Stephen Epstein

Publications (2)3.72 Total impact

• Article: Interventions to improve the timeliness of emergency care.

  Daniel Handel, Stephen Epstein, Rahul Khare, Denise Abernethy, Kevin Klauer, Randy Pilgrim, Olan Soremekun, Osman Sayan
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  ABSTRACT: With a persistent trend of increasing emergency department (ED) volumes every year, services are intensifying. Thus, improving the timeliness of delivering emergency care should be a primary focus, both from an operational and from a research perspective. Much has been published on factors associated with delays in emergency care, and the next phase in this area of research will focus on exploring interventions to improve the timeliness of care. On June 1, 2011, Academic Emergency Medicine held a consensus conference titled "Interventions to Assure Quality in the Emergency Department." This article summarizes the findings of the breakout session that investigated interventions to improve the timeliness of emergency care. This article will explore the background on the concept of timeliness of emergency care, the current state of interventions that have been implemented to improve timeliness, and specific questions as a framework for a future research agenda.
  Academic Emergency Medicine 12/2011; 18(12):1295-302. · 1.86 Impact Factor
• Source

  Available from: Jesse Pines

  Article: The effect of emergency department crowding on clinically oriented outcomes.

  Steven L Bernstein, Dominik Aronsky, Reena Duseja, Stephen Epstein, Dan Handel, Ula Hwang, Melissa McCarthy, K John McConnell, Jesse M Pines, Niels Rathlev, Robert Schafermeyer, Frank Zwemer, Michael Schull, Brent R Asplin
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  ABSTRACT: An Institute of Medicine (IOM) report defines six domains of quality of care: safety, patient-centeredness, timeliness, efficiency, effectiveness, and equity. The effect of emergency department (ED) crowding on these domains of quality has not been comprehensively evaluated. The objective was to review the medical literature addressing the effects of ED crowding on clinically oriented outcomes (COOs). We reviewed the English-language literature for the years 1989-2007 for case series, cohort studies, and clinical trials addressing crowding's effects on COOs. Keywords searched included "ED crowding,"ED overcrowding,"mortality,"time to treatment,"patient satisfaction,"quality of care," and others. A total of 369 articles were identified, of which 41 were kept for inclusion. Study quality was modest; most articles reflected observational work performed at a single institution. There were no randomized controlled trials. ED crowding is associated with an increased risk of in-hospital mortality, longer times to treatment for patients with pneumonia or acute pain, and a higher probability of leaving the ED against medical advice or without being seen. Crowding is not associated with delays in reperfusion for patients with ST-elevation myocardial infarction. Insufficient data were available to draw conclusions on crowding's effects on patient satisfaction and other quality endpoints. A growing body of data suggests that ED crowding is associated both with objective clinical endpoints, such as mortality, as well as clinically important processes of care, such as time to treatment for patients with time-sensitive conditions such as pneumonia. At least two domains of quality of care, safety and timeliness, are compromised by ED crowding.
  Academic Emergency Medicine 12/2008; 16(1):1-10. · 1.86 Impact Factor