A systematic review of triage-related interventions to improve patient flow in emergency departments

Background Overcrowding in emergency departments is a worldwide problem. A systematic literature review was undertaken to scientifically explore which interventions improve patient flow in emergency departments. Methods A systematic literature search for flow processes in emergency departments was followed by assessment of relevance and methodological quality of each individual study fulfilling the inclusion criteria. Studies were excluded if they did not present data on waiting time, length of stay, patients leaving the emergency department without being seen or other flow parameters based on a nonselected material of patients. Only studies with a control group, either in a randomized controlled trial or in an observational study with historical controls, were included. For each intervention, the level of scientific evidence was rated according to the GRADE system, launched by a WHO-supported working group. Results The interventions were grouped into streaming, fast track, team triage, point-of-care testing (performing laboratory analysis in the emergency department), and nurse-requested x-ray. Thirty-three studies, including over 800,000 patients in total, were included. Scientific evidence on the effect of fast track on waiting time, length of stay, and left without being seen was moderately strong. The effect of team triage on left without being seen was relatively strong, but the evidence for all other interventions was limited or insufficient. Conclusions Introducing fast track for patients with less severe symptoms results in shorter waiting time, shorter length of stay, and fewer patients leaving without being seen. Team triage, with a physician in the team, will probably result in shorter waiting time and shorter length of stay and most likely in fewer patients leaving without being seen. There is only limited scientific evidence that streaming of patients into different tracks, performing laboratory analysis in the emergency department or having nurses to request certain x-rays results in shorter waiting time and length of stay.

Systematic work environment management : experiences from implementation in Swedish small-scale enterprises

Small-scale enterprises face difficulties in fulfilling the regulations for organising Systematic Work Environment Management. This study compared three groups of small-scale manufacturing enterprises with and without support for implementing the provision. Two implementation methods, supervised and network method, were used. The third group worked according to their own ideas. Twenty-three enterprises participated. The effects of the implementation were evaluated after one year by semi-structured dialogue with the manager and safety representative. Each enterprise was classified on compliance with ten demands concerning the provision. The work environment was estimated by the WEST-method. Impact of the implementation on daily work was also studied. At the follow-up, the enterprises in the supervised method reported slightly more improvements in the fulfilment of the demands in the provision than the enterprises in the network method and the enterprises working on their own did. The effect of the project reached the employees faster in the enterprises with the supervised method. In general, the work environment improved to some extent in all enterprises. Extensive support to small-scale enterprises in terms of advise and networking aimed to fulfil the regulations of Systematic Work Environment Management had limited effect especially considering the cost of applying these methods.

The Role of Motivational Strategies in the Upper Elementary Classroom : A systematic literature review about teacher strategies that promote self-confidence, motivation and a conducive learning environment

The aim of this literature review is to investigate which strategies teachers use to motivate pupils to communicate orally in English. The literature review also investigates how these teacher strategies affect pupils. The methodology used for this investigation is a systematic literature review. Various databases have been used when searching for literature. Scientific articles and theses have been searched for. They have also been read and analyzed before they have become a part of this review. The results indicate that some teachers feel insecure when speaking English. Therefore Swedish is spoken in many language classrooms. Teachers speaking in front of the class is the traditional way of teaching, and it does not seem to be a strategy who influences pupils positively. If teachers speak the target language among pupils they often get more motivated and focused pupils who feel comfortable speaking English. Young pupils are fast learners. By exposing them to the English language in early ages they receive great opportunities to learn a foreign language and strengthen their self-confidence. Drama, songs and rhymes are preferable strategies to use when teaching young learners. What position teachers decide to take in the classroom is also a significant element when teaching foreign languages.

Teaching Mathematics in English to Swedish Speaking Students : A systematic review of strategies for teaching mathematics to second language learners

The Swedish government has authorised the teaching of mathematics in English to Swedish speaking students. Much of that teaching is performed by foreign trained native English speaking teachers lacking training in second language learners. This systematic review summarises international studies from the last ten years that deal with the teaching of mathematics to second language learners. The review shows that second language students working in a bilingual environment achieve higher rates of content and language knowledge than learners in a monolingual environment. This study also summarises some of the teacher practices that are effective for teaching mathematics in English to second language learners.