scholarly journals Use of Telemedicine for Emergency Triage in an Independent Senior Living Community: Mixed Methods Study

10.2196/23014 ◽  
2020 ◽  
Vol 22 (12) ◽  
pp. e23014
Author(s):  
Kelsi Carolan ◽  
David C Grabowski ◽  
Ateev Mehrotra ◽  
Laura A Hatfield
Keyword(s):  
Independent Living ◽  
Chronically Ill ◽  
Emergency Medical Technician ◽  
Frontline Staff ◽  
Staff Members ◽  
Intervention Community ◽  
Emergency Medicine Physician ◽  
Medicine Physician ◽  
Trained Staff ◽  
Key Barrier

Background Older, chronically ill individuals in independent living communities are frequently transferred to the emergency department (ED) for acute issues that could be managed in lower-acuity settings. Triage via telemedicine could deter unnecessary ED transfers. Objective We examined the effectiveness of a telemedicine intervention for emergency triage in an independent living community. Methods In the intervention community, a 950-resident independent senior living community, when a resident called for help, emergency medical technician–trained staff could engage an emergency medicine physician via telemedicine to assist with management and triage. We compared trends in the proportion of calls resulting in transport to the ED (ie, primary outcome) in the intervention community to two control communities. Secondary outcomes were telemedicine use and posttransport disposition. Semistructured focus groups of residents and staff were conducted to examine attitudes toward the intervention. Qualitative data analysis used thematic analysis. Results Although the service was offered at no cost to residents, use was low and we found no evidence of fewer ED transfers. The key barrier to program use was resistance from frontline staff members, who did not view telemedicine triage as a valuable tool for emergency response, instead perceiving it as time-consuming and as undermining their independent judgment. Conclusions Engagement of, and acceptance by, frontline providers is a key consideration in using telemedicine triage to reduce unnecessary ED transfers.

scholarly journals Use of Telemedicine for Emergency Triage in an Independent Senior Living Community: Mixed Methods Study (Preprint)

2020 ◽  
Author(s):  
Kelsi Carolan ◽  
David C Grabowski ◽  
Ateev Mehrotra ◽  
Laura A Hatfield
Keyword(s):  
Independent Living ◽  
Chronically Ill ◽  
Emergency Medical Technician ◽  
Frontline Staff ◽  
Staff Members ◽  
Intervention Community ◽  
Emergency Medicine Physician ◽  
Medicine Physician ◽  
Trained Staff ◽  
Key Barrier

BACKGROUND Older, chronically ill individuals in independent living communities are frequently transferred to the emergency department (ED) for acute issues that could be managed in lower-acuity settings. Triage via telemedicine could deter unnecessary ED transfers. OBJECTIVE We examined the effectiveness of a telemedicine intervention for emergency triage in an independent living community. METHODS In the intervention community, a 950-resident independent senior living community, when a resident called for help, emergency medical technician–trained staff could engage an emergency medicine physician via telemedicine to assist with management and triage. We compared trends in the proportion of calls resulting in transport to the ED (ie, primary outcome) in the intervention community to two control communities. Secondary outcomes were telemedicine use and posttransport disposition. Semistructured focus groups of residents and staff were conducted to examine attitudes toward the intervention. Qualitative data analysis used thematic analysis. RESULTS Although the service was offered at no cost to residents, use was low and we found no evidence of fewer ED transfers. The key barrier to program use was resistance from frontline staff members, who did not view telemedicine triage as a valuable tool for emergency response, instead perceiving it as time-consuming and as undermining their independent judgment. CONCLUSIONS Engagement of, and acceptance by, frontline providers is a key consideration in using telemedicine triage to reduce unnecessary ED transfers.

Harnessing the Chaplain’s Capacity to Identify Unmet Palliative Needs of Vulnerable Older Adults in the Emergency Department

2021 ◽  
pp. 082585972110033
Author(s):  
Elizabeth Hamill Howard ◽  
Rachel Schwartz ◽  
Bruce Feldstein ◽  
Marita Grudzen ◽  
Lori Klein ◽  
...  
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
End Of Life Care ◽  
Older Patients ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Life Care ◽  
Emergency Medicine Physician ◽  
Medicine Physician ◽  
One Year

Objective: To explore chaplains’ ability to identify unmet palliative care (PC) needs in older emergency department (ED) patients. Methods: A palliative chaplain-fellow conducted a retrospective chart review evaluating 580 ED patients, age ≥80 using the Palliative Care and Rapid Emergency Screening (P-CaRES) tool. An emergency medicine physician and chaplain-fellow screened 10% of these charts to provide a clinical assessment. One year post-study, charts were re-examined to identify which patients received PC consultation (PCC) or died, providing an objective metric for comparing predicted needs with services received. Results: Within one year of ED presentation, 31% of the patient sub-sample received PCC; 17% died. Forty percent of deceased patients did not receive PCC. Of this 40%, chaplain screening for P-CaRES eligibility correctly identified 75% of the deceased as needing PCC. Conclusion: Establishing chaplain-led PC screenings as standard practice in the ED setting may improve end-of-life care for older patients.

