scholarly journals 24-hr observation unit is safe location for rapid glucose control in uncomplicated severe hyperglycaemia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
I. Ibrahim ◽  
R. Macatangay ◽  
C. Y. Chai ◽  
C. M. Khoo ◽  
M. Mahadevan
Keyword(s):  
Emergency Department ◽  
Glucose Control ◽  
Chart Review ◽  
Glucose Monitoring ◽  
Retrospective Chart Review ◽  
Effective Management ◽  
Observation Unit ◽  
Control Protocol ◽  
Sliding Scale ◽  
The Mean

Abstract Background Uncomplicated hyperglycaemia is a common presentation in the emergency department (ED). Rapid glucose control is associated with the risk of iatrogenic hypoglycaemia. We sought to determine the safety of a rapid glucose control protocol delivered in a 24-h emergency department observation unit (OU). Methods This is a retrospective chart review of patients admitted to the OU for hyperglycaemia where the assessing clinician deemed there was no other reason for medical admission apart from hyperglycaemia; and that the patient could be safely discharged provided their hyperglycaemia was adequately treated. The rapid glucose control protocol consists of 4–6 hourly glucose monitoring and insulin injections according to a sliding scale. We report the demographics, reduction in glucose values and the incidence of hypoglycaemia in the OU. We also determine the rate of discharge from OU and the rate of hospital admission at 30 days. Results We included 101 patients. The mean age was 53.5 years (95% CI 50.4–56.6) and 64% of patients were male. The mean HbA1c value was 12.8% (95% CI 12.3–13.3). The mean admission and discharge glucose values were 27.2 (95% CI 26.3–28.1) and 13.9 (95% CI 13.2–14.6) mmols/l respectively. There was no incidence of hypoglycaemia in the OU. We successfully discharged 90.1% of the patients from the OU, of which 3 (3.3%) patients were admitted to the hospital within 30 days of discharge. Conclusion ED OU is a safe location to deliver effective management for patients presented with uncomplicated severe hyperglycaemia.

scholarly journals Necessity of trauma referrals to the emergency department

2020 ◽  
Vol 29 (3) ◽  
pp. 163-166
Author(s):  
Chengjie Lee ◽  
Paul Yugendra ◽  
Choon Peng Jeremy Wee ◽  
Jen Heng Pek
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Odds Ratio ◽  
Chart Review ◽  
Clinical Course ◽  
Retrospective Chart Review ◽  
Smoke Inhalation ◽  
Traumatic Injuries ◽  
The Mean ◽  
Care Costs

Background: Patients with traumatic injuries presenting to the emergency department (ED) may be referred to another hospital for further management. Unnecessary referrals can inflate health-care costs and workload, as well as reduce provider and patient satisfaction. Objectives: In this study, we determined the proportion of unnecessary trauma referrals and described the characteristics of this patient population. Methods: A retrospective chart review was carried out between 1 January and 31 December 2016. Data regarding demographics, diagnosis and clinical course at the ED were collected in standardised forms. A referral was defined as unnecessary if the patient was discharged from the ED without a therapeutic procedure performed. Results: There were 121 trauma referrals. The mean age was 39.0±18.3 years old, and 94 (77.7%) patients were male. Seventy-eight (64.5%) of the referrals were from EDs in the same health-care cluster. Overall, 15 (12.3%) referrals were unnecessary, and of these, nine patients had sustained burns or were suffering from smoke inhalation. The length of stay of these unnecessary referrals was 197.0±96.2 minutes. Referring ED outside the health-care cluster was significantly associated with unnecessary referrals (odds ratio=4.42, 95% confidence interval 1.40–13.97, p=0.007). Conclusion: More than 1 in 10 trauma referrals were unnecessary. Further collaborative prospective studies with other EDs are needed to elucidate the underlying reasons for such unnecessary referrals so that targeted solutions can be implemented to reduce them in the future.

Harnessing the Chaplain’s Capacity to Identify Unmet Palliative Needs of Vulnerable Older Adults in the Emergency Department

2021 ◽  
pp. 082585972110033
Author(s):  
Elizabeth Hamill Howard ◽  
Rachel Schwartz ◽  
Bruce Feldstein ◽  
Marita Grudzen ◽  
Lori Klein ◽  
...  
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
End Of Life Care ◽  
Older Patients ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Life Care ◽  
Emergency Medicine Physician ◽  
Medicine Physician ◽  
One Year

