A Randomized Trial Comparing Telephone Tree, Text Messaging, and Instant Messaging App for Emergency Department Staff Recall for Disaster Response

2018 ◽  
Vol 33 (5) ◽  
pp. 471-477 ◽  
Author(s):  
Valerie Homier ◽  
Raphael Hamad ◽  
Josée Larocque ◽  
Pierre Chassé ◽  
Elene Khalil ◽  
...  
Keyword(s):  
Emergency Department ◽  
Response Time ◽  
Disaster Response ◽  
Text Messaging ◽  
Instant Messaging ◽  
Median Response ◽  
Median Response Time ◽  
Staff Members ◽  
Emergency Department Staff ◽  
Significant Difference

AbstractIntroductionA crucial component of a hospital’s disaster plan is an efficient staff recall communication method. Many hospitals use a “calling tree” protocol to contact staff members and recall them to work. Alternative staff recall methods have been proposed and explored.MethodsAn unannounced, multidisciplinary, randomized emergency department (ED) staff recall drill was conducted at night - when there is the greatest need for back-up personnel and staff is most difficult to reach. The drill was performed on December 14, 2017 at 4:00am and involved ED staff members from three hospitals which are all part of the McGill University Health Centre (MUHC; Montreal, Quebec, Canada). Three tools were compared: manual phone tree, instant messaging application (IMA), and custom-made hospital Short Message Service (SMS) system. The key outcome measures were proportion of responses at 45 minutes and median response time.ResultsOne-hundred thirty-two participants were recruited. There were 44 participants in each group after randomization. In the manual phone tree group, 18 (41%) responded within 45 minutes. In the IMA group, 11 participants (25%) responded in the first 45 minutes. In the SMS group, seven participants responded in the first 45 minutes (16%). Manual phone tree was significantly better than SMS with an effect size of 25% (95% confidence interval for effect: 4.6% to 45.0%; P=.018). Conversely, there was no significant difference between manual phone tree and IMA with an effect size of 16% (95% confidence interval for effect: −5.7% to 38.0%; P=.17) There was a statistically significant difference in the median response time between the three groups with the phone tree group presenting the lowest median response time (8.5 minutes; range: 2.0 to 8.5 minutes; P=.000006).Conclusion:Both the phone tree and IMA groups had a significantly higher response rate than the SMS group. There was no significant difference between the proportion of responses at 45 minutes in the phone tree and the IMA arms. This study suggests that an IMA may be a viable alternative to the traditional phone tree method. Limitations of the study include volunteer bias and the fact that there was only one communication drill, which did not allow staff members randomized to the IMA and SMS groups to fully get familiar with the new staff recall methods.HomierV, HamadR, LarocqueJ, ChasséP, KhalilE, FrancJM.A randomized trial comparing telephone tree, text messaging, and instant messaging app for emergency department staff recall for disaster response. Prehosp Disaster Med. 2018;33(5):471–477.

scholarly journals P064: A randomized trial comparing telephone tree, text messaging, and instant messaging app for emergency department staff recall for disaster response

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S86
Author(s):  
V. Homier ◽  
R. Hamad ◽  
J. Larocque ◽  
P. Chassé ◽  
E. Khalil ◽  
...  
Keyword(s):  
Emergency Department ◽  
Confidence Interval ◽  
Response Time ◽  
Instant Messaging ◽  
Median Response ◽  
Median Response Time ◽  
Staff Members ◽  
Significant Difference ◽  
Tree Group ◽  
Recall Methods

Introduction: A crucial component of a hospital's disaster plan is an efficient staff recall communication method. Many hospitals use a “calling tree” protocol to contact staff members and recall them to work. Alternative staff recall methods have been proposed and explored. Methods: An unannounced, multidisciplinary, randomized emergency department (ED) staff recall drill was conducted at night - when there is the greatest need for back-up personnel and staff is most difficult to reach. The drill was performed on December 14, 2017 at 4:00AM and involved ED staff members from three hospitals which are all part of the McGill University Health Centre (MUHC; Montreal, Quebec, Canada). Three tools were compared: manual phone tree, instant messaging application (IMA), and custom-made hospital Short Message Service (SMS) system. The key outcome measures were proportion of responses at 45 minutes and median response time. Results: One-hundred thirty-two participants were recruited. There were 44 participants in each group after randomization. In the manual phone tree group, 18 (41%) responded within 45 minutes. In the IMA group, 11 participants (25%) responded in the first 45 minutes. In the SMS group, seven participants responded in the first 45 minutes (16%). Manual phone tree was significantly better than SMS with an effect size of 25% (95% confidence interval for effect: 4.6% to 45.0%; P = .018). Conversely, there was no significant difference between manual phone tree and IMA with an effect size of 16% (95% confidence interval for effect: -5.7% to 38.0%; P = .17) There was a statistically significant difference in the median response time between the three groups with the phone tree group presenting the lowest median response time (8.5 minutes; range: 2.0 to 8.5 minutes; P = .000006). Conclusion: Both the phone tree and IMA groups had a significantly higher response rate than the SMS group. There was no significant difference between the proportion of responses at 45 minutes in the phone tree and the IMA arms. This study suggests that an IMA may be a viable alternative to the traditional phone tree method. Limitations of the study include volunteer bias and the fact that there was only one communication drill, which did not allow staff members randomized to the IMA and SMS groups to fully get familiar with the new staff recall methods.

