Emergency room boarding

Mechanically transformative electronic systems (TESs) built using gallium have emerged as an innovative class of electronics due to their ability to switch between rigid and flexible states, thus expanding the versatility of electronics. However, the challenges posed by gallium's high surface tension and low viscosity have substantially hindered manufacturability, limiting high-resolution patterning of TESs. To address this challenge, we introduce a stiffness-tunable gallium-copper composite ink capable of direct ink write printing of intricate TES circuits, offering high-resolution (~50 micrometers) patterning, high conductivity, and bidirectional soft-rigid convertibility...

INTRODUCTION: Congenital heart disease (CHD) has an incidence of 0.8% to 1.2% worldwide, making it the most common birth defect. Researchers have compared high-volume to low-volume hospitals and found significant hospital-level variation in major complications, health resource utilization, and mortality after CHD surgery. In addition, researchers found critical CHD patients at low-volume/non-teaching facilities to be associated with higher odds of inpatient mortality when compared to CHD patients at high-volume/teaching hospitals (odds ratio 1...

BACKGROUND/OBJECTIVE: Cryo-preserved (CP) products are utilized during challenging cases when autogenous or prosthetic conduit use is not feasible. Despite decades of experience with cadaveric greater saphenous vein (GSV), there is limited available data regarding the outcomes and patency of other cryopreserved products, specifically, arterial and deep venous grafts. This study was designed to evaluate outcomes of non-GSV CP conduits in patients undergoing urgent, emergent, and elective arterial reconstruction at our institution...

This study identified the process and agency characteristics associated with poor utilization outcomes - higher percentages of patients ( i ) admitted to an acute care organization and ( ii ) visited an emergency room (ER) unplanned without hospitalization - for home health agencies (HHAs) in the United States. We conducted a secondary analysis of data about HHAs' various characteristics, process adherence levels, and utilization outcomes collected from disparate public repositories for 2010-2022. We developed descriptive tree-based models using HHAs' hospital admission or ER visit percentages as response variables...

Climate change is considered one of the greatest threats to humanity and the most significant global public health emergency of our lifetime. Millions of people from throughout the globe suffer and die each year from degraded air quality, extreme heat, water and vector-borne diseases as well as the mental health effects of climate change. Because clinicians are considered one of the most trusted sources of climate information, they have a unique opportunity to communicate the many health-related effects of climate change to their patients...

BACKGROUND: There have been an increased number of patients boarding in the Emergency Department (ED) who often experience delays in receiving non-urgent medications not typically stocked in the ED automated dispensing cabinets (ADC). OBJECTIVES: To describe a quality improvement project designed to decrease the amount of time it takes nursing staff to obtain patient-specific medications for patients boarding in the ED at a community hospital. PRACTICE DESCRIPTION: Prior to this quality improvement project, standard practice was for pharmacy staff to send all medications to the ED based on inpatient cart fill lists, resulting in a 24-hour supply being sent at one time...

Despite the need for a well-trained emergency medicine (EM) workforce in India, there are still many shortcomings. The COVID-19 pandemic has brought to the limelight the critical importance of digital health data, tools, technologies, and services in monitoring and combating adverse health effects of the pandemic. On the other hand, relevant health care stakeholders have often been underprepared to embrace digital health solutions wholeheartedly and rise to the pandemic challenge. The Global Strategy on Digital Health 2020-2025 clearly states how relevant digital health interventions (DHI) would enhance the access and improve the health outcomes, if used judiciously...

BACKGROUND: Limited capacity in the emergency department (ED) secondary to boarding and crowding has resulted in patients receiving care in hallways to provide access to timely evaluation and treatment. However, there are concerns raised by physicians and patients regarding a decrease in patient centered care and quality resulting from hallway care. We sought to explore social risk factors associated with hallway placement and operational outcomes. STUDY DESIGN/METHODS: Observational study between July 2017 and February 2020...

AUDIENCE: The target audience for this small group session is post-graduate year (PGY) 1-4 emergency medicine (EM) residents, pediatric EM (PEM) fellows, and medical students. INTRODUCTION: Pediatric emergency department visits have been declining since the start of the COVID-19 pandemic, leading to decreased exposure to pediatric emergency care for EM residents and other learners in the ED.1 This is a major problem, given that the Accreditation Council for Graduate Medical Education (ACGME) mandates that a minimum of 20% of patient encounters or five months of training time for EM residents must occur with pediatric patients, with at least 50% of that time spent in the ED setting...

BACKGROUND: Boarding of critically ill patients in the emergency department (ED) has long been known to compromise patient care and affect outcomes. During the COVID-19 pandemic, multiple hospitals worldwide experienced overcrowded emergency rooms. Large influx of patients outnumbered hospital beds and required prolonged length of stay (LOS) in the ED. Our aim was to assess the ED LOS effect on mortality and morbidity, in addition to the predictors of in-hospital mortality, intubation, and complications of critically ill COVID-19 ED boarder patients...

