WorldWideScience

Sample records for department ed methods

  1. National targets, process transformation and local consequences in an NHS emergency department (ED): a qualitative study.

    Science.gov (United States)

    Vezyridis, Paraskevas; Timmons, Stephen

    2014-06-13

    In the attempt to reduce waiting times in emergency departments, various national health services have used benchmarking and the optimisation of patient flows. The aim of this study was to examine staff attitudes and experience of providing emergency care following the introduction of a 4 hour wait target, focusing on clinical, organisational and spatial issues. A qualitative research design was used and semi-structured interviews were conducted with 28 clinical, managerial and administrative staff members working in an inner-city emergency department. A thematic analysis method was employed and NVivo 8 qualitative data analysis software was used to code and manage the emerging themes. The wait target came to regulate the individual and collective timescales of healthcare work. It has compartmentalised the previous unitary network of emergency department clinicians and their workspace. It has also speeded up clinical performance and patient throughput. It has disturbed professional hierarchies and facilitated the development of new professional roles. A new clinical information system complemented these reconfigurations by supporting advanced patient tracking, better awareness of time, and continuous, real-time management of emergency department staff. The interviewees had concerns that this target-oriented way of working forces them to have a less personal relationship with their patients. The imposition of a wait-target in response to a perceived "crisis" of patients' dissatisfaction led to the development of a new and sophisticated way of working in the emergency department, but with deep and unintended consequences. We show that there is a dynamic interrelation of the social and the technical in the complex environment of the ED. While the 4 hour wait target raised the profile of the emergency department in the hospital, the added pressure on clinicians has caused some concerns over the future of their relationships with their patients and colleagues. To

  2. A generic method for evaluating crowding in the emergency department

    DEFF Research Database (Denmark)

    Eiset, Andreas Halgreen; Erlandsen, Mogens; Møllekær, Anders Brøns;

    2016-01-01

    Background Crowding in the emergency department (ED) has been studied intensively using complicated non-generic methods that may prove difficult to implement in a clinical setting. This study sought to develop a generic method to describe and analyse crowding from measurements readily available......, a ‘carry over’ effect was shown between shifts and days. Conclusions The presented method offers an easy and generic way to get detailed insight into the dynamics of crowding in an ED. Keywords Crowding, Emergency department, ED, Generic, Method, Model, Queue, Patient flow...

  3. Suicide Prevention in an Emergency Department Population: The ED-SAFE Study.

    Science.gov (United States)

    Miller, Ivan W; Camargo, Carlos A; Arias, Sarah A; Sullivan, Ashley F; Allen, Michael H; Goldstein, Amy B; Manton, Anne P; Espinola, Janice A; Jones, Richard; Hasegawa, Kohei; Boudreaux, Edwin D

    2017-06-01

    Suicide is a leading cause of deaths in the United States. Although the emergency department (ED) is an opportune setting for initiating suicide prevention efforts, ED-initiated suicide prevention interventions remain underdeveloped. To determine whether an ED-initiated intervention reduces subsequent suicidal behavior. This multicenter study of 8 EDs in the United States enrolled adults with a recent suicide attempt or ideation and was composed of 3 sequential phases: (1) a treatment as usual (TAU) phase from August 2010 to December 2011, (2) a universal screening (screening) phase from September 2011 to December 2012, and (3) a universal screening plus intervention (intervention) phase from July 2012 to November 2013. Screening consisted of universal suicide risk screening. The intervention phase consisted of universal screening plus an intervention, which included secondary suicide risk screening by the ED physician, discharge resources, and post-ED telephone calls focused on reducing suicide risk. The primary outcome was suicide attempts (nonfatal and fatal) over the 52-week follow-up period. The proportion and total number of attempts were analyzed. A total of 1376 participants were recruited, including 769 females (55.9%) with a median (interquartile range) age of 37 (26-47) years. A total of 288 participants (20.9%) made at least 1 suicide attempt, and there were 548 total suicide attempts among participants. There were no significant differences in risk reduction between the TAU and screening phases (23% vs 22%, respectively). However, compared with the TAU phase, patients in the intervention phase showed a 5% absolute reduction in suicide attempt risk (23% vs 18%), with a relative risk reduction of 20%. Participants in the intervention phase had 30% fewer total suicide attempts than participants in the TAU phase. Negative binomial regression analysis indicated that the participants in the intervention phase had significantly fewer total suicide attempts

  4. Can geriatric approaches support the care of old patients in emergency departments? A review from a Swiss ED

    OpenAIRE

    Schoenenberger, Andreas; Exadaktylos, Aristomenis

    2014-01-01

    In the coming decades, old patients will account for an increasing proportion of emergency department (ED) visits. During or after their stay in the ED, they more frequently suffer adverse outcomes than younger patients. There is evidence that specific age-centred approaches improve the outcomes. We therefore reviewed specific conditions needing particular attention in older ED patients, such as cognitive disorders and delirium, impaired mobility and falls, as well as problems related to the ...

  5. Feasibility of Non-Mydriatic Ocular Fundus Photography in the Emergency Department: Phase I of the FOTO-ED Study

    Science.gov (United States)

    Bruce, Beau B.; Lamirel, Cédric; Biousse, Valérie; Ward, Antionette; Heilpern, Katherine L.; Newman, Nancy J.; Wright, David W.

    2011-01-01

    Objectives Examination of the ocular fundus is imperative in many acute medical and neurologic conditions, but direct ophthalmoscopy by non-ophthalmologists is underutilized, poorly performed, and difficult without pharmacologic pupillary dilation. The objective was to examine the feasibility of non-mydriatic fundus photography as a clinical alternative to direct ophthalmoscopy by emergency physicians (EPs). Methods Adult patients presenting to the emergency department (ED) with headache, acute focal neurologic deficit, diastolic blood pressure ≥ 120 mmHg, or acute visual change had ocular fundus photographs taken by nurse practitioners using a non-mydriatic fundus camera. Photographs were reviewed by a neuro-ophthalmologist within 24 hours for findings relevant to acute ED patient care. Nurse practitioners and patients rated ease, comfort, and speed of non-mydriatic fundus photography on a 10-point Likert scale (10 best). Timing of visit and photography were recorded by automated electronic systems. Results Three hundred fifty patients were enrolled. There were 1,734 photographs taken during 230 nurse practitioner shifts. Eighty-three percent of the 350 patients had at least one eye with a high quality photograph, while only 3% of patients had no photographs of diagnostic value. Mean ratings were ≥ 8.7 (standard deviation [SD] ≤ 1.9) for all measures. The median photography session lasted 1.9 minutes (interquartile range [IQR] 1.3 to 2.9 minutes), typically accounting for less that 0.5% of the patient’s total ED visit. Conclusions Non-mydriatic fundus photography taken by nurse practitioners is a feasible alternative to direct ophthalmoscopy in the ED. It is performed well by non-physician staff, is well-received by staff and patients, and requires a trivial amount of time to perform. PMID:21906202

  6. Unplanned 3-day re-attendance rate at Emergency Department (ED) and hospital's bed occupancy rate (BOR).

    Science.gov (United States)

    Sun, Yan; Heng, Bee Hoon; Tay, Seow Yian; Tan, Kelvin Brian

    2015-12-01

    Unplanned re-attendance at the Emergency Department (ED) is often monitored as a quality indicator of the care accorded to patients during their index ED visit. High bed occupancy rate (BOR) has been considered as a matter of reduced patient comfort and privacy. Most hospitals in Singapore operate under BORs above 85 %. This study aims to explore factors associated with the unplanned 3-day ED re-attendance rate and, in particular, if higher BOR is associated with higher 3-day unplanned ED re-attendance rate. This was a multicenter retrospective study using time series data. Three acute tertiary hospitals were selected from all six adult public hospitals in Singapore based on data availability. Daily data from year 2008 to 2013 were collected from the study hospitals' information systems. These included: ED visit date, day of week, month, year, public holiday, daily hospital BOR, daily bed waiting time (BWT) at ED (both median and 95th percentile), daily ED admission rate, and 3-day ED re-attendance rate. The primary outcome of the study was unplanned 3-day ED re-attendance rate from all reasons. Both univariate analysis and generalized linear regression were respectively applied to study the crude and adjusted association between the unplanned 3-day ED re-attendance rate and its potential associated factors. All analyses were conducted using SPSS 18 (PASW 18, IBM). The average age of patients who visited ED was 35 years old (SD = 2), 37 years old (SD = 2), and 40 years old (SD = 2) in hospitals A, B, and C respectively. The average 3-day unplanned ED re-attendance rate was 4.9 % (SE = 0.47 %) in hospital A, 3.9 % (SE = 0.35 %) in hospital B, and 4.4 % (SE = 0.30 %) in hospital C. After controlling for other covariates, the unplanned 3-day ED re-attendance rates were significantly associated with hospital, time trend, day of week, daily average BOR, and ED admission rate. Strong day-of-week effect on early ED re-attendance rate was

  7. Can geriatric approaches support the care of old patients in emergency departments? A review from a Swiss ED.

    Science.gov (United States)

    Schoenenberger, Andreas W; Exadaktylos, Aristomenis K

    2014-01-01

    In the coming decades, old patients will account for an increasing proportion of emergency department (ED) visits. During or after their stay in the ED, they more frequently suffer adverse outcomes than younger patients. There is evidence that specific age-centred approaches improve the outcomes. We therefore reviewed specific conditions needing particular attention in older ED patients, such as cognitive disorders and delirium, impaired mobility and falls, as well as problems related to the activities of daily living, disability, poly-pharmacy, adverse drug effects, co-morbidity and atypical presentation. We also propose steps to further improve the quality of care in older ED patients by using appropriate age-centred management.

  8. Teaching Elementary School Social Studies Methods under edTPA

    Science.gov (United States)

    An, Sohyun

    2016-01-01

    This article reports a self-study that analyzes my experience as a teacher educator navigating a turbulent educational landscape with the advent of edTPA. The data consist of my journal entries, the syllabi, handouts, work submitted by my students, and course evaluations. Data were analyzed by using an inductive process to describe how the edTPA…

  9. 78 FR 71591 - Privacy Act of 1974; Computer Matching Program between the U.S. Department of Education (ED) and...

    Science.gov (United States)

    2013-11-29

    ... Privacy Act of 1974; Computer Matching Program between the U.S. Department of Education (ED) and the U.S.... SUPPLEMENTARY INFORMATION: Pursuant to the Privacy Act of 1974, as amended (Privacy Act) (5 U.S.C. 552a), the..., the Computer Matching and Privacy Protection Act of 1988, 54 FR 25818 (June 19, 1989), and...

  10. Solving the worldwide emergency department crowding problem - what can we learn from an Israeli ED?

    Science.gov (United States)

    Pines, Jesse M; Bernstein, Steven L

    2015-01-01

    ED crowding is a prevalent and important issue facing hospitals in Israel and around the world, including North and South America, Europe, Australia, Asia and Africa. ED crowding is associated with poorer quality of care and poorer health outcomes, along with extended waits for care. Crowding is caused by a periodic mismatch between the supply of ED and hospital resources and the demand for patient care. In a recent article in the Israel Journal of Health Policy Research, Bashkin et al. present an Ishikawa diagram describing several factors related to longer length of stay (LOS), and higher levels of ED crowding, including management, process, environmental, human factors, and resource issues. Several solutions exist to reduce ED crowding, which involve addressing several of the issues identified by Bashkin et al. This includes reducing the demand for and variation in care, and better matching the supply of resources to demands in care in real time. However, what is needed to reduce crowding is an institutional imperative from senior leadership, implemented by engaged ED and hospital leadership with multi-disciplinary cross-unit collaboration, sufficient resources to implement effective interventions, access to data, and a sustained commitment over time. This may move the culture of a hospital to facilitate improved flow within and across units and ultimately improve quality and safety over the long-term.

  11. Modified Adomian decomposition method for fracture of laminated uni-directional composites

    Indian Academy of Sciences (India)

    B K Raghu Prasad; P V Ramana

    2012-02-01

    In this paper, the well-known Adomian Decomposition Method (ADM) is modified to solve the fracture laminated multi-directional problems. The results are compared with the existing analytical/exact or experimental method. The already known existing ADM is modified to improve the accuracy and convergence. Thus, the modified method is named as Modified Adomian Decomposition Method (MADM). The results from MADM are found to converge very quickly, simple to apply for fracture(singularity) problems and are more accurate compared to experimental and analytical methods. MADM is quite efficient and is practically well-suited for use in these problems. Several examples are given to check the reliability of the present method. In the present paper, the principle of the decomposition method is described, and its advantages form the analyses of fracture of laminated uni-directional composites.

  12. Feasibility of nonmydriatic ocular fundus photography in the emergency department: Phase I of the FOTO-ED study.

    Science.gov (United States)

    Bruce, Beau B; Lamirel, Cédric; Biousse, Valérie; Ward, Antionette; Heilpern, Katherine L; Newman, Nancy J; Wright, David W

    2011-09-01

    Examination of the ocular fundus is imperative in many acute medical and neurologic conditions, but direct ophthalmoscopy by nonophthalmologists is underutilized, poorly performed, and difficult without pharmacologic pupillary dilation. The objective was to examine the feasibility of nonmydriatic fundus photography as a clinical alternative to direct ophthalmoscopy by emergency physicians (EPs). Adult patients presenting to the emergency department (ED) with headache, acute focal neurologic deficit, diastolic blood pressure ≥ 120 mm Hg, or acute visual change had ocular fundus photographs taken by nurse practitioners using a nonmydriatic fundus camera. Photographs were reviewed by a neuroophthalmologist within 24 hours for findings relevant to acute ED patient care. Nurse practitioners and patients rated ease, comfort, and speed of nonmydriatic fundus photography on a 10-point Likert scale (10 best). Timing of visit and photography were recorded by automated electronic systems. A total of 350 patients were enrolled. There were 1,734 photographs taken during 230 nurse practitioner shifts. Eighty-three percent of the 350 patients had at least one eye with a high-quality photograph, while only 3% of patients had no photographs of diagnostic value. Mean ratings were ≥ 8.7 (standard deviation [SD] ≤ 1.9) for all measures. The median photography session lasted 1.9 minutes (interquartile range [IQR] = 1.3 to 2.9 minutes), typically accounting for less that 0.5% of the patient's total ED visit. Nonmydriatic fundus photography taken by nurse practitioners is a feasible alternative to direct ophthalmoscopy in the ED. It is performed well by nonphysician staff, is well-received by staff and patients, and requires a trivial amount of time to perform. © 2011 by the Society for Academic Emergency Medicine.

  13. Factors affecting communication in emergency departments: doctors and nurses' perceptions of communication in a trilingual ED in Hong Kong.

    Science.gov (United States)

    Pun, Jack K H; Matthiessen, Christian M I M; Murray, Kristen A; Slade, Diana

    2015-12-01

    This study investigates clinicians' views of clinician-patient and clinician-clinician communication, including key factors that prevent clinicians from achieving successful communication in a large, high-pressured trilingual Emergency Department (ED) in Hong Kong. Researchers interviewed 28 doctors and nurses in the ED. The research employed a qualitative ethnographic approach. The interviews were audio-recorded, transcribed, translated into English and coded using the Nvivo software. The researchers examined issues in both clinician-patient and clinician-clinician communication. Through thematic analyses, they identified the factors that impede communication most significantly, as well as the relationship between these factors. This research highlights the significant communication issues and patterns in Hong Kong EDs. The clinician interviews revealed that communication in EDs is complex, nuanced and fragile. The data revealed three types of communication issues: (1) the experiential parameter (i.e. processes and procedures), (2) the interpersonal parameter (i.e. clinicians' engagements with patients and other clinicians) and (3) contextual factors (i.e. time pressures, etc.). Within each of these areas, the specific problems were the following: compromises in knowledge transfer at key points of transition (e.g. triage, handover), inconsistencies in medical record keeping, serious pressures on clinicians (e.g. poor clinician-patient ratio and long working hours for clinicians) and a lack of focus on interpersonal skills. These communication problems (experiential, interpersonal and contextual) are intertwined, creating a complex yet weak communication structure that compromises patient safety, as well as patient and clinician satisfaction. The researchers argue that hospitals should develop and implement best-practice policies and educational programmes for clinicians that focus on the following: (1) understanding the primary causes of communication problems in

  14. Introducing the Collaborative E-Learning Design Method (CoED)

    DEFF Research Database (Denmark)

    Ryberg, Thomas; Buus, Lillian; Nyvang, Tom;

    2015-01-01

    In this chapter, a specific learning design method is introduced and explained, namely the Collaborative E-learning Design method (CoED), which has been developed through various projects in “e-Learning Lab – Centre for User Driven Innovation, Learning and Design” (Nyvang & Georgsen, 2007). We...... briefly situate this method within the wider area of Learning Design, where after we present the theoretical background of the CoED method. We illustrate the method through discussing its concrete implementation in recent projects and discuss its capacities and challenges in relation to other methods...... within the area of learning design. Finally, we discuss some challenges related to the CoED-method and the field of learning design in general....

  15. Study of patients of road traffic accidents a rriving in emergency department [ED] of V.S hospital at Ahmedabad city, single centre pilot study.

    Directory of Open Access Journals (Sweden)

    Aharnish Shah

    2014-07-01

    Full Text Available Objectives of the study According to the latest world status report on road safety released by WHO, we are now the world leaders in road traffic accident rate & related mortality. Our study intends to find out the epidemiological factors, risk factors, use of safety measures, compliance with traffic laws, presenting injuries & ED intervention required, in patients with road traffic accidents. Materials & methods Our study is a cross sectional observational study in which data was obtained from 150 patients of road traffic accidents arriving at any time to emergency department. Collected data included information about basic details, basic crash characteristics, risk factors, use of safety measures, injuries sustained, ED intervention required & disposition. Results Approximately 77% of the patients belong to 11-50 yr age group. The most common time of RTA is between 6 am to 12 noon [36.67%]. However accidents requiring admission were more during night time [62.74%]. Innocent passengers & pedestrians contributed to 41% of the accident cases. Non compliance with traffic laws & safety measures like driving without license [20%], using mobile phones while driving [10%], not using headlights at night [26%], not using seatbelts [80%], not using helmets [91%], etc were found in a substantial number of cases. Intracranial bleed & skull fractures were significantly (31.2% v/s 0% more in drivers without helmets than those with helmets. ED intervention required in decreasing order were dressing ( 38%, laceration repair (27.33%, splinting (24%, crash intubation (10%, ICD (2.66%. Conclusion: Well equipped secondary & tertiary level trauma centres, specially dedicated to management of trauma patients, with a proper triage plan, are necessary for proper management of trauma patients & better utilisation of resources. Our study shows that an ER physician should be trained in l aceration repair, dressing, splint/slab application, fracture/dislocation reduction

  16. SEM, EDS, PL and absorbance study of CdTe thin films grown by CSS method

    Energy Technology Data Exchange (ETDEWEB)

    Hernandez-Torres, M.E.; Silva-Gonzalez, R.; Gracia-Jimenez, J.M. [Instituto de Fisica, BUAP, Apdo. Postal J-48, San Manuel, 72570 Puebla, Pue. (Mexico); Casarrubias-Segura, G. [CIE- UNAM, 62580 Temixco, Morelos (Mexico)

    2006-09-22

    Oxygen-doped CdTe films were grown on conducting glass substrates by the close spaced sublimation (CSS) method and characterized using SEM, EDS, photoluminescence (PL) and absorbance. A significant change in the polycrystalline morphology is observed when the oxygen proportion is increased in the deposition atmosphere. The EDS analysis showed that all samples are nonstoichiometric with excess Te. The PL spectra show emission bands associated with Te vacancies (V{sub Te}), whose intensities decrease as the oxygen proportion in the CSS chamber is increased. The oxygen impurities occupy Te vacancies and modify the surfaces states, improving the nonradiative process. (author)

  17. Investigation of Detectability of Elementary Composition of Rainbow trout muscle with EDS (Energy Dispersive Spectroscopy Method

    Directory of Open Access Journals (Sweden)

    Saltuk Buğrahan CEYHUN

    2017-06-01

    Full Text Available In present study, it is investigated that detectability of elementary composition of rainbow trout muscle using Energy Dispersive Spectroscopy (EDS. EDS system which has worked with attached to scanning electron microscope can do qualitative and semi-quantitative elementary analyses on selected region of sample using characteristic X-rays. For this purpose, it was performed four point and two mapping analyses from four samples. According to results, it was detected 13 elements which are consist of C, N and O in 87.70 percentage. As a result, although the method is sensitive and reliable, it is concluded that not adequate for elemental analysis alone but can be used as a support for analyzes with systems such as especially atomic absorption and ICP-MS.

  18. Directory of Analytical Methods, Department 1820

    Energy Technology Data Exchange (ETDEWEB)

    Whan, R.E. (ed.)

    1986-01-01

    The Materials Characterization Department performs chemical, physical, and thermophysical analyses in support of programs throughout the Laboratories. The department has a wide variety of techniques and instruments staffed by experienced personnel available for these analyses, and we strive to maintain near state-of-the-art technology by continued updates. We have prepared this Directory of Analytical Methods in order to acquaint you with our capabilities and to help you identify personnel who can assist with your analytical needs. The descriptions of the various capabilities are requester-oriented and have been limited in length and detail. Emphasis has been placed on applications and limitations with notations of estimated analysis time and alternative or related techniques. A short, simplified discussion of underlying principles is also presented along with references if more detail is desired. The contents of this document have been organized in the order: bulky analysis, microanalysis, surface analysis, optical and thermal property measurements.

  19. Adaptation of Lorke's method to determine and compare ED50 values: the cases of two anticonvulsants drugs.

    Science.gov (United States)

    Garrido-Acosta, Osvaldo; Meza-Toledo, Sergio Enrique; Anguiano-Robledo, Liliana; Valencia-Hernández, Ignacio; Chamorro-Cevallos, Germán

    2014-01-01

    We determined the median effective dose (ED50) values for the anticonvulsants phenobarbital and sodium valproate using a modification of Lorke's method. This modification allowed appropriate statistical analysis and the use of a smaller number of mice per compound tested. The anticonvulsant activities of phenobarbital and sodium valproate were evaluated in male CD1 mice by maximal electroshock (MES) and intraperitoneal administration of pentylenetetrazole (PTZ). The anticonvulsant ED50 values were obtained through modifications of Lorke's method that involved changes in the selection of the three first doses in the initial test and the fourth dose in the second test. Furthermore, a test was added to evaluate the ED50 calculated by the modified Lorke's method, allowing statistical analysis of the data and determination of the confidence limits for ED50. The ED50 for phenobarbital against MES- and PTZ-induced seizures was 16.3mg/kg and 12.7mg/kg, respectively. The sodium valproate values were 261.2mg/kg and 159.7mg/kg, respectively. These results are similar to those found using the traditional methods of finding ED50, suggesting that the modifications made to Lorke's method generate equal results using fewer mice while increasing confidence in the statistical analysis. This adaptation of Lorke's method can be used to determine median letal dose (LD50) or ED50 for compounds with other pharmacological activities. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. Pain management trend of vaso-occulsive crisis (VOC) at a community hospital emergency department (ED) for patients with sickle cell disease.

    Science.gov (United States)

    Inoue, Susumu; Khan, Isra'a; Mushtaq, Rao; Sanikommu, Srinivasa Reddy; Mbeumo, Carline; LaChance, Jenny; Roebuck, Michael

    2016-01-01

    Pain management at the emergency department (ED) for vaso-occulsive crisis (VOC) for patients with sickle cell disease has not been optimum, with a long delay in giving the initial analgesic. We conducted a retrospective survey over a 7-year period to determine our ED's timing in giving pain medication to patients with VOC as a quality improvement project. We compared different periods, children vs adults, and the influence of gender in the analgesic administration timing. This is a retrospective chart review of three different periods: (1) years 2007-2008, (2) years 2011-2012, and (3) year 2013. We extracted relevant information from ED records. Data were analyzed using Student t test, chi-square analysis, and the Kruskal-Wallis test. There was a progressive improvement in the time interval to the 1st analgesic over these three periods. Children received analgesics more quickly than adults in all periods. Male adult patients received pain medication faster than female adult patients, although initial pain scores were higher in female than in male patients. Progressively fewer pediatric patients utilized ED over these three periods, but no difference for adult patients was observed. The proportion of pediatric patients admitted to the hospital increased with each period. The progressive decrease in both the number of patients and the number of visits to the ED by children suggested that the collective number of VOC in children has decreased, possibly secondary to the dissemination of hydroxyurea use. We failed to observe the same trend in adult patients. The need for IV access, and ordering laboratory tests or imaging studies tends to delay analgesic administration. Delay in administration of the first analgesic was more pronounced for female adult patients than male adult patients in spite of their higher pain score. Health care providers working in ED should make conscious efforts to respect pain in women as well as pain in men. Though not proven from this study

  1. DEVELOPMENT OF A METHOD STATISTICAL ANALYSIS ACCURACY AND PROCESS STABILITY PRODUCTION OF EPOXY RESIN ED-20

    Directory of Open Access Journals (Sweden)

    N. V. Zhelninskaya

    2015-01-01

    Full Text Available Statistical methods play an important role in the objective evaluation of quantitative and qualitative characteristics of the process and are one of the most important elements of the quality assurance system production and total quality management process. To produce a quality product, one must know the real accuracy of existing equipment, to determine compliance with the accuracy of a selected technological process specified accuracy products, assess process stability. Most of the random events in life, particularly in manufacturing and scientific research, are characterized by the presence of a large number of random factors, is described by a normal distribution, which is the main in many practical studies. Modern statistical methods is quite difficult to grasp and wide practical use without in-depth mathematical training of all participants in the process. When we know the distribution of a random variable, you can get all the features of this batch of products, to determine the mean value and the variance. Using statistical control methods and quality control in the analysis of accuracy and stability of the technological process of production of epoxy resin ED20. Estimated numerical characteristics of the law of distribution of controlled parameters and determined the percentage of defects of the investigated object products. For sustainability assessment of manufacturing process of epoxy resin ED-20 selected Shewhart control charts, using quantitative data, maps of individual values of X and sliding scale R. Using Pareto charts identify the causes that affect low dynamic viscosity in the largest extent. For the analysis of low values of dynamic viscosity were the causes of defects using Ishikawa diagrams, which shows the most typical factors of the variability of the results of the process. To resolve the problem, it is recommended to modify the polymer composition of carbon fullerenes and to use the developed method for the production of

  2. Stroke Education in an Emergency Department Waiting Room: a Comparison of Methods

    Directory of Open Access Journals (Sweden)

    Yu-Feng Yvonne Chan1

    2015-03-01

    Full Text Available Background: Since the emergency department (ED waiting room hosts a large, captive audience of patients and visitors, it may be an ideal location for conduct-ing focused stroke education. The aim of this study was to assess the effective-ness of various stroke education methods.Methods: Patients and visitors of an urban ED waiting room were randomized into one of the following groups: video, brochure, one-to-one teaching, combi-nation of these three methods, or control group. We administered a 13-question multiple-choice test to assess stroke knowledge prior to, immediately after, and at 1 month post-education to patients and visitors in the ED waiting room.Results: Of 4 groups receiving education, all significantly improved their test scores immediately post intervention (test scores 9.4±2.5-10.3±2.0, P<0.01. At 1 month, the combination group retained the most knowledge (9.4±2.4 exceed-ing pre-intervention and control scores (both 6.7±2.6, P<0.01.Conclusion: Among the various stroke education methods delivered in the ED waiting room, the combination method resulted in the highest knowledge reten-tion at 1-month post intervention.

  3. Research on Petroleum Reservoir Diagenesis and Damage Using EDS Quantitative Analysis Method With Standard Samples

    Institute of Scientific and Technical Information of China (English)

    包书景; 陈文学; 等

    2000-01-01

    In recent years,the X-ray spectrometer has been devekloped not only just in enhancing resolution,but also towards dynamic analysis.Computer modeling processing,sampled quantitative analysis and supra-light element analysis.With the gradual sophistication of the quantitative analysis system software,the rationality and accuracy of the established sample deferential document have become the most important guarantee to the reliability of sample quantitative analysis.This work is an important technical subject in China Petroleum Reservoir Research.Through two years of research and experimental work,the EDS quantitative analysis method for petroleum geolgey and resevoir research has been established.and referential documents for five mineral(silicate,etc).specimen standards have been compiled.Closely combining the shape characters and compositional characters of the minerals together and applying them into reservoir diagenetic research and prevention of oil formations from damage,we have obtained obvious geological effects.

