scholarly journals O9 Are parents and patients happy to see an advanced paediatric pharmacist practitioner (APPP)?

2019 ◽  
Vol 104 (7) ◽  
pp. e2.61-e2
Author(s):  
Andrew Lilley
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Nurse Practitioners ◽  
Clinical Skills ◽  
List Type ◽  
Parent Perception ◽  
Hospital Environments ◽  
Graduate Certificate ◽  
Better Than

IntroductionPharmacist independent prescribers have become common in both community and hospital environments. However most prescribing courses contain limited clinical skills and diagnosis training.1 2 NHS England conducted a study to assess the benefit of having pharmacists in the Emergency department (ED). They found that in order to have the biggest impact pharmacists would need additional training above that of an independent prescriber particularly clinical examination and diagnosis skills.3 One pharmacist from the audit hospital completed the post graduate certificate in Advanced Emergency Medicine at Manchester University. The assessments taught included Respiratory, Gastroenterology, Musculoskeletal, Neurological and ENT examinations.Additionally, it required 210 hours of in practice training. On completion of the course the local centre had no resources to appoint an APPP in ED. Instead the APPP took up the role within the respiratory team due to experience within this speciality. An APPP now reviews new and follow up patients in clinic as well as those acutely ill. As this was a new role it was decided to perform an audit of parent perception of the role.MethodsQuestions were integrated into every consultation for a two month period. Pre clinic: Are you happy to see the pharmacist today instead of the consultant? (Yes/No/Will wait to see outcome) Post clinic: Did you think a pharmacist could perform this role? (Yes/No). Do you feel like you need to see the consultant still? (Yes/No) Were you happy with the consultation? (Yes/No) Further commentsResults132 separate consultations were included. 45 of these were new referrals, 67 were follow up appointments and 20 acute examinations. In 124 consultations parents stated they would decide if they needed to see the consultant after. Of these all were happy with the outcome post consultation and did not see the consultant. 9 parents had no reservations to the pharmacist running the consultation from the outset and remained happy post consultation. 126 stated they did not realise a pharmacist could perform this role. Comments received included ‘I had no idea a pharmacist could perform clinical examinations’; ‘At first I had reservations however if the hospital felt comfortable with you running clinic I am happy’; ‘You took the time to make us feel at ease’; ‘You are always approachable when my child is acutely unwell…you know our child better than any ED doctor and would rather see you’.ConclusionAs with Advanced Nurse Practitioners (ANPs) it will take time for parents and patients to adapt to a pharmacist diagnosing and managing them instead of a doctor. This audit has shown the pre-conceptions of what a pharmacist can do could hold some back; however after seeing the pharmacist all were happy with the consultation. This is an exciting new role for pharmacists however it is essential to undertake advanced clinical and diagnosis skills in order to make it a successful.Referenceshttp://www.edgehill.ac.uk/health/cpd-modules/non-medical-prescribing-v300-2 (accessed June 2018)https://www.ljmu.ac.uk/study/cpd/other-cpd-courses/non-medical-prescribing (accessed June 2018)Pharmacists in Emergency Departments - A commissioned study by health education England. available via: https://www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Policy%20statements/PIED%20National%20Report.pdf?ver=2016-10-13-150131-640

scholarly journals P024: Obtaining consensus on optimal management and follow-up of patients presenting to the emergency department with early pregnancy complications – a modified Delphi study

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S71-S72
Author(s):  
A. Cornelis ◽  
R. Clouston ◽  
P. Atkinson
Keyword(s):  
Emergency Department ◽  
Family Medicine ◽  
Nurse Practitioners ◽  
Early Pregnancy ◽  
Pregnancy Complications ◽  
Delphi Study ◽  
Pregnancy Loss ◽  
Early Pregnancy Loss ◽  
Modified Delphi

Introduction: Complications in early pregnancy are common and have many physical and emotional consequences. Locally, there is no early pregnancy loss clinic or standardized guide in the emergency department (ED) for referral and follow-up decisions, and both initial management of patients and follow up can be inconsistent. This study aimed to obtain consensus on the best approach to initial work-up, management, and follow up for patients who present to the ED with early pregnancy complications, with the goal of using this consensus to produce a standardized guide for emergency provider use. Methods: A literature review was completed to produce evidence-based recommendations which were used to initiate a modified Delphi consensus process. A survey was distributed, with three rounds completed. Participants included emergency providers, obstetrician-gynecologists, a radiologist, a sample of family medicine physicians including some involved in primary care obstetrics, and nurse practitioners. An obstetric specialist from outside the local region was also involved. Results: Consensus was reached on several key recommendations, however some areas remained without clear accepted best practice. There was consensus that physical components of early pregnancy complications are addressed well, but that we could improve on patient flow and more consistent follow up. Important investigations to be done for patients were identified. The timing of formal ultrasound, necessity and timing of obstetrician consultation, and safety of discharge was addressed for various patient scenarios including stable and unstable patients, with and without adnexal pain, with intrauterine pregnancy of uncertain viability, and with pregnancy of unknown location. Management of confirmed early pregnancy loss in the ED and family medicine clinics was addressed. Barriers to an early pregnancy loss clinic included lack of funding, space, and staffing as well as lack of resources and uncertain patient volumes. A feasible alternative to an early pregnancy loss clinic was for willing providers to keep appointment times available to facilitate confirmation of follow-up prior to discharge. Other suggested alternatives included an early pregnancy loss clinic, a nurse educator, and having a standardized guideline in the ED. Conclusion: Through a consensus approach, several recommendations were agreed upon for improving care for patients presenting to the ED with early pregnancy complications.

