Emergency Medicine Commons^™

Evaluation Of A Community Based Teaching Hospital’S Geriatric Emergency Medicine Initiative, Josette Hartnett, Isabel Muronzi-Belfon, Suzanne J. Rose

Journal of Geriatric Emergency Medicine

INTRODUCTION: To accommodate the complex healthcare needs of the rising geriatric population, Stamford Hospital’s (SH) emergency department (ED) began a Geriatric Emergency Medicine Initiative (GEMI) in 2018 to improve our ED environment, practices, and focused assessments for our community-dwelling older adults.

METHODS: This retrospective program evaluation describes SH’s novel ED processes for at-risk older adults and compares GEMI and non-GEMI assessed patient outcomes using aggregate frequencies on throughput metrics such as length of stay (LOS), 72 hour and 30-day re-admission rates, and other outcomes of interest. Chi-square tests and group t-tests were used for all analyses with a p-value of …

Nurse Initiated Standing Orders: A Process Improvement At An Emergency Department In Interior Alaska, Justin D. Melberg

Capstone Experience: Master of Public Health

Emergency Departments (EDs) are a valuable and limited public health resource. In addition to treating acute medical emergencies, EDs bridge the gaps in urgent care and primary care accessibility, operating twenty-four hours a day, seven days a week, providing care regardless of an individual’s ability to pay. EDs across the country operate at or above capacity regularly, and overcrowding is projected to increase due to decreased facilities and available inpatient beds. Innovative measures are necessary to increase patient throughput and decrease length of stay while maintaining quality care. Nurse initiated standing orders, also known as nurse driven protocols, standing orders, …

Survey Of Pediatric Critical Care Fellows On Postresuscitation Debriefing, Nicole K. Sather, Lauren E. Zinns, Gillian Brennan, Lily Guo, Nadia Khan, Vinod Havalad

Journal of Patient-Centered Research and Reviews

Purpose: Current guidelines recommend debriefing following medical resuscitations to improve patient outcomes. The goal of this study was to describe national trends in postresuscitation debriefing practices among pediatric critical care medicine (PCCM) fellows to identify potential gaps in fellow education.

Methods: A 13-item survey was distributed to fellows in all 76 ACGME-accredited PCCM programs in the United States in the spring of 2021. The online survey addressed frequency and timing of debriefings following medical resuscitations, whether formal training is provided, which medical professionals are present, and providers’ comfort level leading a debriefing. Results were analyzed using descriptive statistics.

Results: A …

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 …

The Impact Of Telehealth In Urgent Care Settings, Annie Dong

Applied Research Projects

Telehealth is an emerging modality of patient care and has since expanded to urgent care facilities. Urgent care facilities have been around for decades; however, along with telehealth, it has only grown in popularity in recent years due to the COVID-19 pandemic. However, the implementation and usage of telehealth in urgent care facilities is dependent on the provider being able to use it. This study aimed at looking at the perspective of the provider on the implementation and usage of telehealth in the urgent care setting.

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 …

Gericared: Feasibility Of A Pilot Program Of A Geriatric Personal Care Attendant Addressing Mentation, Mobility And Matters Most In An Emergency Department Observation Unit, Ilianna Santangelo, Anne Marie Thompson, Aileen Tubridy, Kendra Cull, Bridget Conly, Benjamin A. White, Maura Kennedy

Journal of Geriatric Emergency Medicine

The aging of the population has a significant impact on the health care system, as older adults have higher rates of emergency department (ED) visits and hospitalization, different care needs, and are at higher risk of iatrogenic harm in the hospital setting. In addition, there has recently been a rapid growth in ED observation units (EDOUs), to which older adults are frequently admitted. Recognizing the specific needs of older adults, our EDOU implemented an ‘Up by 10’ program which incorporates key components of delirium prevention programs. We took an iterative approach to the implementation of this program, resulting in a …

Prioritizing Care Of Older Adults In Times Of Emergency Department Overcrowding, April L. Ehrlich, Mitchel Erickson, Esther Oh, Todd James, Saket A. Saxena

Journal of Geriatric Emergency Medicine

No abstract provided.

