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Geographic Localization Of A Medical Oncology Unit Did Not Reduce Length-Of-Stay, Paris B. Lovett

Paris B Lovett

We report here on a pilot program in which we geographically localized all patients on a medical oncology service. The setting was a large, urban quaternary referral academic medical center. Approximately 40,000 admissions per year at the main campus, with 2,400 medical oncology admissions per year. Metrics to be measured and compared between pre-pilot and pilot periods were LOS, Time-of-Discharge (TOD) and Press Ganey overall, physician and nurse mean scores.

Attacking Patient Flow From All Angles: Combining Multiple Strategies In A Single Implementation, Paris B. Lovett

Paris B Lovett

Background

EDs across the US have experienced increased patient volumes and high levels of boarding and crowding. Several strategies have been described, including immediate bedding, bedside triage, bedside registration, use of vertical space, and attending-in-triage. ED and hospital leadership must choose whether to implement such changes one-at-a-time (piecemeal) or all at once. We describe the results of a combined approach, first piloting changes in piecemeal fashion, then introducing these strategies all at once, in a single permanent implementation.

Intervention Detail:

We conducted a series of pilots introducing each of these steps on a temporary basis. These pilots yielded data, and …

Boarding And Press Ganey Patient Satisfaction Scores Among Discharged Patients - Quantifying The Relationship, Paris B. Lovett

Paris B Lovett

Boarding and Press Ganey Patient Satisfaction Scores Among Discharged Patients - Quantifying the Relationship

Paris B. Lovett, Frederick T. Randolph, Rex G. Mathew

Thomas Jefferson University, Philadelphia, PA

Background: Long wait times, long length of stay, use of hallway beds, and physical crowding have all been reported to negatively affect patient satisfaction. There is a need for quantitative assessment of the relationship among patients discharged from the ED.

Objectives: To describe the association between total boarding hours for given calendar days, and mean Press Ganey patient satisfaction raw scores (PGs) on those days. To determine a quantitative coefficient for the …

Attending In Triage: Impact On Resident Experience, Paris B. Lovett

Paris B Lovett

Attending in Triage: Impact on Resident Experience

Paris B. Lovett, Jamie A. Kahn, Linda Davis- Moon, Rex G. Mathew, Frederick T. Randolph, Bernard L. Lopez

Thomas Jefferson University, Philadelphia, PA

Background: EDs commonly face increasing volume with resultant significant boarding and crowding. New operational measures to improve patient flow in response to these challenges have been developed. One measure is to have a physician evaluate the patient during triage (Attending-in-Triage, AIT). This results in a Medical Screening Examination (MSE) early in the patient visit. Residents in training, as part of their education, participate in medical decision-making for the undifferentiated patient. …

Needles In A Needlestack: ‘‘Prodromal’’ Symptoms Of Unusual Fatigue And Insomnia Are Too Prevalent Among Adult Women Visiting The Ed To Be Useful In Diagnosing Acs Acutely, Paris B. Lovett

Paris B Lovett

Needles In A Needlestack: ‘‘Prodromal’’ Symptoms of Unusual Fatigue and Insomnia Are Too Prevalent Among Adult Women Visiting the ED to be Useful in Diagnosing ACS Acutely

Paris B. Lovett1, Yvonne N. Ezeala1, Rex G. Mathew1, Julia L. Moon2 1

Thomas Jefferson University, Philadelphia, PA; 2Drexel University, School of Public Health, Philadelphia, PA

Background: In 2003, McSweeney et al. reported surveys on ‘‘prodromal’’ symptoms recalled by women who had experienced myocardial infarctions (MI). Unusual fatigue was reported by 70.7% (severe 29.7%) and insomnia by 47.8% (severe 21.0%). These findings have led to risk management recommendations to consider these symptoms as …

Improvement In Satisfaction Scores With Operational Improvements From Front-End Redesign And Attenting-In-Triage, Paris B. Lovett

Paris B Lovett

Improvement in Satisfaction Scores with Operational Improvements from Front-End Redesign and Attenting-in-Triage

Linda Davis-Moon, MSN, CRNP, Paris B. Lovett, MD MBA, Jamie A. Kahn, MD MBA, Rex G. Mathew, MD, Frederick T. Randolph, MD MBA, Logan J. Harper, BS

Thomas Jefferson University Hospitals. Philadelphia, PA.

