An assessment of Chemical, Biological, Radiologic, Nuclear, and Explosive preparedness among emergency department healthcare providers in an inner city emergency department

2015 ◽  
Vol 13 (5) ◽  
pp. 431 ◽  
Author(s):  
Joseph G. Kotora, DO, MPH
Keyword(s):  
Emergency Department ◽  
Emergency Departments ◽  
Online Survey ◽  
Tertiary Care ◽  
Healthcare Providers ◽  
Survey Study ◽  
Care Providers ◽  
Adequate Knowledge ◽  
Practice Experience ◽  
Midlevel Providers

Introduction: Emergency healthcare providers are required to care for victims of Chemical, Biological, Radiologic, Nuclear, and Explosive (CBRNE) agents. However, US emergency departments are often ill prepared to manage CBRNE casualties. Most providers lack adequate knowledge or experience in the areas of patient decontamination, hospital-specific disaster protocols, interagency familiarization, and available supply of necessary medical equipment and medications. This study evaluated the CBRNE preparedness of physicians, nurses, and midlevel providers in an urban tertiary care emergency department.Methods: This retrospective observational survey study used a previously constructed questionnaire instrument. A total of 205 e-mail invitations were sent to 191 eligible providers through an online survey distribution tool (Survey Monkey®). Respondents were enrolled from February 1, 2014 to March 15, 2014. Simple frequencies of correct answers were used to determine the level of preparedness of each group. Cronbach’s coefficient á was used to validate the precision of the study instrument. Finally, validity coefficients and analysis of variance ANOVA were used to determine the strength of correlation between demographic variables, as well as the variation betweenindividual responses. Results: Fifty-nine providers responded to the questionnaire (31.14 percent response rate). The overall frequency of correct answers was 66.26 percent, indicating a relatively poor level of CBRNE preparedness. The study instrument lacked precision and reliability (coefficient á 0.4050). Significant correlations were found between the frequency of correct answers and the respondents’ gender, practice experience, and previous experience with a CBRNE incident. Significant variance exists between how providers believe casualties should be decontaminated, which drugs should be administered, and the interpretation of facility-specific protocols.Conclusions: Emergency care providers are inadequately prepared to manage CBRNE incidents. Furthermore, a valid and precise instrument capable of measuring preparedness needs to be developed. Standardized educational curriculums that consider healthcare providers’ genders, occupations, and experience levels may assist in closing the knowledge gaps between providers and reinforce emergency departments’ CBRNE preparedness.

ENT cases seen at a local ‘walk-in centre’: a one year review

2008 ◽  
Vol 123 (3) ◽  
pp. 339-342 ◽  
Author(s):  
T Rourke ◽  
P Tassone ◽  
C Philpott ◽  
A Bath
Keyword(s):  
Emergency Department ◽  
Retrospective Study ◽  
General Practitioner ◽  
Emergency Departments ◽  
Foreign Bodies ◽  
Healthcare Providers ◽  
One Year

AbstractAim and method:This retrospective study reviewed the ENT-related cases seen, and the discharge or transfer outcomes, at both a local ‘walk-in centre’ and the respective emergency department, over one year in Norwich.Results:Of the 7657 ENT cases seen at the walk-in centre, the commonest conditions included tonsillitis or pharyngitis, otalgia, cough, and deafness. In comparison, 1586 patients were seen at the emergency department, and the commonest conditions were epistaxis and throat foreign bodies. Of the ENT cases seen at the walk-in centre, 85.4 per cent were treated and discharged. Of the 14.6 per cent referred to other healthcare providers, 11.1 per cent were to the general practitioner. In comparison, the emergency department discharged 41.2 per cent and referred 58.8 per cent to other healthcare providers.Conclusion:This study indicates that ENT cases may constitute a large proportion of patients seen in walk-in centres, and that the case types seen may differ from those presenting to emergency departments. It also indicates that walk-in centres may potentially be assessing, treating and discharging 85.4 per cent of ENT patients seen.

