scholarly journals Determination of Antimicrobial Prescribing Practices in an Integrated Health System Emergency Department

2020 ◽  
Vol 13 ◽  
pp. 131-133
Author(s):  
Sarah Sartain ◽  
John Price ◽  
Brooke Bitner ◽  
Elizabeth Wolfe ◽  
Daniel Ortiz
Keyword(s):  
Emergency Department ◽  
Social Services ◽  
Tissue Injury ◽  
Tertiary Care ◽  
Soft Tissue Injury ◽  
Prescribing Practices ◽  
Prescribing Habits ◽  
Antimicrobial Prescribing ◽  
Integrated Health ◽  
Treatment Window

Introduction. Antibiotic stewardship utilizes interprofessional collaborative practices, including professionals from medicine, pharmacy, nursing, social services, and clinical laboratory science, to identify potential problems proactively. A tertiary care integrated health system’s Emergency Department (ED) aimed to identify antimicrobials prescribed to the outpatient community as part of a proactive antimicrobial stewardship project. Methods. A pilot, prospective, snapshot of a tertiary community hospital’s outpatient antimicrobial prescribing habits was conducted. All subjects were identified via a daily report of patients discharged from the ED over 30 days in the summer of 2017 and individually reviewed for prescribed antimicrobial(s). Exclusions were hospital admission, antimicrobial sensitivity, and antimicrobial courses less than five days or more than 14 days. The primary goal was determining the number of antimicrobial oral tablets/capsule prescriptions to adult outpatients within a 5 to 14-day treatment window. Secondary goals were to include the diagnosis, non-capsule/tablet antimicrobial, pediatric patients, and prescriptions outside the treatment window. Results. Total number of antimicrobial prescriptions over the 30-day period was 653 in 5,520 individual visits. Total number of adults prescribed oral antimicrobials was 467 (15.6 daily). Patients were diagnosed with infections including urinary tract, cellulitis, soft tissue injury, abscess, upper respiratory, dental caries, gastrointestinal, sexually transmitted, otitis media/externa, pneumonia, viral, pyelonephritis, tick-borne, fungal, Bell’s Palsy, and sepsis. The number of non-adult, non-oral, and outside window treatment antimicrobial prescriptions were 186 (6.2 daily). With an average 184 patients treated in the ED daily, approximately 11.8% received antimicrobial treatment on discharge. Conclusion. Important aspects of the project were the evaluation of antimicrobial prescribing habits for a midwest ED and identification of potential complications requiring future interventions for follow-up or preventative measures to assist in patient care and community health. Areas of practice improvement were identified inadvertently as a result of this project. Potential future studies included seasonal variability, whether the patient obtained a prescription and complied with treatment, and differences between inpatient and outpatient antimicrobial prescribing practices.

Pediatric Injury Presenting in Emergency Department of Tertiary Care Centre

2020 ◽  
Vol 2 (2) ◽  
pp. 26-30
Author(s):  
Sneha Pradhananga ◽  
Trishna Shrestha ◽  
Kabita Hada Batajoo ◽  
Manjita Bajracharya
Keyword(s):  
Emergency Department ◽  
Road Traffic ◽  
Tissue Injury ◽  
Tertiary Care ◽  
Pediatric Trauma ◽  
Soft Tissue Injury ◽  
Age Group ◽  
Pediatric Injury ◽  
Major Mode ◽  
At Home

