scholarly journals Implementation and Development of Emergency Department Pharmacist-Driven Patient-Care Transitional Model: A Discussion of Our Experiences and Processes

2018 ◽  
Vol 9 (3) ◽  
pp. 1
Author(s):  
Arinze Nkemdirim Okere
Keyword(s):  
Emergency Department ◽  
Patient Care ◽  
Financial Burden ◽  
The Elderly ◽  
Healthcare Systems ◽  
Pharmacist Intervention ◽  
Care Systems ◽  
Ed Visits ◽  
Healthcare Administrators

Frequent preventable emergency department (ED) visits is an area of great concern among healthcare administrators. Although pharmacist interventions have been shown to reduce re-hospitalizations, studies demonstrating reduction in ED utilizations among the elderly are limited. Additionally, factors influencing readmissions in the ED are multifactorial. Hence, some healthcare systems struggle to reduce readmissions using pharmacy services. This has been a major issue facing care provided to the elderly in the ED. As healthcare care systems develops and implement a collaborative pharmacist and physician/mid-level provider comprehensive transitional model of care in the ED, the quality of care provided to the elderly will be enhanced which will ultimately translate to reduced inappropriate ED visit and re-hospitalization with corresponding reduction in financial burden placed on both the patient, caregiver and the society. Therefore, the objective of this article is to discuss our process with implementing pharmacist-providers transitional model in the ED. The intent is to elucidate some pharmacist-intervention principles and a pharmacist-driven, patient-care transitional model that would provide direction for other healthcare systems to improve ED visits within their locality.   Type: Idea Paper  

scholarly journals National Trends in Emergency Department Care Processes for Acute Myocardial Infarction in the United States, 2005 to 2015

2020 ◽  
Vol 9 (20) ◽  
Author(s):  
Akshay Pendyal ◽  
Craig Rothenberg ◽  
Jean E. Scofi ◽  
Harlan M. Krumholz ◽  
Basmah Safdar ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Emergency Department ◽  
Length Of Stay ◽  
Real World ◽  
The United States ◽  
Emergency Department Care ◽  
Care Processes ◽  
Ed Visits

Background Despite investments to improve quality of emergency care for patients with acute myocardial infarction (AMI), few studies have described national, real‐world trends in AMI care in the emergency department (ED). We aimed to describe trends in the epidemiology and quality of AMI care in US EDs over a recent 11‐year period, from 2005 to 2015. Methods and Results We conducted an observational study of ED visits for AMI using the National Hospital Ambulatory Medical Care Survey, a nationally representative probability sample of US EDs. AMI visits were classified as ST‐segment–elevation myocardial infarction (STEMI) and non‐STEMI. Outcomes included annual incidence of AMI, median ED length of stay, ED disposition type, and ED administration of evidence‐based medications. Annual ED visits for AMI decreased from 1 493 145 in 2005 to 581 924 in 2015. Estimated yearly incidence of ED visits for STEMI decreased from 1 402 768 to 315 813. The proportion of STEMI sent for immediate, same‐hospital catheterization increased from 12% to 37%. Among patients with STEMI sent directly for catheterization, median ED length of stay decreased from 62 to 37 minutes. ED administration of antithrombotic and nonaspirin antiplatelet agents rose for STEMI (23%–31% and 10%–27%, respectively). Conclusions National, real‐world trends in the epidemiology of AMI in the ED parallel those of clinical registries, with decreases in AMI incidence and STEMI proportion. ED care processes for STEMI mirror evolving guidelines that favor high‐intensity antiplatelet therapy, early invasive strategies, and regionalization of care.

North central London elective orthopaedic network and health service innovation to improve the quality of NHS patient care

2021 ◽  
pp. 1-4
Author(s):  
Joshua W. Thompson ◽  
Alice O'Brien ◽  
Anna Stewart ◽  
Rob Hurd ◽  
Fares S Haddad
Keyword(s):  
Health Service ◽  
Patient Care ◽  
Integrated Care ◽  
Service Innovation ◽  
Modern Medicine ◽  
North Central ◽  
The North ◽  
Care Systems

Health service innovation is required to meet the ever-growing demands of modern medicine. This editorial discusses the transformation of the north central London elective orthopaedic network and the essential principles which future integrated care systems could incorporate.

