Medicine and Health Sciences Commons^™

Helping Patients Navigate The Emergency Department: Assessing The Utility Of A Poster Illustrating The Patient Journey, Lynette D. Krebs, Cristina Villa-Roel, Maria B. Ospina, Brian R. Holroyd, Brian H. Rowe

Patient Experience Journal

Patients often have limited understanding of the emergency department (ED) care process, which can increase anxiety, frustration, and confusion. This study implemented and assessed the usefulness of a poster explaining the ED care process. A large wall-mounted poster illustrating the patient journey was developed; two different data collection techniques were used. First, a QR code/URL was used to passively collect patient reactions to the poster in 15 EDs. Due to limited response, a paper survey was developed and delivered by research assistants in three study sites using a consecutive sampling method. A total of 67 responses were collected from the …

Assessing Medication Self-Management Challenges And Self-Efficacy During Emergency Department Medication Reconciliation: An Evidence-Based Quality Improvement Project, Mitchel Erickson, Jyu-Lin Chen, Yoonmee Joo, Stephanie Rogers, Thomas Hoffman, Claire Bainbridge

Journal of Geriatric Emergency Medicine

Abstract

Background

Older adult patients (≥65) accessing emergency departments (ED) represent a significant demographic. Recidivism secondary to adverse drug events (ADE) ranges between 6-24% and levels of prescribed medication non-adherence is common among older adults. The ED pharmacist medication reconciliation workflow may mitigate self-management challenges in real time and reduce medication-related harm while potentially impacting recidivism, medication adherence, and patient self-efficacy. The purposes of this evidence-based project were to (1) evaluate the impact of a modified Medication Management for Deficiencies in the Elderly (MedMalDE) intervention on Self-Efficacy for Appropriate Medication Use (SEAMS) and 30-day return to care and (2) identify …

Depression And Anxiety Of Care Partners During The Emergency Department Visit Of Older Adults With Cognitive Impairment, Nancy Glober, Anthony Perkins, Joshua Chodosh, Karen Connor, Sujuan Gao, Frank Messina, Malaz Boustani, Soo Borson, Nicole R. Fowler

Journal of Geriatric Emergency Medicine

Background: Older adults with cognitive impairment (CI) are more likely to visit the emergency department (ED) than those without CI. They are also more likely to suffer poor outcomes after an ED visit. Family and friends who serve as care partners contribute significant time and resources to the care of these patients and may need particular attention to their emotional needs during and after the ED encounter. In this study, we examined the association between patient and care partner characteristics on care partner depression and anxiety at the time of the ED visit.

Methods: Baseline data from 640 patient-care partner …

Patterns Of Care Partner Communication For Persons Living With Dementia In The Emergency Department, Adrian D. Haimovich, Aidan Gilson, Evangeline Gao, Ling Chi, Cameron J. Gettel, Mara Schonberg, Ula Hwang, Richard A. Taylor

Journal of Geriatric Emergency Medicine

Abstract

Background:

Nearly half of all persons living with dementia (PLwD) will visit the emergency department (ED) in any given year and ED visits by PLwD are associated with short-term adverse outcomes. Care partner engagement is critical in the care of PLwD, but little is known about their patterns of communication with ED clinicians.

Methods:

We performed a retrospective electronic health record (EHR) review of a random sampling of patients ≥ 65 years with a historical diagnosis code of dementia who visited an ED within a large

regional health network between 1/2014 and 1/2022. ED notes within the EHRs were …

Cpr-Directive Conversations In The Emergency Department: The Opinion Of Elderly Patients, Kelvin H. Kramp Dr., Rutger De Hond, Mirwais Mehrab, Martijn Van Hooft, Roger A.P.A. Hessels

Journal of Geriatric Emergency Medicine

Background: The average age of patients admitted to the emergency department (ED) continues to rise. Many face difficult discussions about cardiopulmonary resuscitation (CPR) and end-of-life decisions.

Objectives: This study aimed to determine which healthcare professionals elderly patients admitted via the ED preferred to discuss their CPR-directive with and their opinion about the ED as a setting for discussing their CPR-directive.

