scholarly journals Feasibility and Effectiveness of Recruiting Latinos in Decídetexto—A Smoking Cessation Clinical Trial from an Emergency Department Patient Registry

2021 ◽  
Vol 18 (20) ◽  
pp. 10859
Author(s):  
Evelyn Arana-Chicas ◽  
Francisco Cartujano-Barrera ◽  
Chinwe Ogedegbe ◽  
Edward F. Ellerbeck ◽  
Lisa Sanderson Cox ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Emergency Department ◽  
Smoking Cessation ◽  
Regression Models ◽  
Primary Outcome ◽  
Medical Center ◽  
Emergency Department Patient ◽  
Time Of Day ◽  
Patient Registry ◽  
Day Of The Week

There is an underrepresentation of Latinos in smoking cessation clinical trials. This study describes the feasibility and effectiveness of recruiting Latino smokers in the U.S. from an emergency department (ED) patient registry into a randomized smoking cessation clinical trial. Recruitment occurred from the Hackensack University Medical Center ED. Potential participants were contacted from a patient registry. The primary outcome was whether the participant responded to a call or text. Secondary outcomes included the best day of the week, week of the month, and time of day to obtain a response. Of the 1680 potential participants, 1132 were called (67.5%), while 548 (32.5%) were texted. For calls, response rate was higher compared to text (26.4% vs 6.4%; p < 0.001). More participants were interested in the study when contacted by calls compared to text (11.4% vs. 1.8%) and more participants were enrolled in the study when contacted by calls compared to text (1.1% vs. 0.2%). Regression models showed that ethnicity, age, time of day, and week of the month were not significantly associated with response rates. Recruitment of Latinos from an ED patient registry into a smoking cessation clinical trial is feasible using call and text, although enrollment may be low.

Polynomial modeling of emergency department arrivals: An analysis of local and national utilization patterns

2021 ◽  
Vol 19 (2) ◽  
pp. 189-196
Author(s):  
Mitchell Karpman, PhD ◽  
Nandakumar Menon, MD ◽  
Justin Turcotte, PhD, MBA
Keyword(s):  
Emergency Department ◽  
Regression Models ◽  
Polynomial Regression ◽  
Medical Center ◽  
Data File ◽  
Interaction Effects ◽  
Time Of Day ◽  
Hierarchical Regression ◽  
Institutional Data ◽  
Main Effects

Emergency department (ED) overcrowding is a national problem that is associated with ambulance diversion, decreased patient and provider satisfaction and poor patient outcomes. This study presents a novel approach to modeling the relationship between time of day, day of week, and ED arrivals using a hierarchical polynomial regression model. A series of hierarchical regression models were created to determine polynomial effects and capture the covariability (defined as R2) of the relationships from the 2009 to 2017 National Hospital Ambulatory Medical Care Survey (NHAMCS) Emergency Department Public Use Data File and institutional data from a regional medical center from 2018 to 2019. The following hierarchical regression models were constructed: cubic main effects, cubic interaction effects, quartic main effects, quartic interaction effects, quintic main effects, and quantic interaction effects. Based on maximal improvement in R2 and significance of each of the four effects in both the national and institutional data sets, the quartic main effects model was determined to be optimal for describing ED arrival patterns. In alignment with prior studies, significantly higher ED arrival volumes were observed on Mondays in comparison to all other weekdays.

scholarly journals Early versus deferred anti-SARS-CoV-2 convalescent plasma in patients admitted for COVID-19: A randomized phase II clinical trial

PLoS Medicine ◽  
2021 ◽  
Vol 18 (3) ◽  
pp. e1003415
Author(s):  
María Elvira Balcells ◽  
Luis Rojas ◽  
Nicole Le Corre ◽  
Constanza Martínez-Valdebenito ◽  
María Elena Ceballos ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Mechanical Ventilation ◽  
Clearance Rate ◽  
Neutralizing Antibodies ◽  
Statistical Power ◽  
Primary Outcome ◽  
Medical Center ◽  
Academic Medical Center ◽  
Group Versus ◽  
Hospital Length Of Stay

