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Emergency department workflow

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https://www.readbyqxmd.com/read/29025090/effect-of-number-of-open-charts-on-intercepted-wrong-patient-medication-orders-in-an-emergency-department
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
https://www.readbyqxmd.com/read/28855345/workflow-and-factors-associated-with-delay-in-the-delivery-of-intra-arterial-treatment-for-acute-ischemic-stroke-in-the-mr-clean-trial
#7
Esmee Venema, Nikki Boodt, Olvert A Berkhemer, Pleunie P M Rood, Wim H van Zwam, Robert J van Oostenbrugge, Aad van der Lugt, Yvo B W E M Roos, Charles B L M Majoie, Hester F Lingsma, Diederik W J Dippel
OBJECTIVE: The effect of intra-arterial treatment (IAT) for acute ischemic stroke is highly time-dependent. We investigated the delay of IAT and factors associated with such delay. METHODS: MR CLEAN was a randomized trial of IAT plus usual care versus usual care alone (n=500). With multivariable linear regression, we analyzed the effect of intravenous treatment, general anesthesia, off-hours and inter-hospital transfer on time to admission to the emergency department (ED) of the intervention center and time to treatment...
August 30, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28833779/patient-and-system-factors-related-to-missed-opportunities-for-screening-in-an-emr-driven-opt-out-hiv-screening-program-in-the-emergency-department
#8
Janet Lin, Sara Baghikar, Cammeo Mauntel-Medici, Sara Heinert, Daven Patel
OBJECTIVE: Emergency Departments (EDs) have implemented HIV screening using a variety of strategies. This study investigates how specific patient and health system factors in the ED impact who is and is not screened in a combined targeted and non-targeted, EMR-driven, opt-out, HIV screening program. METHODS: This was a retrospective, cross sectional study of ED visits where patients were determined eligible for HIV screening by an EMR algorithm between 11/18/2014 and 7/15/2015...
August 18, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28805550/moving-toward-a-universal-digital-era-in-mass-casualty-incidents-and-disasters-emergency-personnel-s-perspective-in-romania
#9
Adrian Stănescu, Peter Eliot Gordon, Sanda Maria Copotoiu, Cristian Marius Boeriu
BACKGROUND: Despite a recognized need for improved communications and logistics in high acuity situations, the integration of telemedicine services into the mainstream health services has been difficult. This study reports on the opinions of Romanian professional responders to mass casualty incidents and disasters regarding the use and requirements of specific electronic medical documentation solutions. MATERIALS AND METHODS: Doctors, nurses, paramedics, and fire department officers participated in a customized online structured questionnaire...
August 14, 2017: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
https://www.readbyqxmd.com/read/28756439/what-factors-determine-the-use-of-an-electronic-test-result-acknowledgement-system-a-qualitative-study-across-two-eds
#10
Julie Li, Joanne Callen, Johanna I Westbrook, Andrew Georgiou
Electronic medical record-based test results management interventions hold the potential to reduce errors in the test result follow-up process. However, ensuring the adaptability of such systems to the clinical environment has proven challenging. The aim of this study was to explore how contextual factors can influence senior emergency physicians' experience and perceived impacts of an electronic result acknowledgement system across two Emergency Departments. Semi-structured, in-depth interviews relating to physician test result acknowledgement processes before and after system implementation were conducted with 14 senior Emergency Physicians across two Australian metropolitan teaching hospitals...
2017: Studies in Health Technology and Informatics
https://www.readbyqxmd.com/read/28744454/staff-perspectives-on-a-tablet-based-intervention-to-increase-hiv-testing-in-a-high-volume-urban-emergency-department
#11
Ian David Aronson, Honoria Guarino, Alexander S Bennett, Lisa A Marsch, Marya Gwadz, Charles M Cleland, Laura Damschroder, Theodore C Bania
Emergency departments (EDs) frequently serve people who have limited, if any, additional interactions with health care, yet many ED patients are not offered HIV testing, and those who are frequently decline. ED staff (n = 13) at a high volume urban ED (technicians, nurses, physicians, and administrators) were interviewed to elicit their perspectives on the feasibility and acceptability of a tablet-based intervention designed to increase HIV test rates among patients who initially decline testing. Content-based thematic analysis of semi-structured interviews indicated overall support for interventions to increase HIV testing, but a lack of available staff resources emerged as a potential barrier to widespread implementation...