Objective: To explore chaplains’ ability to identify unmet palliative care (PC) needs in older emergency department (ED) patients. Methods: A palliative chaplain-fellow conducted a retrospective chart review evaluating 580 ED patients, age ≥80 using the Palliative Care and Rapid Emergency Screening (P-CaRES) tool. An emergency medicine physician and chaplain-fellow screened 10% of these charts to provide a clinical assessment. One year post-study, charts were re-examined to identify which patients received PC consultation (PCC) or died, providing an objective metric for comparing predicted needs with services received. Results: Within one year of ED presentation, 31% of the patient sub-sample received PCC; 17% died. Forty percent of deceased patients did not receive PCC. Of this 40%, chaplain screening for P-CaRES eligibility correctly identified 75% of the deceased as needing PCC. Conclusion: Establishing chaplain-led PC screenings as standard practice in the ED setting may improve end-of-life care for older patients.

Late endoscopic evaluation of the ostium size after external dacryocystorhinostomy

2020 ◽  
pp. 112067212097604
Author(s):  
Reem R Al Huthail ◽  
Yasser H Al-Faky
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Tertiary Hospital ◽  
Nasal Endoscope ◽  
Long Term Follow Up ◽  
Mean Size ◽  
External Dacryocystorhinostomy ◽  
The Mean

Objective: To evaluate the effect of chronicity on the size of the ostium after external dacryocystorhinostomy (DCR) with intubation. Methods: Design: A retrospective chart review of patients who underwent external DCR with intubation over 10 years from January 2003 at a tertiary hospital. All patients were recruited and examined with rigid nasal endoscope. Results: A total number of 66 (85 eyes) patients were included. The mean age at the time of evaluation was 53.1 years with gender distribution of 54 females (81.8 %). The mean duration ±SD between the date of surgery and the date of evaluation was 33.2 ± 33.6 (6–118 months). Our study showed an overall anatomical and functional success of 98.8% and 95.3%, respectively. The mean size of the ostium (±SD) was 23.0 (±15.7) mm2 (ranging from 1 to 80.4 mm2). The size of the ostium was not a significant factor for failure ( p = 0.907). No statistically significant correlation was found between the long-term duration after surgery and the size of the ostium ( R: 0.025, p = 0.157). Conclusions: Nasal endoscopy after DCR is valuable in evaluating the ostium with no observed potential correlation between the long-term follow-up after surgery and the size of the ostium.

Pediatric Organ Donor Maintenance: Pathophysiologic Derangements and Nursing Requirements

PEDIATRICS ◽  
1989 ◽  
Vol 84 (4) ◽  
pp. 688-693
Author(s):  
N. Kissoon ◽  
T. C. Frewen ◽  
M. Bloch ◽  
M. Gayle ◽  
C. Stiller
Keyword(s):  
Chart Review ◽  
Premature Ventricular Contraction ◽  
Retrospective Chart Review ◽  
Stability Index ◽  
Organ Donor ◽  
Pulmonary Insufficiency ◽  
Organ Donors ◽  
Maintenance Time ◽  
Donor Support ◽  
The Mean

A retrospective chart review was conducted of 26 organ donors to determine hemodynamic and metabolic derangements encountered and nursing requirements for donor organ maintenance. There were 15 boys and 11 girls with a mean age 6.57 ± 5.46 years. Mean donor maintenance time was 10.5 ± 6.7 hours. Cardiorespiratory derangements included hypotension in 16, hypertension in 6, arrhythmias in 17 (premature ventricular contraction in 4, bradycardia in 8, paroxysmal atrial tachycardia in 3, and ventricular tachycardia in 2), asystolic events in 5, pulmonary insufficiency in 6, anemia in 8, and thrombocytopenia in 8. Metabolic and hormonal derangements included hyperglycemia in 18, hypokalemia in 20, hyperkalemia in 4, hyponatremia in 3, hypernatremia in 17, metabolic acidosis in 10, and diabetes insipidus in 15. Hypothermia (temperature 33.3°± 0.4°C, mean ± SD) occurred in 14 donors. The mean physiologic Stability Index score was 22.2 ± 4.7 and mean Therapeutic Intervention Score was 46.7 ± 5.8. Total number of nursing hours spent in donor maintenance was 424.5 hours. Therapies offered included diuretics in 10, sodium bicarbonate in 8, antibiotics in 6, insulin in 12, pitressin in 13, verapamil in 3, isoproterenol in 3, dopamine in 17, and intravenous potassium boluses in 14. Of the potential 26 donors, 46 kidneys, 8 hearts, 14 livers, 3 pancreas, and 9 corneas were retrieved in transplantable condition. With appropriate donor maintenance, organs suitable for transplantation can be retrieved despite significant pathophysiologic derangements. Physicians intending to provide donor support should be comfortable with invasive monitoring and cardiorespiratory support and be prepared to provide a nurse to patient ratio of 2:1 at the bedside.