scholarly journals Organ responses with daratumumab therapy in previously treated AL amyloidosis

2020 ◽  
Vol 4 (3) ◽  
pp. 458-466 ◽  
Author(s):  
Alfred Chung ◽  
Gregory P. Kaufman ◽  
Surbhi Sidana ◽  
Erik Eckhert ◽  
Stanley L. Schrier ◽  
...  
Keyword(s):  
Response Time ◽  
Cardiac Response ◽  
Al Amyloidosis ◽  
Median Response ◽  
Median Response Time ◽  
Hematologic Response ◽  
Cardiac Responses ◽  
Wide Range ◽  
Significant Difference ◽  
Previously Treated

Abstract Immunoglobulin light chain amyloidosis (AL amyloidosis) involves deposition of abnormally folded light chains into a wide range of tissues causing organ dysfunction, including in the heart and kidney. Daratumumab, a CD38-targeted antibody, has recently demonstrated efficacy in producing hematologic responses in previously treated disease. However, data on survival outcomes and organ responses to daratumumab are lacking. Seventy-two patients with previously treated AL amyloidosis who received daratumumab monotherapy with dexamethasone were retrospectively evaluated. With a median follow-up of 27 months, 2-year overall survival (OS) was 86.9% (median OS, not reached) and 2-year time-to-next treatment or death (TTNT)–free survival was 62% (median TTNT, not reached). Forty of 52 evaluable patients achieved a hematologic response (77%), with >60% of patients achieving a very good partial response or better; median time-to-hematologic response was 1 month. Fifty-seven patients (79%) had cardiac involvement, and 55% of evaluable patients achieved a cardiac response, with a median response time of 3.2 months among responders. Cardiac responses were associated with an improvement in OS, with landmark analysis for cardiac responses at 3 months trending toward statistical significance (100% vs 55% at 30 months, P = .051). Forty-seven patients (65%) had renal involvement, and 52% of evaluable patients achieved a renal response, with a median response time of 6 months among responders; there was no significant difference in OS between renal responders and nonresponders. This study demonstrates that daratumumab is highly effective in the treatment of previously treated AL amyloidosis, and a significant proportion of patients can achieve deep hematologic responses, as well as improvements in organ function.

A Typology of Players: Between Instinctive and Contemplative *

2016 ◽  
Vol 131 (2) ◽  
pp. 859-890 ◽  
Author(s):  
Ariel Rubinstein
Keyword(s):  
Response Time ◽  
The Other ◽  
Spearman Correlation ◽  
Median Response ◽  
Median Response Time ◽  
Shed Light

Abstract A new typology of players is proposed based on the classification of actions as either instinctive or contemplative. A person’s type is the probability of him choosing a contemplative action. To test the typology, results of 10 games are analyzed. Actions in each game were classified depending on whether their response time was more or less, respectively, than the median response time of all subjects who played the game. It is argued that fast actions are more instinctive and slow actions are more contemplative. A subject’s contemplative index (CI) is defined as the proportion of games in which he chose a contemplative action. It is found that for 8 of the 10 games, the CI in the other 9 games is positively correlated with a player’s choice of a contemplative action in that game (average Spearman correlation of 9%). The CI is used to shed light on the nature of choice in five additional games.

scholarly journals Pediatric interfacility transport effects on mortality and length of stay

2021 ◽  
Author(s):  
Rod M. Shinozaki ◽  
Andreas Schwingshackl ◽  
Neeraj Srivastava ◽  
Tristan Grogan ◽  
Robert B. Kelly
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Response Time ◽  
Pediatric Intensive Care ◽  
Hospital Length Of Stay ◽  
Median Response ◽  
Median Response Time ◽  
Transport Response ◽  
Mode Of Transport

