05 / EMERGENCY CARE FOR FEBRILE CHILDREN IN EUROPE: DIVERSITY IN CLINICAL PRACTICE AND RESOURCE USE

2018 ◽  
Author(s):  
Dorine Borensztajn
Keyword(s):  
Clinical Practice ◽  
Emergency Care ◽  
Resource Use

Clinical practice guidelines for comprehensive patient assessment in emergency care: A quality evaluation study

2021 ◽  
pp. 205715852110069
Author(s):  
Åsa Falchenberg ◽  
Ulf Andersson ◽  
Birgitta Wireklint Sundström ◽  
Anders Bremer ◽  
Henrik Andersson
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Emergency Care ◽  
Quality Evaluation ◽  
Evaluation Study ◽  
Evidence Based ◽  
Patient Assessment ◽  
Care Needs ◽  
Home Based

Emergency care nurses (ECNs) face several challenges when they assess patients with different symptoms, signs, and conditions to determine patients’ care needs. Patients’ care needs do not always originate from physical or biomedical dysfunctions. To provide effective patient-centred care, ECNs must be sensitive to patients’ unique medical, physical, psychological, social, and existential needs. Clinical practice guidelines (CPGs) provide guidance for ECNs in such assessments. The aim of this study was to evaluate the quality of CPGs for comprehensive patient assessments in emergency care. A quality evaluation study was conducted in Sweden in 2017. Managers from 97 organizations (25 emergency medical services and 72 emergency departments) were contacted, covering all 20 Swedish county councils. Fifteen guidelines were appraised using the validated Appraisal of Guidelines for Research & Evaluation II (AGREE II) tool. The results revealed that various CPGs are used in emergency care, but none of the CPGs support ECNs in performing a comprehensive patient assessment; rather, the CPGs address parts of the assessment primarily related to biomedical needs. The results also demonstrate that the foundation for evidence-based CPGs is weak and cannot confirm that an ECN has the prerequisites to assess patients and refer them to treatment, such as home-based self-care. This may indicate that Swedish emergency care services utilize non-evidence-based guidelines. This implies that ECN managers and educators should actively seek more effective ways of highlighting and safeguarding patients’ various care needs using more comprehensive guidelines.

scholarly journals Glioblastoma treatment patterns, survival, and healthcare resource use in real-world clinical practice in the USA

2015 ◽  
Vol 4 ◽  
pp. 1-12 ◽  
Author(s):  
Allicia Girvan ◽  
Gebra Carter ◽  
Li Lin ◽  
Anna Kaltenboeck ◽  
Jasmina Ivanova ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Resource Use ◽  
Real World ◽  
Healthcare Resource ◽  
Treatment Patterns ◽  
Healthcare Resource Use ◽  
The Usa

scholarly journals P114: Barriers and facilitators affecting implementation of a decision aid for the diagnosis of acute aortic syndrome: a qualitative study

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S106-S106
Author(s):  
C. Dmitriew ◽  
R. Ohle
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Practice Guidelines ◽  
Resource Use ◽  
Decision Aid ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Barriers And Facilitators ◽  
Acute Aortic Syndrome ◽  
D Dimer

Introduction: Acute aortic syndrome (AAS) is an uncommon, life-threatening emergency that is frequently misdiagnosed. The Canadian clinical practice guidelines for the diagnosis of AAS were developed in order to reduce the frequency of misdiagnoses and number of diagnostic tests. As part of the guidelines, a clinical decision aid was developed in order to facilitate clinician decision-making based on practice recommendations. The objective of this study was to identify barriers and facilitators among physicians to implementation of the decision aid. Methods: We conducted semi-structured interviews with emergency room physicians working at 5 sites distributed between urban academic and rural settings. We used purposive sampling, contacting ED physicians until data saturation was reached. Interview questions were designed to understand potential barriers and facilitators affecting the probability of decision aid uptake and accurate application of the tool. Two independent raters coded interview transcripts using an integrative approach to theme identification, combining an inductive approach to identification of themes within an organizing framework (Theoretical Domains Framework), discrepancies in coding were resolved through discussion until consensus was reached. Results: A majority of interviewees anticipated that the decision aid would support clinical decision making and risk stratification while reducing resource use and missed diagnoses. Facilitators identified included validation and publication of the guidelines as well as adoption by peers. Barriers to implementation and application of the tool included the fact that the use of D-dimer and knowledge of the rationale for its use in the investigation of AAS were not widespread. Furthermore, scoring components were, at times, out of alignment with clinician practices and understanding of risk factors. The complexity of the decision aid was also identified as a potential barrier to accurate use. Conclusion: Physicians were amenable to using the AAS decision aid to support clinical decision-making and to reduce resource use, particularly within rural contexts. Key barriers identified included the complexity of scoring and inclusion criteria, and the variable acceptance of D-dimer among clinicians. These barriers should be addressed prior to implementation of the decision aid during validation studies of the clinical practice guidelines.