  4. Kaizen: a method of process improvement in the emergency department.

    Science.gov (United States)

    Jacobson, Gregory H; McCoin, Nicole Streiff; Lescallette, Richard; Russ, Stephan; Slovis, Corey M

    2009-12-01

    Recent position statements from health care organizations have placed a strong emphasis on continuous quality improvement (CQI). CQI finds many of its roots in kaizen, which emphasizes small, low-cost, low-risk improvements. Based on the successful Kaizen Programs at organizations such as Toyota, the authors thought the emergency department (ED) would be an ideal environment to benefit from such a program. The authors sought to create a CQI program using a suggestion-based model that did not require a large time commitment, was easy to implement, and had the potential to empower all physicians in the department. It would not take the place of other improvement efforts, but instead augment them. The hypothesis was that such a program would foster sustainable engagement of emergency physicians in system improvement efforts and lead to a continuous stream of low-cost implementable system improvement interventions. A CQI program was created for the physician staff of the Department of Emergency Medicine at Vanderbilt University Medical Center, focusing on a suggestion-based model using kaizen philosophy. Lectures teaching kaizen philosophy were presented. Over the past 4 years, a methodology was developed utilizing a Web-based application, the Kaizen Tracker, which aids in the submission and implementation of suggestions that are called kaizen initiatives (KIs). The characteristics of the KIs submitted, details regarding resident and faculty participation, and the effectiveness of the Kaizen Tracker were retrospectively reviewed. There were 169, 105, and 101 KIs placed in the postimplementation calendar years 2006, 2007, and 2008, respectively. Seventy-six percent of KIs submitted thus far have identified a "process problem." Fifty-three percent of KIs submitted have led to operational changes within the ED. Ninety-three percent of the resident physicians entered at least one KI, and 73% of these residents submitted more than one KI. Sixty-nine percent of the

  5. Utilization of Failure Mode and Effects Analysis (FMEA Method in Increasing the Revenue of Emergency Department; a Prospective Cohort Study

    Directory of Open Access Journals (Sweden)

    Ali Shahrami

    2013-12-01

    Full Text Available Introduction: The balance between revenue and cost of an organization/system is essential to maintain its survival and quality of services. Emergency departments (ED are one of the most important parts of health care delivery system. Financial discipline of EDs, by increasing the efficiency and profitability, can directly affect the quality of care and subsequently patient satisfaction. Accordingly, the present study attempts to investigate failure mode and effects analysis (FMEA method in identifying the problems leading to the loss of ED revenue and offer solutions to help fix these problems. Methods: This prospective cohort study investigated the financial records of ED patients and evaluated the effective errors in reducing the revenue in ED of Imam Hossein hospital, Tehran, Iran, from October 2007 to November 2009. The whole department was divided based on FMEA into one main system and six subsystems. The study was divided in two phases. In the first phase, the problems leading to the loss in the revenue in each subsystem were identified and weighted to four groups using risk priority number (RPN, and the solutions for fixing them were planned. Then, at the second phase discovered defects in the first phase were fixed according to their priority. Finally, the impact of each solution was compared before and after interventions using the repeated measure ANOVA test. Results: At last, 100 financial records of ED patients were evaluated during the first phase of the study. The average of ED revenue in the six months of the first phase was 73.1±3.65 thousands US dollar/month. 12 types of errors were detected in the predefined subsystems. ED revenue rose from 73.1 to 153.1, 207.06, 240, and 320 thousands US dollar/month after solving of first, second, third, and fourth priority problems, respectively (337.75% increase in two years (p<0.001. 111.0% increase in the ED revenue after solving of first priority problems reveals that they were

  6. Utilization of Failure Mode and Effects Analysis (FMEA Method in Increasing the Revenue of Emergency Department; a Prospective Cohort Study

    Directory of Open Access Journals (Sweden)

    Ali Shahrami

    2015-05-01

    Full Text Available Introduction: The balance between revenue and cost of an organization/system is essential to maintain its survival and quality of services. Emergency departments (ED are one of the most important parts of health care delivery system. Financial discipline of EDs, by increasing the efficiency and profitability, can directly affect the quality of care and subsequently patient satisfaction. Accordingly, the present study attempts to investigate failure mode and effects analysis (FMEA method in identifying the problems leading to the loss of ED revenue and offer solutions to help fix these problems. Methods: This prospective cohort study investigated the financial records of ED patients and evaluated the effective errors in reducing the revenue in ED of Imam Hossein hospital, Tehran, Iran, from October 2007 to November 2009. The whole department was divided based on FMEA into one main system and six subsystems. The study was divided in two phases. In the first phase, the problems leading to the loss in the revenue in each subsystem were identified and weighted to four groups using risk priority number (RPN, and the solutions for fixing them were planned. Then, at the second phase discovered defects in the first phase were fixed according to their priority. Finally, the impact of each solution was compared before and after interventions using the repeated measure ANOVA test. Results: At last, 100 financial records of ED patients were evaluated during the first phase of the study. The average of ED revenue in the six months of the first phase was 73.1±3.65 thousands US dollar/month. 12 types of errors were detected in the predefined subsystems. ED revenue rose from 73.1 to 153.1, 207.06, 240, and 320 thousands US dollar/month after solving of first, second, third, and fourth priority problems, respectively (337.75% increase in two years (p<0.001. 111.0% increase in the ED revenue after solving of first priority problems reveals that they were

  7. The use of SEM/EDS method in mineralogical analysis of ordinary chondritic meteorite

    Directory of Open Access Journals (Sweden)

    Breda Mirtič

    2009-12-01

    Full Text Available The aim of this study was to evaluate the potential of scanning electron microscopy coupled with energy dispersiveX-ray spectroscopy (SEM/EDS for determination of mineral phases according to their stoichiometry and assessment of mineral composition of ordinary chondritic meteorite. For the purposes of this study, H3 type ordinary chondritic meteorite Abbott was selected. SEM/EDS allows identification and characterisation of mineralphases, whose size is below the resolution of an optical microscope. Mineral phases in chondrules and interstitial matrix were located in backscattered electron (BSE mode and were assessed from atomic proportions of constituent elements, obtained by the EDS analysis. SEM/EDS analyses of mineral phases showed that Abbott meteorite is characterised by Fe-rich (Fe, Ni-alloy kamacite, Fe-sulphide troilite or pyrrhotite, chromite, Mg-rich olivine, orthopyroxene bronzite or hypersthene, clinopyroxene Al-diopside, acid plagioclase oligoclase, accessory mineral chlorapatite and secondary minerals Fe-hydroxides (goethite or lepidocrocite. Results of semi-quantitative analyses confirmed that most of analysed mineralphases conform well to stoichiometric minerals with minor deviations of oxygen from stoichiometric proportions. Comparison between mineral phases in chondrules and interstitial matrix was also performed, however it showed no significant differences in elemental composition.Differences in chemical composition between minerals in interstitial matrix and chondrules are sometimes too small to be discernedby the SEM/EDS, therefore knowledge of SEM/EDS capabilities is important for correct interpretation of chondrite formation.

  8. Chronic Pain in the Emergency Department: A Pilot Mixed-Methods Cross-Sectional Study Examining Patient Characteristics and Reasons for Presentations

    Science.gov (United States)

    Nelli, Jennifer; Tremblay, Steven; Caluyong, Myka B.; Freeman, Jeffrey; Stokes, Yehudis; Stiell, Ian G.; Nathan, Howard; Smyth, Catherine E.

    2016-01-01

    Background. Chronic pain (CP) accounts for 10–16% of emergency department (ED) visits, contributing to ED overcrowding and leading to adverse events. Objectives. To describe patients with CP attending the ED and identify factors contributing to their visit. Methods. We used a mixed-method design combining interviews and questionnaires addressing pain, psychological distress, signs of opioid misuse, and disability. Participants were adults who attended the EDs of a large academic tertiary care center for their CP problem. Results. Fifty-eight patients (66% women; mean age 46.5, SD = 16.9) completed the study. The most frequently cited reason (60%) for ED visits was inability to cope with pain. Mental health problems were common, including depression (61%) and anxiety (45%). Participants had questions about the etiology of their pain, concerns about severe pain-related impairment, and problems with medication renewals or efficacy and sometimes felt invalidated in the ED. Although most participants had a primary care physician, the ED was seen as the only or best option when pain became unmanageable. Conclusions. Patients with CP visiting the ED often present with complex difficulties that cannot be addressed in the ED. Better access to interdisciplinary pain treatment is needed to reduce the burden of CP on the ED. PMID:27829785

  9. Chronic Pain in the Emergency Department: A Pilot Mixed-Methods Cross-Sectional Study Examining Patient Characteristics and Reasons for Presentations

    Directory of Open Access Journals (Sweden)

    Patricia A. Poulin

    2016-01-01

    Full Text Available Background. Chronic pain (CP accounts for 10–16% of emergency department (ED visits, contributing to ED overcrowding and leading to adverse events. Objectives. To describe patients with CP attending the ED and identify factors contributing to their visit. Methods. We used a mixed-method design combining interviews and questionnaires addressing pain, psychological distress, signs of opioid misuse, and disability. Participants were adults who attended the EDs of a large academic tertiary care center for their CP problem. Results. Fifty-eight patients (66% women; mean age 46.5, SD = 16.9 completed the study. The most frequently cited reason (60% for ED visits was inability to cope with pain. Mental health problems were common, including depression (61% and anxiety (45%. Participants had questions about the etiology of their pain, concerns about severe pain-related impairment, and problems with medication renewals or efficacy and sometimes felt invalidated in the ED. Although most participants had a primary care physician, the ED was seen as the only or best option when pain became unmanageable. Conclusions. Patients with CP visiting the ED often present with complex difficulties that cannot be addressed in the ED. Better access to interdisciplinary pain treatment is needed to reduce the burden of CP on the ED.

  10. Chronic Pain in the Emergency Department: A Pilot Mixed-Methods Cross-Sectional Study Examining Patient Characteristics and Reasons for Presentations.

    Science.gov (United States)

    Poulin, Patricia A; Nelli, Jennifer; Tremblay, Steven; Small, Rebecca; Caluyong, Myka B; Freeman, Jeffrey; Romanow, Heather; Stokes, Yehudis; Carpino, Tia; Carson, Amanda; Shergill, Yaadwinder; Stiell, Ian G; Taljaard, Monica; Nathan, Howard; Smyth, Catherine E

    2016-01-01

    Background. Chronic pain (CP) accounts for 10-16% of emergency department (ED) visits, contributing to ED overcrowding and leading to adverse events. Objectives. To describe patients with CP attending the ED and identify factors contributing to their visit. Methods. We used a mixed-method design combining interviews and questionnaires addressing pain, psychological distress, signs of opioid misuse, and disability. Participants were adults who attended the EDs of a large academic tertiary care center for their CP problem. Results. Fifty-eight patients (66% women; mean age 46.5, SD = 16.9) completed the study. The most frequently cited reason (60%) for ED visits was inability to cope with pain. Mental health problems were common, including depression (61%) and anxiety (45%). Participants had questions about the etiology of their pain, concerns about severe pain-related impairment, and problems with medication renewals or efficacy and sometimes felt invalidated in the ED. Although most participants had a primary care physician, the ED was seen as the only or best option when pain became unmanageable. Conclusions. Patients with CP visiting the ED often present with complex difficulties that cannot be addressed in the ED. Better access to interdisciplinary pain treatment is needed to reduce the burden of CP on the ED.

  11. Interpretation and method: Empirical research methods and the interpretive turn, 2nd ed.

    NARCIS (Netherlands)

    Yanow, D.; Schwartz-Shea, P.

    2014-01-01

    This book demonstrates the relevance, rigor, and creativity of interpretive research methodologies for the social and human sciences. The book situates methods questions within the context of broader methodological questions--specifically, the character of social realities and their "know-ability."

  12. Department

    African Journals Online (AJOL)

    USER

    2016-09-20

    Sep 20, 2016 ... Department of Mathematics, Faculty of Science, Kibabii University. 2. Department .... be seen that average rainfall exhibited a cyclic pattern with a reducing trend under both scenarios .... Department of Meteorology, University.

  13. A novel method to establish a rat ED model using internal iliac artery ligation combined with hyperlipidemia.

    Directory of Open Access Journals (Sweden)

    Chao Hu

    Full Text Available OBJECTIVE: To investigate a novel method, namely using bilateral internal iliac artery ligation combined with a high-fat diet (BCH, for establishing a rat model of erectile dysfunction (ED that, compared to classical approaches, more closely mimics the chronic pathophysiology of human ED after acute ischemic insult. MATERIALS AND METHODS: Forty 4-month-old male Sprague Dawley rats were randomly placed into five groups (n = 8 per group: normal control (NC, bilateral internal iliac artery ligation (BIIAL, high-fat diet (HFD, BCH, and mock surgery (MS. All rats were induced for 12 weeks. Copulatory behavior, intracavernosal pressure (ICP, ICP/mean arterial pressure, hematoxylin-eosin staining, Masson's trichrome staining, serum lipid levels, and endothelial and neuronal nitric oxide synthase immunohistochemical staining of the cavernous smooth muscle and endothelium were assessed. Data were analyzed by SAS 8.0 for Windows. RESULTS: Serum total cholesterol and triglyceride levels were significantly higher in the HFD and BCH groups than the NC and MS groups. High density lipoprotein levels were significantly lower in the HFD and BCH groups than the NC and MS groups. The ICP values and mount and intromission numbers were significantly lower in the BIIAL, HFD, and BCH groups than in the NC and MS groups. ICP was significantly lower in the BCH group than in the BIIAL and HFD groups. Cavernous smooth muscle and endothelial damage increased in the HFD and BCH groups. Cavernous smooth muscle to collagen ratio, nNOS and eNOS staining decreased significantly in the BIIAL, HFD, and BCH groups compared to the NC and MS groups. CONCLUSIONS: The novel BCH model mimics the chronic pathophysiology of ED in humans and avoids the drawbacks of traditional ED models.

  14. "What do people do if they don't have insurance?": ED to ED Referrals.

    Science.gov (United States)

    Medford-Davis, Laura N; Prasad, Siddharth; Rhodes, Karin V

    2017-08-28

    Up to 20% of patients seen in public emergency departments (EDs) have already been seen for the same complaint at another ED, but little is known about the origin or impact of these duplicate ED visits. The goals of this investigation were to explore (1) whether patients making a repeat ED visit are self-referred or indirectly referred from the other ED; and (2) gather the perspective of affected patients on the health, social, and financial consequences of these duplicate ED visits. This mixed-methods study conducted over a 10-week period during 2016 in a large public hospital ED in Texas prospectively surveyed patients seen in another ED for the same chief complaint. Selected patients presenting with fractures were then enrolled for semi-structured qualitative interviews, which were audiotaped, transcribed, and independently coded by two team members until thematic saturation was reached. 143 patients were identified as being recently seen at another local ED for the same chief complaint prior to presenting to the public hospital; 94% were uninsured and 61% presented with fractures. 27% required admission at the public ED and 95% of those discharged required further outpatient follow-up. 51 patients completed a survey and qualitative interviews were conducted with 23 fracture patients. 53% of patients reported that staff at the first hospital told them to go the public hospital ED, and 23% reported referral from a follow-up physician associated with the first hospital. 73% reported receiving the same tests at both EDs. Interview themes identified multiple healthcare visits for the same injury, concern about complications, disrespectful treatment at the first ED, delayed care, problems accessing needed follow-up care without insurance, loss of work, and financial strain. The majority of patients presenting to a public hospital ED after treatment for the same complaint in another local ED were indirectly referred to the public ED without transferring paperwork or

  15. Utility of Procalcitonin (PCT and Mid regional pro-Adrenomedullin (MR-proADM in risk stratification of critically ill febrile patients in Emergency Department (ED. A comparison with APACHE II score

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    Travaglino Francesco

    2012-08-01

    Full Text Available Abstract Background The aim of our study was to evaluate the prognostic value of MR-proADM and PCT levels in febrile patients in the ED in comparison with a disease severity index score, the APACHE II score. We also evaluated the ability of MR-proADM and PCT to predict hospitalization. Methods This was an observational, multicentric study. We enrolled 128 patients referred to the ED with high fever and a suspicion of severe infection such as sepsis, lower respiratory tract infections, urinary tract infections, gastrointestinal infections, soft tissue infections, central nervous system infections, or osteomyelitis. The APACHE II score was calculated for each patient. Results MR-proADM median values in controls were 0.5 nmol/l as compared with 0.85 nmol/l in patients (P P . MR-proADM and PCT levels were significantly increased in accordance with the Apache II quartiles (P  respectively. In the respiratory infections, urinary infections, and sepsis-septic shock groups we found a correlation between the Apache II and MR-proADM respectively and MR-proADM and PCT respectively. We evaluated the ability of MR-proADM and PCT to predict hospitalization in patients admitted to our emergency departments complaining of fever. MR-proADM alone had an AUC of 0.694, while PCT alone had an AUC of 0.763. The combined use of PCT and MR-proADM instead showed an AUC of 0.79. Conclusions The present study highlights the way in which MR-proADM and PCT may be helpful to the febrile patient’s care in the ED. Our data support the prognostic role of MR-proADM and PCT in that setting, as demonstrated by the correlation with the APACHE II score. The combined use of the two biomarkers can predict a subsequent hospitalization of febrile patients. The rational use of these two molecules could lead to several advantages, such as faster diagnosis, more accurate risk stratification, and optimization of the treatment, with consequent benefit to the patient and

  16. Structured classification for ED presenting complaints – from free text field-based approach to ICPC-2 ED application

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    Malmström Tomi

    2012-11-01

    Full Text Available Abstract Background Although there is a major need to record and analyse presenting complaints in emergency departments (EDs, no international standard exists. The aim of the present study was to produce structured complaint classification suitable for ED use and to implement it in practice. The structured classification evolved from a study of free text fields and ICPC-2 classification. Methods Presenting complaints in a free text field of ED admissions during a one-year period (n=40610 were analyzed and summarized to 70 presenting complaint groups. The results were compared to ICPC-2 based complaints collected in another ED. An expert panel reviewed the results and produced an ED application of ICPC-2 classification. This study implemented the new classification into an ED. Results The presenting complaints summarized from free text fields and those from ICPC-2 categories were remarkably similar. However, the ICPC-2 classification was too broad for ED; an adapted version was needed. The newly developed classification includes 89 presenting complaints and ED staff found it easy to use. Conclusions ICPC-2 classification can be adapted for ED use. The authors suggest a list of 89 presenting complaints for use in EDs adult patients.

  17. Depart

    African Journals Online (AJOL)

    USER

    2017-01-26

    Jan 26, 2017 ... Department of Urban and Regional Planning, Ladoke Akintola University of Technology, ... informal automobile workshops in virtually every open space in Nigerian cities that ..... plantation to encourage a green society and.

  18. Electronic Emergency-Department Whiteboards

    DEFF Research Database (Denmark)

    Hertzum, Morten

    2011-01-01

    Purpose. Many emergency departments (EDs) are in a process of transitioning from dry-erase to electronic whiteboards. This study investigates differences in ED clinicians’ perception and assessment of their electronic whiteboards across departments and staff groups and at two points in time. Method....... We conducted a survey consisting of a questionnaire administered when electronic whiteboards were introduced and another questionnaire administered when they had been in use for 8-9 months. The survey involved two EDs and, for reasons of comparison, a paediatric department. Results. The ED...... respondents consider the whiteboard information important to their overview, and they approve of the introduction of electronic whiteboards. With the electronic whiteboards, the ED respondents experience a better overall overview of their work than with dry-erase whiteboards. They also experience...

  19. Department

    African Journals Online (AJOL)

    USER

    2017-05-25

    May 25, 2017 ... Department of Animal production Federal University of Technology Minna – Niger state,. Nigeria ... principles by poultry farmers in Kwara State, Nigeria. The ma .... usually incur by broiler and layer farmers ... A multi-stage sampling technique .... their birds under intensive care, which is ... husbandry system.

  20. Review: Annette N. Markham & Nancy K. Baym (Eds. (2009. Internet Inquiry: Conversations About Method

    Directory of Open Access Journals (Sweden)

    Alp Biricik

    2010-08-01

    Full Text Available As suggested by the title, this edited collection of articles is aimed at creating a dialogue on crosscutting epistemological and methodological issues relating to qualitative internet study. The scope of the book is not to provide quick tips, but rather encourage the reader to seek new methods of conducting online research. The book is creatively structured into six parts, each one addressing a key question on methods. In addition to the two editors' contributions, 13 accomplished scholars from various disciplines intelligibly respond and share their own qualitative research experiences in online environments, providing a precise and valuable contribution to current debates in internet studies. URN: urn:nbn:de:0114-fqs100396

  1. Revisão do Programa: Multimedia Methods in Molecular Biology; 2nd. Ed.

    Directory of Open Access Journals (Sweden)

    Andre Kimura Okamoto

    2002-09-01

    Full Text Available During this past two decades, multimedia methods have been frequently highlighted as an alternative teaching solution, thus they must be constantly evaluated and corrected in order to avoid a banal use of these tools. This software review evaluated the level of agreement between the authors/editors proposals and its actual relevance and ease o use. Future corrections are expected due to major flaws found in its use.

  2. [Commercial orange juice beverages detection by fluorescence spectroscopy combined with PCA-ED and PLSR methods].

    Science.gov (United States)

    Hu, Yang-jun; Zhu, Chun; Chen, Guo-qing; Zhang, Yong; Kong, Fan-biao; Li, Run; Zhu, Zhuo-wei; Wang, Xu; Gao, Shu-mei

    2014-08-01

    In order to classify the orange juiice beverages effectively, the fluorescence character differences of two kinds of orange juice beverages including 100% orange juice and orange drink were analyzed and compared, principal component analysis combined with Euclidean distance was adopted to classify two kinds of orange juice beverages, and ideal classification results were obtained. Meanwhile, the orange juice content estimation model was established by using fluorescence spectroscopy combined with partial least squares regression method, and the correlation coefficient R, root mean square error of calibration RMSEC and root mean square error of prediction RMSEP were 0.997, 0.87% and 2.05%, respectively. The experimental results indicate that the calibration model offers comparatively accurate content estimation, which reflect the actual orange juice content in the commercial orange juice beverages. The exploration to classify orange juice beverages was carried out from two aspects of qualitative and quantitative analysis by employing fluorescence spectroscopy combined with chemometrics method, which can provide a new idea for the classification and adulteration detection of commercial orange juice beverages, and also can give certain reference basis for the quality control of orange juice raw material.

  3. Effects of emergency department expansion on emergency department patient flow.

    Science.gov (United States)

    Mumma, Bryn E; McCue, James Y; Li, Chin-Shang; Holmes, James F

    2014-05-01

    Emergency department (ED) crowding is an increasing problem associated with adverse patient outcomes. ED expansion is one method advocated to reduce ED crowding. The objective of this analysis was to determine the effect of ED expansion on measures of ED crowding. This was a retrospective study using administrative data from two 11-month periods before and after the expansion of an ED from 33 to 53 adult beds in an academic medical center. ED volume, staffing, and hospital admission and occupancy data were obtained either from the electronic health record (EHR) or from administrative records. The primary outcome was the rate of patients who left without being treated (LWBT), and the secondary outcome was total ED boarding time for admitted patients. A multivariable robust linear regression model was used to determine whether ED expansion was associated with the outcome measures. The mean (±SD) daily adult volume was 128 (±14) patients before expansion and 145 (±17) patients after. The percentage of patients who LWBT was unchanged: 9.0% before expansion versus 8.3% after expansion (difference = 0.6%, 95% confidence interval [CI] = -0.16% to 1.4%). Total ED boarding time increased from 160 to 180 hours/day (difference = 20 hours, 95% CI = 8 to 32 hours). After daily ED volume, low-acuity area volume, daily wait time, daily boarding hours, and nurse staffing were adjusted for, the percentage of patients who LWBT was not independently associated with ED expansion (p = 0.053). After ED admissions, ED intensive care unit (ICU) admissions, elective surgical admissions, hospital occupancy rate, ICU occupancy rate, and number of operational ICU beds were adjusted for, the increase in ED boarding hours was independently associated with the ED expansion (p = 0.005). An increase in ED bed capacity was associated with no significant change in the percentage of patients who LWBT, but had an unintended consequence of an increase in ED boarding hours. ED expansion alone does

  4. The Impact of a Health IT Changeover on Medical Imaging Department Work Processes and Turnaround Times: A mixed method study.

    Science.gov (United States)

    Georgiou, A; Prgomet, M; Lymer, S; Hordern, A; Ridley, L; Westbrook, J

    2015-01-01

    To assess the impact of introducing a new Picture Archiving and Communication System (PACS) and Radiology Information System (RIS) on: (i) Medical Imaging work processes; and (ii) turnaround times (TATs) for x-ray and CT scan orders initiated in the Emergency Department (ED). We employed a mixed method study design comprising: (i) semi-structured interviews with Medical Imaging Department staff; and (ii) retrospectively extracted ED data before (March/April 2010) and after (March/April 2011 and 2012) the introduction of a new PACS/RIS. TATs were calculated as: processing TAT (median time from image ordering to examination) and reporting TAT (median time from examination to final report). Reporting TAT for x-rays decreased significantly after introduction of the new PACS/RIS; from a median of 76 hours to 38 hours per order (pMedical Imaging staff reported that the changeover to the new PACS/RIS led to gains in efficiency, particularly regarding the accessibility of images and patient-related information. Nevertheless, assimilation of the new PACS/RIS with existing Departmental work processes was considered inadequate and in some instances unsafe. Issues highlighted related to the synchronization of work tasks (e.g., porter arrangements) and the material set up of the work place (e.g., the number and location of computers). The introduction of new health IT can be a "double-edged sword" providing improved efficiency but at the same time introducing potential hazards affecting the effectiveness of the Medical Imaging Department.

  5. Emergency Department Escalation in Theory and Practice: A Mixed-Methods Study Using a Model of Organizational Resilience.

    Science.gov (United States)

    Back, Jonathan; Ross, Alastair J; Duncan, Myanna D; Jaye, Peter; Henderson, Katherine; Anderson, Janet E

    2017-06-26

    Escalation policies are used by emergency departments (EDs) when responding to an increase in demand (eg, a sudden inflow of patients) or a reduction in capacity (eg, a lack of beds to admit patients). The policies aim to maintain the ability to deliver patient care, without compromising safety, by modifying "normal" processes. The study objective is to examine escalation policies in theory and practice. This was a mixed-method study involving a conceptual analysis of National Health Service escalation policies (n=12) and associated escalation actions (n=92), as well as a detailed ethnographic study of escalation in situ during a 16-month period in a large UK ED (n=30 observations). The conceptual analysis of National Health Service escalation policies found that their use requires the ability to dynamically reconfigure resources (staff and equipment), change work flow, and relocate patients. In practice, it was discovered that when the ED is under pressure, these prerequisites cannot always be attained. Instead, escalation processes were adapted to manage pressures informally. This adaptive need ("work as done") was found to be incompletely specified in policies ("work as imagined"). Formal escalation actions and their implementation in practice differed and varied in their effectiveness. Monitoring how escalation works in practice is essential in understanding whether and how escalation policies help to manage workload. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  6. Utilización por cuenta propia de los Servicios de Urgencias Hospitalarias: razones que dan las personas con problemas de salud de baja complejidad para utilizar estos servicios Non-Urgent and Non-Referred Patients Presenting to the Emergency Department (ED: Understanding the Reasons of the Non Urgent Patients to Visit the ED

    Directory of Open Access Journals (Sweden)

    Manuel Espinel Vallejo

    2011-09-01

    ó acudir a urgencias porque no mejoró con el tratamiento que le prescribió el MC (71% y porque no estaba satisfecho con el tratamiento y quería una segunda opinión (39%. El 70% consideró que su problema de salud no era grave pero pensaba que sí era merecedor de atención urgente o rápida. El 63% expresó alta preocupación por su problema. El 63% consideró que el actual problema de salud no podía ser resuelto por su MC en caso de ser atendido en ese momento. Finalmente el 50% consideró que el SUH tenía más capacidad para resolver los problemas de salud que el CS. Conclusión: La mejor eficacia y efectividad, en términos de uso y gestión de recursos técnicos y del tiempo para resolver el problema de salud, y la comodidad, en términos de horarios, disponibilidad y accesibilidad, parecen ser las principales razones por las cuales las personas con problemas de salud de baja complejidad utilizan por cuenta propia los SUH. La preocupación, más que la gravedad, parece movilizar activamente la búsqueda de solución al problema de salud de manera rápida y urgente. Estas razones parecen estar condicionadas en la experiencia institucional previa con el CS.

    Objectives: The objectives of this study are: 1 To understand the reasons of non-urgent non-referred patients to use the Emergency Department (ED, 2 To understand the “urgency” and “concern” perceptions of non-urgent non-referring patients. 3 To determinate the associated factors with the use the ED for non-urgent non-referred patients. Methods: Design: Descriptive cross-sectional study. Setting: Emergency Department (ED of “Infanta Cristina” General Hospital, Parla, Madrid, Spain. Patients: non-referred non-urgent adult patients were selected by Emergency Department Triage system in levels IV and V, on weekdays between 10:00 and 22:00 hours,

  7. Treatment of Nausea and Vomiting in Pregnancy: Factors Associated with ED Revisits

    Directory of Open Access Journals (Sweden)

    Brian R. Sharp

    2016-09-01

    Full Text Available Introduction: Nausea and vomiting in pregnancy (NVP is a condition that commonly affects women in the first trimester of pregnancy. Despite frequently leading to emergency department (ED visits, little evidence exists to characterize the nature of ED visits or to guide its treatment in the ED. Our objectives were to evaluate the treatment of NVP in the ED and to identify factors that predict return visits to the ED for NVP. Methods: We conducted a retrospective database analysis using the electronic medical record from a single, large academic hospital. Demographic and treatment variables were collected using a chart review of 113 ED patient visits with a billing diagnosis of “nausea and vomiting in pregnancy” or “hyperemesis gravidarum.” Logistic regression analysis was used with a primary outcome of return visit to the ED for the same diagnoses. Results: There was wide treatment variability of nausea and vomiting in pregnancy patients in the ED. Of the 113 patient visits, 38 (33.6% had a return ED visit for NVP. High gravidity (OR 1.31, 95% CI [1.06-1.61], high parity (OR 1.50 95% CI [1.12-2.00], and early gestational age (OR 0.74 95% CI [0.60-0.90] were associated with an increase in return ED visits in univariate logistic regression models, while only early gestational age (OR 0.74 95% CI [0.59-0.91] was associated with increased return ED visits in a multiple regression model. Admission to the hospital was found to decrease the likelihood of return ED visits (p=0.002. Conclusion: NVP can be difficult to manage and has a high ED return visit rate. Optimizing care with aggressive, standardized treatment in the ED and upon discharge, particularly if factors predictive of return ED visits are present, may improve quality of care and reduce ED utilization for this condition.