Antimicrobial Stewardship in the Emergency Department

2011 ◽  
Vol 24 (2) ◽  
pp. 196-202 ◽  
Author(s):  
Nicole M. Acquisto ◽  
Stephanie N. Baker
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Antimicrobial Stewardship Program ◽  
Implementation Outcomes ◽  
Stewardship Program ◽  
Assessment Skills ◽  
Barriers To Implementation

The practice of antimicrobial stewardship can be defined as optimizing clinical outcomes while minimizing the consequences of antimicrobial therapy such as resistance and superinfection. Antimicrobial stewardship can be difficult to transition to the emergency department (ED) since the traditional activities include the evaluation of broad-spectrum antimicrobial regimens at 72 and 96 hours and intravenous to oral medication conversion. The emergency medicine clinical pharmacist (EPh) has the knowledge and clinical assessment skills to manage an antimicrobial stewardship program focused on culture follow-up for patients discharged from the ED. This paper summarizes the experiences of developing an EPh-managed antimicrobial stewardship and culture follow-up program in the ED from 2 separate institutions. Specifically, the focus is on the steps for establishing an EPh-managed antimicrobial stewardship program, a description of the culture follow-up process, managing the culture data and cultures that require emergent notification and review, medical/legal concerns, and barriers to implementation. Outcomes data available from institutions with similar ED based antimicrobial stewardship programs are also discussed.

A protocol for telemedical consultation

1997 ◽  
Vol 3 (3) ◽  
pp. 163-168 ◽  
Author(s):  
S Tachakra ◽  
A Sivakumar ◽  
J Hayes ◽  
M Dawood
Keyword(s):  
Emergency Department ◽  
Nurse Practitioners ◽  
Depth Perception ◽  
Record Keeping ◽  
Face To Face ◽  
Main Hospital ◽  
Accident And Emergency ◽  
Specialist Referral ◽  
Accident And Emergency Department

We have developed a protocol for telemedical consultations. This has been used by emergency nurse practitioners to consult doctors in a main hospital accident and emergency department, using videoconferencing at 384kbit s. A telemedical consultation should simulate a face-to-face one. The protocol starts with an explanation for the patient of what will happen, followed by the necessary introductions. After relaying the history, the generalist should show the abnormal part to the specialist. Attention should be paid to colour. Depth perception is often enhanced by rotating the camera through 180 . The diagnosis and management, together with their implications, should be discussed with the patient by the specialist. Referral and follow-up should also be discussed. Proper clinical record-keeping is essential. In the first 15 months of using the protocol, we completed more than 300 teleconsultations. An analysis of the first 50 teleconsultations showed that about half were for discussing a radiograph and about half were for examining a patient.

scholarly journals A survey of Midwest physicians’ experiences with patients in psychiatric distress in the emergency department

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Jack Brodeur ◽  
Alyse Folino Ley ◽  
Michelle Bonnet
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Suicidal Ideation ◽  
Social Worker ◽  
Demographic Data ◽  
The United States ◽  
Initial Examination ◽  
Psychiatric Distress ◽  
Final Disposition

