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Emergency department flow

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https://www.readbyqxmd.com/read/27912757/the-sydney-triage-to-admission-risk-tool-start-to-predict-emergency-department-disposition-a-derivation-and-internal-validation-study-using-retrospective-state-wide-data-from-new-south-wales-australia
#1
Michael M Dinh, Saartje Berendsen Russell, Kendall J Bein, Kris Rogers, David Muscatello, Richard Paoloni, Jon Hayman, Dane R Chalkley, Rebecca Ivers
BACKGROUND: Disposition decisions are critical to the functioning of Emergency Departments. The objectives of the present study were to derive and internally validate a prediction model for inpatient admission from the Emergency Department to assist with triage, patient flow and clinical decision making. METHODS: This was a retrospective analysis of State-wide Emergency Department data in New South Wales, Australia. Adult patients (age ≥ 16 years) were included if they presented to a Level five or six (tertiary level) Emergency Department in New South Wales, Australia between 2013 and 2014...
December 3, 2016: BMC Emergency Medicine
https://www.readbyqxmd.com/read/27882440/hemodynamic-changes-in-a-middle-cerebral-artery-aneurysm-at-follow-up-times-before-and-after-its-rupture-a-case-report-and-a-review-of-the-literature
#2
A Sejkorová, K D Dennis, H Švihlová, O Petr, G Lanzino, A Hejčl, D Dragomir-Daescu
Hemodynamic parameters play a significant role in the development of cerebral aneurysms. Parameters such as wall shear stress (WSS) or velocity could change in time and may contribute to aneurysm growth and rupture. However, the hemodynamic changes at the rupture location remain unclear because it is difficult to obtain data prior to rupture. We analyzed a case of a ruptured middle cerebral artery (MCA) aneurysm for which we acquired imaging data at three time points, including at rupture. A patient with an observed MCA aneurysm was admitted to the emergency department with clinical symptoms of a subarachnoid hemorrhage...
November 24, 2016: Neurosurgical Review
https://www.readbyqxmd.com/read/27862986/analysing-the-emergency-department-patient-journey-discovery-of-bottlenecks-to-emergency-department-patient-flow
#3
Sankalp Khanna, Justin Boyle, Norm Good, Anthony Bell, James Lind
OBJECTIVE: Despite significant workflow reform to comply with the federally mandated National Emergency Access Target (NEAT), Australian public hospitals continue to face significant barriers in achieving good ED patient flow. This study was undertaken to identify and analyse the impact of individual waypoints on an ED patient's journey and identify which waypoints act as bottlenecks to a hospital's 4 h ED disposition performance. METHODS: This study involves retrospective analysis and simulation employing 2 years of ED administrative data from a sample of two major and two large metropolitan hospitals in Queensland, Australia...
November 8, 2016: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/27847339/analytical-evaluation-of-a-new-point-of-care-system-for-measuring-cardiac-troponin-i
#4
Danielle Wm Kemper, Veronique Semjonow, Femke de Theije, Diederick Keizer, Lian van Lippen, Johannes Mair, Bernadette Wille, Michael Christ, Felicitas Geier, Pierre Hausfater, David Pariente, Volkher Scharnhorst, Joyce Curvers, Jeroen Nieuwenhuis
OBJECTIVES: Point-of-care cardiac troponin testing with adequate analytical performances has the potential to improve chest pain patients flow in the emergency department. We present the analytical evaluation of the newly developed Philips Minicare cTnI point-of-care immunoassay. DESIGN & METHODS: Li-heparin whole blood and plasma were used to perform analytical studies. The sample type comparison study was performed at 4 different hospitals. The 99th percentile upper reference limit (URL) study was performed using Li-heparin plasma, Li-heparin whole blood and capillary blood samples from 750 healthy adults, aging from 18 to 86years...
