Marc Daryl I.
Mendoza
BSN III - 6
Engineering Shorter Wait
Times in the ER
ScienceDaily (Aug. 31, 2010) —
Emergency room waiting times
could be cut by over one third and
patients' length of stay by almost
two-thirds, thanks to a new
approach to the triage process of
sorting patients for further
assessment and treatment,
according to research published in
the International Journal of Six
Sigma and Competitive Advantage
this month.
Nabeel Mandahawi of The Hashemite
University in Zarqa, Jordan and colleagues
have turned to a design strategy known as
Six Sigma commonly used by engineers
and manufacturers to improve their
products, reduce costs and boost energy
efficiency.
The researchers have investigated how the
Six Sigma approach might improve the
"product" -- treated patients in a hospital
emergency room. ER plays an important
role in a patient's treatment cycle, the team
explains, patients are admitted, go through
a triage orientation, assessment and
treatment process and then are either
transferred to a hospital ward, another
hospital, or discharged based on an
emergency physician plan.
Mandahawi's local hospital has 237 beds
and an average daily volume of emergency
room patients of 448, although that number
is always on the rise. Indeed, the annual
volume of ER patients increased from
75,800 to 128,000 between 2004 and 2008.
There has the team adds been a 75%
increase in emergency patient flow over the
last four years. ER patients are seen by
staff working one of three shifts with an
internist, a surgeon, two emergency
physicians, one pediatrician, six staff
nurses, one plaster -of-Paris (POP) nurse,
and one clerk available on any given shift.
Not all patients arriving in ER are equally
sick. Patients arrive by ambulance, car, or
on foot, depending on their condition and
critical patients must be seen urgently as a
matter of life or death. Time is a significant
factor in saving lives when patients arrive in
ER, the team says.
The team developed a new approach to ER
triage using the principles of Six Sigma and
then modeled the flow of emergency
patients using a computer to validate
different approaches that emerge from the
process. They found that the optimal
approach involved implementing a triage
process that sorted patients into the
appropriate treatment area based on the
severity of their condition rather than their
arrival time. Patient mean waiting time and
length of stay were reduced significantly
when this approach was implemented.
http://www.sciencedaily.com/releases/2010/
08/100824103523.htm
Summary:

Researchers have turned to a design strategy known as Six Sigma that is commonly
used by engineers and manufacturers to improve their products, reduce costs and
boosts energy efficiency. The researchers observed that there had been a 75%
increase in emergency patient flow over the last four years. The team then developed a
new approach to ER triage using the principles of Six Sigma and then modeled the flow
of emergency patients using a computer to validate different approaches that emerge
from the process. They found that the optimal approach involved implementing a triage
process that sorted patients into the appropriate treatment area based on the severity of
their condition rather than their arrival time. As a result, patient mean waiting time and
length of stay were reduced significantly.

Reaction:

In this study, the researchers developed a new approach to ER triage using the
principles of Six Sigma that is commonly used by engineers. This study benefits the
whole health care team and even the patients in treating illnesses. In the developed
triage system, they sort the patients to the treatment areas based on the severity of their
condition rather than their arrival time. In that way, the least severe might end up being
that last one to be treated but then, that also helps the ones with the most severe
conditions that will be treated first.

Theories:

Faye Glenn Abdellah’s Concept of Twenty One Nursing Problems

Nursing is a comprehensive service that is based on the art and science and aims to help people, sick or
well, cope with their health needs. The 21 problem are as to guide care and promote the use of nursing
judgement. The more the problem or the more severe that the patient’s condition is, the more attention
should be given to them. But the care that is given to them should be equal to the others.
Marc Daryl I. Mendoza
BSN III - 6
Study Reveals Superior
Sedation Method for Children
ScienceDaily (Oct. 19, 2010) —
Procedural sedation and analgesia
is an essential element of care for
children requiring painful
procedures in the emergency
department. The practice of
combining ketamine and propofol,
two common medications used in
emergency departments, has
become more popular. However,
until recently, it was unclear
whether this practice was superior
to the use of either agent alone,
especially in children.
Research led by Drs. Amit Shah, Gregory
Mosdossy and Michael Rieder of the
Schulich School of Medicine & Dentistry at
The University of Western Ontario and
Lawson Health Research Institute provides
evidence that when compared to ketamine
alone, patients who receive a combination
of ketamine and propofol have a slightly
faster recovery time and suffer from less
severe side effects.
The study, published online in theAnnals of
Emergency Medicine, included 136 children
treated at London Health Sciences Centre's
Children's Hospital.
Ketamine is well established as a safe and
effective solitary agent for procedural
sedation and analgesia. However, it is
known to cause adverse side effects, such
as vomiting. Propofol is associated with a
dose-dependent risk of respiratory
depression, but has less severe side
effects.
It has been theorized that by combining the
two agents, you can decrease the dose
requirement of both agents thereby
reducing the negative side-effects, but still
have a safe and effective analgesia.
This is the first large well-conducted study
exploring the use of ketamine-propofol for
children in the Paediatric Emergency
Department. Previous studies had hinted at
its advantage but up until now results were
not conclusive.
"Our study found that ketamine-propofol is
an effective combination for pediatric
procedural sedation, providing a slightly
shorter total sedation time than ketamine
alone, with less adverse events and higher
satisfaction scores," says Dr. Shah. "We
believe this study provides evidence for a
safe and effective alternative sedation
regimen for children in the Emergency
Department and may lead to a change in
sedation practices in other hospitals."
http://www.sciencedaily.com/releases/2010/
10/101019152612.htm
Summary:

The researchers provide evidences that when compared to ketamine alone, patients
who receive a combination of ketamin and propofol have a slight faster recovery time
and suffer from less severe side effects. Ketamine is well established as a safe and
effective solitary agent for procedural sedation and analgesia. However, it is known to
cause adverse side effects, such as vomiting. Propofol is associated with a dose-
dependent risk of respiratory depression, but has less severe side effects.

Reaction:

This study says that ketamine with propofol, which are common medications used in
emergency departments, has a better effect especially in children. It says that in
combining the two medications, the effect is the same, the recovery is faster and they
will suffer from less severe side effects. Again, this benefits the nurse and the child or
the client because more care and attention will be given to the client if he/she might
experience the severe side effects of the ketamine. But then with the help of this
research, the combination of these two medications will help the children or the clients
that will have a painful procedure.

Theories:

Jean Watson’s The Philosophy and Science of Caring

Nursing is a human science of persons and human health-illness experiences that are mediated by
professional, personal, scientific, esthetic and ethical human care transactions. The study is made by
professionals and they applied scientific learning to develop or discover that ketamine + propofol is better
than ketamine alone in procedural sedation and analgesia. And also lesser in severe side effects.