Current Issue : January - March Volume : 2016 Issue Number : 1 Articles : 10 Articles
Beginning a residency in Emergency Medicine is a daunting task, and the new physician must be\naware of what abnormal vital signs are and understand when to initiate emergency therapy. This\nmodule was created to teach the new physician about the vital sign of temperature. The module is\nblended to incorporate online learning via both direct and asynchronous methods, as well as faceto-\nface interactions using high fidelity simulation....
Background: The objective of this paper is to evaluate the response times and outcome of patients in two groups\nof patients attended by permanently (PS) and temporarily stationed ambulances (TS) (fluid deployment).\nMethods: Patients transported and treated by EMS between March 21, 2012 and March 20, 2013 in a city with\n1.7 million inhabitants (Shiraz, Iran) were studied. Using the same number of ambulances, patients were divided\ninto two groups: transported by ambulances dispatched from permanent ambulance stations (PS) vs. dispatched\nfrom temporary locations (TS). Furthermore, due to a high discrepancy in the number of missions between PS and\nTS in this group, a pilot study was also conducted to confirm the first result. The results were statistically analyzed\nusing various methods and compared with regard to mortality and response time.\nResults: In this study (both periods), ambulances dispatched from TS had a reduction of their mean response times\nby 2 min compare to ambulances dispatched from PS. The difference was statistically significant (p < 0.001ââ?¬â??[95 % CI,\n1.975, 2.025]). The pre-hospital mortality rate was also significantly lower for this group (p = 0.04ââ?¬â??[95 % CI, 0.006, 0.012]).\nConclusions: The results of this study suggest that temporary deployment of ambulances reduce response times and\nmay improve early survival rates in patients managed by EMS....
Background: As global emergency care grows, practical and effective performance measures are needed to ensure\nhigh quality care. Our objective was to systematically catalog and classify metrics that have been used to measure\nthe quality of emergency care in resource-limited settings.\nMethods: We searched MEDLINE, Embase, CINAHL, and the gray literature using standardized terms. The references\nof included articles were also reviewed. Two researchers screened titles and abstracts for relevance; full text was\nthen reviewed by three researchers. A structured data extraction tool was used to identify and classify metrics into\none of six Institute of Medicine (IOM) quality domains (safe, timely, efficient, effective, equitable, patient-centered)\nand one of three of Donabedian�s structure/process/outcome categories. A fourth expert reviewer blinded to the\ninitial classifications re-classified all indicators, with a weighted kappa of 0.89.\nResults: A total of 1705 articles were screened, 95 received full text review, and 34 met inclusion criteria. One\nhundred eighty unique metrics were identified, predominantly process (57 %) and structure measures (27 %); 16 %\nof metrics were related to outcomes. Most metrics evaluated the effectiveness (52 %) and timeliness (28 %) of care,\nwith few addressing the patient centeredness (11 %), safety (4 %), resource-efficiency (3 %), or equitability (1 %) of\ncare.\nConclusions: The published quality metrics in emergency care in resource-limited settings primarily focus on the\neffectiveness and timeliness of care. As global emergency care is built and strengthened, outcome-based measures\nand those focused on the safety, efficiency, and equitability of care need to be developed and studied to improve\nquality of care and resource utilization....
Problem. Chain saws are a commonly used tool with the potential to inflict severe injuries. Methods. Descriptive epidemiological\nestimates for emergency department (ED) visits for injuries associated with the use of a chain saw were calculated using data from\nthe National Electronic Injury Surveillance System for the years 2009ââ?¬â??2013. Results. A total of 115,895 ED visits for injuries related\nto the use of a chain saw occurred during the study period.Most injury visits occurred among males (95%) and persons aged 30ââ?¬â??59\nyears and during the months of September through November.The main body sites injured were the hand/fingers and knee. The\nmajority of injuries were lacerations (80%). Conclusions. Chain saw injuries present with characteristic patterns which can aid in\nprevention of injuries related to the use of these tools. Examination of the epidemiology of chain saw injuries will help to ascertain\ntargeted needs for prevention and control efforts....
