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Quality and safety in emergency departments

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https://www.readbyqxmd.com/read/29032791/deconstructing-the-4-h-rule-for-access-to-emergency-care-and-putting-patients-first
#1
Ian Scott, Clair Sullivan, Andrew Staib, Anthony Bell
Evidence suggests improved outcomes for patients requiring emergency admission to hospital are associated with improved emergency department (ED) efficiency and lower transit times. Factors preventing timely transfers of emergency patients to in-patient beds across the ED-in-patient interface are major causes for ED crowding, for which several remedial strategies are possible, including parallel processing of probable admissions, direct-to-ward admissions and single-point medical registrars for receiving and processing all referrals directed at specific speciality units...
October 16, 2017: Australian Health Review: a Publication of the Australian Hospital Association
https://www.readbyqxmd.com/read/29025194/procalcitonin-to-initiate-or-discontinue-antibiotics-in-acute-respiratory-tract-infections
#2
REVIEW
Philipp Schuetz, Yannick Wirz, Ramon Sager, Mirjam Christ-Crain, Daiana Stolz, Michael Tamm, Lila Bouadma, Charles E Luyt, Michel Wolff, Jean Chastre, Florence Tubach, Kristina B Kristoffersen, Olaf Burkhardt, Tobias Welte, Stefan Schroeder, Vandack Nobre, Long Wei, Heiner C Bucher, Neera Bhatnagar, Djillali Annane, Konrad Reinhart, Angela Branche, Pierre Damas, Maarten Nijsten, Dylan W de Lange, Rodrigo O Deliberato, Stella Ss Lima, Vera Maravić-Stojković, Alessia Verduri, Bin Cao, Yahya Shehabi, Albertus Beishuizen, Jens-Ulrik S Jensen, Caspar Corti, Jos A Van Oers, Ann R Falsey, Evelien de Jong, Carolina F Oliveira, Bianca Beghe, Matthias Briel, Beat Mueller
BACKGROUND: Acute respiratory infections (ARIs) comprise of a large and heterogeneous group of infections including bacterial, viral, and other aetiologies. In recent years, procalcitonin (PCT), a blood marker for bacterial infections, has emerged as a promising tool to improve decisions about antibiotic therapy (PCT-guided antibiotic therapy). Several randomised controlled trials (RCTs) have demonstrated the feasibility of using procalcitonin for starting and stopping antibiotics in different patient populations with ARIs and different settings ranging from primary care settings to emergency departments, hospital wards, and intensive care units...
October 13, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29021110/collaborative-care-from-the-emergency-department-for-injured-patients-with-prescription-drug-misuse-an-open-feasibility-study
#3
Lauren K Whiteside, Doyanne Darnell, Karlee Jackson, Jin Wang, Joan Russo, Dennis M Donovan, Douglas F Zatzick
Collaborative Care is a comprehensive longitudinal care management strategy. The purpose of this pilot effectiveness-implementation hybrid study was to determine the feasibility of a Collaborative Care intervention initiated from the Emergency Department and proceeding longitudinally for six months for injured patients with prescription drug misuse (PDM). Adult patients presenting to an urban ED with an injury were screened for eligibility from 2/2015-8/2015. Eligible participants with a positive screen for PDM were enrolled in the 'ED-LINC' intervention which included the following elements: 1) active care coordination and linkage, 2) medication safety and utilization of opioid guidelines 3) longitudinal care management and 4) utilization of Electronic Medical Record (EMR) innovations such as the statewide Emergency Department Information Exchange (EDIE) and statewide prescription monitoring program information for assessment and follow-up...
November 2017: Journal of Substance Abuse Treatment
https://www.readbyqxmd.com/read/29016516/barriers-to-effective-teamwork-relating-to-pediatric-resuscitations-perceptions-of-pediatric-emergency-medicine-staff
#4
Joshua M Sherman, Todd P Chang, Nurit Ziv, Alan L Nager
BACKGROUND: In the pediatric emergency department (PED), resuscitations require medical teams form ad hoc, rarely communicating beforehand. Literature has shown that the medical community has deficiencies in communication and teamwork. However, we as medical providers do not know or understand the perceived barriers of our colleagues. Physicians may perceive a barrier that is different from nurses, respiratory therapists, pharmacists, or technicians. Perhaps we do not know in which area of teamwork and communication we are deficient...
