New research highlights emergency care practices

Two studies from the University of Sheffield, focusing on the treatment and processes in US and UK Emergency Departments, have uncovered new information about the way in which they operate.

One study discovered patients who attend Emergency Departments operating a prioritising system, based on their condition, are likely to wait too long for treatment. A second study found that patients receiving treatment in Departments which meet their target times have a better overall experience than in those which do not meet this goal.

The first paper, which was presented at the Society for Academic Emergency Medicine's annual meeting on 4 June 2010, found that in American Emergency Departments where all walk-in patients receive a formal nursing assessment and priority score (triage) before seeing a physician, less than half of the most acutely ill patients are identified within the recommended time frame, and 10% are not recognised for 30 minutes or more.

It has been debated whether a system which does not prioritise all patients results in a delay in recognising acutely ill patients. However the study suggests that applying a fixed triage process to every patient can delay care.

The study was carried out in a US Emergency Department with 40,000 annual visits and uses the Emergency Severity Index triage scale for all patients. The team calculated the arrival time and nursing assessment time for all walk-in patients who were prioritised as most acutely ill in 2008. They then compared the time between arrival and assessment with the time recommended by the triage scale for when a patient should be seen by a provider.

The findings showed that whilst a formal triage system should theoretically identify patients who should be seen more quickly, current procedures may create delays.

The second study, which was also presented at the Society for Academic Emergency Medicine's annual meeting, found that patients in Emergency Department´s which meet the UK four-hour arrival to treatment time standard have shorter lengths of stay, see a physician sooner, and are less likely to have their departure from the Emergency Department in the last 20 minutes of the four hours than those that usually do not meet the target.

Finding evidence of shorter stays and less last-minute activity, the researchers concluded that the more successful Departments are accomplishing this through improved processes.

The research team assessed 15 Emergency Departments for a two month period during 2003-2006, which covered a year before the target was in effect, to a year after it was in place. They then obtained anonymous data on arrival and departure times and time before seeing a physician.

Dr Suzanne Mason, Professor of Emergency Medicine from the University´s School of Health and Related Research (ScHARR) said: "The target has been very challenging to achieve, however, our data suggests that hitting the target improves aspects of the process of the care."

Commenting on triage systems, Dr Ellen Weber, Visiting Professor from the School of Health and Related Research (ScHARR) at the University of Sheffield, and Professor of Emergency Medicine at the University of California, San Francisco, said: "Formally triaging everyone who comes to the emergency department, and assigning priority, is thought to ensure patient safety but it is clear that the current system isn´t working that way. We need to allow experienced nurses to use judgment as to who needs to see a doctor immediately, and who can wait their turn. Otherwise, triage just creates another queue."

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