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Emergency Department Safety

Colin B Page, Lachlan E Parker, Stephen J Rashford, Emma Bosley, Katherine Z Isoardi, Frances E Williamson, Geoffrey K Isbister
STUDY OBJECTIVE: Acute behavioral disturbance is a common problem for emergency medical services. We aimed to investigate the safety and effectiveness of droperidol compared to midazolam in the prehospital setting. METHODS: This was a prospective before and after study comparing droperidol to midazolam for prehospital acute behavioral disturbance, when the state ambulance service changed medications. The primary outcome was the proportion of adverse effects (airway intervention, oxygen saturation < 90%, respiratory rate < 12, systolic blood pressure < 90 mmHg, sedation assessment tool score -3 and dystonic reactions) in patients receiving sedation...
March 20, 2018: Prehospital Emergency Care
Mark Olfson, Melanie Wall, Shuai Wang, Stephen Crystal, Jeffrey A Bridge, Shang-Min Liu, Carlos Blanco
OBJECTIVES: Among adolescents and young adults with nonfatal self-harm, our objective is to identify risk factors for repeated nonfatal self-harm and suicide death over the following year. METHODS: A national cohort of patients in the Medicaid program, aged 12 to 24 years ( n = 32 395), was followed for up to 1 year after self-harm. Cause of death information was obtained from the National Death Index. Repeat self-harm per 1000 person-years and suicide deaths per 100 000 person-years were determined...
March 19, 2018: Pediatrics
J Hansen, L Zhang, A Eaton, R Baxter, C A Robertson, M D Decker, D P Greenberg, E Bassily, N P Klein
BACKGROUND: Menactra® vaccine (MenACWY-D) was licensed in the United States in 2005 for persons 11-55 years of age, in 2007 for children 2-10 years of age, and in 2011 for infants/toddlers 9-23 months of age. We conducted two studies at Kaiser Permanente Northern California (KPNC), an integrated health care organization, to assess the safety of MenACWY-D in 2-10-year-olds and 9-23-month-olds receiving the vaccine during routine clinical care. METHODS: We conducted observational, retrospective studies of MenACWY-D in 2-10-year-olds (October 2007-October 2010) and in 9-23-month-olds (June 2011-June 2014)...
March 14, 2018: Vaccine
J Alcaraz-Martínez, J M Aranaz-Andrés, A Cantero-Sandoval, P Piñera-Salmerón, J Mas-Luzón, J A Serrano-Martínez, E González Garro
OBJECTIVE: To analyse the use of complementary tests and their relationship with safety incidents in hospital emergency departments. METHODOLOGY: An analysis was performed on 935 patients seen in the 9 hospital emergency departments. The source of data used for the detection of incidents were: emergency department clinical record and reports, together with face-to-face observation in the department, plus a telephone survey of the patient or family member at one week after the care...
March 10, 2018: Revista de Calidad Asistencial: Organo de la Sociedad Española de Calidad Asistencial
Ann E Vandenberg, Katharina V Echt, Lawanda Kemp, Gerald McGwin, Molly M Perkins, Anna K Mirk
Suboptimal prescribing persists as a driver of poor quality care of older veterans and is associated with risk of hospitalization and emergency department visits. We adapted a successful medication management model, Integrated Management and Polypharmacy Review of Vulnerable Elders (IMPROVE), from an urban geriatric specialty clinic to rural community-based clinics that deliver primary care. The goals were to promote prescribing quality and safety for older adults, including reduced prescribing of potentially inappropriate medications (PIMs)...
March 2018: Journal of the American Geriatrics Society
Louis Raymond, Guy Paré, Éric Maillet, Ana Ortiz de Guinea, Marie-Claude Trudel, Josianne Marsan
BACKGROUND: The accessibility of laboratory test results is crucial to the performance of emergency departments and to the safety of patients. This study aims to develop a better understanding of which laboratory information exchange (LIE) systems emergency care physicians (ECPs) are using to consult their patients' laboratory test results and which benefits they derive from such use. METHODS: A survey of 163 (36%) ECPs in Quebec was conducted in collaboration with the Quebec's Department of Health and Social Services...
