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https://www.readbyqxmd.com/read/29133262/911-emergency-medical-services-and-re-triage-to-level-i-trauma-centers
#1
Eric Kuncir, Dean Spencer, Kelly Feldman, Cristobal Barrios, Kenneth Miller, Stephanie Lush, Matthew Dolich, Michael Lekawa
BACKGROUND: Interfacility transfer of under-triaged patients to higher level trauma centers has been found to result in a delay of appropriate care and increase in mortality. To address this, for the last 10 years, our region has utilized 911 EMS paramedics for rapid re-triage of under-triaged patients to our institution's Level I trauma center. We sought to determine if utilizing 911 EMS for re-triage (911-RT) to our institution was associated with worse outcomes-with mortality as the primary outcome-compared to direct EMS transport from point of injury...
September 27, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/29132595/remote-ecls-implantation-and-transport-for-retrieval-of-cardiogenic-shock-patients
#2
Sabina P W Guenther, Stefan Buchholz, Frank Born, Stefan Brunner, René Schramm, Dominik J Hoechter, Vera von Dossow, Maximilian Pichlmaier, Christian Hagl, Nawid Khaladj
OBJECTIVE: Extracorporeal life support (ECLS) emerges as a salvage option in therapy refractory cardiogenic shock but is limited to highly specialized tertiary care centers. Critically ill patients are often too unstable for conventional transport. Mobile ECLS programs for remote implantation and subsequent air or ground-based transport for patient retrieval could solve this dilemma and make full-spectrum advanced cardiac care available to patients in remote hospitals in whom shock otherwise might be fatal...
November 2017: Air Medical Journal
https://www.readbyqxmd.com/read/29122111/temperature-sensitive-medications-in-interfacility-transport-the-ice-pack-myth
#3
Jason Clancy, Cassandra Karish, Meghan Roddy, Judith J Sicilia, Michael T Bigham
INTRODUCTION: Critical Care Transport teams use various strategies to maintain temperature sensitive drugs and equipment at optimal temperature. The purpose of this study was to examine the effectiveness of current passive refrigeration of temperature sensitive transport medications/equipment. METHODS: Initially, we performed a retrospective review of transport durations. Subsequently, an experimental paradigm was created using a temperature probe inside of the transport cooler packs utilizing various configurations and initial starting temperatures with high and low "in range" temperature margins of 8°C (max) and 2°C (min)...
November 2017: Air Medical Journal
https://www.readbyqxmd.com/read/29095286/clinical-predictors-of-outcomes-in-patients-undergoing-emergency-air-medical-transport-from-kinmen-to-taiwan
#4
Julia Chia-Yu Chang, Hsien-Hao Huang, Shu-Hua Chang, Yin-Ru Chen, Ju-Shin Fan, Yen-Chia Chen, David Hung-Tsang Yen
Emergency air medical transport (EAMT) is indispensable for acutely or critically ill patients in remote areas. We determined patient-level and transport-specific factors associated with all-cause mortality after EAMT.We conducted a population-based, retrospective cohort study using a prospective registry consisting of clinical/medical records. Study inclusion criteria consisted of all adults undergoing EAMT from Kinmen hospital to the ED of Taipei Veterans General Hospital (TVGH) between January 1, 2006 and December 31, 2012...
November 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29067633/implementation-of-continuous-video-electroencephalography-at-a-community-hospital-enhances-care-and-reduces-costs
#5
Brad J Kolls, Brian E Mace, Keith E Dombrowski
BACKGROUND: Despite data indicating the importance of continuous video-electroencephalography (cvEEG) monitoring, adoption has been slow outside major academic centers. Barriers to adoption include the need for technologists, equipment, and cvEEG readers. Advancements in lower-cost lead placement templates and commercial systems with remote review may reduce barriers to allow community centers to implement cvEEG. Here, we report our experience, lessons learned, and financial impact of implementing a community hospital cvEEG-monitoring program...
