Assessment of the reliability of active radiofrequency identification technology for patient tracking in the pediatric emergency department.

INTRODUCTION: Radiofrequency identification (RFID) technology has been used in other emergency department settings but has not been assessed in a pediatric emergency department setting for its reliability in its application as a patient tracking system. The goal of this study was to assess the accuracy, precision, and reliability of the technology in a simulated pediatric emergency department setting to collect patient tracking information. METHODS: A simulated pediatric emergency department clinical assessment room was developed to serve as a test room to collect patient tracking information. This information included the interaction times between simulated patients, parents, physicians, and nurses. Direct observation of these interaction times were recorded by an observer. A patient tracking system based on active RFID technology recorded interaction times between models wearing RFID devices and recorded this information in a computerized data log. Comparison between the direct observation record and the data log was used to determine accuracy, precision, and reliability. RESULTS: A total of 152 directly observed interactions were recorded. Data extraction from the data log yielded 152 sensor-recorded interactions, resulting in a reliability of 1.0. Data pair comparison on all events resulted in a mean difference of 2.88 seconds. CONCLUSIONS: Active RFID-based patient tracking systems are a precise and reliable means of recording patient interaction events in the pediatric emergency department.

Pediatric Emergency Medicine Fellows Education Day: Addressing CanMEDS objectives at a national subspecialty conference.

Canadian subspecialty residency training programs are developed around the learning objectives listed in the seven Canadian Medical Education Directives for Specialists (CanMEDS) criteria. Delivering content on objectives outside of those traditionally acquired in clinical rotations can be a challenge. In the present article, the planning process, curriculum development, and evaluation and assessment of a national subspecialty conference model in providing CanMEDS objective-based content sessions in the categories other than Medical Expert (Professional, Scholar, Communicator, Collaborator, Manager and Health Advocate) is described. It is hypothesized that the development of a CanMEDS objective-based curriculum would be positively received by subspecialty residents attending this conference. Attendees of sessions in a two-year curriculum cycle assessed the content as valuable, relevant and effective. The application of this process can be useful to other subspecialty residency training programs to meet the needs of their CanMEDS objective-based training requirements.

Les programmes canadiens de formation de résidence en surspécialité sont élaborés conformément aux objectifs d'apprentissage énumérés dans les sept rôles CanMEDS. Il peut être difficile de présenter du contenu au sujet de rôles qui ne font pas partie de ceux habituellement acquis lors des rotations cliniques. Dans le présent article, les chercheurs décrivent le processus de planification, l'élaboration du programme et l'évaluation d'un modèle de congrès national de surspécialité au moyen de séances fondées sur les autres rôles CanMEDS que celui d'expert médical (professionnel, érudit, communicateur, collaborateur, gestionnaire et professionnel de la santé). Ils postulaient que les résidents en surspécialité qui participaient au congrès accueilleraient favorablement un programme reposant sur les rôles CanMEDS. D'après l'évaluation des participants aux séances faisant partie d'un programme de deux ans, le contenu était perçu comme digne d'intérêt, pertinent et efficace. La mise en application de ce processus peut être utile à d'autres programmes de formation en surspécialité qui désirent respecter leurs besoins de formation reposant sur les rôles CanMEDS.

Impact of an observation unit and an emergency department-admitted patient transfer mandate in decreasing overcrowding in a pediatric emergency department: a discrete event simulation exercise.

OBJECTIVES: The primary objective was to examine the effects of a simulated observation unit (OU) and a transfer mandate for admitted patients on pediatric emergency department (PED) patient flow indicators. The secondary objective was to report on the occupancy rate of the simulated OU. METHODS: Simulations were conducted using a previously designed and validated discrete event simulation model of our PED operations. A simulated OU was designed, and an emergency department-admitted patient transfer mandate was developed and then applied to a discrete event simulation model. Four scenarios (regular PED operations with and without a 5-bed OU and transfer mandate in all combinations) were modeled. RESULTS: A combination of an OU and an emergency department-admitted patient transfer mandate resulted in reductions in time to be seen by a physician and length of stay in patients who were triaged with urgent or emergent presentations as compared with PED operations with neither an OU nor a transfer mandate. Small improvements in fractile response were observed for patients triaged with urgent presentations. The OU without the transfer mandate had a simulated occupancy rate of 73.1%. The inclusion of the transfer mandate reduced the occupancy rate to 48.1%. CONCLUSIONS: Simulation scenario analyses predict that an OU and a transfer mandate would reduce overcapacity in the PED, with more substantial reductions in time to be seen and length of stay for patients of high acuity.

