scholarly journals Emergency Department Response to Chemical, Biological, Radiological, Nuclear, and Explosive Events: A Systematic Review

2018 ◽  
Vol 33 (5) ◽  
pp. 543-549 ◽  
Author(s):  
Saydia Razak ◽  
Sue Hignett ◽  
Jo Barnes
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Systems Approach ◽  
Clinical Care ◽  
Evidence Based ◽  
Key Factors ◽  
Publication Type ◽  
Organizational Policies ◽  
Response Planning ◽  
Explosive Events

AbstractIntroductionA Chemical, Biological, Radiological, Nuclear, and explosive (CBRNe) event is an emergency which can result in injury, illness, or loss of life. The emergency department (ED) as a health system is at the forefront of the CBRNe response with staff acting as first receivers. Emergency departments are under-prepared to respond to CBRNe events - recognizing key factors which underlie the ED CBRNe response is crucial to provide evidence-based knowledge to inform policies and, most importantly, clinical practice.ProblemChallenges in detection, decontamination, and diagnosis are associated with the ED CBRNe response when faced with self-presenting patients.MethodsA systematic review was carried out in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). An in-depth search strategy was devised to identify studies which focused on the ED and CBRNe events. The inclusion criteria were stringent in terms of the environment (ED), participants (first receivers), situation (CBRNe response), and actions (detection, decontamination, and diagnosis). Fifteen databases and topic-specific journals were searched. Studies were critically appraised using the Mixed Methods Appraisal Tool (MMAT). Papers were thematically coded and synthesized using NVivo 10 (QSR International Ltd, Melbourne, Australia).ResultsSixty-seven full-text papers were critically appraised using the MMAT; 70% were included (n = 60) as medium- or high-quality studies. Data were grouped into four themes: preparedness, response, decontamination, and personal protective equipment (PPE) problems.DiscussionThis study has recognized the ED as a system which depends on four key factors - preparedness, response, decontamination, and PPE problems - which highlight challenges, uncertainties, inconsistencies, and obstacles associated with the ED CBRNe response. This review suggests that response planning and preparation should be considered at three levels: organizational (policies and procedures); technological (decontamination, communication, security, clinical care, and treatment); and individual (willingness to respond, PPE, knowledge, and competence). Finally, this study highlighted that there was a void specific to detection and diagnosis of CBRNe exposure on self-presenting patients in the ED.Conclusion:The review identified concerns for both knowledge and behaviors which suggests that a systems approach would help understand the ED response to CBRNe events more effectively. The four themes provide an evidence-based summary for the state of science in ED CBRNe response, which can be used to inform future policies and clinical procedures.RazakS,HignettS,BarnesJ.Emergency department response to chemical, biological, radiological, nuclear, and explosive events: a systematic review.Prehosp Disaster Med.2018;33(5):543–549.

scholarly journals Attitudes and Beliefs towards Patients with Hazardous Alcohol Use: A Systematic Review

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Neelam Mabood ◽  
Hansen Zhou ◽  
Kathryn A. Dong ◽  
Samina Ali ◽  
T. Cameron Wild ◽  
...  
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Alcohol Use ◽  
Reference Lists ◽  
Clinical Care ◽  
Attitudes And Beliefs ◽  
Staff Attitudes ◽  
Study Quality ◽  
Hazardous Alcohol Use ◽  
Hazardous Alcohol

