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Quality and safety in emergency departments

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https://www.readbyqxmd.com/read/27923390/the-rapid-ctca-trial-rapid-assessment-of-potential-ischaemic-heart-disease-with-ctca-a-multicentre-parallel-group-randomised-trial-to-compare-early-computerised-tomography-coronary-angiography-versus-standard-care-in-patients-presenting-with-suspected-or-confirmed
#1
Alasdair J Gray, Carl Roobottom, Jason E Smith, Steve Goodacre, Katherine Oatey, Rachel O'Brien, Robert F Storey, Lumine Na, Steff C Lewis, Praveen Thokala, David E Newby
BACKGROUND: Emergency department attendances with chest pain requiring assessment for acute coronary syndrome (ACS) are a major global health issue. Standard assessment includes history, examination, electrocardiogram (ECG) and serial troponin testing. Computerised tomography coronary angiography (CTCA) enables additional anatomical assessment of patients for coronary artery disease (CAD) but has only been studied in very low-risk patients. This trial aims to investigate the effect of early CTCA upon interventions, event rates and health care costs in patients with suspected/confirmed ACS who are at intermediate risk...
December 7, 2016: Trials
https://www.readbyqxmd.com/read/27912950/a-randomized-placebo-controlled-trial-of-traditional-chinese-medicine-as-an-add-on-therapy-to-oral-montelukast-in-the-treatment-of-mild-persistent-asthma-in-children
#2
Pak-Hong Chan, Ching-Yee To, Eric Yat-Tung Chan, Handong Li, Xiuxia Zhang, Pok-Yu Chow, Po-Ling Liu, Shuk-Yu Leung, Chung-Hong Chan, Ka-Yan Chan, Johnny Yick-Chun Chan, Jonathan Pak-Heng Ng, Daniel Kwok-Keung Ng
OBJECTIVES: Traditional Chinese medicine are commonly used for treatment of asthma. However, there are only very limited data about its efficacy in children. Therefore, we aimed to determine the efficacy of augmented Yu Ping Feng San (aYPFS) as an add-on to oral montelukast compared with montelukast alone for treatment of mild persistent asthma in children. DESIGN: A single centre, placebo-controlled, double-blinded, randomized control trial was carried out. Participants with age 6-18 years who had mild persistent asthma were randomized according to random number list to receive either aYPFS plus montelukast for 24 weeks or placebo plus montelukast for 24 weeks...
December 2016: Complementary Therapies in Medicine
https://www.readbyqxmd.com/read/27910796/reinforcement-of-emergency-department-reduces-acute-admissions-to-medical-department
#3
Mansoor Ahmed Dawood, Gideon Ertner, Jacob Hansen-Schwartz
INTRODUCTION: The medical decision capacity of emergency departments (ED) may rest within the department itself or depend on external consultation. The stepwise development of the ED at Zealand University Hospital, Køge, was used to analyse the influence of medical organisation in the ED on the hospital admission pattern. METHODS: Data were recorded for the month of September of 2009, 2012 and 2014. These periods corresponded to the establishment of the department in 2009 and the 2012-period before organisational change was initiated in 2013, with a substantial increase in the number of senior physicians directly in charge of clinical decisions and the establishment of a limited bedding capacity...
December 2016: Danish Medical Journal
https://www.readbyqxmd.com/read/27889367/use-or-abuse-a-qualitative-study-of-emergency-physicians-views-on-use-of-observation-stays-at-three-hospitals-in-the-united-states-and-england
#4
Graham P Martin, Brad Wright, Azeemuddin Ahmed, Jay Banerjee, Suzanne Mason, Damian Roland
STUDY OBJECTIVE: Accumulating evidence has shown increasing use of observation stays for patients presenting to emergency departments and requiring diagnostic evaluation or time-limited treatment plans, but critics suggest that this expansion arises from hospitals' concerns to maximize revenue and shifts costs to patients. Perspectives of physicians making decisions to admit, observe, or discharge have been absent from the debate. We examine the views of emergency physicians in the United States and England on observation stays, and what influences their decisions to use observation services...