Introduction: Pediatric injury is one of the common emergencies encountered in the emergency department. It is emerging as leading cause of death and disabilities in children. This study aims to analyze the patterns of pediatric injury based on age group, gender, mode, type, place of injury and its outcome. Methods: This is a descriptive cross sectional study conducted in Emergency Department of KIST Medical College and Teaching Hospital from 1st May 2019 to 30th July 2019. A total of 110 patients aged 15 years and below and with history of trauma were included in this study. Results: A hundred and ten pediatric patients presented to emergency with injuries. Majority of pediatric trauma cases belonged to age group 1-5 years (38.2%, n=42) and more frequent in male children (66.4%, n=73) .In both gender, male (45.5%, n=50) and female (17.3%, n=19); fall was most common mode of injury followed by accidental cut injury (7.3%,n=8) in male and road traffic accident (6.4%,n=7) in female. Most of the cases sustained soft tissue injury (32.7%, n=36) followed by cut injury (26.4%, n=29) and fracture (16.4%, n=18). Common place of injury was found to be at home (64.5%, n=71). Majority were discharged (n=100; 90.9%), Nine (8.2 %) were admitted and one expired (0.9 %) expired. Conclusion: Fall injuries are the major mode of injury encountered in both male and female children. Injuries tend to occur more at home than school. Children should be adequately supervised at home and school.  

The Hazards of Skateboard-Riding

PEDIATRICS ◽  
1976 ◽  
Vol 57 (5) ◽  
pp. 793-793
Author(s):  
◽  
Fernando Atienza ◽  
Calvin Sia
Keyword(s):  
Emergency Department ◽  
Soft Tissue ◽  
Bone Fractures ◽  
Tissue Injury ◽  
Skull Fracture ◽  
Soft Tissue Injury ◽  
Soft Tissue Injuries ◽  
Major Surgery ◽  
Cerebral Concussion ◽  
Tissue Injuries

Skateboard-riding has become increasingly popular among Hawaii's children. The thrill of the ride and the challenge of keeping one's balance and working intricate maneuvers while speeding down a hill captures the fancy of many of our young. This sport, however, has produced an alarmingly high toll of injury and illness. Pediatricians and emergency departments of our major hospitals have seen and taken care of large numbers of patients (aged between 3 years and 35 years, but with a distribution overwhelmingly pediatric) with significant injuries which include cerebral concussion, fractures, soft tissue injuries of varying degrees of severity and complications, and injury to internal organs. During a three-month period at the Kauikeolani Children's Hospital, July to August 1975, there were 16 patients admitted with the following: seven cerebral concussions, one skull fracture, five assorted bone fractures, one soft tissue injury and infection, one retroperitoneal hemorrhage, and one instance of major surgery for removal of the spleen. During the months of August and September 1975 the Emergency Department of Straub Clinic reported the following skateboard injuries: 14 fractures, 14 soft tissue injuries, 5 lacerations, and 2 cerebral concussions. Of the 35 patients seen, three were admitted—one with an open fracture, one with cerebral concussion, and one with a skull fracture. During a four-week period (two weeks in June and July and two weeks in August and September) at the Emergency Department of Kaiser Medical Center, 66 cases of skateboard injuries were seen with six patients requiring admission for fractures and brain concussion.

scholarly journals The Relationship between Risk Factors of Head Trauma with CT Scan Findings in Children with Minor Head Trauma Admitted to Hospital

2017 ◽  
Vol 5 (3) ◽  
pp. 319-323 ◽  
Author(s):  
Babak Masoumi ◽  
Farhad Heydari ◽  
Hamidreza Hatamabadi ◽  
Reza Azizkhani ◽  
Zahra Yoosefian ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Ct Scan ◽  
Head Trauma ◽  
Predictive Value ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Normal Brain ◽  
Brain Ct ◽  
Brain Ct Scan

