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Laboratory length of stay emergency pediatric

Youwei Li, Qunfeng Lu, Hua Du, Jianping Zhang, Lingling Zhang
OBJECTIVE: To identify the need to revise the program triage nurse-ordered diagnostic tests in the emergency department (ED) of pediatric hospital, and to evaluate implementation of this program with three laboratory routine tests, namely blood, urine and stool, which the triage nurses ordered as relevant to pediatric patients' symptoms. METHODS: The authors retrospectively reviewed the data of patients who registered in their ED between December 2015 and April 2016, including the tests as per the orders by triage nurses, and the time they arrived and the time they had their final payments...
January 24, 2018: Indian Journal of Pediatrics
Courtney E Nelson, Svetlana Ostapenko, Joseph J Zorc, Fran Balamuth
This retrospective cohort study aimed to describe antipyretic use among healthy patients in a pediatric emergency department (ED) with nonurgent fever defined as: triage level 4 or 5, chief complaint fever or temperature 38°C to 39°C, and otherwise normal vital signs, and determine if antipyretic administration is associated with increased ED length of stay (LOS). We compared continuous variables using Kruskal-Wallis and Wilcoxon rank sum testing. We adjusted confounding variables using logistic regression modeling...
October 1, 2017: Clinical Pediatrics
Kelsey Caffy, Tamekia L Jones, Barry G Gilmore
OBJECTIVES: Psychiatric pediatric emergency department (PED) visits are associated with extended length of stay (LOS) compared with nonpsychiatric visits. To address delays in definitive care, our PED incorporated a Collaborative Behavioral Model for patients with a psychiatric complaint. We evaluated LOS and 6-month readmission by comparing patients who received a psychiatric consultation through the model with a control group of nonpsychiatric patients. In addition, we assessed the utilization of laboratory tests and imaging and the impact of testing on final patient disposition...
June 6, 2017: Pediatric Emergency Care
Thomas J An, Michael A Benvenuti, Megan E Mignemi, Jeffrey Martus, James B Wood, Isaac P Thomsen, Jonathan G Schoenecker
BACKGROUND: Prior studies of pediatric musculoskeletal infection have suggested that methicillin-resistant Staphylococcus aureus (MRSA) infections result in worse outcomes compared with infections with methicillin-susceptible S aureus (MSSA) strains. Based on these results, clinical prediction algorithms have been developed to differentiate between MRSA and MSSA early in a patient's clinical course. This study compares hospital outcomes for pediatric patients with MRSA and MSSA musculoskeletal infection presenting to the emergency department at a large tertiary care children's hospital...
2017: Open Forum Infectious Diseases
Rebecca A Carson, Shawna S Mudd, P Jamil Madati
PROBLEM: Acute gastroenteritis (AGE) is a common illness treated in the emergency department. Delays in initiating rehydration for children with mild or moderate dehydration from AGE can lead to prolonged ED visits and increased resource utilization that do not provide prognostic value or support family-centered care. The purpose of this quality improvement project was to promote early oral rehydration therapy (ORT) for persons with AGE in an attempt to reduce unnecessary resource utilization and length of stay (LOS)...
September 2017: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
Daniel T Rogan, Mohit S Kochar, Samuel Yang, James V Quinn
Acute respiratory illnesses (ARIs) are usually viral [influenza, respiratory syncytial virus (RSV)] and account for 25% of emergency department (ED) peak-season visits. Laboratory PCR testing is accurate albeit slow, whereas rapid antigen testing is inaccurate. We determined the impact of bedside PCR (molecular point-of-care test; mPOCT) on pediatric ARI management. This was a prospective cohort study of consecutive pediatric patients with ED-ordered respiratory PCR test, enrolled over 9 weeks during peak flu season...
