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Emergency Department Boarding

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https://www.readbyqxmd.com/read/29456595/geographical-access-to-critical-care-services-in-scotland
#1
Philip Emerson, Naomi Dodds, David R Green, Jan O Jansen
Background: Critical illness requires specialist and timely management. The aim of this study was to create a geographic accessibility profile of the Scottish population to emergency departments and intensive care units. Methods: This was a descriptive, geographical analysis of population access to 'intermediate' and 'definitive' critical care services in Scotland. Access was defined by the number of people able to reach services within 45 to 60 min, by road and by helicopter...
February 2018: Journal of the Intensive Care Society
https://www.readbyqxmd.com/read/29423875/emergency-medicine-in-the-kingdom-of-bahrain
#2
Feras Abuzeyad, Leena Alqusem, Mudhaffar I Al Farras, Shaikha S Al Jawder, Ghada Al Qasim, Salah Alghanem
It has been more than a decade since emergency medicine became recognized as a specialty in the Kingdom of Bahrain. In the last fifteen years emergency medicine has widely established itself and developed rapidly in the Kingdom. The three main emergency departments are: Salmanyia Medical Complex (SMC), Royal Medical Services of Bahrain Defence Force (RMS-BDF) and King Hamad University Hospital (KHUH) are now fully equipped and operated by a majority of board certified emergency physicians.Standardized protocols, and the Central National Ambulance will be established in the near future, and the ambulances will offer both basic and advanced life support by trained nurses and paramedics...
February 8, 2018: International Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29420772/purchased-behavioral-health-care-received-by-military-health-system-beneficiaries-in-civilian-medical-facilities-2000-2014
#3
Nikki R Wooten, Jordan A Brittingham, Ronald O Pitner, Abbas S Tavakoli, Diana D Jeffery, K Sue Haddock
Introduction: Behavioral health conditions are a significant concern for the U.S. military and the Military Health System (MHS) because of decreased military readiness and increased health care utilization. Although MHS beneficiaries receive direct care in military treatment facilities, a disproportionate majority of behavioral health treatment is purchased care received in civilian facilities. Yet, limited evidence exists about purchased behavioral health care received by MHS beneficiaries...
February 6, 2018: Military Medicine
https://www.readbyqxmd.com/read/29401041/perivascular-epicardial-fat-stranding-at-coronary-ct-angiography-a-marker-of-acute-plaque-rupture-and-spontaneous-coronary-artery-dissection
#4
Sandeep Hedgire, Vinit Baliyan, Evan J Zucker, Daniel O Bittner, Pedro Staziaki, Richard A P Takx, Jan-Erik Scholtz, Nandini Meyersohn, Udo Hoffmann, Brian Ghoshhajra
Purpose To evaluate the frequency and implications of perivascular fat stranding on coronary computed tomography (CT) angiograms obtained for suspected acute coronary syndrome (ACS). Materials and Methods This retrospective registry study was approved by the institutional review board. The authors reviewed the medical records and images of 1403 consecutive patients (796 men, 607 women; mean age, 52.8 years) who underwent coronary CT angiography at the emergency department from February 2012 to March 2016. Fat attenuation, length and number of circumferential quadrants of the affected segment, and attenuation values in the unaffected epicardial and subcutaneous fat were measured...
February 5, 2018: Radiology
https://www.readbyqxmd.com/read/29400622/a-retrospective-analysis-of-boarding-times-for-adolescents-in-psychiatric-crisis
#5
Michael Campbell, Jessica Pierce
The boarding of children and adolescents with identified psychiatric conditions at medical facilities has numerous negative effects on the patients and the systems that treat them. Efforts to minimize boarding times serves to increase patients' access to appropriate levels of care, redirect medical resources to patients who need them most, and reduce safety risks to people and property. This study explores the role Clinical Social Workers can play in facilitation of care and highlights the advantages of a coordinated data collection process facilitated by the effective use of the Electronic Medical Record...
February 5, 2018: Social Work in Health Care
https://www.readbyqxmd.com/read/29398586/prospective-study-of-enhanced-recovery-after-surgery-protocol-in-children-undergoing-reconstructive-operations
#6
K O Rove, M A Brockel, A F Saltzman, M I Dönmez, K E Brodie, D J Chalmers, B T Caldwell, V M Vemulakonda, D T Wilcox
BACKGROUND: Enhanced recovery after surgery (ERAS) protocol is a set of peri-operative strategies to increase speed of recovery. ERAS is well established in adults but has not been well studied in children. OBJECTIVE: The purpose of the current study was to establish the safety and efficacy of an ERAS protocol in pediatric urology patients undergoing reconstructive operations. It was hypothesized that ERAS would reduce length of stay and decrease complications when compared with historical controls...
February 1, 2018: Journal of Pediatric Urology
https://www.readbyqxmd.com/read/29394480/interprofessional-huddle-one-children%C3%A2-s-hospital%C3%A2-s-approach-to-improving-patient-flow
#7
Cheryl L McBeth, Blythe Durbin-Johnson, Elena O Siegel
Admitting pediatric patients promptly to the appropriate unit where they can receive specialty care is of critical importance to safe, quality care. A daily morning huddle was implemented at one children’s hospital as a quality improvement project. The aim of this project was to improve patient flow throughout the children’s hospital by improving interprofessional and interdepartmental communication and collaboration. This article reports on changes in patient flow before and after implementation of the daily huddle, as measured by pediatric emergency department (ED) boarding times...
