A novel use of telemedicine during a hospital mass casualty drill

2019 ◽  
pp. 1357633X1989387
Author(s):  
Brenna Farmer ◽  
Lauren Stoerger ◽  
Medha Vyavahare ◽  
Rahul Sharma
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Care Service ◽  
Quality Care ◽  
Rapid Assessment ◽  
Mass Casualty ◽  
Telemedicine Service ◽  
Lower Manhattan ◽  
Attending Physicians

During a mass casualty disaster drill at NewYork-Presbyterian’s Lower Manhattan Hospital in April 2019, the Emergency Department (ED) used telemedicine to see low-acuity ‘walking wounded’ patients. This telemedicine service is provided every day as ED Express Care Service and staffed by off-site, board-certified Emergency Medicine attending physicians. This novel use of the ED Express Care Service allowed the ED to provide timely, safe, quality care while expanding resources and ED capacity through rapid assessment, treatment and discharge of the low-acuity patients.

scholarly journals P043: Standards for change: developing international minimum standards for the care of older people in the emergency department

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S72-S72
Author(s):  
B. Ellis ◽  
C. Carpenter ◽  
J. Lowthian ◽  
S. Mooijaart ◽  
C. Nickel ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Older People ◽  
Older Patients ◽  
Developmental Process ◽  
Quality Care ◽  
Policy Framework ◽  
Care Needs ◽  
Integration Of Care ◽  
Minimum Standards

Introduction: Emergency departments (ED) across Canada acknowledge the need to transform in order to provide high quality care for the increasing proportion of older patients presenting for treatment. Older people are more complex than younger ED users. They have a disproportionately high use of EDs, increased rates of hospitalization, and are more likely to suffer adverse events. The objective of this initiative was to develop minimum standards for the care of older people in the emergency department. Methods: We created a panel of international leaders in geriatrics and emergency medicine to develop a policy framework on minimum standards for care of older people in the ED. We conducted a literature review of international guidelines, frameworks, recommendations, and best practices for the acute care of older people and developed a draft standards document. This preliminary document was circulated to interdisciplinary members of the International Federation of Emergency Medicine (IFEM) geriatric emergency medicine (GEM) group. Following review, the standards were presented to the IFEM clinical practice group. At each step, verbal, written and online feedback were gathered and integrated into the final minimum standards document. Results: Following the developmental process, a series of eight minimum standard statements were created and accepted by IFEM. These standards utilise the IFEM Framework for Quality and Safety in the ED, and are centred on the recognition that older people are a core population of emergency health service users whose care needs are different from those of children and younger adults. They cover key areas, including the overall approach to older patients, the physical environment and equipment, personnel and training, policies and protocols, and strategies for navigating the health-care continuum. Conclusion: These standards aim to improve the evaluation, management and integration of care of older people in the ED in an effort to improve outcomes. The minimum standards represent a first step on which future activities can be built, including the development of specific indicators for each of the minimum standards. The standards are designed to apply across the spectrum of EDs worldwide, and it is hoped that they will act as a catalyst to change.

scholarly journals Urgent considerations for assessment of coma in the emergency department

2021 ◽  
Author(s):  
Tammam Mozher Aldarwish ◽  
Talal Hussain Alolowi ◽  
Rayan Othman Alsadiqi ◽  
Hussain Ali Al Hassan ◽  
Abdullah Saeed Alqahtani ◽  
...  
Keyword(s):  
Emergency Department ◽  
Physical Examination ◽  
Treatment Plan ◽  
Rapid Assessment ◽  
Management Plan ◽  
Management Approach ◽  
Eyes Absent ◽  
Assessment And Evaluation ◽  
Evaluation Approaches ◽  
Attending Physicians

