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Emergency Department Safety

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https://www.readbyqxmd.com/read/28339735/triage-quality-control-is-missing-tools-a-new-observation-technique-for-ed-quality-improvement
#1
Tomi Malmström, Veli-Pekka Harjola, Paulus Torkki, Salla Kumpulainen, Raija Malmström
Objective: Correct assessment of patient urgency is critical to ensuring patient safety in emergency departments (EDs). Although significant time and effort have been devoted to developing triage systems, less attention has been paid to the development of quality control. The aim of this study is to introduce and test observation technique, which enables identifying of patient groups at risk of erroneous assessment in triage. The introduced technique is aimed to be less laborious to use than existing triage quality control methods...
February 23, 2017: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/28331860/quetiapine-misuse-and-abuse-is-it-an-atypical-paradigm-of-drug-seeking-behavior
#2
REVIEW
Sean Kim, Gayoung Lee, Eric Kim, Hyejin Jung, Jongwha Chang
Recent case reports in medical literatures suggest that more and more second-generation atypical antipsychotics (AAs) have been prescribed for off-label use; quetiapine (Brand name: Seroquel(®)) showed increase in its trend for off-label use. Little is known about the reasons behind this trend, although historical sedative and hypnotic prescription patterns suggest that despite relatively superior safety profiles of quetiapine (especially for movement disorders), it may be used for treating substance abuse disorder...
January 2017: Journal of Research in Pharmacy Practice
https://www.readbyqxmd.com/read/28328728/crew-resource-management-in-the-trauma-room-a-prospective-3-year-cohort-study
#3
Marck H T M Haerkens, Matthijs Kox, Pieter M Noe, Johannes G Van Der Hoeven, Peter Pickkers
OBJECTIVE: Human factors account for the majority of adverse events. Human factors awareness training entitled Crew Resource Management (CRM) is associated with improved safety and reduced complications and mortality in critically ill patients. We determined the effects of CRM implementation in the trauma room of an Emergency Department (ED). PATIENTS AND METHODS: A prospective 3-year cohort study was carried out in a level 1 ED, admitting more than 12 000 patients annually (>1500 trauma related)...
March 21, 2017: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/28325679/children-treated-for-lawn-mower-related-injuries-in-us-emergency-departments-1990-2014
#4
Karen S Ren, Thiphalak Chounthirath, Jingzhen Yang, Laura Friedenberg, Gary A Smith
OBJECTIVE: Investigate the epidemiology of lawn mower-related injuries to children in the US. METHODS: A retrospective analysis was conducted of children younger than 18years of age treated in US emergency departments for a lawn mower-related injury from 1990 through 2014 using data from the National Electronic Injury Surveillance System. RESULTS: An estimated 212,258 children <18years of age received emergency treatment for lawn mower-related injuries from 1990 through 2014, equaling an average annual rate of 11...
March 14, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28325207/using-a-systematic-framework-of-interventions-to-improve-early-discharges
#5
Hemali Patel, Sasha Morduchowicz, Michelle Mourad
BACKGROUND: Late-afternoon hospital discharges can lead to admission bottlenecks and negatively affect the flow of patients needing hospital admission. Delays in discharge are a prevalent health care problem and have been linked to increased length of stay, lower patient satisfaction scores, and adverse outcomes. As a result, hospitals are placing a renewed emphasis on early discharge as a way to reduce admission delays and achieve optimal patient flow. This study shows that the Model for Improvement (MFI) is an effective approach for complex improvement efforts...
April 2017: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/28302375/risk-factors-for-unplanned-transfer-to-the-intensive-care-unit-after-emergency-department-admission
#6
Lena M Boerma, Eef P J Reijners, Roger A P A Hessels, Martijn A A V Hooft
INTRODUCTION: Unplanned Intensive Care Unit (ICU) admission has been used as a surrogate marker of adverse events, and is used by the Australian Council of Healthcare Accreditation as a reportable quality indicator. If we can identify independent variables predicting deterioration which require ICU transfer within 24h after emergency department (ED) admission, direct ICU admission should be considered. This may improve patient safety and reduce adverse events by appropriate disposition of patients presenting to the ED...