  8. Treatment of Nausea and Vomiting in Pregnancy: Factors Associated with ED Revisits

    Science.gov (United States)

    Sharp, Brian R.; Sharp, Kristen M.; Patterson, Brian; Dooley-Hash, Suzanne

    2016-01-01

    Introduction Nausea and vomiting in pregnancy (NVP) is a condition that commonly affects women in the first trimester of pregnancy. Despite frequently leading to emergency department (ED) visits, little evidence exists to characterize the nature of ED visits or to guide its treatment in the ED. Our objectives were to evaluate the treatment of NVP in the ED and to identify factors that predict return visits to the ED for NVP. Methods We conducted a retrospective database analysis using the electronic medical record from a single, large academic hospital. Demographic and treatment variables were collected using a chart review of 113 ED patient visits with a billing diagnosis of “nausea and vomiting in pregnancy” or “hyperemesis gravidarum.” Logistic regression analysis was used with a primary outcome of return visit to the ED for the same diagnoses. Results There was wide treatment variability of nausea and vomiting in pregnancy patients in the ED. Of the 113 patient visits, 38 (33.6%) had a return ED visit for NVP. High gravidity (OR 1.31, 95% CI [1.06–1.61]), high parity (OR 1.50 95% CI [1.12–2.00]), and early gestational age (OR 0.74 95% CI [0.60–0.90]) were associated with an increase in return ED visits in univariate logistic regression models, while only early gestational age (OR 0.74 95% CI [0.59–0.91]) was associated with increased return ED visits in a multiple regression model. Admission to the hospital was found to decrease the likelihood of return ED visits (p=0.002). Conclusion NVP can be difficult to manage and has a high ED return visit rate. Optimizing care with aggressive, standardized treatment in the ED and upon discharge, particularly if factors predictive of return ED visits are present, may improve quality of care and reduce ED utilization for this condition. PMID:27625723

  9. The use of performance improvement methods to enhance emergency department patient satisfaction in the United States: a critical review of the literature and suggestions for future research.

    Science.gov (United States)

    Boudreaux, Edwin D; Cruz, Brian L; Baumann, Brigitte M

    2006-07-01

    The authors reviewed the evidence on performance improvement methods for increasing emergency department (ED) patient satisfaction to provide evidence-based suggestions for clinical practice. Data sources consisted of searches through MEDLINE, CINAHL, PSYCHINFO, Cochrane Library, and Emergency Medicine Abstracts and a manual search of references. Articles were included if they reported a performance improvement intervention targeting patient satisfaction in the ED setting. Articles on studies not conducted in the United States or that failed to provide enough details to allow critical evaluation of the study were excluded. Two authors used structured evaluation criteria to independently review each retained study. Nineteen articles met all selection criteria. Three studies found varying levels of support for multicomponent interventions, predominantly focused on implementation of clinical practice guidelines for specific presenting complaints and process redesign. Sixteen studies evaluated single-component interventions, with the following having at least one supportive study: using alternating patient assignment to provider teams rather than "zone"-based assignment, enhancing provider communication and customer service skills, incorporating information delivery interventions (e.g., pamphlets, video) that target patient expectations, using preformatted charts, and establishing ED-based observation units for specific conditions such as asthma and chest pain. There is modest evidence supporting a range of performance improvement interventions for improving ED patient satisfaction. Further work is needed before specific, evidence-based recommendations can be made regarding which process changes are most effective. Recommendations are made for improving the quality of performance improvement efforts in the ED setting.

  10. Application of the (′/)-expansion method for the Burgers, Burgers–Huxley and modified Burgers–KdV equations

    Indian Academy of Sciences (India)

    H Kheiri; M R Moghaddam; V Vafaei

    2011-06-01

    In this work, we present travelling wave solutions for the Burgers, Burgers–Huxley and modified Burgers–KdV equations. The (′/)-expansion method is used to determine travelling wave solutions of these sets of equations. The travelling wave solutions are expressed by the hyperbolic functions, the trigonometric functions and the rational functions. It is shown that the proposed method is direct, effective and can be used for many other nonlinear evolution equations in mathematical physics.

  11. Prospective study of violence against ED workers.

    Science.gov (United States)

    Kowalenko, Terry; Gates, Donna; Gillespie, Gordon Lee; Succop, Paul; Mentzel, Tammy K

    2013-01-01

    Health care support occupations have an assault-injury rate nearly 10 times the general sector. Emergency departments (EDs) are at greatest risk of such events. The objective was to describe the incidence of violence in ED health care workers (HCWs) over 9 months. Specific aims were to (1) identify demographic, occupational, and perpetrator factors related to violent events (VEs) and (2) identify predictors of acute stress in victims and predictors of loss of productivity. A longitudinal, repeated-methods design was used to collect monthly survey data from ED HCWs at 6 hospitals. Surveys assessed number and type of VEs, and feelings of safety and confidence. Victims also completed specific VE surveys. Descriptive statistics and a repeated-measure linear regression model were used. Two hundred thirteen ED HCWs completed 1795 monthly surveys and 827 VEs were reported. Average VE rate per person per 9 months was 4.15. Six hundred one events were physical threats (PTs) (3.01 per person). Two hundred twenty six events were assaults (1.13 per person). Five hundred one VE surveys were completed, describing 341 PTs and 160 assaults. Men perpetrated 63% of PTs and 52% of assaults. Significant differences in VEs were reported between registered nurses (RNs) and medical doctors (MDs) (P = .0017) and patient care assistants (P stress than the MDs (P stress reduced productivity (P stress, and lost productivity. Acute stress has negative consequences on workers' ability to perform their duties. Copyright © 2013 Elsevier Inc. All rights reserved.

  12. Cyclist Injuries Treated in Emergency Department (ED): Consequences and Costs in South-eastern Finland in an Area of 100 000 Inhabitants.

    Science.gov (United States)

    Airaksinen, Noora; Lüthje, Peter; Nurmi-Lüthje, Ilona

    2010-01-01

    In the present study, data of bicycle crashes leading to medical attendance in acute hospital or to death which occurred between June 1(st) 2004 and May 31(st) 2006 were analyzed. The final results consisted of injury data and patient records obtained from Kuusankoski Regional Hospital and from the road accident investigation teams. The total number of cases was 216. The severity of the injuries was classified according to the Abbreviated Injury Scale (2005). The majority of the bicycle crashes considered occurred when the injured was alone, without another party. Crashes were often alcohol-related (31%). Over one third of all cyclists' injuries were head injuries. Only 13% of the injured cyclists wore a helmet. 15% of those who wore a helmet sustained a head injury and, correspondingly, 43% of those who did not. Two bicyclists died. The number of bicycle crashes in the hospital data was at least fourfold compared to the number found in the official police statistics. Systematic collection of data on bicycle crashes in hospital emergency departments should be advanced in order to gain reliable information for prevention.

  13. Complaints and Diagnoses of Emergency Department Patients in the Netherlands: A Comparative Study of Integrated Primary and Emergency Care

    OpenAIRE

    2015-01-01

    OBJECTIVE: In the Netherlands, an increasing number of emergency departments (EDs) and general practitioner cooperatives collaborate by creating one Emergency-Care-Access-Point (ECAP). This has resulted in fewer patients at ECAP EDs. The objective of this study was to explore differences in patient characteristics, presented complaints and ED discharge diagnoses between EDs with an ECAP and EDs without an ECAP. METHODS: A retrospective observational study was performed with 1800 consecutive p...

  14. [Analysis of EDS fingerprint spectra of mineral drug montmorillonite powder relying on dual index grade sequence individualized pattern recognition method and their quickly quality evaluation].

    Science.gov (United States)

    Zou, Hua-Bin; Ayiguzaili; Ablimiti; Zhai, Hong

    2013-12-01

    EDS(energy dispersive spectrometer) element fingerprint spectra is able to quickly measure the kinds and the contents of elements in any mineral drug. In dual index grade sequence individualized pattern recognition method, common (quantity) index and variation (quantity) index ratios of any two samples' fingerprint spectra are calculated, and the individualized dual index sequence of each sample is constructed relying on its own EDS fingerprint spectra as the reference. Then the mean common (quantity) index ratio P and the standard deviation S of all samples in each sample's individualized dual index sequence are computed. On this basis, for each sample, its own similarity scale function P> or =P+xS is built up. By this function, the optimum x suitable for optimized classification/cluster of all samples is determined, and the individualized characteristics sequence of one sample, to which samples in the individualized characteristics sequence are significantly similar, is decided also. Finally, depending on these individualized characteristics sequences, the optimized classification/cluster of all samples can be carried out perfectly without any prior knowledge related to them. This method is not only suitable for the quantitative analysis on fingerprint spectra being of only common peaks, but also fits for that being of both common and variant peaks. In this study, the EDS element fingerprint spectra of seven mineral drug montmorillonite powder samples from different companies were detected. Then common (quantity) index and variant (quantity) index ratios of peak area (or contents of majorly active element Fe, Al, Ca, Mg, Si) among different EDS fingerprint spectra were obtained. In the similarity scale function P> or =P+xS, when x= 0. 5, these seven mineral drug montmorillonite powder samples could be quickly identified with high resolution, be classified into two groups, and their quality could be evaluated precisely. In general EDS element fingerprint spectra

  15. Combined linear response quantum mechanics and classical electrodynamics (QM/ED) method for the calculation of surface-enhanced Raman spectra.

    Science.gov (United States)

    Mullin, Jonathan; Schatz, George C

    2012-03-01

    A multiscale method is presented that allows for evaluation of plasmon-enhanced optical properties of nanoparticle/molecule complexes with no additional cost compared to standard electrodynamics (ED) and linear response quantum mechanics (QM) calculations for the particle and molecule, respectively, but with polarization and orientation effects automatically described. The approach first calculates the total field of the nanoparticle by ED using the finite difference time domain (FDTD) method. The field intensity in the frequency domain as a function of distance from the nanoparticle is calculated via a Fourier transform. The molecular optical properties are then calculated with QM in the frequency domain in the presence of the total field of the nanoparticle. Back-coupling due to dipolar reradiation effects is included in the single-molecule plane wave approximation. The effects of polarization and partial orientation averaging are considered. The QM/ED method is evaluated for the well-characterized test case of surface-enhanced Raman scattering (SERS) of pyridine bound to silver, as well as for the resonant Raman chromophore rhodamine 6G. The electromagnetic contribution to the enhancement factor is 10(4) for pyridine and 10(2) for rhodamine 6G. © 2012 American Chemical Society

  16. Emergency Department Presentations following Tropical Cyclone Yasi

    OpenAIRE

    Peter Aitken; Richard Charles Franklin; Jenine Lawlor; Rob Mitchell; Kerrianne Watt; Jeremy Furyk; Niall Small; Leone Lovegrove; Peter Leggat

    2015-01-01

    Introduction Emergency departments see an increase in cases during cyclones. The aim of this study is to describe patient presentations to the Emergency Department (ED) of a tertiary level hospital (Townsville) following a tropical cyclone (Yasi). Specific areas of focus include changes in: patient demographics (age and gender), triage categories, and classification of diseases. Methods Data were extracted from the Townsville Hospitals ED information system (EDIS) for three periods in 2009, 2...

  17. Rural-Urban Disparities in Child Abuse Management Resources in the Emergency Department

    Science.gov (United States)

    Choo, Esther K.; Spiro, David M.; Lowe, Robert A.; Newgard, Craig D.; Hall, Michael Kennedy; McConnell, Kenneth John

    2010-01-01

    Purpose: To characterize differences in child abuse management resources between urban and rural emergency departments (EDs). Methods: We surveyed ED directors and nurse managers at hospitals in Oregon to gain information about available abuse-related resources. Chi-square analysis was used to test differences between urban and rural EDs.…

  18. Rural-Urban Disparities in Child Abuse Management Resources in the Emergency Department

    Science.gov (United States)

    Choo, Esther K.; Spiro, David M.; Lowe, Robert A.; Newgard, Craig D.; Hall, Michael Kennedy; McConnell, Kenneth John

    2010-01-01

    Purpose: To characterize differences in child abuse management resources between urban and rural emergency departments (EDs). Methods: We surveyed ED directors and nurse managers at hospitals in Oregon to gain information about available abuse-related resources. Chi-square analysis was used to test differences between urban and rural EDs.…

  19. A method for evaluating the host range of bacteriophages using phages fluorescently labeled with 5-ethynyl-2'-deoxyuridine (EdU).

    Science.gov (United States)

    Ohno, Sayaka; Okano, Hironori; Tanji, Yasunori; Ohashi, Akiyoshi; Watanabe, Kazuya; Takai, Ken; Imachi, Hiroyuki

    2012-08-01

    The evaluation of bacteriophage (phage) host range is a significant issue in understanding phage and prokaryotic community interactions. However, in conventional methods, such as plaque assay, target host strains must be isolated, although almost all environmental prokaryotes are recalcitrant to cultivation. Here, we introduce a novel phage host range evaluation method using fluorescently labeled phages (the FLP method), which consists of the following four steps: (i) Fluorescently labeled phages are added to a microbial consortium, and host cells are infected and fluorescently labeled. (ii) Fluorescent cells are sorted by fluorescence-activated cell sorting. (iii) 16S rRNA gene sequences retrieved from sorted cells are analyzed, and specific oligonucleotide probes for fluorescence in situ hybridization (FISH) are designed. (iv) Cells labeled with both fluorescently labeled phage and FISH probe are identified as host cells. To verify the feasibility of this method, we used T4 phage and Escherichia coli as a model. We first used nucleic acid stain reagents for phage labeling; however, the reagents also stained non-host cells. Next, we employed the Click-iT EdU (5-ethynyl-2'-deoxyuridine) assay kit from Invitrogen for phage labeling. Using EdU-labeled T4 phage, we could specifically detect E. coli cells in a complex microbial consortium from municipal sewage. We also confirmed that FISH could be applied to the infected E. coli cells. These results suggest that this FLP method using the EdU assay kit is a useful method for evaluating phage host range and may have a potential application for various types of phages, even if their prokaryotic hosts are currently unculturable.

  20. Inform@ed space

    DEFF Research Database (Denmark)

    Bjerrum, Peter; Olsen, Kasper Nefer

    2001-01-01

    Inform@ed space Sensorial Perception And Computer Enchancement - bidrag til Nordisk Arkitekturforskningsforenings IT-konference, AAA april 2001.......Inform@ed space Sensorial Perception And Computer Enchancement - bidrag til Nordisk Arkitekturforskningsforenings IT-konference, AAA april 2001....

  1. Therapy Dogs in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Nickolas Nahm

    2012-09-01

    Full Text Available Introduction: This study examined acceptance by staff and patients of a therapy dog (TD in the emergency department (ED.Methods: Immediately after TD visits to a University Hospital ED, all available ED staff, patients, and their visitors were invited to complete a survey.Results: Of 125 ‘‘patient’’ and 105 staff responses, most were favorable. Ninety-three percent of patients and 95% of staff agreed that TDs should visit EDs; 87.8% of patients and 92% of staff approved of TDs for both adult and pediatric patients. Fewer than 5% of either patients or staff were afraid of the TDs. Fewer than 10% of patients and staff thought the TDs posed a sanitary risk or interfered with staff work.Conclusion: Both patients and staff approve of TDs in an ED. The benefits of animal-assisted therapy should be further explored in the ED setting.

  2. The emergency department occupancy rate: a simple measure of emergency department crowding?

    Science.gov (United States)

    McCarthy, Melissa L; Aronsky, Dominik; Jones, Ian D; Miner, James R; Band, Roger A; Baren, Jill M; Desmond, Jeffrey S; Baumlin, Kevin M; Ding, Ru; Shesser, Robert

    2008-01-01

    We examine the validity of the emergency department (ED) occupancy rate as a measure of crowding by comparing it to the Emergency Department Work Index Score (EDWIN), a previously validated scale. A multicenter validation study was conducted according to ED visit data from 6 academic EDs for a 3-month period in 2005. Hourly ED occupancy rate (ie, total number of patients in ED divided by total number of licensed beds) and EDWIN scores were calculated. The correlation between the scales was determined and their validity evaluated by their ability to discriminate between hours when 1 or more patients left without being seen and hours when the ED was on ambulance diversion, using area under the curve (AUC) statistics estimated from the bootstrap method. We calculated the ED occupancy rate and EDWIN for 2,208 consecutive hours at each of the 6 EDs. The overall correlation between the 2 scales was 0.58 (95% confidence interval [CI] 0.56 to 0.60). The ED occupancy rate (AUC=0.73; 95% CI 0.65 to 0.80) and the EDWIN (AUC=0.65; 95% CI 0.58 to 0.72) did not differ significantly in correctly identifying hours when patients left without being seen. The ED occupancy rate (AUC=0.78; 95% CI 0.75 to 0.80) and the EDWIN (AUC=0.70; 95% CI 0.59 to 0.81) performed similarly for ED diversion hours. The ED occupancy rate and the EDWIN classified leaving without being seen and ambulance diversion hours with moderate accuracy. Although the ED occupancy rate is not ideal, its simplicity makes real-time assessment of crowding feasible for more EDs nationwide.

  3. Bedside method to estimate actual body weight in the Emergency Department.

    Science.gov (United States)

    Buckley, Robert G; Stehman, Christine R; Dos Santos, Frank L; Riffenburgh, Robert H; Swenson, Aaron; Mjos, Nathan; Brewer, Matt; Mulligan, Sheila

    2012-01-01

    Actual body weight (ABW) is important for accurate drug dosing in emergency settings. Oftentimes, patients are unable to stand to be weighed accurately or clearly state their most recent weight. Develop a bedside method to estimate ABW using simple anthropometric measurements. Prospective, blinded, cross-sectional convenience sampling of adult Emergency Department (ED) patients. A multiple linear regression equation from Derivation Phase (n = 208: 121 males, 87 females) found abdominal and thigh circumferences (AC and TC) had the best fit and an inter-rater correlation of 0.99 and 0.96, respectively: Male ABW (kg) = -47.8 + 0.78 ∗ (AC) + 1.06 ∗ (TC); Female ABW = -40.2 + 0.47 ∗ (AC) + 1.30 ∗ (TC). Derivation phase: Number of patients (%) with a body weight estimation (BWE) > 10 kg from ABW for males/females were: 7 (6%)/1 (1%) for Patients, 46 (38%)/28 (32%) for Doctors, 38 (31%)/24 (27%) for Nurses, 75 (62%)/43 (49%) for 70 kg/60 kg convention, and 14 (12%)/8 (9%) using the anthropometric regression model. For validation phase (55 males, 44 females): Gold standard ABW mean (SD) male/female = 83.6 kg (14.3)/71.5 kg (18.9) vs. anthropometric regression model = 86.3 kg (14.7)/73.3 kg (15.1). R(2) = 0.89, p 10 kg using the anthropometric regression model = 8 (15%)/11 (27%). For male patients, a regression model using supine thigh and abdominal circumference measurements seems to provide a useful and more accurate alternative to physician, nurse, or standard 70-kg male conventional estimates, but was less accurate for use in female patients. Published by Elsevier Inc.

  4. Understanding patient acceptance and refusal of HIV testing in the emergency department

    OpenAIRE

    Christopoulos Katerina A; Weiser Sheri D; Koester Kimberly A; Myers Janet J; White Douglas AE; Kaplan Beth; Morin Stephen F

    2012-01-01

    ABSTRACT Background Despite high rates of patient satisfaction with emergency department (ED) HIV testing, acceptance varies widely. It is thought that patients who decline may be at higher risk for HIV infection, thus we sought to better understand patient acceptance and refusal of ED HIV testing. Methods In-depth interviews with fifty ED patients (28 accepters and 22 decliners of HIV testing) in three ED HIV testing programs that serve vulnerable urban populations in northern California. Re...

  5. Return to the emergency department after ventricular shunt evaluation.

    Science.gov (United States)

    Sarda, Samir; Simon, Harold K; Hirsh, Daniel A; Wang, Andrew; Shane Tubbs, R; Chern, Joshua J

    2016-04-01

    OBJECT Patients with CSF shunts are medically complex and frequently present to the emergency department (ED) with suspected shunt malfunction. After adequate evaluation in the ED and proper disposition, some patients return to the ED within a short period of time. In this study, the authors examined the reasons for ED revisits within 7 days of the index ED visit to discern possible preventable returns. METHODS There were 3080 index ED visits made by patients with shunted hydrocephalus between 2010 and 2013. Index ED visits preceded by another ED visit or neurosurgical procedure within 60 days were excluded. Index ED visits for reasons unrelated to shunt function and those that led directly to admissions and shunt revision surgeries were also excluded. The remaining 1509 ED visits were eligible for analysis in this study. Final dispositions from the index ED visit included home (1176 cases), admission to the neurosurgery service for observation (134 cases), and admission to other services (199 cases). Subsequent events within 7 days, including ED revisits, hospital admissions, and shunt-related surgery were recorded, and reasons for the ED revisits were categorized based on whether the visit was related to shunt function concerns. Clinical and socioeconomic factors were analyzed for their association with ED revisits by using statistical methods. RESULTS Of the 1176 patients discharged home from the ED after shunt function evaluation, 101 (8.6%) returned to the ED within 7 days. Of the 134 patients admitted to the neurosurgery service for observation only, 8 (6.0%) returned to the ED within 7 days of discharge. Of the 199 patients admitted to hospital services other than neurosurgery, 13 (6.5%) returned to the ED within 7 days of discharge. The reasons for ED revisits vary (total of 122 visits combining the 3 groups), but at least 60% of the revisits were clearly unrelated to shunt function. A younger age, daytime arrival to the ED, and living within the

  6. A novel method using intranasal delivery of EdU demonstrates that accessory olfactory ensheathing cells respond to injury by proliferation.

    Science.gov (United States)

    Chehrehasa, Fatemeh; Ekberg, Jenny A K; St John, James A

    2014-03-20

    Olfactory ensheathing cells (OECs) play an important role in the continuous regeneration of the primary olfactory nervous system throughout life and for regeneration of olfactory neurons after injury. While it is known that several individual OEC subpopulations with distinct properties exist in different anatomical locations, it remains unclear how these different subpopulations respond to a major injury. We have examined the proliferation of OECs from one distinct location, the peripheral accessory olfactory nervous system, following large-scale injury (bulbectomy) in mice. We used crosses of two transgenic reporter mouse lines, S100ß-DsRed and OMP-ZsGreen, to visualise OECs, and main/accessory olfactory neurons, respectively. We surgically removed one olfactory bulb including the accessory olfactory bulb to induce degeneration, and found that accessory OECs in the nerve bundles that terminate in the accessory olfactory bulb responded by increased proliferation with a peak occurring 2 days after the injury. To label proliferating cells we used the thymidine analogue ethynyl deoxyuridine (EdU) using intranasal delivery instead of intraperitoneal injection. We compared and quantified the number of proliferating cells at different regions at one and four days after EdU labelling by the two different methods and found that intranasal delivery method was as effective as intraperitoneal injection. We demonstrated that accessory OECs actively respond to widespread degeneration of accessory olfactory axons by proliferating. These results have important implications for selecting the source of OECs for neural regeneration therapies and show that intranasal delivery of EdU is an efficient and reliable method for assessing proliferation of olfactory glia.

  7. REASONS TO ACCESS TO A PEDIATRIC EMERGENCY DEPARTMENT

    OpenAIRE

    Freitas, Ana Cristina; Moreira, Ana Raquel; Tomé, Soraia; Cardoso, Raquel

    2016-01-01

    Introduction: Hospital emergency department (ED) utilization by non-urgent situations is common and leads to worse care, patients and professionals dissatisfaction and increasing costs.Objective: To determine the reasons and adequacy for the use of a hospital pediatric ED. Methods: Descriptive, cross-sectional study between October 10 and December 31 2013 at an hospital pediatric ED, through analysis of questionnaires completed by child caretakers and with clinical data provided by the doctor...

  8. Accuracy of ED Bedside Ultrasound for Identification of Gallstones: Retrospective Analysis of 575 Studies

    Directory of Open Access Journals (Sweden)

    Scruggs, William

    2008-01-01

    Full Text Available Study Objective: To determine the ability of emergency department (ED physicians to diagnose cholelithiasis with bedside ultrasound. Methods: ED gallbladder ultrasounds recorded over 37 months were compared to radiology ultrasound interpretation. Results: Of 1,690 ED gallbladder ultrasound scans performed during this period, radiology ultrasound was performed in 575/1690 (34% cases. ED physician bedside interpretation was 88% sensitive [95% CI, 84-91] and 87% specific [95% CI, 82-91], while positive predictive value (PPV was 91% [88- 94%] and negative predictive value (NPV was 83% [78-87%], using radiology interpretation as the criterion reference. Conclusion: ED physician ultrasound of the gallbladder for cholelithiasis is both sensitive and specific.

  9. 34 CFR 85.942 - ED Deciding Official.

    Science.gov (United States)

    2010-07-01

    ...) Definitions § 85.942 ED Deciding Official. The ED Deciding Official is an ED officer who has delegated authority under the procedures of the Department of Education to decide whether to affirm a suspension or enter a debarment. Authority: E.O. 12549 (3 CFR, 1986 Comp., p. 189), E.O. 12689 ( 3 CFR, 1989 Comp., p...

  10. A Simple Method to Assess In Vivo Proliferation in Lung Vasculature with EdU: The Case of MMC-Induced PVOD in Rat

    Science.gov (United States)

    Fabrice, Antigny; Benoît, Ranchoux; Valérie, Nadeau; Lau, Edmund; Sébastien, Bonnet; Frédéric, Perros

    2015-01-01

    5-Ethynyl-2′-deoxyuridine (EdU) incorporation is becoming the gold standard method for in vitro and in vivo visualization of proliferating cells. The small size of the fluorescent azides used for detection results in a high degree of specimen penetration. It can be used to easily detect DNA replication in large tissue samples or organ explants with low proliferation and turnover of cells formerly believed to be in a “terminal” state of differentiation. Here we describe a protocol for the localization and identification of proliferating cells in quiescent or injured pulmonary vasculature, in a model of pulmonary veno-occlusive disease (PVOD). PVOD is an uncommon form of pulmonary hypertension characterized by progressive obstruction of small pulmonary veins. We previously reported that mitomycin-C (MMC) therapy is associated with PVOD in human. We demonstrated that MMC can induce PVOD in rats, which currently represents the sole animal model that recapitulates human PVOD lesions. Using the EdU assay, we demonstrated that MMC-exposed lungs displayed areas of exuberant microvascular endothelial cell proliferation which mimics pulmonary capillary hemangiomatosis, one of the pathologic hallmarks of human PVOD. In vivo pulmonary cell proliferation measurement represents an interesting methodology to investigate the potential efficacy of therapies aimed at normalizing pathologic angioproliferation. PMID:26345623

  11. A simple method to assess in vivo proliferation in lung vasculature with EdU: the case of MMC-induced PVOD in rat.

    Science.gov (United States)

    Fabrice, Antigny; Benoît, Ranchoux; Valérie, Nadeau; Lau, Edmund; Sébastien, Bonnet; Frédéric, Perros

    2015-01-01

    5-Ethynyl-2'-deoxyuridine (EdU) incorporation is becoming the gold standard method for in vitro and in vivo visualization of proliferating cells. The small size of the fluorescent azides used for detection results in a high degree of specimen penetration. It can be used to easily detect DNA replication in large tissue samples or organ explants with low proliferation and turnover of cells formerly believed to be in a "terminal" state of differentiation. Here we describe a protocol for the localization and identification of proliferating cells in quiescent or injured pulmonary vasculature, in a model of pulmonary veno-occlusive disease (PVOD). PVOD is an uncommon form of pulmonary hypertension characterized by progressive obstruction of small pulmonary veins. We previously reported that mitomycin-C (MMC) therapy is associated with PVOD in human. We demonstrated that MMC can induce PVOD in rats, which currently represents the sole animal model that recapitulates human PVOD lesions. Using the EdU assay, we demonstrated that MMC-exposed lungs displayed areas of exuberant microvascular endothelial cell proliferation which mimics pulmonary capillary hemangiomatosis, one of the pathologic hallmarks of human PVOD. In vivo pulmonary cell proliferation measurement represents an interesting methodology to investigate the potential efficacy of therapies aimed at normalizing pathologic angioproliferation.