Impact Of A Novel Multi-Specialist Telemedicine Consultation Program Model Of Care For Homebound Older Adults, Samir K. Sinha Dr, Kristina Marie Kokorelias, Nicoda Foster, Pauline Kabitsis, Alfiya Mukharyamova, Mary Ann Hamelin, Nga Truong, Anna Grosse Dr, Janny Lee

Journal of Geriatric Emergency Medicine

BACKGROUND: In 2015, a centralised Multi-Specialist Telemedicine (TM) Consultation Program was established to improve access to specialist care and enhance continuity of care for homebound older adults in Toronto, Canada. Community-dwelling patients were referred to the program by their primary care providers (PCP), treating specialists, and inpatient physicians for specialist-led post hospital discharge follow-up care. A clinical nurse specialist (CNS) thereafter collaborated with hospital-based consulting specialists, utilizing videoconferencing technology to facilitate consultations and follow-up visits for homebound patients

METHODS: We conducted a retrospective observational study of the overall intervention including patient characteristics and the number/type of consultations provided by analyzing …

The Missed And The Misdiagnosed: Geriatric Delirium In The Emergency Department, Christienne Shams, Yashar Eshman, Ronan Factora, Stephen Meldon, Saket Saxena

Journal of Geriatric Emergency Medicine

Background: Older patients with delirium are at increased risk for prolonged hospitalization, poor outcomes, higher costs and a greater risk for institutionalization. By identifying those at risk early, interventions can be implemented to prevent or minimize the severity of the delirium. Per hospital policy, our geriatric emergency department (ED) screens for delirium by performing a 4AT only if changes in mental status are noted by caregivers or healthcare providers familiar with the patient. We hypothesize this approach underestimates the prevalence of delirium on presentation to the ED, particularly among high-risk older patients. The aim of this study is to determine …

Video Documentation As A Measure Of Written Documentation Accuracy In Emergency Medical Service Field Intubations, Christopher S. Keller, Christopher Dilger, Shih-Chin Chou, Rasheed Lawal, Shane Jenks

HCA Healthcare Journal of Medicine

Introduction

Quality improvement (QI) is a major focus of all departments and fields of health care, including emergency medical services. The chaotic and rapidly evolving atmosphere in which paramedics must practice can lead to inconsistency between what is documented and the actual events. This leads to difficulty when trying to evaluate the practitioners and when implementing a QI program. In this study, we evaluated the prevalence of discrepancy between the video and written record for Rapid Sequence Intubation (RSI) performed in the field as a demonstration of the utility of video documentation in QI.

Methods

We used a systematic retrospective …

Effectiveness Of An Emergency Department-Based Machine Learning Clinical Decision Support Tool To Prevent Outpatient Falls Among Older Adults: Protocol For A Quasi-Experimental Study, Daniel J Hekman, Amy L Cochran, Apoorva P Maru, Hanna J Barton, Manish N Shah, Douglas Wiegmann, Maureen A Smith, Frank Liao, Brian W Patterson

Faculty, Staff and Student Publications

Background

Emergency department (ED) providers are important collaborators in preventing falls for older adults because they are often the first health care providers to see a patient after a fall and because at-home falls are often preceded by previous ED visits. Previous work has shown that ED referrals to falls interventions can reduce the risk of an at-home fall by 38%. Screening patients at risk for a fall can be time-consuming and difficult to implement in the ED setting. Machine learning (ML) and clinical decision support (CDS) offer the potential of automating the screening process. However, it remains unclear whether …

The Efficacy Of Analgesic Subdissociative Dose Ketamine In Trauma Casualties Treated By U.S. Military Special Operations Medical Professionals In A Prehospital Environment, Darin Schwartz

Theses & Dissertations

Research Focus. This study’s main objective was to determine the efficacy of sub-dissociative ketamine to reduce the pain of trauma casualties treated by U.S. military medical professionals in a prehospital environment evidenced by the 0–10 numeric rating scale (NRS) for pain. Research Methods. This quantitative study was accomplished using a pragmatic approach integrating social cognitive theory complemented by mixing methods using qualitative phenomenological influence through narrative inquiry. This exploratory retrospective, cross-sectional study, utilizing a quasi-experimental pretest-posttest design, used deidentified sample data (N = 47) for secondary analysis from U.S. Special Operations medical providers and were included in a casualty …

Previous Health Care Experiences’ Influence On Health Care Perceptions Among Residents In Six Homeless Shelters In Seattle, Washington, July–October 2021, Ashley A. Meehan, Sarah N. Cox, Nicholas B. Thuo, Julia H. Rogers, Amy C. Link, Miguel A. Martinez, Natalie K. Lo, Brian J. Manns, Melissa A. Rolfes, Eric J. Chow, Helen Y. Chu, Emily Mosites, Morhaf Al Achkar

Journal of Patient-Centered Research and Reviews

Purpose: The study purpose was to learn and describe 1) where homeless shelter residents receive health care, 2) what contributes to positive or negative health care experiences among shelter residents, and 3) shelter resident perceptions toward health care.

