Analysis of Plastic Surgery Consultations in a High-Volume Paediatric Emergency Department: A Quality Improvement Initiative

Introduction: Consult services influence emergency department (ED) workflow. Prolonged ED length of stay (LOS) correlates with ED overcrowding and as a consequence decreased quality of care and satisfaction of health team professionals. To improve management of paediatric ED patients requiring plast...

Full description

Saved in:
Bibliographic Details
Published inCanadian journal of plastic surgery Vol. 29; no. 4; pp. 272 - 279
Main Authors Neuhaus, Kathrin, Ho, Emily S., Low, Nelson, Forrest, Christopher R.
Format Journal Article
LanguageEnglish
Published Los Angeles, CA SAGE Publications 01.11.2021
SAGE PUBLICATIONS, INC
Subjects
Online AccessGet full text

Cover

Loading…
Abstract Introduction: Consult services influence emergency department (ED) workflow. Prolonged ED length of stay (LOS) correlates with ED overcrowding and as a consequence decreased quality of care and satisfaction of health team professionals. To improve management of paediatric ED patients requiring plastic and reconstructive surgery (PRS) expertise, current processes were analyzed. Methods: Patient characteristics and metrics of PRS consultations in our paediatric ED were collected over a 3-month period. Data analysis was followed by feedback education intervention to ED and PRS staff. Data collection was then resumed and results were compared to the pre-intervention period. Results: One hundred ninety-eight PRS consultations were reviewed, mean patient age was 6.3 years. Most common (52%) diagnoses were burns and hand trauma; 81% of PRS referrals were deemed appropriate; 25% of PRS consults were requested after hour with no differences in patient characteristics compared to regular hours; 60% of consultations involved interventions in the ED. Time between ED registration and PRS consultation request (116.5 minutes), quality of procedural sedation (52% rated inadequate), and overall ED LOS (289.2 minutes) were identified as main areas of concern and addressed during feedback education intervention. Emergency department LOS and quality of sedation did not improve in the post-intervention period. Conclusion: The study provides detailed insights in the characteristics of PRS consultation in the paediatric ED population. Despite high referral appropriateness and education feedback intervention, significant inefficiencies were identified that call for further collaborative efforts to optimize quality of care for paediatric ED patients and improve satisfaction of involved healthcare professionals.
AbstractList Introduction: Consult services influence emergency department (ED) workflow. Prolonged ED length of stay (LOS) correlates with ED overcrowding and as a consequence decreased quality of care and satisfaction of health team professionals. To improve management of paediatric ED patients requiring plastic and reconstructive surgery (PRS) expertise, current processes were analyzed. Methods: Patient characteristics and metrics of PRS consultations in our paediatric ED were collected over a 3-month period. Data analysis was followed by feedback education intervention to ED and PRS staff. Data collection was then resumed and results were compared to the pre-intervention period. Results: One hundred ninety-eight PRS consultations were reviewed, mean patient age was 6.3 years. Most common (52%) diagnoses were burns and hand trauma; 81% of PRS referrals were deemed appropriate; 25% of PRS consults were requested after hour with no differences in patient characteristics compared to regular hours; 60% of consultations involved interventions in the ED. Time between ED registration and PRS consultation request (116.5 minutes), quality of procedural sedation (52% rated inadequate), and overall ED LOS (289.2 minutes) were identified as main areas of concern and addressed during feedback education intervention. Emergency department LOS and quality of sedation did not improve in the post-intervention period. Conclusion: The study provides detailed insights in the characteristics of PRS consultation in the paediatric ED population. Despite high referral appropriateness and education feedback intervention, significant inefficiencies were identified that call for further collaborative efforts to optimize quality of care for paediatric ED patients and improve satisfaction of involved healthcare professionals.