scholarly journals Intensive Care Unit design; from advance to basic

2019 ◽  
pp. S17-S20
Author(s):  
Mohsin Nazir Butt ◽  
Muhammad Faisal Khan
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Psychological Health ◽  
Care Delivery ◽  
Healthcare Providers ◽  
Care Providers ◽  
Middle Income ◽  
Adequate Knowledge ◽  
Unit Design ◽  
Information Technologists

Optimum ICU design has pivotal role in critical care delivery that has major impact on physical and psychological health of the patients, physicians and other related staff. Its structure formation is complex and demands the dedicated involvement of not only care providers but also a trained and multi-professional team of architect, engineer and information technologists, etc. This paper tracks the journey from traditional design to recent advances in building the intensive care unit. The limitations in ICU design observed in the lower to middle income countries will also be discussed in this review. Specialist hospital architects are scarce in these countries and the ordinary civil engineering does not impart adequate coaching on matters related to lay-out plans as well as the various minute details about fittings and provisions. Hence, it becomes imperative for the anesthesiologists and other healthcare providers to come to guide and assistance to the architects involved in designing the blue prints. It may only be possible if they have adequate knowledge and professional experience.Citation: Butt MN, Khan MF. Intensive Care Unit design; from advance to basic. Anaesth Pain & Intensive Care 2018;22 Suppl 1:S17-S20

scholarly journals MP05: Injuries in refugee children presenting to a paediatric emergency department

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S41-S42
Author(s):  
E. Zhang ◽  
F. Razik ◽  
S. Ratnapalan
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Primary Care Physicians ◽  
Clinical Care ◽  
Tertiary Care ◽  
Primary Care Providers ◽  
Refugee Children ◽  
Medical Attention ◽  
Care Providers ◽  
Ed Visits

Introduction: The number of refugees accepted to Canada grew from 24,600 in 2014 to 46,700 in 2016. Many of these refugees have young families and the number of child refugees has increased accordingly. Although child refugee health care has been in the forefront of media and medical attention recently, there is limited data on injury patterns in this population. Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) collects data on injuries in children presenting to the emergency department (ED). Our objective is to examine the clinical presentations and outcomes of refugee children with injuries presenting to a tertiary care paediatric ED. Methods: Our paediatric hospital has approximately 70,000 ED visits per year of which 13,000 are due to injuries and/or poisonings. The CHIRPP database was accessed to identify children with injuries presenting to our ED from April 2014 to March 2017 with Interim Federal Health Program (IFHP) registration status. All patient charts were reviewed to extract demographic and clinical care information. Results: There were 74 children with 81 ED visits during the study period of whom 19% were transferred from other facilities. Most of them (72%) were males with a mean age of 8.7 years (standard deviation 4.29). There were significant medical histories in 32% of children. The presentation to our ED (greater than 24 hours post-injury) was seen in 25% of visits. Twenty five percent of injured children were seen in our ED. The distribution of Canadian Triage Acuity Score (CTAS) scores 1, 2, 3, 4, and 5 were 0%, 16%, 37%, 46% and 1% respectively. However, subspecialty consultations were required in 69%, 60% and 27% of CTAS 2, 3 and 4 children respectively. Overall, 46% of all patients required subspecialty consults. The top three categories of injuries include fractures (23%), soft tissue injuries (20%) and lacerations (17%). More than half (56%) required diagnostic imaging. Most (89%) were treated in ED and discharged (average length-of-stay 3 hours 55 minutes) and 11% required admissions. 47% of children lacked primary care physicians. Conclusion: Almost half of refugee children with IFHP status require DI testing, sub-specialty consultations and primary care referrals when presenting to our ED with injuries. Follow up arrangements are needed as many do not have access to primary care providers. This demonstrates a need for securing primary care providers early for this vulnerable population.

