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https://www.readbyqxmd.com/read/28915163/do-prehospital-providers-and-emergency-nurses-agree-on-triage-assignment-an-efficacy-study
#1
Helene Skjøt-Arkil, Louise L Pontoppidan, Jens O Laursen, Matthias Giebner, Jesper D Andersen, Christian B Mogensen
OBJECTIVES: The aim of this study was to investigate the agreement on triage level between prehospital providers and emergency department (ED) nurses in clinical practice when using the same triage system. The objectives were as follows: (a) What is the agreement of triage between prehospital providers and ED nurses, when using Danish Emergency Process Triage (DEPT) correctly? (b) Which part of the triage process yields the highest agreement regarding the final triage? METHODS: The study was a prospective and observational efficacy study...
September 18, 2017: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/28844764/hospital-strategies-for-reducing-emergency-department-crowding-a-mixed-methods-study
#2
Anna Marie Chang, Deborah J Cohen, Amber Lin, James Augustine, Daniel A Handel, Eric Howell, Hyunjee Kim, Jesse M Pines, Jeremiah D Schuur, K John McConnell, Benjamin C Sun
STUDY OBJECTIVE: Emergency department (ED) crowding and patient boarding are associated with increased mortality and decreased patient satisfaction. This study uses a positive deviance methodology to identify strategies among high-performing, low-performing, and high-performance improving hospitals to reduce ED crowding. METHODS: In this mixed-methods comparative case study, we purposively selected and recruited hospitals that were within the top and bottom 5% of Centers for Medicare & Medicaid Services case-mix-adjusted ED length of stay and boarding times for admitted patients for 2012...
August 25, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28782226/perspectives-of-hospital-emergency-department-staff-on-trauma-informed-care-for-injured-children-an-australian-and-new-zealand-analysis
#3
Claire Hoysted, Franz E Babl, Nancy Kassam-Adams, Markus A Landolt, Laura Jobson, Sarah Curtis, Anupam B Kharbanda, Mark D Lyttle, Niccolò Parri, Rachel Stanley, Eva Alisic
AIM: To examine Australian and New Zealand emergency department (ED) staff's training, knowledge and confidence regarding trauma-informed care for children after trauma, and barriers to implementation. METHODS: ED staff's perspectives on trauma-informed care were assessed using a web-based self-report questionnaire. Participants included 468 ED staff (375 nursing and 111 medical staff) from hospitals in Australia and New Zealand. Data analyses included descriptive statistics, χ(2) tests and multiple regressions...
August 6, 2017: Journal of Paediatrics and Child Health
https://www.readbyqxmd.com/read/28756645/the-hii-score-a-novel-tool-to-assess-impairment-from-alcohol-in-emergency-department-patients
#4
J B Hack, E J Goldlust, D Ferrante, B Zink
BACKGROUND: Over 35 million alcohol impaired (AI) patients are cared for in Emergency Departments (EDs) annually. Emergency physicians are charged with ensuring AI patients' safety by identifying resolution of alcohol induced impairment. The most common standard evaluation is an extemporized clinical examination, as ethanol levels are not reliable or predictive of clinical symptoms. There is no standard assessment of ED AI patients. OBJECTIVE: To evaluate a novel standardized emergency department assessment of alcohol impairment - Hack's Impairment Index (HII score), in a busy urban Emergency Department...
July 30, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28750891/triaging-the-emergency-department-not-the-patient-united-states-emergency-nurses-experience-of-the-triage-process
#5
Lisa A Wolf, Altair M Delao, Cydne Perhats, Michael D Moon, Kathleen Evanovich Zavotsky
INTRODUCTION: Triage, as it is understood in the context of the emergency department, is the first and perhaps the most formal stage of the initial patient encounter. Bottlenecks during intake and long waiting room times have been linked to higher rates of patients leaving without being seen. The solution in many emergency departments has been to collect less information at triage or use an "immediate bedding" or "pull until full" approach, in which patients are placed in treatment areas as they become available without previous screening...
