Development and Performance Assessment of a Digital Serious Game to Assess Multi-Patient Care Skills in a Simulated Pediatric Emergency Department

2020 ◽  
Vol 51 (4) ◽  
pp. 550-570
Author(s):  
Cindy Luu ◽  
Thomas B. Talbot ◽  
Cha Chi Fung ◽  
Eyal Ben-Isaac ◽  
Juan Espinoza ◽  
...  
Keyword(s):  
Emergency Department ◽  
Diagnostic Accuracy ◽  
Patient Care ◽  
Skill Acquisition ◽  
Video Game ◽  
Rank Correlation ◽  
Fixed Time ◽  
Serious Game ◽  
Cross Sectional ◽  
Number Of Patients

Objective. Multi-patient care is important among medical trainees in an emergency department (ED). While resident efficiency is a typically measured metric, multi-patient care involves both efficiency and diagnostic / treatment accuracy. Multi-patient care ability is difficult to assess, though simulation is a potential alternative. Our objective was to generate validity evidence for a serious game in assessing multi-patient care skills among a variety of learners. Methods. This was a cross-sectional validation study using a digital serious game VitalSignsTM simulating multi-patient care within a pediatric ED. Subjects completed 5 virtual “shifts,” triaging, stabilizing, and discharging or admitting patients within a fixed time period; patients arrived at cascading intervals with pre-programmed deterioration if neglected. Predictor variables included generic multi-tasking ability, video game experience, medical knowledge, and clinical efficiency with real patients. Outcome metrics in 3 domains measured diagnostic accuracy (i.e. critical orders, diagnoses), efficiency (i.e. number of patients, time-to-order) and critical thinking (number of differential diagnoses); MANOVA determined differences between novice learners and expected expert physicians. Spearman Rank correlation determined associations between levels of expertise. Results. Ninety-five subjects’ gameplays were analyzed. Diagnostic accuracy and efficiency distinguished skill level between residency trained (residents, fellows and attendings) and pre-residency trained (medical students and undergraduate) subjects, particularly for critical orders, patients seen, and correct diagnoses (p < 0.003). There were moderate to strong correlations between the game’s diagnostic accuracy and efficiency metrics compared to level of training, including patients seen (rho = 0.47, p < 0.001); critical orders (rho = 0.80, p < 0.001); time-to-order (rho = −0.24, p = 0.025); and correct diagnoses (rho = 0.69, p < 0.001). Video game experience also correlated with patients seen (rho = 0.24, p = 0.003). Conclusion. A digital serious game depicting a busy virtual ED can distinguish between expected experts in multi-patient care at the pre- vs. post-residency level. Further study can focus on whether the game appropriately assesses skill acquisition during residency.

scholarly journals Description of the effect of patient flow, junior doctor supervision and pandemic preparation on the ability of emergency physicians to provide direct patient care

2020 ◽  
Vol 44 (5) ◽  
pp. 741
Author(s):  
Andy Lim ◽  
Namankit Gupta ◽  
Alvin Lim ◽  
Wei Hong ◽  
Katie Walker
Keyword(s):  
Pilot Study ◽  
Patient Care ◽  
Patient Flow ◽  
High Volume ◽  
Direct Patient Care ◽  
Published Data ◽  
Emergency Physicians ◽  
Cross Sectional ◽  
Number Of Patients ◽  
Process Factors

