scholarly journals Child Abuse Screening in the Emergency Department Before and After Implementation of a Formal Screening Tool

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Erika Robertson ◽  
Jessica Kanis
Keyword(s):  
Emergency Department ◽  
Child Abuse ◽  
Emergency Departments ◽  
Screening Tool ◽  
Diagnostic Testing ◽  
Retrospective Chart Review ◽  
Mortality And Morbidity ◽  
Head Ct ◽  
Positive Screen ◽  
Number Of Patients

Background:   Child abuse and neglect is a leading cause of mortality and morbidity in children.  Victims of abuse often present to emergency departments due to these injuries.  Early identification of suspected child abuse by emergency department staff allows the opportunity for intervention prior to a devastating injury.  Signs of child abuse can be subtle and may not always be identified.  Recent efforts have worked to improve suspected child abuse identification by implementation of validated screening protocols.  Specifically, the IU Health Riley Emergency Department has recently implemented a new child abuse screening tool (effective on 15Apr2021).  The Covid-19 pandemic has further exacerbated this issue, creating social isolation and additional socioeconomic stressors that contribute to child abuse.    Method:    A retrospective chart review was conducted to analyze patients identified for child abuse evaluation in the Riley emergency department.  Patients prior to the implementation of the screening tool were identified by those undergoing a social work evaluation for child abuse.  For patients presenting after implementation of the screening tool, all patients with a positive screen were reviewed.  Charts were then reviewed for baseline demographics, diagnostic testing performed, and injuries identified. All data was recorded in an electronic Redcap database.  Results:  Implementation of a formal screening tool increased the number of patients identified for a child abuse evaluation (1.34% vs 3.17%) and those evaluated who had an injury also increased (1.15% vs 1.81%).  More patients received a head CT scan after implementation of the screening tool (0.89% vs 1.07%), while the percentage of patients with an abnormal head CT decreased (62% vs 45%).  Conclusions:  Implementation of a formal screening tool for child abuse in the emergency department successfully improved identification of patients that should be further evaluated for child abuse.  These results may be used to support implementation of the tool in additional emergency departments. 

scholarly journals Evaluating alcohol intoxication management services: the EDARA mixed-methods study

2020 ◽  
Vol 8 (24) ◽  
pp. 1-214 ◽  
Author(s):  
Simon C Moore ◽  
Davina Allen ◽  
Yvette Amos ◽  
Joanne Blake ◽  
Alan Brennan ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Departments ◽  
Alcohol Intoxication ◽  
Ethnographic Study ◽  
Acute Alcohol Intoxication ◽  
Front Line ◽  
Night Time ◽  
Number Of Patients ◽  
The Impact ◽  
Management Services