Abstract Background We aimed to evaluate the effects of interfacility pediatric critical care transport response time, physician presence during transport, and mode of transport on mortality and length of stay (LOS) among pediatric patients. We hypothesized that a shorter response time and helicopter transports, but not physician presence, are associated with lower mortality and a shorter LOS. Methods Retrospective, single-center, cohort study of 841 patients (< 19 years) transported to a quaternary pediatric intensive care unit and cardiovascular intensive care unit between 2014 and 2018 utilizing patient charts and transport records. Multivariate linear and logistic regression analyses adjusted for age, diagnosis, mode of transport, response time, stabilization time, return duration, mortality risk (pediatric index of mortality-2 and pediatric risk of mortality-3), and inotrope, vasopressor, or mechanical ventilation presence on admission. Results Four hundred and twenty-eight (50.9%) patients were transported by helicopter, and 413 (49.1%) were transported by ambulance. Physicians accompanied 239 (28.4%) transports. The median response time was 2.0 (interquartile range 1.4–2.9) hours. Although physician presence increased the median response time by 0.26 hours (P = 0.020), neither physician presence nor response time significantly affected mortality, ICU length of stay (ILOS) or hospital length of stay (HLOS). Helicopter transports were not significantly associated with mortality or ILOS, but were associated with a longer HLOS (3.24 days, 95% confidence interval 0.59–5.90) than ambulance transports (P = 0.017). Conclusions These results suggest response time and physician presence do not significantly affect mortality or LOS. This may reflect the quality of pre-transport care and medical control communication. Helicopter transports were only associated with a longer HLOS. Our analysis provides a framework for examining transport workforce needs and associated costs.

Abstract 148: A Machine Learning-based Dispatch Rule for Drone-delivered Defibrillators

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Jamal Chu ◽  
K.H. Benjamin Leung ◽  
Sheldon Cheskes ◽  
Paul Snobelen ◽  
Gordon Nevils ◽  
...  
Keyword(s):  
Machine Learning ◽  
Response Time ◽  
Response Times ◽  
Time Of Day ◽  
Sign Test ◽  
Type I ◽  
Similar Response ◽  
Median Response ◽  
Optimal Dispatch ◽  
Median Response Time

Introduction: Drone-delivered defibrillators may reduce response time for out-of-hospital cardiac arrest (OHCA). However, an optimal dispatch rule is not yet known. Methods: We identified all suspected OHCAs in Peel Region, Ontario, Canada from Jan. 2014 to Dec. 2019. We trained a neural network model to predict emergency medical services (EMS) response times using OHCA location, distance from responding ambulance, day of week and time of day. Instead of least-squares loss, our model optimized a loss function that penalized weighted errors in the dispatch decision (type I/II error). Assuming drones were deployed from three bases in the region, we calculated drone response time to each suspected OHCA using real drone specifications. Our dispatch rule dispatched a drone when its calculated response time was shorter than the predicted EMS response time. Response time was calculated as the minimum of the drone and EMS response times. The performance of our dispatch rule was compared on out-of-sample OHCAs using 5-fold cross validation to the baseline cases of (1) no drones, and (2) drone dispatch to every suspected OHCA. Statistical analysis on the median response times was performed using a right-tailed sign test. Results: We identified 4774 suspected OHCAs with a median historical EMS response time of 6.0 minutes. Using our dispatch rule, median response time was significantly shorter at 3.9 minutes (P<0.001). Drones were dispatched to 3803 cases (79.7%) and of those, drone response was faster than EMS in 3076 cases (80.9%). When the drone was not dispatched, it would have been slower than EMS in 856 cases (88.1%). Sending a drone to every suspected OHCA resulted in an identical median response time of 3.9 minutes (P<0.001), with drones arriving before EMS in 3191 cases (66.8%). Conclusion: A machine learning-based dispatch rule can achieve similar response times as a policy that dispatches a drone to all suspected OHCAs, while dispatching drones less frequently.

scholarly journals Staff perceptions toward emergency clinical pharmacists in a Saudi Arabian academic emergency department

2017 ◽  
Vol 25 (2) ◽  
pp. 67-72
Author(s):  
Jameel Talal Abualenain ◽  
Hussain Talal Bakhsh
Keyword(s):  
Emergency Department ◽  
Quality Of Care ◽  
Medication Safety ◽  
Emergency Services ◽  
Survey Study ◽  
Pharmacy Services ◽  
Staff Members ◽  
Emergency Department Staff ◽  
Department Staff