October 24, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28990958/chronic-obstructive-pulmonary-disease-in-the-long-term-care-setting-current-practices-challenges-and-unmet-needs
#6
Manuel Suarez-Barcelo, Joseph L Micca, Sharon Clackum, Gary T Ferguson
: Chronic obstructive pulmonary disease (COPD) is a prevalent and disabling disorder in the United States, especially affecting older individuals, women, and those with a history of smoking. Studies show that COPD may be underrepresented, underdiagnosed, and undertreated in elderly patients residing in long-term care (LTC) facilities. The quality of care for LTC residents with COPD is heterogeneous in regard to both the facility and the patient. For LTC facilities, care should be driven by staff education, interstaff communication, and interfacility communication...
November 2017: Current Opinion in Pulmonary Medicine
https://www.readbyqxmd.com/read/28934993/can-a-single-primary-care-paramedic-configuration-safely-transport-low-acuity-patients-in-air-ambulances
#7
Homer Tien, Bruce Sawadsky, Michael Lewell, Sean Moore, Michael Peddle, Alun Ackery, Brodie Nolan, Russell D MacDonald
OBJECTIVE: To determine if utilizing a single paramedic crew configuration is safe for transporting low acuity patients requiring only a primary care paramedic (PCP) level of care in Air Ambulances. METHODS: We studied single-PCP transports of low acuity patients done by contract air ambulance carriers, organized by Ornge (Ontario's Air Ambulance Service) for one year. We only included interfacility transports. We excluded all scene calls, and all Code 4 (emergent) calls...
September 22, 2017: CJEM
https://www.readbyqxmd.com/read/28886788/logistical-concerns-for-prehospital-blood-product-use-by-air-medical-services
#8
REVIEW
Patrick Maher, Richard Utarnachitt, Max J Louzon, Roxann Gary, Nina Sen, John R Hess
Over the past few decades, reports have described favorable results from transfusion of blood products in helicopter EMS (HEMS). Nevertheless, the initiation of a HEMS transfusion program requires consideration of many factors, some unique to each clinical site. This paper describes our experience developing a HEMS transfusion program in an urban non-hospital based HEMS program with a history of long transport times. When considering blood use away from the hospital, major consideration must be given to safe storage and monitoring of blood products both on the ground and while in flight...
September 2017: Air Medical Journal
https://www.readbyqxmd.com/read/28870269/failure-to-communicate-transmission-of-extensively-drug-resistant-bla-oxa-237-containing-acinetobacter-baumannii-multiple-facilities-in-oregon-2012-2014
#9
Genevieve L Buser, P Maureen Cassidy, Margaret C Cunningham, Susan Rudin, Andrea M Hujer, Robert Vega, Jon P Furuno, Steven H Marshall, Paul G Higgins, Michael R Jacobs, Meredith S Wright, Mark D Adams, Robert A Bonomo, Christopher D Pfeiffer, Zintars G Beldavs
OBJECTIVE To determine the scope, source, and mode of transmission of a multifacility outbreak of extensively drug-resistant (XDR) Acinetobacter baumannii. DESIGN Outbreak investigation. SETTING AND PARTICIPANTS Residents and patients in skilled nursing facilities, long-term acute-care hospital, and acute-care hospitals. METHODS A case was defined as the incident isolate from clinical or surveillance cultures of XDR Acinetobacter baumannii resistant to imipenem or meropenem and nonsusceptible to all but 1 or 2 antibiotic classes in a patient in an Oregon healthcare facility during January 2012-December 2014...
September 5, 2017: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/28862480/national-characteristics-of-emergency-medical-services-responses-for-older-adults-in-the-united-states
#10
Hieu V Duong, Lauren Nicholas Herrera, Justin Xavier Moore, John Donnelly, Karen E Jacobson, Jestin N Carlson, N Clay Mann, Henry E Wang
OBJECTIVE: Older adults, those aged 65 and older, frequently require emergency care. However, only limited national data describe the Emergency Medical Services (EMS) care provided to older adults. We sought to determine the characteristics of EMS care provided to older adults in the United States. METHODS: We used data from the 2014 National Emergency Medical Services Information System (NEMSIS), encompassing EMS response data from 46 States and territories. We excluded EMS responses for children <18 years, interfacility transports, intercepts, non-emergency medical transports, and standby responses...
