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Emergency Medicine Commons

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Accuracy Of Height Estimation Among Bystanders, Sara Carey, Michaeleena Carr, Komaira Ferdous, Gina Marie Moffa, Jennifer Axelband, Shaila Quazi 2018 Aria Health

Accuracy Of Height Estimation Among Bystanders, Sara Carey, Michaeleena Carr, Komaira Ferdous, Gina Marie Moffa, Jennifer Axelband, Shaila Quazi

Aria Health Papers

Introduction: High-risk mechanisms in trauma usually dictate certain treatment and evaluation in protocolized care. A 10-15 feet (ft) fall is traditionally cited as an example of a high-risk mechanism, triggering trauma team activations and costly work-ups. The height and other details of mechanism are usually reported by lay bystanders or prehospital personnel. This small observational study was designed to evaluate how accurate or inaccurate height estimation may be among typical bystanders. Methods: This was a blinded, prospective study conducted on the grounds of a community hospital. Four panels with lines corresponding to varying heights from 1-25 ft were hung within ...


The Association Of Qsofa, Sofa, And Sirs With Mortality In Emergency Department Pneumonia, Ian D. Mecham, Nathan C. Dean, Emily L. Wilson, Al R. Jephson, Michael J. Lanpsa 2018 University of Utah

The Association Of Qsofa, Sofa, And Sirs With Mortality In Emergency Department Pneumonia, Ian D. Mecham, Nathan C. Dean, Emily L. Wilson, Al R. Jephson, Michael J. Lanpsa

The University of Louisville Journal of Respiratory Infections

Objective: To determine the association between 30-day mortality with Systemic Inflammatory Response Syndrome (SIRS), Sequential Organ Failure Assessment (SOFA), and quick SOFA (qSOFA) in emergency department patients with pneumonia. Secondary outcomes included the association of sepsis scores with hospital admission and direct ICU admission.

Methods: This is a secondary analysis of a pneumonia population conducted in the emergency department of 3 tertiary care medical centers and 4 community hospitals. Adult immunocompetent patients diagnosed with pneumonia were included from 3 twelve-month periods spanning December 2009 to October 2015. We generated area under the receiver operating characteristic curve (AUC) values for each ...


Association Between Practice Participation In A Pediatric-Focused Medical Home Learning Collaborative And Reduction Of Preventable Emergency Department Visits By Publicly-Insured Children In Massachusetts, Paul Kirby, Anna Christensen, Louise Bannister, Valerie Konar 2018 University of Massachusetts Medical School

Association Between Practice Participation In A Pediatric-Focused Medical Home Learning Collaborative And Reduction Of Preventable Emergency Department Visits By Publicly-Insured Children In Massachusetts, Paul Kirby, Anna Christensen, Louise Bannister, Valerie Konar

Commonwealth Medicine Publications

Introduction: This study evaluates the impact of practice participation in a pediatric patient-centered medical home learning collaborative on preventable emergency department (ED) visits among children in MassHealth (Massachusetts Medicaid/Children's Health Insurance Program).

Methods: Claims and enrollment data were extracted for child MassHealth members (aged 3–18) comprising 2 groups: members enrolled in a group of 13 child-serving practices that participated in an intensive, 29-month long patient-centered medical home learning collaborative (intervention group), and members enrolled in a group of 12 comparison practices with roughly similar panel size, type, and geographic location (comparison group). Preventable ED visits were identified ...


Quantitative Effect Of Emergency Department Case Management On Visits, Diagnostics, And Cost, Jeffrey Nickel MD, Nancy Connelly, Cameron Duffner, Xyryl Pablo, Aeleia Hughes 2018 Parkview Health

Quantitative Effect Of Emergency Department Case Management On Visits, Diagnostics, And Cost, Jeffrey Nickel Md, Nancy Connelly, Cameron Duffner, Xyryl Pablo, Aeleia Hughes

MAHE Student Research

Background: Frequent users of the ED have been identified as a major contributing factor to over-use of EDs resulting in decreased efficiency of health care delivery and increased costs. Objective: In 2012, Parkview Health initiated a case management (CM) program with the hypothesis that it would reduce emergency department (ED) visits, radiation exposure, and costs for patients who had visited a Parkview ED 5 or more times within 6 months. Methods & Design: This retrospective case series involved examining medical records of 460 CM patients from 2011 to 2018, recording the amount of Parkview ED visits, diagnostic tests, and affected cost ...


