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Emergency Department Boarding

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https://www.readbyqxmd.com/read/29188319/a-dedicated-paracentesis-clinic-decreases-healthcare-utilization-for-serial-paracenteses-in-decompensated-cirrhosis
#1
Yao-Wen Cheng, Kumar Sandrasegaran, Katherine Cheng, Angela Shah, Marwan Ghabril, William Berry, Craig Lammert, Naga Chalasani, Eric S Orman
PURPOSE: The purpose of the study is to describe the effect of a dedicated paracentesis clinic on healthcare utilization by patients with decompensated cirrhosis and refractory ascites. METHODS: This Institutional Review Board-approved retrospective study identified cirrhotic patients receiving paracenteses over a 6-month period before and after creating the paracentesis clinic. Patients were followed for 12 months to collect outcome data including characteristics of subsequent hospitalizations and paracenteses...
November 29, 2017: Abdominal Radiology
https://www.readbyqxmd.com/read/29170354/57%C3%A2-support-for-suddenly-bereaved-parents-in-the-emergency-unit
#2
Emily Jones, Steffan Simpson
: The Paediatric Emergency Unit at the University Hospital of Wales provides care for over 33 000 children per year. There was no provision in place to support suddenly bereaved families. Staff felt that we could improve the services provided to families who's children sadly died in the unit.The aim was to provide immediate support for the suddenly bereaved families by working in partnership with local Charity 2 Wish Upon a Star. Together we created a Standard Operating Procedure (SOP) that consisted of a checklist and pathway allowing us to refer relatives for immediate physical and emotional support...
December 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29170337/40%C3%A2-ed-crowding-the-acceptability-of-dysfunction
#3
Karl Kavanagh, Darragh Shields, Paul Staunton
BACKGROUND: Crowding in the Emergency Department is internationally recognised as one of the greatest challenges to healthcare provision. Numerous studies have highlighted the ill-effects of crowding, including increased length of stay, mortality and cost per admission. Crowding is typically a manifestation of a hospital at full capacity and its main contributor is the practice of boarding patients in the ED. Therefore, a functioning flow system is advised to ease the burden. Different predictive tools/algorithms assess the degree of crowding...
December 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29170328/31%C3%A2-the-quality-improvement-qip-improving-multidisciplinary-staff-engagement-with-quality-improvement-in-the-rvh-emergency-department
#4
Olly Bannon, Emma Greenwood
: In recent years the RVH Emergency Department (ED) had been under intense pressure and public scrutiny. This led to a demoralised workforce who had become disengaged with quality improvement (QI). QI projects had become an exercise in data collection with little focus on improving care for patients.Two consultants undertook training in QI and then decided to develop a QI project aiming to empower staff and embed QI as daily practice. An ED QI steering group of interested multidisciplinary members was formed and devised an improvement plan to increase staff engagement with QI...
December 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29159958/evaluation-of-a-low-risk-mild-traumatic-brain-injury-and-intracranial-hemorrhage-emergency-department-observation-protocol
#5
Brian J Yun, Pierre Borczuk, Lulu Wang, Stephen Dorner, Benjamin A White, Ali S Raja
OBJECTIVES: Among emergency physicians, there is wide variation in admitting practices for patients who suffered a mild traumatic brain injury (TBI) with an intracranial hemorrhage (ICH). The purpose of this study was to evaluate the effects of implementing a protocol in the emergency department (ED) observation unit for patients with mild TBI and ICH. METHODS: This retrospective cohort study was approved by the Institutional Review Board. Study subjects were patients ≥18 years of age with an International Classification of Diseases (ICD) code corresponding to a traumatic IC, and admitted to an ED observation unit (EDOU) of an urban, academic level 1 trauma center between February 1, 2015 and January 31, 2017...
November 20, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29157705/boarding-of-admitted-and-intensive-care-patients-in-the-emergency-department
#6
EDITORIAL
(no author information available yet)
No abstract text is available yet for this article.
December 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/29151053/protocol-of-the-sepsivit-study-a-prospective-observational-study-to-determine-whether-continuous-heart-rate-variability-measurement-during-the-first-48-hours-of-hospitalisation-provides-an-early-warning-for-deterioration-in-patients-presenting-with-infection
#7
Vincent M Quinten, Matijs van Meurs, Maurits H Renes, Jack J M Ligtenberg, Jan C Ter Maaten
INTRODUCTION: One in five patients with sepsis deteriorates within 48 hours after hospital admission. Regrettably, a clear tool for the early detection of deterioration is still lacking. The SepsiVit study aims to determine whether continuous heart rate variability (HRV) measurement can provide an early warning for deterioration in patients presenting with suspected infection or sepsis to the emergency department (ED). METHODS AND ANALYSIS: The protocol of a prospective observational study in the ED...
