A feasible model for early intervention for high-risk substance use in the emergency department setting

2019 ◽  
Vol 43 (2) ◽  
pp. 188 ◽  
Author(s):  
Rebecca Howard ◽  
Stephanie Fry ◽  
Andrew Chan ◽  
Brigid Ryan ◽  
Yvonne Bonomo
Keyword(s):  
At Risk ◽  
Emergency Department ◽  
High Risk ◽  
Patient Engagement ◽  
Real Life ◽  
Community Support ◽  
Pilot Project ◽  
Relative Contribution ◽  
Gamma Hydroxybutyrate ◽  
High Participation

Objective In response to escalating alcohol and other drug (AOD)-related emergency department (ED) presentations, a tertiary Melbourne hospital embedded experienced AOD clinical nurse consultants in the ED on weekends to trial a model for screening, assessment and brief intervention (BI). The aim of the present study was to evaluate the relative contributions of AOD to ED presentations and to pilot a BI model. Methods Using a customised AOD screening tool and a framework for proactive case finding, screened participants were offered a comprehensive AOD assessment and BI in the ED. Immediate effects of the intervention were evaluated via the engagement of eligible individuals and a self-administered ‘intention to change’ survey. Results Over the 32-month pilot, 1100 patients completed a comprehensive AOD assessment, and 95% of these patients received a BI. The most commonly misused substances were, in order, alcohol, tobacco, amphetamine-type stimulants, gamma-hydroxybutyrate and cannabis. Thirty-two per cent of patients were found to be at risk of dependence from alcohol and 25% were found to be at risk of dependence from other substances. Forty per cent of the people assessed reported no previous AOD support or intervention. On leaving the ED, 78% of participants reported an intention to contact community support services and 65% stated they would change the way they used AOD in the future. Conclusion This study of a pilot program quantifies the relative contribution of AOD to ED presentations and demonstrates that hospital EDs can implement a feasible, proactive BI model with high participation rates for people presenting with AOD-related health consequences. What is known about the topic? Clinician-led BI for high-risk consumption of alcohol has been demonstrated to be effective in primary care and ED settings. However, hospital EDs are increasingly receiving people with high-risk AOD-related harms. The relative contribution of other drugs in relation to ED presentations has not been widely documented. In addition, the optimal model and effects of AOD screening and BI programs in the Australian ED setting are unknown. What does this paper add? This paper describes a ‘real-life’ pilot project embedding AOD-specific staff in a metropolitan Melbourne ED at peak times to screen and provide BI to patients presenting with AOD-related risk and/or harms. The study quantifies the relative contribution of other drugs in addition to alcohol to ED presentations and reports on this model’s much higher levels of patient engagement in receiving BI than has been reported previously. What are the implications for practitioners? This study demonstrates the relative contribution of drugs, in addition to alcohol, to ED presentations at peak weekend times. Although BI has been well proven, the pilot project evaluated herein has demonstrated that by embedding AOD-specific staff in the ED, much higher rates of patient engagement, screening and BI can be achieved.

scholarly journals ReCAP: Feasibility and Effectiveness of a Pilot Program to Facilitate Quality Improvement Learning in Oncology: Experience of the American Society of Clinical Oncology Quality Training Program

2016 ◽  
Vol 12 (2) ◽  
pp. 177-177 ◽  
Author(s):  
Arif H. Kamal ◽  
Doris Quinn ◽  
Timothy D. Gilligan ◽  
Barbara Corning Davis ◽  
Carole K. Dalby ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Training Program ◽  
Real Life ◽  
Pilot Project ◽  
Early Adopters ◽  
High Participation ◽  
American Society ◽  
Structured Program

CONTEXT AND QUESTION ASKED: Improving quality of oncology delivery is an important responsibility for busy oncology practices. Is it feasible to construct a training program for oncology professionals to teach quality improvement that is applicable to practice? SUMMARY ANSWER: Using a longitudinal, project-based program with a mix of in-person and distance-learning components, the ASCO Quality Training Program is a highly feasible method to facilitate quality improvement learning in oncology. METHODS: The ASCO Quality Training Program (QTP) consisted of three in-person Learning Sessions and four phases: pre-work, planning, implementation, and sustain and spread. We measured two primary outcomes: program feasibility and effectiveness. BIAS, CONFOUNDING FACTOR(S), DRAWBACKS: Although we observed high participation, satisfaction, and applicability of content to the needs of the oncology learners, it should be noted that this represents a small, pilot project. REAL-LIFE IMPLICATIONS: Even busy oncology clinicians find a structured program to learn and practice quality improvement skills valuable. Conclusions regarding long-term applicability effectiveness and feasibility among non-early adopters require further study.

