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Emergency Department Boarding

Cheryl K Zogg, Fernando Payró Chew, John W Scott, Lindsey L Wolf, Thomas C Tsai, Peter Najjar, Olubode A Olufajo, Eric B Schneider, Elliott R Haut, Adil H Haider, Joseph K Canner
Importance: Trauma is the leading cause of death and disability among young adults, who are also among the most likely to be uninsured. Efforts to increase insurance coverage, including passage of the Patient Protection and Affordable Care Act (ACA), were intended to improve access to care and promote improvements in outcomes. However, despite reported gains in coverage, the ACA's success in promoting use of high-quality care and enacting changes in clinical end points remains unclear...
October 19, 2016: JAMA Surgery
I-Shiang Tzeng, Su-Hsun Liu, Kuan-Fu Chen, Chin-Chieh Wu, Jih-Chang Chen
To reduce patient boarding time at the emergency department (ED) and to improve the overall quality of the emergent care system in Taiwan, the Minister of Health and Welfare of Taiwan (MOHW) piloted the Grading Responsible Hospitals for Acute Care (GRHAC) audit program in 2007-2009.The aim of the study was to evaluate the impact of the GRHAC audit program on the identification and management of acute myocardial infarction (AMI)-associated ED visits by describing and comparing the incidence of AMI-associated ED visits before (2003-2007), during (2007-2009), and after (2009-2012) the initial audit program implementation...
October 2016: Medicine (Baltimore)
Peter J Kelly, Gregory W Albers, Anastasios Chatzikonstantinou, Gian Marco De Marchis, Julia Ferrari, Paul George, Mira Katan, Michael Knoflach, Jong S Kim, Linxin Li, Eun-Jae Lee, Jean-Marc Olivot, Francisco Purroy, Nicolas Raposo, Peter M Rothwell, Vijay K Sharma, Bo Song, Georgios Tsivgoulis, Cathal Walsh, Yuming Xu, Aine Merwick
BACKGROUND: Identification of patients at highest risk of early stroke after transient ischaemic attack has been improved with imaging based scores. We aimed to compare the validity and prognostic utility of imaging-based stroke risk scores in patients after transient ischaemic attack. METHODS: We did a pooled analysis of published and unpublished individual-patient data from 16 cohort studies of transient ischaemic attack done in Asia, Europe, and the USA, with early brain and vascular imaging and follow up...
November 2016: Lancet Neurology
Jessyca Couto Otoni, Julia Noschang, Thábata Yaedu Okamoto, Diego Rosseman Vieira, Michel Souto Mayor Petry, Lucas de Araujo Ramos, Paula Nicole Vieira Pinto Barbosa, Almir Galvão Vieira Bitencourt, Rubens Chojniak
To evaluate the imaging methods used at the emergency department (ED) of a cancer center, with emphasis on computed tomography (CT). A descriptive, retrospective, single-center study was conducted by reviewing imaging exams and medical records, after approval of the institution's Ethics Review Board. The demographic data, cancer history, and imaging exam requested were evaluated for all patients and the indications and results of head, chest, and abdominopelvic CT scans were also evaluated. During the study period, there were 8710 visits to the ED, and 5999 imaging studies were requested in 3788 patients (43...
October 8, 2016: Emergency Radiology
Zihao Yan, Ivan K Ip, Ali S Raja, Anurag Gupta, Joshua M Kosowsky, Ramin Khorasani
Purpose To determine the frequency of, and yield after, provider overrides of evidence-based clinical decision support (CDS) for ordering computed tomographic (CT) pulmonary angiography in the emergency department (ED). Materials and Methods This HIPAA-compliant, institutional review board-approved study was performed at a tertiary care, academic medical center ED with approximately 60 000 annual visits and included all patients who were suspected of having pulmonary embolism (PE) and who underwent CT pulmonary angiography between January 1, 2011, and August 31, 2013...
September 30, 2016: Radiology
Evelyn Suk Yi Looi, Richard Greatbanks, André M Everett
Purpose The purpose of this paper is to examine the alignment of perceived organizational culture between Health Board chairs and Board members with that of their respective senior executive teams. It compares the degree of alignment between these two groups, and analyses them against District Health Board (DHB) performance using the New Zealand Ministry of Health's national measure "shorter stays in Emergency Departments." Design/methodology/approach Primary survey data were collected across eight DHBs using a modified version of the Organizational Culture Assessment Instrument and utilizes a sample of both higher and lower performing DHBs as defined by the "shorter stays" measure...
