Utilizing Six Sigma Lean Strategies to Expedite Emergency Department CT Scan Throughput in a Tertiary Care Facility

Objectives. To assess the impact of a scribe program on an academic, tertiary care facility. Methods. A retrospective analysis of emergency department (ED) data, prior to and after scribe program implementation, was used to quantitatively assess the impact of the scribe program on measures of ED throughput. An electronic survey was distributed to all emergency medicine residents and advanced practice providers to qualitatively assess the impact of the scribe program on providers. Results. Several throughput time measures were significantly lower in the postscribe group, compared to prescribe implementation, including time to disposition. The left without being seen (LWBS) decrease was not statistically significant. A total of 30 providers responded to the survey. 100% of providers indicated scribes are a valuable addition to the department and they enjoy working with scribes. 90% of providers indicated scribes increase their workplace satisfaction and quality of life. Conclusions. Through evaluation of prescribe and postscribe implementation, the postscribe time period reflects many throughput improvements not present before scribes began. Scribe Program implementation led to improved ED throughput for discharged patients with further system-wide challenges needing to be addressed for admitted patients.

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SARS-CoV-2 infection among asymptomatic healthcare workers of the emergency department in a tertiary care facility

Journal of Clinical Virology ◽

10.1016/j.jcv.2020.104710 ◽

2021 ◽

Vol 134 ◽

pp. 104710

Author(s):

Reham Abdelmoniem ◽

Rabab Fouad ◽

Shereen Shawky ◽

Khaled Amer ◽

Tarek Elnagdy ◽

...

Keyword(s):

Emergency Department ◽

Healthcare Workers ◽

Tertiary Care ◽

Care Facility ◽

Tertiary Care Facility

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Abstract TP367: Decreasing Decision to Transfer Times

Stroke ◽

10.1161/str.48.suppl_1.tp367 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Denise Sorenson ◽

Jason Cooke ◽

Lisa Loll

Keyword(s):

Emergency Department ◽

Urban Areas ◽

Best Practice ◽

Tertiary Care ◽

Care Facility ◽

Direct Care ◽

Case Review ◽

Transfer Time ◽

Skin Puncture ◽

Tertiary Care Facility

Novant Health Greater Charlotte market is comprised of three advanced primary stroke care centers; one providing 24/7 stroke interventional radiology coverage. To expedite the transfer of patients meeting criteria for mechanical thrombectomy, the stroke best practice teams in the two community primary stroke centers collaborated to develop a protocol to improve the decision to transfer time to meet a goal of 120 minutes from door to skin puncture time, regardless of original transport destination. The Novant Health Charlotte market teams realize the benefit of cohesive physician coverage among the Emergency Department, Radiology and Inpatient Neurology physician providers. CTA scans performed in the non-interventional facilities are readily available to Neuro-Endovascular Radiologists, allowing for prompt interpretation and mobilization of the IR team to prepare for patient arrival. Recognizing internal critical care transport resources are limited and may not be available, the process was facilitated by the development of an activase transport protocol implemented by Mecklenburg County EMS in June of 2016. Since actual transport time is affected by traffic patterns in urban areas, the controllable measure selected by the teams was decision to transfer time. Prior to the initiation of the protocol, the median decision to transfer time for ischemic stroke patients requiring tertiary care was 66.5 minutes. Post protocol implementation the median time was reduced 32% to 44.5 minutes. Across the market, median door to skin puncture time in 2016 is 131.5 minutes. Ongoing evaluation of the transfer process, and multidisciplinary IR case review with identification of process variation is key to the success of this initiative. The Emergency Department at the tertiary care facility has been an instrumental partner in identifying issues that are barriers to timely throughput of these patients. A consistent feedback process informs all team members regarding patient outcomes. Individual case feedback is provided to all direct care givers, EMS crews and stroke team leaders, usually within 24 to 48 hours of the intervention. This data is shared monthly with the stroke best practice teams at the transferring facilities.

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(A22) Impact of Karachi Terrorist Bombing on an Emergency Department of a Tertiary Care Hospital

Prehospital and Disaster Medicine ◽

10.1017/s1049023x11000355 ◽

2011 ◽

Vol 26 (S1) ◽

pp. s6-s7

Author(s):

H. Waseem ◽

S. Shahbaz ◽

J. Razzak

Keyword(s):

