scholarly journals Getting to the Right Patient at the Right Time: An Interoperable Mobile App to Track the ED Journey in Hospital

2021 ◽  
Author(s):  
Audrey P. Wang ◽  
David Pryce ◽  
Phillip Gough
Keyword(s):  
Emergency Department ◽  
Clinical Care ◽  
Database Systems ◽  
Mobile App ◽  
Data Sources ◽  
Local Health ◽  
Business Analytics ◽  
Waiting Room ◽  
Executive Staff ◽  
The Right

The current legacy ICT framework structures in healthcare are often siloed and do not allow information to flow easily between business analytics and clinical systems, affecting critical decision making.Western Sydney Local Health District (WSLHD) has numerous electronic database systems for business analytics including tracking individual patients waiting for treatment in the emergency department (ED). Administrators of hospital business data report ED performance measures in a weekly static feedback report to clinical and executive staff due to current legacy systems and manual resource allocation processes. The remit of the project was to prototype a system that could integrate data sources from the current QlikSense Dashboard into an interoperable mobile app with the future intention of direct impact on clinical care decision making for the emergency department. A series of meetings between business analytics unit and clinical staff were used to inform a set of requirements for information workflow systems integration to be used on the project. Stimulated patient data that matched typical data feeds from the system was used to develop a prototype interoperable HL7 messaging mobile app that would report waiting patients in their triage categories in near real time. This working protype with synthetic scenarios and data will inform a future deployable production system with information for the patient journey from the ED waiting room into available hospital beds. As most applications are either designed for business analytics or clinical workflows, integrating information data sources into one mobile application that could meet the needs of both clinical and business performance was novel and integral. This proof of concept project successfully integrated the information systems necessary for both purposes and informs future requirements for an interoperable and deployable cross-platform mobile app.

scholarly journals P044: Register to donate while you wait: assessing public acceptability of utilizing the emergency department waiting room for organ and tissue donor registration

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S72-S72
Author(s):  
B. Ellis ◽  
J.J. Perry ◽  
M. Hartwick
Keyword(s):  
Emergency Department ◽  
Religious Affiliation ◽  
Clinical Care ◽  
Tertiary Care ◽  
Organ Donor ◽  
Tissue Donation ◽  
Waiting Room ◽  
Tissue Donor ◽  
Organ And Tissue Donation ◽  
Public Acceptability

Introduction: Our study objectives were to assess the acceptability of using the emergency department (ED) waiting room to provide knowledge on, and offer opportunities for organ and tissue donor registration; and to identify barriers to the donor registration process in Ontario. Methods: We conducted a paper based in-person survey over nine days for eight hour blocks in March and April 2017. The survey instrument was created in English using existing literature and expert opinion, pilot tested and then translated into French. The study collected data from patients and visitors in an urban academic Canadian tertiary care ED waiting room. All adults in the waiting room were approached to participate during the study periods. Individuals waiting in clinical care areas were excluded, as well as those who required immediate treatment. Results: The number of attempted surveys was 324; 67 individuals (20.7%) refused to partake. A total of 257 surveys were distributed and five were returned blank. This gave us a response rate of 77.8% with 252 completed surveys. The median age group was 51-60 years old with 55.9% female. Forty-six percent were Christian (46.0%) and 34.1% did not declare a religious affiliation. Nearly half of participants (44.1%) were registered organ donors. The majority of participants agreed or were neutral (83.3%) that the ED waiting room was an acceptable place to provide information on organ and tissue donation. Further, 82.1% agreed or were neutral that the ED was an acceptable place to register as an organ donor. Nearly half (47.2%) agreed that they would consider registering while in the ED waiting room. A number of barriers to registering as an organ and tissue donor were identified. The most common were: not knowing how to register (22.0%), a lack of time to register (21.1%), and having unanswered questions regarding organ and tissue donation (18.7%). Conclusion: Individuals waiting in the ED are supportive of using the ED waiting room for distributing information regarding organ and tissue donation, and facilitating organ and tissue donation registration. Developing such a practice could help to reduce some of the identified barriers, including a lack of time and having unanswered questions regarding donation.

