The Integration of Nurse Practitioners Into Mass Gathering Medical Teams.

Mass gathering events can greatly impact overburdened emergency medical service systems and emergency departments, which frequently experience staffing shortages and overcrowding. Nurse practitioners (NPs) were introduced into an event medicine team at mass gatherings to reduce emergency transports to local emergency departments as well as offering a "treat and release" disposition for patients presenting to medical tents. This study aimed to examine the impact of NPs at mass gathering events; 147 chart reviews were performed from 05/01/2023 to 09/30/2023 for all patients assessed by an NP at events staffed by an event medicine team; 60% of patients assessed by an NP were treated and released from the event, potentially reducing the number of patient transports and emergency department visits considerably.

Catching Those Who Fall Through the Cracks: Integrating a Follow-Up Process for Emergency Department Patients with Incidental Radiologic Findings.

Study Objective: Abnormal findings unrelated to the indication for testing are identified on emergency department (ED) imaging studies. We report the design and implementation of an electronic health record-based interdisciplinary referral system and our experience from the first 13 months of ensuring that patients with incidental radiology findings were connected with the appropriate outpatient surveillance.

Methods: Our informatics team standardized the contemporaneous reporting of critical radiology alerts using our ED trackboard and created a companion follow-up request form for the treating ED clinicians to complete.

A celebration with unforeseen consequences: Celebratory gunfire causing injury.

A 41-year-old otherwise healthy women presented to the emergency department via emergency services after collapsing after feeling a "slap" on her head while celebrating a national holiday. Physical exam and computed tomography scan showed the presence of a retained ballistic fragment in her high parietal scalp, making her the victim of injury by celebratory gunfire, an illegal, but not uncommon, practice. She was admitted for concussive symptoms, her bullet was removed without incident and after a period of observation she was discharged in stable condition to home.

A model for rapid emergency department expansion for the COVID-19 pandemic.

COVID-19 has caused global dramatic change in medical practices including the introduction of temporary screening and assessment areas outside the footprint of the main hospital structures. Following the initial surge of patients with novel coronavirus (2019-nCoV) in the United States, our medical center rapidly designed and constructed an alternative assessment and treatment site in a converted parking garage deck for emergency department patients with suspected or confirmed 2019-nCoV. During the first month after opening, 651 patients were treated in this alternative assessment area including 54 patients who tested positive for 2019-nCoV.

Charge Reductions Associated With Shorter Time to Recovery in Septic Shock.

Background: Septic shock therapies that shorten the time to physiologic and clinical recovery may result in financial savings. However, the financial implications of improving these nonmortal outcomes are not well characterized. Therefore, we quantified hospital charges associated with four outcomes: ICU length of stay, duration of invasive mechanical ventilation, duration of vasopressor use, and new renal replacement therapy.

Implementation of an Opioid Detoxification Management Pathway Reduces Emergency Department Length of Stay.

Objectives: With the rise of opioid use in the United States, the increasing demand for treatment for opioid use disorders presents both a challenge and an opportunity to develop new care pathways for emergency department (ED) patients seeking opioid detoxification. We set out to improve the care of patients presenting to our ED seeking opioid detoxification by implementing a standardized management pathway and to measure the effects of this intervention.

Methods: We conducted a before-after study of the effects of an opioid detoxification management pathway on ED length of stay (EDLOS), use of resources (social worker consultation, laboratory tests obtained), and return visits to the same ED within 30 days of discharge.

Measuring Emergency Department Acuity.

Background: Emergency department (ED) acuity is the general level of patient illness, urgency for clinical intervention, and intensity of resource use in an ED environment. The relative strength of commonly used measures of ED acuity is not well understood.

Methods: We performed a retrospective cross-sectional analysis of ED-level data to evaluate the relative strength of association between commonly used proxy measures with a full spectrum measure of ED acuity.

Effect of a Handover Tool on Efficiency of Care and Mortality for Interhospital Transfers.

Background: Interhospital transfer is frequent, and transferred patients experience delays in the provision of care and higher mortality rates when compared to patients directly admitted. The interhospital handover is a key opportunity to improve care but has not been evaluated.

Objective: To determine the effect of a universal handover tool on timeliness of care, length of stay (LOS), and mortality among interhospital transfer patients.

Comparison of Etomidate and Ketamine for Induction During Rapid Sequence Intubation of Adult Trauma Patients.

Study Objective: Induction doses of etomidate during rapid sequence intubation cause transient adrenal dysfunction, but its clinical significance on trauma patients is uncertain. Ketamine has emerged as an alternative for rapid sequence intubation induction. Among adult trauma patients intubated in the emergency department, we compare clinical outcomes among those induced with etomidate and ketamine.

Factors Influencing Time-Dependent Quality Indicators for Patients With Suspected Acute Coronary Syndrome.

Objectives: Rapid risk stratification and timely treatment are critical to favorable outcomes for patients with acute coronary syndrome (ACS). Our objective was to identify patient and system factors that influence time-dependent quality indicators (QIs) for patients with unstable angina/non-ST elevation myocardial infarction (NSTEMI) in the emergency department (ED).

Methods: A retrospective, cohort study was conducted during a 42-month period of all patients 24 years or older suspected of having ACS as defined by receiving an electrocardiogram and at least 1 cardiac biomarker test.