March 12, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28301425/dolutegravir-with-tenofovir-disoproxil-fumarate-emtricitabine-as-hiv-post-exposure-prophylaxis-in-gay-and-bisexual-men
#7
John Mcallister, Janet M Towns, Anna Mcnulty, Anna B Pierce, Rosalind Foster, Robyn Richardson, Andrew Carr
OBJECTIVES: Completion rates for HIV post-exposure prophylaxis (PEP) are often low. We investigated the adherence and safety of dolutegravir (DTG 50 mg daily) with tenofovir disoproxil fumarate 300 mg/emtricitabine 200 mg (TDF-FTC) as 3-drug PEP in gay and bisexual men (GBM). DESIGN: Open-label, single-arm study at 3 sexual health clinics and 2 emergency departments in Australia. METHODS: One hundred HIV-uninfected GBM requiring PEP received DTG plus TDF-FTC for 28 days...
March 15, 2017: AIDS
https://www.readbyqxmd.com/read/28300965/collective-strategy-for-facing-occupational-risks-of-a-nursing-team
#8
Marli Maria Loro, Regina Célia Gollner Zeitoune
OBJECTIVE: To socialize an educational action through the process of group discussion and reflection, with the aim to increase the care of nursing workers in facing occupational risks. METHOD: A qualitative descriptive study using the Convergent Care Research modality with nursing staff working in an emergency department of a hospital in the northwest region of the state of Rio Grande do Sul, Brazil. Data collection was carried out through educational workshops and information was processed using content analysis, resulting in two thematic categories: A look at the knowledge and practices about occupational risks in nursing; and adherence to protective measures by the nursing team against occupational risks...
March 9, 2017: Revista da Escola de Enfermagem da U S P
https://www.readbyqxmd.com/read/28296520/facial-intramuscular-lipoma-occurrence-following-topical-cosmetic-injection-with-a-mixture-of-basic-fibroblast-growth-factor-a-report-of-two-cases
#9
Xuan Liao, Zhi-Dan Zhang, Sheng-Hong Li, Li-Ling Xiao, Jin-Qiang Lu, Bo Xie, Hong-Wei Liu
Growth factors and cytokines control cell growth, proliferation and differentiation via a network of inter- and intracellular signalling pathways, and are involved in skin self-renewing and wound healing. In recent years, topical and injectable growth factors and cytokines have emerged as an intriguing therapeutic modality that can be harnessed for aesthetic purposes. However, very little data are available on their long-term safety and tolerability. In this report, we describe two cases of patients, who developed intramuscular lipoma of the chin following topical injection with a mixture of basic fibroblast growth factor as the main ingredients for chin augmentation...
February 16, 2017: Journal of Cosmetic and Laser Therapy: Official Publication of the European Society for Laser Dermatology
https://www.readbyqxmd.com/read/28292506/the-development-and-feasibility-of-a-pharmacy-delivered-opioid-intervention-in-the-emergency-department
#10
Erin L Winstanley, Rebecca Mashni, Sydney Schnee, Nate Miller, Susan M Mashni
OBJECTIVES: To develop a brief intervention and to assess the feasibility of pharmacy-delivered education on opioid safety and overdose prevention in the emergency department. METHODS: A convenience sample of patients (n = 102) approached between May and June 2016 at a single community-based suburban emergency department located in the Midwest. RESULTS: The intervention included scripted counseling to be delivered in person and 2 educational brochures...
March 2017: Journal of the American Pharmacists Association: JAPhA
https://www.readbyqxmd.com/read/28289051/paediatric-early-warning-systems-for-detecting-and-responding-to-clinical-deterioration-in-children-a-systematic-review
#11
Veronica Lambert, Anne Matthews, Rachel MacDonell, John Fitzsimons
OBJECTIVE: To systematically review the available evidence on paediatric early warning systems (PEWS) for use in acute paediatric healthcare settings for the detection of, and timely response to, clinical deterioration in children. METHOD: The electronic databases PubMed, MEDLINE, CINAHL, EMBASE and Cochrane were searched systematically from inception up to August 2016. Eligible studies had to refer to PEWS, inclusive of rapid response systems and teams. Outcomes had to be specific to the identification of and/or response to clinical deterioration in children (including neonates) in paediatric hospital settings (including emergency departments)...
