Emergency Medicine Commons^™

A Multimodal Approach To Reducing Opioid Administration In The Emergency Department, Eddie Ford, Vito Rocco, Shanna Jones, Patrick Karabon

Posters

INTRODUCTION
The United States is battling a deadly epidemic against opioid abuse and misuse, which began as a result of pharmaceutical companies purposely downplaying the addictive potential of their opioid medications. In 2016, a Colorado health care system developed a groundbreaking alternative to opioids (ALTO) protocol for acute pain relief in the Emergency Department (ED). This protocol was adapted and implemented in the Beaumont Troy ED and is the focus of this current study. The primary goal of this study is to characterize the impact of the ALTO protocol on the rate of opioid and non-opioid administration in the ED …

The Current State Of Diagnostic Error Education In U.S. Medical Schools, Dakota Hall, Sandra Lablance, Brett Todd

Posters

Diagnostic error has been identified by the Institute of Medicine as a major cause of patient harm. Despite recent focus on the importance of diagnostic error, little is known about how medical schools are educating future physicians, specifically, the extent to which it is taught. We aimed to investigate the current state of diagnostic error education in U.S. medical schools.

Outcomes For Patients With Congestive Heart Failure And Chronic Kidney Disease Receiving Fluid Resuscitation For Severe Sepsis Or Septic Shock, Melany Wiczorek, Ronny Otero, Steven Knight, Kaitlin Ziadeh, James Blumline, Zachary Rollins

Posters

INTRODUCTION
Sepsis core measures are an integral part of sepsis treatment. Current fluid administration guidelines consist of administering at least 30cc/kg of intravenous fluids (IVF) per ideal body weight (IBW) within the first three hours of sepsis diagnosis regardless of pre-existing comorbidities at risk for fluid overload. This study aims to evaluate the outcomes of patients with a history of congestive heart failure (CHF) and/or chronic kidney disease (CKD) who receive fluid resuscitation for the management of severe sepsis or septic shock.

Journal Club In The Pre-Clinical Years During Medical School, Kristin Cuadra, Steven Joseph

Posters

INTRODUCTION
Traditionally, journal clubs have been conducted within graduate medical programs to help integrate evidence-based learning. This study will be focused on beginning to integrate journal club into the pre-clinical years while implementing successful techniques used in past journal clubs. Our hypothesis is that, with a structured review instrument in place to help students analyze clinical articles, students will be able to benefit from monthly journal clubs and fully grasp concepts taught in these pre-clinical years. Overall, the results will contribute significantly in determining the efficacy of journal club and whether or not it can be a valuable tool in …

Ultrasound Guided Peripheral Iv Access Curriculum For The Pediatric Emergency Department: A Pilot Study., Samuel Dillman, Frances Turcotte Benedict, Christopher S. Kennedy

Posters

Ultrasound Guided Peripheral IV Access Curriculum for the Pediatric Emergency Department: a pilot study. Background: Up to 50% of children have difficult venous access. Studies in the Pediatric Emergency department (PED) have shown that ultrasound guided peripheral IV (USGPIV) access has decreased IV access time and ED length of stay.  Barriers for use include lack of training and comfort with the procedure. Objectives/Goal: Our objectives are to pilot and evaluate USGPIV training for Pediatric Emergency Medicine (PEM) physicians and nurses.  Methods/Design: The course included a 4-hour, hands-on session with US IV training using a blue phantom task trainer in conjunction …

Improving Skin And Soft Tissue Antibiotic Duration Concordance With National Guidelines In Pediatric Urgent Care Clinics, Megan Hamner, Amanda Nedved, Holly Austin, Donna Wyly, Alaina N. Burns, Diana King, Brian Lee, Rana El Feghaly

Posters

Introduction: Skin and soft tissue infections (SSTIs) are the second most common diagnosis leading to pediatric antibiotic prescriptions in the outpatient setting after respiratory diagnoses. Children with SSTIs often receive >7 days of antibiotics, although current guidelines recommend 5-7 days for most diagnoses. At CMH urgent care clinics (UCCs), only 58% patients received the recommended 5-7 days of antibiotics. We aimed to increase the percentage of patients receiving 5-7 days of oral antibiotics for SSTIs from 58% to 75% by December 31st, 2021. Methods: We formed a multidisciplinary team in April 2020. A provider survey assessed factors influencing prescribing habits. …

