scholarly journals Is the Emergency Department an Inappropriate Venue for Code Status Discussions?

2020 ◽  
pp. 104990912093833
Author(s):  
Daniel G. Miller ◽  
J. Priyanka Vakkalanka ◽  
Morgan B. Swanson ◽  
Andrew S. Nugent ◽  
Yuya Hagiwara
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Quality Improvement ◽  
Relative Risk ◽  
Early Recognition ◽  
Code Status ◽  
Before And After ◽  
Aggressive Care ◽  
Time Of Admission ◽  
Dnr Orders

Background: Historically, it has been assumed that the Emergency Department (ED) is a place for maximally aggressive care and that Emergency Medicine Providers (EMPs) are biased towards life-prolonging care. However, emphasis on early recognition of code status preferences is increasingly making the ED a venue for code status discussions (CSDs). In 2018, our hospital implemented a policy requiring EMPs to place a code status order (CSO) for all patients admitted through the ED. We hypothesized that if EMPs enter CSDs with a bias toward life-prolonging care, or if the venue of the ED biases CSDs towards life-prolonging care, then we would observe a decrease in the percentage of patients selecting DNR status following our institution’s aforementioned CSO mandate. Methods: We present a retrospective analysis of rates of DNR orders placed for patients admitted through our ED comparing six-month periods before and after the implementation of the above policy. Results: Using quality improvement data, we identified patients admitted through the ED during pre (n=7,858) and post (n=8,069) study periods. We observed the following: after implementation DNR preference identified prior to hospital admission from the ED increased from 0.4% to 5.3% (relative risk (RR) 12.5; 95% CI: 5.2-29.9), defining CS in the ED setting at the time of admission increased from 2.4% to 98.6% (p <0.001), and DNR orders placed during inpatient admission was unchanged (RR=0.97 (95% CI = 0.88-1.07)). Discussion: Our results suggest that the ED can be an appropriate venue for CSDs.

scholarly journals A Structured Curriculum for Interprofessional Training of Emergency Medicine Interns

2019 ◽  
Vol 21 (1) ◽  
pp. 149-151 ◽  
Author(s):  
Ashley Rider ◽  
Tiffany Anaebere ◽  
Mariko Nomura ◽  
David Duong ◽  
Charlotte Wills
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Interprofessional Education ◽  
Hospital Setting ◽  
Scope Of Practice ◽  
Registered Nursing ◽  
Interprofessional Training ◽  
Before And After ◽  
Team Based Care ◽  
Improve Health

Interprofessional education (IPE) has been shown to improve health outcomes and patient satisfaction. IPE is now represented in the Accreditation Council for Graduate Medical Education’s emergency medicine (EM) milestones given the team-based nature of EM. The Highland Allied Health Rotation Program (H-AHRP) was developed by residents to enhance and standardize IPE for EM residents in a single hospital setting. H-AHRP was incorporated into the orientation month for interns starting in the summer of 2016. EM interns were paired with emergency department preceptors in registered nursing (RN), respiratory therapy (RT), pharmacy (PH), laboratory (LAB), and social work (SW) in either a four-hour shadowing experience (RN, RT, PH) or lecture-based overview (LAB, SW). We conducted a survey before and after the program. Overall, the EM interns reported an improved understanding of the scope of practice and day-to-day logistics after working with the preceptors. They found the program helpful to their future as physicians and would recommend it to other residencies. The H-AHRP program allows for the early incorporation of IPE into EM training, enhances interns’ understanding of both the scope and logistics of their colleagues, and is a well-received effort at improving team-based care.

scholarly journals Quality improvement primer part 2: executing a quality improvement project in the emergency department

CJEM ◽  
2017 ◽  
Vol 20 (4) ◽  
pp. 532-538 ◽  
Author(s):  
Lucas B. Chartier ◽  
Antonia S. Stang ◽  
Samuel Vaillancourt ◽  
Amy H. Y. Cheng
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Emergency Medicine ◽  
Quality Improvement ◽  
Improvement Project ◽  
Emergency Department Setting ◽  
Pdsa Cycle ◽  
Time To Antibiotics ◽  
Final Article

ABSTRACTThe topics of quality improvement (QI) and patient safety have become important themes in health care in recent years, particularly in the emergency department setting, which is a frequent point of contact with the health care system for patients. In the first of three articles in this series meant as a QI primer for emergency medicine clinicians, we introduced the strategic planning required to develop an effective QI project using a fictional case study as an example. In this second article we continue with our example of improving time to antibiotics for patients with sepsis, and introduce the Model for Improvement. We will review what makes a good aim statement, the various categories of measures that can be tracked during a QI project, and the relative merits and challenges of potential change concepts and ideas. We will also present the Model for Improvement’s rapid-cycle change methodology, the Plan-Do-Study-Act (PDSA) cycle. The final article in this series will focus on the evaluation and sustainability of QI projects.