Background Convalescent plasma (CP), despite limited evidence on its efficacy, is being widely used as a compassionate therapy for hospitalized patients with COVID-19. We aimed to evaluate the efficacy and safety of early CP therapy in COVID-19 progression. Methods and findings The study was an open-label, single-center randomized clinical trial performed in an academic medical center in Santiago, Chile, from May 10, 2020, to July 18, 2020, with final follow-up until August 17, 2020. The trial included patients hospitalized within the first 7 days of COVID-19 symptom onset, presenting risk factors for illness progression and not on mechanical ventilation. The intervention consisted of immediate CP (early plasma group) versus no CP unless developing prespecified criteria of deterioration (deferred plasma group). Additional standard treatment was allowed in both arms. The primary outcome was a composite of mechanical ventilation, hospitalization for >14 days, or death. The key secondary outcomes included time to respiratory failure, days of mechanical ventilation, hospital length of stay, mortality at 30 days, and SARS-CoV-2 real-time PCR clearance rate. Of 58 randomized patients (mean age, 65.8 years; 50% male), 57 (98.3%) completed the trial. A total of 13 (43.3%) participants from the deferred group received plasma based on clinical aggravation. We failed to find benefit in the primary outcome (32.1% versus 33.3%, odds ratio [OR] 0.95, 95% CI 0.32–2.84, p > 0.999) in the early versus deferred CP group. The in-hospital mortality rate was 17.9% versus 6.7% (OR 3.04, 95% CI 0.54–17.17 p = 0.246), mechanical ventilation 17.9% versus 6.7% (OR 3.04, 95% CI 0.54–17.17, p = 0.246), and prolonged hospitalization 21.4% versus 30.0% (OR 0.64, 95% CI, 0.19–2.10, p = 0.554) in the early versus deferred CP group, respectively. The viral clearance rate on day 3 (26% versus 8%, p = 0.204) and day 7 (38% versus 19%, p = 0.374) did not differ between groups. Two patients experienced serious adverse events within 6 hours after plasma transfusion. The main limitation of this study is the lack of statistical power to detect a smaller but clinically relevant therapeutic effect of CP, as well as not having confirmed neutralizing antibodies in donor before plasma infusion. Conclusions In the present study, we failed to find evidence of benefit in mortality, length of hospitalization, or mechanical ventilation requirement by immediate addition of CP therapy in the early stages of COVID-19 compared to its use only in case of patient deterioration. Trial registration NCT04375098.

scholarly journals THE EFFECT OF A BOARDING RESTRICTION PROTOCOL ON EMERGENCY DEPARTMENT CROWDING

2021 ◽  
Author(s):  
Ji Hwan Lee ◽  
Ji Hoon Kim ◽  
Incheol Park ◽  
Hyun Sim Lee ◽  
Joon Min Park ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Primary Outcome ◽  
Treatment Time ◽  
Patient Flow ◽  
Hospital Beds ◽  
Before And After ◽  
Day Of The Week ◽  
Ed Crowding ◽  
Post Period

ABSTRACT Background Access block due to a lack of hospital beds causes emergency department (ED) crowding. We initiated the boarding restriction protocol that limits ED length of stay (LOS) for patients awaiting hospitalization to 24 hours from arrival. This study aimed to determine the effect of the protocol on ED crowding. Method This was a pre-post comparative study to compare ED crowding before and after protocol implementation. The primary outcome was the red stage fraction with more than 71 occupying patients in the ED (severe crowding level). LOS in the ED, treatment time and boarding time were compared. Additionally, the pattern of boarding patients staying in the ED according to the day of the week was confirmed. Results Analysis of the number of occupying patients in the ED, measured at 10-minute intervals, indicated a decrease from 65.0 (51.0-79.0) to 55.0 (43.0-65.0) in the pre- and post-periods, respectively (p<0.0001). The red stage fraction decreased from 38.9% to 15.1% of the pre- and post-periods, respectively (p<0.0001). The proportion beyond the goal of this protocol of 24 hours decreased from 7.6% to 4.0% (p<0.0001). The ED LOS of all patients was similar: 238.2 (134.0-465.2) and 238.3 (136.9-451.2) minutes in the pre- and post-periods, respectively. In admitted patients, ED LOS decreased from 770.7 (421.4-1587.1) to 630.2 (398.0-1156.8) minutes (p<0.0001); treatment time increased from 319.6 (198.5-482.8) to 344.7 (213.4-519.5) minutes (p<0.0001); and boarding time decreased from 298.9 (109.5-1149.0) to 204.1 (98.7-545.7) minutes (p<0.0001). In the pre-period, boarding patients accumulated in the ED on weekdays, with the accumulation resolved on Fridays; this pattern was alleviated in the post-period. Conclusions The protocol effectively resolved excessive ED crowding by alleviating the accumulation of boarding patients in the ED on weekdays. Additional studies should be conducted on changes this protocol brings to patient flow hospital-wide.

