scholarly journals Outcomes measurement for asthma following acute presentation to an emergency department

2001 ◽  
Vol 24 (3) ◽  
pp. 53 ◽  
Author(s):  
Geoff Masters ◽  
Sonj E Hall ◽  
Martin Phillips ◽  
Duncan Boldy
Keyword(s):  
Emergency Department ◽  
New Zealand ◽  
Clinical Pathways ◽  
Asthma Management ◽  
Management Plan ◽  
Asthma Care ◽  
Outcomes Measurement ◽  
Acute Presentation ◽  
Asthma Outcomes ◽  
The Impact

The Asthma Management Plan (AMP) was developed by the Thoracic Society of Australia and New Zealand in 1989to provide a more uniform approach to asthma care, aimed at reducing mortality, morbidity and emergencypresentations. The AMP is often supplemented with Asthma Clinical Pathways (CPs) within the emergencydepartment and hospital setting.This study was designed to evaluate the impact of these two instruments on asthma outcomes one month afterpresentation to the emergency department. The AMP and CP were both found to have had positive influences onasthma management. However, the study illustrates that there continue to be problems with asthma management,which would be improved by a more consistent use of these instruments.

scholarly journals Asthma Management at Discharge from the Emergency Department: A Descriptive Study

2005 ◽  
Vol 12 (4) ◽  
pp. 219-222 ◽  
Author(s):  
Pascale Gervais ◽  
Isabelle Larouche ◽  
Lucie Blais ◽  
Anne Fillion ◽  
Marie-France Beauchesne
Keyword(s):  
Emergency Department ◽  
Inhaled Corticosteroids ◽  
Tertiary Care ◽  
Airflow Obstruction ◽  
Asthma Management ◽  
Descriptive Study ◽  
Management Plan ◽  
Oral Corticosteroids ◽  
Tertiary Care Hospitals

BACKGROUND: The management of asthma remains suboptimal despite the publication of Canadian asthma guidelines in 1999.OBJECTIVES AND METHODS: A descriptive study was conducted to estimate the proportion of patients admitted to the emergency department (ED) for an asthma exacerbation who received a management plan at discharge that was in accordance with seven criteria stated in the Canadian asthma guidelines. The present study took place in two tertiary care hospitals in Montreal, Quebec.RESULTS: A total of 37 patients were enrolled. Three (8%) patients received a management plan at discharge that was in accordance with all seven criteria. Inhaled corticosteroids and oral corticosteroids were prescribed at discharge for 29 (78%) and 35 (95%) patients, respectively. Minimal asthma education was provided for 29 (78%) patients and a medical follow-up was recommended to 22 (60%) patients. Airflow obstruction was evaluated at discharge for only 20 (54%) patients.CONCLUSION: Overall, asthma management at discharge from the ED was generally not in accordance with the 1999 Canadian asthma guidelines. A standardized management plan should be implemented in the ED to improve the care of patients with asthma exacerbations.

scholarly journals COVID-19 – Changes in the presentation and management of shoulder and elbow trauma in a UK district general hospital orthopaedic department

2020 ◽  
pp. 175857322097702
Author(s):  
Giles Faria ◽  
Siddharth Virani ◽  
Mohammed Shaeir ◽  
Patricia Velazquez-Ruta ◽  
Baha John Tadros ◽  
...  
Keyword(s):  
Emergency Department ◽  
Upper Limb ◽  
District General Hospital ◽  
Management Plan ◽  
Orthopaedic Department ◽  
Fracture Clinic ◽  
Elbow Trauma ◽  
Exponential Increase ◽  
Elbow Injuries ◽  
The Impact

Introduction COVID-19 has had a significant impact on healthcare systems. We aim to quantify the impact of this outbreak on shoulder and elbow trauma in our institution. Methods We prospectively collected data on patients presenting to our hospital with shoulder and elbow injuries during COVID-19. This included the number of attendances to the emergency department, fracture clinic, inpatient admissions and operative treatments. This was compared to a pre-COVID-19 period. We also assessed the efficacy of telephone clinics. Results There has been a noticeable decrease in the number of emergency department and fracture clinic attendances with upper limb complaints. The number of in-person fracture clinic reviews also decreased, with a reciprocal exponential increase in telephone consultations. We recorded a decrease in the number of shoulder and elbow trauma procedures performed. There was a small increase in the proportion of injuries treated conservatively during COVID-19. Our telephone clinics yielded a diagnosis and management plan in many cases and patient perspective appeared favourable. Conclusion We have noted significant change in the upper limb caseload. Certain injuries have reduced, likely due to COVID-19 lockdown. Moreover, we consider several changes to current practices could be taken forward after the pandemic.