scholarly journals FIMA, the questionnaire for health-related resource use in the elderly population: validity, reliability, and usage of the Polish version in clinical practice

2018 ◽  
Vol Volume 13 ◽  
pp. 787-795 ◽  
Author(s):  
Justyna Mazurek ◽  
Edyta Sutkowska ◽  
Dorota Szcześniak ◽  
Katarzyna Małgorzata Urbańska ◽  
Joanna Rymaszewska
Keyword(s):  
Clinical Practice ◽  
Resource Use ◽  
Elderly Population ◽  
The Elderly ◽  
Polish Version ◽  
Health Related

Febrile Neutropenia in Lymphoma Patients Is Associated with Substantial Resource Use and Healthcare Costs in Clinical Practice in Spain.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 5512-5512 ◽  
Author(s):  
A. López ◽  
J.D. Alonso ◽  
J. Gómez-Codina ◽  
A. Novo ◽  
C. Herrera ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Febrile Neutropenia ◽  
Resource Use ◽  
Healthcare Costs ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Substantial Impact ◽  
Ct Dose ◽  
Common Clinical Practice ◽  
The Impact

Abstract Background Despite the significant impact of chemotherapy-induced febrile neutropenia (FN) on patients (pts) with cancer and its consequences for health care costs, there have been no studies in common clinical practice in Spain assessing the burden and economic impact of this complication. Methods This is a sub-analysis of lymphoma pts included in a multicentre, retrospective, chart review of adult pts from 16 Spanish hospitals who suffered from at least one FN episode related to cytotoxic chemotherapy (CT). Resource use and subsequent costs including days of hospitalization, number of transfusions, number and type of complementary tests, use of colony-stimulating factors (CSFs), and use of antibiotics and other drugs to manage FN were assessed for each episode. The impact of FN on planned CT was also analysed in terms of dose delays (DD) and/or reductions (DR). Results Medical charts from 194 pts were reviewed, 67 (34.5%) of whom had lymphoma, which accounted for 87 documented FN episodes included in this analysis. The median (range) age of patients was 62 (19–85) years, 31.7% had aggressive NHL, and 58.2% were treated with CHOP-like CT. FN appeared during first CT cycle in 61.2% of the pts. Hospitalization was required in 100% of the pts and the median length of hospital stay due to FN was 8 days (p25:6–p75:11). During an FN episode, 42% of pts required ≥1 transfusion, 100% needed a blood test and 98.9% a blood culture. Microbiologically documented infection appeared in 33% of FN episodes. All pts were treated with antibiotics (69.3% with cephalosporins) and CSFs were used in 64.8% of pts. In 40.9% of episodes, FN impacted on planned CT dose and/or schedule: DR was observed in 16.7% of pts, DD in 24.0% and CT withdrawal in 15.2%. Conclusions FN has a substantial impact on resource use and associated costs in pts with lymphoma. Hospitalization and antibiotic treatment were the main drivers of the cost associated with the management of FN in current clinical practice. Furthermore, FN has a meaningful effect on planned CT dose and/or schedule, with potential consequences for treatment outcome. Mean (SD) healthcare costs per FN episode (All cost data expressed as €) Hospitalization Transfusions Complementary Tests CSFs Antibiotics and Other Drugs Total 3,557.17 (3,050.44) 43.24 (58.59) 162.77 (135.36) 223.39(231.40) 527.67 (448.56) 4,514.24 (3,392.20)

Environmentally sustainable emergency medicine

2021 ◽  
pp. emermed-2020-210421
Author(s):  
Timothy Spruell ◽  
Hannah Webb ◽  
Zoe Steley ◽  
James Chan ◽  
Alexander Robertson
Keyword(s):  
Climate Change ◽  
Emergency Medicine ◽  
Clinical Practice ◽  
Emergency Care ◽  
Carbon Emissions ◽  
Environmental Sustainability ◽  
Emergency Departments ◽  
Global Economy ◽  
Healthcare Sector ◽  
Environmentally Sustainable

Emergency clinicians worldwide are demonstrating increasing concern about the effect of climate change on the health of the populations they serve. The movement for sustainable healthcare is being driven by the need to address the climate emergency. Globally, healthcare contributes significantly to carbon emissions, and the healthcare sector has an important role to play in contributing to decarbonisation of the global economy. In this article, we consider the implications for emergency medicine of climate change, and suggest ways to improve environmental sustainability within emergency departments. We identify examples of sustainable clinical practice, as well as outlining research proposals to address the knowledge gap that currently exists in the area of provision of environmentally sustainable emergency care.

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