November 17, 2017: BMJ Open
https://www.readbyqxmd.com/read/29137466/evaluation-of-extremity-injuries-presented-to-emergency-department
#8
Ali Karakus, Guven Kuvandik, Ezgi Atalay
OBJECTIVE: In this study, we aimed to review cases with firearms injury of extremities presented to our hospital. METHODS: After approval by Institutional Board, electronic database was retrospectively screened for firearms injury of extremities between 2012 and 2015. Overall, 600 cases with firearms injury of extremities were included in the study. Cases were assessed for demographic and clinical characteristics, Mangled extremity severity score (MESS), Glasgow Coma Scale (GCS), costs and outcomes...
October 2017: Archives of Iranian Medicine
https://www.readbyqxmd.com/read/29121883/the-association-of-duration-of-boarding-in-the-emergency-room-and-the-outcome-of-patients-admitted-to-the-intensive-care-unit
#9
Saad Al-Qahtani, Abdullah Alsultan, Samir Haddad, Abdulmohsen Alsaawi, Moeed Alshehri, Sami Alsolamy, Afef Felebaman, Hani M Tamim, Nawfal Aljerian, Abdulaziz Al-Dawood, Yaseen Arabi
BACKGROUND: The demand for critical care beds is increasing out of proportion to bed availability. As a result, some critically ill patients are kept in the Emergency Department (ED boarding) awaiting bed availability. The aim of our study is to examine the impact of boarding in the ED on the outcome of patients admitted to the Intensive Care Unit(ICU). METHODS: This was a retrospective analysis of ICU data collected prospectively at King Abdulaziz Medical City, Riyadh from ED between January 2010 and December 2012 and all patients admitted during this time were evaluated for their duration of boarding...
November 9, 2017: BMC Emergency Medicine
https://www.readbyqxmd.com/read/29079490/expedited-discharge-from-an-academic-emergency-department-a%C3%A2-pilot-program
#10
Andrew Goldsmith, Luis Ticona, Ryan Thompson, Benjamin A White, Joan Strauss, Robert Seger, David F M Brown, Ali S Raja, Brian J Yun
BACKGROUND: As the numbers of emergency department (ED) visits and inpatient admissions continue to increase, there is growing interest in alternatives to inpatient hospitalization. OBJECTIVE: Our aim was to investigate a novel approach to expediting discharges from the ED with multidisciplinary discharge services to prevent an avoidable admission into the hospital. METHODS: This pilot study was conducted at a large urban tertiary-care ED in 2016...
October 24, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29066070/net-revenue-analysis-of-inpatient-and-emergency-department-thyroid-ultrasound-at-a-us-quaternary-care-center-from-2012-to-2015
#11
Kushal Parikh, Matthew S Davenport
PURPOSE: The aim of this study was to understand the financial ramifications of performing nonemergent inpatient and emergency department (ED) adult thyroid ultrasound studies at a US quaternary care center. METHODS: A HIPAA-compliant, institutional review board-exempt retrospective review of 10,334 thyroid ultrasound studies performed between February 2012 and December 2015 was conducted. Demographic, imaging, clinical, and financial data were reviewed. Labor cost analysis was calculated using national salary data and local scheduling practices...
October 20, 2017: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/29044462/urgency-of-caesarean-section-grading-alarm-chain-and-intrauterine-resuscitation-a-survey-of-scandinavian-practice
#12
K Wildgaard, M Ismaiel, F Hetmann
BACKGROUND: About 40,000 women have caesarean section in Scandinavia each year. Organizational factors for emergency caesarean section (CS), classification, anaesthetic practice, alarm chain, intrauterine resuscitation has all been investigated in the United Kingdom, but no information from the Scandinavian countries exists. METHODS: Using publicly available data from the National Board of Health, obstetric anaesthetic departments were identified. The heads of the departments provided e-mail contact details of two anaesthesiologists regularly practicing obstetric anaesthesia who were then surveyed...
October 18, 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/29032791/deconstructing-the-4-h-rule-for-access-to-emergency-care-and-putting-patients-first
#13
Ian Scott, Clair Sullivan, Andrew Staib, Anthony Bell
Evidence suggests improved outcomes for patients requiring emergency admission to hospital are associated with improved emergency department (ED) efficiency and lower transit times. Factors preventing timely transfers of emergency patients to in-patient beds across the ED-in-patient interface are major causes for ED crowding, for which several remedial strategies are possible, including parallel processing of probable admissions, direct-to-ward admissions and single-point medical registrars for receiving and processing all referrals directed at specific speciality units...
October 16, 2017: Australian Health Review: a Publication of the Australian Hospital Association
https://www.readbyqxmd.com/read/28976457/revisiting-the-appendiceal-diameter-via-ultrasound-for-the-diagnosis-of-acute-appendicitis
#14
Henry P Chicaiza, Laurie Malia, Christine H Mulvey, Sharon R Smith
OBJECTIVES: This study aims to investigate the optimal outer appendiceal diameter via ultrasound for the diagnosis of acute appendicitis. METHODS: A retrospective chart review was conducted on patients (ages, 2-18 years) presenting to an urban pediatric emergency department between January 1, 2009 and December 31, 2010 with suspected acute appendicitis. Children were considered as having "suspected acute appendicitis" if they (1) presented with acute abdominal pain and had either a surgical consult or an abdominal ultrasound, or (2) presented or transferred with the stated suspicion of acute appendicitis...