scholarly journals A surveillance study to determine the accuracy of mild traumatic brain injury diagnosis in an emergency department: protocol for a retrospective cohort study

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e016222 ◽  
Author(s):  
Ilaria Pozzato ◽  
Ian D Cameron ◽  
Susanne Meares ◽  
Annette Kifley ◽  
Kim Van Vu ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Ethical Issues ◽  
Clinical Care ◽  
Local Health ◽  
South Wales ◽  
Operational Criteria ◽  
Clinical Records

IntroductionPrevious literature confirms that a mild traumatic brain injury (mTBI) may result in long-term emotional impacts and, in vulnerable subgroups, cognitive deficits. The accurate diagnosis of mTBI and its written documentation is an important first step towards providing appropriate and timely clinical care. Surveillance studies involving emergency department (ED) and hospital-based data need to be prioritised as these provide incident mTBI estimates. This project will advance existing research findings by estimating the occurrence of mTBI among those attending an ED and quantifying the accuracy of mTBI diagnoses recorded by ED staff through a comprehensive audit of ED records.Methods and analysisRetrospective chart reviews (between June 2015 and June 2016) of electronic clinical records from an ED in Sydney (New South Wales, Australia) will be conducted. The study population will include persons aged 18–65 years who attended the ED with any clinical features potentially indicative of mTBI. The WHO operational criteria for the clinical identification of mTBI cases is the presence of: (1) a Glasgow Coma Scale (GCS) of 13–15 after 30 min postinjury or on presentation to hospital; (2) one or more of the following: post-traumatic amnesia (PTA) of less than 24 hours’ duration, confusion or disorientation, a witnessed loss of consciousness for ≤30 min and/or a positive CT brain scan. We estimate that 30 000 ED attendances will be screened and that a sample size of 500 cases with mTBI will be identified during this 1-year period, which will provide reliable estimates of mTBI occurrence in the ED setting.Ethics and disseminationThe study was approved by the Northern Sydney Local Health District Ethics Committee. The committee deemed this study as low risk in terms of ethical issues. The written papers from this study will be submitted for publication in quality peer-reviewed medical and health journals. Study findings will be disseminated via presentations at national/international conferences and peer-reviewed journals.

Nearly fatal hypokalaemia due to non-hypertensive primary hyperaldosteronism in the post partum

2021 ◽  
Vol 14 (3) ◽  
pp. e240018
Author(s):  
Juliana Marques-Sá ◽  
Mariana Barbosa ◽  
Vera Fernandes ◽  
Maria Joana Santos
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Heart Rate ◽  
Post Partum ◽  
Plasma Renin ◽  
Primary Hyperaldosteronism ◽  
Waiting Room ◽  
Abdominopelvic Ct ◽  
The Right ◽  
Electric Cardioversion

A previously healthy postpartum 33-year-old woman was admitted at the emergency department after two episodes of syncope. In the waiting room, she collapsed, ventricular fibrillation was detected, and she was reanimated by electric cardioversion. At admission, she was conscient, with blood pressure of 102/74 mm Hg and heart rate of 78 bpm. In the laboratory workup, severe hypokalaemia was found (K+ 1.77 mEq/L). Abdominopelvic CT revealed a 27 mm nodule in the right adrenal gland. High aldosterone and low plasma renin levels were detected, and the diagnosis of primary hyperaldosteronism was made, although she never had hypertension. Posteriorly, a cosecretion of aldosterone and cortisol was found. Two months after admission, the patient remained stable with normal K+ levels under spironolactone and a right adrenalectomy was performed. The cure of primary hyperaldosteronism and a partial adrenal insufficiency were confirmed. K+ levels and blood pressure remained normal without treatment and 10 months after surgery hydrocortisone was suspended.

scholarly journals Improving emergency department patient-doctor conversation through an artificial intelligence symptom taking tool: an action-oriented design pilot study

