Search

Background. Hospital emergency departments (EDs) serve an aging population with an increased burden on health resources. Few studies have examined the effects of comprehensive geriatric assessment interventions on ED use. This study aimed to systematically review the literature and compare the effects of these interventions on ED visits. Methods. Relevant articles were identified through electronic databases and a search of reference lists and personal files. Inclusion criteria included: original research (written in English or French) on interventions conducted in noninstitutionalized populations 60 years old or older, not restricted to a particular medical condition, in which ED visits were a study outcome. Data were abstracted and checked by the first author and a research assistant using a standard protocol. Results. Twenty-six relevant studies were identified, reported in 28 articles, with study samples obtained from EDs (9), hospitals (4), outpatient or primary care settings (10), home care (4), and community (1). The study designs included 17 randomized controlled trials, 3 trials with nonrandom allocation, 4 before-after studies, 1 quasi-experimental time-series study, and 1 cross-sectional study. Hospital-based interventions (mostly short-term assessment and]or liaison) had little overall effect on ED utilization, whereas many interventions in outpatient and/or primary care or home care settings (including geriatric assessment and management and case management) reduced ED utilization. Heterogeneity in study methods, measures of comorbidity, functional status, and ED utilization precluded meta-analysis of the results. Conclusion. Further research, using improved methodologies and standardized measures, is needed to address the effects of innovative geriatric interventions on ED visits.

In recent years, hospitals have been vigorously searching for ways to reduce costs and improve productivity. One tool, simulation, is now widely accepted as an effective method to assist management in evaluating different operational alternatives. It can help improve existing Emergency Departments (EDs) and assist in planning and designing new EDs. In order to increase the acceptance of simulation in healthcare systems in general and EDs in particular, hospital management should be directly involved in the development of these projects. Such involvement will also bolster the simulation's credibility. In addition, it is important to simplify simulation processes as much as is reasonably possible and use visual aids or animation that will heighten users' confidence in the model's ability. This study lays the foundation for the development of a simulation tool which is general, flexible, intuitive, simple to use and contains default values for most of the system's parameters., 1. Introduction Until a few decades ago, service industries used simple methods, if any, to design, analyze and operate systems. However, in recent years, in light of the increased demand [...]