Emergency Medicine Commons^™

Emergency Department Throughput: The Impact Of Vertical Care, Marc Wirtz

Providence Nursing Research Conference 2023 – Present

References

Garrett JS, Berry C, Wong H, Qin H, Kline JA. The effect of vertical split-flow patient management on emergency department throughput and efficiency. Am J Emerg Med. 2018 Sep;36(9):1581-1584. doi: 10.1016/j.ajem.2018.01.035. Epub 2018 Jan 11. PMID: 29352674.

Hsieh A, Arena A, Oraha A, Cotarelo A, McLean M, Hsieh A, Hsieh A, Chen I, Mok N, Milizia R. Implementation of Vertical Split Flow Model for Patient Throughput at a Community Hospital Emergency Department. J Emerg Med. 2023 Jan 12:S0736-4679(22)00570-4. doi: 10.1016/j.jemermed.2022.10.007. Epub ahead of print. PMID: 36641257.

Patient Satisfaction & Usgpiv, Joey Nguyen

St. Joseph Hospital, Orange, CA. Evidence Based Practice Conference

No abstract provided.

A Review Of The Clinical And Cost Effectiveness Of Intravenous And Intramuscular Pharmacological Treatment On Acute Agitation In Patients Admitted To The Emergency Department, Ryan Ferris, Carol Keller

Providence Pharmacy PGY1 Program at Providence Milwaukie and Providence Newberg Medical Centers 2022

No abstract provided.

Implementation Of A Team Discharge Approach To Improve Ecc Throughput, Julie Lisbin, Msn, Rn, Cen

St. Joseph Hospital, Orange, CA. Evidence Based Practice Conference

No abstract provided.

Implementing Bedside Report In The Emergency Care Center 2.0: A Quality Improvement Initiative, Alexandra Rowen, Bsn, Rn, Cen

St. Joseph Hospital, Orange, CA. Evidence Based Practice Conference

No abstract provided.

Blind Taste Testing: A Case Study Of An Emergency Room Rn With Covid-19 Anosmia & Hypogeusia (Loss Of Taste & Smell), Marietta Sperry, Kimberly Kohlieber

2021 Providence Nurse Research Conference

Background: Anosmia, or the loss of taste and smell, is an important symptom for nurses to screen for among patients, as this can result in a poor appetite which impairs healing. In the early stages of the COVID19 pandemic, anosmia was not a known symptom indicative of infection with the virus. Yet, one Registered Nurse who was working in an Emergency Room received a positive COVID test following a workplace exposure to the virus while wearing personal protective equipment, and began to complain of anosmia shortly thereafter. Because the anosmia persisted, his spouse conducted blind taste test on him …

An Evaluation Of The Use Of Tranexamic Acid In The Treatment Of Bradykinin-Mediated Angioedema In The Emergency Department, Sarah Yb Kim, Carol Keller

Providence Pharmacy PGY1 Program at Providence Milwaukie and Providence Newberg Medical Centers 2021

Background

Bradykinin mediated angioedema is an overarching term that includes idiopathic angioedema, angiotensin converting enzyme inhibitor (ACEi) induced angioedema and hereditary angioedema (HAE). •This is an emergent condition that must be treated with the utmost urgency due to the fatal outcomes associated with the rapid constriction of the throat. •Bradykinin mediated angioedema is treated differently from histamine associated angioedema due to its resistance to corticosteroids and antihistamines. •HAE and ACEi induced angioedema are treated similarly but there is a lack of unanimity in the first line pharmacologic treatment. •Current treatment options include fresh frozen plasma, bradykinin-2 receptor antagonists, plasma-kallikrein inhibitors …

Medication And Pharmacy-Related Outcomes As Part Of The Seniors At Risk For Falls After Emergency Room Visit (Safer) Project, Hyesoo Chae, Sharon Leigh, Colleen M Casey

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2021

Background

The United States is comprised of an aging population; adults over the age of 85 are the fastest-growing age group in the United States and will reach approximately 9 million in 2030.1 25% of patients ≥ 65 years old in the United States report falling each year.1 There are over 3 million emergency department visits related to falls in the United States, totaling approximately 50 billion dollars in total medical expenditures.2 Falls are a major threat for older adults as they can lead to increased risk of further injury, loss of independence, decreased mobility, and premature death.1,2 Despite numerous …

Health Disparities In Black, Latinx, And Native Populations Compared To Caucasians: A Retrospective Descriptive-Analysis Of Care Focused On Hypertensive Emergency, Non-St Segment Elevation Myocardial Infarction (Nstemi), And Cerebrovascular Accident (Cva)., Jonathan Aguilar Roa, Evon Anukam