scholarly journals Strategies and processes emergency department nurses consider important to safely manage during an influenza pandemic: A qualitative descriptive study

2021 ◽  
Author(s):  
◽  
Jessica Lockett
Keyword(s):  
Emergency Department ◽  
New Zealand ◽  
Healthcare System ◽  
Emergency Departments ◽  
Influenza Pandemic ◽  
Health Board ◽  
District Health ◽  
Emergency Department Nurses ◽  
Qualitative Descriptive ◽  
The Impact

<p>The influenza virus is responsible for significant morbidity and mortality worldwide each year, with influenza pandemics occurring every 10 to 50 years and responsible for millions of deaths and substantial economic impact. Increasing globalisation through travel and trade means New Zealand is vulnerable to the risks of pandemic influenza, placing a strain on the healthcare system, putting lives at risk and posing a significant cost to the country. Emergency Departments are at the frontline of New Zealand’s healthcare system and are a crucial component in the response to an influenza pandemic, however little research has been done on the impact such an event would have on the nursing staff who work in this area and the care they provide to influenza patients.  This study aims to explore what New Zealand Emergency Department nurses perceive as the biggest challenges to nursing care and staff safety during an influenza pandemic, in order to provide information on how to ensure the engagement of these nurses at the frontline of the pandemic response. With a lack of evidence-based research available, a qualitative descriptive design was used to allow an exploration of the first-hand perspectives of Emergency Department nurses, gaining meaningful insights into a phenomena which has been little explored.  Sixteen nurses from two Emergency Departments participated in face-to-face interviews conducted using semi-structured questions. Raw data was transcribed, and an inductive approach was taken to data analysis, guided by the principles of both content and thematic analysis.  The findings demonstrate that Emergency Department nurses work in an environment that poses risk to patient and staff safety every day, and an understanding of these safety problems is provided in the theme ‘the everyday reality for Emergency Department nurses’. Working within this context shapes the fears that Emergency Department nurses hold about what could happen if an influenza pandemic were to affect New Zealand in the future, and are summarised within the theme ‘fears for a pandemic’. The final theme, ‘strategy and planning for pandemics’ provides insight into how Emergency Department nurses feel these issues could be managed within future pandemic planning at Emergency Department, District Health Board and government level.  This thesis identifies both existing and potential future safety concerns in relation to the management of influenza in New Zealand Emergency Departments, affecting the safety of patients and staff. It also provides specific multi-level and multi-agency recommendations for future pandemic plans that could help to mitigate the significant risks highlighted by those who work within the system every day.</p>

scholarly journals 1518 The Use of OrthoPathway, Decision Support Software, To Reduce Variation in Practice, Optimise Patient Care and Reduce Face-To-Face Appointments in Trauma and Orthopaedics

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M Jones ◽  
W Griffiths-Jones
Keyword(s):  
Emergency Department ◽  
Decision Support ◽  
Web Application ◽  
Clinical Pathways ◽  
Management Plan ◽  
National Guidelines ◽  
Fracture Clinic ◽  
Face To Face ◽  
Musculoskeletal Problems

