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https://www.readbyqxmd.com/read/29341529/-when-the-ward-overflows%C3%A2-the-impact-of-outlying-beds-on-patient-care
#1
Valérie Mosimann, Olivier Lamy, Julien Castioni
Due to the chronic lack of beds in hospitals, patients are often hospitalized in other departments (outlier patients), with a responsible physician working in another department. This causes increased thromboembolics risks, nosocomial infections, falls and delirium in the elderly, morbidity and mortality. Outlier patients, compared to standard patients, stay longer in the emergency department and their discharge documents are available later. Outlying is used daily in the CHUV hospital and new strategies are elaborated to manage patient flow, especially during the flu epidemic...
January 17, 2018: Revue Médicale Suisse
https://www.readbyqxmd.com/read/29331328/pilot-clinical-trial-of-high-flow-oxygen-therapy-in-children-with-asthma-in-the-emergency-service
#2
Yolanda Ballestero, Jimena De Pedro, Nancy Portillo, Otilia Martinez-Mugica, Eunate Arana-Arri, Javier Benito
OBJECTIVES: To assess the efficacy of high-flow nasal cannula (HFNC) oxygen therapy and safety in children with asthma and moderate respiratory failure in the emergency department (ED). STUDY DESIGN: This was a prospective randomized pilot trial of children (aged 1-14 years) presenting to a tertiary academic pediatric ED with moderate-to-severe asthma exacerbations between September 2012 and December 2015. Patients with a pulmonary score (PS) ≥6 or oxygen saturation <94% with a face mask despite initial treatment (salbutamol/ipratropium bromide and corticosteroids) were randomized to HFNC or to conventional oxygen therapy...
January 11, 2018: Journal of Pediatrics
https://www.readbyqxmd.com/read/29330584/a-dedicated-neurologist-at-the-emergency-department-during-out-of-office-hours-decreases-patients-length-of-stay-and-admission-percentages
#3
M Christien van der Linden, Crispijn L van den Brand, Ido R van den Wijngaard, Roeline A Y de Beaufort, Naomi van der Linden, Korné Jellema
BACKGROUND: Emergency departments (EDs) worldwide face crowding, which hampers patient flow. In this study, the impact of a dedicated neurologist present at the ED on patient flow during out-of-office hours was assessed. METHODS: A cross-sectional, mixed methods study was undertaken at a Dutch ED, including a pre-post analysis of data of patients who had a primary neurological disease (n = 458) and staff surveys (n = 152). Descriptive statistics and content analysis were used for analyses...
January 12, 2018: Journal of Neurology
https://www.readbyqxmd.com/read/29321118/a-comparison-of-carotid-doppler-ultrasonography-and-capnography-in-evaluating-the-efficacy-of-cardiopulmonary-resuscitation-the-first-study
#4
Gökhan Yilmaz, Mustafa Silcan, Süha Serin, Bahadır Caglar, Özkan Erarslan, İsmet Parlak
INTRODUCTION AND PURPOSE: The end-tidal carbon dioxide (ETCO2) measurement is accepted as the gold standard method for assessing cardiopulmonary resuscitation (CPR) efficacy. In recent studies, the use of Carotid Doppler Ultrasonography has become widespread in showing CPR efficacy. In the present study, the carotid blood flow measurement was compared with ETCO2 measurement and an evaluation was made of whether this method could be used as an alternative method to capnography in the assessment of CPR efficacy...
January 6, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29310868/high-velocity-nasal-insufflation-in-the-treatment-of-respiratory-failure-a-randomized-clinical-trial
#5
Pratik Doshi, Jessica S Whittle, Michael Bublewicz, Joseph Kearney, Terrell Ashe, Russell Graham, Suesann Salazar, Terry W Ellis, Dianna Maynard, Rose Dennis, April Tillotson, Mandy Hill, Misha Granado, Nancy Gordon, Charles Dunlap, Sheldon Spivey, Thomas L Miller
STUDY OBJECTIVE: We compare high-velocity nasal insufflation, a form of high-flow nasal cannula, with noninvasive positive-pressure ventilation in the treatment of undifferentiated respiratory failure with respect to therapy failure, as indicated by requirement for endotracheal intubation or cross over to the alternative therapy. METHODS: This was a multicenter, randomized trial of adults presenting to the emergency department (ED) with respiratory failure requiring noninvasive positive-pressure ventilation...