May 2017: Journal of Molecular Diagnostics: JMD
Lina Patel, Jeff Michael, Nancy Allen, Lisa Schroeder, Lisa Berglund, Jason G Newland
OBJECTIVES: Care process models (CPMs) for certain conditions have improved clinical outcomes in children. This study describes the implementation and impact of a CPM for the evaluation of musculoskeletal infections in a pediatric emergency department (ED). METHODS: A retrospective pre-post intervention study was performed to analyze the impact of a musculoskeletal infection CPM. Patients were identified retrospectively through electronic order history for imaging of an extremity or joint and recommended laboratory tests...
March 21, 2017: Pediatric Emergency Care
Bethann M Pflugeisen, Mauricio A Escobar, Dustin Haferbecker, Yolanda Duralde, Elizabeth Pohlson
OBJECTIVE: There has been an increasing movement worldwide to create systematic screening and management procedures for atypical injury patterns in children with the hope of better detecting and evaluating nonaccidental trauma (NAT). A legitimate concern for any hospital considering implementation of a systematic evaluation process is the impact on already burdened hospital resources. We hypothesized that implementation of a guideline that uses red flags related to history, physical, or radiologic findings to trigger a standardized NAT evaluation of patients <4 years would not negatively affect resource utilization at our level II pediatric trauma center...
April 2017: Hospital Pediatrics
Marissa A Hendrickson, Jennifer Zaremba, Andrew R Wey, Philippe R Gaillard, Anupam B Kharbanda
BACKGROUND: Guidelines recommend oral rehydration therapy (ORT) and avoidance of laboratory tests and intravenous fluids for mild to moderate dehydration in children with gastroenteritis; oral ondansetron has been shown to be an effective adjunct. OBJECTIVES: The aim of this study was to determine if a triage-based, nurse-initiated protocol for early provision of ondansetron and ORT could safely improve the care of pediatric emergency department (ED) patients with symptoms of gastroenteritis...
April 2018: Pediatric Emergency Care
Sujatha Baddam, Inmaculada Aban, Lee Hilliard, Thomas Howard, David Askenazi, Jeffrey D Lebensburger
BACKGROUND: Patients who develop sickle cell disease (SCD) nephropathy are at a high risk for mortality. The pathophysiology of vaso-occlusive pain crisis may contribute to acute kidney injury (AKI). Non-steroidal anti-inflammatory drugs, known inducers of AKI, are used to treat pain crises. Multiple gaps exist in the knowledge about the impact of AKI in SCD. METHODS: We conducted a 2-year retrospective review of AKI events in patients admitted for vaso-occlusive crisis...
August 2017: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Amanda S Newton, Lisa Hartling, Amir Soleimani, Scott Kirkland, Michele P Dyson, Mario Cappelli
OBJECTIVE: Children with mental health crises require access to specialised resources and services which are not yet standard in general and paediatric EDs. In 2010, we published a systematic review that provided some evidence to support the use of specialised care models to reduce hospitalisation, return ED visits and length of ED stay. We perform a systematic review to update the evidence base and inform current policy statements. METHODS: Twelve databases and the grey literature were searched up to January 2015...
June 2017: Emergency Medicine Journal: EMJ
Chung-Hsien Chaou, Hsiu-Hsi Chen, Shu-Hui Chang, Petrus Tang, Shin-Liang Pan, Amy Ming-Fang Yen, Te-Fa Chiu
BACKGROUND: Emergency department (ED) crowding continues to be an important health care issue in modern countries. Among the many crucial quality indicators for monitoring the throughput process, a patient's length of stay (LOS) is considered the most important one since it is both the cause and the result of ED crowding. The aim of this study is to identify and quantify the influence of different patient-related or diagnostic activities-related factors on the ED LOS of discharged patients...
2017: PloS One
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)...
July 2017: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
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
Andrea Pisesky, Eric I Benchimol, Coralie A Wong, Charles Hui, Megan Crowe, Marc-Andre Belair, Supichaya Pojsupap, Tim Karnauchow, Katie O'Hearn, Abdool S Yasseen, James D McNally
IMPORTANCE: RSV is a common illness among young children that causes significant morbidity and health care costs. OBJECTIVE: Routinely collected health administrative data can be used to track disease incidence, explore risk factors and conduct health services research. Due to potential for misclassification bias, the accuracy of data-elements should be validated prior to use. The objectives of this study were to validate an algorithm to accurately identify pediatric cases of hospitalized respiratory syncytial virus (RSV) from within Ontario's health administrative data, estimate annual incidence of hospitalization due to RSV and report the prevalence of major risk factors within hospitalized patients...