scholarly journals Subarachnoid hemorrhage in the emergency department

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Sima Patel ◽  
Amay Parikh ◽  
Okorie Nduka Okorie
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Subarachnoid Hemorrhage ◽  
Early Management ◽  
Vast Number ◽  
Emergency Medicine Physician ◽  
Medicine Physician ◽  
Diagnostic Modalities ◽  
Poor Outcomes ◽  
Subarachnoid Hemorrhages

Abstract Background Subarachnoid hemorrhage accounts for more than 30,000 cases of stroke annually in North America and encompasses a 4.4% mortality rate. Since a vast number of subarachnoid hemorrhage cases present in a younger population and can range from benign to severe, an accurate diagnosis is imperative to avoid premature morbidity and mortality. Here, we present a straightforward approach to evaluating, risk stratifying, and managing subarachnoid hemorrhages in the emergency department for the emergency medicine physician. Discussion The diversities of symptom presentation should be considered before proceeding with diagnostic modalities for subarachnoid hemorrhage. Once a subarachnoid hemorrhage is suspected, a computed tomography of the head with the assistance of the Ottawa subarachnoid hemorrhage rule should be utilized as an initial diagnostic measure. If further investigation is needed, a CT angiography of the head or a lumbar puncture can be considered keeping risks and limitations in mind. Initiating timely treatment is essential following diagnosis to help mitigate future complications. Risk tools can be used to assess the complications for which the patient is at greatest. Conclusion Subarachnoid hemorrhages are frequently misdiagnosed; therefore, we believe it is imperative to address the diagnosis and initiation of early management in the emergency medicine department to minimize poor outcomes in the future.

Evaluation of the impact of supervisory support on staff experiences of training

2014 ◽  
Vol 19 (2) ◽  
pp. 77-84 ◽  
Author(s):  
Katja Koski ◽  
Kaisa Martikainen ◽  
Katja Burakoff ◽  
Hannu Vesala ◽  
Kaisa Launonen
Keyword(s):  
Design Methodology ◽  
Supervisory Support ◽  
Careful Planning ◽  
Content Type ◽  
Staff Members ◽  
Trained Staff ◽  
Training Programmes ◽  
Staff Experiences ◽  
The Impact

Purpose – This paper aims to evaluate the role of the supervisor's support on the effectiveness of a communication training program targeted at staff members who work with individuals who have profound and multiple learning disabilities. Design/methodology/approach – The aim was to explore which aspects of supervisory support influenced the staff members to participate in the programme and the results for the on-going effects of the training. Findings – Staff members reported a need for more supervisory support to maintain the results of the training and to disseminate the new practices to non-trained staff. Originality/value – Although supervisory support seems to benefit staff members during their participation in training programmes, even careful planning and execution of this support cannot ensure its continuation after the training is finished.

scholarly journals Ingestion and Pharyngeal Trauma Causing Secondary Retropharyngeal Abscess in Five Adult Patients

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Sudhir B. Sharma ◽  
Paul Hong
Keyword(s):  
Emergency Medicine ◽  
Foreign Body ◽  
Clinical Features ◽  
Case Series ◽  
Adult Patients ◽  
Retropharyngeal Abscess ◽  
Emergency Medicine Physician ◽  
Medicine Physician ◽  
Local Trauma ◽  
Pertinent Information

Retropharyngeal abscess most commonly occurs in children. When present in adults the clinical features may not be typical, and associated immunosuppression or local trauma can be part of the presentation. We present a case series of five adult patients who developed foreign body ingestion trauma associated retropharyngeal abscess. The unusual pearls of each case, along with their outcomes, are discussed. Pertinent information for the emergency medicine physician regarding retropharyngeal abscess is presented as well.

Abstract TP241: Neurologists' Role in Telestroke; How Essential Are We?