March 2017: Pediatric Nursing
https://www.readbyqxmd.com/read/29384780/effect-of-emergency-department-and-icu-occupancy-on-admission-decisions-and-outcomes-for-critically-ill-patients
#8
Kusum S Mathews, Matthew S Durst, Carmen Vargas-Torres, Ashley D Olson, Madhu Mazumdar, Lynne D Richardson
OBJECTIVES: ICU admission delays can negatively affect patient outcomes, but emergency department volume and boarding times may also affect these decisions and associated patient outcomes. We sought to investigate the effect of emergency department and ICU capacity strain on ICU admission decisions and to examine the effect of emergency department boarding time of critically ill patients on in-hospital mortality. DESIGN: A retrospective cohort study. SETTING: Single academic tertiary care hospital...
January 30, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29380094/-psychological-boarding-and-community-based-behavioral-health-crisis-stabilization
#9
Dhrubodhi Mukherjee, Verletta Saxon
This exploratory paper presents a case study where a community based mental health organization forging a partnership with a local hospital system to establish a crisis stabilization unit (CSU) to address behavioral health emergency care. The study takes a mixed methods case study approach to address two research questions; (a) did this approach reduce the overall length of stay in the hospital emergency departments? (b) What challenges did the taskforce face in implementing this CSU model? The paper shares recommendation from the findings...
January 27, 2018: Community Mental Health Journal
https://www.readbyqxmd.com/read/29378577/risks-predicting-prolonged-hospital-discharge-boarding-in-a-regional-acute-care-hospital
#10
Sajid A Shaikh, Richard D Robinson, Radhika Cheeti, Shyamanand Rath, Chad D Cowden, Frank Rosinia, Nestor R Zenarosa, Hao Wang
BACKGROUND: Prolonged hospital discharge boarding can impact patient flow resulting in upstream Emergency Department crowding. We aim to determine the risks predicting prolonged hospital discharge boarding and their direct and indirect effects on patient flow. METHODS: Retrospective review of a single hospital discharge database was conducted. Variables including type of disposition, disposition boarding time, case management consultation, discharge medications prescriptions, severity of illness, and patient homeless status were analyzed in a multivariate logistic regression model...
January 30, 2018: BMC Health Services Research
https://www.readbyqxmd.com/read/29372430/emergency-physician-use-of-tissue-doppler-bedside-echocardiography-in-detecting-diastolic-dysfunction-an-exploratory-study
#11
Marina Del Rios, Joseph Colla, Pavitra Kotini-Shah, Joan Briller, Ben Gerber, Heather Prendergast
INTRODUCTION: This study evaluates the agreement between emergency physician (EP) assessment of diastolic dysfunction (DD) by a simplified approach using average peak mitral excursion velocity (e' A ) and an independent cardiologist's diagnosis of DD by estimating left atrial (LA) pressure using American Society of Echocardiography (ASE) guidelines. METHODS: This was a secondary analysis of 48 limited bedside echocardiograms (LBE) performed as a part of a research study of patients presenting to the Emergency Department (ED) with elevated blood pressure but without decompensated heart failure...
January 25, 2018: Critical Ultrasound Journal
https://www.readbyqxmd.com/read/29369261/screening-of-pediatric-facial-fractures-by-brain-computed-tomography-diagnostic-performance-comparison-with-facial-computed-tomography
#12
JongChan Ryu, Seong Jong Yun, Sun Hwa Lee, Yoon Hee Choi
OBJECTIVES: Facial bone fractures secondary to head trauma are more common in children than in adults. Recently, multidetector row computed tomography (CT) has been considered superior to conventional radiography. Some studies have reported that facial soft tissue injuries require both facial and brain CT and that brain CT is helpful in screening facial bone fractures. However, these studies included only adult patients. The aim of this study was to evaluate the diagnostic performance of brain CT and the need for additional facial CT to detect facial bone fractures in emergency pediatrics...
January 23, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29364724/trends-and-variation-in-the-utilization-and-diagnostic-yield-of-chest-imaging-for-medicare-patients-with-suspected-pulmonary-embolism-in-the-emergency-department
#13
Arjun K Venkatesh, Leila Agha, Jason Abaluck, Craig Rothenberg, Christopher Kabrhel, Ali S Raja
OBJECTIVE: The purpose of this study is to assess trends and variation in chest CT utilization in the emergency department (ED) and its diagnostic yield for suspected pulmonary embolism (PE) among a national sample of Medicare beneficiaries. The relationship between hospital and provider characteristics is also discussed. MATERIALS AND METHODS: We conducted an observational analysis of Medicare beneficiaries evaluated in the ED for suspected PE from 2000 to 2009...
