scholarly journals Bridging the Gap between Ophthalmology and Emergency Medicine in Community-Based Emergency Departments (EDs): A Neuro-Ophthalmology Guide for ED Practitioners

2021 ◽  
Vol 11 (4) ◽  
pp. 919-932
Author(s):  
Kristina Thomas ◽  
Cindy Ocran ◽  
Anna Monterastelli ◽  
Alfredo A. Sadun ◽  
Kimberly P. Cockerham
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Patient Care ◽  
Emergency Departments ◽  
Anterior Segment ◽  
Tertiary Hospital ◽  
Coordination Of Care ◽  
Community Based ◽  
Image Capturing ◽  
Game Changer

Coordination of care for patients with neuro-ophthalmic disorders can be very challenging in the community emergency department (ED) setting. Unlike university- or tertiary hospital-based EDs, the general ophthalmologist is often not as familiar with neuro-ophthalmology and the examination of neuro-ophthalmology patients in the acute ED setting. Embracing image capturing of the fundus, using a non-mydriatic camera, may be a game-changer for communication between ED physicians, ophthalmologists, and tele-neurologists. Patient care decisions can now be made with photographic documentation that is then conveyed through HIPAA-compliant messaging with accurate and useful information with both ease and convenience. Likewise, external photos of the anterior segment and motility are also helpful. Finally, establishing clinical and imaging guidelines for common neuro-ophthalmic disorders can help facilitate complete and appropriate evaluation and treatment.

scholarly journals A cross-sectional study of patients presenting for hospital-based screening for COVID-19: risk of disease, and healthcare access preferences

2020 ◽  
Author(s):  
Amanda Rojek ◽  
Martin Dutch ◽  
Daniel Peyton ◽  
Rachel Pelly ◽  
Mark Putland ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Departments ◽  
Healthcare Access ◽  
Tertiary Hospital ◽  
Cross Sectional Study ◽  
Models Of Care ◽  
Sources Of Information ◽  
Cross Sectional Survey ◽  
Community Based ◽  
Cross Sectional

AbstractIntroductionEarly during the SARS-CoV-2 pandemic, Australian emergency departments (EDs) have experienced an unprecedented surge in patients seeking screening for COVID-19. Understanding what proportion of these patients require screening, who can be safely screened in community based models of care, and who requires an emergency departments to care for them is critical for workforce and infrastructure planning across the healthcare system, as well as public messaging campaigns.MethodssIn this cross sectional survey, we screened patients presenting to a SARS-CoV-2 screening clinic in a tertiary hospital Emergency Department in Melbourne, Australia. We assessed the proportion of patients who met screening criteria; self-reported symptom severity; reasons why they came to the ED for screening; views on community-based models of care; and sources of information accessed about COVID-19.ResultsWe included findings from 1846 patients who presented to the Emergency Department (ED) for COVID-19 screening from 18th to 30th March 2020. Most patients (55.3%) did not meet criteria for screening and most (57.6%) had mild or no (13.4%) symptoms. The main reason for coming to the ED was being referred by a telephone health service (31.3%) and 136 (7.4%) said they tried to contact their GP but could not get an appointment. Only 47 (2.6%) said they thought the disease was too specialized for their GP to manage. Patients accessed numerous information sources, commonly government websites (68.4%) and other websites (51.3%) for COVID-19 information.Conclusionsif we are to ensure that emergency departments can cope with the likely surge in presentations requiring resuscitation or inpatient care COVID-19, we should strengthen access to alternative services to triage patients to prevent unnecessary presentations at health services, and to direct those who are well but require screening away from EDs.

Approaches of Emergency Department Physicians to Pediatric Burns: A Survey Assessment

2021 ◽  
Author(s):  
Sabri Demir ◽  
Can Ihsan Oztorun ◽  
Ahmet Erturk ◽  
Dogus Guney ◽  
Ayse Ertoy ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Emergency Departments ◽  
Correct Choice ◽  
Inhalation Injury ◽  
Burn Patients ◽  
Surface Areas ◽  
Pediatric Burns ◽  
Insufficient Knowledge ◽  
Parkland Formula

Abstract Burned children generally arrive at emergency departments before referring to specialized burn centers. Their initial treatments are performed by non-burn doctors who work in emergency departments. The aim of this study was to evaluate emergency department doctors’ knowledge regarding the initial interventions and transfer of pediatric burn patients. There were 196 participants who completed the survey: 59 were emergency medicine specialists, 46 were general practitioners, and 91 were emergency medicine residents. Sixty-five stated that they always calculate the burn surface areas, and 144 stated that the Parkland formula should be used to calculate the fluid requirements for the first 24 hours. Of all participants, only 21 marked the correct choice as the Lund-Browder scheme to calculate the total burned surface area in children. Only 52 participants marked the correct choice as the Lactated Ringer’s of the fluid given in the first 24 hours. Only 108 correctly recognized inhalation injury. To the question “What is the first intervention that doctors should do at the emergency room to burned children?”, 127 participants stated correctly as the assessment of airway maintenance. Among the participants, 124 stated that they use lidocaine pomades when covering burned children’s wounds. Incorrect interventions with burned children increase morbidity and mortality. This survey shows that non-burn doctors working in emergency departments have insufficient knowledge about pediatric burns and require further training. Therefore, they should be trained continuously and regularly on the approach to both adult and childhood burns.

