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Emergency department workflow

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https://www.readbyqxmd.com/read/28186023/randomized-trial-of-population-based-clinical-decision-support-to-facilitate-care-transitions
#1
Eric L Eisenstein, Janese M Willis, Rex Edwards, Kevin J Anstrom, Kensaku Kawamoto, Guilherme Del Fiol, Fred S Johnson, David F Lobach
Medicaid beneficiaries in 6 North Carolina counties were randomly assigned to 1 of 3 clinical decision support (CDS) care transition strategies: (1) usual care (Control), (2) CDS messaging to patients and their medical homes (Reports), or (3) CDS messaging to patients, their medical homes, and their care managers (Reports+). We included 7146 Medicaid patients and evaluated transitions from specialist visit, ER and hospital encounters back to the patient's medical home. Patients enrolled in Medicare and Medicaid were not eligible...
2017: Studies in Health Technology and Informatics
https://www.readbyqxmd.com/read/28138821/transitioning-the-adult-with-type-2-diabetes-from-the-acute-to-chronic-care-setting-strategies-to-support-pragmatic-implementation-success
#2
REVIEW
Michelle Magee, Joan K Bardsley, Amisha Wallia, Kelly M Smith
Scientific evidence is available to guide the how to of medications management when patients with diabetes are hospitalized or present to the Emergency Department. However, few clinical trials in the diabetes field have addressed the execution, coupled with established implementation effectiveness evaluation frameworks to help inform and assess implementation practices to support the transition in care. These deficiencies may be overcome by (1) applying the principles of implementation and delivery systems science; (2) engaging the principles of human factors (HF) throughout the design, development, and evaluation planning activities; and (3) utilizing mixed methods to design the intervention, workflow processes, and evaluate the intervention for sustainability within existing care delivery models...
January 2017: Current Diabetes Reports
https://www.readbyqxmd.com/read/28122657/challenges-and-opportunities-to-engaging-emergency-medical-service-providers-in-substance-use-research-a-qualitative-study
#3
Allysha C Maragh-Bass, Julie C Fields, Junette McWilliams, Amy R Knowlton
: Introduction Research suggests Emergency Medical Services (EMS) over-use in urban cities is partly due to substance users with limited access to medical/social services. Recent efforts to deliver brief, motivational messages to encourage these individuals to enter treatment have not considered EMS providers. Problem Little research has been done with EMS providers who serve substance-using patients. The EMS providers were interviewed about participating in a pilot program where they would be trained to screen their patients for substance abuse and encourage them to enter drug treatment...
January 26, 2017: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/28090164/a-comparison-of-medication-histories-obtained-by-a-pharmacy-technician-versus-nurses-in-the-emergency-department
#4
Marija Markovic, A Scott Mathis, Hoytin Lee Ghin, Michelle Gardiner, Germin Fahim
PURPOSE: To compare the medication history error rate of the emergency department (ED) pharmacy technician with that of nursing staff and to describe the workflow environment. METHODS: Fifty medication histories performed by an ED nurse followed by the pharmacy technician were evaluated for discrepancies (RN-PT group). A separate 50 medication histories performed by the pharmacy technician and observed with necessary intervention by the ED pharmacist were evaluated for discrepancies (PT-RPh group)...
January 2017: P & T: a Peer-reviewed Journal for Formulary Management
https://www.readbyqxmd.com/read/27940752/improving-guideline-based-care-of-acute-asthma-in-a-pediatric-emergency-department
#5
Matthew P Gray, Grant E Keeney, Michael J Grahl, Marc H Gorelick, Christopher D Spahr
BACKGROUND AND OBJECTIVE: Rapid repetitive administration of short-acting β-agonists (SABA) is the most effective means of reducing acute airflow obstruction in asthma. Little evidence exists that assesses process measures (ie, timeliness) and outcomes for asthma. We used quality improvement (QI) methods to improve emergency department care in accordance with national guidelines including timely SABA administration and use of asthma severity scores. METHODS: The Model for Improvement was used and interventions were targeted at 4 key drivers: knowledge, engagement, decision support, and workflow enhancement...
