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Emergency department workflow

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https://www.readbyqxmd.com/read/29410146/a-method-for-the-analysis-and-visualization-of-clinical-workflow-in-dynamic-environments
#1
Akshay Vankipuram, Stephen Traub, Vimla L Patel
The analysis of clinical workflow offers many challenges, especially in settings characterized by rapid dynamic change. Typically, some combination of approaches drawn from ethnography and grounded theory-based qualitative methods are used to develop relevant metrics. Medical institutions have recently attempted to introduce technological interventions to develop quantifiable quality metrics to supplement existing purely qualitative analyses. These interventions range from automated location tracking to repositories of clinical data (e...
February 1, 2018: Journal of Biomedical Informatics
https://www.readbyqxmd.com/read/29408777/streamlined-triage-and-transfer-protocols-improve-door-to-puncture-time-for-endovascular-thrombectomy-in-acute-ischemic-stroke
#2
Akash P Kansagra, Adam N Wallace, David R Curfman, James D McEachern, Christopher J Moran, DeWitte T Cross, Jin-Moo Lee, Andria L Ford, S Goyal Manu, Peter D Panagos, Colin P Derdeyn
OBJECTIVE: Shorter time from symptom onset to treatment is associated with improved outcomes in patients who undergo mechanical thrombectomy for treatment of acute ischemic stroke due to emergent large vessel occlusion. In this work, we detail pre-thrombectomy process improvements in a multi-hospital network and report the effect on door-to-puncture time in patients undergoing mechanical thrombectomy. PATIENTS AND METHODS: A streamlined workflow was adopted to minimize door-to-puncture time...
January 30, 2018: Clinical Neurology and Neurosurgery
https://www.readbyqxmd.com/read/29396123/evaluating-report-text-variation-and-informativeness-natural-language-processing-of-ct-chest-imaging-for-pulmonary-embolism
#3
Marco D Huesch, Rekha Cherian, Sam Labib, Rickhesvar Mahraj
OBJECTIVE: The aim of this study was to quantify the variability of language in free text reports of pulmonary embolus (PE) studies and to gauge the informativeness of free text to predict PE diagnosis using machine learning as proxy for human understanding. MATERIALS AND METHODS: All 1,133 consecutive chest CTs with contrast studies performed under a PE protocol and ordered in the emergency department in 2016 were selected from our departmental electronic workflow system...
January 22, 2018: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/29384428/telehealth-at-the-us-department-of-veterans-affairs-after-hurricane-sandy
#4
Claudia Der-Martirosian, Anne R Griffin, Karen Chu, Aram Dobalian
Background Like other integrated health systems, the US Department of Veterans Affairs has widely implemented telehealth during the past decade to improve access to care for its patient population. During major crises, the US Department of Veterans Affairs has the potential to transition healthcare delivery from traditional care to telecare. This paper identifies the types of Veterans Affairs telehealth services used during Hurricane Sandy (2012), and examines the patient characteristics of those users. Methods This study conducted both quantitative and qualitative analyses...
January 1, 2018: Journal of Telemedicine and Telecare
https://www.readbyqxmd.com/read/29345145/process-improvement-methodologies-uncover-unexpected-gaps-in-stroke-care
#5
Anthony D Kuner, Andrew J Schemmel, B Dustin Pooler, John-Paul J Yu
Background The diagnosis and treatment of acute stroke requires timed and coordinated effort across multiple clinical teams. Purpose To analyze the frequency and temporal distribution of emergent stroke evaluations (ESEs) to identify potential contributory workflow factors that may delay the initiation and subsequent evaluation of emergency department stroke patients. Material and Methods A total of 719 sentinel ESEs with concurrent neuroimaging were identified over a 22-month retrospective time period. Frequency data were tabulated and odds ratios calculated...
January 1, 2018: Acta Radiologica
https://www.readbyqxmd.com/read/29335822/emergency-department-throughput-an-intervention
#6
Nowreen Haq, Rona Stewart-Corral, Eric Hamrock, Jamie Perin, Waseem Khaliq
Shortening emergency department (ED) boarding time and managing hospital bed capacity by expediting the inpatient discharge process have been challenging for hospitals nationwide. The objective of this study is was to explore the effect of an innovative prospective intervention on hospital workflow, specifically on early inpatient discharges and the ED boarding time. The intervention consisted of a structured nursing "admission discharge transfer" (ADT) protocol receiving new admissions from the ED and helping out floor nursing with early discharges...
January 15, 2018: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/29305076/system-level-process-change-improves-communication-and-follow-up-for-emergency-department-patients-with-incidental-radiology-findings
#7
Steven J Baccei, Sneha A Chinai, Martin Reznek, Scott Henderson, Kevin Reynolds, D Eric Brush
The appropriate communication and management of incidental findings on emergency department (ED) radiology studies is an important component of patient safety. Guidelines have been issued by the ACR and other medical associations that best define incidental findings across various modalities and imaging studies. However, there are few examples of health care facilities designing ways to manage incidental findings. Our institution aimed to improve communication and follow-up of incidental radiology findings in ED patients through the collaborative development and implementation of system-level process changes including a standardized loop-closure method...
