scholarly journals Point of Care Ultrasound First: An Opportunity to Improve Efficiency for Uncomplicated Pregnancy in the Emergency Department

POCUS Journal ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. 42-44
Author(s):  
Sara Urquhart ◽  
Kendall Stevens ◽  
Mariah Barnes ◽  
Matthew Flannigan
Keyword(s):  
Emergency Department ◽  
Random Sample ◽  
Medical Center ◽  
Point Of Care ◽  
Tertiary Care ◽  
Radiology Department ◽  
Point Of Care Ultrasound ◽  
Tertiary Care Medical Center ◽  
Time To Diagnosis ◽  
Emergency Department Patients

Introduction: Research suggests emergency providers using point-of-care ultrasound (POCUS) to confirm an uncomplicated intrauterine pregnancy (IUP) can decrease emergency department (ED) length of stay (LOS) compared to a radiology department ultrasound (RADUS). The objective of this study was to compare the time to diagnosis and LOS between POCUS and RADUS patients. Methods: This was a retrospective study at one urban medical center. A standardized tool was used to abstract data from a random sample of pregnant patients diagnosed with uncomplicated IUP between January 2016 and December 2017 at a single tertiary care medical center. Microsoft Excel 2010 software was used to measure time intervals, prepare descriptive statistics, and perform Mann-Whitney U tests to compare differences. Results: A random sample of 836 (36%) of the 2,346 emergency department patients diagnosed with an IUP between 8-20 weeks’ gestation during the study period was evaluated for inclusion. Three hundred sixty-six met inclusion criteria and were included in the final analysis. Patients were divided into 2 groups based on which type of ultrasound scan they received first: POCUS (n=165) and RADUS (n=201). Patients who received POCUS were found to have an IUP identified in an average of 48 minutes (95% CI, 43 to 53), while the RADUS group’s mean time to diagnosis was 120 minutes (95% CI 113 to 127) with a difference of 72 minutes (95% CI, 63 to 80; p<0.001). The mean LOS for patients who received POCUS was 132 minutes (95% CI, 122 to 142), while that of the RADUS group was 177 minutes (95% CI 170 to 184) with a difference of 45 minutes (95% CI 32 to 56; p<0.001). The study is limited by its single-center, retrospective design and by lack of blinding of data abstractors. Conclusion: Pregnant emergency department patients diagnosed with an uncomplicated IUP between 8-weeks and 20-weeks’ gestation had statistically significant reduction in time to diagnosis and disposition from the ED if assessed with POCUS as compared to RADUS.

scholarly journals MP53: A feasibility analysis for successful completion of IVC ultrasound in hypotensive emergency department patients

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S62-S62
Author(s):  
R. Dunfield ◽  
P. Ross ◽  
C. Keyes ◽  
J. Fraser ◽  
D. Lewis ◽  
...  
Keyword(s):  
Emergency Department ◽  
Point Of Care ◽  
Secondary Analysis ◽  
Vena Cava ◽  
International Study ◽  
Point Of Care Ultrasound ◽  
Standard Data ◽  
Fluid Status ◽  
Emergency Department Patients ◽  
Collection Form

Introduction: Determining fluid status prior to resuscitation provides a more accurate guide for appropriate fluid administration in the setting of undifferentiated hypotension. Emergency Department (ED) point of care ultrasound (PoCUS) has been proposed as a potential non-invasive, rapid, repeatable investigation to ascertain inferior vena cava (IVC) characteristics. Our goal was to determine the feasibility of using PoCUS to measure IVC size and collapsibility. Methods: This was a planned secondary analysis of data from a prospective multicentre international study investigating PoCUS in ED patients with undifferentiated hypotension. We prospectively collected data on IVC size and collapsibility using a standard data collection form in 6 centres. The primary outcome was the proportion of patients with a clinically useful (determinate) scan defined as a clearly visible intrahepatic IVC, measurable for size and collapse. Descriptive statistics are provided. Results: A total of 138 scans were attempted on 138 patients; 45.7% were women and the median age was 58 years old. Overall, one hundred twenty-nine scans (93.5%; 95% CI 87.9 to 96.7%) were determinate. 131 (94.9%; 89.7 to 97.7%) were determinate for IVC size, and 131 (94.9%; 89.7 to 97.7%) were determinate for collapsibility. Conclusion: In this analysis of 138 ED patients with undifferentiated hypotension, the vast majority of PoCUS scans to investigate IVC characteristics were determinate. Future work should include analysis of the value of IVC size and collapsibility in determining fluid status in this group.