November 12, 2016: Clinical Biochemistry
https://www.readbyqxmd.com/read/27843036/acute-medical-units-the-way-to-go-a-literature-review
#5
L S van Galen, E M J Lammers, L J Schoonmade, N Alam, M H H Kramer, P W B Nanayakkara
BACKGROUND: Acute healthcare chains in the Netherlands are increasingly under pressure because of rising emergency department (ED) admissions, relative bed shortages and government policy changes. In order to improve acute patient flow and quality of care through hospitals, an acute medical unit (AMU) might be a solution, as demonstrated in the UK. However, limited information is available concerning AMUs in the Netherlands. Therefore, the aims of this study were to METHODS: A systematic literature search was performed searching 3 electronic databases: PubMed, Cochrane and EMBASE...
November 11, 2016: European Journal of Internal Medicine
https://www.readbyqxmd.com/read/27832465/ethnographic-analysis-on-the-use-of-the-electronic-medical-record-for-clinical-handoff
#6
Philippa Nelson, Anthony J Bell, Larry Nathanson, Leon D Sanchez, Jonathan Fisher, Philip D Anderson
The objective of this study was to understand the social elements of clinical and organizational interactions of the key stakeholders in the specific context of an electronic dashboard used by the emergency department (ED) and inpatient medicine teams at the time of clinical referral and handover. An electronic handover function is utilised at the ED-inpatient interface at this institution and has given clinicians the ability to better communicate, monitor the department and strive to improve patient safety in streamline the delivery of care in the acute phase...
November 10, 2016: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/27831655/emergency-department-crowding-and-hospital-bed-shortage-is-lean-a-smart-answer-a-systematic-review
#7
S Bucci, A G de Belvis, S Marventano, A C De Leva, M Tanzariello, M L Specchia, W Ricciardi, F Franceschi
OBJECTIVE: Emergency Departments (EDs) worldwide face the challenges of crowding, waiting times, and cost containment. This review aims to provide a synthesis of the current literature focused on how Lean Thinking Principles and tools can be applied in an ED to address overcrowding and hospital admissions. MATERIALS AND METHODS: Primary studies showing Lean interventions and implementation in ED visits, not requiring additional resources measuring specific outcomes (i...
October 2016: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/27827333/quality-improvement-project-to-improve-timeliness-between-bronchodilator-treatments-from-emergency-department-to-medical-wards
#8
Jennifer R Cockerham, Gary R Lowe, Randy Willis, Ryan M Stecks, Ariel Berlinski
BACKGROUND: Quality improvement methodology was applied to study sporadic reports that patients with asthma were not given bronchodilator treatments or assessed within an appropriate time frame when they were admitted from the emergency department to the medical ward. The goal was to increase the number of patients who had an interval between emergency department assessment/bronchodilator treatment and medical ward assessment/treatment of <120 min. METHODS: A flow chart diagram, a fishbone diagram, data collection, intervention implementation, and data monitoring and analysis were used in this study...
December 2016: Respiratory Care
https://www.readbyqxmd.com/read/27823894/color-flow-doppler-point-of-care-ultrasound-to-evaluate-vessels-before-infant-lumbar-puncture
#9
Brunhild M Halm, David O Kessler
BACKGROUND: Infant lumbar punctures (LPs) are common procedures performed in the emergency department. However, 10% to 35% of these LPs are unsuccessful or grossly bloody, which can lead to increased hospitalization, increased costs, and prolonged exposure to antibiotics or antivirals. Point of care ultrasound (POCUS) may help to surmount the intrinsic causes of LP failure by providing a visual guide of the vascular structures in the needle path before a LP is performed. CASE REPORT: We report two cases where color flow Doppler POCUS was used to identify vascular structures around the spinal canal in infants before attempting a LP...
November 4, 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27800746/nuffield-trust-report-highlights-problems-faced-by-hospitals-in-meeting-4-hour-a-e-target
#10
(no author information available yet)
NHS trusts and health systems need to rethink how they manage patient flow to free up capacity and meet emergency department targets, the Nuffield Trust says.
