scholarly journals A survey of Midwest physicians’ experiences with patients in psychiatric distress in the emergency department

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Jack Brodeur ◽  
Alyse Folino Ley ◽  
Michelle Bonnet
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Suicidal Ideation ◽  
Social Worker ◽  
Demographic Data ◽  
The United States ◽  
Initial Examination ◽  
Psychiatric Distress ◽  
Final Disposition

Abstract Context Emergency medicine (EM) physicians commonly stabilize patients with acute psychiatric distress, such as suicidal ideation. Research has shown that suicidal ideation is difficult to manage in emergency department (ED) settings and that patients in psychiatric distress are often “boarded” in the ED while awaiting more definitive care. Objectives To examine the attitudes and experiences of emergency physicians regarding the care of patients in psychiatric distress. Special attention is given to suicidal ideation due to its prevalence in the United States. Methods A 19 question anonymous survey was sent via email to 55 emergency medicine residency directors throughout Michigan, Ohio, Indiana, and Illinois, who were identified using an Internet search of residency programs in the region. The program directors were asked to distribute the survey to their colleagues and residents. The intent of this procedure was to generate as many survey responses as possible, while obscuring the identities of the respondents. Responses were gathered from October 29, 2019 until January 16, 2020. The survey was designed to assess respondents’ self-reported demographic data as well as their experiences with the boarding process, initial examination, final disposition, reevaluation of the patient, physician training and resources, and follow up care. Statistical analysis was performed using a Mann–Whitney U test, significance was set at p<0.01. Results In total, 47 EM physicians responded to the survey; however, not all of the respondents completed all 19 questions. Ten of 44 respondents (22.7%) reported that they do not perform the initial psychiatric examination themselves and instead defer to a nurse or social worker. Twenty-two of 44 respondents (50.0%) reported that they defer to a social worker when determining the final disposition of psychiatric patients. Respondents reevaluated patients in psychiatric distress statistically significantly less often (p=0.01) compared with patients with cardiac pathology. Additionally, 15 of 38 respondents (39.5%) reported that they did not feel adequately trained to handle psychiatric emergencies, and 36 of 39 respondents (92.3%) of physicians felt that their facility would benefit from additional mental health resources. Thirty five of 39 respondents (89.7%) reported that their facility did not have a system in place to follow up with suicidal patients upon discharge. Conclusions Caring for patients who are acutely suicidal or in psychiatric distress is complex and more research is needed to optimize treatment strategies. The results of this study indicate that EM physicians may regularly defer to nonphysician providers when evaluating and treating patients in psychiatric distress. A perceived lack of training in psychiatry may contribute to this practice. The results of this study are in accord with previous research that indicated a need for additional psychiatry training in EM residencies.

Tracking the Rise of Geriatric Emergency Departments in the United States

2018 ◽  
Vol 39 (8) ◽  
pp. 871-879 ◽  
Author(s):  
John G. Schumacher ◽  
Jon Mark Hirshon ◽  
Phillip Magidson ◽  
Marilyn Chrisman ◽  
Terisita Hogan
Keyword(s):  
Emergency Department ◽  
Emergency Care ◽  
Emergency Departments ◽  
The United States ◽  
Transitions Of Care ◽  
Emergency Department Care ◽  
Equipment And Supplies ◽  
Care Services ◽  
Physical Environments

The traditional model of emergency care no longer fits the growing needs of the over 20 million older adults annually seeking emergency department care. In 2007 a tailored “geriatric emergency department” model was introduced and rapidly replicated among hospitals, rising steeply over the past 5 years. This survey examined all U.S. emergency departments self-identifying themselves as Geriatric Emergency Departments (GEDs) and providing enhanced geriatric emergency care services. It was guided by the recently adopted Geriatric Emergency Department Guidelines and examined domains including, GED identity, staffing, and administration; education, equipment, and supplies; policies, procedures, and protocols; follow-up and transitions of care; and quality improvement. Results reveal a heterogeneous mix of GED staffing, procedures, physical environments and that GEDs’ familiarity with the GED Guidelines is low. Findings will inform emergency departments and gerontologists nationwide about key GED model elements and will help hospitals to improve ED services for their older adult patients.

Capturing missed HIV pre-exposure prophylaxis opportunities—sexually transmitted infection diagnoses in the emergency department

2021 ◽  
pp. 095646242110486
Author(s):  
Stephanie E Mclaughlin ◽  
Farzana Kapadia ◽  
Richard E Greene ◽  
Robert Pitts
Keyword(s):  
Emergency Department ◽  
Sexually Transmitted Infection ◽  
The United States ◽  
Human Immunodeficiency Virus Prevention ◽  
Transmitted Infection ◽  
Missed Opportunities ◽  
Hospital System ◽  
Sexually Transmitted ◽  
Exposure Prophylaxis

