Public Hospital Emergency Research Articles

Unmet Need for Medical Care and Safety Net Accessibility among Birmingham’s Homeless

Although homeless individuals often experience health problems requiring care, there are limitations to available research concerning the scale of their needs and the accessibility of safety net agencies to meet them. Traditional access-to-care surveys calculate unmet need among all persons queried (rather than persons needing care), making it difficult to calculate what percentage of persons requiring care actually obtain it. Additionally, no research has compared the relative accessibility of safety net programs to homeless persons in need. This cross-sectional, community-based survey assessed the prevalence of unmet need for several specific types of health care and compared the accessibility of agencies in Birmingham, AL. Substantial proportions of respondents reported unmet needs for general medical care (46 %), specialty care (51 %), mental health care (51 %), dental care (62 %), medications (57 %), and care of a child (23 %). The most commonly mentioned sites where care was sought included a federally funded Health Care for the Homeless (HCH) program (59 %), a religious free clinic (31 %), and a public hospital emergency department (51 %). The HCH program was most commonly cited as the location where care, once sought, could not be obtained (15 %), followed by the county hospital primary care clinics (13 %). In this survey, unmet need was common for all types of care queried, including primary care. Key components of the safety net, including a federally funded homeless health care program, had suboptimum accessibility.

Occupational stress and self-rated health among nurses

To analyze the association between job stress and self-rated health among nurses in public hospital emergency units. This is a cross-sectional study undertaken through the administration of a self-administered questionnaire in a sample of 134 health professionals, using the brief version of the Job Stress Scale. Descriptive analyses of the socio-demographic, health and work variables were undertaken, as was multivariate analysis through unconditional logistic regression for adjustment of the association between job stress and poor self-rated health, in accordance with potential confounding variables, with a level of significance of 5%. 70% of the interviewees were classified as passive workers or as with high strain. Poor self-rated health was significantly greater among health professionals with high demand and low control, compared to those with low strain, after adjusting for co-variables. Low control, allied with low demand, can serve as a demotivating factor, contributing to the increase in professional dissatisfaction. It is recommended that institutions should adopt a policy of planning and managing human resources so as to encourage the participation of health professionals in decision-making, with a view to reducing job stress among nurses.

The outcome of a rapid training program on nurses’ attitudes regarding the prevention of aggression in emergency departments: A multi-site evaluation

BackgroundPatient aggression is a common source of occupational violence in emergency departments. Staff attitudes regarding the causes for aggression influence the way they manage it. The Management of Clinical Aggression – Rapid Emergency Department Intervention is a 45min educational program that aims to promote the use of de-escalation techniques and effective communication skills to prevent patient aggression. ObjectiveWe sought to evaluate the impact of the program on staff attitudes regarding the prevention and early management of patient aggression. DesignA mixed methods approach was used including a pre-test post-test survey of training participants and individual interviews with key stakeholders. Setting and sampleThe setting was public sector hospital emergency departments located in metropolitan and regional Victoria, Australia. A convenience sample of eighteen emergency departments was recruited via the Victorian Department of Health. ParticipantsSurvey participants were nurses and midwives who were employed at the study sites. Interview participants were a purposive sample of nurse unit managers and trainers. MethodsThe Management of Aggression and Violence Attitude Scale was administered to training participants immediately before and 6–8 weeks after training. Semi-structured telephone interviews with trainers and managers occurred 8–10 weeks after the intervention. ResultsFour hundred and seventy one participants completed the pre-test and post-test. Statistically significant shifts were observed in 5/23 items (Wilcoxon Signed Ranks Test: p≤0.01). Despite training, participants were undecided if it was possible to prevent patient aggression, and continued to be unsure about the use of physical restraint. Twenty-eight (82.3%) of managers’ and trainers’ eligible to be interviewed provided their perceptions of the impact of the program. Overall, these perceptions were consistent with the significant shifts observed in the survey items. ConclusionThere was limited evidence to demonstrate that the program significantly modified staff attitudes towards the prevention of patient aggression using the Management of Aggression and Violence Attitude Scale. Additional survey items that specifically measure staff attitudes about the use of restraint in emergency settings are needed to better understand decision making about restraining practices. Further work is indicated to quantify the impact of training in practice.

