The Alternative Pre-hospital Pathway team: reducing conveyances to the emergency department through patient centered Community Emergency Medicine

Abstract Background Internationally increasing demand for emergency care is driving innovation within emergency services. The Alternative Pre-Hospital Pathway (APP) Team is one such Community Emergency Medicine (CEM) initiative developed in Cork, Ireland to target low acuity emergency calls. In this paper the inception of the APP Team is described, and an observational descriptive analysis of the APP Team’s service data presented for the first 12 months of operation. The aim of this study is to describe and analyse the APP team service. Methods The APP Team, consisting of a Specialist Registrar (SpR) in Emergency Medicine (EM) and an Emergency Medical Technician (EMT) based in Cork, covers a mixed urban and rural population of approximately 300,000 people located within a 40-min drive time of Cork University Hospital. The team are dispatched to low acuity 112/999 calls, aiming to provide definitive care or referring patients to the appropriate community or specialist service. A retrospective analysis was performed of the team’s first 12 months of operation using the prospectively maintained service database. Results Two thousand and one patients were attended to with a 67.8% non-conveyance rate. The median age was 62 years, with 33.0% of patients aged over 75 years. For patients over 75 years, the non-conveyance rate was 62.0%. The average number of patients treated per shift was 7. Medical complaints (319), falls (194), drug and alcohol related presentations (193), urological (131), and respiratory complaints (119) were the most common presentations. Conclusion Increased demand for emergency care and an aging population is necessitating a re-design of traditional models of emergency care delivery. We describe the Alternative Pre-Hospital Pathway service, delivered by an EMT and an Emergency Medicine SpR responding to low acuity calls. This service achieved a 68% non-conveyance rate; our data demonstrates that a community emergency medicine outreach team in collaboration with the National Ambulance Service offering Alternative Pre-Hospital Pathways is an effective model for reducing conveyances to hospital.

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Defining emergency telehealth

Journal of Telemedicine and Telecare ◽

10.1177/1357633x19891653 ◽

2019 ◽

pp. 1357633X1989165

Author(s):

Neal Sikka ◽

Hartmut Gross ◽

Aditi U Joshi ◽

Edward Shaheen ◽

Michael J Baker ◽

...

Keyword(s):

Emergency Medicine ◽

Emergency Services ◽

Care Delivery ◽

Quality Care ◽

Cost Effective ◽

Public Health Care ◽

Emergency Physicians ◽

Working Definition ◽

Effective Manner ◽

Definition Of

The American College of Emergency Physicians Emergency Telehealth Section was charged with development of a working definition of emergency telehealth that aligns with the College’s definition of emergency medicine. A modified Delphi method was used by the section membership who represented telehealth providers in both private and public health-care delivery systems, academia and industry, rural and urban settings. Presented in this manuscript is the final definition of emergency telehealth developed with an additional six clarifying statements to address the context of the definition. Emergency telehealth is a core domain of emergency medicine and is inclusive of remotely providing all types of care for acute conditions of any kind requiring expeditious care irrespective of any prior relationship. The development of this definition is important to the global community of emergency physicians and all patients seeking acute care to ensure that appropriately trained clinicians are providing the highest quality of emergency services via the telehealth modality. We recommend implementing emergency telehealth in a manner that ensures appropriate qualifications of providers, appropriate/parity reimbursement for telehealth services and, most importantly, the delivery of quality care to patients in a safe, efficient, timely and cost-effective manner.

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A Narrative Review of Trauma Care Delivery in India: Challenges and Opportunities

Journal of Surgery and Trauma ◽

10.32592/jsurgery.2021.9.2.101 ◽

2021 ◽

pp. 44-49

Keyword(s):