July 24, 2017: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
https://www.readbyqxmd.com/read/28711345/working-at-the-intersection-of-context-culture-and-technology-provider-perspectives-on-antimicrobial-stewardship-in-the-emergency-department-using-electronic-health-record-clinical-decision-support
#6
Phillip Chung, Jean Scandlyn, Peter S Dayan, Rakesh D Mistry
BACKGROUND: Antibiotic stewardship programs (ASPs) have not been fully developed for the emergency department (ED), in part the result of the barriers characteristic of this setting. Electronic health record-based clinical decision support (EHR CDS) represents a promising strategy to implement ASPs in the ED. We aimed to determine the cultural beliefs and structural barriers and facilitators to implementation of antimicrobial stewardship in the pediatric ED using EHR CDS. METHODS: Interviews and focus groups were conducted with hospital and ED leadership, attending ED physicians, nurse practitioners, physician assistants, and residents at a single health system in Colorado...
July 12, 2017: American Journal of Infection Control
https://www.readbyqxmd.com/read/28684078/falls-prevention-activities-among-community-dwelling-elderly-in-the-netherlands-a-delphi-study
#7
Branko F Olij, Vicki Erasmus, Judith I Kuiper, Frans van Zoest, Ed F van Beeck, Suzanne Polinder
INTRODUCTION: This study aimed to provide an overview of the current falls prevention activities in community-dwelling elderly with an increased risk of falling in the Netherlands. Therefore, we determined: a) how health professionals detect community-dwelling elderly with an increased risk of falling; b) which falls prevention activities are used by health professionals and why; c) how elderly can be stimulated to participate in falls prevention programs; and d) how to finance falls prevention...
June 24, 2017: Injury
https://www.readbyqxmd.com/read/28668663/prevalence-and-determinants-of-poor-food-intake-of-residents-living-in-long-term-care
#8
Heather H Keller, Natalie Carrier, Susan E Slaughter, Christina Lengyel, Catriona M Steele, Lisa Duizer, Jill Morrison, K Stephen Brown, Habib Chaudhury, Minn N Yoon, Alison M Duncan, Veronique Boscart, George Heckman, Lita Villalon
OBJECTIVE: Poor food intake is known to lead to malnutrition in long-term care homes (LTCH), yet multilevel determinants of food intake are not fully understood, hampering development of interventions that can maintain the nutritional status of residents. This study measures energy and protein intake of LTCH residents, describes prevalence of diverse covariates, and the association of covariates with food intake. DESIGN: Multisite cross-sectional study. SETTING: Thirty-two nursing homes from 4 provinces in Canada...
June 28, 2017: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/28557755/validation-of-new-quality-measures-for-transitions-between-sites-of-care
#9
Layla Parast, Q Burkhart, Arti D Desai, Tamara D Simon, Carolyn Allshouse, Maria T Britto, JoAnna K Leyenaar, Courtney A Gidengil, Sara L Toomey, Marc N Elliott, Eric C Schneider, Rita Mangione-Smith
BACKGROUND AND OBJECTIVE: Assessing and improving the quality of transitions to home from the emergency department (ED) or hospital is critical for patient safety. Our objective was to validate 8 newly developed caregiver-reported measures of transition quality. METHODS: This prospective observational study included 1086 caregiver survey respondents whose children had an ED visit (n = 523) or hospitalization (n = 563) at Seattle Children's Hospital in 2014. Caregivers were contacted to complete 2 surveys...
May 2017: Pediatrics
https://www.readbyqxmd.com/read/28539060/a-systematic-review-of-antimicrobial-stewardship-interventions-in-the-emergency-department
#10
Mia Losier, Tasha D Ramsey, Kyle John Wilby, Emily K Black
BACKGROUND/OBJECTIVE: To improve antimicrobial utilization, development and implementation of antimicrobial stewardship programs in the emergency department (ED) has been recommended. The primary objective of this review was to characterize antimicrobial stewardship (AMS) in the ED and to identify interventions that improve patient outcomes or process of care and/or reduce consequences of antimicrobial use. METHODS: This study was completed as a systematic review...
