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Emergency department observation unit

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https://www.readbyqxmd.com/read/28516829/factors-associated-with-failure-of-emergency-wait-time-targets-for-high-acuity-discharges-and-intensive-care-unit-admissions
#1
Ivy Cheng, Merrick Zwarenstein, Alex Kiss, Maaret Castren, Mats Brommels, Michael Schull
OBJECTIVE: Ontario established emergency department length-of-stay (EDLOS) targets but has difficulty achieving them. We sought to determine predictors of target time failure for discharged high acuity patients and intensive care unit (ICU) admissions. METHODS: This was a retrospective, observational study of 2012 Sunnybrook Hospital emergency department data. The main outcome measure was failing to meet government EDLOS targets for high acuity discharges and ICU emergency admissions...
May 18, 2017: CJEM
https://www.readbyqxmd.com/read/28514641/mapping-workforce-configuration-and-operational-models-in-australian-emergency-departments-a-national-survey
#2
Glenn Gardner, Anne Gardner, Sandy Middleton, Julie Considine, Gerard Fitzgerald, Luke Christofis, Anna Doubrovsky, Margaret Adams, Jane O'Connell
Objective Hospital emergency departments (ED) in Australia and internationally have been experiencing increased demand, resulting in reduced hospital quality, impaired access and adverse health outcomes. Effective evaluation of new ED service models and their effect on outcomes is reliant on baseline measures of the staffing configuration and organisational characteristics of the EDs being studied. The aim of the present study was to comprehensively measure these variables in Australian EDs.Methods Australian hospital EDs with 24-h medical and nursing cover were identified and invited to participate in the study...
May 18, 2017: Australian Health Review: a Publication of the Australian Hospital Association
https://www.readbyqxmd.com/read/28514322/relationship-between-a-sepsis-intervention-bundle-and-in-hospital-mortality-among-hospitalized-patients-a-retrospective-analysis-of-real-world-data
#3
Priya A Prasad, Erica R Shea, Stephen Shiboski, Mary C Sullivan, Ralph Gonzales, David Shimabukuro
BACKGROUND: Sepsis is a systemic response to infection that can lead to tissue damage, organ failure, and death. Efforts have been made to develop evidence-based intervention bundles to identify and manage sepsis early in the course of the disease to decrease sepsis-related morbidity and mortality. We evaluated the relationship between a minimally invasive sepsis intervention bundle and in-hospital mortality using robust methods for observational data. METHODS: We performed a retrospective cohort study at the University of California, San Francisco, Medical Center among adult patients discharged between January 1, 2012, and December 31, 2014, and who received a diagnosis of severe sepsis/septic shock (SS/SS)...
May 12, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28511702/what-is-the-evidence-for-the-management-of-patients-along-the-pathway-from-the-emergency-department-to-acute-admission-to-reduce-unplanned-attendance-and-admission-an-evidence-synthesis
#4
Sarah H Credé, Colin O'Keeffe, Suzanne Mason, Anthea Sutton, Emma Howe, Susan J Croft, Mike Whiteside
BACKGROUND: Globally, the rate of emergency hospital admissions is increasing. However, little evidence exists to inform the development of interventions to reduce unplanned Emergency Department (ED) attendances and hospital admissions. The objective of this evidence synthesis was to review the evidence for interventions, conducted during the patient's journey through the ED or acute care setting, to manage people with an exacerbation of a medical condition to reduce unplanned emergency hospital attendance and admissions...
May 16, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28509704/effectiveness-of-2-hour-troponin-in-high-risk-patients-with-suspected-acute-coronary-syndrome
#5
Joseph Bove, Steven Hochman, Jacob Miller, Stephen Artim
BACKGROUND: Research has shown the safety and effectiveness of drawing a standard troponin level at presentation and again at 2 hours in only low-risk patients. Because high-sensitivity troponins are not currently approved in the United States, we studied the utility of a standard troponin that is presently in use. Our goal was to determine if 2-hour standard troponin would be safe and effective in the evaluation of a high-risk cohort of patients never studied previously. METHODS: We conducted a single-center prospective observational study of adult patients presenting to the emergency department with signs and symptoms suggestive of acute coronary syndrome...