Emergency Medicine ◽

Delivery System ◽

Emergency Care ◽

Trauma Care ◽

Motor Vehicle ◽

Care Delivery ◽

Public Healthcare ◽

Infrastructure Development ◽

Road Accidents ◽

Challenges And Opportunities

It is estimated that the cost of road accidents in India is around 3% of the Gross Domestic Product of the country. On average, 400 persons die daily in road accidents in India, and cities, such as New Delhi and the national capital region are on the top of the list of road accident causalities. Based on the Basilica agreement, the Indian government has initiated various policy changes and infrastructure development along the national highways which include the redesign of blindspots on the roads and the infliction of heavy penalties for the violation of traffic rules and compliances. On the academic front, the Indo-US Emergency Medicine forum has inaugurated an academic college for emergency medicine in India that cooperates with various government and private healthcare providers and policymakers for the improvement of emergency/trauma care delivery. Lately, few business schools and healthcare educational institutes have focused on interdisciplinary training and research centers in the area of emergency care delivery. Policymakers are also proactively working with various organizations to implement new rules and compliance mechanisms. This prospective study entails a detailed review of the literature using keywords in the PubMed journals, news articles, and media reports. Authors encountered studies in the area of trauma care delivery in India and other countries in their comprehensive field research. Almost 100% of the cases were medico-legal and only one case out of 100 was an insured patient. Furthermore, 87% of the cases were new and only 13% were review cases. Based on the conducted analysis, the number of accidents reduced across the country after the implementation of the New Motor Vehicle Act in the year 2019. It is worth mentioning that, the government launched awareness programs for the public as well. Some of the major challenges identified included lack of coordination and institutional mechanisms for an integrated emergency care delivery, poor referral processes, inadequate ambulance services, lack of third-party coordination, and poor in-hospital resources, particularly in public healthcare organizations. Apart from these, there was an acute shortage of trained emergency medicine experts at all levels. Trauma care delivery is a complex issue and its accomplishment requires good coordination and collaboration among stakeholders. The study identified various challenges and opportunities for the improvement of trauma care delivery in India. There is an immense need and opportunity for the modification of the emergency care delivery system through the introduction of appropriate changes in the transportation policy, emergency care delivery models, institutional mechanisms, such as referral process, and appropriate resource allocation at different levels of care delivery system.

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The future of emergency medicine in Canada: submission from CAEP to the Romanow Commission. Part 1

CJEM ◽

10.1017/s1481803500007788 ◽

2002 ◽

Vol 4 (05) ◽

pp. 359-368 ◽

Cited By ~ 7

Author(s):

Keyword(s):

Health Care ◽

Emergency Medicine ◽

Health Care System ◽

Emergency Care ◽

Care Delivery ◽

Prehospital Care ◽

Public Health Care ◽

Canadian Association ◽

The Future ◽

Care System

ABSTRACT: In April 2001, the Commission on the Future of Health Care in Canada was established. The Honorable Roy Romanow was given the mandate to “inquire into and undertake dialogue with Canadians on the future of Canada’s public health care system” and “to develop recommendations that will ensure the long-term sustainability of a high quality, universally accessible, publicly administered health care system, for all Canadians.” The Canadian Association of Emergency Physicians (CAEP) recognized an obligation to share in this public dialogue, to communicate the current state of emergency medicine, and to identify the components necessary to achieve excellence in emergency care. The CAEP Advocacy Committee was asked to develop a document that would educate and enlighten the Commissioner. Basic themes were identified, and authors from across the country were invited to write brief, factual essays with achievable recommendations. The resulting series of essays was presented on April 30, 2002, at the Health Care Commission’s open public hearing in Calgary, Alberta. This article, part 1 of a 2-part series, includes discussions of Urban Emergency Care Delivery, Rural Emergency Care, Emergency Care for Children, Prehospital Care and Emergency Medical Services, and National Standards for Hospital Emergency Services.

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Tingkat Ketergantungan dan Lama Perawatan Pasien Rawat Observasi di IGD

Jurnal Keperawatan Padjadjaran ◽

10.24198/jkp.v2i3.89 ◽

1970 ◽

Vol 2 (3) ◽

Author(s):

Erlan Nurmansyah ◽

F Sri Susilaningsih ◽

Setiawan S

Keyword(s):