BACKGROUND: In emergency medicine for determining the intracranial injury (ICI) in children with head trauma, usually brain CT scan is performed. Since brain CT scan, especially in children, has some disadvantages, it is better to find a procedure which could help to choose only the children with real head trauma injury for brain CT scan.AIMS: The aim of this study is to find such procedure. This study was descriptive, analytic and non-interventional.METHODS: We reviewed the archived files of children with head trauma injuries referred to the emergency department of Imam Hossein Hospital within two years. Patient’s CT scan findings and head trauma risk factors were evaluated in this study.RESULTS: Out of 368 patients, 326 patients had normal brain CT scan. 28 of them showed symptoms of ICI consisting intraventricular haemorrhage (IVH), contusion, subarachnoid haemorrhage (SAH), subdural haemorrhage (SDH), epidural hematoma (EDH), and pneumocephalus. Twenty-seven patients showed skull FX, which 14 of them had an Isolated fracture, and 13 of them also showed symptoms of ICI. Since patients with isolated FX usually discharge quickly from Emergency Department; their data did not include in results of the study. The patients have been divided into two groups: 1- ICI, 2- without ICI. RR (relative risk), CI (Confidence interval) and sensitivity, positive predictive value (PPV), negative predictive value (NPV) and association of these risk factors with ICI were assessed with the Chi-2 test. In the end to determine the indications of CT scan, the presence of one of these five risk factors is important including abnormal mental status, clinical symptoms of skull FX, history of vomiting, craniofacial soft tissue injury (including subgaleal hematomas or laceration) and headache.CONCLUSIONS: For all other patients without these risk factors, observation and Follow Up can be used which has more advantages and less cost.

Analysis of Outcomes of Vascularized Flap Reconstruction in Patients with Advanced Mandibular Osteoradionecrosis

2009 ◽  
Vol 141 (2) ◽  
pp. 196-201 ◽  
Author(s):  
Daniel S. Alam ◽  
Michael Nuara ◽  
James Christian
Keyword(s):  
Data Collection ◽  
Tissue Injury ◽  
Tertiary Care ◽  
Soft Tissue Injury ◽  
Case Series ◽  
Fistula Formation ◽  
Wound Complications ◽  
Complication Rates ◽  
Flap Reconstruction ◽  
End Stage

OBJECTIVE: To examine outcomes of vascularized bone flap reconstruction of end-stage osteoradionecrosis of the mandible. STUDY DESIGN: Case series with planned data collection. SETTING: Tertiary care academic hospital. SUBJECTS: Patients with end-stage radiation-induced osteoradionecrosis (ORN) refractory to conservative therapy with wound complications including chronic infections, fistula formation, and pathologic fracture were included. RESULTS: Outcomes of 33 patients were prospectively collected and analyzed, making this the largest series on this subject in the literature and the only one with planned data collection. Data on preoperative variables including radiation dose, sub-site location, treatment date, and prior therapy, along with intraoperative issues and postoperative outcomes, were tracked and are presented. ORN was seen to develop in a bimodal distribution based on the timing of interval surgical intervention. The extent of local soft tissue injury often required the use of contralateral recipient vessels. Local wound complication rates were higher than that seen in primary reconstructions. CONCLUSIONS: Successful reconstruction was achieved in all of the patients in this series. Long-term resolution of infectious complication and disease resolution was seen in 91 percent of the patients in this series.

scholarly journals MP58: Have opioid prescription by emergency physicians changed significantly over five years?

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S63-S63
Author(s):  
M. Wei ◽  
M. Da Silva ◽  
J. Perry
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Tertiary Care ◽  
Opioid Analgesia ◽  
Emergency Physicians ◽  
Prescribing Practices ◽  
Chi Square ◽  
Opioid Prescription ◽  
Emergency Department Care ◽  
Undetermined Etiology

