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Teamwork in the emergency department—Effects on efficiency, patient satisfaction and work environment
Abstracts Just come and get the dam patient Greg McHugh 1,2 1
Royal Flying Doctor Service Central Operations, Australia PO Box 381, Marleston DC 5033, Australia Keywords: Flight Nurses; Patient transfer; Preparation safety 2
‘‘Life was like a box of chocolates. You never know what you’re gonna get.’’ Forrest Gump (1994) Transferring a patient is not a therapeutic intervention in patient care, therefore doing it in a timely and safe manner is paramount to the well being of the patient and the attending staff. When your clinical setting is away from an Emergency Department and the resources available to you are scarce, a number of professional and logistic challenges are presented to the remote area Health Care Worker. This paper will explore some of the risks encountered by Flight Nurses in the delivery of a service to the rural and remote communities of Australia. These include some of the professional and resource constraints of being a solo practitioner, the physical dangers of working in solo practice or relying on a third party for information or a situation report when they have an interest in getting the patient transferred. Within their normal daily practise, Flight Nurses are reliant upon third parties for their clinical information and their own safety during movement between the airstrip and the hospital, clinic or accident site. I will discuss some aspects of patient preparation and describe how Flight Nurses need to be innovative and creative in their thinking to ensure the provision of high quality care in hostile environments. doi:10.1016/j.aenj.2011.09.081 Teamwork in the emergency department—–Effects on efficiency, patient satisfaction and work environment Åsa Muntlin Athlin 1,2,3,∗ , Nasim Farrokhnia 1,2 , Ulrica von Thiele Schwarz 4,5
S33 ing approach to improving care processes in emergency departments (ED). Aim: The aim of this study was to investigate the effects of implementation of teamwork on ED efficiency but also how teamwork affects patient ratings of care quality and staff perceptions of the work environment. Method: A quasi-experimental study using multiple baseline and comparison groups was conducted in a Swedish university hospital ED as they implemented teamwork into clinical practice. Teamwork was implemented to reach the 4-h target by getting the physician involved earlier in the care process and avoid multiple handovers. Data was collected from multiple data sources, including electronic health record, observations, patient questionnaires and selfratings from healthcare professionals. Results: Compared to traditional work, teamwork was related to some improvements in ED efficiency. The patients rated fewer areas in need of quality improvement. They also rated the waiting times to physicians as shorter (although the registered waiting times did not differ significantly). In contrast, staff initially perceived their efficiency as worse and their work as less rewarding. Conclusions: Teamwork is promising in generating better patient flow and is related to improvement in patients’ perceptions of quality of care. However, staff needs time to adjust to the changes in work process. doi:10.1016/j.aenj.2011.09.082 Perceived efficiency in the emergency department—– Short throughput times or rather having a lot to DO? Ulrica von Thiele Schwarz 1,2,∗ , Åsa Muntlin Athlin 3,4 1
Department of Psychology, Stockholm University, Sweden Medical Management Center (MMC), Karolinska Institutet, Sweden 3 Department of Medical Sciences, Uppsala University, Sweden 4 Department of Public Health and Caring Sciences, Uppsala University, Sweden Keywords: Efficiency; Emergency department; Staff; Work environment; 4-h target 2
1
Department of Emergency Care, Uppsala University Hospital, Sweden 2 Department of Medical Sciences, Uppsala University, Sweden 3 Department of Public Health and Caring Sciences, Uppsala University, Sweden 4 Department of Psychology, Stockholm University, Sweden 5 Medical Management Center (MMC), Karolinska Institutet, Sweden Keywords: Efficiency; Teamwork; Emergency department; Quality of care; Patient satisfaction; Staff; work environment Background: Overcrowding and excessively long waits are a concern for emergency departments around the world. It has been argued that simply adding capacity (such as hospital beds) is not sufficient to fix flow problems. Accordingly, process orientation has been embraced and multidisciplinary teamwork has been suggested as a promis-
The challenges facing emergency care have increased the need for shorter throughput times, often expressed in the ‘‘four-hour target’’, e.g. a total transit time for patients less than 4 h. However, little is known of how work under the four-hour target is perceived by the staff. The aim of this study was to compare employee ratings of efficiency, workrelated effort and energy levels on days with short (<4 h) or long throughput times (>4 h). Staff in a Swedish emergency department provided selfratings of perceived efficiency, work-related efforts and rewards and quantity and quality of work after each day shift during six weeks. Ratings were aggregated to a mean per day for each item. Patient throughput times were gathered from patient records. Two groups were formed based on a median split of the daily throughput rates (percentage of patients treated within 4 h): low throughput rates (e.g. longer throughput times) and high throughput rates (e.g. shorter throughput times).