Background: With ED volumes increasing, and with boarding and overcrowding problems, many EDs have introduced an Attending-in-Triage (AIT) to improve patient flow. One of the aims of AIT is to improve patient satisfaction.

Objectives: To report changes in patient satisfaction scores associated with introduction of AIT and resultant operational improvements.

Methods: The study design was …

Building A Nerve Center For Patient Flow: Outcomes From A Comprehensive Integration Of Services At An Academic Medical Center, Paris B. Lovett

Paris B Lovett

Building a Nerve Center for Patient Flow: Outcomes from a Comprehensive Integration of Services at an Academic Medical Center

Paris B. Lovett, MD MBA, Brian E. Sweeney, RN, MBA, FACHE, Megan L. Johnston, , MHSA, Lewis J. DeEugenio Jr, MD, FACP, BSME, Holly Meisner, RN, BSN

Patient Flow Management Center. Thomas Jefferson University Hospitals. Philadelphia, PA

Background: Improving patient flow metrics (inpatient length-of-stay (LOS), bed utilization, process cycle times and discharge efficiency) requires collaboration and coordination between multiple disciplines and departments within a hospital.

Objectives: To report outcomes from a comprehensive geographic and organizational integration of disciplines and services with …

That’S All It Took- Just One Look. Can A Five Second Look At A Patient Predict Disposition, Paris B. Lovett

Paris B Lovett

Study Objectives •To determine whether a five-second viewing of a patient contributes to prediction of disposition. Conclusion •For all but the resident group, a five second viewing of a patient contributes to prediction of disposition status. •The effect size is small, however. Such quick visual impressions may provide a piece of the overall decision-making process in the final disposition of patients.

Managing Patient Flow: Is High Hospital Occupancy A Root Cause Of Ambulance Diversion?, Paris B. Lovett

Paris B Lovett

Inefficient patient flow through an

emergency department (ED) causes

long wait times, reduced patient satisfaction,

and increased walkouts (that is,

leaving without being seen, or LWBS).

Ste Sidebar 1 on page 5 for a look at

related Joint Commission requirements.

Poor patient flow may also lead to ambulance diversion- a request by an attending physician for ambulances to transport patients to other hospitals (while continuing to accept walk-in patients). EDs may go on ambulance diversion when they reach a critical state in which the volume of patients exceeds its capacity to see and treat them.

Stuart E. Greene, M.B.A., Paris …

Is It Useful To Measure Sedimentation Rate (Esr) As A Broad Screening Test In The Emergency Department?, Paris B. Lovett

Paris B Lovett

Is It Useful to Measure Sedimentation Rate (ESR) as a Broad Screening Test in the Emergency Department? Breen LM, Lovett PB, Greenwald RA NewYork Presbyterian Hospital/Columbia University Medical Center, New York, NY; Long Island Jewish Medical Center, New Hyde Park, NY Background: Multiple studies have reported that markedly elevated sedimentation rates (ESR_100) are associated with several groups of diagnoses: infection, systemic inflammatory disorders, malignancy, and renal disease. These associations are largely drawn from case series. ESR is sometimes used as a screening test in the emergency department (ED), yet the clinical value of such screening is uncertain. Study Objectives: Our …

Applicants Report That Their Rankings Of Em Programs Are Most Driven By Wellness, Morale, Happiness And Rapport, Paris B. Lovett

Paris B Lovett

Applicants Report That Their Rankings of EM Programs Are Most Driven by Wellness, Morale, Happiness and Rapport

Lovett PB, Sayan OR, Glassman GD, Petrik R

New York Presbyterian Hospital/ Columbia University Medical Center, New York, NY

Study Objectives: Our objectives were to (1) determine which factors are considered most important to residency applicants as they choose between residency programs in emergency medicine (EM) and (2) compare the response rates on this electronic/Web survey against response rates in prior comparable paper/mail surveys.

