scholarly journals MP26: Development and evaluation of a novel emergency physician fan-out mechanism at an urban centre for use in mass casualty incidents

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S51
Author(s):  
J. Melegrito ◽  
B. Granberg ◽  
K. Hanrahan
Keyword(s):  
Emergency Department ◽  
Emergency Physician ◽  
Large Scale ◽  
Response Rate ◽  
Text Message ◽  
Mass Casualty ◽  
Mass Casualty Incidents ◽  
Process Mapping ◽  
Emergency Physicians ◽  
Physician Response

Background: Understaffing in mass casualty incidents limits flow in the overwhelmed emergency department, which is further compounded by inefficient use of those same human resources. Process mapping analysis of a “Code Orange” exercise at a tertiary academic hospital exposed the failures of telephone-based emergency physician fan-out protocols to address these issues. As such, a quality improvement and patient safety initiative was undertaken to design, implement, and evaluate a new mass casualty incident fan-out mechanism. Aim Statement: By February 2019, emergency physician fan-out will be accomplished within 1 hour of Code Orange declaration, with a response rate greater than 20%. Measures & Design: Process mapping of a Code Orange simulation highlighted telephone fan-out to be ineffective in mobilizing emergency physicians to provide care in mass casualty incidents: available staff were pulled from their usual duties to help unit clerks unsuccessfully reach off-duty physicians by telephone for hours. Stakeholders subsequently identified automation and computerization as a compelling change idea. A de-novo automated bidirectional text-messaging system was thus developed. Early trials were analyzed for process measures including fan-out speed, unit clerk involvement, and physician response rate, with further large-scale tests planned for early 2019. Evaluation/Results: Only 50% of telephone fan-out was completed after a 2-hour exercise despite 3 staff supplementing the 2 on-shift unit clerks, with a 4% physician response rate. In contrast, data from initial trials of the automated system suggest that full fan-out can be performed within 1 hour of Code Orange declaration and require only 1 unit clerk, with text-messages projected to yield higher physician response rates than telephone calls. Early findings have thus far affirmed stakeholder sentiments that automating fan-out can improve speed, unit clerk efficiency, and physician response rate. Discussion/Impact: Automated text-message systems can expedite fan-out protocol in mass casualty incidents, relieve allied health staff strain, and more reliably recruit emergency physicians. Large-scale trials of the novel system are therefore planned for early 2019, with future expansion of the protocol to other medical personnel under consideration. Thus, automated text-message systems can be implemented in urban centres to improve fan-out efficiency and aid overall emergency department flow in mass casualty incidents.

scholarly journals Patient Suggestions to Improve Emergency Physician Empathy and Communication

2021 ◽  
Vol 8 ◽  
pp. 237437352199698
Author(s):  
Sophia Aguirre ◽  
Kristen M Jogerst ◽  
Zachary Ginsberg ◽  
Sandeep Voleti ◽  
Puneet Bhullar ◽  
...  
Keyword(s):  
Emergency Department ◽  
Patient Satisfaction ◽  
Emergency Physician ◽  
Active Listening ◽  
Patient Relationship ◽  
Emergency Physicians ◽  
Future Improvement ◽  
Survey Responses ◽  
Physician Empathy

Emergency physician empathy and communication is increasingly important and influences patient satisfaction. This study investigated if there is a need for improvement in provider empathy and communication in our emergency department and what areas could be targeted for future improvement. Patients cared for by emergency physicians with the lowest satisfaction scores were surveyed within 1 week of discharge. Patients rated their emergency provider’s empathy and communication and provided feedback on the patient–provider interaction. Compared to survey responses nationally, our providers fell between the 10th and 25th percentiles for all questions, except question 5 (making a plan of action with [the patient]) which was between the 5th and 10th percentile. Areas most frequently cited for improvement were “wanting to know why” (N = 30), “time is short” (N = 15), and “listen to the patient” (N = 13). Survey percentiles and open-ended suggestions demonstrate a need for providers to give thorough explanations, spend more time with the patient, and demonstrate active listening. These themes can be used to strengthen the provider–patient relationship.