scholarly journals Prevalence of amblyopia and patterns of refractive error in the amblyopic children of a tertiary eye care center of Nepal

2013 ◽  
Vol 5 (1) ◽  
pp. 38-44 ◽  
Author(s):  
K Sapkota ◽  
A Pirouzian ◽  
NS Matta
Keyword(s):  
Visual Acuity ◽  
Refractive Error ◽  
Chart Review ◽  
Care Center ◽  
Retrospective Chart Review ◽  
Ophthalmological Examination ◽  
Eye Care ◽  
Common Cause ◽  
Ocular Pathology ◽  
The Mean

Introduction: Refractive error is a common cause of amblyopia. Objective: To determine prevalence of amblyopia and the pattern and the types of refractive error in children with amblyopia in a tertiary eye hospital of Nepal. Materials and methods: A retrospective chart review of children diagnosed with amblyopia in the Nepal Eye Hospital (NEH) from July 2006 to June 2011 was conducted. Children of age 13+ or who had any ocular pathology were excluded. Cycloplegic refraction and an ophthalmological examination was performed for all children. The pattern of refractive error and the association between types of refractive error and types of amblyopia were determined. Results: Amblyopia was found in 0.7 % (440) of 62,633 children examined in NEH during this period. All the amblyopic eyes of the subjects had refractive error. Fifty-six percent (248) of the patients were male and the mean age was 7.74 ± 2.97 years. Anisometropia was the most common cause of amblyopia (p < 0.001). One third (29 %) of the subjects had bilateral amblyopia due to high ametropia. Forty percent of eyes had severe amblyopia with visual acuity of 20/120 or worse. About twothirds (59.2 %) of the eyes had astigmatism. Conclusion: The prevalence of amblyopia in the Nepal Eye Hospital is 0.7%. Anisometropia is the most common cause of amblyopia. Astigmatism is the most common types of refractive error in amblyopic eyes. Nepal J Ophthalmol 2013; 5(9):38-44 DOI: http://dx.doi.org/10.3126/nepjoph.v5i1.7820

scholarly journals The mortality of ill infants with false tooth extraction in a rural Ugandan emergency department

2017 ◽  
Vol 8 (1) ◽  
Author(s):  
Amyna Husain ◽  
M. Douglas Baker ◽  
Mark C. Bisanzo ◽  
Martha W. Stevens
Keyword(s):  
Emergency Department ◽  
Tooth Extraction ◽  
Chart Review ◽  
Statistical Significance ◽  
Univariate Analysis ◽  
Retrospective Chart Review ◽  
Cultural Practice ◽  
Fluid Bolus ◽  
Significant Difference ◽  
To Receive

False tooth extraction (FTE), a cultural practice in East Africa used to treat fever and diarrhea in infants, has been thought to increase infant mortality. The mortality of clinically similar infants with and without false tooth extraction has not previously been examined. The objective of our retrospective cohort study was to examine the mortality, clinical presentation, and treatment of infants with and without false tooth extraction. We conducted a retrospective chart review of records of infants with diarrhea, sepsis, dehydration, and fever in a rural Ugandan emergency department. Univariate analysis was used to test statistical significance. We found the mortality of infants with false tooth extraction (FTE+) was 18% and without false tooth extraction (FTE−) was 14% (P=0.22). The FTE+ study group, and FTE− comparison group, had similar proportions of infants with abnormal heart rate and with hypoxia. There was a significant difference in the portion of infants that received antibiotics (P=0.001), and fluid bolus (P=0.002). Although FTE+ infants had clinically similar ED presentations to FTE− infants, the FTE+ infants were significantly more likely to receive emergency department interventions, and had a higher mortality than FTE− infants.

64-LB: Glucose Control after Initiation of Flash Glucose Monitoring in Type 2 Diabetes Managed with Basal Insulin: A Retrospective Real-World Chart Review Study from the U.S.