Antibiotic Durations For Skin And Soft Tissue Infections In Pediatric Urgent Care Clinics, Megan Hamner, Amanda Nedved, Holly Austin, Donna Wyly, Alaina N. Burns, Diana King, Brian R. Lee, Rana El Feghaly

Posters

Background: Skin and soft tissue infections (SSTIs) are the second most common diagnosis leading to pediatric antibiotic prescriptions in the outpatient setting after respiratory diagnoses. However, most antibiotic stewardship programs have mainly focused on the latter. Children seen in the ambulatory setting for SSTIs often receive >7 days of antibiotics, although current society guidelines recommend 5-7 days for most diagnoses.


Objective: To determine the baseline percentage of patients receiving antibiotic prescriptions for >7 days for SSTIs in urgent care clinics (UCC)s of a pediatric health system and to evaluate factors that influence providers towards longer durations.


Design/Methods: We built a …

Evaluation Of The Hypothesis That Viral Meningitis Is A Mimic Of Abusive Head Trauma, Danielle Horton, Tanya Burrell, James Anderst, Lyndsey Hultman, Mary Moffatt, Henry T. Puls, Rangaraj Selvarangan

Posters

Background: Viral meningitis (VM) has been proposed as an alternative cause of subdural hemorrhage (SDH) in young children diagnosed with abusive head trauma (AHT). It has been proposed that VM may mimic symptoms and clinical features of AHT, resulting in an incorrect diagnosis of abuse.


Objective: We aim to evaluate the hypothesis that VM is a mimic of AHT by comparing the history of present illness (HPI) and initial clinical presentation of young children with proven VM to those with subdural hemorrhage and concomitant suspicious injuries (SDH + CSIs) and to those with SDH and no CSIs (SDH only). We …

Simulation Based Clinical Systems Testing Of A Pediatric Ed To Improve Staff And Process Readiness For Pediatric Hypoglycemia, Kevin Meilak Md, Christopher S. Kennedy

Posters

Background: Hypoglycemia is the most common metabolic disorder in children in pediatric emergency department (ED) settings 1. Children may present with nonspecific symptoms, or asymptomatically2. So identification/treatment is very challenging. Delayed recognition and under treatment can lead to poor patient outcomes including seizure, coma, and death. Simulation-based clinical systems tests (SbCSTs) are useful to detect gaps/latent safety threats (LSTs) in system design.3-5


Objective: Our aim was to use SbCSTs combined with rapid cycle training to test system function for ED treatment of hypoglycemia.3-5. The research questions were in 2 frames: 1. Can SbCSTs identify gaps/LSTs and recommendations for improvement and …

Prevalence Of Mycoplasma Genitalium And Macrolide Resistance In Adolescent Females Receiving Care At A Pediatric Hospital, Kayla Barnes, Bishnu Adhikari, Rangaraj Selvarangan, Christopher J. Harrison, Melissa K. Miller

Posters

Background: Mycoplasma genitalium is an established sexually transmitted cause of nongonococcal urethritis in males and macrolide resistance is increasing. The pathogenic role is less well-defined in adolescent females and guidelines recommend M. genitalium testing only be considered in cases of persistent or recurrent cervicitis and pelvic inflammatory disease (PID). We lack understanding of the prevalence and macrolide resistance of M. genitalium in adolescent females.


Objective: To determine the prevalence of M. genitalium and rate of detected macrolide resistance among adolescent females seeking care at a pediatric children’s hospital.


Design/Methods: We collected 200 salvaged urogenital samples (56 urine and 144 vaginal) …

Improving The Rate Of Emergency Department Physician Pre-Procedure Time-Out Documentation For Deep Sedation And Cutaneous Abscess Incision And Drainage, Arjun Sarin, Nikita Sharma, Shobhit Jain

Posters

Background: The pre-procedure time-out, an important safety measure to verify patient identity and accuracy of a planned procedure, and Joint Commission requirement, is not documented consistently by physicians in our emergency department (ED). Deep sedation and cutaneous abscess incision and drainage (I&D) are two high-risk procedures performed in the ED, supporting the use of a time-out in this setting. Between June 2018 and May 2019, a pre-procedure time-out was documented in the physician procedure note of the electronic medical record (EMR) for 75% of deep sedations, and 94% of I&Ds.


