Tracking Fast and Slow

2020 ◽  
pp. 235-240
Author(s):  
Pat Croskerry
Keyword(s):  
Decision Making ◽  
Emergency Department ◽  
Fast Track ◽  
Correct Diagnosis ◽  
Confirmation Bias ◽  
Elderly Female ◽  
Minor Injury ◽  
Track Area ◽  
A Minor

In this case, an elderly female presents to the emergency department with a complaint of shoulder sprain that occurred while she was mowing her lawn earlier in the day. She is assumed to have a minor injury and is seen and assessed in the fast-track area. This first visit is an example of patient cueing leading to triage cueing, confirmation bias, and ultimately misdiagnosis. She returns later the same day, at which time the correct diagnosis is made. The case provides an opportunity to examine the influence of fatigue and important diurnal influences on decision making.

scholarly journals Short‐term outcomes in children following emergency department visits for minor injuries sustained at home

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Matthew J Molloy ◽  
Wendy Shields ◽  
Molly W Stevens ◽  
Andrea C Gielen
Keyword(s):  
Emergency Department ◽  
Pediatric Population ◽  
Pediatric Emergency ◽  
Emergency Department Visits ◽  
Short Term ◽  
Minor Injury ◽  
Minor Injuries ◽  
A Minor ◽  
The Impact ◽  
At Home

Abstract Background Minor injuries are very common in the pediatric population and often occur in the home environment. Despite its prevalence, little is known about outcomes in children following minor injury at home. Understanding the impact of these injuries on children and their families is important for treatment, prevention, and policy. The objectives of our study were (1) To describe the distribution of short-term outcomes following pediatric minor injuries sustained at home and (2) To explore the relationship of injury type and patient and household demographics with these outcomes. Methods Children (n = 102) aged 0–7 years with a minor injury sustained at home were recruited in an urban pediatric emergency department as part of the Child Housing Assessment for a Safer Environment (CHASE) observational study. Each patient had a home visit following the emergency department visit, where five parent-reported outcomes were assessed. Relationships were explored with logistic regression. Results The most common type of injury was soft tissue (57.8 %). 13.2 % of children experienced ≥ 7 days of pain, 21.6 % experienced ≥ 7 days of abnormal activity, 8.9 % missed ≥ 5 days of school, 17.8 % of families experienced ≥ 7 days of disruption, and 9.1 % of parents missed ≥ 5 days of work. Families reported a total of 120 missed school days and 120 missed work days. Children who sustained a burn had higher odds of experiencing pain (OR 6.97), abnormal activity (OR 8.01), and missing school (OR 8.71). The parents of children who sustained a burn had higher odds of missing work (OR 14.97). Conclusions Families of children suffering a minor injury at home reported prolonged pain and changes in activity as well as significant school and work loss. In this cohort, burns were more likely than other minor injuries to have these negative short-term outcomes reported and represent an important target for interventions. The impact of these injuries on missed school and disruption of parental work warrants further consideration.

scholarly journals Impact of streaming "fast track" emergency department patients

2006 ◽  
Vol 30 (4) ◽  
pp. 525 ◽  
Author(s):  
Debra O'Brien ◽  
Aled Williams ◽  
Kerrianne Blondell ◽  
George A Jelinek
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Waiting Time ◽  
Fast Track ◽  
Average Length ◽  
Waiting Times ◽  
Relative Reduction ◽  
Average Waiting Time ◽  
Discharged Patients ◽  
Track Area

Objective: Fast track systems to stream emergency department (ED) patients with low acuity conditions have been introduced widely, resulting in reduced waiting times and lengths of stay for these patients. We aimed to prospectively assess the impact on patient flows of a fast track system implemented in the emergency department of an Australian tertiary adult teaching hospital which deals with relatively few low acuity patients. Methods: During the 12-week trial period, patients in Australasian Triage Scale (ATS) categories 3, 4 and 5 who were likely to be discharged were identified at triage and assessed and treated in a separate fast track area by ED medical and nursing staff rostered to work exclusively in the area. Results: The fast track area managed 21.6% of all patients presenting during its hours of operation. There was a 20.3% (?18 min; 95%CI, ?26 min to ?10 min) relative reduction in the average waiting time and an 18.0% (?41 min; 95%CI, ?52 min to ?30 min) relative reduction in the average length of stay for all discharged patients compared with the same period the previous year. Compared with the 12-week period before the fast track trial, there was a 3.4% (?2.1 min; 95%CI, ?8 min to 4 min) relative reduction in the average waiting time and a 9.7% (?20 min; 95%CI, ?31 min to ?9 min) relative reduction in the average length of stay for all discharged patients. There was no increase in the average waiting time for admitted patients. This was despite major increases in throughput and access block in the study period. Conclusion: Streaming fast track patients in the emergency department of an Australian tertiary adult teaching hospital can reduce waiting times and length of stay for discharged patients without increasing waiting times for admitted patients, even in an ED with few low acuity patients.