Emergency Department ◽

Tertiary Care Hospital ◽

Wound Care ◽

Tertiary Care ◽

Care Facility ◽

Care Hospital ◽

Disaster Plan ◽

Tertiary Care Facility ◽

Number Of Patients ◽

The Government

ObjectivesThe objective of this study was to collect epidemiological injury data on patients presenting to the emergency department of a tertiary care hospital after the bombing on 29 December 2009.MethodsThis was a retrospective review of the medical records of the victims that were brought to a tertiary care hospital. Bombing victims were described as requiring acute care due to the direct effect of the bombing.ResultsThe results are derived from a sample size of 198 bomb blast victims, most of which were first transported to government hospitals by private cars rather than ambulances. After the government announced free treatment, there was a wave of patients, among which, most were stable and already had received some form of treatment. Approximately 5–6 patients who had life-threatening injuries were brought directly to the tertiary care facility and needed surgical intervention. The lack of security in the emergency department could have lead to another terrorist activity. There were no procedures done in the field as there is lack of emergency medical services training in Pakistan, but in the hospital most of the interventions included intravenous (IV) lines, wound care, and laceration repair. The most common treatments included the administration of IV fluids, antibiotics, and analgesia. Radiographs of specific sites and trauma series were used to rule out bone injuries. There was lack of documentation in most of the medical charts.ConclusionsThe emergency department was overwhelmed with the number of patients that it received. Therefore, an updated disaster plan and regular disaster drills are required. Rapid and accurate triage could minimize mortality among bombing survivors significantly. The majority of patients were discharged home.

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Acute Contained Ruptured Aortic Aneurysm Presenting as Left Vocal Fold Immobility

Case Reports in Otolaryngology ◽

10.1155/2015/219090 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3

Author(s):

Sharon H. Gnagi ◽

Brittany E. Howard ◽

Joseph M. Hoxworth ◽

David G. Lott

Keyword(s):

Aortic Aneurysm ◽

Ct Scan ◽

Vocal Fold ◽

Recurrent Laryngeal Nerve Palsy ◽

Tertiary Care ◽

Care Facility ◽

Aortic Aneurysms ◽

Ruptured Aortic Aneurysm ◽

Tertiary Care Facility ◽

Vocal Fold Immobility

Objective. To recognize intrathoracic abnormalities, including expansion or rupture of aortic aneurysms, as a source of acute onset vocal fold immobility.Methods. A case report and review of the literature.Results. An 85-year-old female with prior history of an aortic aneurysm presented to a tertiary care facility with sudden onset hoarseness. On laryngoscopy, the left vocal fold was immobile in the paramedian position. A CT scan obtained that day revealed a new, large hematoma surrounding the upper descending aortic stent graft consistent with an acute contained ruptured aortic aneurysm. She was referred to the emergency department for evaluation and treatment by vascular surgery. She was counseled regarding surgical options and ultimately decided not to pursue further treatment. Her vocal fold immobility was subsequently treated via office-based injection medialization two weeks after presentation and again 5 months after the initial injection which dramatically improved her voice. Follow-up CT scan at 8 months demonstrated a reduction of the hematoma. The left vocal cord remains immobile to date.Conclusion. Ortner’s syndrome, or cardiovocal syndrome, is hoarseness secondary to left recurrent laryngeal nerve palsy caused by cardiovascular pathology. It is a rare condition and, while typically presenting gradually, may also present with acute symptomatology.

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Incidence and predictors of antibiotic prescription errors in an emergency department of a tertiary care facility, Central Saudi Arabia

Journal of Infection and Public Health ◽

10.1016/j.jiph.2015.04.002 ◽

2015 ◽

Vol 8 (4) ◽

pp. 394-395 ◽

Cited By ~ 2

Author(s):

Menyefah Al Anazi ◽

Mahmoud Salam ◽

Majed Al-Jeraisy

Keyword(s):

Emergency Department ◽

Saudi Arabia ◽

Antibiotic Prescription ◽

Tertiary Care ◽

Care Facility ◽

Prescription Errors ◽

Tertiary Care Facility

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Assessing Acute St-Elevation Myocardial Infarction With Prognostic Significance Of The Hyponatramia

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11i3.2445 ◽

2020 ◽

Vol 11 (3) ◽

pp. 3251-3260

Author(s):

Makrand B Mane

Keyword(s):

Myocardial Infarction ◽

Ejection Fraction ◽

Tertiary Care ◽

Prognostic Significance ◽

Care Facility ◽

Early Death ◽

Public Health Issue ◽

Care Hospital ◽

Tertiary Care Facility ◽

Significant Public Health

Acute Myocardial Infarction (AMI) has become a significant public health issue in developed and developing nations, following extensive diagnostic and management research over recent decades. The study intended to research the prognostic values of inexplicable Hyponatremia in patients with severe STelevation of myocardial infarction, in 100 consecutive patients admitted to Tertiary care hospital. In the analysis, identified patients on admission were diagnosed with or produced Hyponatremia within 72 hours—a lower ejection fraction than those with usual amounts of sodium. The research aimed to evaluate the prognosis significance of Hyponatremia for the estimation of early death in acute ST-elevated myocardial infarction. One hundred straight patients admitted in the Coronary Centre Tertiary Care Facility with severe STelevated myocardial infarction were studied. The data of the study on various risk factors in association with the development of Hyponatremia like as age, sex, use of tobacco, diabetes, hypertension, ejection fraction etc. were analyzed. Thus, the researchers reported that in patients diagnosed with severe ST section escalation, Hyponatremia showed the initial emergence of hyponatremia myocardial infarctions. This condition correlates with the severity of LV dysfunction (in term of LVEF) and can be considered as an individual early death indicator as well as a prediction exacerbates with hyponatremia frequency.

