ARTICLE INFO

Article Type

Descriptive & Survey Study

Authors

Talebpour   M. (1)
Payandemehr   P. (2)
Kalhor   P. (3)
Abbasi   N. (4)
Baratloo   (*)






(*) Pre-Hospital and Hospital Research Center” and “Department of Emergency Medicine, School of Medicine”, Tehran University of Medical Sciences, Tehran, Iran
(1) Department of Surgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
(2) Pre-Hospital and Hospital Research Center” and “Department of Emergency Medicine, School of Medicine", Tehran University of Medical Sciences, Tehran, Iran
(3) School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
(4) Department of Emergency Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

Correspondence

Address: Department of Emergency Medicine, Tehran University of Medical Sciences, Poor Sina Street, Tehran, Iran
Phone: +98 (21) 63121432
Fax: +98 (21) 63121432
arbaratloo@sina.tums.ac.ir

Article History

Received:  December  8, 2018
Accepted:  January 20, 2019
ePublished:  March 19, 2019

BRIEF TEXT


Health services are considered as citizens' rights and are considered to be one of the vital needs of the whole world. Given the constraints of the health sector and the state budget defined for it, as well as the constraints on the facilities and resources allocated to the private sector, health sector administrators face the challenge of how to expand the quality and quantity of health services [1-3].

... [4]. In Iran, in 2013, the Health System Evolution Plan was launched with the aim of expanding health services in a qualitative and quantitative way. Among the most important areas affected by this plan were hospital emergencies, which, due to the reduction of direct payments from people's pocket In this plan, the number of people who could benefit from health services has been potentially increasing and it increased congestion in emergency department [5, 6]. This important fact has led to more and more issues related to the management of emergency departments in Iran in recent years and it has attempted to use various management models to allocate existing resources and improve the quality of service to patients. ... [7]. Given the noticeable congestion of emergency departments in governmental and academic hospitals, intervention in the current process is inevitable. However, the need for any intervention to obtain complete and comprehensive information from the status quo is essential, and the analysis and statistical analysis of existing conditions and current trends, provide valuable information to health system managers.

The purpose of this study was to investigate and analyze the input and output of patients in the emergency department of Sina Hospital.

This is a cross-sectional and retrospective study.

This research was carried out at Sina Hospital affiliated to Tehran University of Medical Sciences in March 2018 and all patients who referred to the Emergency Department of this hospital in 2017 and their characteristics had been in hospital registry systems, regardless of age, sex, and complaints, diagnosis, etc. were entered into the research.

Sampling was done by census method. The main criterion for choosing patients in the hospital registry system was the completeness of their electronic records, as well as the availability of case records and complete actions for them, and they would otherwise be excluded.

The data collection was done through a checklist and the electronic registration system of the hospital was used to receive the data, and in the required cases, the files in the archive were also reviewed. This checklist was approved by the deputy director of the Tehran University of Medical Sciences and was previously provided by the Emergency Department's secretary, by the Center's management system, and he was registering information related to the past 24 hours. In this study, firstly, the statistics of the emergency department's inputs were examined. From which paths the patients referred to the emergency department of the hospital. Patient outflow status was assessed on the basis of existing records and they were divided into different groups to determine how much of the emergency department entrance, discharge, dispatch, referral, or possibly death occurred. All data were analyzed using SPSS 21 software. Regarding the abnormality of all quantitative variables, nonparametric tests were used.

