scholarly journals 752. Timing of Antibiotics Administration in Emergency Department and Mortality in Sepsis by Sepsis-3 Definition

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S335-S336
Author(s):  
Hyeri Seok ◽  
Ju-Hyun Song ◽  
Ji Hoon Jeon ◽  
Hee Kyoung Choi ◽  
Won Suk Choi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Sofa Score ◽  
Lactate Level ◽  
P Value ◽  
Antibiotic Administration ◽  
Risk Of Mortality ◽  
Administration Time ◽  
Comorbidity Index ◽  
Time To Antibiotics ◽  
The Mean

Abstract Background Even after the introduction of the Sepsis-3 definition, there is still debate on the ideal antibiotic administration time in patients with sepsis. This study was performed to evaluate the association between the timing of antibiotic administration and mortality in sepsis patients who visited the emergency room. Methods A prospective cohort study was conducted on patients who were diagnosed as sepsis with Sepsis-3 definition among patients who visited the emergency department (ED) of Korea University Ansan Hospital from September 2017 to January 2019. The timing of antibiotic administration was defined as the time in hours from ED arrival until the first antibiotic administration. Cox logistic regression analysis was used to estimate the association between time to antibiotics and 7-, 14-, and 28-day mortality. Results During the study period, a total of 251 patients were enrolled with a 7-, 14-, and 28-day mortality of 16.7%, 36.3%, and 57.4%, respectively. The median time to antibiotic administration was 247 minutes (interquartile range 72 – 202 minutes). The mean age was 72 ± 15 years old and 122 patients (48.6%) were female. The most common site of infection was respiratory infection. The timing of antibiotic administration were not associated with 7-, 14-, and 28-day mortality. Female (adjusted hazard ratio [HR] 2.06 [95% confidence interval (CI) 1.21 – 3.53]; P value = 0.008), SOFA score (aHR 1.17 [95% CI 1.05 - 1.31]; P = 0.005), and initial lactate level (aHR 1.13 [95% CI 1.05 - 1.22]; P = 0.001) increased the risk of 7-day mortality. Female (aHR 2.07 [95% CI 1.48 – 2.89]; P ≤ 0.001), Charlson comorbidity index (aHR 1.12 [95% CI 1.02 - 1.24]; P = 0.025), and initial lactate level (aHR 1.19 [95% CI 1.02 - 1.16]; P = 0.011) increased the risk of 14-day mortality. Female (aHR 1.95 [95% CI 1.50 – 2.54]; P = 0.001) increased the risk of 28-day mortality in patients with sepsis. Conclusion The timing of antibiotic administration did not increase the risk of mortality in the treatment of sepsis patients who visited ED. Rather, the SOFA score, lactate, female, and comorbidity increased the mortality associated with sepsis. Disclosures All authors: No reported disclosures.

scholarly journals Comparison of efficacy between levosalbutamol and levosalbutamol-ipratropum nebulization in mild to moderate childhood asthma

2019 ◽  
Vol 6 (5) ◽  
pp. 1952
Author(s):  
R. Ramanathan ◽  
B. Mahalakshmi
Keyword(s):  
Emergency Department ◽  
Flow Rate ◽  
Childhood Asthma ◽  
Ipratropium Bromide ◽  
Randomized Study ◽  
Airflow Obstruction ◽  
Pediatric Emergency ◽  
P Value ◽  
Pediatric Emergency Department ◽  
The Mean

Background: The objective of the study was to compare the efficacy between levosalbutamol and ipratropium combination over levosalbutamol nebulisation in reversing airflow obstruction and improve oxygenation, evaluated using the pulmonary asthma score, SaO2, and PEFR in mild and moderate asthma.Methods: A prospective, randomized, study was performed in RMMCH pediatric emergency department. Children between 6 and 12 years of age who presented with mild to moderate asthma exacerberations were enrolled in the study. They were randomly allocated into two different groups: one nebulised with levosalbutamol alone and another with addition of ipratropium bromide to levosalbutamol. Baseline Peak expiratory flow rate and Final absolute values or change from baseline 60-120 minutes after the inhalation are measured. Patients were evaluated using the pulmonary score.Results: After treatment there is improvement in the mean pulmonary asthma scores and PEFR percentage in A+B group than A group, but it is not statistically significant (p value >0.05). There is statistically significant improvement in pulmonary asthma score and PEFR in each of the groups after nebulisation and pulmonary asthma score has a sensitivity of 66.7% and 65.6% in diagnosing severity of asthma in relation to PEFR.

