Do the national performance tables really indicate the performance of accident and emergency departments?

OBJECTIVE--To determine the current practice of nurse triage in accident and emergency departments in England, and to examine the relation between triage systems and performance in the Department of Health comparative performance guide. DESIGN--A postal questionnaire was sent to all consultants in accident and emergency medicine in England. RESULTS--151 responses were analysed, representing 72% of the departments seeing at least 15,000 new patients annually. Triage systems vary widely throughout departments, ranging between advanced triage, partial triage, and "eyeballing". There is no standardisation of the process or duration of triage. There appears to be no standard method of measuring the time to immediate assessment. There is no correlation between the quality of initial assessment and performance in the tables. CONCLUSION--The national performance figures do not correlate with the quality of the initial assessment; comparisons based on these figures are therefore misleading. More effective performance indicators are available, which would provide a truer indication of the quality of accident and emergency services.     

Does psychological stress improve physical performance?

The purpose of this study is to determine whether psychological stress enhances physical performance and how personality traits affect it. The annual physical test was chosen as the psychological stressor. Ninety three students ran 50 meters as part of the test and one week after that as a control. The pulse rate and time were measured and pulse rate was used as an indicator of psychological stress. All students took the anxiety-trait scale test of the State-Trait Anxiety Inventory. The pulse rate was higher and the time record was better in the annual physical test compared with that of control. When we categorized the subjects by the anxiety-trait scale test, only the high anxiety-trait students could run faster when faced with higher stress. In conclusion, psychological stress can enhance the physical performance of certain students. It is possible that psychological stress and personality traits interact and both of them affect physical performance.     

Are these emergency department performance data real?

We have recently demonstrated that the distribution of total time spent by patients in emergency departments (EDs) in England shows a peak immediately prior to the current Department of Health target of 4 hours. We aimed to investigate whether this suggested that performance data were being manipulated. We collected data from 117 EDs, and 616067 patient episodes were included in the analysis. Evidence of manipulation of performance data appears to be present in a small proportion of episodes, but because of the numbers involved, it could equate to over 50000 episodes per year in EDs in England.     

What price research? Good preparation contributes to good performance

Marie Cerinus uses a study into the value of clinical supervision to illustrate some of the resource issues involved in the conduct of action research. She describes the range and level of financial and personal commitment required if the research is to be successful.     

Measuring elderly dysphagic patients' performance in eating – a review

Purpose.?This review aims to identify psychometrically robust assessment tools suitable for measuring elderly dysphagic patients' performance in eating for use in clinical practice and research.

Method.?Electronic databases, related citations and references were searched to identify assessment tools integrating the complexity of the eating process. Papers were selected according to criteria defined a priori. Data were extracted regarding characteristics of the assessment tools and the evidence of reliability, validity and responsiveness. Quality appraisal was undertaken using developed criteria concerning the study design, the statistics used for the psychometric evaluation and the reported values.

Results.?Eight of fourteen identified assessment tools met the inclusion criteria. Three assessment tools were specific to dementia, two were specific to stroke and three targeted a range of neurological and geriatric conditions. The rigor of the assessment tools' psychometric properties varied from no evidence available to excellent evidence. Only two assessment tools were rated adequate to excellent.

Conclusion.?‘The Minimal Eating Observation Form-Version II’ to be used for screening and ‘The McGill Ingestive Skills Assessment’ to be used for treatment planning and monitoring appeared to be psychometrically robust for clinical practice and research. However, further research on their psychometric properties is needed.     

Mesure de la performance économique en réanimation

The aim of this work is to evaluate the economic efficiency of French intensive care units (ICUs). We develop a two-stage model. In the first step, we use an extended Data Envelopment Analysis model to evaluate the performance of ICUs at the patient level. Few applied works use patient data to gauge efficiency of health care organizations. From a methodological viewpoint, we introduce a directional distance function to gauge performance for each patient in terms of global ICU resources. From an empirical viewpoint, we introduce validated resource utilization indexes (medical and nursing dimensions) and we also control for case-mix heterogeneity with categorical variables including relevant individual measures of illness severity (SAPS II). Data come from a French survey including 15 178 patients of 26 ICUs in the region of Paris over the year 2000. Results show potential savings up to 30% of ICU’s resources and a strong concentration of inefficiency over 20% of patients.