Falls and delirium in an acute care setting: A retrospective chart review before and after an organisation-wide interprofessional education

Introduction: Patients who present to the Emergency Department (ED) with a drug overdose often require long periods of monitoring. After their initial assessment and stabilization, they spend a significant amount of time in a high cost acute care bed in the ED for monitoring until they are medically cleared for psychiatric care or to be discharged. The shift length at this ED is a maximum of 8 hours; meaning any patients staying over 8 hours must be handed over between physicians, increasing the chance of medical errors. The objective of this study is to examine the total ED length of stay (LOS) of this patient group after physician initial assessment (PIA) to determine if there is there justification for the creation of a toxicology observation or short-stay unit for these patients. Methods: A single-centre, blinded retrospective chart review was conducted examining all adult patients presenting to the ED at an urban academic tertiary care centre with a drug overdose in 2018. Variables examined include: Disposition (home, admitted to acute care setting, admitted to non-acute care setting), time from PIA to disposition and total length of stay from PIA to discharge home or admission to hospital. The primary outcome is total length of stay in the ED after PIA.M Results: A total of 1006 patients presenting with an overdose were included. A total of 388 patients were admitted with 44% (172) having an ED LOS greater than 8 hours and 36% (138) staying 8 hours after PIA. The median [IQR] LOS in the ED for all patients was 343 minutes [191-565] while the median [IQR] time to PIA was 37 minutes [15-97]. The majority of these patients (54%) were discharged with no consulting services involved, 23% received a consult to psychiatry, 22% were consulted to internal medicine and 5% of patients were consulted to Critical Care Medicine. Conclusion: This demonstrates patients presenting to the ED with an overdose are seen in the ED by a physician quickly, however many stay in the department over 5 hours from their initial assessment in a monitored setting. While a majority of these patients are able to go home, 44% of admitted patients wait greater than 8 hours in the ED on monitors. The creation of a toxicology observation unit would be helpful for this population to increase patient safety and ease ED bed congestion.

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Palliative Care in a Pandemic: A Retrospective Chart Review of the Impact of Early Palliative Care Consultation During the COVID-19 Pandemic in the Acute Care Setting (QI705)

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2021.01.041 ◽

2021 ◽

Vol 61 (3) ◽

pp. 656-657

Author(s):

Rachel Sabolish ◽

Jennifer Wilson ◽

Hollie Caldwell

Keyword(s):

Palliative Care ◽

Acute Care ◽

Chart Review ◽

Care Setting ◽

Retrospective Chart Review ◽

Acute Care Setting ◽

Early Palliative Care ◽

Palliative Care Consultation ◽

Care Consultation ◽

The Impact

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1213. How Often Is Portable Equipment Cleaned in an Acute Care Setting?

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1076 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S436-S436

Author(s):

Y Karen Ng Wong ◽

Heba Alhmidi ◽

Thriveen Sankar Chittoor Mana ◽

Annette Jencson ◽

Jennifer Cadnum ◽

...

Keyword(s):

Acute Care ◽

Care Setting ◽

Methicillin Resistant Staphylococcus Aureus ◽

Vital Signs ◽

Acute Care Setting ◽

Portable Equipment ◽

Effective Strategies ◽

Frequency Of Use ◽

Before And After ◽

Healthcare Associated

Abstract Background Portable medical equipment that is shared among patients may frequently become contaminated with healthcare-associated pathogens. Cleaning of these devices may be suboptimal. Here, we aim to determine how frequently mobile equipment is cleaned after being used in an acute care setting. Methods Frequency of use and cleaning practices were surveyed by observation. Thirty pieces of mobile equipment from 4 wards including workstations, EKGs, vital signs monitor, and doppler ultrasounds were disinfected with a sporicidal disinfectant. Samples were taken before and after cleaning for recovery of methicillin-resistant Staphylococcus aureus (MRSA), C. difficile spores, and Gram-negative bacilli. After disinfection, each piece of equipment was tagged with a colored tag to indicate the ward location and a fluorescent gel marker (FGM) was applied to study the frequency of cleaning of portable equipment. Mobile equipment was checked for colored tags and fluorescent gel removal five, 12, and 20 days after application. Results Mobile equipment was infrequently cleaned and moved readily from ward to ward. In 9 of 10 observations, mobile equipment was used and not cleaned after use. Point prevalence sampling showed that 27.5% of mobile equipment had one or more pathogens on them. At day 5, only 30% of equipment marked with FGM had been cleaned and after 20 days, 23% of marked mobile equipment remained uncleaned (figure). 4 pieces of mobile equipment traveled from their original ward to a different ward. Conclusion Our findings demonstrate that portable equipment is frequently used and infrequently cleaned. These items can become contaminated with clinically relevant pathogens. We also saw that portable equipment frequently traveled from ward to ward. There is potential for contaminated portable equipment to serve as a vector for dissemination of pathogens. There is a need for effective strategies to disinfect portable equipment between patients. Disclosures All authors: No reported disclosures.

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