January 3, 2018: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/29275350/workflow-interruptions-and-stress-atwork-a-mixed-methods-study-among-physicians-and-nurses-of-a-multidisciplinary-emergency-department
#8
Matthias Weigl, Joana Beck, Markus Wehler, Anna Schneider
OBJECTIVES: Dealing with multiple workflow interruptions is a major challenge in emergency department (ED) work. This study aimed to establish a taxonomy of workflow interruptions that takes into account the content and purpose of interruptive communication. It further aimed to identify associations of workflow interruptions with ED professionals' work stress. DESIGN: Combined data from expert observation sessions and concomitant self-evaluations of ED providers...
December 22, 2017: BMJ Open
https://www.readbyqxmd.com/read/29212880/standardizing-the-evaluation-of-nonaccidental-trauma-in-a-large-pediatric-emergency-department
#9
Lauren C Riney, Theresa M Frey, Emily T Fain, Elena M Duma, Berkeley L Bennett, Eileen Murtagh Kurowski
BACKGROUND AND OBJECTIVES: Variability exists in the evaluation of nonaccidental trauma (NAT) in the pediatric emergency department because of misconceptions and individual bias of clinicians. Further maltreatment, injury, and death can ensue if these children are not evaluated appropriately. The implementation of guidelines for NAT evaluation has been successful in decreasing differences in care as influenced by race and ethnicity of the patient and their family. Our Specific, Measurable, Achievable, Realistic, and Timely aim was to increase the percent of patients evaluated in the emergency department for NAT who receive guideline-adherent evaluation from 47% to 80% by December 31, 2016...
December 6, 2017: Pediatrics
https://www.readbyqxmd.com/read/29194491/healthcare-providers-perceptions-of-a-situational-awareness-display-for-emergency-department-resuscitation-a-simulation-qualitative-study
#10
Lisa A Calder, Abhi Bhandari, George Mastoras, Kathleen Day, Kathryn Momtahan, Matthew Falconer, Brian Weitzman, Benjamin Sohmer, A Adam Cwinn, Stanley J Hamstra, Avi Parush
Importance: Emergency resuscitation of critically ill patients can challenge team communication and situational awareness. Tools facilitating team performance may enhance patient safety. Objectives: To determine resuscitation team members' perceptions of the Situational Awareness Display's utility. Design: We conducted focus groups with healthcare providers during Situational Awareness Display development. After simulations assessing the display, we conducted debriefs with participants...
November 29, 2017: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/29169818/introduction-of-a-horizontal-and-vertical-split-flow-model-of-emergency-department-patients-as-a-response-to-overcrowding
#11
Gregory Wallingford, Nikita Joshi, Patrice Callagy, Jamie Stone, Ian Brown, Sam Shen
INTRODUCTION: ED overcrowding is an issue that is affecting every emergency department and every hospital. The inability to maintain patient flow into and out of the emergency department paralyzes the ability to provide effective and timely patient care. Many solutions have been proposed on how to mitigate the effects of ED overcrowding. Solutions involve either hospital-wide initiatives or ED-based solutions. In this article, the authors seek to describe and provide metrics for a patient flow methodology that targets ESI 3 patients in a vertical flow model...
November 20, 2017: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
https://www.readbyqxmd.com/read/29167144/efficiency-analysis-of-a-barcode-enabled-and-integrated-medication-tracking-system
#12
Les Louden, Jay M Mirtallo, Marcia Worley, Ryan Naseman, Amanda Hafford, Nicole V Brown
PURPOSE: Operational efficiency improvements for pharmacy workflow processes were evaluated using a barcode-enabled and integrated medication-tracking system for medications dispensed from the pharmacy to the emergency department (ED). METHODS: The preimplementation study period (Period 1) was defined as November 17-December 16, 2015; system implementation and training, were defined as December 17, 2015-January 18, 2016; and postimplementation (Period 2) was defined as January 19-February 17, 2016...
December 1, 2017: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/29132876/the-distraction-in-action-tool%C3%A2-feasibility-and-usability-in-clinical-settings
#13
Kirsten Hanrahan, Charmaine Kleiber, Ben J Miller, Heather Davis, Ann Marie McCarthy
PURPOSE: Distraction is a relatively simple, evidence-based intervention to minimize child distress during medical procedures. Timely on-site interventions that instruct parents on distraction coaching are needed. The purpose of this study was to test the feasibility and usability of the Distraction in Action Tool© (DAT©), which 1) predicts child risk for distress with a needle stick and 2) provides individualized instructions for parents on how to be a distraction coach for their child in clinical settings...