The AFFORD clinical decision aid to identify emergency department patients with atrial fibrillation at low risk for 30-day adverse events.

There is wide variation in the management of patients with atrial fibrillation (AF) in the emergency department (ED). We aimed to derive and internally validate the first prospective, ED-based clinical decision aid to identify patients with AF at low risk for 30-day adverse events. We performed a prospective cohort study at a university-affiliated tertiary-care ED.

Personal experiences and attitudes towards intimate partner violence in healthcare providers in Guyana.

Background: Intimate partner violence (IPV) is prevalent throughout the world and is a devastating public health problem. Healthcare workers (HCWs) are tasked with treating victims of IPV but may be victims themselves. Guyana is a lower-middle income country in South America.

Patient perspectives on opt-out HIV screening in a Guyanese emergency department.

In 2007, the WHO recommended that healthcare providers in areas of a generalised HIV epidemic perform HIV testing on all adults and adolescents presenting for healthcare. Studies regarding patient acceptability of opt-out testing, however, have reported wide variation in acceptance rates. This study examines patient-reported acceptability of such testing at the emergency department (ED) of Georgetown Public Hospital Corporation, the largest public hospital in Guyana.

Who leaves the emergency department without being seen? A public hospital experience in Georgetown, Guyana.

Background: Left without being seen (LWBS) proportions are commonly used as quality control indicators, but little data is available on LWBS proportions in the developing world. This study sought to determine the proportion and characteristics of patients who LWBS from the emergency department (ED) of the main public hospital in Georgetown, Guyana.

Methods: This is a retrospective cross-sectional analysis of an ED quality assurance database.

Reducing blood culture contamination in the emergency department: an interrupted time series quality improvement study.

Objectives: Blood culture contamination is a common problem in the emergency department (ED) that leads to unnecessary patient morbidity and health care costs. The study objective was to develop and evaluate the effectiveness of a quality improvement (QI) intervention for reducing blood culture contamination in an ED.

Methods: The authors developed a QI intervention to reduce blood culture contamination in the ED and then evaluated its effectiveness in a prospective interrupted times series study.

Risk factors for bradycardia requiring pacemaker implantation in patients with atrial fibrillation.

Symptomatic bradycardia may complicate atrial fibrillation (AF) and necessitate a permanent pacemaker. Identifying patients at increased risk for symptomatic bradycardia may reduce associated morbidities and health care costs. The aim of this study was to investigate predictors for developing bradycardia requiring a permanent pacemaker in patients with AF.

Predictors of ambulance transport in patients with ST-elevation myocardial infarction.

Introduction: Despite intense public awareness campaigns, many patients with ST-elevation myocardial infarction (STEMI) do not utilize Emergency Medical Services (EMS) transportation to the Emergency Department (ED). Predictors for mode of transport by EMS versus private vehicle in patients with an acute STEMI were investigated. Hypothesis It was hypothesized that patient characteristics, specifically older age, male sex, and a history of a prior cardiac intervention, would be associated with a higher likelihood of EMS utilization.

Prevalence of intimate partner violence in patients presenting with traumatic injuries to a Guyanese emergency department.

Background: Intimate partner violence (IPV) occurs throughout the world, and has both short- term and long- term negative health effects. Little is know about the prevalence of IPV in patients presenting to Emergency Departments (EDs) in the developing world. This information is needed to help delineate the scope of the problem and shape effective interventions to combat IPV.

ED crowding and the use of nontraditional beds.

Background And Objectives: In an effort to compensate for crowding, many emergency departments (EDs) evaluate and treat patients in nontraditional settings such as gurneys in hallways and conference rooms. The impact of this practice on ED evaluation time is unknown.

Research Design And Subjects: A historical cohort of adult ED visits to an academic hospital between August 1, 2009 and August 1, 2010, was used to evaluate the relationship between ED bed assignment (traditional, hallway, or conference room bed) and mean ED evaluation time, defined as the time spent in an ED bed before admission or discharge.

Atrial fibrillation and flutter outcomes and risk determination (AFFORD): design and rationale.

Background: Atrial fibrillation (AF) is the most common sustained arrhythmia affecting over 700,000 individuals in Japan and 2.2 million in the USA. The proper management of patients with AF is critical due to the well-documented association with heart failure and stroke.

Assessment of the Framingham risk factors among ED patients with newly diagnosed atrial fibrillation.

Study Objective: Atrial fibrillation (AF) is often first diagnosed in the emergency department (ED) and accounts for nearly 1% of all emergency department (ED) visits. Our objective was to assess the Framingham Heart Study risk score for AF development in ED patients with newly diagnosed AF.

Methods: We systematically reviewed the electronic medical records of ED patients with newly diagnosed AF between August 2005 and July 2008.

A clinical prediction model to estimate risk for 30-day adverse events in emergency department patients with symptomatic atrial fibrillation.

Study Objective: Atrial fibrillation affects more than 2 million people in the United States and accounts for nearly 1% of emergency department (ED) visits. Physicians have little information to guide risk stratification of patients with symptomatic atrial fibrillation and admit more than 65%. Our aim is to assess whether data available in the ED management of symptomatic atrial fibrillation can estimate a patient's risk of experiencing a 30-day adverse event.