September 19, 2016: Journal of Health Organization and Management
Sungjae Lee, Hye Jin Baek, Hyun Kyung Jung, Jin Il Moon, Soo Buem Cho, Bo Hwa Choi, Kyungsoo Bae, Kyung Nyeo Jeon, Dae Seob Choi, Hwa Seon Shin, Dong Wook Kim
BACKGROUND: To evaluate the diagnostic performance of radiology residents' interpretations for diffusion-weighted MR imaging (DWI) in the emergency department at different levels of residency training. METHOD AND MATERIALS: A total of 160 patients who underwent DWI with acute neurologic symptoms were included in this retrospective study with an institutional review board approval. Four radiology residents with different training years and one attending neuroradiologist independently assessed the DWI results...
September 26, 2016: La Radiologia Medica
Gregory P Conners, Stacy J Doyle, Milton A Fowler, Lisa L Schroeder, Thomas W Tryon
OBJECTIVE: To describe the association of an unprecedented large-scale Enterovirus-D68 outbreak in 2014 with changes in patient volume and acuity and system stress in 2 pediatric emergency departments and 2 pediatric urgent care centers of a single children's hospital. METHODS: We compared measures of patient volume, acuity, and system stress during the 2014 Enterovirus-D68 outbreak and the corresponding dates of the previous year. RESULTS: Both settings experienced large census increases during the Enterovirus-D68 outbreak; patient census increased significantly more in the pediatric urgent care setting (20...
September 23, 2016: Pediatric Emergency Care
Sharon M Holder, Kenneth Rogers, Eunice Peterson, Robbie Shoenleben, Dawn Blackhurst
OBJECTIVES: This study assessed improvement in the emergency department (ED) length of stay and costs after implementation of an ED program which added board-certified psychiatrists and trained psychiatric social workers to the pediatric ED. METHODS: A retrospective medical record and administrative data review were conducted for all pediatric psychiatric visits of children aged 5 to 18 years who were seen and discharged from the Greenville Memorial Hospital ED between January 1, 2007, and June 31, 2013...
September 23, 2016: Pediatric Emergency Care
Allyson Hunt, Steven Nakajima, Lisa Hall Zimmerman, Manav Patel
BACKGROUND: Delay in appropriate antibiotic therapy is associated with an increase in mortality and prolonged length of stay. Automatic dispensing machines decrease the delivery time of intravenous (IV) antibiotics to patients in the emergency department (ED). However, when IV antibiotics are not reviewed by pharmacists before being administered, patients are at risk for receiving inappropriate antibiotic therapy. The objective of this study was to determine if a difference exists in the time to administration of appropriate antibiotic therapy before and after implementation of prospective verification of antibiotics in the ED...
September 6, 2016: American Journal of Emergency Medicine
Michael Gottlieb, Vibhu Sharma, John Field, Michael Rozum, John Bailitz
INTRODUCTION: Patients with severe pulmonary hemorrhage due to unilateral trauma or a bleeding cancer often present to the emergency department in acute respiratory distress. Although it is generally recommended to perform single lung intubation, most emergency department providers do not have access to or are not familiar with double-lumen endotracheal tubes, and blind insertion of an endotracheal tube to maximum depth does not ensure that the proper (nonhemorrhagic) lung is ventilated...
August 27, 2016: American Journal of Emergency Medicine
Stacy L Reynolds, Jonathan R Studnek, Kathleen Bryant, Kelly VanderHave, Eric Grossman, Charity G Moore, James Young, Melanie Hogg, Michael S Runyon
INTRODUCTION: Fentanyl is the most widely studied intranasal (IN) analgesic in children. IN subdissociative (INSD) ketamine may offer a safe and efficacious alternative to IN fentanyl and may decrease overall opioid use during the emergency department (ED) stay. This study examines the feasibility of a larger, multicentre clinical trial comparing the safety and efficacy of INSD ketamine to IN fentanyl and the potential role for INSD ketamine in reducing total opioid medication usage. METHODS AND ANALYSIS: This double-blind, randomised controlled, pilot trial will compare INSD ketamine (1 mg/kg) to IN fentanyl (1...
2016: BMJ Open
Mark E Sharafinski, Elizabeth Sehnert, David Moe, Liyun Zhang, Pippa Simpson, Nghia J Vo
OBJECTIVES: The aim of the study was to determine whether embedding into the radiology report a patient-specific plan in the event of gastrojejunostomy (GJ) tube dysfunction reduces the need for after-hours utilization of pediatric interventional radiology resources for the replacement of GJ tubes. MATERIALS AND METHODS: This is a Health Insurance Portability and Accountability Act compliant, institutional review board-approved retrospective repeated cross-sectional study of patients requiring after-hours (5 PM-7 AM) or weekend (Saturday and Sunday) GJ tube replacement at a dedicated children's hospital, before and after the inclusion of a patient-specific plan in the radiology report as part of the electronic medical record...