November 2016: Pediatrics
https://www.readbyqxmd.com/read/27869880/-organizational-ethnography-of-direct-drugs-distribution-in-parma-ausl
#6
Lorenza Dodi, Chiara Latini, Marco Lombardi
The locations where healthcare organizations directly distribute medications to patients in specific circumstances, such as at hospital discharge, are settings at risk of professional errors. Using organizational ethnography methodology, we sought to explore the characteristics of points of direct distribution of drugs (PDD) in the AUSL of Parma and identify aspects of the delivery process that could potentially generate errors. We conducted 75 3-hour observations (225 hours at total) of the two Parma AUSL PDDs...
November 2016: Recenti Progressi in Medicina
https://www.readbyqxmd.com/read/27862986/analysing-the-emergency-department-patient-journey-discovery-of-bottlenecks-to-emergency-department-patient-flow
#7
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...
February 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/27852320/a-complex-endeavour-an-ethnographic-study-of-the-implementation-of-the-sepsis-six-clinical-care-bundle
#8
Carolyn Tarrant, Barbara O'Donnell, Graham Martin, Julian Bion, Alison Hunter, Kevin D Rooney
BACKGROUND: Implementation of the 'Sepsis Six' clinical care bundle within an hour of recognition of sepsis is recommended as an approach to reduce mortality in patients with sepsis, but achieving reliable delivery of the bundle has proved challenging. There remains little understanding of the barriers to reliable implementation of bundle components. We examined frontline clinical practice in implementing the Sepsis Six. METHODS: We conducted an ethnographic study in six hospitals participating in the Scottish Patient Safety Programme Sepsis collaborative...
November 16, 2016: Implementation Science: IS
https://www.readbyqxmd.com/read/27805796/implementation-of-a-multicenter-performance-improvement-program-for-early-detection-and-treatment-of-severe-sepsis-in-general-medical-surgical-wards
#9
Christa Schorr, Andrew Odden, Laura Evans, Gabriel J Escobar, Snehal Gandhi, Sean Townsend, Mitchell Levy
Sepsis is a leading cause of in-hospital death, and evidence suggests a higher mortality in patients presenting with sepsis on the ward compared to those presenting to the emergency department. Ward patients who develop severe sepsis may have poor outcomes for a variety of reasons, including delayed diagnosis, lack of readily available staffing, and delayed treatment. We report on a multihospital quality improvement program for early detection and treatment of sepsis on general medical-surgical wards. We describe a multipronged approach to improve severe sepsis outcomes using the Institute for Healthcare Improvement's Plan-Do-Study-Act model...
November 2016: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/27756427/why-is-it-so-hard-to-implement-change-a-qualitative-examination-of-barriers-and-facilitators-to-distribution-of-naloxone-for-overdose-prevention-in-a-safety-net-environment
#10
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
https://www.readbyqxmd.com/read/27733656/coming-full-cycle-linking-poe-findings-to-design-application
#11
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
https://www.readbyqxmd.com/read/27706871/what-cognitive-psychology-tells-us-about-emergency-department-physician-decision-making-and-how-to-improve-it
#12
Jesse M Pines
No abstract text is available yet for this article.
January 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27681511/a-qualitative-study-of-factors-facilitating-clinical-nurse-engagement-in-emergency-department-catheter-associated-urinary-tract-infection-prevention
#13
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
https://www.readbyqxmd.com/read/27658897/systematic-identification-and-management-of-barriers-to-vascular-surgery-patient-discharge-time-of-day
#14
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...
January 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/27652375/optimizing-clinical-decision-support-in-the-electronic-health-record-clinical-characteristics-associated-with-the-use-of-a-decision-tool-for-disposition-of-ed-patients-with-pulmonary-embolism
#15
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...
September 21, 2016: Applied Clinical Informatics
https://www.readbyqxmd.com/read/27641060/the-impact-of-emergency-department-census-on-the-decision-to-admit
#16
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)...
2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27633242/emergency-doctors-strategies-to-manage-competing-workload-demands-in-an-interruptive-environment-an-observational-workflow-time-study
#17
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
https://www.readbyqxmd.com/read/27623691/emergency-radiology-and-mass-casualty-incidents-report-of-a-mass-casualty-incident-at-a-level-1-trauma-center
#18
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
https://www.readbyqxmd.com/read/27622184/a-feasibility-study-for-an-integrated-approach-to-fall-prevention-in-community-care-stay-up-and-active-in-orange-county
#19
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
https://www.readbyqxmd.com/read/27567896/severe-community-acquired-pneumonia-timely-management-measures-in-the-first-24-hours
#20
REVIEW
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
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