November 23, 2016: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/27884844/medication-reconciliation-as-a-medication-safety-initiative-in-ethiopia-a-study-protocol
#5
Alemayehu B Mekonnen, Andrew J McLachlan, Jo-Anne E Brien, Desalew Mekonnen, Zenahebezu Abay
INTRODUCTION: Medication related adverse events are common, particularly during transitions of care, and have a significant impact on patient outcomes and healthcare costs. Medication reconciliation (MedRec) is an important initiative to achieve the Quality Use of Medicines, and has been adopted as a standard practice in many developed countries. However, the impact of this strategy is rarely described in Ethiopia. The aims of this study are to explore patient safety culture, and to develop, implement and evaluate a theory informed MedRec intervention, with the aim of minimising the incidence of medication errors during hospital admission...
November 24, 2016: BMJ Open
https://www.readbyqxmd.com/read/27852639/improving-geriatric-prescribing-in-the-ed-a-qualitative-study-of-facilitators-and-barriers-to-clinical-decision-support-tool-use
#6
Ann E Vandenberg, Camille P Vaughan, Melissa Stevens, Susan N Hastings, James Powers, Alayne Markland, Ula Hwang, William Hung, Katharina V Echt
QUALITY PROBLEM OR ISSUE: Clinical decision support (CDS) may improve prescribing for older adults in the Emergency Department (ED) if adopted by providers. INITIAL ASSESSMENT: Existing prescribing order entry processes were mapped at an initial Veterans Administration Medical Center site, demonstrating cognitive burden, effort and safety concerns. CHOICE OF SOLUTION: Geriatric order sets incorporating 2012 Beers guidelines and including geriatric prescribing advice and prepopulated order options were developed...
November 16, 2016: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/27832465/ethnographic-analysis-on-the-use-of-the-electronic-medical-record-for-clinical-handoff
#7
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/27811162/pediatric-medication-safety-in-adult-community-hospital-settings-a-glimpse-into-nationwide-practice
#8
Francisco Alvarez, Lana Ismail, Allison Markowsky
BACKGROUND AND OBJECTIVES: Most children in the United States are treated in adult settings. Studies show that the pediatric population is vulnerable to medication errors. It can be extrapolated that children cared for in adult settings are at equal or higher risk for errors. The goal of this study was to assess the existing pediatric medication safety infrastructure within adult hospitals. METHODS: Questionnaire developed through Research Electronic Data Capture (REDCap) and distributed to pediatric hospitalist programs listed on the American Academy of Pediatrics, Section on Hospital Medicine web site and members of the American Academy of Pediatrics Quality Improvement Innovation Networks listserv...
December 2016: Hospital Pediatrics
https://www.readbyqxmd.com/read/27752490/disruptive-behaviors-in-an-emergency-department-the-perspective-of-physicians-and-nurses
#9
Maryam Maddineshat, Alan H Rosenstein, Arash Akaberi, Mahbubeh Tabatabaeichehr
Introduction: Disruptive behaviors cause many problems in the workplace, especially in the emergency department (ED).This study was conducted to assess the physician's and nurse's perspective toward disruptive behaviors in the emergency department. Methods: In this cross-sectional study a total of 45 physicians and 110 nurses working in the emergency department of five general hospitals in Bojnurd participated. Data were collected using a translated, changed, and validated questionnaire (25 item). The collected data were analyzed by SPSS ver...
September 2016: Journal of Caring Sciences
https://www.readbyqxmd.com/read/27749590/embedded-structure-template-for-electronic-records-affects-patient-note-quality-and-management-for-emergency-head-injury-patients-an-observational-pre-and-post-comparison-quality-improvement-study
#10
Tomohiro Sonoo, Satoshi Iwai, Ryota Inokuchi, Masataka Gunshin, Yoichi Kitsuta, Susumu Nakajima
Along with article-based checklists, structured template recording systems have been reported as useful to create more accurate clinical recording, but their contributions to the improvement of the quality of patient care have been controversial. An emergency department (ED) must manage many patients in a short time. Therefore, such a template might be especially useful, but few ED-based studies have examined such systems.A structured template produced according to widely used head injury guidelines was used by ED residents for head injury patients...