June 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/28506605/post-traumatic-stress-disorder-among-older-adults-experiencing-motor-vehicle-collision-a-multicenter-prospective-cohort-study
#6
Timothy F Platts-Mills, Bo C Nebolisa, Sean A Flannigan, Natalie L Richmond, Robert M Domeier, Robert A Swor, Phyllis L Hendry, David A Peak, Niels K Rathlev, Jeffrey S Jones, David C Lee, Christopher W Jones, Samuel A McLean
OBJECTIVE: To characterize risk factors for and consequences of post-traumatic stress disorder (PTSD) among older adults evaluated in the emergency department (ED) following motor vehicle collision (MVC). DESIGN: Prospective multicenter longitudinal study (2011-2015). SETTING: 9 EDs across the United States. PARTICIPANTS: Adults aged 65 years and older who presented to an ED after MVC without severe injuries. MEASUREMENTS: PTSD symptoms were assessed 6 months after the ED visit using the Impact of Event Scale-Revised...
April 4, 2017: American Journal of Geriatric Psychiatry
https://www.readbyqxmd.com/read/28506591/early-echocardiography-has-a-low-yield-in-patients-with-transient-ischemic-attack
#7
Elie Harmouche, Ghada A Mahmoud, Michael Ross, Jason Hockenberry, Robin Dharia, Fadi Nahab
STUDY OBJECTIVE: Current guidelines recommend patients presenting with transient ischemic attack (TIA) undergo echocardiography to evaluate for a cardiac source. However, echocardiography is not available daily at many centers. We assessed the yield from early transthoracic echocardiography (TTE) in consecutive patients with TIA evaluated in an emergency department observation unit (EDOU) protocol. METHODS: This observational cohort study took place in an academic medical center from January 1, 2011 to July 31, 2013...
May 11, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28505059/creation-of-an-adult-observation-unit-improving-outcomes
#8
Joy M Plamann, Judith Zedreck-Gonzalez, Laura Fennimore
A growing segment of patients in hospitals are considered outpatients, classified as observation. These patients neither have the severity of illness nor the intensity of service to qualify as inpatients, yet are not well enough to be discharged. Hospitals have created observation units to address the clinical needs of this growing patient type to provide care in the right setting by managing emergency department throughput and utilizing the most efficient staffing resources. This article describes the change processes and improvements in quality, length of stay, and patient satisfaction, which occurred following the implementation of an adult observation unit...
May 12, 2017: Journal of Nursing Care Quality
https://www.readbyqxmd.com/read/28504322/racial-differences-in-the-pain-management-of-children-recovering-from-anesthesia
#9
Olubukola O Nafiu, Wilson T Chimbira, Margaret Stewart, Kathleen Gibbons, L Kareen Porter, Paul I Reynolds
BACKGROUND: When pain management has been studied in settings such as pediatric emergency departments, racial disparities have been clearly identified. To our knowledge, this has not been studied in the pediatric perioperative setting. We sought to determine whether there are differences based on race in the administration of analgesia to children suffering from pain in the postanesthesia care unit. METHODS: This is a prospective, observational, study of 771 children aged 4-17 years who underwent elective outpatient surgery...
May 15, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28501384/acute-heart-failure-in-the-emergency-department-the-safe-simeu-epidemiological-study
#10
Andrea Fabbri, Giulio Marchesini, Giorgio Carbone, Roberto Cosentini, Annamaria Ferrari, Mauro Chiesa, Alessio Bertini, Federico Rea
BACKGROUND: Patients with acute heart failure (AHF) have high rates of attendance to emergency departments (EDs), with significant health care costs. OBJECTIVES: We aimed to describe the clinical characteristics of patients attending Italian EDs for AHF and their diagnostic and therapeutic work-up. METHODS: We carried out a retrospective analysis on 2683 cases observed in six Italian EDs for AHF (January 2011 to June 2012). RESULTS: The median age of patients was 84 years (interquartile range 12), with females accounting for 55...