Abstract Introduction Musculoskeletal problems account for 3.5million Emergency Department attendances annually. Front-line staff are under pressure, faced with complex decisions with limited supportive tools. Without adequate support there is greater variation in practice, poor patient outcomes, longer Emergency Department stays and unnecessary follow-up. OrthoPathway is a web application that enables the production of editable decision support pathways. We have published over 50 Consultant designed, locally approved, interactive pathways. Patient-facing staff can use these to follow national guidelines, by answering questions to establish appropriate treatments. Method New and follow-up fracture clinic patients were audited over a one-week period. Clinic letters and clerking documents were analysed to identify the diagnosis and management plan. From information and radiographs available OrthoPathway was used to generate a management plan, used as the audit standard. Results 78 new patients and 83 follow-up patients were seen in fracture clinic over a one-week period. Clinical pathways were available on OrthoPathway for 42% of new patients and 40% of follow-up patients. Variation in practice was seen in 42% of new patients and 59% of follow-up patients. The associated saving in appointments was 11 and 21 and in the new and follow-up patients, respectively. Conclusions We have shown that OrthoPathway has the potential to reduce face-to-face appointments by 20%, with its current utilisation. Through the deployment of a full set of pathways we anticipated a reduction of greater than 40%, which is particularly pertinent given the current COVID-19 pandemic. This highlights the benefits of Consultant approved decision support pathways published on OrthoPathway.

scholarly journals The Impact of a Clinical Asthma Pathway on Resident Education

2018 ◽  
Vol 2018 ◽  
pp. 1-11 ◽  
Author(s):  
Hina J. Talib ◽  
Yonit Lax ◽  
Marina Reznik
Keyword(s):  
Resident Education ◽  
Clinical Pathways ◽  
Asthma Management ◽  
Knowledge Score ◽  
Educational Impact ◽  
Pediatric Residents ◽  
Educational Benefits ◽  
Based Medicine ◽  
The Impact ◽  
Clinical Asthma

Clinical pathways for asthma management decrease hospital cost and length of stay; however little is known about the educational impact of pathways on residents. Pediatric residents at a children’s hospital (N=114) were invited to complete a 22-item computerized, anonymous survey 6 months before and 6 months after asthma pathway implementation. The survey assessed pathway use and residents (1) pathway knowledge, (2) attitudes and experiences with managing asthma, and (3) perceived educational benefits. Mean pathway knowledge score increased from the case before to the case after implementation [1.5±1.0 versus 2.6±1.3, p<0.001], as did high preparedness to manage asthma [61% versus 91%, p<0.001] and electronic order set use [28% versus 80%, p<0.001]. The top three educational benefits of the pathway endorsed by residents were application of evidence-based medicine (57%), ability to assess exacerbations (52%), and skill at communicating respiratory status (47%). After implementation, residents’ knowledge and preparedness to manage asthma improved as well as many endorsed educational benefits.

The Impact of Clinical Pathways on Antibiotic Prescribing for Acute Otitis Media and Pharyngitis in the Emergency Department

2018 ◽  
Vol 37 (9) ◽  
pp. 901-907 ◽  
Author(s):  
Daniele Dona ◽  
Maura Baraldi ◽  
Giulia Brigadoi ◽  
Rebecca Lundin ◽  
Giorgio Perilongo ◽  
...  
Keyword(s):  
Emergency Department ◽  
Otitis Media ◽  
Clinical Pathways ◽  
Acute Otitis Media ◽  
Antibiotic Prescribing ◽  
The Impact

scholarly journals Multicentre evaluation of an emergency department asthma care pathway for adults

CJEM ◽  
2009 ◽  
Vol 11 (03) ◽  
pp. 215-229 ◽  
Author(s):  
M. Diane Lougheed ◽  
Jennifer Olajos-Clow ◽  
Kim Szpiro ◽  
Patricia Moyse ◽  
Brianna Julien ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Care Delivery ◽  
Care Pathway ◽  
Asthma Management ◽  
Systemic Steroid ◽  
Asthma Care ◽  
Post Intervention ◽  
National Implementation ◽  
Ed Visits

