3. • 5 Major causes of ER overcrowding
1. Increased demand for ED services
2. Reduced supply of ED services
3. Increased demand for inpatient beds and services
4. Reduced supply of inpatient beds and services
5. Operational constraints and other factors that
reduce patient throughput
4. • Increased demand for ED services
1. Availability of primary care physicians
2. Use of the ED for non-urgent conditions
3. Increasing complexity of diagnostic technology
4. Demographics
5. Preferences for ED care
5. • Reduced supply of ED services
1. Shortage of on-call specialists
2. Shortage of nurses
3. Use of More Complex Technology
4. Lack of Community-Wide Coordination Among
Hospitals
6. • Increased Demand for Inpatient Services
1. Changes in Managed Care
2. Technology and the Capabilities of Medicine
3. Demographics
Older : chronic disease
4. Competition and marketing
Advertised more profitable service and elective
7. • Reduced supply of Inpatient service
1. Shortage of Nurses : Licenced, Operating
and staffed beds.
2. Unavailable type of beds
8. • Operational constraints and other factors that
reduce patient throughput
1. Reduced availability of post acute care
2. Unavailable or Delayed Service and Natural
variability.
3. Operational Inefficiencies, Operation management
techniques, and variability Methodology
Avoid bottlenecks
9. • Operational constraints and other factors that
reduce patient throughput
4. Information System and Processing
5. Peak Hour Overcrowding
6. Bed Flexibility
7. Transportation
36. NURSE
• EKG for ER NURSE
• Forensic Record and Injury Surveillance in Emergency
Department
• Management of Animal attack wounds
• การพัฒนาคุณภาพในหน่วยงาน
• Neonatal Resuscitation for Emergency Nurse of Maharaj
Nakorn Chiangmai Hospital
• พยาบาลกู้ชีพ Pre Hospital Nurse 2 รุ่น
67. Stroke 2008
ข้อมูล เกณฑ์มาตรฐาน เวลาที่ได้
(นาที) (นาที)
Door to doctor < 10 1
Door to CT < 25 10.97
Door to report < 45 23.41
Door to needle < 60 78.5
Door to admit < 180 151.6
68. REFERRAL SYSTEM
1. Referral Center
2. Referral Guideline
3. Management Guideline
4. Referral Audit
5. Improve Competency
69.
70.
71.
72. REFERRAL SYSTEM
1. Referral Center
2. Referral Guideline
3. Management Guideline
4. Referral Audit
5. Improve Competency
76. REFERRAL SYSTEM
1. Referral Center
2. Referral Guideline
3. Management Guideline
4. Referral Audit
5. Improve Competency
77. • Head injury : Nurse 2006
• ATLS ( Advanced Trauma Life Support ) : Doctor 4 courses 2007
• Initial assessment & Resuscitation in trauma patient for nurse : Nurses 4
courses 2007
• Evidence Base Practice in Head Injury : Research to Practice : Nurses 2007
• Update wound care : Doctors and Nurses 2008
• Referral Guidelines : Doctors and Nurses 2008
• ATLS ( Advanced Trauma Life Support ) : Doctor 1 course 2008
• Ambulatory trauma care : Doctors and Nurses 2 Courses 2008
• Initial Assessment and Resuscitation in trauma patient : Nurses 2 courses
2008
• Management in trauma care from primary to tertiary care : Nurses 2008