January 5, 2018: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/29287591/systematic-review-of-nephrotoxicity-of-drugs-of-abuse-2005-2016
#6
Kanaan Mansoor, Murad Kheetan, Saba Shahnawaz, Anna P Shapiro, Eva Patton-Tackett, Larry Dial, Gary Rankin, Prasanna Santhanam, Antonios H Tzamaloukas, Tibor Nadasdy, Joseph I Shapiro, Zeid J Khitan
BACKGROUND: The United States is faced with an unprecedented epidemic of drug abuse. Every year thousands of Americans visit the emergency departments all over the country with illicit drug related complaints. These drugs have been known to be associated with a range of renal pathologies, from reversible acute kidney injuries to debilitating irreversible conditions like renal infarction. So far, no comprehensive study or systematic review has been published that includes the commonly used street drugs and designer drugs with potential nephrotoxic outcomes...
December 29, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/29276136/duplex-sonography-of-vertebral-arteries-for-evaluation-of-patients-with-acute-vertigo
#7
Peiman Nazerian, Sofia Bigiarini, Rudi Pecci, Lucia Taurino, Marco Moretti, Andrea Pavellini, Elisa Capretti, Stefano Grifoni, Simone Vanni
We evaluated the role of vertebral artery extracranial color-coded duplex sonography (VAECCS) in predicting vertebrobasilar stroke in consecutive patients presenting to the emergency department with vertigo of suspected ischemic origin. The final diagnosis was established by a panel of experts consisting of an emergency physician, a neurologist, and an otoneurologist. Vertebrobasilar stroke was diagnosed when an acute brain ischemic lesion congruent with symptoms was detected by neuroimaging during the index visit or a stroke was diagnosed within a 3-mo period after emergency department presentation...
December 21, 2017: Ultrasound in Medicine & Biology
https://www.readbyqxmd.com/read/29273909/emergency-department-visits-among-patients-with-left-ventricular-assist-devices
#8
Christopher R Tainter, Oscar Ö Braun, Felipe Teran, Albert P Nguyen, Kimberly Robbins, Edward O O'Brien, Zeb M McMillan, Ulrich Schmidt, Angela Meier, Mat Goebel, Victor Pretorius, Michela Brambatti, Eric D Adler, Raghu Seethala
Continuous-flow left ventricular assist devices (LVADs) are increasingly implanted to support patients with end-stage heart failure. These patients are at high risk for complications, many of which necessitate emergency care. While rehospitalization rates have been described, there is little data regarding emergency department (ED) visits. We hypothesize that ED visits are frequent and often require admission after LVAD implantation. We performed a retrospective review of patients in our health-care system followed by the advanced heart failure service for LVAD management after implantation between January 2011 and July 2015...
December 22, 2017: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/29249343/a-universal-deep-learning-approach-for-modeling-the-flow-of-patients-under-different-severities
#9
Shancheng Jiang, Kwai-Sang Chin, Kwok L Tsui
BACKGROUND AND OBJECTIVE: The Accident and Emergency Department (A&ED) is the frontline for providing emergency care in hospitals. Unfortunately, relative A&ED resources have failed to keep up with continuously increasing demand in recent years, which leads to overcrowding in A&ED. Knowing the fluctuation of patient arrival volume in advance is a significant premise to relieve this pressure. Based on this motivation, the objective of this study is to explore an integrated framework with high accuracy for predicting A&ED patient flow under different triage levels, by combining a novel feature selection process with deep neural networks...
February 2018: Computer Methods and Programs in Biomedicine
https://www.readbyqxmd.com/read/29245337/assessment-of-pulmonary-arterial-enhancement-on-ct-pulmonary-angiography-using-a-leg-vein-for-contrast-media-administration
#10
Cherry Kim, Choong Wook Lee, Gil-Sun Hong, Gihong Kim, Ki Yeol Lee, Sung-Soo Kim
The purpose of our study was to compare pulmonary artery (PA) enhancement according to venous routes of contrast media (CM) administration in patients who underwent CT pulmonary angiography (CTPA) in the emergency department (ED).This retrospective study reviewed the CTPAs of 24 patients who administered CM via leg veins (group A) and 72 patients via arm veins (group B) with age and gender matching at a ratio of 1:3. Clinical data, aorta attenuation (Aoatten), and PA attenuation (PAatten) were compared between group A and B...
