scholarly journals Hurricane Sandy - Initial Evaluation of Patient Characteristics

2019 ◽  
Vol 34 (s1) ◽  
pp. s7-s7
Author(s):  
Marc Rosenthal ◽  
Robert Dunne
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Vital Signs ◽  
Retrospective Chart Review ◽  
Hurricane Sandy ◽  
System Response ◽  
Medical Needs ◽  
Medical Response ◽  
Wide Range ◽  
National Disaster

Introduction:Disaster medical team response by governmental and non-governmental responders is highly variable and poorly characterized. Each response is unique in terms of caseload, patient demographics, and medical needs encountered. This variability increases the difficulty of determining team member composition as well as supply and equipment needs. In an effort to demonstrate this issue, we have reviewed the National Disaster Medical Response to Hurricane Sandy.Methods:This project was a retrospective chart review of Hurricane Sandy data abstracted from the National Disaster Medical System (NDMS) Health Information Repository (HIR) medical records from the NDMS system response, and were abstracted for data including vital signs, ages, sex, chief complaint, and final impressions. In addition, length of stay among other parameters was abstracted. The data was analyzed using Microsoft Excel and Access with descriptive statistics. In addition, the results were compared to similar indices in a community emergency department and prior NDMS responses.Results:The results indicate a wide range of patient ages, chief complaints, and final impressions. The vast majority of patients seen by Disaster Medical Assistance Teams (DMAT) were stable with relatively low acuity issues. The total number of charts reviewed were 7,905. Respiratory complaints were the most frequent at 845 patients followed by toxicology/injuries at 706 patients and mental health issues at 452 patients. In approximately 3,400 patients, no diagnosis was present in the chart. Length of stay averaged below 1 hour and peak patient ages were between 50-60 with a significant number of infants less than 2 years.Discussion:Characterization of NDMS responses by DMATs and comparison with prior events and community emergency department caseloads can provide an insight into the needs of DMATs and other response organizations in future responses.

scholarly journals P077: The health inequalities among foreign patients visiting the emergency room with injury: a nationwide population-based study in South Korea, 2013-2015

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S84-S84
Author(s):  
S. Jung ◽  
H. Lim ◽  
J. Kwon ◽  
N. Kim ◽  
D. Seo
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Emergency Room ◽  
Health Inequalities ◽  
Personal Information ◽  
Age Groups ◽  
Population Based ◽  
Emergency Rooms ◽  
Wide Range ◽  
Region Length

Introduction: Foreign patients often do not receive appropriate treatment in the emergency room as compared to locals. This is due to various causes such as language, insurance, and cultural differences. The purpose of this study was to investigate whether there is a wide range of health inequalities among foreigners who visited the emergency room with injury and to find out what causes it. Methods: We analyzed clinical data from the National Emergency Department Information System(NEDIS) database, which visited the emergency room from January 1, 2013 to December 31, 2015, in all age groups. Foreigners are classified based on the personal information described in the NEDIS. We analyzed the number of injuries, serious cases(death, operation, ICU admission), length of stay in ER, and transfer ratio. Results: A total of 4,464,603 cases of injured patients were included, of whom 67,683 were foreign patients. The incidence rate per 100,000 people per year was 2960.5 from locals and 1659.8 from foreigners. Serious outcomes were higher for foreigners than for locals(31.0% versus 23.2%, p<0.001). There was a further difference in the rural region. Length of stay was longer for foreigners(72 versus 69 minutes, median, p<0.001). The transfer rate was also higher for foreigners(1.9% versus 1.6%, p<0.001). Daegu had the highest ratio of foreigners’ injury compared to locals(ratio=0.998). Jeonnam(0.073) was the highest serious outcome rate in Korea, and Jeonbuk(0.070) was the second. The area with the longest length of stay in the Emergency department was the median 139 minutes for locals and 153 minutes for foreigners in Daegu. The more patients per day, the shorter the time spent in the emergency rooms(Spearman correlation coefficient=-0.388). This phenomenon was more prominent in locals(-0.624 versus -0.175). Multivariable logistic regression was used as a dependent variable for the serious outcomes of foreign patients. The foreign patients(OR=1.413, p<0.001), intention, no insurance, age, sex, urban area, low blood pressure, decreased consciousness, transfer, acuity, and length of stay were statistically significant. Conclusion: This study showed that there is a health inequality for foreigners who came to the emergency room due to injury in Korea. Also, serious outcomes from injury in foreigners have been shown to be related to various causes including factors of the foreigner.

