Freestanding emergency center

BACKGROUND: Freestanding emergency departments have risen in popularity as a means to expand access to care. Although some evaluation of freestanding emergency department utility in specific patient populations exists, management of surgical patients via remote triage and disposition has not been previously described. We report our experience with remote triage to discharge home, level I trauma center, or community hospital admission for general surgery patients who present to an affiliated freestanding emergency department...

STUDY OBJECTIVE: In a perioperative emergency, anesthesiologists must acknowledge the unfolding crisis promptly, call for timely assistance, and avert patient harm. We aimed to identify vital signs and qualitative factors prompting crisis acknowledgment and to compare responses between observers and participants in simulation. DESIGN: Prospective, simulation-based, observational study. SETTING: An anesthesia crisis resource management course at a freestanding simulation center...

BACKGROUND: Primary total hip arthroplasty (THA) is increasingly being performed in the outpatient setting. However, there is little known regarding the differences in same-day discharge rates and complications of operative approach in same-day total hip arthroplasty in the ambulatory surgery center (ASC) setting. METHODS: A retrospective chart review was performed between July 2019 and October 2021 for all patients who underwent primary THA in a single freestanding ASC...

BACKGROUND: Standardization and digitalization are getting more and more essential in surgery. Surgical procedure manager (SPM®) is a freestanding computer serving as a digital supporter in the operating room. SPM® navigates step-by-step through surgery by providing a checklist for each individual step. METHODS: This was a single center, retrospective study at the Department for General and Visceral Surgery at Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin...

BACKGROUND: Unintentional injuries are the leading cause of death in children in the United States. Studies have shown that parent adherence to safety guidelines is improved when education is provided in conjunction with safety equipment. METHODS: This study surveyed parents about specific injury prevention behaviors regarding medication and firearm storage and provided education and safety equipment for safe practice of these behaviors. The project took place in a pediatric emergency department (PED) and partnered with the hospital foundation and the school of medicine...

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The purpose of this study was to assess trends in disparities in utilization of hospital outpatient departments (HOPDs) and ambulatory surgical centers (ASCs) for outpatient ACDF (OP-ACDF) between white, Black, Hispanic, and Asian/Pacific Islander patients from 2015-2018 in New York state. SUMMARY OF BACKGROUND DATA: Racial and ethnic disparities within the field of spine surgery have been thoroughly documented...

BACKGROUND: Little is known regarding the career paths of adult multidisciplinary critical care medicine (CCM) fellowship graduates. OBJECTIVE: The purpose of this study is to describe the demographic profiles and characteristics of the first jobs held by internal medicine-CCM fellowship graduates trained at a freestanding cancer center. METHODS: An electronic survey was developed via Research Electronic Data Capture that addressed first employment parameters and was sent between May 1, 2019, and December 31, 2021, to 133 CCM fellows who completed CCM fellowship training from 2000 to 2020 at our institution...

BACKGROUND: Acute care hospitals increasingly provide care for youth experiencing mental health crises while they await transfer for psychiatric hospitalization. To inform quality improvement efforts, we aimed to characterize hospitalists' perceptions of health care quality during pediatric mental health boarding and their experiences of moral distress in caring for this population. METHODS: In March 2021, we conducted a web-based survey of hospitalists who participate in the Pediatric Research in Inpatient Settings (PRIS) network...

In Washington state, planned community births are attended by direct entry licensed midwives (LMs) and certified nurse-midwives (CNMs). The most recently published vital statistics data from 2018 reported that 3.6% of the 84,648 births in Washington occurred at home or in freestanding birthing centers. Approximately 16.2% of planned home birth and birth center clients experience intrapartum or early postpartum transfer to the hospital, while 1.8% of their newborns do. The safety of and satisfaction with these types of referrals depends on multisystem processes performed by a variety of health care professionals...

OBJECTIVE: The purpose of this study was to describe US freestanding birth center models of prenatal care and to examine how the components of this care contribute to birthing people's confidence in their ability to have a physiologic birth. DESIGN: This was a qualitative descriptive study utilizing semi-structured interviews with birth center midwives. Data were analyzed using thematic analysis, constant comparative method and consensus coding to ensure rigor. SETTING AND PARTICIPANTS: Midwives from six urban and rural freestanding birth centers in a Midwestern US state were interviewed...

