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https://www.readbyqxmd.com/read/29125257/improving-door-to-needle-times-for-patients-with-suspected-neutropenic-sepsis
#1
Tracy Wild
Neutropenic sepsis is a potentially life-threatening complication of chemotherapy and has an associated mortality of 2% to 21%. Patients can deteriorate rapidly and are usually advised to attend their local emergency department (ED) for urgent assessment and antibiotic therapy within one hour of arrival. Delivery of this emergency care is, however, inconsistent, and at times suboptimal, due to a lack of awareness of the condition and of clinical expertise. This article discusses a collaborative project between an acute oncology service and an ED, which has improved and sustained compliance with this standard through a range of initiatives, including revised and integrated sepsis guidelines, education, sepsis champions and a fast-track patient pathway...
November 10, 2017: Emergency Nurse: the Journal of the RCN Accident and Emergency Nursing Association
https://www.readbyqxmd.com/read/29079371/impact-of-revised-triage-to-improve-throughput-in-an-emergency-department-with-limited-traditional-fast-track-population
#2
Ryan M Gardner, Nathan A Friedman, Michael Carlson, Tamala S Bradham, Tyler W Barrett
BACKGROUND: Emergency department (ED) crowding is associated with patient safety concerns, increased patients left without being seen (LWBS), low patient satisfaction, and lost ED revenue. The objective was to measure the impact of a revised triage process on ED throughput. METHODS: This study took place at an urban, university-affiliated, adult ED with an annual census of 70,000 and admission rate of 34%. The revised triage approach included: identifying eligible patients at triage based on complaint, comorbidities, and illness acuity; and reallocating a nurse practitioner (NP) into our triage area...
October 7, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29065634/a-queue-based-monte-carlo-analysis-to-support-decision-making-for-implementation-of-an-emergency-department-fast-track
#3
Kristin Fitzgerald, Lori Pelletier, Martin A Reznek
Emergency departments (EDs) are seeking ways to utilize existing resources more efficiently as they face rising numbers of patient visits. This study explored the impact on patient wait times and nursing resource demand from the addition of a fast track, or separate unit for low-acuity patients, in the ED using a queue-based Monte Carlo simulation in MATLAB. The model integrated principles of queueing theory and expanded the discrete event simulation to account for time-based arrival rates. Additionally, the ED occupancy and nursing resource demand were modeled and analyzed using the Emergency Severity Index (ESI) levels of patients, rather than the number of beds in the department...
2017: Journal of Healthcare Engineering
https://www.readbyqxmd.com/read/28879622/simulation-based-design-of-ed-operations-with-care-streams-to-optimize-care-delivery-and-reduce-length-of-stay-in-the-emergency-department
#4
Duane Steward, Todd F Glass, Yann B Ferrand
Faced with the opportunity to significantly deviate from classic operations, a new emergency department (ED) and novel strategy for patient care delivery were simultaneously initiated with the aid of model-based simulation. To answer the design and implementation questions, a traditional strategy for construction of discrete-eventmodel simulation was employed to define ED operations for a newly constructed facility in terms of workflow, variables, resources, structure, process logic and associated assumptions...
September 6, 2017: Journal of Medical Systems
https://www.readbyqxmd.com/read/28876709/-management-and-orientation-of-severely-infected-patients-relevance-of-a-%C3%A2-sepsis-fast-track-%C3%A2
#5
André Juillerat, Hari Vivekanantham, Raphaël Burger, Joëlle Hausser, Thierry Fumeaux
Sepsis is a syndrome defined by a life-threatening organ dysfunction caused by a dysregulated host response to an infection. The early recognition of this syndrome in the emergency department (ED) can lead to a better prognosis, when associated with a standardized management focusing on identification of the infectious source, its treatment, and appropriate organ support. Therefore, the implementation of a « Sepsis Fast Track », by analogy with similar protocols regarding stroke or ST-elevated myocardial infarct, deserves interest...