Background Front-line health-care services are under increased demand when acute alcohol intoxication is most common, which is in night-time environments. Cities have implemented alcohol intoxication management services to divert the intoxicated away from emergency care. Objectives To evaluate the effectiveness, cost-effectiveness and acceptability to patients and staff of alcohol intoxication management services and undertake an ethnographic study capturing front-line staff’s views on the impact of acute alcohol intoxication on their professional lives. Methods This was a controlled mixed-methods longitudinal observational study with an ethnographic evaluation in parallel. Six cities with alcohol intoxication management services were compared with six matched control cities to determine effects on key performance indicators (e.g. number of patients in the emergency department and ambulance response times). Surveys captured the impact of alcohol intoxication management services on the quality of care for patients in six alcohol intoxication management services, six emergency departments with local alcohol intoxication management services and six emergency departments without local alcohol intoxication management services. The ethnographic study considered front-line staff perceptions in two cities with alcohol intoxication management services and one city without alcohol intoxication management services. Results Alcohol intoxication management services typically operated in cities in which the incidence of acute alcohol intoxication was greatest. The per-session average number of attendances across all alcohol intoxication management services was low (mean 7.3, average minimum 2.8, average maximum 11.8) compared with the average number of emergency department attendances per alcohol intoxication management services session (mean 78.8), and the number of patients diverted away from emergency departments, per session, required for services to be considered cost-neutral was 8.7, falling to 3.5 when ambulance costs were included. Alcohol intoxication management services varied, from volunteer-led first aid to more clinically focused nurse practitioner services, with only the latter providing evidence for diversion from emergency departments. Qualitative and ethnographic data indicated that alcohol intoxication management services are acceptable to practitioners and patients and that they address unmet need. There was evidence that alcohol intoxication management services improve ambulance response times and reduce emergency department attendance. Effects are uncertain owing to the variation in service delivery. Limitations The evaluation focused on health service outcomes, yet evidence arose suggesting that alcohol intoxication management services provide broader societal benefits. There was no nationally agreed standard operating procedure for alcohol intoxication management services, undermining the evaluation. Routine health data outcomes exhibited considerable variance, undermining opportunities to provide an accurate appraisal of the heterogenous collection of alcohol intoxication management services. Conclusions Alcohol intoxication management services are varied, multipartner endeavours and would benefit from agreed national standards. Alcohol intoxication management services are popular with and benefit front-line staff and serve as a hub facilitating partnership working. They are popular with alcohol intoxication management services patients and capture previously unmet need in night-time environments. However, acute alcohol intoxication in emergency departments remains an issue and opportunities for diversion have not been entirely realised. The nurse-led model was the most expensive service evaluated but was also the most likely to divert patients away from emergency departments, suggesting that greater clinical involvement and alignment with emergency departments is necessary. Alcohol intoxication management services should be regarded as fledgling services that require further work to realise benefit. Future work Research could be undertaken to determine if a standardised model of alcohol intoxication management services, based on the nurse practitioner model, can be developed and implemented in different settings. Future evaluations should go beyond the health service and consider outcomes more generally, especially for the police. Future work on the management of acute alcohol intoxication in night-time environments could recognise the partnership between health-care, police and ambulance services and third-sector organisations in managing acute alcohol intoxication. Trial registration Current Controlled Trials ISRCTN63096364. 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. 24. See the NIHR Journals Library website for further project information.

scholarly journals Head CT overuse in children with a mild traumatic brain injury within two Canadian emergency departments

2019 ◽  
Vol 25 (1) ◽  
pp. 26-32
Author(s):  
Martin Gariepy ◽  
Jocelyn Gravel ◽  
France Légaré ◽  
Edward R Melnick ◽  
Erik P Hess ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Emergency Departments ◽  
Retrospective Chart Review ◽  
Trauma Centre ◽  
Diagnostic Tools ◽  
General Level ◽  
Head Ct ◽  
Significant Difference

Abstract Background The validated Pediatric Emergency Care Applied Network (PECARN) rule helps determine the relevance of a head computerized tomography (CT) for children with mild traumatic brain injury (mTBI). We sought to estimate the potential overuse of head CT within two Canadian emergency departments (EDs). Methods We conducted a retrospective chart review of children seen in 2016 in a paediatric Level I (site 1) and a general Level II (site 2) trauma centre. We reviewed charts to determine the appropriateness of head CT use according to the PECARN rule in a random subset of children presenting with head trauma. Simple descriptive statistics were applied. Results One thousand five hundred and forty-six eligible patients younger than 17 years consulted during the study period. Of the 203 randomly selected cases per setting, 16 (7.9%) and 24 (12%), respectively from sites 1 and 2 had a head CT performed. Based on the PECARN rule, we estimated the overuse for the younger group (<2 years) to be below 3% for both hospitals without significant difference between them. For the older group (≥2 years), the overuse rate was higher at site 2 (9.3%, 95% confidence interval [CI]: 4.8 to 17% versus 1.2%, 95% CI: 0.2 to 6.5%, P=0.03). Conclusion Both EDs demonstrated overuse rates below 10% although it was higher for the older group at site 2. Such low rates can potentially be explained by the university affiliation of both hospitals and by two Canadian organizations working to raise awareness among physicians about the overuse of diagnostic tools and dangers inherent to radiation.

scholarly journals P109: Does an elevated troponin ultimately matter? An assessment of outcomes in patients presenting to the emergency department with non-cardiac complaints

