scholarly journals An Assessment of Emergency Department Throughput and Provider Satisfaction after the Implementation of a Scribe Program

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Brandon Allen ◽  
Ben Banapoor ◽  
Emily C. Weeks ◽  
Thomas Payton
Keyword(s):  
Emergency Department ◽  
Program Implementation ◽  
Tertiary Care ◽  
Care Facility ◽  
Workplace Satisfaction ◽  
Electronic Survey ◽  
Left Without Being Seen ◽  
Tertiary Care Facility ◽  
Discharged Patients ◽  
The Impact

Objectives. To assess the impact of a scribe program on an academic, tertiary care facility. Methods. A retrospective analysis of emergency department (ED) data, prior to and after scribe program implementation, was used to quantitatively assess the impact of the scribe program on measures of ED throughput. An electronic survey was distributed to all emergency medicine residents and advanced practice providers to qualitatively assess the impact of the scribe program on providers. Results. Several throughput time measures were significantly lower in the postscribe group, compared to prescribe implementation, including time to disposition. The left without being seen (LWBS) decrease was not statistically significant. A total of 30 providers responded to the survey. 100% of providers indicated scribes are a valuable addition to the department and they enjoy working with scribes. 90% of providers indicated scribes increase their workplace satisfaction and quality of life. Conclusions. Through evaluation of prescribe and postscribe implementation, the postscribe time period reflects many throughput improvements not present before scribes began. Scribe Program implementation led to improved ED throughput for discharged patients with further system-wide challenges needing to be addressed for admitted patients.

scholarly journals Decreasing High Risk Exposures for Healthcare-workers through Universal Masking and Universal SARS-CoV-2 Testing upon entry to a Tertiary Care Facility

2020 ◽  
Author(s):  
Jeremey Walker ◽  
Molly E Fleece ◽  
Russell L Griffin ◽  
Sixto M Leal ◽  
Jorge A Alsip ◽  
...  
Keyword(s):  
High Risk ◽  
Healthcare Workers ◽  
Tertiary Care ◽  
Care Facility ◽  
Universal Testing ◽  
Tertiary Care Facility ◽  
The Impact

Abstract We describe the impact of universal masking and universal testing at admission on high risk exposures to SARS-CoV-2 for healthcare workers. Universal masking decreased the rate per patient day of high risk exposures by 68%, and universal testing further decreased those exposures by 77%.

scholarly journals SARS-CoV-2 infection among asymptomatic healthcare workers of the emergency department in a tertiary care facility

2021 ◽  
Vol 134 ◽  
pp. 104710
Author(s):  
Reham Abdelmoniem ◽  
Rabab Fouad ◽  
Shereen Shawky ◽  
Khaled Amer ◽  
Tarek Elnagdy ◽  
...  
Keyword(s):  
Emergency Department ◽  
Healthcare Workers ◽  
Tertiary Care ◽  
Care Facility ◽  
Tertiary Care Facility

Abstract TP367: Decreasing Decision to Transfer Times

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Denise Sorenson ◽  
Jason Cooke ◽  
Lisa Loll
Keyword(s):  
Emergency Department ◽  
Urban Areas ◽  
Best Practice ◽  
Tertiary Care ◽  
Care Facility ◽  
Direct Care ◽  
Case Review ◽  
Transfer Time ◽  
Skin Puncture ◽  
Tertiary Care Facility

Novant Health Greater Charlotte market is comprised of three advanced primary stroke care centers; one providing 24/7 stroke interventional radiology coverage. To expedite the transfer of patients meeting criteria for mechanical thrombectomy, the stroke best practice teams in the two community primary stroke centers collaborated to develop a protocol to improve the decision to transfer time to meet a goal of 120 minutes from door to skin puncture time, regardless of original transport destination. The Novant Health Charlotte market teams realize the benefit of cohesive physician coverage among the Emergency Department, Radiology and Inpatient Neurology physician providers. CTA scans performed in the non-interventional facilities are readily available to Neuro-Endovascular Radiologists, allowing for prompt interpretation and mobilization of the IR team to prepare for patient arrival. Recognizing internal critical care transport resources are limited and may not be available, the process was facilitated by the development of an activase transport protocol implemented by Mecklenburg County EMS in June of 2016. Since actual transport time is affected by traffic patterns in urban areas, the controllable measure selected by the teams was decision to transfer time. Prior to the initiation of the protocol, the median decision to transfer time for ischemic stroke patients requiring tertiary care was 66.5 minutes. Post protocol implementation the median time was reduced 32% to 44.5 minutes. Across the market, median door to skin puncture time in 2016 is 131.5 minutes. Ongoing evaluation of the transfer process, and multidisciplinary IR case review with identification of process variation is key to the success of this initiative. The Emergency Department at the tertiary care facility has been an instrumental partner in identifying issues that are barriers to timely throughput of these patients. A consistent feedback process informs all team members regarding patient outcomes. Individual case feedback is provided to all direct care givers, EMS crews and stroke team leaders, usually within 24 to 48 hours of the intervention. This data is shared monthly with the stroke best practice teams at the transferring facilities.