September 6, 2017: Revue Médicale Suisse
https://www.readbyqxmd.com/read/28833302/patient-experience-with-early-discharge-after-total-knee-arthroplasty-a-focus-group-study
#6
Lise Husby Høvik, Bjørg Aglen, Vigdis Schnell Husby
BACKGROUND: Total knee arthroplasty is experienced as a painful procedure, and pain after surgery seems to be the most limiting factor for early mobilisation. Physical exercise is of utter importance for avoiding complications such as persistent pain and functional limitations. A fast-track pathway aims at improving patient outcome, and patients are now discharged 2-3 days after surgery. Little is known about how the patients cope with pain, exercise or daily activities at home. AIM: To explore the experience of patients undergoing total knee arthroplasty in a fast-track pathway during the first 2 weeks after surgery...
August 23, 2017: Scandinavian Journal of Caring Sciences
https://www.readbyqxmd.com/read/28829214/fast-track-consultation-in-the-infectious-diseases-department-of-a-french-university-hospital-evaluation-of-the-service-delivered-to-the-general-practitioner
#7
Nicolas Weiss, Johan Courjon, Christian Pradier, Cécile Caisso, Véronique Mondain, Pierre-Marie Roger, Elisa Demonchy
PURPOSE: Since 2010, the Infectious Diseases (ID) department of the Nice university hospital (France) has implemented a fast track consultation (FTC): it allows General Practitioners (GP) to directly reach an ID specialist through a dedicated phone number for initial advice. Depending on the first observation, a formal consultation can be planned within 48 h. Our aim was to evaluate in a pilot study, the contribution of the FTC regarding the management of patients 28 days after the first phone contact...
August 22, 2017: Infectious Diseases
https://www.readbyqxmd.com/read/28822624/evaluating-an-australian-emergency-nurse-practitioner-candidate-training-program
#8
Sharyn J Plath, Mary Wright, Julia Hocking
Nurse Practitioners (NPs) receive core clinical training at master's level, with their employer providing the opportunity to upskill in clinical and procedural competencies. It is increasingly recognised that this generic education requires supplementary training for operating effectively within a specific clinical environment. In this paper we describe a pilot program designed to train Australian NP Candidates to work effectively within the Emergency Department Fast Track model of care. The training program consisted of a 12-month period: four hours in-house training per week over two semesters, running concurrently with the NP candidate's University semesters, and 3 months' clinical practice to consolidate...
August 16, 2017: Australasian Emergency Nursing Journal: AENJ
https://www.readbyqxmd.com/read/28794660/a-renal-colic-fast-track-pathway-to-improve-waiting-times-and-outcomes-for-patients-presenting-to-the-emergency-department
#9
Omar Al Kadhi, Kate Manley, Madhavi Natarajan, Valmiki Lutchmedial, Abbi Forsyth, Kate Tabrett, Jonathan Betteridge, William Finch, Heinrich Hollis
INTRODUCTION: Renal colic is commonly encountered in the emergency department (ED). We validated a fast track renal colic (FTRC) initiative to decrease patient waiting times and streamline patient flow. METHOD: The FTRC pathway was devised according to the National Institute for Health and Care Excellence clinical summary criteria for the management of patients with suspected renal colic. ED triage nurses use the pathway to identify patients with likely renal colic suitable for fast track to analgesia, investigation and management...
2017: Open Access Emergency Medicine: OAEM
https://www.readbyqxmd.com/read/28714834/adjusting-patients-streaming-initiated-by-a-wait-time-threshold-in-emergency-department-for-minimizing-opportunity-cost
#10
Byungjoon B J Kim, Theodore R Delbridge, Dawn B Kendrick
Purpose Two different systems for streaming patients were considered to improve efficiency measures such as waiting times (WTs) and length of stay (LOS) for a current emergency department (ED). A typical fast track area (FTA) and a fast track with a wait time threshold (FTW) were designed and compared effectiveness measures from the perspective of total opportunity cost of all patients' WTs in the ED. The paper aims to discuss these issues. Design/methodology/approach This retrospective case study used computerized ED patient arrival to discharge time logs (between July 1, 2009 and June 30, 2010) to build computer simulation models for the FTA and fast track with wait time threshold systems...
