Pharmacist Presence Decreases Time to Prothrombin Complex Concentrate in Emergency Department Patients with Life-Threatening Bleeding and Urgent Procedures

Background: In a busy local emergency department, patients with certain non-life-threatening conditions which only require relatively quick and straightforward management may encounter long waiting times. A new service model called the “Fast Track” Nursing Service attempts to lessen the service load of the regular service queues and to improve patient outcomes. Objectives: This article reports the service outcomes of the Fast Track Nursing Service. Methods: Nurses at our department are selected and trained under clinical protocols specially developed for this service. Assessments and quality assurance audits ensure the quality of service. Results: This service resulted in comparatively shorter waiting times for patients included in predetermined clinical protocols. There was also a high level of patient satisfaction with this service. Conclusion: Our Fast Track Enhanced Nursing service is a model of tailored service diversification to shorten waiting times, thus improving patient satisfaction and outcome.

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Point of care lung ultrasound is useful when screening for CoVid-19 in Emergency Department patients.

10.1101/2020.06.09.20123836 ◽

2020 ◽

Cited By ~ 1

Author(s):

Andrea Hankins ◽

Heejung Bang ◽

Paul Walsh

Keyword(s):

Emergency Department ◽

Null Hypothesis ◽

Lung Ultrasound ◽

Point Of Care ◽

Vital Signs ◽

P Value ◽

Inclusion Criteria ◽

Upper Respiratory Infection ◽

Life Threatening ◽

Emergency Department Patients

Background CoVid-19 can be a life-threatening lung disease or a trivial upper respiratory infection depending on whether the alveoli are involved. Emergency department (ED) screening in symptomatic patients with normal vital signs is frequently limited to oro-nasopharyngeal swabs. We tested the null hypothesis that patients being screened for CoVid-19 in the ED with normal vital signs and without hypoxia would have a point-of-care lung ultrasound (LUS) consistent with CoVid-19 less than 2% of the time. Methods Subjects Subjects were identified from ED ultrasound logs. Inclusion criteria Age 14 years or older with symptoms prompting ED screening for CoVid-19. Exclusion criteria Known congestive heart failure or other chronic lung condition likely to cause excessive B lines on LUS. Intervention Structured blinded ultrasound review and chart review Analysis We used an exact hypothesis tests for binomial random variables. We also measured LUS diagnostic performance using computed tomography as the gold standard. Results We reviewed 77 charts; 62 met inclusion criteria. Vital signs were normal in 31 patients; 10 (32%) of these patients had LUS consistent with CoVid-19. We rejected the null hypothesis (p-value for bitest <0.001). The treating physicians' interpretation of their own point of care lung ultrasounds had a sensitivity of 100% (95% CI 75%, 100%) and specificity of 80% (95% CI 68%, 89%). Conclusion LUS has a meaningful detection rate for CoVid-19 in symptomatic emergency department patients with normal vital signs. We recommend at least LUS be used in addition to PCR testing when screening symptomatic ED patients for CoVid-19.

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Screening for alcohol problems in emergency department patients with minor injury: results and recommendations for practice and policy

Contemporary Drug Problems ◽

10.1177/009145099802500304 ◽

1998 ◽

Vol 25 (3) ◽

pp. 463-475 ◽

Cited By ~ 7

Author(s):

Linda C. Degutis

Keyword(s):

Emergency Department ◽

Blood Alcohol Concentration ◽

Alcohol Concentration ◽

Alcohol Problems ◽

Screening Process ◽

Multiple Strategies ◽

Life Threatening ◽

Emergency Department Patients ◽

Minor Injuries ◽

One Year

In order to assess the feasibility of emergency department (ED) physician screening of patients with minor injuries for alcohol problems, a two-part screening process was implemented in an urban ED. Blood alcohol concentration was measured using either a saliva strip or a serum alcohol test. Questions about alcohol use frequency, and consumption quantity were asked in addition to the CAGE questions. Over a one-year period 2,439 adults (age ≥ 18 years) with non-life-threatening injuries were screened. Multiple strategies were used in order to increase compliance over the course of the study. Over the first six months, the overall screening rate increased from 8% to 45% and remained level for most of the duration of the project. Individual variations in rates ranged from 5% to 70%. Screening for alcohol problems is feasible in the ED setting and may be integrated as part of the role of the ED physician.

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