Emergency department overcrowding: Quality improvement in a Taiwan Medical Center.

BACKGROUND/PURPOSE: Overcrowding of hospital emergency departments (ED) is a worldwide health problem. The Taiwan Joint Commission on Hospital Accreditation has stressed the importance of finding solutions to overcrowding, including, reducing the number of patients with >48 h stay in the ED. Moreover, the Ministry of Health and Welfare aims at transferring non-critical patients to district or regional hospitals. We report the results of our Quality Improvement Project (QIP) on ED overcrowding, especially focusing on reducing length of stay (LOS) in ED. METHODS: For QIP, the following 3 action plans were initiated: 1) Changing the choice architecture of patients' willingness to transfer from opt-in to opt-out; 2) increasing the turnover rate of beds and daily monitoring of the number of free beds for boarding ED patients; 3) reevaluation of patients with a LOS of >32 h after the morning shift. RESULTS: Transfer rates increased minimally after implementation of this project, but the sample size was too small to achieve statistical significance. No significant increase was observed in the number of free medical beds, but discharge rates after 12 pm decreased significantly (p < 0.001). The proportion of over 48 h LOSs decreased from 4.9% to 3.7% before and after QIP implementation, respectively (p < 0.001). CONCLUSION: Patients with LOS of >32 h were reevaluated first. After QIP, the proportion of LOSs of >48 h dropped significantly. Changing the choice architecture may require further systemic effort and a longer observation duration. Higher-level administrators will need to formulate a more comprehensive bed management plan to speed up the turnover rate of free inpatient beds.

The experiences of prenatal depression among Taiwanese women.

AIM: This paper is a report of a study to describe Taiwanese women's experiences of prenatal depression. BACKGROUND: Despite its long-term adverse effects for both mother and child, prenatal depression has received less scholarly attention than postpartum depression. Studies to date have proposed structured measures for quantifying prenatal depression, but the characteristics of this phenomenon have not been qualitatively analysed. METHOD: A convenience sample of 12 Taiwanese pregnant women scoring above 15 on the Edinburgh Perinatal Depression Scale participated in in-depth interviews during 2005. The interviews were transcribed verbatim and analysed using content analysis. FINDINGS: Unbalanced commitment to motherhood was the primary theme of the life experiences of prenatal depression in these Taiwanese women, which summarized their feelings of engagement and ambivalence towards their experiences of transition to motherhood. Five recurring sub-themes were identified: multiple conflicting roles, lack of social support, dissatisfaction with body image, future uncertainty and emotional instability. CONCLUSION: Prenatal depression is a painful growth experience represented by silent and unbalanced commitment during the maternal role transition. Our findings may help healthcare professionals to understand the vulnerable experiences of pregnant women and devise preventive intervention strategies, such as prenatal education for both parents and comprehensive screening for prenatal depression in at-risk pregnant women, so that they are better prepared for the transition to motherhood.