Abstract Context Emergency medicine (EM) physicians commonly stabilize patients with acute psychiatric distress, such as suicidal ideation. Research has shown that suicidal ideation is difficult to manage in emergency department (ED) settings and that patients in psychiatric distress are often “boarded” in the ED while awaiting more definitive care. Objectives To examine the attitudes and experiences of emergency physicians regarding the care of patients in psychiatric distress. Special attention is given to suicidal ideation due to its prevalence in the United States. Methods A 19 question anonymous survey was sent via email to 55 emergency medicine residency directors throughout Michigan, Ohio, Indiana, and Illinois, who were identified using an Internet search of residency programs in the region. The program directors were asked to distribute the survey to their colleagues and residents. The intent of this procedure was to generate as many survey responses as possible, while obscuring the identities of the respondents. Responses were gathered from October 29, 2019 until January 16, 2020. The survey was designed to assess respondents’ self-reported demographic data as well as their experiences with the boarding process, initial examination, final disposition, reevaluation of the patient, physician training and resources, and follow up care. Statistical analysis was performed using a Mann–Whitney U test, significance was set at p<0.01. Results In total, 47 EM physicians responded to the survey; however, not all of the respondents completed all 19 questions. Ten of 44 respondents (22.7%) reported that they do not perform the initial psychiatric examination themselves and instead defer to a nurse or social worker. Twenty-two of 44 respondents (50.0%) reported that they defer to a social worker when determining the final disposition of psychiatric patients. Respondents reevaluated patients in psychiatric distress statistically significantly less often (p=0.01) compared with patients with cardiac pathology. Additionally, 15 of 38 respondents (39.5%) reported that they did not feel adequately trained to handle psychiatric emergencies, and 36 of 39 respondents (92.3%) of physicians felt that their facility would benefit from additional mental health resources. Thirty five of 39 respondents (89.7%) reported that their facility did not have a system in place to follow up with suicidal patients upon discharge. Conclusions Caring for patients who are acutely suicidal or in psychiatric distress is complex and more research is needed to optimize treatment strategies. The results of this study indicate that EM physicians may regularly defer to nonphysician providers when evaluating and treating patients in psychiatric distress. A perceived lack of training in psychiatry may contribute to this practice. The results of this study are in accord with previous research that indicated a need for additional psychiatry training in EM residencies.

Novel Multidisciplinary Approach for Outpatient Antimicrobial Stewardship Using an Emergency Department Follow-Up Program

2021 ◽  
pp. 089719002110483
Author(s):  
Hongkai Bao ◽  
Yanina Dubrovskaya ◽  
Shin-Pung Jen ◽  
Arnold Decano ◽  
Nabeela Ahmed ◽  
...  
Keyword(s):  
Emergency Department ◽  
Nurse Practitioners ◽  
Antimicrobial Stewardship ◽  
Multidisciplinary Approach ◽  
Positive Culture ◽  
Patient Specific ◽  
Common Source ◽  
Discontinue Therapy ◽  
Third Generation Cephalosporins

Purpose: Outpatient antimicrobial stewardship programs (ASPs) are becoming increasingly prevalent in healthcare. Many programs have demonstrated the effectiveness of pharmacist-driven outpatient consultations or follow-up programs to ensure appropriate antimicrobial prescribing. However, there is a paucity of literature describing multidisciplinary approaches in large healthcare systems for patients discharged from the emergency department (ED). The objective of this study was to describe the feasibility and impact of a combined effort between ASP pharmacotherapy specialists and nurse practitioners (NPs) in managing an ED follow-up center. Methods: A retrospective analysis was conducted for patients discharged from the ED between January 2018 and June 2019. Patients were identified for inclusion based on documentation by ASP pharmacotherapy specialists in the electronic health record for patient-specific inquiries from ED follow-up center NPs. The primary outcome of this study was to describe the number and types of interventions made by ASP pharmacotherapy specialists. Results: A total of 1088 patients were included in the study, for 1114 documented ASP calls. The urinary tract was the most common source of positive culture (79%), and third-generation cephalosporins were the most frequent antibiotic associated with calls (20%). Out of total calls, 60% lead to ASP interventions. Among total calls, the most frequent interventions were to correct drug-bug mismatches (20%), initiate new therapy (10%), and discontinue therapy (7%). Conclusion: This report describes a novel initiative that combines the efforts of ED NPs and ASP pharmacotherapy specialists in managing an ED follow-up center at a large healthcare system.

scholarly journals Emergency Department Ophthalmology Consultations in a Tertiary Care Hospital

2019 ◽  
Vol 11 (01) ◽  
pp. e25-e29 ◽  
Author(s):  
Michael Heiferman ◽  
Saira Khanna ◽  
David Gu ◽  
Samantha Agron ◽  
Sarah Eichinger ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Clinic Visit ◽  
Senior Resident ◽  
Care Hospital ◽  
Common Diagnosis ◽  
Made In