Abstract 257: Cutting Down the Lag- an Assessment of the Delay in the House Staff’s Evaluation of an Admission

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Jason G Kaplan ◽  
Arjun Kanwal ◽  
John Berquist ◽  
Samuel Eis ◽  
Rabia Zahid ◽  
...  
Keyword(s):  
Emergency Department ◽  
Response Time ◽  
Current System ◽  
Lag Time ◽  
P Value ◽  
Post Intervention ◽  
Emergency Department Admission ◽  
Admission Time ◽  
Evaluation Time ◽  
The Mean

Background: At this institution, a delay occurs between the time the emergency department admits a patient and the admitting service’s evaluation of the patient. Since the emergency department is run on paper charting, the current system, at night, involves the emergency department writing a name and a diagnosis in the emergency department’s admission book. The night residents’ job is to admit teaching patients to the teaching service. The current system requires the night resident to physically go to the emergency department and look in the admissions book to find out about a new admission. This lack of communication can cause a great delay in evaluation of a new admission, which can be problematic. The catalyst for this study was an adverse event where a stroke was missed in the emergency department and the patient was not evaluated by the admitting service for 15 hours falling well outside the tPA window. Decreasing the delay in thorough evaluation is crucial in proper treatment of many cardiovascular conditions, which are time sensitive and can potentially prevent a catastrophic outcome. Intervention: Residents on the admitting service will be first asked to document their evaluation time without intervention, which will be documented with the emergency department admission time to establish a baseline. In addition to the current system of manually checking the admissions book in the emergency department, the ward clerk will page the night staff when new admissions are written in the book. Residents on the admitting service will then document their evaluation time with this new intervention, along with the emergency department admission time. The goal of this new system is to decrease the time the patient is waiting to be evaluated by the admitting service. Results: The mean lag time pre-intervention (N=20) was 73 minutes with a range of 0-279 minutes. Post-intervention (N=25) the mean lag time was 82 minutes with a range of 5- 337 minutes. The P-value of this study was 0.707. Residents on the admitting service were very compliant with documenting their evaluation times. Admitting residents did note the pages were inconsistent and were often missed. The rate of pages successfully sent out was not documented. Conclusion: The lag time before and after intervention was not found to be statistically significant. Pages were inconsistently sent out but did not impact the internal validity of the study. Since the study tested if paging the on-call residents improved the delay in evaluation, the ability to reliably send the page is as important as the response time. The paging system in this study was used as an augmentation to the current system out of some trepidation that pages could be missed and thus negatively impacting the response time. Due to the statistically insignificant data, it can be concluded that the paging system made no impact on the response time patients were seen by the admitting residents.

Use Of Prothrombin Complex Concentrates In Warfarin Anticoagulation Reversal In The Emergency Department: A Quality Improvement Study Of Administration Delays

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 4824-4824
Author(s):  
Simon Bordeleau ◽  
Daniele Marceau ◽  
Julien Poitras ◽  
Patrick Archambeault ◽  
Carolle Breton
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Action Plan ◽  
Blood Bank ◽  
Audit And Feedback ◽  
Chart Audit ◽  
Improvement Project ◽  
Administration Time ◽  
The Mean ◽  
Timely Administration

