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Free standing emergency departments

Jocelyn R Grunwell, Curtis Travers, Courtney E McCracken, Patricia D Scherrer, Anne G Stormorken, Corrie E Chumpitazi, Mark G Roback, Jana A Stockwell, Pradip P Kamat
OBJECTIVE: Most studies of ketamine administered to children for procedural sedation are limited to emergency department use. The objective of this study was to describe the practice of ketamine procedural sedation outside of the operating room and identify risk factors for adverse events. DESIGN: Observational cohort review of data prospectively collected from 2007 to 2015 from the multicenter Pediatric Sedation Research Consortium. SETTING: Sedation services from academic, community, free-standing children's hospitals and pediatric wards within general hospitals...
August 8, 2016: Pediatric Critical Care Medicine
Ashley M Strobel, Rose M Chasm, Dale P Woolridge
BACKGROUND: In 1998, emergency medicine-pediatrics (EM-PEDS) graduates were no longer eligible for the pediatric emergency medicine (PEM) sub-board certification examination. There is a paucity of guidance regarding the various training options for medical students who are interested in PEM. OBJECTIVES: We sought to to determine attitudes and personal satisfaction of graduates from EM-PEDS combined training programs. METHODS: We surveyed 71 graduates from three EM-PEDS residences in the United States...
October 2016: Journal of Emergency Medicine
Edward R Melnick, Elizabeth G J O'Brien, Olga Kovalerchik, William Fleischman, Arjun K Venkatesh, R Andrew Taylor
BACKGROUND: Variation in emergency physician computed tomography (CT) imaging utilization is well described, but little is known about what drives it. Physician empathy has been proposed as a potential characteristic affecting CT utilization. OBJECTIVES: The objective was to describe empathy in a cohort of emergency physicians and evaluate its association with CT utilization. We also sought to compare emergency physician performance on an empathy psychometric test with performance on other psychometric tests previously proposed as predictors of CT utilization...
August 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
You Zhou, Xiaofei Guan, Hua Zhou, Koushik Ramadoss, Suhare Adam, Huajun Liu, Sungsik Lee, Jian Shi, Masaru Tsuchiya, Dillon D Fong, Shriram Ramanathan
Fuel cells convert chemical energy directly into electrical energy with high efficiencies and environmental benefits, as compared with traditional heat engines. Yttria-stabilized zirconia is perhaps the material with the most potential as an electrolyte in solid oxide fuel cells (SOFCs), owing to its stability and near-unity ionic transference number. Although there exist materials with superior ionic conductivity, they are often limited by their ability to suppress electronic leakage when exposed to the reducing environment at the fuel interface...
June 9, 2016: Nature
James Corbett Worthy, Cheryl L Anderson
The federal government provides special tax-exemption status, known as the community benefit standard, to some nonprofit hospitals. It is not known if hospitals that claim the community benefit standard provide more or different services from those provided by hospitals that do not claim the community benefit status. Guided by the socioecological model, this quantitative study investigated 95 hospitals serving 52 counties in South Texas--43 that claimed a community benefit and 52 that did not. The independent variables were hospitals that claimed the community benefit standard versus hospitals that did not...
March 2016: Journal of Healthcare Management / American College of Healthcare Executives
Elizabeth A Biddell, Brian L Vandersall, Stephanie A Bailes, Stephanie A Estephan, Lori A Ferrara, Kristine M Nagy, Joyce L O'Connell, Mary D Patterson
On October 10, 2014, a health care worker exposed to Ebola traveled to Akron, OH, where she became symptomatic. The resulting local public health agencies and health care organization response was unequalled in our region. The day this information was announced, the emergency disaster response was activated at our hospital. The simulation center had 12 hours to prepare simulations to evaluate hospital preparedness should a patient screen positive for Ebola exposure. The team developed hybrid simulation scenarios using standardized patients, mannequin simulators, and task trainers to assess hospital preparedness in the emergency department, transport team, pediatric intensive care unit, and for interdepartmental transfers...
April 2016: Simulation in Healthcare: Journal of the Society for Simulation in Healthcare
Misha Amoils, Kay W Chang, Olga Saynina, Paul H Wise, Anita Honkanen
IMPORTANCE: A large-scale review is needed to characterize the rates of airway, respiratory, and cardiovascular complications after pediatric tonsillectomy and adenoidectomy (T&A) for inpatient and ambulatory cohorts. OBJECTIVE: To identify risk factors for postoperative complications stratified by age and operative facility type among children undergoing T&A. DESIGN, SETTING, AND PARTICIPANTS: This retrospective review included 115,214 children undergoing T&A in hospitals, hospital-based facilities (HBF), and free-standing facilities (FSF) in California from January 1, 2005, to December 31, 2010...