Correlates of cognitive functioning in independent elderly patients discharged home from the emergency department after a minor injury

2016 ◽  
Vol 28 (8) ◽  
pp. 1313-1322 ◽  
Author(s):  
Marie-Christine Ouellet ◽  
Marie-Josée Sirois ◽  
Simon Beaulieu-Bonneau ◽  
Marie-Ève Gagné ◽  
Jacques Morin ◽  
...  
Keyword(s):  
Emergency Department ◽  
Elderly Patients ◽  
Cognitive Functioning ◽  
Significant Proportion ◽  
Minor Injury ◽  
Memory Problems ◽  
Lower Baseline ◽  
Minor Injuries ◽  
A Minor ◽  
Trajectory Of Care

ABSTRACTBackground:The objective of this study was to explore correlates of cognitive functioning of older adults visiting the emergency department (ED) after a minor injury.Methods:These results are derived from a large prospective study in three Canadian EDs. Participants were aged ≥ 65 years and independent in basic activities of daily living, visiting the ED for minor injuries and discharged home within 48 hours (those with known dementia, confusion, and delirium were excluded). They completed the Montreal Cognitive Assessment (MoCA). Potential correlates included sociodemographic and injury variables, and measures of psychological and physical health, social support, mobility, falls, and functional status.Results:Multivariate analyses revealed that male sex, age ≥ 85 years, higher depression scores, slower walking speed, and self-reported memory problems were significantly associated with lower baseline MoCA scores.Conclusions:These characteristics could help ED professionals identify patients who might need additional cognitive evaluations or follow-ups after their passage through the ED. Obtaining information on these characteristics is potentially feasible in the ED context and could help professionals alter favorably elderly's trajectory of care. Since a significant proportion of elderly patients consulting at an ED have cognitive impairment, the ED is an opportunity to prevent functional and cognitive decline.

Is Cognitive Function a Concern in Independent Elderly Adults Discharged Home from the Emergency Department in Canada After a Minor Injury?

2014 ◽  
Vol 62 (11) ◽  
pp. 2130-2135 ◽  
Author(s):  
Marie-Christine Ouellet ◽  
Marie-Josée Sirois ◽  
Simon Beaulieu-Bonneau ◽  
Jacques Morin ◽  
Jeffrey Perry ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cognitive Function ◽  
Elderly Adults ◽  
Minor Injury ◽  
A Minor ◽  
Independent Elderly

scholarly journals The impact of a fast track area on quality and effectiveness outcomes: A Middle Eastern emergency department perspective

2009 ◽  
Vol 9 (1) ◽  
Author(s):  
Subashnie Devkaran ◽  
Howard Parsons ◽  
Murray Van Dyke ◽  
Jonathan Drennan ◽  
Jaishen Rajah
Keyword(s):  
Emergency Department ◽  
Fast Track ◽  
Middle Eastern ◽  
Track Area ◽  
The Impact

scholarly journals Fear of falling in community-dwelling older adults presenting to the emergency department for minor injuries: Impact on return to the ED and future falls

CJEM ◽  
2020 ◽  
Vol 22 (5) ◽  
pp. 692-700
Author(s):  
Marie-Pier Lanoue ◽  
Marie-Josée Sirois ◽  
Jeffrey J. Perry ◽  
Jacques Lee ◽  
Raoul Daoust ◽  
...  
Keyword(s):  
Emergency Department ◽  
Fear Of Falling ◽  
Strong Predictor ◽  
Community Dwelling ◽  
Risk Of Falling ◽  
Predictive Values ◽  
Minor Injury ◽  
Increased Risk ◽  
Minor Injuries ◽  
A Minor