Consult services influence emergency department (ED) workflow. Prolonged ED length of stay (LOS) correlates with ED overcrowding and as a consequence decreased quality of care and satisfaction of health team professionals. To improve management of paediatric ED patients requiring plastic and reconstructive surgery (PRS) expertise, current processes were analyzed. Patient characteristics and metrics of PRS consultations in our paediatric ED were collected over a 3-month period. Data analysis was followed by feedback education intervention to ED and PRS staff. Data collection was then resumed and results were compared to the pre-intervention period. One hundred ninety-eight PRS consultations were reviewed, mean patient age was 6.3 years. Most common (52%) diagnoses were burns and hand trauma; 81% of PRS referrals were deemed appropriate; 25% of PRS consults were requested after hour with no differences in patient characteristics compared to regular hours; 60% of consultations involved interventions in the ED. Time between ED registration and PRS consultation request (116.5 minutes), quality of procedural sedation (52% rated inadequate), and overall ED LOS (289.2 minutes) were identified as main areas of concern and addressed during feedback education intervention. Emergency department LOS and quality of sedation did not improve in the post-intervention period. The study provides detailed insights in the characteristics of PRS consultation in the paediatric ED population. Despite high referral appropriateness and education feedback intervention, significant inefficiencies were identified that call for further collaborative efforts to optimize quality of care for paediatric ED patients and improve satisfaction of involved healthcare professionals.
INTRODUCTIONConsult services influence emergency department (ED) workflow. Prolonged ED length of stay (LOS) correlates with ED overcrowding and as a consequence decreased quality of care and satisfaction of health team professionals. To improve management of paediatric ED patients requiring plastic and reconstructive surgery (PRS) expertise, current processes were analyzed. METHODSPatient characteristics and metrics of PRS consultations in our paediatric ED were collected over a 3-month period. Data analysis was followed by feedback education intervention to ED and PRS staff. Data collection was then resumed and results were compared to the pre-intervention period. RESULTSOne hundred ninety-eight PRS consultations were reviewed, mean patient age was 6.3 years. Most common (52%) diagnoses were burns and hand trauma; 81% of PRS referrals were deemed appropriate; 25% of PRS consults were requested after hour with no differences in patient characteristics compared to regular hours; 60% of consultations involved interventions in the ED. Time between ED registration and PRS consultation request (116.5 minutes), quality of procedural sedation (52% rated inadequate), and overall ED LOS (289.2 minutes) were identified as main areas of concern and addressed during feedback education intervention. Emergency department LOS and quality of sedation did not improve in the post-intervention period. CONCLUSIONThe study provides detailed insights in the characteristics of PRS consultation in the paediatric ED population. Despite high referral appropriateness and education feedback intervention, significant inefficiencies were identified that call for further collaborative efforts to optimize quality of care for paediatric ED patients and improve satisfaction of involved healthcare professionals.
Introduction: Consult services influence emergency department (ED) workflow. Prolonged ED length of stay (LOS) correlates with ED overcrowding and as a consequence decreased quality of care and satisfaction of health team professionals. To improve management of paediatric ED patients requiring plastic and reconstructive surgery (PRS) expertise, current processes were analyzed. Methods: Patient characteristics and metrics of PRS consultations in our paediatric ED were collected over a 3-month period. Data analysis was followed by feedback education intervention to ED and PRS staff. Data collection was then resumed and results were compared to the pre-intervention period. Results: One hundred ninety-eight PRS consultations were reviewed, mean patient age was 6.3 years. Most common (52%) diagnoses were burns and hand trauma; 81% of PRS referrals were deemed appropriate; 25% of PRS consults were requested after hour with no differences in patient characteristics compared to regular hours; 60% of consultations involved interventions in the ED. Time between ED registration and PRS consultation request (116.5 minutes), quality of procedural sedation (52% rated inadequate), and overall ED LOS (289.2 minutes) were identified as main areas of concern and addressed during feedback education intervention. Emergency department LOS and quality of sedation did not improve in the post-intervention period. Conclusion: The study provides detailed insights in the characteristics of PRS consultation in the paediatric ED population. Despite high referral appropriateness and education feedback intervention, significant inefficiencies were identified that call for further collaborative efforts to optimize quality of care for paediatric ED patients and improve satisfaction of involved healthcare professionals.
Author Ho, Emily S.
Forrest, Christopher R.
Low, Nelson
Neuhaus, Kathrin
AuthorAffiliation 1 Division of Plastic and Reconstructive Surgery, Department of Surgery, University Children’s Hospital, Zurich, Switzerland
2 Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
3 Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Ontario, Canada
AuthorAffiliation_xml – name: 1 Division of Plastic and Reconstructive Surgery, Department of Surgery, University Children’s Hospital, Zurich, Switzerland
– name: 3 Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Ontario, Canada
– name: 2 Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
Author_xml – sequence: 1
  givenname: Kathrin
  surname: Neuhaus
  fullname: Neuhaus, Kathrin
– sequence: 2
  givenname: Emily S.
  orcidid: 0000-0003-4082-1770
  surname: Ho
  fullname: Ho, Emily S.