Air quality is critical for public health. Residents rely chiefly on government agencies such as the Environmental Protection Agency (EPA) in the United States to establish standards for the measurement of harmful contaminants including ozone, sulfur dioxide, carbon monoxide, volatile organic chemicals (VOCs), and fine particulate matter at or below 2.5 μm. According to the California Air Resources Board [1], "short-term PM2.5 exposure (up to 24-h duration) has been associated with premature mortality, increased hospital admissions for heart or lung causes, acute and chronic bronchitis, asthma attacks, emergency room visits, respiratory symptoms, and restricted activity days"...

INTRODUCTION: The prostatic urethral lift (PUL) is a popular surgical option for benign prostatic hyperplasia (BPH) with lower urinary tract symptoms (LUTS). Prior 5-year data from the multicenter L.I.F.T. trial suggested durability and a surgical retreatment rate of 13.6% at five years. We assessed the proportion of patients who had ongoing medical or surgical BPH management following PUL. METHODS: With institutional review board approval, cases of PUL performed from 2015-2020 at our academic institution were retrospectively reviewed for management of BPH following PUL...

BACKGROUND AND OBJECTIVES: Virtual reality (VR) is an emerging technology that can be used to promote a shared mental model among a surgical team. We present a case series demonstrating the use of 3-dimensional (3D) VR models to visually communicate procedural steps to a surgical team to promote a common operating objective. We also review the literature on existing uses of VR for preoperative communication and planning in spine surgery. METHODS: Narrations of 3 to 4-minute walkthroughs were created in a VR visualization platform, converted, and distributed to team members through text and email the night before surgical intervention...

OBJECTIVE: Dispersed population, mountainous topography, and extreme weather present logistical challenges for the emergency services providing care to the resident population and tourists visiting the Scottish Highlands. Debate over the value of air ambulances has left uncertainty over when they benefit patients and when their use may inadvertently prolong transfer times in rural settings. The primary objective of this study was to find a provisional threshold at which air ambulances are likely to improve time from injury to arrival at the emergency department for this rural patient cohort using motorcycle road traffic collisions as a single trauma etiology...

Jejunal gastrointestinal stromal tumors (GIST) are rare mesenchymal tumors of the gastrointestinal (GI) tract and a rare cause of massive GI bleeding. Due to this rarity and non-specific presentation, diagnosis and treatment may be difficult and often delayed. Urgent surgical intervention is crucial for controlling the source of bleeding and total tumor excision. Herein, we present the case of a 40-year-old male who presented to the emergency room (ER) with features of upper GI bleeding. He referred astheny and black stools, and was pale, sweaty, and tachycardic despite normal blood pressure...

Background Bicycle helmet use has a known protective health benefit; yet, pediatric populations have suboptimal helmet rates, which increases the risk of severe injuries. It is imperative to have an updated assessment of behavioral social disparities and for providers to be aware of them to better counsel patients. The study objective was to identify social determinants correlated with helmet use in children involved in bicycle accidents. Based on previous literature, we hypothesized that higher socioeconomic status, female sex, and Caucasian race were associated with increased helmet use...

Boarding across pediatric healthcare systems is on the rise during the pandemic. Children with positive COVID-19 test results awaiting psychiatric placements in the emergency department or medical unit settings are at increased risk for decompensation with unmet psychiatric needs during a time of crisis marked by vulnerability. There is scant literature unveiling best practices on delivery of care for these patients to achieve acute crisis stabilization. Recent studies have uncovered substantial increases in mental health disorders among children during the pandemic compared to previous incidence and prevalence rates prior to the pandemic...

INTRODUCTION: The purpose of this study was to assess the impact of COVID-19 on the cost of hip fracture care in the geriatric/middle-aged cohort, hypothesizing the cost of care increased during the pandemic, especially in COVID+ patients. METHODS: Between October 2014 and January 2022, 2,526 hip fracture patients older than 55 years were analyzed for demographics, injury details, COVID status on admission, hospital quality measures, and inpatient healthcare costs from the inpatient admission...

INTRODUCTION: Medicine is increasingly influenced by politics, but physicians have historically had lower voter turnout than the general public. Turnout is even lower for younger voters. Little is known about the political interests, voting activity, or political action committee (PAC) involvement of emergency physicians in training. We evaluated EM trainees' political priorities, use of and barriers to voting, and engagement with an emergency medicine (EM) PAC. METHODS: Resident/medical student Emergency Medicine Residents' Association members were emailed a survey between October-November 2018...

Background Blenderized gastrostomy tube feedings (BGTFs) consist of pureed table foods and liquids that are administered as enteral tube feedings. Compared to commercial enteral formulas (CEFs), BGTF has been shown to have fewer side effects. Despite these results, apprehensions have been raised about microbial contamination, nutritional deficiencies or surplus, risk of gastrostomy tube (GT) blockages, and lack of consistency in clinical outcomes. The goal of this retrospective, prospective, 18-month-long study is to report the clinical and nutritional outcomes of GT-dependent pediatric patients who attended a multidisciplinary feeding clinic...