Comprehensive Migraine Initiative in the Pediatric Emergency Department Improves Treatment Outcomes

2019 ◽  
Vol 35 (3) ◽  
pp. 235-241 ◽  
Author(s):  
Clare E. Skora ◽  
Lila T. Worden ◽  
Chris B. Oakley
Keyword(s):  
Emergency Department ◽  
Intervention Group ◽  
Treatment Protocol ◽  
Pediatric Emergency ◽  
P Value ◽  
Migraine Treatment ◽  
Pediatric Emergency Department ◽  
Pediatric Migraine ◽  
Before And After ◽  
Standardized Treatment

Objective: To compare pediatric migraine treatment efficacy in the emergency department before and after the implementation of a comprehensive migraine initiative, consisting of a standardized treatment protocol, provider educational series and standardized physician documentation template. Background: Pediatric migraine is common, accounting for 1% of pediatric emergency department visits. Yet there is large variability in treatment practices, with few studies looking into measures of both clinical effectiveness and timeliness of treatment following implementation of standardized protocols. Methods: A single-center retrospective chart review of pediatric patients presenting to the emergency department with migraine before and after implementation of an institutional headache initiative designed to more effectively and efficiently deliver care to pediatric migraine patients. Results: The study yielded 110 patients each in the intervention and preintervention groups. There were no significant differences in patient characteristics with respect to age, gender, or initial pain score. Compared with the preintervention group, the intervention group demonstrated a significant reduction in headache pain score prior to discharge (decrease of 5.9 vs 4.8 in preintervention group, P value .006) with a greater percentage of patients achieving ≥50% reduction in pain (82% vs 67% in preintervention group, P value .039). Additionally, we found a significantly decreased time to treatment in the intervention group compared with the preintervention group (1.8 vs 2.1 hours, P value .046). Conclusion: Through the use of a standardized treatment protocol, improved provider education, and ease of documentation, this comprehensive migraine initiative improved efficacy and efficiency of migraine treatment in the pediatric emergency department.

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.

Time Motion Study in a Pediatric Emergency Department Before and After Computer Physician Order Entry

2009 ◽  
Vol 53 (4) ◽  
pp. 462-468.e1 ◽  
Author(s):  
Kenneth Yen ◽  
Elizabeth L. Shane ◽  
Sachin S. Pawar ◽  
Nicole D. Schwendel ◽  
Robert J. Zimmanck ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
Order Entry ◽  
Time Motion ◽  
Motion Study ◽  
Before And After ◽  
Physician Order Entry

scholarly journals The Effect of the COVID-19 Pandemic on the Pediatric Emergency Department Flow

2021 ◽  
pp. 1-25
Author(s):  
Andrea Rivera-Sepulveda ◽  
Timothy Maul ◽  
Katherine Dong ◽  
Kylee Crate ◽  
Talia Helman ◽  
...  
Keyword(s):  
Emergency Department ◽  
Patient Flow ◽  
Admission Rate ◽  
Severity Index ◽  
Pediatric Emergency ◽  
Cross Sectional Study ◽  
P Value ◽  
Pediatric Emergency Department ◽  
Cross Sectional ◽  
Chief Complaints

ABSTRACT Objective: To determine how the early stages of the COVID-19 pandemic affected the utilization of the Pediatric Emergency Department (PED). Methods: Cross-sectional study of PED visits during January through April, 2016-2020. Data included: total PED visits, emergency severity index (ESI), disposition, chief complaint, age (months), time from first Provider to Disposition (PTD), and PED length of stay (PED-LOS). P-value <0.01 was statistically significant. Results: In total, 67,499 visits were reported. There was a significant decrease in PED visits of 24-71% from March to April 2020. Chief complaints for fever and cough were highest in March 2020; while April 2020 had a shorter mean PED-LOS (from 158 to 123 minutes), an increase of admissions (from 8% to 14%), a decrease in ESI 4 (10%), and an increase in ESI 3 (8%) (p<0.001). There was no difference in mean monthly PTD time. Conclusions: Patient flow in the PED was negatively affected by a decrease in PED visits and increase in admission rate that may be related to higher acuity. By understanding the interaction between hospital processes on PEDs and patient factors during a pandemic, we are able to anticipate and better allocate future resources.

scholarly journals Characteristics and risk factors for admission in children undergoing hematopoietic cell transplantation in a pediatric emergency department

2021 ◽  
Author(s):  
Jose Antonio Alonso Cadenas ◽  
Beatriz Corredor Andrés ◽  
David Andina Martínez ◽  
Gustavo Cañedo ◽  
Blanca Molina Ángulo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Cell Transplantation ◽  
Diagnostic Tests ◽  
Hematopoietic Cell Transplantation ◽  
Pediatric Emergency ◽  
Hematopoietic Cell ◽  
P Value ◽  
Pediatric Emergency Department ◽  
Main Complaint

