Abstract TP249: Collaborative In-Person Bedside Handover Improves Emergency Department Nurses’ Confidence in and Compliance With Documentation of Frequent Post Alteplase Neurological Assessments

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Kailey L Cox ◽  
Jessica Lobell ◽  
Xavier Champagne ◽  
Alyx Lesko ◽  
Leslie Corless ◽  
...  
Keyword(s):  
Emergency Department ◽  
Phase 1 ◽  
Vital Signs ◽  
Retrospective Chart Review ◽  
Chi Square ◽  
Emergency Department Nurses ◽  
New Strategy ◽  
Improve Compliance ◽  
Chi Square Test ◽  
Strongly Agree

Introduction: Stroke centers are often cited for poor compliance with post alteplase (tPA) neurological assessment documentation (SNAP DOC). Emergency department nurses (ED RNs) have less exposure to patients receiving tPA than neurocritical care nurses (NCCU RNs) and are less compliant with SNAP. In this project we sought to improve compliance of SNAP DOC in the ED. Methods: Data included retrospective chart review of SNAP DOC compliance for patients in ED treated with tPA age 18 and over from 03/2018 to 07/2019. In phase 1, ED RNs were trained in-person on SNAP three separate times between 02/2018 and 09/2018 (PRE). After seeing no improvement with SNAP in ED after the in-person education interventions, ED and NCCU collaborated to form a new strategy. In phase 2, beginning 12/14/2018 NCCU RNs retrieved their tPA patients from ED, performed a bedside SNAP and coached ED RNs on any missing SNAP DOC (POST). ED SNAP DOC were evaluated by finding the total number completed among the total possible opportunities combined across the four components of SNAP and vital signs. Three Likert scale questions were administered to assess ED RN confidence in SNAP practices for both PRE and POST timeframe with answers from 1 (strongly disagree) to 5 (strongly agree). PRE and POST responses were then dichotomized into agree (4-5) or disagree (1-3) and compared using Pearson’s chi square test. Descriptive analyses were performed to assess SNAP DOC compliance for the PRE and POST periods. Results: There were 111 charts audited for compliance that met inclusion criteria with 56 in the PRE and 55 in the POST. ED RNs were more compliant with SNAP in the POST (77.3%) compared to the PRE (65.6%). Confidence surveys were completed by 52 ED RNs in PRE and 72 RNs in POST. RNs were more confident in, “I understand the rationale behind each component of [SNAP]”, in the POST vs PRE timeframe (87.5% vs 68.6%, p=.010). Conclusion: ED RNs remained confident in their use of SNAP throughout the project despite compliance scores. However, in the POST period, ED RNs reported improvement in their understanding of SNAP. In-person handover process improves SNAP DOC compliance in ED more than in-person training.

scholarly journals Agreement between Impression of Stroke in the Emergency Department and Diagnosis at the Neurology Department

2019 ◽  
Vol 7 (3) ◽  
pp. 7
Author(s):  
Samad Shams-Vahdati ◽  
Alireza Ala ◽  
Eliar Sadeghi-Hokmabad ◽  
Neda Parnianfard ◽  
Maedeh Gheybi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Ischemic Stroke ◽  
Statistical Significance ◽  
Retrospective Chart Review ◽  
Chi Square ◽  
Prevention Therapy ◽  
Significant Difference ◽  
Chi Square Test ◽  
Academic Teaching Hospital ◽  
The Mean

Background: Missing to detect an ischemic stroke in the emergency department leads to miss acute interventions and treatment with secondary prevention therapy. Our study examined the diagnosis of stroke in the emergency department (ED) and neurology department of an academic teaching hospital. Methods and Materials: A retrospective chart review was performed from March 2017 to March 2018. ED medical document (chart) were reviewed by a stroke neurologist to collect the clinical diagnosis and characteristics of ischemic stroke patients. For determining the cases of misdiagnosed and over diagnosed data, the administrative data codes were compared with the chart adjudicated diagnosis. The adjusted estimate of effect was estimated through testing the significant variables in a multivariable model. The comparisons were done with chi square test. Statistical significance was considered at P < 0.05. Results: Of 861 patients of the study, 54% were males and 43% were females; and the mean age of them was 66.51 ± 15.70. We find no statically significant difference between patient’s Glasgow Coma Scale (GCS) in the emergency department (12.87±3.25) and patients GCS in the neurology department (11.77±5.15). There were 18 (2.2%) overdiagnosed of ischemic stroke, 8 (0.9%) misdiagnosed of ischemic stroke and 36 (4.1%) misdiagnosed of hemorrhagic strokes in the emergency department. Conclusion: There was no significant difference between impression of stroke in the emergency department and diagnosis at the neurology department.