Introduction In some bleeding situations, quick reversal of warfarin anticoagulation is important. In the event of a major life-threatening bleeding event, the anticoagulation reversal delay can have an impact on mortality. This study aimed to improve the administration delay when using Prothrombin Complex Concentrate (PCC) for the emergent reversal of warfarin anticoagulation in the emergency department. Methods An audit and feedback quality improvement project was conducted in three phases: a retrospective audit phase, an analysis and feedback phase and prospective evaluation phase. The charts of all eligible patients in a single Emergency Department (ED) in Québec, Canada, who received 4-factor PCC since the introduction of this product in 2009 until October 31, 2011 were retrospectively audited with pre-planned evaluation criteria. The administration delay of PCC was calculated from the time of prescription to the time of administration. After this retrospective chart audit, we determined where improvements could be attained, gave feedback to the ED and the blood bank, and we created an action plan to ensure the timely administration of PCC. The action plan was then implemented in practice to reduce the administration delay. Finally, a six-month prospective evaluation study was conducted to determine if our action plan was followed and improved the administration delays. Results Seventy-seven charts were reviewed in the retrospective chart audit. The mean administration delay was 73.6 minutes (STD [34.1]) with a median of 70.0 minutes (25-75% IQR [45.0-95.0]). We found that this delay was principally due to the following barriers that prevented timely administration of PCCs: communication problems between the ED and the blood bank and reconstitution and delivery inefficiencies. In order to address these barriers, we developed an action plan that involved the following elements: a flowchart to remind all clinicians how to order PCCs and a new delivery method from the blood bank to the ED. During the 6 months following the implementation of our action plan, 39 patients received PCCs and the mean administration time decreased to 33.2 minutes (STD [14.2]) (p<.0001) with a median of 30.0 minutes (25-75% IQR [24.3-38.8]). Conclusion This audit and feedback quality improvement project involving the development and the implementation of an action plan comprising of a flowchart and a new delivery process reduced the administration time of PCC by more than half. Future studies to measure the impact of implementing a similar audit and feedback process involving an action plan in other centers should be conducted before this type of improvement process is implemented on wider scale. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Relative Hyperlactatemia in the Emergency Department: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Ralphe Bou Chebl ◽  
Sarah Jamali ◽  
Nancy Mikati ◽  
Reem Al Assaad ◽  
Karim Abdel Daem ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hospital Mortality ◽  
Lactate Level ◽  
Reference Range ◽  
Serum Lactate ◽  
Optimal Cutoff ◽  
The Mean ◽  
Emergency Department Patients ◽  
Lactate Levels ◽  
Youden’S Index

Abstract Objective The clinical interpretation of lactate ≤ 2.00 mmol/L in emergency department (ED) patients is not well characterized. This study aims to determine the optimal cutoff value for lactate within the reference range that predicts in-hospital mortality among ED patients with initial serum lactate levels within the reference range. Methods This was a retrospective study of adult patients presenting to a tertiary ED between the dates of January 1, 2014 and June 30, 2019 with an initial serum lactate level less than 2.00 mmol/L. The primary outcome was in-hospital mortality. Youden’s index was utilized to determine the optimal threshold that predicts mortality. Patients above the threshold were labeled as having relative hyperlactatemia. A multivariate logistic regression was performed to determine the association between relative hyperlactatemia and in-hospital mortality. Subgroup analyses were done to further examine the interaction between relative hyperlactatemia and hospital mortality. Results During the study period, 1638 patients were included. The mean age was 66.9 ± 18.6 years, 47.1% of the population were female, and the most prevalent comorbidity was hypertension (56.7%). The mean lactate level at presentation was 1.5 ± 0.3 mmol/L. In-hospital mortality was 3.8% in the overall population and 16.2% were admitted to the ICU. A lactate of 1.33 mmol/L was found to be the optimal cutoff that best discriminates between survivors and non-survivors. Relative hyperlactatemia was an independent predictor of in-hospital mortality (OR 1.78 CI1.18-4.03; p 0.02). Finally, Relative hyperlactatemia was associated with increased mortality in patients without hypertension (4.7% versus 1.1%; p 0.008), as well as patients without diabetes or COPD. Conclusion The optimal cutoff of initial serum lactate that discriminates between survivors and non-survivors is in the ED 1.33 mmol/L. Relative hyperlactatemia is associated with increased mortality in emergency department patients, and this interaction seems to be more important in healthy patients.