  12. A Simple Method to Assess In Vivo Proliferation in Lung Vasculature with EdU: The Case of MMC-Induced PVOD in Rat

    Directory of Open Access Journals (Sweden)

    Antigny Fabrice

    2015-01-01

    Full Text Available 5-Ethynyl-2′-deoxyuridine (EdU incorporation is becoming the gold standard method for in vitro and in vivo visualization of proliferating cells. The small size of the fluorescent azides used for detection results in a high degree of specimen penetration. It can be used to easily detect DNA replication in large tissue samples or organ explants with low proliferation and turnover of cells formerly believed to be in a “terminal” state of differentiation. Here we describe a protocol for the localization and identification of proliferating cells in quiescent or injured pulmonary vasculature, in a model of pulmonary veno-occlusive disease (PVOD. PVOD is an uncommon form of pulmonary hypertension characterized by progressive obstruction of small pulmonary veins. We previously reported that mitomycin-C (MMC therapy is associated with PVOD in human. We demonstrated that MMC can induce PVOD in rats, which currently represents the sole animal model that recapitulates human PVOD lesions. Using the EdU assay, we demonstrated that MMC-exposed lungs displayed areas of exuberant microvascular endothelial cell proliferation which mimics pulmonary capillary hemangiomatosis, one of the pathologic hallmarks of human PVOD. In vivo pulmonary cell proliferation measurement represents an interesting methodology to investigate the potential efficacy of therapies aimed at normalizing pathologic angioproliferation.

  13. Geriatric Homelessness: Association with Emergency Department Utilization

    Science.gov (United States)

    Hategan, Ana; Tisi, Daniel; Abdurrahman, Mariam; Bourgeois, James A.

    2016-01-01

    Background Homeless adults frequently use emergency departments (EDs), yet previous studies investigating ED utilization by the older segment received little attention. This study sought to characterize older homeless adults who utilized local urban EDs. Methods ED encounters at three hospitals in Hamilton (Ont.) were analyzed, and demographic and clinical characteristics of the older homeless (age > 50) vs. younger counterparts (age ≤ 50) were compared during a 24-month period. Results Of all adults, 1,330 were homeless, of whom 66% were above age 50. Older homeless adults sought less acute care within 30 days from an index visit compared with their younger counterparts. Non-acute illnesses constituted only 18% of triaged cases. Older homeless women with access to a primary care physician (PCP) were 3.3 times more likely to return to ED within 30 days, whereas older homeless men (irrespective of PCP access) were less likely to return to ED. Conclusions Despite high homeless patient acuity, a lesser number of ED visits with increasing age remains concerning because of previously reported high morbidity and mortality rates. Access to primary care may not be enough to reduce ED utilization. Further research is needed to evaluate acute care interventions and their effectiveness in ED, and to identify homeless patients requiring more targeted services. PMID:28050223

  14. Etiology of Shock in the Emergency Department

    DEFF Research Database (Denmark)

    Holler, Jon Gitz; Jensen, Helene Kildegaard; Henriksen, Daniel Pilsgaard

    2017-01-01

    INTRODUCTION: The knowledge of the etiology and associated mortality of undifferentiated shock in the emergency department (ED) is limited. We aimed to describe the etiology based proportions and incidence rates (IR) of shock, as well as the associated mortality in the ED. METHODS: Population......-based cohort study at an University Hospital ED in Denmark from January 1, 2000, to December 31, 2011. Patients aged ≥18 years living in the ED-catchment area (N = 225,000) with a first time ED presentation with shock (n = 1,646) defined as hypotension (systolic blood pressure ≤100 mmHg)) and ≥1 organ failures...... were included. Discharge diagnoses defined the etiology and were grouped as; distributive septic shock (SS), distributive non-septic shock (NS)), cardiogenic shock (CS), hypovolemic shock (HS), obstructive shock (OS) and other conditions (OC). Outcomes were etiology-based characteristics, annual IR per...

  15. Study of Low Voltage Prebreakdown Sites in Multicrystalline Si Based Cells by the LBIC, EL, and EDS Methods

    Directory of Open Access Journals (Sweden)

    V. I. Orlov

    2017-01-01

    Full Text Available Breakdown sites in multicrystalline Si solar cells have been studied by reverse-bias electroluminescence, electron beam induced current (EBIC and laser beam induced current (LBIC, and Energy Dispersive X-Ray Spectroscopy methods. In the breakdown sites revealed by EL at small reverse bias (~5 V, the enhanced aluminum and oxygen concentration is revealed. Such breakdowns can be located inside the depletion region because they are not revealed by the EBIC or LBIC methods. Breakdowns revealed by EL at larger bias correlate well with extended defects in the EBIC and LBIC images.

  16. Methods for reducing sepsis mortality in emergency departments and inpatient units.

    Science.gov (United States)

    Doerfler, Martin E; D'Angelo, John; Jacobsen, Diane; Jarrett, Mark P; Kabcenell, Andrea I; Masick, Kevin D; Parmentier, Darlene; Nelson, Karen L; Stier, Lori

    2015-05-01

    As part of a zero-tolerance approach to preventable deaths, North Shore-LIJ Health System (North Shore-LIJ) leadership prioritized a major patient safety initiative to reduce sepsis mortality in 2009 across 10 acute care hospitals (an 11th joined later). At baseline (2008), approximately 3,500 patients were discharged with a diagnosis of sepsis, which ranked as the top All Patient Refined Diagnosis-Related Group by number of deaths (N = 883). Initially, the focus was sepsis recognition and treatment in the emergency departments (EDs). North Shore-LIJ, the 14th largest health care system in the United States, cares for individuals at every stage of life at 19 acute care and specialty hospitals and more than 400 outpatient physician practice sites throughout New York City and the greater New York metropolitan area. The health system launched a strategic partnership with the Institute for Healthcare Improvement (IHI) in August 2011 to accelerate the pace of sepsis improvement. Throughout the course of the initiative, North Shore-LIJ collaborated with many local, state, national, and international organizations to test innovative ideas, share evidence-based best practices, and, more recently, to raise public awareness. North Shore-LIJ reduced overall sepsis mortality by approximately 50% in a six-year period (2008-2013; sustained through 2014) and increased compliance with sepsis resuscitation bundle elements in the EDs and inpatient units in the 11 acute care hospitals. Improvements were achieved by engaging leadership; fostering interprofessional collaboration, collaborating with other leading health care organizations; and developing meaningful, real-time metrics for all levels of staff.

  17. Teaching and Assessing ED Handoffs: A Qualitative Study Exploring Resident, Attending, and Nurse Perceptions

    Directory of Open Access Journals (Sweden)

    Moira Flanigan

    2015-10-01

    Full Text Available Introduction: The Accreditation Council for Graduate Medical Education requires that residency programs ensure resident competency in performing safe, effective handoffs. Understanding resident, attending, and nurse perceptions of the key elements of a safe and effective emergency department (ED handoff is a crucial step to developing feasible, acceptable educational interventions to teach and assess this fundamental competency. The aim of our study was to identify the essential themes of ED-based handoffs and to explore the key cultural and interprofessional themes that may be barriers to developing and implementing successful ED-based educational handoff interventions. Methods: Using a grounded theory approach and constructivist/interpretivist research paradigm, we analyzed data from three primary and one confirmatory focus groups (FGs at an urban, academic ED. FG protocols were developed using open-ended questions that sought to understand what participants felt were the crucial elements of ED handoffs. ED residents, attendings, a physician assistant, and nurses participated in the FGs. FGs were observed, hand-transcribed, audiorecorded and subsequently transcribed. We analyzed data using an iterative process of theme and subtheme identification. Saturation was reached during the third FG, and the fourth confirmatory group reinforced the identified themes. Two team members analyzed the transcripts separately and identified the same major themes. Results: ED providers identified that crucial elements of ED handoff include the following: 1 Culture (provider buy-in, openness to change, shared expectations of sign-out goals; 2 Time (brevity, interruptions, waiting; 3 Environment (physical location, ED factors; 4 Process (standardization, information order, tools. Conclusion: Key participants in the ED handoff process perceive that the crucial elements of intershift handoffs involve the themes of culture, time, environment, and process. Attention

  18. PREFACE: EDS2010 Preface

    Science.gov (United States)

    Heggie, Malcolm I.

    2011-03-01

    The biennial international conference on Extended Defects in Semiconductors started in 1978 with a meeting in Hünfeld, Germany. Subsequent meetings rotated between Poland, France, Great Britain, Germany, Russia and Italy, culminating in EDS2004 in Chernogolovka, EDS2006 in Halle and EDS2008 in Poitiers. EDS2010 was held at the University of Sussex at Brighton, UK from September 19th to 24th. An extension of the tabulation of this history, which first appeared on the EDS2006 website, is given in the attached PDF. It is with sadness that we note one of the founders of the series, Prof. Dr Helmut Alexander, passed away on 3 December 2009 and we were proud to dedicate EDS2010 to his memory. It has become a tradition to make an award in his name, and this year it was made to Ivan Isacov for his poster "Electrical levels of dislocation networks in p- and n-type silicon". A short and warm celebration of Prof. Dr Alexander's life by his friends and colleagues, Prof. Drs Helmut Gottschalk, Eicke Weber and Wolfgang Schröter, is included in this volume. The conference was a forum for the state-of-the-art of investigation and modelling of extended defects in semiconductors. Scientists from universities, research institutes and industry made contributions to a deeper understanding of extended defects, their interaction with point defects and their role in the development of semiconductor technology. The remit of the conference included extended defects, nanostructures, nanoparticles, quantum dots and interfaces within semiconducting materials ranging from narrow to wide band gaps, including graphene-derived materials and diamond. Scientific interests range from defect geometry, electronic structure, dynamics, spectroscopy, microscopy, reactions and chemistry to introduction mechanisms, such as implantation and strained layers and the operation of devices such as integrated circuits, heterostructures, and solar cells. The organisers were confronted with a long period between

  19. The role of plain radiographs in patients with acute abdominal pain at the ED

    NARCIS (Netherlands)

    van Randen, Adrienne; Lameris, Wytze; Luitse, Jan S. K.; Gorzeman, Michiel; Hesselink, Erik J.; Dolmans, Dennis E. J. G. J.; Peringa, Jan; van Geloven, Anna A. W.; Bossuyt, Patrick M.; Stoker, Jaap; Boermeester, Marja A.

    2011-01-01

    Objective: The purpose of this study was to evaluate the added value of plain radiographs on top of clinical assessment in unselected patients presenting with acute abdominal pain at the emergency department (ED). Methods: In a multicenter prospective trial, patients with abdominal pain more than 2

  20. The role of plain radiographs in patients with acute abdominal pain at the ED

    NARCIS (Netherlands)

    Randen, A. van; Lameris, W.; Luitse, J.S.; Gorzeman, M.; Hesselink, E.J.; Dolmans, D.E.; Peringa, J.; Geloven, A.A. van; Bossuyt, P.M.; Stoker, J.; Boermeester, M.A.; Gooszen, H.G.

    2011-01-01

    OBJECTIVE: The purpose of this study was to evaluate the added value of plain radiographs on top of clinical assessment in unselected patients presenting with acute abdominal pain at the emergency department (ED). METHODS: In a multicenter prospective trial, patients with abdominal pain more than 2

  1. Self-referrals in the emergency department: reasons why patients attend the emergency department without consulting a general practitioner first-a questionnaire study

    NARCIS (Netherlands)

    Kraaijvanger, N.; Rijpsma, D.; Leeuwen, H. van; Edwards, M.J.R.

    2015-01-01

    BACKGROUND: To influence self-referral, it is crucial to know a patient's motives to directly visit the emergency department (ED). The goal of this study is to examine motives for self-referral to the ED and compare these motives in relation to appropriateness. METHODS: All self-referred patients vi

  2. Self Inflicted Injuries among Children in United States - estimates from a nationwide emergency department sample.

    Directory of Open Access Journals (Sweden)

    Naseem Sulyman

    Full Text Available OBJECTIVE: The objectives of the current study are to provide nationally representative estimates of hospital based emergency department visits (ED attributed to self inflicted injuries and attempted suicides among children in United States; and to identify potential methods of such intentional self inflicted injuries and attempted suicides. METHODS: The Nationwide Emergency Department Sample (year 2007 was used. All ED visits occurring among children (aged ≤18 years with an External Cause of Injury for any of self inflicted injuries were selected. Outcomes examined include hospital ED charges and hospitalization charges. All estimates were projected to national levels. RESULTS: 77,420 visits to hospital based emergency departments were attributed to self inflicted injuries among children (26,045 males and 51,370 females. The average age of the ED visits was 15.7 years. 134 patients died in ED's (106 males and 28 females and 93 died in hospitals following in-patient admission (75 males and 18 females. A greater proportion of male ED visits were discharged routinely as opposed to female ED visits (51.1% versus 44%. A greater proportion of male ED visits also died in the emergency departments compared to female visits (0.4% versus 0.05%. 17,965 ED visits necessitated admission into same hospital. The mean charge for each ED visit was $1,874. Self inflicted injuries by poisoning were the most frequently reported sources accounting for close to 70% of all ED visits. CONCLUSIONS: Females comprise a greater proportion of ED visits attributed to self inflicted injuries. 227 children died either in the ED's or in hospitals. The current study results highlight the burden associated with such injuries among children.

  3. Ed Deutschman Interview [video

    OpenAIRE

    Deutschman, Ed

    2011-01-01

    Background: Ed Deutschman was a Navy cadet at the Del Monte Pre-Flight School, located at the now (2013) Naval Postgraduate School. Mr Deutschman visited the Dudley Knox Library on May 2, 2011, and spoke about his service in World War II as a Corsair fighter pilot in the Pacific.

  4. War-related psychological sequelae among emergency department patients in the former Republic of Yugoslavia

    OpenAIRE

    Gorgieva Gordana; Dierberg Kerry; Sisco Sarah; Galea Sandro; Fernandez William G; Nelson Brett D; Nandi Arijit K; Ahern Jennifer; Mitrović Mihajlo; VanRooyen Michael; Vlahov David

    2004-01-01

    Abstract Background Residents of the Republic of Serbia faced civil war and a NATO-led bombing campaign in 1999. We sought to assess the burden of metal health dysfunction among emergency department (ED) patients presenting for care three years post-war in Serbia. Methods This study was conducted during July and August 2002 at two sites: a university hospital ED in Belgrade, Serbia and an ED in a remote district hospital serving a Serbian enclave in Laplje Selo, Kosovo. Investigators collecte...

  5. Online Health Information Impacts Patients’ Decisions to Seek Emergency Department Care

    OpenAIRE

    Pourmand, Ali; Sikka, Neal

    2011-01-01

    Objective: To investigate the impact of online health information (OHI) and patients’ decisions to seek emergency department (ED) care. Methods: We conducted a survey of a convenience sample of 489 ambulatory patients at an academic ED between February and September 2006. The primary measure was the prevalence of Internet use, and the secondary outcome was the impact of OHI on patients’ decision to seek ED care. Results: The study group comprised 175 (38%) males. Mean age wa...

  6. Comparison Between Emergency Department and Inpatient Nurses’ Perceptions of Boarding of Admitted Patients

    Directory of Open Access Journals (Sweden)

    Bryce C. Pulliam

    2013-03-01

    Full Text Available Introduction: The boarding of admitted patients in the emergency department (ED is a major causeof crowding and access block. One solution is boarding admitted patients in inpatient ward (Whallways. This study queried and compared ED and W nurses’ opinions toward ED and W boarding.It also assessed their preferred boarding location if they were patients.Methods: A survey administered to a convenience sample of ED and W nurses was performedin a 631-bed academic medical center (30,000 admissions/year with a 68-bed ED (70,000 visits/year. We identified nurses as ED or W, and if W, whether they had previously worked in the ED. Thenurses were asked if there were any circumstances where admitted patients should be boarded inED or W hallways. They were also asked their preferred location if they were admitted as a patient.Six clinical scenarios were then presented, and the nurses’ opinions on boarding based on eachscenario were queried.Results: Ninety nurses completed the survey, with a response rate of 60%; 35 (39% were currentED nurses (cED, 40 (44% had previously worked in the ED (pED. For all nurses surveyed 46(52% believed admitted patients should board in the ED. Overall, 52 (58% were opposed to Wboarding, with 20% of cED versus 83% of current W (cW nurses (P < 0.0001, and 28% of pEDversus 85% of nurses never having worked in the ED (nED were opposed (P < 0.001. If admittedas patients themselves, 43 (54% of all nurses preferred W boarding, with 82% of cED versus33% of cW nurses (P < 0.0001 and 74% of pED versus 34% nED nurses (P = 0.0007. The mostcommonly cited reasons for opposition to hallway boarding were lack of monitoring and patientprivacy. For the 6 clinical scenarios, significant differences in opinion regarding W boarding existedin all but 2 cases: a patient with stable chronic obstructive pulmonary disease but requiring oxygen,and an intubated, unstable sepsis patient.Conclusion: Inpatient nurses and those who have never worked in

  7. Image and Imaging an Emergency Department: Expense and Benefit of Different Quality Assessment Methods

    Directory of Open Access Journals (Sweden)

    Carmen Andrea Pfortmueller

    2013-01-01

    Full Text Available Introduction. In this era of high-tech medicine, it is becoming increasingly important to assess patient satisfaction. There are several methods to do so, but these differ greatly in terms of cost, time, and labour and external validity. The aim of this study is to describe and compare the structure and implementation of different methods to assess the satisfaction of patients in an emergency department. Methods. The structure and implementation of the different methods to assess patient satisfaction were evaluated on the basis of a 90-minute standardised interview. Results. We identified a total of six different methods in six different hospitals. The average number of patients assessed was 5012, with a range from 230 (M5 to 20 000 patients (M2. In four methods (M1, M3, M5, and M6, the questionnaire was composed by a specialised external institute. In two methods, the questionnaire was created by the hospital itself (M2, M4.The median response rate was 58.4% (range 9–97.8%. With a reminder, the response rate increased by 60% (M3. Conclusion. The ideal method to assess patient satisfaction in the emergency department setting is to use a patient-based, in-emergency department-based assessment of patient satisfaction, planned and guided by expert personnel.

  8. Facilitators and barriers to screening for child abuse in the emergency department

    NARCIS (Netherlands)

    E.C.F.M. Louwers (Eveline (Eefje)); I.J. Korfage (Ida); M.J. Affourtit (Marjo); H.J. de Koning (Harry); H.A. Moll (Henriëtte)

    2012-01-01

    textabstractBackground: To identify facilitators of, and barriers to, screening for child abuse in emergency departments (ED) through interviews with ED staff, members of the hospital Board, and related experts.Methods: This qualitative study is based on semi-structured interviews with 27 profession

  9. Facilitators and barriers to screening for child abuse in the emergency department

    NARCIS (Netherlands)

    E.C.F.M. Louwers (Eveline (Eefje)); I.J. Korfage (Ida); M.J. Affourtit (Marjo); H.J. de Koning (Harry); H.A. Moll (Henriëtte)

    2012-01-01

    textabstractBackground: To identify facilitators of, and barriers to, screening for child abuse in emergency departments (ED) through interviews with ED staff, members of the hospital Board, and related experts.Methods: This qualitative study is based on semi-structured interviews with 27

  10. Validity of different pediatric early warning scores in the emergency department

    NARCIS (Netherlands)

    N. Seiger (Nienke); I.K. MacOnochie (Ian); R. Oostenbrink (Rianne); H.A. Moll (Henriëtte)

    2013-01-01

    textabstractObjective: Pediatric early warning scores (PEWS) are being advocated for use in the emergency department (ED). The goal of this study was to compare the validity of different PEWS in a pediatric ED. Methods: Ten different PEWS were evaluated in a large prospective cohort. We included chi

  11. Shock in the emergency department

    DEFF Research Database (Denmark)

    Holler, Jon Gitz; Henriksen, Daniel Pilsgaard; Mikkelsen, Søren

    2016-01-01

    BACKGROUND: The knowledge of the frequency and associated mortality of shock in the emergency department (ED) is limited. The aim of this study was to describe the incidence, all-cause mortality and factors associated with death among patients suffering shock in the ED. METHODS: Population......-based cohort study at an University Hospital ED in Denmark from January 1, 2000, to December 31, 2011. All patients aged ≥18 years living in the hospital catchment area with a first time ED presentation with shock (n = 1646) defined as hypotension (systolic blood pressure (SBP) ≤100 mmHg)) and ≥1 organ...... failures. Outcomes were annual incidence per 100,000 person-years at risk (pyar), all-cause mortality at 0-7, and 8-90 days and risk factors associated with death. RESULTS: We identified 1646 of 438,191 (0.4 %) ED patients with shock at arrival. Incidence of shock increased from 53.8 to 80.6 cases per 100...

  12. Perceptions of Emergency Department Crowding in Pennsylvania

    Directory of Open Access Journals (Sweden)

    Pines, Jesse M

    2013-02-01

    Full Text Available Introduction: The state of emergency department (ED crowding in Pennsylvania has not previously been reported.Methods: We assessed perceptions of ED crowding by surveying medical directors/chairs from Pennsylvania EDs in the spring of 2008.Results: A total of 106 completed the questionnaire (68% response rate. A total of 83% (86/104 agreed that ED crowding was a problem; 26% (27/105 reported that at least half of admitted patients boarded for more than 4 hours. Ninety-eight percent (102/104 agreed that patient satisfaction suffers during crowding and 79% (84/106 stated that quality suffers. Sixty-five percent (68/105 reported that crowding had worsened during the past 2 years. Several hospital interventions were used to alleviate crowding: expediting discharges, 81% (86/106; prioritizing ED patients for inpatient beds, 79% (84/ 106; and ambulance diversion, 55% (57/105. Almost all respondents who had improved ED operations reported that it had reduced crowding.Conclusion: ED crowding is a common problem in Pennsylvania and is worsening in the majority of hospitals, despite the implementation of a variety of interventions. [West J EmergMed. 2013;14(1:1–10.

  13. Emergency Department Crowding and Time to Antibiotic Administration in Febrile Infants

    Directory of Open Access Journals (Sweden)

    Jennifer K Light

    2013-09-01

    Full Text Available Introduction: Early antibiotic administration is recommended in newborns presenting with febrile illness to emergency departments (ED to avert the sequelae of serious bacterial infection. Although ED crowding has been associated with delays in antibiotic administration in a dedicated pediatric ED, the majority of children that receive emergency medical care in the U.S. present to EDs that treat both adult and pediatric emergencies. The purpose of this study was to examine the relationship between time to antibiotic administration in febrile newborns and crowding in a general ED serving both an adult and pediatric population.Methods: We conducted a retrospective chart review of 159 newborns presenting to a general ED between 2005 and 2011 and analyzed the association between time to antibiotic administration and ED occupancy rate at the time of, prior to, and following infant presentation to the ED.Results: We observed delayed and variable time to antibiotic administration and found no association between time to antibiotic administration and occupancy rate prior to, at the time of, or following infant presentation (P > 0.05. ED time to antibiotic administration was not associated with hospital length of stay, and there was no inpatient mortality.Conclusion: Delayed and highly variable time to antibiotic treatment in febrile newborns was common but unrelated to ED crowding in the general ED study site. Guidelines for time to antibiotic administration in this population may reduce variability in ED practice patterns. [West J Emerg Med. 2013;14(5:518-524.

  14. Emergency department crowding: Factors influencing flow

    NARCIS (Netherlands)

    van der Linden, M.C.

    2015-01-01

    This thesis focuses on emergency department (ED) crowding. In the first part (ED crowding in the Netherlands) the current state of EDs regarding patients’ length of stay and ED managers’ experiences of crowding are described. Part two (input factors) contains three studies which describe the case lo

  15. Modeling factors influencing the demand for emergency department services in ontario: a comparison of methods

    Directory of Open Access Journals (Sweden)

    Meaney Christopher

    2011-08-01

    Full Text Available Abstract Background Emergency departments are medical treatment facilities, designed to provide episodic care to patients suffering from acute injuries and illnesses as well as patients who are experiencing sporadic flare-ups of underlying chronic medical conditions which require immediate attention. Supply and demand for emergency department services varies across geographic regions and time. Some persons do not rely on the service at all whereas; others use the service on repeated occasions. Issues regarding increased wait times for services and crowding illustrate the need to investigate which factors are associated with increased frequency of emergency department utilization. The evidence from this study can help inform policy makers on the appropriate mix of supply and demand targeted health care policies necessary to ensure that patients receive appropriate health care delivery in an efficient and cost-effective manner. The purpose of this report is to assess those factors resulting in increased demand for emergency department services in Ontario. We assess how utilization rates vary according to the severity of patient presentation in the emergency department. We are specifically interested in the impact that access to primary care physicians has on the demand for emergency department services. Additionally, we wish to investigate these trends using a series of novel regression models for count outcomes which have yet to be employed in the domain of emergency medical research. Methods Data regarding the frequency of emergency department visits for the respondents of Canadian Community Health Survey (CCHS during our study interval (2003-2005 are obtained from the National Ambulatory Care Reporting System (NACRS. Patients' emergency department utilizations were linked with information from the Canadian Community Health Survey (CCHS which provides individual level medical, socio-demographic, psychological and behavioral information for

  16. Use of the SONET Score to Evaluate High Volume Emergency Department Overcrowding: A Prospective Derivation and Validation Study

    Directory of Open Access Journals (Sweden)

    Hao Wang

    2015-01-01

    Full Text Available Background. The accuracy and utility of current Emergency Department (ED crowding estimation tools remain uncertain in EDs with high annual volumes. We aimed at deriving a more accurate tool to evaluate overcrowding in a high volume ED setting and determine the association between ED overcrowding and patient care outcomes. Methods. A novel scoring tool (SONET: Severely overcrowded-Overcrowded-Not overcrowded Estimation Tool was developed and validated in two EDs with both annual volumes exceeding 100,000. Patient care outcomes including the number of left without being seen (LWBS patients, average length of ED stay, ED 72-hour returns, and mortality were compared under the different crowding statuses. Results. The total number of ED patients, the number of mechanically ventilated patients, and patient acuity levels were independent risk factors affecting ED overcrowding. SONET was derived and found to better differentiate severely overcrowded, overcrowded, and not overcrowded statuses with similar results validated externally. In addition, SONET scores correlated with increased length of ED stay, number of LWBS patients, and ED 72-hour returns. Conclusions. SONET might be a better fit to determine high volume ED overcrowding. ED overcrowding negatively impacts patient care operations and often produces poor patient perceptions of standardized care delivery.

  17. An objective method for bed capacity planning in a hospital department - a comparison with target ratio methods.

    Science.gov (United States)

    Nguyen, J M; Six, P; Chaussalet, T; Antonioli, D; Lombrail, P; Le Beux, P

    2007-01-01

    To propose an objective approach in order to determine the number of beds required for a hospital department by considering how recruitment fluctuates over time. To compare this approach with classical bed capacity planning techniques. A simulated data-based evaluation of the impact that the variability in hospital department activity produces upon the performance of methods used for determining the number of beds required. The evaluation criteria included productive efficiency measured by the bed occupancy rate, accessibility measured by the transfer rate of patients due to lack of available beds and a proxy of clinical effectiveness, by the proportion of days during which there is no possibility for unscheduled admission. When the variability of the number of daily patients increases, the Target Occupancy Rate favors productive efficiency at the expense of accessibility and proxy clinical effectiveness. On the contrary, when the variability of the department activity is marginal, the Target Activity Rate penalizes the proxy of clinical effectiveness, and the Target Occupancy Rate underoptimizes productive efficiency. The method we propose led to a superior performance in terms of accessibility and proxy of clinical effectiveness at the expense of productive efficiency. Such a situation is suitable for intensive care units. In the case of other departments, a weighting procedure should be used to improve productive efficiency. This approach could be considered as the first step of a family of methods for quantitative healthcare planning.

  18. Automated electronic medical record sepsis detection in the emergency department

    OpenAIRE

    Su Q. Nguyen; Edwin Mwakalindile; Booth, James S.; Vicki Hogan; Jordan Morgan; Prickett, Charles T; Donnelly, John P; Wang, Henry E.

    2014-01-01

    Background. While often first treated in the emergency department (ED), identification of sepsis is difficult. Electronic medical record (EMR) clinical decision tools offer a novel strategy for identifying patients with sepsis. The objective of this study was to test the accuracy of an EMR-based, automated sepsis identification system. Methods. We tested an EMR-based sepsis identification tool at a major academic, urban ED with 64,000 annual visits. The EMR system collected vital sign and lab...

  19. Automated electronic medical record sepsis detection in the emergency department

    OpenAIRE

    Nguyen, Su Q.; Edwin Mwakalindile; Booth, James S.; Vicki Hogan; Jordan Morgan; Prickett, Charles T; Donnelly, John P.; Wang, Henry E.

    2014-01-01

    Background. While often first treated in the emergency department (ED), identification of sepsis is difficult. Electronic medical record (EMR) clinical decision tools offer a novel strategy for identifying patients with sepsis. The objective of this study was to test the accuracy of an EMR-based, automated sepsis identification system. Methods. We tested an EMR-based sepsis identification tool at a major academic, urban ED with 64,000 annual visits. The EMR system collected vital sign and lab...

  20. Automated electronic medical record sepsis detection in the Emergency Department

    OpenAIRE

    Nguyen, Su; Mwakalindile, Edwin; Booth, James S.; Hogan, Vicki; Morgan, Jordan; Prickett, Charles T; Donnelly, John P.; Wang, Henry E.

    2014-01-01

    Background: While often first treated in the Emergency Department (ED), identification of sepsis is difficult. Electronic medical record (EMR) clinical decision tools offer a novel strategy for identifying patients with sepsis. The objective of this study was to test the accuracy of an EMR-based, automated sepsis identification system. Methods : We tested an EMR-based sepsis identification tool at a major academic, urban ED with 64,000 annual visits. The EMR system collected vital sign and la...