scholarly journals Management of COVID-19 Patients in the Emergency Department

2021 ◽  
Vol 11 (10) ◽  
pp. 961
Author(s):  
Ioannis Pantazopoulos ◽  
Stamatoula Tsikrika ◽  
Stavroula Kolokytha ◽  
Emmanouil Manos ◽  
Konstantinos Porpodis
Keyword(s):  
Public Health ◽  
Emergency Department ◽  
Current Literature ◽  
Emergency Care ◽  
Emergency Physician ◽  
Care Delivery ◽  
Health Concern ◽  
Global Public Health ◽  
Emergency Physicians ◽  
Public Health Concern

COVID-19 is an emerging disease of global public health concern. As the pandemic overwhelmed emergency departments (EDs), a restructuring of emergency care delivery became necessary in many hospitals. Furthermore, with more than 2000 papers being published each week, keeping up with ever-changing information has proven to be difficult for emergency physicians. The aim of the present review is to provide emergency physician with a summary of the current literature regarding the management of COVID-19 patients in the emergency department.

scholarly journals MP38: The impact of physician handoffs on the outcomes of emergency department patients: a medical administrative database retrospective cohort study

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S56-S56
Author(s):  
A. Mokhtari ◽  
D. Simonyan ◽  
A. Pineault ◽  
M. Mallet ◽  
S. Blais ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Emergency Physician ◽  
Retrospective Cohort ◽  
Independent Predictor ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Emergency Physicians ◽  
Icu Admission ◽  
The Impact

Introduction: A physician handoff is the process through which physicians transfer the primary responsibility of a care unit. The emergency department (ED) is a fast-paced and crowded environment where the risk of information loss between shifts is significant. Yet, the impact of handoffs between emergency physicians on patient outcomes remains understudied. We performed a retrospective cohort study in the ED to determine if handed-off patients, when compared to non-handed-off patients, were at higher risk of negative outcomes. Methods: We included every adult patient first assessed by an emergency physician and subsequently admitted to hospital in one of the five sites of the CHU de Québec-Université Laval during fiscal year 2016-17. Data were extracted from the local hospital discharge database and the ED information system. Primary outcome was mortality. Secondary outcomes were incidence of ICU admission and surgery and hospital length of stay. We conducted multilevel multivariate regression analyses, accounting for patient and hospital clusters and adjusting for demographics, CTAS score, comorbidities, admitting department delay before evaluation by an emergency physician and by another specialty, emergency department crowding, initial ED orientation and handoff timing. We conducted sensitivity analyses excluding patients that had an ED length of stay > 24 hours or events that happened after 72 hours of hospitalization. Results: 21,136 ED visits and 17,150 unique individuals were included in the study. Median[Q1-Q3] age, Charlson index score, door-to-emergency-physician time and ED length of stay were 71[55-83] years old, 3[1-4], 48 [24,90] minutes, 20.8[9.9,32.7] hours, respectively. In multilevel multivariate analysis (OR handoff/no handoff [CI95%] or GMR[SE]), handoff status was not associated with mortality 0.89[0.77,1.02], surgery 0.95[0.85,1.07] or hospital length of stay (-0.02[0.03]). Non-handed-off patients had an increased risk of ICU admission (0.75[0.64,0.87]). ED occupancy rate was an independent predictor of mortality and ICU admission rate irrespectively of handoff status. Sensitivity and sub-group based analyses yielded no further information. Conclusion: Emergency physicians’ handoffs do not seem to increase the risk of severe in-hospital adverse events. ED occupancy rate is an independent predictor of mortality. Further studies are needed to explore the impact of ED handoffs on adverse events of low and moderate severity.

scholarly journals (P1-38) Emergency Department Preparedness for Training Management Plan towards Mass Casualty Incidents

2011 ◽  
Vol 26 (S1) ◽  
pp. s110-s111
Author(s):  
W.L. Chan
Keyword(s):  
Emergency Department ◽  
Food Poisoning ◽  
Management Plan ◽  
Mass Casualty ◽  
Mass Casualty Incidents ◽  
Working Relationships ◽  
Work Processes ◽  
Hospital Emergency ◽  
New Information ◽  
Planning Department