May 1, 2017: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/28437523/emergency-department-query-for-patient-centered-approaches-to-sexual-orientation-and-gender-identity-the-equality-study
#11
Adil H Haider, Eric B Schneider, Lisa M Kodadek, Rachel R Adler, Anju Ranjit, Maya Torain, Ryan Y Shields, Claire Snyder, Jeremiah D Schuur, Laura Vail, Danielle German, Susan Peterson, Brandyn D Lau
Importance: The Institute of Medicine and The Joint Commission recommend routine documentation of patients' sexual orientation in health care settings. Currently, very few health care systems collect these data since patient preferences and health care professionals' support regarding collection of data about patient sexual orientation are unknown. Objective: To identify the optimal patient-centered approach to collect sexual orientation data in the emergency department (ED) in the Emergency Department Query for Patient-Centered Approaches to Sexual Orientation and Gender Identity study...
June 1, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28435498/security-violent-events-and-anticipated-surge-capabilities-of-emergency-departments-in-washington-state
#12
Jonathan S Weyand, Emily Junck, Christopher S Kang, Jason D Heiner
INTRODUCTION: Over the past 15 years, violent threats and acts against hospital patients, staff, and providers have increased and escalated. The leading area for violence is the emergency department (ED) given its 24/7 operations, role in patient care, admissions gateway, and center for influxes during acute surge events. This investigation had three objectives: to assess the current security of Washington State EDs; to estimate the prevalence of and response to threats and violence in Washington State EDs; and to appraise the Washington State ED security capability to respond to acute influxes of patients, bystanders, and media during acute surge events...
April 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28401622/predicting-mortality-in-the-emergency-department-external-validation-and-derivation-of-a-clinical-prediction-tool
#13
Rajat N Moman, Caitlin E Loprinzi Brauer, Katherine M Kelsey, Rachel D Havyer, Christine M Lohse, M Fernanda Bellolio
BACKGROUND: The Choosing Wisely campaign has called for better engagement of palliative and hospice care services for patients in the emergency department (ED). PREDICT is a clinical prediction tool that was derived in an Australian ED cohort. It assesses a patient's risk of mortality at 1 year to select those who would benefit from advanced care planning. Such goals-of-care discussion can improve patients' ability to communicate what they want out of their healthcare and, in cases of end of life, potentially reduce the number of futile interventions...
July 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28350717/missed-fractures-in-infants-presenting-to-the-emergency-department-with-fussiness
#14
Jamie S Kondis, Jared Muenzer, Janet D Luhmann
OBJECTIVES: The aim of this study was to evaluate incidence of prior fussy emergency visits in infants with subsequently diagnosed fractures suggestive of abuse. METHODS: This was a retrospective chart review of infants younger than 6 months who presented to the pediatric emergency department (ED) between January 1, 2006, and December 31, 2011. Inclusion criteria included age 0 to 6 months, discharge diagnosis including "fracture," "broken" (or break), or "trauma" or any child abuse diagnosis or chief complaint of "fussy" or "crying" as documented in the electronic medical record by the triage nurse...
March 27, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28285863/low-dose-ketamine-use-in-the-emergency-department-a-new-direction-in-pain-management
#15
REVIEW
A Pourmand, M Mazer-Amirshahi, C Royall, R Alhawas, R Shesser
There is a need for alternative non-opioid analgesics for the treatment of acute, chronic, and refractory pain in the emergency department (ED). Ketamine is a fast acting N-methyl-d-aspartate (NMDA) receptor antagonist that provides safe and effective analgesia. The use of low dose ketamine (LDK) (<1mg/kg) provides sub-dissociative levels of analgesia and has been studied as an alternative and/or adjunct to opioid analgesics. We reviewed 11 studies using LDK either alone or in combination with opioid analgesics in the ED...