2020 ◽  
Author(s):  
Justus Scheder-Bieschin ◽  
Bibiana Blümke ◽  
Erwin de Buijzer ◽  
Fabian Echterdiek ◽  
Júlia Nacsa ◽  
...  
Keyword(s):  
Emergency Department ◽  
Clinical Care ◽  
Interdisciplinary Treatment ◽  
Future Research ◽  
Study Phase ◽  
History Taking ◽  
Two Phase ◽  
Waiting Room ◽  
Time Saving ◽  
Record Keeping

AbstractIMPORTANCECommunication between patients and healthcare professionals is frequently challenging in the crowded emergency department (ED), with few opportunities to develop rapport or empathy. Digital tools for patients and physicians have been proposed as helpful but their utility is not established.OBJECTIVETo evaluate a patient-facing digital symptom and history taking, as well as handover tool in the waiting room.DESIGNA two-phase, questionnaire-based quality improvement study. Phase I observations guided iterative improvement, which was then further evaluated in Phase II.SETTINGED of a German tertiary referral and major trauma hospital providing interdisciplinary treatment for an average of 120 patients daily.PARTICIPANTSAll patients who were willing/able to provide consent, excluding patients: (i) with severe injury/illness requiring immediate treatment; (ii) with traumatic injury; (iii) incapable of completing a health assessment; or, (iv) under 18 years old. Of 1699 patients presenting to the ED, 815 were eligible based on triage level. With available recruitment staff, 135 were approached, of whom 81 were included in the study.INTERVENTION/OBSERVATIONPatients entered information into the tool, which generated a handover report to be accessed via a clinician dashboard. All users completed evaluation questionnaires. Clinicians were trained to observationally assess the tool as a prototype, without relying upon it for clinical care.MAIN OUTCOMES AND MEASURESPatient and clinician Likert scale ratings of tool performance.RESULTSRespondents were strongly positive in endorsing the tool’s usefulness in facilitating conversation (75% of patients, 73% physicians, 100% nurses). Nurses judged the tool as potentially time saving, whilst physicians assessed it as time saving only in some ED medical specialisms (e.g. Surgery). Patients understood the tool questions and reported high usability. The proportion of patients, physicians and nurses who would recommend the tool was 78%, 53% and 76%.CONCLUSIONS AND RELEVANCEThe system has clear potential to improve patient-HCP interaction and make efficiency savings in the ED. Future research and development will extend the range of patients for which the history collection has clinical utility.Key PointsQuestionCan a patient-facing digital symptom and clinical history taking tool provide conversational support, aid in symptom taking, facilitate record keeping, and lead to improved rapport between patients, physicians and nurses in the emergency department (ED)?FindingsAcceptability was high, with improved rapport experienced 90% of the time for patients, 73% for physicians and 100% for nurses. Nurses assessed the tool as having workflow benefit through potential time saving. Physicians assessed the current tool design as providing time saving in certain ED medical specialisms including Surgery.MeaningThe patient-facing tool for symptom and history taking provided meaningful conversation support and showed potential for efficiency savings, however, further research and testing is required before time savings can be consistently delivered to ED clinicians across the range of relevant ED medical specialisms.

Interventions to change clinician behaviour in relation to suicide prevention care in the emergency department: A scoping review protocol

2020 ◽  
Author(s):  
Hwayeon Danielle Shin ◽  
Christine Cassidy ◽  
Janet Curran ◽  
Lori Weeks ◽  
Leslie Anne Campbell ◽  
...  
Keyword(s):  
Emergency Department ◽  
Suicide Prevention ◽  
Behaviour Change ◽  
Clinical Care ◽  
Grey Literature ◽  
Allied Health Professionals ◽  
Wide Range ◽  
Knowledge And Attitude ◽  
Clinician Behaviour ◽  
Google Search