scholarly journals P042: Pilot study for the inter-arm blood pressure systematic measurement during the diagnosis of transient ischemic attack in the emergency department

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S78
Author(s):  
P. La Rochelle ◽  
S. Lavoie ◽  
V. Boucher ◽  
M. Émond ◽  
J. Perry
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Pilot Study ◽  
Transient Ischemic Attack ◽  
Systematic Measurement ◽  
P Value ◽  
Systemic Thrombolysis ◽  
The Mean ◽  
Mild Stroke ◽  
Ischemic Attack

Introduction: Our principal aim was to document the feasibility of the systematic measurement of the inter-arm blood pressure difference (IABPD) during an episode of transient ischemic attack (TIA) or mild stroke diagnosed in the Emergency Department (ED). As secondary goal was to compare the systolic blood pressure (BP) at triage with the systolic BPs measured during the IABPD. Methods: This is a single center pilot study. Patients presenting in the ED for a diagnosis of TIA were recruited. Once patient has been triaged and diagnosed of TIA, a research assistant made sure that the patient lay on a stretcher for at least 5 minutes. Two automated sphygmomanometers were applied, on each arm. No specific device or device calibration were required. Three consecutive simultaneous BP readings were performed, inverting cuffs arm to arm between each reading. Only the last two set of readings were used to calculate the mean IABPD. This method enables to minimize the error coming from the potential sphygmomanometers’ inaccuracies. Results: 32 patients were recruited from June to September 2017 and all had a successful IABPD measurement. Four patients had an IABPD &gt;10 mmHg, varying from 1.5 to 13 mmHg when the left arm was higher and from 1 to 61 mmHg when the right arm was higher. Of the 22 patients where the triage BP arm side selection was recorded, only 11 were congruent with the arm presenting the highest BP during the IABPD measurement. Selecting of the arm with the highest BP value may better reflect cerebrovascular risk exposition. The mean systolic BP at triage was 159.3 mmHg (95%CI: 144.9-173.7) compared to144.8 mmHg (95%CI: 132.9-156.7) if the arm with the highest value during the IABPD measurement is selected and 142.4 mmHg (95%CI: 130.8-154.0) if the same arm as triage is selected. The p-value for these differences were 0.003 and 0.001 respectively. The patient which presented the IABPD of 61 mmHg, had a stroke 3 days after its ED visit which subsequently led to her death 10 days later. Conclusion: Our results show that the systematic IABPD measurement using a pragmatic approach in the ED is feasible and is ready to investigate its use in the context of a new TIA or mild stroke. This information may contribute to a better discrimination of the short-term risk of stroke and may help to diagnose acute aortic dissection, monitor more accurately BP during hyperacute stroke or estimate intracerebral hemorrhage risk if systemic thrombolysis is considered.

scholarly journals The Validity of SOFA Score to Predict Mortality in Adult Patients with Cardiogenic Shock on Venoarterial Extracorporeal Membrane Oxygenation

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Mohamed Laimoud ◽  
Mosleh Alanazi
Keyword(s):  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Blood Lactate ◽  
Sofa Score ◽  
Lactate Level ◽  
Blood Lactate Level ◽  
Ecmo Support ◽  
Adult Patients ◽  
The Mean ◽  
Va Ecmo