ObjectiveA pilot study to: (1) describe the ability of emergency physicians to provide primary consults at an Australian, major metropolitan, adult emergency department (ED) during the COVID-19 pandemic when compared with historical performance; and (2) to identify the effect of system and process factors on productivity. MethodsA retrospective cross-sectional description of shifts worked between 1 and 29 February 2020, while physicians were carrying out their usual supervision, flow and problem-solving duties, as well as undertaking additional COVID-19 preparation, was documented. Effect of supervisory load, years of Australian registration and departmental flow factors were evaluated. Descriptive statistical methods were used and regression analyses were performed. ResultsA total of 188 shifts were analysed. Productivity was 4.07 patients per 9.5-h shift (95% CI 3.56–4.58) or 0.43 patients per h, representing a 48.5% reduction from previously published data (P&lt;0.0001). Working in a shift outside of the resuscitation area or working a day shift was associated with a reduction in individual patient load. There was a 2.2% (95% CI: 1.1–3.4, P&lt;0.001) decrease in productivity with each year after obtaining Australian medical registration. There was a 10.6% (95% CI: 5.4–15.6, P&lt;0.001) decrease in productivity for each junior physician supervised. Bed access had no statistically significant effect on productivity. ConclusionsEmergency physicians undertake multiple duties. Their ability to manage their own patients varies depending on multiple ED operational factors, particularly their supervisory load. COVID-19 preparations reduced their ability to see their own patients by half. What is known about the topic?An understanding of emergency physician productivity is essential in planning clinical operations. Medical productivity, however, is challenging to define, and is controversial to measure. Although baseline data exist, few studies examine the effect of patient flow and supervision requirements on the emergency physician’s ability to perform primary consults. No studies describe these metrics during COVID-19. What does this paper add?This pilot study provides a novel cross-sectional description of the effect of COVID-19 preparations on the ability of emergency physicians to provide direct patient care. It also examines the effect of selected system and process factors in a physician’s ability to complete primary consults. What are the implications for practitioners?When managing an emergency medical workforce, the contribution of emergency physicians to the number of patients requiring consults should take into account the high volume of alternative duties required. Increasing alternative duties can decrease primary provider tasks that can be completed. COVID-19 pandemic preparation has significantly reduced the ability of emergency physicians to manage their own patients.

scholarly journals P078: Handover education in Canadian adult and pediatric emergency medicine residencies: a national survey and needs assessment

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S104-S105
Author(s):  
P. Lee ◽  
I. Rigby ◽  
S.J. McPherson
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Patient Care ◽  
Pediatric Emergency ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Risk Period ◽  
Hand Off ◽  
Pediatric Inpatient ◽  
Didactic Lecture

Introduction: Emergency department handover is a high-risk period for patient safety. A recent study showed a decreased rate of preventable adverse events and errors after implementation of a resident hand-off bundle on pediatric inpatient wards. In a 2013 survey by the Canadian Associations of Internes and Residents, only 11% of residents in any discipline stated they received a formal teaching session on handover. Recently, the CanMEDS 2015 Physician Competency Framework has added safe and skillful transfer of patient care as a new proficiency within the collaborator role. We hypothesize that significant variation exists in the current delivery and evaluation of handover education in Canadian EM residencies. Methods: We conducted a descriptive, cross-sectional survey of Canadian residents enrolled in the three main training streams of Emergency Medicine (FRCP CCFP-EM, PEM). The primary outcome was to determine which educational modalities are used to teach and assess handover proficiency. Secondarily, we described current sign-over practices and perceived competency at patient handover. Results: 130 residents completed the survey (73% FRCP, 19% CCFP-EM, 8% PEM). 6% of residents were aware of handover proficiency objectives within their curriculum, while 15% acknowledged formal evaluation in this area. 98% of respondents were taught handover by observation of staff or residents on shift, while 55% had direct teaching on the job. Less than 10% of respondents received formal sessions in didactic lecture, small group or simulation formats. Evaluation of handover skills occurred primarily by on shift observation (100% of respondents), while 3% of residents had received assessment through simulation. Local centre handover practices were variable; less than half of residents used mnemonic tools, written or electronic adjuncts. Conclusion: Canadian EM residents receive variable and sparse formal training and assessment on emergency department handover. The majority of training occurs by on shift observation and few trainees receive instruction on objective tools or explicit patient care standards. There exists potential for further development of standardized objectives, utilization of other educational modalities and formal assessments to better prepare residents to conduct safer patient handoffs.