July 10, 2017: International Journal of Health Care Quality Assurance
https://www.readbyqxmd.com/read/28494481/enhanced-hip-fracture-management-use-of-statistical-methods-and-dataset-to-evaluate-a-fractured-neck-of-femur-fast-track-pathway-pilot-study
#11
Nigel Gilchrist, Kristian Dalzell, Scott Pearson, Gary Hooper, Kit Hoeben, Jeremy Hickling, John McKie, Ma Yi, Sandra Chamberlain, Caroline McCullough, Marc Gutenstein
The increasing elderly population and subsequent rise in total hip fracture(s) in this group means more effective management strategies are necessary to improve efficiency. We have changed our patient care strategy from the emergency department (ED), acute orthopaedic wards, operating theatre, post-operation and rehabilitation, and called it Fracture Neck of Femur Fast Track Pathway. All clinical data and actions were captured, integrated and displayed on a weekly basis using 'signalfromnoise' (SFN) software...
May 12, 2017: New Zealand Medical Journal
https://www.readbyqxmd.com/read/28413420/overcrowding-in-emergency-departments-a-review-of-strategies-to-decrease-future-challenges
#12
REVIEW
Mohammad H Yarmohammadian, Fatemeh Rezaei, Abbas Haghshenas, Nahid Tavakoli
Emergency departments (EDs) are the most challenging ward with respect to patient delay. The goal of this study is to present strategies that have proven to reduce delay and overcrowding in EDs. In this review article, initial electronic database search resulted in a total of 1006 articles. Thirty articles were included after reviewing full texts. Inclusion criteria were assessments of real patient flows and implementing strategies inside the hospitals. In this study, we discussed strategies of team triage, point-of-care testing, ideal ED patient journey models, streaming, and fast track...
2017: Journal of Research in Medical Sciences: the Official Journal of Isfahan University of Medical Sciences
https://www.readbyqxmd.com/read/28243442/speeding-up-laboratory-test-reporting-in-medical-emergency-and-cardiac-arrest-calls-a-quality-improvement-project
#13
Mohammed Al-Talib, Isla Leslie
Many hospitals deploy Medical Emergency (MET) and Cardiac Arrest teams to improve the management and treatment of patients who become critically ill. In many cases, blood results are key in allowing the clinicians involved in these teams to make definitive management decisions for these patients. Following anecdotal reports that these results were often delayed, we assessed the process of blood tests being reported in emergency calls, identified the key factors causing delays and sought to make improvements...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28151394/a-fast-track-anaemia-clinic-in-the-emergency-department-cost-analysis-of-intravenous-iron-administration-for-treating-iron-deficiency-anaemia
#14
Manuel Quintana-Díaz, Raúl Muñoz-Romo, Susana Gómez-Ramírez, José Pavía, Alberto M Borobia, José A García-Erce, Manuel Muñoz
BACKGROUND: A fast-track anaemia clinic (FTAC) for the management of moderate-to-severe iron-deficiency anaemia (IDA) was established in our Emergency Department in 2010. In this FTAC, the replacement of packed red cell transfusion by ferric carboxymaltose administration was proven to be safe and effective. The aim of this study was a cost-analysis of IDA management in the FTAC, comparing this management with the previous standard care pathway consisting of packed red cell transfusion, if needed, and referral to outpatient specialised care...