March 12, 2018: International Journal of Emergency Medicine
Frank X Scheuermeyer, Christopher DeWitt, Jim Christenson, Brian Grunau, Andrew Kestler, Eric Grafstein, Jane Buxton, David Barbic, Stefan Milanovic, Reza Torkjari, Indy Sahota, Grant Innes
STUDY OBJECTIVE: Fentanyl overdoses are increasing and few data guide emergency department (ED) management. We evaluate the safety of an ED protocol for patients with presumed fentanyl overdose. METHODS: At an urban ED, we used administrative data and explicit chart review to identify and describe consecutive patients with uncomplicated presumed fentanyl overdose (no concurrent acute medical issues) from September to December 2016. We linked regional ED and provincial vital statistics databases to ascertain admissions, revisits, and mortality...
March 9, 2018: Annals of Emergency Medicine
Patrick G Chan, Lara W Schaheen, Ernest G Chan, Chris C Cook, James D Luketich, Jonathan D'Cunha
OBJECTIVE: Transitioning from medical school and general surgery training to cardiothoracic (CT) surgical training poses unique challenges for trainees and patient care. We hypothesized that participation in technology-enhanced simulation modules that provided early exposure to urgent/emergent CT patient problems would improve cognitive skills and readiness to manage common urgencies/emergencies. DESIGN: Traditional and integrated cardiothoracic residents at our institution participated in a technology-enhanced simulation curriculum...
March 9, 2018: Journal of Surgical Education
Ronald W Gimbel, Ronald G Pirrallo, Steven C Lowe, David W Wright, Lu Zhang, Min-Jae Woo, Paul Fontelo, Fang Liu, Zachary Connor
BACKGROUND: The frequency of head computed tomography (CT) imaging for mild head trauma patients has raised safety and cost concerns. Validated clinical decision rules exist in the published literature and on-line sources to guide medical image ordering but are often not used by emergency department (ED) clinicians. Using simulation, we explored whether the presentation of a clinical decision rule (i.e. Canadian CT Head Rule - CCHR), findings from malpractice cases related to clinicians not ordering CT imaging in mild head trauma cases, and estimated patient out-of-pocket cost might influence clinician brain CT ordering...
March 12, 2018: BMC Medical Informatics and Decision Making
Paul Abraham, Laurence Augey, Antoine Duclos, Philippe Michel, Vincent Piriou
INTRODUCTION: Patient misidentification continues to be an issue in everyday clinical practice and may be particularly harmful. Incident reporting systems (IRS) are thought to be cornerstones to enhance patient safety by promoting learning from failures and finding common root causes that can be corrected. The aim of this study was to describe common patient misidentification incidents and contributory factors related to perioperative care. DESIGN AND SETTINGS: We retrospectively analyzed IRS data reported by healthcare workers from a large academic hospital federation from 2011 to 2014...
March 9, 2018: Journal of Patient Safety
Craig I Coleman, Alexander G G Turpie, Thomas J Bunz, Jan Beyer-Westendorf
PURPOSE: Frailty predicts poorer outcomes in patients receiving anticoagulation. We sought to assess the effectiveness and safety of rivaroxaban versus warfarin in frail patients experiencing venous thromboembolism in routine practice. METHODS: Using United States MarketScan claims data from 1/2012-12/2016, we identified frail patients (using the Johns Hopkins Claims-Based Frailty Indicator score) who had ≥1 primary hospitalization/emergency department visit discharge diagnosis code for venous thromboembolism (index event), received rivaroxaban or warfarin as their first outpatient oral anticoagulant (OAC) within 30-days of the index event and had ≥12-month of insurance coverage prior the index venous thromboembolism (baseline)...
March 8, 2018: American Journal of Medicine
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
Jane H Brice, Matthew A Psioda, Renee Johnson, Amy Oakley, Julianne M Cyr, Christopher S Cowden, Richard Uribe
BACKGROUND: Accessing the emergency medical services system via 9-1-1 operators is an effective way for patients to seek urgent health care; however, technological advances and telecommunication practices inundate the 9-1-1 and emergency services infrastructure with unintentional calls that delay response efforts to legitimate medical emergencies. OBJECTIVE: To determine whether the change in university-wide dial-out prefix from "9" to "7" reduced unnecessary calls to a 9-1-1 call center...
March 9, 2018: Prehospital Emergency Care
J Torres Macho, F J García Sánchez, P Garmilla Ezquerra, L Beltrán Romero, J Canora Lebrato, J M Casas Rojo, P Arribas Arribas, S López Palmero, S Pintos Martínez, J M Cepeda Rodrigo, D Luordo, M Beltrán López, M Méndez Bailón, E Rodilla Sala, L Manzano Espinosa, A Zapatero Gaviria, G García de Casasola
This positioning document describes the most important aspects of clinical ultrasonography in the internal medicine setting, from its fundamental indications to the recommended training period. There is no question as to the considerable usefulness of this tool in the standard clinical practice of internists in numerous clinical scenarios and settings (emergencies, hospital ward, general and specific consultations and home care). Ultrasonography has a relevant impact on the practitioner's ability to resolve issues, increasing diagnostic reliability and safety and providing important information on the prognosis and progression...