scholarly journals 458. Diagnostic Accuracy and Management of Suspected Moderate to Severe Cellulitis Referred to an Infectious Diseases Outpatient Parenteral Antibiotic Clinic: A Prospective Cross-Sectional Study

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S225-S225
Author(s):  
Jolanta Piszczek ◽  
Eric Partlow ◽  
Shay-Anne Daniels ◽  
Milena Semproni ◽  
Wayne Ghesquiere
Keyword(s):  
Emergency Department ◽  
Infectious Diseases ◽  
Diagnostic Accuracy ◽  
Cross Sectional Study ◽  
High Rate ◽  
Sectional Study ◽  
Cross Sectional ◽  
Parenteral Antibiotic ◽  
Intravenous Antibiotics ◽  
The Impact

Abstract Background Moderate to severe cellulitis is a common reason for presentation to the emergency department and administration of intravenous antibiotics. Misdiagnosis of cellulitis occurs frequently as the disease can masquerade as a wide variety of noninfectious and infectious problems. There are currently no studies evaluating the impact of infectious diseases physicians on the diagnostic accuracy and management of cellulitis referred to an outpatient parenteral antibiotic clinic from the emergency department. The objective of this study was to quantify the prevalence of misdiagnosed moderate to severe cellulitis through an evaluation by an infectious diseases specialist, characterize the alternative diagnoses, and assess variables associated with misdiagnosis. Methods A prospective cross-sectional study of adults referred from emergency departments with presumed moderate to severe cellulitis to an outpatient parenteral antibiotic clinic staffed by infectious diseases specialists. Results 301 consecutive patients with presumed cellulitis were evaluated over a 6-month period. A concurring diagnosis of cellulitis was found in 170 patients (56.5%), for a misdiagnosis rate of 43.5% (131/301). Table 1 summarizes the alternative diagnoses. Infectious conditions other than cellulitis were the most common (63/301; 20.9%), with abscess being present in 23 (7.6%) of patients. Fifty-two of 301 (17.3%) of the diagnoses were noninfectious and 16/301 (5.3%) patients had a dual diagnosis where minor cellulitis was present, but secondary to another, predomintating condition. The presence of stasis dermatitis (OR 6.62, P = 0.013) and a history of physical trauma (OR 1.76, P = 0.046) were associated with a misdiagnosis. 31.9% (107/335) of antibiotic regimens prescribed by emergency physicians were inappropriate or sub-optimal compared with 7.9% (22/280) of those ordered by infectious disease doctors. Conclusion Moderate to severe cellulitis was incorrectly diagnosed in nearly half of the patients referred for intravenous antibiotics and resulted in a high rate of unstewardly antimicrobial use. Infectious diseases physicians at an outpatient antibiotic clinic improved the diagnostic accuracy and management of this complicated condition. Disclosures All authors: No reported disclosures.

scholarly journals COVID-19 Pandemic Impact on Emergency Department Visits and Quality of Service: A Comparative Cross-Sectional Study in a Tertiary Centre

2021 ◽  
pp. 471-483
Author(s):  
Maram Mohammed Jaboua ◽  
Warif Jameel Abdulhaq ◽  
Nada Saeed Almuntashiri ◽  
Sarah Saud Almohammdi ◽  
Asayel Qeblan Aldajani ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cross Sectional Study ◽  
Emergency Department Visits ◽  
Critical Conditions ◽  
Sectional Study ◽  
Cross Sectional ◽  
Coronary Syndrome ◽  
Number Of Patients ◽  
Ed Visits

