Medicine and Health Sciences Commons^™

Sepsis Inservice And Video At An Urban Hospital In California, Angela T. Ho

Master's Projects and Capstones

The emergency department at an urban hospital in California was performing below institutional goals related to sepsis protocols over the past few months. This intervention was targeted at nurses and was composed of a PowerPoint in-service on compliance to SEP-1 protocols and follow-along video on using the correct sepsis order set and documentation in the electronic health record (EHR). Goals included increased compliance to the SEP-1 protocol and documentation, (2) reduced time between the onset of symptoms, recognition, and intervention, (3) decline in sepsis rates and mortality rates, and (4) lower cost of care. Data was collected from the EHR …

Emergency Medicine Clinician Experiences Addressing Uncertainty In First-Trimester Bleeding., Garrison Nord, Amanda Doty, Andrew J Monick, Danielle M Mccarthy, Robin J Casten, Amer Z Aldeen, Philip S Nawrocki, Kristin L. Rising

Department of Emergency Medicine Faculty Papers

The purpose of this work is to understand Emergency Department (ED) clinicians' experiences in communicating uncertainty about first-trimester bleeding (FTB) and their need for training on this topic. This cross-sectional study surveyed a national sample of attending physicians and advanced practice providers (APPs). The survey included quantitative and qualitative questions about communicating with patients presenting with FTB. These questions assessed clinicians' frequency encountering challenges, comfort, training, prior experience, and interest in training on the topic. Of 402 respondents, 54% reported that they encountered challenges at least sometimes when discussing FTB with patients where the pregnancy outcome is uncertain. While the …

The Impact Of Follow-Up Calls After A Pediatric Emergency Department Visit, Joseph R. Mijares Iii, Sephora Morrison

Patient Experience Journal

Pediatric emergency department (ED) visits can be a stressful time for patients and their caregivers. This high stress environment can lead to questions and needed clarifications post-discharge. We implemented a post-discharge callback system to resolve these concerns for a focused subset of patients who historically have provided the most negative comment feedback on ED patient experience surveys. We hypothesized that comment types would shift to more positive than negative and the themes of the comments received would change. We developed a discharge callback process that focused on patients who were triaged as ESI level 4 during their emergency department visit. …

Key Healthcare Providers’ Perspectives On The Implementation Of Senior-Friendly Emergency Department Care In Quebec, Deniz Cetin-Sahin, Francine Ducharme, Jane Mccusker, Mona Magalhaes, Nathalie Veillette, Paul-André Lachance, Sylvie Cossette, Alain Vadeboncoeur, Rick Mah, T.T. Minh Vu, Simon Berthelot

Journal of Geriatric Emergency Medicine

Background: Senior-friendly emergency department (ED) care is emerging to address large numbers of older adults in healthcare and implementation is variable.

Objectives: We aimed to explore key healthcare providers’ perspectives on factors affecting implementation of senior-friendly ED care during the first five years of the Senior-Friendly Hospital Initiative in the Province of Quebec, Canada.

Methods: We conducted a descriptive qualitative study of four urban EDs. Key healthcare providers involved in care within the ED or after discharge to the community were purposefully selected. Semi-structured telephone interviews were conducted in participants’ preferred language, English or French. Recorded interviews were transcribed. A …

Emergency Medicine Journal Club, Dave Gibbs, Dylan Norton, Kyle Barbour

Advances in Clinical Medical Research and Healthcare Delivery

In this column, we provide a brief review of important papers recently published that relate to the field of Emergency Medicine. The goal is to provide the busy clinician a bullet-like summary of the study, focusing on the research question, methods, results, limitations and bottom line interpretation.

The Relationship Between Emergency Physicians’ Creative Thinking Preference And Their Risk Of Burnout: An Opportunity To Make A Difference, Naghma S. Khan

Creativity and Change Leadership Graduate Student Master's Projects

The FourSight theory contends that individuals exhibit a preference for the mental operations involved in creative problem solving. The four fundamental mindset preferences measured by FourSight are Clarifiers, Ideators, Developers and Implementers. Individuals can exhibit a peak preference for one, two, or three of these mindsets, or they can show an even distribution of energy across all four creative-thinking preferences. Robust and creative solutions to complex and recurrent problems are only possible if an individual or a team of individuals consciously move through the four stages of problem solving. Creative problem-solving can be taught. The ability to be creative at …

Heart To Heart, Mom To Mom, Karis L. Tekwani

Journal of Patient-Centered Research and Reviews

This essay describes the human connection forged between two young moms, one the physician and one the patient, when their paths collided one night in the emergency department of a busy hospital. It describes a challenging and most memorable care experience in the career of a young emergency physician, the clinical outcome, and the patient’s appreciative follow-up message years later.

