627 Strategies for Reducing Emergency Department Lengths of Stay for Admitted Pediatric Burn Patients

Abstract Introduction Various strategies to reduce emergency department (ED) lengths of stay (LOS) for admitted pediatric burn patients may be employed as a quality improvement project. Decreasing ED LOS may promote patient outcomes and reduce morbidity. Initial discussions were brought forth during trauma and burn multidisciplinary peer review rounds in March 2019 and have persisted to present day. Methods Several strategies, such as preparation of the burn unit staff within one hour of patient arrival in ED, notification to the burn unit by the burn attending of an incoming pediatric burn patient, allowing the PICU charge nurses or advisors to assist with room set up and admissions, and creating a checklist to assist PICU nurses and advisors in helping prepare for anticipating inpatient admissions. These strategies were designed and enforced in March/April 2019. In addition to these action plans, trauma activation alerts were added in December 2019 to the burn charge nurse phone for pediatric burn trauma one and trauma alerts for more expedient notifications. Finally, communication efforts between ED and burn leadership teams were conducted in June 2020 to help with additional mitigating of ED LOS, such as discussing the appropriateness of specialty consults while in the ED. Results Initial ED LOS was reduced from 209 minutes in March 1019 to 150 minutes in June 2019. Increased trends were noted in early 2020, with a peak at 244 minutes in July 2020. Additional interventions, such as trauma activation alerts and ED/Burn team communications, did not provide sustainable long-term reductions. Conclusions Recent strategies to reduce overall ED LOS trends have been beneficial, but not consistent, in sustaining downward trends. Action to perform a gap analysis to discover persistent barriers and to introduce additional structure, such as a burn trauma one algorithm, may provide stability to this metric.

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799 Free Transportation for Socioeconomically Disadvantaged Burn Patients: Quality Improvement Project

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.376 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S236-S236

Author(s):

Laura Perez ◽

Rebecca Castro ◽

Steven E Wolf ◽

Jong Lee

Keyword(s):

Emergency Department ◽

Quality Improvement ◽

Access To Care ◽

Low Socioeconomic Status ◽

Emergency Department Visits ◽

Quality Improvement Project ◽

Burn Patients ◽

Socioeconomically Disadvantaged ◽

Improvement Project ◽

Transportation Program

Abstract Introduction Our Burn Center provides care to persons living in southeast area of our State. Patients residing in this area sometimes have low socioeconomic status (SES), and are often unable to return to burn clinic for continued care due to transportation barriers. Typically driving distance is over 80 miles involving ferry access, taking two or more hours each way. The aim of this quality improvement project was to examine the feasibility of a free transportation program for low SES patients who have barriers to transportation. Methods Our first step was to assess transportation needs. We started with a patient survey in clinic to determine if patients would be interested in free transportation and if the service would increase access to care. Survey with six questions was used to assess needs. Results We surveyed ten patients during burn clinic to determine if transportation would increase access to care. Nine patients responded positively and found transportation would be beneficial. One responded that he would not use it as he would use clinic appointment as opportunity to vacation in the area. Funding was secured from our School of Medicine. Community transportation providers were contacted and pricing was obtained. Transportation van was contracted with existing vender. Transportation is now available to patients with burn clinic appointments. We hope to expand to other clinics in the hospital in the future. The Transportation program will assist patients with access to care, compliance, decrease non-emergent Emergency Department visits and 30-day readmissions. Conclusions Transportation assistance for socioeconomically disadvantaged burn patients to follow up in clinic is needed. Nine out of ten patients surveyed were willing to use free transportation. We obtained funding to start a free transportation program once a month. This project began in October 2019. We have begun a once-a-month transportation assistance service to determine ridership and continued need. Twice monthly assistance may be needed and will be assessed over time. Our goal is ultimately to expand the program to include other clinics. Applicability of Research to Practice Free transportation program can assist patients with access to care, compliance, and decrease non-emergent Emergency Department visits and 30-day readmissions.

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583 Impacting the Length of Stay of Burn Patients in the Emergency Department

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.209 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S133-S133

Author(s):

Nicole M Kopari

Keyword(s):

