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https://www.readbyqxmd.com/read/28721927/coagulopathy-and-haemorrhagic-progression-in-traumatic-brain-injury-advances-in-mechanisms-diagnosis-and-management
#1
REVIEW
Marc Maegele, Herbert Schöchl, Tomas Menovsky, Hugues Maréchal, Niklas Marklund, Andras Buki, Simon Stanworth
Normal haemostasis depends on an intricate balance between mechanisms of bleeding and mechanisms of thrombosis, and this balance can be altered after traumatic brain injury (TBI). Impaired haemostasis could exacerbate the primary insult with risk of initiation or aggravation of bleeding; anticoagulant use at the time of injury can also contribute to bleeding risk after TBI. Many patients with TBI have abnormalities on conventional coagulation tests at admission to the emergency department, and the presence of coagulopathy is associated with increased morbidity and mortality...
August 2017: Lancet Neurology
https://www.readbyqxmd.com/read/28719480/a-rare-pediatric-case-of-posttraumatic-pseudoaneurysm-case-report-and-literature-review
#2
Ada Gu, April J Kam
Posttraumatic pseudoaneurysms are extremely rare in pediatric populations. In many cases, pseudoaneurysms may be confused with abscesses, epidermoid cysts, arteriovenous fistula, foreign objects, and ganglion cysts, as well as tumors. They are associated with distinguishing findings of "pulsatile mass, a palpable thrill, and an audible to-and-fro murmur" (1), which can be confirmed by various imaging techniques. In this report, we describe the case of a 4-year-old boy who presented to the pediatric emergency department 3 weeks after falling and subsequently getting cut by glass...
July 17, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28718257/risk-factors-for-heat-related-deaths-during-the-june-2015-heat-wave-in-karachi-pakistan
#3
Syed Ghazanfar Saleem, Tehreem Ansari, Ashraf Shamshad Ali, Sara Fatima, Mariam Hassan Rizvi, Muhammad Abdul Samad
BACKGROUND: Mortality as a consequence of heat related illness is a public health concern. Emergency department (ED) experiences increased patients' flow and decreased survival as a consequence of heat stroke during the episodes of heat wave. The present study was conducted to identify the risk factors for mortality among victims of heat wave (17th - 23rd June), 2015 evaluated in the Emergency Department of The Indus Hospital (TIH), Karachi. METHODS: In this cross-sectional study data was retrospectively collected...
April 2017: Journal of Ayub Medical College, Abbottabad: JAMC
https://www.readbyqxmd.com/read/28714834/adjusting-patients-streaming-initiated-by-a-wait-time-threshold-in-emergency-department-for-minimizing-opportunity-cost
#4
Byungjoon B J Kim, Theodore R Delbridge, Dawn B Kendrick
Purpose Two different systems for streaming patients were considered to improve efficiency measures such as waiting times (WTs) and length of stay (LOS) for a current emergency department (ED). A typical fast track area (FTA) and a fast track with a wait time threshold (FTW) were designed and compared effectiveness measures from the perspective of total opportunity cost of all patients' WTs in the ED. The paper aims to discuss these issues. Design/methodology/approach This retrospective case study used computerized ED patient arrival to discharge time logs (between July 1, 2009 and June 30, 2010) to build computer simulation models for the FTA and fast track with wait time threshold systems...
July 10, 2017: International Journal of Health Care Quality Assurance
https://www.readbyqxmd.com/read/28707273/team-communication-patterns-in-emergency-resuscitation-a-mixed-methods-qualitative-analysis
#5
Lisa Anne Calder, George Mastoras, Mitra Rahimpour, Benjamin Sohmer, Brian Weitzman, A Adam Cwinn, Tara Hobin, Avi Parush
BACKGROUND: In order to enhance patient safety during resuscitation of critically ill patients, we need to optimize team communication and enhance team situational awareness but little is known about resuscitation team communication patterns. The objective of this study is to understand how teams communicate during resuscitation; specifically to assess for a shared mental model (organized understanding of a team's relationships) and information needs. METHODS: We triangulated 3 methods to evaluate resuscitation team communication at a tertiary care academic trauma center: (1) interviews; (2) simulated resuscitation observations; (3) live resuscitation observations...
December 2017: International Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28704269/the-impact-of-medical-specialist-staffing-on-emergency-department-patient-flow-and-satisfaction
#6
M Christien van der Linden, Roeline A Y de Beaufort, Sven A G Meylaerts, Crispijn L van den Brand, Naomi van der Linden
OBJECTIVE: The aim of this study was to describe the impact of additional medical specialists, non-emergency physicians (non-EPs), performing direct supervision or a combination of direct and indirect supervision at an EP-led emergency department (ED), on patient flow and satisfaction. PATIENTS AND METHODS: An observational, cross-sectional, three-part study was carried out including staff surveys (n=379), a before and after 16-week data collection using data of visits during the peak hours (n=5270), and patient questionnaires during 1 week before the pilot and during week 5 of the pilot...