scholarly journals Timing Matters: HIV Testing Rates in the Emergency Department

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Rebecca Schnall ◽  
Nan Liu
Keyword(s):  
Emergency Department ◽  
New York ◽  
New York City ◽  
Hiv Testing ◽  
New York State ◽  
Time Of Day ◽  
Patient Acuity ◽  
York State ◽  
Hiv Test ◽  
Day Of The Week

Study Objectives.In response to the 2010 New York State HIV testing law, we sought to understand the contextual factors that influence HIV testing rates in the emergency department (ED).Methods.We analyzed electronic health record logs from 97,655 patients seen in three EDs in New York City. We used logistic regression to assess whether time of day, day of the week, and season significantly affected HIV testing rates.Results.During our study period, 97,655 patients were evaluated and offered an HIV test. Of these, 7,763 (7.9%) agreed to be tested. Patients arriving between 6 a.m. and 7:59 p.m. were significantly (P<0.001) more likely to be tested for HIV, followed by patients arriving between 8:00 p.m. and 9:59 p.m. (P<0.01) and followed by patients arriving between 5–5:59 a.m. and 10–10:59 p.m. (P<0.05) compared to patients arriving at midnight. Seasonal variation was also observed, where patients seen in July, August, and September (P<0.001) were more likely to agree to be tested for HIV compared to patients seen in January, while patients seen in April and May (P<0.001) were less likely to agree to be tested for HIV.Conclusion.Time of day and season affect HIV testing rates in the ED, along with other factors such as patient acuity and completion of other blood work during the ED visit. These findings provide useful information for improving the implementation of an HIV testing program in the ED.

scholarly journals A Comparison of Patient Satisfaction with Emergency Department Opt-In and Opt-Out Rapid HIV Screening

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Douglas A. E. White ◽  
Alicia N. Scribner ◽  
Maria E. Martin ◽  
Stacy Tsai
Keyword(s):  
Emergency Department ◽  
Patient Satisfaction ◽  
Primary Outcome ◽  
Emergency Department Patient ◽  
Hiv Screening ◽  
Convenience Sample ◽  
Study Objective ◽  
Opt Out ◽  
Race Ethnicity ◽  
Test Result

Study objective. To compare patient satisfaction with emergency department (ED) opt-in and opt-out HIV screening.Methods. We conducted a survey in an urban ED that provided rapid HIV screening using opt-in (February 1, 2007–July 31, 2007) and opt-out (August 1, 2007–January 31, 2008) approaches. We surveyed a convenience sample of patients that completed screening in each phase. The primary outcome was patient satisfaction with HIV screening.Results. There were 207 and 188 completed surveys during the opt-in and opt-out phases, respectively. The majority of patients were satisfied with both opt-in screening (95%, 95% confidence interval [CI] = 92–98) and opt-out screening (94%, 95% CI = 89–97). Satisfaction ratings were similar between opt-in and opt-out phases even after adjusting for age, gender, race/ethnicity, and test result (adjusted odds ratio 1.3, 95% CI = 0.5–3.1).Conclusions. Emergency department patient satisfaction with opt-in and opt-out HIV screening is similarly high.

scholarly journals Trends in emergency department visits in Lubbock from 2011-2017

2019 ◽  
Vol 7 (27) ◽  
pp. 50-54
Author(s):  
Sarah Jaroudi ◽  
Shengping Yang ◽  
Gilbert Berdine
Keyword(s):  
Emergency Department ◽  
Medical Center ◽  
Emergency Department Visits ◽  
Local Data ◽  
Factors Affecting ◽  
Long Term Trends ◽  
Ed Visits ◽  
Day Of The Week ◽  
Relationship Of