Emergency Department ◽

Length Of Stay ◽

Process Improvement ◽

Life Support ◽

Early Interventions ◽

Burn Patients ◽

Burn Unit ◽

Early Transfer ◽

Activation Criteria ◽

Rapid Transfer

Abstract Introduction Burn patients represent a challenging patient population and require early interventions. Advance Burn Life Support classes have been developed to guide first responders with assessing and treating burn patients in the pre-hospital setting. In the emergency department (ED) patients may experience hypothermia, delayed resuscitation, inadequate pain control, and delayed wound cares. Methods ED length of stay (LOS) was retrospectively reviewed for burn patient who met trauma activation criteria from 2013–2018. Patients were categorized based on ED disposition to burn stepdown, burn unit intensive care (BICU), or directly to the burn operating room (OR). Patients who died in the ED or were discharged home were excluded. In 2019, guidelines for burn activations, responses, and consults were developed to mirror the activation criteria for a Level 1 trauma institution. ED nurses and physicians were educated on burn assessment, wound care, and the new triage guidelines with emphasis on the importance of early transfer out of the ED. Results Prior to the change in burn activation guidelines, rapid transfer of burn patients out of the ED had not been emphasized. Of the 144 patients examined, ED LOS was 5.4 hours for those going to burn stepdown, 4.3 hours for BICU, and 3.7 hours for those who went directly to the burn OR. Several barriers to early transfer out of the ED were identified including lack of bed availability, lack of cleaning staff on nights and weekends, difficult lateral transfers of non-burn patients out of the Burn Unit, and a lack of education on the importance of early interventions by nursing staff. Since the implementation of the guidelines, there has been an improvement in LOS for BICU patients, but the goal of less than one hour in the ED has not yet been achieved. Conclusions Unacceptable ED LOS for burn patients were identified, triage guidelines were developed, and education was provided to staff. Guidelines and education, in conjunction with emphasizing the importance of having available beds in the Burn Unit, have led to a decrease in ED length of stay. Ongoing education and process improvement are key for rapid transfer of burn patients out of the ED. Applicability of Research to Practice Burn Centers can improve patient accounts by identifying areas that put burn patients at risk. Implementation of protocols can lead to process improvement and lead to better patient outcomes.

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Quality improvement primer part 2: executing a quality improvement project in the emergency department

CJEM ◽

10.1017/cem.2017.393 ◽

2017 ◽

Vol 20 (4) ◽

pp. 532-538 ◽

Cited By ~ 9

Author(s):

Lucas B. Chartier ◽

Antonia S. Stang ◽

Samuel Vaillancourt ◽

Amy H. Y. Cheng

Keyword(s):

Health Care ◽

Emergency Department ◽

Emergency Medicine ◽

Quality Improvement ◽

Improvement Project ◽

Emergency Department Setting ◽

Pdsa Cycle ◽

Time To Antibiotics ◽

Final Article

ABSTRACTThe topics of quality improvement (QI) and patient safety have become important themes in health care in recent years, particularly in the emergency department setting, which is a frequent point of contact with the health care system for patients. In the first of three articles in this series meant as a QI primer for emergency medicine clinicians, we introduced the strategic planning required to develop an effective QI project using a fictional case study as an example. In this second article we continue with our example of improving time to antibiotics for patients with sepsis, and introduce the Model for Improvement. We will review what makes a good aim statement, the various categories of measures that can be tracked during a QI project, and the relative merits and challenges of potential change concepts and ideas. We will also present the Model for Improvement’s rapid-cycle change methodology, the Plan-Do-Study-Act (PDSA) cycle. The final article in this series will focus on the evaluation and sustainability of QI projects.

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Quick Looks Into the Acute Abdomen- Findings from A 1 Year Audit of Asian Emergency Department Ct Scans

10.21203/rs.3.rs-399261/v1 ◽

2021 ◽

Author(s):

Siang Hiong Goh ◽

Calvin Yit-Kun Goh ◽

Hong Choon Oh ◽

Narayan Venkataraman ◽

Ling Tiah

Keyword(s):

Emergency Department ◽

Abdominal Pain ◽

Clinical Performance ◽

Biliary Tract Disease ◽

Renal Stones ◽

Adverse Outcomes ◽

Ct Scans ◽

Lower Quadrant ◽

Lengths Of Stay ◽

The Common

Abstract BackgroundMuch of the literature regarding Emergency Department CT scan usage for abdominal pain has been in American and European settings, and less so in the rest of the world. We performed an audit for this in our Southeast Asian hospital to see how we compare with international data, also to glean some insights into optimising its use locally.Results – An anonymised de-identified electronic database of all ED patients had been set up since 2020 with the aim of capturing 10 years of ED retrospective data for audit of our clinical performance. From this master database, a subset of all CTAPs done in 2020 was created and then extracted for analysis. Costs, length of stay in the ED and wards, CT reports, disposal from ED, and other data were captured for study. A description was made of the common conditions found, with a subgroup analysis of the elderly, and disposal outcomes from the ED. Specific analysis was done for appendicitis using Mann-Whitney U tests. For 2020, 1860 patients (56% male, and ages 14 to 99 years) had ED CTAPs done. Top indications included right upper and lower quadrant pains, flank pains, persistent abdominal pain despite analgesia, and suspicion for intestinal obstruction. Acute appendicitis, biliary tract disease, renal stones, ovarian disease, and bowel disease were the common diagnoses. 16.2% of CTAPs revealed no abnormality. Malignancies were uncommon diagnoses. For the patients that were discharged from the ED after a negative CTAP, no patient returned within 72 hours nor were there any adverse outcomes. When analysed using Mann-Whitney U tests, patients who had ED CTAPs done for appendicitis had significantly faster time to CT and surgery than those with inpatient imaging, with lower inpatient costs and lengths of stay.Conclusion – CT scans in the ED for appendicitis patients reduces costs, time to surgery, and lengths of stay. Generally, ED CTAPs allows better siting and disposition of patients. Presence of RLQ pain increases the likelihood of a positive scan. Our negative scan rate of 16.2% is comparable to other studies. Protocols and senior inputs can improve accuracy of this important ED resource.