Not speaking, closed eyes, absent response to tactile, verbal or noxious stimuli are characteristic of comatose patients. Many causes of coma have been identified and reported in the literature. However, other causes might require extensive assessment and evaluation approaches. The attending physicians start with the baseline support of life for the affected patients, followed by rapid assessment and evaluation of the etiology and pathophysiology and adequate physical examination. In addition, it requires imaging and laboratory investigations whenever needed to determine the most appropriate management plan. In this literature review, we have conducted a brief discussion about the urgent considerations for the assessment of coma in the emergency department. Many causes can attribute to the development of coma. Therefore, adequate assessment and evaluation is a key component in the management of the affected patients in the emergency department. Moreover, the management approach might differ based on the underlying etiology. Nevertheless, caring for breathing, circulation, management of the airways, and stabilization are the main steps that should be done for each comatose patient. Physical examination is also critical in such situations, where imaging or conducting laboratory tests might not be suitable for some patients. Finally, the treatment plan should be directed based on the underlying etiology of coma.

Violence in the Emergency Department: A National Survey of Emergency Medicine Residents and Attending Physicians

2011 ◽  
Vol 40 (5) ◽  
pp. 565-579 ◽  
Author(s):  
Marcelina Behnam ◽  
Roger D. Tillotson ◽  
Stephen M. Davis ◽  
Gerald R. Hobbs
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
National Survey ◽  
Attending Physicians

scholarly journals Learning Clinical Versus Leadership Competencies in the Emergency Department: Strategies, Challenges, and Supports of Emergency Medicine Residents

2011 ◽  
Vol 3 (3) ◽  
pp. 320-325 ◽  
Author(s):  
Ellen F Goldman ◽  
Margaret M Plack ◽  
Colleen N Roche ◽  
Jeffrey P Smith ◽  
Catherine L Turley
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Learning Process ◽  
Medical Center ◽  
Academic Medical Center ◽  
Leadership Skills ◽  
Clinical Skill ◽  
Skill Learning ◽  
Formal Leadership ◽  
Attending Physicians

Abstract Background Emergency medicine residents are expected to master 6 competencies that include clinical and leadership skills. To date, studies have focused primarily on teaching strategies, for example, what attending physicians should do to help residents learn. Residents' own contributions to the learning process remain largely unexplored. The purpose of this study was to explore what emergency medicine residents believe helps them learn the skills required for practice in the emergency department. Methods This qualitative study used semistructured interviews with emergency medicine residents at a major academic medical center. Twelve residents participated, and 11 additional residents formed a validation group. We used phenomenologic techniques to guide the data analysis and techniques such as triangulation and member checks to ensure the validity of the findings. Results We found major differences in the strategies residents used to learn clinical versus leadership skills. Clinical skill learning was approached with rigor and involved a large number of other physicians, while leadership skill learning was unplanned and largely relied on nursing personnel. In addition, with each type of skills, different aspects of the residents' personalities, motivation, and past nonclinical experiences supported or challenged their learning process. Conclusion The approaches to learning leadership skills are not well developed among emergency medicine residents and result in a narrow perspective on leadership. This may be because of the lack of formal leadership training in medical school and residency, or it may reflect assumptions regarding how leadership skills develop. Substantial opportunity exists for enhancing emergency medicine residents' learning of leadership skills as well as the teaching of these skills by the attending physicians and nurses who facilitate their learning.

scholarly journals Emergency medicine airway leads: a rapid response distributed educational model for emergency department COVID-19 airway management

CJEM ◽  
2021 ◽  
Author(s):  
Adam Harris ◽  
Lorri Beatty ◽  
Nicholas Sowers ◽  
Sam G. Campbell ◽  
David Petrie ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Airway Management ◽  
Rapid Response ◽  
Educational Model

scholarly journals Predictive factors for prolonged hospitalisation in acute pyelonephritis patients admitted to the emergency medicine ward

2021 ◽  
pp. 102490792110009
Author(s):  
Howard Tat Chun Chan ◽  
Ling Yan Leung ◽  
Alex Kwok Keung Law ◽  
Chi Hung Cheng ◽  
Colin A Graham
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Length Of Stay ◽  
Acute Pyelonephritis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Prolonged Length ◽  
Reactive Protein ◽  
Prolonged Hospital ◽  
Emergency Medicine Ward

