P019: Prehospital diversion of intoxicated patients to a detoxification facility vs the emergency department: safety and compliance of an EMS direct transport protocol

Introduction: Prehospital transport of patients to an alternative destination (diversion) has been proposed as part of a solution to overcrowding in emergency departments (ED). We evaluated compliance and safety of an EMS bypass protocol allowing paramedics to transport intoxicated patients directly to an alternate facility [Withdrawal Management Services (WMS)], bypassing the ED. Patients were eligible for diversion if they were ≥18 years old, classified as CTAS level III-IV, scored <4 on the Prehospital Early Warning (PHEW) score, and did not have any vital sign parameters in a danger zone (as per PHEW score criteria). Methods: A retrospective analysis was conducted on intoxicated patients presenting to Sudbury EMS. Data was abstracted from EMS reports, hospital medical records, and discharge forms from WMS. Protocol compliance was measured using missed protocol opportunities (patients eligible for diversion but taken directly to the ED) and protocol noncompliance rates; protocol safety was measured using protocol failure (presentation to ED within 48 hours of appropriate diversion) and patient morbidity rates (hospital admission within 48 hours of diversion). Data was analysed qualitatively and quantitatively using proportions. Results: EMS responded to 681 calls for intoxication. Of the 568 taken directly to the ED, 65 met diversion criteria; these were missed protocol opportunities (11%). 113 patients were diverted. There was protocol noncompliance in 41 cases (36%), but 35 were due to incomplete recording of vital signs. There were direct protocol violations in only 6 cases (5%). There was protocol failure in 16 cases (22%), and patient morbidity in 1 case (1%). No patients died within 48 hours of diversion. Conclusion: EMS providers were fairly compliant with the protocol when transporting patients directly to the ED. There was some protocol non-compliance with patients diverted to WMS, though this is largely attributed to incomplete recording of vital signs; direct protocol violations were low. The protocol provides high levels of safety for patients diverted to WMS. Broader implementation of the protocol could reduce the volume of intoxicated patients seen in the ED, and improve quality of care received by this population.

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P018: Prehospital diversion of mental health patients to a mental health center vs the emergency department: safety and compliance of an EMS direct transport protocol

CJEM ◽

10.1017/cem.2017.220 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S83-S84

Author(s):

V. Bismah ◽

J. Prpic ◽

S. Michaud ◽

N Sykes

Keyword(s):

Mental Health ◽

Medical Records ◽

Mental Health Center ◽

Vital Signs ◽

Transport Protocol ◽

Danger Zone ◽

Patient Morbidity ◽

Mental Health Patients ◽

Psychiatric Issues

Introduction: Prehospital transport of patients to an alternative destination (diversion) has been proposed as part of a solution to overcrowding in emergency departments (ED). We evaluated compliance and safety of an EMS protocol allowing paramedics to transport medically stable patients with psychiatric issues directly to an alternate facility [Crisis Intervention (CI)], bypassing the ED. Patients were eligible for diversion if they were ≥18 years old, classified as CTAS III-IV, scored <4 on the Prehospital Early Warning (PHEW) score, and did not have any vital sign parameters in a danger zone (as per PHEW score criteria). Methods: A retrospective analysis was conducted on patients presenting to Sudbury EMS with behavioural or psychiatric issues. Data was abstracted from EMS reports, hospital medical records, and discharge forms from CI. Protocol compliance was measured using missed protocol opportunities (patients eligible for diversion but taken directly to the ED) and protocol noncompliance rates; protocol safety was measured using protocol failure (presentation to ED within 48 hours of appropriate diversion) and patient morbidity rates (hospital admission within 48 hours of diversion). Data was analysed qualitatively and quantitatively using proportions. Results: EMS responded to 695 calls with psychiatric complaints. Of the 650 taken directly to the ED, 18 met diversion criteria; these were missed protocol opportunities (3%). 45 patients were diverted. There was protocol noncompliance in 36 cases (80%), but 34 were due to incomplete recording of vital signs. There were direct protocol violations in only 2 cases (4%). There was protocol failure in 3 cases (33%), and patient morbidity in 8 cases (18%). No patients died within 48 hours of diversion. Conclusion: EMS providers were highly compliant with the protocol when transporting patients directly to the ED. There were high levels of protocol non-compliance in diverting patients to CI, though this is largely attributed to incomplete recording of vital signs; direct protocol violations were low. The protocol provides moderate levels of safety in diverted patients. Broader implementation of a diversion protocol could reduce the volume of mental health patients seen in the ED, and improve quality of care received by this patient population.

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MP04: rEDirect: safety and compliance of an emergency department diversion protocol for mental health and addictions patients

CJEM ◽

10.1017/cem.2019.139 ◽

2019 ◽

Vol 21 (S1) ◽

pp. S43

Author(s):

V. Bismah ◽

J. Prpic ◽

S. Michaud ◽

N. Sykes ◽

J. Amyotte ◽

...

