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Length of stay pediatric emergency

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https://www.readbyqxmd.com/read/27902671/prehospital-transport-for-pediatric-trauma-a-comparison-of-private-transport-and-emergency-medical-services
#1
Yea-Chyi Lin, York Tien Lee, Jasmine Xun Yi Feng, Li Wei Chiang, Shireen Anne Nah
OBJECTIVES: We describe the demographics of pediatric patients with trauma transferred using private transport (PT) versus emergency medical services (EMS) and evaluate the potential impact on their treatment and outcome. METHODS: We accessed data from our national trauma registry, a prospectively collected database. Data were extracted on all patients with trauma admitted to our institution between January 2011 and June 2013, with injury severity score (ISS) higher than 8...
November 29, 2016: Pediatric Emergency Care
https://www.readbyqxmd.com/read/27873234/eeg-monitoring-and-antiepileptic-drugs-in-children-with-severe-tbi
#2
Christopher M Ruzas, Peter E DeWitt, Kimberly S Bennett, Kevin E Chapman, Nicole Harlaar, Tellen D Bennett
BACKGROUND: Traumatic brain injury (TBI) causes substantial morbidity and mortality in US children. Post-traumatic seizures (PTS) occur in 11-42% of children with severe TBI and are associated with unfavorable outcome. Electroencephalographic (EEG) monitoring may be used to detect PTS and antiepileptic drugs (AEDs) may be used to treat PTS, but national rates of EEG and AED use are not known. The purpose of this study was to describe the frequency and timing of EEG and AED use in children hospitalized after severe TBI...
November 21, 2016: Neurocritical Care
https://www.readbyqxmd.com/read/27856140/impact-of-scribes-on-emergency-department-patient-throughput-one-year-after-implementation
#3
Heather A Heaton, David M Nestler, Christine M Lohse, Annie T Sadosty
OBJECTIVES: Assess the impact of scribes on an academic emergency department's (ED) throughput one year after implementation. METHODS: A prospective cohort design compared throughput metrics of patients managed when scribes were and were not a part of the treatment team during pre-defined study hours in a tertiary academic ED with both an adult and pediatric ED. An alternating-day pattern one year following scribe implementation ensured balance between the scribe and non-scribe groups in time of day, day of week, and patient complexity...
November 5, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27811579/a-comprehensive-approach-to-pediatric-pneumonia-relationship-between-standardization-antimicrobial-stewardship-clinical-testing-and-cost
#4
Lori Rutman, Davene R Wright, James OʼCallaghan, Suzanne Spencer, K Casey Lion, Matthew P Kronman, Chuan Zhou, Rita Mangione-Smith
OBJECTIVE: In September 2012, our institution implemented an emergency department (ED) and inpatient pathway for community-acquired pneumonia (CAP) based on national guideline recommendations. The objective of this study was to determine the relationship between standardizing ED and inpatient care for CAP and antimicrobial stewardship, clinical testing, and cost. METHODS: We used descriptive statistics, statistical process control, and interrupted time series analysis to analyze measures 12 months before and after implementation...
November 1, 2016: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/27779964/intraosseous-infusion-as-a-bridge-to-definitive-access
#5
Megan Johnson, Kenji Inaba, Saskya Byerly, Erika Falsgraf, Lydia Lam, Elizabeth Benjamin, Aaron Strumwasser, Jean-Stephane David, Demetrios Demetriades
Intraosseous (IO) needle placement is an alternative for patients with difficult venous access. The purpose of this retrospective study was to examine indications and outcomes associated with IO use at a Level 1 trauma center (January 2008-May 2015). Data points included demographics, time to insertion, intravenous (IV) access points, indications, infusions, hospital and intensive care unit length of stay, and mortality. Of 68 patients with IO insertion analyzed (63.2% blunt trauma, 29.4% penetrating trauma, and 7...