December 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29223696/key-players-in-key-roles-the-baystate-patient-progress-initiative-to-improve-emergency-department-efficiency-and-productivity
#11
Niels K Rathlev, Jacqualyn Anderson, Joseph Schmidt, Joeli Hettler, Lynn Garreffi, Molly Gray, Douglas Neal, Paul Visintainer
BACKGROUND: The percentage of patients who leave the emergency department without being seen by a provider is a measure of efficiency and presents risk-management concerns. The number of patients actually "seen" by a provider is a measure of productivity. The opening of our new emergency department in December 2012, resulted in increases in both demand and the percentage of patients who left without being seen. Operational nursing leadership managed ED patient flow, but the structure was loosely organized on an ad hoc basis...
December 6, 2017: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
https://www.readbyqxmd.com/read/29201481/cystic-lymphangioma-of-the-chest-wall-in-a-5-year-old-male-patient-a-rare-and-atypical-localization-a-case-report-and-comprehensive-review-of-the-literature
#12
Dimitrios Patoulias, Ioannis Patoulias, Christos Kaselas, Maria Kalogirou, Chatzopoulos Kyriakos, Farmakis Konstantinos, Thomas Feidantsis, Papacrivou Eleni
Lymphangioma is a benign congenital malformation. The extremely rare and atypical localization of a lymphangioma in the chest wall was the real motive for the present case study. A 5-year-old boy was admitted to the Emergency Department of the 1st Department of Pediatric Surgery, Aristotle University of Thessaloniki, due to the presence of a mildly painful swelling in the left lateral chest wall, which was first noticed three months ago, after a blunt injury during sport. Physical examination revealed the presence of a palpable, spherical, painful, nut-sized subcutaneous lesion in the left lateral chest wall, respectively, with the anterior axillary line, at the height of the 6th to 7th intercostal space...
2017: Case Reports in Pediatrics
https://www.readbyqxmd.com/read/29200244/management-of-airway-obstruction-and-stridor-in-pediatric-patients-digest
#13
Ashley Marchese, Melissa L Langhan, Kathryn H Pade
Stridor is a result of turbulent air-flow through the trachea from upper airway obstruction, and although in children it is often due to croup, it can also be caused by noninfectious and/or congenital conditions as well as life-threatening etiologies. The history and physical examination guide initial management, which includes reduction of airway inflammation, treatment of bacterial infection, and, less often, imaging, emergent airway stabilization, or surgical management. This issue discusses the most common as well as the life-threatening etiologies of acute and chronic stridor and its management in the emergency department...
November 22, 2017: Pediatric Emergency Medicine Practice
https://www.readbyqxmd.com/read/29197316/developing-a-mass-casualty-surge-capacity-protocol-for-emergency-medical-services-to-use-for-patient-distribution
#14
Samuel E Shartar, Brooks L Moore, Lori M Wood
OBJECTIVES: Metropolitan areas must be prepared to manage large numbers of casualties related to a major incident. Most US cities do not have adequate trauma center capacity to manage large-scale mass casualty incidents (MCIs). Creating surge capacity requires the distribution of casualties to hospitals that are not designated as trauma centers. Our objectives were to extrapolate MCI response research into operational objectives for MCI distribution plan development; formulate a patient distribution model based on research, hospital capacities, and resource availability; and design and disseminate a casualty distribution tool for use by emergency medical services (EMS) personnel to distribute patients to the appropriate level of care...
December 2017: Southern Medical Journal
https://www.readbyqxmd.com/read/29183366/the-effect-on-the-patient-flow-in-local-health-care-services-after-closing-a-suburban-primary-care-emergency-department-a-controlled-longitudinal-follow-up-study
#15
Katri Mustonen, Jarmo Kantonen, Timo Kauppila
BACKGROUND: It has not been studied what happens to patient flow to EDs and other parts of local health care system if distances to ED services are manipulated as a part of health policy in urban areas. METHODS: The present work was an observational and quasi-experimental study with a control and it was based on before-after comparisons. The impact of terminating a geographically distant suburban primary care ED on patient flow to doctors in local public primary care EDs, office-hour primary care, secondary care EDs and in private primary care was studied...