May 10, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28499787/motocross-associated-head-and-spine-injuries-in-adult-patients-evaluated-in-an-emergency-department
#11
Lucas Oliveira J E Silva, M Fernanda Bellolio, Elisa M Smith, David J Daniels, Christine M Lohse, Ronna L Campbell
BACKGROUND: Motor vehicle-related injuries (including off-road) are the leading cause of traumatic brain injury (TBI) and acute traumatic spinal cord injury in the United States. OBJECTIVES: To describe motocross-related head and spine injuries of adult patients presenting to an academic emergency department (ED). METHODS: We performed an observational cohort study of adult ED patients evaluated for motocross-related injuries from 2010 through 2015...
April 27, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28492404/trend-and-outcomes-of-video-laryngoscope-use-across-picus
#12
Jocelyn R Grunwell, Pradip P Kamat, Michael Miksa, Ashwin Krishna, Karen Walson, Dennis Simon, Conrad Krawiec, Ryan Breuer, Jan Hau Lee, Eleanor Gradidge, Keiko Tarquinio, Asha Shenoi, Justine Shults, Vinay Nadkarni, Akira Nishisaki
OBJECTIVE: Video (indirect) laryngoscopy is used as a primary tracheal intubation device for difficult airways in emergency departments and in adult ICUs. The use and outcomes of video laryngoscopy compared with direct laryngoscopy has not been quantified in PICUs or cardiac ICUs. DESIGN: Retrospective review of prospectively collected observational data from a multicenter tracheal intubation database (National Emergency Airway Registry for Children) from July 2010 to June 2015...
May 10, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28492403/pediatric-in-hospital-acute-respiratory-compromise-a-report-from-the-american-heart-association-s-get-with-the-guidelines-resuscitation-registry
#13
Lars W Andersen, Mikael Vognsen, Alexis Topjian, Linda Brown, Robert A Berg, Vinay M Nadkarni, Hans Kirkegaard, Michael W Donnino
OBJECTIVES: The main objectives of this study were to describe in-hospital acute respiratory compromise among children (< 18 yr old), and its association with cardiac arrest and in-hospital mortality. DESIGN: Observational study using prospectively collected data. SETTING: U.S. hospitals reporting data to the "Get With The Guidelines-Resuscitation" registry. PATIENTS: Pediatric patients (< 18 yr old) with acute respiratory compromise...
May 10, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28489698/epidemiology-of-isolated-versus-nonisolated-mild-traumatic-brain-injury-treated-in-emergency-departments-in-the-united-states-2006-2012-sociodemographic-characteristics
#14
Carol Cancelliere, Victor G Coronado, Christopher A Taylor, Likang Xu
OBJECTIVES: To describe the frequencies and rates of mild traumatic brain injury (mTBI) emergency department (ED) visits, analyze the trend across the years, and compare sociodemographic characteristics of visits by mTBI type (ie, mTBI as the only injury, or present along with other injuries). DESIGN: Population-based descriptive study using data from the Nationwide Emergency Department Sample (2006-2012). METHODS: Joinpoint regression was used to calculate the average annual percent changes of mTBI incidence rates...
November 8, 2016: Journal of Head Trauma Rehabilitation
https://www.readbyqxmd.com/read/28485313/clinical-characteristics-and-current-interventions-in-shock-patients-in-chinese-emergency-departments-a-multicenter-prospective-cohort-study
#15
Shu-Bin Guo, Yun-Xia Chen, Xue-Zhong Yu
BACKGROUND: Shock is a life-threatening condition in emergency departments (EDs) and is associated with a high mortality; however, its clinical characteristics and current interventions in China are seldom reported. This study investigated the clinical characteristics and current interventions of shock patients in Chinese EDs. METHODS: This multicenter prospective cohort study was conducted in the EDs of 33 academic hospitals in 16 Chinese provinces. Adult shock patients were enrolled from December 2013 to April 2014...