Background: Patient safety in the context of emergency medicine is a relatively new field of study. To date, no\nbroad research agenda for patient safety in emergency medicine has been established. The objective of this study\nwas to establish patient safety-related research priorities for emergency medicine. These priorities would provide a\nfoundation for high-quality research, important direction to both researchers and health-care funders, and an essential\nstep in improving health-care safety and patient outcomes in the high-risk emergency department (ED) setting.\nMethods: A four-phase consensus procedure with a multidisciplinary expert panel was organized to identify, assess,\nand agree on research priorities for patient safety in emergency medicine. The 19-member panel consisted of clinicians,\nadministrators, and researchers from adult and pediatric emergency medicine, patient safety, pharmacy, and mental\nhealth; as well as representatives from patient safety organizations. In phase 1, we developed an initial list of potential\nresearch priorities by electronically surveying a purposeful and convenience sample of patient safety experts, ED\nclinicians, administrators, and researchers from across North America using contact lists from multiple organizations. We\nused simple content analysis to remove duplication and categorize the research priorities identified by survey\nrespondents. Our expert panel reached consensus on a final list of research priorities through an in-person meeting\n(phase 3) and two rounds of a modified Delphi process (phases 2 and 4).\nResults: After phases 1 and 2, 66 unique research priorities were identified for expert panel review. At the end of\nphase 4, consensus was reached for 15 research priorities. These priorities represent four themes: (1) methods to\nidentify patient safety issues (five priorities), (2) understanding human and environmental factors related to patient\nsafety (four priorities), (3) the patient perspective (one priority), and (4) interventions for improving patient safety\n(five priorities).\nConclusion: This study established expert, consensus-based research priorities for patient safety in emergency\nmedicine. This framework could be used by researchers and health-care funders and represents an essential guiding\nstep towards enhancing quality of care and patient safety in the ED....
Background: The purpose of this study was to assess the feasibility of the Emergency Department (ED) as a place\nfor obesity education and to evaluate its impact on patient�s lifestyle modification.\nMethods: In this study, children between 8 and 18 years of age, who presented to the ED for non-urgent reasons\nin a single urban hospital, were enrolled. Parents� perception of their child�s diet and exercise were assessed prior to\nthe intervention. Both parents and children attended a brief audio-visual presentation that provided educational\ninformation on age-appropriate diet and exercise. Following the intervention, the participants were asked about their\nimpressions regarding the ED as a place to receive obesity education and whether they plan to make any changes in\ndiet and exercise.\nResults: One hundred children and their parents participated in this study. Of these, 76 were Latino and 21\nwere African-Americans. The mean age was 14 years, and the mean body mass index (BMI) was 25.6. Following the\nintervention, 21 (100 %) of the African-American parents and 73 (98.6 %) of the Latino parents felt that the ED should\nprovide obesity education. Eighteen (85.7 %) of the African-American parents and 72 (97.3 %) of the Latino parents\nplanned to make changes in their child�s diet and exercise. Among the children, 21 (100 %) of African-American\nparticipants and 76 (100 %) of Latino participants reported that they found the audio-visual useful. Seventeen\n(81.0 %) of the African-American children and 73 (96.1 %) of Latino children stated learning new information from\nthe intervention program.\nConclusions: This study suggests the ED may have a role in primary health promotion and obesity prevention.\nAn ED-based intervention may be used to provide education about obesity prevention and has the potential to\nimpact life style modifications, including diet and exercise....
Objective. To determine the accuracy of Point-Of-Care testing (PoCT) creatinine values when compared to standard central\nlaboratory testing (IDMS) and to demonstrate if and how a discrepancy could lead to improper risk stratification for contrast\ninduced nephropathy (CIN). Methods. We conducted a descriptive retrospective chart review of patients seen in the Emergency\nDepartment of a single suburban, community, and academic medical center.We included patients who presented to the department\nbetweenMarch 2013 and September 2014who had blood samples analyzed by both PoCT and IDMS. Results.Mean IDMScreatinine\nvalues were 0.23mg/dL higher when compared with i-Stat values. 95% of the time, the IDMS creatinine value was variable and\nranged from âË?â??0.45mg/dL to +0.91mg/dL when compared to the i-Stat creatinine.When using i-Stat creatinine values to calculate\nGFR, 47 out of 156 patients had risk category variations compared to using the IDMS value. This affected 30.1% of the total\neligible sample population (22.9% to 37.3% with 95% CI). Conclusion.We found a significant discrepancy between PoCT and IDMS\ncreatinine values and found that this discrepancy could lead to improper risk stratification for CIN....