Methods: Semi-structured interviews (SSIs) utilizing purposive sampling and focus group discussions (FGDs) utilizing convenience sampling were conducted at 6 homeless shelters in Seattle-King County, Washington, during July–October 2021. All residents (age ≥ 18) were eligible to participate. SSIs were conducted with 25 residents, and 8 FGDs were held. Thematic analysis was conducted using Dedoose.

Results: Participants received health care …

Oxygen Therapy Education To Improve Oxygen Safety In The Emergency Department: A Quality Improvement Project, Latania Wolfe

DNP Projects

Background and Significance: Oxygen is often administered in emergency departments (ED) in US without the nurses and other healthcare staff inputting orders for this medication. This gap in placing orders poses a risk to patient safety and poses a regulation issue.

Purpose: The goal of this quality improvement project is to increase the rate of orders placed for patients using oxygen in ED staff by 12% from March 1, 2023 to May 31, 2023.

Methods: The Model for Improvement guided this quality improvement project. Two PDSA cycles were completed.

Results: PDSA #1 Completed SWOT analysis and used information to …

Geriatric Emergency Medicine Fellowship Journal Club: Screening For High-Risk Alcohol Use Among Older Adults In The Emergency Department, Kira Gossack-Keenan

Journal of Geriatric Emergency Medicine

Alcohol use in older adults is a growing and under-recognized issue. Older adults are at higher risk of alcohol-related complications due to underlying comorbidities, frailty, and polypharmacy. High-risk alcohol use and alcohol use disorder (AUD) are often missed among older patients. We present two recent studies on screening older patients for alcohol use. Older adults have unique needs and require a specialized approach to screening.

Patient Experience After Geriatric Emergency Medicine Assessment, Jessica Kuxhause, Natalie Liogas, Sarah Keene, Rebecca Fisher, Lauren Cameron Comasco

Journal of Geriatric Emergency Medicine

Study Objectives

The geriatric population is increasing in size and expected to represent 20% of the United States population by 2030 per US census data estimates, with expectant increase in geriatric emergency department (ED) visits.¹ Prior research has demonstrated older adults evaluated in the ED are more likely to have an increased length of stay, more diagnostic tests, and higher overall costs than their younger counterparts, but despite consuming greater resources and staff time, older adults are still more likely to be dissatisfied with their treatment outcomes and less likely to feel that their presenting complaint has been resolved. …

Shared Disposition Decision Making In The Emergency Department For Persons Living With Dementia, Justine Seidenfeld, Fernanda Bellolio, Anita Vashi, Courtney Van Houtven, Susan Hastings

Journal of Geriatric Emergency Medicine

N/A

Current Best Practice In Pelvic And Hip Fracture Management In The Older Adult Population, Anthony P. Joseph

Journal of Geriatric Emergency Medicine

Fractures of the pelvis and hip are a relatively frequent occurrence in the older population. Pelvic fractures in older patients usually occur after a fall from standing height. CT scan is the investigation of choice. There are several classifications available which are useful in risk stratification and predicting surgical treatment. Haemorrhage is a major complication and can usually be treated by interventional radiology. An Orthopedic opinion should be sought promptly, and surgical stabilisation (if indicated) should be completed as early as possible to enable early mobilisation and the avoidance of complications such as deep vein thrombosis or pneumonia.

Hip fractures …

Top 10 Things To Know About Falls In Older Adults, Alexander W. Zirulnik, Shan Liu

Journal of Geriatric Emergency Medicine

No abstract provided.

Geriatric Trauma Triage - The Scope Of The Problem, Mya Cubitt, Rachel Key

Journal of Geriatric Emergency Medicine

n/a

End-Of-Life Care In The Trauma Bay: Six Key Points, Louis Christie Dr

Journal of Geriatric Emergency Medicine

The dominant culture across North America, Europe and Australia has been characterized by workers in hospice and palliative care as ‘death denying’ or ‘death phobic’. The last two decades have seen a significant increase in the number of trauma patients with complex background co-morbidities due to advanced age. Effective end-of-life care in trauma requires physicians to begin careful, balanced and sensitive conversations encompassing goals of care and expectation-setting, in the trauma bay. These pointers will help the reader communicate the principles of these clinical decisions clearly to patients and their families.