July 12, 2017: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/28702185/potential-cost-savings-by-minimisation-of-blood-sample-delays-on-care-decision-making-in-urgent-care-services
#7
David M S Bodansky, Sophie E Lumley, Rudrajoy Chakraborty, Dhanasekaran Mani, James Hodson, Mike T Hallissey, Olga N Tucker
BACKGROUND: Timely availability of blood sample results for interpretation affects planning and delivery of patient care from initial assessment in Accident and Emergency (A&E) departments. MATERIALS AND METHODS: Rates of, and reasons for, rejected blood samples submitted from all clinical areas over one month were evaluated. Haemoglobin (Hb) represented haematology and potassium (K(+)), biochemistry. A prospective observational study evaluated the methodology of sample collection and impact on utility...
August 2017: Annals of Medicine and Surgery
https://www.readbyqxmd.com/read/28701232/the-three-paradoxes-of-patient-flow-an-explanatory-case-study
#8
Sara A Kreindler
BACKGROUND: Health systems in many jurisdictions struggle to reduce Emergency Department congestion and improve patient flow across the continuum of care. Flow is often described as a systemic issue requiring a "system approach"; however, the implications of this idea remain poorly understood. Focusing on a Canadian regional health system whose flow problems have been particularly intractable, this study sought to determine what system-level flaws impede healthcare organizations from improving flow...
July 12, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28695351/robustness-and-effectiveness-of-the-triage-system-in-the-pediatric-context
#9
Marcello Montefiori, Enrico di Bella, Lucia Leporatti, Paolo Petralia
BACKGROUND: The increasing use of emergency departments (EDs) potentially compromises their effectiveness and quality. The evaluation of the performance of the triage code system in a pediatric context is important because waiting time affects the quality of care for acutely ill patients. OBJECTIVE: In this study, we aimed to assess the effectiveness and robustness of the triage code system in a pediatric context and identify the determinants of waiting times for urgent and non-urgent patients...
July 10, 2017: Applied Health Economics and Health Policy
https://www.readbyqxmd.com/read/28679887/telehealth-and-the-re-design-of-emergency-medical-services
#10
Richard W Jones, George Despotou, Theodoros N Arvanitis
As patient numbers continue to rise Emergency Department's (ED's) are struggling to not only control patient wait times but also to maintain the quality of patient care. Improving patient flow through the ED has been a priority for many years with techniques such as Lean Six-Sigma being implemented specifically to help alleviate the problem. The Institute for Healthcare Improvement recently stated that the best opportunities to improving patient flow relate to the front-end of the ED, namely triage. This contribution examines the use of Telehealth initiatives at the front-end of the ED, specifically tele-consultation, to reduce patient loading, provide timelier healthcare (with improved patient outcomes) and reduce costs...
2017: Studies in Health Technology and Informatics
https://www.readbyqxmd.com/read/28676415/emergency-department-flow-measures-for-adult-and-pediatric-patients-in-british-columbia-and-ontario-a-retrospective-repeated-cross-sectional-study
#11
Gregory Georgio, Astrid Guttmann, Quynh H Doan
BACKGROUND: Evidence suggests emergency department (ED) overcrowding is associated with poor health outcomes. Children comprise 20-25% of general ED visits, yet few studies have examined the differential impact of ED overcrowding on pediatric and adult populations. OBJECTIVE: The primary objective of this study was to compare flow measures, such as wait time to see a physician, length of stay (LOS), and rate of patients leaving without being seen by a physician (LWBS) between adults and children in British Columbia and Ontario, clustered by province, and then stratified by acuity level during the study period...
July 1, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28662909/emergency-department-escalation-in-theory-and-practice-a-mixed-methods-study-using-a-model-of-organizational-resilience
#12
Jonathan Back, Alastair J Ross, Myanna D Duncan, Peter Jaye, Katherine Henderson, Janet E Anderson
STUDY OBJECTIVE: Escalation policies are used by emergency departments (EDs) when responding to an increase in demand (eg, a sudden inflow of patients) or a reduction in capacity (eg, a lack of beds to admit patients). The policies aim to maintain the ability to deliver patient care, without compromising safety, by modifying "normal" processes. The study objective is to examine escalation policies in theory and practice. METHODS: This was a mixed-method study involving a conceptual analysis of National Health Service escalation policies (n=12) and associated escalation actions (n=92), as well as a detailed ethnographic study of escalation in situ during a 16-month period in a large UK ED (n=30 observations)...
June 26, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28659247/two-emergency-departments-6000km-apart-differences-in-patient-flow-and-staff-perceptions-about-crowding
#13
M Christien Van Der Linden, Munawar Khursheed, Khairunnissa Hooda, Jesse M Pines, Naomi Van Der Linden
INTRODUCTION: Emergency department (ED) crowding is a worldwide public health issue. In this study, patient flow and staff perceptions of crowding were assessed in Pakistan (Aga Khan University Hospital (AKUH)) and in the Netherlands (Haaglanden Medical Centre Westeinde (HMCW)). Bottlenecks affecting ED patient flow were identified. METHODS: First, a one-year review of patient visits was performed. Second, staff perceptions about ED crowding were collected using face-to-face interviews...
