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Emergency Department Safety

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https://www.readbyqxmd.com/read/29784718/opinion-and-special-articles-stress-when-performing-the-first-lumbar-puncture-may-compromise-patient-safety
#1
Mikael Johannes Vuokko Henriksen, Troels Wienecke, Jesper Kristiansen, Yoon Soo Park, Charlotte Ringsted, Lars Konge
OBJECTIVE: To quantify physician stress levels when performing lumbar puncture (LP) and explore operator stress effect on patient outcomes. METHODS: This was a cross-sectional, multicenter study. Novices, intermediates, and experts in performing LP were recruited from 4 departments of neurology and emergency medicine. Stress was measured before and during performance of the LP using cognitive appraisal (CA), State-Trait Anxiety Inventory-Short (STAI-S) questionnaire, and the heart rate variability measure low frequency/high frequency index (LF/HF ratio)...
May 22, 2018: Neurology
https://www.readbyqxmd.com/read/29782453/a-robust-approach-to-implementing-fascia-iliaca-compartment-nerve-blocks-in-hip-fracture-patients
#2
Mark G Williams, Zachary Jeffery, Henry W Corner, John Charity, Marina Quantick, Natalie Sartin
BACKGROUND: A clear imperative exists to optimize the preoperative pain management of hip fracture patients. Increasingly, fascia iliaca compartment blocks (FICBs) are being effectively utilized as an adjunct to oral analgesia in the emergency department. PURPOSE: We investigated the feasibility, safety, and delivery rate when junior doctors and specialist nurses are trained in FICBs delivery, alongside the introduction of a step-by-step proforma. METHODS: We conducted a retrospective study of hip fractures patients presenting preinterventions (n = 138) between October and December 2014 and postinterventions (n = 246) between April and August 2015...
May 2018: Orthopaedic Nursing
https://www.readbyqxmd.com/read/29782353/implementing-best-practice-into-the-emergency-department-triage-process
#3
Luke Burgess, Kathryn Kynoch, Sonia Hines
BACKGROUND: Triage is the process by which emergency departments (EDs) sort patients presenting for medical treatment. The Australasian Triage Scale, validated to measure urgency, answers the question 'This patient should wait for medical assessment and treatment no longer than…' Multiple patients may present within short time frames, and some will have conditions that have outcomes directly related to timeliness of treatment such as stroke, sepsis and myocardial infarction. The safety of patients within the ED is thus directly related to the triage system...
May 17, 2018: International Journal of Evidence-based Healthcare
https://www.readbyqxmd.com/read/29779398/handoff-tool-enabling-standardized-transitions-between-the-emergency-department-and-the-hospitalist-inpatient-service-at-a-major-cancer-center
#4
Carmen E Gonzalez, Norman Brito-Dellan, Srinivas R Banala, David Rubio, Mohamed Ait Aiss, Terry W Rice, Karen Chen, Diane C Bodurka, Carmelita P Escalante
Communication failures during patient handoff can lead to serious errors. A quality improvement team created a standardized handoff tool/process (DE-PASS: Decisive problem requiring admission, Evaluation time, Patient summary, Acute issues/action list, Situation unfinished/awareness, Signed out to) for admitting patients from the emergency department (ED) to the hospitalist inpatient service of a tertiary cancer center. DE-PASS mirrors the institution's ED workflow, stratifies patients as stable/urgent/emergent, and establishes requirements for verbal and email communications between providers...
May 1, 2018: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
https://www.readbyqxmd.com/read/29778034/early-discharge-of-patients-with-pulmonary-embolism-in-daily-clinical-practice-a-prospective-observational-study-comparing-clinical-gestalt-and-clinical-rules
#5
Simone Vanni, Cecilia Becattini, Peiman Nazerian, Carlo Bova, Valerio Teodoro Stefanone, Ludovica Anna Cimini, Gabriele Viviani, Cosimo Caviglioli, Michela Sanna, Giuseppe Pepe, Stefano Grifoni
OBJECTIVES: To estimate the efficiency and safety of clinicians' gestalt in the identification of patients with pulmonary embolism (PE) candidates for early discharge and to compare the efficiency and safety of clinical gestalt with that of the Pulmonary Embolism Severity Index (PESI), the simplified PESI (sPESI) and the Hestia criteria (HC). METHODS: Consecutive adult patients presenting to the emergency department of four Italian hospitals with confirmed diagnosis of PE were included...
