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https://www.readbyqxmd.com/read/29773255/-student-nurses-view-of-emergency-departments
#1
Sophie Roucher, Julie Trolliet
The emergency department is an environment described by the staff working there as 'different', with its own particular codes and way of working. Faced with the constant flow of patients, the need to guide, relieve, treat, how can nurses find the time to reassure? What is the nature of the nurse-patient relationship in emergency departments? Student nurses share their views of emergency departments.
May 2018: Soins; la Revue de Référence Infirmière
https://www.readbyqxmd.com/read/29768698/financial-viability-of-emergency-department-observation-unit-billing-models
#2
Christopher W Baugh, Pawan Suri, Christopher G Caspers, Michael A Granovsky, Keith Neal, Michael A Ross
BACKGROUND: Outpatients receive observation services to determine the need for inpatient admission. These services are usually provided without the use of condition-specific protocols and in an unstructured manner, scattered throughout a hospital in areas typically designated for inpatient care. Emergency department observation units (EDOUs) use protocolized care to offer an efficient alternative with shorter lengths of stay, lower costs and higher patient satisfaction. EDOU growth is limited by existing policy barriers that prevent a "two-service" model of separate professional billing for both emergency and observation services...
May 16, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29764613/the-joint-use-of-resilience-engineering-and-lean-production-for-work-system-design-a-study-in-healthcare
#3
Caroline Brum Rosso, Tarcisio Abreu Saurin
Although lean production (LP) has been increasingly adopted in healthcare systems, its benefits often fall short of expectations. This might be partially due to the failure of lean to account for the complexity of healthcare. This paper discusses the joint use of principles of LP and resilience engineering (RE), which is an approach for system design inspired by complexity science. Thus, a framework for supporting the design of socio-technical systems, which combines insights from LP and RE, was developed and tested in a system involving a patient flow from an emergency department to an intensive care unit...
September 2018: Applied Ergonomics
https://www.readbyqxmd.com/read/29748230/senior-doctor-triage-sdt-a-qualitative-study-of-clinicians-views-on-senior-doctors-involvement-in-triage-and-early-assessment-of-emergency-patients
#4
Maysam Ali Abdulwahid, Janette Turner, Suzanne M Mason
INTRODUCTION: Despite the focus during the last decade on introducing interventions such as senior doctor initial assessment or senior doctor triage (SDT) to reduce emergency department (ED) crowding, there has been little attempt to identify the views of emergency healthcare professionals on such interventions. The aim of this study was to gain an understanding of SDT from the perspective of emergency hospital staff. A secondary aim of this study was to develop a definition of SDT based on the interview findings and the available literature on this process...
May 10, 2018: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29748058/unusual-aspect-of-posterior-reversible-encephalopathy-syndrome-in-an-elderly-adult
#5
Benjamin Hebant, Omar Bennani
BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) classically occurs in patients presenting with a sudden increase of arterial pressure or eclampsia, but the range of etiologies is very wide. Although the mechanisms underlying PRES remain unclear, research suggests that when the extent of hypertension exceeds the threshold of cerebral blood flow autoregulation, this induces blood-brain barrier disruption that leads to brain edema. Unusual presentations on magnetic resonance imaging (MRI) are possible, including the involvement of frontal or temporal lobes, cerebellar hemispheres, basal ganglia, brainstem, or deep white matter...
May 7, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29742036/emergency-department-telepsychiatry-service-model-for-a-rural-regional-health-system-the-first-steps
#6
James D Meyer, Alastair J S McKean, Rebecca N Blegen, Bart M Demaerschalk
BACKGROUND: Emergency departments (EDs) have recognized an increasing number of patients presenting with mental health (MH) concerns. This trend imposes greater demands upon EDs already operating at capacity. Many ED providers do not feel they are optimally prepared to provide the necessary MH care. One consideration in response to this dilemma is to use advanced telemedicine technology for psychiatric consultation. INTRODUCTION: We examined a rural- and community-based health system operating 21 EDs, none of which has direct access to psychiatric consultation...