The United States Centers for Disease Control and Prevention (CDC) recommends HIV pre-exposure prophylaxis (PrEP) be considered for all patients diagnosed with a sexually transmitted infection (STI). Emergency departments (EDs) are an important site for diagnosis and treatment of STIs for under-served populations. Consequently, we identified 377 patients diagnosed with a bacterial sexually transmitted infection (gonorrhea, chlamydia, and/or syphilis) at a major New York City emergency department between 1/1/2014 and 7/30/2017 to examine associations between key sociodemographic characteristics and missed opportunities for PrEP provision. In this sample, 299 (79%) emergency department patients missed their medical follow-up 90 days after STI diagnosis, as recommended. Results from adjusted generalized estimating equation regression models indicate that patients >45 yo (aOR = 2.2, 95% CI 1.2–3.9) and those with a primary care provider in the hospital system (aOR = 6.8, 95% CI 3.8–12.0) were more likely to return for follow-up visits, whereas Black patients (aOR = 0.44, 95% CI 0.25–0.77) were less likely to return for follow-up visits. These findings indicate that lack of STI treatment follow-up visits are significantly missed opportunities for PrEP provision and comprehensive human immunodeficiency virus prevention care.

Abstract 220: Impact of a Cardiology-managed, Non-emergency Department, Outpatient Observation Unit

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Karen Cajiao ◽  
Joseph Wallins ◽  
Peter Zimetbaum ◽  
Michael Gavin
Keyword(s):  
Emergency Department ◽  
Discharge Rate ◽  
Medical Center ◽  
Tertiary Care ◽  
Direct Access ◽  
Observation Units ◽  
Phone Calls ◽  
Final Disposition ◽  
Made In

Background: With the progress emergency department (ED) observation units have made in reducing admissions for cardiac conditions, we previously reported a discharge rate of only 23.7% (n=1,549/6,546) from our ED, without an observation stay, for these patients. We opened a Cardiac Direct Access (CDAc) unit at a tertiary care urban medical center hypothesizing that cardiologists can reduce testing and observation stays for appropriate cardiac patients. Methods: Patients are referred to the CDAc for evaluation on an emergent (same day) or urgent (within 7 day) basis. We performed a retrospective review of 629 consecutive patients referred to the CDAc between November 2016 and June 2017. Final disposition was determined using charge data. The 30-day return rate to an ED, hospital, or the CDAc was determined by follow-up phone calls and chart review. Results: Patients were referred by non-cardiologists (n=403/629, 64%) and cardiologists (n=226/629, 36%). The most common indications for evaluation were chest pain, arrhythmia, and suspected heart failure. Disposition of patients evaluated in the CDAc are reported in the figure. The mean length of stay in CDAc observation was 22+/-13 hours. Among the 574 patients discharged from the CDAc, 62 (11%) were seen in an ED and/or hospitalized, while 31 (5.4%) were seen in the CDAc within 30 days. Conclusion: A CDAc unit may serve as a high value alternative to the ED. Further research can help assess comparative cost-effectiveness and refine patient selection.

DİCLE ÜNİVERSİTESİ TIP FAKÜLTESİ ARAŞTIRMA HASTANESİ ACİL SERVİSİNDE YAPILAN KAN VE KAN ÜRÜNLERİ TRANSFÜZYONLARININ DEĞERLENDİRİLMESİ

2021 ◽  
Vol 8 (16) ◽  
pp. 36-48
Author(s):  
Hüseyin Gürbüz ◽  
Yılmaz Zengin ◽  
Ercan Gündüz ◽  
Hasan Mansur Durgun ◽  
Recep Dursun ◽  
...  
Keyword(s):  
Emergency Department ◽  
Demographic Data ◽  
Fresh Frozen Plasma ◽  
Blood Product Transfusion ◽  
Blood Products ◽  
Platelet Suspension ◽  
Hospital Emergency Service ◽  
Specific Protocol ◽  
Fresh Frozen

This study was designed prospectively to investigate the demographic data of the patients who had blood and blood products in Dicle University Medical Faculty Research Hospital Emergency Service between 01 November 2014- 01 November 2015, also to investigate the indications for blood products used, the amount and the type of the products used. When we look at the diagnosis of patients who underwent transfusion in the emergency department; It was determined that 26.2% were transfused for malignancy, 32.6% for anemia, 18.3% for trauma, 12.5% for GIS bleeding, and 10.4% for other reasons. The patients who had blood product transfusion were 623; 53.8% were male and 46.2% were female. The mean age of the patients was determined 47.87±23.66. The percentage of transfused blood products were as following: 83.6% erythrocyte suspension (ES), 17.3% fresh frozen plasma (FFP), 17.3 % platelet suspension(PS), 0.6% whole blood(WB), %4.3 other blood components (OBC). As a result, we can say that in our study, a large number of transfusions were performed in the emergency department, a specific protocol was not adhered to in determining the indication, and transfusion was performed in support of patients who were mostly under outpatient follow-up. Emergency transfusion decisions should be performed with true emergency indication, follow-up with clinical response rather than laboratory response, and consciousness about the aim of transfusion.

scholarly journals Emergency Department Youth Patients With Suicidal Ideation or Attempts: Predicting Suicide Attempts Through 18 Months of Follow-Up