November 1, 2016: Nursing Management (Harrow)
https://www.readbyqxmd.com/read/27773335/nurse-staffing-and-hospital-characteristics-predictive-of-time-to-diagnostic-evaluation-for-patients-in-the-emergency-department
#11
Judith Shindul-Rothschild, Catherine Y Read, Kelly D Stamp, Jane Flanagan
: In the 2014 Emergency Department Benchmarking Alliance Summit, for the first time, participants recommended tracking nursing and advanced practice nurse hours. Performance data from the Centers for Medicare and Medicaid Services provides an opportunity to analyze factors associated with delays in emergency care. The purpose of this study was to investigate hospital characteristics associated with time to a diagnostic evaluation in 67 Massachusetts emergency departments from 2013 to 2014...
October 20, 2016: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
https://www.readbyqxmd.com/read/27771424/impact-of-minimally-invasive-benign-prostatic-hyperplasia-therapies-on-30-and-90-day-postoperative-office-encounters
#12
Ram A Pathak, Gregory A Broderick, Todd C Igel, Steven P Petrou, Paul R Young, Michael J Wehle, Michael G Heckman, Nancy N Diehl, Emily R Vargas, Kandarp Shah, David D Thiel
OBJECTIVE: To compare the frequency of postoperative encounters in the 30-day and 90-day postoperative periods for various bladder outlet obstruction surgical therapies. METHODS: All patients who underwent transurethral resection of the prostate (TURP), GreenLight laser photovaporization of the prostate (GL-PVP) (American Medical Systems Inc.), and holmium laser enucleation of the prostate (HoLEP) from January 1(st), 2012 through December 31(st), 2014 were followed for 6 months postoperatively...
October 19, 2016: Urology
https://www.readbyqxmd.com/read/27770082/endovascular-reconstruction-of-extrahepatic-portal-vein-in-noncirrhotic-and-nonmalignant-chronic-portal-vein-thrombosis-secondary-to-an-iatrogenic-stenotic-lesion
#13
Manuel Guerrero-Hernandez, Carlos A Hinojosa, Javier E Anaya-Ayala, Erika Elenes, Aldo Torre
Portal vein (PV) thrombosis (PVT) in the absence of liver disease or thrombophilia is rare. We report a 57-year-old male with a history of stage 3 chronic kidney disease who presented at the emergency department 18 months after abdominal surgery with progressive abdominal pain and distention. Computed tomography revealed PVT with multiple collaterals and moderate ascites. He had undergone partial gastrectomy and gastrojejunal anastomosis at an outside facility for gastrointestinal stromal tumors that caused an iatrogenic stenotic lesion in the PV...
October 20, 2016: Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/27752631/extracorporeal-cardiopulmonary-resuscitation-among-patients-with-out-of-hospital-cardiac-arrest
#14
Dae-Hee Choi, Youn-Jung Kim, Seung Mok Ryoo, Chang Hwan Sohn, Shin Ahn, Dong-Woo Seo, Ju Yong Lim, Won Young Kim
OBJECTIVE: Extracorporeal cardiopulmonary resuscitation (ECPR) may be considered as a rescue therapy for patients with refractory cardiac arrest. Identifying patients who might benefit from this potential life-saving procedure is crucial for implementation of ECPR. The objective of this study was to estimate the number of patients who fulfilled a hypothetical set of ECPR criteria and to evaluate the outcome of ECPR candidates treated with conventional cardiopulmonary resuscitation. METHODS: We performed an observational study using data from a prospective registry of consecutive adults (≥18 years) with non-traumatic out-of-hospital cardiac arrest in a tertiary hospital between January 2011 and December 2015...
September 2016: Clin Exp Emerg Med
https://www.readbyqxmd.com/read/27752619/improving-emergency-department-patient-flow
#15
Paul Richard Edwin Jarvis
Emergency departments (ED) face significant challenges in delivering high quality and timely patient care on an ever-present background of increasing patient numbers and limited hospital resources. A mismatch between patient demand and the ED's capacity to deliver care often leads to poor patient flow and departmental crowding. These are associated with reduction in the quality of the care delivered and poor patient outcomes. A literature review was performed to identify evidence-based strategies to reduce the amount of time patients spend in the ED in order to improve patient flow and reduce crowding in the ED...
