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Intensity of care among patients in the Emergency Department of Medisch Spectrum Twente

Lugtenberg, M.A.M. (2011) Intensity of care among patients in the Emergency Department of Medisch Spectrum Twente.

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Abstract:Aim. This study aimed to develop a score chart that measures the intensity of care and is applicable to the wide variety of patients who visit the emergency department (ED) of the Medisch Spectrum Twente (MST). In the long term the information about the intensity of care per patient should be used for staff planning. The research focused on the following priorities: the indicators that affect the intensity of care, how these indicators are incorporated in a score chart that measures the intensity of care, and the validity and functionality of the score chart. Background. Nowadays there is a growing need to get more insight in the demand of care and patient flow on the ED. These insights provide important information for staff scheduling. Many ED's still base their staffing on patient census alone, but that is only one of many relevant factors. Hence, it is important to analyze and relate the demand of care and patient characteristics in an ED. Patient Classification System´s (PCS) have been developed to measure intensity of care, especially nursing care. Studies abroad have shown that there are two types of PCS'-s, prototype systems (PS-PCS) and factor type systems (FS-PCS). A prototype system is a system, which uses only a few indicators that have been shown to be predictors of the amount of care provided. Patients are then categorized into groups based on whether they demonstrate one or more of these critical indicators. The factor type system identifies a comprehensive list of tasks or procedures performed, with a numerical value given to each task based on the time required to perform them. These values are summed and the category is determined by classifying the number of points. Currently, none of these systems are used in Dutch emergency departments to measure the intensity of care. To investigate which type of PCS is most suitable for application on the ED of the MST the PCS’-s can be assessed on the guidelines, validity, reliability, simplicity, efficiency, utility, objectivity and acceptability. Method. Literature research, observations of personnel and processes at the ED and semi- structured interviews with ED nurses and ED physicians have been conducted to find critical indicators that affect the intensity of care. Because most of the indicators of the intensity of care can be or are expressed in time, time recordings of all consecutive steps in the care pathway were performed. With the information from the literature, the observations, the interviews and the time measurements, the MST intensity of care score sheet is developed. A pilot study has been executed to test the validity and reliability of the score sheet. The pilot study includes 10 randomly selected patients who have visited the ED of the MST. Findings. Assessing guidelines on the PCS’-s has showed that prototype PCS’-s are most suitable for application on the ED. After applying existing prototype PCS’-s on the ED of the MST it was found that the needs of the ED of the MST were entirely different. A normal prototype PCS categorizes patients into groups based on whether they demonstrate one or more indicators. Because in this research intensity of care is viewed from the perspective of planning, the classification of patients into groups gives too little information about the actual time spent per patient. The prototype PCS has therefore only been used as basis for developing a score chart for the ED of the MST. The critical indicators for measuring the intensity of care at the ED of the MST are communication, movement and transportation, administration, triage, time in the ED, equipment setup, psychological patient characteristics, physical patient characteristics and medical actions. An important question that remained after the determination of the critical indicators was how the various Intensity of care among patients in the Emergency Department of Medisch Spectrum Twente-indicators could be combined. Five of the seven interviews showed that time has to be the connecting factor between the indicators. Therefore measurements of all the indicators that can be expressed in time were undertaken. With the results of the measurements the MST intensity of care score sheet was developed to measure the intensity of care on the ED. In the pilot study the validity and reliability were tested. The score chart is valid when the time spend on the ED is long and many actions are performed on the patient. The validity is less when the time spend on the ED is short and the actions performed on the patient are less numerous. The reliability of the score chart is low because of the fact that in some cases nobody knows what exactly happened to the patient, so that acts were checked on the score sheet, which did not match reality. Conclusion. The MST intensity of care score sheet is well applicable to the ED of the MST. Using the MST intensity of care score sheet, there is a better understanding of the investment of time per patient. In addition, the results from the score sheet give a better understanding of the crowds at the ED than a situation in which only the number of patient is counted. Further assessment of validity and reliability of the score sheet within the ED setting are recommended.
Item Type:Essay (Master)
Faculty:BMS: Behavioural, Management and Social Sciences
Subject:85 business administration, organizational science
Programme:Health Sciences MSc (66851)
Link to this item:https://purl.utwente.nl/essays/62968
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