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"Fast Track" AND "Emergency"

Kristyn C Huffman
Fast tracks are widely used in emergency departments to increase patient throughput as annual visits continue to rise in the United States. A modified triage process known as QuickLook, which omits patients' past medical history, is used in some hospitals to further increase throughput. This article discusses the effects of QuickLook on patient placement, reviews the role of past medical history in triage, and discusses the impact of integrating a targeted history question into the QuickLook process of an emergency department in Arizona...
March 2019: Nursing Clinics of North America
Katherine Walker, Michael Ben-Meir, William Dunlop, Rachel Rosler, Adam West, Gabrielle O'Connor, Thomas Chan, Diana Badcock, Mark Putland, Kim Hansen, Carmel Crock, Danny Liew, David Taylor, Margaret Staples
OBJECTIVES: To evaluate the changes in productivity when scribes were used by emergency physicians in emergency departments in Australia and assess the effect of scribes on throughput. DESIGN: Randomised, multicentre clinical trial. SETTING: Five emergency departments in Victoria used Australian trained scribes during their respective trial periods. Sites were broadly representative of Australian emergency departments: public (urban, tertiary, regional referral, paediatric) and private, not for profit...
January 30, 2019: BMJ: British Medical Journal
Lijie Ren, Chao Li, Weiping Li, Yixuan Zeng, Shisheng Ye, Zhichao Li, Hongye Feng, Zhihao Lei, Jingjing Cai, Shiyu Hu, Yi Sui, Qiang Liu, Bernard M Y Cheung
China has the largest stroke population and at-risk population in the world. However, it has a lower thrombolytic therapy rate and longer onset-to-needle time/door-to-needle time for patients who had an acute stroke compared with developed countries, which might be due to redundant procedures or inefficient systems. Things are changing due to some new initiatives. Two years ago, a new emergency system in China, Stroke Emergency Map, was first launched as a regional emergency system in Shenzhen, the bustling metropolis just north of Hong Kong...
January 29, 2019: Postgraduate Medical Journal
Robin M Hermann, Elizabeth Long, Rebecca L Trotta
INTRODUCTION: As health care becomes increasingly patient centered, organizations strive to improve patients' ratings of satisfaction with care. Communication with nurses and providers drives overall satisfaction, yet little evidence exists to guide them in ensuring effective communication in the emergency department. METHODS: A semistructured interview guide based on the Hospital Consumer Assessment of Healthcare Providers survey was used to elicit qualitative data from 30 patients seen in the emergency department and fast track regarding communication with nurses and providers...
January 14, 2019: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
Jonathan Youngs, Yasser Iqbal, Stephen Glass, Peter Riley, Cassie Pope, Timothy Planche, David Carrington
The cobas® Liat® influenza A/B & RSV assay (Liat) was used in the adult Emergency Department of a large London Hospital from 21/1/18-14/4/18. Influenza was detected in 308/1027 (30%) of samples tested; influenza A in 157 (15.3%) and influenza B in 149 (14.5%) and RSV in 28 (2.7%). When compared against Fast Track Diagnostics Respiratory Pathogens 21 multiplex PCR and Cepheid Xpert® Xpress Flu/RSV assay, Liat performance for the detection of influenza A or B was: sensitivity 85% (95% CI, 76-92), specificity 98% (95% CI, 97-99), negative predictive value 94% (95% CI, 92-96), positive predictive value 95% (95% CI, 91-97)...
December 15, 2018: Journal of Hospital Infection
N A Sizonenko, D A Surov, I A Solov'ev, A E Demko, A V Osipov, M A Gabrielyan, A L Pavlovsky
Effectiveness of enhanced recovery program is being earnestly confirmed in various surgical areas. Certain aspects of fast track rehabilitation are analyzed in the article.
2018: Khirurgiia
Khairunnisa Abdul Ghaffar, Lisa F P Ng, Laurent Renia
In early 2014, a relatively obscure virus, the Zika virus, made headlines worldwide following an increase in the number of congenital malformations. Since then, research on Zika virus, treatment and vaccines have progressed swiftly with various drugs being repurposed and vaccines heading into clinical trials. Nonetheless, the need for a vaccine is crucial in order to eradicate this re-emerging arthropod-borne virus which remained silent since its first discovery in 1947. In this review, we focused on how the inconspicuous virus managed to spread, the key immunological factors required for a vaccine and the various vaccine platforms that are currently being studied...