2017: Frontiers in Public Health
https://www.readbyqxmd.com/read/28711345/working-at-the-intersection-of-context-culture-and-technology-provider-perspectives-on-antimicrobial-stewardship-in-the-emergency-department-using-electronic-health-record-clinical-decision-support
#12
Phillip Chung, Jean Scandlyn, Peter S Dayan, Rakesh D Mistry
BACKGROUND: Antibiotic stewardship programs (ASPs) have not been fully developed for the emergency department (ED), in part the result of the barriers characteristic of this setting. Electronic health record-based clinical decision support (EHR CDS) represents a promising strategy to implement ASPs in the ED. We aimed to determine the cultural beliefs and structural barriers and facilitators to implementation of antimicrobial stewardship in the pediatric ED using EHR CDS. METHODS: Interviews and focus groups were conducted with hospital and ED leadership, attending ED physicians, nurse practitioners, physician assistants, and residents at a single health system in Colorado...
July 12, 2017: American Journal of Infection Control
https://www.readbyqxmd.com/read/28711339/imaging-department-organization-in-a-stroke-center-and-workflow-processes-in-acute-stroke
#13
REVIEW
Zarina Abdul Assis, Bijoy K Menon, Mayank Goyal
The imaging department is an integral part of the stroke management task force and plays a critical role. Accurate and timely interpretation of images obtained in the emergency department and involvement in decision-making has contributed immensely in stroke care. In fact, the treatment paradigm has changed considerably after the recent positive endovascular clinical trials; and so is the hospital workflow and treatment site. As a result, the imaging department has become the site of maximum activity during an acute stroke protocol...
June 20, 2017: European Journal of Radiology
https://www.readbyqxmd.com/read/28679909/real-time-process-analytics-in-emergency-healthcare
#14
Vassiliki Koufi, Flora Malamateniou, Adrianna Prentza, George Vassilacopoulos
Emergency medical systems (EMS) are considered to be amongst the most crucial systems as they involve a variety of activities which are performed from the time of a call to an ambulance service till the time of patient's discharge from the emergency department of a hospital. These activities are closely interrelated so that collaboration and coordination becomes a vital issue for patients and for emergency healthcare service performance. The utilization of standard workflow technology in the context of Service Oriented Architecture can provide an appropriate technological infrastructure for defining and automating EMS processes that span organizational boundaries so that to create and empower collaboration and coordination among the participating organizations...
2017: Studies in Health Technology and Informatics
https://www.readbyqxmd.com/read/28633314/qualitative-identification-of-fentanyl-analogs-and-other-opioids-in-postmortem-cases-by-uhplc-ion-trap-msn
#15
Elisa N Shoff, M Elizabeth Zaney, Joseph H Kahl, George W Hime, Diane M Boland
Since 2013, the Miami-Dade County Medical Examiner Department has experienced an increase in the number of opioid-related deaths. The majority of cases coincided with the introduction of fentanyl into the local heroin supply. From 2014 to 2015, Miami-Dade County experienced a near 600% increase in fentanyl-related deaths, followed by an additional 200% increase in 2016. In 2015, two novel fentanyl analogs were identified in medical examiner cases: beta-hydroxythiofentanyl and acetyl fentanyl. In 2016, four additional fentanyl analogs emerged: para-fluoroisobutyryl fentanyl, butyryl fentanyl, furanyl fentanyl and carfentanil, as well as the synthetic opioid U-47700...
July 1, 2017: Journal of Analytical Toxicology
https://www.readbyqxmd.com/read/28579532/dashboard-visualizations-supporting-real-time-throughput-decision-making
#16
Amy Franklin, Swaroop Gantela, Salsawit Shifarraw, Todd R Johnson, David J Robinson, Brent R King, Amit M Mehta, Charles L Maddow, Nathan R Hoot, Vickie Nguyen, Adriana Rubio, Jiajie Zhang, Nnaemeka G Okafor
Providing timely and effective care in the emergency department (ED) requires the management of individual patients as well as the flow and demands of the entire department. Strategic changes to work processes, such as adding a flow coordination nurse or a physician in triage, have demonstrated improvements in throughput times. However, such global strategic changes do not address the real-time, often opportunistic workflow decisions of individual clinicians in the ED. We believe that real-time representation of the status of the entire emergency department and each patient within it through information visualizations will better support clinical decision-making in-the-moment and provide for rapid intervention to improve ED flow...