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S104-S104
Author(s):  
K. Endres ◽  
B. Chow ◽  
H. Garuba
Keyword(s):  
Myocardial Infarction ◽  
Emergency Department ◽  
Preliminary Data ◽  
Diagnostic Testing ◽  
Retrospective Chart Review ◽  
Cardiac Events ◽  
Significant Difference ◽  
Chi Squared ◽  
Invaluable Tool ◽  
The Difference

Introduction: Acute myocardial infarction (MI) is one of the most time-sensitive diagnoses made in the emergency department (ED). Troponin (TNI) measurement is an invaluable tool; however, its utility depends on the clinical context and is highest where there is a strong pre-test probability. Studies show that most TNI elevations are due to non-cardiovascular causes; however, elevated TNI has been associated with increased morbidity and mortality, often prompting additional investigations. The aim of our study was to compare 1-year cardiac outcomes of patients who presented to the ED with non-cardiac complaints and elevated TNI who had further cardiac testing versus those who did not. Methods: We conducted a retrospective chart review of patients ≥18 seen in the ED for non-cardiac complaints with a high TNI from January-June 2016. Patients were stratified into two groups: 1) those who received diagnostic testing for ischemia and/or a cardiac consultation and 2) those without cardiac consultation or testing. Data was also collected on major adverse cardiac events within 1-year of ED presentation. Chi-squared analysis assessed the difference in proportions of outcomes between groups. We present our preliminary data. Results: In total, 1500 patients met inclusion criteria and 861 have been analyzed thus far. Of these 861, 209 went on to have either diagnostic testing for ischemia and/or a cardiology consult while 652 had no further investigations. There was no statistically significant difference in the proportion of patients who developed unstable angina (p = 0.9824), ST-elevation myocardial infarction (STEMI) (p = 0.9956), non-STEMI (p = 0.9008), stroke/TIA (p = 0.9657), revascularization (p = 0.8873), cardiac hospitalization (p = 0.9446) or died (p = 0.8972), within 1-year of their ED presentation. Conclusion: In patients with isolated elevated TNI and non-cardiac complaints, preliminary data showed no difference in mortality or cardiac event rates between those who had further testing/consultations and those who did not. TNI ordering could be cautiously limited to only presenting complaints/preliminary diagnoses likely to have cardiac etiology or sequelae or those in whom further testing would impact management/outcomes. Quality of care may be improved by reducing length of stay in the ED and potential risks of unnecessary tests. Future studies include determining cost implications and classifying what level of TNI elevation in non-ACS patients may predict a future cardiac outcome.

Characterization of Emergency Department Rabies Post-Exposure Prophylaxis Procedures with an Infectious Diseases Clinic Referral Process

2020 ◽  
pp. 001857872097388
Author(s):  
Jessica J. Frederickson ◽  
Alexandra K. Monroe ◽  
Gregory A. Hall ◽  
Kyle A. Weant
Keyword(s):  
Emergency Department ◽  
Retrospective Chart Review ◽  
Future Research ◽  
Post Exposure Prophylaxis ◽  
Referral Process ◽  
Post Exposure ◽  
Care Plans ◽  
Number Of Patients ◽  
Exposure Prophylaxis