In 2016, a total of 34,901 patients were referred to the emergency department of Sina Hospital, of whom 9721 (27.8%) had emergency medical services, 584 (1.7%) dispatched from other centers and 24596 (70.5%) outpatients entered emergency department. In the second half of the year, the percentage of referrals with emergency medical services was increased compared to the first half of the year, but the total number of clients in the first half of the year was more than the second half of the year (p> 0.05; Figure 1). Of the total number of patients admitted in 2017, 2980 (8.5%) were admitted after an accident. The proportion of crashed people referring to the emergency department in the month of September was higher than other months of the year, and this ratio was lower than other months in April (p> 0.05; Fig. 2)Out of 34901 entry persons, 27390 (78.48%) were discharged from the emergency department after taking appropriate measures from the emergency department. Out of 7511 people (21.22%) of other outputs, 10 cases (0.03%) had been died at the time of arrival;155 (44.4%) cases had been died after admission, 40 (1.15%) had been referrals to other centers; 6809 (19.51%) patients were transferred from emergency department to other departments of the hospital and 497 (1.42%) had been discharged with personal satisfaction.The percentage of transmission of patients from the emergency department to the other hospital departments in the second 6 months was more than the first 6 months (Fig. 3).The percentage of monthly deaths in the emergency department in the second 6 months of the year was more than the first 6 months of the year (p> 0.05).

All matters relating to the admission of patients, including medical treatment for them, as well as the withdrawal of patients from the emergency department to the hospital departments, their discharge or deployment to other treatment centers, should be recorded quantitatively and qualitatively, that our main focus in the present study, was quantitative data in the mentioned three sections. However, in the next step, we need to model the patient's movement from outside of the hospital to the emergency department and exit. As Cento et al. conducted a linear planning in 2003, and were able to provide a new model that reduces the staffing costs of the emergency department [8]. Although this was merely a theoretical discussion, we in Iran, considering the limitations of health system resources, need to carry out similar studies as well as accurate modeling for the best use of our limited resources. ... [9]. As an emergency department manager, unnecessary inputs to the emergency department should be prevented so that excessive occupancy of the emergency department due to its bustle and reduced quality of service to patients will not be difficult. This has also been noted in the McKinsey and Brett research, and more than 60% of US Emergency Centers have been identified with disproportionate inputs and overcapacity [10]. Such findings have been reported in similar studies in Iran [11]. ... [12]. In a study conducted by Basuli et al. in 2003, they have looked at all the issues related to the actions taken in the emergency department, and even the behavior of the emergency staff with the patients has been examined, which includes only a few cases, including tests and imaging and patient visits, but quality items have also been taken into consideration, and the results show that by improving the cases, the indicators for the performance of the emergency can be improved [13]. The results of the research, Deirelt et al., Show that not only do we need to manage the emergency department, but also we must provide the necessary conditions for patient discharge and admission in the admissions departments by introducing and interacting with the hospital departments [14]. The proposed models for assessing the status of patients in an emergency can vary according to the characteristics of each country. Modeling needs to be done according to indigenous data. Perhaps one of the most successful examples of current counseling can be found in Flicher et al., 2007, in England, which was scheduled to be delivered to the emergency department after a maximum of 4 hours after the patient entered the emergency room. This may indicate that even in the UK's seven-decade-long system of health, which is managed with vigor and consistency, a new plan can be proposed that addresses the current challenges in dealing with patients and managing them in the emergency department to a satisfactory level [15]. ... [16-22].

non declared

One of the most important limitations of this research is the lack of evaluation of the decision process for patients in the emergency department, which was not the goal of the present study. The limitations of the plan may be that some of the files may be incomplete, which, of course, is acceptable in the statistical community with such a size, and this problem probably will not lead to a general conclusion.

Outpatient referral, referral by the emergency department and dispatch from other centers, respectively, have the most statistics on how to get patients into the emergency department. About 80% of patients referred to the emergency department are visited by emergency department and only about 20% of cases are admitted to the hospital.

This research is based on Dr. Parvin Kalhor's dissertation for obtaining a doctoral degree in general medicine from Tehran University of Medical Sciences.

There are no conflicts of interest.

The research protocol was approved by the Ethics Committee of Tehran University of Medical Sciences and assigned IR.TUMS.MEDICINE.REC.1397.139 code.

No financial support has been received for this research.