Methods: A mixed-methods study with an explanatory sequential design was conducted. A questionnaire was administered to 100 patients >65 years of age admitted to nursing wards via the ED that had a CPR-directive conversation during admission 24-48 hours earlier. Patients …

Bringing Upstairs Care Downstairs; Integration Of Rehabilitation Medicine, Care Management, And The Hospital Elder Life Program (Help) Into An Emergency Department., Robert Anderson, Molly Anderson, Rhonda Babine, Farid Feghali, Elizabeth Dunstan, Matthew Glazer, Susan Horton, Stephanie O'Brien, Elizabeth Pontius, David Smith, Megan Viens, Heather Williams

Journal of Maine Medical Center

Introduction: Services such as physical therapy (PT), occupational therapy (OT), speech-language pathology (SLP), social work (SW), care management, and elder life specialists have long been an established part of care for patients admitted to Maine Medical Center (MMC) but not for patients in the Emergency Department (ED). Methods and Results: Driven in part by changes in Medicare reimbursement models, care management established a presence in the Emergency Department (ED) in 2003 with a focus on care planning and cost avoidance. In recent years PT, OT, SLP, SW, and the Hospital Elder Life Program (HELP) have increased their ED involvement substantially. …

Utilization Of Acupuncture Services In The Emergency Department Setting: A Quality Improvement Study, John R. Burns, Jessica J. F. Kram, Vashir Xiong, Jeanne M. Stark Casadont, Tiffany A. Mullen, Nancy Conway, Dennis J. Baumgardner

Journal of Patient-Centered Research and Reviews

Purpose: Patients often present to the emergency department (ED) for pain. As opioid fatalities rise, alternative treatments are warranted for pain management. Acupuncture, a nonpharmacological treatment involving the insertion of needles into skin or tissue at specific points within the body, may help to decrease acute pain. Our study aimed to assess the utilization and impact of acupuncture in the ED for acute pain management.

Methods: We conducted a retrospective analysis of purposefully collected quality improvement data. Patients who were ≥18 years old and who presented to the ED at an urban medical center in Wisconsin during 2017 were offered …

Decreasing Time To Broad Spectrum Antibiotics For Septic Patients In The Emergency Department, Joseph J. Zieminski, Emily E. Bryant

Journal of Patient-Centered Research and Reviews

Background: Timely administration of broad spectrum antibiotics has been shown to be directly correlated with decreased mortality for patients with severe sepsis and septic shock. As such, both the Surviving Sepsis Campaign and the SEP-1 CMS measure recognize timely antibiotic administration as a cornerstone of therapy for patients with severe sepsis or septic shock.

Purpose: Decrease time to broad spectrum antibiotic administration for septic patients in the emergency department (ED) of Aurora St. Luke’s Medical Center.

Methods: An alert within the electronic medical record was created to more rapidly identify potentially septic patients in the ED. After receiving the alert, …

Can Bedside Ultrasound Inferior Vena Cava Measurements Accurately Diagnose Congestive Heart Failure In The Emergency Department? A Clin-Iq, Miranda Gaskamp, Mark Blubaugh, Laine H. Mccarthy, Dewey C. Scheid

Journal of Patient-Centered Research and Reviews

Congestive heart failure (CHF) is a major cause of morbidity and mortality. Early diagnosis of CHF in patients presenting to the emergency department with undifferentiated dyspnea would allow clinicians to begin appropriate treatment more promptly. Current guidelines recommend B-type natriuretic peptide (BNP) levels for more accurate diagnosis of CHF in dyspneic patients. Although BNP levels are relatively inexpensive, the test is not usually performed at bedside and results may take up to an hour or more. BNP also may have a “gray zone” in which the values can neither confirm nor rule out CHF. BNP has a reported sensitivity of …

Handoff Communication In The Emergency Department, Kristen Matichko

DNP Forum

The communication of patient information through use of handoff ensures continuity of care and patient safety. A study of hand-off reports between pre-hospital personnel and staff in the emergency department revealed a lack of complete or formal information dialogue. Nurses play a vital role in the process of communication and information exchange through the use of handoff despite minimal guidelines for that exchange in current nursing practice. The pre-hospital hand-off informational exchange impacts patient safety as well as the planning and implementation of nursing care based upon that information.

The sample used was from a convenience sampling of patients arriving …