March 13, 2017: BMJ Open
https://www.readbyqxmd.com/read/28288080/management-of-pediatric-type-i-open-fractures-in-the-emergency-department-or-operating-room-a-multicenter-perspective
#12
Jenna Godfrey, Paul D Choi, Lior Shabtai, Sarah B Nossov, Amy Williams, Antoinette W Lindberg, Selina Silva, Michelle S Caird, Mathew D Schur, Alexandre Arkader
BACKGROUND: The management of pediatric type I open fractures remains controversial. The aim of this study is to compare outcomes in type I open fractures managed with superficial wound debridement and antibiotics in the emergency department (ED) (nonoperative management) to patients managed with operative debridement and antibiotics (operative management). METHODS: A multicenter retrospective review was performed of all pediatric type I open forearm, wrist, and tibia fractures treated at 4 high volume pediatric centers between 2000 and 2015...
March 10, 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28283497/direct-comparison-of-four-very-early-rule-out-strategies-for-acute-myocardial-infarction-using-high-sensitivity-cardiac-troponin-i
#13
Jasper Boeddinghaus, Thomas Nestelberger, Raphael Twerenbold, Karin Wildi, Patrick Badertscher, Janosch Cupa, Tobias Bürge, Patrick Mächler, Sydney Corbière, Karin Grimm, Maria Rubini Giménez, Christian Puelacher, Samyut Shrestha, Dayana Flores Widmer, Jakob Fuhrmann, Petra Hillinger, Zaid Sabti, Ursina Honegger, Nicolas Schaerli, Nikola Kozhuharov, Katharina Rentsch, Òscar Miró, Beatriz López Barbeito, F Javier Martin-Sanchez, Esther Rodriguez-Adrada, Beata Morawiec, Damian Kawecki, Eva Ganovská, Jiri Parenica, Jens Lohrmann, Wanda Kloos, Andreas Buser, Nicolas Geigy, Dagmar I Keller, Stefan Osswald, Tobias Reichlin, Christian Müller
Background -Four strategies for very early rule-out of acute myocardial infarction (AMI) using high-sensitivity cardiac troponin I (hs-cTnI) have been identified. It remains unclear which strategy is most attractive for clinical application. Methods -We prospectively enrolled unselected patients presenting to the emergency department (ED) with symptoms suggestive of AMI. The final diagnosis was adjudicated by two independent cardiologists. Hs-cTnI levels were measured at presentation and after 1h in a blinded fashion...
March 10, 2017: Circulation
https://www.readbyqxmd.com/read/28279550/tale-of-2-health-care-systems-disparities-in-demographic-and-clinical-characteristics-between-2-ischemic-stroke-populations-in-los-angeles-county
#14
Amytis Towfighi, Erica Patel, Nerses Sanossian, Natalie P Valle, Bruce Ovbiagele
BACKGROUND: Individuals who present to the emergency departments of safety-net systems often have poorly controlled risk factors due to lack of primary care. Little is known about potential differences in presenting characteristics, discharge medications, and discharge destinations of patients with acute ischemic stroke (AIS) who present to safety-net settings versus university medical centers (UMCs). METHODS: Demographic characteristics, medical history, premorbid medication use, stroke severity, discharge medications, and discharge destination were assessed among consecutive admissions for AIS over a 2-year period at a UMC (n = 385) versus 2 university-affiliated safety-net hospitals (SNHs) (n = 346) in Los Angeles County...
March 6, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28277414/implementation-of-an-electronic-clinical-decision-support-tool-for-pediatric-appendicitis-within-a-hospital-network
#15
Marissa A Hendrickson, Andrew R Wey, Philippe R Gaillard, Anupam B Kharbanda
OBJECTIVES: Computed tomography (CT) has been widely used in the evaluation of children with suspected appendicitis, but concerns about ionizing radiation have increased interest in ultrasound for these patients. We sought to assess the effectiveness of an appendicitis electronic clinical decision support (E-CDS) system in increasing ultrasound and decreasing CT use in children evaluated in emergency departments (EDs) for suspected appendicitis. METHODS: This was a preintervention and postintervention analysis of an E-CDS implemented into an electronic health record system shared by an academic, tertiary-care children's hospital and a community hospital...
