Controlled Deliveryof High vs Low Humidity vs Mist Therapy for Croup in Emergency Departments: A Randomized Controlled Trial

2008 ◽  
Vol 2008 ◽  
pp. 93-95
Author(s):  
J.A. Stockman
Keyword(s):  
Randomized Controlled Trial ◽  
Emergency Departments ◽  
Controlled Trial ◽  
Randomized Controlled ◽  
Low Humidity

scholarly journals Comparative Effectiveness of Direct Admission & Admission through Emergency Departments for Children: A Randomized Stepped Wedge Study Protocol

2020 ◽  
Author(s):  
JoAnna K. Leyenaar ◽  
Corrie E McDaniel ◽  
Stephanie Acquilano ◽  
Andrew Schaefer ◽  
Martha L. Bruce ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Hospital Admission ◽  
Emergency Departments ◽  
Controlled Trial ◽  
Healthcare Systems ◽  
Care Practice ◽  
Stepped Wedge ◽  
Randomized Controlled ◽  
Experience Of Care ◽  
Direct Admission

Abstract Background: Approximately 2 million children are hospitalized each year in the United States, with more than three-quarters of non-elective hospitalizations admitted through emergency departments (EDs). Direct admission, defined as admission to hospital without first receiving care in the hospital’s ED, may offer benefits for patients and healthcare systems in quality, timeliness, and experience of care. While ED utilization patterns are well studied, there is a paucity of research comparing the effectiveness of direct and ED admissions. The overall aim of this project is to compare the effectiveness of a standardized direct admission approach to admission beginning in the ED for hospitalized children.Methods/Design: We will conduct a stepped wedge cluster randomized controlled trial at 3 structurally and geographically diverse hospitals. A total of 70 primary and urgent care practice sites in the hospitals’ catchment areas will be randomized to a time point when they will begin participation in the multi-stakeholder informed direct admission program. This crossover will be unidirectional and occur at 4 time points, six months apart, over a 24-month implementation period. Our primary outcome will be the timeliness of clinical care provision. Secondary outcomes include: (i) parent-reported experience of care; (ii) unanticipated transfer to the intensive care unit within 6 hours of hospital admission; and (iii) rapid response calls within 6 hours of hospital admission. We anticipate that 190 children and adolescents will be directly admitted, with 1506 admitted through EDs. Analyses will compare the effectiveness of direct admission to admission through the ED, and will evaluate the causal effect of implementing a direct admission program using linear regression with random effects for referring practice clusters and time period fixed effects. We will further examine heterogeneity of treatment effects based on hypotheses specified a priori. In addition, we will conduct a mixed-methods process evaluation to assess reach, effectiveness, adoption, implementation and maintenance of our direct admission intervention.Discussion: Our study represents the first randomized controlled trial to compare the effectiveness of direct admission to admission through the ED for pediatric patients. Our scientific approach, pairing a stepped-wedge design with a multi-level assessment of barriers to and facilitators of implementation, will generate valuable data about how positive findings can be reproduced across other healthcare systems.Trial registration: This trial is registered in ClinicalTrials.gov (NCT04192799, registered December 10, 2019, https://clinicaltrials.gov/ct2/show/NCT04192799)

scholarly journals The BEACON Study: Protocol for a cluster randomized controlled trial of a service to deliver smartphone-assisted problem-solving therapy compared to usual care in men who present with intentional self-harm to Emergency Departments in Ontario

2020 ◽  
Author(s):  
Simon Hatcher ◽  
Marnin Heisel ◽  
Oyedeji Ayonrinde ◽  
Julie Kathleen Campbell ◽  
Ian Colman ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Problem Solving ◽  
Health System ◽  
Usual Care ◽  
Emergency Departments ◽  
Controlled Trial ◽  
Problem Solving Therapy ◽  
Randomized Controlled ◽  
Self Harm ◽  
Cluster Randomized