– sequence: 3
  givenname: Nelson
  surname: Low
  fullname: Low, Nelson
– sequence: 4
  givenname: Christopher R.
  orcidid: 0000-0002-2934-9690
  surname: Forrest
  fullname: Forrest, Christopher R.
  email: christopher.forrest@sickkids.ca
BackLink https://www.ncbi.nlm.nih.gov/pubmed/34760844$$D View this record in MEDLINE/PubMed
BookMark eNp1UU1rGzEUFCWlSd3ceyqCXnrZVN-r7aFg3LQxBJrSj-si7751FHYlR9IaFvrjK9eJmwR60uNpZjSaeYmOnHeA0GtKzigty_eMVUxKwhmpVKUke4ZOdqtCSkqPDjPhx-g0xhtCCBWSK6FfoGMuSkW0ECfo99yZfoo2Yt_hq97EZBv8fQxrCBNeeBfHPplk84CtwwZf2PV18cv34wD4ykBrTQqZcT5Aprhmwp9gY0IawKUPeI6_jaa3acLLYRP8FnZrvHQ2ZZrdwiv0vDN9hNO7c4Z-fj7_sbgoLr9-WS7ml0UjFEsFyBVriW6lkZzqjjcrwjkQwTijFeetpmKlqxxBqZTUpOIaJNVlDkk1HRUtn6GPe93NuBqgbbKLYPp6E-xgwlR7Y-vHN85e12u_rbUsueJVFnh3JxD87Qgx1YONDfS9ceDHWDNZKaGkYCpD3z6B3vgx5JD_ohgjnGb3M0T2qCb4GAN0BzOU1Lt266ftZsqbh584EO67zIBiD4hmDf9e_a_gH6GgrhM
CitedBy_id crossref_primary_10_1097_PEC_0000000000003133
Cites_doi 10.2310/8000.2013.131280
10.1136/emermed-2012-201908
10.1136/bmj.a1501
10.12927/hcq.2007.19312
10.1016/j.jped.2017.07.009
10.1111/j.1553-2712.2008.00224.x
10.1097/01.prs.0000259209.56609.83
10.1111/j.1553-2712.2011.01136.x
10.1016/j.ajem.2008.12.014
10.1016/j.ijsu.2009.08.010
10.1016/j.ajem.2016.03.064
10.5694/j.1326-5377.2006.tb00204.x
10.1016/j.clineuro.2010.06.012
10.1542/peds.112.1.116
10.1111/j.1553-2712.2008.00295.x
10.1136/bmj.d2983
10.1097/PRS.0000000000000128
10.1097/PRS.0000000000002147
10.1111/j.1553-2712.2011.01235.x
10.1097/PEC.0b013e3180302c22
10.1016/j.jvs.2015.08.057
ContentType Journal Article
Copyright 2020 The Author(s)
2020 The Author(s).
2020 The Author(s) 2020 Plastic Surgery Journal Corporation
Copyright_xml – notice: 2020 The Author(s)
– notice: 2020 The Author(s).
– notice: 2020 The Author(s) 2020 Plastic Surgery Journal Corporation
DBID NPM
AAYXX
CITATION
K9.
7X8
5PM
DOI 10.1177/2292550320969652
DatabaseName PubMed
CrossRef
ProQuest Health & Medical Complete (Alumni)
MEDLINE - Academic
PubMed Central (Full Participant titles)
DatabaseTitle PubMed
CrossRef
ProQuest Health & Medical Complete (Alumni)
MEDLINE - Academic
DatabaseTitleList
PubMed
MEDLINE - Academic
ProQuest Health & Medical Complete (Alumni)
Database_xml – sequence: 1
  dbid: NPM
  name: PubMed
  url: https://proxy.k.utb.cz/login?url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
  sourceTypes: Index Database
DeliveryMethod fulltext_linktorsrc
EISSN 2292-5511
EndPage 279
ExternalDocumentID 10_1177_2292550320969652
34760844
10.1177_2292550320969652
Genre Journal Article
GroupedDBID 0R~
3V.
