scholarly journals The mobile emergency recovery intervention trial (MERIT): Protocol for a 3-year mixed methods observational study of mobile recovery outreach teams in Nevada’s emergency departments

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258795
Author(s):  
Krysti P. Smith ◽  
Roy F. Oman ◽  
Minggen Lu ◽  
Ashley D. Dawkins ◽  
Robert W. Harding ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Emergency Departments ◽  
Emergency Department Visits ◽  
List Type ◽  
Opioid Epidemic ◽  
Intervention Trial ◽  
Public Health Response ◽  
Research Activities ◽  
Fatal Overdose ◽  
Evaluation Phase

Background The Substance Abuse and Mental Health Administration awarded State Targeted Response grants to support states’ efforts to address the opioid epidemic. In Nevada, one component of this grant was mobile recovery outreach teams (MROTs) that utilized peer recovery support specialists to provide care for qualifying patients in emergency departments (EDs). The Mobile Emergency Recovery Intervention Trial (MERIT) is a mixed methods study to assess the feasibility/acceptability and effectiveness of the MROT intervention. This protocol mainly describes the R33 research activities and outcomes. The full protocol can be found protocols.io. Methods Data will be derived from state-level data sets containing de-identified emergency department visits, substance use disorder treatment records, and mortality files; in-person mixed methods interviews; participant observation; and self-report process evaluation forms. Primary outcomes include Medication Assisted Treatment (MAT) initiation and non-fatal overdose; secondary outcomes include MAT retention and fatal overdose. Quantitative hypotheses will be tested using generalized linear mixed effects models, Bayesian hierarchical models, and marginal Cox models. Qualitative interview data will be analyzed using an inductive thematic analysis procedure. Discussion It is impossible to conduct a randomized controlled trial of the effectiveness of the MROTs, given the ethical and logistical considerations of this intervention. This study’s innovative design employs a mixed methods formative phase to examine feasibility and acceptability, and a quasi-experimental outcomes evaluation phase employing advanced statistical methods to mitigate bias and suggest causal inference regarding the effectiveness of the MROTs. Innovative interventions have been deployed in many states; evidence regarding their effectiveness is lacking, but critical to informing an effective public health response to the opioid epidemic.

scholarly journals Changing the Narrative: Refocusing the Efforts of Emergency Departments in the Opioid Epidemic

2018 ◽  
Vol 33 (4) ◽  
pp. 345-347 ◽  
Author(s):  
Jennifer Voelker ◽  
Vittorio Maio ◽  
Priya Mammen
Keyword(s):  
Emergency Departments ◽  
Opioid Epidemic

scholarly journals Drivers of ‘clinically unnecessary’ use of emergency and urgent care: the DEUCE mixed-methods study

2020 ◽  
Vol 8 (15) ◽  
pp. 1-256
Author(s):  
Alicia O’Cathain ◽  
Emma Knowles ◽  
Jaqui Long ◽  
Janice Connell ◽  
Lindsey Bishop-Edwards ◽  
...  
Keyword(s):  
General Practice ◽  
Mixed Methods ◽  
General Practitioner ◽  
Health Service ◽  
Health Services ◽  
Focus Groups ◽  
Emergency Departments ◽  
Help Seeking ◽  
Mixed Methods Study ◽  
Coping Capacity

Background There is widespread concern about the pressure on emergency and urgent services in the UK, particularly emergency ambulances, emergency departments and same-day general practitioner appointments. A mismatch between supply and demand has led to interest in what can be termed ‘clinically unnecessary’ use of services. This is defined by the research team in this study as ‘patients attending services with problems that are classified as suitable for treatment by a lower urgency service or self-care’. This is a challenging issue to consider because patients may face difficulties when deciding the best action to take, and different staff may make different judgements about what constitutes a legitimate reason for service use. Objectives To identify the drivers of ‘clinically unnecessary’ use of emergency ambulances, emergency departments and same-day general practitioner appointments from patient and population perspectives. Design This was a sequential mixed-methods study with three components: a realist review; qualitative interviews (n = 48) and focus groups (n = 3) with patients considered ‘clinically unnecessary’ users of these services, focusing on parents of young children, young adults and people in areas of social deprivation; and a population survey (n = 2906) to explore attitudes towards seeking care for unexpected, non-life-threatening health problems and to identify the characteristics of someone with a tendency for ‘clinically unnecessary’ help-seeking. Results From the results of the three study components, we found that multiple, interacting drivers influenced individuals’ decision-making. Drivers could be grouped into symptom related, patient related and health service related. Symptom-related drivers were anxiety or need for reassurance, which were caused by uncertainty about the meaning or seriousness of symptoms; concern about the impact of symptoms on daily activities/functioning; and a need for immediate relief of intolerable symptoms, particularly pain. Patient-related drivers were reduced coping capacity as a result of illness, stress or limited resources; fear of consequences when responsible for another person’s health, particularly a child; and the influence of social networks. Health service-related drivers were perceptions or previous experiences of services, particularly the attractions of emergency departments; a lack of timely access to an appropriate general practitioner appointment; and compliance with health service staff’s advice. Limitations Difficulty recruiting patients who had used the ambulance service to the interviews and focus groups meant that we were not able to add as much as we had anticipated to the limited evidence base regarding this service. Conclusions Patients use emergency ambulances, emergency departments and same-day general practitioner appointments when they may not need the level of clinical care provided by these services for a multitude of inter-related reasons that sometimes differ by population subgroup. Some of these reasons relate to health services, in terms of difficulty accessing general practice leading to use of emergency departments, and to population-learnt behaviour concerning the positive attributes of emergency departments, rather than to patient characteristics. Social circumstances, such as complex and stressful lives, influence help-seeking for all three services. Demand may be ‘clinically unnecessary’ but completely understandable when service accessibility and patients’ social circumstances are considered. Future work There is a need to evaluate interventions, including changing service configuration, strengthening general practice and addressing the stressors that have an impact on people’s coping capacity. Different subgroups may require different interventions. Study registration This study is registered as PROSPERO CRD42017056273. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 15. See the NIHR Journals Library website for further project information.