Head Injury In Older Adults: To Scan Or Not To Scan? Ten Tips To Make The Best Decision, Audrey-Anne Brousseau, Éric Mercier

Journal of Geriatric Emergency Medicine

Ground-level falls are a leading cause of emergency department (ED) visits by older adults. In addition to understanding the cause of the fall, the assessment of potential fall-induced injuries such as traumatic intracranial hemorrhage, can be highly challenging for emergency clinicians. Premorbid conditions, medications and concomitant injuries can all interfere with the physical examination and impact the prevalence of signs traditionally associated with traumatic brain injury (TBI). When it comes to the decision to potentially investigate for a traumatic intracranial hemorrhage with a brain imaging such as a head computed tomography (CT), many potential predictors and factors will be considered. …

Older Person Fracture Presentation And Management Including Tips For Pain Management, Timothy D W Arnold

Journal of Geriatric Emergency Medicine

Fractures in older adults occur in patients who commonly carry chronic, complex multi-system disease. Nuanced management for these injuries is required in this patient group to reduce mortality, morbidity and improve outcomes.

Ethical Considerations Of Clinical Research In Emergency Care Settings: A Review, Adith Velavan

Honors Scholar Theses

Emergency and acute care settings are some of the most volatile and high intensity areas of any healthcare operation. Better understanding of systems and treatments in these spaces are critical to improving outcomes for the high risk patients that are treated there. Clinical research serves as a cornerstone of modern medical research, and is critical to the further improvement of clinical care in these settings. This thesis serves to explore the ethicality of such research given the constraints of emergency medicine settings. Not only does this thesis provide a strong foundation regarding the history and current practices of clinical research, …

Isolated Temazepam Overdose: A Unique Case Of An Unresponsive Female, Eric Doane

Rowan-Virtua Research Day

Cases of acute overdose presenting to the emergency department pose a great challenge given that history can sometimes be limited or at times be inaccurate. While naloxone is routinely given in the field to help reduce opiate’s sedating effects, the routine use of flumazenil has not been routinely adopted in cases of benzodiazepine overdose. This is because, unlike naloxone, there are many medications that act on the GABA receptor, and flumazenil is only specific for binding to the benzodiazepine/GABA receptor. This can lead to an unmasking of other medications that may be co-ingested that also effect the GABA receptor leading …

Bedside Teaching In Emergency Medicine Brief Review And Practical Suggestions, James Espinosa, Alan Lucerna, Frank Wheeler, Sergey Medlenov, Robin Lahr, James Lee

Rowan-Virtua Research Day

Bedside teaching has been a tradtional practice and value in medicine. There is literature attesting the positive role of bedside teaching in medicine in general---and in emergency medicine in particular. The value proposition is centered around teaching overall clinical skills, communication skills and procedural skills. There is very little actual data concerning the outcomes of various bedside teaching approaches in EM. There are a number of very interesting suggestions In this review, we will discuss practical strategies to support bedside teaching in the speciality of emergency medicine.

Case Report: Epinephrine-Containing Topical Anesthetic Gel Inducing Systemic Epinephrine Toxicity, Md Fateha, Philip Willsie

Rowan-Virtua Research Day

Systemic epinephrine toxicity is a rare complication following inadvertent or excessively large or rapid subcutaneous, intramuscular or intravenous administration. Signs and symptoms of epinephrine toxicity include rapid onset of transient agitation, hypertension, tachycardia, lactic acidosis, and dysrhythmias with potentially fatal consequences. In this case report, we present a 33-year-old female who experienced epinephrine toxicity following the use of a topical anesthetic cream containing lidocaine and epinephrine. The patient had multiple applications to her chest before and during tattoo placement which led to tachycardia, elevated blood pressure, headache, chest pain, nausea, vomiting, and anxiety. The patient was brought into the ED …

Chemical Restraints In The Emergency Department, Nicholas Noffsinger

Rowan-Virtua Research Day

Chemical restraint is a critical intervention used in emergency departments to manage acutely agitated or violent patients. It involves the administration of medication to induce sedation and control behavior, with the goal of ensuring patient and staff safety while allowing necessary medical interventions to be performed. However, the use of chemical restraints necessitates close observation of vital signs and any potential side effects, as well as careful consideration of patient-specific considerations.

Analysis Of Implementing Best Practices For Co-Prescribing Naloxone In Your Agency Online Cme Training Module Via Pre- And Post- Knowledge Assessment., Alicia Podwojniak, Arvind Venkataraman, Richard Jermyn

Rowan-Virtua Research Day

The opioid epidemic poses substantial risk to society. Providers must ensure that their patients understand the uses and risks of both opioids and naloxone. One way to analyze this concept is via metacognition. This refers to a person’s knowledge about cognitive phenomena, and thus it regulates self-awareness abilities in decision making, such as planning and evaluating. It is not only important for providers to have knowledge on best practices, but also to have self-awareness, and confidence in their decision making to ensure optimal patient outcomes. True-false confidence weighted scoring can be utilized, whereby various levels of confidence are assessed from …