November 28, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/29175310/no-more-code-black-intervention-to-improve-inpatient-flow-at-a-large-public-hospital
#16
Charles E Coffey, Valda Carter, Eric Wei, Douglas Hutcheon, John P Gruen, Annie Anonas-Ternate, Rebecca Sandoval, Annie Marquez, Laura Sarff, Brad Spellberg
Code Black is a documentary movie, and now television series, whose name derives from a term used to describe critical hospital overcrowding resulting in dangerously inadequate patient flow. The Los Angeles County + University of Southern California (LAC+USC) Medical Center is a large, urban, public hospital with a long history of spending substantial amounts of time in Code Black-indeed the movie was created by a former Emergency Medicine resident at LAC+USC Medical Center. To change years of inadequate inpatient flow, we implemented time-limited cardiac monitoring criteria and empowered existing staff to enforce admission and downgrade criteria for our telemetry, step-down care unit, and intensive care units...
November 21, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/29170352/55%C3%A2-mini-sim-innovative-bite-sized-simulation-teaching-in-a-busy-children-s-emergency-department
#17
Rachel Sunley, Karen Moloney, Jessica Parker, Christopher Arrowsmith, Kirsty Brown, Alex Wilson
: Emergency Medicine requires a highly skilled workforce who are passionate about delivering excellent patient care. Shift patterns linked with the ever increasing numbers of patients who attend Emergency Departments puts strain on educating the workforce and fostering team togetherness.Our objective in devising and instigating the 'Mini Sim' programme was to embed regular in-situ simulation training to enhance the learning of all staff within our Emergency Department team, building a highly trained workforce to deliver excellent care within the remit of our busy department...
December 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29170350/53%C3%A2-piloting-patch-providing-assessment-and-treatment-for-children-at-home-and-piecing-together-what-works
#18
Caroline Ward, Katie Knight, Mary-Rose Ballard, Georgina Keogh, Miriam Samuel, Sara Buttle, Claire Robb, Francesca Cleugh
AIMS: PATCH is a pilot acute community children's nurse led service delivering assessment and treatment for children at home who are moderately unwell and might otherwise be admitted to hospital or attend Paediatric Emergency Department (PED). Children are referred by PED or GP and followed up via telephone support and home visits depending on clinical need for duration of acute illness. METHODS: Pilot year funded by Imperial Charity. Using evaluation to build business case for sustained commissioned service...
December 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29170337/40%C3%A2-ed-crowding-the-acceptability-of-dysfunction
#19
Karl Kavanagh, Darragh Shields, Paul Staunton
BACKGROUND: Crowding in the Emergency Department is internationally recognised as one of the greatest challenges to healthcare provision. Numerous studies have highlighted the ill-effects of crowding, including increased length of stay, mortality and cost per admission. Crowding is typically a manifestation of a hospital at full capacity and its main contributor is the practice of boarding patients in the ED. Therefore, a functioning flow system is advised to ease the burden. Different predictive tools/algorithms assess the degree of crowding...
December 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29170318/21%C3%A2-daily-dynamic-discharge-a-whole-system-solution-to-ed-crowding
#20
Jacques Kerr, Helen Maitland, Claire Bell, Julie White, Alan Hunter
INTRODUCTION: ED crowding is associated with increased mortality, poor staff and patient experience, an increased inpatient length of stay and poor compliance with the four-hour emergency access standard.1 Where crowding is caused by exit block, the focus needs to be on whole system patient management, reducing the temporal mismatch between admissions and discharges since at times of peak demand hospitals may become gridlocked until patients are discharged.In an attempt to tackle exit block, the Scottish Government Unscheduled Care Team have implemented the Daily Dynamic Discharge (DDD) approach, which aims to increase the number of inpatient discharges by 12 pm, thus enabling more timeous flow through the ED...
December 2017: Emergency Medicine Journal: EMJ
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