Palliative medicine in the emergency department: symptom control and aggressive care

2021 ◽  
pp. bmjspcare-2021-003332
Author(s):  
Raquel de Oliveira ◽  
Carolina B. Lobato ◽  
Leonardo Maia-Moço ◽  
Mariana Santos ◽  
Sara Neves ◽  
...  
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
Palliative Medicine ◽  
Symptom Control ◽  
Well Being ◽  
Blood Collection ◽  
Intravenous Fluid Therapy ◽  
Aggressive Care ◽  
Aggressive Interventions ◽  
Time Of Admission

ObjectivesIdentifying the prevalence of palliative care (PC) needs among patients who die at the emergency department (ED) and to assess symptom control and aggressiveness of care.MethodsWe conducted a decedent cohort study of adults deceased at the ED of a Portuguese teaching hospital in 2016. PC needs were identified using the National Hospice Organization terminality criteria and comorbidities measurement by the Charlson’s Index.Results384 adults died at the ED (median age 82 (IQR 72–89) years) and 78.4% (95% CI 73.9% to 82.2%) presented PC needs. Only 3.0% (n=9) were referred to the hospital PC team. 64.5%, 38.9% and 57.5% experienced dyspnoea, pain and confusion, respectively. Dyspnoea was commonly medicated (92%), against 56% for pain and 8% for confusion. Only 6.3% of the patients were spared from aggressive interventions, namely blood collection (86.0%) or intravenous fluid therapy (63.5%). The burden of aggressive interventions was similar between those with or without withhold cardiopulmonary resuscitation order (median 3 (2–4) vs 3 (2–5)), p=0.082.ConclusionsNearly four out of five adults who died at the ED had PC needs at the time of admission. Most experienced poor symptom control and care aggressiveness in their last hours of life and were mostly unknown to the PC team. The findings urge improvements in the care provided to patients with PC needs at the ED, focusing on patient well-being and increased PC referral.

Emergency department airway management before and after an emergency medicine residency

1999 ◽  
Vol 17 (3) ◽  
pp. 427-431 ◽  
Author(s):  
Laurence Friedman ◽  
Gary M. Vilke ◽  
Theodore C. Chan ◽  
Stephen R. Hayden ◽  
David A. Guss ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Airway Management ◽  
Before And After

You’ve Got to Hand It to Them: Assessing Final Year Medical Students Knowledge of Hand Anatomy and Pathology

2016 ◽  
Vol 21 (03) ◽  
pp. 388-394 ◽  
Author(s):  
Cormac Weekes Joyce ◽  
Shazrinizam Shaharan ◽  
Kate Lawlor ◽  
Melanie Elizabeth Burke ◽  
Michael John Kerin ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
General Practice ◽  
Medical Students ◽  
Medical School ◽  
Upper Limb ◽  
Teaching Module ◽  
Musculoskeletal Anatomy ◽  
Practice Of Medicine ◽  
Before And After

Background: Knowledge of hand anatomy and pathology is important for final year medical students as it frequently appears in examinations as a short case or in a written paper. Studies have shown that doctors in the Emergency Department have a deficient grasp of musculoskeletal anatomy secondary to a lack of dedicated teaching in medical school. Methods: A questionnaire was handed out to 111 final year medical students. Students were asked to fill it out before and after dedicated upper limb teaching sessions during their rotation. The questionnaire consisted of an anatomical and pathological component. Students were tested on basic anatomy and pathology of several common upper limb conditions. Results: There was a significant improvement in the medical students knowledge after the dedicated hand teaching. The identification of the carpal bones showed the most improvement overall. Conclusions: Basic musculoskeletal knowledge is essential to the practice of medicine. The majority of medical students gravitate towards a career in general practice or emergency medicine and good knowledge of upper limb anatomy is important. We have piloted a new interactive dedicated upper limb teaching module and have shown that there has been a significant improvement in students knowledge.

scholarly journals Implementation of Scribes in an Academic Emergency Department: The Resident Perspective

2017 ◽  
Vol 9 (4) ◽  
pp. 518-522 ◽  
Author(s):  
Evan Ou ◽  
Mary Mulcare ◽  
Sunday Clark ◽  
Rahul Sharma
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Residency Program ◽  
Medical Center ◽  
Academic Medical Center ◽  
Educational Experience ◽  
Patient Disposition ◽  
Before And After ◽  
Faculty Supervision ◽  
Medical Scribes

ABSTRACT Background  Medical scribes have been shown to improve emergency department (ED) throughput, physician productivity metrics, and patient satisfaction by fulfilling primary documentation and nonclinical functions. Little research has been done to date to study the effect of implementing a scribe program in a residency setting. Objective  Our goal was to investigate emergency medicine residents' perception of their educational experience, including interactions with faculty, before and after the implementation of an ED scribe program. Methods  We used a pre-post design to assess residents' perceptions of their educational experience before and after implementation of the scribe program. Residents at a large, urban academic medical center with an Accreditation Council for Graduate Medical Education–accredited, 4-year emergency medicine residency program were surveyed during August 2015 (prior to the implementation of the scribe program) and April 2016 (6 months after implementation). Results  Residents reported improved educational experiences with statistically significant changes in the following areas: increased interaction with faculty due to fewer documentation requirements (P = .012); more face-to-face teaching with faculty (P &lt; .001); increased faculty supervision for procedures (P = .016); and a decrease of delays in patient disposition due to incomplete documentation (P = .029). Conclusions  Implementation of an ED scribe program in an urban 4-year emergency medicine residency program led to improvements in residents' perceptions of their education.

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