2016 ◽  
Vol 47 (5) ◽  
pp. 551-566 ◽  
Author(s):  
Joan Rosenbaum Asarnow ◽  
Michele Berk ◽  
Lily Zhang ◽  
Peter Wang ◽  
Lingqi Tang
Keyword(s):  
Emergency Department ◽  
Suicidal Ideation ◽  
Suicide Attempts

scholarly journals LO30: Prevalence of pulmonary embolism among emergency department patients with syncope: a multicenter prospective cohort study

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S17-S17 ◽  
Author(s):  
V. Thiruganasambandamoorthy ◽  
M. L.A. Sivilotti ◽  
B. H. Rowe ◽  
A. D. McRae ◽  
M. Mukarram ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pulmonary Embolism ◽  
The United States ◽  
Pulmonary Angiogram ◽  
Emergency Department Patients ◽  
Multicenter Prospective Cohort Study ◽  
Multicenter Prospective Cohort ◽  
D Dimer ◽  
Combined Data

Introduction: The prevalence of pulmonary embolism (PE) among patients with syncope is understudied. Based on a recent study with an exceptionally high PE prevalence, some advocate investigating all syncope patients for PE, including those with another clear cause for their syncope. We sought to evaluate the PE prevalence among emergency department (ED) patients with syncope. Methods: We combined data from two large prospective studies enrolling adults with syncope from 17 EDs in Canada and the United States. Each study collected the results of investigations related to PE (i.e. D-dimer or ventilation-perfusion (VQ) scan, or computed tomography pulmonary angiogram (CTPA)), and 30-day adjudicated outcomes including diagnosis of PE, arrhythmia, myocardial infarction, serious hemorrhage and/or death. Results: Of the 9,091 patients (median age 66 years, 51.9% females, 39.1% hospitalized) with 30-day follow-up, 546 (6.0%) were investigated for PE: 278 (3.1%) had D-dimer, 39 (0.4%) had VQ and 347 (3.8%) patients had CTPA performed. 30-day outcomes included: 874 (9.6%) patients with any serious outcome; 0.9% deaths; and 818 (9.0%) patients with non-PE serious outcomes. Overall, 56 patients (prevalence 0.6%; 95% CI 0.5% 0.8%) were diagnosed with PE, including 8 (0.1%) of those admitted to hospital at the index presentation. Only 11 patients (0.1%) with a non-PE serious condition had a concomitant underlying PE identified. Conclusion: The prevalence of PE is very low among ED patients with syncope, including those hospitalized following syncope. While acknowledging syncope may be caused by an underlying PE, clinicians should be cautious against indiscriminate over-investigations for PE.

scholarly journals Actions speak louder: Young female patients with acute ischemic stroke in the emergency department

2019 ◽  
Vol 15 (2) ◽  
Author(s):  
Mor Saban ◽  
Tal Shachar ◽  
Heli Patito ◽  
Lev Zaretsky
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Demographic Data ◽  
Case Series ◽  
Young Female ◽  
Initial Examination ◽  
Young Females ◽  
Case Series Study

The aim was to explore the diagnostic cascade of young females with acute ischemic stroke (AIS) in the emergency department (ED) setting. A retrospective case series study was conducted between the years 2016-2018 in the ED of a tertiary hospital (N=10). We collected socio-demographic data, clinical risk factors and co-morbidities, ED characteristics and medical examination related data. Ten females presenting with AIS were identified. Results show that each case had a variety of characteristics, there are no similar medical background or clear-cut risk factors, and each case has been presented clinically different. All these factors, with the possible added effect of age and sex bias serve as possible hindrance for correct and efficient diagnosis of stroke in young females. In conclusion, clinical presentation of young female with AIS is misleading. Initial examination in the ED setting may appear to be the determining point of impact on the outcome severity in young females.

Antimicrobial Stewardship in the Emergency Department

2011 ◽  
Vol 24 (2) ◽  
pp. 196-202 ◽  
Author(s):  
Nicole M. Acquisto ◽  
Stephanie N. Baker
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Antimicrobial Stewardship Program ◽  
Implementation Outcomes ◽  
Stewardship Program ◽  
Assessment Skills ◽  
Barriers To Implementation

The practice of antimicrobial stewardship can be defined as optimizing clinical outcomes while minimizing the consequences of antimicrobial therapy such as resistance and superinfection. Antimicrobial stewardship can be difficult to transition to the emergency department (ED) since the traditional activities include the evaluation of broad-spectrum antimicrobial regimens at 72 and 96 hours and intravenous to oral medication conversion. The emergency medicine clinical pharmacist (EPh) has the knowledge and clinical assessment skills to manage an antimicrobial stewardship program focused on culture follow-up for patients discharged from the ED. This paper summarizes the experiences of developing an EPh-managed antimicrobial stewardship and culture follow-up program in the ED from 2 separate institutions. Specifically, the focus is on the steps for establishing an EPh-managed antimicrobial stewardship program, a description of the culture follow-up process, managing the culture data and cultures that require emergent notification and review, medical/legal concerns, and barriers to implementation. Outcomes data available from institutions with similar ED based antimicrobial stewardship programs are also discussed.

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