To determine trends in daily emergency department (ED) visits, a preliminary retrospective study was done to analyze the relationship of long-term trends, day of week, and month of year to ED volume at University Medical Center in Lubbock, TX. Local data were collected from January 1, 2011, through December 31, 2017. An increase in ED visits from 2011 to 2014 was followed by a decrease in ED visits from 2014 to 2017. The best fit third order polynomial was “ ” with y=number of ED visits and x=cumulative day. The busiest day of the week was Monday with an average of 235.6 visits per day. Throughout the week, ED visits decreased to a minimum value of 201.9 visits per day on Saturday. The differences between each day of the week were significant (p < 0.001). Seasonal trends were present with peaks during February and September. The differences among months were significant (p < 0.001).  The total variance of the ED visit data was decreased after adjusting for the long-term trend, day of week, and month of year. These adjustments remove noises not relevant to the study goal and are necessary for further studies testing hypotheses about factors affecting ED visits that may not be uniformly distributed over time. 

Longitudinal Assessment of Cocaine Toxicity in Emergency Department Patients

1993 ◽  
Vol 6 (2) ◽  
pp. 74-82 ◽  
Author(s):  
William A. Watson
Keyword(s):  
Emergency Department ◽  
Kansas City ◽  
Drug Testing ◽  
Medical Center ◽  
Emergency Department Patient ◽  
Longitudinal Assessment ◽  
University Of Missouri ◽  
Cocaine Use ◽  
Study Results ◽  
Cocaine Toxicity

Longitudinal data are necessary to identify changes in drug abuse and resultant toxicity. The development of COC-LOG, a longitudinal database used to assess cocaine-associated emergency department patient visits at Truman Medical Center, the University of Missouri-Kansas City, is described. COC-LOG currently contains 1,054 patient visits. The data demonstrate that cocaine toxicity has remained relatively constant in our emergency department (ED) over the last 4 years. The majority of cocaine use is through smoking crack, and major differences in toxicity are not seen between this route and IV cocaine use. The relatively low prevalence of severe cardiac toxicity and deaths has lead to a series of projects to evaluate cocaine toxicity's clinical course. Electrocardiographic abnormalities are common, but do not frequently indicate severe clinical toxicity. In the first 3 years after ED discharge, deaths in cocaine patients occur almost twice as frequently as in age-, race-, and sex-matched control ED patients. Urine drug testing of pregnant patients suggests that documentation of recent cocaine use by history alone underestimates the prevalence of cocaine use in ED patients approximately four-fold. COC-LOG is a useful method of following cocaine's impact on department patients. Study results can be applied to patient care and the education of ED faculty, residents, students, and personnel.

scholarly journals 86 Intra-nasal ketamine for laceration repair in the Emergency Department: The DosINK studies

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e35-e36
Author(s):  
Soha Rached-d’Astous ◽  
Yaron Finkelstein ◽  
Benoit Bailey ◽  
Chistopher Marquis ◽  
Denis Lebel ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Emergency Department ◽  
Trial Design ◽  
Primary Outcome ◽  
Clinical Trial Design ◽  
Physician Satisfaction ◽  
Dose Finding ◽  
Procedural Sedation ◽  
Healthy Children ◽  
Convenience Sample