  1. Application of case analysis teaching method in nursing teaching in Department of Internal Medicine

    Directory of Open Access Journals (Sweden)

    Zhang-xiu SHENG

    2014-04-01

    Full Text Available Objective:In order to adapt to the modern occupation education teaching idea, to stimulate students’ interest in learning, training students' comprehensive quality, improve the students' active participation, understanding, analysis and problem solving skills. Methods: I In the course of different stages using teaching methods of case analysis: case introduction before class teaching method, case analysis during and after class teaching method, and case analysis of the whole chapter after class teaching method.  Results and Conclusion: Through the course of different stages of using case analysis teaching method, we can launch the students’ active learning, stimulate the students' interest in learning, activate classroom atmosphere, train students' independent thinking, strengthen the problems solving ability, improve the self-learning ability of students, activate their participation and awareness, analysis, judgment, introduction, and strengthen students' exam ability, improve the test scores of students and the teaching effect of nursing in Department of internal medicine.

  2. Temporal Trends in Emergency Department Visits for Bronchiolitis in the United States, 2006-2010

    Science.gov (United States)

    Hasegawa, Kohei; Tsugawa, Yusuke; Brown, David F.M.; Mansbach, Jonathan M.; Camargo, Carlos A.

    2014-01-01

    Background To examine temporal trends in emergency departments (ED) visits for bronchiolitis among US children between 2006 and 2010. Methods Serial, cross-sectional analysis of the Nationwide Emergency Department Sample, a nationally-representative sample of ED patients. We used ICD-9-CM code 466.1 to identify children bronchiolitis. Primary outcome measures were rate of bronchiolitis ED visits, hospital admission rate, and ED charges. Results Between 2006 and 2010, weighted national discharge data included 1,435,110 ED visits with bronchiolitis. There was a modest increase in the rate of bronchiolitis ED visits, from 35.6 to 36.3 per 1000 person-years (2% increase; Ptrend=0.008), due to increases in the ED visit rate among children from 12 months to 23 months (24% increase; Ptrendbronchiolitis increased from $337 million to $389 million (16% increase; Ptrendbronchiolitis ED visits by age group. Despite a significant increase in associated ED charges, ED-associated hospital admission rates for bronchiolitis significantly decreased over this same period. PMID:23934206

  3. Contribution of ED admissions to inpatient hospital revenue.

    Science.gov (United States)

    Sacchetti, Alfred; Harris, Russell H; Warden, Todd; Roth, Sandra

    2002-01-01

    Emergency department (ED) practices are traditionally profiled in terms of their patient encounters. Such evaluations reflect a preponderance of outpatient visits while crediting income from admitted patients to traditional hospital-based services. This study evaluates the contribution of ED admissions to inpatient hospital revenue. The study was set at an urban tertiary care community hospital with university affiliation. Information referable to ED patients was collected from the hospital's Universal Billing Code (UB-92)-based patient information warehouse. Data fields referable to hospital charges, insurance type, and disposition were used for analysis of a 1-year period from September 1, 1998 to August 31, 1999. Statistical analysis was through chi square and ANOVA. During the study period 33,174 patients were treated in the ED with 6,671 (20%) admitted to inpatient services. Total hospital charges for all ED patients during this time were $107 million dollars with $9.1 million (8.5%) generated from discharged patients and $98.0 million (91.5%) from admitted ED patients (P revenue for inpatient services for the study period was $288 million of which 34% was contributed from admitted ED patients. ED services represent a major source of inpatient hospital revenue. The recognition of the ED's potential in this area may be lost if income from patients admitted through the ED is credited to traditional hospital-based services.

  4. Safe Handling of Snakes in an ED Setting.

    Science.gov (United States)

    Cockrell, Melanie; Swanson, Kristofer; Sanders, April; Prater, Samuel; von Wenckstern, Toni; Mick, JoAnn

    2017-01-01

    Efforts to improve consistency in management of snakes and venomous snake bites in the emergency department (ED) can improve patient and staff safety and outcomes, as well as improve surveillance data accuracy. The emergency department at a large academic medical center identified an opportunity to implement a standardized process for snake disposal and identification to reduce staff risk exposure to snake venom from snakes patients brought with them to the ED.

  5. Scientific Method in Teaching Physics in Languages and Social Sciences Department of High—Schools

    Science.gov (United States)

    Nagl, Mirko G.; Obadović, Dušanka Ž.; Stojanović, Maja M.

    2010-01-01

    The expansion of scientific materials in the last few decades, demands that the contemporary educational system should select and develop methods of effective learning in the process of acquiring skills and knowledge usable and feasible for a longer period of time. Grammar schools as general educational institutions possess all that is necessary for the development of new teaching methods and fitting into contemporary social tendencies. In the languages and social sciences department in of grammar schools physics is the only natural sciences subject present during all four years. The classical approach to teaching is tiring as such and creates aversion towards learning physic when it deals with pupils oriented towards social sciences. The introduction of scientific methods raises the motivation to a substantial level and when applied both the teacher and pupils forget when the class starts or ends. The assignment has shown the analysis of initial knowledge of physics of the pupils attending the first grade of languages and social sciences department of of grammar schools as a preparation for the introduction of the scientific method, the analysis of the initial test with the topic of gravitation, as well as the analysis of the final test after applying the scientific method through the topic of gravitation. The introduction of the scientific method has duly justified the expectations and resulted in increasing the level of achievement among the pupils in the experimental class.

  6. Pedagogical effectiveness of innovative teaching methods initiated at the Department of Physiology, Government Medical College, Chandigarh.

    Science.gov (United States)

    Nageswari, K Sri; Malhotra, Anita S; Kapoor, Nandini; Kaur, Gurjit

    2004-12-01

    Modern teaching trends in medical education exhibit a paradigm shift from the conventional classroom teaching methods adopted in the past to nonconventional teaching aids so as to encourage interactive forms of learning in medical students through active participation and integrative reasoning where the relationship of the teacher and the taught has undergone tremendous transformation. Some of the nonconventional teaching methods adopted at our department are learning through active participation by the students through computer-assisted learning (CD-ROMs), Web-based learning (undergraduate projects), virtual laboratories, seminars, audiovisual aids (video-based demonstrations), and "physioquiz."

  7. Critical care in the emergency department.

    LENUS (Irish Health Repository)

    O'Connor, Gabrielle

    2012-02-01

    BACKGROUND: The volume and duration of stay of the critically ill in the emergency department (ED) is increasing and is affected by factors including case-mix, overcrowding, lack of available and staffed intensive care beds and an ageing population. The purpose of this study was to describe the clinical activity associated with these high-acuity patients and to quantify resource utilization by this patient group. METHODS: The study was a retrospective review of ED notes from all patients referred directly to the intensive care team over a 6-month period from April to September 2004. We applied a workload measurement tool, Therapeutic Intervention Scoring System (TISS)-28, which has been validated as a surrogate marker of nursing resource input in the intensive care setting. A nurse is considered capable of delivering nursing activities equal to 46 TISS-28 points in each 8-h shift. RESULTS: The median score from our 69 patients was 19 points per patient. Applying TISS-28 methodology, we estimated that 3 h 13 min nursing time would be spent on a single critically ill ED patient, with a TISS score of 19. This is an indicator of the high levels of personnel resources required for these patients in the ED. ED-validated models to quantify nursing and medical staff resources used across the spectrum of ED care is needed, so that staffing resources can be planned and allocated to match service demands.

  8. Use of Emergency Department by Elderly Patients

    Directory of Open Access Journals (Sweden)

    Orhan Akpinar

    2016-01-01

    Full Text Available Aim: Using of EDs by the geriatric population is being increased in parallel to increase of our geriatric population. Objective of this study was to demonstrate what can be done for the EDs to be more effectively benefited by evaluating clinical and demographic data of the patients over 65 years old who presented to an emergency department. Material and Method: Recordings of the patients who presented to Isparta Public Hospital, ED in 2011 were retrospectively screened. All the data were evaluated through SPSS 17.0 software. Results: Of total 114,522 patients who presented to our ED during the study, 14,645 (12.7% were geriatrics. Mean age was found as 74,6 ± 6 years. The most common cause of presentation was found as cardiologic problems as 3,120 (21.3%, followed by respiratory system problems as 2,040 (13.9%, gastrointestinal problems as 1,875 (12.8%, neurological problems as 1,512 (10.3% and musculo-skeletal system problems as 1,230 (8.4% patients. While 71% of these patients were treated in basis of outpatients, 1,877 patients (12.8% were hospitalized and 9 patients were lost in the ED. Discussion: Some regional differences may be seen in the follow-up of geriatric patients. We recommend that, each hospital should arrange its ED services considering its patient profile.

  9. Risk for poor outcomes in older patients discharged from an emergency department: feasibility of four screening instruments.

    NARCIS (Netherlands)

    Buurman, B.M.; Berg, W. van den; Korevaar, J.C.; Milisen, K.; Haan, R.J. de; Rooij, S.E. de

    2011-01-01

    Objectives: To compare the prognostic value of four screening instruments used to detect the risk for poor outcomes [in terms of likelihood of recurrent emergency department (ED) visits, hospitalizations, or mortality] for older patients discharged home from an ED in the Netherlands. Methods: This i

  10. Collegiate-Based Emergency Medical Service: Impact on Alcohol-Related Emergency Department Transports at a Small Liberal Arts College

    Science.gov (United States)

    Rosen, Joshua B.; Olson, Mark H.; Kelly, Marianne

    2012-01-01

    Objective: The authors examined the impact of a collegiate-based emergency medical service (CBEMS) on the frequency of emergency department (ED) transports. Participants: Students transported to the ED for acute alcohol intoxication during the Fall 2008 and the Fall 2009 semesters (N = 50). Methods: The frequency of students receiving…

  11. Using Google Flu Trends data in forecasting influenza-like-illness related ED visits in Omaha, Nebraska.

    Science.gov (United States)

    Araz, Ozgur M; Bentley, Dan; Muelleman, Robert L

    2014-09-01

    Emergency department (ED) visits increase during the influenza seasons. It is essential to identify statistically significant correlates in order to develop an accurate forecasting model for ED visits. Forecasting influenza-like-illness (ILI)-related ED visits can significantly help in developing robust resource management strategies at the EDs. We first performed correlation analyses to understand temporal correlations between several predictors of ILI-related ED visits. We used the data available for Douglas County, the biggest county in Nebraska, for Omaha, the biggest city in the state, and for a major hospital in Omaha. The data set included total and positive influenza test results from the hospital (ie, Antigen rapid (Ag) and Respiratory Syncytial Virus Infection (RSV) tests); an Internet-based influenza surveillance system data, that is, Google Flu Trends, for both Nebraska and Omaha; total ED visits in Douglas County attributable to ILI; and ILI surveillance network data for Douglas County and Nebraska as the predictors and data for the hospital's ILI-related ED visits as the dependent variable. We used Seasonal Autoregressive Integrated Moving Average and Holt Winters methods with3 linear regression models to forecast ILI-related ED visits at the hospital and evaluated model performances by comparing the root means square errors (RMSEs). Because of strong positive correlations with ILI-related ED visits between 2008 and 2012, we validated the use of Google Flu Trends data as a predictor in an ED influenza surveillance tool. Of the 5 forecasting models we have tested, linear regression models performed significantly better when Google Flu Trends data were included as a predictor. Regression models including Google Flu Trends data as a predictor variable have lower RMSE, and the lowest is achieved when all other variables are also included in the model in our forecasting experiments for the first 5 weeks of 2013 (with RMSE = 57.61). Google Flu Trends data

  12. Preconcentration and determination of ultra-traces of platinum in human serum using the combined electrodeposition-electrothermal atomic absorption spectroscopy (ED-ETAAS) and chemometric method.

    Science.gov (United States)

    Najafi, Nahid Mashkouri; Shahparvizi, Shahram; Rafati, Hasan; Ghasemi, Ensieh; Alizadeh, Reza

    2010-09-21

    Platinum compounds, including cis-dichlorodiaminoplatinum(II) or cisplatin, are an important class of anti-cancer drugs, which should be carefully monitored in the biological fluids. In this study, electrodeposition coupled with electrothermal atomic absorption spectrometry (ETAAS) was used for determination of Pt concentration in the human serum samples. The chemometric techniques were also used to verify the probable interactions among the important and effective parameters in the atomization process. Using response surfaces obtained by two factorial design techniques, the experimental design was applied for three effective parameters namely ashing temperature, atomizing temperature and modifier concentration as effective parameters on the atomization of Pt. The in situ digestions of serum samples, as well as the separation of the ultra-traces of Pt from concomitant in these samples were performed by using the in situ electrodeposition (ED) technique prior to the measurement by ETAAS. Six plasma samples of a patient who was administered parenteral cisplatin were analyzed using the proposed ED-ETAAS technique. The results showed the pharmacokinetic parameters of cisplatin in serum in accordance to the well-established data. A relatively good reproducibility %RSD=2.44, low limit of detection LOD=2.54 microg/L and promising characteristic mass m(o)=91.30 pg were obtained using this technique.

  13. Early detection of abnormal patient arrivals at hospital emergency department

    KAUST Repository

    Harrou, Fouzi

    2015-10-21

    Overcrowding is one of the most crucial issues confronting emergency departments (EDs) throughout the world. Efficient management of patient flows for ED services has become an urgent issue for most hospital administrations. Handling and detection of abnormal situations is a key challenge in EDs. Thus, the early detection of abnormal patient arrivals at EDs plays an important role from the point of view of improving management of the inspected EDs. It allows the EDs mangers to prepare for high levels of care activities, to optimize the internal resources and to predict enough hospitalization capacity in downstream care services. This study reports the development of statistical method for enhancing detection of abnormal daily patient arrivals at the ED, which able to provide early alert mechanisms in the event of abnormal situations. The autoregressive moving average (ARMA)-based exponentially weighted moving average (EWMA) anomaly detection scheme proposed was successfully applied to the practical data collected from the database of the pediatric emergency department (PED) at Lille regional hospital center, France.

  14. On the quantitativeness of EDS STEM

    Energy Technology Data Exchange (ETDEWEB)

    Lugg, N.R. [Institute of Engineering Innovation, The University of Tokyo, 2-11-16, Yayoi, Bunkyo-ku, Tokyo 113-8656 (Japan); Kothleitner, G. [Institute for Electron Microscopy and Nanoanalysis, Graz University of Technology, Steyrergasse 17, 8010 Graz (Austria); Centre for Electron Microscopy, Steyrergasse 17, 8010 Graz (Austria); Shibata, N.; Ikuhara, Y. [Institute of Engineering Innovation, The University of Tokyo, 2-11-16, Yayoi, Bunkyo-ku, Tokyo 113-8656 (Japan)

    2015-04-15

    Chemical mapping using energy dispersive X-ray spectroscopy (EDS) in scanning transmission electron microscopy (STEM) has recently shown to be a powerful technique in analyzing the elemental identity and location of atomic columns in materials at atomic resolution. However, most applications of EDS STEM have been used only to qualitatively map whether elements are present at specific sites. Obtaining calibrated EDS STEM maps so that they are on an absolute scale is a difficult task and even if one achieves this, extracting quantitative information about the specimen – such as the number or density of atoms under the probe – adds yet another layer of complexity to the analysis due to the multiple elastic and inelastic scattering of the electron probe. Quantitative information may be obtained by comparing calibrated EDS STEM with theoretical simulations, but in this case a model of the structure must be assumed a priori. Here we first theoretically explore how exactly elastic and thermal scattering of the probe confounds the quantitative information one is able to extract about the specimen from an EDS STEM map. We then show using simulation how tilting the specimen (or incident probe) can reduce the effects of scattering and how it can provide quantitative information about the specimen. We then discuss drawbacks of this method – such as the loss of atomic resolution along the tilt direction – but follow this with a possible remedy: precession averaged EDS STEM mapping. - Highlights: • Signal obtained in EDS STEM maps (of STO) compared to non-channelling signal. • Deviation from non-channelling signal occurs in on-axis experiments. • Tilting specimen: signal close to non-channelling case but atomic resolution is lost. • Tilt-precession series: non-channelling signal and atomic-resolution features obtained. • Associated issues are discussed.

  15. Characteristics of patients returning to emergency departments in Naples, Italy

    Directory of Open Access Journals (Sweden)

    Marinelli Paolo

    2008-05-01

    Full Text Available Abstract Background Crowding in hospital Emergency Departments (EDs is a problem in several countries. We evaluated the number and characteristics of patients who make repeated visits to the EDs in Naples, Italy. Methods All patients (≥ 16 years who presented to the EDs of three randomly selected non-academic acute care public hospitals, within randomly selected week periods, were studied. The two outcomes of interest were the re-utilization, within 72 hours, of the ED and the number of visits in the previous year. Results Of the 1430 sampled patients, 51.9% self-reported multiple visits in the previous year and 10.9% and 1.6% used the ED for 3 and ≥4 times, respectively. The number of visits in the previous year was significantly higher in those who live closer to hospital, with a more severe burden of overall comorbidity, and who were on pharmacological treatment. Overall, 72-hours return visits were found in 215 patients (15.8%. Patients were more likely to re-use within 72 hours the ED if younger, were not on pharmacological treatment, attended the ED more times in the previous year, were referred by a physician, arrived at the ED by car driven by other person, had problems of longer duration prior to arrival at the ED, had a surgical ED discharge diagnosis, and were admitted to the hospital. Conclusion The data may assist policymakers in the development and implementation of protocols to track changes in the re-utilization of the ED for the high financial impact and for the benefit of the patients.

  16. A Method for Reviewing the Accuracy and Reliability of a Five-Level Triage Process (Canadian Triage and Acuity Scale in a Community Emergency Department Setting: Building the Crowding Measurement Infrastructure

    Directory of Open Access Journals (Sweden)

    Michael K. Howlett

    2012-01-01

    Full Text Available Objectives. Triage data are widely used to evaluate patient flow, disease severity, and emergency department (ED workload, factors used in ED crowding evaluation and management. We defined an indicator-based methodology that can be easily used to review the accuracy of Canadian Triage and Acuity Scale (CTAS performance. Methods. A trained nurse reviewer (NR retrospectively triaged two separate month’s ED charts relative to a set of clinical indicators based on CTAS Chief Complaints. Interobserver reliability and accuracy were compared using Kappa and comparative statistics. Results. There were 2838 patients in Trial 1 and 3091 in Trial 2. The rate of inconsistent triage was 14% and 16% (Kappa 0.596 and 0.604. Clinical Indicators “pain scale, chest pain, musculoskeletal injury, respiratory illness, and headache” captured 68% and 62% of visits. Conclusions. We have demonstrated a system to measure the levels of process accuracy and reliability for triage over time. We identified five key clinical indicators which captured over 60% of visits. A simple method for quality review uses a small set of indicators, capturing a majority of cases. Performance consistency and data collection using indicators may be important areas to direct training efforts.

  17. Understanding communication networks in the emergency department

    Directory of Open Access Journals (Sweden)

    Braithwaite Jeffrey

    2009-12-01

    Full Text Available Abstract Background Emergency departments (EDs are high pressure health care settings involving complex interactions between staff members in providing and organising patient care. Without good communication and cooperation amongst members of the ED team, quality of care is at risk. This study examined the problem-solving, medication advice-seeking and socialising networks of staff working in an Australian hospital ED. Methods A social network survey (Response Rate = 94% was administered to all ED staff (n = 109 including doctors, nurses, allied health professionals, administrative staff and ward assistants. Analysis of the network characteristics was carried out by applying measures of density (the extent participants are concentrated, connectedness (how related they are, isolates (how segregated, degree centrality (who has most connections measured in two ways, in-degree, the number of ties directed to an individual and out-degree, the number of ties directed from an individual, betweenness centrality (who is important or powerful, degree of separation (how many ties lie between people and reciprocity (how bi-directional are interactions. Results In all three networks, individuals were more closely connected to colleagues from within their respective professional groups. The problem-solving network was the most densely connected network, followed by the medication advice network, and the loosely connected socialising network. ED staff relied on each other for help to solve work-related problems, but some senior doctors, some junior doctors and a senior nurse were important sources of medication advice for their ED colleagues. Conclusions Network analyses provide useful ways to assess social structures in clinical settings by allowing us to understand how ED staff relate within their social and professional structures. This can provide insights of potential benefit to ED staff, their leaders, policymakers and researchers.

  18. Complaints and Diagnoses of Emergency Department Patients in the Netherlands: A Comparative Study of Integrated Primary and Emergency Care

    Science.gov (United States)

    Thijssen, Wendy A. M. H.; van Miero, Elske; Willekens, Maartje; Rebel, Jasper; Sandel, Maro H.; Giesen, Paul; Wensing, Michel

    2015-01-01

    Objective In the Netherlands, an increasing number of emergency departments (EDs) and general practitioner cooperatives collaborate by creating one Emergency-Care-Access-Point (ECAP). This has resulted in fewer patients at ECAP EDs. The objective of this study was to explore differences in patient characteristics, presented complaints and ED discharge diagnoses between EDs with an ECAP and EDs without an ECAP. Methods A retrospective observational study was performed with 1800 consecutive patient records sampled from six EDs spread over the Netherlands in 2013. We extracted data on time and date of presentation, sex, age, presenting complaint, discharge diagnosis, origin and follow up. Results At ECAP EDs, the mean age was 47.8 years (95%CI 46.1-49.4) compared to 41.3 (95%CI 39.7-42.9). Compared to non-ECAP EDs, more patients were referred by medical professionals (74.7% versus 46.8%), more patients received hospital admission (45.2% versus 29.0%) and fewer patients received GP follow-up (4.1% versus 16.9%). There was no significant difference in presenting complaints between ECAP and non-ECAP EDs. Most prevalent complaints were trauma (25.7% versus 29.7%), abdominal pain (12.1% versus 10.9%) and general symptoms (7.8% versus 4.8%). The most prevalent ED diagnoses significantly differed with fractures and dislocations (10.8%), sprains and strains (10.4%) and respiratory infections (6.8%) at ECAP EDs versus fractures and dislocations (10.7%), wounds (9.3%) and sprains and strains (8.9%) at non-ECAP EDs. Conclusion Compared to non-ECAP EDs, patients at ECAP EDs were older, medical professionals referred more patients and more patients received a hospital admission. We found some small differences in discharge diagnoses between ECAP EDs compared to non-ECAP EDs, but no difference in presented complaints. PMID:26131564

  19. [Cost management: the implementation of the activity-based costing method in sterile processing department].

    Science.gov (United States)

    Jericó, Marli de Carvalho; Castilho, Valéria

    2010-09-01

    This exploratory case study was performed aiming at implementing the Activity-based Costing (ABC) method in a sterile processing department (SPD) of a major teaching hospital. Data collection was performed throughout 2006. Documentary research techniques and non participant closed observation were used. The ABC implementation allowed for learning the activity-based costing of both the chemical and physical disinfection cycle/load: (dollar 9.95) and (dollar 12.63), respectively; as well as the cost for sterilization by steam under pressure (autoclave) (dollar 31.37) and low temperature steam and gaseous formaldehyde sterilization (LTSF) (dollar 255.28). The information provided by the ABC method has optimized the overall understanding of the cost driver process and provided the foundation for assessing performance and improvement in the SPD processes.

  20. The full moon and ED patient volumes: unearthing a myth.

    Science.gov (United States)

    Thompson, D A; Adams, S L

    1996-03-01

    To determine if there is any effect of the full moon on emergency department (ED) patient volume, ambulance runs, admissions, or admissions to a monitored unit, a retrospective analysis of the hospital electronic records of all patients seen in an ED during a 4-year period was conducted in an ED of a suburban community hospital. A full moon occurred 49 times during the study period. There were 150,999 patient visits to the ED during the study period, of which 34,649 patients arrived by ambulance. A total of 35,087 patients was admitted to the hospital and 11,278 patients were admitted to a monitored unit. No significant differences were found in total patient visits, ambulance runs, admissions to the hospital, or admissions to a monitored unit on days of the full moon. The occurrence of a full moon has no effect on ED patient volume, ambulance runs, admissions, or admissions to a monitored unit.

  1. Rebooting the EdD

    Science.gov (United States)

    Wergin, Jon F.

    2011-01-01

    In this essay, Jon Wergin reminds readers of the philosophical and historical foundations of the doctor of education (EdD) degree. He argues that the EdD should be based, in large part, on John Dewey's progressive ideals of democratization and Paulo Freire's concepts of emancipatory education. Drawing on theories of reflective practice,…

  2. EDS becoms CERN Openlab contributor

    CERN Multimedia

    2007-01-01

    "EDS announced that it has become an official contributor to CERN openlab. The purpose of the joint project beteween CERN and EDS is to carry out research and development in the field of monitoring, management and operation of grid services." (1 page)

  3. EDS becomes CERN Openlab contributor

    CERN Multimedia

    2007-01-01

    "EDS today announced that it has become an official contributor to CERN openlab. The purpose of the joint project between CERN and EDS is to carry out research and development in the field of monitoring, management and operaiton of grid services." (2/3 page)

  4. A Successful ED Fall Risk Program Using the KINDER 1 Fall RiskAssessment Tool.

    Science.gov (United States)

    Townsend, Ann B; Valle-Ortiz, Marisol; Sansweet, Tracy

    2016-11-01

    Emergency nurses did not perform falls risk assessments routinely on our ED patients; the instrument used was aimed at inpatients. We identified a need to revise fall assessment practices specific to our emergency department. The purpose of the performance improvement project was to reduce ED falls and evaluate the use of an ED-specific fall risk tool, the KINDER 1 Fall Risk Assessment. The plan was to establish fall risk assessment practices at point of ED entry and to decrease total falls.

  5. Using the Deming quality improvement method to manage medical record department product lines.

    Science.gov (United States)

    Postal, S N

    1990-06-01

    The above application of the quality improvement cycle provides insight into the use of the Deming method to address one of several identified customer needs and expectations obtained during the managing phase of product-line administration. Implementation of the quality improvement method requires a major commitment from all team members. Process improvement requires a willingness to be detail oriented. Gathering of statistics--such as analysis turn-around time--and evaluation are critical. This objective view of processes requires accountability and a commitment to change. Improvements focus on long-term problem resolution, not the quick fixes that result from addressing symptoms of problems. True problem resolution occurs by solving the root causes of variations. Medical record departments must move from being outcome oriented to being process focused. It is no longer feasible to be constantly putting out fires in an environment that demands well-planned and well-designed products that meet customers' expectations. The long-term management of product lines requires a systematic method of planning, doing, checking, and acting. The Deming quality improvement method provides a framework for positive change that focuses on quality processes resulting in a quality product that meets consumers' needs.

  6. A new quantification method based on SEM-EDS to assess fly ash composition and study the reaction of its individual components in hydrating cement paste

    Energy Technology Data Exchange (ETDEWEB)

    Durdziński, Paweł T., E-mail: pawel.durdzinski@gmail.com [Laboratory of Construction Materials, École Polytechnique Fédérale de Lausanne (EPFL), Station 12, CH-1015 Lausanne (Switzerland); Dunant, Cyrille F. [Laboratory of Construction Materials, École Polytechnique Fédérale de Lausanne (EPFL), Station 12, CH-1015 Lausanne (Switzerland); Haha, Mohsen Ben [HeidelbergCement Technology Center GmbH (HeidelbergCement AG), Rohrbacher Str. 95, 69181 Leimen (Germany); Scrivener, Karen L. [Laboratory of Construction Materials, École Polytechnique Fédérale de Lausanne (EPFL), Station 12, CH-1015 Lausanne (Switzerland)

    2015-07-15

    Calcareous fly ashes are high-potential reactive residues for blended cements, but their qualification and use in concrete are hindered by heterogeneity and variability. Current characterization often fails to identify the dominant, most reactive, amorphous fraction of the ashes. We developed an approach to characterize ashes using electron microscopy. EDS element composition of millions of points is plotted in a ternary frequency plot. A visual analysis reveals number and ranges of chemical composition of populations: silicate, calcium-silicate, aluminosilicate, and calcium-rich aluminosilicate. We quantified these populations in four ashes and followed their hydration in two Portland-ash systems. One ash reacted at a moderate rate: it was composed of 70 vol.% of aluminosilicates and calcium-silicates and reached 60% reaction at 90 days. The other reacted faster, reaching 60% at 28 days due to 55 vol.% of calcium-rich aluminosilicates, but further reaction was slower and 15 vol.% of phases, the silica-rich ones, did not react.

  7. Safety and efficiency of emergency department interrogation of cardiac devices

    Science.gov (United States)

    Neuenschwander, James F.; Peacock, W. Frank; Migeed, Madgy; Hunter, Sara A.; Daughtery, John C.; McCleese, Ian C.; Hiestand, Brian C.