54M
7X7
8FI
8FJ
8FQ
AACMV
AAEWN
AAKGS
AARIX
AATAA
AAUAS
ABCCA
ABJNI
ABLUO
ABPNF
ABQXT
ABRHV
ABUWG
ACARO
ACDXX
ACFEJ
ACGFS
ACLFY
ACOXC
ACROE
ACSIQ
ACUAV
ACUIR
ACXKE
ACXMB
ADBBV
ADRRZ
AEPTA
AESZF
AEWDL
AEWHI
AFKRA
AFKRG
AFMOU
AFQAA
AFUIA
AGKLV
AGNHF
AHMBA
AIOMO
AJUZI
AJXAJ
ALIPV
ALMA_UNASSIGNED_HOLDINGS
ALTZF
AMCVQ
ARTOV
AUTPY
AYAKG
BBRGL
BDDNI
BENPR
BKIIM
BKSCU
BPACV
BPHCQ
BVXVI
BWJAD
CCPQU
DC.
DIK
DV7
DWQXO
EAS
EBS
EJD
ESX
FHBDP
FYUFA
GROUPED_SAGE_PREMIER_JOURNAL_COLLECTION
HMCUK
HYE
J8X
JCYGO
K.F
M3G
M4V
O9-
OK1
PQQKQ
PROAC
RPM
SAFTQ
SCNPE
SFC
SHG
SPQ
SPV
UKHRP
ZONMY
ZPPRI
ZRKOI
ZSSAH
ACJER
ALKWR
ANDLU
H13
NPM
AAYXX
ADVBO
CITATION
19Q
29B
53G
BAWUL
E3Z
F5P
GX1
K9.
PZZ
7X8
5PM
ID FETCH-LOGICAL-c462t-e5b2d08d5a5318f3cb033e042321933d814b89965766580938e51871176cf14d3
IEDL.DBID RPM
ISSN 2292-5503
IngestDate Tue Sep 17 21:30:59 EDT 2024
Sat Oct 26 00:47:44 EDT 2024
Tue Nov 19 06:47:47 EST 2024
Fri Dec 06 07:32:23 EST 2024
Sat Sep 28 08:19:41 EDT 2024
Tue Jul 16 20:46:27 EDT 2024
IsDoiOpenAccess false
IsOpenAccess true
IsPeerReviewed true
IsScholarly true
Issue 4
Keywords consult
plastic surgery
emergency department
sedation
Language English
License 2020 The Author(s).
LinkModel DirectLink
MergedId FETCHMERGED-LOGICAL-c462t-e5b2d08d5a5318f3cb033e042321933d814b89965766580938e51871176cf14d3
Notes ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
ORCID 0000-0002-2934-9690
0000-0003-4082-1770
OpenAccessLink https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8573639
PMID 34760844
PQID 2592203103
PQPubID 44048
PageCount 8
ParticipantIDs pubmedcentral_primary_oai_pubmedcentral_nih_gov_8573639
proquest_miscellaneous_2596465426
proquest_journals_2592203103
crossref_primary_10_1177_2292550320969652
pubmed_primary_34760844
sage_journals_10_1177_2292550320969652
PublicationCentury 2000
PublicationDate 2021-11-01
PublicationDateYYYYMMDD 2021-11-01
PublicationDate_xml – month: 11
  year: 2021
  text: 2021-11-01
  day: 01
PublicationDecade 2020
PublicationPlace Los Angeles, CA
PublicationPlace_xml – name: Los Angeles, CA
– name: United States
– name: Montreal
– name: Sage CA: Los Angeles, CA
PublicationTitle Canadian journal of plastic surgery
PublicationTitleAlternate Plast Surg (Oakv)
PublicationYear 2021
Publisher SAGE Publications
SAGE PUBLICATIONS, INC
Publisher_xml – name: SAGE Publications
– name: SAGE PUBLICATIONS, INC
References Kulstad, Sikka, Sweis, Kelley, Rzechula 2010; 28
Drolet, Tandon, Ha 2016; 137
Brick, Lowes, Lovstrom, Kokotilo, Villa-Roel, Lee, Land, Rowe 2014; 31
Anzarut, Singh, Cook, Domes, Olson 2007; 119
Bernstein, Aronsky, Duseja 2009; 16
Kannikeswaran, Lieh-Lai, Malian, Wang, Farooqi, Roback 2016; 34
Timm, Ho, Luria 2008; 15
Gorman, Lochrin, Khan, Urso-Baiarda 2012; 2
Drolet, Prsic, Schmidt 2014; 133
Van Essen, Heeringa, Muizelaar 2010; 112
Leithead, Matthews, Pearce 2016; 63
Ramalho, Bretas, Schvartsman, Reis 2017; 93
Sills, Fairclough, Ranade, Kahn 2011; 18
Richardson 2006; 184
Lang, Sutherland, Mack, Wang, Andruchow 2014; 64
Godambe, Elliot, Matheny, Pershad 2003; 112
Guttmann, Schull, Vermeulen, Stukel 2011; 342
Doan, Genuis, Yu 2014; 16
Bond, Ospina, Blitz 2007; 10