June 25, 2017: International Emergency Nursing
https://www.readbyqxmd.com/read/28654852/adductor-canal-compression-syndrome-in-an-18-year-old-female-patient-leading-to-acute-critical-limb-ischemia-a-case-report
#14
Yi Zhou, Evan J Ryer, Robert P Garvin, Jeremy L Irvan, James R Elmore
BACKGROUND: Adductor canal compression syndrome is a rare non-atherosclerotic cause of arterial occlusion and limb ischemia. PRESENTATION OF CASE: The patient is an 18-year-old healthy female who presented to the emergency department with acute left lower extremity ischemia. Her symptoms began as sudden onset mild foot pain approximately two months ago. Over the 72h prior to presentation, she developed severe pain, pallor, paralysis, loss of pedal pulses, paresthesia, and poikilothermia...
June 17, 2017: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/28646595/point-of-care-ultrasound-work-flow-innovation-impact-on-documentation-and-billing
#15
Matthew J Flannigan, Srikar Adhikari
OBJECTIVES: To evaluate the impact that an innovative automated ultrasound (US) work flow, which allows for bedside performance of examination documentation and order placement, has on point-of-care US billing compared to ordering US examinations through an electronic medical record. METHODS: We conducted a retrospective review of point-of-care US billing data (March 2014-February 2016) for adult and pediatric emergency departments with an emergency medicine residency and a US fellowship...
June 24, 2017: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
https://www.readbyqxmd.com/read/28637582/principles-of-capacity-management-applied-in-the-mental-health-context
#16
Kathryn Zeitz, Darryl Watson
Objective The aim of the paper was to describe a suite of capacity management principles that have been applied in the mental health setting that resulted in a significant reduction in time spent in two emergency departments (ED) and improved throughput.Methods The project consisted of a multifocal change approach over three phases that included: (1) the implementation of a suite of fundamental capacity management activities led by the service and clinical director; (2) a targeted Winter Demand Plan supported by McKinsey and Co...
June 22, 2017: Australian Health Review: a Publication of the Australian Hospital Association
https://www.readbyqxmd.com/read/28625173/return-visits-to-the-pediatric-emergency-department-a-multicentre-retrospective-cohort-study
#17
Colin B Meyer-Macaulay, Mimi Truong, Garth D Meckler, Quynh H Doan
OBJECTIVE: Return visits to the emergency department (RTED) for the same clinical complaint occur in 2.7% to 8.1% of children presenting to pediatric emergency departments (PEDs). Most studies examining RTEDs have focused solely on PEDs and do not capture children returning to other local emergency departments (EDs). Our objective was to measure the frequency and characterize the directional pattern of RTED to any of 18 EDs serving a large geographic area for children initially evaluated at a PED...
June 19, 2017: CJEM
https://www.readbyqxmd.com/read/28624270/implementation-and-evaluation-of-a-navigator-role-to-improve-emergency-department-throughput
#18
Paul Fulbrook, Melanie Jessup, Frances Kinnear
BACKGROUND: Emergency department overcrowding impacts patients, staff, and quality of care, and there is government pressure to optimize throughput and reduce waiting times. One solution for improving patient flow is the emerging 'navigator' role: a nurse that supports staff in care delivery; facilitating efficient and timely patient movement through the emergency department. METHODS: A 20-week project was implemented to evaluate an emergency department nurse navigator role...
June 14, 2017: Australasian Emergency Nursing Journal: AENJ
https://www.readbyqxmd.com/read/28621799/clinical-guideline-for-the-management-of-odontogenic-infections-in-the-tertiary-setting
#19
Sushma Vytla, Dieter Gebauer
BACKGROUND: Odontogenic infections are a common presentation to Emergency Departments of Australian hospitals. Due to the limited training in diagnosis and treatment of dental conditions, these patients can present a challenge for the medical practitioner. The objective of this study was to provide an evidence-based approach to the management of odontogenic infections in adults presenting to Royal Perth Hospital. METHODS: A literature search was conducted to identify evidence based guidelines for the management of odontogenic infections in the tertiary hospital setting...
June 16, 2017: Australian Dental Journal
https://www.readbyqxmd.com/read/28601264/high-flow-nasal-cannula-versus-conventional-oxygen-therapy-in-emergency-department-patients-with-cardiogenic-pulmonary-edema-a%C3%A2-randomized-controlled-trial
#20
Onlak Makdee, Apichaya Monsomboon, Usapan Surabenjawong, Nattakarn Praphruetkit, Wansiri Chaisirin, Tipa Chakorn, Chairat Permpikul, Phakphoom Thiravit, Tanyaporn Nakornchai
STUDY OBJECTIVE: High-flow nasal cannula is a new method for delivering high-flow supplemental oxygen for victims of respiratory failure. This randomized controlled trial compares high-flow nasal cannula with conventional oxygen therapy in emergency department (ED) patients with cardiogenic pulmonary edema. METHODS: We conducted an open-label randomized controlled trial in the ED of Siriraj Hospital, Bangkok, Thailand. Patients aged 18 years or older with cardiogenic pulmonary edema were randomly assigned to receive either conventional oxygen therapy or high-flow nasal cannula...
June 7, 2017: Annals of Emergency Medicine
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