scholarly journals (A22) Impact of Karachi Terrorist Bombing on an Emergency Department of a Tertiary Care Hospital

2011 ◽  
Vol 26 (S1) ◽  
pp. s6-s7
Author(s):  
H. Waseem ◽  
S. Shahbaz ◽  
J. Razzak
Keyword(s):  
Emergency Department ◽  
Tertiary Care Hospital ◽  
Wound Care ◽  
Tertiary Care ◽  
Care Facility ◽  
Care Hospital ◽  
Disaster Plan ◽  
Tertiary Care Facility ◽  
Number Of Patients ◽  
The Government

ObjectivesThe objective of this study was to collect epidemiological injury data on patients presenting to the emergency department of a tertiary care hospital after the bombing on 29 December 2009.MethodsThis was a retrospective review of the medical records of the victims that were brought to a tertiary care hospital. Bombing victims were described as requiring acute care due to the direct effect of the bombing.ResultsThe results are derived from a sample size of 198 bomb blast victims, most of which were first transported to government hospitals by private cars rather than ambulances. After the government announced free treatment, there was a wave of patients, among which, most were stable and already had received some form of treatment. Approximately 5–6 patients who had life-threatening injuries were brought directly to the tertiary care facility and needed surgical intervention. The lack of security in the emergency department could have lead to another terrorist activity. There were no procedures done in the field as there is lack of emergency medical services training in Pakistan, but in the hospital most of the interventions included intravenous (IV) lines, wound care, and laceration repair. The most common treatments included the administration of IV fluids, antibiotics, and analgesia. Radiographs of specific sites and trauma series were used to rule out bone injuries. There was lack of documentation in most of the medical charts.ConclusionsThe emergency department was overwhelmed with the number of patients that it received. Therefore, an updated disaster plan and regular disaster drills are required. Rapid and accurate triage could minimize mortality among bombing survivors significantly. The majority of patients were discharged home.

scholarly journals Impact of the Novel Coronavirus 2019 (COVID-19) Pandemic on Head and Neck Cancer Care

2021 ◽  
pp. 019459982110045
Author(s):  
Joshua Adam Thompson ◽  
Joshua E. Lubek ◽  
Neha Amin ◽  
Reju Joy ◽  
Donita Dyalram ◽  
...  
Keyword(s):  
Head And Neck ◽  
Tertiary Care ◽  
Care Facility ◽  
Cross Sectional Study ◽  
Tumor Board ◽  
Secondary Outcome ◽  
Cross Sectional ◽  
Tertiary Care Facility ◽  
Procedural Volume ◽  
The Impact

Objective The study aimed to assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on head and neck oncologic care at a tertiary care facility. Study Design This was a cross-sectional study conducted between March 18, 2020, and May 20, 2020. The primary planned outcome was the rate of treatment modifications during the study period. Secondary outcome measures were tumor conference volume, operative volume, and outpatient patient procedure and clinic volumes. Setting This single-center study was conducted at a tertiary care academic hospital in a large metropolitan area. Methods The study included a consecutive sample of adult subjects who were presented at a head and neck interdepartmental tumor conference during the study period. Patients were compared to historical controls based on review of operative data, outpatient procedures, and clinic volumes. Results In total, 117 patients were presented during the review period in 2020, compared to 69 in 2019. There was an 8.4% treatment modification rate among cases presented at the tumor conference. There was a 61.3% (347 from 898) reduction in outpatient clinic visits and a 63.4% (84 from 230) reduction in procedural volume compared to the prior year. Similarly, the operative volume decreased by 27.0% (224 from 307) compared to the previous year. Conclusion Restrictions related to the COVID-19 pandemic resulted in limited treatment modifications. Transition to virtual tumor board format observed an increase in case presentations. While there were reductions in operative volume, there was a larger proportion of surgical cases for malignancy, reflecting the prioritization of oncologic care during the pandemic.

scholarly journals The Impact of COVID-19 Pandemic on Cancer Care in a Tertiary Care Facility