Van Veen, Steyerberg, Ruige 2008; 337
Bourgeois, Shannon 2007; 23
Urso-Baiarda 2009; 7
Pines, Hilton, Weber 2011; 18
bibr8-2292550320969652
bibr20-2292550320969652
bibr14-2292550320969652
bibr1-2292550320969652
bibr6-2292550320969652
bibr12-2292550320969652
bibr3-2292550320969652
bibr22-2292550320969652
Lang E (bibr16-2292550320969652) 2014; 64
Gorman M (bibr5-2292550320969652) 2012; 2
bibr18-2292550320969652
bibr13-2292550320969652
bibr2-2292550320969652
bibr9-2292550320969652
bibr21-2292550320969652
bibr7-2292550320969652
bibr11-2292550320969652
bibr4-2292550320969652
bibr10-2292550320969652
bibr23-2292550320969652
bibr15-2292550320969652
bibr17-2292550320969652
bibr19-2292550320969652
References_xml – volume: 119
  start-page: 1933
  year: 2007
  end-page: 1939
  article-title: Continuing medical education in emergency prospective assessment of educational needs
  publication-title: Plast Reconstr Surg
  contributor:
    fullname: Olson
– volume: 64
  start-page: 76
  issue: 4
  year: 2014
  article-title: 210 General surgery consultations in the emergency department: a multicenter analysis of the appropriateness and timing of surgical referrals
  publication-title: Can J Emerg Med
  contributor:
    fullname: Andruchow
– volume: 10
  start-page: 32
  issue: 4
  year: 2007
  end-page: 40
  article-title: Frequency, determinants and impact of overcrowding in emergency departments in Canada: a national survey
  publication-title: Healthc Q
  contributor:
    fullname: Blitz
– volume: 337
  start-page: a1501
  year: 2008
  article-title: Manchester triage system in paediatric emergency care: prospective observational study
  publication-title: BMJ
  contributor:
    fullname: Ruige
– volume: 184
  start-page: 213
  issue: 5
  year: 2006
  end-page: 216
  article-title: Increase in patient mortality at 10 days associated with emergency department overcrowding
  publication-title: Med J Aust
  contributor:
    fullname: Richardson
– volume: 93
  start-page: 2
  issue: suppl 1
  year: 2017
  end-page: 18
  article-title: Sedation and analgesia for procedures in the pediatric emergency room
  publication-title: J Pediatr (Rio J)
  contributor:
    fullname: Reis
– volume: 112
  start-page: 775
  issue: 9
  year: 2010
  end-page: 780
  article-title: (In)appropriate neurosurgical consultation
  publication-title: Clin Neurol Neurosurg
  contributor:
    fullname: Muizelaar
– volume: 23
  start-page: 94
  issue: 2
  year: 2007
  end-page: 102
  article-title: Emergency care for children in pediatric and general emergency departments
  publication-title: Pediatr Emerg Care
  contributor:
    fullname: Shannon
– volume: 342
  start-page: d2983
  issue: 7809
  year: 2011
  article-title: Association between waiting times and short term mortality and hospital admission after departure from emergency department: population based cohort study from Ontario, Canada
  publication-title: BMJ
  contributor:
    fullname: Stukel
– volume: 16
  start-page: 1
  issue: 1
  year: 2009
  end-page: 10
  article-title: The effect of emergency department crowding on clinically oriented outcomes
  publication-title: Acad Emerg Med
