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https://www.readbyqxmd.com/read/29759261/deriving-a-framework-for-a-systems-approach-to-agitated-patient-care-in-the-emergency-department
#1
Ambrose H Wong, Halley Ruppel, Lauren J Crispino, Alana Rosenberg, Joanne D Iennaco, Federico E Vaca
BACKGROUND: The rising agitated patient population presenting to the emergency department (ED) has caused increasing safety threats for health care workers and patients. Development of evidence-based strategies has been limited by the lack of a structured framework to examine agitated patient care in the ED. In this study, a systems approach from the patient safety literature was used to derive a comprehensive theoretical framework for addressing ED patient agitation. METHODS: A mixed-methods approach was used with ED staff members at an academic site and a community site of a regional health care network...
May 2018: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/29754670/knowledge-to-action-rationale-and-design-of-the-patient-centered-care-transitions-in-heart-failure-pact-hf-stepped-wedge-cluster-randomized-trial
#2
Harriette G C Van Spall, Shun Fu Lee, Feng Xie, Dennis T Ko, Lehana Thabane, Quazi Ibrahim, Peter R Mitoff, Michael Heffernan, Manish Maingi, Michael C Tjandrawidjaja, Mohammad I Zia, Mohamed Panju, Richard Perez, Kim D Simek, Liane Porepa, Ian D Graham, R Brian Haynes, Dilys Haughton, Stuart J Connolly
INTRODUCTION: Heart Failure (HF) is a common cause of hospitalization in older adults. The transition from hospital to home is high-risk, and gaps in transitional care can increase the risk of re-hospitalization and death. Combining health care services supported by meta-analyses, we designed the PACT-HF transitional care model. METHODS: Adopting an integrated Knowledge Translation (iKT) approach in which decision-makers and clinicians are partners in research, we implement and test the effectiveness of PACT-HF among patients hospitalized for HF...
May 2018: American Heart Journal
https://www.readbyqxmd.com/read/29742626/delta-alert-expanding-gerotrauma-criteria-to-improve-patient-outcomes-a-2-year-study
#3
Lynn L Wiles, Mark D Day
BACKGROUND/SIGNIFICANCE: Because of their decreased physical reserve and increased risk of complications, the geriatric trauma patient (GTP) population warrants heightened awareness by clinical staff. PURPOSE: The purpose of this study is to determine whether the institution of a third-tier trauma protocol results in a change in GTP outcomes, complications, and mortality rates. METHODS: Researchers conducted a retrospective review of 2 years of data from the trauma registry, hospital quality improvement audits, and patient charts to examine what, if any, patient outcomes were impacted by the institution of the expanded GTP protocol...
May 2018: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
https://www.readbyqxmd.com/read/29698339/disparities-in-adherence-to-pediatric-diabetic-ketoacidosis-management-guidelines-across-a-spectrum-of-emergency-departments-in-the-state-of-indiana-an-observational-in-situ-simulation-based-study
#4
Kamal Abulebda, Samer Abu-Sultaneh, Erin E White, Michele L Kirby, Brian C Phillips, Courtney T Frye, Lee D Murphy, Riad Lutfi
BACKGROUND: Diabetic ketoacidosis (DKA) is a common presentation to an emergency department (ED), with the majority presenting to community EDs. Adherence to clinical guidelines in these EDs can reduce morbidity and mortality. Few methods to describe practice gaps for DKA management have been reported. OBJECTIVES: We hypothesized that high-fidelity in situ simulation can be used to measure and compare the quality of the care provided to pediatric patients with DKA presenting to community EDs in the state of Indiana...
April 24, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29664893/occupational-exposure-during-emergency-department-thoracotomy-a-prospective-multi-institution-study
#5
Andrew Nunn, Priya Prakash, Kenji Inaba, Alvarez Escalante, Zoë Maher, Seiji Yamaguchi, Dennis Y Kim, James Maciel, William C Chiu, Byron Drumheller, Joshua P Hazelton, Kaushik Mukherjee, Xian Luo-Owen, Rachel M Nygaard, Ashley P Marek, Bryan C Morse, Caitlin A Fitzgerald, Patrick L Bosarge, Randeep S Jawa, Susan E Rowell, Louis J Magnotti, Adrian W Ong, Tejal S Brahmbhatt, Michael D Grossman, Mark J Seamon
BACKGROUND: Occupational exposure is an important consideration during emergency department thoracotomy (EDT). While HIV/hepatitis prevalence in trauma patients (0-16.8%) and occupational exposure rates during operative trauma procedures (1.9-18.0%) have been reported, exposure risk during EDT is unknown. We hypothesized that occupational exposure risk during EDT would be greater than other operative trauma procedures. METHODS: A prospective, observational study at 16 US trauma centers was performed (2015-2016)...