Nursing Care ◽

Care Delivery ◽

Care Service ◽

Descriptive Analysis ◽

Sampling Technique ◽

Consecutive Sampling ◽

Patient Dependency ◽

Number Of Patients ◽

Need To Evaluate ◽

Observation Period

Ketidakseimbangan jumlah pasien dan ketersediaan ruang rawat dapat berakibat pada memanjangnya masa rawat pasien di Instalasi Gawat Darurat (IGD). Hal tersebut berdampak pada bertambahnya aktivitas dan beban kerja perawat selama pasien menunggu ketersediaan ruang rawat inap di ruang IGD. Berdasarkan situasi tersebut, penting untuk mengidentifikasi tingkat ketergantungan pasien selama periode rawat observasi dan rata-rata waktu yang digunakan untuk perawatan pasien rawat observasi selama pasien menjadi tanggung jawab perawat IGD. Penelitian deskriptif dilakukan melalui observasi terhadap pasien yang menjalani rawat observasi di IGD dan intervensi keperawatan yang diterima, serta jumlah waktu yang dipergunakan dalam perawatan tersebut. Teknik consecutive sampling dipergunakan untuk menetapkan pasien sebagai sampel penelitian.dan sebanyak 74 pasien rawat observasi dilibatkan dalam penelitian ini. Data dianalisis secara deskriptif. Hasil penelitian menunjukkan bahwa sebaran tingkat ketergantungan pasien rawat observasi adalah ketergantungan minimal (37,84%), sedang (25,68%), agak berat (24,32%), dan maksimal (12,16%). Rata-rata waktu yang digunakan untuk perawatan pasien rawat observasi 19 menit/perawat/shift dan total waktu 3,72 jam perhari. Implikasi penelitian bagi rumah sakit yaitu perlu dilakukan evaluasi terhadap adanya peningkatan beban kerja perawat IGD dan perencanaan kebutuhan ruang transientdi luar IGD.Kata kunci:Beban kerja perawat, gawat darurat, ketergantungan pasienAbstractAn imbalances between number of patients beimg admitted in Emergency Department (ED) and the availability of beds in it’s department have an impact on the length of stay of patient who actually have to be discharged from ED. This problem will affect to the additional nurses activity and the workload, as these pastient should wait to the availability of rooms for the inpatient care in the transient rooms. Based on this situation, it is important to identify the level of dependency of patient during the observation period in transient rooms, and the time consumtion for delivering nursing care service, since it’s being the responsibility of ED nurses. This data was collected through observations and analyzed with descriptive analysis (percentage). Consecutive sampling technique was administered 74 patients who receives nusing service in this transient room involved in this study. The results of this study obtained that distribution of level dependency of observed patients was minimal dependency (37.84%), medium (25.68%), (24.32%) is higher dependency, and maximal dependency (12.16%). The average time consumtion for nursing care delivery is 19 minutes/nurses/shift, and the total time consumtion is 3,72 hours/day. The implication of this study is for the Hospital need to evaluate the additional workload of the ED nurses, and need to plan the availability of transient room out side the ED.Key words:Nursing workload, emergency, patient dependency

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Delivering Community Emergency Medicine during the COVID-19 pandemic: the Physician Response Unit

Emergency Medicine Journal ◽

10.1136/emermed-2020-210112 ◽

2021 ◽

Vol 38 (5) ◽

pp. 371-372

Author(s):

Rich Carden ◽

Bill Leaning ◽

Tony Joy

Keyword(s):

Emergency Medicine ◽

Emergency Care ◽

Hospital Admissions ◽

Hospital Setting ◽

Response Unit ◽

Care Services ◽

Vulnerable Patients ◽

Palliative Care Services ◽

Alternative Solutions ◽

Physician Response

The COVID-19 pandemic has presented significant challenges to services providing emergency care, in both the community and hospital setting. The Physician Response Unit (PRU) is a Community Emergency Medicine model, working closely with community, hospital and pre-hospital services. In response to the pandemic, the PRU has been able to rapidly introduce novel pathways designed to support local emergency departments (EDs) and local emergency patients. The pathways are (1) supporting discharge from acute medical and older people’s services wards into the community; (2) supporting acute oncology services; (3) supporting EDs; (4) supporting palliative care services. Establishing these pathways have facilitated a number of vulnerable patients to access patient-focussed and holistic definitive emergency care. The pathways have also allowed EDs to safely discharge patients to the community, and also mitigate some of the problems associated with trying to maintain isolation for vulnerable patients within the ED. Community Emergency Medicine models are able to reduce ED attendances and hospital admissions, and hence risk of crowding, as well as reducing nosocomial risks for patients who can have high-quality emergency care brought to them. This model may also provide various alternative solutions in the delivery of safe emergency care in the postpandemic healthcare landscape.

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Impact of the COVID-19 pandemic and its related psychological effect on orthopedic surgeries conducted in different types of hospitals in Taiwan

Journal of Orthopaedic Surgery ◽

10.1177/2309499021996072 ◽

2021 ◽

Vol 29 (1) ◽

pp. 230949902199607 ◽

Cited By ~ 1

Author(s):

Chia-Lung Shih ◽

Peng-Ju Huang ◽

Hsuan-Ti Huang ◽

Chung-Hwan Chen ◽

Tien-Ching Lee ◽

...