May 9, 2018: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
https://www.readbyqxmd.com/read/29739439/immature-teratoma-mimicking-pulmonary-stenosis-a-case-report
#7
Dardan Koçinaj, Xhevdet Krasniqi, Aurora Bakalli
BACKGROUND: Immature teratoma in a mediastinal location is a rare disease that might present as a valve pathology. Germ cell tumors with mediastinal locations account for up to 6% of immature teratoma cases. We present a case of an immature teratoma located primarily in the anterior mediastinum that manifested solely through symptoms of pulmonary stenosis. CASE PRESENTATION: We report a case of a 20-year-old white man with an immature teratoma who presented with progressive exertional dyspnea...
May 9, 2018: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/29730093/adverse-events-and-satisfaction-with-use-of-intranasal-midazolam-for-emergency-department-procedures-in-children
#8
Laurie Malia, V Matt Laurich, Jesse J Sturm
PURPOSE: Procedural sedation is commonly performed in the emergency department (ED). Having safe and fast means of providing sedation and anxiolysis to children is important for the child's tolerance of the procedure, parent satisfaction and efficient patient flow in the ED. OBJECTIVE: To evaluate fasting times associated with the administration of intranasal midazolam (INM) and associated complications. Secondary objectives included assessing provider and caregiver satisfaction scores...
April 30, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29705219/multicentric-standardized-flow-cytometry-routine-assessment-of-septic-patient-to-predict-clinical-worsening
#9
Thomas Daix, Estelle Guerin, Elsa Tavernier, Emmanuelle Mercier, Valérie Gissot, Olivier Hérault, Jean-Paul Mira, Florence Dumas, Nicolas Chapuis, Christophe Guitton, Marie C Béné, Jean-Pierre Quenot, Cindy Tissier, Julien Guy, Gaël Piton, Anne Roggy, Grégoire Muller, Éric Legac, Nicolas de Prost, Mehdi Khellaf, Orianne Wagner-Ballon, Rémi Coudroy, Elodie Dindinaud, Fabrice Uhel, Mikaël Roussel, Thomas Lafon, Robin Jeannet, Frédéric Vargas, Catherine Fleureau, Mickaël Roux, Kaoutar Allou, Philippe Vignon, Jean Feuillard, Bruno François
BACKGROUND: In this study, we primarily sought to assess the ability of flow cytometry to predict early clinical deterioration and overall survival in septic patients admitted in the emergency department and intensive care unit. METHODS: Patients admitted for community-acquired acute sepsis from 11 hospital centers were eligible. Early (Day 7) and late (Day 28) deaths were notified. Levels of CD64pos granulocytes, CD16pos monocytes, CD16dim immature granulocytes (IG), T and B lymphocytes were assessed by flow cytometry, using an identical, cross-validated, robust and simple consensus standardized protocol in each center...
April 26, 2018: Chest
https://www.readbyqxmd.com/read/29701415/antiphospholipid-syndrome-and-acute-postpartum-limb-ischemia
#10
Inês Antunes, Carlos Pereira, Rui Machado, Duarte Rego, Vitor Ferreira, João Gonçalves, Gabriela Teixeira, Carlos Veiga, Daniel Mendes, Rui Almeida
INTRODUCTION: The diagnosis of Antiphospholipid syndrome (APS) implies the identification of antiphospoholipid antibodies and arterial/venous thrombosis or pregnancy loss. During pregnancy, there is an increased risk of thrombotic complications. METHODS: Present a case of acute lower limb ischemia in a patient with APS during postpartum period Materials/ Methods: review of a clinical case and available literature Results: Patient diagnosed with APS (triple antibody positive and antecedent of 3 previous abortions) underwent cesarean at 29 weeks of gestation...