    2016-01-01

    Objective Patients with implanted cardiac devices may wait extended periods for interrogation in emergency departments (EDs). Our purpose was to determine if device interrogation could be done safely and faster by ED staff. Methods Prospective randomized, standard therapy controlled, trial of ED staff device interrogation vs. standard process (SP), with 30-day follow-up. Eligibility criteria: ED presentation with a self-report of a potential device related complaint, with signed informed consent. SP interrogation was by company representative or hospital employee. Results Of 60 patients, 42 (70%) were male, all were white, with a median (interquartile range) age of 71 (64 to 82) years. No patient was lost to follow up. Of all patients, 32 (53%) were enrolled during business hours. The overall median (interquartile range) ED vs. SP time to interrogation was 98.5 (40 to 260) vs. 166.5 (64 to 412) minutes (P=0.013). While ED and SP interrogation times were similar during business hours, 102 (59 to 138) vs. 105 (64 to 172) minutes (P=0.62), ED interrogation times were shorter vs. SP during non-business hours; 97 (60 to 126) vs. 225 (144 to 412) minutes, P=0.002, respectively. There was no difference in ED length of stay between the ED and SP interrogation, 249 (153 to 390) vs. 246 (143 to 333) minutes (P=0.71), regardless of time of presentation. No patient in any cohort suffered an unplanned medical contact or post-discharge adverse device related event. Conclusion ED staff cardiac device interrogations are faster, and with similar 30-day outcomes, as compared to SP. PMID:28168230

  8. Health Care Utilization before and after an Outpatient Emergency Department Visit in Older People

    Science.gov (United States)

    Horney, Carolyn; Schmader, Kenneth; Sanders, Linda L.; Heflin, Mitchell; Ragsdale, Luna; McConnell, Eleanor; Hocker, Michael; Hastings, S. Nicole

    2010-01-01

    Background Older adults in the U.S. receive a significant amount of care in the emergency department (ED), yet the associations between ED and other types of health care utilization has not been adequately studied in this population. Objectives The goal of this study were to examine the relationships between health care use before and after an ED visit among older adults. Methods This retrospective cohort study examined health care use among 308 patients ≥ 65 years old discharged from a university-affiliated ED. Proportional-hazards models were used to assess the relationship between pre-ED health care use (primary care physician (PCP), specialist, ED and hospital) and risk of return ED visits. Results Older ED patients in this study had visited other types of providers frequently in the previous year (median number of primary care physician (PCP) and specialist visits = 4). Patients who used the ED on 2 or more occasions in the previous year were found to have visited their PCP more often than those without frequent ED use (median number of visits 7.0 vs 4.0, p<.001). Despite more PCP use in this population, frequent ED use was associated with increased risk of a repeat ED visit (HR 2.20, 95% CI 1.15–4.21), in models adjusted for demographics and health status. Conclusion Older adults who use the ED are also receiving significant amounts of care from other sources; simply providing additional access to care may not improve outcomes for these vulnerable individuals. PMID:21216555

  9. Injury patterns in children with frequent emergency department visits

    DEFF Research Database (Denmark)

    Laursen, B

    2006-01-01

    OBJECTIVES: To compare injury patterns in children with many and few emergency department (ED) visits in order to reveal the causes for the frequent visits. METHODS: Three cohorts of Danish children (total 579 721 children) were followed for three years when their ages were 0-2, 6-8, and 12...

  10. TechEdSat Project

    Data.gov (United States)

    National Aeronautics and Space Administration — The overall goal of the Technical Education Satellite (TechEdSat) is to employ a small spacecraft to evaluate, demonstrate, and validate two new technologies for...

  11. Factors Associated With Emergency Department Visits

    Directory of Open Access Journals (Sweden)

    Parul Agarwal

    2016-05-01

    Full Text Available Objective: The objective of this study was to examine the association of patient- and county-level factors with the emergency department (ED visits among adult fee-for-service (FFS Medicaid beneficiaries residing in Maryland, Ohio, and West Virginia. Methods: A cross-sectional design using retrospective observational data was implemented. Patient-level data were obtained from 2010 Medicaid Analytic eXtract files. Information on county-level health-care resources was obtained from the Area Health Resource file and County Health Rankings file. Results: In adjusted analyses, the following patient-level factors were associated with higher number of ED visits: African Americans (incidence rate ratios [IRR] = 1.47, Hispanics (IRR = 1.63, polypharmacy (IRR = 1.89, and tobacco use (IRR = 2.23. Patients with complex chronic illness had a higher number of ED visits (IRR = 3.33. The county-level factors associated with ED visits were unemployment rate (IRR = 0.94 and number of urgent care clinics (IRR = 0.96. Conclusion: Patients with complex healthcare needs had a higher number of ED visits as compared to those without complex healthcare needs. The study results provide important baseline context for future policy analysis studies around Medicaid expansion options.

  12. The Financial Impact of Emergency Department Crowding

    Directory of Open Access Journals (Sweden)

    Foley, Mathew

    2011-05-01

    Full Text Available Objective: The economic benefits of reducing emergency department (ED crowding are potentially substantial as they may decrease hospital length of stay. Hospital administrators and public officials may therefore be motivated to implement crowding protocols. We sought to identify a potential cost of ED crowding by evaluating the contribution of excess ED length of stay (LOS to overall hospital length of stay. Methods: We performed a retrospective review of administrative data of adult patients from two urban hospitals (one county and one university in Brooklyn, New York from 2006-2007. Data was provided by each facility. Extrapolating from prior research (Krochmal and Riley, 2005, we determined the increase in total hospital LOS due to extended ED lengths of stay, and applied cost and charge analyses for the two separate facilities. Results: We determined that 6,205 (5.0% admitted adult patients from the county facility and 3,017 (3.4% patients from the university facility were held in the ED greater than one day over a one-year period. From prior research, it has been estimated that each of these patient’s total hospital length of stay was increased on average by 11.7% (0.61 days at the county facility, and 0.71 days at the university facility. The increased charges over one year at the county facility due to the extended ED LOS was therefore approximately $9.8 million, while the increased costs at the university facility were approximately $3.9 million. Conclusion: Based on extrapolations from Krochmal and Riley applied to two New York urban hospitals, the county hospital could potentially save $9.8 million in charges and the university hospital $3.9 million in costs per year if they eliminate ED boarding of adult admitted patients by improving movement to the inpatient setting. [West J Emerg Med. 2011;12(2:192-197.

  13. Perception of Noise by Emergency Department Nurses

    Directory of Open Access Journals (Sweden)

    John Graneto

    2013-09-01

    Full Text Available Introduction: Noise in the emergency department (ED may be perceived to be high by both patients and nurses alike. This increased noise level is hypothesized to be responsible for communication interference and subsequent disruption of complex procedures and decision-making. The objective of this study is to quantify ambient noise level in an ED while obtaining coincident subjective surveys from nurses in the assessment of actual versus perceived noise.Methods: Data collected from surveys of ED nurses on each of 3 different dates revealed that sound levels within the selected ED were consistently at or below 70 decibels (dB of sound as measured by a sound level meter. This level of sound is of the same decibel of normal conversation at a 3-5 foot distance. Nurses surveyed overwhelmingly rated noise as “low” or “not loud” irrespective of a variance (though predominantly within a 10 dB range in actual sound decibel measurements.Results: Years of experience of work within emergency departments proved the most consistent predictor of nurses’ opinions on the frequency with which noise levels within the ED were louder than they should be, with more experienced nurses all ranking noise levels as “frequently” or “always” louder than they should be.Conclusion: Individual variance existed in how nurses felt that noise level affected work function. ED nurses��� perception of noise is perceived to be low and generally not interfering with their cognitive function. [West J Emerg Med. 2013;14(5:547–550.

  14. Process Improvements to Reform Patient Flow in the Emergency Department.

    Science.gov (United States)

    Whatley, Shawn D; Leung, Alexander K; Duic, Marko

    2016-01-01

    Emergency departments (ED) function to diagnose, stabilize, manage and dispose patients as efficiently as possible. Although problems may be suspected at triage, ED physician input is required at each step of the patient journey through the ED, from diagnosis to disposition. If we want timely diagnosis, appropriate treatment and great outcomes, then ED processes should connect patients and physicians as quickly as possible. This article discusses the key concepts of ED patient flow, value and efficiency. Based on these fundamentals, it describes the significant impact of ED process improvements implemented on measures of ED efficiency at a large community ED in Ontario, Canada.

  15. Rate, characteristics, and factors associated with high emergency department utilization

    NARCIS (Netherlands)

    M.C. van der Linden (M. Christien); C.L. van den Brand (Crispijn); N. van der Linden (Naomi); A.H. Rambach (Anna H.J.H.); C. Brumsen (Caro)

    2014-01-01

    textabstractBackground: Patients with high emergency department (ED) utilization account for a disproportionate number of ED visits. The existing research on high ED utilization has raised doubts about the homogeneity of the frequent ED user. Attention to differences among the subgroups of frequent

  16. Exploring the Relationship Among Moral Distress, Coping, and the Practice Environment in Emergency Department Nurses.

    Science.gov (United States)

    Zavotsky, Kathleen Evanovich; Chan, Garrett K

    2016-01-01

    Emergency department (ED) nurses practice in environments that are highly charged and unpredictable in nature and can precipitate conflict between the necessary prescribed actions and the individual's sense of what is morally the right thing to do. As a consequence of multiple moral dilemmas, ED staff nurses are at risk for experiencing distress and how they cope with these challenges may impact their practice. To examine moral distress in ED nurses and its relationship to coping in that specialty group. Using survey methods approach. One hundred ninety-eight ED nurses completed a moral distress, coping, and demographic collection instruments. Advanced statistical analysis was completed to look at relationships between the variables. Data analysis did show that moral distress is present in ED nurses (M = 80.19, SD = 53.27), and when separated into age groups, the greater the age, the less the experience of moral distress. A positive relationship between moral distress and some coping mechanisms and the ED environment was also noted. This study's findings suggest that ED nurses experience moral distress and could receive some benefit from utilization of appropriate coping skills. This study also suggests that the environment in which ED nurses practice has a significant impact on the experience of moral distress. Because health care is continuing to evolve, it is critical that issues such as moral distress and coping be studied in ED nurses to help eliminate human suffering.

  17. Stroke Risk After Non-Stroke ED Dizziness Presentations: A Population-Based Cohort Study

    Science.gov (United States)

    Kerber, Kevin A.; Zahuranec, Darin B.; Brown, Devin L.; Meurer, William J.; Burke, James F.; Smith, Melinda A.; Lisabeth, Lynda D.; Fendrick, A. Mark; McLaughlin, Thomas; Morgenstern, Lewis B.

    2014-01-01

    Objective Acute stroke is a serious concern in Emergency Department (ED) dizziness presentations. Prior studies, however, suggest that stroke is actually an unlikely cause of these presentations. Lacking are data on short- and long-term follow-up from population-based studies to establish stroke risk after presumed non-stroke ED dizziness presentations. Methods From 5/8/2011 to 5/7/2012, patients ≥ 45 years of age presenting to EDs in Nueces County, Texas, with dizziness, vertigo, or imbalance were identified, excluding those with stroke as the initial diagnosis. Stroke events after the ED presentation up to 10/2/2012 were determined using the Brain Attack Surveillance in Corpus Christi (BASIC) study, which uses rigorous surveillance and neurologist validation. Cumulative stroke risk was calculated using Kaplan-Meier estimates. Results 1,245 patients were followed for a median of 347 days (IQR 230- 436 days). Median age was 61.9 years (IQR, 53.8-74.0 years). After the ED visit, fifteen patients (1.2%) had a stroke. Stroke risk was 0.48% (95% CI, 0.22%-1.07%) at 2 days; 0.48% (95% CI, 0.22%-1.07%) at 7 days; 0.56% (95% CI, 0.27%-1.18%) at 30 days; 0.56% (95% CI, 0.27%-1.18%) at 90 days; and 1.42% (95% CI, 0.85%-2.36%) at 12 months. Interpretation Using rigorous case ascertainment and outcome assessment in a population-based design, we found that the risk of stroke after presumed non-stroke ED dizziness presentations is very low, supporting a non-stroke etiology to the overwhelming majority of original events. High-risk subgroups likely exist, however, because most of the 90-day stroke risk occurred within 2-days. Vascular risk stratification was insufficient to identify these cases. PMID:24788511

  18. Health care utilization before and after an outpatient ED visit in older people.

    Science.gov (United States)

    Horney, Carolyn; Schmader, Kenneth; Sanders, Linda L; Heflin, Mitchell; Ragsdale, Luna; McConnell, Eleanor; Hocker, Michael; Hastings, S Nicole

    2012-01-01

    Older adults in the United States receive a significant amount of care in the emergency department (ED), yet the associations between ED and other types of health care utilization have not been adequately studied in this population. The goals of this study were to examine the relationships between health care use before and after an ED visit among older adults. This retrospective cohort study examined health care use among 308 patients 65 years or older discharged from a university-affiliated ED. Proportional-hazards models were used to assess the relationship between pre-ED health care use (primary care physician [PCP], specialist, ED, and hospital) and risk of return ED visits. Older ED patients in this study had visited other types of providers frequently in the previous year (median number of PCP and specialist visits, 4). Patients who used the ED on 2 or more occasions in the previous year were found to have visited their PCP more often than those without frequent ED use (median number of visits, 7.0 vs 4.0; P < .001). Despite more PCP use in this population, frequent ED use was associated with increased risk of a repeat ED visit (hazard ratio, 2.20; 95% confidence interval, 1.15-4.21), in models adjusted for demographics and health status. Older adults who use the ED are also receiving significant amounts of care from other sources; simply providing additional access to care may not improve outcomes for these vulnerable individuals. Published by Elsevier Inc.

  19. Factors affecting ED length-of-stay in surgical critical care patients.

    Science.gov (United States)

    Davis, B; Sullivan, S; Levine, A; Dallara, J

    1995-09-01

    To determine what patient characteristics are associated with prolonged emergency department (ED) length-of-stay (LOS) for surgical critical care patients, the charts of 169 patients admitted from the ED directly to the operating room (OR) or intensive care unit (ICU) during a 6-week period in 1993 were reviewed. The ED record was reviewed for documentation of factors that might be associated with prolonged ED LOS, such as use of computed tomographic (CT), radiology special procedures, and the number of plain radiographs and consultants. ED LOS was considered to be the time from triage until a decision was made to admit the patient. Using a Cox proportional hazards model, use of CT and special procedures were the strongest independent predictors of prolonged ED length-of-stay. The number of plain radiographs and consultants had only a minimal effect. Use of a protocol-driven trauma evaluation system was associated with a shorter ED LOS. In addition to external factors that affect ED overcrowding, ED patient management decisions may also be associated with prolonged ED length-of-stay. Such ED-based factors may be more important in surgical critical care patients, whose overall ED LOS is affected more by the length of the ED work-up rather than the time spent waiting for a ICU bed or operating suite.

  20. CriticalEd

    DEFF Research Database (Denmark)

    Kjellberg, Caspar Mølholt; Meredith, David

    2014-01-01

    The best text method is commonly applied among music scholars engaged in producing critical editions. In this method, a comment list is compiled, consisting of variant readings and editorial emendations. This list is maintained by inserting the comments into a document as the changes are made....... Since the comments are not input sequentially, with regard to position, but in arbitrary order, this list must be sorted by copy/pasting the rows into place—an error-prone and time-consuming process. Scholars who produce critical editions typically use off-the-shelf music notation software...... such as Sibelius or Finale. It was hypothesized that it would be possible to develop a Sibelius plug-in, written in Manuscript 6, that would improve the critical editing work flow, but it was found that the capabilities of this scripting language were insufficient. Instead, a 3-part system was designed and built...

  1. The emergency department "carousel": an ethnographically-derived model of the dynamics of patient flow.

    Science.gov (United States)

    Nugus, Peter; Forero, Roberto; McCarthy, Sally; McDonnell, Geoff; Travaglia, Joanne; Hilman, Ken; Braithwaite, Jeffrey

    2014-01-01

    Emergency department (ED) overcrowding reduces efficiency and increases the risk of medical error leading to adverse events. Technical solutions and models have done little to redress this. A full year's worth of ethnographic observations of patient flow were undertaken, which involved making hand-written field-notes of the communication and activities of emergency clinicians (doctors and nurses), in two EDs in Sydney, Australia. Observations were complemented by semi-structured interviews. We applied thematic analysis to account for the verbal communication and activity of emergency clinicians in moving patients through the ED. The theoretical model that emerged from the data analysis is the ED "carousel". Emergency clinicians co-construct a moving carousel which we conceptualise visually, and which accounts for the collective agency of ED staff, identified in the findings. The carousel model uniquely integrates diagnosis, treatment and transfer of individual patients with the intellectual labour of leading and coordinating the department. The latter involves managing staff skill mix and the allocation of patients to particular ED sub-departments. The model extends traditional patient flow representations and underlines the importance of valuing ethnographic methods in health services research, in order to foster organisational learning, and generate creative practical and policy alternatives that may, for example, reduce or ameliorate access block and ED overcrowding. Copyright © 2013 Elsevier Ltd. All rights reserved.

  2. Effect of a change management program in a medical device reprocessing department: a mixed methods study.

    Science.gov (United States)

    Chadwick, Judy; Knapp, Mike; Sinclair, Douglas; Arshoff, Larry

    2014-01-01

    Faced with a variety of challenges in relation to performance, quality, staff engagement and morale in the Medical Device Reprocessing Department, managers at St. Michael's Hospital developed and implemented several innovative approaches including combining staff training and performance metrics. The results of these initiatives included a substantial reduction in the departmental budget along with higher productivity, output and quality; better staff morale; an improved relationship between management and the union; and a stronger partnership between the department and its institutional customers.

  3. Quantum physics. 2. ed.

    Energy Technology Data Exchange (ETDEWEB)

    Scheck, Florian [Mainz Univ. (Germany). Inst. fuer Physik, Theoretische Elementarteilchenphysik

    2013-11-01

    New edition with added sections on nonlinear quantum mechanics and path integral methods in field theory. Contains an encyclopedic coverage from uncertainty relation to many-body systems, from symmetries to electroweak interation. Includes problems, partly with solutions, partly with hints towards solutions. Starting with basic principles and providing the framework all vital elements of nonrelativistic quantum mechanics are explained, even an introduction to quantum electrodynamics is included. Scheck's Quantum Physics presents a comprehensive introductory treatment, ideally suited for a two-semester course. Part One covers the basic principles and prime applications of quantum mechanics, from the uncertainty relations to many-body systems. Part Two introduces to relativistic quantum field theory and ranges from symmetries in quantum physics to electroweak interactions. Numerous worked-out examples as well as exercises, with solutions or hints, enables the book's use as an accompanying text for courses, and also for independent study. For both parts, the necessary mathematical framework is treated in adequate form and detail. The book ends with appendices covering mathematical fundamentals and enrichment topics, plus selected biographical notes on pioneers of quantum mechanics and quantum field theory. The new edition was thoroughly revised and now includes new sections on quantization using the path integral method and on deriving generalized path integrals for bosonic and fermionic fields.

  4. Emergency team calls for critically ill non-trauma patients in the emergency department

    DEFF Research Database (Denmark)

    Jensen, Søren Marker; Do, Hien Quoc; Rasmussen, Søren W.

    2015-01-01

    BACKGROUND: Handling critically ill patients is a complex task for Emergency Department (ED) personnel. Initial treatment is of major importance and requires adequately experienced ED doctors to initiate and decide for the right medical or surgical treatment. Our aim was, with regard to clinical...... presentation, management and mortality to describe adult non-trauma patients that upon ED arrival elicited emergency team calls. METHODS: An observational study of adult patients (≥ 18 years) admitted to a regional ED with conditions that elicited acute team activation and additional emergency team.......004). Additionally, 115 adult patients were admitted to the ICU directly from the ED without eliciting an emergency team call during the study period. These patients mainly comprised patients who were intoxicated, were unconscious or had respiratory failure. CONCLUSION: The majority of emergency team call patients...

  5. Systematic Review of ED-based Intimate Partner Violence Intervention Research

    Directory of Open Access Journals (Sweden)

    Esther K. Choo,

    2015-12-01

    Full Text Available Introduction: Assessment reactivity may be a factor in the modest results of brief interventions for substance use in the emergency department (ED. The presence of assessment reactivity in studies of interventions for intimate partner violence (IPV has not been studied. Our objectives were to identify ED IPV intervention studies and evaluate the presence of a consistently positive effect on the control groups. Methods: We performed a systematic search of electronic databases for English=language intervention studies addressing IPV in the ED published since 1990. Study selection and assessment of methodologic quality were performed by two independent reviewers. Data extraction was performed by one reviewer and then independently checked for completeness and accuracy by a second reviewer. Results: Of 3,620 unique manuscripts identified by database search, 667 underwent abstract review and 12 underwent full-text review. Only three met full eligibility criteria; data on the control arm were available for two studies. In these two studies, IPV-related outcomes improved for both the experimental and control condition. Conclusion: The paucity of controlled trials of IPV precluded a robust evaluation for assessment reactivity. This study highlighted a critical gap in ED research on IPV.

  6. Mathematical Modeling of the Impact of Hospital Occupancy: When Do Dwindling Hospital Beds Cause ED Gridlock?

    Directory of Open Access Journals (Sweden)

    Lori Whelan

    2014-01-01

    Full Text Available Objectives. The time emergency department (ED patients spend from presentation to admittance is known as their length of stay (LOS. This study aimed to quantify the inpatient occupancy rate (InptOcc/ED LOS relationship and develop a methodology for identifying resource-allocation triggers using InptOcc-LOS association-curve inflection points. Methods. This study was conducted over 200 consecutive days at a 700-bed hospital with an annual ED census of approximately 50,000 using multivariate spline (piecewise regression to model the InptOcc/LOS relationship while adjusting for confounding covariates. Nonlinear modeling was used to assess for InptOcc/LOS associations and determine the inflection point where InptOcc profoundly impacted LOS. Results. At lower InptOcc, there was no association. Once InptOcc reached ≥88%, there was a strong InptOcc/LOS association; each 1% InptOcc increase predicted a 16-minute (95% CI, 12–20 minutes LOS prolongation, while the confounder-adjusted analysis showed each 1% InptOcc increase >89% precipitating a 13-minute (95% CI, 10–16 minutes LOS prolongation. Conclusions. The study hospital’s InptOcc was a significant predictor of prolonged ED LOS beyond the identified inflection point. Spline regression analysis identified a clear inflection point in the InptOcc-LOS curve that potentially identified a point at which to optimize inpatient bed availability to prevent increased costs of prolonged LOS.

  7. Heat conduction. 3. ed.

    Energy Technology Data Exchange (ETDEWEB)

    Jiji, Latif M. [City Coll. of City Univ. of New York, NY (United States). Dept. of Mechanical Engineering

    2009-07-01

    This textbook presents the classical topics of conduction heat transfer and extends the coverage to include chapters on perturbation methods, heat transfer in living tissue, and microscale conduction. This makes the book unique among the many published textbook on conduction heat transfer. Other noteworthy features of the book are: The material is organized to provide students with the tools to model, analyze and solve a wide range of engineering applications involving conduction heat transfer. Mathematical techniques are presented in a clear and simplified fashion to be used as instruments in obtaining solutions. The simplicity of one-dimensional conduction is used to drill students in the role of boundary conditions and to explore a variety of physical conditions that are of practical interest. Examples are carefully selected to illustrate the application of principles and the construction of solutions. Students are trained to follow a systematic problem solving methodology with emphasis on thought process, logic, reasoning and verification. Solutions to all examples and end-of-chapter problems follow an orderly problems solving approach. (orig.)

  8. Blowers. 2. ed.; Ventilatoren

    Energy Technology Data Exchange (ETDEWEB)

    Bommes, L.; Fricke, J.; Grundmann, R. (eds.)

    2003-07-01

    Economic efficiency, high availability, materials and wear resistance are still the main goals of development on the blower sector, together with noise reduction. Subjects: (a) Modified methods for calculation and design of axial and radial blowers; (b) Test stand measurements of aerodynamic and acoustic performance; (c) Problems of experimental determination of performance data; (d) effects of the installation conditions and thre resulting electric field disturbances influencing the aerodynamic and acoustic blower characteristics; (e) Centrifugal and vibration loads on the rotors; (f) Determination of the axial thrust of radial blowers; (g) Special designs and specifications for special applications; (h) Blower noise: Sources, measurement, prediction; (i) Noise reduction measures; (j) Specific aspects of working with solid-gas mixtures. The book presents a wide range of research findings, modern design methods and problem solutions. Fundamentals of fluidics, thermodynamics, similarity mechanics and aeroacoustics are discussed in detail in as far as they are of importance for blower construction. This second edition was revised with a view to practical applicability and to the latest state of research. (orig.) [German] Ventilatoren sind zentraler Bestandteil aller lueftungstechnischen Anlagen- und Geraetesysteme und daher fuer deren Funktionstuechtigkeit von ausschlaggebender Bedeutung. Sie zaehlen nach der heute gueltigen Definition zu den Stroemungsmaschinen, in denen mechanische Energie in Stroemungsenergie umgewandelt wird. Nach der Norm reicht bei Ventilatoren der Bereich der Druckerhoehung des Foerdermediums zwischen Ventilatoreintritt und -austritt bis zu 30 000 Pa, entsprechend einem Druckverhaeltnis bis zu 1,3. Hauptentwicklungsziele bei Ventilatoren sind nach wie vor die Steigerung der Wirtschaftlichkeit, Betriebssicherheit, Werkstoffbelastbarkeit und Verschleissfestigkeit. Darueber hinaus spielen im Rahmen des staendig wachsenden Umweltbewusstseins

  9. Real-time demand forecasting in the emergency department.

    Science.gov (United States)

    Jones, Spencer S

    2007-10-11

    Shifts in the supply of and demand for emergency department (ED) services have led to ED overcrowding and make the efficient allocation of ED resources increasingly important. Reliable means of modeling and forecasting the demand for resources are critical to any ED resource planning strategy. Vector Autoregression (VAR) is a flexible multivariate time-series forecasting methodology that is well suited to modeling demand for resources in the ED.

  10. Graduate Program Assessment of Student Satisfaction: A Method for Merging University and Department Outcomes.

    Science.gov (United States)

    Lipschultz, Jeremy H.; Hilt, Michael L.

    1999-01-01

    Evaluates a communication graduate program based upon the perceptions of M.A. alumni satisfaction. Uses the department's assessment plan to measure graduates' perceived knowledge of theory and research, as well as feelings about career preparation. Finds that assessment measures related to content taught may be linked to perceptions about quality,…

  11. Graduate Program Assessment of Student Satisfaction: A Method for Merging University and Department Outcomes.

    Science.gov (United States)

    Lipschultz, Jeremy H.; Hilt, Michael L.

    1999-01-01

    Evaluates a communication graduate program based upon the perceptions of M.A. alumni satisfaction. Uses the department's assessment plan to measure graduates' perceived knowledge of theory and research, as well as feelings about career preparation. Finds that assessment measures related to content taught may be linked to perceptions about quality,…

  12. Tackling causes and costs of ED presentation for American football injuries: a population-level study.

    Science.gov (United States)

    Smart, Blair J; Haring, R Sterling; Asemota, Anthony O; Scott, John W; Canner, Joseph K; Nejim, Besma J; George, Benjamin P; Alsulaim, Hatim; Kirsch, Thomas D; Schneider, Eric B

    2016-07-01

    American tackle football is the most popular high-energy impact sport in the United States, with approximately 9 million participants competing annually. Previous epidemiologic studies of football-related injuries have generally focused on specific geographic areas or pediatric age groups. Our study sought to examine patient characteristics and outcomes, including hospital charges, among athletes presenting for emergency department (ED) treatment of football-related injury across all age groups in a large nationally representative data set. Patients presenting for ED treatment of injuries sustained playing American tackle football (identified using International Classification of Diseases, Ninth Revision, Clinical Modification code E007.0) from 2010 to 2011 were studied in the Nationwide Emergency Department Sample. Patient-specific injuries were identified using the primary International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code and categorized by type and anatomical region. Standard descriptive methods examined patient demographics, diagnosis categories, and ED and inpatient outcomes and charges. During the study period 397363 football players presented for ED treatment, 95.8% of whom were male. Sprains/strains (25.6%), limb fractures (20.7%), and head injuries (including traumatic brain injury; 17.5%) represented the most presenting injuries. Overall, 97.9% of patients underwent routine ED discharge with 1.1% admitted directly and fewer than 11 patients in the 2-year study period dying prior to discharge. The proportion of admitted patients who required surgical interventions was 15.7%, of which 89.9% were orthopedic, 4.7% neurologic, and 2.6% abdominal. Among individuals admitted to inpatient care, mean hospital length of stay was 2.4days (95% confidence interval, 2.2-2.6) and 95.6% underwent routine discharge home. The mean total charge for all patients was $1941 (95% confidence interval, $1890-$1992) with substantial

  13. Acupuncture as analgesia for non-emergent acute non-specific neck pain, ankle sprain and primary headache in an emergency department setting: a protocol for a parallel group, randomised, controlled pilot trial

    OpenAIRE

    2014-01-01

    Introduction This study aims to assess the feasibility of acupuncture as an add-on intervention for patients with non-emergent acute musculoskeletal pain and primary headache in an emergency department (ED) setting. Methods and analysis A total of 40 patients who present to the ED and are diagnosed to have acute non-specific neck pain, ankle sprain or primary headache will be recruited by ED physicians. An intravenous or intramuscular injection of analgesics will be provided as the initial st...