Background. Venoarterial ECMO is increasingly used in resuscitation of adult patients with cardiogenic shock with variable mortality reports worldwide. Our objectives were to study the variables associated with hospital mortality in adult patients supported with VA-ECMO and to determine the validity of repeated assessments of those patients by the Sequential Organ Failure Assessment (SOFA) score for prediction of hospital mortality. We retrospectively studied adult patients admitted to the cardiac surgical critical care unit with cardiogenic shock supported with VA-ECMO from January 2015 to August 2019 in our tertiary care hospital. Results. One hundred and six patients supported with VA-ECMO were included in our study with in-hospital mortality of 56.6%. The mean age of studied patients was 40.2 ± 14.4 years, and the patients were mostly males (69.8%) with a mean BMI of 26.5 ± 7 without statistically significant differences between survivors and nonsurvivors. Presence of CKD, chronic atrial fibrillation, and cardiac surgeries was significantly more frequent in the nonsurvivors group. The nonsurvivors had more frequent AKI (p<0.001), more haemodialysis use (p<0.001), more gastrointestinal bleeding (p=0.039), more ICH (p=0.006), and fewer ICU days (p=0.002) compared to the survivors group. The mean peak blood lactate level was 11 ± 3 vs 16.7 ± 3.3, p<0.001, and the mean lactate level after 24 hours of ECMO initiation was 2.2 ± 0.9 vs 7.9 ± 5.7, p<0.001, in the survivors and nonsurvivors, respectively. Initial SOFA score ≥13 measured upon ICU admission had a 85% sensitivity and 73.9% specificity for predicting hospital mortality [AUROC = 0.862, 95% CI: 0.791–0.932; p<0.001] with 81% PPV, 79.1% NPV, and 80.2% accuracy while SOFA score ≥13 at day 3 had 100% sensitivity and 91.3% specificity for predicting mortality with 93.8% PPV, 100% NPV, and 96.2% accuracy [AUROC = 0.995, 95% CI: 0.986–1; p<0.001]. The ∆1 SOFA (3-1) ≥2 had 95% sensitivity and 93.5% specificity for predicting hospital mortality [AUROC = 0.958, 95% CI: 0.913–1; p<0.001] with 95% PPV, 93.5% NPV, and 94.3% accuracy. SOFA score ≥15 at day 5 had 98% sensitivity and 100% specificity for predicting mortality with 99% accuracy [AUROC = 0.994, 95% CI: 0.982–1; p<0.001]. The ∆2 SOFA (5-1) ≥2 had 90% sensitivity and 97.8% specificity for predicting hospital mortality [AUROC = 0.958, 95% CI: 0.909–1; p<0.001] with 97.8% PPV, 90% NPV, and 94.8% accuracy. Multivariable regression analysis revealed that increasing ∆1 SOFA score (OR = 2.506, 95% CI: 1.681–3.735, p<0.001) and increasing blood lactate level (OR = 1.388, 95% CI: 1.015–1.898, p=0.04) were significantly associated with hospital mortality after VA-ECMO support for adults with cardiogenic shock. Conclusion. The use of VA-ECMO in adult patients with cardiogenic shock is still associated with high mortality. Serial evaluation of those patients with SOFA score during the first few days of ECMO support is a good predictor of hospital mortality. Increase in SOFA score after 48 hours and hyperlactataemia are significantly associated with increased hospital mortality.

Evaluation of First-Dose, Intravenous Push Penicillins and Carbapenems in the Emergency Department

2020 ◽  
pp. 089719002097775
Author(s):  
Emmeline C. Academia ◽  
Jordan E. Jenrette ◽  
Scott W. Mueller ◽  
Julie M. McLaughlin
Keyword(s):  
Emergency Department ◽  
Adverse Events ◽  
Cost Savings ◽  
Medication Administration ◽  
Primary Objective ◽  
Antibiotic Administration ◽  
Administration Time ◽  
Acquisition Costs ◽  
American Society ◽  
Administration Timing

Background: Early appropriate antibiotic administration is associated with improved outcomes in infectious illnesses. During drug shortages in 2017, the American Society of Health-System Pharmacists recommended intravenous push (IVP) administration of medications when possible to conserve small-volume parenteral solutions. Data supporting IVP penicillins and carbapenems was limited. Objective: The primary objective of this study compared time from patient emergency department (ED) arrival to antibiotic administration between IVP and intravenous piggy-back (IVPB) administration. Methods: This single-center pre-post protocol study assessed changes in administration timing and safety of ampicillin/sulbactam, piperacillin/tazobactam, and ertapenem from 2015-2018. Medication administration by IVPB (pre) or IVP (post), ED arrival, antibiotic order and administration times, potential effectors of administration time, and safety events were assessed. Acquisition costs were estimated. Results: A total of 696 administrations were included, with 351 and 345 subjects in the IVPB and IVP cohorts, respectively. The median time from ED arrival to initiation of antibiotic administration was 140 (IQR 87-221) minutes and 110 (IQR 68-181) minutes in the IVPB and IVP cohorts, respectively, (P < 0.01). IVP administration increased the proportion of indexed antibiotics administered within 60 minutes of ED arrival compared to IVPB (20% vs. 12%, respectively, P < 0.01). There was no difference in adverse events between both cohorts. Supply acquisition cost savings totaled an more than $5,000 with the IVP protocol. Conclusion: IVP administration of ampicillin/sulbactam, piperacillin/tazobactam, and ertapenem improved times to initiation of empiric, first-dose antibiotics in the ED without an increase in adverse events, saving over $5,000 annually.