Background: Acute pyelonephritis is a bacterial infection of the upper urinary tract. Patients can be admitted to a variety of wards for treatment. However, at the Prince of Wales Hospital in Hong Kong, they are managed initially in the emergency medicine ward. The aim of the study is to identify the risk factors that are associated with a prolonged hospital length of stay. Methods: This was a retrospective cohort study conducted in Prince of Wales Hospital. The study recruited patients who were admitted to the emergency medicine ward between 1 January 2014 and 31 December 2017. These patients presented with clinical features of pyelonephritis, received antibiotic treatment and had a discharge diagnosis of pyelonephritis. The length of stay was measured and any length of stay over 72 h was considered to be prolonged. Results: There were 271 patients admitted to the emergency medicine ward, and 118 (44%) had a prolonged hospital length of stay. Univariate and multivariate analyses showed that the only statistically significant predictor of prolonged length of stay was a raised C-reactive protein (odds ratio 1.01; 95% confidence 1.01–1.02; p < 0.0001). Out of 271 patients, 261 received antibiotics in the emergency department. All 10 patients (8.5%) who did not receive antibiotics in emergency department had a prolonged length of stay (p = 0.0002). Conclusion: In this series of acute pyelonephritis treated in the emergency medicine ward, raised C-reactive protein levels were predictive for prolonged length of stay. Patients who did not receive antibiotics in the emergency department prior to emergency medicine ward admission had prolonged length of stay.

scholarly journals Subarachnoid hemorrhage in the emergency department

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Sima Patel ◽  
Amay Parikh ◽  
Okorie Nduka Okorie
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Subarachnoid Hemorrhage ◽  
Early Management ◽  
Vast Number ◽  
Emergency Medicine Physician ◽  
Medicine Physician ◽  
Diagnostic Modalities ◽  
Poor Outcomes ◽  
Subarachnoid Hemorrhages

Abstract Background Subarachnoid hemorrhage accounts for more than 30,000 cases of stroke annually in North America and encompasses a 4.4% mortality rate. Since a vast number of subarachnoid hemorrhage cases present in a younger population and can range from benign to severe, an accurate diagnosis is imperative to avoid premature morbidity and mortality. Here, we present a straightforward approach to evaluating, risk stratifying, and managing subarachnoid hemorrhages in the emergency department for the emergency medicine physician. Discussion The diversities of symptom presentation should be considered before proceeding with diagnostic modalities for subarachnoid hemorrhage. Once a subarachnoid hemorrhage is suspected, a computed tomography of the head with the assistance of the Ottawa subarachnoid hemorrhage rule should be utilized as an initial diagnostic measure. If further investigation is needed, a CT angiography of the head or a lumbar puncture can be considered keeping risks and limitations in mind. Initiating timely treatment is essential following diagnosis to help mitigate future complications. Risk tools can be used to assess the complications for which the patient is at greatest. Conclusion Subarachnoid hemorrhages are frequently misdiagnosed; therefore, we believe it is imperative to address the diagnosis and initiation of early management in the emergency medicine department to minimize poor outcomes in the future.

scholarly journals The International Federation for Emergency Medicine report on emergency department crowding and access block: a brief summary

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
A. P. Javidan ◽  
◽  
K. Hansen ◽  
I. Higginson ◽  
P. Jones ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Task Force ◽  
Video Conferencing ◽  
International Federation ◽  
Emergency Physicians ◽  
Emergency Department Crowding ◽  
Comprehensive Guidance ◽  
The World ◽  
Ed Crowding

Abstract Objective To develop comprehensive guidance that captures international impacts, causes, and solutions related to emergency department crowding and access block Methods Emergency physicians representing 15 countries from all IFEM regions composed the Task Force. Monthly meetings were held via video-conferencing software to achieve consensus for report content. The report was submitted and approved by the IFEM Board on June 1, 2020. Results A total of 14 topic dossiers, each relating to an aspect of ED crowding, were researched and completed collaboratively by members of the Task Force. Conclusions The IFEM report is a comprehensive document intended to be used in whole or by section to inform and address aspects of ED crowding and access block. Overall, ED crowding is a multifactorial issue requiring systems-wide solutions applied at local, regional, and national levels. Access block is the predominant contributor of ED crowding in most parts of the world.

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