Abstract 216: Describing Geographically High-Risk Areas for PAD in the Netherlands: Socio-Economic Profile, Treatment Rates and Cardiovascular Prognosis

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Tijmen Koëter ◽  
Patrick W Vriens ◽  
Moniek van Zitteren ◽  
Jan M Heyligers ◽  
Desiree H Burger ◽  
...  
Keyword(s):  
At Risk ◽  
High Risk ◽  
The Netherlands ◽  
Interventional Procedures ◽  
Pilot Project ◽  
Cardiovascular Outcomes ◽  
Care Providers ◽  
Mapping Technology ◽  
Risk Areas ◽  
Geospatial Mapping

Introduction: Geospatial mapping technology has been previously successfully used in cardiac disease to identify geographical areas where at-risk patients live in terms of their socio-economic background and cardiovascular outcomes. This methodology has not been applied for peripheral arterial disease (PAD). By doing so, we could identify vulnerable subpopulations that may benefit from more aggressive secondary prevention and follow-up. Methods: We are introducing the Geographically High-Risk Areas for PAD (GAP) study in the Netherlands as a pilot project to leverage the use of geospatial mapping technology in a national outpatient database focusing on patients with PAD. The pilot project reports on 816 patients with newly identified PAD (>Rutherford 1) identified at the regional vascular clinics between March 2006 and November 2011 in the city of Tilburg, The Netherlands. Using the ESRI ArcGIS software, we will address the following specific aims: 1) to geo-map patients’ residential location based on their zip code;2) to describe patients’ socioeconomic characteristics based on data obtained from the Central Bureau for Statistics in the Netherlands and patient interviews;3) to geo-map their interventional procedures (endovascular and/or surgical); and 4) to geo-map patients’ cardiovascular outcomes. As an exploratory aim, we will evaluate the association between having a more vulnerable socioeconomic profile, and undergoing more interventional procedures, and having an adverse prognosis, respectively. Results: As an example and to test feasibility, we created a density map with the occurrence of newly identified PAD in the Tilburg area (Figure a), as well as several overviews of maps containing socioeconomic variables (e.g. Figure b - number of patients with PAD on welfare) and cardiovascular risk factors (e.g. Figure c - BMI categories distribution among patients with PAD). Conclusion: Using the geospatial mapping methodology in the GAP pilot project in Tilburg, The Netherlands, we will be able to leverage the use of this technology in larger national databases to better identify patients with PAD who are at risk of increased health care utilization and adverse outcomes. This information will be instrumental to help improve prevention and care for PAD in collaboration with local care providers.

Comparison of fall risk assessment scales in the triage of an Italian emergency department

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
I Piras ◽  
G Murenu ◽  
G Piras ◽  
G Pia ◽  
A Azara ◽  
...  
Keyword(s):  
Risk Assessment ◽  
At Risk ◽  
Emergency Department ◽  
High Risk ◽  
Fall Risk ◽  
Low Risk ◽  
Risk Level ◽  
Moderate Risk ◽  
Fall Risk Assessment ◽  
Risk Levels

Abstract Background Falls in hospital are adverse events with serious consequences for the patient. Fall risk assessment requires easy tools that are suitable for the specific clinical context. This is important to quickly identify preventing measures. The aim of the study is to identify an appropriate scale for assessing fall risk in patients from an emergency department. Methods For the fall risk assessment in the emergency department, three scales were identified in literature: Kinder 1, MEDFRAT, and Morse. MEDFRAT and Morse classify the patient in high, moderate, and low risk; Kinder 1 split patients “at risk” (also when there is only one positive item) and “non-risk” (in which all items are negative). The study was carried out in July 2019 in an Italian emergency department. Patients who arrived in triage were assessed for the fall risk using the three scales. Results On a sample of 318 patients, the used scales show different levels of fall risk. For Kinder 1, 83.02% is at risk and 16.98% is not at risk; for MEDFRAT, 14.78% is at high risk, 15.09% moderate, and 70.13% low risk; for Morse, 8.81% is at high risk, 35.53% moderate, and 56.66% low risk. As Kinder 1 implies as “high risk” that all items of the questionnaire are positive, to compare Kinder 1 to the other scales with three measurements, we assumed only one positive response as “moderate risk”, all negative responses as “low risk”. Thus, Kinder 1 shows no cases at high risk, 83.02% moderate risk, and 16.98% low risk. All the scales show that the moderate-high risk increases with age. MEDFRAT and Morse have concordant percentages for young (13.6%), elderly (61.2%), and long-lived (66.6%) people. Kinder 1, 59%, 96.7%, and 100%, respectively. Conclusions The comparison between scales shows inhomogeneity in identifying the level of risk. MEDFRAT and Morse appear more reliable and consistent. Key messages An appropriate assessment scale is important to identify the fall risk level. Identifying accurate fall risk levels allows for implementing specific prevention actions.