July 2017: Journal of Biomedical Informatics
https://www.readbyqxmd.com/read/28578757/decision-making-under-pressure-medical-errors-in-uncertain-and-dynamic-environments
#17
Alicia M Zavala, Gary E Day, David Plummer, Anita Bamford-Wade
Objective This paper provides a narrative overview of the literature concerning clinical decision-making processes when staff come under pressure, particularly in uncertain, dynamic and emergency situations.Methods Studies between 1980 and 2015 were analysed using a six-phase thematic analysis framework to achieve an in-depth understanding of the complex origins of medical errors that occur when people and systems are under pressure and how work pressure affects clinical performance and patient outcomes. Literature searches were conducted using a Summons Search Service platform; search criteria included a variety of methodologies, resulting in the identification of 95 papers relevant to the present review...
June 5, 2017: Australian Health Review: a Publication of the Australian Hospital Association
https://www.readbyqxmd.com/read/28533683/new-standardized-nursing-cooperation-workflow-to-reduce-stroke-thrombolysis-delays-in-patients-with-acute-ischemic-stroke
#18
Yan Zhou, Zhuojun Xu, Jiali Liao, Fangming Feng, Lai Men, Li Xu, Yanan He, Gang Li
OBJECTIVE: We assessed the effectiveness of a new standardized nursing cooperation workflow in patients with acute ischemic stroke (AIS) to reduce stroke thrombolysis delays. PATIENTS AND METHODS: AIS patients receiving conventional thrombolysis treatment from March to September 2015 were included in the control group, referred to as T0. The intervention group, referred to as T1 group, consisted of AIS patients receiving a new standardized nursing cooperation workflow for intravenous thrombolysis (IVT) at the emergency department of Shanghai East Hospital (Shanghai, People's Republic of China) from October 2015 to March 2016...
2017: Neuropsychiatric Disease and Treatment
https://www.readbyqxmd.com/read/28479220/electronic-medication-complete-communication-strategy-for-opioid-prescriptions-in-the-emergency-department-rationale-and-design-for-a-three-arm-provider-randomized-trial
#19
Danielle M McCarthy, D Mark Courtney, Patrick M Lank, Kenzie A Cameron, Andrea M Russell, Laura M Curtis, Kwang-Youn A Kim, Surrey M Walton, Enid Montague, Abbie L Lyden, Stephanie J Gravenor, Michael S Wolf
BACKGROUND: Thousands of people die annually from prescription opioid overdoses; however there are few strategies to ensure patients receive medication risk information at the time of prescribing. OBJECTIVES: To compare the effectiveness of the Emergency Department (ED) Electronic Medication Complete Communication (EMC(2)) Opioid Strategy (with and without text messaging) to promote safe medication use and improved patient knowledge as compared to usual care. METHODS: The ED EMC(2) Opioid Strategy consists of 5 automated components to promote safe medication use: 1) physician reminder to counsel, 2) inbox message sent on to the patient's primary care physician, 3) pharmacist message on the prescription to counsel, 4) MedSheet supporting prescription information, and 5) patient-centered Take-Wait-Stop wording of prescription instructions...
May 4, 2017: Contemporary Clinical Trials
https://www.readbyqxmd.com/read/28391603/embedded-clinical-decision-support-in-electronic-health-record-decreases-use-of-high-cost-imaging-in-the-emergency-department-embed-study
#20
Kelly Bookman, David West, Adit Ginde, Jennifer Wiler, Robert McIntyre, Andrew Hammes, Nichole Carlson, David Steinbruner, Matthew Solley, Richard Zane
OBJECTIVE: The objective was to evaluate the impact of evidence-based clinical decision support tools integrated directly into provider workflow in the electronic health record on utilization of computed tomography (CT) brain, C-spine, and pulmonary embolism (PE). METHODS: Validated, well-accepted scoring tools for head injury, C-spine injury, and PE were embedded into the electronic health record in a manner minimally disruptive to provider workflow. This was a longitudinal, before/after study in five emergency departments (EDs) in a healthcare system with a common electronic health record...
July 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
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