Leeds Metropolitan University Emergency Department Crowding Discussion

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PICOT Discussion Post
Name
Course
Tutor
University
Date of Submission
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PICOT Question
Emergency Department (ED) crowding is a prevalent safety issue in the contemporary
health care environment. The issue exists as a global health concern, with significant impacts on
both the patient and facility. The U.S continues to report a significant and unsustainable
increment in ED presentations, a condition one cannot explain by a growing demand in health
services alone. In this case, the researcher notes that ED crowding happens following delays in
processing patients already in ED as well as constraints in patients leaving upon treatment. For
this reason, it is crucial to pose the following clinical question for assessment.
In ED staff, does education on care coordination during high traffic hours compared to lack of
education reduce patient crowding within 10 weeks upon implementation?
?
Population: ED staff
?
Intervention: Education on care coordination during high traffic hours
?
Comparison: lack of education
?
Outcome: reduced patient crowding
?
Time: Ten weeks
Articles
Pines et al. (2008) is a basic or primary research article that studies the interactions
between factors to ED crowding and patient satisfaction. The researchers performed a cohort
research design of all patients admitted in the ED. They determined the need for coordinated care
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in improved patient traffic flow. Peterson et al. (2018) is an EBP article aimed at summarizing
findings around the causes, consequences, and solutions to ED crowding. The article utilized
evidence from a myriad of databases including CINAHL, Medline, and EMBASE. They
determine the need of a system-wide solution on multidisciplinary collaboration to address
causes and stem crowding. The last article, a quality improvement project by Hsu et al. (2019)
called for systematic measures around ED traffic management for shortened observation
duration. This way, the hospital?s ED speeds up turnover for enhanced flow.
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References
Hsu, M., Liang, L., Chang, Y., & Juang, W. (2019). Emergency Department Overcrowding:
Quality Improvement in a Taiwan Medical Center . Journal of the Formosan Medical
Association, 118 (1), 186-193.
Peterson, G., Unwin, M., Morley, C., Kinsman, L., & Stankovich, J. (2018). Emergency
department crowding: A systematic review of causes, consequences and solutions. PLoS
One, 13 (8), doi: 10.1371/journal.pone.0203316.
Pines, J., Iyer, S., Disbot, M., Hollander, J., Shofer, F., & Datner, E. (2008). The Effect of
Emergency Department Crowding on Patient Satisfaction for Admitted Patients.
Academic Emergency Medicine, 15 (9), 825-831.
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Article Appraisal
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Evidence-Based Practice
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09/29/2020
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Article Appraisal
APPENDIX C
Appraisal Guide:
Conclusions of a Systematic Review with Narrative Synthesis
Citation:
Peterson, G., Unwin, M., Morley, C., Kinsman, L., & Stankovich, J. (2018). Emergency
department crowding: A systematic review of causes, consequences and solutions. PLoS One, 13
(8), 1-42. https://doi.org/10.1371/journal.pone.0203316.
Synopsis
What organization or persons produced the systematic review (SR)?
Five researchers conducted this systemic review: Claire Morley, Maria Unwin, Gregory M.
Peterson, Jim Stankovich, and Leigh Kinsman.
How many persons were involved in conducting the review?
As indicated, five scholars participated in producing the systemic review.
What topic or question did the SR address?
The primary subject was emergency department overcrowding and the five researchers explored
the causes, consequences, and solutions.
How were potential research reports identified?
The researchers conducted structured searches in four reputable scientific databases: Web of
Science, EMBASE, CINAHL, and Medline. The experts only selected peer-reviewed articles
that concentrated on their selected area of study.
What determined if a study was included in the analysis?
The scholars only included peer-reviewed journal articles that assessed the causes, consequences,
and solutions of emergency department overcrowding. The reviewers only selected studies that
had been published between January 2000 and June 2018.
How many studies were included in the review?
The researchers included 102 studies in their systematic review.
What research designs were used in the studies?
Most of the selected articles were retrospective cohort studies.
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What were the consistent and important across-studies conclusions?
All the selected studies focused on emergency department overcrowding and touched on the
causes, consequences, and possible solutions to address this chronic problem.
Credibility
Was the topic clearly defined?
Yes
No
Not clear
Was the search for studies and other
evidence comprehensive and unbiased?
Yes
No
Not clear
Was the screening of citations for
inclusion based on explicit criteria?
Yes
No
Not clear
*Were the included studies assessed
for quality?
Yes
No
Not clear
Were the design characteristics and
findings of the included studies displayed
or discussed in sufficient detail?
Yes
No
Not clear
*Was there a true integration (i.e., synthesis) of the findings?not
merely reporting of findings from
each study individually?