Estimating the risk of functional decline in the elderly after discharge from an Australian public tertiary hospital emergency department

To estimate the risk of functional decline after discharge for older people presenting to, and discharged from, a large emergency department (ED) of a tertiary hospital. The cohort was generated by consecutive sampling of non-Indigenous males and females aged 65 years or over or Aboriginal and Torres Strait Islander males and females aged 45 years or more, without diagnosed dementia, who were living independently in the community before presenting at ED and who were not admitted to hospital as an inpatient after presenting to ED. The hospital assessment risk profile (HARP) was administered to all eligible participants. Sociodemographic information was collected. Approximately 40 patients per day over two 14-week data collection periods were potentially eligible for inclusion in the study. In total, 597 (17.6% of individuals who presented to ED) were eligible, agreed to participate and continued to be eligible on discharge from ED. Their HARP scores suggested that ~52% were at-risk of functional decline (14.1% high risk, 38.5% intermediate risk). Elderly patients present to and are discharged from ED every day. The routinely administered HARP instrument scores suggested that approximately half these individuals were at-risk of functional decline in one large hospital ED. Given this instrument's moderate diagnostic accuracy, the true figure may be higher. We suggest that all over-65 year olds presenting at ED without being admitted as an inpatient should be considered for routine screening for potential downstream functional decline, and for intervention if indicated. What is known about the topic? Older individuals often present to ED in lieu of consulting a general medical practitioner, and are not admitted to a hospital bed. Patient demographics, functional and mental capacity and reasons for presentation may be flags for functional decline in the coming months. These could be used by ED staff to implement targeted assessment and intervention. What does this paper add? This paper highlights the high percentage of older individuals who, at time of ED presentation, are at-risk of downstream functional decline. What are the implications for practitioners? Older people who are discharged from ED without a hospital admission may 'slip through the net', as an ED presentation presents a limited window of opportunity for ED staff to undertake targeted assessment, and intervention, to address the potential for downstream functional decline. The busy nature of ED, resource implications and the range of presenting conditions of older people may preclude this. This research suggests a reality that a large percentage of older people who present at ED but do not require a subsequent hospital admission have the potential for functional decline after discharge. Addressing this, in terms of specific screening processes and interventions, requires a rethink of hospital and community resources, and relationships.

Factors affecting length of stay for women presenting with early pregnancy complications to a public hospital emergency department

This study aimed to determine factors associated with length of stay (LOS) for women presenting with early pregnancy complications to a public hospital ED. In particular, we sought to investigate the impact the involvement of the Clinical Midwife Consultant (CMC), specialising in early pregnancy care, had on the ED LOS. We undertook a retrospective cohort study of women less than 20 weeks pregnant who presented between August 2008 and December 2010 with early pregnancy complications to the ED of the Royal Prince Alfred Hospital in Sydney, Australia and who were then discharged. The main outcome measured was LOS. We performed logistic regression analysis to identify factors significantly associated with this outcome. Data were available for 1739 women. Involvement of the CMC reduced LOS and patients were significantly more likely to be discharged within 4 h or less (OR = 0.47, 95% CI = 0.37-0.60). The factors that increased LOS to over 4 h were arrival after hours (OR = 2.09, 95% CI = 1.66-2.63), being triaged as category 1 to 3 (OR = 1.36, 95% CI = 1.11-1.67) and requiring an ultrasound assessment (OR = 2.44, 95% CI = 1.81-3.28). This study was able to show factors significantly associated with ED LOS, many of which are not modifiable. The involvement of the CMC reduced LOS, whereas requiring an ultrasound assessment increased LOS. Thus, improvement could be achieved by greater access to a CMC and more rapid access to ultrasound services.

Provider profiling models for acute coronary syndrome mortality using administrative data

