Read by QxMD icon Read

Emergency department workflow

Mari-Lynn Drainoni, Elisa A Koppelman, James A Feldman, Alexander Y Walley, Patricia M Mitchell, Jacqueline Ellison, Edward Bernstein
BACKGROUND: The increase in opioid overdose deaths has become a national public health crisis. Naloxone is an important tool in opioid overdose prevention. Distribution of nasal naloxone has been found to be a feasible, and effective intervention in community settings and may have potential high applicability in the emergency department, which is often the initial point of care for persons at high risk of overdose. One safety net hospital introduced an innovative policy to offer take-home nasal naloxone via a standing order to ensure distribution to patients at risk for overdose...
October 18, 2016: BMC Research Notes
Lindsey Fay, Allison Carll-White, James Harrell
PURPOSE: This article illustrates a collaborative, full cycle diagnostic postoccupancy evaluation (POE) conducted in an emergency department (ED) to demonstrate methods of planning a POE, conducting research to capture meaningful data, and applying outcomes through the use of a design charrette. BACKGROUND: POEs often end with the reporting of findings rather than suggesting how this knowledge feeds forward. A design charrette presents an opportunity to engage with POE evidence and integrate research into practice...
October 12, 2016: HERD
Jesse M Pines
In this issue of Academic Emergency Medicine, Patterson et al. report a link between two measures of emergency department (ED) crowding -ED census and physician load - to hospital admission decisions. Disposition appeared to change based on both the degree of ED crowding and how many total patients the physician making the admission decision was carrying at the time. This translated to important swings: an average admission rate of 35% with an empty waiting room and zero patient load which increased to 40% with 12 patients waiting or physician was carrying 16 ED patients...
October 5, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Eileen J Carter, Daniel J Pallin, Leslie Mandel, Corine Sinnette, Jeremiah D Schuur
OBJECTIVE: The aim of this study was to explore the actions of nurse leaders that facilitated clinical nurses' active involvement in emergency department (ED) catheter-associated urinary tract infection (CAUTI) prevention programs. BACKGROUND: Hospitals face increasing financial pressures to reduce CAUTI. Urinary catheters, often inserted in the ED, expose patients to CAUTI risk. Nurses are the principal champions of ED CAUTI prevention programs. METHODS: This was a qualitative analysis from a multisite, comparative case study project...
October 2016: Journal of Nursing Administration
Gaurav Sharma, Danny Wong, Dean J Arnaoutakis, Samir K Shah, Alice O'Brien, Stanley W Ashley, C Keith Ozaki
OBJECTIVE: Length of stay fails to completely capture the clinical and economic effects of patient progression through the phases of inpatient care, such as admission, room placement, procedures, and discharge. Delayed hospital throughput has been linked to increased time spent in the emergency department and postanesthesia care unit, delayed time to treatment, increased in-hospital mortality, decreased patient satisfaction, and lost hospital revenue. We identified barriers to vascular surgery inpatient care progression and instituted defined measures to positively impact standardized metrics...
September 19, 2016: Journal of Vascular Surgery
Dustin W Ballard, Ridhima Vemula, Uli K Chettipally, Mamata V Kene, Dustin G Mark, Andrew K Elms, James S Lin, Mary E Reed, Jie Huang, Adina S Rauchwerger, David R Vinson
OBJECTIVE: Adoption of clinical decision support (CDS) tools by clinicians is often limited by workflow barriers. We sought to assess characteristics associated with clinician use of an electronic health record-embedded clinical decision support system (CDSS). METHODS: In a prospective study on emergency department (ED) activation of a CDSS tool across 14 hospitals between 9/1/14 to 4/30/15, the CDSS was deployed at 10 active sites with an on-site champion, education sessions, iterative feedback, and up to 3 gift cards/clinician as an incentive...
2016: Applied Clinical Informatics
Jillian K Gorski, Robert J Batt, Erkin Otles, Manish N Shah, Azita G Hamedani, Brian W Patterson
OBJECTIVE: We evaluated the effect of Emergency Department (ED) census on disposition decisions made by ED physicians. METHODS: We performed a retrospective analysis using 18 months of all adult patient encounters seen in the main ED at an academic tertiary care center. Patient census information was calculated at the time of physician assignment for each individual patient, and included the number of patients in the waiting room (waiting room census) and number of patients being managed by the patient's attending (physician load census)...