April 16, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29664889/transfer-status-a-significant-risk-factor-for-mortality-in-emergency-general-surgery-patients-requiring-colon-resection
#6
Michael P DeWane, Kimberly A Davis, Kevin M Schuster, Scott P Erwin, Adrian A Maung, Robert D Becher
BACKGROUND: Patients requiring emergency surgery have increased rates of morbidity and mortality. Transfer from outside institution delays effective control of ongoing infection and has been linked with worse outcomes. Previous research suggests transfer status negatively impacts survival but hasn't examined the effect of location and type of institution prior to transfer. This study aims to characterize the effect of type of transferring institution on postoperative outcomes after emergency colon surgery...
April 16, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29652592/development-of-the-emergency-department-senior-abuse-identification-ed-senior-aid-tool
#7
Timothy F Platts-Mills, Joseph A Dayaa, Bryce B Reeve, Kayla Krajick, Laura Mosqueda, Jason S Haukoos, Mehul D Patel, Carrie F Mulford, Samuel A McLean, Phil D Sloane, Debbie Travers, Sheryl Zimmerman
Emergency departments (EDs) are an important health care setting for the identification of elder abuse (EA). Our objective was to develop an ED-based tool to identify EA. The initial tool included a brief cognitive assessment, questions to detect multiple domains of EA, and a physical examination. Refinement of the tool was based on input from clinical experts and nurse and patient feedback. The revised tool, which included 15 questions about EA, was then tested in an academic ED. We calculated the inter-rater reliability, sensitivity, and specificity of individual EA questions...
April 13, 2018: Journal of Elder Abuse & Neglect
https://www.readbyqxmd.com/read/29613919/addressing-dual-patient-and-staff-safety-through-a-team-based-standardized-patient-simulation-for-agitation-management-in-the-emergency-department
#8
Ambrose H Wong, Marc A Auerbach, Halley Ruppel, Lauren J Crispino, Alana Rosenberg, Joanne D Iennaco, Federico E Vaca
INTRODUCTION: Emergency departments (EDs) have seen harm rise for both patients and health workers from an increasing rate of agitation events. Team effectiveness during care of this population is particularly challenging because fear of physical harm leads to competing interests. Simulation is frequently employed to improve teamwork in medical resuscitations but has not yet been reported to address team-based behavioral emergency care. As part of a larger investigation of agitated patient care, we designed this secondary study to examine the impact of an interprofessional standardized patient simulation for ED agitation management...
April 3, 2018: Simulation in Healthcare: Journal of the Society for Simulation in Healthcare
https://www.readbyqxmd.com/read/29502904/assessing-for-occult-suicidality-at-triage-experiences-of-emergency-nurses
#9
Lisa A Wolf, Cydne Perhats, Altair M Delao, Paul R Clark, Michael D Moon, Kathleen Evanovich Zavotsky
INTRODUCTION: Screening for suicidality is a critical nursing function at the initial ED encounter. Suicide is the tenth leading cause of death in the United States, and a substantial percentage of people who die by suicide present for health care in the year before their deaths. The emergency department provides health care professionals with a critical opportunity to identify patients at risk for suicide and intervene appropriately. METHODS: Qualitative exploratory study using focus-group data...
March 1, 2018: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
https://www.readbyqxmd.com/read/29476798/prevalence-of-dyspnea-among-hospitalized-patients-at-the-time-of-admission
#10
Jennifer P Stevens, Tenzin Dechen, Richard Schwartzstein, Carl O'Donnell, Kathy Baker, Michael D Howell, Robert B Banzett
CONTEXT: Dyspnea is an uncomfortable and distressing sensation experienced by hospitalized patients. OBJECTIVES: There is no large-scale study of the prevalence and intensity of patient-reported dyspnea at the time of admission to the hospital. METHODS: Between March 2014 and September 2016, we conducted a prospective cohort study among all consecutive hospitalized patients at a single tertiary care center in Boston, MA. During the first 12 hours of admission to medical-surgical and obstetric units, nurses at our institution routinely collect a patient's (1) current level of dyspnea on a 0-10 scale with 10 anchored at "unbearable", (2) worst dyspnea in the past 24 hours prior to arrival at the hospital on the same 0-10 scale, and (3) what activities were associated with dyspnea prior to admission...