Keyword(s):

Community Hospital ◽

University Hospital ◽

Total Knee Arthroplasties ◽

Peak Period ◽

Number Of Patients ◽

Total Knee ◽

Investigation Period ◽

Orthopedic Diseases ◽

The University ◽

The Impact

Aim: Taiwan’s response to the coronavirus disease 2019 (COVID-19) differed in that it successfully prevented the spread without having to shutdown or overburden medical services. Patients’ fear regarding the pandemic would be the only reason to reduce surgeries, so Taiwan could be the most suitable place for research on the influence of psychological factors. This study aimed to assess the impact of patients’ fear on orthopedic surgeries in Taiwan amid the peak period of the COVID-19 pandemic. Patients and Methods: The investigation period included the COVID-19 pandemic (March 2020 to April 2020) and the corresponding period in the previous year. The following data on patients with orthopedic diseases were collected: outpatient visits, hospital admission, and surgical modalities. Results: The COVID-19 pandemic led to a 22%–29% and 20%–26% reduction in outpatients, 22%–27% and 25%–37% reduction in admissions, and 26%–35% and 18%–34% reduction in surgeries, respectively, at both hospitals. The weekly mean number of patients was significantly smaller during the COVID-19 pandemic for all types of surgery and elective surgeries at the university hospital, and for all types of surgery, elective surgeries, and total knee arthroplasties at the community hospital. Further, patients visiting the community hospital during the pandemic were significantly younger, for all types of surgery, elective surgeries, and total knee arthroplasties. Conclusions: The reduction in orthopedic surgeries in Taiwan’s hospitals during COVID-19 could be attributed to patients’ fear. Even without restriction, the pandemic inevitably led to a reduction of about 20%–30% of the operation volume.

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A multicenter randomized trial to assess the efficacy of CONvalescent plasma therapy in patients with Invasive COVID-19 and acute respiratory failure treated with mechanical ventilation: the CONFIDENT trial protocol

BMC Pulmonary Medicine ◽

10.1186/s12890-020-01361-x ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Benoît Misset ◽

Eric Hoste ◽

Anne-Françoise Donneau ◽

David Grimaldi ◽

Geert Meyfroidt ◽

...

Keyword(s):

Mechanical Ventilation ◽

Respiratory Failure ◽

Neutralizing Antibodies ◽

Ethical Issues ◽

High Titer ◽

Passive Immunization ◽

University Hospital ◽

Optimal Time ◽

Relative Reduction ◽

Number Of Patients

Abstract Background The COVID-19 pandemic reached Europe in early 2020. Convalescent plasma is used without a consistent evidence of efficacy. Our hypothesis is that passive immunization with plasma collected from patients having contracted COVID-19 and developed specific neutralizing antibodies may alleviate symptoms and reduce mortality in patients treated with mechanical ventilation for severe respiratory failure during the evolution of SARS-CoV-2 pneumonia. Methods We plan to include 500 adult patients, hospitalized in 16 Belgian intensive care units between September 2020 and 2022, diagnosed with SARS-CoV-2 pneumonia, under mechanical ventilation for less than 5 days and a clinical frailty scale less than 6. The study treatment will be compared to standard of care and allocated by randomization in a 1 to 1 ratio without blinding. The main endpoint will be mortality at day 28. We will perform an intention to treat analysis. The number of patients to include is based on an expected mortality rate at day 28 of 40 percent and an expected relative reduction with study intervention of 30 percent with α risk of 5 percent and β risk of 20 percent. Discussion This study will assess the efficacy of plasma in the population of mechanically ventilated patients. A stratification on the delay from mechanical ventilation and inclusion will allow to approach the optimal time use. Selecting convalescent plasmas with a high titer of neutralizing antibodies against SARS-CoV-2 will allow a homogeneous study treatment. The inclusion in the study is based on the consent of the patient or his/her legal representative, and the approval of the Investigational Review Board of the University hospital of Liège, Belgium. A data safety monitoring board (DSMB) has been implemented. Interim analyses have been planned at 100, 2002, 300 and 400 inclusions in order to decide whether the trail should be discontinued prematurely for ethical issues. We plan to publish our results in a peer-reviewed journal and to present them at national and international conferences. Funding and registration The trial is funded by the Belgian Health Care Knowledge Center KCE # COV201004 Trial registration Clinicaltrials.gov registration number NCT04558476. Registered 14 September 2020—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04558476

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Sonographic Evaluation of Hidradenitis Suppurativa with Smartphone-Linked Portable Ultrasound

Dermatology ◽

10.1159/000513920 ◽

2021 ◽

pp. 1-5

Author(s):

Maximillian A. Weigelt ◽

Yuval Hilerowicz ◽

Jeffrey A. Leichter ◽

Hadar Lev-Tov

Keyword(s):