Objective: This review aims to explore, characterize, and map the literature on interventions implemented to change emergency department (ED) clinicians’ behaviour related to suicide prevention using the Behaviour Change Wheel (BCW) as a guiding theoretical framework. Introduction: An ED is a critical place for suicide prevention. Yet, many patients who present with suicide-related thoughts and behaviours are discharged without proper assessment or appropriate treatment. Supporting clinicians (who provide direct clinical care, including nurses, physicians, allied health professionals) to make the desired behaviour change following evidence-based suicide prevention care is an essential step toward improving patient outcomes. However, reviews to date have yet to take a theoretical approach to investigate interventions implemented to change clinicians’ behaviour. Inclusion criteria: This review will consider literature that includes interventions that target ED clinicians’ behaviour change related to suicide prevention. Behaviour change refers to observable practice changes as well as proxy measures of behaviour change including knowledge and attitude. There are many ways in which an intervention can change clinicians’ behaviour (e.g., education, altering service delivery). This review will include a wide range of interventions that target behaviour change regardless of the type but exclude interventions that exclusively target patients.Methods: Multiple databases will be searched: PubMed, PsycInfo, CINAHL and Embase. We will also include grey literature, including Google search, ProQuest Dissertations and Theses Global, and Scopus conference papers. Full text of included studies will be reviewed, critically appraised and extracted. Extracted data will be coded to identify intervention functions using the BCW. Findings will be summarized in tables accompanied by narrative reports.

A rare encounter of obstructed direct inguinal hernia

2019 ◽  
Vol 22 (2) ◽  
pp. 41-43
Author(s):  
Amit Kumar Singh ◽  
Nripesh Rajbhandari ◽  
Balaram Malla ◽  
Gakul Bhatta
Keyword(s):  
Emergency Department ◽  
Inguinal Hernia ◽  
Intestinal Obstruction ◽  
Intestinal Resection ◽  
Posterior Wall ◽  
Acute Intestinal Obstruction ◽  
University Hospital ◽  
Direct Inguinal Hernia ◽  
Direct Hernia ◽  
The Right

The direct inguinal hernia has a wider neck and thus usually doesn’t present as strangulation or incarceration in comparison to the indirect component. When direct inguinal hernias are untreated for a longer duration, they may get strangulated and incarcerated. Hence such long-standing direct hernias with features of intestinal obstruction and /or peritonism should be promptly seen and diagnosed to prevent massive and unwanted intestinal resection. We are reporting a case of 83-year-old male presented to Surgical Emergency Department of Dhulikhel Hospital, Kathmandu University hospital with complaints of swelling in the right inguinoscrotal region for 12 years and progressed to become irreducible and painful for 12 hours. Clinically he had an acute intestinal obstruction. Intra-operatively we found a direct hernia containing congested small bowel loops and toxic fluids. The toxic fluid was suctioned and after confirming viability, modified Bassini’s repair was done with reinforcement of the posterior wall. Even direct inguinal hernia of longer duration can cause acute or sub-acute intestinal obstruction with or without features of peritonism. This complication is more common in elderly patients.

Am I Doing the Right Thing? Provider Perspectives on Improving Palliative Care in the Emergency Department

2009 ◽  
Vol 54 (1) ◽  
pp. 86-93.e1 ◽  
Author(s):  
Alexander K. Smith ◽  
Jonathan Fisher ◽  
Mara A. Schonberg ◽  
Daniel J. Pallin ◽  
Susan D. Block ◽  
...  
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
Provider Perspectives ◽  
The Right

The Waiting Room Assessment to Virtual Emergency Department pathway: Initiating video-based telemedicine in the pediatric emergency department

2021 ◽  
pp. 1357633X2110440
Author(s):  
Esli Osmanlliu ◽  
Isabelle Gagnon ◽  
Saskia Weber ◽  
Chi Quan Bach ◽  
Jennifer Turnbull ◽  
...  
Keyword(s):  
Emergency Department ◽  
Care Delivery ◽  
Care Pathway ◽  
Clinical Pathways ◽  
A Priori ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
Pilot Phase ◽  
Waiting Room ◽  
Hospital Pediatric