May 8, 2018: Thrombosis Research
https://www.readbyqxmd.com/read/29777436/fatigue-related-risk-management-in-the-emergency-department-a-focus-group-study
#6
Pierre Bérastégui, Mathieu Jaspar, Alexandre Ghuysen, Anne-Sophie Nyssen
Fatigue has major implications on both patient safety and healthcare practitioner's well-being. Traditionally, two approaches can be used to reduce fatigue-related risk: reducing the likelihood of a fatigued operator working (i.e. fatigue reduction), or reducing the likelihood that a fatigued operator will make an error (i.e. fatigue proofing). Recent progress mainly focussed on fatigue reduction strategies such as reducing work hours. Yet it has to be recognized that such approach has not wholly overcome the experience of fatigue...
May 18, 2018: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/29775117/intravenous-low-dose-ketamine-provides-greater-pain-control-compared-to-fentanyl-in-a-civilian-prehospital-trauma-system-a-propensity-matched-analysis
#7
E Stein Bronsky, Catherine Koola, Alessandro Orlando, Diane Redmond, Cecile D'Huyvetter, Heather Sieracki, Allen Tanner, Ray Fowler, Charles Mains, David Bar-Or
OBJECTIVE: A few studies report comparable analgesic efficacy between low-dose ketamine and opioids such as morphine or fentanyl; however, limited research has explored the safety and effectiveness of intravenous low-dose ketamine as a primary analgesic in a civilian prehospital setting. The objective of this study is to compare pain control between low-dose ketamine and fentanyl when administered intravenously (IV) for the indication of severe pain. METHODS: This was a retrospective, observational review of prehospital adult patients (≥18 years) who presented with severe pain (numeric rating scale, 7-10) and were treated solely with either low-dose ketamine IV or fentanyl IV between January 1, 2014 and December 31, 2016...
May 18, 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29774760/safety-of-nonsteroidal-anti-inflammatory-drugs-in-copperhead-snakebite-patients
#8
Hoang X Pham, Michael E Mullins
INTRODUCTION: Current management guidelines for pit viper envenomations recommend against the use of nonsteroidal anti-inflammatory drugs (NSAIDs) for pain control due to concern for platelet dysfunction and resulting coagulopathy. However, prior research suggests that copperhead snakes generally do not cause coagulopathy and they are responsible for most of the venomous snakebites in the USA. Thus, we compared the occurrences of clinically apparent bleeding and most abnormal laboratory values of coagulation between copperhead envenomation patients who received NSAIDs and those who did not...
May 18, 2018: Clinical Toxicology
https://www.readbyqxmd.com/read/29773254/-the-integration-of-advanced-practice-nurses-in-emergency-departments
#9
Christophe Debout
The saturation of emergency departments due to inappropriate attendance by patients is becoming increasingly commonplace. It often leads to the discontent of users, due to long waiting times, and stretches the hospital staff physically, mentally and psychologically. Innovative organisation models have been developed abroad. They draw on the skills of advanced practice nurses in emergency departments. The impact of these models has been assessed very positively in numerous studies. They improve the quality and safety of care as well as the satisfaction of users...
May 2018: Soins; la Revue de Référence Infirmière
https://www.readbyqxmd.com/read/29773252/-the-emergency-department-triage-nurse-a-constantly-evolving-role
#10
Claire Maillard Acker
The number of patients attending emergency departments is constantly growing. They are fast becoming a place of primary care. Early assessment of patients must guarantee the safety of their care. The triage nurse uses a clinical examination and a triage chart to classify the patients. The reception of the patients by the triage nurse is professional. With tension often high in emergency departments, triage nurses play a role in defusing situations, which could constitute the next area of focus of their professionalization...