April 2016: JAMA Otolaryngology—Head & Neck Surgery
Erin M Holcomb, Stephanie Towns, Joel E Kamper, Scott D Barnett, Mark Sherer, Clea Evans, Risa Nakase-Richardson
OBJECTIVE: Following traumatic brain injury, both sleep dysfunction and cognitive impairment are common. Unfortunately, little is known regarding the potential associations between these 2 symptoms during acute recovery. This study sought to prospectively examine the relationship between ratings of sleep dysfunction and serial cognitive assessments among traumatic brain injury acute neurorehabilitation admissions. METHODS: Participants were consecutive admissions to a free-standing rehabilitation hospital following moderate to severe traumatic brain injury (Median Emergency Department Glasgow Coma Scale = 7)...
March 2016: Journal of Head Trauma Rehabilitation
Pavitra Kotini-Shah, Teresa R Camp-Rogers, Robert A Swor, Kelly N Sawyer
Implementation of postarrest care by individual physicians and systems has been slow. Deadoption, or discontinuation of therapeutic hypothermia (TH) treatment targets, after recent prospective study results has not been well reported. This study assesses practices in the early stages of postarrest care across emergency departments (EDs) in Michigan. A 27-question Internet-based survey was distributed to EDs in Michigan in September 2013. To assess changes in practice after publication of Nielsen et al., we sent follow-up questions to all original respondents a year later...
March 2016: Therapeutic Hypothermia and Temperature Management
Yu-Hsiang Hsieh, David R Holtgrave, Stephen Peterson, Charlotte A Gaydos, Richard E Rothman
High operating costs challenge sustainability of successful US emergency department (ED) HIV screening programs. Free-standing registration kiosks could potentially reduce the marginal costs of ED HIV screening. We investigated incremental cost-effectiveness ratio (CER) per new HIV diagnosis for a kiosk-based approach for offering screening at ED registration versus a testing staff-based approach to offer testing at the bedside. A rapid oral-fluid HIV screening program, instituted in a US ED since 2005, had a rate of new HIV diagnosis 0...
2016: AIDS Care
Katherine T Flynn-O'Brien, Leah L Thompson, Christine M Gall, Mary E Fallat, Tom B Rice, Frederick P Rivara
PURPOSE: Evaluate national variation in structure and care processes for critically injured children. METHODS: Institutions with pediatric intensive care units (PICUs) that treat trauma patients were identified through the Virtual Pediatric Systems (n=72). Prospective survey data were obtained from PICU and Trauma Directors (n=69, 96% response). Inquiries related to structure and care processes in the PICU and emergency department included infrastructure, physician staffing, team composition, decision making, and protocol/checklist use...
March 2016: Journal of Pediatric Surgery
Sandra P Spencer, Michael J Stoner, Kelly Kelleher, Daniel M Cohen
BACKGROUND: Informed consent is an ethical process for ensuring patient autonomy. Multimedia presentations (MMPs) often aid the informed consent process for research studies. Thus, it follows that MMPs would improve informed consent in clinical settings. OBJECTIVE: The aim of this study was to determine if an MMP for the informed consent process for ketamine sedation improves parental satisfaction and comprehension as compared with standard practice. METHODS: This 2-phase study compared 2 methods of informed consent for ketamine sedation of pediatric patients...
August 2015: Pediatric Emergency Care
Avani S Mehta, Monika K Goyal, Nadia Dowshen, Rakesh D Mistry
OBJECTIVE: Limited data exist regarding knowledge of and compliance to the Centers for Disease Control and Prevention's universal adolescent human immunodeficiency virus (HIV) screening recommendations. Our objective was to assess current guideline knowledge, practice, and perceived barriers to emergency department (ED)-based adolescent HIV screening. METHODS: We administered an anonymous Web-based cross-sectional survey from May 1, 2012, to June 30, 2012, to 1073 physicians from the American Academy of Pediatrics Section on Emergency Medicine LISTSERV...
September 2015: Pediatric Emergency Care
Halden F Scott, Sara J Deakyne, Jason M Woods, Lalit Bajaj
OBJECTIVES: This study sought to determine the prevalence, test characteristics, and severity of illness of pediatric patients with systemic inflammatory response syndrome (SIRS) vital signs among pediatric emergency department (ED) visits. METHODS: This was a retrospective descriptive cohort study of all visits to the ED of a tertiary academic free-standing pediatric hospital over 1 year. Visits were included if the patient was <18 years of age and did not leave before full evaluation or against medical advice...