Objective. To describe emergency department (ED) staff attitudes and beliefs towards patients presenting with hazardous alcohol use and their clinical management. Methods. A search of MEDLINE, EMBASE, CINAHL, SCOPUS from 1990 to 2010, and reference lists from included studies was conducted. Two reviewers independently screened for inclusion and assessed study quality. One reviewer extracted the data and a second checked for completeness and accuracy. Results. Among nine studies four reported varied beliefs on whether screening was worthwhile for identifying hazardous alcohol use (physicians: 42%–88%; nurses: 50%–100%). Physicians in three studies were divided on intervention provision (32%–54% in support of intervention provision) as were nurses in two studies (39% and 64% nurses in support of intervention provision). Referral for treatment was identified in two studies as an important part of ED management (physicians: 62% and 97%; nurses: 95%). Other attitudes and beliefs identified across the studies included concern that asking about alcohol consumption would be seen as obtrusive or offensive, and a perceived lack of time and resources available for providing care and referrals. Conclusions. ED staff had varying attitudes towards ED management of patients with hazardous alcohol use. Investigations into improving clinical care for hazardous alcohol use are needed to optimize ED management for these patients.

scholarly journals Implementation of an Evidence-Based Care Pathway for Emergency Department Management of Sickle Cell Vaso-Occlusive Crisis Leads to Improved Clinical Outcomes

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4678-4678
Author(s):  
Jennifer Yui ◽  
Scott A. Peslak ◽  
David Lambert ◽  
Eric Russell ◽  
Farzana Sayani
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Hospital Admission ◽  
Sickle Cell ◽  
Clinical Pathway ◽  
Care Pathway ◽  
Clinical Care ◽  
Evidence Based ◽  
Opioid Dose ◽  
Clinical Care Pathway

BACKGROUND Painful vaso-occlusive crises (VOC) are the most common reason for acute care utilization in patients with sickle cell disease (SCD), and the emergency department (ED) is often the site of initial management and treatment. Treatment guidelines recommend initiation of analgesia with parenteral opioids within 30 minutes of presentation, timely reassessment of pain, and additional opioids as needed every 15-30 minutes. These targets are infrequently met, resulting in uncontrolled pain, increased likelihood of hospital admission, and deterioration of physician-patient relationships. METHODS We undertook a multidisciplinary effort to improve the management of VOC in the ED, by development and implementation of an evidence-based clinical care pathway. The clinical pathway was implemented at the Hospital of the University of Pennsylvania in December 2018, with direct education of hematology and ED providers around the content of the clinical pathway, and availability of the pathway on the institutional intranet. Specific areas of focus in the pathway included appropriate triaging of patients as emergency severity index 2, timely administration of initial opioid dose, rapid reassessment and administration of additional opioid doses as needed, as well as appropriate laboratory evaluation and evaluation for other common and/or serious complications of SCD. Outcome measures included time from ED registration to administration of first opioid dose, time between administration of first opioid dose and second opioid dose, and proportion of patients discharged from the ED. Balance measures included rate of ED readmission and length of stay. RESULTS There were 602 ED visits from 103 unique patients in the study period, with 256 visits in the six-month period prior to pathway implementation and 346 visits in the six-month period after implementation. Following pathway implementation, time from registration to first opioid dose fell from 114 minutes to 93 minutes (p = 0.003). The proportion of patients receiving their first opioid dose within 60 minutes of registration increased from 19% to 33%. Time from administration of the first opioid dose to the second opioid dose improved from 117 minutes to 94 minutes (p = 0.002). The proportion of patients receiving their second opioid dose within 60 minutes of the first opioid dose increased from 27% to 37%. There was no change in the rate of hospital admission from the ED, or in the proportion of patients who left without being seen (p = 0.710). There was also no change in rate of ED readmissions (p = 0.138) or length of stay (p = 0.483). CONCLUSION Implementation of an evidence-based clinical care pathway in the ED for SCD patients presenting with VOC led to significant improvement in outcomes, with decreased time to first opioid dose and decreased time from first to second opioid dose. Nevertheless, very few patients received guideline-based care, particularly with the goal of time to first opioid dose of less than 30 minutes. While our data demonstrate that provider education and clinical pathways clearly improve the management of VOC in the ED, additional interventions will be required to target other barriers to optimal management, including implicit biases, negative provider attitudes, and social stigma surrounding SCD. Disclosures No relevant conflicts of interest to declare.

scholarly journals Developing an evidence base of best practices for integrating computerized systems into the exam room: a systematic review

