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ED critical care

Zerrin Defne Dundar, Sedat Kocak, Abdullah Sadik Girisgin
INTRODUCTION: In this study, we aimed to investigate the prognostic power of the first lactate level measured in the emergency department (ED), National Early Warning Score (NEWS), and NEWS-lactate (NEWS-L) on ED admission in critically ill geriatric patients. METHODS: This retrospective observational study was conducted in the ED of a university hospital. Consecutive patients ≥65 years of age admitted to our ED between July 1, 2017, and December 31, 2017, and transferred to the intensive care unit after the ED follow-up period were included in the study...
February 7, 2019: American Journal of Emergency Medicine
Yanny Trisyani, Carol Windsor
PURPOSE: While emergency department nurses in Indonesia are critical to quality care, the role lacks recognition and standard practices and regulation of scope of practice are absent. This research explored the role of nurses in Indonesian EDs. METHOD: The conceptual lens applied in the research was grounded theory. The main data source was 51 semi- structured interviews with 43 ED nurses, three directors of nursing, three nurse leaders and two nurse educators. Data were also generated through observations and memos...
December 2019: International Journal of Qualitative Studies on Health and Well-being
Jaclyn M Stoffel, Regan A Baum, Adam J Dugan, Abby M Bailey
Purpose: The purpose of this survey-based research project is to identify factors, including prior training, institution demographics, and pharmacist prioritization of services that may impact variability in practice among emergency medicine (EM) pharmacists. Methods: An electronic survey was available for 6 weeks. Participants were contacted through professional membership directories. Survey questions addressed EM pharmacist training and institution demographics...
February 8, 2019: American Journal of Health-system Pharmacy: AJHP
Roseanne Moody Fairchild, Shiaw-Fen Ferng-Kuo, Stephanie Laws, Hicham Rahmouni, Daniel Hardesty
BACKGROUND: Telehealth has been proposed as an important care delivery strategy to increase access to behavioral health care, especially in rural and medically-underserved settings where mental health care provider shortage areas predominate, to speed access to behavioral health care, and reduce health disparities. INTRODUCTION: This study was conducted to determine the effects of telehealth-based care delivery on clinical, temporal, and cost outcomes for behavioral health patients in rural emergency departments (EDs) of four Midwestern critical access hospitals (CAHs)...
February 8, 2019: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
Joshua R Radparvar, George Lim, Alan T Chiem
OBJECTIVES: As point of care ultrasound (POCUS) has become more integrated into emergency and critical care medicine, there has been increased interest in utilizing ultrasound to assess volume status. However, recent studies of carotid POCUS on volume status and fluid responsiveness fail to recognize the effect insonation angle has on their results. To address this, we studied the effect of insonation angle on peak systolic velocity (PSV) change associated with respiratory variation (RV) and passive leg raise (PLR)...
January 29, 2019: American Journal of Emergency Medicine
Kathleen Wyatt Chester, Megan Corrigan, J Megan Schoeffler, Michelle Shah, Florence Toy, Barbara Purdon, George M Dillon
Alteplase, reteplase, and tenecteplase are tissue plasminogen activators (TPA) approved for the management of acute myocardial infarction. Only alteplase is also approved for the treatment of acute ischemic stroke (AIS). The US Food and Drug Administration has received reports of accidental administration of tenecteplase or reteplase instead of alteplase in patients with AIS, which can result in failure to treat patients with the intended agent and lead to potential overdose. Areas covered: This review compares the molecular and clinical features of alteplase, reteplase, and tenecteplase (TNK), identifies factors contributing to medication errors among these agents, and provides steps to reduce medication errors...
February 4, 2019: Expert Opinion on Drug Safety
Rachel Yaffa Zisk-Rony, Charles Weissman, Yoram G Weiss
BACKGROUND: Mechanical ventilation is a life supporting modality increasingly utilized when caring for severely ill patients. Its increasing use has extended the survival of the critically ill leading to increasing healthcare expenditures. We examined changes in the hospital-wide use of mechanical ventilation over 20 years (1997-2016) in two Israeli hospitals to determine whether there were specific patterns (e.g. seasonality, weekday vs. weekend) and trends (e.g. increases or decreases) among various hospital departments and units...
