medRxiv - Emergency Medicine最新文献

{"title":"Emergency Department Discharge Center Program Evaluation from a \"Learning Organization\" lens: Methods, Lessons Learned, and Future Directions","authors":"Bibi S Razack, Naya B Mahabir, Lisa Iyeke, Lindsay Jordan, Roland Hope, Emily Diaz, Lyze Barcia, Diana Fuzailov, Helena Willis, Marina Gizzi-Murphy, Frederick Davis, Adam Berman, Mark Richman, Nancy Kwon","doi":"10.1101/2024.07.30.24310873","DOIUrl":"https://doi.org/10.1101/2024.07.30.24310873","url":null,"abstract":"Our ED's Discharge Center (EDDC) facilitates appointments and paper-based social determinants of health (SDoH) screening. No criteria guide EDDC utilization. The ED's provider-administrator-run, patient-satisfying follow-up call program contacts only ~25% of discharges. We describe Learning Organization-principle-guided evaluation of EDDC efficiency, aiming to create EDDC time to expand the follow-up program. We reviewed appointment-making, SDoH-screening, and follow-up program data. We surveyed patients to determine whether adopting SHOUT tool criteria (no home, no primary care physician, or insurance) might yield more-judicious EDDC utilization. EDDC staff's 20 minutes/patient yielded fewer ED returns and admissions. Most patients improved post-discharge and made appointments themselves; 6% met SHOUT criteria for EDDC assistance; 4.5% would benefit from SDoH screening.\u0000Adopting SHOUT criteria would create significant time for EDDC-staffed follow-up program expansion. QR-code-accessible SDoH surveys would screen thousands more patients, minimizing EDDC staff involvement, saving 95% of the effort while retaining 100% of the benefit.","PeriodicalId":501290,"journal":{"name":"medRxiv - Emergency Medicine","volume":"126 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141864007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discussions about Goals of Care in the Emergency Department: a Qualitative Study of Emergency Physicians' Opinions Using the Normalization Process Theory","authors":"Fannie Péloquin, Emile Marmen, Véronique Gélinas, Ariane Plaisance, Maude Linteau, Audrey Nolet, Nathalie Germain, Patrick Archambault","doi":"10.1101/2024.07.26.24310500","DOIUrl":"https://doi.org/10.1101/2024.07.26.24310500","url":null,"abstract":"Purpose We explored emergency department (ED) physicians' opinions about the feasibility of leading goals of care discussions (GCD) in their daily practice. Method\u0000This qualitative study was based on the Normalization Process Theory (NPT). We conducted semi-structured interviews between April and May 2018 with a convenience sample of ten emergency physicians from one academic ED (Lévis, Canada) and aimed to reach data saturation. Using a mixed deductive and inductive thematic analysis, two authors codified the interviews under the four NPT constructs: coherence, cognitive participation, collective action, and reflexive monitoring. We calculated a kappa statistic to measure inter-rater agreement. Results\u0000We interviewed 10 emergency physicians. No new ideas emerged after the ninth interview and the inter-rater agreement was substantial. Fourteen themes were identified as factors influencing the feasibility of implementing GCD: (1) interpersonal communication, (2) efficiency of care, (3) anxiety generated by the discussion, (4) identification of an acute deterioration leading to the GCD, (5) meeting of the clinician, patient, and family, (6) importance of knowing the patient's goals of care before medical handover, (7) lack of training, (8) availability of protocols, (9) heterogeneous prioritization for leading GCD, (10) need to take action before patients consult in the ED, (11) need to develop education programs, (12) need for legislation, (13) need to improve the ED environment and human resources, and (14) selective systematization of GCD for patients. Conclusion\u0000Goals of care discussions are possible and essential with selected ED patients. Physicians identified outstanding needs to normalize GCD in their practice: education for both themselves and patients on the concept of GCD, legislative action for the systematization of GCD for patients, and proactive documentation of patients' preferences pre-ED. Patient, clinician and system-level policy-making efforts remain necessary to address these needs and ensure the normalization of GCD in emergency physicians' daily practice as suggested by clinical guidelines.","PeriodicalId":501290,"journal":{"name":"medRxiv - Emergency Medicine","volume":"59 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141778822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of Delayed Percutaneous Coronary Intervention for STEMI in the Southeast United States","authors":"Maxwell C Messinger, Nicklaus Ashburn, Joshua S Chait, Anna C Snavely, Siena Hapig-Ward, Jason P Stopyra, Simon A. Mahler","doi":"10.1101/2024.07.11.24310307","DOIUrl":"https://doi.org/10.1101/2024.07.11.24310307","url":null,"abstract":"Background\u0000Emergent reperfusion by percutaneous coronary intervention (PCI) within 90 minutes of first medical contact (FMC) is indicated in patients with ST-segment elevation myocardial infarction (STEMI). However, long transport times in rural areas in the Southeast US make meeting this goal difficult. The objective of this study was to determine the number of Southeast US residents with prolonged transport times to the nearest 24/7 primary PCI (PPCI) center. Methods\u0000A cross-sectional study of residents in the Southeastern US was conducted based on geographical and 2022 5-Year American Community Survey data. The geographic information system (GIS) ArcGIS Pro was used to estimate Emergency Medical Services (EMS) transport times for Southeast US residents to the nearest PPCI center. All 24/7 PPCI centers in North Carolina, South Carolina, Georgia, Florida, Mississippi, Alabama, and Tennessee were included in the analysis, as well as nearby PPCI centers in surrounding states. To identify those at risk of delayed FMC-to-device time, the primary outcome was defined as a >30-minute transport time, beyond which most patients would not have PCI within 90 minutes. A secondary outcome was defined as transport >60 minutes, the point at which FMC-to-device time would be >120 minutes most of the time. These cutoffs are based on national median EMS scene times and door-to-device times. Results\u0000Within the Southeast US, we identified 62,880,528 residents and 350 PPCI centers. Nearly 11 million people living in the Southeast US reside greater than 30 minutes from a PPCI center (17.3%, 10,866,710, +/- 58,143 ), with 2% (1,271,522 +/- 51,858/62,880,528) living greater than 60 minutes from a PPCI hospital. However, most patients reside in short transport zones; 82.7% (52,013,818 +/- 98,741). Within the Southeast region, 8.4% (52/616) of counties have more than 50% of their population in a long transport zone and 42.3% (22/52) of those have more than 90% of their population in long transport areas. Conclusions\u0000Nearly 11 million people in the Southeast US do not have access to timely PCI for STEMI care. This disparity may contribute to increased morbidity and mortality.","PeriodicalId":501290,"journal":{"name":"medRxiv - Emergency Medicine","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141611202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A qualitative study exploring Emergency Department Staff attitudes to COVID-19 research","authors":"Joanna Quinn, Antonia Ho, Andrew Blunsum, David J Lowe","doi":"10.1101/2024.07.04.24309781","DOIUrl":"https://doi.org/10.1101/2024.07.04.24309781","url":null,"abstract":"Introduction: Research conducted in the Emergency Department (ED) is essential for improving patient care and advancing evidence-based practice. However, there are several challenges to research engagement in the ED, including lack of time, awareness of research opportunities, and concerns about the impact on clinical duties. This study aimed to explore the attitudes and perceptions of ED staff involved in an enhanced syndromic surveillance of hospitalised severe acute respiratory illness (CHARISMA study) during the COVID-19 pandemic. Methods: This qualitative study utilised semi-structured interviews with a mix of nursing and medical staff with a range of experience levels. Thematic analysis was then undertaken. Results: 9 respondents informed our four key themes: the value of research, the user experience of the study tools, clinician research engagement and improvement recommendations for future iterations of the study. Our findings reveal that ED staff value research and recognise its importance in improving patient care and evidence-based practice. However, they also face significant challenges in participating in research due to time constraints, lack of awareness of research opportunities, and concerns about the impact on clinical duties. Conclusion: To address these challenges, we propose strategies