Unscheduled Revisits after Diagnosis of Abdominal Pain at Emergency Department, Mukdahan Hospital

2021 ◽  
Vol 104 (Suppl. 1) ◽  
pp. S40-S43
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Patient Care ◽  
Acute Abdominal Pain ◽  
Signs And Symptoms ◽  
Discharge System ◽  
Effective Discharge ◽  
Time Period ◽  
Pain Patients

Background: Abdominal pain is a common complaint for patients revisiting the Emergency Department (ED). Evaluating the cause of the revisit can improve the quality of ED patient care. Objective: We aimed to analyzed unscheduled revisits after diagnosis of abdominal pain at emergency department. Materials and Methods: In order to determine the characteristics of their abdominal pain and the causes for the revisits, the charts of 90 patients were reviewed. These patients had experienced acute abdominal pain and had returned to the Emergency Department within 48 hours after their initial treatment during the period between January 2019 and December 2019. Results: During that time period, 44,000 patients visited the ED. Of these, 90 patients (0.2%) with acute abdominal pain or related symptoms had revisited the ED within the following 48 hours. Most of these patients had been 20 to 60 years of age and had had no co-morbid diseases. Almost half of patient revisits had occurred during the evening shift (45.6%). There were 74% of these patients, who had been admitted to hospital for observation or for procedures. No in-hospital mortality was reported for this study. The signs and symptoms of abdominal pain in these patients had not been specific. The factors, which most often contributed to the ED revisits, had been inappropriate consultations and inappropriate discharges or advises. Conclusion: The majority of the acute abdominal pain patients, who revisited the ED within 48 hours, had been admitted. The most common cause of revisits had been inappropriate consultations and inappropriate discharges. Improving ED patient care can be managed by contributing to effective consultations and to establishing an effective discharge system for the ED. Keywords: Revisits, Emergency medicine department, Acute abdominal pain

scholarly journals COVID-19 Pandemic Impact on Emergency Department Visits and Quality of Service: A Comparative Cross-Sectional Study in a Tertiary Centre

2021 ◽  
pp. 471-483
Author(s):  
Maram Mohammed Jaboua ◽  
Warif Jameel Abdulhaq ◽  
Nada Saeed Almuntashiri ◽  
Sarah Saud Almohammdi ◽  
Asayel Qeblan Aldajani ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cross Sectional Study ◽  
Emergency Department Visits ◽  
Critical Conditions ◽  
Sectional Study ◽  
Cross Sectional ◽  
Coronary Syndrome ◽  
Number Of Patients ◽  
Ed Visits

Background: The COVID-19 pandemic has contributed to a devastating impact on emergency departments worldwide, resulting in a global crisis with various health consequences. We aimed to evaluate this impact on an emergency department (ED) visit of critical conditions such as Acute Coronary Syndrome (ACS), Cerebrovascular accident (CVA), Sepsis and Febrile neutropenia (FN), and to assess the quality of the ED after new adaptive measures were applied. Methods: This is a comparative cross-sectional study to assess the number of patients who presented to the ED of King Abdullah Medical city with the specified diagnosis. We collected data via the E-medical records. We compared the data over three periods pre-lockdown, lockdown and post lockdown in years 2019-2021. For quality measurement, Adaa (Ministry of Health's program) was used to calculate the percentage of patients who stayed 4 hours or less in the ED. Results: The total number of ED visits in the specified periods of study was 8387. The total numbers of patients for 2019, 2020, and 2020 respectively were 2011 (, ACS 70.4%, CVA 16.3%, sepsis and FN 13.3%.), 2733 (ACS 73.1%, CVA 9.9%, sepsis and FN 17.0%), and 3643 (ACS 64.0%, CVA 19.4%, sepsis and FN 16.7). The average percentage of patients who stayed 4 hours or less in the ED was 60% and 57.5% for 2020 and 2021, respectively. Conclusion: Although we expected reductions in ED visits during COVID-19 periods, we found that visits were rising through the years 2019-2021.

scholarly journals Fragile X Syndrome-Associated Emergency Department Visits in the United States, 2006–2011

2020 ◽  
Vol 125 (2) ◽  
pp. 103-108
Author(s):  
Thuy Quynh N. Do ◽  
Catharine Riley ◽  
Pangaja Paramsothy ◽  
Lijing Ouyang ◽  
Julie Bolen ◽  
...  
Keyword(s):  
Emergency Department ◽  
Fragile X Syndrome ◽  
Fragile X ◽  
The United States ◽  
Emergency Department Visits ◽  
Surveillance Systems ◽  
Diagnosis Code ◽  
National Data ◽  
Ed Visits

Abstract Using national data, we examined emergency department (ED) encounters during 2006–2011 for which a diagnosis code for fragile X syndrome (FXS) was present (n = 7,217). Almost half of ED visits coded for FXS resulted in hospitalization, which is much higher than for ED visits not coded for FXS. ED visits among females coded for FXS were slightly more likely to result in hospitalization. These findings underscore the importance of surveillance systems that could accurately identify individuals with FXS, track healthcare utilization and co-occurring conditions, and monitor quality of care in order to improve care and reduce FXS-associated morbidity.