September 1, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28860727/the-role-of-caregivers-in-interfacility-care-transitions-a-qualitative-study
#11
Lianne Jeffs, Marianne Saragosa, Madelyn P Law, Kerry Kuluski, Sherry Espin, Jane Merkley
A qualitative design was used to explore the nature of caregiver involvement in care transitions of patients being transferred from an acute care hospital to a rehabilitation hospital. Participants included older adults (n=13), informal caregivers (n=9), and health care professionals (n=50) from inpatient orthopedic units in two academic health science centers and one orthopedic inpatient rehabilitation unit. Semistructured interviews were conducted, audio-taped, and transcribed. Directed content analysis revealed the following four themes: watching, being an active care provider, advocating, and navigating the health care system...
2017: Patient Preference and Adherence
https://www.readbyqxmd.com/read/28822393/identifying-futile-interfacility-surgical-transfers
#12
Kristy Kummerow Broman, Sharon E Phillips, Jesse M Ehrenfeld, Mayur B Patel, Oscar M Guillamondegui, Kenneth W Sharp, Richard A Pierce, Benjamin K Poulose, Michael D Holzman
Surgeons perceive that some surgical transfers are futile, but the incidence and risk factors of futile transfer are not quantified. Identifying futile interfacility transfers could save cost and undue burdens to patients and families. We sought to describe the incidence and factors associated with futile transfers. We conducted a retrospective cohort study from 2009 to 2013 including patients transferred to a tertiary referral center for general or vascular surgical care. Futile transfers were defined as resulting in death or hospice discharge within 72 hours of transfer without operative, endoscopic, or radiologic intervention...
August 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28754811/consistency-of-pressure-injury-documentation-across-interfacility-transfers
#13
Lee Squitieri, David A Ganz, Carol M Mangione, Jack Needleman, Patrick S Romano, Debra Saliba, Clifford Y Ko, Daniel A Waxman
BACKGROUND: Hospital-acquired pressure injuries (HAPIs) are publicly reported in the USA and used to adjust Medicare payment to acute inpatient facilities. Current methods used to identify HAPIs in administrative claims rely on hospital-reported present-on-admission (POA) data instead of prior patient health information. OBJECTIVE: To study the reliability of claims data for HAPIs and pressure injury (PI) stage by evaluating diagnostic coding agreement across interfacility transfers...
July 28, 2017: BMJ Quality & Safety
https://www.readbyqxmd.com/read/28743480/the-influence-of-insurance-type-on-interfacility-pediatric-emergency-department-transfers
#14
Chris A Rees, Stephanie Pryor, Ben Choi, Mamata V Senthil, Nicholas Tsarouhas, Sage R Myers, Michael C Monuteaux, Richard G Bachur, Joyce Li
BACKGROUND: Disparities exist in the care children receive in the emergency department (ED) based on their insurance type. It is unknown if these differences exist among children transferred from outside EDs to pediatric tertiary care EDs. OBJECTIVE: To compare reasons for transfer and services received at pediatric tertiary care EDs between children with private and public insurance. METHODS: We performed a secondary analysis of a multicenter survey of ED providers transferring patients to pediatric tertiary care EDs in three major U...
July 19, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28739240/evaluation-of-situation-background-assessment-recommendation-tool-during-neonatal-and-pediatric-interfacility-transport
#15
Diane Wilson, Anuradha Kochar, Andrew Whyte-Lewis, Hilary Whyte, Kyong-Soon Lee
OBJECTIVE: We aimed to determine if the implementation of Situation, Background, Assessment, Recommendation (SBAR) training improved the quality of real-life telephone communication. We evaluated interfacility neonatal and pediatric transports performed by registered nurses, respiratory therapists, and physicians (MDs). METHODS: This was a quality improvement study performed to evaluate telephone communication before and after SBAR training. Training consisted of lectures, review of audio files, and simulated role-playing...
July 2017: Air Medical Journal
https://www.readbyqxmd.com/read/28706095/elucidating-the-information-exchange-during-interfacility-care-transitions-insights-from-a-qualitative-study
#16
Lianne Jeffs, Marianne Saragosa, Madelyn Law, Kerry Kuluski, Sherry Espin, Jane Merkley, Chaim M Bell
OBJECTIVE: To explore the perceptions of patients, their caregivers and healthcare professionals associated with the exchange of information during transitioning from two acute care hospitals to one rehabilitation hospital. DESIGN: An exploratory qualitative study using semi-structured interviews and observation. PARTICIPANTS AND SETTING: Patients over the age of 65 years admitted to an orthopaedic unit for a non-elective admission, their caregivers and healthcare professionals involved in their care...