to enhance research engagement in the ED, including providing more support from senior staff, more transparent communication about research studies, training on research methods and tools, and opportunities for feedback and input. Implementing these measures, we can enhance the environment for research in the ED, enabling wider staff contribution.","PeriodicalId":501290,"journal":{"name":"medRxiv - Emergency Medicine","volume":"63 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141572157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Emergency Department point-of-care ultrasound in the evaluation of possible small bowel obstruction lead to meaningful improvements in patient-centric milestones?","authors":"Yi-Ru Chen, Melva Morales Sierra, Rida Nasir, Naya Mahabir, Lisa Iyeke, Lindsay Jordan, Trupti Shah, Kevin Burke, Matthew Friedman, Daniel Dexeus, Athena Mihailos, Mark Richman, Joshua Guttman","doi":"10.1101/2024.07.01.24309689","DOIUrl":"https://doi.org/10.1101/2024.07.01.24309689","url":null,"abstract":"Introduction: Point-of-care ultrasound (POCUS) has 90-95% sensitivity and specificity for small bowel obstruction (SBO) compared with computed tomography (CT). ED clinicians might reasonably use a positive POCUS to progress to patient-centric milestones (eg, nasogastric tube (NGT) placement, general surgery consult, and disposition). Awaiting CT performance and interpretation before moving to such milestones may delay care. Literature is limited concerning the effects of POCUS vs. CT alone on such patient-centric milestones for patients with SBO. This study compared time to patient-centric milestones (NGT, general surgery consult, and disposition) among ED patients suspected of having SBO who underwent POCUS vs. CT only in their SBO diagnostic process. Methods: Data from 11,801 SBO patients seen among 14 EDs between 2017-2022 was queried. Patients were categorized into two groups according to diagnostic method (POCUS + CT vs. CT alone). Patients were included if they had a POCUS positive for SBO and an ED diagnosis of SBO; they were excluded from analysis of any specific/particular milestone (NGT, general surgery consult, or disposition) if they had that milestone prior to POCUS. Median time from ED arrival to each milestone was calculated for both groups (POCUS + CT vs. CT alone). Results: Compared to CT-only patients, patients with POCUS plus CT had a non-statistically-significant longer wait time from ED arrival to NGT (414 vs. 390, p=0.7) and from ED arrival to general surgery consult (487.5 vs. 442 minutes, p = 0.07). They had statistically-significantly longer time to from ED arrival to disposition (475.5 vs. 377 minutes, p=0.009). Among cases in which POCUS was performed, 80% of the time the NGT was placed, 77% of the time the general surgery consult was performed, and 100% of time disposition was made only after CT result rather than after POCUS but before CT result. Conclusion:\u0000Use of POCUS was not associated with earlier achievement of patient-centric milestones (NGT or general surgery consult) and was associated with longer time to disposition. This is most-likely because, despite POCUS suggesting SBO, clinicians waited for CT results prior to placing the NGT, consulting general surgery, and entering the disposition. Such results suggest that, despite POCUS's high sensitivity and specificity, ED and/or general surgery clinicians rely on CT scan results to confirm SBO, delaying patient-centric milestones.","PeriodicalId":501290,"journal":{"name":"medRxiv - Emergency Medicine","volume":"120 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141551823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of trauma quality improvement program implementation on mortality: A multi-center controlled interrupted time-series study","authors":"Johanna Berg, Siddarth David, Girish D. Bakhshi, Debojit Basak, Shamita Chatterjee, Kapil Dev Soni, Ulf Ekelund, Li Felländer-Tsai, Manjul Joshipura, Tamal Khan, Monty Khajanchi, Mohan L N, Anurag Mishra, Max Petzold, Sendhil Rajan, Nobhojit Roy, Rajdeep Singh, Martin Gerdin Wärnberg","doi":"10.1101/2024.05.27.24307748","DOIUrl":"https://doi.org/10.1101/2024.05.27.24307748","url":null,"abstract":"<strong>Importance</strong> Trauma causes over four million deaths annually, the majority of these in low- and middle-income countries. Implementing trauma quality improvement programs may improve outcomes, and though extensively used, high-quality evidence