Sprint Team Approach Yields Rapid Improvement in Leapfrog Quality Indicators.

Goal: Patient safety and quality care are two critical areas that every healthcare organization strives to grow and improve upon. At Scripps Health, specific efforts reviewed for this article were implemented to reduce hospital-acquired conditions and hospital readmissions that are components of Centers for Medicare & Medicaid Services programs and Leapfrog Hospital Survey scores.

Methods: Sprint teams, a novel approach to rapidly develop a checklist for lower-performing care improvement areas, were implemented after an internal review of existing tools and an evidence-based literature review.

Recovering Patient Trust We Lost in the Pandemic.

The question of how to engender patient trust in a pandemic is not easy to answer, and yet it is a critical question that requires a convincing response. On March 14, 2020, the surgeon general of the United States called for a stop to elective procedures. Ultimately, that led us at Scripps Health to close some clinics to protect personal protective equipment supplies and then furlough staff because of the decrease in patient visits.

MD to MD Coaching: Improving Physician-Patient Experience Scores: What Works, What Doesn't.

With increasing national focus on patient experience scores through public reporting and the Value-Based Purchasing Program, hospitals and medical groups are challenged with initiating sustainable programs to improve their scores. Our system initiated 3 pilot programs to determine which approaches and techniques would be the most beneficial. The pilot trails included: (a) MD to MD 1:1 coaching with monthly MD-specific individual reports; (b) all staff patient experience training sessions at two of our urgent care centers; and (c) physician group patient experience training at one of our outpatient clinics.

Inpatient Treatment after Multi-Dose Racemic Epinephrine for Croup in the Emergency Department.

Background: Emergency department (ED) discharge is safe when croup-related stridor has resolved after corticosteroids and a single dose of racemic epinephrine (RE). Little evidence supports the traditional practice of hospital admission after ≥ 2 doses of RE.

Objective: Our aim was to describe the frequency and timing of clinically important inpatient interventions after ≥ 2 ED RE doses.

Decreasing avoidable hospital admissions with the implementation of an emergency department case management program.

With the passage of the Affordable Care Act, increased emphasis has been placed on optimizing quality and reducing expenditures. The use of an emergency department case manager (EDCM) is reemerging as an important initiative in the quest to provide high-quality care and decrease unnecessary hospital admissions. A pilot study of the use of EDCMs was conducted in one of the authors' EDs during a 6-month trial period.

Improving emergency department time to provider, left-without-treatment rates, and average length of stay.

Background: Emergency Department (ED) overcrowding and ensuing concern about patients who leave without treatment have become a mounting national concern. In addition, the Centers for Medicaid and Medicare Services released regulatory standards for EDs requiring reporting of time from initial triage to decision to admit, as well as actual time of admission.

Objectives: To implement an improved ED patient flow process.

Rapid medical assessment: improving pediatric emergency department time to provider, length of stay, and left without being seen rates.

Objectives: This article aimed to study the impact of a rapid medical assessment (RMA) program on patient flow and left without being seen (LWBS) rates in a pediatric emergency department (ED). RMA is designed to evaluate and discharge uncomplicated patients quickly or initiate diagnostic workup and treatment before the patient is placed in an ED bed.

Methods: Rapid medical assessment was initiated January 1, 2008 with an assigned midlevel provider.

Afebrile pediatric seizures.

Most well-appearing children who have had an afebrile seizure can be managed as outpatients with instructions for an outpatient electroencephalogram and primary care physician follow-up. Laboratory studies are needed only in children younger than 6 months, in patients with prolonged seizures or altered level of consciousness, or in those with history of a metabolic disorder or dehydration. Emergent neuroimaging is not recommended in children with a first unprovoked afebrile seizure, although studies should be considered in children with a predisposing condition or focal seizures if younger than 3 years.

The management of children with gastroenteritis and dehydration in the emergency department.

Background: Acute gastroenteritis is characterized by diarrhea, which may be accompanied by nausea, vomiting, fever, and abdominal pain.

Objective: To review the evidence on the assessment of dehydration, methods of rehydration, and the utility of antiemetics in the child presenting with acute gastroenteritis.

Discussion: The evidence suggests that the three most useful predictors of 5% or more dehydration are abnormal capillary refill, abnormal skin turgor, and abnormal respiratory pattern.

Electrocardiographic manifestations: pediatric ECG.

Interpretation of pediatric electrocardiograms (ECGs) can be challenging for the Emergency Physician. Part of this difficulty arises from the fact that the normal ECG findings, including rate, rhythm, axis, intervals and morphology, change from the neonatal period through infancy, childhood, and adolescence. These changes occur as a result of the maturation of the myocardium and cardiovascular system with age.

