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Emergency department flow

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https://www.readbyqxmd.com/read/28331130/cytopenias-and-clonal-expansion-of-gamma-delta-t-cells-in-a-patient-with-anaplasmosis-a-potential-diagnostic-pitfall
#1
Daniel Marko, Anamarija M Perry, Arjuna Ponnampalam, Michel R Nasr
Human granulocytic anaplasmosis is a rare, tick-borne infectious disease caused by Anaplasma phagocytophilum. Herein, we report a rare case of human granulocytic anaplasmosis associated with cytopenias and clonal expansion of gamma/delta T-cells in the bone marrow. A 77-year old man presented multiple times to the emergency department complaining of muscle weakness. Complete blood count detected cytopenias and peripheral blood smear showed pseudo Pelger-Huet neutrophils. These findings prompted bone marrow evaluation with ancillary studies including flow cytometry, karyotyping and T-cell rearrangement studies...
2017: Journal of Clinical and Experimental Hematopathology: JCEH
https://www.readbyqxmd.com/read/28325207/using-a-systematic-framework-of-interventions-to-improve-early-discharges
#2
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/28296829/ovarian-torsion-in-the-normal-ovary-a-diagnostic-challenge-in-postmenarchal-adolescent-girls-in-the-emergency-department
#3
Erbil Karaman, Burhan Beger, Orkun Çetin, Mehmet Melek, Yasemin Karaman
BACKGROUND Ovarian torsion can be seen in the otherwise-normal ovary and is a challenging issue in the emergency department. The aims were (1) to evaluate and compare the surgically verified ovarian torsion cases in otherwise-normal ovaries and ovaries including a mass or cyst and (2) to investigate whether the normal-appearing ovaries on ultrasound examination affected the diagnosis of ovarian torsion or not. MATERIAL AND METHODS A retrospective cohort study design was used. The medical records of all postmenarchal adolescent girls with surgically verified ovarian torsion treated in a university hospital from 2010 to 2016 were reviewed...
March 15, 2017: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
https://www.readbyqxmd.com/read/28286823/protocol-adherence-for-severe-sepsis-and-septic-shock-management-in-the-emergency-department-a-clinical-audit
#4
Mostafa Alavi-Moghaddam, Ali Anvari, Reaza Soltani Delgosha, Hamid Kariman
INTRODUCTION: Although significant development in the field of medicine is achieved, sepsis is still a major issue threatening humans' lives. This study was aimed to audit the management of severe sepsis and septic shock patients in emergency department (ED) according to the present standard guidelines. METHOD: This is a prospective audit on approaching adult septic patients who were admitted to ED. The audit checklist was created based on the protocols of Surviving Sepsis Campaign and British Royal College recommendations...
2017: Emergency (Tehran, Iran)
https://www.readbyqxmd.com/read/28280700/allograft-loss-from-acute-page-kidney-secondary-to-trauma-after-kidney-transplantation
#5
Kazuhiro Takahashi, Rohini Prashar, Krishna G Putchakayala, William J Kane, Jason E Denny, Dean Y Kim, Lauren E Malinzak
We report a rare case of allograft loss from acute Page kidney secondary to trauma that occurred 12 years after kidney transplantation. A 67-year-old Caucasian male with a past surgical history of kidney transplant presented to the emergency department at a local hospital with left lower abdominal tenderness. He recalled that his cat, which weighs 15 lbs, jumped on his abdomen 7 d prior. On physical examination, a small tender mass was noticed at the incisional site of the kidney transplant. He was producing a normal amount of urine without hematuria...
February 24, 2017: World Journal of Transplantation
https://www.readbyqxmd.com/read/28279543/emergency-department-holding-orders
#6
Stephen J Traub, M'Hamed Temkit, Soroush Saghafian
BACKGROUND: Holding orders help transition admitted emergency department (ED) patients to hospital beds. OBJECTIVE: To describe the effect of ED holding orders. METHODS: We conducted a single-site retrospective study of ward admissions from the ED to the hospital internal medicine (HIM) service over 2 years. Patients were classified based on whether the ED did (group 1) or did not (group 2) write holding orders; group 1 was subdivided into patients sent to the floor with only ED holding orders (group 1A) vs...
March 6, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28279382/trials-of-imaging-use-in-the-emergency-department-for-acute-chest-pain
#7
REVIEW
Gilbert L Raff, Udo Hoffmann, James E Udelson
Over 8 million patients seek emergency department care for acute chest pain annually in the United States alone, and <5% have an acute coronary syndrome. In the absence of overt electrocardiographic or biomarker evidence, expensive and time-consuming diagnostic strategies are frequently required. Beginning in 2000, radionuclide myocardial perfusion, stress echocardiography, cardiac magnetic resonance imaging, and coronary computed tomographic angiography have become increasingly common in evaluating these patients...