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2021

Background

• Health disparity is a sum of differences in healthcare seen in underserved populations of the United States. 1 • Differences include incidence, prevalence, mortality, burden of disease, and other adverse health conditions • According to ASHP, health disparities continue to be a major public health problem confronting the U.S. health care systems. 2 • Evidence suggests that health disparities can be in part due to differences in the quality of care for different racial and ethnic groups. 2 • All the different disparity factors have been shown to lead to different health outcomes that do not favor Black, …

Evaluation And Implementation Of A New Phenobarbital Protocol For Alcohol Withdrawal Management In The Emergency Department, Sarah J. Kim, Sara Clark, Joshua L. Floyd

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2021

Background

• Alcohol withdrawal syndrome can lead to substantial health care costs and mortality. • Although historically benzodiazepines (BZDs) are considered the mainstay treatment for alcohol withdrawal, some studies have shown that phenobarbital may be the safer and preferred alternative option. • Advantages of phenobarbital are its mechanism of action, more predictable pharmacokinetics, and greater therapeutic index. • A prospective study by Rosenson et al. 2012 found that a single 10 mg/kg IV dose of phenobarbital versus standardized lorazepam protocol resulted in decreased ICU admissions (8% vs. 25%). • A retrospective study by Tidewell et al. 2018 demonstrated shorter hospital …

Assessing Time From Door-To-Antibiotic Administration For Adult Cancer Patients With Neutropenic Fever In The Emergency Department, Sarah Roy, Tina Magsarili

All Nursing Boot Camp Posters

Background:

Infection, related to febrile neutropenia, in patients receiving chemotherapy for cancer remains a common complication and is a medical emergency. Fever is often the only sign of severe underlying infection in neutropenic patients due to the patient’s immunosuppressed state (Butts, et.al, 2017). Vigilant nursing assessment and immediate medical attention for neutropenic fever (NF) is imperative because the rate of major organ complication and mortality is as high as 30% and 11% respectively (Freifield et.al, 2011 & Taplitz et.al, 2018). In the setting of severe sepsis or septic shock the mortality rate may be as high as 50% (Taplitz et.al, …

Assessing Time From Door-To-Antibiotic Administration For Adult Cancer Patients With Neutropenic Fever In The Emergency Department, Sarah Roy, Tina Magsarili

Books, Presentations, Posters, Etc.

No abstract provided.

C. Blind Taste Testing: A Case Study Of An Emergency Room Rn With Covid-19 Anosmia & Hypogeusia (Loss Of Smell & Taste), Marietta Sperry, Kimberly Kohlieber

Year of the Nurse: Clinical Scholarship Presentations

No abstract provided.

Decreasing Inappropriate Usage Of The Emergency Department (Creating Alliances To Deliver Population Health To Seasonal Workforce), Olivia Foster, Lynley Steele-Miller

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No abstract provided.

Moral Distress To Moral Courage, A Pathway To Success For Resident Nurses, Melinda Furrer

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No abstract provided.

Creating An Effective Poster: Research Versus Evidenced-Based Practice Projects, The Ena Institute For Emergency Nursing Research Advisory Council

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Purpose Provide information regarding the: Advantages/disadvantages of a poster presentation, Differences between a research and evidence-based poster, and Key elements of a research and evidenced-based poster. Advantages of a Poster Presentation Allows the emergency nurse to communicate innovative and useful information to peers on a one-to-one basis. ENA conference poster sessions are scheduled over several days so that posters are available for previewing and then interested persons can prepare questions and meet the presenter later Allows the audience to view the poster at their own pace. Presented as “stand alone” or with narrative from presenter who remains with the poster. …

Trauma Pause, Melissa Leighty, Carol Reed, Lance Somerfield, Dawn Rohrbach

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No abstract provided.

Improving Ed Sepsis Bundle Compliance, Jen Selby

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No abstract provided.

Respiratory Failure Due To A Large Mediastinal Mass In A 4-Year-Old Female With Blast Cell Crisis: A Case Report., Christian I Wade, Cody J Couperus-Mashewske, Mia E Geurts, Nicholas Derfler, John Ngo, Kyle S Couperus

Articles, Abstracts, and Reports

INTRODUCTION: Symptomatic leukostasis is an exceptionally atypical presentation of blast crisis; and when coupled with an enlarged neoplastic mediastinal mass in a four-year-old female, an extremely rare and challenging pediatric emergency arises.

CASE REPORT: We present a unique case of a four-year-old female who arrived via emergency medical services in cardiopulmonary arrest with clinical and radiographic evidence suggestive of bilateral pneumothoraces, prompting bilateral chest tube placement. Further evaluation revealed a large mediastinal mass and a concurrent white blood cell count of 428,400 per milliliter (/mL) (4,400-12,900/mL), with a 96% blast differential, consistent with complications of T-cell acute lymphoblastic leukemia.