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Clinical features and outcomes of infective endocarditis in Egypt: an 11-year experience at a tertiary care facility

The Egyptian Heart Journal ◽

10.1186/s43044-019-0018-y ◽

2019 ◽

Vol 71 (1) ◽

Cited By ~ 1

Author(s):

Hussein Hassan Rizk ◽

Ahmed Adel Elamragy ◽

Ghada Sayed Youssef ◽

Marwa Sayed Meshaal ◽

Ahmad Samir ◽

...

Keyword(s):

Infective Endocarditis ◽

Hospital Mortality ◽

Tertiary Care ◽

Care Facility ◽

Period 2 ◽

Peripheral Embolization ◽

Tertiary Care Facility ◽

Few Data ◽

Healthcare Associated ◽

Complications And Mortality

Abstract Background Few data are available on the characteristics of infective endocarditis (IE) cases in Egypt. The aim of this work is to describe the characteristics and outcomes of IE patients and evaluate the temporal changes in IE diagnostic and therapeutic aspects over 11 years. Results The IE registry included 398 patients referred to the Endocarditis Unit of a tertiary care facility with the diagnosis of possible or definite IE. Patients were recruited over two periods; period 1 (n = 237, 59.5%) from February 2005 to December 2011 and period 2 (n = 161, 40.5%) from January 2012 to September 2016. An electronic database was constructed to include information on patients’ clinical and microbiological characteristics as well as complications and mortality. The median age was 30 years and rheumatic valvular heart disease was the commonest underlying cardiac disease (34.7%). Healthcare-associated IE affected 185 patients (46.5%) and 275 patients (69.1%) had negative blood cultures. The most common complications were heart failure (n = 148, 37.2%), peripheral embolization (n = 133, 33.4%), and severe sepsis (n = 100, 25.1%). In-hospital mortality occurred in 108 patients (27.1%). Period 2 was characterized by a higher prevalence of injection drug use-associated IE (15.5% vs. 7.2%, p = 0.008), a higher staphylococcal IE (50.0% vs. 35.7%, p = 0.038), lower complications (31.1% vs. 45.1%, p = 0.005), and a lower in-hospital mortality (19.9% vs. 32.1%, p = 0.007). Conclusion This Egyptian registry showed high rates of culture-negative IE, complications, and in-hospital mortality in a largely young population of patients. Improvements were noted in the rates of complications and mortality in the second half of the reporting period.

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Characteristics of Critically Ill Patients with COVID-19 Compared to Patients with Influenza—A Single Center Experience

Journal of Clinical Medicine ◽

10.3390/jcm10102056 ◽

2021 ◽

Vol 10 (10) ◽

pp. 2056

Author(s):

Frank Herbstreit ◽

Marvin Overbeck ◽

Marc Moritz Berger ◽

Annabell Skarabis ◽

Thorsten Brenner ◽

...

Keyword(s):

Influenza A ◽

Health Care Systems ◽

Severe Disease ◽

Tertiary Care ◽

Care Facility ◽

High Volume ◽

Single Center Experience ◽

Severe Influenza ◽

Tertiary Care Facility ◽

Care Systems

Infections with SARS-CoV-2 spread worldwide early in 2020. In previous winters, we had been treating patients with seasonal influenza. While creating a larger impact on the health care systems, comparisons regarding the intensive care unit (ICU) courses of both diseases are lacking. We compared patients with influenza and SARS-CoV-2 infections treated at a tertiary care facility offering treatment for acute respiratory distress syndrome (ARDS) and being a high-volume facility for extracorporeal membrane oxygenation (ECMO). Patients with COVID-19 during the first wave of the pandemic (n = 64) were compared to 64 patients with severe influenza from 2016 to 2020 at our ICU. All patients were treated using a standardized protocol. ECMO was used in cases of severe ARDS. Both groups had similar comorbidities. Time in ICU and mortality were not significantly different, yet mortality with ECMO was high amongst COVID-19 patients with approximately two-thirds not surviving. This is in contrast to a mortality of less than 40% in influenza patients with ECMO. Mortality was higher than estimated by SAPSII score on admission in both groups. Patients with COVID-19 were more likely to be male and non-smokers than those with influenza. The outcomes for patients with severe disease were similar. The study helps to understand similarities and differences between patients treated for severe influenza infections and COVID-19.

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