TABLES and CHARTS

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CITIATION LINKS

[1]Isken MW, Rajagopalan B. Data mining to support simulation modeling of patient flow in hospitals. J Med Syst. 2002;26(2):179-97.
[2]Haroutunian P, Alsabri M, Kerdiles FJ, Hassan AA, Bellou A. Analysis of factors and medical errors involved in patient complaints in a european emergency department. Adv J Emerg Med. 2018;2(1):e4.
[3]Mirbaha S, Forouzanfar M, Mohebi M, Kariman H. The cost of leaving the emergency department without notice: A cross-sectional study. Adv J Emerg Med. 2018;2(1):e6.
[4]van Sambeek JR, Cornelissen FA, Bakker PJ, Krabbendam JJ. Models as instruments for optimizing hospital processes: A systematic review. Int J Health Care Qual Assur. 2010;23(4):356-77.
[5]Majidi A, Mahmoodi S, Adineh VH. An epidemiologic study of emergency department visits before and after executing health sector evolution plan: A brief report. Iran J Emerg Med. 2017;4(3):130-4. [Persian]
[6]Hashemi B, Baratloo A, Forouzafar MM, Motamedi M, Tarkhorani M. Patient satisfaction before and after executing health sector evolution plan. Iran J Emerg Med. 2015;2(3):127-33. [Persian]
[7]Asplin BR, Magid DJ, Rhodes KV, Solberg LI, Lurie N, Camargo CA, Jr. A conceptual model of emergency department crowding. Ann Emerg Med. 2003;42(2):173-80.
[8]Centeno M, Giachetti R, Linn R, Ismail A. A simulation-ilp based tool for scheduling ER staff. Proceedings of the 2003 Winter Simulation Conference. New Orleans, LA: IEEE; 2003. pp. 1930-8.
[9]Hall R, editor. Patient flow: Reducing delay in healthcare delivery. New York: Elsevier; 2007.
[10]McCaig LF, Burt CW. National hospital ambulatory medical care survey: 1999 emergency department summary. Adv Data. 2001;25(320):1-34.
[11]Dolatabadi AA, Maleki M, Memary E, Kariman H, Shojaee M, Baratloo A. The use of emergency department services for non-emergency conditions. Health Med. 2017;11(1):3-9.
[12]Christopher G. Reducing Patient Flow to help America's emergency departments. Urgent Matters. 2004.
[13]Bazzoli GJ, Brewster LR, Liu G, Kuo S. Does US hospital capacity need to be expanded?. Health Aff. 2003;22(6):40-54.
[14]Derlet R, Richards J, Kravitz R. Frequent overcrowding in US emergency departments. Acad Emerg Med. 2001;8(2):151-5.
[15]Fletcher A, Halsall D, Huxham S, Worthington D. The DH accident and emergency department model: A national generic model used locally. J Oper Res Soc. 2007;58(12):1554-62.
[16]Fletcher A, Worthington D. What is a generic hospital model?—a comparison of generic and specific hospital models of emergency patient flows. Health Care Manag Sci. 2009;12(4):374-91.
[17]Konnyu H, Turner L, Skidmore B, Daniel R, Forster A, Mohan D. What input and output variables have been used in models of patient flow in acute care hospital settings? Evidence Summary No 12 developed as part of the ohri-champlainlhin knowledge to action research program June 2011.
[18] Dent AW, Phillips GA, Chenhall AJ, McGregor LR. The heaviest repeat users of an inner city emergency department are not general practice patients. Emerg Med. 2003;15(4):322-9.
[19]Momeni M, Vahidi E, Seyedhosseini J, Jarchi A, Naderpour Z, Saeedi M. Emergency overcrowding impact on the quality of care of patients presenting with acute stroke. Adv J Emerg Med. 2018;2(1):e3.
[20]Warden CR, Bangs C, Norton R, Huie J. Temporal trends in ambulance diversion in a mid-sized metropolitan area. Prehosp Emerg Care. 2003;7(1):109-13.
[21]Safari S, Rahmati F, Baratloo A, Motamedi M, Forouzanfar MM, Hashemi B, et al. Hospital and pre-hospital triage systems in disaster and normal conditions: A review article. Iran J Emerg Med. 2015;2(1):2-10.
[22]Derlet RW. Triage and ED overcrowding: Two cases of unexpected outcome. Cal J Emerg Med. 2002;3(1):8.