scholarly journals Point-of-care ultrasound versus radiology department pelvic ultrasound on emergency department length of stay

2016 ◽  
Vol 7 (3) ◽  
pp. 178 ◽  
Author(s):  
Sean P. Wilson ◽  
Kiah Connolly ◽  
Shadi Lahham ◽  
Mohammad Subeh ◽  
Chanel Fischetti ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Point Of Care ◽  
Radiology Department ◽  
Point Of Care Ultrasound ◽  
Pelvic Ultrasound

scholarly journals Implementation of Preoperative Screening Protocols in Otolaryngology During the COVID-19 Pandemic

2020 ◽  
Vol 163 (2) ◽  
pp. 265-270 ◽  
Author(s):  
Matthew J. Urban ◽  
Tirth R. Patel ◽  
Richard Raad ◽  
Phillip LoSavio ◽  
Kerstin Stenson ◽  
...  
Keyword(s):  
Medical Center ◽  
Point Of Care ◽  
Tertiary Care ◽  
Operative Procedures ◽  
Preoperative Screening ◽  
Critical Aspect ◽  
Significant Delay ◽  
Care Protocol ◽  
Tertiary Care Medical Center ◽  
High Risk Case

Objective To highlight emerging preoperative screening protocols and document workflow challenges and successes during the early weeks of the COVID-19 pandemic. Methods This retrospective cohort study was conducted at a large urban tertiary care medical center. Thirty-two patients undergoing operative procedures during the COVID-19 pandemic were placed into 2 preoperative screening protocols. Early in the pandemic a “high-risk case protocol” was utilized to maximize available resources. As information and technology evolved, a “universal point-of-care protocol” was implemented. Results Of 32 patients, 25 were screened prior to surgery. Three (12%) tested positive for COVID-19. In all 3 cases, the procedure was delayed, and patients were admitted for treatment or discharged under home quarantine. During this period, 86% of operative procedures were indicated for treatment of oncologic disease. There was no significant delay in arrival to the operating room for patients undergoing point-of-care screening immediately prior to their procedure ( P = .92). Discussion Currently, few studies address preoperative screening for COVID-19. A substantial proportion of individuals in this cohort tested positive, and both protocols identified positive cases. The major strengths of the point-of-care protocol are ease of administration, avoiding subsequent exposures after testing, and relieving strain on “COVID-19 clinics” or other community testing facilities. Implications for Practice Preoperative screening is a critical aspect of safe surgical practice in the midst of the widespread pandemic. Rapid implementation of universal point-of-care screening is possible without major workflow adjustments or operative delays.

scholarly journals P088: Emergency department utilization of point-of-care ultrasound in the assessment and management of shock

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S108
Author(s):  
J. McGuire ◽  
K. Van Aarsen ◽  
D. Thompson ◽  
B. Hassani
Keyword(s):  
Emergency Department ◽  
Quality Assurance ◽  
Point Of Care ◽  
Image Acquisition ◽  
Tertiary Care ◽  
Direct Result ◽  
Emergency Department Utilization ◽  
Point Of Care Ultrasound ◽  
Diagnostic Code ◽  
Management Change

Introduction: Recent studies have shown that point of care ultrasound is a valuable tool in the assessment and management of shock in the Emergency Department (ED). Despite proven utility, data is limited on the current utilization and quality assurance of POCUS in ED management of shock. The aim of this study was to determine the rate of POCUS use, characterize data collection methods and determine rate of quality assurance in both the ED and Intensive Care Unit (ICU) of a tertiary care academic center. Methods: The study included all patients who visited the ED from Jan-Jun 2015 that were transferred to the ICU, and were in shock, as determined by sBP &lt;90, diagnostic code or vasopressor use. Patient charts, as well as wirelessly archived ultrasound studies were reviewed to determine which patients had POCUS performed, and how the results were recorded. By reviewing formal worksheets archived online, it could be determined if a management change was recommended, if studies were over-read for quality assurance and if improvement was recommended to image acquisition or interpretation. Results: Both departments used POCUS in roughly half of patients presenting in shock (53% ED, 41% ICU) with no statistical difference in usage (Δ12, 95% CI −0.01 to 0.25; p=0.06). Most ED studies (87%), had some form of documentation either on paper or online, however few (9%) had a formal worksheet completed. In comparison 71% of ICU studies had a worksheet. There was no difference in the number of performed scans that were saved electronically (66% ED vs 71% ICU; Δ5%, 95%CI −0.13 to 0.21; p=0.60).In the ICU the majority (77%) of the formal reports recommended a management change as a direct result of scan findings. Furthermore, of worksheets submitted for quality assurance (88%), over half the reviews (55%) suggested an improvement in image acquisition or interpretation. Conclusion: To our knowledge, our study is the first to demonstrate that POCUS is only utilized in about half of the shock cases in ED and ICU. Given that the majority of the formally reported studies in the ICU that were over-read for quality assurance found areas for potential improvement and given that the majority of ED studies were reported informally, it stands to reason that POCUS operators in the ED could benefit from a formalized quality assurance program. Future studies should explore potential barriers to implementation of such a program.