BackgroundAdministrative data have been used to construct risk-adjustment models for provider profiling to benchmark hospital performance for acute myocardial infarction (AMI), but much less for acute coronary syndrome (ACS). We assess the impact on risk model performance and hospital-level mortality rate ratios (SMRs) of three key issues: comorbidity measurement methods, inter-hospital transfers and post-discharge deaths. MethodsLogistic regression models for 30-day total mortality used three years of national public hospital emergency (unplanned) admissions data for England for ACS (n=329,369) linked to death registrations. We compared using the Charlson comorbidity index with modelling previous admissions. ResultsPrior admission for various conditions such as cancer and renal failure was associated with higher post-ACS mortality, whereas previous AMIs, PCI and unstable angina admissions were associated with lower mortality. The Charlson comorbidity index performed better than one- and five-year admission histories. Discrimination (c=0.81) was comparable with that from clinical databases. Adjusted 30-day total mortality rates ranged between hospitals from 6.3% to 13.3%.Median differences in SMRs between the comorbidity-adjustment methods were small. Although SMRs and outlier status could change, a hospital's ‘qualitative’ mortality rating (low, average or high) was not affected. In contrast, a sizeable minority of SMRs changed by ≥10 points if transfers were excluded or post-discharge deaths ignored. Model choice occasionally affected funnel plot outlier status. ConclusionsModels for comparing hospitals' ACS mortality can be constructed with good discrimination using English administrative hospital data. Adjusting for transfers in and capturing post-discharge deaths are more important than the choice of comorbidity adjustment.

Demand at the emergency department front door: 10‐year trends in presentations

To measure the increase in volume and age-specific rates of presentations to public hospital emergency departments (EDs), as well as any changes in ED length of stay (LOS); and to describe trends in ED utilisation. Population-based retrospective analysis of Department of Health public hospital ED data for metropolitan Melbourne for 1999-00 to 2008-09. Presentation numbers; presentation rates per 1000 person-years; ED LOS. ED presentations increased from 550,662 in 1999-00 to 853,940 in 2008-09. This corresponded to a 32% rise in rate of presentation (95% CI, 29%-35%), an average annual increase of 3.6% (95% CI, 3.4%-3.8%) after adjustment for population changes. Almost 40% of all patients remained in the ED for ≥4 hours in 2008-09, with LOS increasing over time for patients who were more acutely unwell. The likelihood of presentation rose with increasing age, with people aged≥85 years being 3.9 times as likely to present as those aged 35-59 years (95% CI, 3.8-4.0). The volume of older people presenting more than doubled over the decade. They were more likely to arrive by emergency ambulance and were more acutely unwell than 35-59 year olds, with 75% having an LOS≥4 hours and 61% requiring admission in 2008-09. The rise in presentation numbers and presentation rates per 1000 person-years over 10 years was beyond that expected from demographic changes. Current models of emergency and primary care are failing to meet community needs at times of acute illness. Given these trends, the proposed 4-hour targets in 2012 may be unachievable unless there is significant redesign of the whole system.

Urine Collection in the Emergency Department: What Really Happens in There?

Introduction:In women with suspected urinary tract infection (UTI), a non-contaminated voided specimen is considered important for valid urinalysis and culture results. We assess whether midstream parted-labia catch (MSPC) instructions were provided by nurses, understood, and performed correctly, according to the patient.Methods:We conducted a cross-sectional survey of English- and Spanish-speaking female patients submitting voided urine samples for urinalysis for suspected UTI. The survey was conducted in a public teaching hospital emergency department (ED) from June to December 2010, beginning 2 months after development and dissemination of a nursing MSPC instructions protocol. Research assistants administered the survey within 2 hours of urine collection. Nurses were unaware of the study purpose.Results:Of 129 patients approached, 74 (57%) consented and were included in the analysis. Median age was 35; 44% were Latino. Regarding instructions from nurses, patients reported the following: 45 (61%; 95% CI 50–72%) received any instructions; of whom 37 (82%; 95% CI 71–93%) understood them completely. Sixteen (36%; 95% CI 22–51%) were instructed to collect midstream; and 7 (16%; 95% CI 6–29%) to part the labia. Regardless of receiving or understanding instructions, 33 (45%; 95% CI 33–57%) reported actually collecting midstream, and 11 (15%, 95% CI 8–25%) parting the labia.Conclusion:In this ED, instructions for MSPC urine collection frequently were not given, despite a nursing protocol, and patients rarely performed the essential steps. An evidence-based approach to urine testing in the ED that considers urine collection technique, is needed.

Transfer from residential aged care to emergency departments: an analysis of patient outcomes

In order to design optimal systems to meet the acute healthcare needs of the frail elderly living in residential care, good clinical information is essential. The aims of this study were to analyse the casemix and outcomes of patients transferred from residential aged care facilities to public hospital emergency departments in New South Wales. Individual patient data from six hospital emergency departments and inpatient wards were obtained from merged databases and analysed using descriptive and comparative statistics. Outcomes in 4680 patient transfers over a 12-month period in 2006-2007 were analysed. Transfers occur mostly in high-acuity patients, with approximately three of every four transfers admitted; one in every 12 dying; and admitted patients undergoing an average of 2.4 interventions or procedures during each hospital stay. Several variables are associated with prolonged length of emergency department stay including triage urgency, type of hospital and transfers occurring in winter or out of hours. Patients transferred from aged care facilities to emergency departments are predominantly high-acuity patients with a substantial likelihood of hospitalisation, intervention and death. Nevertheless, scope exists for some episodes of acute care, in both discharged and admitted patients, to be provided outside a hospital setting.