Implementation of the Theory of Planned Behavior to Promote Compliance with a Chlorhexidine Gluconate Protocol

2017 ◽  
Vol 22 (2) ◽  
pp. 64-70 ◽  
Author(s):  
Christina Ryan
Keyword(s):  
Emergency Department ◽  
Blood Culture ◽  
Theory Of Planned Behavior ◽  
Medical Treatment ◽  
Patient Care ◽  
Planned Behavior ◽  
False Positive ◽  
Chlorhexidine Gluconate ◽  
Blood Cultures

Abstract Introduction: Blood cultures are critical values for identifying the source of an infection in patients seeking medical treatment for an acute illness. False-positive cultures can negatively influence patient care when physicians use inaccurate information to prescribe treatment. Inaccurate prescribed treatment negatively influences the quality of patient care related to prolonged medical treatment and hospital stay and unnecessary repetition of diagnostic tests. Purpose: The purpose of this project was to determine if blood culture contamination rates would be decreased if improved availability of CHG products was provided in all emergency department patient care areas would reduce the contamination rates of blood cultures. Methodology: The Theory of Planned Behavior provided the theoretical framework for this descriptive correlational project to examine barriers to following the procedural guidelines to cleanse venipuncture sites with a chlorhexidine gluconate (CHG) product before venipuncture Alcohol preparation pads were removed from the emergency department and a CHG product packaged similar to the alcohol preparation pads was placed in the department procedure trays and bedside carts. Results: During the first 2 weeks of the pilot project, blood culture contamination rates were reduced from 4.5% to 1.5%. The following month, rates remained low at 1.9%. Conclusion: Placement of CHG products at the bedside will improve patient safety and quality of care by reducing the incidence of inaccurate diagnosis and treatment based on false-positive blood cultures.

scholarly journals Physician Perceptions of Disposition Decision-making for Older Adults in the Emergency Department: A Preliminary Analysis

2020 ◽  
Vol 64 (1) ◽  
pp. 648-652
Author(s):  
Rachel A. Rutkowski ◽  
Megan Salwei ◽  
Hanna Barton ◽  
Kathryn Wust ◽  
Peter Hoonakker ◽  
...  
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Emergency Department ◽  
Patient Safety ◽  
Quality Of Care ◽  
Care Transitions ◽  
Physician Perceptions ◽  
Ed Visits ◽  
Promote Patient Safety

Disposition decision-making in the emergency department (ED) is critical to patient safety and quality of care. Disposition decision-making has particularly important implications for older adults who comprise a significant portion of ED visits annually and are vulnerable to suboptimal outcomes throughout ED care transitions. We conducted a secondary inductive content analysis of interviews with ED physicians (N= 11) to explore their perceptions of who they involve in disposition decision-making and what information they use to make disposition decisions for older adults. ED physicians cited 7 roles (5 types of clinicians, patients and families) and 11 information types, both clinical (e.g. test/lab results) and non-clinical (e.g. family’s preference). Our preliminary findings represent a key first step toward the development of interventions that promote patient safety and quality of care for older adults in the ED by supporting the cognitive and communicative aspects of disposition decision-making.

scholarly journals The Role of Primary Care in Asthma Control and Severity

Spectrum ◽  
2019 ◽  
Author(s):  
Joel Agarwal ◽  
Monette Dimitrov ◽  
Kerri MacKay ◽  
Alan Kaplan ◽  
Donald Cockcroft ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Emergency Department ◽  
Asthma Control ◽  
Primary Care Providers ◽  
Care Utilization ◽  
Life Questionnaire ◽  
Care Providers ◽  
Ed Visits

Background: Asthma is a common chronic inflammatory disease of the airways affecting 3 millionCanadians. Primary Care Providers (PCPs) are integral to care coordination, enhanced through thedevelopment of a strong patient-PCP relationship with Continuity of Care (COC). A recent CIHI studynoted that 40% of Albertans do not have a COC model for primary care.Objectives: We aim to evaluate how primary care for adults with asthma impacts different measures ofcontrol.Methods: Prospective population-based recruitment of adults through various community venuesacross Alberta. Those who had self-reported asthma and were willing to participate completed a surveywhich included demographics, comorbidities, medication use (including biologics, allergy medications,steroids), Asthma Control Questionnaire (ACQ-5), Asthma Control Test (ACT), Quality of Life (QoL)measured through the mini-Asthma Quality of Life Questionnaire (mini-AQLQ) and health care utilization(including Emergency Department (ED) visits, hospitalizations and ICU stays for asthma).Results: Of the 1685 individuals approached, 61 (3.6%) reported having asthma, of which 47 lived inAlberta. Most (41, 87%) had a PCP, with 30 (64%) visiting their PCP at least twice a year. Uncontrolledasthma was noted in 21 (45%) with either the ACQ-5 or ACT. The mini-AQLQ indicated 5 (11%) withreduced QoL. Mean lifetime hospitalizations, lifetime Emergency Department (ED) visits, and ICU staysrelated to asthma were 1.52, 4.55 and 0.25 respectively. Further, mean hospitalizations and ED visits inthe past 12 months related to asthma were 0.05 and 0.30 respectively.Conclusions: Asthma control was poor in 21 (45%) surveyed individuals, suggesting sub-optimal asthmamanagement in Alberta. Knowledge of Primary Care Networks (PCNs) was low, while ED and hospitalusage was high.

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