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ED critical care

Joon-Myoung Kwon, Youngnam Lee, Yeha Lee, Seungwoo Lee, Hyunho Park, Jinsik Park
AIM: Triage is important in identifying high-risk patients amongst many less urgent patients as emergency department (ED) overcrowding has become a national crisis recently. This study aims to validate that a Deep-learning-based Triage and Acuity Score (DTAS) identifies high-risk patients more accurately than existing triage and acuity scores using a large national dataset. METHODS: We conducted a retrospective observational cohort study using data from the Korean National Emergency Department Information System (NEDIS), which collected data on visits in real time from 151 EDs...
2018: PloS One
Hadi Hassankhani, Amin Soheili, Samad S Vahdati, Farough A Mozaffari, Justin F Fraser, Neda Gilani
STUDY OBJECTIVE: We evaluate the extent and nature of treatment delays and the contributing factors influencing them for patients with acute ischemic stroke, as well as main barriers to stroke care in an Iranian emergency department (ED). METHODS: A retrospective chart review was conducted on 394 patients with acute ischemic stroke who were referred to the ED of a tertiary academic medical center in northwest Iran from March 21 to June 21, 2017. The steps of this review process included instrument development, medical records retrieval, data extraction, and data verification...
October 11, 2018: Annals of Emergency Medicine
Michael Pulia, Robert Redwood, Larissa May
The emergency department (ED) is the hub of the US health care system. Acute infectious diseases are frequently encountered in the ED setting, making this a critical setting for antimicrobial stewardship efforts. Systems level and behavioral stewardship interventions have demonstrated success in the ED setting but successful implementation depends on institutional support and the presence of a physician champion. Antimicrobial stewardship efforts in the ED should target high-impact areas: antibiotic prescribing for nonindicated respiratory tract conditions, such as bronchitis and sinusitis; overtreatment of asymptomatic bacteriuria; and using two antibiotics (double coverage) for uncomplicated cases of cellulitis or abscess...
November 2018: Emergency Medicine Clinics of North America
Jiha Lee, Judith Lin, Lisa Gale Suter, Liana Fraenkel
OBJECTIVE: To evaluate SLE patients who persistently frequent the ED to identify opportunities to improve outpatient care. METHODS: We conducted a retrospective study of SLE patients who frequented the ED for ≥3 visits in a calendar year from 2013-2016. Persistent users met criteria for frequent use for at least 2 out of the 4 years, and limited users for 1 out of the 4 years. Each ED encounter was categorized as; SLE-, infection-, pain- related, or "other"...
October 8, 2018: Arthritis Care & Research
Emanuele Amodio, Luca Cavalieri d'Oro, Elisabetta Chiarazzo, Carlo Picco, Maurizio Migliori, Isabella Trezzi, Silvano Lopez, Oliviero Rinaldi, Massimo Giupponi
Background: Hospital emergency departments (ED) can contribute to improve health outcomes and reduce costs of health care system. This study evaluated ED admissions during a twelve months period, analyzing characteristics of patients who underwent to emergency care in order to understand factors involved in ED overcrowding and promote adequate management. Methods: This retrospective study analyzed a twelve months window, with in-depth focus on December/January when almost all EDs reported overcrowding. All ED admissions were recorded in electronic schedules including: demographic characteristics, time/date of the access, incoming triage code, diagnosis, performed procedures, discharge, time/date of discharge...
2018: AIMS Public Health
Leanne Rachel Male, Adam Noble, Darlene Ann Snape, Peter Dixon, Tony Marson
OBJECTIVES: To establish the appropriateness of a previously developed seizure care pathway by exploring to what extent patients valued the intervention and perceived it as being helpful or not. DESIGN: Qualitative descriptive study, using semistructured, in-depth interviews and thematic template analysis, theoretically informed by critical realism. SETTING: In North West England, a seizure care pathway has been developed in collaboration with a specialist neurology hospital to support clinical management of seizure patients on initial presentation to the emergency department (ED), as well as access to follow-up services on discharge, with the aim of improving patient experience...