ABSTRACTObjective:We sought to determine whether a standardized emergency department (ED) asthma care pathway (ACP) for adults would be accepted by ED staff, improve adherence to Canadian ED asthma management guidelines and improve patient outcomes.Methods:Ten Ontario hospital EDs (5 intervention, 5 control) participated in a 5-month pre–post intervention study. Emergency department management, admissions, repeat ED visits and ED length of stay were compared between sites and by ACP use versus nonuse at intervention sites.Results:The ACP was used in 101 of 383 visits (26.4%) at 5 intervention sites. Use of the ACP varied significantly between sites, ranging from 6% to 60% (p&lt; 0.001). When compared with control sites, there were significant increases in the use of metered dose inhalers (MDIs), inhaled steroids, referrals, documentation of teaching, patient recollection of teaching (all with a p &lt; 0.001) and oxygen (p= 0.001). Use of peak expiratory flow rate (PEFR) measurements decreased in both intervention and control sites. Increased PEFR documentation and systemic steroid use in the ED and on discharge were only found in patients who were on the ACP at intervention sites. Admissions increased from 3.9% to 9.4% at intervention sites in contrast to control sites, where they remained fairly stable (p= 0.016), but did not differ by ACP use. The length of stay for discharged patients increased by a mean of 16 minutes for ACP patients at intervention sites (p= 0.002). There were no statistically significant differences in repeat ED visits.Conclusion:Adoption of a standardized ED ACP for adults is highly variable. Despite modest uptake, which averaged 26%, beneficial changes in specific aspects of asthma care delivery were found, notably in referrals and recollection of teaching done during the ED visit, without a substantial increase in ED length of stay. These changes may lead to improvements in outcomes, such as reduced relapse rates, which this study was not designed or powered to detect. Provincial and national implementation strategies that address barriers to clinical pathway adoption are warranted and have the potential to improve adherence to guidelines and outcomes for asthma patients.

scholarly journals Patient preferences for asthma management: a qualitative study

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e037491 ◽  
Author(s):  
Christina Baggott ◽  
Amy Chan ◽  
Sally Hurford ◽  
James Fingleton ◽  
Richard Beasley ◽  
...  
Keyword(s):  
New Zealand ◽  
Qualitative Study ◽  
Lived Experience ◽  
Health Beliefs ◽  
Patient Preferences ◽  
Inhaled Corticosteroids ◽  
Descriptive Analysis ◽  
Healthcare Providers ◽  
Asthma Management ◽  
The Impact

ObjectivePreference for asthma management and the use of medications is motivated by the interplay between lived experiences of asthma and patients’ attitudes towards medications. Many previous studies have focused on individual aspects of asthma management, such as the use of preventer and reliever inhalers. The aim of this qualitative study was to explore the preferences of patients with mild-moderate asthma for asthma management as a whole and factors that influenced these preferences.DesignA qualitative study employing qualitative descriptive analysis situated within a constructionist epistemology to analyse transcribed audio recordings from focus groups.SettingThree locations within the greater Wellington area in New Zealand.ParticipantsTwenty-seven adults with self-reported doctor’s diagnosis of asthma, taking short-acting beta-agonists alone or inhaled corticosteroids with or without long-acting beta2-agonist, who had used any inhaled asthma medication within the last month.ResultsFour key areas described preferences for asthma management. Preferences for self-management: participants wanted to be in control of their asthma and developed personal strategies to achieve this. Preferences for the specific medications or treatment regimen: participants preferred regimens that were convenient and reliably relieved symptoms. Preferences for inhaler devices: devices that had dose counters and were easy to use and portable were important. Preferences for asthma services: participants wanted easier access to their inhalers and to be empowered by their healthcare providers. Participant preferences within each of these four areas were influenced by the impact asthma had on their life, their health beliefs, emotional consequences of asthma and perceived barriers to asthma management.ConclusionsThis study illustrates the interaction of the lived experience of asthma, factors specific to the individual, and factors relating to asthma treatments in shaping patient preferences for asthma management. This aids our understanding of preferences for asthma management from the patient perspective.Trial registration numberAustralian New Zealand Clinical Trials Registry (ACTRN12619000601134).

scholarly journals Evaluating a clinical practice intervention to promote delivery of salbutamol by metered-dose inhalers with holding chambers in a pediatric emergency department

CJEM ◽  
2013 ◽  
Vol 15 (02) ◽  
pp. 101-108 ◽  
Author(s):  
Barbara J. Hill-Taylor ◽  
Katrina F. Hurley ◽  
Ingrid Sketris ◽  
Colleen O'Connell ◽  
Douglas Sinclair ◽  
...  
Keyword(s):  
Emergency Department ◽  
Clinical Practice ◽  
Hospital Admissions ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
Inventory Data ◽  
Asthma Care ◽  
Hospital Admission Rate ◽  
Metered Dose ◽  
The Impact