Royal Flying Doctor Service Central Operations, Australia PO Box 381, Marleston DC 5033, Australia Keywords: Flight Nurses; Patient transfer; Preparation safety 2
‘‘Life was like a box of chocolates. You never know what you’re gonna get.’’ Forrest Gump (1994) Transferring a patient is not a therapeutic intervention in patient care, therefore doing it in a timely and safe manner is paramount to the well being of the patient and the attending staff. When your clinical setting is away from an Emergency Department and the resources available to you are scarce, a number of professional and logistic challenges are presented to the remote area Health Care Worker. This paper will explore some of the risks encountered by Flight Nurses in the delivery of a service to the rural and remote communities of Australia. These include some of the professional and resource constraints of being a solo practitioner, the physical dangers of working in solo practice or relying on a third party for information or a situation report when they have an interest in getting the patient transferred. Within their normal daily practise, Flight Nurses are reliant upon third parties for their clinical information and their own safety during movement between the airstrip and the hospital, clinic or accident site. I will discuss some aspects of patient preparation and describe how Flight Nurses need to be innovative and creative in their thinking to ensure the provision of high quality care in hostile environments. doi:10.1016/j.aenj.2011.09.081 Teamwork in the emergency department—–Effects on efficiency, patient satisfaction and work environment Åsa Muntlin Athlin 1,2,3,∗ , Nasim Farrokhnia 1,2 , Ulrica von Thiele Schwarz 4,5
S33 ing approach to improving care processes in emergency departments (ED). Aim: The aim of this study was to investigate the effects of implementation of teamwork on ED efficiency but also how teamwork affects patient ratings of care quality and staff perceptions of the work environment. Method: A quasi-experimental study using multiple baseline and comparison groups was conducted in a Swedish university hospital ED as they implemented teamwork into clinical practice. Teamwork was implemented to reach the 4-h target by getting the physician involved earlier in the care process and avoid multiple handovers. Data was collected from multiple data sources, including electronic health record, observations, patient questionnaires and selfratings from healthcare professionals. Results: Compared to traditional work, teamwork was related to some improvements in ED efficiency. The patients rated fewer areas in need of quality improvement. They also rated the waiting times to physicians as shorter (although the registered waiting times did not differ significantly). In contrast, staff initially perceived their efficiency as worse and their work as less rewarding. Conclusions: Teamwork is promising in generating better patient flow and is related to improvement in patients’ perceptions of quality of care. However, staff needs time to adjust to the changes in work process. doi:10.1016/j.aenj.2011.09.082 Perceived efficiency in the emergency department—– Short throughput times or rather having a lot to DO? Ulrica von Thiele Schwarz 1,2,∗ , Åsa Muntlin Athlin 3,4 1
Department of Psychology, Stockholm University, Sweden Medical Management Center (MMC), Karolinska Institutet, Sweden 3 Department of Medical Sciences, Uppsala University, Sweden 4 Department of Public Health and Caring Sciences, Uppsala University, Sweden Keywords: Efficiency; Emergency department; Staff; Work environment; 4-h target 2
1
Department of Emergency Care, Uppsala University Hospital, Sweden 2 Department of Medical Sciences, Uppsala University, Sweden 3 Department of Public Health and Caring Sciences, Uppsala University, Sweden 4 Department of Psychology, Stockholm University, Sweden 5 Medical Management Center (MMC), Karolinska Institutet, Sweden Keywords: Efficiency; Teamwork; Emergency department; Quality of care; Patient satisfaction; Staff; work environment Background: Overcrowding and excessively long waits are a concern for emergency departments around the world. It has been argued that simply adding capacity (such as hospital beds) is not sufficient to fix flow problems. Accordingly, process orientation has been embraced and multidisciplinary teamwork has been suggested as a promis-
The challenges facing emergency care have increased the need for shorter throughput times, often expressed in the ‘‘four-hour target’’, e.g. a total transit time for patients less than 4 h. However, little is known of how work under the four-hour target is perceived by the staff. The aim of this study was to compare employee ratings of efficiency, workrelated effort and energy levels on days with short (<4 h) or long throughput times (>4 h). Staff in a Swedish emergency department provided selfratings of perceived efficiency, work-related efforts and rewards and quantity and quality of work after each day shift during six weeks. Ratings were aggregated to a mean per day for each item. Patient throughput times were gathered from patient records. Two groups were formed based on a median split of the daily throughput rates (percentage of patients treated within 4 h): low throughput rates (e.g. longer throughput times) and high throughput rates (e.g. shorter throughput times).