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Nursing driven approaches to improving emergency department discharge

Published:February 12, 2019DOI:https://doi.org/10.1016/j.ajem.2019.02.015
      Emergency departments (EDs) are critiqued for wait times, delayed or inadequate pain management, and poor communication [
      • Twanmoh J.R.
      • Cunningham G.P.
      When overcrowding paralyzes an emergency department.
      ,
      • Tekwani K.L.
      • Kerem Y.
      • Mistry C.D.
      • Sayger B.M.
      • Kulstad E.B.
      Emergency department crowding is associated with reduced satisfaction scores in patients discharged from the emergency department.
      ,
      • Wang H.
      • Kline J.A.
      • Jackson B.E.
      • et al.
      The role of patient perception of crowding in the determination of real-time patient satisfaction at Emergency Department.
      ]. ED volumes are projected to increase, likely exacerbating these issues [
      • Lin M.P.
      • Baker O.
      • Richardson L.D.
      • Schuur J.D.
      Trends in emergency department visits and admission rates among US acute care hospitals.
      ,
      • Schuur J.D.
      • Venkatesh A.K.
      The growing role of emergency departments in hospital admissions.
      ]. Systems are increasingly relying on EDs to provide not only high-quality clinical care, but also to promote the patient experience [
      • Twanmoh J.R.
      • Cunningham G.P.
      When overcrowding paralyzes an emergency department.
      ,
      • Agarwal A.K.
      • Mahoney K.
      • Lanza A.L.
      • et al.
      Online ratings of the patient experience: emergency departments versus urgent care centers.
      ,
      • Johnson K.D.
      • Winkelman C.
      The effect of emergency department crowding on patient outcomes: a literature review.
      ,
      • Pitts S.R.
      • Pines J.M.
      • Handrigan M.T.
      • Kellermann A.L.
      National trends in emergency department occupancy, 2001 to 2008: effect of inpatient admissions versus emergency department practice intensity.
      ].The overlap between efficiency, quality of care and patient satisfaction is significant [
      • Wang H.
      • Kline J.A.
      • Jackson B.E.
      • et al.
      The role of patient perception of crowding in the determination of real-time patient satisfaction at Emergency Department.
      ,
      • Johnson K.D.
      • Winkelman C.
      The effect of emergency department crowding on patient outcomes: a literature review.
      ,
      • Pines J.M.
      • Iyer S.
      • Disbot M.
      • Hollander J.E.
      • Shofer F.S.
      • Datner E.M.
      The effect of emergency department crowding on patient satisfaction for admitted patients.
      ].

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