Background: The COVID-19 pandemic has contributed to a devastating impact on emergency departments worldwide, resulting in a global crisis with various health consequences. We aimed to evaluate this impact on an emergency department (ED) visit of critical conditions such as Acute Coronary Syndrome (ACS), Cerebrovascular accident (CVA), Sepsis and Febrile neutropenia (FN), and to assess the quality of the ED after new adaptive measures were applied. Methods: This is a comparative cross-sectional study to assess the number of patients who presented to the ED of King Abdullah Medical city with the specified diagnosis. We collected data via the E-medical records. We compared the data over three periods pre-lockdown, lockdown and post lockdown in years 2019-2021. For quality measurement, Adaa (Ministry of Health's program) was used to calculate the percentage of patients who stayed 4 hours or less in the ED. Results: The total number of ED visits in the specified periods of study was 8387. The total numbers of patients for 2019, 2020, and 2020 respectively were 2011 (, ACS 70.4%, CVA 16.3%, sepsis and FN 13.3%.), 2733 (ACS 73.1%, CVA 9.9%, sepsis and FN 17.0%), and 3643 (ACS 64.0%, CVA 19.4%, sepsis and FN 16.7). The average percentage of patients who stayed 4 hours or less in the ED was 60% and 57.5% for 2020 and 2021, respectively. Conclusion: Although we expected reductions in ED visits during COVID-19 periods, we found that visits were rising through the years 2019-2021.

Prisoners seeking healthcare in emergency department

2020 ◽  
pp. 1-15
Author(s):  
Bedriye Muge Sonmez ◽  
Fevzi Yilmaz ◽  
Murat Dogan Iscanli ◽  
Cihat Yel ◽  
Ali Demir ◽  
...  
Keyword(s):  
Emergency Department ◽  
Healthcare Facility ◽  
Cross Sectional Study ◽  
Medical Group ◽  
Cross Sectional ◽  
Medical Disorders ◽  
Number Of Patients ◽  
Tertiary Healthcare ◽  
Training And Research ◽  
Surgical Conditions

Abstract Objectives: To evaluate inmate referrals to emergency department of a tertiary healthcare facility in terms of demographical and clinical characteristics as well as their impact on the department. Method: The retrospective cross-sectional study was conducted at Ankara Numune Training and Research Hospital, Ankara, Turkey, and comprised data of incarcerated patients who were brought to the emergency department from January 01, 2010, to December 31, 2012. . Demographical characteristics, consultations, duration of hospitalisation, recurrent admissions, disposal and mortality rates were noted. The referrals were grouped as surgical conditions, medical disorders, Eye, Ear, Nose, Throat problems, injury and psychiatric disorders. The groups were then subdivided according to diagnosis. SPSS 22 was used for data analysis. Results: Of the 856 patients, 804(93.4%) were men and 52(6.1%) were women. The overall mean age was 37.54±14.81 years (range: 15-83 years). The number of patients was the highest in the medical group 363(42.4%) and the lowest in the Eye, Ear, Nose, Throat group 56(6.5%). Mean age of the surgical group was significantly lower than the medical group (p<0.001) but significantly higher than that of the trauma group (p=0.001). Conclusion: Functional emergency response units, strict emergency triage of inmates, and their rapid care and management in jails can help avoid referring these patients to already overcrowded emergency departments. Key Words: Prisoners, Healthcare, Emergency department.

UTILIZATION OF EMERGENCY DEPARTMENT, UKM MEDICAL CENTRE: PATTERN OF PATIENT

2016 ◽  
Vol 78 (4-4) ◽  
Author(s):  
Wan Malissa Wan Mohd Aminuddin ◽  
Wan Rosmanira Ismail ◽  
Husyairi Harunarashid ◽  
Raymond Azman Ali ◽  
Ismail Mohd Saiboon ◽  
...  
Keyword(s):  
Emergency Department ◽  
Census Data ◽  
Early Morning ◽  
Cross Sectional Study ◽  
Huge Number ◽  
Cross Sectional ◽  
Number Of Patients ◽  
Ed Overcrowding ◽  
Critical Patients

An emergency department (ED) is a front door for a hospital where a huge number of patients visit the department to seek immediate treatment. This has led to ED overcrowding. A cross sectional study was conducted to determine the pattern of patients attending the ED in a public teaching hospital in Malaysia. 2013 daily census data contained 66,603 patients were used. In this study, 62.1% of ED attendances are non-critical case. They commonly utilized the ED in the early morning, during weekends, and early part of the week. In conclusion, non-critical patients are seen to be the most frequent ED users. They are commonly present at the ED with minor problems. Hence, ED management should implement various solving methods in order to educate such people regarding the real functions of an ED.