June 2016: Clinical and Experimental Emergency Medicine
https://www.readbyqxmd.com/read/27752312/improving-emergency-department-flow-through-optimized-bed-utilization
#16
Lucas Brien Chartier, Licinia Simoes, Meredith Kuipers, Barb McGovern
Over the last decade, patient volumes in the emergency department (ED) have grown disproportionately compared to the increase in staffing and resources at the Toronto Western Hospital, an academic tertiary care centre in Toronto, Canada. The resultant congestion has spilled over to the ED waiting room, where medically undifferentiated and potentially unstable patients must wait until a bed becomes available. The aim of this quality improvement project was to decrease the 90th percentile of wait time between triage and bed assignment (time-to-bed) by half, from 120 to 60 minutes, for our highest acuity patients...
2016: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/27748221/impact-of-process-improvements-on-measures-of-emergency-department-efficiency
#17
Alexander K Leung, Shawn D Whatley, Dechang Gao, Marko Duic
OBJECTIVE: To study the operational impact of process improvements on emergency department (ED) patient flow. The changes did not require any increase in resources or expenditures. METHODS: This was a 36-month pre- and post-intervention study to evaluate the effect of implementing process improvements at a community ED from January 2010 to December 2012. The intervention comprised streamlining triage by having patients accepted into internal waiting areas immediately after triage...
October 17, 2016: CJEM
https://www.readbyqxmd.com/read/27745899/phagocytizing-activity-of-pmn-from-severe-trauma-patients-in-different-post-traumatic-phases-during-the-10-days-post-injury-course
#18
Ramona Sturm, David Heftrig, Katharina Mörs, Nils Wagner, Kerstin Kontradowitz, Katrin Jurida, Ingo Marzi, Borna Relja
OBJECTIVE: Phagocytizing leukocytes (granulocytes and monocytes) play a fundamental role in immunological defense against pathogens and clearance of cellular debris after tissue injury due to trauma. According to the "two-hit hypothesis", phagocytes become primed due to/after trauma. Subsequently, a secondary stimulus may lead to their exaggerated response. This immune dysfunction can result in serious infectious complications, also depending on trauma injury pattern. Here, we investigated the phagocytizing capacity of leukocytes, and its correlation to trauma injury pattern...
September 29, 2016: Immunobiology
https://www.readbyqxmd.com/read/27700005/high-flow-oxygen-in-patients-undergoing-procedural-sedation-in-the-emergency-department-a-retrospective-chart-review
#19
David Thomson, Timothy Cowan, Conrad Loten, Christina Botfield, Elizabeth Holliday, John Attia
OBJECTIVE: Hypoxia is a recognised complication of procedural sedation. This study sought to determine whether there was an association between the use of high-flow oxygen delivery by a non-rebreather (NRB) mask during ED procedural sedation and decreased rates of hypoxia when compared with alternative oxygenation methods. METHODS: Records of all procedural sedations performed over a 12 month period in an Australian tertiary ED were reviewed retrospectively. The primary outcome was whether recorded oxygen saturations fell below 90%...
October 3, 2016: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/27692357/correlation-of-cat-score-with-peak-expiratory-flow-in-acute-exacerbation-of-copd-patients
#20
Cemil Kavalci, Muhittin Serkan Yilmaz, Afsin Emre Kayipmaz, Bahattin Isık, Elif Celikel, Gulsum Kavalci, Fevzi Yilmaz, Miray Ozlem, Bedriye Muge Sonmez, Selman Celebi
INTRODUCTION: Chronic obstructive pulmonary disease (COPD) leads to physical activity limitation and a significant reduction in quality of life. This study aimed to investigate the correlation between The COPD Assessment Test (CAT) score and peak expiratory flow (PEF), and the factors effecting hospital admission rates of patients with COPD. METHODS: This observational study was conducted prospectively. CAT score was calculated and PEF measured at the time of emergency department admission...
2016: Journal of the National Medical Association
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