Objective The main objective of this article is to characterize ophthalmology consultations in the emergency department (ED) of a tertiary care hospital and identify specific ways to modify the curriculum for ophthalmology and emergency medicine residency programs to train residents to effectively manage eye-related consultations. Design This is a retrospective chart review study of ED encounters between January 1, 2008 and January 1, 2017 during which ophthalmology was consulted. Setting Single-center urban tertiary care center. Participants All adult patients who were seen by the ophthalmology consultation service in the ED during the study time period. Main Outcome Measured We identified the reason for and timing of ophthalmology consultation; diagnoses made in the ED and follow-up ophthalmology clinic visit; procedures resulting from consultation; and communication with a senior resident, fellow, or attending. Results We identified 3,583 consecutive ED encounters with an ophthalmology consultation over a 9-year period. About 51.1% of patients were female and mean age of patients was 49 years. Blurry vision/vision loss was the most common reason for consultation (24.8%) and posterior vitreous detachment was the most common diagnosis made in the ED by the ophthalmology team (11.0%). Of the patients with documented follow-up ophthalmology clinic visits, 96.7% of diagnoses made at the first ophthalmology clinic visit were the same as those determined in the ED. About 12.7% of visits resulted in a procedure with the most common being eyelid laceration repairs, pars plana vitrectomy, and laser retinopexy. Overall, 40.4% of visits required communication with a senior resident, fellow, or attending. The frequency of residents seeking assistance from more senior ophthalmologists decreased over the course of the academic year (p < 0.0001). Conclusions This study provides data that ophthalmology residency training programs can use to more effectively prepare residents for consultations in the ED. Furthermore, identifying the reasons for consultation and subsequent diagnoses can guide the education of emergency medicine physicians to improve their ability to diagnose and triage ophthalmologic presentations.

Emergency Department Admission and Mortality Rate for Suicidal Behavior

Crisis ◽  
2014 ◽  
Vol 35 (6) ◽  
pp. 406-414 ◽  
Author(s):  
Raimondo Maria Pavarin ◽  
Angelo Fioritti ◽  
Francesca Fontana ◽  
Silvia Marani ◽  
Alessandra Paparelli ◽  
...  
Keyword(s):  
Emergency Department ◽  
Metropolitan Area ◽  
Suicidal Behavior ◽  
Mortality Risk ◽  
Illicit Drugs ◽  
Attempted Suicide ◽  
Cox Model ◽  
Emergency Department Admission ◽  
Completed Suicide

Background: The international literature reports that for every completed suicide there are between 8 and 22 visits to an Emergency Department (ED) for attempted suicide/suicidal behavior. Aims: To describe the characteristics of admission to emergency departments (EDs) for suicide-related presenting complaints in the metropolitan area of Bologna; to estimate the risk for all-cause mortality and for suicide; to identify the profiles of subjects most at risk. Method: Follow-up of patients admitted to the EDs of the metropolitan area of Bologna between January 2004 and December 2010 for attempted suicide. A Cox model was used to evaluate the association between sociodemographic variables and the general mortality risk. Results: We identified 505 cases of attempted suicide, which were more frequent for female subjects, over the weekend, and at night (8:00 p.m./8:00 a.m.). The most used suicide methods were psychotropic drugs, sharp or blunt objects, and jumping from high places. In this cohort, 3.6% of subjects completed suicide (4.5% of males vs. 2.9% of females), 2.3% within 1 year of the start of follow-up. The most common causes of death were drug use and hanging. In the multivariate analysis, those who used illicit drugs 24 hr prior to admission to the ED (hazard ratio [HR] = 3.46, 95% CI = 1.23–9.73) and patients who refused the treatment (HR = 6.74, 95% CI = 1.86–24.40) showed an increased mortality risk for suicide. Conclusion: Deliberate self-harm patients presenting to the ED who refuse treatment represent a specific target group for setting up dedicated prevention schemes.

The “How” of Animacy Effects in Episodic Memory

2015 ◽  
Vol 62 (6) ◽  
pp. 371-384 ◽  
Author(s):  
Patrick Bonin ◽  
Margaux Gelin ◽  
Betty Laroche ◽  
Alain Méot ◽  
Aurélia Bugaiska
Keyword(s):  
Memory Load ◽  
Recall Performance ◽  
Memory Task ◽  
Human Memory ◽  
Recall Rate ◽  
Interactive Imagery ◽  
Ultimate Explanation ◽  
Better Than ◽  
Observation Results

Abstract. Animates are better remembered than inanimates. According to the adaptive view of human memory ( Nairne, 2010 ; Nairne & Pandeirada, 2010a , 2010b ), this observation results from the fact that animates are more important for survival than inanimates. This ultimate explanation of animacy effects has to be complemented by proximate explanations. Moreover, animacy currently represents an uncontrolled word characteristic in most cognitive research ( VanArsdall, Nairne, Pandeirada, & Cogdill, 2015 ). In four studies, we therefore investigated the “how” of animacy effects. Study 1 revealed that words denoting animates were recalled better than those referring to inanimates in an intentional memory task. Study 2 revealed that adding a concurrent memory load when processing words for the animacy dimension did not impede the animacy effect on recall rates. Study 3A was an exact replication of Study 2 and Study 3B used a higher concurrent memory load. In these two follow-up studies, animacy effects on recall performance were again not altered by a concurrent memory load. Finally, Study 4 showed that using interactive imagery to encode animate and inanimate words did not alter the recall rate of animate words but did increase the recall of inanimate words. Taken together, the findings suggest that imagery processes contribute to these effects.

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