Purpose: Rabies post-exposure prophylaxis (rPEP) in the emergency department (ED) is associated with high costs, complicated administration protocols, and a time-sensitive vaccination series that often requires ED follow-up visits for subsequent vaccine administration. This study sought to characterize the number of redirected vaccine administrations in those patients referred to ID Clinic, guideline compliance, and opportunities for improvement. Methods: Retrospective chart review of adult and pediatric patients presenting to the ED from 2016 to 2019 and prescribed rabies immunoglobulin. Results: Of the 89 patients included, 66.3% were referred to ID Clinic. Those referred to clinic had significantly fewer average visits to the ED for repeat vaccination ( P < .001). Of the 177 vaccinations prescribed for patients referred, 105 were administered in clinic. Overall, having insurance significantly increased the odds of completing the prescribed vaccination series (Odds Ratio (OR) = 4.34, 95% Confidence Interval (CI) = 1.34 to 15.52). Among those patients referred to clinic, having insurance significantly increased the odds of receiving any follow-up doses in clinic (OR = 6.00, 95% CI = 1.48 to 25.98), receiving all of their prescribed follow-up doses in clinic (OR = 10.00, 95% CI = 1.72 to 190.80), and completing the entirety of their vaccination series (OR = 5.89, 95% CI = 1.50 to 26.21). Conclusions: The use of an ID Clinic referral process for rPEP resulted in a significant reduction in the average number of visits to the ED for repeat vaccination, hence avoiding 105 ED visits. Insurance status was a significant factor in both the utilization of the ID Clinic referral system and overall completion of the vaccination series. Future research should explore workflows inclusive of both ED care and outpatient follow-up, care plans for the uninsured, and mechanisms to limit the number of patients that fail to complete the recommended vaccination series.

scholarly journals Reduction of paediatric head CT utilisation at a rural general hospital emergency department

2020 ◽  
Vol 29 (11) ◽  
pp. 912-920
Author(s):  
Jeffrey Paul Louie ◽  
Joseph Alfano ◽  
Thuy Nguyen-Tran ◽  
Hai Nguyen-Tran ◽  
Ryan Shanley ◽  
...  
Keyword(s):  
Emergency Department ◽  
Head Injury ◽  
Rural Community ◽  
Emergency Departments ◽  
Control Charts ◽  
Intervention Period ◽  
Head Ct ◽  
Pediatric Injury ◽  
Ct Utilization ◽  
Ct Head

BackgroundBlunt head injury is a common pediatric injury and often evaluated in general emergency departments. It estimated that 50% of children will undergo a head computed tomography (CT), often unnecessarily exposing the child to ionizing radiation. Pediatric academic centers have shown quality improvement (QI) measures can reduce head CT rates within their emergency departments. We aimed to reduce head CT utilization at a rural community emergency department.MethodsChildren presenting with a complaint of blunt head injury and were evaluated with or without a head CT. Head CT rate was the primary outcome. We developed a series of interventions and presented these to the general emergency department over the duration of the study. The pre and intervention data was analysed with control charts.ResultsThe preintervention and intervention groups consisted of 576 children: 237 patients with a median age of 8.0 years and 339 patients with a median age of 9.00 years (p=0.54), respectively. The preintervention HCT rate was 41.8% (95% CI 35.6% to 48.1%) and the postintervention rate was 27.7% (95% CI 23.3% to 32.7%), a decrease of 14.1% (95% CI 6.2% to 21.9%, p=0.0004). During the intervention period, there was a decrease in HCT rate of one per month (OR 0.96, 95% CI 0.92 to 1.00, p=0.07). The initial series of interventions demonstrated an incremental decrease in HCT rates corresponding with a special cause variation.ConclusionThe series of interventions dispersed over the intervention period was an effective methodology and successfully reduced HCT utilisation among children with blunt head injury at a rural community emergency department.

scholarly journals Impact of Family Medicine Resident Physicians on Emergency Department Wait Times and Patients Leaving Without Being Seen

CJEM ◽  
2015 ◽  
Vol 17 (5) ◽  
pp. 475-483
Author(s):  
Wang Xi ◽  
Vikram Dalal
Keyword(s):  
Emergency Department ◽  
Family Medicine ◽  
Retrospective Chart Review ◽  
Initial Assessment ◽  
Wait Times ◽  
Family Medicine Resident ◽  
Medicine Resident ◽  
Resident Physicians ◽  
Number Of Patients ◽  
Resident Group