scholarly journals Epidemiology of burns and scalds in children presenting to the emergency department of a regional burns unit: a 7-year retrospective study

2016 ◽  
Vol 4 ◽  
pp. 1-6 ◽  
Author(s):  
Ceri Elisabeth Battle ◽  
Vanessa Evans ◽  
Karen James ◽  
Katherine Guy ◽  
Janet Whitley ◽  
...  
Keyword(s):  
Emergency Department ◽  
Thermal Injury ◽  
Age Groups ◽  
Retrospective Chart Review ◽  
Final Analysis ◽  
Accidental Injury ◽  
Chi Square ◽  
Burn Prevention ◽  
South Wales ◽  
Chi Square Test

Abstract Background Variation in the incidence and mechanism of thermal injury has been reported in different age groups in children. The aim of this study was to report the incidence, mechanisms, and environmental factors of all burns presentations to the emergency department (ED) of a regional burns centre over a 7-year period. Methods A retrospective, chart review study of all burns presentations to the ED of a regional burns centre in South Wales was conducted. All children recorded as having sustained a burn or scald, aged less than 16 years were included in the analysis. Subjects’ demographics were analysed using descriptive statistics, and comparisons were made between patients aged less than 5 and patients aged 5–16 using chi-square test and Mann–Whitney U test. Results A total of 1387 cases were included in the final analysis. Scalds were the most common thermal injury with 569 (41.0 %) reported, followed by contact burns in 563 (40.6 %) patients. The patients requiring hospitalisation were significantly younger (2 vs 3 years; p &lt; 0.001) and had a higher rate of non-accidental injury (10 vs 4; p &lt; 0.001). The most commonly injured site in both age groups was a hand or digit. Conclusions Scalds and contact burns were the most commonly reported thermal injury in children aged less than 16. Common mechanisms were hot beverages, hobs and hair straighteners, highlighting further burn prevention strategies are needed and good-quality prospective studies that investigate the effectiveness of such strategies.

Improving Water Quality Can Reduce Pyrogenic Reactions Associated With Reuse of Cardiac Catheters

2003 ◽  
Vol 24 (12) ◽  
pp. 955-960 ◽  
Author(s):  
Rosemary E. Duffy ◽  
Braulio Couto ◽  
Jussara M. Pessoa ◽  
Carlos Starling ◽  
Silma Pinheiro ◽  
...  
Keyword(s):  
Water Quality ◽  
Cardiac Catheterization ◽  
Linear Trend ◽  
Phase 1 ◽  
Standard Operating Procedures ◽  
Chi Square ◽  
Cardiac Catheters ◽  
Standard Operating ◽  
Chi Square Test ◽  
Belo Horizonte

AbstractObjective:To report the results of our preintervention investigation and subsequent 19-month three-phase intervention study designed to reduce pyrogenic reactions among patients undergoing cardiac catheterization using reprocessed catheters.Design:A case-control study for the preintervention period and a prospective cohort study for the intervention period.Setting:A 400-bed hospital in Belo Horizonte, Brazil.Participants:Any patient undergoing cardiac catheterization in the hospital.Interventions:Three intervention phases were implemented to improve the quality of the water supplied to the cardiac catheter reprocessing laboratory. Standard operating procedures for reprocessing cardiac catheters were established and reprocessing staff were trained and educated.Results:The rate of pyrogenic reactions decreased significantly during the intervention phases, from 12.8% (159 of 1,239) in phase 1 to 5.3% (38 of 712) in phase 2 to 0.5% (4 of 769) in phase 3 (chi-square test for linear trend, 97.5;P< .001).Conclusion:Improving water quality and using standard operating procedures for reprocessing catheters can prevent pyrogenic reactions in hospitalized patients.

Abstract 14721: Impact of Covid-19 on Cardiology Consultation in Tertiary Care Hospital of a Developing Country

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
ghufran adnan ◽  
Osman Faheem ◽  
Maria Khan ◽  
Pirbhat Shams ◽  
Jamshed Ali
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Reduction Rate ◽  
Care Hospital ◽  
Chi Square ◽  
Coronary Syndrome ◽  
Significant Difference ◽  
Drastic Increase ◽  
Chi Square Test ◽  
The Difference