Facilitating Hiv/Aids And Hiv Testing Literacy For Emergency Department Patients: A Randomized, Controlled, Trial, Roland C. Merchant, Tao Liu, Melissa A. Clark, Michael P. Carey 2018 Harvard Medical School

Facilitating Hiv/Aids And Hiv Testing Literacy For Emergency Department Patients: A Randomized, Controlled, Trial, Roland C. Merchant, Tao Liu, Melissa A. Clark, Michael P. Carey

Quantitative Health Sciences Publications and Presentations

BACKGROUND: Although this has not been fully studied, videos and pictorial brochures might be equivalent methods of delivering HIV/AIDS and HIV testing information to emergency departments (ED) patients. It also is not known how well or for how long such knowledge is retained, if this information should be tailored according to patient health literacy, and if retention of this knowledge impacts future HIV testing behavior.

METHODS: We will conduct a multi-site, randomized, controlled, longitudinal trial among 600 English- and 600 Spanish-speaking 18-64-year-old ED patients to investigate these questions. We will stratify our sample within language (English vs. Spanish) by ...


Systemwide Clinical Ultrasound Program Development: An Expert Consensus Model., Robert Strony, Jennifer R. Marin, John Bailitz, Anthony J. Dean, Mike Blaivas, Vivek Tayal, Chris Raio, Rachel Liu, Aimee Woods, Michael Zwank, Matthew Fields, Alyssa Abo, Stan Wu, Tarina Kang, Teresa Liu, Megan Leo, Courtney Smalley, Jerry Chiricolo, Mikaela Chilstrom, Resa E. Lewiss 2018 Geisinger Commonwealth School of Medicine

Systemwide Clinical Ultrasound Program Development: An Expert Consensus Model., Robert Strony, Jennifer R. Marin, John Bailitz, Anthony J. Dean, Mike Blaivas, Vivek Tayal, Chris Raio, Rachel Liu, Aimee Woods, Michael Zwank, Matthew Fields, Alyssa Abo, Stan Wu, Tarina Kang, Teresa Liu, Megan Leo, Courtney Smalley, Jerry Chiricolo, Mikaela Chilstrom, Resa E. Lewiss

Department of Emergency Medicine Faculty Papers

Clinical ultrasound (CUS) is integral to the practice of an increasing number of medical specialties. Guidelines are needed to ensure effective CUS utilization across health systems. Such guidelines should address all aspects of CUS within a hospital or health system. These include leadership, training, competency, credentialing, quality assurance and improvement, documentation, archiving, workflow, equipment, and infrastructure issues relating to communication and information technology. To meet this need, a group of CUS subject matter experts, who have been involved in institution- and/or systemwide clinical ultrasound (SWCUS) program development convened. The purpose of this paper was to create a model for ...


Emergency Department Overcrowding And The Full Capacity Protocol Cross Over Study: What Patients Who Have Experienced Both Think About Being An Extra Patient In The Emergency Department Or On A Ward., Hugh McGowan, Krystal Gopeesingh, Patrick O'Kelly, Peadar Gilligan 2018 Royal College of Surgeons in Ireland

Emergency Department Overcrowding And The Full Capacity Protocol Cross Over Study: What Patients Who Have Experienced Both Think About Being An Extra Patient In The Emergency Department Or On A Ward., Hugh Mcgowan, Krystal Gopeesingh, Patrick O'Kelly, Peadar Gilligan

Emergency Medicine Articles

Hospital overcrowding is evidenced by Emergency Department (ED) overcrowding. The Full Capacity Protocol (FCP) is activated to move patients to temporary extra beds placed in the inpatient wards. This research aims to establish patient preferences when waiting for a ward bed in an Irish Hospital. The FCP in Beaumont Hospital was updated in the context of national guidelines. Patients’ attitudes towards boarding in the ED as opposed to being in extra beds on the wards were assessed using a questionnaire based structured interview. Ninety nine patients took part in the study. Eighty three patients (83.83%) preferred being an additional ...