ABSTRACTObjective:The primary objective of this study was to quantify the impact of a clinical practice intervention to promote the delivery of salbutamol by metered-dose inhaler (MDI) in a pediatric emergency department (PED). A secondary objective was to retrospectively document the components of the intervention.Methods:PED inventory data for salbutamol inhalation solution (nebules), MDIs, and holding chambers were obtained from the pharmacy department. Patient data were obtained fromthe hospital's decision support unit. Interrupted time series analysis was used to evaluate trends in salbutamol inventory data, patient triage acuity, and hospital admissions from January 1, 2003, to May 31, 2010. Interviews and administrative documents were used to identify components of the intervention, which began in 2006.Results:There was a 1,215% increase in the proportion of salbutamol delivered as MDIs compared to total inhaled salbutamol (MDI plus nebulization solution) following the intervention (95% CI 1,032% to 1,396%,p&lt; 0.001). Increases in salbutamol MDI use were associated with the implementation of an institution-specific asthma care map. A relative decrease of 32% in the hospital admission rate (absolute –7.25%: 95% CI –8.31 to –6.19,p&lt; 0.001) was associated with the change in salbutamol MDI use and the use of the asthma care map.Conclusions:A multifaceted intervention, designed and implemented by local PED clinical leaders, resulted in a pronounced change in salbutamol inhalation practice, with an associated decrease in admission rates. This intervention demonstrated many of the criteria for successful health system change. Findings from this research may be contextualized to inform change elsewhere.

scholarly journals Strategies and processes emergency department nurses consider important to safely manage during an influenza pandemic: A qualitative descriptive study

2021 ◽  
Author(s):  
◽  
Jessica Lockett
Keyword(s):  
Emergency Department ◽  
New Zealand ◽  
Healthcare System ◽  
Emergency Departments ◽  
Influenza Pandemic ◽  
Health Board ◽  
District Health ◽  
Emergency Department Nurses ◽  
Qualitative Descriptive ◽  
The Impact

<p>The influenza virus is responsible for significant morbidity and mortality worldwide each year, with influenza pandemics occurring every 10 to 50 years and responsible for millions of deaths and substantial economic impact. Increasing globalisation through travel and trade means New Zealand is vulnerable to the risks of pandemic influenza, placing a strain on the healthcare system, putting lives at risk and posing a significant cost to the country. Emergency Departments are at the frontline of New Zealand’s healthcare system and are a crucial component in the response to an influenza pandemic, however little research has been done on the impact such an event would have on the nursing staff who work in this area and the care they provide to influenza patients.  This study aims to explore what New Zealand Emergency Department nurses perceive as the biggest challenges to nursing care and staff safety during an influenza pandemic, in order to provide information on how to ensure the engagement of these nurses at the frontline of the pandemic response. With a lack of evidence-based research available, a qualitative descriptive design was used to allow an exploration of the first-hand perspectives of Emergency Department nurses, gaining meaningful insights into a phenomena which has been little explored.  Sixteen nurses from two Emergency Departments participated in face-to-face interviews conducted using semi-structured questions. Raw data was transcribed, and an inductive approach was taken to data analysis, guided by the principles of both content and thematic analysis.  The findings demonstrate that Emergency Department nurses work in an environment that poses risk to patient and staff safety every day, and an understanding of these safety problems is provided in the theme ‘the everyday reality for Emergency Department nurses’. Working within this context shapes the fears that Emergency Department nurses hold about what could happen if an influenza pandemic were to affect New Zealand in the future, and are summarised within the theme ‘fears for a pandemic’. The final theme, ‘strategy and planning for pandemics’ provides insight into how Emergency Department nurses feel these issues could be managed within future pandemic planning at Emergency Department, District Health Board and government level.  This thesis identifies both existing and potential future safety concerns in relation to the management of influenza in New Zealand Emergency Departments, affecting the safety of patients and staff. It also provides specific multi-level and multi-agency recommendations for future pandemic plans that could help to mitigate the significant risks highlighted by those who work within the system every day.</p>

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