October 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27743423/the-patient-care-paradox-an-interprofessional-qualitative-study-of-agitated-patient-care-in-the-emergency-department
#11
Ambrose Hon-Wai Wong, Joan Combellick, Beth Ann Wispelwey, Allison Squires, Maureen Gang
OBJECTIVES: The emergency department (ED) has been recognized as a high-risk environment for workplace violence. Acutely agitated patients who perpetrate violence against healthcare workers represent a complex care challenge in the ED. Recommendations to improve safety are often based on expert opinion rather than empirical data. In this study we aim to describe the lived experience of staff members caring for this population in order to provide a broad perspective of ED patient violence...
October 15, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27730103/the-challenges-of-measuring-quality-of-care-indicators-in-rural-emergency-departments-a-cross-sectional-descriptive-study
#12
Géraldine Layani, Richard Fleet, Renée Dallaire, Fatoumata K Tounkara, Julien Poitras, Patrick Archambault, Jean-Marc Chauny, Mathieu Ouimet, Josée Gauthier, Gilles Dupuis, Alain Tanguay, Jean-Frédéric Lévesque, Geneviève Simard-Racine, Jeannie Haggerty, France Légaré
BACKGROUND: Evidence-based indicators of quality of care have been developed to improve care and performance in Canadian emergency departments. The feasibility of measuring these indicators has been assessed mainly in urban and academic emergency departments. We sought to assess the feasibility of measuring quality-of-care indicators in rural emergency departments in Quebec. METHODS: We previously identified rural emergency departments in Quebec that offered medical coverage with hospital beds 24 hours a day, 7 days a week and were located in rural areas or small towns as defined by Statistics Canada...
July 2016: CMAJ Open
https://www.readbyqxmd.com/read/27677651/comparing-the-effectiveness-of-pharmacist-managed-warfarin-anticoagulation-with-other-models-a-systematic-review-and-meta-analysis
#13
REVIEW
S Zhou, X Y Sheng, Q Xiang, Z N Wang, Y Zhou, Y M Cui
WHAT IS KNOWN AND OBJECTIVE: Anticoagulation management services are well known to improve the quality of patient care and to reduce the rates of hospitalization and emergency department visits following adverse events related to anticoagulation therapy. The complexity of managing warfarin has led to the development of a variety of specialized models managed by pharmacists, physicians, nurses, and self-managed care. The aim of the study is to compare the effectiveness of pharmacist-managed anticoagulation control of warfarin with other models...
December 2016: Journal of Clinical Pharmacy and Therapeutics
https://www.readbyqxmd.com/read/27664401/prioritizing-systemic-corticosteroid-treatments-to-mitigate-relapse-in-adults-with-acute-asthma-a-systematic-review-and-network-meta-analysis
#14
Brian H Rowe, Scott W Kirkland, Ben Vandermeer, Sandy Campbell, Amanda Newton, Francine M Ducharme, Cristina Villa-Roel
OBJECTIVES: While systemic corticosteroids (SCS) are widely used to prevent relapse in adults with acute asthma discharged from the emergency department, the most effective route of administration is unclear. The objective of this review was to examine the effectiveness of SCS in adults and to identify the most effective route of SCS to preventing relapse. METHODS: A search was conducted to identify randomized controlled trials comparing the effectiveness of intramuscular, oral short-course or long-course corticosteroids to prevent relapse in adults with acute asthma...
September 24, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27640877/associations-of-emergency-department-length-of-stay-with-publicly-reported-quality-of-care-measures
#15
Anna Marie Chang, Amber Lin, Rongwei Fu, K John McConnell, Benjamin Sun
OBJECTIVE: The Institute of Medicine identified emergency department (ED) crowding as a critical threat to patient safety. We assess the association between changes in publicly reported ED length-of-stay (LOS) and changes in quality-of-care measures in a national cohort of hospitals. METHODS: Longitudinal analysis of 2012 and 2013 data from the American Hospital Association (AHA) Survey, Center for Medicare and Medicaid Services (CMS) Cost Reports, and CMS Hospital Compare...