Methods: We surveyed all 118 applicants who interviewed at an urban, academic PGY1-4 EM program in 2005-6. A Web …

The Insecure Airway: A Comparison Of Knots And Commercial Devices For Securing Endotracheal Tubes, Paris B. Lovett

Paris B Lovett

Abstract Background: Endotracheal Tubes (ETTs) are commonly secured using adhesive tape, cloth tape, or commercial devices. The objectives of the study were (1) To compare degrees of movement of ETTs secured with 6 different commercial devices and (2) To compare movement of ETTs secured with cloth tape tied with 3 different knots (hitches). Methods: A 17 cm diameter PVC tube with 14 mm "mouth" hole in the side served as a mannequin. ETTs were subjected to repeated jerks, using a cable and pulley system. Measurements: (1) Total movement of ETTs relative to "mouth" (measure used for devices) (2) Slippage of …

Rotators In The Emergency Department: Conference Attendance, Duty Hours Compliance, Sick Call, And Other Issues. A Survey Of Academic Emergency Medicine Programs, Paris B. Lovett

Paris B Lovett

Rotators in the Emergency Department: Conference Attendance, Duty Hours Compliance, Sick Call, and Other Issues. A Survey of Academic Emergency Medicine Programs

Lovett PB, Lera L, Sturmann KM,

Columbia Presbyterian Medical Center, New York, NY; Beth Israel Medical Center, New York, NY

Study Objectives: To document rules, practices and perceptions regarding Internal Medicine (IM) residents who rotate in emergency departments (EDs), and Emergency Medicine (EM) residents on rotating with other services.

Methods: We mailed a survey to program directors (PDs) and chief residents of 132 EM residency programs. Surveys were returned by mail, with follow-up via telephone and internet.

Results: …

Progress Report: Emergency Medicine In Southern Israel, Paris B. Lovett

Paris B Lovett

To the Editor:—In the United States, debates about the ‘‘acceptance’’ of emergency medicine (EM) seem to belong to another era. Specialized care by emergency physicians (EPs) has become a widespread expectation held by patients and by medical providers. In other countries, however, EM has not reached the same stage of progress as a specialty. This is true even in countries where lifelong practitioners of EM have leading roles in research and public policy. The case of Israel is particularly poignant. Israelis are highly skilled in preparing for and managing mass casualty events, and disaster medicine is prominent and well developed. …

The Insecure Airway: A Comparison Of Knots And Commercial Devices For Securing Endotracheal Tubes, Paris B. Lovett

Paris B Lovett

The Insecure Airway: A Comparison of Knots and Commercial Devices for Securing Endotracheal Tubes

Paris B Lovett, Alexander Flaxman, Kai Sturmann;

Beth Israel Medical Center: New York, NY, University of Medicine and Dentistry of New Jersey–New Jersey Medical School: Newark, NJ

Background: ETTs are commonly secured using adhesive tape, cloth tape, or commercial devices. Adhesive and cloth tape have been reported equally effective, but there has been no experimental comparison of cloth tape tied with different knots. Movement of an ETT by 3cm may be life-threatening.

Objectives: To compare rates of failure of the following methods: cloth tape tied with …

The Vexatious Vital: A Comparison Of Clinical Vs Electronic Measurement Of Respiratory Rate In Triage, Paris B. Lovett

Paris B Lovett

The Vexatious Vital: A Comparison of Clinical vs Electronic Measurement of Respiratory Rate in Triage

Paris B Lovett, Jason M Buchwald, Kai Sturmann, Polly Bijur;

Beth Israel Medical Center: New York, NY, Albert Einstein College of Medicine: Bronx, NY

Background: Of all the vital signs, only Respiratory Rate (RR) is still measured clinically. The authors’ experience at multiple centers is that RR recorded in triage shows low variability and accuracy.

Objectives: To assess the method, duration, variability and accuracy of triage nurses’ measurements of RR (RNRR). To compare this with electronic measurement of RR (ERR) using transthoracic impedance plethysmography (TTIP), …