of their effectiveness is scarce.","PeriodicalId":501290,"journal":{"name":"medRxiv - Emergency Medicine","volume":"55 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141191134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Sepsis Care in Rural Emergency Departments: A Qualitative Study of Emergency Department User Perspectives","authors":"Nicholas M. Mohr, Kimberly A.S. Merchant, Brian M. Fuller, Brett Faine, Luke Mack, Amanda Bell, Katie DeJong, Edith A. Parker, Keith Mueller, Elizabeth Chrischilles, Christopher R. Carpenter, Michael P. Jones, Steven Q. Simpson, Marcia M. Ward","doi":"10.1101/2024.05.05.24306891","DOIUrl":"https://doi.org/10.1101/2024.05.05.24306891","url":null,"abstract":"<strong>Objective</strong> Sepsis is a leading cause of hospitalization and death in the United States, and rural patients are at particularly high risk. Telehealth has been proposed as one strategy to narrow rural-urban disparities. The objective of this study was to understand why staff use provider-to-provider telehealth in rural emergency departments (tele-ED) and how tele-ED care changes the care for rural patients with sepsis.","PeriodicalId":501290,"journal":{"name":"medRxiv - Emergency Medicine","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140938840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A disposable female urinal bottle (the EasyWee tm pending) improves patient experience for immobilised females with lower limb fractures","authors":"Siân Thomas, Sophy Booth, Peter Ellis, Savneet Lochab, Mark D Lyttle, James Pegrum","doi":"10.1101/2024.05.06.24306419","DOIUrl":"https://doi.org/10.1101/2024.05.06.24306419","url":null,"abstract":"Female patients with lower limb fractures often experience pain and loss of dignity when manoeuvred onto a bedpan. Poor bladder management, including urinary catheterisation for convenience, can lead to longer hospital stays and eventual loss of independence. Disposable pulp male urinal bottles have been modified into a shape that accommodates the female perineum but they have not been used consistently, the design has varied depending on the fabricator and no formal evidence supported their use.","PeriodicalId":501290,"journal":{"name":"medRxiv - Emergency Medicine","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140938726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Numerical Cincinnati Stroke Scale versus Stroke Severity Screening Tools for the Prehospital Determination of LVO","authors":"Holden M. Wagstaff, Remle P. Crowe, Scott T. Youngquist, H. Hill Stoecklein, Ali Treichel, Yao He, Jennifer J. Majersik","doi":"10.1101/2024.05.02.24306794","DOIUrl":"https://doi.org/10.1101/2024.05.02.24306794","url":null,"abstract":"<strong>Background</strong> Previous research demonstrated that the numerical Cincinnati Prehospital Stroke Scale (CPSS) identifies large vessel occlusion (LVO) at similar rates compared to a limited number of stroke severity screening tools. We aimed to compare numerical CPSS to additional stroke scales using a national EMS database.","PeriodicalId":501290,"journal":{"name":"medRxiv - Emergency Medicine","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140889762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sepsis in patients with vs. without mental illness: a comparison of demographic, insurance, comorbidity, and infection source characteristics","authors":"Yi-Ru Chen, Melva Morales Sierra, Jaime Jacob, Lisa Iyeke, Lindsay Jordan, Khatija Paperwalla, Mark Richman","doi":"10.1101/2024.04.15.24305016","DOIUrl":"https://doi.org/10.1101/2024.04.15.24305016","url":null,"abstract":"<strong>Background</strong> Adherence to the Surviving Sepsis Campaign’s 3- and 6-hour bundles (blood cultures/serum lactate/antibiotics/IV fluids/vasopressors) improves mortality. Septic patients with mental health illness may not receive optimal care, being unable to explain symptoms, understand/accept their condition/care, or remain calm. We compare characteristics of ED septic patients with vs without mental health illnesses in their demographics, insurance, housing status, comorbidities, and infected organs, part of a larger, retrospective study seeking to compare such patients’ sepsis care quality (bundle adherence, length-of-stay (LOS)).","PeriodicalId":501290,"journal":{"name":"medRxiv - Emergency Medicine","volume":"90 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140625005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}