scholarly journals LO27: Relevance of Choosing Wisely Canada non-emergency medicine specialty lists to emergency medicine practice

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S16-S17
Author(s):  
S. Upadhye ◽  
C. Davies-Schinkel ◽  
S. Pilakka
Keyword(s):  
Emergency Medicine ◽  
Quality Improvement ◽  
Patient Care ◽  
Resource Use ◽  
Emergency Departments ◽  
Rating Scale ◽  
Likert Scale ◽  
Choosing Wisely ◽  
Low Back ◽  
Potential Impact

Introduction: The Choosing Wisely Canada (CWC) initiative is dedicated towards optimizing patient care and reduce unnecessary resource use. Different specialty organizations create recommendations lists towards these outcomes. The goal of this study was to examine the applicability of non-Emergency Medicine (EM) recommendations towards EM practice. Methods: The entire master recommendations listings spreadsheet was downloaded from the CWC website (March 2019; n = 333). The EM-specific items from the CAEP checklist were deliberately excluded (n = 10). Items were rated by Niagara community EM physicians (n = 7) using the previously validated Best Evidence in Emergency Medicine (BEEM) rating scale (7 point Likert scale) to determine potential impact on EM practice. Items rated “6 or 7/7” were determine as “high relevance.” Redundant items were consolidated. Results: From the retrieved CWC master list, a total of 102 “highly relevant” recommendations were identified (41 items scored 6/7 [12%], 61 scored 7/7 [18%]; total 31%). Redundant items consolidated included antimicrobial avoidance (n = 18), opioid avoidance for pain (n = 11), reduction of unnecessary imaging (n = 11), and avoidance of routine low back imaging (n = 7). Conclusion: There are a large number of non-EM specialty recommendations highly relevant to EM practice in the CWC database (31%). Quality improvement initiatives looking to operational CWC recommendations in Canadian Emergency Departments should be aware of these as a part of optimizing patient care.

scholarly journals P078: Handover education in Canadian adult and pediatric emergency medicine residencies: a national survey and needs assessment

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S104-S105
Author(s):  
P. Lee ◽  
I. Rigby ◽  
S.J. McPherson
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Patient Care ◽  
Pediatric Emergency ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Risk Period ◽  
Hand Off ◽  
Pediatric Inpatient ◽  
Didactic Lecture

Introduction: Emergency department handover is a high-risk period for patient safety. A recent study showed a decreased rate of preventable adverse events and errors after implementation of a resident hand-off bundle on pediatric inpatient wards. In a 2013 survey by the Canadian Associations of Internes and Residents, only 11% of residents in any discipline stated they received a formal teaching session on handover. Recently, the CanMEDS 2015 Physician Competency Framework has added safe and skillful transfer of patient care as a new proficiency within the collaborator role. We hypothesize that significant variation exists in the current delivery and evaluation of handover education in Canadian EM residencies. Methods: We conducted a descriptive, cross-sectional survey of Canadian residents enrolled in the three main training streams of Emergency Medicine (FRCP CCFP-EM, PEM). The primary outcome was to determine which educational modalities are used to teach and assess handover proficiency. Secondarily, we described current sign-over practices and perceived competency at patient handover. Results: 130 residents completed the survey (73% FRCP, 19% CCFP-EM, 8% PEM). 6% of residents were aware of handover proficiency objectives within their curriculum, while 15% acknowledged formal evaluation in this area. 98% of respondents were taught handover by observation of staff or residents on shift, while 55% had direct teaching on the job. Less than 10% of respondents received formal sessions in didactic lecture, small group or simulation formats. Evaluation of handover skills occurred primarily by on shift observation (100% of respondents), while 3% of residents had received assessment through simulation. Local centre handover practices were variable; less than half of residents used mnemonic tools, written or electronic adjuncts. Conclusion: Canadian EM residents receive variable and sparse formal training and assessment on emergency department handover. The majority of training occurs by on shift observation and few trainees receive instruction on objective tools or explicit patient care standards. There exists potential for further development of standardized objectives, utilization of other educational modalities and formal assessments to better prepare residents to conduct safer patient handoffs.

