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Emergency Department Safety

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https://www.readbyqxmd.com/read/28816011/lessons-learnt-from-incidents-involving-the-airway-and-breathing-reported-from-australasian-emergency-departments
#1
Carmel Crock, Kim Hansen, Toby Fogg, Angela Cahill, Anita Deakin, William B Runciman
OBJECTIVE: To review incident reports relating to problems encountered during the ED management of patients with 'airway or breathing' problems, with the aim of finding and highlighting common themes within these rare events, and making recommendations to further improve patient safety in the areas in which deficiencies have been identified. METHODS: Thematic analysis of 36 incidents reported from Australasian EDs, which were related to problems with airway and breathing...
August 16, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/28809180/exploring-socio-technical-insights-for-safe-nursing-handover
#2
Ming Chao Wong, Kwang Chien Yee, Paul Turner
Current efforts to improve nursing handover frequently use prescriptive approaches based on research evidence of handover issues within a single nursing ward or nursing specialty. Despite reported handover improvement, few studies adequately consider the transferability of results to other nursing handover environments or acknowledge the unique attributes that supported sustained improvement. With the increasing diffusion of electronic tools it has become even more critical to ensure that socio-technical issues that may impact on the quality and safety of nursing handovers are identified...
2017: Studies in Health Technology and Informatics
https://www.readbyqxmd.com/read/28807069/a-pilot-project-demonstrating-that-combat-medics-can-safely-administer-parenteral-medications-in-the-emergency-department
#3
Steven G Schauer, Cord W Cunningham, Andrew D Fisher, Robert A DeLorenzo
Introduction Select units in the military have improved combat medic training by integrating their functions into routine clinical care activities with measurable improvements in battlefield care. This level of integration is currently limited to special operations units. It is unknown if regular Army units and combat medics can emulate these successes. The goal of this project was to determine whether US Army combat medics can be integrated into routine emergency department (ED) clinical care, specifically medication administration...
August 15, 2017: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/28806444/eliminating-creatine-kinase-myocardial-band-testing-in-suspected-acute-coronary-syndrome-a-value-based-quality-improvement
#4
Matthew D Alvin, Allan S Jaffe, Roy C Ziegelstein, Jeffrey C Trost
Cardiac biomarker testing is estimated to occur in nearly 30 million emergency department visits nationwide each year in the United States. The American College of Cardiology/European Society of Cardiology indicate that cardiac troponin is the biomarker of choice owing to its nearly absolute myocardial tissue specificity and high clinical sensitivity for myocardial injury. Multiple academic medical centers have implemented interventions to eliminate the routine ordering of creatine kinase-myocardial band tests, with published patient safety outcomes data; however, creatine kinase-myocardial band testing is still ordered in many hospitals and emergency departments...
August 14, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28802985/clinical-analysis-of-48-h-emergency-department-visit-post-outpatient-extracorporeal-shock-wave-lithotripsy-for-urolithiasis
#5
Chin-Heng Lu, Junne-Yih Kuo, Tzu-Ping Lin, Yi-Hsiu Huang, Hsiao-Jen Chung, William J S Huang, Howard H H Wu, Yen-Hwa Chang, Alex T L Lin, Kuang-Kuo Chen
BACKGROUND: Patients suffering from renal or ureteral stones can undergo significant discomfort, even when timely diagnosed and treated. The aim of this study was to assess the risk factors and safety of outpatient Extracorporeal Shock Wave Lithotripsy (ESWL) in the management of patients with renal or ureteral stones. METHODS: In this study, our cohort consisted of 844 outpatients who underwent outpatient ESWL treated between February 2012 and November 2014 at Taipei Veterans General Hospital...