October 2016: American Surgeon
https://www.readbyqxmd.com/read/27747549/anticipated-resource-utilization-for-injury-versus-non-injury-pediatric-visits-to-emergency-departments
#6
Mark R Zonfrillo, Michelle L Macy, Lawrence J Cook, Tomohiko Funai, Rachel M Stanley, James M Chamberlain, Rebecca M Cunningham, Elizabeth R Alpern
BACKGROUND: Childhood injuries are increasingly treated in emergency departments (EDs) but the relationship between injury severity and ED resource utilization has not been evaluated. The objective of this study was to compare resource utilization for pediatric injury-related ED visits across injury-severity levels and with non-injury visits, using standardized, validated scales. METHODS: A retrospective analysis of 2004-2008 ED visits from the Pediatric Emergency Care Applied Research Network Core Data Project...
December 2016: Injury Epidemiology
https://www.readbyqxmd.com/read/27697316/time-driven-activity-based-costing-to-identify-opportunities-for-cost-reduction-in-pediatric-appendectomy
#7
Yangyang R Yu, Paulette I Abbas, Carolyn M Smith, Kathleen E Carberry, Hui Ren, Binita Patel, Jed G Nuchtern, Monica E Lopez
PURPOSE: As reimbursement programs shift to value-based payment models emphasizing quality and efficient healthcare delivery, there exists a need to better understand process management to unearth true costs of patient care. We sought to identify cost-reduction opportunities in simple appendicitis management by applying a time-driven activity-based costing (TDABC) methodology to this high-volume surgical condition. METHODS: Process maps were created using medical record time stamps...
September 15, 2016: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/27679958/effect-of-fireworks-laws-on-pediatric-fireworks-related-burn-injuries
#8
John Myers, Carlee Lehna
Changes in U.S. fireworks laws have allowed younger children to purchase fireworks. In addition, the changes have allowed individuals to purchase more powerful fireworks. The purpose of this study is to examine the epidemiology of pediatric firework-related burn injuries among a nationally representative sample of the United States for the years 2006 to 2012. We examined inpatient admissions for pediatric firework-related burn patients from 2006 to 2012 using the nationwide inpatient sample and examined emergency department admissions using the nationwide emergency department sample...
September 20, 2016: Journal of Burn Care & Research: Official Publication of the American Burn Association
https://www.readbyqxmd.com/read/27668922/system-stresses-in-2-pediatric-emergency-departments-and-2-pediatric-urgent-care-centers-during-the-2014-enterovirus-d68-outbreak
#9
Gregory P Conners, Stacy J Doyle, Milton A Fowler, Lisa L Schroeder, Thomas W Tryon
OBJECTIVE: To describe the association of an unprecedented large-scale Enterovirus-D68 outbreak in 2014 with changes in patient volume and acuity and system stress in 2 pediatric emergency departments and 2 pediatric urgent care centers of a single children's hospital. METHODS: We compared measures of patient volume, acuity, and system stress during the 2014 Enterovirus-D68 outbreak and the corresponding dates of the previous year. RESULTS: Both settings experienced large census increases during the Enterovirus-D68 outbreak; patient census increased significantly more in the pediatric urgent care setting (20...
September 23, 2016: Pediatric Emergency Care
https://www.readbyqxmd.com/read/27668915/the-impact-of-mental-health-services-in-a-pediatric-emergency-department-the-implications-of-having-trained-psychiatric-professionals
#10
Sharon M Holder, Kenneth Rogers, Eunice Peterson, Robbie Shoenleben, Dawn Blackhurst
OBJECTIVES: This study assessed improvement in the emergency department (ED) length of stay and costs after implementation of an ED program which added board-certified psychiatrists and trained psychiatric social workers to the pediatric ED. METHODS: A retrospective medical record and administrative data review were conducted for all pediatric psychiatric visits of children aged 5 to 18 years who were seen and discharged from the Greenville Memorial Hospital ED between January 1, 2007, and June 31, 2013...
September 23, 2016: Pediatric Emergency Care
https://www.readbyqxmd.com/read/27662389/effects-of-antibiotic-timing-on-culture-results-and-clinical-outcomes-in-pediatric-musculoskeletal-infection
#11
Michael A Benvenuti, Thomas J An, Megan E Mignemi, Jeffrey E Martus, Isaac P Thomsen, Jonathan G Schoenecker
INTRODUCTION: Musculoskeletal infection (MSI) is a common cause of morbidity and hospital resource utilization in the pediatric population. Many physicians prefer to withhold antibiotics until tissue cultures can be taken in an effort to improve culture yields. However, there is little evidence that this practice improves culture results or outcomes in pediatric MSI. Therefore, investigating the effects of antibiotic timing may lead to improved clinical practice guidelines for treating children with MSI...