scholarly journals Reliability of Thrombocytopenia in Sepsis as a Predicting Tool for ICU Mortality

2021 ◽  
Author(s):  
Akash Shridharani ◽  
Labani Ghosh ◽  
Jyoti Mannari
Keyword(s):  
Sofa Score ◽  
Apache Ii ◽  
P Value ◽  
Chi Square ◽  
Failure Assessment ◽  
Chi Square Test ◽  
The Mean ◽  
Poor Outcomes ◽  
User Friendly ◽  
New Onset

Introduction: There are many easy reproducible scores used in Intensive Care Unit (ICU) to predict mortality. But these need to be reassessed on a regular basis. There are many variables used to calculate these scores. But there can be some loss of data as the scores are repeated 24-48 hours apart and have many parameters which may make the process less user friendly. Aim: To study the predictive value of new onset thrombocytopenia as an effective tool in predicting mortality in septic patients. Materials and Methods: In this prospective observational study, 200 patients with thrombocytopenia at admission or at any time during ICU hospitalisation between 1st February 2015 to 1st November 2016 were selected; patients hospitalised for less than 24 hours were excluded. Thrombocytopenia is defined as a platelet count lower than 150,000/mm3, and recovery is defined as returning to levels above 150,000/mm3 after showing thrombocytopenia. Admission prognosis variables Acute Physiology, Age and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) Score and platelet counts during the hospitalisation and outcomes were assessed using descriptive statistics, Chi-square test and One-way Analysis of Variance (ANOVA). Results: Out of 200 patients included, overall incidence of thrombocytopenia was 29.83%. The mean age was 49 (SD 18.24) years and mean duration of stay was 8.85 (SD 6.58) days. Maximum patients belonged to the age group of 18-30 years and 51-60 years. Total 89 (44.5%) of the 200 had sepsis and out of them 24 patients died, therefore, mortality rate among those in sepsis with thrombocytopenia was 27%. Mean SOFA score and APACHE II scores were 6.32 (SD 3.44) and 14 (SD 7.89), respectively. In the patients with thrombocytopenia and poor outcomes in the form of death or Discharge Against Medical Advice (DAMA), the SOFA scores were 9.04 and 6.96, respectively (p=0.0438). Similarly, patients with sepsis and thrombocytopenia who had either died or given DAMA the mean APACHE II scores were 18.66 and 17.96, respectively (p-value 0.0492). Conclusion: There was a significant association between, APACHE II and SOFA scores with new onset thrombocytopenia. Therefore, it can be used as an independent individual variable to predict mortality in patients of sepsis with thrombocytopenia.

The association between the transfer of emergency department boarders to inpatient hallways or off-service beds and the quality of oncology care.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 113-113
Author(s):  
Simron Singh ◽  
Maureen E. Trudeau ◽  
Kevin Robert Imrie ◽  
Ben De Mendonca ◽  
John Fralick ◽  
...  
Keyword(s):  
Emergency Department ◽  
Patient Care ◽  
Vital Signs ◽  
Antibiotic Administration ◽  
Care Hospital ◽  
High Quality Medical Care ◽  
Administration Time ◽  
Ed Crowding ◽  
The Impact ◽  
Mean Time