July 2017: Revista Portuguesa de Cirurgia Cardio-torácica e Vascular
https://www.readbyqxmd.com/read/29697806/decreasing-triage-time-effects-of-implementing-a-step-wise-esi-algorithm-in-an-ehr
#11
Stephen Villa, Ellen J Weber, Steven Polevoi, Christopher Fee, Andrew Maruoka, Tina Quon
Objectives: To determine if adapting a widely-used triage scale into a computerized algorithm in an electronic health record (EHR) shortens emergency department (ED) triage time. Design: Before-and-after quasi-experimental study. Setting: Urban, tertiary care hospital ED. Participants: Consecutive adult patient visits between July 2011 and June 2013. Intervention: A step-wise algorithm, based on the Emergency Severity Index (ESI-5) was programmed into the triage module of a commercial EHR...
April 25, 2018: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/29697685/-ruptures-of-popliteal-artery-aneurysms
#12
I P Mikhaylov, V N Lavrenov, G A Isaev, L S Kokov, E Yu Trofimova
AIM: To improve diagnosis and surgical outcomes in patients with ruptured popliteal artery aneurysm. MATERIAL AND METHODS: Eight patients with ruptured popliteal artery aneurysm have undergone surgery for the period from 1999 to 2015 at the Vascular Surgery Department of Sklifosovsky Research Institute for Emergency Care. Incidence of rupture was 2.9% from total number of popliteal artery aneurysm. 7 patients with rupture had signs of lower limb ischemia (acute form grade I in 2 (25%) cases, grade IIA in 1 (12...
2018: Khirurgiia
https://www.readbyqxmd.com/read/29685008/medicamentous-thrombolysis-disguises-pulmonary-thromboembolism-as-a-cause-of-death
#13
I Šoša, A Ferencic, V Stemberga, G Zamolo, S Arbanas, I Dasek, M Perkovic, D Cuculic
We report the case of a 31-year-old female who was admitted to the emergency department with symptoms of cardiac arrest and ultimately died in spite of enormous resuscitation efforts. During resuscitation, pulmonary embolism was considered as a possible non-cardiac cause of cardiac arrest, and following its extremely unfavorable prognosis, the fatal outcome was not so surprising. However, since acute pulmonary emboli obstructing blood flow to a lobe or multiple lung segments was suspected, alteplase was indicated and administered...
March 2018: Journal of Biological Regulators and Homeostatic Agents
https://www.readbyqxmd.com/read/29682619/path-of-least-resistance-how-computerised-provider-order-entry-can-lead-to-and-reduce-wasteful-practices
#14
Joseph Choi, Cori Rebecca Atlin
Background: Computerised provider order entry (CPOE) is rapidly becoming the mainstay in clinical care and has the potential to improve provider efficiency and accuracy. However, this hinges on careful planning and implementation. Poorly planned CPOE order sets can lead to undetected errors and waste. In our emergency department (ED), lactate dehydrogenase (LDH) was bundled into various blood work panels but had little clinical value. Objectives: This quality improvement initiative aimed to reduce unnecessary LDH testing in the ED...
2018: BMJ Open Quality
https://www.readbyqxmd.com/read/29679414/rates-and-features-of-methamphetamine-related-presentations-to-emergency-departments-an-integrative-literature-review
#15
REVIEW
Rikki Jones, Cindy Woods, Kim Usher
AIMS AND OBJECTIVES: To review the clinical impact methamphetamine has on emergency departments (ED) by assessing the available research on the rates and features of methamphetamine-related presentations. BACKGROUND: Globally, methamphetamine availability, distribution and use has rapidly increased. As a result, the number of methamphetamine-related presentations to EDs has also increased. In this context, it is timely to review the rate and features of methamphetamine-related presentations to understand the impact of methamphetamine on EDs and facilitate the allocation of services, staff and resources...
