Current Issue : April - June Volume : 2016 Issue Number : 2 Articles : 7 Articles
Objective: In 2003, we published a study on the Israeli workforce in emergency medicine (EM). We repeated the\nstudy in 2012 to assess changes in the workforce that have occurred in the interval decade.\nMethods: This is an observational cross-sectional study of the physician workforce in EM in Israel in 2012. An online\nsurvey was sent to the ED medical directors of all general hospitals in Israel querying the numbers of physicians\nworking in the ED, as well as the specialty and level of training of those manning the ED at various times during\nthe day. The workforce in 2012 was compared to that of 2003.\nResults: Twenty-four of 28 (86 %) EDs responded. Certified EM specialists have increased from 59 to 164 since 2003.\nDisparities continue regarding their presence in the ED. Most EM specialists are scheduled during the day whereas\nthey are virtually absent during the night. A total of 58 EM specialists were scheduled countrywide for the weekday\nday shift and only one overnight. The preponderance of EM specialists working during the day and the large number of\nsupervised and unsupervised residents working at night has not changed substantially since 2003. Eleven departments\nreported having an EM specialist present during the evenings whereas in 2003, only two departments reported so.\nConclusion: Since 2003, there are more certified EM specialists and more specialist coverage in the ED into the evening\nhours. Most ED providers are still not emergency physicians, and there is still a preponderance of EM specialist coverage\nduring the day and a lack thereof overnight....
Objectives. A free-standing emergency department (FSED) is a facility that provides comprehensive emergencymedical care similar\nto a traditional emergency department but is not attached to a hospital campus. Medical scribes are increasingly likely to work in\nfree-standing emergency departments. The purpose of this study was to retrospectively investigate the benefits of a scribe program\nin an FSED. Methods. A retrospective, Institutional Review Board-approved analysis from December 1, 2013, to February 1, 2015,\nof free-standing emergency department medical data was extracted to determine if scribed charts resulted in increased revenue\nand improved throughput. Results. When scribes are present in the FSED there is a small, but statistically significant, decrease in\ntime from patient arrival to provider by 2.74 minutes. Scribed charts collected $4.69 more per chart and resulted in an increase in\nproductivity. Incremental cost effectiveness ratios resulted in proven cost-utility with a net-positive effect. Conclusion.While there\nare some gains in terms of operational metrics and provider productivity with the addition of scribes to a free-standing emergency\ndepartment, there is a net-positive financial impact of scribes. Implementing a scribe program at a FSED is cost-effective and\njustified from both an operational and a financial analysis....
Introduction. The potential for hospital-based interventions for male victims of intimate partner violence (IPV) as well as adult\nperpetrators of both genders has been largely unexplored despite early evidence of acute-care utilization that may be as high\nas female victims. The current investigation compared the emergency department (ED) and injury-related-hospitalization rates\nof IPV-involved individuals against standardized national norms, assessing differences by gender and victim/perpetrator-status.\nMethods.This cross-sectional study collected one-year ED and in-patient visit data from hospital records for individuals listed as\nvictim or perpetrator in an IPV criminal charging request in a Midwestern county (...
Background: Prehospital delays in receiving emergency care for suspected stroke and myocardial infarction (MI)\npatients have significant impacts on health outcomes. Use of Emergency Medical Services (EMS) has been shown\nto reduce these delays. However, disparities in EMS transport delays are thought to exist. Therefore the objective of\nthis study was to investigate and identify disparities in EMS transport times for suspected stroke and MI patients.\nMethods: Over 3,900 records of suspected stroke and MI patients, reported during 2006ââ?¬â??2009, were obtained from\ntwo EMS agencies (EMS 1 & EMS 2) in Tennessee. Summary statistics of transport time intervals were computed.\nMultivariable logistic models were used to identify predictors of time intervals exceeding EMS guidelines.\nResults: Only 66 and 10 % of suspected stroke patients were taken to stroke centers by EMS 1 and 2, respectively.\nMost (80ââ?¬â??83 %) emergency calls had response times within the recommended 10 min. However, over 1/3 of\nthe calls had on-scene times exceeding the recommended 15 min. Predictors of time intervals exceeding EMS\nguidelines were EMS agency, patient age, season and whether or not patients were taken to a specialty center.\nThe odds of total transport time exceeding EMS guidelines were significantly lower for patients not taken to\nspecialty centers. Noteworthy was the 72 % lower odds of total time exceeding guidelines for stroke patients\nserved by EMS 1 compared to those served by EMS 2. Additionally, for every decade increase in age of the patient,\nthe odds of on-scene time exceeding guidelines increased by 15 and 19 % for stroke and MI patients, respectively.\nConclusion: In this study, prehospital delays, as measured by total transport time exceeding guideline was influenced\nby season, EMS agency responsible, patient age and whether or not the patient is transported to a specialty center.\nThe magnitude of the delays associated with some of the factors are large enough to be clinically important although\nothers, though statistically significant, may not be large enough to be clinically important. These findings should be\nuseful for guiding future studies and local health initiatives that seek to reduce disparities in prehospital delays so as to\nimprove health services and outcomes for stroke and MI patients....