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Amelia Adcock ◽  
Justin Choi ◽  
Ashley Petrone
Keyword(s):  
Emergency Medicine ◽  
Acute Stroke ◽  
Final Diagnosis ◽  
Stroke Patients ◽  
Provider Group ◽  
Emergency Medicine Physician ◽  
Medicine Physician ◽  
Significant Difference ◽  
Hemorrhagic Complications ◽  
Trained Provider

Background: Telestroke networks have effectively increased the number of ischemic stroke patients who have access to acute stroke therapy. However, the availability of a dedicated group of stroke subspecialists is not always feasible. Hypothesis: Rates of tPA recommendation, accuracy of final diagnosis and post-tPA hemorrhagic complications do not differ significantly between neurologists and an emergency-medicine physician during telestroke consultations. Methods: Retrospective review of all telestroke consults performed at a comprehensive stroke center during one year. Statistical analysis: Chi squared test. Results: 303 consults were performed among 6 spoke sites. 16% (48/303) were completed by the emergency medicine physician; 25% (76/303) were performed by non stroke-trained neurologists, and 60% (179/303) were completed by a board-certified Vascular Neurologist. Overall rate of tPA recommendation was 40% (104/255), 38% (18/48), 41% (73/179), and 41% (31/76) among the all neurology-trained, emergency medicine- trained, stroke neurology-trained and other neurology- trained provider groups respectively (p = .427). Accuracy of final stroke diagnosis was 77% (14/18) and 72% (75/104) in the emergency-medicine trained and neurology-trained provider groups (p = 0.777) No symptomatic hemorrhagic complications following the administration of tPA via telestroke consultation occurred in any group over this time period. One asymptomatic intracerebral hemorrhage was observed (0.96% or 1/104) in the neurology-trained provider group. Conclusion: Our results did not illustrate any statistically significant difference between care provided by an Emergency Medicine-trained physician and neurologists during telestroke consultation. While our study is limited by its relatively low numbers, it suggests that identifying a non-neurologist provider who has requisite clinical experience with acute stroke patients can safely and appropriately provide telestroke consultation. The lack of formerly trained neurologists, therefore may not need to serve as an impediment to building an effective telestroke network. Future efforts should be focused on illuminating all strategies that facilitate sustainable telestroke implementation.

Preacher Woman

2021 ◽  
pp. 165-186
Author(s):  
Katie Lauve-Moon
Keyword(s):  
Social Justice ◽  
Gender Equality ◽  
Women Pastors ◽  
Church Staff ◽  
Staff Members ◽  
Key Barrier ◽  
Leadership Approaches

Chapter 7 presents instances in which fellow church staff members fail to see or understand fully the effects of gender structure and, therefore, often simultaneously function as allies as well as additional barriers in the pursuit of gender equality within congregations. This chapter also examines the particular standpoint of women pastors and how their experiences of exclusion and marginalization inform their social justice–oriented and riskier approaches to their jobs as compared to men pastors. While these approaches are often evaluated positively by social justice–minded congregants, some congregants described women pastors’ leadership approaches as “agenda driven” or “biased.” While this was not a key barrier in the context of this study, it may serve as a barrier in less social justice–oriented congregations. Finally, the chapter examines barriers to feminist initiatives that occur on the congregational level and emphasizes the importance of listening to the voices of women.

The Utilization of Quality Assurance Methods in Emergency Medical Services

1993 ◽  
Vol 8 (2) ◽  
pp. 127-132 ◽  
Author(s):  
Eric A. Davis ◽  
Anthony J. Billitier
Keyword(s):  
Emergency Medicine ◽  
Quality Assurance ◽  
Emergency Medical Services ◽  
Medical Director ◽  
Medical Services ◽  
Residency Programs ◽  
Medical Control ◽  
Emergency Medical ◽  
Emergency Medicine Physician ◽  
Medicine Physician

AbstractObjective:The concept of the necessity of a good quality assurance (QA) plan for emergency medical services (EMS) is well-accepted; guidelines as how best to achieve this and how current systems operate have not been defined. The purpose of this study was to survey EMS systems to discover current methods used to perform medical control and QA and to examine whether the existence of an emergency medicine residency affected these components.Methods:A survey was mailed in 1989 to the major teaching hospitals associated with all of the emergency medicine residency programs (n = 79) and all other hospitals with greater than 350 beds within the 50 largest United States metropolitan areas (n = 172). If no response was received, a second request was sent in 1990. The survey consisted of questions concerning four general EMS-QA categories: 1) general information; 2) prospective; 3) immediate; and 4) retrospective medical control.Results:Completed surveys were received from 78.5% of residency and 50% of non-residency programs. The majority had an emergency medicine physician as medical director (80.1% vs 61.5%, p = .03). While both residency and non-residency hospitals participated in initial public and prehospital personnel education, academic programs were more likely to be involved in continuing medical education (98.2% vs 82.3%, p = .009). On-line (direct) supervision was more likely to be provided by residency institutions (96.4% vs 81.0%, p = .017) which was provided by a physician in 88.3%. Trip sheet review was utilized by 62.0% of non-residency and 75.5% of residency programs responding, and utilized the paramedic coordinator (44.5% vs 46.1%) or medical director (35.7% vs 34.5 %) primarily.Conclusion:This survey characterizes some of the current methods utilized nationwide in EMS-QA programs. Further research is needed to determine the effectiveness of these various methods, and to develop a model program.

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