes, training, and assessment. Routine data indicate that 54% of patient contacts with the ECP service did not require a referral to another health professional or use of emergency transport. In a subset of six sites, factors contributing to a successful operational framework were strategic visions crossing traditional organisational boundaries and appropriately skilled workforce integrating flexibly with existing services. Issues across all schemes were patient safety, appropriate clinical governance, and supervision and workforce issues. On the data available, the mean cost per ECP patient contact is 24.00 pounds sterling, which is less than an ED contact of 55.00 pounds sterling. CONCLUSION: Indications are that the ECP schemes are moving forward in line with original objectives and could be having a significant impact on the emergency services workload.

Emergency nursing: historical, current, and future roles.

Building upon a historical context, the current and future roles of the clinical emergency nurse are reviewed. For several reasons, emergency nurse availability is expected to be insufficient to meet staffing demands in the near future. Emergency physicians can partner with emergency nurses and hospital administrators to pursue the following strategies for addressing the nursing shortage: (1) improve the workplace environment by improving nurse-to-patient ratios and avoiding the boarding of admitted patients in the emergency department (ED); (2) refocus the emergency nurse job description to patients and their families; (3) promote mutually supportive relationships and comradeship between emergency nurses and physicians; (4) create an environment that allows unique solutions to staff scheduling and accommodates shiftwork; (5) increase nursing wages, and recognize special contributions of emergency nurses with financial reward; (6) identify and promote the personnel of the hospital ED as members of an elite unit; (7) develop preceptorships and internships for nurses new to emergency nursing and invest in clinical specialists or nurse-mentors to assist in "on-the-job" instruction of nurses with previous experience; and (8) invest in nursing education. Taking these steps today will strengthen the ED health care safety net for decades to come.