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Emergency Department Boarding

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https://www.readbyqxmd.com/read/28646558/neurology-concepts-young-women-and-ischemic-stroke-evaluation-and-management-in-the-emergency-department
#1
Bernard P Chang, Charles Wira, Joseph Miller, Murtaza Akhter, Bradley E Barth, Joshua Willey, Lauren Nentwich, Tracy Madsen
OBJECTIVE: Ischemic stroke is a leading cause of morbidity and mortality worldwide. While the incidence of ischemic stroke is highest in older populations, incidence of ischemic stroke in adults has been rising particularly rapidly among young (e.g. premenopausal) women. The evaluation and timely diagnosis of ischemic stroke in young women presents a challenging situation in the emergency department, due to a range of sex-specific risk factors and to broad differentials. The goals of this concepts paper are to summarize existing knowledge regarding the evaluation and management of young women with ischemic stroke in the acute setting...
June 24, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28643577/an-assessment-of-advance-relatives-approach-for-brain-death-organ-donation
#2
Carine Michaut, Antoine Baumann, Hélène Gregoire, Corinne Laviale, Gérard Audibert, Xavier Ducrocq
BACKGROUND: Advance announcement of forthcoming brain death has developed to enable intensivists and organ procurement organisation coordinators to more appropriately, and separately from each other, explain to relatives brain death and the subsequent post-mortem organ donation opportunity. Research aim: The aim was to assess how potentially involved healthcare professionals perceived ethical issues surrounding the strategy of advance approach. RESEARCH DESIGN: A multi-centre opinion survey using an anonymous self-administered questionnaire was conducted in the six-member hospitals of the publicly funded East of France regional organ and tissue procurement network called 'Prélor'...
January 1, 2017: Nursing Ethics
https://www.readbyqxmd.com/read/28637582/principles-of-capacity-management-applied-in-the-mental-health-context
#3
Kathryn Zeitz, Darryl Watson
Objective The aim of the paper was to describe a suite of capacity management principles that have been applied in the mental health setting that resulted in a significant reduction in time spent in two emergency departments (ED) and improved throughput.Methods The project consisted of a multifocal change approach over three phases that included: (1) the implementation of a suite of fundamental capacity management activities led by the service and clinical director; (2) a targeted Winter Demand Plan supported by McKinsey and Co...
June 22, 2017: Australian Health Review: a Publication of the Australian Hospital Association
https://www.readbyqxmd.com/read/28632577/outcome-of-pediatric-forearm-fracture-reductions-performed-by-pediatric-emergency-medicine-providers-compared-with-reductions-performed-by-orthopedic-surgeons-a-retrospective-cohort-study
#4
Donna Milner, Ernest Krause, Karen Hamre, Andrew Flood
OBJECTIVE: The aim of this study was to describe the outcome differences between board-certified orthopedists and pediatric emergency medicine (PEM) physicians conducting forearm fracture reductions. METHODS: We performed an analysis of patients between 1 and 14 years of age who presented to the emergency department (ED) with a forearm fracture requiring reduction. Data collected included reducing provider (PEM or orthopedist) and prereduction, postreduction, and follow-up fracture angles and displacements of both radius and ulna...
June 20, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28619774/protocol-for-a-multicentre-multistage-prospective-study-in-china-using-system-based-approaches-for-consistent-improvement-in-surgical-safety
#5
Xiaochu Yu, Jingmei Jiang, Changwei Liu, Keng Shen, Zixing Wang, Wei Han, Xingrong Liu, Guole Lin, Ye Zhang, Ying Zhang, Yufen Ma, Haixin Bo, Yupei Zhao
INTRODUCTION: Surgical safety has emerged as a crucial global health issue in the past two decades. Although several safety-enhancing tools are available, the pace of large-scale improvement remains slow, especially in developing countries such as China. The present project (Modern Surgery and Anesthesia Safety Management System Construction and Promotion) aims to develop and validate system-based integrated approaches for reducing perioperative deaths and complications using a multicentre, multistage design...
June 15, 2017: BMJ Open
https://www.readbyqxmd.com/read/28611885/american-association-for-emergency-psychiatry-task-force-on-medical-clearance-of-adult-psychiatric-patients-part-ii-controversies-over-medical-assessment-and-consensus-recommendations
#6
REVIEW
Michael P Wilson, Kimberly Nordstrom, Eric L Anderson, Anthony T Ng, Leslie S Zun, Jennifer M Peltzer-Jones, Michael H Allen
INTRODUCTION: The emergency medical evaluation of psychiatric patients presenting to United States emergency departments (ED), usually termed "medical clearance," often varies between EDs. A task force of the American Association for Emergency Psychiatry (AAEP), consisting of physicians from emergency medicine, physicians from psychiatry and a psychologist, was convened to form consensus recommendations for the medical evaluation of psychiatric patients presenting to U.S.EDs. METHODS: The task force reviewed existing literature on the topic of medical evaluation of psychiatric patients in the ED and then combined this with expert consensus...