October 9, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28971369/patterns-of-hospital-performance-on-the-hospital-wide-30-day-readmission-metric-is-the-playing-field-level
#5
Erik H Hoyer, William V Padula, Daniel J Brotman, Natalie Reid, Curtis Leung, Diane Lepley, Amy Deutschendorf
BACKGROUND: Hospital performance on the 30-day hospital-wide readmission (HWR) metric as calculated by the Centers for Medicare and Medicaid Services (CMS) is currently reported as a quality measure. Focusing on patient-level factors may provide an incomplete picture of readmission risk at the hospital level to explain variations in hospital readmission rates. OBJECTIVE: To evaluate and quantify hospital-level characteristics that track with hospital performance on the current HWR metric...
October 2, 2017: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/28967529/intranasal-fentanyl-and-quality-of-pediatric-acute-care
#6
Kathleen M Adelgais, Alison Brent, Joseph Wathen, Suhong Tong, Derrek Massanari, Sara Deakyne, Marion R Sills
BACKGROUND: Changes in the manner in which medications can be delivered can have significant effects on the quality of care in the acute care setting. OBJECTIVE: The objective of this study was to evaluate the change in three Institute of Medicine quality indicators (timeliness, safety, and effectiveness) in the pediatric emergency department (ED) after the introduction of the Mucosal Atomizer Device Nasal™ (MADn) for opioid analgesia. METHODS: This was a retrospective review of patients receiving opioid analgesia for certain conditions over a 5-year period...
September 26, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28960689/point-of-care-cognitive-support-technology-in-emergency-departments-a-scoping-review-of-technology-acceptance-by-clinicians
#7
Shelly Jun, Amy C Plint, Sandy M Campbell, Sarah Curtis, Kyrellos Sabir, Amanda S Newton
OBJECTIVE: Cognitive support technologies that support clinical decisions and practices in the emergency department (ED) have the potential to optimize patient care. However, limited uptake by clinicians can prevent successful implementation. A better understanding of acceptance of these technologies from the clinician perspective is needed. We conducted a scoping review to synthesize diverse, emerging evidence on clinicians' acceptance of point-of-care (POC) cognitive support technology in the ED...
September 28, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28958419/workplace-bullying-in-emergency-nursing-development-of-a-grounded-theory-using-situational-analysis
#8
Lisa A Wolf, Cydne Perhats, Paul R Clark, Michael D Moon, Kathleen Evanovich Zavotsky
BACKGROUND: The Institute of Medicine recognizes that the workplace environment is a crucial factor in the ability of nurses to provide safe and effective care, and thus interactions that affect the quality and safety of the work environment require exploration. OBJECTIVES: The purpose of this study was to use situational analysis to develop a grounded theory of workplace bullying as it manifests specifically in the emergency care setting. METHODS: This study used a grounded theory methodology called situational analysis...
September 22, 2017: International Emergency Nursing
https://www.readbyqxmd.com/read/28938900/the-role-and-benefits-of-accessing-primary-care-patient-records-during-unscheduled-care-a-systematic-review
#9
Tom Bowden, Enrico Coiera
BACKGROUND: The purpose of this study was to assess the impact of accessing primary care records on unscheduled care. Unscheduled care is typically delivered in hospital Emergency Departments. Studies published to December 2014 reporting on primary care record access during unscheduled care were retrieved. RESULTS: Twenty-two articles met inclusion criteria from a pool of 192. Many shared electronic health records (SEHRs) were large in scale, servicing many millions of patients...
