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Emergency Department Boarding

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https://www.readbyqxmd.com/read/29928127/isolated-proximal-greater-saphenous-vein-thrombosis-and-the-risk-of-propagation-to-deep-vein-thrombosis-and-pulmonary-embolism
#1
Samuel H Kim, Nimesh Patel, Kanika Thapar, Ananda V Pandurangadu, Amit Bahl
Objectives: Greater saphenous vein (GSV) thrombosis is concerning due to its close proximity to the deep femoral vein. This study sought to identify the risk of propagation to deep vein thrombosis (DVT) or pulmonary embolism (PE) among patients with isolated proximal GSV superficial thrombosis and describe provider practice patterns related to treatment. Materials and methods: This is an Institutional Review Board-approved retrospective multi-center study. Patients presented to one of three possible emergency departments in a large health system...
2018: Vascular Health and Risk Management
https://www.readbyqxmd.com/read/29915933/an-electronic-dashboard-to-monitor-patient-flow-at-the-johns-hopkins-hospital-communication-of-key-performance-indicators-using-the-donabedian-model
#2
Diego A Martinez, Erin M Kane, Mehdi Jalalpour, James Scheulen, Hetal Rupani, Rohit Toteja, Charles Barbara, Bree Bush, Scott R Levin
Efforts to monitoring and managing hospital capacity depend on the ability to extract relevant time-stamped data from electronic medical records and other information technologies. However, the various characterizations of patient flow, cohort decisions, sub-processes, and the diverse stakeholders requiring data visibility create further overlying complexity. We use the Donabedian model to prioritize patient flow metrics and build an electronic dashboard for enabling communication. Ten metrics were identified as key indicators including outcome (length of stay, 30-day readmission, operating room exit delays, capacity-related diversions), process (timely inpatient unit discharge, emergency department disposition), and structural metrics (occupancy, discharge volume, boarding, bed assignation duration)...
June 18, 2018: Journal of Medical Systems
https://www.readbyqxmd.com/read/29893609/racial-disparities-in-the-treatment-of-acute-overdose-in-the-emergency-department
#3
Marcee E Wilder, Lynne D Richardson, Robert S Hoffman, Gary Winkel, Alex F Manini
OBJECTIVES: Racial and ethnic disparities in the United States continue to exist in many disciplines of medicine, extending to care in the Emergency Department (ED). We sought to examine the relationship between patient race/ethnicity and use of either antidotal therapy or gastrointestinal decontamination for individuals presenting to the ED for acute drug overdose. METHODS: We completed a secondary analysis of a prospective cohort of patients with suspected acute overdose presenting to two urban tertiary care hospitals between 2009 and 2014...
June 12, 2018: Clinical Toxicology
https://www.readbyqxmd.com/read/29873504/using-body-mass-index-and-bioelectric-impedance-analysis-to-assess-the-need-for-positive-oral-contrast-agents-before-abdominopelvic-ct
#4
Yuhao Wu, Ismail Ali, Bernd Teunissen, Timothy O'Connell, Faisal Khosa, Savvas Nicolaou, Patrick McLaughlin
OBJECTIVE: The objective of this study was to determine whether body fat percentage, measured using a portable handheld bioelectric impedance analysis (BIA) device, and body mass index (BMI, weight in kilograms divided by the square of height in meters) can estimate the amount of intraabdominal and intrapelvic fat and thereby predict the need for oral contrast material before abdominopelvic CT. SUBJECTS AND METHODS: A prospective, institutional review board-approved study consisting of 101 patients who presented to the emergency department of a level I trauma center was conducted between June 1, 2016, and July 19, 2016...
June 6, 2018: AJR. American Journal of Roentgenology
https://www.readbyqxmd.com/read/29872643/three-dimensional-map-of-isoprognostic-zones-in-glottic-cancer-treated-by-transoral-laser-microsurgery-as-a-unimodal-treatment-strategy
#5
Cesare Piazza, Marta Filauro, Alberto Paderno, Filippo Marchi, Pietro Perotti, Riccardo Morello, Stefano Taboni, Giampiero Parrinello, Fabiola Incandela, Andrea Iandelli, Francesco Missale, Giorgio Peretti
Introduction: The Union for International Cancer Control-American Joint Committee on Cancer TNM staging system for glottic squamous cell carcinoma (SCC) includes different types of lesions defined by the involvement of specific subsites in each T category. Our study aims to identify different subcategories according to tumor local extension and determine oncologic outcomes after treatment by transoral laser microsurgery (TLM) alone. Methods: We retrospectively evaluated 410 patients affected by previously untreated pT1-pT3 glottic SCC treated by TLM alone from January 2005 to December 2015 at the Departments of Otorhinolaryngology-Head and Neck Surgery, Universities of Genoa and Brescia, Italy...