  contributor:
    fullname: Duseja
– volume: 7
  start-page: 539
  issue: 6
  year: 2009
  end-page: 542
  article-title: An observational study of timing versus appropriateness of acute plastic surgery referrals in the UK
  publication-title: Int J Surg
  contributor:
    fullname: Urso-Baiarda
– volume: 2
  start-page: 68
  issue: 1
  year: 2012
  end-page: 76
  article-title: Waiting times and decision-making behind acute plastic surgery referrals in the UK
  publication-title: J Hosp Adm
  contributor:
    fullname: Urso-Baiarda
– volume: 34
  start-page: 1347
  issue: 8
  year: 2016
  end-page: 1353
  article-title: Optimal dosing of intravenous ketamine for procedural sedation in children in the ED—a randomized controlled trial
  publication-title: Am J Emerg Med
  contributor:
    fullname: Roback
– volume: 28
  start-page: 304
  issue: 3
  year: 2010
  end-page: 309
  article-title: ED overcrowding is associated with an increased frequency of medication errors
  publication-title: Am J Emerg Med
  contributor:
    fullname: Rzechula
– volume: 16
  start-page: 405
  issue: 05
  year: 2014
  end-page: 410
  article-title: Trends in use in a Canadian pediatric emergency department
  publication-title: CJEM
  contributor:
    fullname: Yu
– volume: 133
  start-page: 1295
  year: 2014
  end-page: 1302
  article-title: Special topic duty hours and home call: the experience of plastic surgery residents and fellows
  publication-title: Plast Reconstr Surg
  contributor:
    fullname: Schmidt
– volume: 63
  start-page: 177
  issue: 1
  year: 2016
  end-page: 181
  article-title: Analysis of emergency vascular surgery consults within a tertiary health care system
  publication-title: J Vasc Surg
  contributor:
    fullname: Pearce
– volume: 137
  start-page: 1927
  issue: 6
  year: 2016
  end-page: 1933
  article-title: Unnecessary emergency transfers for evaluation by a plastic surgeon: a burden to patients and the health care system
  publication-title: Plast Reconstr Surg
  contributor:
    fullname: Ha
– volume: 18
  start-page: 1330
  issue: 2
  year: 2011
  end-page: 1338
  article-title: Emergency department crowding is associated with decreased quality of care for children
  publication-title: Acad Emerg Care
  contributor:
    fullname: Kahn
– volume: 18
  start-page: 1358
  issue: 12
  year: 2011
  end-page: 1370
  article-title: International perspectives on emergency department crowding
  publication-title: Acad Emerg Med
  contributor:
    fullname: Weber
– volume: 112
  start-page: 116
  issue: 1
  year: 2003
  end-page: 123
  article-title: Comparison of propofol/fentanyl versus ketamine/midazolam for brief orthopedic procedural sedation in a pediatric emergency department
  publication-title: Pediatrics
  contributor:
    fullname: Pershad
– volume: 15
  start-page: 832
  issue: 9
  year: 2008
  end-page: 837
  article-title: Pediatric emergency department overcrowding and impact on patient flow outcomes
  publication-title: Acad Emerg Med
  contributor:
    fullname: Luria
– volume: 31
  start-page: 134
  issue: 2
  year: 2014
  end-page: 138