Background: This study investigates clinicians� views of clinician-patient and clinician-clinician communication,\nincluding key factors that prevent clinicians from achieving successful communication in a large, high-pressured\ntrilingual Emergency Department (ED) in Hong Kong.\nMethods: Researchers interviewed 28 doctors and nurses in the ED. The research employed a qualitative\nethnographic approach. The interviews were audio-recorded, transcribed, translated into English and coded using\nthe Nvivo software. The researchers examined issues in both clinician-patient and clinician-clinician communication.\nThrough thematic analyses, they identified the factors that impede communication most significantly, as well as the\nrelationship between these factors. This research highlights the significant communication issues and patterns in\nHong Kong EDs.\nResults: The clinician interviews revealed that communication in EDs is complex, nuanced and fragile. The data\nrevealed three types of communication issues: (1) the experiential parameter (i.e. processes and procedures), (2) the\ninterpersonal parameter (i.e. clinicians� engagements with patients and other clinicians) and (3) contextual factors\n(i.e. time pressures, etc.). Within each of these areas, the specific problems were the following: compromises in\nknowledge transfer at key points of transition (e.g. triage, handover), inconsistencies in medical record keeping,\nserious pressures on clinicians (e.g. poor clinician-patient ratio and long working hours for clinicians) and a lack of\nfocus on interpersonal skills.\nConclusions: These communication problems (experiential, interpersonal and contextual) are intertwined, creating a\ncomplex yet weak communication structure that compromises patient safety, as well as patient and clinician\nsatisfaction. The researchers argue that hospitals should develop and implement best-practice policies and\neducational programmes for clinicians that focus on the following: (1) understanding the primary causes of\ncommunication problems in EDs, (2) accepting the tenets and practices of patient-centred care, (3) establishing clear\nand consistent knowledge transfer procedures and (4) lowering the patient-to-clinician ratio in order to create the\nconditions that foster successful communication. The research provides a model for future research on the relationship\nbetween communication and the quality and safety of the patient safety....
Background: Acutely ill patients admitted to the emergency department (ED) constantly require at least one fast\nand reliable peripheral intravenous (PIV) access. In many conditions (morbid obesity, underweight state, chronic\ndiseases, intravenous drug abuse, adverse local conditions, etc.), PIV placement may be challenging.\nUltrasound guidance is a useful tool for obtaining a peripheral intravenous access in the emergency department,\nparticularly when superficial veins are difficult to identify by palpation and direct visualization, though standard\nperipheral intravenous cannulas are not ideal for this technique of insertion and may have limited duration.\nLong polyurethane catheters inserted with ultrasound guidance and direct Seldinger technique appear to have\nseveral advantages over short cannulas in terms of success of insertion and of duration.\nMethods: A retrospective analysis was conducted on all the ultrasound-guided peripheral venous accesses\nobtained by insertion of long polyurethane catheters in patients admitted to the emergency department of our\nuniversity hospital during 1 year. The main indication to the procedure was the urgent need of a peripheral venous\naccess in patients with superficial veins difficult to palpate and/or visualize. All relevant data concerning the\ninsertion and the maintenance of these peripheral lines were collected from the chart.\nResults: Seventy-six patients were included in this review. The success rate of insertion was 100 %, with an average\nof 1.57 punctures per each successful cannulation. The mean time needed for the complete procedure was 9.5 min.\nIn 73 % of patients, the catheter was used for more than 1 week; a minority of catheters were removed\nprematurely for end of use. No major infective or thrombotic complication was reported.\nConclusions: In our experience, 8- to 10-cm-long polyurethane catheters may offer a fast and reliable peripheral\nvenous access in the emergency department, if placed by ultrasound guidance and with the Seldinger technique.\nFurther studies with prospective, randomized, and controlled design are warranted to confirm our results....
Background: Ventilation monitoring practice for intubated pediatric patients with severe traumatic brain injury (TBI)\nduring interfacility transport (IFT) has not been well documented. We describe the difference of practices in\nventilation monitoring during IFT from the perspective of a level I pediatric trauma center with an enormous\ncatchment area.\nMethods: Patients admitted between July 2008 and September 2013 at Winnipeg Health Science Center, Canada,\nwere examined in this retrospective chart review. All patients with severe TBI were intubated in regional health\ncenters and required transport to the level 1 trauma center. Injuries due to inflicted head trauma (<5 years of age),\nstroke, drowning, and asphyxia were excluded. Patient characteristics, injury data, ventilation monitoring, and\ntransport metrics were obtained from a regional health center, and transport and trauma center charts.\nResults: Thirty four patients were studied. Specialty transport teams utilized ventilation monitoring significantly\nmore often (95 vs. 23 %; p < 0.001) than non-specialized ground transport. Specialty teams were more likely to\nobtain a blood gas prior to departure (74 vs. 0 %; p = 0.037) if end-tidal monitoring was used. Among unmonitored\nground transport patients, mean transport time was 69.1 min.\nConclusions: Non-specialized ground IFT teams did not reliably monitor ventilation in intubated severe pediatric\nTBI patients. Blood gas monitoring was not a ubiquitous practice for either team. Optimal ventilation monitoring\nstrategies for severe pediatric TBI may require both blood gas and end-tidal monitoring....
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