scholarly journals Comparative performance of five commercially available serologic assays to detect antibodies to SARS-CoV-2 and identify individuals with high neutralizing titers

2020 ◽  
Author(s):  
Eshan Patel ◽  
Evan M Bloch ◽  
William Clarke ◽  
Yu-Hsiang Hsieh ◽  
Denali Boon ◽  
...  
Keyword(s):  
Emergency Department ◽  
Diagnostic Accuracy ◽  
Symptom Onset ◽  
Neutralizing Antibodies ◽  
Positive Test ◽  
Receiver Operating Curve ◽  
Comparative Performance ◽  
Cross Sectional ◽  
High Diagnostic Accuracy ◽  
Emergency Department Patients

Accurate serological assays to detect antibodies to SARS-CoV-2 are needed to characterize the epidemiology of SARS-CoV-2 infection and identify potential candidates for COVID-19 convalescent plasma (CCP) donation. This study compared the performance of commercial enzyme immunoassays (EIAs) to detect IgG or total antibodies to SARS-CoV-2 and neutralizing antibodies (nAb). The diagnostic accuracy of five commercially available EIAs (Abbott, Euroimmun, EDI, ImmunoDiagnostics, and Roche) to detect IgG or total antibodies to SARS-CoV-2 was evaluated from cross-sectional samples of potential CCP donors that had prior molecular confirmation of SARS-CoV-2 infection for sensitivity (n=214) and pre-pandemic emergency department patients for specificity (n=1,102). Of the 214 potential CCP donors, all were sampled >14 days since symptom onset and only a minority had been hospitalized due to COVID-19 (n=16 [7.5%]); 140 potential CCP donors were tested by all five EIAs and a microneutralization assay. When performed according to the manufacturers’ protocol to detect IgG or total antibodies to SARS-CoV-2, the sensitivity of each EIA ranged from 76.4% to 93.9%, and the specificity of each EIA ranged from 87.0% to 99.6%. Using a nAb titer cutoff of ≥160 as the reference positive test (n=140 CCP donors), the empirical area under receiver operating curve of each EIA ranged from 0.66 (Roche) to 0.90 (Euroimmun). Commercial EIAs with high diagnostic accuracy to detect SARS-CoV-2 antibodies did not necessarily have high diagnostic accuracy to detect high nAbs. Some but not all commercial EIAs may be useful in the identification of individuals with high nAbs in convalescent individuals.

scholarly journals ANALYSIS OF FACTORS ASSOCIATED WITH BOARDING TIME IN YELLOW ZONE OF EMERGENCY DEPARTMENT AT dr.ISKAK TULUNGAGUNG HOSPITAL

2017 ◽  
Vol 2 (2) ◽  
pp. 109
Author(s):  
Fitrio Deviantony ◽  
Ahsan Ahsan ◽  
Setyoadi Setyoadi
Keyword(s):  
Emergency Department ◽  
Linear Regression ◽  
Observational Research ◽  
Dominant Factor ◽  
Time Of Arrival ◽  
Cross Sectional ◽  
Laboratory Test Results ◽  
Number Of Patients ◽  
Diagnostic Time ◽  
Spearman Test