  article-title: The impact of consultation on length of stay in tertiary care emergency departments
  publication-title: Emerg Med J
  contributor:
    fullname: Rowe
– ident: bibr6-2292550320969652
  doi: 10.2310/8000.2013.131280
– ident: bibr12-2292550320969652
  doi: 10.1136/emermed-2012-201908
– ident: bibr20-2292550320969652
  doi: 10.1136/bmj.a1501
– ident: bibr4-2292550320969652
  doi: 10.12927/hcq.2007.19312
– ident: bibr21-2292550320969652
  doi: 10.1016/j.jped.2017.07.009
– ident: bibr7-2292550320969652
  doi: 10.1111/j.1553-2712.2008.00224.x
– ident: bibr3-2292550320969652
  doi: 10.1097/01.prs.0000259209.56609.83
– ident: bibr9-2292550320969652
  doi: 10.1111/j.1553-2712.2011.01136.x
– ident: bibr14-2292550320969652
  doi: 10.1016/j.ajem.2008.12.014
– ident: bibr2-2292550320969652
  doi: 10.1016/j.ijsu.2009.08.010
– ident: bibr23-2292550320969652
  doi: 10.1016/j.ajem.2016.03.064
– ident: bibr10-2292550320969652
  doi: 10.5694/j.1326-5377.2006.tb00204.x
– volume: 64
  start-page: 76
  issue: 4
  year: 2014
  ident: bibr16-2292550320969652
  publication-title: Can J Emerg Med
  contributor:
    fullname: Lang E
– ident: bibr18-2292550320969652
  doi: 10.1016/j.clineuro.2010.06.012
– ident: bibr22-2292550320969652
  doi: 10.1542/peds.112.1.116
– ident: bibr15-2292550320969652
  doi: 10.1111/j.1553-2712.2008.00295.x
– volume: 2
  start-page: 68
  issue: 1
  year: 2012
  ident: bibr5-2292550320969652
  publication-title: J Hosp Adm
  contributor:
    fullname: Gorman M
– ident: bibr11-2292550320969652
  doi: 10.1136/bmj.d2983
– ident: bibr17-2292550320969652
  doi: 10.1097/PRS.0000000000000128
– ident: bibr1-2292550320969652
  doi: 10.1097/PRS.0000000000002147
– ident: bibr13-2292550320969652
  doi: 10.1111/j.1553-2712.2011.01235.x
– ident: bibr8-2292550320969652
  doi: 10.1097/PEC.0b013e3180302c22
– ident: bibr19-2292550320969652
  doi: 10.1016/j.jvs.2015.08.057
SSID ssj0001453648
ssj0041793
Score 2.2216432
Snippet Introduction: Consult services influence emergency department (ED) workflow. Prolonged ED length of stay (LOS) correlates with ED overcrowding and as a...
Consult services influence emergency department (ED) workflow. Prolonged ED length of stay (LOS) correlates with ED overcrowding and as a consequence decreased...
Introduction: Consult services influence emergency department (ED) workflow. Prolonged ED length of stay (LOS) correlates with ED overcrowding and as a...
INTRODUCTIONConsult services influence emergency department (ED) workflow. Prolonged ED length of stay (LOS) correlates with ED overcrowding and as a...
SourceID pubmedcentral
proquest
crossref
pubmed
sage
SourceType Open Access Repository
Aggregation Database
Index Database
Publisher
StartPage 272
SubjectTerms Anesthesia
Feedback
Intervention
Original
Pediatrics
Quality control
Quality improvement
Title Analysis of Plastic Surgery Consultations in a High-Volume Paediatric Emergency Department: A Quality Improvement Initiative
URI https://journals.sagepub.com/doi/full/10.1177/2292550320969652
https://www.ncbi.nlm.nih.gov/pubmed/34760844
https://www.proquest.com/docview/2592203103
https://search.proquest.com/docview/2596465426