2016 ◽  
Vol 24 (e1) ◽  
pp. e207-e215 ◽  
Author(s):  
Minal R Patel ◽  
Jennifer Vichich ◽  
Ian Lang ◽  
Jessica Lin ◽  
Kai Zheng
Keyword(s):  
Systematic Review ◽  
Best Practices ◽  
Clinical Care ◽  
Strong Support ◽  
Evidence Base ◽  
Evidence Based ◽  
Patient Centered ◽  
Exam Room ◽  
Communication Practices ◽  
Electronic Health

Objective: The introduction of health information technology systems, electronic health records in particular, is changing the nature of how clinicians interact with patients. Lack of knowledge remains on how best to integrate such systems in the exam room. The purpose of this systematic review was to (1) distill “best” behavioral and communication practices recommended in the literature for clinicians when interacting with patients in the presence of computerized systems during a clinical encounter, (2) weigh the evidence of each recommendation, and (3) rank evidence-based recommendations for electronic health record communication training initiatives for clinicians. Methods: We conducted a literature search of 6 databases, resulting in 52 articles included in the analysis. We extracted information such as study setting, research design, sample, findings, and implications. Recommendations were distilled based on consistent support for behavioral and communication practices across studies. Results: Eight behavioral and communication practices received strong support of evidence in the literature and included specific aspects of using computerized systems to facilitate conversation and transparency in the exam room, such as spatial (re)organization of the exam room, maintaining nonverbal communication, and specific techniques that integrate the computerized system into the visit and engage the patient. Four practices, although patient-centered, have received insufficient evidence to date. Discussion and Conclusion: We developed an evidence base of best practices for clinicians to maintain patient-centered communications in the presence of computerized systems in the exam room. Further work includes development and empirical evaluation of evidence-based guidelines to better integrate computerized systems into clinical care.

scholarly journals Effectiveness of Implementing Evidence‐based Interventions to Reduce C‐spine Image Ordering in the Emergency Department: A Systematic Review

2018 ◽  
Vol 25 (6) ◽  
pp. 672-683 ◽  
Author(s):  
Shashwat Desai ◽  
Chaocheng Liu ◽  
Scott W. Kirkland ◽  
Lynette D. Krebs ◽  
Diana Keto‐Lambert ◽  
...  
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Evidence Based

scholarly journals Development of a core outcome set for traumatic brachial plexus injuries (COMBINE): study protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e030146 ◽  
Author(s):  
Caroline Miller ◽  
Jane Cross ◽  
Dominic M Power ◽  
Derek Kyte ◽  
Christina Jerosch-Herold
Keyword(s):  
Systematic Review ◽  
Brachial Plexus ◽  
Clinical Outcomes ◽  
Clinical Care ◽  
Core Outcome Set ◽  
Evidence Based ◽  
Core Outcome ◽  
Permanent Disability ◽  
Outcome Set ◽  
Patient Reported

IntroductionTraumatic brachial plexus injury (TBPI) involves major trauma to the large nerves of the arm which control the movement and sensation. Fifty per cent of injuries result in complete paralysis of the arm with many other individuals having little movement, sensation loss and unremitting pain. The injury often causes severe and permanent disability affecting work and social life, with an estimated cost to the National Health Service and the economy of £35 million per annum. Advances in microsurgery have resulted in an increase in interventions aimed at reconstructing these injuries. However, data to guide evidence-based decisions is lacking. Different outcomes are used across studies to assess the effectiveness of treatments. This has impeded our ability to synthesise results to determine which treatments work best. Studies frequently report short-term clinical outcomes but rarely report longer term outcomes and those focused on quality of life. This project aims to produce a core outcome set (COS) for surgical and conservative management of TBPI. The TBPI COS will contain a minimum set of outcomes to be reported and measured in effectiveness studies and collected through routine clinical care.Methods and analysisThis mixed-methods project will be conducted in two phases. In phase 1 a long list of patient-reported and clinical outcomes will be identified through a systematic review. Interviews will then explore outcomes important to patients. In phase 2, the outcomes identified across the systematic review, and the interviews will be included in a three-round online Delphi exercise aiming to reach consensus on the COS. The Delphi process will include patient and healthcare participants. A consensus meeting will be held to achieve the final COS.Ethics and disseminationThe use of a COS in TBPI will increase the relevance of research and clinical care to all stakeholders, facilitate evidence synthesis and evidence-based decision making. The study has ethical approval.Trial registration numbersCRD42018109843.