August 9, 2017: Journal of the Chinese Medical Association: JCMA
https://www.readbyqxmd.com/read/28802869/use-of-a-standardized-procedure-to-improve-behavioral-health-patients-care-a-quality-improvement-initiative
#6
Elizabeth J Winokur, Jeannine Loucks, Glenn H Raup
PROBLEM: Meeting the complex needs of behavioral health (BH) patients in the emergency department is an ongoing challenge. Delays in care can have adverse consequences for patient and staff safety and delay transfer to specialized care. METHODS: A quality improvement, nurse-driven initiative using a standardized procedure (STP) was developed and implemented in our busy Southern California Emergency Department, which focused on improving time to first medication and reduction of restraints...
August 9, 2017: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
https://www.readbyqxmd.com/read/28797422/in-hospital-outcomes-of-percutaneous%C3%A2-coronary-intervention-in%C3%A2-america-s-safety%C3%A2-net-insights-from-the-ncdr-cath-pci-registry
#7
Tushar Acharya, Adam C Salisbury, John A Spertus, Kevin F Kennedy, Amarbir Bhullar, H Kiran K Reddy, Bipin K Joshi, John A Ambrose
OBJECTIVES: This study compared risk-adjusted percutaneous coronary intervention (PCI) outcomes of safety-net hospitals (SNHs) and non-SNHs. BACKGROUND: Although risk adjustment is used to compare hospitals, SNHs treat a disproportionate share of uninsured and underinsured patients, who may have unmeasured risk factors, limited health care access, and poorer outcomes than patients treated at non-SNHs. METHODS: Using the National Cardiovascular Data Registry CathPCI Registry from 2009 to 2015, we analyzed 3,746,961 patients who underwent PCI at 282 SNHs (hospitals where ≥10% of PCI patients were uninsured) and 1,134 non-SNHs...
August 14, 2017: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28792800/national-antimicrobial-resistance-monitoring-system-two-decades-of-advancing-public-health-through-integrated-surveillance-of-antimicrobial-resistance
#8
Beth E Karp, Heather Tate, Jodie R Plumblee, Uday Dessai, Jean M Whichard, Eileen L Thacker, Kis Robertson Hale, Wanda Wilson, Cindy R Friedman, Patricia M Griffin, Patrick F McDermott
Drug-resistant bacterial infections pose a serious and growing public health threat globally. In this review, we describe the role of the National Antimicrobial Resistance Monitoring System (NARMS) in providing data that help address the resistance problem and show how such a program can have broad positive impacts on public health. NARMS was formed two decades ago to help assess the consequences to human health arising from the use of antimicrobial drugs in food animal production in the United States. A collaboration among the Centers for Disease Control and Prevention, the U...
August 9, 2017: Foodborne Pathogens and Disease
https://www.readbyqxmd.com/read/28791782/predicting-short-term-risk-of-arrhythmia-among-patients-with-syncope-the-canadian-syncope-arrhythmia-risk-score
#9
Venkatesh Thiruganasambandamoorthy, Ian G Stiell, Marco L A Sivilotti, Brian H Rowe, Muhammad Mukarram, Kirtana Arcot, Kenneth Kwong, Andrew D McRae, George A Wells, Monica Taljaard
BACKGROUND: Syncope can be caused by serious occult arrhythmias not evident during initial emergency department (ED) evaluation. We sought to develop a risk-tool for predicting 30-day arrhythmia or death after ED disposition. METHODS: We conducted a multicenter prospective cohort study at six tertiary-care EDs and included adults (≥16 years) with syncope. We collected standardized variables from clinical evaluation, and investigations including ECG and troponin at index presentation...
August 9, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28789733/mobile-health-care-for-people-who-are-homeless
#10
Angela L Caires
Individuals experiencing homelessness face significant challenges on a daily basis. The ongoing need to find shelter, safety, and food becomes a priority and often supersedes the need for health care. People who are homeless have significantly higher morbidity and mortality rates than those who are sheltered, at least in part because care is sought when health care issues become acute and more difficult to manage from a medical standpoint. Most acute care for this population is provided in the emergency department, which is more expensive and more fragmented than regular care provided by a primary provider...