A Structured Approach to Transforming a Large Public Hospital Emergency Department via Lean Methodologies

Emergency Departments (EDs) face significant challenges in providing efficient, quality, safe, cost-effective care. Lean methodologies are a proposed framework to redesign ED practices and processes to meet these challenges. We outline a systematic way that lean principles can be applied across the entire ED patient experience to transform a high volume ED in a safety net hospital. We review the change in ED performance metrics prior to and after lean implementation. We discuss critical insights and key lessons learned from our lean transformation to date. The steps to implementing lean principles across the patient's ED experience are described with specific attention to executive planning of rapid improvement experiments and the subsequent roll-out of lean transformation over an 18-month time frame. Basic ED performance data were compared to the year prior. Results of the exploratory analysis (using median and interquartile ranges and nonparametric tests for group comparisons) have shown improvement in several performance metrics after initiating lean transformation. The approach, lessons learned, and early data of our transformation can provide critical insights for EDs seeking to incorporate continuous improvement strategies. Key lessons and unique challenges encountered in safety net hospitals are discussed.

Urine Collection in the Emergency Department: What Really Happens

Introduction: In women with suspected urinary tract infection (UTI), a non-contaminated voided specimen is considered important for valid urinalysis and culture results. We assess whether midstream parted-labia catch (MSPC) instructions were provided by nurses, understood, and performed correctly, according to the patient.Methods: We conducted a cross-sectional survey of English- and Spanish-speaking female patients submitting voided urine samples for urinalysis for suspected UTI. The survey was conducted in a public teaching hospital emergency department (ED) from June to December 2010, beginning 2 months after development and dissemination of a nursing MSPC instructions protocol. Research assistants administered the survey within 2 hours of urine collection. Nurses were unaware of the study purpose.Results: Of 129 patients approached, 74 (57%) consented and were included in the analysis. Median age was 35; 44% were Latino. Regarding instructions from nurses, patients reported the following: 45 (61%; 95% CI 50-72%) received any instructions; of whom 37 (82%; 95% CI 71-93%) understood them completely. Sixteen (36%; 95% CI 22-51%) were instructed to collect midstream; and 7 (16%; 95% CI 6-29%) to part the labia. Regardless of receiving or understanding instructions, 33 (45%; 95% CI 33-57%) reported actually collecting midstream, and 11 (15%, 95% CI 8-25%) parting the labia.Conclusion: In this ED, instructions for MSPC urine collection frequently were not given, despite a nursing protocol, and patients rarely performed the essential steps. An evidence-based approach to urine testing in the ED that considers urine collection technique, is needed. [West J Emerg Med. 2012;13(5):401-405.]

Estado vacinal e conhecimento dos profissionais de saúde sobre hepatite B em um hospital público do nordeste brasileiro

RESUMO OBJETIVO: analisar o estado vacinal e o conhecimento prévio sobre o vírus da hepatite B pelos profissionais de saúde (PS) de um hospital público. MÉTODOS: estudo descritivo de corte transversal, baseado no preenchimento do formulário pelos PS, contemplando: biomédicos, odontólogos, enfermeiros, fisioterapeutas, médicos, técnicos e auxiliares de enfermagem e de laboratório. Para analisar idade, categoria profissional, estado vacinal e conhecimento destes profissionais sobre hepatite B, utilizou-se o teste de qui-quadrado, considerando significante p < 0,05. RESULTADOS: durante quatro meses de 2007, foram questionados 861 profissionais no principal hospital de urgência da rede pública de Sergipe. Houve uma relação estatisticamente significante entre grau de escolaridade e conhecimento acerca da hepatite B pelos PS. Quanto ao estado vacinal dos participantes, constatou-se que 67% declararam estar completamente imunizados, enquanto 21,6% apresentavam-se incompletamente vacinados, 6,2% desconheciam seu estado vacinal e 5,2% não eram vacinados. Entre os de nível superior, 75,3% estavam completamente imunizados, comparados a 64,5% do nível técnico. CONCLUSÃO: os PS com nível superior mostraram mais conhecimento sobre o tema em detrimento dos profissionais com nível técnico, razão que deveria motivar os gestores da saúde a implantar programas de educação continuada, além de desenvolver pesquisas neste âmbito.