January 24, 2018: AJR. American Journal of Roentgenology
https://www.readbyqxmd.com/read/29336787/clinical-severity-alone-does-not-determine-disposition-decisions-for-patients-in-the-emergency-department-with-suicide-risk
#14
David S Kroll, Jennifer Karno, Brian Mullen, Sejal B Shah, Daniel J Pallin, David F Gitlin
BACKGROUND: Boarding of patients with suicide risk in emergency departments (EDs) negatively affects both patients and society. Factors other than clinical severity may frequently preclude safe outpatient dispositions among suicidal patients boarding for psychiatric admission in the ED. OBJECTIVE: To determine the extent to which nonclinical factors preclude safe outpatient discharge from the ED among patients boarding for psychiatric admission based on suicide risk...
December 7, 2017: Psychosomatics
https://www.readbyqxmd.com/read/29335822/emergency-department-throughput-an-intervention
#15
Nowreen Haq, Rona Stewart-Corral, Eric Hamrock, Jamie Perin, Waseem Khaliq
Shortening emergency department (ED) boarding time and managing hospital bed capacity by expediting the inpatient discharge process have been challenging for hospitals nationwide. The objective of this study is was to explore the effect of an innovative prospective intervention on hospital workflow, specifically on early inpatient discharges and the ED boarding time. The intervention consisted of a structured nursing "admission discharge transfer" (ADT) protocol receiving new admissions from the ED and helping out floor nursing with early discharges...
January 15, 2018: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/29333496/improving-the-wait-time-to-consultation-at-the-emergency-department
#16
Yuzeng Shen, Lin Hui Lee
Prolonged wait times at the emergency department (ED) are associated with increased morbidity and mortality, and decreased patient satisfaction. Reducing wait times at the ED is challenging. The objective of this study is to determine if the implementation of a series of interventions would help decrease the wait time to consultation (WTC) for patients at the ED within 6 months. Interventions include creation of a common board detailing work output, matching manpower to patient arrivals and adopting a team-based model of care...
2018: BMJ Open Quality
https://www.readbyqxmd.com/read/29315613/the-learning-curve-in-diagnosing-acute-appendicitis-with-emergency-sonography-among-novice-emergency-medicine-residents
#17
Jeehyun Kim, Kipum Kim, Jungwan Kim, Jungwoo Yoo, Wonjoon Jeong, Sunguk Cho, Kihyuk Joo, Yongchul Cho, Jinwoong Lee, Seung Ryu, Yeonho Yoo
PURPOSE: Ultrasonography (US) has good accuracy for diagnosing appendicitis when it is performed by emergency physicians. This study aimed to determine the amount of experience that is required to achieve competency in this field. METHODS: Three novice emergency medicine residents completed a 1-day training course regarding the US diagnosis of appendicitis. Then, they performed appendix US in the emergency department on patients complaining of right lower quadrant pain...
January 5, 2018: Journal of Clinical Ultrasound: JCU
https://www.readbyqxmd.com/read/29310983/applying-advanced-analytics-to-guide-emergency-department-operational-decisions-a-proof-of-concept-study-examining-the-effects-of-boarding
#18
R Andrew Taylor, Arjun Venkatesh, Vivek Parwani, Sharon Chekijian, Marc Shapiro, Andrew Oh, David Harriman, Asim Tarabar, Andrew Ulrich
BACKGROUND: Emergency Department (ED) leaders are increasingly confronted with large amounts of data with the potential to inform and guide operational decisions. Routine use of advanced analytic methods may provide additional insights. OBJECTIVES: To examine the practical application of available advanced analytic methods to guide operational decision making around patient boarding. METHODS: Retrospective analysis of the effect of boarding on ED operational metrics from a single site between 1/2015 and 1/2017...
January 4, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29306646/characterizing-surf-zone-injuries-from-the-five-most-populated-beaches-on-the-atlantic-fronting-delaware-coast-delaware-surf-zone-injury-demographics
#19
Matthew B Doelp, Jack A Puleo, Paul Cowan, Michelle Arford-Granholm
INTRODUCTION: Beaches are a popular destination for recreation activities. Surf zone injuries (SZI) can occur resulting from a variety of in-water activities. Little is known regarding the sustained injury types, or demographics of injured persons and activities leading to injuries. METHODS: This study examines the distribution of SZI types, activities and populations occurring on Delaware Beaches as recorded by a local level III trauma center (Department of Emergency Medicine at Beebe Healthcare in Lewes, Delaware)...
December 24, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29278979/impact-of-a-telemedicine-eicu-cart-on-sepsis-management-in-a-community-hospital-emergency-department
#20
Shana M Machado, Erika H Wilson, John O Elliott, Kim Jordan
Introduction Intensivist involvement for patients with sepsis is associated with decreased complications and mortality, and lower hospital resource utilization, but few studies have evaluated outcomes for patients exposed to electronic intensive care unit (eICU) telemedicine sepsis management in the emergency department (ED). In this study, we assess whether eICU cart exposure in the ED improved compliance with components of the 2010 Surviving Sepsis Campaign bundles, length of stay (LOS), disposition and hospital costs...
January 1, 2017: Journal of Telemedicine and Telecare
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