  14. Quantitative sensory testing measures individual pain responses in emergency department patients

    Directory of Open Access Journals (Sweden)

    Duffy KJ

    2017-05-01

    Full Text Available Kevin J Duffy, Katharyn L Flickinger, Jeffrey T Kristan, Melissa J Repine, Alexandro Gianforcaro, Rebecca B Hasley, Saad Feroz, Jessica M Rupp, Jumana Al-Baghli, Maria L Pacella, Brian P Suffoletto, Clifton W Callaway Department of Emergency Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA Background: Refining and individualizing treatment of acute pain in the emergency department (ED is a high priority, given that painful complaints are the most common reasons for ED visits. Few tools exist to objectively measure pain perception in the ED setting. We speculated that variation in perception of fixed painful stimuli would explain individual variation in reported pain and response to treatment among ED patients. Materials and methods: In three studies, we 1 describe performance characteristics of brief quantitative sensory testing (QST in 50 healthy volunteers, 2 test effects of 10 mg oxycodone versus placebo on QST measures in 18 healthy volunteers, and 3 measure interindividual differences in nociception and treatment responses in 198 ED patients with a painful complaint during ED treatment. QST measures adapted for use in the ED included pressure sensation threshold, pressure pain threshold (PPT, pressure pain response (PPR, and cold pain tolerance (CPT tests. Results: First, all QST measures had high inter-rater reliability and test–retest reproducibility. Second, 10 mg oxycodone reduced PPR, increased PPT, and prolonged CPT. Third, baseline PPT and PPR revealed hyperalgesia in 31 (16% ED subjects relative to healthy volunteers. In 173 (88% ED subjects who completed repeat testing 30 minutes after pain treatment, PPT increased and PPR decreased (Cohen’s dz 0.10–0.19. Verbal pain scores (0–10 for the ED complaint decreased by 2.2 (95% confidence intervals [CI]: 1.9, 2.6 (Cohen’s dz 0.97 but did not covary with the changes in PPT and PPR (r=0.05–0.13. Treatment effects were greatest in ED subjects

  15. Mitigating Higher Ed Cyber Attacks

    Science.gov (United States)

    Rogers, Gary; Ashford, Tina

    2015-01-01

    In this presentation we will discuss the many and varied cyber attacks that have recently occurred in the higher ed community. We will discuss the perpetrators, the victims, the impact and how these institutions have evolved to meet this threat. Mitigation techniques and defense strategies will be covered as will a discussion of effective security…

  16. Triple Rule Out versus CT Angiogram Plus Stress Test for Evaluation of Chest Pain in the Emergency Department

    OpenAIRE

    Sawyer, Kelly N.; Payal Shah; Lihua Qu; Kurz, Michael C.; Clark, Carol L.; Swor, Robert A.

    2015-01-01

    Introduction: Undifferentiated chest pain in the emergency department (ED) is a diagnostic challenge. One approach includes a dedicated chest computed tomography (CT) for pulmonary embolism or dissection followed by a cardiac stress test (TRAD). An alternative strategy is a coronary CT angiogram with concurrent chest CT (Triple Rule Out, TRO). The objective of this study was to describe the ED patient course and short-term safety for these evaluation methods. Methods: This was ...

  17. Physician Assistants Contribution to Emergency Department Productivity

    Directory of Open Access Journals (Sweden)

    Christopher Brook, MD

    2012-05-01

    Full Text Available Introduction: The objective of this report is to determine physician assistant (PA productivity in anacademic emergency department (ED and to determine whether shift length or department censusimpact productivity.Methods: A retrospective chart review was conducted at a tertiary ED during June and July of 2007.Productivity was calculated as the mean number of patients seen each hour. Analysis of variance wasused to compare the productivity of different length shifts, and linear regression analysis was used toassess the relationship between productivity and department volume.Results: One hundred sixty PA shifts were included. Shifts ranged from 4 to 13 hours. Meanproductivity was 1.16 patients per hour (95% confidence interval [CI] ¼ 1.12–1.20. Physicianassistants generated a mean of 2.35 relative value units (RVU per hour (95% CI¼1.98–2.72. Therewas no difference in productivity on different shift lengths (P¼0.73. There was no correlation betweendepartmental census and productivity, with an R2 (statistical term for the coefficient of determination of0.01.Conclusion: In the ED, PAs saw 1.16 patients and generated 2.35 RVUs per hour. The length of theshift did not affect productivity. Productivity did not fluctuate significantly with changing departmentalvolume.

  18. Measuring social contacts in the emergency department.

    Directory of Open Access Journals (Sweden)

    Douglas W Lowery-North

    Full Text Available BACKGROUND: Infectious individuals in an emergency department (ED bring substantial risks of cross infection. Data about the complex social and spatial structure of interpersonal contacts in the ED will aid construction of biologically plausible transmission risk models that can guide cross infection control. METHODS AND FINDINGS: We sought to determine the number and duration of contacts among patients and staff in a large, busy ED. This prospective study was conducted between 1 July 2009 and 30 June 2010. Two 12-hour shifts per week were randomly selected for study. The study was conducted in the ED of an urban hospital. There were 81 shifts in the planned random sample of 104 (78% with usable contact data, during which there were 9183 patient encounters. Of these, 6062 (66% were approached to participate, of which 4732 (78% agreed. Over the course of the year, 88 staff members participated (84%. A radiofrequency identification (RFID system was installed and the ED divided into 89 distinct zones structured so copresence of two individuals in any zone implied a very high probability of contact <1 meter apart in space. During study observation periods, patients and staff were given RFID tags to wear. Contact events were recorded. These were further broken down with respect to the nature of the contacts, i.e., patient with patient, patient with staff, and staff with staff. 293,171 contact events were recorded, with a median of 22 contact events and 9 contacts with distinct individuals per participant per shift. Staff-staff interactions were more numerous and longer than patient-patient or patient-staff interactions. CONCLUSIONS: We used RFID to quantify contacts between patients and staff in a busy ED. These results are useful for studies of the spread of infections. By understanding contact patterns most important in potential transmission, more effective prevention strategies may be implemented.

  19. Nurses' evaluation of a new formalized triage system in the emergency department - a qualitative study

    DEFF Research Database (Denmark)

    Johansen, Mette Brehm; Forberg, Jakob Lundager

    2011-01-01

    Formalized triage in the emergency department (ED) is not widely used in Denmark; this study explores the effects of introducing a five-level process triage system in a Danish ED.......Formalized triage in the emergency department (ED) is not widely used in Denmark; this study explores the effects of introducing a five-level process triage system in a Danish ED....

  20. Thermally Induced Silane Dehydrocoupling on Silicon Nanostructures (International ed.)

    Science.gov (United States)

    2016-07-29

    Arkles Gelest Inc. 11 East Steel Rd., Morrisville, PA 19067 (USA) Y. W. Jun, Prof. Dr. K. H. Ahn Department of Chemistry Pohang University of Science...Figure 1a) and elemental analysis by energy-dispersive X-ray (EDS) analysis revealed strong carbon and oxygen signals (Table S2). By contrast, a

  1. Registered Nurses and Discharge Planning in a Taiwanese ED: A Neglected Issue?

    Science.gov (United States)

    Chang, Wen; Goopy, Suzanne; Lin, Chun-Chih; Barnard, Alan; Liu, Hsueh-Erh; Han, Chin-Yen

    2016-10-01

    Published research on discharge planning is written from the perspective of hospital wards and community services. Limited research focuses on discharge planning in the emergency department (ED). The objective of this study was to identify ED nurses' perceptions of factors influencing the implementation of discharge planning. This qualitative study collected data from 25 ED nurses through in-depth interviews and a drawing task in which participants were asked to depict on paper the implementation of discharge planning in their practice. Factors influencing discharge planning were grouped into three categories: discharge planning as a neglected issue in the ED, heavy workload, and the negative attitudes of ED patients and their families. The study highlighted a need for effective discharge planning to be counted as an essential clinical competency for ED nurses and factored into their everyday workload. Nurses perceived that organizational culture, and parents' and relatives' attitudes were barriers to implementing discharge teaching in the ED.

  2. Effect of the improving teaching method on the prevention of needle stick injuries in the department of infectious disease

    Directory of Open Access Journals (Sweden)

    Yi CHEN

    2014-11-01

    Full Text Available Objective: To discuss the effect of improving teaching method and strengthening the training of occupational protection on the prevention of needle stick injuries in the department of infectious disease. Methods: Collect 17 cases of needle stick injuries that occurred in 2012 among 178 nurses in department of infectious disease. The same cases occurred in 2013 when the nurses had received the occupational protection training and targeted countermeasures were also collected. Results: The incidence of needle stick injuries was 9.55% in infectious department in 2012, and it is down to 3.4% in 2013. Conclusion: Nursing students are more likely to cause needle stick injuries. Training of occupational protection together with nursing technical operation specification can effectively control the occurrence of needle stick injuries.

  3. Delirium in the Emergency Department and Its Extension into Hospitalization (DELINEATE) Study: Effect on 6-month Function and Cognition.

    Science.gov (United States)

    Han, Jin H; Vasilevskis, Eduard E; Chandrasekhar, Rameela; Liu, Xulei; Schnelle, John F; Dittus, Robert S; Ely, E Wesley

    2017-06-01

    The natural course and clinical significance of delirium in the emergency department (ED) is unclear. We sought to (1) describe the extent to which delirium in the ED persists into hospitalization (ED delirium duration) and (2) determine how ED delirium duration is associated with 6-month functional status and cognition. Prospective cohort study. Tertiary care, academic medical center. ED patients ≥65 years old who were admitted to the hospital. The modified Brief Confusion Assessment Method was used to ascertain delirium in the ED and hospital. Premorbid and 6-month function were determined using the Older American Resources and Services Activities of Daily Living (OARS ADL) questionnaire which ranged from 0 (completely dependent) to 28 (completely dependent). Premorbid and 6-month cognition were determined using the short form Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) which ranged from 1 to 5 (severe dementia). Multiple linear regression was performed to determine if ED delirium duration was associated with 6-month function and cognition adjusted for baseline OARS ADL and IQCODE, and other confounders. A total of 228 older ED patients were enrolled. Of the 105 patients who were delirious in the ED, 81 (77.1%) patients' delirium persisted into hospitalization. For every ED delirium duration day, the 6-month OARS ADL decreased by 0.63 points (95% CI: -1.01 to -0.24), indicating poorer function. For every ED delirium duration day, the 6-month IQCODE increased 0.06 points (95% CI: 0.01-0.10) indicating poorer cognition. Delirium in the ED is not a transient event and frequently persists into hospitalization. Longer ED delirium duration is associated with an incremental worsening of 6-month functional and cognitive outcomes. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  4. Which Dermatological Conditions Present to an Emergency Department in Australia?

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    Julia Lai-Kwon

    2014-01-01

    Full Text Available Background/Objectives. There is minimal data available on the types of dermatological conditions which present to tertiary emergency departments (ED. We analysed demographic and clinical features of dermatological presentations to an Australian adult ED. Methods. The St. Vincent’s Hospital Melbourne (SVHM ED database was searched for dermatological presentations between 1 January 2009 and 31 December 2011 by keywords and ICD-10 diagnosis codes. The lists were merged, and the ICD-10 codes were grouped into 55 categories for analysis. Demographic and clinical data for these presentations were then analysed. Results. 123 345 people presented to SVHM ED during the 3-year period. 4817 (3.9% presented for a primarily dermatological complaint. The most common conditions by ICD-10 diagnosis code were cellulitis (n=1741, 36.1%, allergy with skin involvement (n=939, 19.5%, boils/furuncles/pilonidal sinuses (n=526, 11.1%, eczema/dermatitis (n=274, 5.7%, and varicella zoster infection (n=161, 3.3%. Conclusion. The burden of dermatological disease presenting to ED is small but not insignificant. This information may assist in designing dermatological curricula for hospital clinicians and specialty training organisations as well as informing the allocation of dermatological resources to ED.

  5. National study of emergency department observation services.

    Science.gov (United States)

    Wiler, Jennifer L; Ross, Michael A; Ginde, Adit A

    2011-09-01

    The objective was to describe patient and facility characteristics of emergency department (ED) observation services in the United States. The authors analyzed the 2007 National Hospital Ambulatory Medical Care Survey (NHAMCS). Characteristics of EDs with observation units (OUs) were compared to those without, and patients with a disposition of ED observation were compared to those with a "short-stay" (observational analysis. An estimated 1,746 U.S. EDs (36%) reported having OUs, of which 56% are administratively managed by ED staff. Fifty-two percent of hospitals with ED-managed OUs are in an urban location, and 89% report ED boarding, compared to 29 and 65% of those that do not have an OU. The admission rate is 38% at those with ED-managed OUs and 15% at those without OUs. Of the 15.1% of all ED patients who are kept in the hospital following an ED visit, one-quarter are kept for either a short-stay admission (1.8%) or an ED observation admission (2.1%). Most (82%) ED observation patients were discharged from the ED. ED observation patients were similar to short-stay admission patients in terms of age (median = 52 years for both, interquartile range = 36 to 70 years), self-pay (12% vs. 10%), ambulance arrival (37% vs. 36%), urgent/emergent triage acuity (77% vs. 74%), use of ≥1 ED medication (64% vs.76%), and the most common primary chief complaints and primary diagnoses. Over one-third of U.S. EDs have an OU. Short-stay admission patients have similar characteristics as ED observation patients and may represent an opportunity for the growth of OUs. © 2011 by the Society for Academic Emergency Medicine.

  6. Investigation on corrosion stratigraphy and morphology in some Iron Age bronze alloys vessels by OM, XRD and SEM-EDS methods

    Science.gov (United States)

    Oudbashi, Omid; Hasanpour, Ata; Davami, Parviz

    2016-04-01

    The recently study of the corrosion in some bronze artefacts from the Sangtarashan Iron Age site, western Iran, was established to identify corrosion morphology and mechanism in these objects. The corrosion layers in 22 samples were studied by optical microscopy, scanning electron microscopy-energy-dispersive X-ray spectroscopy and X-ray diffraction methods. The results showed that a thin corrosion crust has formed on the surface of bronzes with a triple-layer structure, including two internal and one external corrosion layers. The formation of these layers is due to copper leaching from the bronze surface. The internal corrosion part has been a compact, tin-rich corrosion/oxidation product (noble patina) with some evidences from original metallurgical aspects of the bronze as well as a very thin layer beneath the tin-rich layer. External corrosion products have been identified as basic copper carbonates, malachite and azurite. Based on the results, the corrosion morphology in the Sangtarashan Iron Age bronzes is due to long-term burial in an appropriate environment in a moderately corrosive soil. Although it is the first time to investigate Iron Age bronzes from Iran, this corrosion morphology is partially similar to type I corrosion morphology observed in archaeological bronze objects; nevertheless, some deviations are visible in comparison with previously established patterns.

  7. Overview of Deployed EDS Technologies

    Energy Technology Data Exchange (ETDEWEB)

    Martz, H E; Crawford, C

    2009-09-24

    The term explosive detection system (EDS) is used by the TSA to describe equipment that is certified to detect explosives in checked bags. The EDS, as certified, by the TSL must consist of device for interrogating a bag and an automated detection algorithm (ATD) for evaluating the results of the interrogation. We only consider CT as the interrogation device in this report. A schematic drawing of a CT-based EDS is shown in Figure 2. The output of the ATD is the binary decision of alarm or non-alarm. Alarms may true- or false-positives. Non-alarms may be true- or false-negatives. False positives are also denoted false alarms. The true detection means that the ATD reports an alarm when a threat is present in the scanned bag. The probability of detecting a threat given that a threat is present is denoted the probability of detection (PD). The probability of false alarm (PFA) is the case when an alarm is reported when a threat is not present in a bag. Certification in this context means passing tests for PD and PFA at the TSL. The results of the EDS include CT cross-sectional images of the bag and specifics about the alarmed objects generated by ATD. These results are presented on a display so that a person may override the decision of ATD and declare the alarm to be a non-alarm. This process is denoted clearing. Bags that are not cleared by the person are sent to a secondary inspection process. Here the bags may be opened or assessed with explosive trace detection (ETD) in order to clear the bags. Bags that are not cleared at this point are evaluated by an ordinance disposal team. The CT scanner along with ATD is denoted Level 1 screening. The process of clearing on a display is denoted Level 2 screening. Secondary inspection is denoted Level 3 screening. Vendors of the deployed EDSs supply the TSA with equipment for all three levels. Therefore, the term EDS may include the equipment provided for Levels 1, 2 and 3. A schematic diagram of an EDS and the levels of

  8. The Impact of Psychiatric Patient Boarding in Emergency Departments

    Directory of Open Access Journals (Sweden)

    B. A. Nicks

    2012-01-01

    Full Text Available Objectives. Studies have demonstrated the adverse effects of emergency department (ED boarding. This study examines the impact of resource utilization, throughput, and financial impact for psychiatric patients awaiting inpatient placement. Methods. The authors retrospectively studied all psychiatric and non-psychiatric adult admissions in an Academic Medical Center ED (>68,000 adult visits from January 2007-2008. The main outcomes were ED length of stay (LOS and associated reimbursement. Results. 1,438 patients were consulted to psychiatry with 505 (35.1% requiring inpatient psychiatric care management. The mean psychiatric patient age was 42.5 years (SD 13.1 years, with 2.7 times more women than men. ED LOS was significantly longer for psychiatric admissions (1089 min, CI (1039–1140 versus 340 min, CI (304–375; <0.001 when compared to non-psychiatric admissions. The financial impact of psychiatric boarding accounted for a direct loss of ($1,198 compared to non-psychiatric admissions. Factoring the loss of bed turnover for waiting patients and opportunity cost due to loss of those patients, psychiatric patient boarding cost the department $2,264 per patient. Conclusions. Psychiatric patients awaiting inpatient placement remain in the ED 3.2 times longer than non-psychiatric patients, preventing 2.2 bed turnovers (additional patients per psychiatric patient, and decreasing financial revenue.

  9. Does Limiting Oral Contrast Decrease Emergency Department Length of Stay?

    Directory of Open Access Journals (Sweden)

    Erik Barton

    2012-12-01

    Full Text Available Introduction: The purpose of this study was to examine the impact on emergency department (EDlength of stay (LOS of a new protocol for intravenous (IV-contrast only abdominal/pelvic computedtomography (ABCT compared to historical controls.Methods: This was a retrospective case-controlled study performed at a single academic medicalcenter. Patients ≥ 18 undergoing ABCT imaging for non-traumatic abdominal pain were included inthe study. We compared ED LOS between historical controls undergoing ABCT imaging with PO/IVcontrast and study patients undergoing an IV-contrast-only protocol. Imaging indications were thesame for both groups and included patients with clinical suspicion for appendicitis, diverticulitis, smallbowel obstruction, or perforation. We identified all patients from the hospital’s electronic storehouse(imaging code, ordering department, imaging times, and we abstracted ED LOS and dispositionfrom electronic medical records.Results: Two hundred and eleven patients who underwent PO/IV ABCT prep were compared to 184patients undergoing IV-contrast only ABCT prep. ED LOS was shorter for patients imaged with theIV-contrast only protocol (4:35 hrs vs. 6:39 hrs, p < 0.0001.Conclusion: Implementation of an IV-contrast only ABCT prep for select ED patients presentingfor evaluation of acute abdominal pain significantly decreased ED LOS.

  10. Simulation modelling of a patient surge in an emergency department under disaster conditions

    Directory of Open Access Journals (Sweden)

    Muhammet Gul

    2015-10-01

    Full Text Available The efficiency of emergency departments (EDs in handling patient surges during disaster times using the available resources is very important. Many EDs require additional resources to overcome the bottlenecks in emergency systems. The assumption is that EDs consider the option of temporary staff dispatching, among other options, in order to respond to an increased demand or even the hiring temporarily non-hospital medical staff. Discrete event simulation (DES, a well-known simulation method and based on the idea of process modeling, is used for establishing ED operations and management related models. In this study, a DES model is developed to investigate and analyze an ED under normal conditions and an ED in a disaster scenario which takes into consideration an increased influx of disaster victims-patients. This will allow early preparedness of emergency departments in terms of physical and human resources. The studied ED is located in an earthquake zone in Istanbul. The report on Istanbul’s disaster preparedness presented by the Japan International Cooperation Agency (JICA and Istanbul Metropolitan Municipality (IMM, asserts that the district where the ED is located is estimated to have the highest injury rate. Based on real case study information, the study aims to suggest a model on pre-planning of ED resources for disasters. The results indicate that in times of a possible disaster, when the percentage of red patient arrivals exceeds 20% of total patient arrivals, the number of red area nurses and the available space for red area patients will be insufficient for the department to operate effectively. A methodological improvement presented a different distribution function that was tested for service time of the treatment areas. The conclusion is that the Weibull distribution function used in service process of injection room fits the model better than the Gamma distribution function.

  11. Be careful with triage in emergency departments: interobserver agreement on 1,578 patients in France

    Directory of Open Access Journals (Sweden)

    Olivier Philippe

    2011-10-01

    Full Text Available Abstract Background For several decades, emergency departments (EDs utilization has increased, inducing ED overcrowding in many countries. This phenomenon is related partly to an excessive number of nonurgent patients. To resolve ED overcrowding and to decrease nonurgent visits, the most common solution has been to triage the ED patients to identify potentially nonurgent patients, i.e. which could have been dealt with by general practitioner. The objective of this study was to measure agreement among ED health professionals on the urgency of an ED visit, and to determine if the level of agreement is consistent among different sub-groups based on following explicit criteria: age, medical status, type of referral to the ED, investigations performed in the ED, and the discharge from the ED. Methods We conducted a multicentric cross-sectional study to compare agreement between nurses and physicians on categorization of ED visits into urgent or nonurgent. Subgroups stratified by criteria characterizing the ED visit were analyzed in relation to the outcome of the visit. Results Of 1,928 ED patients, 350 were excluded because data were lacking. The overall nurse-physician agreement on categorization was moderate (kappa = 0.43. The levels of agreement within all subgroups were variable and low. The highest agreement concerned three subgroups of complaints: cranial injury (kappa = 0.61, gynaecological (kappa = 0.66 and toxicology complaints (kappa = 1.00. The lowest agreement concerned two subgroups: urinary-nephrology (kappa = 0.09 and hospitalization (kappa = 0.20. When categorization of ED visits into urgent or nonurgent cases was compared to hospitalization, ED physicians had higher sensitivity and specificity than nurses (respectively 94.9% versus 89.5%, and 43.1% versus 30.9%. Conclusions The lack of physician-nurse agreement and the inability to predict hospitalization have important implications for patient safety. When urgency screening is used

  12. Management of Pediatric Skin Abscesses in Pediatric, General Academic and Community Emergency Departments

    Directory of Open Access Journals (Sweden)

    Baumann, Brigitte M

    2011-05-01

    Full Text Available Objectives: To compare the evaluation and management of pediatric cutaneous abscess patients at three different emergency department (ED settings.Method: We conducted a retrospective cohort study at two academic pediatric hospital EDs, a general academic ED and a community ED in 2007, with random sampling of 100 patients at the three academic EDs and inclusion of 92 patients from the community ED. Eligible patients were ≤18 years who had a cutaneous abscess. We recorded demographics, predisposing conditions, physical exam findings, incision and drainage procedures, therapeutics and final disposition. Laboratory data were reviewed for culture results and antimicrobial sensitivities. For subjects managed as outpatients from the ED, we determined where patients were instructed to follow up and, using electronic medical records, ascertained the proportion of patients who returned to the ED for further management.Result: Of 392 subjects, 59% were female and the median age was 7.7 years. Children at academic sites had larger abscesses compared to community patients, (3.5 versus 2.5 cm, p=0.02. Abscess incision and drainage occurred in 225 (57% children, with the lowest rate at the academic pediatric hospital EDs (51% despite the relatively larger abscess size. Procedural sedation and the collection of wound cultures were more frequent at the academic pediatric hospital and the general academic EDs. Methicillin-resistant Staphylococcus aureus (MRSA prevalence did not differ among sites; however, practitioners at the academic pediatric hospital EDs (92% and the general academic ED (86% were more likely to initiate empiric MRSA antibiotic therapy than the community site (71%, (p<0.0001. At discharge, children who received care at the community ED were more likely to be given a prescription for a narcotic (23% and told to return to the ED for ongoing wound care (65%. Of all sites, the community ED also had the highest percentage of follow-up visits (37

  13. Patients Prefer Boarding in Inpatient Hallways: Correlation with the National Emergency Department Overcrowding Score

    Directory of Open Access Journals (Sweden)

    John R. Richards

    2011-01-01

    Full Text Available Objective. The boarding of patients in Emergency Department (ED hallways when no inpatient beds are available is a major cause of ED crowding. One solution is to board admitted patients in an inpatient rather than ED hallway. We surveyed patients to determine their preference and correlated their responses to real-time National Emergency Department Overcrowding Score (NEDOCS. Methods. This was a survey of admitted patients in the ED of an urban university level I trauma center serving a community of 5 million about their personal preferences regarding boarding. Real-time NEDOCS was calculated at the time each survey was conducted. Results. 99 total surveys were completed during October 2010, 42 (42% patients preferred to be boarded in an inpatient hallway, 33 (33% preferred the ED hallway, and 24 (24% had no preference. Mean (±SD NEDOCS (range 0–200 was 136±46 for patients preferring inpatient boarding, 112±39 for ED boarding, and 119±43 without preference. Male patients preferred inpatient hallway boarding significantly more than females. Preference for inpatient boarding was associated with a significantly higher NEDOCS. Conclusions. In this survey study, patients prefer inpatient hallway boarding when the hospital is at or above capacity. Males prefer inpatient hallway boarding more than females. The preference for inpatient hallway boarding increases as the ED becomes more crowded.

  14. Further development of a method for assessing mine rescuers` heat tolerance. Final report; Rev. ed.; Weiterentwicklung eines Verfahrens zur Ermittlung der Waermevertraeglichkeit von Grubenwehrmitgliedern. Schlussbericht

    Energy Technology Data Exchange (ETDEWEB)

    Bresser, G.; Kampmann, B.

    1997-08-01

    A test method was to be developed which permits reliable prediction of mine rescuers` heat tolerance. Apart from the anthropometric data like age, body weight and body size, further reference data were to be obtained from a standard test and a test of the rescuers` physical condition (Dynavit{sup R} test). These tests provide further parameters that may influence heat tolerance and which have been monitored both quantitatively and qualitatively for long years by the Central Mine Rescuing Authority. The description of stress incurred during the standard test and the heat test while wearing protective clothing will relate the criteria applied for the standard physical acceptance examination to the loads incurred during the tests. In order to take account of day-to-day variations of physical fitness, quarterly tests were carried out with four staff members, and performance variations were recorded. The results will serve as a basis for deciding on how rigid potential classification criteria should be applied. (orig./MG) [Deutsch] Es sollte ein Testverfahren entwickelt werden, das eine zuverlaessige Prognose der Waermevertraeglichkeit eines Grubenwehrmitgliedes zulaesst. Als Bezugsrahmen sollte die Beanspruchung bei der Standarduebung und das Abschneiden bei einem Konditionstest (Dynavit{sup R}-Test) zusaetzlich erfasst werden. Damit stehen - neben den anthropometrischen Daten wie Alter, Koerpergewicht und Koerpergroesse - weitere moegliche Einflussgroessen zur Abschaetzung der Hitzetauglichkeit zur Verfuegung, ueber deren Groesse und Verteilung langjaehrige Erfahrungen im Bereich der Hauptstelle fuer das Grubenrettungswesen vorliegen. Durch die Beschreibung der Beanspruchung der Grubenwehrmitglieder bei der Standarduebung und bei der Klimabelastung unter Flammenschutzkleidung sollen die Kriterien der Grubenwehrtauglichkeitsuntersuchung in Bezug zur Beanspruchung bei Uebungen gesetzt werden. Um die Schwankungen der Tagesform, die bei den Untersuchungen vorliegt

  15. Defining Emergency Department Necessary Policies Based on Clinical Governance Accreditation Scores

    Directory of Open Access Journals (Sweden)

    Mehrdad Esmailian

    2015-05-01

    Full Text Available Introduction: The role of accreditation scheme in quality improvement of emergency departments (ED has not been thoroughly evaluated in studies. Therefore, this study was designed to appraise the effects of policies defined based on clinical governance accreditation scores, on improvement of the procedures in ED. Methods: The present cohort study was carried out in the ED of Alzahra University Hospital, Isfahan, Iran in 2012-2013. In 2012 the deficiencies in ED of this hospital was determined based on clinical governance indicators. Then the deficiencies were classified based on their importance and changes were made in the ED. Finally, the effects of the changes were evaluated in August 2013. Results: The evaluation made in 2012 showed that 23 clinical and non-clinical procedures were carried out with deficiencies. Over the mentioned period, 6 (26.1% procedures were not done at all, while 17 (73.9% were done without a policy and irregularly. The overall score for clinical and non-clinical procedures in the ED before carrying out the accreditation scheme was 43 / 230 (18.7% of the maximum possible score. The score was raised to 222 equal to 96.5% of the maximum possible score after carrying out the scheme. This increase was statistically significant (p < 0.001. Conclusion: The findings of the present study showed that defining policies for improving the procedures carried out in ED based on accreditation scheme leads to improvement of medical services in ED.

  16. Effective recruitment method for the marketing department of a metallurgical enterprise

    Directory of Open Access Journals (Sweden)

    E. Jaba

    2014-04-01

    Full Text Available This paper presents some solutions to recruit staff for the Marketing Department of a metallurgical enterprise. Our goal is to present the psychological characteristics of a certain category of employees on a sample of 107 employees and to evaluate the relationship between the motivation to work and those characteristics. In order to realize such evaluation we used the linear mixed effects model in the statistical software program R. The results showed that a significant effect on work motivation have factors like work climate and the employee agreeability.