scholarly journals Clinical operations of academic versus non-academic emergency departments: a descriptive comparison of two large emergency department operations surveys

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Martin A. Reznek ◽  
Sean S. Michael ◽  
Cathi A. Harbertson ◽  
James J. Scheulen ◽  
James J. Augustine
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Emergency Departments ◽  
Operational Performance ◽  
Academic Mission ◽  
Median Proportion ◽  
Primary Teaching ◽  
Patient Arrival ◽  
Survey Results ◽  
Level I

Abstract Background Academic and non-academic emergency departments (EDs) are regularly compared in clinical operations benchmarking despite suggestion that the two groups may differ in their clinical operations characteristics. and outcomes. We sought to describe and compare clinical operations characteristics of academic versus non-academic EDs. Methods We performed a descriptive, comparative analysis of academic and non-academic adult and general EDs with 40,000+ annual encounters, using the Academy of Academic Administrators of Emergency Medicine (AAAEM)/Association of Academic Chairs of Emergency Medicine (AACEM) and Emergency Department Benchmarking Alliance (EDBA) survey results. We defined academic EDs as primary teaching sites for emergency medicine (EM) residencies and non-academic EDs as sites with minimal resident involvement. We constructed the academic and non-academic cohorts from the AAAEM/AACEM and EDBA surveys, respectively, and analyzed metrics common to both surveys. Results Eighty and 454 EDs met inclusion criteria for academic and non-academic EDs, respectively. Academic EDs had more median annual patient encounters (73,001 vs 54,393), lower median proportion of pediatric patients (6.3% vs 14.5%), higher median proportion of EMS patients (27% vs 19%), and were more commonly designated as Level I or II Trauma Centers (94% vs 24%). Median patient arrival-to-provider times did not differ (26 vs 25 min). Median length-of-stay was longer (277 vs 190 min) for academic EDs, and left-before-treatment-complete was higher (5.7% vs 2.9%). MRI utilization was higher for academic EDs (2.2% patients with at least one MRI vs 1.0 MRIs performed per 100 patients). Patients-per-hour of provider coverage was lower for academic EDs with and without consideration for advanced practice providers and residents. Conclusions Demographic and operational performance measures differ between academic and non-academic EDs, suggesting that the two groups may be inappropriate operational performance comparators. Causes for the differences remain unclear but the differences appear not to be attributed solely to the academic mission.

scholarly journals Canadian Emergency Department Triage and Acuity Scale (CTAS): Rural Implementation Statement

CJEM ◽  
2003 ◽  
Vol 5 (02) ◽  
pp. 104-107 ◽  
Author(s):  
Keyword(s):  
Emergency Department ◽  
Adverse Effects ◽  
Patient Care ◽  
Emergency Departments ◽  
Improve Patient Care ◽  
Emergency Department Triage ◽  
Improve Patient

BACKGROUND The Canadian Emergency Department Triage and Acuity Scale (CTAS) has been recognized as a significant improvement in standardizing triage in Canadian emergency departments (EDs), both urban and rural. Since its publication an increasing number of Canadian EDs have implemented the CTAS. It was intended to improve patient care through more appropriate triaging of patients, but a number of adverse effects from its implementation have been encountered in rural EDs.

scholarly journals LO095: Developing and implementing an interprofessional in-situ simulation program in an academic, tertiary-care emergency department: barriers, successes and the Ottawa Hospital experience

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S63-S63
Author(s):  
C. Poulin ◽  
B. Weitzman ◽  
G. Mastoras ◽  
L. Norman ◽  
A. Pozgay ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Patient Care ◽  
Financial Support ◽  
Tertiary Care ◽  
Simulation Program ◽  
In Situ Simulation ◽  
Simulation Center ◽  
The Impact

Introduction / Innovation Concept: During Emergency Department (ED) resuscitation of critically ill patients, effective teamwork and communication among various healthcare professionals is essential to ensure favorable patient outcomes and to minimize threats to patient safety. However, numerous individual and system factors create barriers to effective team functioning. Simulation center- based training has been used to improve Crisis Resource Management skills among physician and nursing trainees, but in-situ simulation is a relatively new concept in adult Emergency Medicine in North America. Methods: To enhance patient care and team effectiveness, an ED nursing and physician group was created to develop and implement a novel interprofessional in-situ simulation program in two Canadian, academic tertiary-care emergency departments. Departmental approval and financial support was obtained and sessions commenced in January 2015. Curriculum, Tool, or Material: Monthly high-fidelity simulation sessions are held in the ED resuscitation rooms at both campuses of our hospital. Each session is facilitated and debriefed by simulation-trained Emergency Medicine faculty and senior residents, a nurse educator and a research assistant. Technical support is provided by our simulation center staff. Participants are recruited from the physicians, residents, nurses, respiratory therapists and other support staff working in the ED. To minimize the impact on patient care, two additional nurses are scheduled to cover nursing assignments on “sim days”. Simulations are limited to fifteen minutes, followed by a twenty minute debriefing. Conclusion: We have successfully developed and implemented an interprofessional in-situ simulation program in our ED. Participant feedback has been overwhelmingly positive. Lack of financial support, reluctance of staff to participate, and overwhelmed resources are some of the challenges to running a program like this in a busy ED environment. However, there are clear benefits: empowering team members, culture change, identification of latent safety threats, and a perception of improved teamwork and communication.