June 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28611873/the-economics-of-an-admissions-holding-unit
#7
Kraftin E Schreyer, Richard Martin
INTRODUCTION: With increasing attention to the actual cost of delivering care, return-on-investment calculations take on new significance. Boarded patients in the emergency department (ED) are harmful to clinical care and have significant financial opportunity costs. We hypothesize that investment in an admissions holding unit for admitted ED patients not only captures opportunity cost but also significantly lowers direct cost of care. METHODS: This was a three-phase study at a busy urban teaching center with significant walkout rate...
June 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28566122/necrotizing-enterocolitis-classification-and-two-initial-steps-towards-prevention
#8
Sandra Meinich Juhl
The premature infant suffers from immaturity of all organ systems, one of them being the gastrointestinal tract. When the infant is born, the immature gastrointestinal tract is exposed to milk and simultaneously colonized by high densities of bacteria. The combination of milk, microbiota and an immature gut, leaves the infant vulnerable to developing the dreaded intestinal emergency necrotizing enterocolitis (NEC). NEC is often very aggressive and no cure exists, which means that prevention is an utmost important topic to researchers, physicians, parents - and infants...
June 2017: Danish Medical Journal
https://www.readbyqxmd.com/read/28557753/oral-corticosteroid-prescribing-for-children-with-asthma-in-a-medicaid-managed-care-program
#9
Harold J Farber, Edwin A Silveira, Douglas R Vicere, Viral D Kothari, Angelo P Giardino
BACKGROUND AND OBJECTIVE: Short courses of oral corticosteroid (OCS) medication are recommended for treatment of moderate to severe asthma exacerbations. Concern has been raised about OCS overuse. Our objective is to describe rates of OCS dispensing among children with asthma and factors associated with variation in OCS dispensing. METHODS: Claims data for children 1 to <18 years of age with an asthma diagnosis between January 2011 and January 2016 were extracted from the computerized databases of Texas Children's Health Plan...
May 2017: Pediatrics
https://www.readbyqxmd.com/read/28557729/early-prediction-model-of-patient-hospitalization-from-the-pediatric-emergency-department
#10
Yuval Barak-Corren, Andrew M Fine, Ben Y Reis
BACKGROUND AND OBJECTIVES: Emergency departments (EDs) in the United States are overcrowded and nearing a breaking point. Alongside ever-increasing demand, one of the leading causes of ED overcrowding is the boarding of hospitalized patients in the ED as they await bed placement. We sought to develop a model for early prediction of hospitalizations, thus enabling an earlier start for the placement process and shorter boarding times. METHODS: We conducted a retrospective cohort analysis of all visits to the Boston Children's Hospital ED from July 1, 2014 to June 30, 2015...
May 2017: Pediatrics
https://www.readbyqxmd.com/read/28550896/pediatric-near-drowning-events-do-they-warrant-trauma-team-activation
#11
Pranit N Chotai, Lisa Manning, Benjamin Eithun, Joshua C Ross, James W Eubanks, Chad Hamner, Ankush Gosain
BACKGROUND: The purpose of this study was to determine the incidence of traumatic injuries, factors associated with mortality, and need for pediatric trauma surgery involvement for drowning and near-drowning events in children. MATERIALS AND METHODS: An institutional review board-approved, retrospective chart review was performed at three American College of Surgeons-verified Pediatric Trauma Centers (2011-2014). Patients with International Classification of Diseases, Ninth Revision, codes or E-codes for fatal-nonfatal drowning, fall into water, accidental drowning, or submersion were included...
May 15, 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28511773/psychiatric-patient-length-of-stay-in-the-emergency-department-following-closure-of-a-public-psychiatric-hospital
#12
Ryan K Misek, Ashley D Magda, Samantha Margaritis, Robert Long, Erik Frost
BACKGROUND: Psychiatric patient boarding in the emergency department (ED) is a ubiquitous problem associated with increased morbidity and mortality. OBJECTIVE: We evaluate the effect of closing a public psychiatric facility in a major metropolitan area on the ED length of stay (LOS) of psychiatric patients. METHODS: This was a retrospective chart review at two metropolitan EDs of all patients assessed to require inpatient psychiatric hospitalization...
May 13, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28502910/balancing-volume-and-duration-of-information-consumption-by-physicians-the-case-of-health-information-exchange-in-critical-care
#13
Liran Politi, Shlomi Codish, Iftach Sagy, Lior Fink
BACKGROUND: The realization of the potential benefits of health information exchange systems (HIEs) for emergency departments (EDs) depends on the way these systems are actually used. The attributes of volume of information and duration of information processing are important for the study of HIE use patterns in the ED, as cognitive load and time constraints may result in a trade-off between these attributes. Experts and non-experts often use different problem-solving strategies, which may be consequential for their system use patterns...