February 1, 2019: Israel Journal of Health Policy Research
Claus Vogelmeier, Jürgen Floege, Thomas Gamstätter
Celebrating the 200th anniversary of its founder, Friedrich Theodor von Frerichs, the German Society of Internal Medicine (DGIM) publishes perspectives for its work in the coming years, which will be shaped by challenges for medicine and science. Based on ten critically analyzed topics - namely physicians as researchers, "choosing wisely", digital medicine, the economization of medicine, medical education, demographic changes and multimorbidity, systems medicine, infectious diseases and hygiene, intensive care and emergency departments, and nursing and medical assistance jobs - this paper outlines the fundamental positions of the society...
February 2019: Deutsche Medizinische Wochenschrift
Yohei Kamikawa, Hiroyuki Hayashi
OBJECTIVE: To prevent misjudgment of the severity of patients in the emergency department who initially seem non-severe but are in a critical state, methods that differ from the conventional viewpoint are needed. We aimed to determine whether vital sign changes between prehospital and in-hospital could predict in-hospital mortality among non-trauma patients. METHODS: This observational cohort study was conducted in two tertiary care hospitals. Patients were included if they were transported by ambulance for non-trauma-related conditions but were excluded if they experienced prehospital cardiopulmonary arrest, were pregnant, were aged <15 years, had undergone inter-hospital transfer, or had complete missing data regarding prehospital or in-hospital vital signs...
2019: PloS One
Mark Rose, Carina Newton, Benchaa Boualam, Nancy Bogne, Adam Ketchum, Umang Shah, Jordan Mitchell, Safura Tanveer, Tucker Lurie, Walesia Robinson, Rebecca Duncan, Stephen Thom, Quincy Khoi Tran
BACKGROUND: Acute aortic dissection (AoD) is a hypertensive emergency often requiring the transfer of patients to higher care hospitals; thus, clinical care documentation and compliance with the Emergency Medical Treatment and Active Labor Act (EMTALA) is crucial. The study assessed emergency providers (EP) documentation of clinical care and EMTALA compliance among interhospital transferred AoD patients. METHODS: This retrospective study examined adult patients transferred directly from a referring emergency department (ED) to a quaternary academic center between January 1, 2011 and September 30, 2015...
2019: World Journal of Emergency Medicine
Anna Russo, Alfonso Reginelli, Maria Pignatiello, Fabrizio Cioce, Giovanni Mazzei, Olimpia Fabozzi, Vincenzo Parlato, Salvatore Cappabianca, Sabrina Giovine
Emergency department assessment is a critical opportunity to identify elder abuse and violence against women, which represent a growing problem, requiring the attention of health care systems. Elder abuse is most frequently perpetrated by family members because of the higher levels of stress, burnout, and financial problems affecting the caregivers that can even lead to deadly consequences. Intimate partner violence is defined as physical, sexual, or psychological harm caused to another by a current or former partner or spouse, and can range from a single acute hit to chronic battering, varying in frequency and severity...
February 2019: Seminars in Ultrasound, CT, and MR
Nicole M Benson, John B Taylor, Suzanne A Bird, Scott R Beach
BACKGROUND: Resident supervision is critical for education and ensuring patient safety. After hours, communication with attendings is variable. OBJECTIVE: The objective was to identify differences among psychiatry residents and attendings regarding the desired level of supervision for issues that arise overnight in the psychiatric emergency department (ED). METHODS: In a single-site psychiatric ED, an electronic survey containing 30 hypothetical scenarios was administered...
December 25, 2018: Psychosomatics
Isaac Siegfried, Jennifer Jacobs, Robert P Olympia
BACKGROUND: Although urgent care centers (UCCs) can often evaluate and treat minor injuries/illnesses, patients may present with life threatening conditions that require immediate recognition, stabilization, and transfer to a higher level of care, beyond the capabilities of most UCCs. OBJECTIVE: To describe adult ED referrals from UCCs and to determine the percentage of referrals considered critical, complex, and simple. METHODS: A prospective study was conducted between 8/2016-8/2017 on patients >18 years referred directly to our ED from surrounding UCCs...