Finding Acute Coronary Syndrome With Serial Troponin Testing For Rapid Assessment Of Cardiac Ischemic Symptoms (Fast-Trac): A Study Protocol, W Frank Peacock, Alan S Maisel, Christian Mueller, Stefan D Anker, Fred S Apple, Robert H Christenson, Paul Collinson, Lori B Daniels, Deborah B Diercks, Salvatore Di Somma, Gerasimos Filippatos, Gary Headden, Brian Hiestand, Judd Hollander, Juan C Kaski, Joshua M Kosowsky, John T Nagurney, Richard M Nowak, Donald Schreiber, Gary M Vilke, Marvin A Wayne, Martin Than

Department of Emergency Medicine Faculty Papers

Objective: To determine the utility of a highly sensitive troponin assay when utilized in the emergency department.

Methods: The FAST-TRAC study prospectively enrolled >1,500 emergency department patients with suspected acute coronary syndrome within 6 hours of symptom onset and 2 hours of emergency department presentation. It has several unique features that are not found in the majority of studies evaluating troponin. These include a very early presenting population in whom prospective data collection of risk score parameters and the physician's clinical impression of the probability of acute coronary syndrome before any troponin data were available. Furthermore, two gold standard diagnostic …

Emergency Medicine Journal Club, Dave M. Gibbs, Dylan Norton, Kyle Barbour

Advances in Clinical Medical Research and Healthcare Delivery

In this column, we provide a brief review of important papers recently published that relate to the field of Emergency Medicine. The goal is to provide the busy clinician a bullet-like summary of the study, focusing on the research question, methods, results, limitations and bottom line interpretation.

A Just-In-Time Video Primer On Pneumothorax Pathophysiology And Early Management, Nicholas Macdonald, Jacob Garcia, Gregory C. Kane, Xiao Chi Zhang, Dimitrios Papanagnou

Department of Emergency Medicine Faculty Papers

Audience: Emergency medicine residents (interns, junior residents), medical students, and mid-level providers (physician assistants, nurse practitioners).

Introduction: Pneumothorax refersto the presence of gas within the pleuralspace and is a relatively common clinical entity in the emergency department Traumatic pneumothorax results from blunt or penetrating trauma to the thorax. Iatrogenic pneumothorax is a risk inherent to a number of invasive procedures and represents a significant cause of preventable morbidity. Specifically, central venous catheterization (43.8%), thoracentesis (20.1%), and barotrauma due to mechanical ventilation (9.1%) are the most frequent causes. A feared complication of pneumothorax is the development of tension pneumothorax, which involves …

Troponin Is Unrelated To Outcomes In Heart Failure Patients Discharged From The Emergency Department, Gregory J Fermann, Jon W Schrock, Phillip D Levy, Peter Pang, Javed Butler, Anna Marie Chang, Douglas Char, Deborah Diercks, Jin H Han, Brian Hiestand, Chris Hogan, Cathy A Jenkins, Christy Kampe, Yosef Khan, Vijaya A Kumar, Sangil Lee, Joann Lindenfeld, Dandan Liu, Karen F Miller, W Frank Peacock, Carolyn M Reilly, Chad Robichaux, Russell L Rothman, Wesley H Self, Adam J Singer, Sarah A Sterling, Alan B Storrow, William B Stubblefield, Cheryl Walsh, John Wilburn, Sean P Collins

Department of Emergency Medicine Faculty Papers

Background: Prior data has demonstrated increased mortality in hospitalized patients with acute heart failure (AHF) and troponin elevation. No data has specifically examined the prognostic significance of troponin elevation in patients with AHF discharged after emergency department (ED) management.

Objective: Evaluate the relationship between troponin elevation and outcomes in patients with AHF who are treated and released from the ED.

Methods: This was a secondary analysis of the Get with the Guidelines to Reduce Disparities in AHF Patients Discharged from the ED (GUIDED-HF) trial, a randomized, controlled trial of ED patients with AHF who were discharged. Patients with elevated conventional …

Emergency Medicine Journal Club, David Gibbs, Dylan Norton, Kyle Barbour

Advances in Clinical Medical Research and Healthcare Delivery

In this column, we provide a brief review of important papers recently published that relate to the field of Emergency Medicine. The goal is to provide the busy clinician a bullet-like summary of the study, focusing on the research question, methods, results, limitations and bottom line interpretation.

What You Need To Know About Em Administration Fellowships, Michael Muradian

Articles

No abstract provided.