September 2017: Blood Transfusion, Trasfusione del Sangue
https://www.readbyqxmd.com/read/28110990/quick-sofa-scores-predict-mortality-in-adult-emergency-department-patients-with-and-without-suspected-infection
#15
Adam J Singer, Jennifer Ng, Henry C Thode, Rory Spiegel, Scott Weingart
STUDY OBJECTIVE: The Quick Sequential Organ Failure Assessment (qSOFA) score (composed of respiratory rate ≥22 breaths/min, systolic blood pressure ≤100 mm Hg, and altered mental status) may identify patients with infection who are at risk of complications. We determined the association between qSOFA scores and outcomes in adult emergency department (ED) patients with and without suspected infection. METHODS: We performed a single-site, retrospective review of adult ED patients between January 2014 and March 2015...
April 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/27712833/-acute-cardiac-disease-in-the-emergency-department-fast-track-approach-for-outpatient-management
#16
EDITORIAL
X Marcaggi, L Belle
No abstract text is available yet for this article.
November 2016: Annales de Cardiologie et D'angéiologie
https://www.readbyqxmd.com/read/27693165/-fast-track-chest-pain-pathway-in-emergency-department
#17
O Nallet, N Ketata, N Ferrier, X Marcaggi
Acute chest pain is a common reason of consultation in the emergency department. The difficulty lies in discriminating patients with acute coronary syndrome or other life-threatening conditions from those non-cardiovascular, non-life-threatening chest pain. Only 15 to 25 % of patients with acute chest pain actually have acute coronary syndrome. Algorithms using high sensitivity troponin at admission and a second assessment 1 or 3hours later are validated to "rule in" or "rule out" the diagnosis of non ST-elevation myocardial infarction...
November 2016: Annales de Cardiologie et D'angéiologie
https://www.readbyqxmd.com/read/27692752/-optimization-of-the-management-of-acute-heart-failure-new-concept-of-fast-track
#18
S Andrieu, B Jouve, M Pansieri
The acute heart failure generates a very important number of hospitalizations for a high cost. A recent reflection on optimizing its management is ongoing, based on the fastest management in the emergency department, with a distinction between which patient should remain and who returns at home, and under what conditions, allowing to limit the number of hospitalizations. It will require a reorganization of emergency department and updating of decision algorithms and new guidelines of care.
November 2016: Annales de Cardiologie et D'angéiologie
https://www.readbyqxmd.com/read/27677560/comparison-of-emergency-department-wait-times-in-adults-with-sickle-cell-disease-versus-other-painful-etiologies
#19
COMPARATIVE STUDY
Dianne Pulte, Paris B Lovett, David Axelrod, Albert Crawford, John McAna, Rhea Powell
Sickle cell disease is characterized by intermittent painful crises often requiring treatment in the emergency department (ED). Past examinations of time-to-provider (TTP) in the ED for patients with sickle cell disease demonstrated that these patients may have longer TTP than other patients. Here, we examine TTP for patients presenting for emergency care at a single institution, comparing patients with sickle cell disease to both the general population and to those with other painful conditions, with examination of both institutional and patient factors that might affect wait times...
September 2016: Hemoglobin
https://www.readbyqxmd.com/read/27538991/an-innovative-fast-track-solution-for-food-bolus-impaction-due-to-jackhammer-esophagus-in-an-emergency-department-the-nitro-push-blind-technique-case-report
#20
Luigi Marano, Alessandro Cecchi, Federica Chiodo, Francesco Gullo, Pasquale Fiorillo, Luca Roncetti, Mattia Longaroni, Gianluca Proietti Silvestri, Silvano Lolli, Giorgio Nicolic, Alberto Patriti
BACKGROUND: In the medical literature are described only few clinical cases of esophageal food bolus impaction due to esophageal motility disorders. Moreover, the management of this condition is highly variable with no evidence in the literature to strongly support a clear defined intervention. CASE PRESENTATION: In this paper we describe for the first time a case of 53-year-old male with food bolus impaction due to Jackhammer esophagus referred to emergency department...
August 18, 2016: BMC Gastroenterology
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