March 5, 2018: Revista Clínica Española
Jason M Glanz, Sophia R Newcomer, Matthew F Daley, Frank DeStefano, Holly C Groom, Michael L Jackson, Bruno J Lewin, Natalie L McCarthy, David L McClure, Komal J Narwaney, James D Nordin, Ousseny Zerbo
Importance: Some parents are concerned that multiple vaccines in early childhood could weaken their child's immune system. Biological data suggest that increased vaccine antigen exposure could increase the risk for infections not targeted by vaccines. Objective: To examine estimated cumulative vaccine antigen exposure through the first 23 months of life in children with and without non-vaccine-targeted infections from 24 through 47 months of age. Design, Setting, and Participants: A nested case-control study was conducted in 6 US health care organizations participating in the Vaccine Safety Datalink...
March 6, 2018: JAMA: the Journal of the American Medical Association
Maryann Mazer-Amirshahi, Sergey Motov, Lewis S Nelson
Hydromorphone (HM) is a potent opioid analgesic that is commonly administered in the emergency department (ED) and other acute care settings, such as medical surgical wards. In recent years, there has been a significant increase in the ED administration of HM relative to other opioids. Although HM is an effective analgesic, its use has been commonly implicated in adverse drug events and medication errors. In addition, intravenous HM has potent euphoric effects that may contribute to its abuse liability. There are limited data regarding how acute parenteral administration of opioid analgesics in the setting of high rates of preexisting chronic opioid use (medical or nonmedical) may contribute to or reinforce addictive behavior, making the potential contribution of rising HM administration to subsequent prescription opioid abuse and overdose uncertain...
January 2018: Journal of Opioid Management
Anna Helene Meldgaard Pedersen, Kurt Rasmussen, Regine Grytnes, Kent Jacob Nielsen
Purpose The purpose of this paper is to examine how conflicts about collaboration between staff at different departments arose during the establishment of a new emergency department and how these conflicts affected the daily work and ultimately patient safety at the emergency department. Design/methodology/approach This qualitative single case study draws on qualitative semi-structured interviews and participant observation. The theoretical concepts "availability" and "receptiveness" as antecedents for collaboration will be applied in the analysis...
March 19, 2018: Journal of Health Organization and Management
Tina Shah, Shilpa Patel-Teague, Laura Kroupa, Ashley N D Meyer, Hardeep Singh
BACKGROUND: Emerging evidence suggests electronic health record (EHR)-related information overload is a risk to patient safety. In the US Department of Veterans Affairs (VA), EHR-based 'inbox' notifications originally intended for communicating important clinical information are now cited by 70% of primary care practitioners (PCPs) to be of unmanageable volume. We evaluated the impact of a national, multicomponent, quality improvement (QI) programme to reduce low-value EHR notifications...
March 5, 2018: BMJ Quality & Safety
Maria Farm, Anwar J Siddiqui, Liselotte Onelöv, Ingela Järnberg, Jaak Eintrei, Filip Maskovic, Anders Kallner, Margareta Holmström, Jovan P Antovic
BACKGROUND: The study compares different D-dimer assays and age-adjusted cutoffs in outpatients with suspected venous thromboembolism (VTE). The plasma concentration of this sensitive biomarker is increased by activated coagulation, but also by several conditions that are linked to an increased risk of VTE. One such condition is old age, which poses a common clinical problem where many prefer not to analyze D-dimer in elderly patients. Age-adjusted cutoffs have been validated for both deep venous thrombosis (DVT) and pulmonary embolism, aiming to increase specificity without notably decreasing sensitivity...
March 5, 2018: Journal of Thrombosis and Haemostasis: JTH
Catherine G Corey, Joanne T Chang, Brian L Rostron
BACKGROUND: Currently, an estimated 7.9 million US adults use electronic nicotine delivery systems (ENDS). Although published reports have identified fires and explosions related to use of ENDS since 2009, these reports do not provide national estimates of burn injuries associated with ENDS batteries in the US. FINDINGS: We analyzed nationally representative data provided in the National Electronic Injury Surveillance System (NEISS) to estimate the number of US emergency department (ED) visits for burn injuries associated with ENDS batteries...
March 5, 2018: Injury Epidemiology
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