The COVID-19 pandemic has presented pediatric emergency departments with unique challenges, resulting in a heightened demand for adapted clinical pathways. In response to this need, the Montreal Children's Hospital pediatric emergency department introduced the WAVE (Waiting Room Assessment to Virtual Emergency Department) pathway, a video-based telemedicine pathway for selected non-critical patients, aiming to reduce safety issues related to emergency department overcrowding, while providing timely care to all children presenting and registering at our emergency department. The objective of the WAVE pilot phase was to evaluate the feasibility and acceptability of telemedicine in our pediatric emergency department, which was previously unfamiliar with this mode of care delivery. During the six-week, three-evening per week deployment, we conducted 18 five-hour telemedicine shifts. In total, 27 patients participated in the WAVE pathway. Results from this pilot phase met four of five a priori feasibility and acceptability criteria. Overall, participating families were satisfied with this novel care pathway and reported no disruptive technological barriers.

Appendicitis: a rare adverse event in colonoscopy

2021 ◽  
Vol 14 (7) ◽  
pp. e242523
Author(s):  
Samer Al-Dury ◽  
Mohammad Khalil ◽  
Riadh Sadik ◽  
Per Hedenström
Keyword(s):  
Emergency Department ◽  
Adverse Event ◽  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Physical Examination ◽  
De Novo ◽  
Perforated Appendicitis ◽  
Lower Quadrant ◽  
The Right ◽  
Right Lower Quadrant

We present a case of a 41-year-old woman who visited the emergency department (ED) with acute abdomen. She was diagnosed with perforated appendicitis and abscess formation on CT. She was treated conservatively with antibiotics and discharged. On control CT 3 months later, the appendix had healed, but signs of thickening of the terminal ileum were noticed and colonoscopy was performed, which was uneventful and showed no signs of inflammation. Twelve hours later, she developed pain in the right lower quadrant, followed by fever, and visited the ED. Physical examination and blood work showed signs consistent with acute appendicitis, and appendectomy was performed laparoscopically 6 hours later. The patient recovered remarkably shortly afterwards. Whether colonoscopy resulted in de novo appendicitis or exacerbated an already existing inflammation remains unknown. However, endoscopists should be aware of this rare, yet serious complication and consider it in the workup of post-colonoscopy abdominal pain.

EdgeDIPN

2020 ◽  
Vol 14 (3) ◽  
pp. 320-328
Author(s):  
Long Guo ◽  
Lifeng Hua ◽  
Rongfei Jia ◽  
Fei Fang ◽  
Binqiang Zhao ◽  
...  
Keyword(s):  
Real Time ◽  
Large Scale ◽  
Attention Mechanism ◽  
Data Sources ◽  
User Intent ◽  
Multiple User ◽  
Shopping Experience ◽  
Data Source ◽  
Intent Prediction ◽  
The Right

With the rapid growth of e-commerce in recent years, e-commerce platforms are becoming a primary place for people to find, compare and ultimately purchase products. To improve online shopping experience for consumers and increase sales for sellers, it is important to understand user intent accurately and be notified of its change timely. In this way, the right information could be offered to the right person at the right time. To achieve this goal, we propose a unified deep intent prediction network, named EdgeDIPN, which is deployed at the edge, i.e., mobile device, and able to monitor multiple user intent with different granularity simultaneously in real-time. We propose to train EdgeDIPN with multi-task learning, by which EdgeDIPN can share representations between different tasks for better performance and saving edge resources in the meantime. In particular, we propose a novel task-specific attention mechanism which enables different tasks to pick out the most relevant features from different data sources. To extract the shared representations more effectively, we utilize two kinds of attention mechanisms, where the multi-level attention mechanism tries to identify the important actions within each data source and the inter-view attention mechanism learns the interactions between different data sources. In the experiments conducted on a large-scale industrial dataset, EdgeDIPN significantly outperforms the baseline solutions. Moreover, EdgeDIPN has been deployed in the operational system of Alibaba. Online A/B testing results in several business scenarios reveal the potential of monitoring user intent in real-time. To the best of our knowledge, EdgeDIPN is the first full-fledged real-time user intent understanding center deployed at the edge and serving hundreds of millions of users in a large-scale e-commerce platform.

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