It is important to equip emergency department (ED) staff with skills to manage mass casualty incidents (MCI) as disasters strike without warning. Our hospital, Tan Tock Seng Hospital, has been the national screening centre for severe acute respiratory distress syndrome (SARS) and H1N1 outbreaks in 2003 and 2009. Furthermore, our ED has managed casualties from mass food poisoning in the community. We would like to share our experiences in training our staff for MCI. For the ED to operate smoothly in a MCI, comprehensive training of staff during “peace” time is essential. We have a selected team of doctors and nurses as the department disaster workgroup. This team, together with the hospital emergency planning department, prepare the disaster protocols using an “all hazard approach concept” and aim to minimise variations between different protocols (Conventional, Infectious disease, Hazmat, Radioactive MCI). These protocols are updated regularly, with new information disseminated to all staff. Next, all staff must be well-versed in the protocols. New staffs undergo orientation programmes to familiarize them with the work processes. Regular audits are conducted to ensure that the quality is well-maintained. Additionally, training also occurs at the inter-departmental and national levels. There are regular activation exercises to test inter-departmental response to MCI and collaborations with Ministry of Health to conduct disaster exercises e.g. the biennial Kingfisher Exercise in preparation for radiation-related MCI. Such exercises improve communication and working relationships within the ED and with other departments. The camaraderie developed can act as a pillar of support during stressful times of MCI. Lastly, the ED staffs attend local and international courses and conferences to update ourselves on the latest training and knowledge in the handling of MCI. This allows us to share our ideas and to learn from our local and international counterparts, and helps better prepare ourselves.

Abstract 104: Survey of Emergency Physician Cardiac Imaging Technology and Guideline Knowledge

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Carolyn Martin ◽  
Michael Lacey ◽  
James Spalding ◽  
Breanna Essoi
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Radionuclide Imaging ◽  
Cardiac Imaging ◽  
Emergency Physician ◽  
Emergency Physicians ◽  
Appropriate Use Criteria ◽  
Appropriate Use ◽  
Stress Echo ◽  
Pain Patients

Objectives: Chest pain is among the most common reasons for emergency room presentation. Providing emergency physicians with the tools necessary to evaluate and triage chest pain patients is a key component of health care efficiency. The study objective was to increase understanding of the clinical tools available to evaluate chest pain in the emergency setting. Methods: A total of 630 emergency physicians were invited to participate in a web-based survey. Eligible respondents must have had at least 3 years of experience and spend at least 30% of time providing direct patient care. Over the course of 2 days, 163 physicians responded; 101 were eligible and completed the survey. The survey consisted of 3 screening questions and 11 survey questions. Survey questions included: experience with chest pain patients, cardiac imaging technologies as well as knowledge and use of the appropriate use criteria (AUC) for cardiac radionuclide imaging. Findings: Over ¾ of all respondents were male, averaged 46 years of age, and had been practicing emergency medicine for nearly 15 years. On average, the respondents saw 20 chest pain patients per week and 72% of those were of unknown cardiac etiology. Diagnostic Catheterization and Stress ECG were the most common evaluation tools available in the emergency department (72% and 71% respectively). When available, stress ECG was the most commonly used evaluation tool in the emergency department. MPI-SPECT was only available to 27% of respondents, and of those, only used 44% of the time. Respondents selecting the “other” response most commonly reported that imaging evaluation was not done in the emergency department. Older physicians (> 61 years) were less likely to report access to stress ECHO; physicians with fewer years of experience (20 or less) were more likely to have access to stress ECHO and diagnostic catheterization. Rural physicians were less likely to report the availability of MPI, CT or diagnostic catheterization. Less than half of emergency physicians (42%) were familiar with the cardiac radionuclide imaging appropriate use criteria, and 80% rarely or never use them. AUC knowledge and use did not differ by years in practice but did differ by age. Physicians in rural practices were the least likely to have knowledge or use the AUC. Conclusions: Despite the frequency of chest pain patients presenting to the emergency department, access to imaging tools for evaluation of cardiac etiology is limited. Knowledge and use of AUC guidelines was also limited. These results question the current clinical paradigm which appears to limit the emergency physician knowledge and use of imaging technology to evaluate the chest pain patient despite the high frequency of presentation.

scholarly journals The removal of coins from the upper esophageal tract of children by emergency physicians: a pilot study

CJEM ◽  
2004 ◽  
Vol 6 (06) ◽  
pp. 434-440 ◽  
Author(s):  
Edward J. Vargas ◽  
Ameer P. Mody ◽  
Tommy Y. Kim ◽  
T. Kent Denmark ◽  
James A. Moynihan ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pilot Study ◽  
Emergency Physician ◽  
Foley Catheter ◽  
Tertiary Care ◽  
Pediatric Emergency ◽  
Rapid Sequence Intubation ◽  
Emergency Physicians ◽  
Common Procedure ◽  
Data Set