May 20, 2017: Chinese Medical Journal
https://www.readbyqxmd.com/read/28467976/increase-in-the-admission-of-stroke-mimics-after-change-in-emergency-shifts
#16
Mariana Vargas, Mariana Costa, Teresa Pinho E Melo, José M Ferro, Ana Catarina Fonseca
BACKGROUND: In 2010, changes were made to the shift pattern of neurology residents for cover in the Emergency Department at a university hospital. This resulted in a decrease in the number of emergency hours worked by neurology specialists and allowed for a natural quasi-experiment. AIM: We aimed to evaluate if changes to the number of emergency hours worked by neurology residents and specialist neurologists, (intervention) altered the number or pattern of admitted stroke mimics (SMs)...
May 4, 2017: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/28452886/platelet-transfusions-reduce-fibrinolysis-but-do-not-restore-platelet-function-during-trauma-hemorrhage
#17
Paul Vulliamy, Scarlett Gillespie, Lewis S Gall, Laura Green, Karim Brohi, Ross A Davenport
INTRODUCTION: Platelets play a critical role in hemostasis with aberrant function implicated in trauma-induced coagulopathy. However, the impact of massive transfusion protocols on platelet function during trauma hemorrhage is unknown. The aim of this study was to characterize the effects of platelet transfusion on platelet aggregation and fibrinolytic markers during hemostatic resuscitation. METHODS: Trauma patients enrolled into the prospective Activation of Coagulation and Inflammation in Trauma (ACIT) study between January 2008 and November 2015 who received at least four units of packed red blood cells (PRBCs) were included...
April 27, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28452300/a-comparison-of-seasonal-trends-in-asthma-exacerbations-among-children-from-geographic-regions-with-different-climates
#18
Julia A Wisniewski, Anne P McLaughlin, Philip J Stenger, James Patrie, Mark A Brown, Jane M El-Dahr, Thomas A E Platts-Mills, Nora J Byrd, Peter W Heymann
BACKGROUND: The fall peak in childhood asthma exacerbations is thought to be related to an increase in viral infections and allergen exposure when children return to school. Whether the seasonality of asthma attacks among children from different geographic regions follows similar trends is unclear. OBJECTIVE: To compare seasonal trends in asthma exacerbations among school-age children who lived in different geographic locations, with different climates, within the United States...
November 1, 2016: Allergy and Asthma Proceedings:
https://www.readbyqxmd.com/read/28435485/impact-of-health-policy-changes-on-emergency-medicine-in-maryland-stratified-by-socioeconomic-status
#19
Laura Pimentel, David Anderson, Bruce Golden, Edward Wasil, Fermin Barrueto, Jon M Hirshon
INTRODUCTION: On January 1, 2014, the financing and delivery of healthcare in the state of Maryland (MD) profoundly changed. The insurance provisions of the Patient Protection and Affordable Care Act (ACA) began implementation and a major revision of MD's Medicare waiver ushered in a Global Budget Revenue (GBR) structure for hospital reimbursement. Our objective was to analyze the impact of these policy changes on emergency department (ED) utilization, hospitalization practices, insurance profiles, and professional revenue...
April 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28435481/a-patient-centered-emergency-department-management-strategy-for-sickle-cell-disease-super-utilizers
#20
Grant G Simpson, Hallie R Hahn, Alex A Powel, Robert R Leverence, Linda A Morris, Lara G Thompson, Marc S Zumberg, Deepa J Borde, Joseph A Tyndall, Jonathan J Shuster, Donald M Yealy, Brandon R Allen
INTRODUCTION: A subpopulation of sickle-cell disease patients, termed super-utilizers, presents frequently to emergency departments (EDs) for vaso-occlusive events and may consume disproportionate resources without broader health benefit. To address the healthcare needs of this vulnerable patient population, we piloted a multidisciplinary intervention seeking to create and use individualized patient care plans that alter utilization through coordinated care. Our goals were to assess feasibility primarily, and to assess resource use secondarily...
April 2017: Western Journal of Emergency Medicine
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