September 28, 2018: BMJ Open
Lindsey A Query, Krisjon R Olson, Michael T Meyer, Amy L Drendel
BACKGROUND: Pediatric emergency care provision in the United States is uneven. Institutional barriers to readiness in the general emergency department (GED) are known, but little is understood about the frontline providers. Our objective was to explore the lived experiences of emergency medicine (EM) providers caring for acutely ill children in the GED and identify opportunities to optimize their pediatric practice. METHODS: This grounded theory study used theoretical sampling with snowball recruitment to enroll EM physicians and advanced practice providers from 25 Wisconsin GEDs...
September 29, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Donna Goodridge, Steven Martyniuk, James Stempien
Background: Emergency departments (ED) serve a critical role in addressing the health care needs of older adults, although organizational and provider characteristics can result in unintended negative outcomes for this population, such as emotional harm. This study aimed to describe the patient experience of older adults in the ED and generate recommendations for enhancing their experience. Methods: Data from focus groups and individual interviews of older adults and caregivers who had visited the ED were thematically analyzed...
January 2018: Gerontology & Geriatric Medicine
Ethan F Kuperman, Eric L Linson, Kate Klefstad, Evelyn Perry, Kevin Glenn
BACKGROUND: On-site hospitalist care can improve patient care, but it is economically infeasible for small critical access hospitals (CAHs). A telemedicine "virtual hospitalist" may expand CAH capabilities at a fractional cost of an on"site provider. OBJECTIVE: To evaluate the impact of a virtual hospitalist on transfers from a CAH to outside hospitals. DESIGN, SETTING, PATIENTS: A 6-month pilot program providing "virtual hospitalist" coverage to patients at a CAH in rural Iowa...
September 26, 2018: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Allyson A Kreshak, Jesse J Brennan, Gary M Vilke, Vaishal M Tolia, Max Caccese, Edward M Castillo, Theodore C Chan
BACKGROUND: A recent hepatitis A virus (HAV) outbreak in San Diego, California represents one of the largest HAV outbreaks in the United States. The County of San Diego Health and Human Services Agency identified homelessness and illicit or injection drug use as risk factors for contracting HAV during this outbreak. OBJECTIVE: We describe those patients who presented to our Emergency Department (ED) and were identified as HAV positive. METHODS: This was a retrospective descriptive study conducted at a tertiary care university health system's EDs from November 2016 to February 2018...
September 22, 2018: Journal of Emergency Medicine
Naif Alzahrani, Russell Jones, Mohamed E Abdel-Latif
BACKGROUND: A hospital culture that promotes and insures patient safety is a critical aspect for the effective delivery of hospital services and patient care. Yet there are significant patient health and safety issues in hospitals worldwide. This study aims to investigate doctors' and nurses' attitudes toward patient safety in the emergency departments (ED) of two Saudi hospitals. METHOD: A cross-sectional survey using a validated Safety Attitudes Questionnaire (SAQ) was used...
September 25, 2018: BMC Health Services Research
Lucio Naccarella, Michelle Raggatt, Bernice Redley
OBJECTIVE: To identify spatial design factors that influence informal interprofessional team-based communication within hospital emergency departments (EDs). BACKGROUND: Effective team communication in EDs is critical for interprofessional collaborative care and prevention of serious errors due to miscommunication. Limited evidence exists about how informal communication in EDs is shaped by the physical workspace and how workplace design principles can improve the quality of ED team communication...
September 20, 2018: HERD
Emily L Aaronson, Benjamin A White, Lauren Black, David F Brown, Theodore Benzer, Allison Castagna, Ali S Raja, Jonathan Sonis, Elizabeth Mort
Patient-provider communication has been recognized as a critical area of focus for improved health care quality, with a mounting body of evidence tying patient satisfaction and provider communication to important health care outcomes. Despite this, few programs have been studied in the emergency department (ED) setting. The authors designed a communication curriculum and conducted trainings for all ED clinical staff. Although only 72% of clinicians believed the course would be a valuable use of their time before taking it, 97% reported that it was a valuable use of their time after ( P < ...