AbstractObjectiveTo quantify the effect of family medicine resident physicians on emergency department (ED) wait times and patients leaving without being seen or treated.MethodsIn a medium-volume community ED over twelve months, we used retrospective chart review to compare wait times between patients seen during shifts where staff were working alone versus with a resident. We measured the time from initial triage time to physician initial assessment (T1) and disposition time (LOS), and number of patients leaving without being seen or treated.ResultsIn our analysis, 21,141 patients (91% of total visits) were included; 48% were in the staff-with-resident group, and 52% were in the staff-only group. Mean T1 in the resident group was significantly shorter than the staff-only group (1 hour 23 minutes versus 1 hour 38 minutes, difference 15 minutes, 95% CI 13 to 17 minutes, p<0.001). Mean total LOS in the resident group was also reduced (2 hours 38 minutes versus 2 hours 50 minutes, difference 12 minutes, 95% CI 8 to 17 minutes, p<0.001). Fewer patients left without being seen in the resident group than the staff only group (2.8% versus 4.9%, p<0.001). There were no differences in patients leaving without being treated (0.5% versus 0.5%).ConclusionsThis is the first study to demonstrate that residents are associated with a reduction in ED wait times and patients leaving without being seen in a low-acuity, community hospital, compared to previous studies demonstrating no difference or increased wait times.

Development and Evaluation of a Pharmacist-Driven Screening Tool to Identify Patients Presenting to the Emergency Department Who Are Eligible for Outpatient Treatment of Deep Vein Thrombosis

2019 ◽  
pp. 089719001987258
Author(s):  
Shaina E. Musco ◽  
Shannon M. Smallwood ◽  
Jill Gossard
Keyword(s):  
Emergency Department ◽  
Deep Vein Thrombosis ◽  
Outpatient Treatment ◽  
Screening Tool ◽  
Cost Savings ◽  
Retrospective Chart Review ◽  
Inpatient Setting ◽  
Potential Cost ◽  
Vein Thrombosis ◽  
Deep Vein

Background: Deep vein thrombosis (DVT) is a critical and costly health issue. Treatment in the outpatient setting is preferred compared to the inpatient setting. However, there is a lack of evidence regarding how best to identify patients who are ideal for outpatient DVT treatment. Objective: To design and evaluate a pharmacist-driven screening tool for the identification of patients presenting to the emergency department (ED) at a community hospital with DVT who are appropriate for outpatient treatment. Methods: This study was conducted in sequential phases: compilation and vetting of screening criteria, descriptive evaluation of criteria through retrospective chart review, and quantification of potential cost savings by avoiding admissions. Criteria were collected via literature search and assembled into a screening tool, which was applied retroactively to a cohort of ED patients admitted with DVT diagnosis. Results: A screening tool was developed with multidisciplinary input and consisted of 5 categories with individual patient and disease state criteria. The majority (91%) of patients reviewed would not have qualified for outpatient DVT treatment based on the retrospective application of the screening tool. The most common disqualification criteria category was high risk of bleeding/clotting (n = 81), and the most frequently represented parameter within that category was antithrombotic therapy prior to admission (n = 53). Conclusion: A screening tool may not be the most efficient method for health-care practitioners such as pharmacists to identify ED patients appropriate for outpatient management of DVT. Other avenues should be explored for improving the cost-effective management of these patients.

scholarly journals Patient profile of patients attending to emergency department of a tertiary neurological and neurosurgical hospital of Nepal: One year experience

2020 ◽  
Vol 1 (1) ◽  
pp. 20-24
Author(s):  
Rashmi Shrestha ◽  
Rachana Nakarmi ◽  
Ritesh Luitel ◽  
Subodh Sharma Paudel
Keyword(s):  
Emergency Department ◽  
Road Traffic ◽  
Neurological Diseases ◽  
Physical Assault ◽  
Female Ratio ◽  
Mortality And Morbidity ◽  
Patient Profile ◽  
Number Of Patients ◽  
One Year ◽  
Ischemic Attack

