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| 1 | Lean techniques for the improvement of patients' flow in emergency department显示文摘BACKGROUND: Emergency departments(EDs) face problems with overcrowding, access block, cost containment, and increasing demand from patients. In order to resolve these problems, there is rising interest to an approach called 'lean' management. This study aims to(1) evaluate the current patient flow in ED,(2) to identify and eliminate the non-valued added process, and(3) to modify the existing process.METHODS: It was a quantitative, pre- and post-lean design study with a series of lean management work implemented to improve the admission and blood result waiting time. These included structured re-design process, priority admission triage(PAT) program, enhanced communication with medical department, and use of new high sensitivity troponin-T(hsTnT) blood test. Triage waiting time, consultation waiting time, blood result time, admission waiting time, total processing time and ED length of stay were compared.RESULTS: Among all the processes carried out in ED, the most time consuming processes were to wait for an admission bed(38.24 minutes; SD 66.35) and blood testing result(mean 52.73 minutes, SD 24.03). The triage waiting time and end waiting time for consultation were significantly decreased. The admission waiting time of emergency medical ward(EMW) was significantly decreased from 54.76 minutes to 24.45 minutes after implementation of PAT program(P<0.05).CONCLUSION: The application of lean management can improve the patient flow in ED. Acquiescence to the principle of lean is crucial to enhance high quality emergency care and patient satisfaction. | HY Chan SM Lo LLY Lee WYL Lo WC Yu YF Wu ST Ho RSD Yeung JTS Chan | 2014 | World Journal of Emergency Medicine2014，5，1： | 6 |
| 2 | Non-invasive versus invasive mechanical ventilation for respiratory failure in severe acute respiratory syndrome显示文摘Background Severe acute respiratory syndrome is frequently complicated by respiratory failure requiringventilatory support.We aimed to compare the efficacy of non-invasive ventilation against invasive mechanicalventilation treating respiratory failure in this disease.Methods Retrospective analysis was conducted on all respiratory failure patients identified from the HongKong Hospital Authority Severe Acute Respiratory Syndrome Database.Intubation rate, mortality and secondaryoutcome of a hospital utilizing non-invasive ventilation under standard infection control conditions ( NIVHospital) were compared against13 hospitals using solely invasive ventilation (IMVHospitals).Multiple logisticregression analyses with adjustments for confounding variables were performed to test for association betweenoutcomes and hospital groups.Results Both hospital groups had comparable demographics and clinical profiles, but NIV Hospital (42patients) had higher lactate dehydrogenase ratio and worse radiographic score on admission and ribavirin-corticosteroid commencement.Compared to IMV Hospitals (451 patients), NIV Hospital had lower adjustedodds ratios for intubation (0.36, 95% CI 0.164 -0.791,P=0.011) and death (0.235, 95% CI 0.077 -0.716,P=0.011), and improved earlier after pulsed steroid rescue.There were no instances of transmission ofsevere acute respiratory syndrome among health care workers due to the use of non-invasive ventilation.Conclusion Compared to invasive mechanical ventilation, non-invasive ventilation as initial ventilatory supportfor acute respiratory failure in the presence of severe acute respiratory syndrome appeared to be associated withreduced intubation need and mortality. | Loretta YC Yam Alfred YF Chan Thomas MT Cheung Eva LH Tsui Jane CK Chan Vivian CW Wong | 2005 | Chinese Medical Journal2005，，17： | 3 |
| 3 | Prevalence of human papillomavirus in cervical cancer:a multicenter study in China 显示文摘 | Lo WK Wong YF Chan KM et at | 2002 | Int J Cancer2002，100，3： | 1 |
| 4 | The sweet potato sporamin promoter confers high- level phytase expression and improves organic phosphorus acquisition and tuber yield of transgenic potato 显示文摘 | Hong YF Liu CY Cheng KJ Hour AL Chan MT Tseng TH Chert KY Shaw JF Yu SM | 2008 | Plant Mol Biol2008，67，： | 1 |
| 5 | Emergence of dengue virus type 4 genotype ⅡA in Malaysia 显示文摘 | AbuBakar S Wong PF Chan YF | 2002 | J Gen Virol2002，83，： | 1 |
| 6 | Temporal lobe necrosis in nasopharyngeal cacinoma pictorial essay显示文摘 | Chong VFH Fan YF Chan LL | 1997 | Austral Radiol1997，41，3： | 1 |
| 7 | Extracoronal resilient attachments in distal extension removable partial dentures 显示文摘 | Ku YC Shen YF Chan CP | 2000 | Quintessence lnt2000，31，5： | 1 |
| 8 | Community nursing services for postdischarge chronically ill patients显示文摘 | Susan KY Chow Frances KY Wong Tony MF Chan Loretta YF Chung Katherine KP Chang Rance PL Lee | 2008 | Journal of Clinical Nursing2008，，7： | 1 |
| 9 | Chikungunya virus diagnosis in the developing world: a pressing need显示文摘 | Sam IC Chua CL Chan YF | 2011 | Expert Rev Anti Infect Ther2011，9，12： | 1 |
| 10 | NEPTUNE Study: On-treatment HBsAg level analysis confirms prediction of response observed in phase 3 study of peginterferon alfa-2a in HBeAg-positive patients 显示文摘 | Gane E Jia J Han K Tanwandee T Chuang WL Marcellin P Chan HL Piratvisuth T Wat C Martins E Liaw YF | 2011 | J Hepatol2011，54，： | 1 |
| 11 | Prevlence of human papillomavirus in cervical cancer : a multicenter srudy in China显示文摘 | LO KW Wong YF Chan MK | 2002 | Int J Cancer2002，100，3： | 1 |
| 12 | Outbreaks of enterovirus 71 infection显示文摘 | AbuBakar S Chan YF Lain SK | | 0，，05： | 1 |
| 13 | Aberrant serum adiponectin levels in women with uterine leiomyomas显示文摘 | Chen HS Chan TF Chung YF | 2004 | Gynecol Obstet Invest2004，58，3： | 1 |
| 14 | Extracoronal resilient attachments indistal-extension removable partial dentures显示文摘 | Ku YC Shen YF Chan CP | 2003 | QIIintesence hat2003，31，5： | 1 |
| 15 | Extracoronal resilient attachments in distal extension removable partial dentures 显示文摘 | Ku YC Shen YF Chan CP | 2000 | Quintessence Int2000，31，5： | 1 |
| 16 | Chronic Kidney Disease and Its Association With Mortality and Hospitalization in Chinese Nursing Home Older Residents:A 3-Year Prospective Cohort Study显示文摘 | Chan TC Yap DY Shea YF | 2012 | J Am Med Dir Assoc2012，13，： | 1 |
| 17 | Course of depression, mental health service utilization and treatment preferences in women receiving chemotherapy for breast cancer显示文摘 | Reece JC Chan YF Herbert J et d | 2013 | Gen Hosp Psychiatry2013，35，4： | 1 |
| 18 | CHD1L promotes hepat0cellu- lar carcinoma progression and metastasis in mice and is associated with these processes in human patients 显示文摘 | Chen L Chan TH Yuan YF | 2010 | J Chn Invest2010，120，： | 1 |
| 19 | Outbreaks of enterovinis 71 infection显示文摘 | AbuBakar S Chan YF Lam SK | 2000 | N Engl J Med2000，342，5： | 1 |
| 20 | Evolutionary genetics of human enterovirus 71:origin,popμlation dynamics,natural selection,and seasonal periodicity of the VP1 gene显示文摘 | Tee KK Lam TT Chan YF | 2010 | J Virol2010，84，7： | 1 |
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