We describe 68 hematopoietic cell transplantation (HCT) patients who visited our pediatric emergency department during 2014-2015 (188 encounters). Fever was the main complaint in 74 (34.8%) encounters. Diagnostic tests were performed in 147 (78.2%) episodes [100% of patients with unstable Pediatric Assessment Triangle (PAT) and 75.7% with stable PAT (P value 0.02)] and treatment was required in 93 (49.5%) episodes [15 (78.9%) with unstable PAT and 78 (46.2%) with stable PAT (P value <0.001)]. Risk factors for admission were unstable PAT [relative risk (RR) 3.4 (2.6-4.6), P value <0.001] and ≤100 days since HCT [RR 2.1 (1.4-3.1), P value <0.001].

scholarly journals Clinical Features And Prognostic Factors For Status Epilepticus In The Pediatric Emergency Department: A Retrospective Study

2021 ◽  
Author(s):  
Sohyun Eun ◽  
Hye Eun Kwon ◽  
Heoung Jin Kim ◽  
Seo Hee Yoon ◽  
Moon Kyu Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Status Epilepticus ◽  
Clinical Features ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
First Line ◽  
Before And After ◽  
Icu Management ◽  
The Brain

Abstract Background: Uncontrolled status epilepticus (SE) causes damage to all organs, especially the brain. Although there are guidelines regarding the management of convulsive SE, the timing for administering first-line rescue medications (RMeds) remains unclear. Therefore, we analyzed patients with persistent SE lasting for >30 min, who visited the pediatric emergency department (pED), to determine clinical features and risk factors and provide directions for management on arrival to the pED. Methods: This study was conducted by retrospectively reviewing medical charts of patients aged 0–19 years diagnosed with SE and accompanying motor seizures, who visited the pED between January 2010 and December 2019. After arrival at the pED, patients were divided into two groups, namely ≥30 min (n = 12) and <30 min (n = 13), according to the additional seizure time and administration of the first dose of RMeds before and after 5 min. Results: Seizures lasting for <30 min were mainly belonged to idiopathic SE in the pED. Among four SE patients who needed intensive care unit (ICU) management, three had delayed administration of RMeds of >5 min, which was statistically significant; hence, more hospitalizations in the ICU were observed when RMed administration was delayed (p = 0.047). In acute symptomatic SE such as encephalitis, more than three doses of RMeds were needed to control seizures. Conclusions: Patients with convulsive SE should arrive at the pED as soon as possible and immediately receive RMeds after arrival at the pED for good outcomes.

Exploring the Effect of Mindfulness on Burnout in a Pediatric Emergency Department

2021 ◽  
pp. 216507992110044
Author(s):  
Kei U. Wong ◽  
Lauren Palladino ◽  
Melissa L. Langhan
Keyword(s):  
Emergency Department ◽  
Health Care Providers ◽  
Nurse Practitioners ◽  
Large Scale ◽  
Maslach Burnout Inventory ◽  
Pediatric Emergency ◽  
Personal Accomplishment ◽  
Pediatric Emergency Department ◽  
Care Providers ◽  
Before And After

Background: Burnout is a common phenomenon among health care providers known to adversely affect their mental health and clinical acumen. As mindfulness has been shown to diminish burnout with large-scale interventions, our aim was to assess whether smaller, on-shift activities aimed at increasing mindfulness could decrease burnout among staff in a pediatric emergency department (PED). Methods: Prior to the implementation of a series of mindfulness-based activities, a diverse cohort of PED staff including nurses, physicians, nurse practitioners, technicians, and administrative personnel completed electronic preintervention surveys about their demographics, personal mindfulness engagement, and individual baseline burnout level using the Maslach Burnout Inventory (MBI). Trained nurses and physicians served as champions who coordinated on-shift mindfulness activities, and burnout levels were subsequently reassessed using a postintervention survey. Findings: Among 83 eligible staff, 75 completed the preintervention and 69 completed the postintervention survey. For the MBI, the majority of staff had moderate to high burnout levels at baseline. Few staff engaged in personal mindfulness activities outside of work. Although 82% of staff participated in the on-shift interventions, no significant differences were found in scores before and after the intervention for emotional exhaustion (20.1 vs. 20, p = .93), depersonalization (7.6 vs. 7.3, p = .97), and personal accomplishment (36.1 vs. 34.8, p = .11). Conclusion/Application to Practice: While mindfulness effectively combats burnout, few PED providers regularly practice mindfulness activities. Brief, on-shift mindfulness activities were insufficient to significantly reduce burnout levels. Hospital leadership should consider dedicating resources to more intensive mindfulness activities to combat amplified burnout levels among emergency department staff.

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