Opioid Administration And Prescribing In Older Adults In U.S. Emergency Departments (2005-2015)., Erin M Marra, Maryann Mazer-Amirshahi, Peter Mullins, Jesse M Pines 2018 George Washington University

Opioid Administration And Prescribing In Older Adults In U.S. Emergency Departments (2005-2015)., Erin M Marra, Maryann Mazer-Amirshahi, Peter Mullins, Jesse M Pines

Emergency Medicine Faculty Publications

Introduction: We assess trends in opioid administration and prescribing from 2005-2015 in older adults in United States (U.S.) emergency departments (ED).

Methods: We analyzed data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) survey from 2005 to 2015. ED visits for painful conditions were selected and stratified by age (18-64, 65-74, 75-84, ≥ 85 years). We analyzed trends in opioid administration in the ED and prescribing at discharge to encounters ≥ 65 and assessed predictors of use using survey-weighted chi-square tests and logistic regression. Trends in the use of five commonly prescribed opioids were also explored.

Results: Opioid administration in ...


Health Literacy, Care Transition And Adherence With Discharge Instructions Of Patients Discharged To Home From The Emergency Department, Virginia B. Mangolds 2018 University of Massachusetts Medical School

Health Literacy, Care Transition And Adherence With Discharge Instructions Of Patients Discharged To Home From The Emergency Department, Virginia B. Mangolds

Graduate School of Nursing Dissertations

Purpose: The purpose of this study is to describe the relationship between health literacy, preparedness for discharge, adherence to discharge instructions and difficulty coping after discharge among emergency department patients.

Specific Aims: The Aims of this study were to: (1) describe the variability of health literacy of adult patients in an academic tertiary Emergency Department; (2) describe the relationship between health literacy, care transition, and perceived readiness for discharge on the patient’s adherence to discharge instructions and (3) explore whether health literacy, perceived preparation for discharge and care transition, predicts difficulty coping after discharge.

Framework: Dr. Meleis’s Transitions ...


Central Line Cart: An Emergency Department Initiative To Improve Efficiency, M. Ahmed, MD 2018 Thomas Jefferson University

Central Line Cart: An Emergency Department Initiative To Improve Efficiency, M. Ahmed, Md

House Staff Quality Improvement and Patient Safety Posters

Background

  • Critically ill patients that present to the emergency room often require time sensitive resuscitative measures, which often necessitates placement of a central venous catheter.
  • Efficient placement of a central venous catheter is often limited by the time it takes to gather the number of supplies needed for the task.
  • It is already known that central venous catheter procedure carts and kits decrease the incidence of central line associated bloodstream infections (CLABSIs)1 as well as reduce the incidence of procedural mistakes during central line insertion2
  • However, there is a paucity of data in regards to the impact of central ...


Improving Medical And Endovascular Management For Acute Ischemic Stroke Through Multidisciplinary Education And Simulation, Richard F. Schmidt, MD, Megan Margiotta, MD, Elan Miller, MD, Robin D'Ambrosio, BSN, SCRN, Robin Dharia, MD, Maria Aini, MD, Diana Tzeng, MD, Fred Rincon, MD, Pascal Jabbour, MD, Nabeel Herial, MD 2018 Thomas Jefferson University

Improving Medical And Endovascular Management For Acute Ischemic Stroke Through Multidisciplinary Education And Simulation, Richard F. Schmidt, Md, Megan Margiotta, Md, Elan Miller, Md, Robin D'Ambrosio, Bsn, Scrn, Robin Dharia, Md, Maria Aini, Md, Diana Tzeng, Md, Fred Rincon, Md, Pascal Jabbour, Md, Nabeel Herial, Md

House Staff Quality Improvement and Patient Safety Posters

Primary goals:

  1. Reduce door to treatment times (both DTN and DTP) to meet and exceed existing guidelines metrics.
  2. Educate residents about acute stroke management, including national guidelines and new institutional protocols to improve efficiency during stroke alerts.