January 17, 2019: American Journal of Emergency Medicine
Antonio Giulio de Belvis, Andrea Barbara, Gabriele Giubbini, Serena Traglia, Carmen Angioletti, Gianluca Janiro, Luca Masucci, Maurizio Sanguinetti, Patrizia Laurenti, Andrea Cambieri, Antonio Gasbarrini, Walter Ricciardi, Giovanni Cammarota
BACKGROUND: Clostridium Difficile Infections (CDIs) have been increasing both in incidence and in severity, representing a big public health concern. AIM: The aim of this study was to evaluate the impact of a recently implemented Critical Pathway (CP) focused on patients with CDI in an Italian Teaching Hospital. METHODS: The CP implementation consisted of intervention aimed to: faster diagnosis and appropriateness in admission and discharge point of care; activation of a multidisciplinary team; staff training; information to patients and caregivers...
January 22, 2019: International Journal of Infectious Diseases: IJID
Cynthia I Campbell, Constance Weisner, Ingrid A Binswanger, Gwen T Lapham, Brian K Ahmedani, Bobbi Jo H Yarborough, Irina V Haller, Andrea Altschuler, Rulin C Hechter, Amy M Loree, Andrea H Kline-Simon
BACKGROUND: The prevalence of opioid use disorder (OUD) has increased rapidly in the United States and improving treatment access is critical. Among patients with OUD, we examined factors associated with the Healthcare Effectiveness Data and Information Set (HEDIS) performance measures of alcohol and other drug (AOD) treatment initiation and engagement. METHODS: Electronic health record and claims data between October 1, 2014, and August 15, 2015, from 7 health systems were used to identify patients (n = 11,490) with a new index OUD diagnosis (no AOD diagnosis prior <60 days) based on International Classification of Diseases (ICD)-9 codes...
January 24, 2019: Substance Abuse
Lynn Jiang, Nicholas D Caputo, Bernard P Chang
OBJECTIVE: Early identification of shock allows for timely resuscitation. Previous studies note the utility of bedside calculations such as the shock index (SI) and quick sepsis-related organ failure assessment (qSOFA) to detect occult shock. Respiratory rate may also be an important marker of occult shock. The goal of our study was to evaluate whether using a modified SI with respiratory rate would improve identification of emergency department sepsis patients admitted to an ICU or stepdown unit...
January 15, 2019: American Journal of Emergency Medicine
Dori A Cross, Jeffrey S McCullough, Julia Adler-Milstein
OBJECTIVES: To characterize the drivers of the use of electronic health information exchange (HIE) by skilled nursing facilities (SNFs) to access patient hospital data during care transitions. STUDY DESIGN: Explanatory, sequential mixed-methods study. Quantitative data from an audit log captured HIE use by 3 SNFs to retrieve hospitalization information for the 5487 patients discharged to their care between June 2014 and March 2017, along with patient demographic data...
January 1, 2019: American Journal of Managed Care
Drayton A Hammond, Payal K Gurnani, Alexander H Flannery, Keaton S Smetana, Jennifer C Westrick, Ishaq Lat, Megan A Rech
A framework for evaluating pharmacists' impact on cost avoidance in the intensive care unit (ICU) and emergency department (ED) has not been established. This scoping review was registered (CRD42018091217) and conducted to identify, aggregate, and qualitatively describe the highest quality evidence for cost avoidance generated by clinical pharmacists on interventions performed in an ICU or ED. Searches were conducted in PubMed, Scopus, CINAHL, Cochrane CENTRAL Register of Controlled Trials, and Cochrane Database of Systematic Reviews from inception until April 2018...
January 21, 2019: Pharmacotherapy
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
Yusaku Shibata, Akihiro Shirakabe, Hirotake Okazaki, Masato Matsushita, Tomofumi Sawatani, Saori Uchiyama, Kenichi Tani, Nobuaki Kobayashi, Toshiaki Otsuka, Noritake Hata, Kuniya Asai, Wataru Shimizu
BACKGROUND: The prognostic impact of hyperuricemia and the factors that induce hyperuricemia in cardiovascular intensive care patients remain unclear. METHODS AND RESULTS: A total of 3257 emergency department patients were screened, and data for 2435 patients who were admitted to an intensive care unit were analyzed. The serum uric acid level was measured within 15 min of admission. The patients were assigned to a low-uric acid group (uric acid ⩽7.0 mg/dl, n=1595) or a high-uric acid group (uric acid >7...
January 17, 2019: European Heart Journal. Acute Cardiovascular Care
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