Emergency severity level-3 patient flow based on point-of-care testing improves patient outcomes.

BACKGROUND: Overcrowding of the Emergency Department is rapidly becoming a global challenge and a major source of concern for emergency physicians. The desire to improve Emergency Department throughput requires novel approaches to patient flow. MATERIALS AND METHODS: We conducted a prospective and cluster-randomized study, to evaluate the impact in patient outcomes of a new patient flow based on Point-of-Care Testing (POCT). A total of 380 Emergency Severity Level-3 patients were enrolled and studied in two different groups, interventional arm (laboratory analyses performed on POCT analyzers implemented in the Emergency Department) or control arm (central laboratory). The primary outcome was the Emergency Department length of stay. Secondary outcome included the time to first medical intervention, the laboratory turnaround time and the time to disposition decision. Readmission within the 7 days after discharge was also calculated. RESULTS: Length of stay significantly decreased by 88.50 min (from 247.00 to 158.50), time to disposition decision by 89.00 min (from 192.00 to 103.00) and laboratory turnaround time by 67.11 min (from 89.84 to 22.73) in the POCT group. No increase in readmission was found. CONCLUSION: Our strategy based on POCT represents a good approach to optimize patient flow in the Emergency Department and it should be seen as a starting point for further studies focusing on improving throughput.

Valoración del riesgo psicosocial en las enfermeras de nefrología de los hospitales de Sevilla / Evaluation of the psychosocial risk in nephrology nurses in hospitals in seville

El objetivo general de este trabajo fue realizar una evaluación psicosocial del personal de enfermería de las unidades de nefrología de los hospitales “Virgen del Rocío” y “Virgen Macarena” de Sevilla, siendo los objetivos específicos del estudio describir la situación de este grupo en cuanto a clima laboral, tipo de conflictos del grupo, gestión de los conflictos, relación con el mando inmediato y bases de poder, acoso laboral y comparación entre las unidades de ambas instituciones. El estudio se realizó evaluando 66 encuestas contestadas por el personal de enfermería de los servicios de nefrología, de ambos hospitales. Las conclusiones obtenidas fueron las siguientes: 1. El clima laboral es una mezcla entre clima de apoyo y reglas.2. El tipo de conflicto que predomina en la organización es de tareas sobre el afectivo.3. El estilo de gestión para solucionar los conflictos es el deintegración.4. Las bases de poder están divididas entre formales e informales y el mando no es autoritario.5. El acoso laboral es casi inexistente, siendo éste sobre la función laboral del trabajador, lo que provoca muy baja incidencia somática en el individuo.6. Las diferencias halladas entre las dos unidades no son significativas

The general aim of this work was to conduct a psychosocial assessment of nursing staff in the nephrology units of the hospitals Virgen del Rocío and Virgen Macarena in Seville, the specific aims of the study being to describe the situation of this group as regards the working environment, type of group conflicts, conflict management, relations with immediate superiors and power bases, harassment and comparison between the units in the two hospitals. The study was carried out by assessing 66 surveys to which nephrology service nursing staff in both hospitals had responded. The conclusions obtained were as follows: 1. The working environment is a mixture of support and rules.2. The predominating type of conflict in the organization relates to tasks rather than emotional. 3. The management style to resolve conflicts is integration.4. The power bases are divided between formal and informal and command is not authoritarian.5. Harassment is almost non-existent, and is directed at the employee’s work, which causes a very low somatic incidence on the individual.6. The differences found between the two units are not significant