October 2, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28965896/could-musculo-skeletal-radiograph-interpretation-by-radiographers-be%C3%A2-a-source-of-support-to-australian-medical-interns-a-quantitative-evaluation
#15
J R McConnell, M A Baird
INTRODUCTION: Public expectations regarding access to the emergency department (ED) challenges providers and policy makers with finite resources being stretched beyond capacity. To enable education of a greater numbers of doctors the format of the medical internship in Australia has changed and assumes that sufficient supervision is provided to interns to enable image interpretation skills development. Furthermore this assumes that appropriate foundational skills are established during undergraduate education...
November 2017: Radiography
https://www.readbyqxmd.com/read/28952811/ct-in-the-evaluation-of-acute-injuries-of-the-anterior-eye-segment
#16
Khaled Gad, Eric L Singman, Rohini N Nadgir, David M Yousem, Jay J Pillai
OBJECTIVE: Slit-lamp ophthalmologic examination and ocular B-scan sonography of the globe are frequently constrained by technical limitations in the setting of traumatic orbital injury. The main purpose of this study was to evaluate the diagnostic performance of CT in acute anterior segment ocular injuries as an adjunctive diagnostic modality. MATERIALS AND METHODS: We retrospectively identified 122 patients who presented to the emergency department from April 2011 through April 2016 with recent direct trauma to the anterior segment of the eye...
December 2017: AJR. American Journal of Roentgenology
https://www.readbyqxmd.com/read/28947466/randomised-controlled-trial-of-lactobacillus-rhamnosus-lgg-versus-placebo-in-children-presenting-to-the-emergency-department-with-acute-gastroenteritis-the-pecarn-probiotic-study-protocol
#17
David Schnadower, Phillip I Tarr, Casper T Charles, Marc H Gorelick, Michael J Dean, Karen J O'Connell, Prashant Mahajan, Thomas H Chun, Seema R Bhatt, Cindy G Roskind, Elizabeth C Powell, Alexander J Rogers, Cheryl Vance, Robert E Sapien, Feng Gao, Stephen B Freedman
INTRODUCTION: Acute gastroenteritis (AGE) is a common and burdensome condition that affects millions of children worldwide each year. Currently available strategies are limited to symptomatic management, treatment and prevention of dehydration and infection control; no disease-modifying interventions exist. Probiotics, defined as live microorganisms beneficial to the host, have shown promise in improving AGE outcomes, but existing studies have sufficient limitations such that the use of probiotics cannot currently be recommended with confidence...
September 24, 2017: BMJ Open
https://www.readbyqxmd.com/read/28945476/assessment-of-lungs-for-transplant-recovered-from-uncontrolled-donation-after-circulatory-determination-of-death-donors
#18
Thomas Egan, John Blackwell, Katherine Birchard, Benjamin Haithcock, Jason Long, Stephen Gazda, Nissa Casey, Caitlin Thys
RATIONALE: To address the lung donor shortage, we obtained institutional review board and US Food and Drug Administration approval to transplant lungs recovered from uncontrolled donation after circulatory determination of death donors (uDCDDs). OBJECTIVES: To compare outcomes of recipients of lungs recovered from uDCDDs vs. brain-dead donors. METHODS: After consent and screening, lungs recovered from uDCDDs were assessed by 4 hours ex vivo lung perfusion (EVLP) and computed tomography (CT) scan...
September 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28914285/hospital-medicine-point-of-care-ultrasound-credentialing-an-example-protocol
#19
Benji K Mathews, Michael Zwank
Though the use of point-of-care ultrasound (POCUS) has increased over the last decade, formal hospital credentialing for POCUS may still be a challenge for hospitalists. This document details the Hospital Medicine Department Ultrasound Credentialing Policy from Regions Hospital, which is part of the HealthPartners organization in Saint Paul, Minnesota. National organizations from internal medicine and hospital medicine (HM) have not published recommended guidelines for POCUS credentialing. Revised guidelines for POCUS have been published by the American College of Emergency Physicians, though these are not likely intended to guide hospitalists when working with credentialing committees and medical boards...
September 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28874952/duration-of-mechanical-ventilation-in-the-emergency-department
#20
Lauren B Angotti, Jeremy B Richards, Daniel F Fisher, Jeffrey D Sankoff, Todd A Seigel, Haitham S Al Ashry, Susan R Wilcox
INTRODUCTION: Due to hospital crowding, mechanically ventilated patients are increasingly spending hours boarding in emergency departments (ED) before intensive care unit (ICU) admission. This study aims to evaluate the association between time ventilated in the ED and in-hospital mortality, duration of mechanical ventilation, ICU and hospital length of stay (LOS). METHODS: This was a multi-center, prospective, observational study of patients ventilated in the ED, conducted at three academic Level I Trauma Centers from July 2011 to March 2013...
August 2017: Western Journal of Emergency Medicine
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