September 22, 2017: BMC Medical Informatics and Decision Making
https://www.readbyqxmd.com/read/28934995/quality-improvement-primer-part-2-executing-a-quality-improvement-project-in-the-emergency-department
#10
Lucas B Chartier, Antonia S Stang, Samuel Vaillancourt, Amy H Y Cheng
The topics of quality improvement (QI) and patient safety have become important themes in health care in recent years, particularly in the emergency department setting, which is a frequent point of contact with the health care system for patients. In the first of three articles in this series meant as a QI primer for emergency medicine clinicians, we introduced the strategic planning required to develop an effective QI project using a fictional case study as an example. In this second article we continue with our example of improving time to antibiotics for patients with sepsis, and introduce the Model for Improvement...
September 22, 2017: CJEM
https://www.readbyqxmd.com/read/28905296/potentially-preventable-medical-hospitalizations-and-emergency-department-visits-by-the-behavioral-health-population
#11
Eric M Schmidt, Simone Behar, Alinne Barrera, Matthew Cordova, Leonard Beckum
This study investigated geographic variation in potentially preventable medical outcomes that might be used to monitor access to high-quality medical care in the behavioral health population. Analyzing public and non-public data sources from California on adults admitted between 2009 and 2011 to all non-federal licensed medical inpatient (N = 6,603,146) or emergency department units (N = 21,011,958) revealed that 33.6% of nearly 1 million potentially preventable hospitalizations and 9.8% of 1.5 million potentially preventable emergency department visits were made by people with mental or substance use disorder diagnoses...
September 13, 2017: Journal of Behavioral Health Services & Research
https://www.readbyqxmd.com/read/28901005/delivery-arrangements-for-health-systems-in-low-income-countries-an-overview-of-systematic-reviews
#12
REVIEW
Agustín Ciapponi, Simon Lewin, Cristian A Herrera, Newton Opiyo, Tomas Pantoja, Elizabeth Paulsen, Gabriel Rada, Charles S Wiysonge, Gabriel Bastías, Lilian Dudley, Signe Flottorp, Marie-Pierre Gagnon, Sebastian Garcia Marti, Claire Glenton, Charles I Okwundu, Blanca Peñaloza, Fatima Suleman, Andrew D Oxman
BACKGROUND: Delivery arrangements include changes in who receives care and when, who provides care, the working conditions of those who provide care, coordination of care amongst different providers, where care is provided, the use of information and communication technology to deliver care, and quality and safety systems. How services are delivered can have impacts on the effectiveness, efficiency and equity of health systems. This broad overview of the findings of systematic reviews can help policymakers and other stakeholders identify strategies for addressing problems and improve the delivery of services...
September 13, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28881007/delayed-antibiotic-prescriptions-for-respiratory-infections
#13
REVIEW
Geoffrey Kp Spurling, Chris B Del Mar, Liz Dooley, Ruth Foxlee, Rebecca Farley
BACKGROUND: Concerns exist regarding antibiotic prescribing for respiratory tract infections (RTIs) owing to adverse reactions, cost, and antibacterial resistance. One proposed strategy to reduce antibiotic prescribing is to provide prescriptions, but to advise delay in antibiotic use with the expectation that symptoms will resolve first. This is an update of a Cochrane Review originally published in 2007, and updated in 2010 and 2013. OBJECTIVES: To evaluate the effects on clinical outcomes, antibiotic use, antibiotic resistance, and patient satisfaction of advising a delayed prescription of antibiotics in respiratory tract infections...
September 7, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28870249/improving-emergency-department-radiology-transportation-time-a-successful-implementation-of-lean-methodology
#14
Eveline A Hitti, Ghada R El-Eid, Hani Tamim, Rana Saleh, Miriam Saliba, Lena Naffaa
BACKGROUND: Emergency Department overcrowding has become a global problem and a growing safety and quality concern. Radiology and laboratory turnaround time, ED boarding and increased ED visits are some of the factors that contribute to ED overcrowding. Lean methods have been used in the ED to address multiple flow challenges from improving door-to-doctor time to reducing length of stay. The objective of this study is to determine the effectiveness of using Lean management methods on improving Emergency Department transportation times for plain radiography...