Aim. To describe the actual use of blood alcohol concentration (BAC) testing in an emergency department. Method. This study\nwas performed to examine in what circumstances emergency medicine doctors and nurses request blood alcohol concentrations\nand the outcome of patients so tested. A retrospective study was performed. A database of all the patients who presented to the\nemergency department and who were tested for BAC in 2012 was created. Descriptive statistics are used to present the findings.\nResults.During 2012, there were 1191 patients on whom BAC testing was performed. 37 patients had a BAC greater than the allegedly\nlethal concentration of 400 mg/100 mL. Using a multifactorial analysis model, a higher blood alcohol concentration was associated\nwith a lower Glasgow Coma Score. Conclusion. BAC testing is most often performed in the context of alleged overdose. BAC was\nperformed in other clinical scenarios albeit in less than 2% of all ED attendances....
Background.The simulation literature widely agrees that the reflective learning phase after the simulation is equal to or perhaps of\neven greater importance than the actual simulated scenario in ensuring learning. Nevertheless, advanced life support (ALS) tends\nto have many simulated scenarios followed by short feedback sessions. The aim of this study was to compare the ability of two\ngroups of novice learners to stay adherent to the ALS guidelines in their provision of ALS after they had received either 8 or 12\nsimulated resuscitation scenarios, both in 4 hours. Methods. This study was a randomised controlled trial. Participants were either\nrandomised to the control group with 12 scenarios (15 minutes per scenario) with 5 minutes of feedback or the intervention group\nwith 8 simulations (15 minutes per scenario) with 15 minutes of feedback. Results.There was no statistically significant difference\nin test scores between the intervention group and control group in the 1-week retention test (...
Background: Unplanned re-attendance at the Emergency Department (ED) is often monitored as a quality\nindicator of the care accorded to patients during their index ED visit. High bed occupancy rate (BOR) has been\nconsidered as a matter of reduced patient comfort and privacy. Most hospitals in Singapore operate under BORs\nabove 85 %. This study aims to explore factors associated with the unplanned 3-day ED re-attendance rate and, in\nparticular, if higher BOR is associated with higher 3-day unplanned ED re-attendance rate.\nMethods: This was a multicenter retrospective study using time series data. Three acute tertiary hospitals were\nselected from all six adult public hospitals in Singapore based on data availability. Daily data from year 2008 to\n2013 were collected from the study hospitals� information systems. These included: ED visit date, day of week,\nmonth, year, public holiday, daily hospital BOR, daily bed waiting time (BWT) at ED (both median and 95th\npercentile), daily ED admission rate, and 3-day ED re-attendance rate. The primary outcome of the study was\nunplanned 3-day ED re-attendance rate from all reasons. Both univariate analysis and generalized linear regression\nwere respectively applied to study the crude and adjusted association between the unplanned 3-day ED reattendance\nrate and its potential associated factors. All analyses were conducted using SPSS 18 (PASW 18, IBM).\nResults: The average age of patients who visited ED was 35 years old (SD = 2), 37 years old (SD = 2), and 40 years old\n(SD = 2) in hospitals A, B, and C respectively. The average 3-day unplanned ED re-attendance rate was 4.9 % (SE = 0.47 %)\nin hospital A, 3.9 % (SE = 0.35 %) in hospital B, and 4.4 % (SE = 0.30 %) in hospital C. After controlling for other covariates,\nthe unplanned 3-day ED re-attendance rates were significantly associated with hospital, time trend, day of week, daily\naverage BOR, and ED admission rate. Strong day-of-week effect on early ED re-attendance rate was first explored in this\nstudy. Thursday had the lowest re-attendance rate, while Sunday has the highest re-attendance rate. The patients who\nvisited at ED on the dates with higher BOR were more likely to re-attend the ED within 3 days for hospitals A and B.\nThere was no significant association between BOR and ED re-attendance rate in hospital C.\nConclusions: A study using time series data has been conducted to explore the factors associated with the\nunplanned 3-day ED re-attendance rate. Strong day-of-week effect was first reported. The association between\nBOR and the ED re-attendance rate varied with hospital....
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