Patient’s visits in the emergency room (ER) increase in number in every year. The increasing number of hospital visits is directly associated with the increasing number of patients who come to the emergency department. The increased number of patients resulted in the buildup of patients in the ER, especially in the Yellow Zone and causing the boarding time after the inpatient decision was decided to be longer. The purpose of this study was to analyze the problems related to variables that have a correlation with the boarding time of the patient after the decision of hospitalization is decided in the yellow zone of the emergency department at RSUD dr. Iskak Tulungagung. The method of this research was analytic observational research with cross sectional approach. The number of samples was 78 respondents. The sampling technique used nonprobability sampling. Pearson test and Spearman test were applied to identify the correlation between variables and multivariate linear regression test was used to find out the most dominant factor in influencing patient boarding time after the decision of hospitalization was made. The result of bivariate test showed the correlation between boarding time with room preparation time (p = 0.000), laboratory test results (p = 0.000), diagnostic time (p = 0.000), and ratio between nurse and patient (p = 0.000). Boarding time was not correlated with time of arrival (p = 0.263) and insurance coverage (p = 0.980). Multivariate analysis with linear regression obtained result of constant value (B = 681.212), ratio between nurse and patient (p= 0.000; B = -861.011), bed occupancy time (p= 0.000; B =0.620) and diagnostic time (p=0.022; B = 2.636). The implication of this research is to get a formula that able to shorten patient boarding time after the decision of hospitalization was made and can give a standart time for boarding time.

scholarly journals Factors determining self-harm

1970 ◽  
Vol 32 (3) ◽  
pp. 14-17
Author(s):  
YL Shakya ◽  
R Acharya ◽  
MP Gupta ◽  
MR Banjara ◽  
PR Prasad
Keyword(s):  
Emergency Department ◽  
Significant Proportion ◽  
Cross Sectional Study ◽  
University Teaching ◽  
Institute Of Medicine ◽  
Biochemical Tests ◽  
Cross Sectional ◽  
Delivery Of Care ◽  
Number Of Patients ◽  
Self Harm

Introduction: Self-harm forms a significant proportion of patient attending in emergency departments, typically 10-30 per 100000 people commit suicide annually. The objective of this study was to find out the factors responsible for self harm. Methods: This is a cross sectional study of 100 patients of self harm coming to Emergency Department of Tribhuvan University Teaching Hospital from 1stOctober 2007 to 31stMarch, 2008. Questionnaire about demographic information of patient along with details about cause of self harm, and any other illnesses associated was filled. Information about duration of arrival in emergency department, place of self harm was gathered. Patients were clinically examined and hematological and biochemical tests including liver function test and the type of poison used and its level in blood were examined. Results: Total number of patients with self harm was 100 (female - 71%; male- 29%).Among female, 16-30 years age group to be the largest (76%). Mean duration of arrival in emergency department was 3.08 hour. Metacid ingestion (29%) was found to be the most common cause for self harm. There is no difference of self harm for suicide and threat cause. Only 5% of patient with self harm has psychiatry illness in the past. Conclusions: Self harm forms a significant proportion of patient attending the Emergency department and the most common form of self harm used was metacid ingestion. There is compelling evidence for the need to improve delivery of care for patients who inflict self harm. Key words: Cause; emergency department; self harm. DOI: http://dx.doi.org/10.3126/joim.v32i3.4954 Journal of Institute of Medicine, December, 2010; 32:3 14-17

scholarly journals EMERGENCY DEPARTMENT OCCUPANCY ASSESSMENT IN LITHUANIA

2017 ◽  
Vol 39 (4) ◽  
pp. 537-551
Author(s):  
Gintautas Virketis ◽  
Vinsas Janušonis
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Intensive Care ◽  
Patient Care ◽  
Waiting Time ◽  
Negative Consequences ◽  
Number Of Patients ◽  
Quality Of Patient Care ◽  
Patient Health

Emergency department (ED) occupancy can cause many negative consequences for the quality of patient care. The purpose was to find out the reasons for the increased occupancy of the ED, to determine the appropriate criteria for the assessment of ED occupancy and the limits of waiting queues or waiting time. The heads and managers of Lithuanian in-patient health care institutions and ambulance services, in-patient reanimation and intensive care units and emergency departments were interviewed. The reasons for the increased waiting time of the ED and the appropriate criteria for the assessment of ED occupancy were determined: "the number of patients waiting in the queue" and “the estimated waiting time before doctor examination”.

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