Hurry up, it's quiet in the emergency department.

INTRODUCTION: Emergency department (ED) crowding is a contemporary problem. Solutions are multiple, but often involve a lengthy implementation process and/or substantial funding. Therefore, it is important that in the meanwhile, we aim to identify simple strategies, focussing on optimising efficiency of the available resources, which can be adopted in the ED here and now. METHODS: We made a careful analysis of inflow, throughput and outflow data of all 24,823 patients visiting the ED of a large teaching hospital in the year 2015, and looked in more detail at the 10 days with the longest average throughput times. RESULTS: The average throughput time during the study period was 130 minutes. The time between inflow and outflow peaks was well beyond the average daily ED throughput time, indicating that the 'midday surge in patient arrivals could not be handled adequately by the ED system. For the 10 days with the longest average throughput times, we found a very distinctive pattern, with a backlog of patients building up in the morning hours when maximum bed capacity had not yet been reached. This backlog had consequences during a significant part of the day. CONCLUSION: Improved timing of internal efforts in the ED based on careful analysis of ED performance data should be an integral part of a system approach to prevent ED crowding.

Implementation of a unit dose distribution system for respiratory therapy medications.

The development and implementation of a comprehensive unit dose distribution system for respiratory medications is described. Initially, an evaluation of carts and unit dose packaging materials for respiratory medications was conducted. Subsequent to the selection, a unit dose processing and packaging program was developed in accordance with the Respiratory Therapy Medical Director's Standard Treatment Orders. A 24-hour exchange system, separate but paralleling the already operational unit dose system, was implemented. The primary advantages attributed to the implementation of this system were 1) a decrease in potential respiratory medication order interpretation/transcription errors; 2) a decrease in the waste of medication solutions; 3) a decrease in potential preparation errors by the respiratory therapists; 4) standardization and accuracy of respiratory medication dosages; and 5) a more equitable method of charging patients.

Balancing workload and staffing in satellite pharmacies by using a patient acuity index.

The assignment of beds to satellite pharmacies is based primarily on proximity. Assignment will usually be by nursing unit to encourage more effective communication among the patient, doctor, nurse, and pharmacist. Usually, an equal number of beds is assigned to each satellite. Recognizing that some nursing units (e.g., Intensive Care Units) place greater demands on pharmacy resources than others makes it obvious that there is a need for a system to measure the consumption of pharmacy resources by patient acuity. This article tells how such a measure was conceived, developed, and applied.

Estrogens + patient package insert = confused patients.

A brief review of the patient package inserts concept and estrogen pharmacology is presented. Then the need for patient education is discussed along with recommendations for a team approach to managing patient anxiety by helping patients understand the estrogen-containing products they are using.

PIP: This article takes issue with the physicians' handling of patient inserts in estrogen-containing medications when presenting such medication to a patient in need. This discussion follows a brief review of the rationale of the Food and Drug Administration of using package inserts and a review of estrogen uses, adverse reactions, cautions, and side effects. The author argues for a more cooperative approach to patient package inserts, which would require direct participation by the physician rather than simple passive reading by the patient. A questionnaire survey on patients' attitudes, knowledge, views, and sources of drug information on oral contraceptives, with particular attention to the role of the patient-oriented package insert, concluded that professional sources (physician, nurse, or pharmacist) were preferred over nonprofessional and media sources. A collaborative approach to drug education is recommended, and suggestions for implementation are set forth.