Epidemiology of injuries due to tropical cyclones in Hong Kong: A retrospective observational study

BackgroundTropical cyclones are huge circulating masses of wind which form over tropical and sub-tropical waters. They affect an average of 78 million people each year. Hong Kong is a large urban centre with a population of just over 7 million which is frequently affected by tropical cyclones. We aimed to describe the numbers and types of injuries due to tropical cyclones in Hong Kong, as well as their relation to tropical cyclone characteristics. MethodsThe records of all patients presenting to Hong Kong's public hospital emergency departments from 1st January 2004 to 31st December 2009 with tropical cyclone related injuries were reviewed and information regarding patient and injury characteristics was collected. Meteorological records for the relevant periods were examined and data on wind speed, rainfall and timing of landfall and warning signals was recorded and compared with the timing of tropical cyclone related injuries. ResultsA total of 460 tropical cyclone related injuries and one fatality across 15 emergency departments were identified during the study period. The mean age of those injured was 48 years and 48% were female. 25.4% of injuries were work related. The head (33.5%) and upper limb (32.5%) were the most commonly injured regions, with contusions (48.6%) and lacerations (30.2%) being the most common injury types. Falls (42.6%) were the most common mechanism of injury, followed by being hit by a falling or flying object (22.0%). In univariable analysis the relative risk of injury increased with mean hourly wind speed and hourly maximum gust. Multivariable analysis, however, showed that relative risk of injury increased with maximum gust but not average wind speed, with relative risk of injury rising sharply above maximum gusts of greater than 20m/s. Moderate wind speed with high gust (rather than high average and high gust) appears to be the most risky situation for injuries. Relative risk of injury was not associated with rainfall. The majority of injuries (56%) occurred in the 3h before and after a tropical cyclone's closest proximity to Hong Kong, with relative risk of injury being highest mid-morning. ConclusionsIn tropical cyclone related injuries in Hong Kong the head and upper limb are the most commonly affected sites with falls and being hit by a falling or flying object being the most common mechanisms of injury. Hourly maximum gust appears to be more important that mean hourly wind speed in determining risk of injury. These findings have implications for injury prevention measures and emergency planning in Hong Kong and other regions effected by tropical cyclones.

Impact of influenza across 27 public emergency departments in Australia: a 5-year descriptive study

ObjectiveTo describe the incidence, characteristics and outcomes of patients with influenza-like symptoms presenting to 27 public hospital emergency departments (EDs) in Queensland, Australia.MethodsA descriptive retrospective study covering 5 years (2005–9)...

Demand for public hospital emergency department services in Australia: 2000–2001 to 2009–2010

Hospital EDs are a significant and high-profile component of Australia's health-care system, which in recent years have experienced considerable crowding. This crowding is caused by the combination of increasing demand, throughput and output factors. The aim of the present article is to clarify trends in the use of public ED services across Australia with a view to providing an evidence basis for future policy analysis and discussion. The data for the present article have been extracted, compiled and analysed from publicly available sources for a 10 year period between 2000-2001 and 2009-2010. Demand for public ED care increased by 37% over the decade, an average annual increase of 1.8% in the utilization rate per 1000 persons. There were significant differences in utilization rates and in trends in growth among states and territories that do not easily relate to general population trends alone. This growth in demand exceeds general population growth, and the variability between states both in utilization rates and overall trends defies immediate explanation. The growth in demand for ED services is a partial contributor to the crowding being experienced in EDs across Australia. There is a need for more detailed study, including qualitative analysis of patient motivations in order to identify the factors driving this growth in demand.

