The waits that matter.

Division of General Surgery, University of California, San Francisco, School of Medicine, San Francisco, USA.
New England Journal of Medicine (Impact Factor: 54.42). 06/2011; 364(24):2279-81. DOI: 10.1056/NEJMp1101882
Source: PubMed
  • JAMA The Journal of the American Medical Association 12/2011; 306(22):2500-1. DOI:10.1001/jama.2011.1819 · 30.39 Impact Factor
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    ABSTRACT: An Emergency Department visit that ended tragically prompted my yearlong journey to Washington, DC, and emergency rooms across the country to search for solutions to the national crisis in emergency care. I reached the conclusion that the crisis is entirely solvable, and I developed a three-part solution that includes 1) nationally standardizing and coordinating care, 2) prioritizing resources and incentives in the delivery of emergency care, and 3) inspiring young clinicians to careers in emergency care. Physicians across America should now harness the power of storytelling to strengthen both the delivery of patient care and health care reform efforts on Capitol Hill.
    The Permanente journal 01/2012; 16(3):71-4.
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    ABSTRACT: Concern exists regarding care patients receive while boarding (staying in the emergency department [ED] after a decision to admit has been made). This exploratory study compares care for such ED patients under "Inpatient Responsibility" (IPR) and "ED Responsibility" (EDR) models using mixed methods. The authors abstracted quantitative data from 1,431 patient charts for ED patients admitted to two academic hospitals in 2004-2005 and interviewed 10 providers for qualitative data. The authors compared delays using logistic regression and used provider interviews to explore reasons for quantitative findings. EDR patients had more delays to receiving home medications over the first 26 hours of admission but fewer while boarding; EDR patients had fewer delayed cardiac enzymes checks. Interviews revealed that culture, resource prioritization, and systems issues made care for boarded patients challenging. A theoretically better responsibility model may not deliver better care to boarded patients because of cultural, resource prioritization, and systems issues.
    Medical Care Research and Review 08/2012; 69(6). DOI:10.1177/1077558712457426 · 2.57 Impact Factor