November 21, 2018: Vaccines
Adam Richardson, Semhar Z Tewelde, Zachary D W Dezman
A 48-year-old male with a history of intravenous (IV) drug use presented to the emergency department (ED) for an area of mild pain and erythema on his chest. He was then triaged to the urgent care, or fast track, area of the ED. He was well appearing with normal lab findings and vital signs, but his workup revealed mediastinitis with osteomyelitis of the manubrium and clavicles, a surgical emergency. His treatment course included IV antibiotics and operative intervention with thoracic surgery. The patient looked too good to be sick , yet he had a life-threatening infection...
November 2018: Clinical practice and cases in emergency medicine
Himanshu L Kataria, Marc A Jacobson
Introduction: Elderly patients often present to the emergency department (ED) with nonspecific signs of infection and excessive fluid loss, with limited research into their management. The purpose of this audit was to assess the initial management of hypotensive elderly patients in the ED: observations within 15 min, fluid challenge within 1 h, time to assessment by a physician, and initial management of septic shock. Subjects and Methods: Online patient systems were reviewed to find 40 patients >65 years old who were hypotensive (systolic blood pressure <100 mmHg or diastolic blood pressure <60 mmHg) in the ED between 1st October 2015 and 16th November 2015...
July 2018: Journal of Emergencies, Trauma, and Shock
Auwal I Kabuga, Mohamed E El Zowalaty
Since the eradication of smallpox approximately 39 years ago, monkeypox virus remains the most pathogenic poxvirus, being mainly restricted to Central and West Africa. Before 1970, there were no reports of human monkeypox in Nigeria, while between 1971 and 1978 there were three cases, with none having been reported thereafter. However, in September 2017, a case of contagious skin rash disease, typical of monkeypox, was observed in an 11-year-old boy from the southern part of the country, and confirmed to be associated with the monkeypox virus...
October 24, 2018: Journal of Medical Virology
Alberto Carli, Francesca Moretti, Giulia Giovanazzi, Valentina Niero, Valeria Perilli, Giovanna Ghirlanda, Chiara Bovo, Stefano Tardivo
BACKGROUND AND AIM: Patients could leave ED not receiving the desired care either Without Being Seen by a doctor (LWBS) or Against Medical Advice (DAMA). In term of care quality, LWBS may be related to inappropriate access and process of care, while DAMA may lead to increased risk of mortality and re-admissions. This study aims to identify frequency of patients who leave ED, determine their characteristics and identify associated factor. METHODS: This was a retrospective observational study of patients that attended EDs of University Hospital Trust of Verona in 2017...
October 8, 2018: Acta Bio-medica: Atenei Parmensis
Kirsten Specht, Hanne Agerskov, Per Kjaersgaard-Andersen, Rebecca Jester, Birthe D Pedersen
BACKGROUND: Due to the shortened length of stay in fast-track total hip and knee arthroplasty, patients must at a very early stage following surgery take responsibility for their postoperative care and treatment. It is important to establish if this treatment modality of fast-track is not only cost-effective, but meets patients' expectations and needs. AIM: To explore the lived experience of patients in fast-track total hip and knee arthroplasty during the first 12 weeks after discharge...
November 2018: International Journal of Orthopaedic and Trauma Nursing
Fabrice Petitjeans, Cyrille Pichot, Marco Ghignone, Luc Quintin
Acute respiratory distress syndrome (ARDS) is not a failure of the neurological command of the ventilatory muscles or of the ventilatory muscles; it is an oxygenation defect. As positive pressure ventilation impedes the cardiac function, paralysis under general anaesthesia and controlled mandatory ventilation should be restricted to the interval needed to control the acute cardio-ventilatory distress observed upon admission into the critical care unit (CCU; "salvage therapy" during "shock state")...
September 2018: Turkish Journal of Anaesthesiology and Reanimation
Alberto Tlacuilo-Parra, Sandy P López-Valenzuela, Gabriela Ambriz-González, Elizabeth Guevara-Gutiérrez
Objetivo: Comparar la seguridad y la eficacia de la atención fast-track vs. atención convencional en apendicitis no complicada en un hospital pediátrico. Método: Ensayo clínico controlado, aleatorizado, con dos grupos de 30 pacientes cada uno: A) fast-track, apendicitis no complicada que cumplieron el programa; y B) atención convencional, apendicitis no complicada con atención habitual. Variables de seguridad y eficacia: proporción de complicaciones y tiempo de estancia hospitalaria...