Keyword(s):

Mental Health ◽

Emergency Department ◽

Vital Signs ◽

Mortality Data ◽

Transport Protocol ◽

Patient Morbidity ◽

Mental Health Patients ◽

Ed Overcrowding ◽

Pilot Implementation ◽

Withdrawal Management

Introduction: Transportation of patients better served at an alternative destinations (diversion) is part of a proposed solution to emergency department (ED) overcrowding. We evaluated the pilot implementation of the “Mental Health and Addiction Triage and Transport Protocol”. This is the first Canadian diversion protocol that allows paramedics to transport intoxicated or mental health patients to an alternative facility, bypassing the ED. Our aim was to implement a safe diversion protocol to allow patients to access more appropriate service without transportation to the emergency department. Methods: A retrospective analysis was conducted on patients presenting to EMS with intoxication or psychiatric issues. Study outcomes were protocol compliance, determined through missed protocol opportunities, noncompliance, and protocol failure (presentation to ED within 48 hours of appropriate diversion); and protocol safety, determined through patient morbidity (hospital admission within 48 hours of diversion) and mortality. Data was abstracted from EMS reports, hospital records, and discharge forms from alternative facilities. Data was analyzed qualitatively and quantitatively. Results: From June 1st, 2015 to May 31st, 2016 Greater Sudbury Paramedic Services responded to 1376 calls for mental health or intoxicated patients. 241 (17.5%) met diversion criteria, 158 (12.9%) patients were diverted and 83 (4.6%) met diversion criteria but were transported to the ED. Of the diverted patients 9 (5.6%) represented to the ED <48rs later and were admitted. Of the 158 diversions, 113 (72%) were transported to Withdrawal Management Services (WMS) and 45 (28%) were taken to Crisis Intervention (CI). There was protocol noncompliance in 77 cases, 69 (89.6%) were due to incomplete recording of vital signs; 6 (10.3%) were direct protocol violations of being transferred with vital sings outside the acceptable range. Conclusion: The Mental Health and Addiction Triage and Transport Protocol has the potential to safely divert 1 in 6 mental health or addiction patients to an alternative facility.

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Improving Nursing Care Documentation in Emergency Department: A Participatory Action Research Study in Iran

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2018.303 ◽

2018 ◽

Vol 6 (8) ◽

pp. 1527-1532 ◽

Cited By ~ 3

Author(s):

Seyed Majid Vafaei ◽

Zahra Sadat Manzari ◽

Abbas Heydari ◽

Razieh Froutan ◽

Leila Amiri Farahani

Keyword(s):

Emergency Department ◽

Action Research ◽

Nursing Care ◽

Medical Records ◽

Research Study ◽

Collaborative Action Research ◽

Second Phase ◽

Monitoring And Control ◽

Action Research Study

BACKGROUND: Standardization of documentation has enabled the use of medical records as a primary tool for evaluating health care functions and obtaining appropriate credit points for medical centres. However, previous studies have shown that the quality of medical records in emergency departments is unsatisfactory.AIM: The aim of this study was improving the nursing care documentation in an emergency department, in Iran.MATERIAL AND METHODS: This collaborative action research study was carried out in two phases to improve nursing care documentation in cooperation with individuals involved in the process, from February 2015 to December 2017 in an affiliated academic hospital in Iran. The first phase featured virtual training, an educational workshop, and improvements to the hospital information system. The second phase involved the recruitment of human resources, the implementation of continuous codified training, the establishment of an appropriate reward and penalty system, and the review of patient education forms.RESULTS: The interventions improved nursing documentation quality score of 73.20%, which was the highest accreditation ranking provided by Iran’s Ministry of Health and Medical Education in 2017. In other words, this study caused a 32% improvement in the quality of nursing care documentation in the hospital.CONCLUSION: The appropriate practices for improving nursing care documentation are employee participation, managerial accountability, nurses’ adherence to documentation standards, improved leadership style, and continuous monitoring and control.

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A Simulation Study to Improve Quality of Care in the Emergency Department of a Community Hospital

Journal of Emergency Nursing ◽

10.1016/j.jen.2011.03.005 ◽

2012 ◽

Vol 38 (4) ◽

pp. 322-328 ◽

Cited By ~ 53

Author(s):

Zhen Zeng ◽

Xiaoji Ma ◽

Yao Hu ◽

Jingshan Li ◽

Deborah Bryant

Keyword(s):

Emergency Department ◽

Quality Of Care ◽

Simulation Study ◽

Community Hospital ◽

Improve Quality

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Does Health Information Exchange Reduce Unnecessary Neuroimaging and Improve Quality of Headache Care in the Emergency Department?

Journal of General Internal Medicine ◽

10.1007/s11606-012-2092-7 ◽

2012 ◽

Vol 28 (2) ◽

pp. 176-183 ◽

Cited By ~ 55

Author(s):

James E. Bailey ◽

Jim Y. Wan ◽

Lisa M. Mabry ◽

Stephen H. Landy ◽

Rebecca A. Pope ◽

...