CONCLUSION: …

Solving The Sepsis Puzzle: Every Minute Counts, Jamie Roney, Amber Cline

Articles, Abstracts, and Reports

SPEMS Pre-Conference Course Sepsis Class

A Case Of Blunt Trauma-Induced St-Elevation Myocardial Infarction Sustained During A Prison Brawl., Zachary T Clark, Natalie Thiel, John Perry, Michael R Minckler

Articles, Abstracts, and Reports

Myocardial infarction (MI) is a serious and time-sensitive condition. MIs are typically seen in patients with coronary artery disease (CAD) and are caused by the rupture of an atherosclerotic plaque due to factors contributing to plaque instability. However, this case illustrates that plaque rupture can also be caused by blunt trauma to the chest. Considering MI as a possible result of chest trauma may decrease time from presentation to diagnosis and treatment and, therefore, improve outcomes in similar cases, particularly when patients presents unusually or with very few risk factors for MI.

Pharmacists Improve Door To Needle Times In The Emergency Department, Kevin Phan, Megan Degener

Books, Presentations, Posters, Etc.

No abstract provided.

A Case Of An Acutely Ill Adult Athlete With Previously Undiagnosed Hypertrophic Obstructive Cardiomyopathy., Michael R Minckler, Madeleine Maker

Articles, Abstracts, and Reports

Hypertrophic obstructive cardiomyopathy (HOCM) is a genetic condition most commonly characterized by hypertrophy of the ventricular septum, which leads to left ventricle outflow obstruction. Due to the severity of the condition, it is often diagnosed in adolescents, especially in those who exercise. We describe the case of a 53-year-old male, previously undiagnosed with hypertrophic cardiomyopathy (HCM), who became dyspneic during a bike race. He was found to have elevated troponin, pulmonary edema, and was diagnosed with HOCM. The late presentation of the case, in an active individual, makes the situation unique.

Prognostic Value Of A Modified Surprise Question Designed For Use In The Emergency Department Setting., Samir A Haydar, Tania D Strout, Alicia G Bond, Paul Kj Han

Articles, Abstracts, and Reports

OBJECTIVE: Few reliable and valid prognostic tools are available to help emergency physicians identify patients who might benefit from early palliative approaches. We sought to determine if responses to a modified version of the surprise question, "Would you be surprised if this patient died in the next 30 days" could predict in-hospital mortality and resource utilization for hospitalized emergency department patients.

METHODS: For this observational study, emergency physicians responded to the modified surprise question with each admission over a five-month study period. Logistic regression analyses were completed and standard test characteristics evaluated.

RESULTS: 6,122 visits were evaluated. Emergency physicians responded …

Integrate Behavioral Health In The Ed And Upstream, Katie Gilligan, Heidi Beazizo

Books, Presentations, Posters, Etc.

This interactive session will describe the changes being tested by 10 hospitals in the Integrating Behavioral Health in the ED and Upstream Learning Community, convened by IHI and Well Being Trust, to achieve meaningful improvements for patients with mental health and substance abuse conditions, their families, and ED staff. Participants will learn from experts and participating team members, share learning with other participants, and develop action plans for bringing this critical work to their organizations.

After this presentation you will be able to:

1. Describe a theory of change and set of core measures to improve patient outcomes, experience, and staff …

Comparison Of Outcomes Of Antibiotic Drugs And Appendectomy (Coda) Trial: A Protocol For The Pragmatic Randomised Study Of Appendicitis Treatment., Giana H Davidson, David R Flum, David A Talan, Larry G Kessler, Danielle C Lavallee, Bonnie J Bizzell, Farhood Farjah, Skye D Stewart, Anusha Krishnadasan, Erin E Carney, Erika M Wolff, Bryan A Comstock, Sarah E Monsell, Patrick J Heagerty, Annie P Ehlers, Daniel A Deugarte, Amy H Kaji, Heather L Evans, Julianna T Yu, Katherine Mandell, Ian C Doten, Kevin S Clive, Karen M Mcgrane, Brandon C Tudor, Careen S Foster, Darin J Saltzman, Richard C Thirlby, Erin O Lange, Amber K Sabbatini, Gregory J Moran

Articles, Abstracts, and Reports

INTRODUCTION: Several European studies suggest that some patients with appendicitis can be treated safely with antibiotics. A portion of patients eventually undergo appendectomy within a year, with 10%-15% failing to respond in the initial period and a similar additional proportion with suspected recurrent episodes requiring appendectomy. Nearly all patients with appendicitis in the USA are still treated with surgery. A rigorous comparative effectiveness trial in the USA that is sufficiently large and pragmatic to incorporate usual variations in care and measures the patient experience is needed to determine whether antibiotics are as good as appendectomy.

OBJECTIVES: The Comparing Outcomes of …

Community Collaboration To Decrease Atypical Emergency Department Utilization, Becky Wilkinson

Articles, Abstracts, and Reports

No abstract provided.

Providence Ed Guide Program - Analysis Of Program Impacts; The Center For Outcomes Research & Education (Core); Providence Health & Services, Bill J. Wright

Articles, Abstracts, and Reports

No abstract provided.