ABSTRACTObjectives1) To characterize mild, moderate, and severe fear of falling in older emergency department (ED) patients for minor injuries, and 2) to assess whether fear of falling could predict falls and returns to the ED within 6 months of the initial ED visit.MethodsThis study was part of the Canadian Emergency and Trauma Initiative (CETI) prospective cohort (2011–2016). Patients ages ≥ 65, who were independent in their basic daily activities and who were discharged from the ED after consulting for a minor injury, were included. Fear of falling was measured by the Short Falls Efficacy Scale International (SFES-I) in order to stratify fear of falling as mild (SFES-I = 7-8/28), moderate (SFES-I = 9-13/28), or severe (SFES-I = 14-28/28). Many other physical and psychological characteristics where collected. Research assistants conducted follow-up phone interviews at 3 and 6 months’ post-ED visit, in which patients were asked to report returns to the ED.ResultsA total of 2,899 patients were enrolled and 2,009 had complete data at 6 months. Patients with moderate to severe fear of falling were more likely to be of ages ≥ 75, female, frailer with multiple comorbidities, and decreased mobility. Higher baseline fear of falling increased the risk of falling at 3 and 6 months (odds ratio [OR]-moderate-fear of falling: 1.63, p < 0.05, OR-severe-fear of falling 2.37, p < 0.05). Fear of falling positive predictive values for return to the ED or future falls were 7.7% to 17%.ConclusionAlthough a high fear of falling is associated with increased risk of falling within 6 months of a minor injury in older patients, fear of falling considered alone was not shown to be a strong predictor of return to the ED and future falls.

Effects of a fast-track area on emergency department performance

2006 ◽  
Vol 31 (1) ◽  
pp. 117-120 ◽  
Author(s):  
Miquel Sanchez ◽  
Alan J. Smally ◽  
Robert J. Grant ◽  
Lenworth M. Jacobs
Keyword(s):  
Emergency Department ◽  
Fast Track ◽  
Track Area

scholarly journals LO14: In emergency department, do serum biomarkers are useful to screen independent frail seniors exposed to functional or mobility impairments after a minor injury?

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S11-S11
Author(s):  
M. Emond ◽  
M. Blouin ◽  
M. Sirois ◽  
M. Aubertin-Leheudre ◽  
L. Griffith ◽  
...  
Keyword(s):  
Emergency Department ◽  
Functional Decline ◽  
Serum Biomarkers ◽  
Community Dwelling ◽  
Geriatric Syndrome ◽  
Mobility Impairments ◽  
Frailty Status ◽  
Minor Injury ◽  
Minor Injuries ◽  
A Minor

Introduction: Frailty is a geriatric syndrome conferring a high risk of declining functional capacities. Some serum biomarkers were associated with frailty, but no study has investigated this possible association among community-dwelling seniors with minor injuries in the emergency department (ED). The aim was to determine if ED serum biomarker assay combined with frailty status improve the prediction of 3-months functional or mobility impairments in this population, beyond frailty status alone. Methods: This prospective sub-study of the CETI cohort includes 190 participants (age 65 years, ED consultation within 2 weeks of a minor injury, independent in daily activities 4 weeks prior to injury, and discharged home from EDs). Biomarkers were obtained from blood samples at baseline (ED visit). Normal vs. at risk physiological states were defined according to clinical threshold values. Also, the patients were screened for frailty at baseline) while their functional (OARS scale) and mobility characteristics were assessed at the ED visit and 3 months later. Patients were classified as robust or pre-frail/frail according of the CHSA-CFS and SOF scales. Simple generalized linear models with a binomial distribution and a log link function were used to explore the differences in functional and mobility outcomes at three months across sub-groups (RR). Results: When compared to robust ones, ED pre-frail/frail patients were less functional in their instrumental activities of day living (p=0.004), slower walkers (p=0.02), more frequent users of walking aids (p=0.03), more fearful of falling (p=0.006), went outside their home less often weekly (p=0.004) and had higher abnormal creatinine levels (p=0.02). We observed an overall 3-month functional decline in around 10% of patients combined with worsened mobility characteristics. We found that vitamin D [RR: 0.51 (0.07-3.9)], glucose (RR: 0.27 [(0.03-2.16)]) and creatinine (RR: [1.10 [(0.40-2.97]) modulate the prediction of 3-months mobility impairments. However, ED frailty status with CHSA-CFS and SOF scales clearly remained the stronger predictor of mobility impairments [vitamin DRR: 2.93 (1.12-7.65); glucoseRR: 2.36 (0.85-6.55); creatinine: RR2.06 (1.21-3.53)]. Conclusion: Since they do not improve the prediction of 3-months functional or mobility impairments associated with frailty status, ED biomarker assays are not useful in adequately screening for frailty among independent seniors with minor injuries.

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