scholarly journals The association between the transfer of emergency department admitted patients to inpatient hallways and outcomes of oncology patients

2015 ◽  
Vol 4 (2) ◽  
pp. 1 ◽  
Author(s):  
Charles Lim ◽  
Matthew C. Cheung ◽  
Maureen E. Trudeau ◽  
Kevin R. Imrie ◽  
Ben De Mendonca ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Patient Flow ◽  
Vital Signs ◽  
Medication Administration ◽  
Oncology Patients ◽  
Flow Quality ◽  
Ed Crowding ◽  
The Impact

Objective: A protocol was implemented to ease Emergency Department (ED) crowding by moving suitable admitted patients into inpatient hallway beds (HALL) or off-service beds (OFF) when beds on an admitting service’s designated ward (ON) were not available. This study assessed the impact of hallway and off-service oncology admissions on ED patient flow, quality of care and patient satisfaction.Methods: Retrospective and prospective data were collected on patients admitted to the medical oncology service from Jan 1 to Dec 31, 2011. Data on clinician assessments and time performance measures were collected. Satisfaction surveys were prospectively administered to all patients. Results: Two hundred and ninty-seven patients (117 HALL, 90 OFF, 90 ON) were included in this study. There were no significant differences between groups for frequency of physician assessments, physical exam maneuvers at initial physician visit, time to complete vital signs or time to medication administration. The median (IQR) time spent admitted in the ED prior to departure from the ED was significantly longer for HALL patients (5.53 hrs [1.59-13.03 hrs]) compared to OFF patients (2.00 hrs [0.37-3.69 hrs]) and ON patients (2.18 hrs [0.15-5.57 hrs]) (p < .01). Similarly, the median (IQR) total ED length of stay was significantly longer for HALL patients (13.82 hrs [7.43-20.72 hrs]) compared to OFF patients (7.18 hrs [5.72-11.42 hrs]) and ON patients (9.34 hrs [5.43-14.06 hrs]) (p < .01). HALL patients gave significantly lower overall satisfaction scores with mean (SD) satisfaction scores for HALL, OFF and ON patients being 3.58 (1.20), 4.23 (0.58) and 4.29 (0.69) respectively (p < .01). Among HALL patients, 58% were not comfortable being transferred into the hallway and 4% discharged themselves against medical advice. Conclusions: The protocol for transferring ED admitted patients to inpatient hallway beds did not reduce ED length of stay for oncology patients. The timeliness and frequency of clinical assessments were not compromised; however, patient satisfaction was decreased.

scholarly journals Appropriate Use of Ceftriaxone in the Emergency Department of a Veteran’s Health Care System

2017 ◽  
Vol 33 (6) ◽  
pp. 215-218 ◽  
Author(s):  
Spencer H. Durham ◽  
Mary J. Wingler ◽  
Lea S. Eiland
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Health Care System ◽  
Inappropriate Prescribing ◽  
Vital Signs ◽  
Retrospective Chart Review ◽  
The United States ◽  
Generation Cephalosporin ◽  
Veteran’S Health ◽  
Care System

Background: Ceftriaxone is a third-generation cephalosporin commonly utilized as an empiric antibiotic treatment option in the emergency department (ED). Overuse can lead to decreased susceptibility and emergence of multidrug-resistant pathogens, increased costs, and unnecessary adverse effects. Objective: The purpose of this project was to determine the appropriateness of ceftriaxone usage in the ED of a veteran’s health care system. Methods: This retrospective chart review included all veterans who received at least one dose of ceftriaxone in the ED between June 1, 2014, and June 1, 2015. The primary outcome was the percentage of appropriate ceftriaxone use. Usage appropriateness was determined on a case-by-case basis by examining current published guidelines and local recommendations based on the institutional antibiogram. Results: Ceftriaxone was prescribed for a wide variety of indications and was determined to be inappropriately prescribed in 164 patients (53%). The most common reason for inappropriate prescribing was lack of a first-line indication for ceftriaxone (64%). Only 120 patients (38.5%) exhibited systemic signs of infection based on vital signs and laboratory parameters, and 25 patients (8%) likely did not require antibiotic therapy at all. Conclusions: Ceftriaxone was used inappropriately in more than half of the patients who received the drug in the ED. The literature on the prescribing habits for ceftriaxone is limited in the United States, but these results are similar to studies conducted in other countries. Attempts should be made to educate prescribers on appropriate indications for the use of ceftriaxone.