The Doctor Can See You Now: A Key Stakeholder Study Into The Acceptability Of Ambulance Based Telemedicine., Peadar Gilligan, A Bennett, A Houlihan, A Padki, Niall Owens, Donal Morris, Ioannis P. Chochliouros, A Mohammed, A Mutawa, M A. Eswararaj, S Gannon, A Alrmawi, J Z. Gassem, P PN Sheung, C Tynan, R Little, W Merriman, Ahjoku Amadi-Obi, L Kenna, D A. Alim, Courtney O'Donnell 2018 Beaumont Hospital, Dublin

The Doctor Can See You Now: A Key Stakeholder Study Into The Acceptability Of Ambulance Based Telemedicine., Peadar Gilligan, A Bennett, A Houlihan, A Padki, Niall Owens, Donal Morris, Ioannis P. Chochliouros, A Mohammed, A Mutawa, M A. Eswararaj, S Gannon, A Alrmawi, J Z. Gassem, P Pn Sheung, C Tynan, R Little, W Merriman, Ahjoku Amadi-Obi, L Kenna, D A. Alim, Courtney O'Donnell

Emergency Medicine Articles

Using telecommunications technology it would be possible to link a patient and paramedic to a Doctor in the Emergency Department (ED) at the point of first patient contact. A questionnaire-based study on telemedicine in the pre-hospital environment involving patients, paramedics, doctors and nurses in the ED, was performed to assess if they would want and accept telemedicine in pre-hospital emergency care. When asked 98.5% (55) of patients, 89% (11) of doctors, 76% (14) of nurses and 91% (42) of ambulance personnel saw the potential of an audio-visual link from the pre-hospital environment to the ED. The potential benefits were ...


Reducing Pediatric Asthma Visits In The Emergency Department, Kathleen Grimley Ahn 2018 University of San Diego

Reducing Pediatric Asthma Visits In The Emergency Department, Kathleen Grimley Ahn

Doctor of Nursing Practice Final Manuscripts

Purpose/Aims: The purpose of this project was to reduce the number of unnecessary pediatric asthma management visits to an urban emergency department (ED) by performing a brief action plan for improved National Heart, Lung, and Blood Institute (NHLBI) guideline adherence. This plan was shared with parents during an NP-initiated follow-up phone call.

Rationale/Background: Inadequate outpatient management of pediatric asthma can result in avoidable visits to the ED. Acute exacerbations comprise a large portion of pediatric asthma patients seeking care in the ED. Reasons for persistent under-utilization of outpatient care for asthma management in primary care settings are multifactorial ...


International Scope Of Emergency Ultrasound: Barriers In Applying Ultrasound To Guide Central Line Placement By Providers In Nairobi, Kenya, Fareen Zaver, Keith Boniface, Benjamin Wachira, Grace Wanjiku, Hamid Shokoohi 2018 George Washington University

International Scope Of Emergency Ultrasound: Barriers In Applying Ultrasound To Guide Central Line Placement By Providers In Nairobi, Kenya, Fareen Zaver, Keith Boniface, Benjamin Wachira, Grace Wanjiku, Hamid Shokoohi

Emergency Medicine, East Africa

Background: While ultrasound (US) use for internal jugular central venous catheter (CVC) placement is standard of care in North America, most developing countries have not adopted this practice. Previous surveys of North American physicians have identified lack of training and equipment availability as the most important barriers to the use of US.

Objective: We sought to identify perceived barriers to the use of US to guide CVC insertion in a resource-constrained environment.

Methods: Prior to an US-guided CVC placement training course conducted at the Aga Khan University Hospital in Nairobi, Kenya, physicians were asked to complete a survey to determine ...


When Disaster Strikes: A Training Intervention To Improve Nurses' Confidence And Preparedness For The Surge, Nichole M. Weber 2018 Valparaiso University

When Disaster Strikes: A Training Intervention To Improve Nurses' Confidence And Preparedness For The Surge, Nichole M. Weber

Evidence-Based Practice Project Reports

There has been an exponential rise in mass casualty incidents (MCI) internationally. These human induced and naturally occurring events have affected over 4.6 billion people, and are not discriminatory to region or community (World Health Organization, 2011). Governing bodies require training and education, but nurses continue to report suboptimal competence and self-reported readiness, and a need for standardized, evidence-based training remains. The purpose if this evidence-based practice project is to authenticate current research supporting implementation of competency-based education, to improve nurses’ self- perceived preparedness and confidence in their ability to respond to MCI. The project results can be utilized ...