scholarly journals Delirium Assessment in Older People in Emergency Departments. A Literature Review

Diseases ◽  
2019 ◽  
Vol 7 (1) ◽  
pp. 14 ◽  
Author(s):  
Pilar Pérez-Ros ◽  
Francisco Martínez-Arnau
Keyword(s):  
Emergency Department ◽  
Older People ◽  
Sensitivity And Specificity ◽  
Emergency Departments ◽  
Rating Scales ◽  
Healthcare Providers ◽  
High Sensitivity ◽  
Delirium Assessment ◽  
Systematic Screening ◽  
Emergency Department Staff

Delirium is a neuropsychiatric syndrome often manifesting in acute disease conditions, and with a greater prevalence in the older generation. Delirium in the Emergency Department (ED) is a highly prevalent problem that typically goes unnoticed by healthcare providers. The onset of a delirium episode in the ED is associated with an increase in morbidity and mortality. Because delirium is a preventable syndrome, these statistics are unacceptable. Emergency Department staff therefore should strive to perform systematic screening in order to detect delirium. Different tools have been developed for the assessment of delirium by healthcare professionals other than psychiatrists or geriatricians. Emergency Departments require delirium assessment scales of high sensitivity and specificity, suited to the characteristics of the Department, since the time available is scarce. In addition, the presence of dementia in the assessment of delirium may induce sensitivity bias. Despite the existence of numerous delirium rating scales, scales taking less than three minutes to complete are recommended. The choice of the tool depends on the characteristics of the ED. The only scale affording high sensitivity and specificity in older people with and without dementia is the Four “A”s Test (4AT); it requires no training on the part of the rater, and can be performed in under two minutes.

Comparing subspecialty and intensive care providers perspectives on pediatric complex chronic patients: A survey study

2021 ◽  
pp. 205343452110680
Author(s):  
Taylor A Kobussen ◽  
Gregory Hansen ◽  
Tanya R Holt
Keyword(s):  
Acute Care ◽  
Chronic Care ◽  
Tertiary Care ◽  
Likert Scale ◽  
Survey Study ◽  
Complex Care ◽  
Care Providers ◽  
Short Answer ◽  
Provider Perspectives ◽  
Short Answer Questions

Introduction Pediatric complex chronic care patients present unique challenges regarding healthcare provision: complex medical regimes, complicated family/provider dynamics, and multiple healthcare teams that can result in inconsistent care. This study examined subspecialty providers’ perspectives regarding pediatric complex chronic care patients and compared them with acute care providers while exploring opportunities to better facilitate care provided to pediatric complex chronic care patients. Methods This survey study occurring within a Canadian tertiary care pediatric center, utilized REDCap to deploy surveys involving Likert Scale and short answer questions. The Kruskal–Wallis test compared subspecialty provider perspectives when providing care to pediatric complex chronic care patients versus non-pediatric complex chronic care patients; and perspectives between subspecialty and acute care providers. Results Survey response rate was 24/46 (52.2%). Eight overarching themes emerged from Likert scale questions. Short answer questions revealed factors that may facilitate care provided to pediatric complex chronic care patients: access to funding; discharge planning; communication methods between specialists; and healthcare provider continuity. Several differences were identified when working with pediatric complex chronic care patients, compared to non-pediatric complex chronic care patients: increased time/resource burden; managing expectations of patients/families; navigating discrepancies in goals of care; complexity of coordination between services; increased efforts in coordinating discharge from hospital and working with medicalized patients/families. Discussion Exploring pediatric subspecialty provider perspectives of pediatric complex chronic care patients revealed opportunities to enhance care provided: increased resources to ease the strain of care provision for parents, implementation of a discharge coordinator, complex care clinics with a pediatrician to “quarterback” care, and co-management between the complex care pediatrician and acute care physician when admitted to an acute care service. Implementation of these initiatives may improve the care provided to pediatric complex chronic care patients.

