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Length of stay pediatric emergency

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https://www.readbyqxmd.com/read/28092120/pediatric-peritonsillar-abscess-outcomes-and-cost-savings-from-using-transcervical-ultrasound
#1
Zhen Huang, William Vintzileos, Heather Gordish-Dressman, Anjum Bandarkar, Brian K Reilly
OBJECTIVES: 1) To analyze clinical outcomes of children stratified by ultrasound into three diagnoses: acute tonsillitis, peritonsillar phlegmon, and abscess; and 2) To compare clinical outcomes and financial impact between children who underwent ultrasound protocol to those who did not. STUDY DESIGN: Retrospective analysis between two cohorts: ultrasound protocol group and control group. METHODS: Children with peritonsillar abscess (PTA) diagnosed in the emergency department (ED) were enrolled during a 2-year period for transcervical ultrasound evaluation of bilateral tonsillar fossae...
January 16, 2017: Laryngoscope
https://www.readbyqxmd.com/read/28063721/point-of-care-lung-ultrasound-of-children-with-acute-asthma-exacerbations-in-the-pediatric-emergency-department
#2
Samantha Dankoff, Patricia Li, Adam J Shapiro, Terry Varshney, Alexander S Dubrovsky
OBJECTIVES: Primary objective was to characterize lung ultrasound findings in children with asthma presenting with respiratory distress to the emergency department (ED). Secondary objectives included correlating these findings with patients' clinical course in the ED. METHODS: Eligible patients 2-17years of age, underwent a lung ultrasound by the study sonographer between November 2014 to December 2015. Positive lung ultrasound was defined as the presence of ≥1 of the following findings: ≥3 B-lines per intercostal space, consolidation and/or pleural abnormalities...
December 26, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28029490/factors-influencing-drainage-setting-and-cost-for-cutaneous-abscesses-among-pediatric-patients
#3
Corrie E Chumpitazi, Chris A Rees, Elizabeth A Camp, Karina L Valdez, Benjamin Choi, Bruno P Chumpitazi, Faria Pereira
OBJECTIVE: To evaluate the clinical and microbiological factors associated with skin and soft tissue infections drained in the emergency department (ED) vs operative drainage (OD) in a tertiary care children's hospital. METHODS: This was a cross-sectional study among children aged 2 months to 17 years who required incision and drainage (I&D). Demographic information, signs and symptoms, abscess size and location, and wound culture/susceptibility were recorded. Patient-specific charges were collected from the billing database...
October 17, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28002386/should-grade-of-solid-organ-injury-determine-need-for-hospitalization-in-children
#4
Jillian Walsh, Pierre Schmit, Natalie Yanchar
BACKGROUND: Management of solid organ injuries (SOI) in children is often predicated on radiologic grade of injury. Hypothesizing that grade may not necessarily determine hospitalization need, we investigated factors associated with hospitalization in cases of isolated SOI in children. METHODS: Retrospective review of all cases admitted to one pediatric trauma centre over 10 yrs revealed 86 cases with SOI established by computed tomography (CT) scan upon admission...
January 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27940752/improving-guideline-based-care-of-acute-asthma-in-a-pediatric-emergency-department
#5
Matthew P Gray, Grant E Keeney, Michael J Grahl, Marc H Gorelick, Christopher D Spahr
BACKGROUND AND OBJECTIVE: Rapid repetitive administration of short-acting β-agonists (SABA) is the most effective means of reducing acute airflow obstruction in asthma. Little evidence exists that assesses process measures (ie, timeliness) and outcomes for asthma. We used quality improvement (QI) methods to improve emergency department care in accordance with national guidelines including timely SABA administration and use of asthma severity scores. METHODS: The Model for Improvement was used and interventions were targeted at 4 key drivers: knowledge, engagement, decision support, and workflow enhancement...
November 2016: Pediatrics
https://www.readbyqxmd.com/read/27940683/modification-of-an-established-pediatric-asthma-pathway-improves-evidence-based-efficient-care
#6
Lori Rutman, Robert C Atkins, Russell Migita, Jeffrey Foti, Suzanne Spencer, K Casey Lion, Davene R Wright, Michael G Leu, Chuan Zhou, Rita Mangione-Smith
OBJECTIVE: In September 2011, an established pediatric asthma pathway at a tertiary care children's hospital underwent significant revision. Modifications included simplification of the visual layout, addition of evidence-based recommendations regarding medication use, and implementation of standardized admission criteria. The objective of this study was to determine the impact of the modified asthma pathway on pathway adherence, percentage of patients receiving evidence-based care, length of stay, and cost...
December 2016: Pediatrics
https://www.readbyqxmd.com/read/27935745/does-abnormal-laboratory-results-notification-with-the-short-message-service-shorten-length-of-stay-in-the-pediatric-emergency-department-observation-unit
#7
Ibrahim Hakan Bucak, Habip Almis
BACKGROUND: A new age in communications began with the entry into use of cell phones and their applications. Cell phones and their various applications must be actively used in patient monitoring in the healthcare system. INTRODUCTION: The purpose of this study was to determine the length of stay in the pediatric emergency department observation unit (PEDOU) based upon the notification of abnormal laboratory results (ALRs) via the short message service (SMS). MATERIALS AND METHODS: Patients with ALRs notified through the SMS (April-May-June 2015: study period) were evaluated retrospectively, and those admitted to hospital after such notification were enrolled as the study group (SG)...
December 9, 2016: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
https://www.readbyqxmd.com/read/27933399/implementation-of-clinical-decision-support-in-young-children-with-acute-gastroenteritis-a-randomized-controlled-trial-at-the-emergency-department
#8
Dorien Geurts, Evelien de Vos-Kerkhof, Suzanne Polinder, Ewout Steyerberg, Johan van der Lei, Henriëtte Moll, Rianne Oostenbrink
: Acute gastroenteritis (AGE) is one of the most frequent reasons for young children to visit emergency departments (EDs). We aimed to evaluate (1) feasibility of a nurse-guided clinical decision support system for rehydration treatment in children with AGE and (2) the impact on diagnostics, treatment, and costs compared with usual care by attending physician. A randomized controlled trial was performed in 222 children, aged 1 month to 5 years at the ED of the Erasmus MC-Sophia Children's hospital in The Netherlands ( 2010-2012)...
February 2017: European Journal of Pediatrics
https://www.readbyqxmd.com/read/27918376/reduced-length-of-stay-and-adverse-events-using-bier-block-for-forearm-fracture-reduction-in-the-pediatric-emergency-department
#9
Emmanuelle Fauteux-Lamarre, Brett Burstein, Adam Cheng, Adam Bretholz
OBJECTIVES: Forearm fractures are among the most common pediatric injuries. Procedural sedation is frequently used for analgesia during fracture reduction but requires a prolonged recovery period and can be associated with adverse events. Bier block is a safe alternative for fracture reduction analgesia. This study sought to compare Bier block and procedural sedation for forearm fracture reduction. METHODS: We performed a retrospective study of patients aged 6 to 18 years, presenting with forearm fractures requiring closed reduction from June 2012 to March 2014...
January 1, 2016: Pediatric Emergency Care
https://www.readbyqxmd.com/read/27902671/prehospital-transport-for-pediatric-trauma-a-comparison-of-private-transport-and-emergency-medical-services
#10
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
#11
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
#12
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
#13
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
#14
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
#15
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
#16
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...
December 2016: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/27679958/effect-of-fireworks-laws-on-pediatric-fireworks-related-burn-injuries
#17
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...
January 2017: 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
#18
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
#19
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
#20
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
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