May 11, 2017: Journal of Biomedical Informatics
https://www.readbyqxmd.com/read/28498968/the-involvement-of-alcohol-in-hospital-treated-self-harm-and-associated-factors-findings-from-two-national-registries
#14
Eve Griffin, Ella Arensman, Ivan J Perry, Brendan Bonner, Denise O'Hagan, Caroline Daly, Paul Corcoran
Background: Alcohol is often involved in hospital-treated self-harm. Therefore it is important to establish the role of alcohol in self-harm as well as to identify associated factors, in order to best inform service provision. Methods: Data on self-harm presentations to hospital emergency departments in Ireland and Northern Ireland from April 2012 to December 2013 were analysed. We calculated the prevalence of alcohol consumption in self-harm. Using Poisson regression models, we identified the factors associated with having consumed alcohol at the time of a self-harm act...
May 12, 2017: Journal of Public Health
https://www.readbyqxmd.com/read/28494475/impact-of-a-national-time-target-for-ed-length-of-stay-on-patient-outcomes
#15
Peter Jones, Susan Wells, Alana Harper, James Le Fevre, Joanna Stewart, Elana Curtis, Papaarangi Reid, Shanthi Ameratunga
AIM: The impact of national targets for emergency department (ED) length of stay (LOS) on patient care is unclear. This study aimed to determine the effect of New Zealand's six-hour time target (95% of ED patients discharged or admitted to hospital within six hours) on a range of quality indicators. METHODS: A nationwide observational study from 2006 to 2012 modelled differences in changes over time before and after target introduction in 2009. The observed model estimates in 2012 were compared to those predicted if pre-target trends had continued...
May 12, 2017: New Zealand Medical Journal
https://www.readbyqxmd.com/read/28486022/wound-concerns-and-healthcare-consumption-of-resources-after-colorectal-surgery-an-opportunity-for-innovation
#16
Puja M Shah, Heather L Evans, Amy Harrigan, Robert G Sawyer, Charles M Friel, Traci L Hedrick
BACKGROUND: Significant portions of patients undergoing colorectal surgical procedures have minor incision disturbances, yet very few meet definitions for surgical site infection (SSI). We sought to investigate the natural history of incision disturbances with a focus on the patient experience and resource utilization. We hypothesize that patients who have an incision disturbance consume frequent healthcare resources in the post-operative period despite the fact that most never receive a diagnosis of SSI...
May 9, 2017: Surgical Infections
https://www.readbyqxmd.com/read/28466184/thirty-day-emergency-room-visits-and-hospital-admissions-after-outpatient-non-vascular-image-guided-procedures
#17
Quang Nguyen, Sahil V Mehta, Jieming Fang, Robert Sheiman, Robert Kane, Muneeb Ahmed, Ammar Sarwar, Bettina Siewert, Olga R Brook
PURPOSE: To evaluate the rate of post-procedure emergency department (ED) visits and hospital admissions following outpatient non-vascular image-guided interventions performed under moderate sedation and to identify common and preventable causes of emergency department visits and hospital admissions. MATERIALS AND METHODS: Institutional review board approval was acquired for this HIPAA-compliant retrospective study with waiver of informed consent. 1426 consecutive patients undergoing 1512 outpatient image-guided procedures under moderate sedation from November 2012 to August 2014 were included...
May 2, 2017: Abdominal Radiology
https://www.readbyqxmd.com/read/28441242/identifying-undiagnosed-pediatric-mental-illness-in-the-emergency-department
#18
La Vonne A Downey, Leslie S Zun
BACKGROUND: It is well known that pediatric psychiatric patients frequent emergency department (ED), but the number of patients with undiagnosed psychiatric illness presenting to an ED is not well known. Identification and referral of these patients may provide an opportunity for improved patient care. The primary study objective was to identify a tool that can screen for unsuspected psychiatric illness in pediatric patients who present to the ED with non-psychiatric-related complaints...
April 24, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28435496/-choosing-wisely-imaging-recommendations-initial-implementation-in-new-england-emergency-departments
#19
Ali S Raja, Arjun Venkatesh, Nathan Mick, Cristopher P Zabbo, Kohei Hasegawa, Janice A Espinola, Jane C Bittner, Carlos A Camargo
INTRODUCTION: In June 2016, the American College of Emergency Physicians (ACEP) Emergency Quality Network began its Reduce Avoidable Imaging Initiative, designed to "reduce testing and imaging with low risk patients through the implementation of Choosing Wisely recommendations." However, it is unknown whether New England emergency departments (ED) have already implemented evidence-based interventions to improve adherence to ACEP Choosing Wisely recommendations related to imaging after their initial release in 2013...
April 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28435492/applying-systems-engineering-reduces-radiology-transport-cycle-times-in-the-emergency-department
#20
Benjamin A White, Brian J Yun, Michael H Lev, Ali S Raja
INTRODUCTION: Emergency department (ED) crowding is widespread, and can result in care delays, medical errors, increased costs, and decreased patient satisfaction. Simultaneously, while capacity constraints on EDs are worsening, contributing factors such as patient volume and inpatient bed capacity are often outside the influence of ED administrators. Therefore, systems engineering approaches that improve throughput and reduce waste may hold the most readily available gains. Decreasing radiology turnaround times improves ED patient throughput and decreases patient waiting time...
April 2017: Western Journal of Emergency Medicine
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