Abstract Introduction/Background Lacerations are common in children presenting to the emergency department (ED). Children can be uncooperative and in pain when repair with sutures is performed and may require procedural sedation. There is a growing interest in the intranasal (IN) route of administration for procedural sedation and pain control. In contrast to intravenous (IV) line placement, IN administration is relatively painless for the patient, is simple and rapid to administer by the healthcare provider and requires minimal training. Few studies have evaluated intranasal (IN) ketamine for procedural sedation in children, mostly for brief dental procedures, with doses between 3 to 9 mg/kg. Objectives We sought to determine the optimal IN ketamine dose for effective and safe procedural sedation for laceration repair with sutures in children aged 1 to 12 years presenting to the ED using a two-step (dosINK- 1 trial and dosINK-2 trial) dose-finding clinical trial design. Design/Methods We enrolled otherwise healthy children 1 to 12 years requiring PS for their laceration repair by sutures in the ED. DosINK-1 consisted in a single center 3 + 3 dose escalation trial design with an initial dose of 3 up to 9 mg/kg of IN ketamine. For each dose, 3 patients were enrolled. Escalation to the next dose was performed if sedation was unsuccessful without serious adverse event (SAE). This process was repeated until 6 consecutive patients reached adequate PS with a maximum of 1 SAE. The primary outcome was the optimal dose for adequate PS as per the PERC/PECARN consensus criteria. We subsequently conducted DosINK-2, a multicenter single-arm clinical trial. We enrolled a convenience sample of 30 children who all received the identified dose of IN ketamine from DosINK-1. The primary outcome was the proportion (95% CI) of patients who achieved adequate PS. Secondary outcomes included adverse events and parent, patient and physician satisfaction. Results In DosINK-1, 12 patients were recruited from April 2017 to March 2018 in one pediatric ED. Median age was 2.6 (interquartile range [IQR] 1.9, 3.7) years, 10 (85%) had facial laceration, and in 8 (67%) the laceration was &gt;2 cm long. Sedation was adequate in 1/3 patients at doses of 3 and 4 mg/kg and in 3/3 patients at doses of 5 and 6 mg/kg, all without SAE. The identified dose of IN ketamine was 6 mg/kg. Nausea and vomiting in 4/12 (33%) patients were the only reported side effects. In DosINK-2, we recruited 30 patients from April 2018 to November 2019 in two pediatric EDs. The median age was 3.2 (IQR 1.9, 4.7) years; 21 (70%) had facial laceration, and in 20 (67%) the laceration was longer than 2 cm. Sedation was adequate in 18/30 (60% [95% CI 45, 80]) children, was suboptimal (procedure completed with minimal difficulties) in 6 (20%), was poor (struggle that interfered with procedure, competed with difficulty) in 3 (10%) and required additional sedative agents in 3 (10%) patients. Twenty-one (70%) physicians were willing to reuse IN ketamine at the same doses and 25 (83%) parents would agree to the same sedation in the future. Median time to return to baseline status was 58 min (IQR 33, 73). Two patients, including one who received supplemental IV ketamine, desaturated during the procedure and required oxygen by-mask and repositioning. After the procedure, 1(3%) patient had nausea, and 2(7%) vomited. Conclusion A single dose of 6 mg/kg of IN ketamine for PS during laceration repair by sutures in children in the ED was adequate in 60%(95% CI 45, 80). In an additional 20% PS was suboptimal, but procedures were completed with minimal difficulties only. IN ketamine, which saves painful IV insertion, was acceptable by most physicians and parents. An additional IN ketamine dose may further increase the proportion of adequate sedation, but its safety and efficacy should be examined.

scholarly journals Use of My Health Record by Clinicians in the Emergency Department: An Analysis of Log Data

2021 ◽  
Vol 3 ◽  
Author(s):  
Alexandra K. Mullins ◽  
Heather Morris ◽  
Joanne Enticott ◽  
Michael Ben-Meir ◽  
David Rankin ◽  
...  
Keyword(s):  
Emergency Department ◽  
Primary Outcome ◽  
Health Record ◽  
Log Data ◽  
For Profit ◽  
Not For Profit ◽  
Dichotomous Variable ◽  
User Groups ◽  
Day Of The Week ◽  
Data Log

Objectives: Leverage log data to explore access to My Health Record (MHR), the national electronic health record of Australia, by clinicians in the emergency department.Materials and Methods: A retrospective analysis was conducted using secondary routinely-collected data. Log data pertaining to all patients who presented to the emergency department between 2019 and 2021 of a not-for-profit hospital (that annually observes 23,000 emergency department presentations) were included in this research. Attendance data and human resources data were linked with MHR log data. The primary outcome was a dichotomous variable that indicated whether the MHR of a patient was accessed. Logistic regression facilitated the exploration of factors (user role, day of the week, and month) associated with access.Results: My Health Record was accessed by a pharmacist, doctor, or nurse in 19.60% (n = 9,262) of all emergency department presentations. Access was dominated by pharmacists (18.31%, n = 8,656). All users demonstrated a small, yet significant, increase in access every month (odds ratio = 1.07, 95% Confidence interval: 1.06–1.07, p ≤ 0.001).Discussion: Doctors, pharmacists, and nurses are increasingly accessing MHR. Based on this research, substantially more pharmacists appear to be accessing MHR, compared to other user groups. However, only one in every five patients who present to the emergency department have their MHR accessed, thereby indicating a need to accelerate and encourage the adoption and access of MHR by clinicians.

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