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Genetic gap analysis of wildHordeumtaxa

Plant Genetic Resources ◽

10.1017/s1479262112000317 ◽

2012 ◽

Vol 10 (3) ◽

pp. 242-253 ◽

Cited By ~ 7

Author(s):

Holly Vincent ◽

Roland von Bothmer ◽

Helmut Knüpffer ◽

Ahmed Amri ◽

Jan Konopka ◽

...

Keyword(s):

Gap Analysis ◽

Plant Genetic Resources ◽

Ex Situ ◽

Conservation Strategies ◽

Gene Pools ◽

Barley Plant ◽

Genetic Reserve ◽

Set Up ◽

Global Inventory

To facilitate the updating ofin situandex situconservation strategies for wild taxa of the genusHordeumL., a combined ecogeographic survey and gap analysis was undertaken. The analysis was based on the Global Inventory of Barley Plant Genetic Resources held by ICARDA plus additional datasets, resulting in a database containing 17,131 wildHordeumaccessions. The analysis concluded that a genetic reserve should be established in the Mendoza Province of Argentina, as this is the most species-rich area globally forHordeum. A network of reserves should also be set up across the Fertile Crescent in Israel, Palestine, Syria, Jordan, Lebanon and Turkey to provide effective conservation within the centres of diversity for gene pools 1B (Hordeum vulgaresubsp.spontaneum(C. Koch) Thell.) and 2 (Hordeum bulbosumL.). The majority of the species were deemed under-collected, so further collecting missions are required worldwide where possible. Althoughex situandin situconservation strategies have been developed, there needs to be further investigation into the ecological environments thatHordeumspecies occupy to ensure that any adaptive traits expressed are fully conserved. Additionally, studies are required to characterize existing collections and test the viability of rare species accessions held in genebanks to determine whether furtherex situcollections are required alongside the proposedin situconservation.

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Connecting Chronically Ill, Uninsured Patients Who Use the Emergency Department as a Medical Home: A Process Improvement Project

Journal of Emergency Nursing ◽

10.1016/j.jen.2018.08.011 ◽

2019 ◽

Vol 45 (3) ◽

pp. 249-253

Author(s):

Kysha Cerisier

Keyword(s):

Emergency Department ◽

Process Improvement ◽

Medical Home ◽

Chronically Ill ◽

Uninsured Patients ◽

Improvement Project

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Front door to post-take: an interdepartmental quality improvement project to enhance patient journeys from emergency department triage through to the medical post-take review

Future Healthcare Journal ◽

10.7861/fhj.7.1.s23 ◽

2020 ◽

Vol 7 (Suppl 1) ◽

pp. s23-s23

Author(s):

Darryl E Bernstein ◽

Dana Li ◽

Abhishek Sharma ◽

Ajitha Jayaratnam

Keyword(s):

Emergency Department ◽

Quality Improvement ◽

Quality Improvement Project ◽

Improvement Project ◽

Front Door ◽

Emergency Department Triage

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Use of Analgesia in an Emergency Department

Journal of Nepal Medical Association ◽

10.31729/jnma.554 ◽

2013 ◽

Vol 52 (189) ◽

pp. 224-228 ◽

Cited By ~ 2

Author(s):

Rabin Bhandari ◽

Gyanendra Malla ◽

Indrajit Prasad Mahato ◽

Pramendra Gupta

Keyword(s):

Emergency Department ◽

Median Time ◽

Descriptive Statistics ◽

Emergency Ward ◽

Record Keeping ◽

Case File ◽

Common Presentation ◽

Pain Descriptor ◽

Set Up

Introduction: Pain is a common presentation to the emergency department but often overlooked with little research done on the topic in Nepal. We did an observational retrospective study on 301 patients in the emergency ward of BP Koirala Institute of Health Sciences with the objective of finding the practice of analgesia. The specific focus was on the time to analgesia, drugs for analgesia and method of pain assessment. Methods: Case file analysis of patients discharged home after presenting with pain was performed. Time to analgesia and other factors were analyzed with descriptive statistics. Results: Diclofenac injection intramuscular (80%) was the commonest analgesic used. Assessment methods and record keeping were poor. Pain in the abdomen was the commonest. The median time to analgesia from triage was 45 minutes (IQR 30 to 80) and the median time to analgesia from doctor evaluation was 40 minutes (IQR 20 to 70). Conclusions: Time to analgesia from triage and doctors assessment in our set up is comparable to others. The quality of documentation is poor. Problems with pain identification and assessment may lead to inadequate analgesia so reinforcing the use of pain descriptor at triage itself with pain score would be helpful in adopting a protocol based management of pain. Keywords: analgesia; emergency; Nepal.

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