February 21, 2018: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/29429847/the-impact-of-geriatric-focused-nurse-assessment-and-intervention-in-the-emergency-department-a-systematic-review
#11
REVIEW
M Malik, Z Moore, D Patton, T O'Connor, L E Nugent
BACKGROUND: Nursing assessment of elderly patients is imperative in Emergency Departments (ED) while providing interventions that increase independence facilitating discharge to primary healthcare. AIMS: To systematically review the impact of geriatric focused nurse assessment and intervention in the ED on hospital utilisation in terms of admission rate, ED revisits and length of hospital stay (LOHS). METHODS: Search strategy used following databases; Cochrane, Medline, CINAHL, Embase, Scopus and Web of Knowledge; And terms; geriatric nurse assessment, nurse discharge planning, geriatric nurse specialist, nurse intervention, emergency department, accident and emergency, patient outcomes, discharge, admissions, readmissions, hospital utilization, hospitalization, length of stay/hospital stay...
March 2018: International Emergency Nursing
https://www.readbyqxmd.com/read/29406472/novel-approach-to-emergency-departments-pediatric-readiness-across-a-health-system
#12
Isabel A Barata, Joriane M Stadnyck, Meredith Akerman, Kate OʼNeill, Jill Castaneda, Anupama Subramony, Paula Fessler, Charles Schleien, John DʼAngelo
STUDY OBJECTIVE: A gap analysis of emergency departments' (EDs') pediatric readiness across a health system was performed after the appointment of a service line health system pediatric emergency medicine (PEM) quality director. METHODS: A 55-question survey was completed by each eligible ED to generate a weighted pediatric readiness score (WPRS). The survey included questions regarding volume, ED configuration, presence of a pediatric emergency care coordinator (PECC), quality initiatives, policies and procedures, and equipment...
February 5, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29383079/interprofessional-emergency-training-leads-to-changes-in-the-workplace
#13
Dorothea Eisenmann, Fabian Stroben, Jan D Gerken, Aristomenis K Exadaktylos, Mareen Machner, Wolf E Hautz
Introduction: Preventable mistakes occur frequently and can lead to patient harm and death. The emergency department (ED) is notoriously prone to such errors, and evidence suggests that improving teamwork is a key aspect to reduce the rate of error in acute care settings. Only a few strategies are in place to train team skills and communication in interprofessional situations. Our goal was to conceptualize, implement, and evaluate a training module for students of three professions involved in emergency care...
January 2018: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29383066/do-end-of-rotation-and-end-of-shift-assessments-inform-clinical-competency-committees-ccc-decisions
#14
Linda Regan, Leslie Cope, Rodney Omron, Leah Bright, Jamil D Bayram
Introduction: Clinical Competency Committees (CCC) require reliable, objective data to inform decisions regarding assignment of milestone proficiency levels, which must be reported to the Accreditation Council for Graduate Medical Education. After the development of two new assessment methods, the end-of-shift (EOS) assessment and the end-of-rotation (EOR) assessment, we sought to evaluate their performance. We report data on the concordance between these assessments, as well as how each informs the final proficiency level determined in biannual CCC meetings...
January 2018: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29371045/pediatric-emergency-department-triage-based-pain-guideline-utilizing-intranasal-fentanyl-effect-of-implementation
#15
Kristin Schoolman-Anderson, Roni D Lane, Jeff E Schunk, Nancy Mecham, Richard Thomas, Kathleen Adelgais
BACKGROUND: Pain management guidelines in the emergency department (ED) may reduce time to analgesia administration (TTA). Intranasal fentanyl (INF) is a safe and effective alternative to intravenous opiates. The effect of an ED pain management guideline providing standing orders for nurse-initiated administration of intranasal fentanyl (INF) is not known. The objective of this study was to determine the impact of a pediatric ED triage-based pain protocol utilizing intranasal fentanyl (INF) on time to analgesia administration (TTA) and patient and parent satisfaction...