Oral analgesia before pediatric ketamine sedation is not associated with an increased risk of emesis and other adverse events.

The objective of this study was to determine the association between recent administration of oral analgesics and frequency of adverse events during ketamine sedation in pediatric patients undergoing fracture reduction in the emergency department (ED). This retrospective study was conducted in the ED of a large, urban pediatric teaching hospital. Subjects were patients aged View Article and Find Full Text PDF

Ketamine-propofol combination sedation for fracture reduction in the pediatric emergency department.

Objectives: To evaluate the time of onset and recovery from and the efficacy and safety of intravenous ketamine-propofol sedation for reduction of forearm fractures in the pediatric emergency department setting.

Study Design: Prospective, observational pilot study.

Methods: Children presenting to an urban pediatric emergency department requiring sedation for closed reduction of forearm fractures received ketamine 0.

Pediatric respiratory infections.

Pediatric respiratory infections are a common presenting complaint to the emergency department. This article discusses the presentation and management of infectious conditions, including bacterial tracheitis, bronchiolitis, croup, epiglottitis, pertussis, pneumonia, and retropharyngeal abscess.

Pediatric resuscitation update.

In 2005, the American Heart Association updated the guidelines for newborn and pediatric resuscitation. These changes are now being taught in the current Basic Life Support and Pediatric Advanced Life Support classes. This article reviews the pertinent new changes in caring for the critically ill child.

An update on the approach to apparent life-threatening events.

Purpose Of Review: Apparent life-threatening events are an ongoing diagnostic dilemma for clinicians. Since most apparent life-threatening event episodes occur in infants under 6 months of age, they can generate considerable anxiety in parents and providers. This review will discuss issues to consider in the evaluation of infants after an apparent life-threatening event.

Seizures in children.

Seizures are the most common pediatric neurologic disorder. Four to ten percent of children suffer at least one seizure in the first 16 years of life. The incidence is highest in children less than 3 years of age, with a decreasing frequency in older children.

Abdominal pain in children.

Abdominal pain and gastrointestinal symptoms such as vomiting or diarrhea are common chief complaints in young children who present in emergency departments. It is the emergency physician's role to differentiate between a self-limited process such as viral gastroenteritis or constipation and more life-threatening surgical emergencies. Considering the difficulties inherent in the pediatric examination, it is not surprising that appendicitis, intussusception, and malrotation with volvulus continue to be among the most elusive diagnoses.

Pediatric dysrhythmias.

Arrhythmias in children are less common than in adults but are increasing because of successful repair of congenital heart diseases. Supraventricular tachycardia is the most common symptomatic pediatric tachyarrhythmia. Atrial flutter and atrial fibrillation in children are attributed largely to structural heart disease.

Newborn emergencies: the first 30 days of life.

The evaluation and appropriate management of the critically ill neonate requires knowledge of the physiologic changes and life-threatening pathologies that may present during this time period. A broad systematic approach to evaluating the neonate is necessary to provide a comprehensive yet specific differential diagnosis for a presenting complaint or symptom. Efficient recognition and prompt management of illness in the neonatal period may be life saving.

The pediatric ECG.

Knowledge of the basics of pediatric ECG interpretation is helpful in differentiating normal from abnormal findings. These basics include familiarity with the age-related normal findings in heart rate, intervals, axis, and waveform morphologies; an understand-ing of cardiac physiologic changes associated with age and maturation, particularly the adaptation from right to left ventricular predominance; and a rudimentary understanding of common pediatric dysrhythmias and findings associated with congenital heart diseases.

Emergency physicians and the care of children.

The care of children is an integral aspect of emergency medicine. This article reviews the many important contributions that emergency physicians have made in advancing the acute care of children.

Pediatric cardiac disorders.

Although pediatric cardiac disorders are not commonly seen in the Emergency Department, they are important to identify to prevent further morbidity or mortality. Diagnosis may be complicated by the lack of classic complaints such as chest pain or palpitations that are commonly associated with cardiac disorders. In fact, presenting complaints associated with pediatric cardiac disorders, like "fussiness" or "difficulty feeding," may seem quite nonspecific.

Abdominal surgical emergencies in infants and young children.

Surgical emergencies can be missed easily in children, who are not always able to volunteer relevant information. Awareness of the entities discussed in this review might help the EP uncover subtle clues to early diagnoses that might not be initially apparent. Ill-appearing children who have abdominal pain and vomiting should be considered to have ischemic or necrotic bowel until proven otherwise.