Emergency Medicine Commons^™

Post-Overdose Interventions Triggered By Calling 911: Centering The Perspectives Of People Who Use Drugs (Pwuds), Karla D. Wagner, Robert W. Harding, Richard Kelley, Brian Labus, Silvia R. Verdugo, Elizabeth Copulsky, Jeanette M. Bowles, Maria Luisa Mittal, Peter J. Davidson

Environmental & Global Health Faculty Research

Background Opioid overdose deaths have increased exponentially in the United States. Bystander response to opioid overdose ideally involves administering naloxone, providing rescue breathing, and calling 911 to summon emergency medical assistance. Recently in the US, public health and public safety agencies have begun seeking to use 911 calls as a method to identify and deliver post-overdose interventions to opioid overdose patients. Little is known about the opinions of PWUDs about the barriers, benefits, or potential harms of post-overdose interventions linked to the 911 system. We sought to understand the perspectives of PWUDs about a method for using 911 data to …

Medication Overdoses In The Emergency Department: Oral Hypoglycemic Agents, Atypical Antipsychotic Agents, Beta-Blockers, Calcium Channel Blockers, And Digoxin, Brooke Marlowe, Tara Tokar, Kayti Kintner, Kelsey Fink, Grant Walliser

Pharmacy and Wellness Review

The number of medication toxicities has been steadily increasing with more patients presenting to the emergency department for both intentional and unintentional overdoses. Oral hypoglycemics, atypical antipsychotics, betablockers, calcium channel blockers and digoxin overdoses are some of the more common medication toxicities health care professionals may see in practice. Toxic doses of oral hypoglycemic agents, beta-blockers, calcium channel blockers and digoxin have more definitive options for treatment, while atypical antipsychotic overdoses are managed with supportive care. Pharmacists in particular play a pivotal role in identifying presenting symptoms and recommending appropriate treatment options in toxicological emergencies.

Pheochromocytoma – Clinical Manifestations, Diagnosis And Current Perioperative Management, Maria Manea, Dragos R. Marcu, Ovidiu G. Bratu, Ana M. Stanescu, Anca Pantea Stoian, Mihnea A. Gaman, Camelia C. Diaconu

Journal of Mind and Medical Sciences

Pheochromocytoma is a neuroendocrine tumor characterized by the excessive production of catecholamines (epinephrine, norepinephrine, and dopamine). The diagnosis is suspected due to hypertensive paroxysms, associated with vegetative phenomena, due to the catecholaminergic hypersecretion. Diagnosis involves biochemical tests that reveal elevated levels of catecholamine metabolites (metanephrine and normetanephrine). Functional imaging, such as 123I-metaiodobenzylguanidine scintigraphy (123I-MIBG), has increased specificity in identifying the catecholamine-producing tumor and its metastases. The gold-standard treatment for patients with pheochromocytoma is represented by the surgical removal of the tumor. Before surgical resection, it is important to optimize blood pressure and intravascular volume in order to avoid negative hemodynamic …

A Paramedic Staffed Prehospital Program May Reduce Hospital Readmissions For Heart Failure, Bruce Feldman Do, Christopher J. Greb Nrp, Orlando E. Rivera Rn, Mahek Shah Md, Jennifer Nesfeder, Deborah W. Sundlof Do, Nael Hawwa Md, Alma N. Ohl Crnp, Tara K. Henry-Morrow Emt-P, Jeanne L. Jacoby Md

Department of Emergency Medicine

No abstract provided.

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.

Antioxidant Enzyme-Mimetic Activity And Neuroprotective Effects Of Cerium Oxide Nanoparticles Stabilized With Various Ratios Of Citric Acid And Edta, Ana Y. Estevez, Mallikarjunarao Ganesana, John F. Trentini, James E. Olson, Guang Ze Li, Yvonne O. Boateng, Jennifer M. Lipps, Sarah E.R. Yablonski, William T. Donnelly, James C. Leiter, Joseph S. Erlichman

Emergency Medicine Faculty Publications

Cerium oxide (CeO2) nanoparticles (CeNPs) are potent antioxidants that are being explored as potential therapies for diseases in which oxidative stress plays an important pathological role. However, both beneficial and toxic effects of CeNPs have been reported, and the method of synthesis as well as physico-chemical, biological, and environmental factors can impact the ultimate biological effects of CeNPs. In the present study, we explored the effect of different ratios of citric acid (CA) and EDTA (CA/EDTA), which are used as stabilizers during synthesis of CeNPs, on the antioxidant enzyme-mimetic and biological activity of the CeNPs. We separated the CeNPs into …

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 …

Chemical Disaster Preparedness For Hospitals And Emergency Departments, Gregory K. Wanner, Do, Sukhi Atti, Md, Edward Jasper, Md

Department of Emergency Medicine Faculty Papers

Preparing to evaluate and treat victims of a chemical exposure incident is one aspect of hospital disaster preparedness. Past chemical disasters, including terrorist attacks and industrial or transit accidents, have highlighted the need for hospital planning, preparation, and training. Emergency department and hospital staff members must be familiar with their facility-specific protocols and be trained for their individual roles during these incidents. This article provides a brief review of the requirements and guidelines related to chemical disaster response from a healthcare perspective. Resources for training and the evaluation of chemically contaminated patients are discussed. Decontamination procedures, including pre-hospital and hospital-based …

Hour Prediction Rule - Letter To The Editor., Andrew L. Koons Do, Robert D. Cannon Do, Facmt, Gillian A. Beauchamp Md, Kenneth D. Katz Md, Matthew D. Cook Do, Ryan M. Surmaitis Do

