Disposition of Patients Before and After Establishment of Emergency Medicine Specialists
Introduction: Emergency department (ED) as the fundamental part of hospital has a specific importance due to admitting the most various and sensitive group of patients. The aim of the ED is presenting services with highest quality in the least time. To reach this goal establishment of an emergency medicine specialist who performs assessment, resuscitation, stabilization, detection, and maintenance of emergency patients is noteworthy. The aim of this study was evaluating the effect of establishing the emergency medicine specialists on the performance of ED in Poursina Hospital, Rasht, Iran. Methods: In this cross-sectional study files of all patients hospitalized in the ED of Poursina, Rasht, Iran, through 2005-2012 were evaluated. Variables such as age, gender, cause of refer and number of hospitalization, number of discharging from department, percentage of bed occupation and daily bed occupation, time of hospitalization, number of discharging under six hours, number of transportation to other wards or hospitals, and the rate of bed circulation in the ED were assessed, too. Data was gathered through hospital information system and analyzed using SPSS 20. Results: Through 2005 to 2012 number of admitted patients in the ED has increased so that the most admitted number was related to 2012 (p=0.0001). The present of discharged patients under six hours and the rate of direct discharging before the presence of emergency medicine specialists have increased from 15.5% and 58.9% to 23.4% and 61.2% in after their presence, respectively(p=0.001). Transporting to other wards and hospitals were also decreased from 41.1% to 38.8% (p=0.0001). The occupied beds percentage after presenting of emergency medicine specialists has noticeably decreased compared to the past, while bed turnover rate increased. In other words, the bed turnover mean has increased from 354.5±108.4 during 2005-2008 to 637.7±30.8 through 2009-2012 (p=0.002). Also, during 2005-2008 the hospitalization mean of the patient has remarkably decreased from 1.08±0.44 days to 0.35±0.05 days in 2009-2012 (p=0.021). The occupied bed mean before and after the presence of emergency medicine specialists were 12173±3453 and 6217±219, respectively, showed a descending trend into the past (p=0.018). Conclusion: It seems that presenting of emergency medicine specialists in health system leads to improve the service delivery to patients and decrease the waiting time. Also with decreasing the waiting time of patients and timely disposition, more prepared beds can be accessible in the ED for future admission.
Zohour A, Pilevarzade M. The study of service provision speed in emergency department of Kerman Bahonar hospital in 2000. J Iran Uni Med Sci. 2004;35:413-20.
Shojaee M, Faridaalaee G, Yousefifard M, et al. New scoring system for intra-abdominal injury diagnosis after blunt trauma. Chinese J Traumatol. 2014;17(1):19-24.
Rahmani H, Arab M, Akbari F, Zeraati H. Structure, process and performance of the emergency unit of teaching hospitals of Tehran University of Medical Sciences. J School Public Health. 2006;4(4):13-22.
Yousefzadeh chabok S, Mohtasham Amiri Z, Haghdoost Z, Mohseni M, Asadi P, Kazemnezhad Leili E. Patients discharged before and after presence of medical emergency specialists. Holist Nurs Midwifery 2014;24(1):64-70.
Hosseini Irani J, Ayazi Z, Malekpour Teharani A, Salehi Tali S, Rahimi Madiseh M. The effect of CPR training on performance of nurses in selected hospitals of Shahrekord University of Medical Sciences, 2010. J Clin Nurs Midwifery. 2007;1(1):73-80. [Persian].
Amiri H SvS, Ghodrat N. Emergency Medicine Physicians can Manage all Emergent Procedures in the Emergency Department. Turk J Emerg Med. 2009;9(3):101–4.
Ghafouri H-B, Shokraneh F, Saidi H, Jokar A. How do Iranian emergency doctors decide? Clinical decision making processes in practice. Emerg Med J. 2011;29(5):394-8.
Levsky ME, Young SE, Masullo LN, Miller MA, Herold TJ. The effects of an accelerated triage and treatment protocol on left without being seen rates and wait times of urgent patients at a military emergency department. Mil Med. 2008;173(10):999-1003.
Horwitz LI, Green J, Bradley EH. US emergency department performance on wait time and length of visit. Ann Emerg Med. 2010;55(2):133-41.
Hosseini M, Shaker H, Ghafouri H, Shokraneh F. Chronometric Study of Patients' Workflow and Effective Factors on It in Emergency Department of 7th Tir Martyrs Hospital of Tehran, Iran. J Health Admin. 2010;13(40):13-22. [Persian].
Yousefzadeh chabok Sh, Mohtasham Amiri Z, Haghdust Z, Mohseni M, Asadi P, Kazemnezhad Leil E. Patients discharged before and after presence of medical emergency specialists. Holist Nurs Midwifery. 2014;24(1):64-70. [Persian].
Hashemi B, Baratloo A, Rahmati F, et al. Emergency Department Performance Indexes Before and After Establishment of Emergency Medicine. Emergency. 2013;1(1):20-3.
Zohour A, Pilevarzadeh M. Study of speed of offering services in emergency department at kerman bahonar hospital in 2000. Razi Med Sci. 2003;10(35):413-9. [Persian].
Shams AS, Bahmanziari N, Kordi A, Pourentezari M, Shokri A, Naghdi B. Patient’s Satisfaction and Their Problems in Emergency Department of Alzahra Hospital. J Health Syst Res. 2013;9(8):803-11. [Persian].
Jayaprakash N, O’Sullivan R, Bey T, Ahmed SS, Lotfipour S. Crowding and delivery of healthcare in emergency departments: the European perspective. West J Emerg Med. 2009;10(4):233.
Wilper AP, Woolhandler S, Lasser KE, et al. Waits to see an emergency department physician: US trends and predictors, 1997–2004. Health Aff (Millwood). 2008;27(2):84-95.
Hosseini M, Shaker H, Basir Ghafouri H, Shokraneh F. Chronometric Study of Patients' Workflow and Effective Factors on It in Emergency Department of 7th Tir Martyrs Hospital of Tehran, Iran. J Health Admin. 2010;13(40):13-22. [Persian].
Based on the obtained author agreement upon submission, "Iranian Journal of Emergency Medicine" is the copyright owner of the published material. However, according to Bethesda Statement, all works published in this journal are open access and freely available to anyone on the journal web site without cost under creative common license BY-NC. Based on this license, under the condition of proper citation, “Iranian Journal of Emergency Medicine” grants to all users the following rights:
1. Free, irrevocable, worldwide, perpetual access to all published materials.
2. To copy, use, distribute, transmit and display the work on third party repositories and social media.
3. To make and distribute derivative works in any digital medium for any non-commercial purpose.