July 12, 2017: BMJ Open
https://www.readbyqxmd.com/read/28697156/transitions-of-care-the-presence-of-written-interfacility-transfer-guidelines-and-agreements-for-pediatric-patients
#17
Andrea Lynn Genovesi, Lenora M Olson, Russell Telford, Diana Fendya, Ellen Schenk, Theresa Morrison-Quinata, Elizabeth A Edgerton
OBJECTIVE: Every year, emergency medical services agencies transport approximately 150,000 pediatric patients between hospitals. During these transitions of care, patient safety may be affected and contribute to adverse events when important clinical information is missing, incomplete, or inaccurate. Written interfacility transfer policies are one way to standardize procedures and facilitate communication between the hospitals leading to improved patient safety and satisfaction for children and families...
July 11, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28697154/interfacility-transport-shock-index-is-associated-with-decreased-survival-in-children
#18
Ryan M Jennings, Bradley A Kuch, Kathryn A Felmet, Richard A Orr, Joseph A Carcillo, Ericka L Fink
BACKGROUND: Shock index, the ratio of heart rate to systolic blood pressure that changes with age, is associated with mortality in adults after trauma and in children with sepsis. We assessed the utility of shock index to predict sepsis diagnosis and survival in children requiring interfacility transport to a tertiary care center. METHODS: We studied children aged 1 month to 21 years who had at least 2 sets of vital signs recorded during interfacility transport to the Children's Hospital of Pittsburgh by our critical care transport team...
July 11, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28673618/extracorporeal-membrane-oxygenation-and-interfacility-transfer-a-regional-referral-experience
#19
David N Ranney, Desiree Bonadonna, Babatunde A Yerokun, Michael S Mulvihill, Nawar Al-Rawas, Michael Weykamp, Rathnayaka M Gunasingha, Raquel R Bartz, John C Haney, Mani A Daneshmand
BACKGROUND: The number of adults referred to high-volume centers for extracorporeal membrane oxygenation (ECMO) is increasing. Outcomes of patients requiring transport are not well characterized, and referral guidelines are lacking. This study describes the experience and outcomes of a single high-volume center. METHODS: A retrospective study was performed that included adults undergoing ECMO between June 2009 and December 2015. Patient characteristics and outcomes were acquired from the medical record...
November 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28615088/healthcare-antibiotic-resistance-prevalence-dc-harp-dc-a-regional-prevalence-assessment-of-carbapenem-resistant-enterobacteriaceae-cre-in-healthcare-facilities-in-washington-district-of-columbia
#20
Jacqueline Reuben, Nancy Donegan, Glenn Wortmann, Roberta DeBiasi, Xiaoyan Song, Princy Kumar, Mary McFadden, Sylvia Clagon, Janet Mirdamadi, Diane White, Jo Ellen Harris, Angella Browne, Jane Hooker, Michael Yochelson, Milena Walker, Gary Little, Gail Jernigan, Kathleen Hansen, Brenda Dockery, Brendan Sinatro, Morris Blaylock, Kimary Harmon, Preetha Iyengar, Trevor Wagner, Jo Anne Nelson
OBJECTIVE Carbapenem-resistant Enterobacteriaceae (CRE) are a significant clinical and public health concern. Understanding the distribution of CRE colonization and developing a coordinated approach are key components of control efforts. The prevalence of CRE in the District of Columbia is unknown. We sought to determine the CRE colonization prevalence within healthcare facilities (HCFs) in the District of Columbia using a collaborative, regional approach. DESIGN Point-prevalence study. SETTING This study included 16 HCFs in the District of Columbia: all 8 acute-care hospitals (ACHs), 5 of 19 skilled nursing facilities, 2 (both) long-term acute-care facilities, and 1 (the sole) inpatient rehabilitation facility...
June 15, 2017: Infection Control and Hospital Epidemiology
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