June 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28259482/accuracy-of-postresuscitation-team-debriefings-in-a-pediatric-emergency-department
#16
Paul C Mullan, Niall H Cochrane, James M Chamberlain, Randall S Burd, Fawn D Brown, Lauren E Zinns, Kristen M Crandall, Karen J O'Connell
STUDY OBJECTIVE: Guideline committees recommend postresuscitation debriefings to improve performance. "Hot" postresuscitation debriefings occur immediately after the event and rely on team recall. We assessed the ability of resuscitation teams to recall their performance in team-based, hot debriefings in a pediatric emergency department (ED), using video review as the criterion standard. We hypothesized that debriefing accuracy will improve during the course of the study. METHODS: Resuscitation physician and nurse leaders cofacilitated debriefings after ED resuscitations involving cardiopulmonary resuscitation (CPR) or intubation...
September 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28057048/a-preliminary-study-of-a-novel-emergency-department-nursing-triage-simulation-for-research-applications
#17
Steven L Dubovsky, Daniel Antonius, David G Ellis, Werner Ceusters, Robert C Sugarman, Renee Roberts, Sevie Kandifer, James Phillips, Elsa C Daurignac, Kenneth E Leonard, Lisa D Butler, Jessica P Castner, G Richard Braen
BACKGROUND: Studying the effect on functioning of the emergency department of disasters with a potential impact on staff members themselves usually involves table top and simulated patient exercises. Computerized virtual reality simulations have the potential to configure a variety of scenarios to determine likely staff responses and how to address them without intensive utilization of resources. To decide whether such studies are justified, we determined whether a novel computer simulation has the potential to serve as a valid and reliable model of on essential function in a busy ED...
January 3, 2017: BMC Research Notes
https://www.readbyqxmd.com/read/27932362/predicting-functional-decline-in-older-emergency-patients-the-safe-elderly-emergency-discharge-seed-project
#18
Judy A Lowthian, Lahn D Straney, Caroline A Brand, Anna Barker, P de Villiers Smit, Harvey Newnham, Peter Hunter, Cathie Smith, Peter A Cameron
Objective: to profile the trajectory of, and risk factors for, functional decline in older patients in the 30 days following Emergency Department (ED) discharge. Methods: prospective cohort study of community-dwelling patients aged ≥65 years, discharged home from a metropolitan Melbourne ED, 31 July 2012 to 30 November 2013. The primary outcome was functional decline, comprising either increased dependency in personal activities of daily living (ADL) or in skills required for living independently instrumental ADL (IADL), deterioration in cognitive function, nursing home admission or death...
March 1, 2017: Age and Ageing
https://www.readbyqxmd.com/read/27930356/impact-of-insurance-status-on-outcomes-and-use-of-rehabilitation-services-in-acute-ischemic-stroke-findings-from-get-with-the-guidelines-stroke
#19
Laura N Medford-Davis, Gregg C Fonarow, Deepak L Bhatt, Haolin Xu, Eric E Smith, Robert Suter, Eric D Peterson, Ying Xian, Roland A Matsouaka, Lee H Schwamm
BACKGROUND: Insurance status affects access to care, which may affect health outcomes. The objective was to determine whether patients without insurance or with government-sponsored insurance had worse quality of care or in-hospital outcomes in acute ischemic stroke. METHODS AND RESULTS: Multivariable logistic regressions with generalized estimating equations stratified by age under or at least 65 years were adjusted for patient demographics and comorbidities, presenting factors, and hospital characteristics to determine differences in in-hospital mortality and postdischarge destination...
November 14, 2016: Journal of the American Heart Association
https://www.readbyqxmd.com/read/27860022/shared-decision-making-with-vulnerable-populations-in-the-emergency-department
#20
Ana Castaneda-Guarderas, Jeffrey Glassberg, Corita R Grudzen, Ka Ming Ngai, Margaret E Samuels-Kalow, Erica Shelton, Stephen P Wall, Lynne D Richardson
The emergency department (ED) occupies a unique position within the healthcare system, serving as a safety net for vulnerable patients, regardless of their race, ethnicity, religion, country of origin, sexual orientation, socioeconomic status, or medical diagnosis. Shared decision making (SDM) presents special challenges when used with vulnerable population groups. The differing circumstances, needs, and perspectives of vulnerable groups invoke issues of provider bias, disrespect, judgmental attitudes, and lack of cultural competence, as well as patient mistrust and the consequences of their social and economic disenfranchisement...
December 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
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