2018: Frontiers in Oncology
https://www.readbyqxmd.com/read/29870457/consensus-guidelines-on-the-use-of-intravenous-ketamine-infusions-for-acute-pain-management-from-the-american-society-of-regional-anesthesia-and-pain-medicine-the-american-academy-of-pain-medicine-and-the-american-society-of-anesthesiologists
#6
Eric S Schwenk, Eugene R Viscusi, Asokumar Buvanendran, Robert W Hurley, Ajay D Wasan, Samer Narouze, Anuj Bhatia, Fred N Davis, William M Hooten, Steven P Cohen
BACKGROUND: Ketamine infusions have been used for decades to treat acute pain, but a recent surge in usage has made the infusions a mainstay of treatment in emergency departments, in the perioperative period in individuals with refractory pain, and in opioid-tolerant patients. The widespread variability in patient selection, treatment parameters, and monitoring indicates a need for the creation of consensus guidelines. METHODS: The development of acute pain ketamine guidelines grew as a corollary from the genesis of chronic pain ketamine guidelines...
July 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29807261/estimating-the-number-of-airports-potentially-contaminated-with-perfluoroalkyl-and-polyfluoroalkyl-substances-from-aqueous-film-forming-foam-a-canadian-example
#7
Shawn A Milley, Iris Koch, Patricia Fortin, Jeremy Archer, David Reynolds, Kela P Weber
Assessing the extent to which emerging contaminants (ECs) such as perfluoroalkyl and polyfluoroalkyl substances (PFAS) have been released into the environment is one of the foundations for developing effective management and remediation strategies for impacted sites. PFAS are known to have caused the contamination of soil, groundwater, and surface water as a result of aqueous film forming foam (AFFF) being accidentally or intentionally released into the environment. To date, the scope of the issue has not been evaluated in Canada...
May 25, 2018: Journal of Environmental Management
https://www.readbyqxmd.com/read/29768297/pediatric-esophageal-foreign-body-possible-role-for-digital-tomosynthesis
#8
Andrew Johansen, Gregory P Conners, Jacob Lee, Amie L Robinson, William L Chew, Sherwin S Chan
OBJECTIVES: Foreign body (FB) ingestion is a common reason for emergency department visits, affecting more than 80,000 children in the United States annually. Whereas most ingested FBs are coins or other radiopaque objects, some are radiolucent FBs such as food. Digital tomosynthesis (DTS) is a radiographic technique that produces cross-sectional images with in-plane resolution similar to that of traditional radiographs. Our pilot study evaluated the sensitivity and specificity of DTS to detect FB in comparison to esophagram and clinical impression...
May 15, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29760941/hip-fracture-in-the-elderly-multidisciplinary-rehabilitation-femur-feasibility-study-testing-the-use-of-routinely-collected-data-for-future-health-economic-evaluations
#9
Nefyn H Williams, Kevin Mawdesley, Jessica L Roberts, Nafees Ud Din, Nicola Totton, Joanna M Charles, Zoe Hoare, Rhiannon T Edwards
Background: Health economic evaluations rely on the accurate measurement of health service resource use in order to calculate costs. These are usually measured with patient completed questionnaires using instruments such as the Client Service Receipt Inventory (CSRI). These rely on participants' recall and can be burdensome to complete. Health service activity data are routinely captured by electronic databases.The aim was to test methods for obtaining these data and compare with those data collected using the CSRI, within a feasibility study of an enhanced rehabilitation intervention following hip fracture (Fracture in the Elderly Multidisciplinary Rehabilitation: FEMuR)...
2018: Pilot and Feasibility Studies
https://www.readbyqxmd.com/read/29760848/code-help-can-this-unique-state-regulatory-intervention-improve-emergency-department-crowding
#10
Sean S Michael, John P Broach, Kevin A Kotkowski, D Eric Brush, Gregory A Volturo, Martin A Reznek
Introduction: Emergency department (ED) crowding adversely affects multiple facets of high-quality care. The Commonwealth of Massachusetts mandates specific, hospital action plans to reduce ED boarding via a mechanism termed "Code Help." Because implementation appears inconsistent even when hospital conditions should have triggered its activation, we hypothesized that compliance with the Code Help policy would be associated with reduction in ED boarding time and total ED length of stay (LOS) for admitted patients, compared to patients seen when the Code Help policy was not followed...