January 16, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29371005/perception-and-practice-among-emergency-medicine-health-care-providers-regarding-discharging-patients-after-opioid-administration
#16
Ryan M Surmaitis, Alexandra Amaducci, Kathryn Henry, Michael Jong, Emily A Kiernan, Hope Kincaid, Lindsay J Houck, Sandra J Sabbatini, Marna Rayl Greenberg, Kenneth D Katz
PURPOSE: This study aimed to determine the current attitudes, perceptions, and practices of emergency medicine providers and nurses (RNs) regarding the discharge of adult patients from the emergency department (ED) after administration of opioid analgesics. METHODS: A cross-sectional survey was administered at 3 hospital sites with a combined annual ED census of >180,000 visits per year. All 59 attending emergency physicians (EPs), 233 RNs, and 23 advanced practice clinicians (APCs) who worked at these sites were eligible to participate...
February 2018: Clinical Therapeutics
https://www.readbyqxmd.com/read/29318583/geriatric-emergency-department-innovations-transitional-care-nurses-and-hospital-use
#17
Ula Hwang, Scott M Dresden, Mark S Rosenberg, Melissa M Garrido, George Loo, Jeremy Sze, Stephanie Gravenor, D Mark Courtney, Raymond Kang, Carolyn W Zhu, Carmen Vargas-Torres, Corita R Grudzen, Lynne D Richardson
OBJECTIVES: To examine the effect of an emergency department (ED)-based transitional care nurse (TCN) on hospital use. DESIGN: Prospective observational cohort. SETTING: Three U.S. (NY, IL, NJ) EDs from January 1, 2013, to June 30, 2015. PARTICIPANTS: Individuals aged 65 and older in the ED (N = 57,287). INTERVENTION: The intervention was first TCN contact. Controls never saw a TCN during the study period...
March 2018: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/29219828/improving-care-for-older-patients-in-the-acute-setting-a-qualitative-study-with-healthcare-providers
#18
C Brouwers, H Merten, M Willems, D J Habraken, F W Bloemers, T H Biesheuvel, L S van Galen, P W B Nanayakkara, C Wagner
BACKGROUND: The proportion of older people needing acute care is rapidly growing, thereby posing an increased burden on the acute care chain. The aim of this study is to gain more insight into the obstacles and potential improvement opportunities of the acute care process for older patients arriving at the hospital. METHODS: Semi-structured interviews were conducted to determine the experiences of 18 different primary (i.e. general practitioner, community nurse) and secondary healthcare professionals (i...
October 2017: Netherlands Journal of Medicine
https://www.readbyqxmd.com/read/29214627/a-12-month-descriptive-analysis-of-emergency-intubations-at-brooke-army-medical-center-a-national-emergency-airway-registry-study
#19
Michael D April, Steven G Schauer, Calvin A Brown Rd, Patrick C Ng, Jessie Fernandez, Andrea E Fantegrossi, Joseph K Maddry, Shane Summers, Daniel J Sessions, Robert M Barnwell, Mark Antonacci
Emergency airway management is a critical skill for military healthcare providers. Our goal was to describe the Emergency Department (ED) intubations at Brooke Army Medical Center (BAMC) over a 12-month period. MATERIAL AND METHODS: Physicians performing endotracheal intubations in the BAMC ED complete data collection forms for each intubation event as part of the National Emergency Airway Registry, including patient demographics, intubation techniques, success and failure rates, adverse events, and patient disposition...
October 2017: U.S. Army Medical Department Journal
https://www.readbyqxmd.com/read/29190172/implementation-of-a-real-world-school-based-asthma-therapy-program-targeting-urban-children-with-poorly-controlled-asthma
#20
Elizabeth D Allen, Kimberly Arcoleo, Courtney Rowe, William W Long
OBJECTIVE: Describe implementation and clinical impact of a "real world" School-Based Asthma Therapy (SBAT) Program serving an urban, largely Medicaid population in a large midwestern city in the United States. METHODS: A retrospective, descriptive evaluation of SBAT was conducted. Students were referred by school nurses or providers, enrolled throughout the year, and could reenroll in subsequent years. A total of 286 students participated in the 2015-2016 school year...
November 30, 2017: Journal of Asthma: Official Journal of the Association for the Care of Asthma
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