scholarly journals Impact of an emergency department electronic sepsis surveillance system on patient mortality and length of stay

2017 ◽  
Vol 25 (5) ◽  
pp. 523-529 ◽  
Author(s):  
Jonathan S Austrian ◽  
Catherine T Jamin ◽  
Glenn R Doty ◽  
Saul Blecker
Keyword(s):  
Emergency Department ◽  
Time Series ◽  
Length Of Stay ◽  
Vital Signs ◽  
Interrupted Time Series ◽  
Alert System ◽  
Process Measures ◽  
Emergency Department Patients ◽  
Series Study

Abstract Objective The purpose of this study was to determine whether an electronic health record–based sepsis alert system could improve quality of care and clinical outcomes for patients with sepsis. Materials and Methods We performed a patient-level interrupted time series study of emergency department patients with severe sepsis or septic shock between January 2013 and April 2015. The intervention, introduced in February 2014, was a system of interruptive sepsis alerts triggered by abnormal vital signs or laboratory results. Primary outcomes were length of stay (LOS) and in-hospital mortality; other outcomes included time to first lactate and blood cultures prior to antibiotics. We also assessed sensitivity, positive predictive value (PPV), and clinician response to the alerts. Results Mean LOS for patients with sepsis decreased from 10.1 to 8.6 days (P &lt; .001) following alert introduction. In adjusted time series analysis, the intervention was associated with a decreased LOS of 16% (95% CI, 5%-25%; P = .007, with significance of α = 0.006) and no change thereafter (0%; 95% CI, −2%, 2%). The sepsis alert system had no effect on mortality or other clinical or process measures. The intervention had a sensitivity of 80.4% and a PPV of 14.6%. Discussion Alerting based on simple laboratory and vital sign criteria was insufficient to improve sepsis outcomes. Alert fatigue due to the low PPV is likely the primary contributor to these results. Conclusion A more sophisticated algorithm for sepsis identification is needed to improve outcomes.

scholarly journals P024: A retrospective chart review of the length of stay of patients presenting to the emergency department with a drug overdose

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S73-S73
Author(s):  
R. Soegtrop ◽  
K. Van Aarsen ◽  
M. Columbus ◽  
A. Dong
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Acute Care ◽  
Drug Overdose ◽  
Chart Review ◽  
Care Setting ◽  
Retrospective Chart Review ◽  
Initial Assessment ◽  
Acute Care Setting ◽  
Total Length

Introduction: Patients who present to the Emergency Department (ED) with a drug overdose often require long periods of monitoring. After their initial assessment and stabilization, they spend a significant amount of time in a high cost acute care bed in the ED for monitoring until they are medically cleared for psychiatric care or to be discharged. The shift length at this ED is a maximum of 8 hours; meaning any patients staying over 8 hours must be handed over between physicians, increasing the chance of medical errors. The objective of this study is to examine the total ED length of stay (LOS) of this patient group after physician initial assessment (PIA) to determine if there is there justification for the creation of a toxicology observation or short-stay unit for these patients. Methods: A single-centre, blinded retrospective chart review was conducted examining all adult patients presenting to the ED at an urban academic tertiary care centre with a drug overdose in 2018. Variables examined include: Disposition (home, admitted to acute care setting, admitted to non-acute care setting), time from PIA to disposition and total length of stay from PIA to discharge home or admission to hospital. The primary outcome is total length of stay in the ED after PIA.M Results: A total of 1006 patients presenting with an overdose were included. A total of 388 patients were admitted with 44% (172) having an ED LOS greater than 8 hours and 36% (138) staying 8 hours after PIA. The median [IQR] LOS in the ED for all patients was 343 minutes [191-565] while the median [IQR] time to PIA was 37 minutes [15-97]. The majority of these patients (54%) were discharged with no consulting services involved, 23% received a consult to psychiatry, 22% were consulted to internal medicine and 5% of patients were consulted to Critical Care Medicine. Conclusion: This demonstrates patients presenting to the ED with an overdose are seen in the ED by a physician quickly, however many stay in the department over 5 hours from their initial assessment in a monitored setting. While a majority of these patients are able to go home, 44% of admitted patients wait greater than 8 hours in the ED on monitors. The creation of a toxicology observation unit would be helpful for this population to increase patient safety and ease ED bed congestion.

scholarly journals P035: Continuous intravenous low-dose ketamine infusion for managing pain in the emergency department