Introduction: COVID-19 pandemic has overwhelmed the healthcare system of Pakistan. There has been observation regarding changes in pattern of patient presentation to emergency department (ED) for all diseases particularly cardiovascular. The aim of the study is to investigate these changes in cardiology consultations and compare pre-COVID-19 and COVID-19 era. Hypothesis: There is a significant difference in cardiology consultations during COVID era as compared to non-COVID era. Method: We collected data retrospectively of consecutive patients who visited emergency department (ED) during March-April 2019 (non-COVID era) and March-April 2020 (COVID era). Comparison has been made to quantify the differences in clinical characteristics, locality, admission, type, number, and reason of Cardiology consults generated. Results: We calculated the difference of 1351 patients between COVID and non-COVID era in terms of cardiology consults generated from Emergency department, using Chi-square test. Out of which 880 (59%) are male with mean age of 61(SD=15). Analysis shows pronounced augmentation in number of comorbidities [Hypertension(6%), Chronic kidney disease (6%), Diabetes (5%)] but there was 36% drop in total cardiology consultations and 43% reduction rate in patient’s ED visit from other cities during COVID era. There was 60% decrease in acute coronary syndrome presentation in COVID era, but fortuitously drastic increase (30%) in type II myocardial injury has been noted. Conclusion: There is a remarkable decline observed in patients presenting with cardiac manifestations during COVID era. Lack in timely care could have a pernicious impact on outcomes, global health care organizations should issue directions to adopt telemedicine services in underprivileged areas to provide timely care to cardiac patients.

scholarly journals Frequency and Management of Acute Poisoning Among Children Attending an Emergency Department in Saudi Arabia

Pharmacy ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 189
Author(s):  
Mansour Tobaiqy ◽  
Bandar A. Asiri ◽  
Ahmed H. Sholan ◽  
Yahya A. Alzahrani ◽  
Ayed A. Alkatheeri ◽  
...  
Keyword(s):  
Emergency Department ◽  
Saudi Arabia ◽  
Age Groups ◽  
Retrospective Chart Review ◽  
Evidence Base ◽  
Acute Poisoning ◽  
Chi Square ◽  
Jeddah City ◽  
Policy And Strategy ◽  
Poisoning In Children

Background: Acute poisoning is one of the common medical emergencies in children that leads to morbidity and mortality. Medications and chemical agents play a major role in these adverse events resulting in social, economic, and health consequences. Aims of the study: This study aimed to evaluate the frequency and management of acute poisoning among children attending the emergency room at East Jeddah Hospital, Jeddah city, Saudi Arabia. Methods: This study was a retrospective chart review of all acute pediatric poisoning incidences in children (0–16 years of age) from October-21-2016 to March-03-2020 who were attending the emergency department. Data were analyzed via SPSS software. Results: A total of 69 incidences of acute poisoning in children who attended the emergency department at East Jeddah Hospital; males (n = 38, 55.1%). Most children were aged 5 years or younger (n = 41, 59.4%). Unintentional poisoning occurred among 56.5% of observed cases of which 52.2% occurred in children younger than 5 years; 7.20% (n = 5) of patients were 12 to 16 years of age and had deliberate self-poisoning. The association between type of poisoning and age groups was statistically significant (chi-square = 28.5057, p = 0.0001). Most incidences occurred at home (n = 64, 92.8%). Medicines were the most common cause of poisoning (n = 53, 76.8%). An excessive dose of prescribed medicine poisoning accidents was reported in 10.1% cases. Analgesics such as paracetamol were the most documented medication associated with poisoning (39.1%) followed by anticonvulsants and other central nervous system acting medicines (18.8%). The most common route of poisoning was oral ingestion (81.2%). One mortality case was documented. Conclusion: Although not common, accidental and deliberate acute poisoning in children does occur. More can be done to educate parents on safe storage of medicines, household cleaning and other products associated with acute poisoning in children. Likewise, children can be taught more about the risks of poisoning from an early age. As importantly, clinicians need to include more detailed notes in the electronic medical records (EMR) or the system needs to be improved to encourage completeness to more accurately inform the research evidence-base for future service design, health policy and strategy.