May 2018: Soins; la Revue de Référence Infirmière
https://www.readbyqxmd.com/read/29771715/whole-blood-for-resuscitation-in-adult-civilian-trauma-in-2017-a-narrative-review
#11
Evan G Pivalizza, Christopher T Stephens, Srikanth Sridhar, Sam D Gumbert, Susan Rossmann, Marsha F Bertholf, Yu Bai, Bryan A Cotton
After a hiatus of several decades, the concept of cold whole blood (WB) is being reintroduced into acute clinical trauma care in the United States. Initial implementation experience and data grew from military medical applications, followed by more recent development and data acquisition in civilian institutions. Anesthesiologists, especially those who work in acute trauma facilities, are likely to be presented with patients either receiving WB from the emergency department or may have WB as a therapeutic option in massive transfusion situations...
May 15, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29771164/retrospective-evaluation-of-clinical-experience-with-intravenous-ascorbic-acid-in-patients-with-cancer
#12
Anthony J Bazzan, George Zabrecky, Nancy Wintering, Andrew B Newberg, Daniel A Monti
BACKGROUND: Intravenous ascorbic acid (IV AA) has been used extensively in cancer patients throughout the United States. Currently, there are limited data on the safety and clinical effects of IV AA. The purpose of this study was to expand the current literature using a retrospective analysis of adverse events and symptomatic changes of IV AA in a large sample of cancer patients. METHODS: We conducted a retrospective chart review of all patients receiving IV AA for cancer at the Thomas Jefferson University Hospital over a 7-year period...
May 1, 2018: Integrative Cancer Therapies
https://www.readbyqxmd.com/read/29768633/evaluating-the-efficiency-and-safety-of-speech-recognition-within-a-commercial-electronic-health-record-system-a-replication-study
#13
Tobias Hodgson, Farah Magrabi, Enrico Coiera
OBJECTIVE:  To conduct a replication study to validate previously identified significant risks and inefficiencies associated with the use of speech recognition (SR) for documentation within an electronic health record (EHR) system. METHODS:  Thirty-five emergency department clinicians undertook randomly allocated clinical documentation tasks using keyboard and mouse (KBM) or SR using a commercial EHR system. The experiment design, setting, and tasks (E2) replicated an earlier study (E1), while technical integration issues that may have led to poorer SR performance were addressed...
April 2018: Applied Clinical Informatics
https://www.readbyqxmd.com/read/29764844/second-look-laparostomy-for-perforated-gangrenous-gastric-volvulus-to-prevent-total-gastrectomy
#14
Paul K Okeny, Omar Abbassi, Ali Warsi
A 42-year-old Caucasian woman presented to the emergency department with severe upper abdominal pain and vomiting. Clinically, she was septic, and abdominal examination suggested peritonitis. Following immediate resuscitation, the patient was stabilised and underwent urgent contrast-enhanced CT of the abdomen and pelvis. This revealed a mesenteroaxial gastric volvulus with traction on the mesentery and a small volume of free fluid. She underwent laparotomy revealing gangrenous gastric fundus perforation complicated by persistent intraoperative hypotension...
May 15, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29764737/a-comparison-of-head-injuries-in-male-and-female-lacrosse-participants-seen-in-us-emergency-departments-from-2005-to-2016
#15
Christopher N Cooley, Tyler J Beranek, Matthew A Warpinski, Robert Alexander, Amanda O Esquivel
INTRODUCTION: In the United States there has been a large increase in participation in lacrosse for both males and females. The purpose of this study was to analyze the number of head injuries, injury rates (calculated using the reported number of participants) and types of head injuries that are seen in emergency departments in the United States. METHODS: We compared injuries between male and female lacrosse participants. This was a retrospective study using a publicly available database produced by the US Consumer Product Safety Commission and information about lacrosse participation from US Lacrosse...