Objective: We aimed to improve ED physician pre-procedure time-out documentation …

Teaching Pediatric Procedural Pain And Anxiety Management To Residents: Early Outcomes Of A Newly Developed Curriculum, Jennifer J. Dilts, Brian R. Lee, Shobhit Jain, Ross Newman, Sarah Fouquet, Michael Brancato, Kadriye O. Lewis

Posters

Background: Poorly managed pediatric pain has negative long-term outcomes, including needle phobia, increased pain and anxiety with subsequent procedures, and healthcare avoidance in adulthood. Evidence-based interventions to reduce procedural pain and anxiety are vastly underutilized, and a literature search revealed no specific curriculum to teach residents optimal skills for pain and anxiety management in minor procedures (e.g. venipuncture, laceration repair). Thus, we developed a multimedia-based lecture with PowerPoint, utilizing results from a focus group interview (conducted with 7 pediatric residents, to determine educational content and identify residents’ needs and learning preferences).


Objective: To measure residents’ learning outcomes (knowledge, attitudes, perceived …

Using Standardized Scripting To Improve Antibiotic Stewardship In A National Pediatric Urgent Care Collaborative, Amanda Nedved, Melody Fung, Cindy Liu, Rana Hamdy, Amanda Montalbano

Posters

Background: A study using administrative data reported urgent care providers as having the highest rates of inappropriate antibiotic use for upper respiratory illnesses. In a national survey, pediatric urgent care providers reported family expectations as a primary driver for prescribing inappropriate antibiotics. Standardized scripting has been effective at reducing unnecessary antibiotics while increasing family satisfaction.


Objective: To reduce inappropriate prescribing for upper respiratory infections (acute otitis media (AOM), otitis media with effusion (OME), and pharyngitis) in pediatric urgent cares by 20% by December 1, 2020 through use of standardized scripting in Year 2 of a national pediatric urgent care quality …

Simulation Based Clinical Systems Testing In The Pediatric Emergency Department To Prepare For Covid-19 Pandemic, Christopher S. Kennedy, Marc Sycip, Lisa Ell, Shautonja Woods

Posters

Background: The COVID-19 prompted pediatric emergency departments (PED) to prepare for a surge in patients. In response, guidelines developed represent “work as imagined” and may not reflect work as done. In situ simulations could identify gaps and help to mitigate errors. Simulation-based clinical systems tests (SbCSTs) can detect latent safety threats (LSTs) in systems design.


Objective: Our aim was to use SbCSTs combined with rapid cycle training to test hospital system modifications for ED preparation. This method represenst a new application of SbCSTs. The research questions were in 2 frames: 1. Can rapidly deployed SbCSTs identify LSTs and recommendations for …

Global Health Immersive Elective In The Philippines, Lisa Godfrey

Posters

Describes her experiences working at Fabella Memorial NICU and the Philippines General Hospital.

Making The Management Of Acute Otitis Media A Snap, Cassandra Newell, Donna Wyly, Tanis Stewart, Alaina N. Burns, Brian R. Lee, Rana El Feghaly

Posters

AIM:

To improve Watchful Waiting or Safety Net Antibiotic Prescription (WW/SNAP) in children >6 months old diagnosed with acute otitis media by Advanced Practice Nurses in the Emergency Department by May 2020.

Optimizing Antibiotic Management Of Pediatric Acute Otitis Media In An Emergency Department, Alicia Daggett, Alaina N. Burns, Brian R. Lee, Nirav Shastri, Patricia Phillips, Rana E. El Feghaly

Posters

Problem

Children diagnosed with acute otitis media (AOM) at the Children's Mercy Hospital Kansas Emergency Department routinely get antibiotic prescriptions. There is rarely discussion with families about watchful waiting (defined as discussion of observation with parents and providing a safety-net antibiotic prescription that parents can ill if the patient is not improving or is worsening over the next 48 hours).

The aim of this quality improvement project is to increase watchful waiting for AOM at the CMK ED by 20% by March 2020, with an overall goal of decreasing antibiotic use for AOM.