scholarly journals Providers' Perceptions of Caring for Pediatric Patients in Community Hospital Emergency Departments: A Mixed‐methods Analysis

2018 ◽  
Vol 25 (12) ◽  
pp. 1385-1395 ◽  
Author(s):  
Michael P. Goldman ◽  
Ambrose H. Wong ◽  
Ambika Bhatnagar ◽  
Beth L. Emerson ◽  
Linda L. Brown ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Emergency Departments ◽  
Pediatric Patients ◽  
Community Hospital ◽  
Hospital Emergency ◽  
Hospital Emergency Departments

scholarly journals Building and strengthening relationships between academic departments/divisions of emergency medicine and rural and regional emergency departments

CJEM ◽  
2019 ◽  
Vol 21 (5) ◽  
pp. 595-599 ◽  
Author(s):  
Aaron Johnston ◽  
Kylie Booth ◽  
Jim Christenson ◽  
David Fu ◽  
Shirley Lee ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Emergency Departments ◽  
Academic Departments ◽  
List Type ◽  
Emergency Physicians ◽  
Common Value ◽  
Rural And Urban ◽  
Canadian Association ◽  
Rural Physicians ◽  
Training Opportunities

ABSTRACTObjectivesMake recommendations on approaches to building and strengthening relationships between academic departments or divisions of Emergency Medicine and rural and regional emergency departments.MethodsA panel of leaders from both rural and urban/academic practice environments met over 8 months. Draft recommendations were developed from panel expertise as well as survey data and presented at the 2018 Canadian Association of Emergency Physicians (CAEP) Academic Symposium. Symposium feedback was incorporated into final recommendations.ResultsSeven recommendations emerged and are summarized below: 1)CAEP should ensure engagement with other rural stakeholder organizations such as the College of Family Physicians of Canada and the Society of Rural Physicians of Canada.2)Engagement efforts require adequate financial and manpower resources.3)Training opportunities should be promoted.4)The current operational interface between the academic department of Emergency Medicine and the emergency departments in the catchment area must be examined and gaps addressed as part of building and strengthening relationships.5)Initial engagement efforts should be around projects with common value.6)Academic Departments should partner with and support rural scholars.7)Academic departments seeking to build or strengthen relationships should consider successful examples from elsewhere in the country as well as considering local culture and challenges.ConclusionThese recommendations serve as guidance for building and strengthening mutually beneficial relationships between academic departments or divisions of Emergency Medicine and rural and regional emergency departments.

scholarly journals A mixed-methods assessment of the impact of the opioid epidemic on first responder burnout

2019 ◽  
Vol 205 ◽  
pp. 107620 ◽  
Author(s):  
Erika Pike ◽  
Martha Tillson ◽  
J. Matthew Webster ◽  
Michele Staton
Keyword(s):  
Mixed Methods ◽  
Opioid Epidemic ◽  
First Responder ◽  
The Impact

scholarly journals PEAK LOWER EXTREMITY SOCCER INJURIES OCCUR IMMEDIATELY FOLLOWING GROWTH IN ADOLESCENTS: AN EPIDEMIOLOGIC REVIEW OF EMERGENCY DEPARTMENT VISITS

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0021
Author(s):  
Aidan P. Wright ◽  
Aaron J. Zynda ◽  
Jane S. Chung ◽  
Philip L. Wilson ◽  
Henry B. Ellis ◽  
...  
Keyword(s):  
Emergency Department ◽  
Lower Extremity ◽  
Emergency Departments ◽  
Skeletal Maturity ◽  
Epidemiologic Study ◽  
The United States ◽  
Emergency Department Visits ◽  
Injury Surveillance System ◽  
Lower Extremity Injuries ◽  
Extremity Injuries