scholarly journals 104 Management of sports-related concussion in UK emergency departments: a multi-centre study

2020 ◽  
Vol 37 (12) ◽  
pp. 822.2-822
Author(s):  
Haroon Rashid ◽  
Nick Dobbin ◽  
Smarak Mishra
Keyword(s):  
Emergency Department ◽  
Emergency Departments ◽  
Online Survey ◽  
Cross Sectional Study ◽  
Return To Play ◽  
Cross Sectional ◽  
Multi Centre Study ◽  
North West ◽  
The North ◽  
Consensus Statements

Aims/Objectives/BackgroundIt is necessary for those working in emergency departments to have adequate knowledge and delivery of current sport-related concussion (SRC) management protocols including identifying patients with concussion, managing their symptoms, giving appropriate advice with regards to return to play and referring those at risk of further injuries to an appropriate service.This study aimed to establish the current practice, knowledge base and views towards SRC management of emergency department clinicians who have trained or are currently training in emergency medicine in the North West of England.Methods/DesignThis study was a multi centre, cross sectional study of 111 emergency department clinicians (EDCs) working across 15 centres in the North West of England A 21 item online survey was issued. The key questions focused on the advice given to patients on discharge, the importance of cognitive and physical rest, and knowledge of GRTP.Results/ConclusionsApproximately, 37% of the population responded to the invitation, with 111 responses included in this study. Only 27% of total respondents were aware of the Consensus Statements of Concussion in Sport guidelines, whilst 45% were unaware of any SRC guidelines. 57% of respondents had heard of a graded return to play (GRTP) protocol. Physical rest following an SRC was advised by 95% of respondents with 61% advising concomitant cognitive rest and 42% of respondents providing specific written advice. 90% of clinicians had not received any SRC training.There is a lack of knowledge amongst EDCs in the North West of England in managing and providing discharge advice according to recommendations for patients with SRC. This is likely a consequence of the limited training that these clinicians have received in managing SRC and suggests further work needs to be undertaken to educate EDCs on current SRC management guidance to ensure appropriate care and discharge advice is given to patients.

scholarly journals The Quebec emergency department guide: A cross-sectional study to evaluate its use, perceived usefulness, and implementation in rural emergency departments

CJEM ◽  
2017 ◽  
Vol 21 (1) ◽  
pp. 103-110
Author(s):  
Richard Fleet ◽  
Sandrine Hegg-Deloye ◽  
Julie Maltais-Giguère ◽  
France Légaré ◽  
Mathieu Ouimet ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Departments ◽  
Online Survey ◽  
Cross Sectional Study ◽  
Professional Services ◽  
Perceived Usefulness ◽  
Cross Sectional ◽  
Nursing Services ◽  
Emergency Department Management ◽  
Department Directors

AbstractObjectivesThe Quebec Emergency Department Management Guide (QEDMG) is a unique document with 78 recommendations designed to improve the organization of emergency departments (EDs) in the province of Quebec. However, no study has examined how this guide is perceived or used by rural health care management.MethodsWe invited all directors of professional services (DPS), directors of nursing services (DNS), head nurses (HN), and emergency department directors (EDD) working in Quebec’s rural hospitals to complete an online survey (144 questions). Simple frequency analyses (percentage [%] and 95% confidence interval) were conducted to establish general familiarity and use of the QEDMG, as well as perceived usefulness and implementation of its recommendations.ResultsSeventy-three percent (19/26) of Quebec’s rural EDs participated in the study. A total of 82% (62/76) of the targeted stakeholders participated. Sixty-one percent of respondents reported being “moderately or a lot” familiar with the QEDMG, whereas 77% reported “almost never or sometimes” refer to this guide. Physician management (DPS, EDD) were more likely than nursing management (DNS and especially HN) to report “not at all” or “little” familiarity on use of the guide. Finally, 98% of the QEDMG recommendations were considered useful.ConclusionsAlthough the QEDMG is considered a useful guide for rural EDs, it is not optimally known or used in rural EDs, especially by physician management. Stakeholders should consider these findings before implementing the revised versions of the QEDMG.