May 9, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29763979/extended-international-normalized-ratio-testing-intervals-for-warfarin-treated-patients
#16
G D Barnes, X Kong, D Cole, B Haymart, E Kline-Rogers, S Almany, M Dahu, M Ekola, S Kaatz, J Kozlowski, J B Froehlich
BACKGROUND: A prior single center randomized trial suggested that patients with stable INR values could safely receive INR testing as infrequently as every 12 weeks. OBJECTIVE: To test the implementation success of an extended INR testing interval for stable warfarin patients in a practice-based, multi-center collaborative of anticoagulation clinics. METHODS: At six anticoagulation clinics, patients were identified as being eligible for extended INR testing based on prior INR value stability and minimal warfarin dose changes between 2014 and 2016...
May 15, 2018: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/29762292/a-dedicated-satellite-trauma-orthopaedic-program-operating-room-safely-increases-capacity
#17
Peter M Waters, Brian W Yang, Doreen White, Ellen Barth, Vincent Chiang, Arielle Mizrahi-Arnaud, William Sparks
BACKGROUND: Providing high-value care for urgent orthopaedic trauma patients requires effective and timely treatment. Herein, we describe the implementation of an innovative program utilizing the operating room (OR) capacity of a satellite campus to decrease stress on a pediatric tertiary care center without jeopardizing patient safety. METHODS: In addition to the daily emergency surgical room on the main campus, a dedicated orthopaedic trauma surgery OR was established in a satellite hospital location for 3 days per week in the summer and for 2 days per week for the rest of the year...
May 16, 2018: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/29760856/continuous-intravenous-sub-dissociative-dose-ketamine-infusion-for-managing-pain-in-the-emergency-department
#18
Sergey Motov, Jefferson Drapkin, Antonios Likourezos, Tyler Beals, Ralph Monfort, Christian Fromm, John Marshall
Introduction: Our objective was to describe dosing, duration, and pre- and post-infusion analgesic administration of continuous intravenous sub-dissociative dose ketamine (SDK) infusion for managing a variety of painful conditions in the emergency department (ED). Methods: We conducted a retrospective chart review of patients aged 18 and older presenting to the ED with acute and chronic painful conditions who received continuous SDK infusion in the ED for a period over six years (2010-2016)...
May 2018: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29760847/decreased-nursing-staffing-adversely-affects-emergency-department-throughput-metrics
#19
Zachariah Ramsey, Joseph S Palter, John Hardwick, Jordan Moskoff, Errick L Christian, John Bailitz
Introduction: The effect of nurse staffing on emergency department (ED) efficiency remains a significant area of interest to administrators, physicians, and nurses. We believe that decreased nursing staffing adversely affects key ED throughput metrics. Methods: We conducted a retrospective observational review of our electronic medical record database from 1/1/2015 to 12/31/2015 at a high-volume, urban public hospital. We report nursing hours, door-to-discharge length of stay (LOS) and door-to-admit LOS, and percentage of patients who left without being seen (LWBS)...
May 2018: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29759261/deriving-a-framework-for-a-systems-approach-to-agitated-patient-care-in-the-emergency-department
#20
Ambrose H Wong, Halley Ruppel, Lauren J Crispino, Alana Rosenberg, Joanne D Iennaco, Federico E Vaca
BACKGROUND: The rising agitated patient population presenting to the emergency department (ED) has caused increasing safety threats for health care workers and patients. Development of evidence-based strategies has been limited by the lack of a structured framework to examine agitated patient care in the ED. In this study, a systems approach from the patient safety literature was used to derive a comprehensive theoretical framework for addressing ED patient agitation. METHODS: A mixed-methods approach was used with ED staff members at an academic site and a community site of a regional health care network...
May 2018: Joint Commission Journal on Quality and Patient Safety
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