BACKGROUND: Soccer has become the most popular youth sport in the world. Within the last decade, there has been limited epidemiologic research on pediatric soccer-related injuries based on sex and age. PURPOSE: To examine trends associated with soccer injuries presenting to emergency departments and to describe differences in injury pattern and location based on sex and age during periods of growth. METHODS: An epidemiologic study was conducted utilizing publicly accessible data from the National Electronic Injury Surveillance System (NEISS). The NEISS compiles Emergency Department (ED) data on all injuries presenting to the approximately 100 participating network hospitals in the United States. Information on all soccer-related injuries occurring in ages 7-19 from January 2009 – December 2018 was extracted and summary statistics were calculated. RESULTS: Approximately 54,287 pediatric soccer-related injuries were identified. The average age for all injuries was 13.3 years, and males (60.50%) presented more often than females (39.50%). Concussions and head injuries (15.57%) were most commonly reported overall, with a greater percentage occurring in females than males (17.44% vs. 14.35%). The ankle (15.3%) was the second most common injury location with females also presenting more commonly than males (18.71% vs. 13.62%). Age and sex-based evaluation noted peaks in lower extremity injuries in females younger than in males. Both ankle (F=13-15 years, M=15-17 years) and knee (F=14 years, M=16 years) injuries peaked at ages coinciding with recognized sex-based lower extremity skeletal maturity (Figure 1). CONCLUSION: Peak pediatric soccer-related ankle and knee injuries presenting to emergency departments occur at different ages in females and males and appear to, on average, coincide with maturation (age 14 in females and 16 in males). Lower extremity injuries significantly increase nearing the completion of lower extremity growth, and may indicate appropriate timing for differential sex-specific injury prevention programs within soccer. [Figure: see text]

17 Key information summary (KIS) generation for people who died in scotland in 2017: a mixed methods study

2018 ◽  
Vol 8 (3) ◽  
pp. 366.1-366
Author(s):  
Anne M Finucane ◽  
Deborah Davydaitis ◽  
Emma Carduff ◽  
Zoe Horseman ◽  
Paul Baughan ◽  
...  
Keyword(s):  
Palliative Care ◽  
Mixed Methods ◽  
Mixed Methods Study ◽  
Care Plan ◽  
List Type ◽  
Electronic Patient Records ◽  
Essential Information ◽  
Out Of Hours ◽  
Essential Components ◽  
Out Of Hours Care

IntroductionThe percentage of people with a key information summary (KIS) or an anticipatory care plan (ACP) at the time of death can act as an indicator of access to palliative care. Key information summaries (KIS) introduced throughout Scotland in 2013, are shared electronic patient records which contain essential information relevant to a patient’s care including palliative care. There is now a need to examine current levels of KIS generation and ACP documentation in the last months of life to assess progress and review barriers and facilitators to sharing patient information across settings and to inform out-of-hours care.AimsTo estimate the extent and timing of KIS and ACP generation for people who die with an advanced progressive condition and to compare with our previous study (Tapsfield et al. 2016).To explore GP experiences of commencing and updating a KIS; and their perspectives on what works well and what can be improved in supporting this process.MethodsA mixed methods study consisting of a retrospective review of the electronic records of all patients who died in 16 Scottish general practices in 2017 and semi-structured interviews with 16 GPs.ResultsQuantitative and qualitative data collection is in progress.ConclusionFindings will describe current levels of KIS and ACP documentation for people who die in Scotland. We will synthesize GP experiences of KIS use and describe the essential components of an ACP that need to be documented to enable good palliative care across settings including emergency and out-of-hours care.Reference. Tapsfield J, Hall C, Lunan C, McCutheon H, McLoughlin P, Rhee J, Rus A, Spiller J, Finucane AM, Murray SA. Many people in Scotland now benefit from anticipatory care before they die: An after death analysis and interviews with general practitioners. BMJ Supportive and Palliative Care2016. doi:10.1136/bmjspcare-2015-001014

scholarly journals Geospatial analysis of emergency department visits for targeting community-based responses to the opioid epidemic

PLoS ONE ◽  
2017 ◽  
Vol 12 (3) ◽  
pp. e0175115 ◽  
Author(s):  
Daniel A. Dworkis ◽  
Lauren A. Taylor ◽  
David A. Peak ◽  
Benjamin Bearnot
Keyword(s):  
Emergency Department ◽  
Geospatial Analysis ◽  
Emergency Department Visits ◽  
Opioid Epidemic ◽  
Community Based

Challenges with the Emergency Departments Use among Cancer Patients; a Mini Review

2019 ◽  
Author(s):  
Maryam Beigom Mobasheri ◽  
Rahim Behtar ◽  
Sanambar Sadighi
Keyword(s):  
End Of Life ◽  
Cancer Patients ◽  
Emergency Departments ◽  
Primary Diagnosis ◽  
Emergency Department Visits ◽  
Cancer Type ◽  
Health Insurance Status ◽  
Cancer Management ◽  
Life Period ◽  
Surgical Treatments

According to the studies the rate of emergency departments use among cancer patients exceed those of general population; however, there are differences based on cancer type, initial treatments, socioeconomic status, disease stages, health insurance status and so on. Patients’ symptoms and the severity of complications are varied as well. The emergency departments are actively involved in different stages of cancer management such as primary diagnosis, ongoing treatments and end-of-life period. Cancer patients usually have more serious complications and need more specialized cares at the end of life period, during chemotherapy and surgical treatments. Understanding the reasons for such visits could be useful in the development of dedicated interventions for preventing unnecessary emergency department visits, which is discussed in this mini-review.

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