Yes
No
Not clear
*Did the reviewers explore why differences
in findings might have occurred?
Yes
No
Not clear
Did the reviewers distinguish between
conclusions based on consistent findings
from several good studies and those
based on inferior evidence (number or quality)?
Yes
No
Not clear
Which conclusions were supported by
consistent findings from two or more
good or high-quality studies?
List
Emergency department overcrowding affected staff negatively
____________________________________________________________________________
Emergency department overcrowding could increase patient mortality
____________________________________________________________________________
Nurse workflow coordination can help hospitals address emergency department overcrowding
____________________________________________________________________________
ARE THE CONCLUSIONS
CREDIBLE?
Clinical Significance
Yes All
Yes Some
No
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*Across studies, is the size of the
treatment or the strength of the
association found or the
meaningfulness of qualitative findings
strong enough to make a difference
in patient outcomes or experiences of care?
Yes
No
Not clear
Are the conclusions relevant to the
care the nurse gives?
Yes
No
Not clear
ARE THE CONCLUSIONS
CLINICALLY SIGNIFICANT?
Yes All
Yes Some
No
Applicability
Does the SR address a problem,
situation, or decision we are addressing in our setting?
Yes
No
Not clear
Are the patients in the studies or a
subgroup of patients in the studies
similar to those we see?
Yes
No
Not clear
What changes, additions, training, or
purchases would be needed to implement
and sustain a clinical protocol based
on these conclusions?
Specify and list
Emergency department need to adjust opening and closing time to reduce overcrowding
____________________________________________________________________________
____________________________________________________________________________
Is what we will have to do to implement
the new protocol realistically achievable
by us (resources, capability, commitment)?
How will we know if our patients are
benefiting from our new protocol?
Yes
No
Not clear
Specify
When there is a decline in complaints arising from emergency department overcrowding
____________________________________________________________________________
____________________________________________________________________________
ARE THESE CONCLUSIONS
APPLICABLE TO YOUR SETTING?
Yes All
Yes Some
No
SHOULD YOU PROCEED TO DESIGN
A PROTOCOL INCORPORATING
THESE CONCLUSIONS?
Yes All
Yes Some
No
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* = Important criteria
Comments
Significantly, this was a high-quality systematic review that highlighted multiple causes,
consequences and solutions to emergency department overcrowding.
____________________________________________________________________________
____________________________________________________________________________
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APPENDIX E
Appraisal Guide:
Findings of a Qualitative Study
Citation:
Hsu, M., Liang, L., Chang, Y., & Juang, W. (2019). Emergency department overcrowding:
Quality improvement in a Taiwan medical center. Journal of the Formosan Medical Association,
118 (1), 186-193. https://doi.org/10.1016/j.jfma.2018.03.008
Synopsis
What experience, situation, or subculture does the researcher seek to understand?
The researchers sought to explore the challenge of emergency department overcrowding through
a quality improvement mission in a Taiwan medical center.
Does the researcher want to produce a description of an experience, a social process, or an event,
or is the goal to generate a theory?
Indeed, the researcher wanted to understand patients? perspectives and satisfaction levels when
accessing emergency departments in the selected care facility.
How was data collected?
The study used surveys to collect primary data from participants.
How did the researcher control his or her biases and preconceptions?
The scholars involved medical professionals in this study to prevent biases and preconceptions.
Are specific pieces of data (e.g., direct quotes) and more generalized statements (themes,
theories) included in the report?
The article does not have direct quotes and generalized statements.
What are the main findings of the study?
The study disclosed that the choice of architecture in these departments could increase or reduce
overcrowding. Care managers have to formulate comprehensive bed management plans to
address overcrowding challenges.
Credibility
Is the study published in a source
that required peer review?
Yes
No
Not clear
Were the methods used appropriate
to the study purpose?
Yes
No
Not clear
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Was the sampling of observations or
interviews appropriate and varied
enough to serve the purpose of the study?
Yes
No
Not clear
*Were data collection methods
effective in obtaining in-depth data?
Yes
No
Not clear
Did the data collection methods
avoid the possibility of oversight,
underrepresentation, or
overrepresentation from certain
types of sources?
Yes
No
Not clear
Were data collection and analysis
intermingled in a dynamic way?
Yes
No
Not clear
*Is the data presented in ways that
provide a vivid portrayal of what was
experienced or happened and its
context?
Yes
No
Not clear
*Does the data provided justify
generalized statements, themes,
or theory?
Yes
No
Not clear
ARE THE FINDINGS CREDIBLE?
Yes All
Yes Some
No
Clinical Significance
*Are the findings rich and informative?