March 9, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28274646/general-characteristics-and-activity-of-emergency-department-short-stay-units-in-spanish-hospitals
#16
Carles Ferré, Ferran Llopis, Francisco Javier Martín-Sánchez, Gonzalo Sempere, Pere Llorens, Carmen Navarro, Mikel Martínez-Ortiz, Antoni Juan
BACKGROUND: Emergency Department (ED) overcrowding mainly due to the lack of access to inpatient beds negatively affects safety and quality of care. Implementation of ED short-stay units (EDSSUs) may help to mitigate this situation. OBJECTIVES: To describe the general characteristics and evaluate the activity of EDSSUs in Spanish hospitals. METHODS: This is a cross-sectional study. A questionnaire was sent to coordinators responsible for the EDSSUs identified among Spanish hospitals appearing on the Ministry of Health Web page...
March 5, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28272179/workplace-violence-and-perceptions-of-safety-among-emergency-department-staff-members-experiences-expectations-tolerance-reporting-and-recommendations
#17
(no author information available yet)
No abstract text is available yet for this article.
March 2017: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
https://www.readbyqxmd.com/read/28272178/workplace-violence-and-perceptions-of-safety-among-emergency-department-staff-members-experiences-expectations-tolerance-reporting-and-recommendations
#18
Darcy Copeland, Melissa Henry
Workplace violence (WPV) is a widely recognized problem in emergency departments (EDs). The majority of WPV studies do not include nonclinical staff and do not address expectations of violence, tolerance to violence, or perceptions of safety. Among a multidisciplinary sample of ED staff members, specific study aims were to (a) describe exposure to WPV; (b) describe perceptions of safety, tolerance to violence, and expectation of violence; (c) describe reporting behaviors and perceived barriers to reporting violence; (d) examine relationships between demographic variables, experiences of violence, tolerance to violence, perceptions of safety, and reporting behaviors; and (e) identify perceptions of viable interventions to improve workplace safety...
March 2017: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
https://www.readbyqxmd.com/read/28269800/leader-member-exchange-and-safety-citizenship-behavior-the-mediating-role-of-coworker-trust
#19
Li Jiang, Feng Li, YongJuan Li, Rui Li
BACKGROUND: To achieve high safety levels, mere compliance with safety regulations is not sufficient; employees must be proactive and demonstrate safety citizenship behaviors. Trust is considered as a mechanism for facilitating the effects of a leader on employee citizenship behaviors. Increasingly research has focused on the role of trust in a safety context; however, the role of coworker trust has been overlooked. OBJECTIVES: The mediating role of coworker trust in the relationship between the leader-member exchange and safety citizenship behavior is the focus of this field study...
February 27, 2017: Work: a Journal of Prevention, Assessment, and Rehabilitation
https://www.readbyqxmd.com/read/28267474/results-of-a-curtailed-randomized-controlled-trial-evaluating-the-efficacy-and-safety-of-azimilide-in-patients-with-implantable-cardioverter-defibrillators-the-shield-2-trial
#20
Victoria M Robinson, David B Bharucha, Kenneth W Mahaffey, Paul Dorian, Peter R Kowey
BACKGROUND: Frequent hospital attendances in patients with implantable cardioverter-defibrillators (ICDs) result in significant morbidity and health care costs. Current drugs to reduce ICD shocks and hospital visits have limited efficacy and considerable toxicity. We evaluated the efficacy and safety of azimilide, a novel oral class III antiarrhythmic, for use in ICD patients. METHODS: A total of 240 patients were enrolled in a prospective, randomized, double-blind, placebo-controlled trial to evaluate the effect of oral azimilide 75 mg daily in ICD patients with previously documented ventricular tachycardia or ventricular fibrillation, and a left ventricular ejection fraction ≤40%...
March 2017: American Heart Journal
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