Abstract Background Patients who present to Emergency Departments (ED) after intentional self-harm receive variable levels care in Ontario. Many are not assessed by a mental health professional following discharge from ED and do not receive psychological services available in the community as many of these services are not covered by the provincial health insurance. Patients who present with intentional self-harm to hospital are more likely to die by suicide and premature death by other means compared to the general population. This risk is elevated in men, who represent two-thirds of those who die by suicide in Ontario. One way of potentially addressing this gap is to offer problem-solving therapy (PST) designed specifically for men, facilitated by the use of a patient facing smartphone application and a clinician facing dashboard. This attempts to blend the use of face to face therapy and technology to create an effective intervention after self-harm.Methods This is a pragmatic, multicentre pre- and post-design cluster randomized controlled trial (cRCT) comparing the provision of a suicide prevention intervention to usual care, in men who present to the ED with self-harm. The study intervention is composed of: 1) staff education; 2) resource materials for men who present to the ED with self-harm; and, 3) the option to refer patients to a blended PST service for the treatment of self-harm. The primary outcome to be assessed is a composite of the incidence of suicides and/or re-presentations to any ED in Ontario for self-harm in the year after presentation with self-harm. Secondary outcome measures include: total number of suicides; re-presentations to any ED in Ontario for the repetition of self-harm; re-presentations to any ED in Ontario for any reason; other health system use including use of primary care and hospital outpatient appointments; mortality not related to suicide; and, health system costs over one year. All outcomes will be measured from provincial health administrative databases available at the Institute for Clinical and Evaluative Sciences (IC/ES).

scholarly journals Comparative effectiveness of direct admission and admission through emergency departments for children: a randomized stepped wedge study protocol

Trials ◽  
2020 ◽  
Vol 21 (1) ◽  
Author(s):  
JoAnna K. Leyenaar ◽  
Corrie E. McDaniel ◽  
Stephanie C. Acquilano ◽  
Andrew P. Schaefer ◽  
Martha L. Bruce ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Hospital Admission ◽  
Emergency Departments ◽  
Controlled Trial ◽  
Healthcare Systems ◽  
Care Practice ◽  
Stepped Wedge ◽  
Randomized Controlled ◽  
Experience Of Care ◽  
Direct Admission

Abstract Background Approximately 2 million children are hospitalized each year in the United States, with more than three-quarters of non-elective hospitalizations admitted through emergency departments (EDs). Direct admission, defined as admission to hospital without first receiving care in the hospital’s ED, may offer benefits for patients and healthcare systems in quality, timeliness, and experience of care. While ED utilization patterns are well studied, there is a paucity of research comparing the effectiveness of direct and ED admissions. The overall aim of this project is to compare the effectiveness of a standardized direct admission approach to admission beginning in the ED for hospitalized children. Methods/design We will conduct a stepped wedge cluster randomized controlled trial at 3 structurally and geographically diverse hospitals. A total of 70 primary and urgent care practice sites in the hospitals’ catchment areas will be randomized to a time point when they will begin participation in the multi-stakeholder informed direct admission program. This crossover will be unidirectional and occur at 4 time points, 6 months apart, over a 24-month implementation period. Our primary outcome will be the timeliness of clinical care provision. Secondary outcomes include (i) parent-reported experience of care, (ii) unanticipated transfer to the intensive care unit within 6 h of hospital admission, and (iii) rapid response calls within 6 h of hospital admission. We anticipate that 190 children and adolescents will be directly admitted, with 1506 admitted through EDs. Analyses will compare the effectiveness of direct admission to admission through the ED and will evaluate the causal effect of implementing a direct admission program using linear regression with random effects for referring practice clusters and time period fixed effects. We will further examine the heterogeneity of treatment effects based on hypotheses specified a priori. In addition, we will conduct a mixed-methods process evaluation to assess reach, effectiveness, adoption, implementation, and maintenance of our direct admission intervention. Discussion Our study represents the first randomized controlled trial to compare the effectiveness of direct admission to admission through the ED for pediatric patients. Our scientific approach, pairing a stepped wedge design with a multi-level assessment of barriers to and facilitators of implementation, will generate valuable data about how positive findings can be reproduced across other healthcare systems. Trial registration ClinicalTrials.gov NCT04192799. Registered on December 10, 2019).

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