Best practice management in emergency medicine – latest approach
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Focus International News TV BS Taiwan*.
Best practice management in Best practice management in emergency medicine emergency medicine –– latest approach.latest approach.
>350 patients/day>350 patients/dayMay 20 2014
Michael Hansen-Nord, MD, Head of Department
Odense University Hospital, Denmark
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We have to deal with
1. Overcrowding
2. Staff1. Stress
2. High % of absence1. 8 – 10 %
3.
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Patients in ED, OUH
127.000
(350/day)
60.000Emergency services
(7 hours daily)
40.000Somatic fast-track
27.000Triage (admittance?)
(2/3 of all)
Patients/year
(average)Categories
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Identify paradigmes..
1. Consultant in front2. Standardization 3. Do things on time .. Don't pros pone4. Diagnostic packages
1. standardization5. 4 hours to diagnose6. Synergy by performers7. M.fl.
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Challenges?
1. Standardization1. Processes
2. Logistics
3. Professional approach
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Standardization
1. Processes
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Emergency Emergency service.service.
Admittance?Admittance?
Fast trackFast track
Blue patientsBlue patients
Cut down to 3 different tracks
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Competences ProcestimeProcesses ”green”
180Waiting timeconsultant30Evaluation
X-ray and lab.360Answers on diagnostics
Resident90Medical recordSkilled nurse10Triage
Nurse15In-bed proceduresSecretary5Pre visitationSecretary5Registration
11,5 timer
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Keep the patients in flow
1. 4 hours stay in ED2. All acute diagnostics should be at
hand before the patient leaves the ETC.
3. Introducing TRIAGE (ADAPT) for all patients.
4. 70 % discharged < 48 timer
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The challenge…!
1. Passing time in ED 4 hours. 1. 14 – 18 staff members needed
2. > 85 % of the patients are yellow or green in triage
1. They do not need immediate action
2. …but they should be kept in flow also
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Triage - ADAPTRed
Orange
Green
Yellow
Rescusation
Blue
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Admittance ?
160
Nurse2 eller 515Initial nursing
Nurse2 eller 510Stafet
Internist245Patients file
Senior doctor215Senior doctors evaluation
4Waiting area
Radiologist315Radiology
Lab. technician215Blood-analysis
Nurse and senior doctor220Triage and visitation
Nurse215In bed
Nurse15Previsitation
Secretary15Registration
240Total minutes in the acute area
Staff … competencesLocationMinutesTime pr. process
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Simulation options?
� Staffing
� First edition of standardized, process-driving patient tracks
� Variations over the day/month/year
� Bottlenecks?
� Chaos-handling
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Standardization
1. Logistics
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Conference
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Conference
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Logistics in ED
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Logistics in ED
Who's next?
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Logistics in ED
How fare are we?
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Logistics in ED
Time from arrival – to meet the 4 hour criteria?
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Standardization
1. Professional approach
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Incoming patients
1. We don't know them by diagnose1. ..do you?
2. ..but we know them by symptoms1. 34 somatic symptoms (97%)2. 5 psychiatric symptoms
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From diagnose- to symptom based visitation
1. Visitation by suspected diagnose1. Obs. MI2. Obs. Appendicitic3. Etc.
2. Visitation based on symptoms combined by triage-color
1. Chest-pain and red2. Abdominal pain and orange3. Etc.
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Diagnostic packages (DP)in the region of Southern Denmark
1. 34 somatic DP and 5 psychiatric2. Recipe on what professional output a sudden
somatic symptom must provoke1. Blood samples2. Radiology
3. Part of the triage-process
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Yes – we perform!
1. ½-hour criterion1. Average 41 minutes
2. 4- hour criterion1. Average 3 hours 51 minutes
3. Not admitted?1. 60 to 75 %
4. Average admittance in ED?1. 18 to 13 hours
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Thank You for Your attentionMichael Hansen-Nord [email protected]