Increasing impact of mental health presentations on New South Wales public hospital emergency departments 1999–2006

The percentage of mental health (MH) presentations to New South Wales (NSW) EDs in recent years has not been described at the statewide level. Evidence from other states suggests this burden might be increasing. The present study aims to evaluate recent trends in MH presentations to NSW EDs, including geographic variations and the spectrum of MH disorders encountered. Data were sourced from the NSW Emergency Department Data Collection, which collates information from routine reporting undertaken in all NSW EDs. The database employs ICD-9 diagnostic descriptors. The present study retrospectively analyses presentations from 1999 to 2006 for patients who received an MH primary discharge diagnosis, as defined by ICD-9. In addition, rates of presentation for poisoning are considered. The percentage of MH presentations to the three largest hospital categories--principal referral, major metropolitan and rural base (i.e. major non-metropolitan)--is examined. During 1999 and 2006, there were 9,013,357 ED presentations at the study sites. Of these, 3.22% received an MH primary discharge diagnosis. An additional 0.93% received a diagnosis of poisoning. In 2006, there were 15,262 more MH presentations than in 1999, a 49.78% increase. Over this period, total annual ED presentations increased by 201,763 (19.30%). General population growth was 6.31%. Across the state, 32.0% of MH presentations were for psychotic conditions and 68.0% for neurotic illnesses. Mental health presentations to NSW EDs are increasing. There is a need to review emergency services to accommodate these changes. The reasons for this growth remain unclear and require formal prospective evaluation.

Psychosocial aspects of work: impact on the quality of life of professionals of a public emergency hospital

ABSTRACTObjective: to analyze the impact of psychosocial aspects of work on the quality of life of health care professionals who work in a public emergency hospital in Porto Velho – Rondonia, Brazil. Method: it is a quantitative, descriptive, and transversal study with a survey design. This work was approved by the Research Ethics Committee of Universidade Federal de Rondonia (CAAE: 6563.0.000.047-10) in December 2010. The instruments used for the data collection were three self-applicable and independent questionnaires: 1) questionnaire of sociodemographic and labour characterization (developed by the authors); 2) instrument for quality of life assessment (WHOQOL-BREF); 3) brief instrument for psychosocial aspects of work assessment (Job Stress Scale). Elements of descriptive statistics will be used in the analysis, according to the instructions provided by the editors of these research tools. After the individual statistical analysis of each instrument is concluded, the results found will be discussed. Descriptors: quality of life; workers; emergency medical services, psychologyRESUMOObjetivo: analisar o impacto dos aspectos psicossociais do trabalho sobre a qualidade de vida de profissionais da saúde, que trabalham em um pronto-socorro do serviço público de Porto Velho – Rondônia. Método: trata-se de estudo quantitativo, descritivo e transversal que utiliza delineamento de levantamento (survey). Trabalho aprovado pelo Comitê de Ética em Pesquisa da Universidade Federal de Rondônia (CAAE: 6563.0.000.047-10), em dezembro de 2010. Os instrumentos para a coleta de dados são três questionários auto-aplicáveis e independentes: 1) questionário de caracterização sócio-demográfica e laboral (elaborado pelos autores); 2) instrumento para avaliação de qualidade de vida (WHOQOL-BREF); 3) instrumento abreviado para avaliação de aspectos psicossociais do trabalho (Job Stress ScaleI). Para a análise serão utilizados elementos de estatística descritiva, conforme orientação dos editores dessas ferramentas de pesquisa. Após a análise estatística individual de cada instrumento, os resultados obtidos serão correlacionados. Descritores: qualidade de vida; trabalhadores; pronto-socorro; psicologiaRESUMENObjetivo: evaluar el impacto de los aspectos psicosociales del trabajo sobre la calidad de vida en profesionales de asistencia a la salud de una unidad de emergencia publica de Porto Velho – Rondônia. Método: estudio cuantitativo, descriptivo, transversal, utilizando el delineamiento de levantamiento o survey; el estudio fue aprobado por el Comité de Ética en Investigación de la Fundación Universidad Federal de Rondônia en 10 de diciembre de 2010 (CAAE: 6563.0.000.047-10) y ha sido desenvuelto teniendo en cuenta todas las recomendaciones de la Resolución 196/96 do Consejo Nacional de Salud. Para la recopilación de datos tres cuestionarios auto-aplicables y independientes serán aplicados: cuestionario de caracterización socio-demográfica y laboral (preparado por los autores); instrumento para evaluación de calidad de vida – WHOQOL-BREF y el instrumento abreviado para evaluación de los de aspectos psicosociales del trabajo – Job Stress Scale. Para análisis estadística serán utilizados elementos de estadística descriptiva recomendados por los autores de los respectivos instrumentos. Después de la análisis estadística individual de cada instrumento, los resultados obtenidos serán tratados de manera correlaciónale. Descriptores: calidad de vida; trabajadores; servicios médicos de urgencia; psicología.