Interrater agreement of Canadian Emergency Department Triage and Acuity Scale scores assigned by base hospital and emergency department nurses

CJEM ◽  
2010 ◽  
Vol 12 (01) ◽  
pp. 45-49 ◽  
Author(s):  
Clémence Dallaire ◽  
Julien Poitras ◽  
Karine Aubin ◽  
André Lavoie ◽  
Lynne Moore ◽  
...  
Keyword(s):  
Emergency Department ◽  
Online Communication ◽  
Vital Signs ◽  
Prehospital Setting ◽  
Interrater Agreement ◽  
Base Hospital ◽  
Emergency Department Nurses ◽  
Scale Scores ◽  
Emergency Department Triage ◽  
Κ Statistic

ABSTRACTObjective:We sought to assess the applicability of the Canadian Emergency Department Triage and Acuity Scale (CTAS) in the prehospital setting by comparing CTAS scores assigned during ambulance transportation by base hospital (BH) nurses with CTAS scores given by emergency department (ED) nurses on patients' arrival.Methods:We recruited a prospective sample of consecutive patients who were transported to the ED by ambulance between December 2006 and March 2007 for whom a contact was made with the BH. Patients were triaged by the BH nurse with online communication and vital signs transmission. On arrival, patients were blindly triaged again by the ED nurse. We used the quadratic weighted κ statistic to measure the agreement between the 2 CTAS scores.Results:Ninety-four patients were triaged twice by 2 nursing teams (9 nurses at the BH and 39 nurses in the ED). The agreement obtained on prehospital and ED CTAS scores was moderate (κ = 0.50; 95% confidence interval 0.37–0.63).Conclusion:The moderate interrater agreement we obtained may be a result of the changing conditions of patients during transport or may indicate that CTAS scoring requires direct contact to produce reliable triage scores. Our study casts a serious doubt on the appropriateness of BH nurses performing triage with CTAS in the prehospital setting.

Palliative treatment directives for bone metastases: A quality-directed approach to guiding institutional practice.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 188-188 ◽  
Author(s):  
Lindsay Puckett ◽  
Lucille Lee ◽  
Petrina Zuvic ◽  
Isabella Bingchan Zhang ◽  
Louis Potters ◽  
...  
Keyword(s):  
Bone Metastasis ◽  
Bone Metastases ◽  
Radiation Treatment ◽  
Standard Of Care ◽  
Evidence Based ◽  
Chi Square ◽  
Evidence Based Treatment ◽  
Improve Compliance ◽  
Chi Square Test ◽  
New Treatment

188 Background: The efficacy of single fraction (fx) radiation treatment (RT) has proven to have equipoise for palliation of bone metastases when compared to courses of 10 fx or more. Despite these data, there has been a slow adoption of this practice in the US and worldwide. Examination of our multicenter practice from 2004 - 2016 showed that single fx RT utilization has remained at 17% and hypofractionationed (HFX) courses (1 or 5 fx) have remained at 71% since 2009. We hypothesized that evidence-based, treatment-guiding directives could improve HFX utilization in this population. Methods: Institutionally, palliative bone metastasis treatments are routinely tracked by a Quality Assurance committee. In 2/2016, two consensus-driven and evidence-based clinical directives were created within our electronic health system for use with either simple or complicated bone metastasis, irrespective of primary histology. The simple and complex directives had default prescriptions of 8 Gy/1fx or 20 Gy/5fx, respectively. The directives were reviewed with physician staff to improve compliance; directives were allowed to be edited at the physician’s discretion if an alternative fx was indicated. The chi-square test was used for analysis. Results: From 1/2009-5/2016, there were 1,781 treatment courses of palliative external beam RT. Following implementation in 2/2016, the new clinical directives were used for 96% of cases and were modified in 12 cases (n = 72). Single fx use increased from 17% to 36% among palliative bone metastasis treatments (p ≤ 0.001) and HFX (1 or 5 fx) utilization increased from 71% to 92% compared to other fractionation schemes (10 fx or other) (p = 0.001). Conclusions: The institution-wide adoption of evidence-based, treatment directives proved to be a straightforward and successful intervention which allowed for rapid adoption and increased utilization of the standard of care. Our early data suggests that this may be a useful approach in the setting of reticence to new treatment paradigms. Further examination of evidence based directives is warranted to address issues of overtreatment in palliation and in standardizing oncologic care.

scholarly journals A Comparative Study of Rural Entrepreneurial Challenges: Towards Rural Economic Development and a Policy Framework

2019 ◽  
Vol 11 (3(J)) ◽  
pp. 58-71
Author(s):  
Albert Tchey Agbenyegah
Keyword(s):  
Small Businesses ◽  
Policy Framework ◽  
Primary Data ◽  
Chi Square ◽  
Rural Economic Development ◽  
Rural Study ◽  
Chi Square Test ◽  
Cross Tabulation ◽  
Strongly Agree ◽  
Entrepreneurial Activities