scholarly journals Barriers and facilitators to pre-exposure prophylaxis uptake among male sex workers in Mexico: an application of the RE-AIM framework

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hemant Kadiamada-Ibarra ◽  
Nicola L. Hawley ◽  
Sandra G. Sosa-Rubí ◽  
Marta Wilson-Barthes ◽  
Omar Galárraga ◽  
...  
Keyword(s):  
High Risk ◽  
Mexico City ◽  
Sex Workers ◽  
National Policy ◽  
Real Life ◽  
Community Support ◽  
Male Sex Workers ◽  
Related Stigma ◽  
Male Sex ◽  
Exposure Prophylaxis

Abstract Background The ImPrEP México demonstration project is the first to distribute free HIV pre-exposure prophylaxis (PrEP) to men who have sex with men (MSM) and transgender women living in Mexico. In Mexico City, MSM who are also male sex workers (MSWs) face a disproportionately high risk of HIV infection. PrEP is highly effective for HIV prevention, yet “real-life” implementation among MSWs is a challenge due to the unique adherence barriers faced by this population. Methods This study uses the RE-AIM implementation science framework to characterize the unique barriers to and facilitators of PrEP uptake among MSWs in Mexico City. We conducted 9 in-depth key informant interviews and 2 focus group discussions with MSWs across 5 clinic and community sites. Qualitative data were analyzed using inductive, open coding approaches from grounded theory. We supplemented findings from the primary qualitative analysis with quantitative indicators derived from ImPrEP program records to describe the current Reach of the ImPrEP program among MSWs in Mexico City and the potential for wider PrEP Adoption among other high-risk populations in Mexico. Results The Reach of the ImPrEP program was 10% of known HIV-negative MSWs in Mexico City. Program Reach was lowest among MSWs who were street-based sex workers, of lower socioeconomic status, migrants from other states and self-identified as heterosexual. Barriers to program Reach included limited PrEP knowledge, HIV-related stigma, and structural barriers; facilitators included in-person program recruitment, patient-centered care, and spread of information through word of mouth among MSWs. Two out of the four eligible institutions had adopted the ImPrEP protocol. Barriers to wider program Adoption included HIV- and sexual identity– related stigma, protocol limitations, and lack of a national policy for PrEP distribution; facilitators of Adoption included existing healthcare infrastructure, sensitized providers, and community support from non-governmental organizations. Conclusions Increasing the ImPrEP program’s Reach among MSWs will depend on improving PrEP education and addressing HIV-related stigma and access barriers. Future Adoption of the ImPrEP program should build on existing clinical infrastructure and community support. Creation of a national policy for PrEP distribution may improve the Reach and Adoption of PrEP among highest-risk populations in Mexico.

The Red Legs RATED tool to improve diagnosis of lower limb cellulitis in the emergency department

2021 ◽  
Vol 30 (12) ◽  
pp. S22-S29
Author(s):  
Gillian O'Brien ◽  
Patricia White
Keyword(s):  
Emergency Department ◽  
Lower Limb ◽  
Treatment Guidelines ◽  
Positive Impact ◽  
Data Gathering ◽  
Pilot Project ◽  
Accurate Diagnosis ◽  
Evidence Based ◽  
Significant Burden ◽  
User Friendly

Background: Lower limb cellulitis poses a significant burden for the Irish healthcare system. Accurate diagnosis is difficult, with a lack of validated evidence-based tools and treatment guidelines, and difficulties distinguishing cellulitis from its imitators. It has been suggested that around 30% of suspected lower limb cellulitis is misdiagnosed. An audit of 132 patients between May 2017 and May 2018 identified a pattern of misdiagnosis in approximately 34% of this cohort. Objective: The aim of this pilot project was to develop a streamlined service for those presenting to the emergency department with red legs/suspected cellulitis, through introduction of the ‘Red Leg RATED’ tool for clinicians. Method: The tool was developed and introduced to emergency department clinicians. Individuals (n=24) presenting with suspected cellulitis over 4 weeks in 2018 were invited to participate in data gathering. Finally, clinician questionnaire feedback regarding the tool was evaluated. Results: Fourteen participants consented, 6 female and 8 male with mean age of 65 years. The tool identified 50% (n=7) as having cellulitis, of those 57% (n=4) required admission, 43% (n=3) were discharged. The remainder who did not have cellulitis (n=7) were discharged. Before introduction of the tool, all would typically have been admitted to hospital for further assessment and management of suspected lower limb cellulitis. Overall, 72% (n=10) of patients who initially presented with suspected cellulitis were discharged, suggesting positive impact of the tool. Clinician feedback suggested all were satisfied with the tool and contents. Conclusion: The Red Leg RATED tool is user friendly and impacts positively on diagnosis treatment and discharge. Further evaluation is warranted.

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