Hidradenitis Suppurativa ◽

Wound Care ◽

University Hospital ◽

Clinical Staging ◽

Routine Practice ◽

Portable Ultrasound ◽

Number Of Patients ◽

Staging Systems ◽

Conventional Ultrasound ◽

Potential Benefits

Background: Clinical staging systems for hidradenitis suppurativa (HS) have poor interrater reliability and may underestimate disease activity. Sonographic staging systems may overcome these challenges, but conventional ultrasound (US) machines are expensive and bulky. Portable (p)US may facilitate the integration of sonography into routine practice. Objectives: To assess the ability of a novel smartphone-linked pUS device to identify key sonographic lesions of HS. Methods: The charts of 16 patients with HS who were assessed with pUS at the outpatient Dermatology and Wound Care Clinics of a university hospital center were retrospectively reviewed. Clinical and sonographic images of the affected areas were examined. The main outcome measures were the number of patients with identifiable sonographic lesions and the number of patients with subclinical lesions detected by pUS. Results: All 3 key sonographic lesions of HS were identifiable with pUS. Sonographic lesions were identified in 10 patients (62.5%). Subclinical lesions were identified in 2 patients (12.5%); in both cases, this affected management decisions. Conclusions: We demonstrate the ability of pUS to identify the key sonographic lesions of HS. pUS is a simple and affordable way to integrate HSUS into clinical and research settings, with clear potential benefits to patients.

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A Descriptive Analysis of the Use of Twitter by Emergency Medicine Residency Programs

Journal of Graduate Medical Education ◽

10.4300/jgme-d-16-00716.1 ◽

2018 ◽

Vol 10 (1) ◽

pp. 51-55 ◽

Cited By ~ 5

Author(s):

David Diller ◽

Lalena M. Yarris

Keyword(s):

Emergency Medicine ◽

Medical Education ◽

Descriptive Analysis ◽

Descriptive Statistics ◽

Mixed Methods Study ◽

Instructional Tool ◽

Residency Programs ◽

The Public ◽

Twitter Account ◽

E Mail

ABSTRACT Background Twitter is increasingly recognized as an instructional tool by the emergency medicine (EM) community. In 2012, the Council of Residency Directors in Emergency Medicine (CORD) recommended that EM residency programs' Twitter accounts be managed solely by faculty. To date, little has been published regarding the patterns of Twitter use by EM residency programs. Objective We analyzed current patterns in Twitter use among EM residency programs with accounts and assessed conformance with CORD recommendations. Methods In this mixed methods study, a 6-question, anonymous survey was distributed via e-mail using SurveyMonkey. In addition, a Twitter-based search was conducted, and the public profiles of EM residency programs' Twitter accounts were analyzed. We calculated descriptive statistics and performed a qualitative analysis on the data. Results Of 168 Accreditation Council for Graduate Medical Education–accredited EM programs, 88 programs (52%) responded. Of those programs, 58% (51 of 88) reported having a program-level Twitter account. Residents served as content managers for those accounts in the majority of survey respondents (61%, 28 of 46). Most programs did not publicly disclose the identity or position of their Twitter content manager. We found a wide variety of applications for Twitter, with EM programs most frequently using Twitter for educational and promotional purposes. There is significant variability in the numbers of followers for EM programs' Twitter accounts. Conclusions Applications and usage among EM residency programs are varied, and are frequently not consistent with current CORD recommendations.

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Analysis of the infant traffic injuries peculiarities of according to the trauma mechanism and optimization of the emergency care principles

Practical medicine ◽

10.32000/2072-1757-2021-3-99-102 ◽

2021 ◽

Vol 19 (3) ◽

pp. 99-102

Author(s):

Yo. B. GULYAMOV ◽

◽

D. A. LATIPOV ◽

N. R. ISHBURIEV ◽

Yo. Yo. JOYNAROV ◽

...

Keyword(s):

Emergency Medicine ◽

Emergency Care ◽

Traffic Accidents ◽

Injury Mechanism ◽

Associated Injuries ◽

Trauma Mechanism ◽

Internal Organs ◽

Diagnostic Measures ◽

Combined Injuries ◽

All Treatment

The article analyzes the injuries in children received as a result of traffic accidents, depending on the injury mechanism. For those children, who were in the car, predominantly local injuries of the MSS were noted with a smaller number of associated injuries. For those children, who were hit by a car, severe polyfocal injuries of MSS with damage to internal organs were noted. The principles of providing qualified and specialized emergency medicine to the children with combined injuries are described, that improve the efficiency and adequacy of all treatment-diagnostic measures and their qualified implementation.

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