The primary purpose of this rural study was to compare the challenges that impede successful operations of entrepreneurial activities and small businesses. Through quantitative design, a seven-point Likert-scale questionnaire was utilized to gather primary data. Two sampling techniques, namely simple random and purposive, were applied to select the research participants. Based on a Likert spectrum, 267 questionnaires were administered to SME owners by the researcher, assisted by two research trainees. These questionnaires were ranked from (1) strongly disagree to (7) strongly agree. Two main questions, which provided guidance to this study, were certified reliable by the Cronbach alpha coefficient of 0.768 and 0.976. Data analysis was possible through the descriptive and inferential tools supported by the independent t-test, Pearson’s chi-square test, and cross-tabulation. The final outcomes demonstrate higher levels of challenges in the Frances Baard (FB) District than in the John Taolo Gaetsewe (JTG) District. This implies that owner-managers of small businesses in the FB District experienced more challenges in operating their businesses. The study recommends SME Policy Framework (SPF) training and intensifying the existing processes of monitoring after training to justify the owner-managers’ moral commitments.

scholarly journals Satisfaction of Telehealth in Patients With Established Neuromuscular Disorders

2021 ◽  
Vol 12 ◽  
Author(s):  
Sara Hooshmand ◽  
Junsang Cho ◽  
Shivangi Singh ◽  
Raghav Govindarajan
Keyword(s):  
Rural Areas ◽  
Neuromuscular Disease ◽  
Neuromuscular Disorders ◽  
Demographic Factors ◽  
Chi Square ◽  
Survey Question ◽  
Chi Square Test ◽  
Safety Precaution ◽  
Strongly Agree ◽  
Survey Responses

Introduction/aims: Determine established neuromuscular disease patients' satisfaction with telehealth during the COVID-19 pandemic.Methods: We received 50 completed Utah telehealth satisfaction surveys from a cohort of 90 from April 2020 to June 2020. Returning neuromuscular disease patients rated seven aspects from 1 (strongly disagree) to 5 (strongly agree): Communication, timeliness of physician, picture quality, sound quality, protection of privacy, the comfort of the physical exam, the ease of healthcare, and whether patients would prefer “in-person” visits despite safety precaution. A favorable response was defined as a response of “Agree” or “Strongly Agree” to the survey questions. An independent t-test, Fisher's or chi-square test were used to compare demographic factors on outcomes for each survey question.Results: The average age was 47.54 ± 20.63, 54% were female, 70% from rural areas, 60% had family present “webside,” and 14% had family present remotely. The majority of patients reported “Agree” or “Strongly Agree” to each survey question assessing their telehealth satisfaction, except for whether patients preferred in-person appointments. Demographic factors, including location and clinical diagnosis, did not influence survey responses.Discussion: The vast majority of established neuromuscular disease patients responded favorably to their telehealth experience during the COVID-19 pandemic.

scholarly journals Hurricane Sandy - Initial Evaluation of Patient Characteristics

2019 ◽  
Vol 34 (s1) ◽  
pp. s7-s7
Author(s):  
Marc Rosenthal ◽  
Robert Dunne
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Vital Signs ◽  
Retrospective Chart Review ◽  
Hurricane Sandy ◽  
System Response ◽  
Medical Needs ◽  
Medical Response ◽  
Wide Range ◽  
National Disaster

Introduction:Disaster medical team response by governmental and non-governmental responders is highly variable and poorly characterized. Each response is unique in terms of caseload, patient demographics, and medical needs encountered. This variability increases the difficulty of determining team member composition as well as supply and equipment needs. In an effort to demonstrate this issue, we have reviewed the National Disaster Medical Response to Hurricane Sandy.Methods:This project was a retrospective chart review of Hurricane Sandy data abstracted from the National Disaster Medical System (NDMS) Health Information Repository (HIR) medical records from the NDMS system response, and were abstracted for data including vital signs, ages, sex, chief complaint, and final impressions. In addition, length of stay among other parameters was abstracted. The data was analyzed using Microsoft Excel and Access with descriptive statistics. In addition, the results were compared to similar indices in a community emergency department and prior NDMS responses.Results:The results indicate a wide range of patient ages, chief complaints, and final impressions. The vast majority of patients seen by Disaster Medical Assistance Teams (DMAT) were stable with relatively low acuity issues. The total number of charts reviewed were 7,905. Respiratory complaints were the most frequent at 845 patients followed by toxicology/injuries at 706 patients and mental health issues at 452 patients. In approximately 3,400 patients, no diagnosis was present in the chart. Length of stay averaged below 1 hour and peak patient ages were between 50-60 with a significant number of infants less than 2 years.Discussion:Characterization of NDMS responses by DMATs and comparison with prior events and community emergency department caseloads can provide an insight into the needs of DMATs and other response organizations in future responses.

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