September 19, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27640217/can-paramedics-safely-refuse-transport-of-non-urgent-patients
#16
Alex J Fraess-Phillips
OBJECTIVE: The goal of this search was to review the current literature regarding paramedic triage of primary care patients and the safety of paramedic-initiated non-transport of non-urgent patients. METHODS: A narrative literature review was conducted using the Medline (Medline Industries, Inc.; Mundelein, Illinois USA) database and a manual search of Google Scholar (Google; Mountain View, California USA). RESULTS: Only 11 studies were found investigating paramedic triage and safety of non-transport of non-urgent patients...
December 2016: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/27634174/unplanned-readmissions-in-younger-and-older-adult-patients-the-role-of-healthcare-related-adverse-events
#17
Fabienne J H Magdelijns, Larissa Schepers, Evelien Pijpers, Coen D A Stehouwer, Patricia M Stassen
BACKGROUND: Readmissions are a burden for patients and increase healthcare costs. In Europe, factors associated with readmissions have not yet been extensively investigated. This study aimed to discover factors associated with readmissions in both young and older adult internal medicine patients. Furthermore, we explored the role of healthcare-related adverse events (AEs) in readmissions. METHODS: All patients admitted through the emergency department to the internal medicine department in the last 2 weeks of each month (2011) were included...
2016: European Journal of Medical Research
https://www.readbyqxmd.com/read/27592123/rationale-and-study-design-of-a-trial-of-mindfulness-based-cognitive-therapy-for-preventing-suicidal-behavior-mbct-s-in-military-veterans
#18
Anna Kline, Megan Chesin, Miriam Latorre, Rachael Miller, Lauren St Hill, Anton Shcherbakov, Arlene King, Barbara Stanley, Marc D Weiner, Alejandro Interian
BACKGROUND: Although suicide ranks 10th as a cause of death in the United States, and 1st among active military personnel, there are surprisingly few evidence-based therapies addressing suicidality, and development of new treatments is limited. This paper describes a clinical trial testing a novel therapy for reducing suicide risk in military veterans. The intervention, Mindfulness-Based Cognitive Therapy for Preventing Suicide Behavior (MBCT-S), is a 10-week group intervention adapted from an existing treatment for depression (Mindfulness-Based Cognitive Therapy - MBCT)...
September 2016: Contemporary Clinical Trials
https://www.readbyqxmd.com/read/27588581/inhaled-short-acting-bronchodilators-for-managing-emergency-childhood-asthma-an-overview-of-reviews
#19
M Pollock, I P Sinha, L Hartling, B H Rowe, S Schreiber, R M Fernandes
International guidelines provide conflicting recommendations on how to use bronchodilators to manage childhood acute wheezing conditions in the emergency department (ED), and there is variation within and among countries in how these conditions are managed. This may be reflective of uncertainty about the evidence. This overview of systematic reviews (SRs) aimed to synthesize, appraise, and present all SR evidence on the efficacy and safety of inhaled short-acting bronchodilators to treat asthma and wheeze exacerbations in children 0-18 years presenting to the ED...
October 5, 2016: Allergy
https://www.readbyqxmd.com/read/27585528/readmittance-rates-within-seven-days-are-preferable-in-quality-measuring-of-emergency-departments
#20
Mathias Gierløff Heitmann, Mir Sarwary, Jesper Juul Larsen, Jens Tingleff, Jacob Hansen-Schwartz
INTRODUCTION: The objective of this article was to qualify and test the recommendations of a national Danish report. We conducted an investigation on the readmittance rate as well as reasons for readmittance in a patient cohort defined through the process of internal audit at the Emergency Department at Zealand University Hospital, Køge, Denmark. METHODS: A retrospective, descriptive study of admitted patients in November 2014, including a total of 1,440 patients...
September 2016: Danish Medical Journal
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