113 Background: Emergency department (ED) crowding is an important issue in the delivery of high-quality medical care. At our quaternary care hospital a policy was implemented to ease ED crowding by moving suitable admitted patients into inpatient hallway beds or off-service beds. This study assesses the impact of off service and hallway bed admissions on patient care and satisfaction. Methods: Retrospective and prospective data were collected from Jan 1 to Dec 31, 2011, on admissions to the oncology service via the ED. Patient care data was collected as follows: chest/abdominal exams performed at first MD visit, number of MD visits within 48 hours, time to antibiotic administration, time to complete vitals, and mean time spent in the ED. Satisfaction surveys were also given to all patients. Results: One hundred and eighteen patients were admitted to a hallway bed (HALL). A random sample of 90 patients were used for comparison in the on service (ON) and off service (OFF) groups. Among HALL patients, 4% percent discharged themselves against medical advice (0% of OFF and ON patients). MD visits within 48 hours were the same among all groups (mean=6). Forty-two percent of hallway patients had a chest/abdominal exam during the first MD visit (32% and 33% for OFF and ON patients, respectively). Time to first completion of vitals was 1:05 (hh:mm) for HALL patients (1:21 and 00:34 for OFF and ON patients, respectively). Time to antibiotic administration was 15:34 for hallway patients (23:59 and 12:35 for OFF and ON patients, respectively). More HALL patients expressed dissatisfaction with their hospital stay (16.7%) compared to OFF (0%) and ON patients (0%). Mean time for admitted patients in the ED awaiting their HALL bed was 9:14, considerably longer than for OFF patients (3:08) and ON patients (4:19). Conclusions: Admission of oncology patients in hallway or in off-service beds did not appear to compromise the timeliness or frequency of medical assessments. However, delays in nursing care (completion of vital signs and drug administration) were noted and patient satisfaction was decreased. Moreover, the policy did not meet its intent to reduce patient time spent in the ED.

scholarly journals LO18: Access to take home naloxone in the Royal Alexandra Hospitals emergency department for patients at risk of an opioid overdose

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S12-S13
Author(s):  
D. W. Dabbs ◽  
K. Dong ◽  
K. Lavergne ◽  
H. Brooks ◽  
E. Hyshka
Keyword(s):  
Emergency Department ◽  
Chart Review ◽  
Target Population ◽  
Tertiary Hospital ◽  
Primary Diagnosis ◽  
Opioid Overdose ◽  
Risk Of Mortality ◽  
Patients At Risk ◽  
Ed Visits ◽  
The Mean

Introduction: Take Home Naloxone (THN) programs prevent death from opioid poisoning by training laypersons to recognize an overdose and administer naloxone. Dispensing THN through the emergency department (ED) is particularly critical because an ED visit for opioid poisoning strongly predicts future mortality. Many EDs have implemented THN programs, yet almost no literature examines the reach of such initiatives. To address this gap, we conducted a chart review of all patients presenting for opioid poisoning to an urban tertiary hospital, with a large ED-based THN program. This exploratory study hypothesized that more than 50% of ED patients presenting for opioid poisoning would be offered a THN kit. Methods: Data on demographics, clinical characteristics, and THN kit dispensing were extracted and analyzed from the charts of all ED patients presenting with a primary diagnosis of opioid poisoning between April 1 2016 and April 30 2017. Logistic regression analyzed predictors of being offered a THN kit. Results: A total of 347 ED visits for 301 unique patients occurred during the study period. The mean age ± SD of patients was 38 ± 14 years, and 69% were male. In 49% of ED visits, a THN kit was offered; 73% of these episodes had a THN kit dispensation. Patients who were male (AOR=1.94; 95% CI 1.11 - 3.40), and reported that their overdose was unintentional (AOR=2.95; 95% CI 1.04 8.35) and caused by illegal opioids (AOR=4.73; 95% CI 2.63 8.52) were significantly more likely to be offered a THN kit. Conclusion: ED-based THN programs have the potential to reach significant proportions of patients at high risk of mortality. However, these programs may have differential reach within the target population. Further research is needed to examine barriers and facilitators to offering all eligible ED patients a THN kit.

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