March 2017: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/28252906/-what-nurses-see-occurrence-and-typology-of-wastes-in-medical-and-surgical-wards-a-cross-sectional-study
#8
Angelo Dante, Michela Marega, Adriana Peteani, Adriana Checchi, Loreto Lancia
AIM: To describe the occurrence and the typology of waste in the nurses clinical practice as well as the differences between the medical and surgical area. METHODS: A cross-sectional study was conducted in a north eastern Italian hospital. Data collection, conducted on 100 nurses in September 2015, was carried out using a semi-structured questionnaire consisting of 56 items and eight dimensions (Overproduction / Underutilisation, Wait, Stocks, Process, Inefficiency and Errors, Material Transport and Information Flows, Movements, Dispersion of Knowledge)...
October 2016: Professioni Infermieristiche
https://www.readbyqxmd.com/read/28238385/distributive-shock-in-the-emergency-department-sepsis-anaphylaxis-or-capillary-leak-syndrome
#9
Cansu Alyeşil, Nurettin Özgür Doğan, İbrahim Ulaş Özturan, Seda Güney
BACKGROUND: Distributive shock is a hyperdynamic process resulting from excessive vasodilatation. Impaired blood flow causes inadequate tissue perfusion, which can lead to end-organ damage. Although the most common etiology is septic shock, anaphylactic and other etiologies should be considered. CASE REPORT: We report the case of a 30-year-old female who presented to the emergency department with nonspecific symptoms and hypotension after a viral upper respiratory infection...
February 18, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28237382/application-of-high-flow-nasal-cannula-to-heterogeneous-condition-in-the-emergency-department
#10
Areum Durey, Soo Kang, Young Ju Suh, Seung Baik Han, Ah Jin Kim
No abstract text is available yet for this article.
February 14, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28235966/inter-rater-reliability-between-nurses-for-a-new-paediatric-triage-system-based-primarily-on-vital-parameters-the-paediatric-triage-instrument-peti
#11
Jaana Karjala, Staffan Eriksson
INTRODUCTION: The major paediatric triage systems are primarily based on flow charts involving signs and symptoms for orientation and subjective estimates of the patient's condition. In contrast, the 4-level Paediatric Triage Instrument (PETI) is primarily based on vital parameters and was developed exclusively for paediatric triage in patients with medical symptoms. The aim of this study was to assess the inter-rater reliability of this triage system in children when used by nurses. METHODS: A design was employed in which triage was performed simultaneously and independently by a research nurse and an emergency department (ED) nurse using the PETI...
February 23, 2017: BMJ Open
https://www.readbyqxmd.com/read/28222904/the-2016-proposal-for-the-reorganisation-of-urgent-care-provision-in-belgium-a-political-struggle-to-co-locate-primary-care-providers-and-emergency-departments
#12
Koen Van den Heede, Wilm Quentin, Cécile Dubois, Stephan Devriese, Carine Van de Voorde
Internationally the number of emergency department (ED) visits is on the rise while evidence suggests that a substantial proportion of these patients do not require emergency care but primary care. This paper presents the Belgian 2016 proposal for the reorganisation of urgent care provision and places it into its political context. The proposal focused on re-designing patient flow aiming to reduce inappropriate ED visits by improving guidance of patients through the system. Initially policymakers envisaged, as cornerstone of the reform, to roll-out as standard model the co-location of primary care centres and EDs...
February 17, 2017: Health Policy
https://www.readbyqxmd.com/read/28210350/use-of-physician-in-triage-model-in-the-management-of-abdominal-pain-in-an-emergency-department-observation-unit
#13
John R Marshall, Robert Katzer, Shahram Lotfipour, Bharath Chakravarthy, Siri Shastry, Jessica Andrusaitis, Craig L Anderson, Erik D Barton
INTRODUCTION: Given the nationwide increase in emergency department (ED) visits it is of paramount importance for hospitals to find efficient ways to manage patient flow. The purpose of this study was to determine whether there is a significant difference in success rates, length of stay (LOS), and other demographic factors in two cohorts of patients admitted directly to an ED observation unit (EDOU) under an abdominal pain protocol by a physician in triage (bypassing the main ED) versus those admitted via the traditional pathway (evaluated and treated in the main ED prior to EDOU admission)...
February 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28188202/progressive-prediction-of-hospitalisation-in-the-emergency-department-uncovering-hidden-patterns-to-improve-patient-flow
#14
Yuval Barak-Corren, Shlomo Hanan Israelit, Ben Y Reis
INTRODUCTION: One of the factors contributing to ED crowding is the lengthy delay in transferring an admitted patient from the ED to an inpatient department (ie, boarding time). An earlier start of the admission process using an automatic hospitalisation prediction model could potentially shorten these delays and reduce crowding. METHODS: Clinical, operational and demographic data were retrospectively collected on 80 880 visits to the ED of Rambam Health Care Campus in Haifa, Israel, from January 2011 to January 2012...
