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Emergency Department Boarding

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https://www.readbyqxmd.com/read/29665984/emergency-department-overcrowding-quality-improvement-in-a-taiwan-medical-center
#1
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
#2
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 (EP) to identify hydronephrosis using point-of-care ultrasound (POCUS) has been assessed in the past using CT scans as the reference standard. We aimed to determine the ability of EP for identifying and grading of 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
#3
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
https://www.readbyqxmd.com/read/29605480/emergency-department-boarding-and-adverse-hospitalization-outcomes-among-patients-admitted-to-a-general-medical-service
#4
Kito Lord, Vivek Parwani, Andrew Ulrich, Emily B Finn, Craig Rothenberg, Beth Emerson, Alana Rosenberg, Arjun K Venkatesh
OBJECTIVE: Overcrowding in the emergency department (ED) has been associated with patient harm, yet little is known about the association between ED boarding and adverse hospitalization outcomes. We sought to examine the association between ED boarding and three common adverse hospitalization outcomes: rapid response team activation (RRT), escalation in care, and mortality. METHOD: We conducted an observational analysis of consecutive patient encounters admitted from the ED to the general medical service between February 2013 and June 2015...
March 20, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29602665/relocation-of-blood-gas-laboratory-to-the-emergency-department-helps-decrease-lactic-acid-values
#5
Jared Brazg, Phyllis Huang, Corey Weiner, Guneet Singh, Antonios Likourezos, Linda Salem, Eitan Dickman, John Marshall
IMPORTANCE: Emergency physicians often rely on Lactic Acid (LA) values to make important clinical decisions. Accuracy of LA values improve when blood gas analysis is performed in the emergency department (ED) as opposed to a satellite laboratory (SL). OBJECTIVE: To investigate an association between blood gas laboratory location and accuracy of ED lactic acid samples. METHODS: The study team evaluated lactic acid values from venous and arterial blood gas samples drawn between June 1, 2015 and September 30, 2016...
March 20, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29595610/accreditation-s-role-in-bolstering-resilience-in-the-face-of-the-zika-virus-outbreak
#6
Celeste Philip, Kelli T Wells, Russell Eggert, Jennifer Elmore, Reynald Jean, Jennifer Johnson, Jeanne Lane, Ximena Lopez, Lillian Rivera, Elmir Samir, Natasha Strokin, Yesenia Villalta, Rene Ynestroza
The Florida Department of Health (Department) received accreditation status as an integrated public health system from the Public Health Accreditation Board (PHAB) in 2 phases: the State Health Office received accreditation in June 2014 and the 67 county health departments received accreditation in March 2016. Six weeks after PHAB awarded accreditation to the Department as an integrated public health system in March 2016, the World Health Organization declared the Zika outbreak in the Americas a Public Health Emergency of International Concern...
May 2018: Journal of Public Health Management and Practice: JPHMP
https://www.readbyqxmd.com/read/29595427/bundling-care-for-cardiac-surgery-patients
#7
Patti Cochrane, Michelle DiEmanuele
Patients returning to the community after surgery often experience a disconnect when transitioning from hospital to community home care. Many receive little organized/planned care following discharge sometimes resulting in unplanned expensive care in hospital emergency departments and inpatient readmissions. Trillium Health Partners, a large community/teaching hospital, in partnership with community care provider Saint Elizabeth Health Care, designed and implemented a seamless "bundled care program" for cardiac surgery patients extending from hospitalization to 30 days after discharge...
January 2018: Healthcare Quarterly
https://www.readbyqxmd.com/read/29581182/pediatric-hoverboard-and-skateboard-injuries
#8
Sean Bandzar, Daniel G Funsch, Rex Hermansen, Seema Gupta, Andrew Bandzar
OBJECTIVES: To investigate the characteristics of hoverboard injuries compared with skateboard injuries in children presenting to US emergency departments (EDs). METHODS: Data regarding hoverboard and skateboard injuries in children <18 years of age were obtained from the National Electronic Injury Surveillance System for calendar years 2015 and 2016. Data included demographics, body regions injured, and ED disposition. RESULTS: There were an estimated 26 854 hoverboard and 121 398 skateboard injuries treated in US EDs between 2015 and 2016...
March 26, 2018: Pediatrics
https://www.readbyqxmd.com/read/29573904/causes-of-emergency-department-overcrowding-and-blockage-of-access-to-critical-services-in-beijing-a-2-year-study
#9
Zhen Wang, Xiaying Xiong, Shuang Wang, Junguo Yan, Martin Springer, R P Dellinger
BACKGROUND: Emergency department (ED) overcrowding is a serious issue worldwide. OBJECTIVES: This study was done to evaluate the degree of overcrowding in local "teaching hospitals" in Beijing, and to ascertain the apparent root causes for the pervasive degree of overcrowding in these EDs. METHODS: This is a multicenter cross-sectional study. The studied population included all ED patients from 18 metropolitan teaching hospital EDs in Beijing for calendar years 2013 and 2014...
March 21, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29570120/mortality-associated-with-emergency-department-boarding-exposure-are-there-differences-between-patients-admitted-to-icu-and-non-icu-settings
#10
Martin A Reznek, Benjavan Upatising, Samantha J Kennedy, Natassia T Durham, Richard M Forster, Sean S Michael
BACKGROUND: Emergency Department (ED) boarding threatens patient safety. It is unclear whether boarding differentially affects patients admitted to intensive care units (ICUs) versus non-ICU settings. RESEARCH DESIGN AND SUBJECTS: We performed a 2-hospital, 18-month, cross-sectional, observational, descriptive study of adult patients admitted from the ED. We used Kaplan-Meier estimation and Cox Proportional Hazards regression to describe differences in boarding time among patients who died during hospitalization versus those who survived, controlling for covariates that could affect mortality risk or boarding exposure, and separately evaluating patients admitted to ICUs versus non-ICU settings...