Background: Convenience clinics-such as urgent care centers (UCCs), retail clinics, and freestanding emergency departments (FSEDs)-where patients can receive treatment for a variety of medical conditions have increased in number and popularity. We quantify the impact an FSED had on UCC visits in an underserved area in North Baton Rouge, Louisiana. Methods: All FSED and UCC visits were abstracted from 2015 to 2020. Visits were classified using International Classification of Diseases, Tenth Revision codes. We used a time series analysis to evaluate the association of nonemergent and emergent visits to the UCC after the opening of the FSED...

BACKGROUND: Only a fraction of pediatric trauma patients are treated in pediatric-specific facilities, leaving the remaining to be seen in centers that must decide to admit the patient to a pediatric or adult unit. Thus, there may be inconsistencies in pediatric trauma admission practices among trauma centers. OBJECTIVE: Describe current practices in admission decision making for pediatric patients. METHODS: An email survey was distributed to members of three professional organizations: The American Association for the Surgery of Trauma, Society of Trauma Nurses, and Pediatric Trauma Society...

Pneumothorax is a known complication following breast surgery but is likely underappreciated by anesthesiologists. Iatrogenic pneumothorax can be caused by needle injury during local anesthetic injection, surgical damage to the intercostal fascia or pleura, or pulmonary injury from mechanical ventilation. We present two cases of pneumothorax following bilateral mastectomy with bilateral pectoral blocks and immediate breast reconstruction. Both cases occurred at a freestanding ambulatory surgery center in patients with no history of lung disease...

BACKGROUND: The Kids Intracranial Injury Decision Support tool for Traumatic Brain Injury (KIIDS-TBI) tool is a validated risk prediction model for managing children with mild traumatic brain injuries (mTBI) and intracranial injuries. Electronic clinical decision support (CDS) may facilitate the clinical implementation of this evidence-based guidance. OBJECTIVE: Our objective was to evaluate the acceptability and usability of an electronic CDS tool for managing children with mTBI and intracranial injuries...

Strontium titanate (STO), with a wide spectrum of emergent properties such as ferroelectricity and superconductivity, has received significant attention in the community of strongly correlated materials. In the strain-free STO film grown on the SrRuO3 buffer layer, the existing polar nanoregions can facilitate room-temperature ferroelectricity when the STO film thickness approaches 10 nm. Here we show that around this thickness scale, the freestanding STO films without the influence of a substrate show the tetragonal structure at room temperature, contrasting with the cubic structure seen in bulk form...

INTRODUCTION: The purpose of this study was to establish emergency department (ED) utilization rate and reasons for presentation to the ED after outpatient rotator cuff repair (RCR) and determine preoperative predictors for these ED visits. METHODS: Patients who underwent outpatient RCR between 2014 and 2015 were retrospectively evaluated using the New York and Florida State Databases. The primary outcome was all-cause 7- and 30-day ED utilization rates. Reasons for presentation to the ED were recorded and stratified...

As the wars in Iraq and Afghanistan end, the US military has begun to transition to the multi-domain operations concept with preparation for large scale combat operations against a near-peer adversary. In large scale combat operations, the deployed trauma system will likely see challenges not experienced during the Global War on Terrorism. The development of science and technology will be critical to close existing capability gaps and optimize casualty survival. This review comprises a framework of deployed trauma care to provide nonmilitary investigators a general understanding of our deployed trauma care system...

OBJECTIVE: Public health emergencies, like the coronavirus disease 2019 pandemic, can cause unprecedented demand for critical care services. We describe statewide implementation of a critical care coordination center designed to optimize ICU utilization. To describe a centralized critical care coordination center designed to ensure appropriate intensive care resource allocation. DESIGN: A descriptive case series of consecutive critically ill adult patients. SETTING: ICUs, emergency departments, freestanding medical facilities in the state of Maryland and adjacent states, serving a population of over 6,045,000 across a land area of 9,776 sq mi (25,314 km2 )...

INTRODUCTION: Migration of total knee arthroplasty (TKA) procedures from the inpatient setting to outpatient venues, especially freestanding ambulatory surgery centers (ASCs), requires the use of reliable patient selection algorithms and standardized perioperative pathways to facilitate favorable outcomes for patients. METHODS: This retrospective chart review included consecutive TKA procedures performed over a 5-year period between January 2014 and January 2019 at 2 freestanding ASCs...

BACKGROUND: Emergency physicians must maintain procedural skills, but clinical opportunities may be insufficient. We sought to determine how often practicing emergency physicians in academic, community and freestanding emergency departments (EDs) perform 4 procedures: central venous catheterization (CVC), tube thoracostomy, tracheal intubation, and lumbar puncture (LP). METHODS: This was a retrospective study evaluating emergency physician procedural performance over a 12-month period...