September 22, 2016: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/27649041/implementation-of-a-clinical-pathway-for-chest-pain-in-a-pediatric-emergency-department
#12
Shaun Mohan, Deipanjan Nandi, Paul Stephens, Mirna MʼFarrej, R Lee Vogel, Christopher P Bonafide
OBJECTIVE: To evaluate the impact of a pediatric emergency department (ED) chest pain clinical pathway on resource utilization. METHODS: Motivated by perceived overuse of cardiology consultation for non-cardiac chest pain in the ED, clinicians from the Divisions of Cardiology and Emergency Medicine collaboratively developed a chest pain clinical pathway, educated staff, and implemented the pathway on March 1, 2014. We reviewed records of children aged 3 to 18 years without prior diagnoses of heart disease who presented to the ED with chest pain between March 1, 2013, and April 22, 2015...
September 20, 2016: Pediatric Emergency Care
https://www.readbyqxmd.com/read/27643455/elective-cholecystectomy-reduces-morbidity-of-cholelithiasis-in-pediatric-sickle-cell-disease
#13
Emily F Goodwin, Paige I Partain, Jeffrey D Lebensburger, Naomi S Fineberg, Thomas H Howard
BACKGROUND: Cholelithiasis is a frequent complication in pediatric sickle cell disease (SCD). Though it is standard practice to perform a cholecystectomy in pediatric SCD patients with symptoms of cholelithiasis, the use of elective cholecystectomy for asymptomatic patients remains controversial. PROCEDURE: Records of 191 pediatric sickle cell patients with cholelithiasis who underwent cholecystectomy were retrospectively reviewed. Patients classified as follows: (i) elective-no preoperative symptoms, cholelithiasis on screening ultrasound, comprehensive preoperative plan; (ii) symptomatic-preoperative symptoms of cholelithiasis on diagnostic ultrasound, comprehensive preoperative plan; or (iii) emergent-hospitalization for acute cholecystitis symptoms, cholelithiasis on diagnostic ultrasound, limited preoperative preparation...
September 19, 2016: Pediatric Blood & Cancer
https://www.readbyqxmd.com/read/27637444/emergent-interhospital-transport-of-pediatric-patient-with-a-berlin-heart-device
#14
James H Hertzog, Thomas E Pearson, Marc A Priest, Ellen Spurrier, Ryan R Davies
Ventricular assist devices (VADs) for the mechanical support of cardiac failure are being used more frequently in children of increasingly younger age. These children have significant and multiple medical comorbidities, and their length of hospital stay has been increasing. As this population of hospitalized VAD-supported children increases, so does the possibility of their need for interfacility transport for specialized diagnostic or therapeutic procedures. Reports on such transports are limited to 3 children who underwent scheduled elective transfers...
September 2016: Air Medical Journal
https://www.readbyqxmd.com/read/27630456/prevalence-and-risk-factors-of-pneumothorax-among-patients-admitted-to-a-pediatric-intensive-care-unit
#15
Ahmed Ahmed El-Nawawy, Amina Sedky Al-Halawany, Manal Abdelmalik Antonios, Reem Gamal Newegy
OBJECTIVE: Pneumothorax should be considered a medical emergency and requires a high index of suspicion and prompt recognition and intervention. AIMS: The objective of the study was to evaluate cases developing pneumothorax following admission to a Pediatric Intensive Care Unit (PICU) over a 5-year period. SETTINGS AND DESIGN: Case notes of all PICU patients (n = 1298) were reviewed, revealing that 135 cases (10.4%) developed pneumothorax, and these were compared with those patients who did not...