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S69-S69
Author(s):  
J. Drapkin ◽  
S. Motov ◽  
A. Likourezos ◽  
T. Beals ◽  
R. Monfort ◽  
...  
Keyword(s):  
Emergency Department ◽  
Age Groups ◽  
Analgesic Efficacy ◽  
Secondary Data ◽  
Retrospective Chart Review ◽  
Primary Data ◽  
Ketamine Infusion ◽  
Wide Range ◽  
Post Infusion ◽  
Analgesic Administration

Introduction: To describe dosing, duration, and pre- and post-infusion analgesic administration of continuous intravenous sub-dissociative dose ketamine (SDK) infusion for managing a variety of painful conditions in the emergency department (ED). Methods: Retrospective chart review of patients aged 18 and older presenting to the ED with acute and chronic painful conditions who received continuous SDK infusion in the ED for a period over 6 years (2010-2016). Primary data analyses included dosing and duration of infusion, rates of pre- and post-infusion analgesic administration, and final diagnoses. Secondary data included pre- and post-infusion pain scores and rates of side effects. Results: 104 patients were enrolled in the study. Average dosing of ketamine infusion was 11.26 mg/hr, the mean duration of infusion was 135.87 minutes with 38% increase in patients not requiring post-infusion analgesia. The average decrease in pain score was 5.04. There were 12 reported adverse effects with nausea being the most prevalent. Conclusion: Continuous intravenous SDK infusion has a role in controlling pain of various etiologies in the ED with a potential to reduce need for co-analgesics or rescue analgesic administration. There is a need for more robust, prospective, randomized trials that will further evaluate the analgesic efficacy and safety of this modality across wide range of pain syndromes and different age groups in the ED.

scholarly journals Geographic Distribution of Disaster-Specific Emergency Department Use After Hurricane Sandy in New York City

2016 ◽  
Vol 10 (3) ◽  
pp. 351-361 ◽  
Author(s):  
David C. Lee ◽  
Silas W. Smith ◽  
Brendan G. Carr ◽  
Kelly M. Doran ◽  
Ian Portelli ◽  
...  
Keyword(s):  
Emergency Department ◽  
New York ◽  
New York City ◽  
Geographic Distribution ◽  
Vulnerable Populations ◽  
York City ◽  
Hurricane Sandy ◽  
Social Needs ◽  
Emergency Department Use ◽  
Medical Needs

AbstractObjectiveWe aimed to characterize the geographic distribution of post-Hurricane Sandy emergency department use in administrative flood evacuation zones of New York City.MethodsUsing emergency claims data, we identified significant deviations in emergency department use after Hurricane Sandy. Using time-series analysis, we analyzed the frequency of visits for specific conditions and comorbidities to identify medically vulnerable populations who developed acute postdisaster medical needs.ResultsWe found statistically significant decreases in overall post-Sandy emergency department use in New York City but increased utilization in the most vulnerable evacuation zone. In addition to dialysis- and ventilator-dependent patients, we identified that patients who were elderly or homeless or who had diabetes, dementia, cardiac conditions, limitations in mobility, or drug dependence were more likely to visit emergency departments after Hurricane Sandy. Furthermore, patients were more likely to develop drug-resistant infections, require isolation, and present for hypothermia, environmental exposures, or administrative reasons.ConclusionsOur study identified high-risk populations who developed acute medical and social needs in specific geographic areas after Hurricane Sandy. Our findings can inform coherent and targeted responses to disasters. Early identification of medically vulnerable populations can help to map “hot spots” requiring additional medical and social attention and prioritize resources for areas most impacted by disasters. (Disaster Med Public Health Preparedness. 2016;10:351–361)

scholarly journals 2100. A Retrospective Chart Review of Emergent Antibiotic Use

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S710-S710
Author(s):  
Michelle Blyth ◽  
James McNary ◽  
Arnold Decano ◽  
Audrey Renson ◽  
Jeanne Carey
Keyword(s):  
Emergency Department ◽  
Antibiotic Stewardship ◽  
Chart Review ◽  
Vital Signs ◽  
Retrospective Chart Review ◽  
Antibiotic Use ◽  
Academic Community ◽  
Suspected Sepsis ◽  
Empiric Antibiotics ◽  
Data Points