Department of Emergency Medicine

In a recent issue of Academic Emergency Medicine, we read with interest the article titled: Hospital Observation Upon Reversal (HOUR) with Naloxone: A Prospective Clinical Prediction Rule Validation Study by Clemency et al. In order to avoid over-reliance on this decision rule and possible untoward effects of early discharge, we feel that there are some key points worth considering in this regard. It is important to note that the average dose of prehospital naloxone was 3.1mg, which was administered intranasally (IN) in 85% of the patients. This fact was briefly discussed in the paper in terms of area under the …

Feasibility Of Implementation Of An Emergency Department Discharge Opioid Taper Protocol, Gillian A. Beauchamp Md, Joshua Rosentel Bsn, Rn, Erin Farber Do, Joseph Levi Do, Dpt, Lexis Laubach Bs, Lauren Crowley Ba, Richard S. Mackenzie Md, Mboe, David M. Richardson Md, Marna R. Greenberg Do, Mph, Facep

Department of Emergency Medicine

No abstract provided.

Do Female Residents Actually Demonstrate Better Levels Of Empathy, Emotional Intelligence And Burnout Than Their Male Counterparts?, Jeanne L. Jacoby Md, Bryan G. Kane Md, Marna R. Greenberg Do, Mph, Facep, Robert D. Barraco Md, Mph, Elaine A. Donoghue Md, Kevin Weaver D.O.,Facoep, Jennifer E. Macfarlan Mph, Alexander M. Rosenau Do, Joann F. Quinn Phd, Amy B. Smith Phd

Department of Emergency Medicine

No abstract provided.

Overcoming Brick And Mortar: Feasibility Of Implementation Of A Mat And Linkage To Treatment Program By Leveraging Community Partnerships, Gillian A. Beauchamp Md, Priyanka Lauber Do, Jamie Allen Do, Nathan Boateng Ba, Samantha A. Shaak Phd, Paige Roth Msw, Lsw, Crs, Lexis Laubach Bs, Lauren M. Crowley Ba, David B. Burmeister Do, Facep, Cpe, Marna R. Greenberg Do, Mph, Facep

Department of Emergency Medicine

No abstract provided.

Do Incoming Residents Vary In Measures Of Emotional Status Even Prior To Residency Training?, Jeanne L. Jacoby Md, Bryan G. Kane Md, Marna R. Greenberg Do, Mph, Facep, Robert D. Barraco Md, Mph, Elaine A. Donoghue Md, Kevin Weaver D.O.,Facoep, Jennifer E. Macfarlan Mph, Alexander M. Rosenau Do, Joann F. Quinn Phd, Amy B. Smith Phd

Department of Emergency Medicine

No abstract provided.

Police Use Of Naloxone After Statewide Legislation Enabling First-Responder Administration, John F. Mccarthy Do, Kathryn A. Henry Do, Lauren Crowley Ba, David M. Sassa Aas, Kira D. Weaver Do, Robert D. Cannon Do, Tara K. Henry-Morrow Emt-P, Jennifer E. Macfarlan Mph, Jeanne L. Jacoby Md

Department of Emergency Medicine

No abstract provided.

A Study Of Scars: Narratives Of Unintentional Childhood Injuries In Cato Manor, Carolyn Fox

Independent Study Project (ISP) Collection

The purpose of this study is to identify the specific types of injuries children experience growing up in Cato Manor, specifically, KwaMasxha, to understand how community members process and make meaning of their injuries over time, and to analyze the social determinants of health in Cato Manor that have been conducive to these injuries.

In order to learn about experiences of unintentional childhood injuries in Cato Manor, data was collected using a qualitative, narrative-based approach. I conducted interviews with young adult community members aged 19 to 27 years, asking about their personal experiences with childhood injuries as someone who grew …

The Make ‘Em Well Project -Rewards And Recognition Phase, Diann M. Krywko

Journal of Wellness

The Make ‘EM Well Project- Rewards and Recognition

Background: Physicians report high burnout levels and difficulty finding joy in work, causing a healthcare system crisis. Our institution assessed burnout by administering the Areas of Work-life (AWS) and Maslach Burnout Inventory™ (MBI) Surveys. Emergency Medicine (EM) results were alarming. Effectively rewarding and recognizing employees requires understanding different appreciation languages. Administrators should understand what enhances and detracts from joy in the workplace. This study describes the “Make ‘EM Well Project” and its focus on Rewards and Recognition (RR).

Methods: Two surveys were sent to EM providers including faculty, residents, fellows, and advanced …

A New Horizon: Emergency Department Pharmacy Practice, Amanda C. Mcdavid

Pharmacy and Wellness Review

No abstract provided.

Improving The Workflow And Partnership Between Registration And Clinical Staff In An Outpatient Urgent Care Center, Melissa Fairfield, Bailey Eells, Faye Collins, Joyce Cornish, Stephen Tyzik, Joy Moody, Wendy Osgood, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operations Transformation

An outpatient urgent care unit was experiencing challenges in balancing the need to register patients and delivering care in the timeliest manner as possible. Upon examination, it was found that delays were being experienced in patient triage and discharge that resulted in low patient satisfaction scores.

A team of providers was established to review all process steps and a quality improvement project was created to attain a goal of 100% of the time discharge would not be delayed due to incomplete registration.

Baseline metrics demonstrated current numbers of delayed discharges, median time from door to triage as well as door …