September 19, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Scott R Walter, Magdalena Z Raban, William T M Dunsmuir, Heather E Douglas, Johanna I Westbrook
An observational workflow time study was conducted involving doctors in the emergency department (ED) of a large Australian hospital. During 121.7 h across 58 sessions, we observed interruptive events, conceptualised as prompts, and doctors' strategies to handle those prompts (task-switching, multitasking, acknowledgement, deferral and deflection) to assess the role of multiple work system factors influencing doctors' work in the ED. Prompt rates varied vastly between work scenarios, being highest during non-verbal solo tasks...
January 2017: Applied Ergonomics
Ferdia Bolster, Ken Linnau, Steve Mitchell, Eric Roberge, Quynh Nguyen, Jeffrey Robinson, Bruce Lehnert, Joel Gross
The aims of this article are to describe the events of a recent mass casualty incident (MCI) at our level 1 trauma center and to describe the radiology response to the event. We also describe the findings and recommendations of our radiology department after-action review. An MCI activation was triggered after an amphibious military vehicle, repurposed for tourist activities, carrying 37 passengers, collided with a charter bus carrying 45 passengers on a busy highway bridge in Seattle, WA, USA. There were 4 deaths at the scene, and 51 patients were transferred to local hospitals following prehospital scene triage...
September 13, 2016: Emergency Radiology
Spencer W Lindgren, Katie Kwaschyn, Ellen Roberts, Jan Busby-Whitehead, Lori A Evarts, Tiffany Shubert
INTRODUCTION: Falls among persons over 60 present significant risks for serious injury or debility. Falls place burdens on Emergency Medical Services (EMS), hospitals, and the adults themselves. Recognizing a need to provide interventions to minimize risk, Orange County Emergency Services (OCES), the Orange County Department on Aging (OCDoA), and the University of North Carolina at Chapel Hill (UNC) partnered to create the Stay Up and Active Program (SUAA). The purpose of this study was to determine if SUAA was a feasible program to implement in the community...
2016: Frontiers in Public Health
Jason Phua, Nathan C Dean, Qi Guo, Win Sen Kuan, Hui Fang Lim, Tow Keang Lim
Mortality rates for severe community-acquired pneumonia (CAP) range from 17 to 48 % in published studies.In this review, we searched PubMed for relevant papers published between 1981 and June 2016 and relevant files. We explored how early and aggressive management measures, implemented within 24 hours of recognition of severe CAP and carried out both in the emergency department and in the ICU, decrease mortality in severe CAP.These measures begin with the use of severity assessment tools and the application of care bundles via clinical decision support tools...
August 28, 2016: Critical Care: the Official Journal of the Critical Care Forum
Ian David Aronson, Charles M Cleland, David C Perlman, Sonali Rajan, Wendy Sun, Theodore C Bania
Young people face greatly increased human immunodeficiency virus (HIV) risk and high rates of undiagnosed HIV, yet are unlikely to test. Many also have limited or inconsistent access to health care, including HIV testing and prevention education, and prior research has documented that youth lack knowledge necessary to understand the HIV test process and to interpret test results. Computer-based interventions have been used to increase HIV test rates and knowledge among emergency department (ED) patients, including those who decline tests offered at triage...
September 2016: Journal of Health Communication
Mark E Sharafinski, Elizabeth Sehnert, David Moe, Liyun Zhang, Pippa Simpson, Nghia J Vo
OBJECTIVES: The aim of the study was to determine whether embedding into the radiology report a patient-specific plan in the event of gastrojejunostomy (GJ) tube dysfunction reduces the need for after-hours utilization of pediatric interventional radiology resources for the replacement of GJ tubes. MATERIALS AND METHODS: This is a Health Insurance Portability and Accountability Act compliant, institutional review board-approved retrospective repeated cross-sectional study of patients requiring after-hours (5 PM-7 AM) or weekend (Saturday and Sunday) GJ tube replacement at a dedicated children's hospital, before and after the inclusion of a patient-specific plan in the radiology report as part of the electronic medical record...
September 2016: Journal of Pediatric Gastroenterology and Nutrition
David Peddie, Serena S Small, Katherin Badke, Maeve E Wickham, Chantelle Bailey, Adam Chruscicki, Christine Ackerley, Ellen Balka, Corinne M Hohl
BACKGROUND: Adverse drug events (ADEs) are unintended and harmful events related to medication use. Up to 30% of serious ADEs recur within six months because culprit drugs are unintentionally represcribed and redispensed. Improving the electronic communication of ADE information between care providers, and across care settings, has the potential to reduce recurrent ADEs. OBJECTIVE: We aim to describe the methods used to design Action ADE, a novel electronic ADE reporting system that can be leveraged to prevent unintentional reexposures to harmful drugs in British Columbia, Canada...