Keyword(s):

Emergency Department ◽

Health Information ◽

Information Exchange ◽

Health Information Exchange ◽

Improve Quality ◽

Headache Care

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Epilepsy in children with shunted hydrocephalus

Neurosurgical FOCUS ◽

10.3171/foc.1999.6.2.4 ◽

1999 ◽

Vol 6 (2) ◽

pp. E3

Author(s):

Marie Bourgeois ◽

Christian Sainte-Rose ◽

Giuseppe Cinalli ◽

Wirginia Maixner ◽

Conor Malucci ◽

...

Keyword(s):

Medical Records ◽

Epileptic Seizures ◽

Developmental Outcome ◽

Improve Quality ◽

Intellectual Outcome ◽

History Of ◽

A Prospective Study ◽

Significant Data

The incidence of epilepsy among children with hydrocephalus and its relation to shunts and their complications, raised intracranial pressure (ICP), and developmental outcome are explored in a retrospective study. The authors studied a series of 802 children with hydrocephalus due to varying causes, who were treated by ventriculoperitoneal shunt placement between 1980 and 1990, with a mean follow-up period of 8 years. Patients who had tumoral hydrocephalus and those whose files lacked significant data were excluded. Data extracted from medical records, including history of the hydrocephalus and history of seizures, if any, were analyzed. Thirty-two percent of the children had epilepsy, the onset of which frequently occurred at approximately the same time that the diagnosis of hydrocephalus was made. The majority of the affected children had severe uncontrolled epilepsy. The incidence of epilepsy was significantly affected by the original cause of the hydrocephalus. The presence of radiological abnormalities was also found to be a significant predictor of epilepsy. Similarly, shunt complications predisposed to epilepsy. Episodes of raised ICP related to hydrocephalus or in association with shunt malfunction may also predispose to epileptic seizures. Furthermore, the presence of a shunt by itself seems able to promote an epileptogenic focus. Finally, epilepsy appears to be an important predictor of poor intellectual outcome in hydrocephalic children with shunts. A prospective study is needed to identify clearly and confirm avoidable factors predisposing to seizures in these children so that we can strive to reduce the incidence of these seizures and, subsequently, improve quality of life.

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Peningkatan Kualitas Timbang Terima Di Instalasi Gawat Darurat Era Revolusi Industri 4.0

Jurnal Kepemimpinan dan Manajemen Keperawatan ◽

10.32584/jkmk.v2i2.243 ◽

2019 ◽

Vol 2 (2) ◽

pp. 40

Author(s):

Tri Andri Pujiyanti ◽

Luky Dwiantoro ◽

Muhammad Hasib Ardani

Keyword(s):

Emergency Department ◽

Medical Record ◽

Industrial Revolution ◽

Technological Development ◽

Cultural Influences ◽

Effective Communication ◽

Improve Quality ◽

Application Form ◽

Digital Revolution

A handover is an application form for improving effective communication which is part of the patient safety goal. Ineffective handover has been shown to increase the risk of preventable side effects, length of stay and rates of complications. High patient mobilization, a lot of time taken, and increased workload are reasons why nurses do not have time for handover. While the ER Nurses are also required to develop, improve their knowledge and skills to improve quality services in line with the technological development of the era industrial revolution 4.0. The objective of this review to identify efforts for improving quality of handover in Emergency Departement in accordance with the development of the industrial revolution era 4.0. This review source search through CINAHL Ebsco, Science Direct, and pubmed from 2010 to 2019, in English, and full text. Searching keywords are Improvemenr, Quality Handover, Technology, and Emergency Department. From this literature review, it was found that efforts to improve quality of handover in the emergency departement included the establishment of appropriate communication / protocol tools / frameworks, developing multi-disciplinary teams, recognizing the influence of culture and implementing training. These efforts cannot be separated, all are interrelated to realize quality handover. Facing the digital revolution 4.0 based on Cyber Physical Systems in the health sector, improving quality handover may use electronic communication framework. Materials handover is using patient data in the medical record (RM) or electronic medical record (ERM). Electronic Handover tool aswer the challenges for facing the digital revolution 4.0. Efforts to improve the quality of handover in the emergency department are established effective communication tools / frameworks, Multidicipline Team meetings, training / coaching and recognizing cultural influences.

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Top 10 evidence-based countermeasures for night shift workers

Emergency Medicine Journal ◽

10.1136/emermed-2019-209134 ◽

2020 ◽

Vol 37 (9) ◽

pp. 562-564 ◽

Cited By ~ 1

Author(s):

Patrick J Wallace ◽

Jordana J Haber

Keyword(s):

Quality Of Life ◽

Emergency Department ◽

Formal Education ◽

Night Shift ◽

Evidence Based ◽

Improve Quality ◽

Weekly Basis ◽

Shift Workers ◽

Online Sources

Emergency edicine providers are responsible for ensuring the emergency department is staffed 24 hours a day. As such, providers must efficiently transition between day, swing and night shift on an almost weekly basis. There is no formal education in medical school or residency on how to approach the transition to and from night shift, remain alert and productive and maximise sleep during the day. There are a multitude of blogs and online sources discussing night shift, but few, if any, provide an evidence-based approach. This article will provide the top 10 evidence-based recommendations to increase sleep, maximise performance, decrease fatigue on shift and improve quality of life outside the workplace.

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