Diabetes ◽  
2021 ◽  
Vol 70 (Supplement 1) ◽  
pp. 64-LB
Author(s):  
ANDERS L. CARLSON ◽  
TIMOTHY D. DANIEL ◽  
ANDREA DESANTIS ◽  
SERGE JABBOUR ◽  
ESRA KARSLIOGLU-FRENCH ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Real World ◽  
Glucose Control ◽  
Basal Insulin ◽  
Chart Review ◽  
Glucose Monitoring ◽  
Flash Glucose Monitoring ◽  
Review Study ◽  
The U.S

Appropriateness of Imaging Decisions for Low Back Pain Presenting to the Emergency Department: A Retrospective Chart Review Study

2021 ◽  
Author(s):  
Adrian Traeger ◽  
Gustavo C Machado ◽  
Sally Bath ◽  
Martin Tran ◽  
Lucinda Roper ◽  
...  
Keyword(s):  
Emergency Department ◽  
Low Back Pain ◽  
Back Pain ◽  
Chart Review ◽  
Imaging Modality ◽  
Cauda Equina ◽  
Retrospective Chart Review ◽  
Low Back ◽  
Review Study ◽  
Hospital Emergency Departments

ABSTRACT Background Imaging for low back pain is widely regarded as a target for efforts to reduce low value care. We aimed to estimate the prevalence of overuse and underuse of lumbar imaging in the Emergency Department. Methods Retrospective chart review study of five public hospital Emergency Departments in Sydney, Australia, in 2019/20. We reviewed the clinical charts of consecutive adult patients who presented with a complaint of low back pain and extracted clinical features relevant to a decision to request lumbar imaging. We estimated the proportion of encounters where a decision to request lumbar imaging was inappropriate (overuse) or where a clinician did not request an appropriate and informative lumbar imaging test when indicated (underuse). Results 649 patients presented with a complaint of low back pain of which 158 (24.3%) were referred for imaging. 79 (12.2%) had a combination of features suggesting lumbar imaging was indicated according to clinical guidelines. The prevalence of overuse and underuse of lumbar imaging was 8.8% (57 of 649 cases, 95%CI 6.8% to 11.2%) and 4.3% (28 of 649 cases, 95%CI 3.0% to 6.1%), respectively. 13 cases were classified as underuse because the patient was referred for an uninformative imaging modality (e.g. referred for radiography for suspected cauda equina syndrome). Conclusion In this study of emergency care there was evidence of overuse of lumbar imaging, but also underuse through failure to request lumbar imaging when indicated or referral for an uninformative imaging modality. These three issues seem more important targets for quality improvement than solely focusing on overuse.

Abstract WP252: Reduction in Stroke Readmission Rates After Implementing an Emergency Department-based Transient Ischemic Attack Observation Unit

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Lori Fayas ◽  
Kathy Polum ◽  
Heather Stanko
Keyword(s):  
Emergency Department ◽  
Comprehensive Evaluation ◽  
Recurrent Stroke ◽  
Retrospective Chart Review ◽  
Rapid Evaluation ◽  
Observation Unit ◽  
Readmission Rates ◽  
Community Based ◽  
Ischemic Attack ◽  
Work Up

Background and Purpose —Diagnosis and treatment of transient ischemic attacks (TIAs) is often delayed by lack of access to immediate comprehensive evaluation of the underlying etiology. Early initiation of treatment can reduce the risk of early recurrent stroke by up to 80%. Up to 40% of people who have experienced a TIA will go on to have a stroke. The purpose of this review was to determine the efficacy of an Emergency Department (ED)-based TIA observation unit using a standardized TIA protocol designed to provide rapid evaluation and treatment of patients presenting with TIA in reducing the rates of readmission with stroke to a community-based hospital. Methods —We did a retrospective chart review of all patients discharged from Bellin Hospital with a diagnosis of stroke before implementing a standardized TIA protocol in our ED-based TIA observation unit (July to December 2010) and after implementation of the TIA observation unit (November 2011 to April 2012). We identified the patients in these cohorts who had previously been evaluated in the ED with signs or symptoms of stroke in the 6 months prior to admission and compared their stroke readmission rates. Patients who received evaluation through the TIA observation unit from November 2011 to April 2012 were monitored for readmission for stroke in the 6 months after evaluation. Results —Prior to use of the TIA observation unit, 7 of 51 (13.7%) patients discharged with a diagnosis of stroke had been seen in the ED in the previous 6 months with stroke-like symptoms. After implementation of the TIA observation unit, 7 of 119 (5.9%) patients discharged with a diagnosis of stroke had been seen in the ED, a 57.1% reduction in stroke readmission at 6 months. Of these, 4 (57.1%) had not completed the work-up during their previous ED visit. 122 patients underwent evaluation using the TIA observation unit. Of these, only 3 (2.5%) patients were readmitted for stroke in the next 6 months. 16 of these 122 (13.1%) patients were diagnosed with stroke during their TIA work-up. Conclusions —Rapid evaluation and treatment of TIA through an ED-based TIA observation unit substantially reduces the risk of readmission for stroke.

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