Emergency department observation beds improve patient care: Society for academic emergency medicine debate

1992 ◽  
Vol 21 (8) ◽  
pp. 967-975 ◽  
Author(s):  
Louis Graff ◽  
Leslie S Zun ◽  
Jerrold Leikin ◽  
Brian Gibler ◽  
Michael S Weinstock ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Patient Care ◽  
Improve Patient Care ◽  
Care Society ◽  
Improve Patient

scholarly journals Non-urgent visits to emergency departments: a qualitative study in Iran exploring causes, consequences and solutions

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e028257 ◽  
Author(s):  
Mohammadkarim Bahadori ◽  
Seyyed Meysam Mousavi ◽  
Ehsan Teymourzadeh ◽  
Ramin Ravangard
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Emergency Departments ◽  
Qualitative Content Analysis ◽  
Healthcare Providers ◽  
Military Hospital ◽  
Complex Nature ◽  
Negative Consequences ◽  
Middle Income ◽  
Emergency Medicine Resident

ObjectiveTo explore the causes and consequences of non-urgent visits to emergency departments in Iran and then suggest solutions from the healthcare providers’ viewpoint.DesignQualitative descriptive study with in-depth, open-ended, and semistructured interviews, which were inductively analysed using qualitative content analysis.SettingA territorial, educational and military hospital in Iran.ParticipantsEleven healthcare providers including eight nurses, two emergency medicine specialists and one emergency medicine resident.ResultsThree overarching themes of causes and consequences of non-urgent visits to the emergency department in addition to four suggested solutions were identified. The causes have encompassed the specialised services in emergency department, demand-side factors, and supply-side factors. The consequences have been categorised into three overarching themes including the negative consequences on patients, healthcare providers and emergency departments as well as the health system in general. The possible solutions for limiting and controlling non-urgent visits also involved regulatory plans, awareness-raising plans, reforms in payment mechanisms, and organisational arrangements.ConclusionWe highlighted the need for special attention to the appropriate use of emergency departments in Iran as a middle-income country. According to the complex nature of emergency departments and in order to control and prevent non-urgent visits, it can be suggested that policy-makers should design and implement a combination of the possible solutions.

scholarly journals CAEP 2018 Academic Symposium: Recommendations for developing and supporting Global Emergency Medicine in Canadian academic emergency departments and divisions

CJEM ◽  
2019 ◽  
Vol 21 (5) ◽  
pp. 600-606 ◽  
Author(s):  
Amanda Collier ◽  
Gregory Marton ◽  
Shannon Chun ◽  
Cheri Nijssen-Jordan ◽  
Susan A. Bartels ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Literature Review ◽  
Global Health ◽  
Emergency Departments ◽  
Financial Support ◽  
Academic Departments ◽  
Research Administration ◽  
Strategic Plans ◽  
Local Leaders

ABSTRACTObjectivesThe objective of the CAEP Global Emergency Medicine (EM) panel was to identify successes, challenges, and barriers to engaging in global health in Canadian academic emergency departments, formulate recommendations for increasing engagement of faculty, and guide departments in developing a Global EM program.MethodsA panel of academic Global EM practitioners and residents met regularly via teleconference in the year leading up to the CAEP 2018 Academic Symposium. Recommendations were drafted based on a literature review, three mixed methods surveys (CAEP general members, Canadian Global EM practitioners, and Canadian academic emergency department leaders), and panel members’ experience. Recommendations were presented at the CAEP 2018 Academic Symposium in Calgary and further refined based on feedback from the Academic Section.ResultsA total of nine recommendations are presented here. Seven of these are directed towards Canadian academic departments and divisions and intend to increase their engagement in Global EM by recognizing it as an integral part of the practice of emergency medicine, deliberately incorporating it into strategic plans, identifying local leaders, providing tangible supports (i.e., research, administration or financial support, shift flexibility), mitigating barriers, encouraging collaboration, and promoting academic deliverables. The final two recommendations pertain to CAEP increasing its own engagement and support of Global EM.ConclusionsThese recommendations serve as guidance for Canadian academic emergency departments and divisions to increase their engagement in Global EM.

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