ABSTRACT:Objective:There are few reports in the medical literature describing removal of a coin from the upper esophageal tract of a child by an emergency physician. However, given the nature of their training and practice, emergency physicians are well suited to perform this common procedure. We describe our experience with this procedure.Methods:This was a retrospective review of a continuous quality improvement data set from a university-based tertiary care pediatric emergency department between Nov. 1, 2003, and Mar. 31, 2004.Results:Thirteen children, with a median age of 20 months, underwent rapid sequence intubation and had coins successfully removed from their upper esophageal tract by emergency physicians. In 10 cases, the coin was visible at laryngoscopy and removed with Magill forceps. In 3 cases this approach failed and a Foley catheter was used to remove the coin. One child suffered a tonsillar abrasion and two sustained minor lip trauma, but all were extubated and discharged home from the emergency department with no significant complications. Eleven of the 13 patients were successfully followed up, and the parents reported no problems.Conclusions:This pilot study suggests that the removal of a coin from the upper esophageal tract by an emergency physician can be both safe and effective. A larger study is needed before this procedure can be generally recommended.

Improving Pediatric Administrative Disaster Preparedness Through Simulated Disaster Huddles

2020 ◽  
pp. 1-6 ◽  
Author(s):  
Isabel T. Gross ◽  
Scott A. Goldberg ◽  
Travis Whitfill ◽  
Storm Liebling ◽  
Angelica Garcia ◽  
...  
Keyword(s):  
Emergency Department ◽  
Patient Outcomes ◽  
Disaster Preparedness ◽  
Mass Casualty ◽  
Mass Casualty Incidents ◽  
Time Commitment ◽  
Potential Impact

ABSTRACT Members of an emergency department (ED) staff need to be prepared for mass casualty incidents (MCIs) at all times. Didactic sessions, drills, and functional exercises have shown to be effective, but it is challenging to find time and resources for appropriate training. We conducted brief, task-specific drills (deemed “disaster huddles”) in a pediatric ED (PED) to examine if such an approach could be an alternative or supplement to traditional MCI training paradigms. Over the course of the study, we observed an improving trend in the overall score for administrative disaster preparedness. Disaster huddles may be an effective way to improve administrative disaster preparedness in the PED. Low-effort, low-time commitment education could be an attractive way for further disaster preparedness efforts. Further studies are indicated to show a potential impact on lasting behavior and patient outcomes.

scholarly journals Training Emergency Department Charge Nurses Through Tabletop Exercises

2019 ◽  
Vol 34 (s1) ◽  
pp. s19-s19
Author(s):  
Beth Weeks
Keyword(s):  
Decision Making ◽  
Emergency Department ◽  
Training Program ◽  
Disaster Response ◽  
Mass Casualty ◽  
Full Scale ◽  
Leadership Role ◽  
Mass Casualty Incidents ◽  
Charge Nurses ◽  
Incident Command

Introduction:In a disaster or mass casualty incident, the Emergency Department (ED) charge nurse is thrust into an expanded leadership role, expected to not only manage the department but also organize a disaster response. Hospital emergency preparedness training programs typically focus on high-level leadership, while frontline decision-making staff get experience only through online training and infrequent full-scale exercises. Financial and time limitations of full-scale exercises have been identified as major barriers to frontline training.Aim:To discuss a cost-effective approach to training ED charge nurses and informal leaders in disaster response.Methods:A formal training program was implemented in the ED. All permanent and relief charge nurses are required to attend one four-hour Hospital ICS course within their first year in their position, as well as participate in a minimum of one two-hour ED-based tabletop exercise per year. The tabletop exercises are offered bimonthly, covering various mass casualty scenarios such as apartment complex fires, riots, and a tornado strike. Full-scale exercises involving the ED occur annually.Results:ED permanent and relief charge nurses expressed increased skills and knowledge in areas such as initiation of disaster processes, implementation of hospital incident command, and familiarization with protocols and available resources. Furthermore, ED charge nurses have demonstrated strong leadership, decision-making, and improved response to actual mass casualty incidents since implementing ICS training and tabletop exercises.Discussion:Limitations of relying on full-scale disaster exercises to provide experience to frontline leaders can be overcome by the inclusion of ICS training and tabletop exercises for ED charge nurses in a hospital training and exercise plan. Implementing a structured training program for ED charge nurses focusing on leadership in mass casualty incidents is one step to building a more resilient and prepared ED, hospital, and community.

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