February 10, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28185509/developing-an-advanced-nurse-practitioner-approach-to-clinical-assessments
#15
Caroline Prescott, Nick Stackhouse
Emergency departments (EDs) often experience reduced patient flow, which results in low capacity, increased congestion and delays in patient care. Advanced nurse practitioners (ANPs) possess the skills required to relieve these pressures and enhance care delivery. This article describes how introducing ANP-led rapid assessment triage in an ED has enabled these practitioners to use advanced practice skills in assessment and intervention, and to request early diagnostic processes to improve patient flow. The system enables the ANPs to identify high-acuity patients who can be cared for in the ED without the need for admission, while ensuring their safety, rapid assessment and timely interventions...
February 10, 2017: Emergency Nurse: the Journal of the RCN Accident and Emergency Nursing Association
https://www.readbyqxmd.com/read/28168128/three-dimensional-printing-of-a-hemorrhagic-cervical-cancer-model-for-postgraduate-gynecological-training
#16
Michael Bartellas, Stephen Ryan, Gregory Doucet, Deanna Murphy, Jacqueline Turner
INTRODUCTION: A realistic hemorrhagic cervical cancer model was three-dimensionally (3D) printed and used in a postgraduate medical simulation training session. MATERIALS AND METHODS: Computer-assisted design (CAD) software was the platform of choice to create and refine the cervical model. Once the prototype was finalized, another software allowed for the addition of a neoplastic mass, which included openings for bleeding from the neoplasm and cervical os. 3D printing was done using two desktop printers and three different materials...
January 1, 2017: Curēus
https://www.readbyqxmd.com/read/28166114/examining-emergency-department-treatment-processes-in-severe-pediatric-traumatic-brain-injury
#17
Ali Ajdari, Linda Ng Boyle, Nithya Kannan, Ali Rowhani-Rahbar, Jin Wang, Richard Mink, Benjamin Ries, Mark Wainwright, Jonathan I Groner, Michael J Bell, Chris Giza, Douglas F Zatzick, Richard G Ellenbogen, Pamela H Mitchell, Frederick P Rivara, Monica S Vavilala
BACKGROUND: In the treatment of pediatric traumatic brain injury (TBI), timely treatment of patients can affect the outcome. Our objectives were to examine the treatment process of acute pediatric TBI and the impact of non-value-added time (NVAT) on patient outcomes. METHODS: Data for 136 pediatric trauma patients (age < 18 years) with severe TBI from 2 trauma centers in the United States were collected. A process flow and value stream map identified NVATs and their sources in the treatment process...
February 3, 2017: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/28161016/high-flow-warm-humidified-oxygen-versus-standard-low-flow-nasal-cannula-oxygen-for-moderate-bronchiolitis-hfwho-rct-an-open-phase-4-randomised-controlled-trial
#18
Elizabeth Kepreotes, Bruce Whitehead, John Attia, Christopher Oldmeadow, Adam Collison, Andrew Searles, Bernadette Goddard, Jodi Hilton, Mark Lee, Joerg Mattes
BACKGROUND: Bronchiolitis is the most common lung infection in infants and treatment focuses on management of respiratory distress and hypoxia. High-flow warm humidified oxygen (HFWHO) is increasingly used, but has not been rigorously studied in randomised trials. We aimed to examine whether HFWHO provided enhanced respiratory support, thereby shortening time to weaning off oxygen. METHODS: In this open, phase 4, randomised controlled trial, we recruited children aged less than 24 months with moderate bronchiolitis attending the emergency department of the John Hunter Hospital or the medical unit of the John Hunter Children's Hospital in New South Wales, Australia...
March 4, 2017: Lancet
https://www.readbyqxmd.com/read/28141773/point-of-care-ultrasound-use-to-differentiate-hematoma-and-sarcoma-of-the-thigh-in-the-pediatric-emergency-department
#19
Cathie-Kim Le, Gregory Harvey, Lianne McLean, Jason Fischer
Hematomas and soft tissue sarcomas can be difficult to differentiate clinically, even with the addition of traditional imaging modalities. There are several case reports of sarcomas being misdiagnosed as hematomas, most commonly with a history of mild trauma. In this case report, we described a sarcoma initially misinterpreted as a hematoma on ultrasound. Key clinical features and sonographic findings that may assist clinicians using point-of-care ultrasound to correctly differentiate sarcomas from hematomas are reviewed...
February 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28139312/impact-of-an-emergency-short-stay-unit-on-emergency-department-performance-of-poisoned-patients
#20
Michael A Downes, James K Balshaw, Tracy M Muscat, Nicole Ritchie, Geoffrey K Isbister
OBJECTIVES: This was a before and after study which sought to assess the impact of opening an ED short stay unit (ESSU) on the ED performance of poisoned patients. METHODS: Data was collected from two groups of adult patients presenting to an ED with a tertiary referral inpatient Toxicology unit from the 2009 and 2012 calendar years, to assess the impact of the ESSU. The toxicology unit clinical database and hospital electronic medical records were interrogated for demographic, clinical and hospital flow details of presentations...
January 26, 2017: American Journal of Emergency Medicine
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