September 5, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28828479/development-and-validation-of-a-tool-to-identify-patients-with-type-2-diabetes-at-high-risk-of-hypoglycemia-related-emergency-department-or-hospital-use
#15
MULTICENTER STUDY
Andrew J Karter, E Margaret Warton, Kasia J Lipska, James D Ralston, Howard H Moffet, Geoffrey G Jackson, Elbert S Huang, Donald R Miller
Importance: Hypoglycemia-related emergency department (ED) or hospital use among patients with type 2 diabetes (T2D) is clinically significant and possibly preventable. Objective: To develop and validate a tool to categorize risk of hypoglycemic-related utilization in patients with T2D. Design, Setting, and Participants: Using recursive partitioning with a split-sample design, we created a classification tree based on potential predictors of hypoglycemia-related ED or hospital use...
October 1, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28819068/rural-emergency-care-360%C3%A2-mobilising-healthcare-professionals-decision-makers-patients-and-citizens-to-improve-rural-emergency-care-in-the-province-of-quebec-canada-a-qualitative-study-protocol
#16
Richard Fleet, Gilles Dupuis, Jean-Paul Fortin, Jocelyn Gravel, Mathieu Ouimet, Julien Poitras, France Légaré
INTRODUCTION: Emergency departments (EDs) are an important safety net for rural populations. Results of our earlier studies suggest that rural Canadian hospitals have limited access to advanced imaging services and intensive care units and that patients are transferred over large distances. They also revealed significant geographical variations in rural services. In the absence of national standards, our studies raise questions about inequities in rural access to emergency services and the risks for citizens...
August 17, 2017: BMJ Open
https://www.readbyqxmd.com/read/28809180/exploring-socio-technical-insights-for-safe-nursing-handover
#17
Ming Chao Wong, Kwang Chien Yee, Paul Turner
Current efforts to improve nursing handover frequently use prescriptive approaches based on research evidence of handover issues within a single nursing ward or nursing specialty. Despite reported handover improvement, few studies adequately consider the transferability of results to other nursing handover environments or acknowledge the unique attributes that supported sustained improvement. With the increasing diffusion of electronic tools it has become even more critical to ensure that socio-technical issues that may impact on the quality and safety of nursing handovers are identified...
2017: Studies in Health Technology and Informatics
https://www.readbyqxmd.com/read/28807069/a-pilot-project-demonstrating-that-combat-medics-can-safely-administer-parenteral-medications-in-the-emergency-department
#18
Steven G Schauer, Cord W Cunningham, Andrew D Fisher, Robert A DeLorenzo
Introduction Select units in the military have improved combat medic training by integrating their functions into routine clinical care activities with measurable improvements in battlefield care. This level of integration is currently limited to special operations units. It is unknown if regular Army units and combat medics can emulate these successes. The goal of this project was to determine whether US Army combat medics can be integrated into routine emergency department (ED) clinical care, specifically medication administration...
August 15, 2017: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/28806444/eliminating-creatine-kinase-myocardial-band-testing-in-suspected-acute-coronary-syndrome-a-value-based-quality-improvement
#19
REVIEW
Matthew D Alvin, Allan S Jaffe, Roy C Ziegelstein, Jeffrey C Trost
Cardiac biomarker testing is estimated to occur in nearly 30 million emergency department visits nationwide each year in the United States. The American College of Cardiology/European Society of Cardiology indicate that cardiac troponin is the biomarker of choice owing to its nearly absolute myocardial tissue specificity and high clinical sensitivity for myocardial injury. Multiple academic medical centers have implemented interventions to eliminate the routine ordering of creatine kinase-myocardial band tests, with published patient safety outcomes data; however, creatine kinase-myocardial band testing is still ordered in many hospitals and emergency departments...
October 1, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28802869/use-of-a-standardized-procedure-to-improve-behavioral-health-patients-care-a-quality-improvement-initiative
#20
Elizabeth J Winokur, Jeannine Loucks, Glenn H Raup
PROBLEM: Meeting the complex needs of behavioral health (BH) patients in the emergency department is an ongoing challenge. Delays in care can have adverse consequences for patient and staff safety and delay transfer to specialized care. METHODS: A quality improvement, nurse-driven initiative using a standardized procedure (STP) was developed and implemented in our busy Southern California Emergency Department, which focused on improving time to first medication and reduction of restraints...
August 9, 2017: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
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