April 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Michelle L Macy, Matthew Hall, Elizabeth R Alpern, Evan S Fieldston, Leticia A Shanley, Carla Hronek, Paul D Hain, Samir S Shah
BACKGROUND: Pediatric observation units (OUs) have demonstrated reductions in lengths of stay (LOS) and costs of care. Hospital-level outcomes across all observation-status stays have not been evaluated in relation to the presence of a dedicated OU in the hospital. OBJECTIVE: To compare observation-status stay outcomes in hospitals with and without a dedicated OU. DESIGN: Cross-sectional analysis of hospital administrative data. METHODS: Observation-status stay outcomes were compared in hospitals with and without a dedicated OU across 4 categories: (1) LOS, (2) standardized costs, (3) conversion to inpatient status, and (4) return care...
June 2015: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Steven H Saef, Cathy L Melvin, Christine M Carr
INTRODUCTION: Use clinician perceptions to estimate the impact of a health information exchange (HIE) on emergency department (ED) care at four major hospital systems (HS) within a region. Use survey data provided by ED clinicians to estimate reduction in Medicare-allowable reimbursements (MARs) resulting from use of an HIE. METHODS: We conducted the study during a one-year period beginning in February 2012. Study sites included eleven EDs operated by four major HS in the region of a mid-sized Southeastern city, including one academic ED, five community hospital EDs, four free-standing EDs and 1 ED/Chest Pain Center (CPC) all of which participated in an HIE...
November 2014: Western Journal of Emergency Medicine
Jessica Bettenhausen, Henry Puls, Mary Ann Queen, Christina Peacock, Stephanie Burrus, Christopher Miller, Ashley Daly, Jeffrey D Colvin
OBJECTIVE: To examine the relationship between pediatric obesity and inpatient length of stay (LOS), resource utilization, readmission rates, and total billed charges for in-hospital status asthmaticus. DESIGN/METHODS: We conducted a cross-sectional study of patients 5 to 17 years old hospitalized with status asthmaticus to 1 free-standing children's hospital system over 12 months. Only hospitalized patients initially treated in the hospital's emergency department were included to ensure all therapies/charges were examined...
March 2015: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Xabier García-Albéniz, Roger W Logan, Deborah Schrag, Miguel A Hernán
BACKGROUND: To quantify and characterize duplicated tests performed during the staging of localized colon cancer in the Medicare population. METHODS: We used the SEER-Medicare linked database to select patients diagnosed with localized colon cancer between the years 1996 and 2009. We considered a patient as adequately staged after having received a colonoscopy, an abdominal computed tomography (CT) scan, and a pelvic CT scan. Abdominal and pelvic CT scans performed between complete staging and first cancer-directed treatment, if not ordered due to an acute condition, were considered duplicates...
November 2014: Medical Care
Chou-Jui Lin, Lauren C Pierce, Patricia M Roblin, Bonnie Arquilla
OBJECTIVE: Hurricane Sandy forced closures of many free-standing dialysis centers in New York City in 2012. Hemodialysis (HD) patients therefore sought dialysis treatments from nearby hospitals. The surge capacity of hospital dialysis services was the rate-limiting step for streamlining the emergency department flow of HD patients. The aim of this study was to determine the extent of the HD patients surge and to explore difficulties encountered by hospitals in Brooklyn, New York (USA) due to Hurricane Sandy...
August 2014: Prehospital and Disaster Medicine
Susan Wu, Chris Baker, Michael E Lang, Sheree M Schrager, Fasha F Liley, Carmel Papa, Valerie Mira, Ara Balkian, Wilbert H Mason
IMPORTANCE: Bronchiolitis is one of the most common and costly respiratory diseases in infants and young children. Previous studies have shown a potential benefit of nebulized hypertonic saline; however, its effect in the emergency department (ED) setting is unclear. OBJECTIVE: To compare the effect of nebulized 3% hypertonic saline vs 0.9% normal saline on admission rate and length of stay in infants with bronchiolitis. DESIGN, SETTING, AND PARTICIPANTS: We conducted a double-blind, randomized clinical trial during 3 consecutive bronchiolitis seasons from March 1, 2008, through April 30, 2011...
July 2014: JAMA Pediatrics
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