2016: PloS One
Sara C Fallon, David Delemos, Adesola Akinkuotu, Daniel Christopher, Bindi J Naik-Mathuria
BACKGROUND: A novel protocol to standardize the emergency center (EC) management of abdominal trauma in children was developed and implemented at our trauma center. The purpose of this study was to evaluate whether this protocol improved patient safety by decreasing unnecessary computed tomography (CT) radiation and improved quality of care by decreasing EC length of stay (LOS) and laboratory costs. METHODS: We performed a prospective, longitudinal study of children who presented to the EC with a mechanism for abdominal trauma and received an abdominal CT scan from January 2011 to September 2014...
January 2016: Journal of Trauma and Acute Care Surgery
I Claudet, E Grouteau, L Cordier, N Franchitto, C Bréhin
CONTEXT: Hyperglycemia has been described in severe scorpion envenomation, we wanted to analyze if it was applicable to viper bites in children. AIM: To describe clinical, biological, and therapeutic characteristics of 83 children bitten by European viper (Vipera spp.) and to confirm that hyperglycemia is a risk factor for high-grade envenomation. MATERIAL AND METHODS: A retrospective study was conducted between 2001 and 2014 in the pediatric emergency department of a tertiary level children's hospital...
2016: Clinical Toxicology
Shabnam Jain, Gary Frank, Kelly McCormick, Baohua Wu, Brent A Johnson
BACKGROUND AND OBJECTIVES: Variability in practice patterns and resource use in the emergency department (ED) can affect costs without affecting outcomes. ED quality measures have not included resource use in relation to ED outcomes and efficiency. Our objectives were to develop a tool for comprehensive physician feedback on practice patterns relative to peers and to study its impact on resource use, quality, and efficiency. METHODS: We evaluated condition-specific resource use (laboratory tests; imaging; antibiotics, intravenous fluids, and ondansetron; admission) by physicians at 2 tertiary pediatric EDs for 4 common conditions (fever, head injury, respiratory illness, gastroenteritis)...
September 2015: Pediatrics
Kenneth A Michelson, Michael C Monuteaux, Mark I Neuman
OBJECTIVE: To evaluate whether glucocorticoid administration is associated with improved outcomes in children with anaphylaxis. STUDY DESIGN: We included children from the Pediatric Health Information System database who were diagnosed with anaphylaxis at 35 US children's hospitals between 2009 and 2013. Patients were stratified by disposition from the emergency department (ED), either hospitalized or discharged. We evaluated the association between glucocorticoid administration and prolonged length of stay (LOS), defined as hospital stay ≥ 2 days, and subsequent epinephrine administration among hospitalized children...
September 2015: Journal of Pediatrics
Ireneusz Haponiuk, Ewelina Kwasniak, Maciej Chojnicki, Radoslaw Jaworski, Mariusz Steffens, Aneta Sendrowska, Katarzyna Gierat-Haponiuk, Katarzyna Leszczyńska, Konrad Paczkowski, Jacek Zielinski
INTRODUCTION: Cardiac tamponade is excessive collection of fluid in the pericardial sac surrounding the heart that leads to restriction of cardiac function and causes critical cardiogenic shock and rapid circulatory depression. Despite the potential variety of different etiologies in the face of a dangerous decrease of cardiac output, the emergency life-saving procedure is surgical pericardial fluid evacuation. AIM: To perform a retrospective analysis of clinical data and the results of minimally invasive transxiphoid pediatric cardiac tamponade evacuation procedures performed in a cardiac surgery center...
April 2015: Wideochirurgia i Inne Techniki Mało Inwazyjne, Videosurgery and Other Miniinvasive Techniques
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