September 21, 2018: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
Zahra Zamani
OBJECTIVE: The purpose of this study was to identify the role of emergency department (ED) design on ED staff satisfaction and performance. BACKGROUND: High patient volume, surging workloads, and violent behaviors are expected pressures for ED staff. Literature suggests the substantial role of the physical environment in the delivery of care and its role in staff and patient experiences. Nevertheless, limited studies have explored simultaneous interactions between ED physical design elements, attributes (security, wayfinding, visibility, privacy, and efficiency), and staff satisfaction or performance...
September 19, 2018: HERD
Samah Riaz, Andrew Rowland, Steve Woby, Tony Long, Joan Livesley, Sarah Cotterill, Calvin Heal, Damian Roland
BACKGROUND: Increasing attendances by children (aged 0-16 years) to United Kingdom Emergency Departments (EDs) challenges patient safety within the National Health Service (NHS) with health professionals required to make complex judgements on whether children attending urgent and emergency care services can be sent home safely or require admission. Health regulation bodies have recommended that an early identification systems should be developed to recognise children developing critical illnesses...
September 17, 2018: BMC Pediatrics
Tim Montrief, Alex Koyfman, Brit Long
INTRODUCTION: Coronary artery bypass graft (CABG) surgery remains a high-risk procedure, and many patients require emergency department (ED) management for complications after surgery. OBJECTIVE: This narrative review provides an evidence-based summary of the current data for the emergency medicine evaluation and management of post-CABG surgery complications. DISCUSSION: While there has been a recent decline in all cardiac revascularization procedures, there remains over 200,000 CABG surgeries performed in the United States annually, with up to 14% of these patients presenting to the ED within 30 days of discharge with post-operative complications...
September 8, 2018: American Journal of Emergency Medicine
Babiche E J M Driesen, Bauke H G van Riet, Lisa Verkerk, H Jaap Bonjer, Hanneke Merten, Prabath W B Nanayakkara
BACKGROUND: Emergency department (ED) crowding is common and associated with increased costs and negative patient outcomes. The aim of this study was to conduct an in-depth analysis to identify the root causes of an ED length of stay (ED-LOS) of more than six hours. METHODS: An observational retrospective record review study was conducted to analyse the causes for ED-LOS of more than six hours during a one-week period in an academic hospital in the Netherlands. Basic administrative data were collected for all visiting patients...
2018: PloS One
Woo Jin Jung, Min Heui Yu, Yoonsuk Lee, Hyun Kim, Yong Sung Cha, Kyung Hye Park
PURPOSE: Organophosphates, commonly used in agricultural pesticides, pose high risks and incidences of poisoning. In the present study, we investigated the relative risk and clinical severity, including laboratory results, of non-oral route poisoning (NORP) patients, compared to oral route poisoning (ORP) patients. MATERIALS AND METHODS: A single institutional toxicology database registry was utilized to gain information on clinical laboratory results on organophosphate poisoning patients who visited the emergency department (ED) between January 2000 and October 2016...
October 2018: Yonsei Medical Journal
Muhammad Ahmed Alshyyab, Gerard FitzGerald, Kaeleen Dingle, Joseph Ting, Paula Bowman, Frances B Kinnear, Erika Borkoles
Patient safety culture is a critical component of modern health care. However, the high-paced, unpredictable nature of the emergency department (ED) environment may impact adversely on it. The aim of this paper is to explore the concept of patient safety culture as it may apply to emergency health care, and to propose a conceptual framework that could form the basis for interventions designed to improve it. This is a systematic review of the literature. A search was undertaken of common electronic bibliographic databases using key words such as safety culture, safety climate, and Emergency Department...
September 5, 2018: International Journal of Health Planning and Management
Maysam Ali Abdulwahid, Andrew Booth, Janette Turner, Suzanne M Mason
BACKGROUND: Optimising the efficiency and productivity of senior doctors is critical to ED function and delivery of safe patient care. Time and motion studies (TMS) can allow quantification of how these doctors spend their working time, identify inefficiencies in the current work processes and provide insights into improving working conditions, and enhancing productivity. Three questions were addressed: (1) How do senior emergency doctors spend their time in the ED? (2) How much of their time is spent on multitasking? (3) What is the number of tasks completed per hour? METHODS: The literature was systematically searched for TMS of senior emergency doctors...
September 5, 2018: Emergency Medicine Journal: EMJ
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