September 2016: Journal of Pediatric Gastroenterology and Nutrition
Adam J Singer, Jim Xiang, Christopher Kabrhel, Gino J Merli, Charles Pollack, Victor F Tapson, Peter Wildgoose, W Frank Peacock
STUDY OBJECTIVE: Traditionally, patients with pulmonary embolism (PE) are admitted from the emergency department and treated with low molecular weight heparin followed by warfarin. Several studies now demonstrate that it is possible to identify low-risk PE patients that can safely be treated as outpatients. The advent of the direct-acting oral anticoagulants such as rivaroxaban has made it easier than ever to manage patients outside of the hospital. This paper describes the design of a randomized controlled trial aimed at testing the hypothesis that low-risk PE patients can be safely and effectively managed at home using rivaroxaban, resulting in fewer days of hospitalization than standard of care treatment...
August 18, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Ashley M Strobel, Rose M Chasm, Dale P Woolridge
BACKGROUND: In 1998, emergency medicine-pediatrics (EM-PEDS) graduates were no longer eligible for the pediatric emergency medicine (PEM) sub-board certification examination. There is a paucity of guidance regarding the various training options for medical students who are interested in PEM. OBJECTIVES: We sought to to determine attitudes and personal satisfaction of graduates from EM-PEDS combined training programs. METHODS: We surveyed 71 graduates from three EM-PEDS residences in the United States...
October 2016: Journal of Emergency Medicine
James Anderson, Joanne Hill, Max Alford, Maria Oto, Aline Russell, Saif Razvi
INTRODUCTION: Epilepsy and epilepsy mimics may lead to high healthcare resource utilization (HRU) including diagnostic resources. The William Quarrier Scottish Epilepsy Centre (SEC) provides medium-term residential assessment (MTRA; average length of stay: 28days) and treatment for complex presentations of epilepsy and related conditions (principally psychogenic nonepileptic seizures, PNES). We studied the effect of MTRA on HRU in a defined health board area in Scotland. METHODS: A retrospective audit of individuals admitted to the SEC from a defined health board area using SEC and health board medical records...
September 2016: Epilepsy & Behavior: E&B
Pari V Pandharipande, Claude I Alabre, David L Coy, Atif Zaheer, Chad M Miller, Maurice S Herring, Angela C Tramontano, Emily C Dowling, Jonathan D Eisenberg, Bimal H Ashar, Elkan F Halpern, Karen Donelan, G Scott Gazelle
Purpose To determine the effect of computed tomography (CT) results on physician decision making in three common clinical scenarios in primary care. Materials and Methods This research was approved by the institutional review board (IRB) and was HIPAA compliant. All physicians consented to participate with an opt-in or opt-out mechanism; patient consent was waived with IRB approval. In this prospective multicenter observational study, outpatients referred by primary care providers (PCPs) for CT evaluation of abdominal pain, hematuria, or weight loss were identified...
July 29, 2016: Radiology
Sarah A Sterling, Samantha R Seals, Alan E Jones, Melissa H King, Robert L Galli, Kristen C Isom, Richard L Summers, Kristi A Henderson
INTRODUCTION: Timely, appropriate intervention is key to improving outcomes in many emergent conditions. In rural areas, it is particularly challenging to assure quality, timely emergency care. The TelEmergency (TE) program, which utilizes a dual nurse practitioner and emergency medicine-trained, board-certified physician model, has the potential to improve access to quality emergency care in rural areas. The objective of this study was to examine how the implementation of the TE program impacts rural hospital Emergency Department (ED) operations...
July 28, 2016: Journal of Telemedicine and Telecare
Emma Mason, Debbie Jenkins, Meg Williams, James Davies
Unscheduled acute hospital admissions and subsequent deaths in hospitals of patients considered palliative are increasing, despite many patients' preference to die at home. A large proportion of these patients are admitted via acute medical units or emergency departments. The integration of primary and secondary care within Wales should enhance the delivery of end-of-life care at home but unscheduled admission for patients with palliative care needs remains prevalent. The aim of our study was to explore the characteristics amongst patients who die shortly after unscheduled hospital admission...
2016: Acute Medicine
Julia Berendt, Stephanie Stiel, Steffen T Simon, Andrea Schmitz, Birgitt van Oorschot, Peter Stachura, Christoph Ostgathe
BACKGROUND: International associations admit that specialized palliative care (SPC) is an obvious component of excellent cancer care. Nevertheless, gaps in integration at the international level have been identified. Recommendations for integrating SPC in clinical care, research, and education are needed, which are subject of the present study. MATERIALS AND METHODS: A Delphi study, with three written Delphi rounds, including a face-to-face-meeting with a multiprofessional expert panel (n = 52) working in SPC in 15 German Comprehensive Cancer Centers (CCCs) funded by the German Cancer Aid was initiated...
October 2016: Oncologist
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