Rapid Assessment Of Adults With Traumatic Brain Injuries, Pedro Colio 2018 University of San Diego

Rapid Assessment Of Adults With Traumatic Brain Injuries, Pedro Colio

Doctor of Nursing Practice Final Manuscripts

The aim of this evidence-based project was to improve the medical screening process, enhance medical decision-making, and standardized the utilization of an adult traumatic brain injury neuroimaging guideline among advanced practice providers in a rural emergency department. Neuroimaging, specifically computed tomography (CT) scans, help to identify life-threatening intracranial injuries when clinically appropriate. The literature supports the utilization of neuroimaging guidelines, clinical exam, and provider expertise when identifying the need for a head CT scan. Although head CT scans are clinically useful, they increase healthcare costs and pose potential cancer risks from radiation exposure. Eight advanced practice providers (i.e., nurse ...


The Right Care, The Right Place, The Right Time: Emergency Department Avoidance Across The U.S., Jay Flanagan, Michael Steinkrauss 2018 University of Massachusetts Medical School

The Right Care, The Right Place, The Right Time: Emergency Department Avoidance Across The U.S., Jay Flanagan, Michael Steinkrauss

Commonwealth Medicine Publications

Optometrists across the country enrolled in the Southern New England Practice Transformation Network (SNE-PTN) have helped 22,765 patients avoid the Emergency Department, according to data reported from October 2017 through February 2018. That’s 4,445 patients per month who did not have to visit the Emergency Department because of SNE-PTN’s Emergency Department Avoidance initiative. SNE-PTN is led by the University of Massachusetts Medical School and UConn Health.


Code Help: Can This Unique State Regulatory Intervention Improve Emergency Department Crowding?, Sean S. Michael, John Broach, Kevin A. Kotkowski, David Eric Brush, Gregory A. Volturo, Martin A. Reznek 2018 University of Massachusettts Medical School

Code Help: Can This Unique State Regulatory Intervention Improve Emergency Department Crowding?, Sean S. Michael, John Broach, Kevin A. Kotkowski, David Eric Brush, Gregory A. Volturo, Martin A. Reznek

Open Access Articles

Introduction: Emergency department (ED) crowding adversely affects multiple facets of high-quality care. The Commonwealth of Massachusetts mandates specific, hospital action plans to reduce ED boarding via a mechanism termed "Code Help." Because implementation appears inconsistent even when hospital conditions should have triggered its activation, we hypothesized that compliance with the Code Help policy would be associated with reduction in ED boarding time and total ED length of stay (LOS) for admitted patients, compared to patients seen when the Code Help policy was not followed.

Methods: This was a retrospective analysis of data collected from electronic, patient-care, timestamp events and from ...


Sne-Ptn Initiative Helps Optometrists Keep Thousands Of Patients Out Of The Emergency Department, Jay Flanagan 2018 Southern New England Practice Transformation Network

Sne-Ptn Initiative Helps Optometrists Keep Thousands Of Patients Out Of The Emergency Department, Jay Flanagan

Commonwealth Medicine Publications

It’s a common scenario: a patient injures his eye, self-refers to the Emergency Department, and receives treatment from a doctor who does not specialize in optometry. The result? Higher medical bills to address an ocular trauma that could have been successfully treated in an optometrist’s office.

The Southern New England Practice Transformation Network (SNE-PTN) led by the University of Massachusetts Medical School and UConn Health, is addressing this costly issue head on with its Emergency Department Avoidance initiative, and the results are astounding.


Spinal Cord Trauma: An Overview Of Normal Structure And Function, Primary And Secondary Mechanisms Of Injury, And Emerging Treatment Modalities, Daniel Morin 2018 Liberty University

Spinal Cord Trauma: An Overview Of Normal Structure And Function, Primary And Secondary Mechanisms Of Injury, And Emerging Treatment Modalities, Daniel Morin

Senior Honors Theses

The structures of the spinal cord and vertebral column are designed to provide flexibility, while still providing ample protection for the spinal cord deep within. While it does offer remarkable protection against most routine trauma, the spinal cord is still vulnerable to high-force etiologies of trauma and may become damaged as a result. These events are referred to as primary injury. Following the initial injury, the body’s own physiological responses cause a cascade of deleterious effects, known as secondary injury. Secondary injury is a major therapeutic target in mitigating the effects of spinal cord injury (SCI), and much research ...


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