Yes
No
Not clear
*Is the perspective provided
potentially useful in providing
insight, support, or guidance
for assessing patient status
or progress?
Yes
Some
ARE THE FINDINGS
CLINICALLY SIGNIFICANT?
Yes All
No
Yes Some
Not clear
No
* = Important criteria
Comments
The study had a low sample size, making it challenging to generalize the findings.
___________________________________________________________________________
___________________________________________________________________________
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APPENDIX F
Appraisal Guide:
Findings of a Quantitative Study
Citation:
Pines, J., Iyer, S., Disbot, M., Hollander, J., Shofer, F., & Datner, E. (2008). The effect of
emergency department crowding on patient satisfaction for admitted patients. Academic
Emergency Medicine, 15 (9), 825-831. https://doi.org/10.1111/j.1553-2712.2008.00200.x
Synopsis
What was the purpose of the study (research questions, purposes, and hypotheses)?
The study intended to assess the impact of emergency department overcrowding on patient
satisfaction levels.
How was the sample obtained?
The researcher targeted patients visiting an urban medical facility and collected data from these
individuals.
What inclusion or exclusion criteria were used?
The study included adult patients (18 years and older), who were admitted to the emergency
department between July 1, 2006, to June 30, 2007. The researchers only included individuals
who agreed to fill the Press-Ganey patient satisfaction survey.
Who from the sample actually participated or contributed data (demographic or clinical profile
and dropout rate)?
The study indicates that all the participants were above 18 years and admitted to the emergency
department. The researchers did not reveal the dropout.
What methods were used to collect data (e.g., sequence, timing, types of data, and measures)?
The researchers required participants to fill the Press-Ganey patient satisfaction survey.
Was an intervention tested?
Yes
No
1. How was the sample size determined?
The researcher did not calculate the sample size. Alternatively, the study sought to
engage with all patients who visited the emergency department in the selected
hospital.
2. Were patients randomly assigned to treatment groups?
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The study did not assign patients to random and treatment groups.
What are the main findings?
The study concluded that prolonged boarding and poor emergency department services lower
patient satisfaction. Hospitals must increase efforts to reduce overcrowding in these divisions to
enhance patient satisfaction.
Credibility
Is the study published in a source
that required peer review?
Yes
No
Not clear
*Did the data obtained and the
analysis conducted answer the
research question?
Yes
No
Not clear
Were the measuring instruments
reliable and valid?
Yes
No
Not clear
*Were important extraneous
variables and bias controlled?
Yes
No
Not clear
*If an intervention was tested,
answer the following five questions:
Yes
No
Not clear
1. Were participants randomly
assigned to groups and were
the two groups similar at the
start (before the intervention)?
Yes
No
Not clear
2. Were the interventions well
defined and consistently
delivered?
Yes
No
Not clear
3. Were the groups treated
equally other than the
difference in interventions?
Yes
No
Not clear
4. If no difference was found, was
the sample size large enough
to detect a difference if one existed?
Yes
No
Not clear
5. If a difference was found, are
you confident it was due to the
intervention?
Yes
No
Not clear
Yes
Some
Are the findings consistent with
findings from other studies?
ARE THE FINDINGS CREDIBLE?
Yes All
No
Yes Some
Not clear
No
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Clinical Significance
Note any difference in means, r2s, or measures of clinical effects (ABI, NNT, RR, OR)
*Is the target population clearly
described?
Yes
No
Not clear
*Is the frequency, association, or
treatment effect impressive enough
for you to be confident that the finding
would make a clinical difference if used
as the basis for care?
Yes
No
Not clear
ARE THE FINDINGS
CLINICALLY SIGNIFICANT?
Yes All
Yes Some
No
* = Important criteria
Comments
The researchers were vigorous and relied on an adequate sample to make conclusions.
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
References
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Hsu, M., Liang, L., Chang, Y., & Juang, W. (2019). Emergency department overcrowding:
Quality improvement in a Taiwan medical center. Journal of the Formosan Medical
Association, 118 (1), 186-193. https://doi.org/10.1016/j.jfma.2018.03.008
Peterson, G., Unwin, M., Morley, C., Kinsman, L., & Stankovich, J. (2018). Emergency
department crowding: A systematic review of causes, consequences and solutions. PLoS
One, 13 (8), 1-42. https://doi.org/10.1371/journal.pone.0203316.
Pines, J., Iyer, S., Disbot, M., Hollander, J., Shofer, F., & Datner, E. (2008). The effect of
emergency department crowding on patient satisfaction for admitted patients. Academic
Emergency Medicine, 15 (9), 825-831. https://doi.org/10.1111/j.1553-2712.2008.00200.x

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