2021 ◽  
Vol 10 (01) ◽  
pp. 32-35
Author(s):  
Pradeep Kumar Reddy K. ◽  
Jyosthna Elagandula ◽  
Shivani Patel ◽  
Rajesh Patidar ◽  
Vikas Asati ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Active Treatment ◽  
Lymphoblastic Leukemia ◽  
Tertiary Care ◽  
Care Facility ◽  
Cancer Type ◽  
Cancer Management ◽  
Tertiary Care Facility ◽  
Anticancer Treatment ◽  
The Impact

Abstract Background Coronavirus disease 2019 (COVID-19) pandemic had an overwhelming impact on health care worldwide. Cancer patients represent a subgroup that is vulnerable and is under high risk. It is, therefore, necessary to analyze factors that predict outcomes in these patients so that they can be triaged accordingly to mitigate the effects of COVID-19 on cancer management. To date, the impact of COVID-19 on cancer patients remain largely unknown. Methods Data of 291 cancer patients undergoing active treatment from March 23 to August 15, 2020 were retrospectively reviewed; the incidence, demographic and clinical characteristics, treatment, and outcomes of cancer patients infected by COVID-19 were included in the analysis. Discussion During the index period (March 23–August 15, 2020), 4,494 confirmed cases of COVID-19 were admitted at our institute. In the department of medical oncology out of 578 patients presented to outpatient department, 291 patients were admitted for active treatment. Considering the cancer patients, infection rate was 7.9% (23/291) and mortality 13% (3/23). Median age was 40 years and the majority of patients were male (60%). The most common cancer type was acute lymphoblastic leukemia presented at various stages of treatment. Twenty patients (86.9%) were discharged after full clinical recovery and negative real-time polymerase chain reaction on a nasopharyngeal swab. Anticancer treatment was modified according to the type of cancer under intensive surveillance. Conclusion Although mortality rate in COVID-19 cancer patients is elevated, our results support the feasibility and safety of continuing anticancer treatment during pandemic by endorsing consistent preventive measures, but however should be modified based on the type and prognosis of cancer.

scholarly journals The effect of a zero-diversion policy on emergency department performance measures

2013 ◽  
Vol 2 (4) ◽  
pp. 144
Author(s):  
Eman Spaulding ◽  
Laurie Byrne ◽  
Eric Armbrecht ◽  
Collin Jackson ◽  
Preeti Dalawari
Keyword(s):  
Emergency Department ◽  
Performance Measures ◽  
Care Center ◽  
Tertiary Care ◽  
Admission Rate ◽  
Medical Advice ◽  
Hospital Admission Rate ◽  
Left Without Being Seen ◽  
Before And After ◽  
Discharged Patients

This study examines how emergency department (ED) performance measures at an academic tertiary care center in the Midwest were affected by a regionally-adopted zero diversion policy. Two six-month periods before and after the policy was enacted were selected to measure differences in key performance measures, including left without treatment (LWOT), left without being seen (LWBS), left against medical advice (AMA), mortality, length of stay and hospital admission rate. Total ED census during the two periods was similar. While the zero diversion policy was in effect, LWOT and LWBS rates were 19.4% and 18.2% lower, respectively, than the prior period, p < .002; discharged patients had faster treatment times (228 + 8.0 minutes vs. 242 + 9.0 minutes), p = .015. No differences were observed in AMA or mortality rates. This study revealed no worsening of ED performance measures after adoption of a zero diversion policy. 

scholarly journals LO67: A variation on Triage Liaison Physicians (TLP): a comparative analysis of the Emergency Department Disposition and Care Consultant (EDC) concept

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S30-S30
Author(s):  
B. H. Rowe ◽  
A. Haponiuk ◽  
J. Lowes ◽  
W. Sevcik ◽  
C. Villa-Roel ◽  
...  
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Pilot Project ◽  
Chi Square ◽  
Left Without Being Seen ◽  
Ed Overcrowding ◽  
Discharged Patients ◽  
Level 3 ◽  
Dichotomous Outcomes ◽  
And Control