Assessment And Improvement Of Data Collection Errors Through Inter-Departmental Collaboration, Charlott Williams, Kelli L. Behr, Mary Moffatt, Rangaraj Selvarangan

Posters

Specific Aims:

1. To maintain the ED team's high rate of accuracy in data collection
2. To begin team participation in corrective action planning
3. To improve interdepartmental problem solving

Conclusion

Open communication about errors among all collaborating departments, combing with a shared approach to solving them:

• improved morale and perception of error tracking by the team
• led to a decrease in errors overall, and
• increased interdepartmental collaboration

When all members of the interdepartmental team work together with a positive approach to corrective action, improvement in error rates is a natural outcome of the solutions derived.

Decreasing Length Of Stay In Pediatric Urgent Care With Electronic Discharge Instructions, Jennifer Wooster, Aimy Patel, Brian R. Lee, Amanda Nedved

Posters

Time spent waiting in the urgent care clinic is dissatisfying for patient and staff. This "wasted time" accounted for more than 52% of the urgent care visit at our urgent care.

The aim of our project is to decrease length of stay by 10 minutes by April 30, 2019 for all patients discharged from Blue Valley Urgent Care by offering patients a paperless depart process. To be eligible for discharge without paper families must be enrolled in the online patient portal.

Electronic discharge instructions significantly decrease length of stay and is associated with improved patient experience scores. Patients who received …

Improving Bronchiolitis Care Across Multiple Care Settings Using A Deimplementation Bundle, Amanda Nedved, Kathleen Berg, Troy Richardson, Amanda Montalbano, Matthew B. Johnson

Posters

Despite the availability of a bronchiolitis CPG; variation in care practices still existed at our institution. The aim of our quality improvement (QI) project was to increase overall adherence with our institutional CPG in patients 60 days to 24 months of age diagnosed with bronchiolitis in the urgent care centers (UCC), emergency departments (ED), and general inpatient units from a baseline of 40.9% to 60% by the end of two bronchiolitis seasons.

Utility Of Point-Of-Care Beta-Hydroxybutyrate Testing For Predicting Diabetic Ketoacidosis In The Pediatric Emergency Department, Michelle Knoll, Kelsee Halpin, Ryan Mcdonough

Posters

The objective of our investigation was to describe the diagnostic characteristics of point-of-care capillary beta-hydroxybutyrate (BOHB) testing to predict diabetic ketoacidosis among pediatric patients presenting with hyperglycemia in the pediatric emergency department.

Financial Stewardship Through Appropriate Critical Care Documentation, Shobhit Jain, Nirav Shastri, Gregory P. Conners, Irene Walsh

Posters

No abstract provided.

A "Passport" To Urgent Care: Medical Student Education In The Pediatric Urgent Care Setting, Emily Montgomery, David Skoglund, Tiffany Addington, Robert Riss, Amanda Montalbano

Posters

Background
Pediatric Urgent Care (PUC) serves as a rich environment to teach outpatient pediatric acute care. 96% of PUCs host trainees, but only 4% host medical students.1 Constraints on clinical teaching slots2 necessitate the utilization of novel settings.

Fall 2017, the University of Kansas (KU) School of Medicine approached the Division of Urgent Care at Children’s Mercy Hospital (CMH) in Kansas City, Missouri to host 3rd year medical students as part of their pediatric clerkship.

The PUC became a new site for medical student education, necessitating the development of a new curriculum.

Objective
Create a curriculum for pediatric clerkship students …

More Timely Care: Effect Of Online Queuing System Vs. Change In Hours Of Operation On Hourly Arrival Volumes, Aimy Patel, Brian R. Lee, Amanda Montalbano

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No abstract provided.

Sepsis: Triage Triggers, Outcomes Quicker, Rylee Ainge, Mackenzie Flaws, Natalie Heim, Emily Herndon, Hayley Norris, Amy Scott

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No abstract provided.

Medication Timeliness In Emergency Department In Pediatric Sickle Cell Disease Population Presenting With Vaso-Occlusive Episode, Derrick Goubeaux, Kaitlyn Hoch, Gerald Woods, Julie Routhieaux, Maureen Guignon, Valerie Mcdougall Kestner

Posters

No abstract provided.