May 2018: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29760842/appropriateness-of-extremity-magnetic-resonance-imaging-examinations-in-an-academic-emergency-department-observation-unit
#11
McKinley Glover, Ravi V Gottumukkala, Yadiel Sanchez, Brian J Yun, Theodore I Benzer, Benjamin A White, Anand M Prabhakar, Ali S Raja
Introduction: Emergency departments (ED) and hospitals face increasing challenges related to capacity, throughput, and stewardship of limited resources while maintaining high quality. Appropriate utilization of extremity magnetic resonance imaging (MRI) examinations within the emergency setting is not well known. Therefore, this study aimed to determine indications for and appropriateness of MRI of the extremities for musculoskeletal conditions in the ED observation unit (EDOU). Methods: We conducted this institutional review board-approved, retrospective study in a large, quaternary care academic center and Level I trauma center...
May 2018: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29759656/well-being-among-emergency-medicine-resident-physicians-results-from-the-abem-longitudinal-study-of-emergency-medicine-residents
#12
Debra G Perina, Catherine A Marco, Rebecca Smith-Coggins, Terry Kowalenko, Mary M Johnston, Anne Harvey
BACKGROUND: The Longitudinal Study of Emergency Medicine Residents (LSEMR) conducted by the American Board of Emergency Medicine queries a randomized cohort of emergency medicine (EM) residents. It is designed to identify residents' perceptions of their training, sources of stress, well-being level, and career choice satisfaction over time. OBJECTIVES: This study utilizes LSEMR to identify resident well-being levels, career satisfaction, factors producing stress, and whether a specific cohort is more stressed than the overall respondent group...
May 11, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29752651/emergency-ct-for-assessment-and-management-of-blunt-traumatic-splenic-injuries-at-a-level-1-trauma-center-13-year-study
#13
Sergio Margari, Fernanda Garozzo Velloni, Massimo Tonolini, Ettore Colombo, Diana Artioli, Niccolò Ettore Allievi, Fabrizio Sammartano, Osvaldo Chiara, Angelo Vanzulli
PURPOSE: To determine the relationship between multidetector computed tomography (MDCT) findings, management strategies, and ultimate clinical outcomes in patients with splenic injuries secondary to blunt trauma. MATERIALS AND METHODS: This Institutional Review Board-approved study collected 351 consecutive patients admitted at the Emergency Department (ED) of a Level I Trauma Center with blunt splenic trauma between October 2002 and November 2015. Their MDCT studies were retrospectively and independently reviewed by two radiologists to grade splenic injuries according to the American Association for the Surgery of Trauma (AAST) organ injury scale (OIS) and to detect intraparenchymal (type A) or extraparenchymal (type B) active bleeding and/or contained vascular injuries (CVI)...
May 12, 2018: Emergency Radiology
https://www.readbyqxmd.com/read/29688158/prospective-comparison-of-the-diagnostic-accuracy-of-mr-imaging-versus-ct-for-acute-appendicitis
#14
Michael D Repplinger, Perry J Pickhardt, Jessica B Robbins, Douglas R Kitchin, Tim J Ziemlewicz, Scott J Hetzel, Sean K Golden, John B Harringa, Scott B Reeder
Purpose To compare the accuracy of magnetic resonance (MR) imaging with that of computed tomography (CT) for the diagnosis of acute appendicitis in emergency department (ED) patients. Materials and Methods This was an institutional review board-approved, prospective, observational study of ED patients at an academic medical center (February 2012 to August 2014). Eligible patients were nonpregnant and 12- year-old or older patients in whom a CT study had been ordered for evaluation for appendicitis. After informed consent was obtained, CT and MR imaging (with non-contrast material-enhanced, diffusion-weighted, and intravenous contrast-enhanced sequences) were performed in tandem, and the images were subsequently retrospectively interpreted in random order by three abdominal radiologists who were blinded to the patients' clinical outcomes...
April 24, 2018: Radiology
https://www.readbyqxmd.com/read/29685020/ability-of-computed-tomography-to-predict-right-heart-strain-on-an-echocardiogram-in-patients-with-acute-pulmonary-embolus
#15
A Shams, J Hung, A Bahl
Patients with submassive pulmonary embolism (PE) resulting in right heart strain (RHS) have an increased risk of mortality compared to those with a preserved right ventricular function. This study aimed to investigate the predictive value of computed tomography pulmonary angiogram (CTPA) findings of right heart strain in patients with computed tomography (CT)-proven PE for the diagnosis of right heart strain by echocardiogram (ECHO). The institutional review board (IRB) approved retrospective chart review of the adult emergency department patients diagnosed with an acute PE between 2012 and 2016...