2016: JMIR Research Protocols
James Ryan, James Hendler, Kristin P Bennett
Electronic Healthcare Records (EHRs) have the potential to improve healthcare quality and to decrease costs by providing quality metrics, discovering actionable insights, and supporting decision-making to improve future outcomes. Within the United States Medicaid Program, rates of recidivism among emergency department (ED) patients serve as metrics of hospital performance that help ensure efficient and effective treatment within the ED. We analyze ED Medicaid patient data from 1,149,738 EHRs provided by a hospital over a 2-year period to understand the characteristics of the ED return visits within a 72-hour time frame...
December 2015: Big Data
Eric Tham, Marguerite Swietlik, Sara Deakyne, Jeffrey M Hoffman, Robert W Grundmeier, Marilyn D Paterno, Beatriz H Rocha, Molly H Schaeffer, Deepika Pabbathi, Evaline Alessandrini, Dustin Ballard, Howard S Goldberg, Nathan Kuppermann, Peter S Dayan
INTRODUCTION: For children who present to emergency departments (EDs) due to blunt head trauma, ED clinicians must decide who requires computed tomography (CT) scanning to evaluate for traumatic brain injury (TBI). The Pediatric Emergency Care Applied Research Network (PECARN) derived and validated two age-based prediction rules to identify children at very low risk of clinically-important traumatic brain injuries (ciTBIs) who do not typically require CT scans. In this case report, we describe the strategy used to implement the PECARN TBI prediction rules via electronic health record (EHR) clinical decision support (CDS) as the intervention in a multicenter clinical trial...
2016: Applied Clinical Informatics
D Tahtali, F Bohmann, P Rostek, B Misselwitz, A Reihs, F Heringer, K Jahnke, H Steinmetz, W Pfeilschifter
BACKGROUND: Time is of critical importance in acute stroke management. The establishment of thrombectomy now adds to the complexity and interdisciplinarity of the initial phase. In non-medical high-fidelity situations, such as aviation, crew resource management (CRM) has proven to be highly efficient. It has therefore also been implemented in professional cardiovascular life support training. In a setting where every minute counts, CRM and regular training of the high-fidelity stroke team could offer ways to improve treatment of acute stroke patients...
July 18, 2016: Der Nervenarzt
Preethy S, Teenu Xavier, Reghunathan N, Metilda Robin, Deepak Agrawal
The aim of this study was to assess the effect of the emergency nurse coordinator in optimization of workflow of the emergency department. A retrospective analysis of all patient encounters in the emergency department between Aug 1 to Sept 31 of 2014 (n = 6,189) and Aug 1 to September 31 of 2015 (n = 8,626) was conducted. There was a statistically significant decrease in the admission time, length of stay, transfer time, and review time of the patients after the introduction of the emergency nurse coordinator in the emergency department...
2016: Studies in Health Technology and Informatics
Niclas Skyttberg, Joana Vicente, Rong Chen, Hans Blomqvist, Sabine Koch
BACKGROUND: Vital sign data are important for clinical decision making in emergency care. Clinical Decision Support Systems (CDSS) have been advocated to increase patient safety and quality of care. However, the efficiency of CDSS depends on the quality of the underlying vital sign data. Therefore, possible factors affecting vital sign data quality need to be understood. This study aims to explore the factors affecting vital sign data quality in Swedish emergency departments and to determine in how far clinicians perceive vital sign data to be fit for use in clinical decision support systems...
2016: BMC Medical Informatics and Decision Making
Resa E Lewiss, Jessica Cook, Allison Sauler, Nicholas Avitabile, Nicole L Kaban, Jeffrey Rabrich, Turandot Saul, Sebastian D Siadecki, Dan Wiener
BACKGROUND: Emergency point-of-care ultrasound (POC u/s) is an example of a health information technology that improves patient care and time to correct diagnosis. POC u/s examinations should be documented, as they comprise an integral component of physician decision making. Incomplete documentation prevents coding, billing and physician group compensation for ultrasound-guided procedures and patient care. We aimed to assess the effect of directed education and personal feedback through a task force driven initiative to increase the number of POC u/s examinations documented and transferred to medical coders by emergency medicine physicians...
December 2016: Critical Ultrasound Journal
Fetch more papers »
Fetching more papers... Fetching...
Read by QxMD. Sign in or create an account to discover new knowledge that matter to you.
Remove bar
Read by QxMD icon Read

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"