A consensus-established set of important indicators of pediatric emergency department performance.

BACKGROUND: Quality assurance is a new and important area of research in pediatric emergency medicine (PEM). There are few studies that describe which performance indicators best represent the PEM practice. The primary study objective is to construct a set of performance indicators that have been selected by current and former pediatric emergency department (PED) medical directors as most useful in assessing PED performance. The secondary objective is to assess which indicators are currently measured to assess performance in PEDs. METHODS: Current and former directors of accredited Canadian PEM programs were considered as eligible participants. A list of indicators was generated by a survey (item pool generation); this list was refined by clarifying unclear terms or eliminating redundant and unquantifiable performance indicators (item scaling); PED directors were asked to rate each item of this refined list to indicate which indicators were more useful in assessing PED performance (item prioritization). A novel ranking formula was used to prioritize those items considered most useful by a larger proportion of respondents, using the provided rating scores. RESULTS: Fourteen current and former medical directors were considered eligible participants. Indicators related to patient morbidity and mortality, adverse outcomes, return visits, patient length of stay (LOS), and waiting times were considered to be more useful. Less useful indicators included the number of deaths, daily census, number of incident reports, and individual physicians' admission rates. The most commonly measured PED performance indicators included the rate of patients who left without being seen, patient LOS, and the waiting time until being seen by a physician by triage category. CONCLUSIONS: The top quartile of performance indicators considered most useful by participants included indicators that reflected clinical outcomes, LOS, and waiting times. A dichotomy may exist between those performance indicators that PED directors considered more useful and those indicators that are currently measured.

Computer modeling of patient flow in a pediatric emergency department using discrete event simulation.

UNLABELLED: Increasing patient census and department overcrowding are universal concerns in pediatric emergency medicine. Accurate predictions of patient flow and resource utilization in the pediatric emergency department (PED) are important in determining what aspects of PED activity could be modified to improve patient flow, reduce patient waiting times, and increase staff efficiency and morale, and thus direct change more effectively. BACKGROUND: We report (1) the construction of a Patient Flow Model (PFM) using discrete event simulation to test simulated PED staffing scenarios that were designed to alleviate the pressures that result from increased census and overcrowding, and (2) a Physician Scheduling Analysis Tool to assist in physician scheduling. METHODS: Arena discrete event simulation modeling software was used to develop a model of PED patient flow after extensive interviews with PED staff and direct observation of patient flow in July 2005. A total of 517 patients were directly observed, and all modeled aspects of their interaction with PED staff and resources were recorded. Historical demographic patient arrival information was combined with observed patient flow data to provide simulated patient arrival rates for the PFM and was also used to construct the Physician Scheduling Analysis Tool. Validation of the PFM was performed by comparing annual simulated patient flow data with actual patient flow data. Previously determined staffing scenarios were applied to the simulation and the resulting performance indicator outputs examined. RESULTS: The PFM was validated on model-wide and process-specific levels, with excellent validation observed on high acuity-patient length of stay and for highly detailed processes such as triage and registration. Simulation of the addition of a hospital volunteer and a second triage nurse demonstrated reductions in pretriage waiting time and the proportion of patients waiting longer than 30 or 60 minutes for pretriage. Simulation of an extra physician shift to the staff schedule demonstrated reductions in length of stay for patients of all triage categories. CONCLUSIONS: The PFM accurately represents patient flow through the department and can provide simulated patient flow information on a variety of scenarios. It can effectively simulate changes to the model and its effects on patient flow.

Principles of managing children with asthma in the emergency department.

INTRODUCTION: Paediatric asthma exacerbations comprise a significant portion of emergency department (ED) visits and hospitalizations. Recognition of diagnostic symptoms and signs, and timely use of appropriate medications may reduce the need of hospitalizations and the impact of this disease on the lives of children and their families. OBJECTIVE: To review the pathophysiology of asthma, the current recommendations for conventional medical treatment in the ED, the controversies surrounding adjunct therapies, and the importance of discharge planning and follow-up. CONCLUSIONS: Paediatric asthma exacerbations may be successfully treated in the ED with the use of appropriate inhaled and systemic medications.