March 2018: Journal of Biological Regulators and Homeostatic Agents
https://www.readbyqxmd.com/read/29678969/reducing-the-default-dispense-quantity-for-new-opioid-analgesic-prescriptions-study-protocol-for-a-cluster-randomised-controlled-trial
#16
Marcus A Bachhuber, Denis Nash, William N Southern, Moonseong Heo, Matthew Berger, Mark Schepis, Chinazo O Cunningham
INTRODUCTION: As opioid analgesic consumption has grown, so have opioid use disorder and opioid-related overdoses. Reducing the quantity of opioid analgesics prescribed for acute non-cancer pain can potentially reduce risks to the individual receiving the prescription and to others who might unintentionally or intentionally consume any leftover tablets. Reducing the default dispense quantity for new opioid analgesic prescriptions in the electronic health record (EHR) is a promising intervention to reduce prescribing...
April 20, 2018: BMJ Open
https://www.readbyqxmd.com/read/29678018/advantages-of-a-web-based-real-time-bed-management-system-for-hospital-admission-monitoring-in-iran
#17
Somayeh Abedian, Ehsan Bitaraf, Marjan Askari
Lack of up-to-date information of hospitals beds, specifically in emergencies, is a significant problem in many large countries; The Ministry of Health and Medical Education of Iran (MOHME) designed and implemented a dynamic system that reports the status of beds in 2012. This system created great opportunities for national bed management, including real-time hospital admission monitoring, especially for emergency departments, ICUs and CCUs. Therefore, an additional online system was planned to be implemented for monitoring hospital admissions, including a national alert system...
2018: Studies in Health Technology and Informatics
https://www.readbyqxmd.com/read/29665984/emergency-department-overcrowding-quality-improvement-in-a-taiwan-medical-center
#18
Chen-Mei Hsu, Li-Lin Liang, Yun-Te Chang, Wang-Chuan Juang
BACKGROUND/PURPOSE: Overcrowding of hospital emergency departments (ED) is a worldwide health problem. The Taiwan Joint Commission on Hospital Accreditation has stressed the importance of finding solutions to overcrowding, including, reducing the number of patients with >48 h stay in the ED. Moreover, the Ministry of Health and Welfare aims at transferring non-critical patients to district or regional hospitals. We report the results of our Quality Improvement Project (QIP) on ED overcrowding, especially focusing on reducing length of stay (LOS) in ED...
April 14, 2018: Journal of the Formosan Medical Association, Taiwan Yi Zhi
https://www.readbyqxmd.com/read/29663580/emergency-physician-interpretation-of-point-of-care-ultrasound-for-identifying-and-grading-of-hydronephrosis-in-renal-colic-compared-with-consensus-interpretation-by-emergency-radiologists
#19
Sameer A Pathan, Biswadev Mitra, Salman Mirza, Umais Momin, Zahoor Ahmed, Lubna G Andraous, Dharmesh Shukla, Mohammed Y Shariff, Magid M Makki, Tinsy T George, Saad S Khan, Stephen H Thomas, Peter A Cameron
OBJECTIVE: The ability of emergency physicians (EPs) to identify hydronephrosis using point-of-care ultrasound (POCUS) has been assessed in the past using computed tomography (CT) scans as the reference standard. We aimed to determine the ability of EPs to identify and grade hydronephrosis on POCUS using the consensus interpretation of POCUS by emergency radiologists as the reference standard. METHODS: The study was conducted at an urban academic emergency department (ED) as a secondary analysis of previously collected ultrasound data from the EP-performed POCUS databank...
April 16, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29619913/emergency-department-boarding-a-descriptive-analysis-and-measurement-of-impact-on-outcomes
#20
Leila Salehi, Prashant Phalpher, Rahim Valani, Christopher Meaney, Qamar Amin, Kiki Ferrari, Mathew Mercuri
CLINICIAN'S CAPSULE What is known about the topic? Bed boarding is one of the major contributors to emergency department overcrowding. What did this study ask? What are the characteristics of patients with prolonged boarding times, and what are the impacts on patient-oriented outcomes? What did this study find? Patients who were older, sicker, and had isolation and telemetry requirements experienced longer boarding times, and longer inpatient length of stay even after correcting for confounders. Why does this study matter to clinicians? Organization-wide interventions to improve efficiency and flow are required to mitigate the burden of bed boarding...
April 5, 2018: CJEM
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