scholarly journals Review of implementation strategies to change healthcare provider behaviour in the emergency department

CJEM ◽  
2018 ◽  
Vol 20 (3) ◽  
pp. 453-460 ◽  
Author(s):  
Kerstin de Wit ◽  
Janet Curran ◽  
Brent Thoma ◽  
Shawn Dowling ◽  
Eddy Lang ◽  
...  
Keyword(s):  
Emergency Department ◽  
Implementation Research ◽  
Best Practice ◽  
Clinical Care ◽  
Intervention Strategy ◽  
Implementation Strategies ◽  
Evidence Based ◽  
Medicine Research ◽  
Canadian Association ◽  
New Evidence

AbstractObjectivesAdvances in emergency medicine research can be slow to make their way into clinical care, and implementing a new evidence-based intervention can be challenging in the emergency department. The Canadian Association of Emergency Physicians (CAEP) Knowledge Translation Symposium working group set out to produce recommendations for best practice in the implementation of a new science in Canadian emergency departments.MethodsA systematic review of implementation strategies to change health care provider behaviour in the emergency department was conducted simultaneously with a national survey of emergency physician experience. We summarized our findings into a list of draft recommendations that were presented at the national CAEP Conference 2017 and further refined based on feedback through social media strategies.ResultsWe produced 10 recommendations for implementing new evidence-based interventions in the emergency department, which cover identifying a practice gap, evaluating the evidence, planning the intervention strategy, monitoring, providing feedback during implementation, and desired qualities of future implementation research.ConclusionsWe present recommendations to guide future emergency department implementation initiatives. There is a need for robust and well-designed implementation research to guide future emergency department implementation initiatives.

Point-of-care troponin testing and management of patients with acute coronary syndrome: a systematic review

2020 ◽  
Vol 15 (2) ◽  
pp. 1-16
Author(s):  
Huiyun Du ◽  
So Ting Chan ◽  
Parichat Wonggom ◽  
Peter Newman ◽  
Rosy Tirimacco ◽  
...  
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Cardiac Troponin ◽  
Point Of Care ◽  
Clinical Care ◽  
Grey Literature ◽  
Rapid Test ◽  
Point Of Care Testing ◽  
Coronary Syndrome

Background Early identification of acute coronary syndrome is crucial for a patient's likelihood of survival. Point-of-care testing of cardiac troponin is a rapid test of cardiac troponin that can be conducted closer to where clinical care is delivered, with a significant shorter turnaround time. Point-of-care testing of troponin may improve timely diagnosis of acute coronary syndrome. Aim To examine existing evidence on the effectiveness of point-of-care testing of troponin for acute coronary syndrome management in the emergency department. Methods A systematic review of randomised controlled trials was conducted across databases, and grey literature. Results No study evaluated adherence to acute coronary syndrome management guidelines. One of the five studies that assessed length of stay showed a statistically significant reduction (P=0.035). Two of the three studies that measured time to disposition in emergency department demonstrated statistically significant effects (P=0.04 vs P=0.05) favouring point-of-care testing of troponin. One study demonstrated statistically significant effects on successful discharge to home from emergency department (P=0.001). No significant effects were reported for mortality or accuracy. Conclusion Point-of-care testing of troponin can significantly reduce time to disposition in emergency department and successful discharge home. Translation of this evidence into clinical practice is recommended.

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