(A229) Financing Emergency and Disaster Treatment: A Proactive Funding Approach

Financing the care and treatment of victims of emergencies and disasters is a critically important area for policy. It needs deliberations to evolve policies that will be relevant, robust and enduring. This is more so as the ideological and political leanings of a people determine what will be allowed and what policies endure. The sustainability of the funding model makes a large impact on the success of the treatment, in this case the specialized treatment needed in the traumatic event of emergency and disaster. The paper defined emergencies and disasters and observed that though the timing of funding is critical in the events, the volume and complexity of funding is higher in the latter. The paper reviewed the several current models in use today, particularly with locus on costs which should be incorporated in a payment model, including flag fall or set-up costs (for instance managing new patient records), consumables, investigations (such as pathology and diagnostic imaging) and pharmacological services (prescriptions, logistics of procurement under crisis, etc,) staffing costs which in public hospital emergency departments often do not vary within a shift i.e. emergency departments rarely draw staff from ward areas to the emergency departments to assist with unpredicted demand peaks- but which may become significant in event of disasters. These models are essentially public funded. The paper also highlighted the political underpinnings which make each of the current models popular in each of the ideological settings. The pros and cons associated with the models are reviewed in depth. The paper concludes, after the ideological/funding analysis, by recommending a private/public mix of funding. Details of this proactive funding approach are given and ways to modify and adapt them to different ideological (political) backgrounds suggested.

Effects of bed configurations at a hospital emergency department

This paper analysed and optimised the patient flow of a public hospital emergency department (ED). The simulation model enabled a detailed analysis of variables in the system without the chaos and potential risk that physical changes to the ED would have resulted in. The main performance indicator used throughout the study was compliance with national waiting time standards. The performance of the ED had substantial increases with balancing the utilisation of physicians, treatment areas and critical bed levels. In addition, an optimisation model was built to optimise various aspects of the multi-criteria objectives with a focus on minimising tardiness, number of tardy jobs, weighted percentage tardy jobs and waiting time in the queue. Positive results included an increase in waiting time performance with adjustments to shift allocations and important evaluations of current policies and resources. Performances were increased significantly by the solutions of the optimisation model, particularly when there was a small relaxation of the number of resuscitation beds in exchange for a combination of acute and subacute treatment areas, still ensuring space and cost constraints are met.

Do place of residence and ethnicity affect health services utilization? evidence from greece

BackgroundEqual utilization of health services for equal need, is one of the main targets for public health systems. Given the public-private structure of the Greek NHS, the main aim of the study was to investigate the impact of underlying factors, such as health care needs, socio-demographic characteristics and ethnicity, on the utilization of primary and hospital health care in an urban and rural population of the Greek region, Thessaly.MethodsA cross-sectional study was carried out in 2006 in Thessaly, a Greek region of Central Greece, in a representative sample of 1372 individuals (18+ years old, response rate 91.4%) via face-to-face interview. Health care needs were determined by self-perceived health status estimated by the SF-36 Health Survey, using the summary scores of physical and mental health. The utilization of primary care was measured by last month visits to 1) primary public services and 2) private practitioners visits and utilization of secondary care was measured by past year visits to 3) public hospital emergency departments and 4) admissions to public hospitals. Multivariable stepwise logistic regression analysis was applied in the whole sample and separately for the urban and rural population, in order to determine the predictors of health services utilization. Statistical significance was determined with a p value < 0.05.ResultsHealth care needs were the most significant determinants of primary and secondary health services utilization in both the urban and rural areas. Poor physical and mental health was associated with higher likelihood of use. In the urban areas middle-aged, elderly and Greeks were more likely to use primary health services, whereas primary education was associated with more visits to the emergency departments. Wealthier individuals were two times more likely to be admitted to hospitals. Individuals from the rural areas with university education visited more the public primary services, while wealthier individuals visited more the private practitioners. Immigrants had a higher likelihood of visiting emergency departments.ConclusionsAlthough health care needs were the main determinant of health services utilization in both the urban and rural population, socio-economic and ethnic differences also seem to contribute to the inequities observed in some types of health services use, favouring the better-off. Such findings provide important information to policy makers, which attempt to reduce inequalities in health care according to place of residence and ethnicity.