Introduction: Despite evidence that triage liaison physicians (TLP) effectively reduce emergency department (ED) overcrowding, support for these interventions is patchy. The aim of this study was to evaluate the implementation of a TLP-like ED Disposition and Care Consultant (EDC) shift at an academic tertiary care ED. Methods: A 24-week pilot project was conducted 11/16-04/17. Physicians worked 8- hour day (07-15:00) and/or evening (15:00-23:00) EDC shifts and performed immediate triage and patient care when needed, assisted triage RNs, answered all incoming calls, and managed administrative matters. Due to their voluntary nature, not all shifts were filled. This study compared active (EDC) and control (C) shifts on the following ED metrics: length of stay (LOS), proportions of patients who left without being seen (LWBS), and safety (return visits to ED). Descriptive (median and interquartile range {IQR} and proportions) and simple (Wilcoxson-Mann-Whitney, chi-square, z-proportion) tests are presented for continuous and dichotomous outcomes, respectively. Multiple linear regression identified factors associated with LOS. Results: Of 112 possible EDC shifts, 58 (52%) were filled involving 4289 patients and compared to 276 C shifts involving 21,358 patients. ED volume, patient age (49; IQR: 31, 66), mode of arrival (~30% EMS), triage levels (~51% level 3), and complaints were similar between the groups. Overall, the EDC group reduced LWBS by 16% (8.7% vs. 10.4%; p=0.001), ED LOS for discharged patients by 30 minutes (5.5 vs. 6.0 hours; p<0.001), and ED LOS for admitted patients by 42 minutes (9.7 vs. 10.4 hours; p=0.02). The EDC increased the proportion discharged <4 hours by 28% (20.1 vs. 15.7%; p<0.001) and increased the proportion admitted <8 hours by 17% (8.2% vs. 9.6%, p=0.002). ED relapses <72 hours were similar (9.3% vs. 8.9%; p=0.4); however, admissions were higher in the EDC shifts (25.3% vs. 23.8%; p=0.04). In addition to EDC coverage status, LOS was influenced by triage level (1.7%, p<0.001), disposition (19.6%, p<0.001), and age (4.8%, p<0.001). Conclusion: Our results indicate that an EDC shift, while unpopular with many physicians, provides valuable services to an overcrowded ED and that the implementation of this type of shift could reduce LOS and LWBS statistics in a tertiary care institution. Additional evaluations to examine this and other front-end interventions in other ED centers are indicated.

scholarly journals 748. The Impact of a Positive Respiratory Viral Panel Among Hospitalized Adult Patients with Negative Rapid Influenza Testing at an Academic Tertiary Care Facility: A-matched Cohort Study

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S268-S268
Author(s):  
Emily Ciccone ◽  
Alan Kinlaw ◽  
Vahini Chundi ◽  
Melissa Miller ◽  
David Weber ◽  
...  
Keyword(s):  
Clinical Management ◽  
Tertiary Care ◽  
Care Facility ◽  
Respiratory Illness ◽  
Adult Patients ◽  
Nucleic Acid Amplification ◽  
Matched Cohort ◽  
Research Support ◽  
Tertiary Care Facility ◽  
The Impact

Abstract Background Multiplex nucleic acid amplification assays (NAATs) are increasingly used to evaluate respiratory illnesses. Viral diagnosis has the potential to change clinical management and, specifically, decrease antibiotic use. However, the assays are expensive, and their effect on clinical management is unknown. This study evaluated the incremental impact of a multiplex respiratory viral panel after negative rapid influenza testing. Methods We completed a retrospective review of all adult patients with respiratory viral panel (RVP; GenMark) and/or rapid influenza or RSV/influenza PCR tests (PCR; Cepheid Xpert) collected within 48 hours of admission to non-ICU, inpatient units from September 1, 2015 to April 15, 2016. We matched hospitalizations with a positive RVP simultaneously with or following negative PCR testing (PCR−RVP+) 1:1 with patient encounters with negative rapid PCR testing only (PCR−). Matching of the referent PCR-group occurred without replacement based on age (±10 years), sex, race, season of testing (±50 days), and any respiratory viral test in the prior 30 days. The primary outcome was a change in management, defined as antimicrobial de-escalation (discontinuation, switch from intravenous to oral administration, and/or narrowing of spectrum), antiviral initiation, and/or change in isolation precautions. Results During the study period, there were 153 PCR−RVP+ patient encounters and 524 with PCR− testing only from which we identified 134 matched pairs. In the matched cohort, the median age was 60 years (IQR: 41–71), 47.8% were female, and 34.3% were non-White. Respiratory viral testing was associated with management change in 3.7% of PCR− and 23.9% of PCR−RVP+ patients (risk difference 20.1%; 95% CI 12.2–28.0%). Antimicrobial de-escalation did not occur after testing for any PCR- patients but did occur for 15.7% of PCR−RVP+ patients (95% CI 9.5–21.8%). Conclusion Among patients with negative rapid influenza testing, a subsequent or simultaneous positive RVP was associated with a higher frequency of antibiotic de-escalation. This suggests multiplex NAATs could play a role in improving antimicrobial stewardship in the setting of respiratory illness. Disclosures M. Miller, GenMark: Investigator, Research support. R. Jhaveri, GenMark: Investigator, Research support.

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