May 2018: Medical Care
https://www.readbyqxmd.com/read/29567091/non-contrast-mdct-for-ureteral-calculi-and-alternative-diagnoses-yield-in-adult-women-vs-in-adult-men
#11
Parisa Fani, Michael N Patlas, Sandra Monteiro, Douglas S Katz
PURPOSE: To determine the yield of non-contrast multi-detector computed tomography (MDCT) of the abdomen and pelvis in diagnosing ureteral calculi as well as other alternative acute conditions in male vs in female adult patients presenting to the emergency department with new onset of symptoms. METHODS: Our institutional review board approved a retrospective review of the official reports of the non-contrast MDCT examinations of the abdomen and pelvis performed on adults (18 years and older) presenting to our emergency department with a suspected ureteral calculus from October 1, 2011 to October 30, 2013...
February 2, 2018: Current Problems in Diagnostic Radiology
https://www.readbyqxmd.com/read/29559357/relocation-of-blood-gas-laboratory-to-the-emergency-department-helps-decrease-lactic-acid-values
#12
Jared Brazg, Phyllis Huang, Corey Weiner, Guneet Singh, Antonios Likourezos, Linda Salem, Eitan Dickman, John Marshall
IMPORTANCE: Emergency Physicians often rely on Lactic Acid (LA) values to make important clinical decisions. Accuracy of LA values improve when blood gas analysis is performed in the emergency department (ED) as opposed to a satellite laboratory (SL). OBJECTIVE: To investigate an association between blood gas laboratory location and accuracy of ED lactic acid samples. METHODS: The study team evaluated lactic acid values from venous and arterial blood gas samples drawn between June 1, 2015 and September 30, 2016...
March 12, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29555082/non-accidental-trauma-a-national-survey-on-management
#13
Richard Sola, Valerie A Waddell, Shawn D St Peter, Pablo Aguayo, David Juang
INTRODUCTION: Non-accidental trauma (NAT) has significant societal and health care implications. Standardized care has been shown to improve outcomes. The purpose of our study was to survey trauma centers and elucidate the continued variable management of NAT. METHODS: After institutional review board approval, an email survey was sent to Level 1 and 2 ACS verified trauma centers along with general and pediatric surgery training programs. Trauma hospital characteristics and NAT management were analyzed...
March 10, 2018: Injury
https://www.readbyqxmd.com/read/29525534/the-evaluation-of-three-comorbidity-indices-in-predicting-postoperative-complications-and-readmissions-in-pediatric-urology
#14
Ruiyang Jiang, Steven Wolf, Muhammad H Alkazemi, Gina-Maria Pomann, J Todd Purves, John S Wiener, Jonathan C Routh
INTRODUCTION: The surgical comorbidity assessment is important for patient risk stratification, counseling, and research. In adults, risk assessment indices, such as the Charlson Co-morbidity Score (CCS) or Van Walraven Index (VWI), are well established. In pediatrics, however, risk assessment indices are scarce. Recently, a pediatric-specific risk assessment index, the Rhee index, was developed to discriminate mortality for pediatric general surgery patients. Currently, there is no validated risk assessment tool in pediatric urology...
February 26, 2018: Journal of Pediatric Urology
https://www.readbyqxmd.com/read/29525480/safety-of-reassessment-and-release-practice-for-mental-health-patients-boarded-in-the-emergency-department
#15
Sangil Lee, Karisa K Harland, Morgan Bobb Swanson, Sara Lawson, Elijah Dahlstrom, Lance Clemson, Elaine Himadi
OBJECTIVES: Among emergency department (ED) mental health and substance abuse (MHSA) patients, we sought to compare mortality and healthcare utilization by ED discharge disposition and inpatient bed request status. METHODS: A retrospective cohort study of 492 patients was conducted at a single University ED. We reviewed three groups of MHSA patients including ED patients that were admitted, ED patients with a bed request that were discharged from the ED, and ED patients with no bed request that were discharged from the ED...
February 27, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29496361/high-fidelity-emergency-department-thoracotomy-simulator-with-beating-heart-technology-and-osats-tool-improves-trainee-confidence-and-distinguishes-level-of-skill
#16
Jordan D Bohnen, Leah Demetri, Eva Fuentes, Kathryn Butler, Reza Askari, Rahul J Anand, Emil Petrusa, Haytham M A Kaafarani, D Dante Yeh, Noelle Saillant, David King, Susan Briggs, George C Velmahos, Marc de Moya
OBJECTIVE: Resuscitative Thoracotomy or Emergency Department Thoracotomy (EDT) is a time-sensitive and potentially life-saving procedure. Yet, trainee experience with this procedure is often limited in both clinical and simulation settings. We sought to develop a high-fidelity EDT simulation module and assessment tool to facilitate trainee education. DESIGN: Using the Kern model for curricular development, a group of expert trauma surgeons identified EDT as a high-stakes, low-frequency procedure...
February 26, 2018: Journal of Surgical Education
https://www.readbyqxmd.com/read/29456595/geographical-access-to-critical-care-services-in-scotland
#17
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
#18
Feras Abuzeyad, Leena Alqasem, 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
#19
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
#20
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
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