Abstract Background The need for responsible antibiotic stewardship can be difficult to reconcile with the clinician’s task of quickly recognizing and treating sepsis. Empiric antibiotics are often given in patients with any suspicion of infection, yet antibiotics carry non-trivial risks including antibiotic resistance and susceptibility to other infections, such as Clostridium difficile. Methods This retrospective chart review includes 200 patients who were admitted to the hospital and administered antibiotics while in the Emergency Department (ED). From clinical documentation several clinical data points were gathered such as: changes to (including discontinuation of) antibiotics by the admitting team, final culture data, discharge diagnosis, vital signs and routine laboratory values. Results Our study finds that the majority of patients administered antibiotics in the ED of our academic community hospital were not diagnosed with sepsis (67%) and did not meet SIRS (62.5%) nor qSOFA (88%) criteria prior to administration of antibiotics. Vancomycin (39.7%) and piperacillin–tazobactam (22.2%) were the most frequent empiric antibiotics started. Antibiotics were stopped completely on admission by the admitting team in 22.2% of included patients. A wide variety of sources of infection were suspected, pneumonia (33%), cellulitis (15%), and cystitis (18%) being the most common. The overall mortality rate for this group during the admission was 4.5%, which was comparable to all-cause hospital mortality during the same time period. Infection was ruled out by discharge in 91 of the included 200 patients (45.5%). At least 37.5% of all included patients had received antibiotics within the last 3 months. Intriguingly, recent exposure was nearly twice as common (47.8%) among infected patients than in those without infections (24.7%), with a relative risk of 1.48 (CI 1.0993–2.0014). Conclusion These findings suggest that an opportunity exists for increased antibiotic stewardship in the emergency department in the management of suspected sepsis and/or infection. Stable patients in whom infection cannot be definitively ruled out may benefit more from prompt, thorough evaluation by an admitting team prior to the initiation of empiric antibiotics. Disclosures All authors: No reported disclosures.

Abstract TP249: Collaborative In-Person Bedside Handover Improves Emergency Department Nurses’ Confidence in and Compliance With Documentation of Frequent Post Alteplase Neurological Assessments

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Kailey L Cox ◽  
Jessica Lobell ◽  
Xavier Champagne ◽  
Alyx Lesko ◽  
Leslie Corless ◽  
...  
Keyword(s):  
Emergency Department ◽  
Phase 1 ◽  
Vital Signs ◽  
Retrospective Chart Review ◽  
Chi Square ◽  
Emergency Department Nurses ◽  
New Strategy ◽  
Improve Compliance ◽  
Chi Square Test ◽  
Strongly Agree

Introduction: Stroke centers are often cited for poor compliance with post alteplase (tPA) neurological assessment documentation (SNAP DOC). Emergency department nurses (ED RNs) have less exposure to patients receiving tPA than neurocritical care nurses (NCCU RNs) and are less compliant with SNAP. In this project we sought to improve compliance of SNAP DOC in the ED. Methods: Data included retrospective chart review of SNAP DOC compliance for patients in ED treated with tPA age 18 and over from 03/2018 to 07/2019. In phase 1, ED RNs were trained in-person on SNAP three separate times between 02/2018 and 09/2018 (PRE). After seeing no improvement with SNAP in ED after the in-person education interventions, ED and NCCU collaborated to form a new strategy. In phase 2, beginning 12/14/2018 NCCU RNs retrieved their tPA patients from ED, performed a bedside SNAP and coached ED RNs on any missing SNAP DOC (POST). ED SNAP DOC were evaluated by finding the total number completed among the total possible opportunities combined across the four components of SNAP and vital signs. Three Likert scale questions were administered to assess ED RN confidence in SNAP practices for both PRE and POST timeframe with answers from 1 (strongly disagree) to 5 (strongly agree). PRE and POST responses were then dichotomized into agree (4-5) or disagree (1-3) and compared using Pearson’s chi square test. Descriptive analyses were performed to assess SNAP DOC compliance for the PRE and POST periods. Results: There were 111 charts audited for compliance that met inclusion criteria with 56 in the PRE and 55 in the POST. ED RNs were more compliant with SNAP in the POST (77.3%) compared to the PRE (65.6%). Confidence surveys were completed by 52 ED RNs in PRE and 72 RNs in POST. RNs were more confident in, “I understand the rationale behind each component of [SNAP]”, in the POST vs PRE timeframe (87.5% vs 68.6%, p=.010). Conclusion: ED RNs remained confident in their use of SNAP throughout the project despite compliance scores. However, in the POST period, ED RNs reported improvement in their understanding of SNAP. In-person handover process improves SNAP DOC compliance in ED more than in-person training.

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