Introduction: It is believed by some that emergency physicians prescribe more opioids than required to manage patients’ pain, and this may contribute to opioid misuse. The objective of our study was to assess if there has been a change in opioid prescribing practices by emergency physicians over time for undifferentiated abdominal pain. Methods: A medical record review for adult patients presenting at two urban academic tertiary care emergency departments was conducted for two distinct time periods; the years of 2012 and 2017. The first 500 patients within each time period with a discharge diagnosis of “abdominal pain” or “abdominal pain not yet diagnosed” were included. Data were collected regarding analgesia received in the emergency department and opioid prescriptions written. Opioids were standardized into morphine equivalent doses to compare quantities of opioids prescribed. Analyses included t-test for continuous and chi-square for categorical data. Results: 1,000 patients were included in our study. The mean age was 42.0 years and 69.6% of patients were female. Comparing 2017 to 2012, there was a non-significant decrease in opioid prescriptions written for patients discharged directly by emergency physicians, from 17.8% to 14.4% (p = 0.14). Mean opioid quantities per prescription decreased from 130.4 milligrams of morphine equivalents per prescription to 98.9 milligrams per prescription (p = 0.002). 13.9% of opioid prescriptions in 2017 were for more than 3 days, which is a decrease from 28.1% in 2012. During the emergency department care, there was an increase in foundational analgesia use prior to initiating opioids from 17.6% to 26.8% (p = 0.001). There was also a decrease for within ED opioid analgesia use from 40.0% to 32.8% (p = 0.018). Conclusion: Opioid prescription rates did not change significantly during our study. However, physicians reduced the quantity of opioids per prescription and used less opioid analgesia in the emergency department for abdominal pain of undetermined etiology.

scholarly journals Antimicrobial prescribing practices at a tertiary-care center in patients diagnosed with COVID-19 across the continuum of care

2020 ◽  
Vol 42 (1) ◽  
pp. 89-92 ◽  
Author(s):  
Ryan W. Stevens ◽  
Kelsey Jensen ◽  
John C. O’Horo ◽  
Aditya Shah
Keyword(s):  
Disease Severity ◽  
Care Center ◽  
Tertiary Care ◽  
Continuum Of Care ◽  
Antibiotic Prescribing ◽  
Tertiary Care Center ◽  
Single Center ◽  
Prescribing Practices ◽  
Antimicrobial Prescribing ◽  
The Continuum

AbstractIn a single-center review of antibiotic prescribing in COVID-19 patients, 10% of patients received antimicrobials, and inpatients encounters had the highest rate and spectrum of prescribing. Prescribing rate, spectrum, and duration appeared to increase with disease severity in inpatients. Antimicrobial prescribing in patients managed in ambulatory encounters was less common.

scholarly journals Exploring Physicians’ Views, Perceptions and Experiences about Broad-Spectrum Antimicrobial Prescribing in a Tertiary Care Hospital Riyadh, Saudi Arabia: A Qualitative Approach

Antibiotics ◽  
2021 ◽  
Vol 10 (4) ◽  
pp. 366
Author(s):  
Nada A. Alsaleh ◽  
Hussain A. Al-Omar ◽  
Ahmed Y. Mayet ◽  
Alexander B. Mullen
Keyword(s):  
Saudi Arabia ◽  
Tertiary Care Hospital ◽  
Guideline Implementation ◽  
Tertiary Care ◽  
Sampling Strategy ◽  
Care Hospital ◽  
Global Public Health ◽  
Snowball Sampling ◽  
Prescribing Practices ◽  
Antimicrobial Prescribing

Antimicrobial resistance (AMR) is a global public health threat associated with increased mortality, morbidity and costs. Inappropriate antimicrobial prescribing, particularly of broad-spectrums antimicrobials (BSAs), is considered a major factor behind growing AMR. The aim of this study was to explore physician perception and views about BSAs and factors that impact upon their BSAs prescribing decisions. Qualitative semistructured telephone interviews over an eleven-week period were conducted with physicians in a single tertiary care hospital in Riyadh, Saudi Arabia. Purposeful and snowball sampling techniques were adopted as sampling strategy. All interviews were audio recorded, transcribed verbatim, uploaded to NVivo® software and analysed following thematic analysis approach. Four major themes emerged: views on BSAs, factors influencing BSA prescribing and antimicrobial stewardship: practices and barriers and recommendations to improve appropriate BSA prescribing. Recommendations for the future include improving clinical knowledge, feedback on prescribing, multidisciplinary team decision-making and local guideline implementation. Identification of views and determinants of BSA prescribing can guide the design of a multifaceted intervention to support physicians and policymakers to improve antimicrobial prescribing practices.

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