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Objective: Lean methodology can be utilized to increase throughput in a fast-track care area without changing staffing in a busy, urban emergency department (ED). Methods: A retrospective before-and-after analysis was performed to an improvement process in a fast-track care area within an ED with a census of 100,000 patients. The intervention utilized Lean methodologies to identify inefficiencies in the throughput model set for patients triaged to fast-track. Multiple ED stakeholders were involved in formulating a more efficient framework for how patients would receive care when triaged to fast-track. Results: There was a decline in the patient's overall length of stay (-9%, p=0.08), arrival to the room (-10%, p=0.4418), and ED attending to disposition (-9%, p=0.003). Additionally, all aspects of patients leaving prior to treatment completion (against medical advice (-29.4%, p=0.006), elopement (-20.4%, p=0.049), and left without being seen (-5.3%, p=0.11)) declined. Discussion: Identifying wasted time and resources in a patient's stay in the ED allowed for a more efficient throughput model to be developed. This resulted in patients being able to be seen in a more methodical manner leading to decreased wait times and lower left without being seen rates. Conclusion: A Lean-based throughput model was implemented to improve efficiency, reducing the length of stay and increasing the volume of patients evaluated per shift without additional costs. This improvement led to fewer patients leaving before treatment and demonstrated the value of process improvement in healthcare.
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BACKGROUND: Aimed at bridging the gap in continuing medical education (CME) resource availability in low- and middle-income countries (LMICs), the "Continuing Medical Education on Stick" (CMES) program introduces two technological solutions: a universal serial bus (USB) drive and the CMES-Pi computer facilitating access to monthly updated CME content without data cost. Feedback from users suggests a lack of content on tropical infectious diseases (IDs) and content from a Western perspective, which may be less relevant in LMIC settings. METHODS: This quality improvement project was intended to identify areas for improvement of the CMES database to better meet the educational needs of users. We compared the CMES content with the American Board of Emergency Medicine (ABEM) Exam content outline to identify gaps. The curriculum map of the CMES library, encompassing content from 2019 to 2024, was reviewed. An anonymous survey was conducted among 47 global users to gather feedback on unmet educational needs and suggestions for content improvements. All healthcare workers who were members of the CMES WhatsApp group were eligible to participate in the survey. RESULTS: The curriculum map included 2,572 items categorized into 23 areas. The comparison with the ABEM outline identified gaps in several clinical areas, including procedures, traumatic disorders, and geriatrics, which were represented -5%, -5%, and -4% in the CMES library compared with the ABEM outline, respectively. Free responses from users highlighted a lack of content on practical skills, such as electrocardiogram (ECG) interpretation and management of tropical diseases. Respondents identified emergency medical services (EMS)/prehospital care (81%), diagnostic imaging (62%), and toxicology/pharmacology (40%) as the most beneficial areas for clinical practice. In response to feedback from users, new content was added to the CMES platform on the management of sickle cell disease and dermatologic conditions in darkly pigmented skin. Furthermore, a targeted podcast series called "ID for Users of the CMES Program (ID4U)" has been launched, focusing on tropical and locally relevant ID, with episodes now being integrated into the CMES platform. CONCLUSIONS: The project pinpointed critical gaps in emergency medicine (EM) content pertinent to LMICs and led to targeted enhancements in the CMES library. Ongoing updates will focus on including more prehospital medicine, diagnostic imaging, and toxicology content. Further engagement with users and education on utilizing the CMES platform will be implemented to maximize its educational impact. Future adaptations will consider local relevance over the ABEM curriculum to better serve the diverse needs of global users.
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BACKGROUND: Medical professionals' low level of apprehension and insights may result in the undervaluing of emergency medicine (EM) as a speciality to pursue in the future, which is a vital component in the everyday management of hundreds of patients. AIM: The aim of this study is to assess medical professionals' perception of the barriers in opting for EM as a career option in Pakistan. METHOD: This was an online survey study that examined doctors'/medical students' perception of hurdles in EM in Pakistan between November and December 2023. This study was conducted at Rawalpindi Medical University, Rawalpindi, Pakistan. Social media platforms were used to recruit the participants to carry out this survey. The questionnaire proforma comprised three sections: a demographic characteristics section (six questions), a perception section (11 questions), and the last section, where participants were asked to give their opinion to improve EM for a future speciality. RESULTS: An online Google survey form was used for the acquisition of data. Percentage and frequency distribution analysis was used. A total of 144 individuals (N = 144) participated in this study. Around 33.3% (N = 48) of the participants expressed that they had not considered a career in EM. Around 43% (N = 62) of them reported not having done a clinical placement in this speciality. A majority of the participants said that either they or their close friends/family members had faced a medical emergency. Leading barriers that proved a hindrance in pursuing this field were high levels of burnout, poor work-life balance, loss of patient follow-up, inability to work independently, more hostile environment, increased mortalities, and lack of exposure. Interestingly, family pressure had been reported by some participants as a limiting factor in pursuing EM. CONCLUSION: In Pakistan, many doctors and medical students are not willing to pursue their careers in EM. Nationwide educational seminars should be conducted to increase awareness and interest among doctors in this field. Moreover, more and more clinical placement opportunities should be made available for junior doctors in EM. In the future, further research should be carried out to identify effective educational interventions to increase doctors'/medical students' awareness in this field of medicine.