April 20, 2018: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/29627769/development-and-validation-of-an-admission-prediction-tool-for-emergency-departments-in-the-netherlands
#16
Nicole Kraaijvanger, Douwe Rijpsma, Lian Roovers, Henk van Leeuwen, Karin Kaasjager, Lillian van den Brand, Laura Horstink, Michael Edwards
OBJECTIVE: Early prediction of admission has the potential to reduce length of stay in the ED. The aim of this study is to create a computerised tool to predict admission probability. METHODS: The prediction rule was derived from data on all patients who visited the ED of the Rijnstate Hospital over two random weeks. Performing a multivariate logistic regression analysis factors associated with hospitalisation were explored. Using these data, a model was developed to predict admission probability...
April 7, 2018: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29619913/emergency-department-boarding-a-descriptive-analysis-and-measurement-of-impact-on-outcomes
#17
Leila Salehi, Prashant Phalpher, Rahim Valani, Christopher Meaney, Qamar Amin, Kiki Ferrari, Mathew Mercuri
CLINICIAN'S CAPSULE What is known about the topic? Bed boarding is one of the major contributors to emergency department overcrowding. What did this study ask? What are the characteristics of patients with prolonged boarding times, and what are the impacts on patient-oriented outcomes? What did this study find? Patients who were older, sicker, and had isolation and telemetry requirements experienced longer boarding times, and longer inpatient length of stay even after correcting for confounders. Why does this study matter to clinicians? Organization-wide interventions to improve efficiency and flow are required to mitigate the burden of bed boarding...
April 5, 2018: CJEM
https://www.readbyqxmd.com/read/29601462/incident-reporting-to-improve-patient-safety-the-effects-of-process-variance-on-pediatric-patient-safety-in-the-emergency-department
#18
Karen J OʼConnell, Kathy N Shaw, Richard M Ruddy, Prashant V Mahajan, Richard Lichenstein, Cody S Olsen, Tomohiko Funai, Stephen Blumberg, James M Chamberlain
OBJECTIVE: Medical errors threaten patient safety, especially in the pediatric emergency department (ED) where overcrowding, multiple handoffs, and workflow interruptions are common. Errors related to process variance involve situations that are not consistent with standard ED operations or routine patient care. SETTING/PARTICIPANTS: We performed a planned subanalysis of the Pediatric Emergency Care Applied Research Network incident reporting data classified as process variance events...
April 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29593715/comparative-analysis-of-the-regulatory-t-cells-dynamics-in-peripheral-blood-in-human-and-porcine-polytrauma
#19
Rafael Serve, Ramona Sturm, Lukas Schimunek, Philipp Störmann, David Heftrig, Michel P J Teuben, Elsie Oppermann, Klemens Horst, Roman Pfeifer, Tim P Simon, Yannik Kalbas, Hans-Christoph Pape, Frank Hildebrand, Ingo Marzi, Borna Relja
Background: Severely injured patients experience substantial immunological stress in the aftermath of traumatic insult, which often results in systemic immune dysregulation. Regulatory T cells (Treg) play a key role in the suppression of the immune response and in the maintenance of immunological homeostasis. Little is known about their presence and dynamics in blood after trauma, and nothing is known about Treg in the porcine polytrauma model. Here, we assessed different subsets of Treg in trauma patients (TP) and compared those to either healthy volunteers (HV) or data from porcine polytrauma...
2018: Frontiers in Immunology
https://www.readbyqxmd.com/read/29589336/acute-hospital-reconfiguration-and-self-harm-presentations-a-before-and-after-study
#20
Eve Griffin, Catherine Murphy, Ivan J Perry, Brenda Lynch, Ella Arensman, Paul Corcoran
BACKGROUND: The evidence for improved patient outcomes following acute hospital reconfiguration is limited. AIMS: We assessed the impact of the reconfiguration of acute services within a hospital group in terms of the number and clinical management of self-harm presentations. METHODS: The study was conducted across the three Mid-Western regional hospitals in Ireland during 2004-2014. Reconfiguration in April 2009 involved two hospitals reducing the operation of their emergency departments (EDs) from 24 to 12 h...
March 27, 2018: Irish Journal of Medical Science
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