August 2016: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/27604184/high-reliability-pediatric-septic-shock-quality-improvement-initiative-and-decreasing-mortality
#16
Roni D Lane, Tomohiko Funai, Ron Reeder, Gitte Y Larsen
BACKGROUND AND OBJECTIVE: Septic shock impacts mortality, morbidity, and health care costs. A quality improvement (QI) initiative was launched to improve early recognition and timely treatment of patients with septic shock in a pediatric emergency department (PED). Our primary aim was to describe the longitudinal effectiveness of the program, iterative changes in clinical practice, and associated outcomes. METHODS: We implemented multiple interventions during our QI initiative (February 2007 to December 2014)...
September 7, 2016: Pediatrics
https://www.readbyqxmd.com/read/27585125/development-of-a-model-to-measure-emergency-department-staffing-limitations
#17
Kenneth A Michelson, Anne M Stack, Richard G Bachur
BACKGROUND: The optimal staffing model for emergency departments (EDs) is not known. Improving staffing could lead to more timely, efficient, and effective care. We created a model of staffing to identify times of staffing limitation by provider type. METHODS: We analyzed data from an academic pediatric ED with 60,000 visits per year. Each 10-minute interval from January 1, 2011, through December 31, 2012, was categorized as nonlimited (no staffing limitation), space limited (≥2 patients in the waiting room with wait times > 30 minutes and ≥ 80% ED bed occupancy), nurse limited (≥2 patients in the waiting room with wait times > 30 min and < 80% ED bed occupancy), or physician limited (≥2 patients in examination rooms who have waited > 30 minutes for a physician) using computer modeling...
September 2016: Pediatric Emergency Care
https://www.readbyqxmd.com/read/27547282/geospatial-and-clinical-analyses-on-pediatric-related-road-traffic-injury-in-malaysia
#18
Nik Hisamuddin Rahman, Ruslan Rainis, Syed Hatim Noor, Sharifah Mastura Syed Mohamad
BACKGROUND: The main aim of this study is to utilize the geographical information system (GIS) software and perform the spatial analysis in relation to clinical data for road traffic injury (RTI) pediatric cases attending the emergency department. METHODS: The study sample included pediatric patients (age less than 18 years) with road-related injuries within a district in Malaysia who attended emergency departments of two tertiary hospitals within the district. In addition to injury, pre-hospital care and outcome data, the coordinate of the locations were obtained by the ambulance paramedics by using portable handheld GPS unit brand Garmin(®) model GPS 72 H...
2016: World Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27506243/a-cost-analysis-of-salbutamol-administration-by-metered-dose-inhalers-with-spacers-versus-nebulization-for-patients-with-wheeze-in-the-pediatric-emergency-department-evidence-from-observational-data-in-nova-scotia
#19
Paul Spin, Ingrid Sketris, Barbara Hill-Taylor, Courtney Ward, Katrina F Hurley
BACKGROUND: Despite evidence demonstrating the advantages of metered-dose inhalers with spacers (MDI-s), nebulization (NEB) remains the primary method of asthma treatment in some pediatric emergency departments (PEDs). There is a perception that delivering salbutamol by MDI-s is more costly than by NEB. This research evaluates the relative costs of MDI-s and NEB using local, hospital-specific, patient-level data. METHODS: Regression models estimated associations between the salbutamol inhalation method and costs, length of stay (LOS) in the PED and hospital, and the probability of admission...
August 10, 2016: CJEM
https://www.readbyqxmd.com/read/27500722/treatment-of-pediatric-septic-shock-with-the-surviving-sepsis-campaign-guidelines-and-picu-patient-outcomes
#20
Jennifer K Workman, Stefanie G Ames, Ron W Reeder, E Kent Korgenski, Susan M Masotti, Susan L Bratton, Gitte Y Larsen
OBJECTIVES: The Surviving Sepsis Campaign recommends rapid recognition and treatment of severe sepsis and septic shock. Few reports have evaluated the impact of these recommendations in pediatrics. We sought to determine if outcomes in patients who received initial care compliant with the Surviving Sepsis Campaign time goals differed from those treated more slowly. DESIGN: Single center retrospective cohort study. SETTING: Emergency department and PICU at an academic children's hospital...
October 2016: Pediatric Critical Care Medicine
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