Delirium etiology subtypes and their effect on six-month function and cognition in older emergency department patients

2018 ◽  
Vol 31 (2) ◽  
pp. 267-276 ◽  
Author(s):  
Jamie Cirbus ◽  
Alasdair M. J. MacLullich ◽  
Christopher Noel ◽  
E. Wesley Ely ◽  
Rameela Chandrasekhar ◽  
...  
Keyword(s):  
Emergency Department ◽  
Short Form ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
The Elderly ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Emergency Department Patients ◽  
Factor Interactions

ABSTRACTBackground:Delirium is heterogeneous and can vary by etiology.Objectives:We sought to determine how delirium subtyped by etiology affected six-month function and cognition.Design:Prospective cohort study.Setting:Tertiary care, academic medical center.Participants:A total of 228 hospitalized patients > 65 years old were admitted from the emergency department (ED).Measurements:The modified Brief Confusion Assessment Method was used to determine delirium in the ED. Delirium etiology was determined by three trained physician reviewers using a Delirium Etiology checklist. Pre-illness and six-month function and cognition were determined using the Older American Resources and Services Activities of Daily Living (OARS ADL) questionnaire and the short-form Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Multiple linear regression was performed to determine if delirium etiology subtypes were associated with six-month function and cognition adjusted for baseline OARS ADL and IQCODE. Two-factor interactions were incorporated to determine pre-illness function or cognition-modified relationships between delirium subtypes and six-month function and cognition.Results:In patients with poorer pre-illness function only, delirium secondary to metabolic disturbance (β coefficient = −2.9 points, 95%CI: −0.3 to −5.6) and organ dysfunction (β coefficient = −4.3 points, 95%CI: −7.2 to −1.4) was significantly associated with poorer six-month function. In patients with intact cognition only, delirium secondary to central nervous system insults was significantly associated with poorer cognition (β coefficient = 0.69, 95%CI: 0.19 to 1.20).Conclusions:Delirium is heterogeneous and different etiologies may have different prognostic implications. Furthermore, the effect of these delirium etiologies on outcome may be dependent on the patient's pre-illness functional status and cognition.

scholarly journals An Extended Laboratory Validation Study and Comparative Performance Evaluation of the Abbott ID NOW™ COVID-19 Assay in a Coastal California Tertiary Care Medical Center

2020 ◽  
Author(s):  
Stewart Comer ◽  
David Fisk
Keyword(s):  
Test Performance ◽  
Medical Center ◽  
Point Of Care ◽  
Tertiary Care ◽  
Molecular Diagnostic ◽  
Patient Classification ◽  
Optimal Test ◽  
Comparative Performance ◽  
Tertiary Care Medical Center ◽  
Molecular Diagnostic Test

AbstractThe Abbott ID NOW™ COVID-19 assay is a rapid molecular diagnostic test particularly designed for on-site, rapid turnaround point of care (POC) testing. The utilization of rapid diagnostic tests is integral to optimizing workflow within the hospital and/or procedural-based clinics. The capability to provide both rapid disposition and correct patient classification during this COVID-19 pandemic is critically important with broad infection control implications for both patients and healthcare staff. A tightly controlled, extended laboratory validation was performed at our medical center to determine the negative test agreement of the Abbott ID NOW™ compared with the BD MAX™ analyzer, a laboratory-based, two target, molecular analyzer with a sensitive cycle threshold (Ct) positive cutoff value of ≤ 42. There was strict adoption of the procedures listed in the Abbott ID NOW™ Instruction for Use (IFU)1 insert delineating preferred practices for “optimal test performance.” Under these conditions, our institution demonstrated a significant negative percent agreement with 116 out of 117 patients correlating, which equates to a 99.1% concordance similar to a recently reported correlation study2.

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