https://pubmed.ncbi.nlm.nih.gov/PMC8573639
Volume 29
hasFullText 1
inHoldings 1
isFullTextHit
isPrint
link http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV1LSyQxEC7Uk5dlRV17fRBBhD20k86r097EBz5QBnYVb0PSSbMD2iM6cxD88VbS3aOjePGaBBJSSeqRr74C2LGFkU4XKrVG-FRYgVfKc5rmeAC80rziMaZ7eaVOr8X5rbydA9nlwkTQfmmHe_Xd_V49_B-xlQ_3Za_DifX6l4da5hw1a28e5lH9vnPRY2BFSK5i1SzGCnS0JOVv35O90BaaGA20MDIUs-EiV1QLMauZPpmbn1GT76BfURud_IQfrRlJDprlLsGcr5fhpWMYIaOK9NEsxk7yt8l7JqEy5-Su-Xh_IsOaGBIwHulNfJ5I33Q1O8hxl5FJjlBXPUYY-j45IA3dxjNp4hAxrEjOAvYocoevwPXJ8b_D07StrpCWQrFx6qVljmonDV5DXfHSUs59gMngI8a505mw6IwpdEjQSqEF115m6F5luSqrTDi-Cgv1qPZrQDKjaG4q6jkrhMmdKb3TnknnKlvmvkzgT7ezg4eGRGOQtTzjHwWSwEa39YP2Oj0N0EdjLJCY8gS2p914EcLvhqn9aBLHqEAOx1QCvxpJTSfrRJxAPiPD6YBAsj3bg2cvkm23Zy2B3SDttyV9tf7f355iHRZZAMzERMcNWBg_TvwmWjxju4W2_tnFVjznr0xo_QQ
link.rule.ids 230,314,727,780,784,885,27924,27925,53791,53793
linkProvider National Library of Medicine
linkToHtml http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV3daxQxEB9qfdAXUfxarRpBBB-2l83ka30rteWqvXJgK31bkk0WD9q90t49FPrHm2R3rz2LL74mgYTMJJmZ_OY3AJ9saYTTpcyt4T7nlocj5ZHmKiiAlxobTDHdyZEcn_Dvp-J0A8SQC5NA-7Wdbbdn59vt7HfCVl6c16MBJzaaTna1UBhe1tEDeChQlcUdJz2FVrhAmepmMVYGV0tQvP2gHMW22MRoJIYRsZwNciWp5nz9bbpncN7HTd4Bf6X3aP8pPOkNSbLTLfgZbPj2OdwMHCNk3pBpMIxDJ_nZZT6TWJtzedZ9vV-RWUsMiSiP_Fe6oMjUDFU7yN6Qk0m-hdfqMgHRv5Id0hFuXJMuEpECi-Qgoo8Se_gLONnfO94d5319hbzmki1yLyxzVDthwkHUDdaWIvoIlAnXGKLTBbfBHZPBJQl2Ci1Re1EEB6tQsm4K7vAlbLbz1r8GUhhJlWmoR1Zyo5ypvdOeCecaWytfZ_Bl2NnqoqPRqIqeafxvgWSwNWx91R-oqyp4aYxFGlPM4OOqOxyF-L9hWj9fpjEy0sMxmcGrTlKryQYRZ6DWZLgaEGm213uC9iW67V7bMvgcpX27pH-t_81_T_EBHo2PJ4fV4cHRj7fwmEX4TEp73ILNxeXSvwv2z8K-T9r-B84v_2A
linkToPdf http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV3daxQxEB-0gvhSFL_WVhtBBB-2m83XZn0rbY9WbTnQSt-WZJPFg3bvaO8eCv3jnWR3r3ctvviaBBIyM5mZ5JffAHyypZFOlyq1RvhUWIEm5TlNC1QArzRveLzTPTlVR2fi27k8Xyn1FUH7tZ3stheXu-3kT8RWzi7rbMCJZeOTfS0Ljp41m7kmewxPJEclW0nU4_WKkFzF2lmMlZhuScrvHimz0BaaGA3kMDKUtOGiUFQLse6fHgSdD7GTKwCw6JNGz2GzDybJXrfoF_DIty_hduAZIdOGjDE4xk7ys_v9TEJ9zsVF9_x-TSYtMSQgPdLf8ZAiYzNU7iCHw79McoAe6yqC0b-SPdKRbtyQ7jYiXi6S44BAigzir-BsdPhr_yjtayyktVBsnnppmaPaSYPGqBteW8q5D2AZPMo4dzoXFlMyhWkJxiq05NrLHJOsvFB1kwvHX8NGO239WyC5UbQwDfWclcIUztTeac-kc42tC18n8GXY2WrWUWlUec82fl8gCWwPW1_1RnVdYabGWKAy5Ql8XHajOYQ3DtP66SKOUYEijqkE3nSSWk42iDiBYk2GywGBanu9BzUwUm73GpfA5yDtuyX9a_3v_nuKHXg6PhhVP45Pv2_BMxYQNPHn4zZszK8W_j2GQHP7ISr7X42pAII
openUrl ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Analysis+of+Plastic+Surgery+Consultations+in+a+High-Volume+Paediatric+Emergency+Department%3A+A+Quality+Improvement+Initiative&rft.jtitle=Plastic+surgery+%28Oakville+%28Ont.%29%29&rft.au=Neuhaus%2C+Kathrin&rft.au=Ho%2C+Emily+S&rft.au=Low%2C+Nelson&rft.au=rest%2C+Christopher+R&rft.date=2021-11-01&rft.issn=2292-5503&rft.volume=29&rft.issue=4&rft.spage=272&rft.epage=279&rft_id=info:doi/10.1177%2F2292550320969652&rft.externalDBID=NO_FULL_TEXT
thumbnail_l http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=2292-5503&client=summon
thumbnail_m http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=2292-5503&client=summon
thumbnail_s http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=2292-5503&client=summon