Introduction: In Saudi Arabia, the establishment of pharmacy services as a part of the emergency department is relatively new and has been run by non-residency-trained pharmacists and limited to non-emergency services. We sought to explore emergency department staff members’ perceptions of clinical emergency pharmacy services in an academic emergency department. Method: In this survey study, 24 questions were sent to all emergency department staff 9 months after establishing an emergency pharmacist program with the goal of improving medication safety and quality of care. Results: Most, 122 out of 145 (84%), emergency department staff members responded to the survey. All 41 emergency department providers completed the survey, compared to 81 (78%) nurses. Half of the respondents had less than 1 year of experience working with emergency pharmacist. Two-thirds (66%) had consulted an emergency pharmacist at least once; however, 68% of providers had no contact with the emergency pharmacist. Almost half (46%) agreed that the emergency pharmacist’s contribution to medication safety was maximized through the order review process, and more than three-fourths (77%) agreed that an emergency pharmacist should review all orders. Most respondents agreed that the emergency pharmacist improves the quality of care (89%), is an integral part of the emergency department team (86%), is more useful if located in the emergency department (87%); it is helpful if he or she checks medication orders before they are carried out (88%), enhances the emergency department staff’s ability to deliver safe, quality care during medical resuscitations (85%), and is a valuable educator serving both patients (88%) and emergency department staff (77%). All respondents were in positive agreement with the different specific functions for the emergency pharmacist role. Conclusion: The emergency department staff believes that an emergency pharmacist is an important part of the emergency department team, acts to maximize medication safety, contributes to the education of emergency department staff and patients, and improves the quality of care.

Observational study to understand interpreter service use in emergency medicine: why the key may lie outside of the initial provider assessment

2019 ◽  
Vol 36 (10) ◽  
pp. 582-588 ◽  
Author(s):  
Natalie C Benda ◽  
Rollin J Fairbanks ◽  
D Jeffrey Higginbotham ◽  
Li Lin ◽  
Ann M Bisantz
Keyword(s):  
Emergency Department ◽  
Service Use ◽  
Hospital Staff ◽  
Interpreter Services ◽  
Staff Members ◽  
Emergency Department Staff ◽  
Department Staff ◽  
Common Strategy ◽  
Eastern Usa ◽  
Interpreter Service

ObjectiveTo characterise the use of interpreter services and other strategies used to communicate with limited English proficient (LEP) patients throughout their emergency department visit.MethodsWe performed a process tracing study observing LEP patients throughout their stay in the emergency department. A single observer completed 47 hours of observation of 103 communication episodes between staff and nine patients with LEP documenting the strategy used to communicate (eg, professional interpreter, family member, own language skills) and duration of conversations for each communicative encounter with hospital staff members. Data collection occurred in a single emergency department in the eastern USA between July 2017 and February 2018.ResultsThe most common strategy (per communicative encounter) was for the emergency department staff to communicate with the patient in English (observed in 29.1% of encounters). Total time spent in communicating was highest using telephone-based interpreters (32.9% of total time spent communicating) and in-person interpreters (29.2% of total time spent communicating). Communicative mechanism also varied by care task/phase of care with the most use of interpreter services or Spanish proficient staff (as primary communicator) occurring during triage (100%) and the initial provider assessment (100%) and the lowest interpreter service use during ongoing evaluation and treatment tasks (24.3%).ConclusionsEmergency department staff use various mechanisms to communicate with LEP patients throughout their length of stay. Utilisation of interpreter services was poorest during evaluation and treatment tasks, indicating that this area should be a focus for improving communication with LEP patients.

Emergency Department Staff Responses to a Protocol of Care for Abused Women

2000 ◽  
Vol 27 (5) ◽  
pp. 572-590 ◽  
Author(s):  
Sue Loughlin ◽  
Carla Spinola ◽  
Liz Stewart ◽  
Janet Fanslow ◽  
Robyn Norton
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Health Care Providers ◽  
Public Hospital ◽  
Partner Abuse ◽  
Care Providers ◽  
Staff Members ◽  
Emergency Department Staff ◽  
Department Staff ◽  
Depth Interviews

While there is increasing recognition by health care providers of the need to identify and intervene in cases of partner abuse, there has been little evaluation of the interventions that have been implemented. This article documents emergency department staff responses to a five-step protocol of care on partner abuse implemented in a public hospital. It draws on in-depth interviews with a range of emergency department staff members, undertaken as part of the project’s process evaluation. Findings suggest protocol training provided staff members with an opportunity to gain a greater awareness and understanding of partner abuse. Protocol use improved and consolidated existing practices; however, staff members were concerned about screening all women for abuse and highlighted areas in which further support and resources are required. Taking these factors into account may assist the appropriate and effective introduction of such protocols in other health care settings.

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