2018: Cirugia y Cirujanos
Charles Hobson, Nicholas Lysak, Matthew Huber, Salvatore Scali, Azra Bihorac
OBJECTIVE: Conventional clinical wisdom has often been nihilistic regarding the prevention and management of acute kidney injury (AKI), despite its being a frequent and morbid complication associated with both increased mortality and cost. Recent developments have shown that AKI is not inevitable and that changes in management of patients can reduce both the incidence and morbidity of perioperative AKI. The purpose of this narrative review was to review the epidemiology and outcomes of AKI in patients undergoing vascular surgery using current consensus definitions, to discuss some of the novel emerging risk stratification and prevention techniques relevant to the vascular surgery patient, and to describe a standardized perioperative pathway for the prevention of AKI after vascular surgery...
September 2018: Journal of Vascular Surgery
Glenn Larsson, Ulf Strömberg, Cecilia Rogmark, Anna Nilsdotter
Background: Older patients with a hip fracture require specialized emergency care and their first healthcare encounter before arriving at the hospital is often with the ambulance service. Since 2005 there has been a registered nurse on the crew of every ambulance in Sweden in order to provide prehospital emergency care and to prepare the patients for hospitalization. It is important to investigate patient satisfaction with prehospital emergency care following a hip fracture to ensure that their expectations of good care are met...
2018: BMC Nursing
Loren De Freitas, Steve Goodacre, Rachel O'Hara, Praveen Thokala, Seetharaman Hariharan
OBJECTIVES: Patient flow and crowding are two major issues in ED service improvement. A substantial amount of literature exists on the interventions to improve patient flow and crowding, making it difficult for policymakers, managers and clinicians to be familiar with all the available literature and identify which interventions are supported by the evidence. This umbrella review provides a comprehensive analysis of the evidence from existing quantitative systematic reviews on the interventions that improve patient flow in EDs...
October 2018: Emergency Medicine Journal: EMJ
Jeong-Ju Yoo, Won Kim, Moon Young Kim, Dae Won Jun, Sang Gyune Kim, Jong-Eun Yeon, Jin Woo Lee, Yong Kyun Cho, Sang Hoon Park, Joo Hyun Sohn
Nonalcoholic fatty liver disease (NAFLD), together with metabolic syndrome and obesity, has shown a rapid increase in prevalence worldwide and is emerging as a major cause of chronic liver disease and liver transplantation. Among the various phenotypes of NAFLD, nonalcoholic steatohepatitis (NASH) is highly likely to progress to development of end-stage liver disease and cardiometabolic disease, resulting in liver-related and non-liver-related mortality. Nonetheless, there is no standardized pharmacotherapy against NASH and many drugs are under development in ongoing clinical trials...
August 8, 2018: Clinical and Molecular Hepatology
R Sudhakaran, Jeetinder K Makkar, Divya Jain, Jyotsna Wig, R Chabra
Background and Aims: Several techniques have evolved over time to monitor depth of anesthesia and ensure enhanced recovery. This randomized double-blinded trial was designed to compare bispectral index (BIS) or end-tidal anaesthetic concentration (ETAC) monitoring on the recovery characteristics of patients undergoing thoracolumbar spine surgeries. Methods: Seventy American Society of Anesthesiologist I-II patients of either sex were randomized to Group B - BIS-guided protocol, Group E - ETAC-guided protocol, or Group S - Standard protocol...
July 2018: Indian Journal of Anaesthesia
Carol Anne Celona, Andrew Amaranto, Robin Ferrer, Matt Wieland, Stacy Abrams, Farley Obusan, Sharon LoPuzzo, Valsamma Joy
Delays in medical care will increase risks for patients. For this reason, timeliness of care is a public health priority and the one of the missions for this facility. The goal of this process improvement project was to enhance timeliness of care by restructuring fast track. Door-to-provider time, treat and release time, and the number of patients who left without being seen by a provider were monitored. Nurse practitioners were introduced into advanced practice provider mix and the development of care teams was implemented...
July 2018: Advanced Emergency Nursing Journal
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