scholarly journals Experiences of LGBT Patients and Families With Hospice and Palliative Care: Perspectives of the Palliative Care Team

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 67-67
Author(s):  
Cathy Berkman ◽  
Gary Stein
Keyword(s):  
Palliative Care ◽  
Social Services ◽  
Online Survey ◽  
Healthcare Providers ◽  
Cross Sectional Study ◽  
Care Providers ◽  
Cross Sectional ◽  
Term Care ◽  
Lgbt Community ◽  
Hospice And Palliative Care

Abstract The lesbian, gay, bisexual, and transgender (LGBT) community experiences discrimination and stigma in accessing health care and social services – including palliative, hospice, and long-term care. Healthcare providers not recognize or address disparities in care. Providers and institutions may be uncomfortable with sexual orientation and gender identity and expression issues, and often don’t inquire about these. LGBT patients fear being open about their identities, not receiving equal or safe treatment, and having their family of choice and designated surrogates disrespected or ignored by healthcare staff. This study examines the degree to which hospice and palliative care providers report inadequate, disrespectful, or abusive care to LGBT patients and family members. A cross-sectional study using an online survey was completed by 865 providers, including social workers, physicians, nurses, and chaplains. Among respondents, 55% reported that LGB patients were more likely than non-LGB patients to experience discrimination at their institution; 24% observed discriminatory care; 65% reported that transgender patients were more likely than non-transgender patients to experience discrimination; 20% observed discrimination to transgender patients; 14% observed the spouse/partner of LGBT patients having their treatment decisions disregarded or minimized; and 13% observed the spouse/partner being treated disrespectfully. Qualitative data are presented to illustrate discomfort with LGBT patients and spouses/partners, disrespectful care, gossip and ridicule, inadequate care, and denial of care. Implications and suggestions for implementing non-discriminatory and respectful institutional and public policy, and for staff education and training to provide competent and respectiful care to this population are presented.

scholarly journals Knowledge of hand hygiene among healthcare providers in a tertiary care hospital, Bengaluru

2018 ◽  
Vol 5 (10) ◽  
pp. 4433
Author(s):  
Karavadi Sri Sai Vidusha ◽  
Margaret Menzil
Keyword(s):  
Health Care ◽  
Hand Hygiene ◽  
Health Care Providers ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Healthcare Providers ◽  
World Health ◽  
Care Hospital ◽  
Care Providers ◽  
Cross Sectional

Background: Healthcare providers (HCPs) have been identified as the most common vehicle for transmission of hospital acquired infections (HAIs) from patient to patient and within the healthcare environment. Hand hygiene has been identified as the single most important, simplest and least expensive means of preventing HAIs. This study was conducted to assess the knowledge of hand hygiene among healthcare providers in a tertiary care hospital in Bengaluru.Methods: A cross sectional descriptive study was conducted among all the health care providers who have been working in the hospital for more than one year. Total 122 health care providers were included in the study. A semi-structured, self-administered questionnaire was developed and used to obtain information on respondent’s socio-demographic characteristics, and knowledge of hand hygiene. For collecting data in this study, the World Health Organization (WHO) "Hand Hygiene Knowledge Questionnaire "revised 2009 edition was used. Descriptive statistics was used as necessary.Results: A total of 122 health care providers participated in the study. Among them 78 (63.9%) have received formal training in hand washing. The mean age of the study participants was 29.11±8.6 years. Majority opined that hand rubbing is required before palpation of the abdomen (86.9%) knowledge about hand hygiene was found to be moderate in majority of the study subjects (144 out of 200, 74%).Conclusions: In the present study the knowledge on hand hygiene among health care providers is moderate it highlights the importance of improving the current training programs targeting hand hygiene practices among health care providers.

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