August 1, 2017: Creative Nursing
https://www.readbyqxmd.com/read/28777450/self-management-interventions-including-action-plans-for-exacerbations-versus-usual-care-in-patients-with-chronic-obstructive-pulmonary-disease
#11
REVIEW
Anke Lenferink, Marjolein Brusse-Keizer, Paul Dlpm van der Valk, Peter A Frith, Marlies Zwerink, Evelyn M Monninkhof, Job van der Palen, Tanja W Effing
BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) self-management interventions should be structured but personalised and often multi-component, with goals of motivating, engaging and supporting the patients to positively adapt their behaviour(s) and develop skills to better manage disease. Exacerbation action plans are considered to be a key component of COPD self-management interventions. Studies assessing these interventions show contradictory results. In this Cochrane Review, we compared the effectiveness of COPD self-management interventions that include action plans for acute exacerbations of COPD (AECOPD) with usual care...
August 4, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28777317/type-and-context-of-alcohol-related-injury-among-patients-presenting-to-emergency-departments-in-a-caribbean-country
#12
Sandra D Reid, Jannel Gentius
There is an association between alcohol consumption and injuries in Latin America and the Caribbean. This cross-sectional study explores the socio-contextual factors of alcohol-related injuries in Trinidad and Tobago. Data on drinking patterns, injury type, drinking context prior to injury, and demographics were collected from patients presenting with injuries to the Emergency Departments (ED) of four hospitals. Findings show that 20.6% of patients had consumed alcohol, mainly beer, in the 6 h before injury...
August 4, 2017: International Journal of Environmental Research and Public Health
https://www.readbyqxmd.com/read/28774498/vaccine-hesitancy-where-we-are-and-where-we-are-going
#13
REVIEW
Catherine C McClure, Jessica R Cataldi, Sean T O'Leary
PURPOSE: Vaccines represent one of the most important aspects of pediatric preventive care. However, parents are increasingly questioning the safety of and need for vaccines, and as a result, vaccination rates have fallen to dangerously low levels in certain communities. The effects of vaccine hesitancy are widespread. Community pediatricians who interact regularly with vaccine-hesitant parents report higher levels of burnout and lower levels of job satisfaction. Not surprisingly, vaccine hesitancy has also had direct influence on vaccination rates, which in turn are linked to increased emergency department use, morbidity, and mortality...
July 31, 2017: Clinical Therapeutics
https://www.readbyqxmd.com/read/28770895/hydrogen-sulfide-gas-poisoning-in-fish-garbage-room-a-report-of-a-fisherman
#14
Sadaf Sheikh, Muhammad Akbar Baig, Noman Ali, NadeemUllah Khan
We report the case of a fisherman who was exposed to high concentrations of hydrogen sulfide (H2S) gas from the fish garbage room. The patient survived and was discharged with full recovery from the hospital. H2S is a colourless, foul smelling and highly toxic gas next to carbon monoxide, which causes inhalation death. It is a by-product of various industrial processes particularly involves exposure from agriculture, petrochemical industry and organic matter decomposition from sewage processing. It is a by-product of H2S has been referred as the "knock down gas" because inhalation of high concentrations can cause immediate loss of consciousness and death...
July 2017: JPMA. the Journal of the Pakistan Medical Association
https://www.readbyqxmd.com/read/28765132/a-systematic-review-to-identify-and-assess-the-effectiveness-of-alternatives-for-people-over-the-age-of-65-who-are-at-risk-of-potentially-avoidable-hospital-admission
#15
Alyson L Huntley, Melanie Chalder, Ali R G Shaw, William Hollingworth, Chris Metcalfe, Jonathan Richard Benger, Sarah Purdy
BACKGROUND/OBJECTIVES: There are some older patients who are 'at the decision margin' of admission. This systematic review sought to explore this issue with the following objective: what admission alternatives are there for older patients and are they safe, effective and cost-effective? A secondary objective was to identify the characteristics of those older patients for whom the decision to admit to hospital may be unclear. DESIGN: Systematic review of controlled studies (April 2005-December 2016) with searches in Medline, Embase, Cinahl and CENTRAL databases...