Introduction: Neurological emergencies are life threatening conditions that arise frequently and have devastating results if not diagnosed and treated quickly with high rates of neurological mortality and morbidity. Being a tertiary neurological center, Upendra Devkota Memorial National Institute of Neurological and Allied Science is a major referral center for neurological diseases. The objective of this study is to assess the types and number of diseases that present to the emergency department of a tertiary neurological center. Methods: This is a retrospective study conducted in emergency department of national neurosurgical/neurological referral hospital in Kathmandu, from Oct 2018 to Sept 2019. Clinico-epidemiological details of the patients were noted. Results: The total number of patients presenting to the emergency in one year period were 2995. 58.33% were males and 41.67% were females with male to female ratio of 1:1.4. Majority of the patients (24.91%) were above 60 years of age. Trauma (26.08%) was the major admissions followed by stroke (25.71%) and headache (11.79%). The majority of trauma were road traffic accident (43.02%) followed by fall injury (29.83%) and physical assault (18.96%). Out of the stroke cases, 51.68% were ischemic followed by hemorrhagic stroke 44.55% and transient ischemic attack (3.77%). One thousand eight hundred and ten people were admitted. Conclusion: The study presents an overview of the patients presenting as neurological emergency. It helps to better plan and devise resources and system in a neurosurgical emergency.

scholarly journals Development of screening tool for child abuse in the korean emergency department

Medicine ◽  
2018 ◽  
Vol 97 (51) ◽  
pp. e13724 ◽  
Author(s):  
So Hyun Paek ◽  
Jin Hee Jung ◽  
Young Ho Kwak ◽  
Do Kyun Kim ◽  
Jeong Min Ryu ◽  
...  
Keyword(s):  
Emergency Department ◽  
Child Abuse ◽  
Screening Tool

scholarly journals Designers Drugs—A New Challenge to Emergency Departments—An Observational Study in Poland

Medicina ◽  
2020 ◽  
Vol 56 (7) ◽  
pp. 354
Author(s):  
Rakesh Jalali ◽  
Paula Dmochowska ◽  
Izabela Godlewska ◽  
Justyna Balmas ◽  
Katarzyna Młynarska ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Departments ◽  
Therapeutic Process ◽  
Symptomatic Treatment ◽  
Pediatric Emergency ◽  
Designer Drugs ◽  
New Psychoactive Substances ◽  
Pediatric Emergency Department ◽  
Psychoactive Substances ◽  
Number Of Patients

Background and Objective: In the last decade, the phenomenon of using new psychoactive substances (NPS), called designer drugs, has been on rise. Though their production and marketing in Poland is prohibited, reports of the Supreme Audit Office noted that young people are increasingly reaching for new intoxication agents in the form of designer drugs. There is a significant increase in the number of patients with NPS abuse admitted to the emergency departments. As NPS cannot be detected by standard tests for the presence of psychoactive substances, it is difficult to choose the appropriate therapeutic intervention. Therefore, the aim of the present study was to evaluate the patient characteristics in the population of adults and children suspected of using NPS and formulate the protocol for diagnosis and treatment. Materials and Method: The paper is based on a retrospective analysis of medical records of hospitalized patients in the Clinical Emergency Department of The Regional Specialist Hospital in Olsztyn (SKOR WSS, emergency department (ED)) and the Pediatric Emergency Department of the Provincial Specialist Children′s Hospital in Olsztyn (SORD WSSD, pediatric emergency department (PED)) between years 2013 to 2018. The patient records related to their general symptoms at admission, mental state and laboratory diagnostic tests were evaluated. Results: The majority of patients hospitalized due to the suspected use of NPS were adolescents in 2013–2016 and a reversal of this trend was observed in 2017–2018 when number of adults admitted to the emergency department (ED) due to NPS use was higher. The NPS abuse was significantly higher among male patients, alcoholics, people using other psychoactive substances, patients suffering from mental disorders and teenagers in difficult socio-economic family situations. Whereas, the most common symptoms among pediatric patients were co-ordination disorder and aggression, in adults mainly tachycardia and aggression was observed. The laboratory tests in significant number of adult patients showed leukocytosis and ketonuria. Conclusions: In the present study, no unambiguous toxidrome or biochemical pattern characteristic for using NPS was observed. However, evaluation of blood morphology, coagulation parameters, liver and kidney function can be helpful in the diagnostic and therapeutic process. Symptomatic treatment of patients, fluid therapy and sedation was sufficient in most cases to resolve the patient symptoms in 48 h.

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