November 10, 2017: Journal of Pediatric Nursing
https://www.readbyqxmd.com/read/29079489/physician-interrupted-workflow-interruptions-and-patient-care-in-the-emergency-department
#14
Renaldo C Blocker, Heather A Heaton, Katherine L Forsyth, Hunter J Hawthorne, Nibras El-Sherif, M Fernanda Bellolio, David M Nestler, Thomas R Hellmich, Kalyan S Pasupathy, M Susan Hallbeck
BACKGROUND: It is unclear how workflow interruptions impact emergency physicians at the point of care. OBJECTIVES: Our study aimed to evaluate interruption characteristics experienced by academic emergency physicians. METHODS: This prospective, observational study collected interruptions during attending physician shifts. An interruption is defined as any break in performance of a human activity that briefly requires attention. One observer captured interruptions using a validated tablet PC-based tool that time stamped and categorized the data...
October 24, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29025090/effect-of-number-of-open-charts-on-intercepted-wrong-patient-medication-orders-in-an-emergency-department
#15
Thomas G Kannampallil, John D Manning, David W Chestek, Jason Adelman, Hojjat Salmasian, Bruce L Lambert, William L Galanter
To reduce the risk of wrong-patient errors, safety experts recommend allowing only one patient chart to be open at a time. Due to the lack of empirical evidence, the number of allowable open charts is often based on anecdotal evidence or institutional preference, and hence varies across institutions. Using an interrupted time series analysis of intercepted wrong-patient medication orders in an emergency department during 2010-2016 (83.6 intercepted wrong-patient events per 100 000 orders), we found no significant decrease in the number of intercepted wrong-patient medication orders during the transition from a maximum of 4 open charts to a maximum of 2 (b = -0...
September 11, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/29016971/efficiency-and-safety-of-speech-recognition-for-documentation-in-the-electronic-health-record
#16
Tobias Hodgson, Farah Magrabi, Enrico Coiera
Objective: To compare the efficiency and safety of using speech recognition (SR) assisted clinical documentation within an electronic health record (EHR) system with use of keyboard and mouse (KBM). Methods: Thirty-five emergency department clinicians undertook randomly allocated clinical documentation tasks using KBM or SR on a commercial EHR system. Tasks were simple or complex, and with or without interruption. Outcome measures included task completion times and observed errors...
November 1, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28971325/a-novel-oral-fluid-assay-lc-qtof-ms-for-the-detection-of-fentanyl-and-clandestine-opioids-in-oral-fluid-after-reported-heroin-overdose
#17
Matthew K Griswold, Peter R Chai, Alex J Krotulski, Melissa Friscia, Brittany P Chapman, Neha Varma, Edward W Boyer, Barry K Logan, Kavita M Babu
INTRODUCTION: The adulteration of heroin with non-pharmaceutical fentanyl and other high-potency opioids is one of the factors contributing to striking increases in overdose deaths. To fully understand the magnitude of this problem, accurate detection methods for fentanyl and other novel opioid adulterant exposures are urgently required. The objective of this work was to compare the detection of fentanyl in oral fluid and urine specimens using liquid chromatography quadrupole time-of-flight mass spectrometry (LC-QTOF-MS) in a population of heroin users presenting to the Emergency Department after overdose...
October 2, 2017: Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology
https://www.readbyqxmd.com/read/28926507/point-of-care-ultrasound-could-streamline-the-emergency-department-workflow-of-clinically-nonspecific-intussusception
#18
Jung Heon Kim, Jeong-Yong Lee, Jae Hyun Kwon, Hyung-Rae Cho, Jong Seung Lee, Jeong-Min Ryu
OBJECTIVES: The aim of this study was to evaluate whether point-of-care ultrasound (POCUS) for intussusception screening streamlines the workflow of clinically nonspecific intussusception (CNI), an intussusception presenting with only 1 manifestation of the classic triad, and/or vomiting. METHODS: We reviewed 274 consecutive children with intussusception, aged 6 years or younger, who visited a tertiary care hospital emergency department between May 2012 and April 2016...
September 18, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28925416/extracting-autism-spectrum-disorder-data-from-the-electronic-health-record
#19
Ruth A Bush, Cynthia D Connelly, Alexa Pérez, Halsey Barlow, George J Chiang
BACKGROUND: Little is known about the health care utilization patterns of individuals with pediatric autism spectrum disorder (ASD). OBJECTIVES: Electronic health record (EHR) data provide an opportunity to study medical utilization and track outcomes among children with ASD.  Methods: Using a pediatric, tertiary, academic hospital's Epic EHR, search queries were built to identify individuals aged 2-18 with International Classification of Diseases, Ninth Revision (ICD-9) codes, 299...
July 19, 2017: Applied Clinical Informatics
https://www.readbyqxmd.com/read/28879622/simulation-based-design-of-ed-operations-with-care-streams-to-optimize-care-delivery-and-reduce-length-of-stay-in-the-emergency-department
#20
Duane Steward, Todd F Glass, Yann B Ferrand
Faced with the opportunity to significantly deviate from classic operations, a new emergency department (ED) and novel strategy for patient care delivery were simultaneously initiated with the aid of model-based simulation. To answer the design and implementation questions, a traditional strategy for construction of discrete-eventmodel simulation was employed to define ED operations for a newly constructed facility in terms of workflow, variables, resources, structure, process logic and associated assumptions...
September 6, 2017: Journal of Medical Systems
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