August 1, 2017: BMJ Open
https://www.readbyqxmd.com/read/28764789/exploring-how-nurses-assess-monitor-and-manage-acute-pain-for-adult-critically-ill-patients-in-the-emergency-department-protocol-for-a-mixed-methods-study
#16
Wayne Varndell, Margaret Fry, Doug Elliott
BACKGROUND: Many critically ill patients experience moderate to severe acute pain that is frequently undetected and/or undertreated. Acute pain in this patient cohort not only derives from their injury and/or illness, but also as a consequence of delivering care whilst stabilising the patient. Emergency nurses are increasingly responsible for the safety and wellbeing of critically ill patients, which includes assessing, monitoring and managing acute pain. How emergency nurses manage acute pain in critically ill adult patients is unknown...
August 1, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28760210/a-randomized-trial-of-a-1-hour-troponin-t-protocol-in-suspected-acute-coronary-syndromes-design-of-the-rapid-assessment-of-possible-acs-in-the-emergency-department-with-high-sensitivity-troponin-t-rapid-tnt-study
#17
RANDOMIZED CONTROLLED TRIAL
Cynthia Papendick, Andrew Blyth, Anil Seshadri, Michael J R Edmonds, Tom Briffa, Louise Cullen, Stephen Quinn, Jon Karnon, Anthony Chuang, Adam J Nelson, Matthew Horsfall, Erin Morton, Derek P Chew
BACKGROUND: Protocols incorporating high-sensitivity troponin to guide decision making in the disposition of patients with suspected acute coronary syndromes (ACS) in the emergency department have received a lot of attention. Traditionally, patients with chest pain have required long periods of observation in emergency department before being deemed safe for discharge. In an era of limited health service resources, a protocol that could discharge patients safely within an hour of presentation is extremely attractive...
August 2017: American Heart Journal
https://www.readbyqxmd.com/read/28756779/quality-improvement-primer-part-1-preparing-for-a-quality-improvement-project-in-the-emergency-department
#18
Lucas B Chartier, Amy H Y Cheng, Antonia S Stang, Samuel Vaillancourt
Emergency medicine (EM) providers work in a fast-paced and often hectic environment that has a high risk for patient safety incidents and gaps in the quality of care. These challenges have resulted in opportunities for frontline EM providers to play a role in quality improvement (QI) projects. QI has developed into a mature field with methodologies that can dramatically improve the odds of having a successful project with a sustainable impact. However, this expertise is not yet commonly taught during professional training...
July 31, 2017: CJEM
https://www.readbyqxmd.com/read/28756645/the-hii-score-a-novel-tool-to-assess-impairment-from-alcohol-in-emergency-department-patients
#19
J B Hack, E J Goldlust, D Ferrante, B Zink
BACKGROUND: Over 35 million alcohol impaired (AI) patients are cared for in Emergency Departments (EDs) annually. Emergency physicians are charged with ensuring AI patients' safety by identifying resolution of alcohol induced impairment. The most common standard evaluation is an extemporized clinical examination, as ethanol levels are not reliable or predictive of clinical symptoms. There is no standard assessment of ED AI patients. OBJECTIVE: To evaluate a novel standardized emergency department assessment of alcohol impairment - Hack's Impairment Index (HII score), in a busy urban Emergency Department...
July 30, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28756439/what-factors-determine-the-use-of-an-electronic-test-result-acknowledgement-system-a-qualitative-study-across-two-eds
#20
Julie Li, Joanne Callen, Johanna I Westbrook, Andrew Georgiou
Electronic medical record-based test results management interventions hold the potential to reduce errors in the test result follow-up process. However, ensuring the adaptability of such systems to the clinical environment has proven challenging. The aim of this study was to explore how contextual factors can influence senior emergency physicians' experience and perceived impacts of an electronic result acknowledgement system across two Emergency Departments. Semi-structured, in-depth interviews relating to physician test result acknowledgement processes before and after system implementation were conducted with 14 senior Emergency Physicians across two Australian metropolitan teaching hospitals...
2017: Studies in Health Technology and Informatics
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