  17. ED becomes 'lean' and cuts LBTC, LOS times.

    Science.gov (United States)

    2008-04-01

    Lean manufacturing techniques, first developed by Toyota, can be successfully adapted to help improve processes in your ED. St. Luke's Episcopal Hospital in Houston, has used Lean to reduce median length of stay, frequency of diversions, and the percentage of patients who left before treatment was complete (LBTC). Here's why "Lean" can help improve the performance of your ED: It enables you and your staff to see things from the patient's point of view. Lean tools enable you to view the status of your department in real-time and to compare that status with your performance goals. Exercises help identify areas where your processes break down and determine the most likely solutions.

  18. New psych unit eases patient burden in ED.

    Science.gov (United States)

    2008-06-01

    Creating a special unit for psychiatric patients frees up beds in your ED, ensures better care for that patient population, and improves the atmosphere in the main department for the rest of your patients. Consider these suggestions: The creation of a psych unit can be extremely costly. Be prepared to demonstrate projected savings when pitching the idea to administration. Make sure an ED physician has overall responsibility for each patient at all times. Keep a regular group of nurses in rotation. This setup will help ensure smooth handoffs.

  19. Ed Watson - 1940-2006

    CERN Document Server

    2006-01-01

    Ed Watson passed away suddenly on 1 August in Geneva, he was 66. He leaves his wife and two children. Ed Watson arrived at CERN in March 1973 to work on digital electronics and CAMAC systems under Bob Dobinson, after many years at Rolls Royce in Scotland. He joined the European Muon Collaboration in 1976, where he played a major role in the design, deployment and running of its data acquisition system (DAQ) with David Botterill, Bob Dobinson, and Vicky White. The CAMAC-ROMULUS system was by far the largest and most advanced of its time, and it became a defining standard for DAQ systems for years to come. Ed was deeply involved in the detailed planning of the control rooms and the experiment cabling, as well as sharing the responsibility for the CAMAC readout system. He had a real talent for trouble shooting and played a vital part in supporting the experiment throughout its lifetime. He offered great moral support to the younger members of the collaboration and helped them a great deal with their work. The...

  20. Ed Watson 1940-2006

    CERN Multimedia

    2006-01-01

    Ed Watson arrived at CERN in March 1973 to work on digital electronics and CAMAC systems under Bob Dobinson, after many years at Rolls Royce in Scotland. He joined the European Muon Collaboration in 1976, where he played a major role in the design, deployment and running of its data acquisition system (DAQ) with David Botterill, Bob Dobinson, and Vicky White. The CAMAC-ROMULUS system was by far the largest and most advanced of its time, and it became a defining standard for DAQ systems for years to come. Ed was deeply involved in the detailed planning of the control rooms and the experiment cabling, as well as sharing the responsibility for the CAMAC readout system. He had a real talent for trouble shooting and played a vital part in supporting the experiment throughout its lifetime. He offered great moral support to the younger members of the collaboration and helped them a great deal with their work. The EMC had a wonderful social life to which Ed was a major contributor - who can forget its barbecues?  In...

  1. SWOT analysis: The analytical method in the process of planning and its application in the development of orthopaedic hospital department

    Directory of Open Access Journals (Sweden)

    Terzić Zorica

    2010-01-01

    Full Text Available Introduction. SWOT analysis is a managerial tool used to evaluate internal and external environment through strengths and weaknesses, opportunities and threats. Objective. The aim was to demonstrate the application of the SWOT analysis on the example of the Department for Paediatric Orthopaedics and Traumatology at the Institute of Orthopaedic Surgery 'Banjica' in Belgrade. Methods. Qualitative research was conducted during December 2008 at the Department for Paediatric Orthopaedics and Traumatology of the Institute of Orthopaedic Surgery 'Banjica' by applying the focus group technique. Participants were members of the medical staff and patients. In the first phase of the focus group brainstorming was applied to collect the factors of internal and external environment, and to identify strengths and weaknesses, opportunities and threats, respectively. In the second phase the nominal group technique was applied in order to reduce the list of factors. The factors were assessed according to their influence on the Department. Factors ranked by the three point Likert scale from 3 (highest impact to 1 (lowest impact. Results. The most important strengths of the Department are competent and skilled staff, high quality of services, average hospital bed utilization, the Department providing the educational basis of the School of Medicine, satisfied patients, pleasant setting, and additional working hours. The weaknesses are: poor spatial organization, personnel unmotivated to refresh knowledge, lack of specifically trained personnel, inadequate sanitary facilities, and uncovered services by the Insurance Fund, long average hospital stay, and low economic status of patients. The opportunities are: legislative regulations, formed paediatric traumatology service at the City level, good regional position of the Institute, and extension of referral areas. The threats are: absent Department autonomy in the personnel policy of the Institute, competitions within

  2. Determining the rate of follow-up after hospital emergency department visits for dental conditions

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    Meyer B

    2016-03-01

    Full Text Available Beau Meyer,1,2 Eric Adkins,3,4 Nathan M Finnerty,4 Fonda G Robinson5 1Division of Pediatric Dentistry, College of Dentistry, The Ohio State University, Columbus, OH, 2Department of Pediatric Dentistry, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 3The Ohio State University Wexner Medical Center Emergency Department, 4Department of Emergency Medicine, College of Medicine, 5Clinic Administration and Patient Care, College of Dentistry, The Ohio State University, Columbus, OH, USA Background: Emergency department (ED visits for dental reasons continue to impact EDs nationwide. This investigation determined the rate of follow-up in an emergency dental clinic (EDC after hospital ED visits for nontraumatic dental conditions. Methods: This prospective investigation reports the number of patients who presented to an ED for nontraumatic dental conditions and the rate of follow-up at an EDC. Upon ED discharge, patients were provided instructions to follow-up for low-cost care at the EDC. Telephone contact was attempted following failed referrals. Descriptive statistics were reported for comparing referral sources and demographic trends. Results: Two hundred and forty-seven referrals were made and 31% followed up for definitive treatment at the EDC. More referrals were made on weekends than on weekdays. Failed referrals were unreachable by telephone in 75% of cases. Tooth extraction was the most common treatment rendered in the EDC. Of the ED patients who accessed EDC care, 14% became comprehensive patients in the EDC's regular dental clinic. Conclusion: Less than one-third of ED referrals to the EDC followed up for definitive care when provided an opportunity to do so, and 75% of referrals were unreachable by telephone in the week following the ED dental visit. Keywords: emergencies, dental health services, health services accessibility, access to care, dental emergency treatment

  3. Applying the Balanced Scorecard Strategic Evaluation Method to a University Athletic Department

    Directory of Open Access Journals (Sweden)

    THANOS KRIEMADIS, ANDREAS KOTSOVOS & PANAYIOTIS ALEXOPOULOS

    2008-01-01

    Full Text Available The Balanced Scorecard (BSC has been extensively used in manufacturing organisations, service organisations, non-profit organisations, and governmental organizations with outstanding results (Kaplan and Norton, 2001b. Performance measures are at the core of the BSC system.However, financial measurement alone does not reflect the organisational mission of governmental and non-profit organisations; rather the mission of government or non-profitorganisation should be placed at top of the BSC in measuring whether such an organisation has been successful. Hence, the greatest difference between businesses and nonprofit organisations lies in the achievement of the mission.The purpose of this article is to present the evaluation of the performance of a University Athletic Department using the balanced scorecard strategic approach which includes four dimensions such as: (a the customer dimension, (b the financial dimension,(c the learning and growth dimension and (d the internal business process dimension.

  4. Racial Disparity in Duration of Patient Visits to the Emergency Department: Teaching Versus Non-teaching Hospitals

    Directory of Open Access Journals (Sweden)

    Zynal Karaca

    2013-09-01

    Full Text Available Introduction: The sources of racial disparity in duration of patients’ visits to emergency departments (EDs have not been documented well enough for policymakers to distinguish patient-related factors from hospital- or area-related factors. This study explores the racial disparity in duration of routine visits to EDs at teaching and non-teaching hospitals.Methods: We performed retrospective data analyses and multivariate regression analyses to investigate the racial disparity in duration of routine ED visits at teaching and non-teaching hospitals. The Healthcare Cost and Utilization Project (HCUP State Emergency Department Databases (SEDD were used in the analyses. The data include 4.3 million routine ED visits encountered in Arizona, Massachusetts, and Utah during 2008. We computed duration for each visit by taking the difference between admission and discharge times.Results: The mean duration for a routine ED visit was 238 minutes at teaching hospitals and 175 minutes at non-teaching hospitals. There were significant variations in duration of routine ED visits across race groups at teaching and non-teaching hospitals. The risk-adjusted results show that the mean duration of routine ED visits for Black/African American and Asian patients when compared to visits for white patients was shorter by 10.0 and 3.4%, respectively, at teaching hospitals; and longer by 3.6 and 13.8%, respectively, at non-teaching hospitals. Hispanic patients, on average, experienced 8.7% longer ED stays when compared to white patients at non-teaching hospitals.Conclusion: There is significant racial disparity in the duration of routine ED visits, especially in non-teaching hospitals where non-White patients experience longer ED stays compared to white patients. The variation in duration of routine ED visits at teaching hospitals when compared to non-teaching hospitals was smaller across race groups. [West J Emerg Med. 2013;14(5:529–541.

  5. HCUP Nationwide Emergency Department Database (NEDS) Restricted Access File

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Nationwide Emergency Department Sample (NEDS) was created to enable analyses of emergency department (ED) utilization patterns and support public health...

  6. Trends of CT Use in the Pediatric Emergency Department in a Tertiary Academic Hospital of Korea during 2001-2010

    OpenAIRE

    2012-01-01

    Objective We wanted to assess the trends of computed tomography (CT) examinations in a pediatric emergency department (ED). Materials and Methods We searched the medical database to identify the pediatric patients who had visited the ED, and the number of CTs conducted from January 2001 to December 2010. We analyzed the types of CTs, according to the anatomic region, and the patients who underwent CT examinations for multiple regions. Data were stratified, according to the patient age (< 13 y...

  7. Graduate Physics Education Adding Industrial Culture and Methods to a Traditional Graduate Physics Department

    Science.gov (United States)

    Vickers, Ken

    2005-03-01

    The education and training of the workforce needed to assure global competitiveness of American industry in high technology areas, along with the proper role of various disciplines in that educational process, is currently being re-examined. Several academic areas in science and engineering have reported results from such studies that revealed several broad themes of educational need that span and cross the boundaries of science and engineering. They included greater attention to and the development of team-building skills, personal or interactive skills, creative ability, and a business or entrepreneurial where-with-all. We will report in this paper the results of a fall 2000 Department of Education FIPSE grant to implement changes in its graduate physics program to address these issues. The proposal goal was to produce next-generation physics graduate students that are trained to evaluate and overcome complex technical problems by their participation in courses emphasizing the commercialization of technology research. To produce next-generation physics graduates who have learned to work with their student colleagues for their mutual success in an industrial-like group setting. And finally, to produce graduates who can lead interdisciplinary groups in solving complex problems in their career field.

  8. Predicting asthma-related emergency department visits using big data.

    Science.gov (United States)

    Ram, Sudha; Zhang, Wenli; Williams, Max; Pengetnze, Yolande

    2015-07-01

    Asthma is one of the most prevalent and costly chronic conditions in the United States, which cannot be cured. However, accurate and timely surveillance data could allow for timely and targeted interventions at the community or individual level. Current national asthma disease surveillance systems can have data availability lags of up to two weeks. Rapid progress has been made in gathering nontraditional, digital information to perform disease surveillance. We introduce a novel method of using multiple data sources for predicting the number of asthma-related emergency department (ED) visits in a specific area. Twitter data, Google search interests, and environmental sensor data were collected for this purpose. Our preliminary findings show that our model can predict the number of asthma ED visits based on near-real-time environmental and social media data with approximately 70% precision. The results can be helpful for public health surveillance, ED preparedness, and targeted patient interventions.

  9. The utility of transvaginal ultrasound in the ED evaluation of complications of first trimester pregnancy.

    Science.gov (United States)

    Panebianco, Nova L; Shofer, Frances; Fields, J Matthew; Anderson, Kenton; Mangili, Alessandro; Matsuura, Asako C; Dean, Anthony J

    2015-06-01

    For patients with early intrauterine pregnancy (IUP), the sonographic signs of the gestation may be below the resolution of transabdominal ultrasound (TAU); however, it may be identified by transvaginal ultrasound (TVU). We sought to determine how often TVU performed in the emergency department (ED) reveals a viable IUP after a nondiagnostic ED TAU and the impact of ED TVU on patient length of stay (LOS). This was a retrospective cohort study of women presenting to our ED with complications of early pregnancy from January 1, 2007 to February 28, 2009 in a single urban adult ED. Abstractors recorded clinical and imaging data in a database. Patient imaging modality and results were recorded and compared with respect to ultrasound (US) findings and LOS. Of 2429 subjects identified, 795 required TVU as part of their care. Emergency department TVU was performed in 528 patients, and 267 went to radiology (RAD). Emergency department TVU identified a viable IUP in 261 patients (49.6%). Patients having initial ED US had shorter LOS than patients with initial RAD US (median 4.0 vs 6.0 hours; P < .001). Emergency department LOS was shorter for women who had ED TVU performed compared with those sent for RAD TVU regardless of the findings of the US (median 4.9 vs 6.7 hours; P < .001). There was no increased LOS for patients who needed further RAD US after an indeterminate ED TVU (7.0 vs 7.1 hours; P = .43). There was no difference in LOS for those who had a viable IUP confirmed on ED TAU vs ED (median 3.1 vs 3.2 hours, respectively; P < .32). When an ED TVU was performed, a viable IUP was detected 49.6% of the time. Emergency department LOS was significantly shorter for women who received ED TVU after indeterminate ED TAU compared with those sent to RAD for TVU, with more marked time savings among those with live IUP diagnosed on ED TVU. For patients who do not receive a definitive diagnosis of IUP on ED TVU, this approach does not result in increased LOS. Copyright © 2015

  10. Improving ED specimen TAT using Lean Six Sigma.

    Science.gov (United States)

    Sanders, Janet H; Karr, Tedd

    2015-01-01

    Lean and Six Sigma are continuous improvement methodologies that have garnered international fame for improving manufacturing and service processes. Increasingly these methodologies are demonstrating their power to also improve healthcare processes. The purpose of this paper is to discuss a case study for the application of Lean and Six Sigma tools in the reduction of turnaround time (TAT) for Emergency Department (ED) specimens. This application of the scientific methodologies uncovered opportunities to improve the entire ED to lab system for the specimens. This case study provides details on the completion of a Lean Six Sigma project in a 1,000 bed tertiary care teaching hospital. Six Sigma's Define, Measure, Analyze, Improve, and Control methodology is very similar to good medical practice: first, relevant information is obtained and assembled; second, a careful and thorough diagnosis is completed; third, a treatment is proposed and implemented; and fourth, checks are made to determine if the treatment was effective. Lean's primary goal is to do more with less work and waste. The Lean methodology was used to identify and eliminate waste through rapid implementation of change. The initial focus of this project was the reduction of turn-around-times for ED specimens. However, the results led to better processes for both the internal and external customers of this and other processes. The project results included: a 50 percent decrease in vials used for testing, a 50 percent decrease in unused or extra specimens, a 90 percent decrease in ED specimens without orders, a 30 percent decrease in complete blood count analysis (CBCA) Median TAT, a 50 percent decrease in CBCA TAT Variation, a 10 percent decrease in Troponin TAT Variation, a 18.2 percent decrease in URPN TAT Variation, and a 2-5 minute decrease in ED registered nurses rainbow draw time. This case study demonstrated how the quantitative power of Six Sigma and the speed of Lean worked in harmony to improve

  11. Comparison of traditional and interactive teaching methods in a UK emergency department.

    Science.gov (United States)

    Armstrong, Peter; Elliott, Tim; Ronald, Julie; Paterson, Brodie

    2009-12-01

    Didactic teaching remains a core component of undergraduate education, but developing computer assisted learning (CAL) packages may provide useful alternatives. We compared the effectiveness of interactive multimedia-based tutorials with traditional, lecture-based models for teaching arterial blood gas interpretation to fourth year medical students. Participants were randomized to complete a tutorial in either lecture or multimedia format containing identical content. Upon completion, students answered five multiple choice questions assessing post-tutorial knowledge, and provided feedback on their allocated learning method. Marks revealed no significant difference between either group. All lecture candidates rated their teaching as good, compared with 89% of the CAL group. All CAL users found multiple choice questions assessment useful, compared with 83% of lecture participants. Both groups highlighted the importance of interaction. CAL complements other teaching methods, but should be seen as an adjunct to, rather than a replacement for, traditional methods, thus offering students a blended learning environment.

  12. AdvancED Flex 4

    CERN Document Server

    Tiwari, Shashank; Schulze, Charlie

    2010-01-01

    AdvancED Flex 4 makes advanced Flex 4 concepts and techniques easy. Ajax, RIA, Web 2.0, mashups, mobile applications, the most sophisticated web tools, and the coolest interactive web applications are all covered with practical, visually oriented recipes. * Completely updated for the new tools in Flex 4* Demonstrates how to use Flex 4 to create robust and scalable enterprise-grade Rich Internet Applications.* Teaches you to build high-performance web applications with interactivity that really engages your users.* What you'll learn Practiced beginners and intermediate users of Flex, especially

  13. Co-­Teaching Social Research Methods in a Joint Sociology/Anthropology Department

    Science.gov (United States)

    Manthei, Jennifer; Isler, Jonathan

    2011-01-01

    In the course of developing and co-­teaching Social Research Methods (SRM), an interdisciplinary, upper-­division undergraduate course at the University of Illinois at Springfield (UIS), the authors discovered that this type of partnership is ripe ground for exploring integration of anthropology and sociology on epistemological and methodological…

  14. The U.S. Department of Agriculture Automated Multiple-Pass Method accurately assesses sodium intakes

    Science.gov (United States)

    Accurate and practical methods to monitor sodium intake of the U.S. population are critical given current sodium reduction strategies. While the gold standard for estimating sodium intake is the 24 hour urine collection, few studies have used this biomarker to evaluate the accuracy of a dietary ins...

  15. Multimedia Education Increases Elder Knowledge of Emergency Department Care

    Directory of Open Access Journals (Sweden)

    Thomas E. Terndrup

    2013-03-01

    Full Text Available Introduction: Elders who utilize the emergency department (ED may have little prospectiveknowledge of appropriate expectations during an ED encounter. Improving elder orientation toED expectations is important for satisfaction and health education. The purpose of this study wasto evaluate a multi-media education intervention as a method for informing independently livingelders about ED care. The program delivered messages categorically as, the number of tests,providers, decisions and disposition decision making.Methods: Interventional trial of representative elders over 59 years of age comparing pre andpost multimedia program exposure. A brief (0.3 hour video that chronicled the key events after ahypothetical 911 call for chest pain was shown. The video used a clinical narrator, 15 ED healthcare providers, and 2 professional actors for the patient and spouse. Pre- and post-video testsresults were obtained with audience response technology (ART assessed learning using a 4point Likert scale.Results: Valid data from 142 participants were analyzed pre to post rankings (Wilcoxon signedranktests. The following four learning objectives showed significant improvements: number oftests expected [median differences on a 4-point Likert scale with 95% confidence intervals: 0.50(0.00, 1.00]; number of providers expected 1.0 (1.00, 1.50; communications 1.0 (1.00, 1.50;and pre-hospital medical treatment 0.50 (0.00, 1.00. Elders (96% judged the intervention asimproving their ability to cope with an ED encounter.Conclusion: A short video with graphic side-bar information is an effective educational strategy toimprove elder understanding of expectations during a hypothetical ED encounter following calling911.

  16. Patient-Centered Care Transition for Patients Admitted through the ED: Improving Patient and Employee Experience

    Directory of Open Access Journals (Sweden)

    Andrea Algauer BSN, RN

    2015-05-01

    Full Text Available With increasing wait times in emergency departments (ED across America, there is a need to streamline the inpatient admission process in order to decrease wait times and more important, to increase patient and employee satisfaction. One inpatient unit at New York-Presbyterian Weill Cornell Medical Center initiated a program to help expedite the inpatient admission process from the ED. The goal of the ED Bridge program is to ease the patient's transition from the ED to an inpatient unit by visiting the patient in the ED and introducing and setting expectations for the inpatient environment (i.e. telemetry alarms, roommates, hourly comfort rounds. Along with improving the patient experience, this program intends to improve the collaboration between ED nurses and inpatient nurses. With the continued support of our nurse management, hospital administrators and most important, our staff, this concept is aimed to increase patient satisfaction scores and subsequently employee satisfaction.

  17. Poor asthma education and medication compliance are associated with increased emergency department visits by asthmatic children

    Directory of Open Access Journals (Sweden)

    Saleh Al-Muhsen

    2015-01-01

    Full Text Available BACKGROUND: Acute exacerbations of bronchial asthma remain a major cause of frequent Emergency Department (ED visits by pediatric patients. However, other factors including psychosocial, behavioural and educational, are also reportedly associated with repetitive ED visits. Therefore, it is necessary to determine whether such visits are justifiable. OBJECTIVE: The objective of this cross-sectional study was to identify risk factors associated with visits to ED by asthmatic children. METHODS: Asthmatic children (n = 297 between 1-17 years old were recruited and information collected at the time of visiting an ED facility at two major hospitals. RESULTS: Asthmatic patients visited the ED 3.9 ΁ 3.2 times-per-year, on average. Inadequately controlled asthma was perceived in 60.3% of patients. The majority of patients (56.4% reported not receiving education about asthma. Patients reflected misconceptions about the ED department, including the belief that more effective treatments are available (40.9%, or that the ED staff is better qualified (27.8%. About half of patients (48.2% visited the ED because of the convenience of being open 24 hours, or because they are received immediately (38.4%. Uncontrolled asthma was associated with poor education about asthma and/or medication use. Patients educated about asthma, were less likely to stop corticosteroid therapy when their symptoms get better (OR:0.55; 95% CI:0.3-0.9; P = 0.04. CONCLUSION: This study reports that most patients had poor knowledge about asthma and were using medications improperly, thus suggesting inefficient application of management action plan. Unnecessary and frequent visits to the ED for asthma care was associated with poor education about asthma and medication use. Potential deficiencies of the health system at directing patients to the proper medical facility were uncovered and underline the necessity to improve education about the disease and medication compliance of patients and

  18. Real time analysis under EDS

    Energy Technology Data Exchange (ETDEWEB)

    Schneberk, D.

    1985-07-01

    This paper describes the analysis component of the Enrichment Diagnostic System (EDS) developed for the Atomic Vapor Laser Isotope Separation Program (AVLIS) at Lawrence Livermore National Laboratory (LLNL). Four different types of analysis are performed on data acquired through EDS: (1) absorption spectroscopy on laser-generated spectral lines, (2) mass spectrometer analysis, (3) general purpose waveform analysis, and (4) separation performance calculations. The information produced from this data includes: measures of particle density and velocity, partial pressures of residual gases, and overall measures of isotope enrichment. The analysis component supports a variety of real-time modeling tasks, a means for broadcasting data to other nodes, and a great degree of flexibility for tailoring computations to the exact needs of the process. A particular data base structure and program flow is common to all types of analysis. Key elements of the analysis component are: (1) a fast access data base which can configure all types of analysis, (2) a selected set of analysis routines, (3) a general purpose data manipulation and graphics package for the results of real time analysis. Each of these components are described with an emphasis upon how each contributes to overall system capability. 3 figs.

  19. COMPOSITE PEDAGOGICAL STAFF-CLUSTERS AS A CONDITION OF DEPARTMENT EDUCATIONAL AND METHODICAL WORK DEVELOPMENT

    Directory of Open Access Journals (Sweden)

    Vladimir A. Fedorov

    2015-01-01

    Full Text Available The aim of the investigation is to justify urgency and efficiency of teachers’ collective work of the chair on formation of integrated special professional competences of trainees.Methods. Teamwork is considered as a leading method of aim realisation; it is suggested to carry this method in practice on the basis of a situational technique of intra-chair structure formation – composite staff-clusters, whose activity is based on synergetic interaction of educational process participants.Results. Described innovations will give the chance to carry out necessary integration of educational processes content; will promote natural interaction of teachers on the basis of the generated complete integrated subsystem – composite staff-clusters. The innovation vector can be connected with more dimensional field of integration, i.e. generating not only special professional competences, but also general professional and common cultural ones.Scientific novelty. Activity of pedagogical composite staff-clusters is offered to consider in the complete block of scientific-theoretical and practice-pedagogical aspects: scientifically-organizational, academic, practice-organizational, educational, etc. Scientific novelty of article is connected with expansion of some content positions which are based on scientific-theoretical conclusions of researches pedagogic-collective (by V. A. Suhomlinsky, etc. and organizational-psychological (by K. Rogers, etc. processes, and also ideas of synergetics extrapolated into organizational-pedagogical processes. It is shown that efficiency of educational process can be reached under a condition of organizational and methodical work interrelatedness; synthesis of administrative and performing activity on the basis of the whole educational process interaction. Necessity of composite pedagogical creativity is proved by synergetic processes and motivation-emotional characteristics.Practical significance. Authors give specific

  20. Access to and Use of Point-of-Care Ultrasound in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Jason L. Sanders

    2015-10-01

    Full Text Available Introduction: Growing evidence supports emergency physician (EP-performed point-of-care ultrasound (PoC US. However, there is a utilization gap between academic emergency departments (ED and other emergency settings. We elucidated barriers to PoC US use in a multistate sample of predominantly non-academic EDs to inform future strategies to increase PoC US utilization, particularly in non-academic centers. Methods: In 2010, we surveyed ED directors in five states (Arkansas, Hawaii, Minnesota, Vermont, and Wyoming; n=242 EDs about general ED characteristics. In four states we determined barriers to PoC US use, proportion of EPs using PoC US, use privileges, and whether EPs can bill for PoC US. Results: Response rates were >80% in each state. Overall, 47% of EDs reported PoC US availability. Availability varied by state, from 34% of EDs in Arkansas to 85% in Vermont. Availability was associated with higher ED visit volume, and percent of EPs who were board certified/board eligible in emergency medicine. The greatest barriers to use were limited training (70%, expense (39%, and limited need (perceived or real (32%. When PoC US was used by EPs, 50% used it daily, 44% had privileges not requiring radiology confirmation, and 34% could bill separately for PoC US. Only 12% of EPs used it ≥80% of the time when placing central venous lines. Conclusion: Only 47% of EDs in our five-state sample of predominantly non-academic EDs had PoC US immediately available. When available, the greatest barriers to use were limited training, expense, and limited need. Recent educational and technical advancements may help overcome these barriers.

  1. Emergency department crowding in The Netherlands: managers’ experiences

    NARCIS (Netherlands)

    C. van der Linden (Christien); R. Reijnen (Resi); R. Derlet (Robert); N. van der Linden (Naomi); R. Lindeboom (Robert); C. Lucas (Cees); J. Richards (John)

    2013-01-01

    markdownabstract__Abstract__ __Background__ In The Netherlands, the state of emergency department (ED) crowding is unknown. Anecdotal evidence suggests that current ED patients experience a longer length of stay (LOS) compared to some years ago, which is indicative of ED crowding. However, no multi

  2. Predictors of Emergency Department Utilization Among Children in Vulnerable Families.

    Science.gov (United States)

    Flood, Colin; Sheehan, Karen; Crandall, Marie

    2016-03-08

    Preventable visits to the emergency department (ED) are estimated to represent as much as 56% of overall annual ED utilization and contribute to the high cost of health care in the United States. There are more than 25 million annual pediatric ED visits.

  3. Internal quality audit and quality standards as a method of quality improvement at the Department of Ophthalmology, University Hospital.

    Science.gov (United States)

    Nasić, Mirjana; Pokupec, Rajko; Katusić, Damir; Miklić, Pavle; Suić, Ivan; Galić, Slobodan

    2005-01-01

    Quality assessment of clinical health care with the programme of quality standard is a method of health management, through which better efficiency and safety of health outcomes can be achieved. In the period from 2002 to 2004, a pilot program of quality has been carried out on the Department of Ophthalmology, University Hospital Center in Zagreb. Seven internal audit teams of hospital commission and teams of hospital departments were evaluating introducing practice for quality standards every three months. In the period of two years improvement in all standards of quality has been noticed (expressed in percent of progress towards the ideal result of 100%): personnel 20%, patient rights 15%, medical equipment 40%, quality of emergency service 60%, implementation of clinical guidelines and criteria for elective admission 55%, quality of risk prevention 70%, quality of medical records 60%. The two-years-improvement dynamics of about 46%, first year 24%.

  4. Assigning treatment rooms at the Emergency Department

    NARCIS (Netherlands)

    van de Vrugt, Noëlle Maria; Boucherie, Richardus J.

    2016-01-01

    Increasing efficiency at the Emergency Department (ED) reduces overcrowding. At the ED in typical Dutch Hospitals treatment rooms are mostly shared by two residents of different specialties: a Surgeon and an Internist. Each resident uses multiple rooms in parallel; while one patient awaits test resu

  5. Emergency teams in Danish emergency departments

    DEFF Research Database (Denmark)

    Lafrenz, Thomas; Lindberg, Søren Østergaard; La Cour, Jeppe Lerche;

    2012-01-01

    The use of designated emergency teams for cardiac arrest and trauma patients is widely implemented. However, the use of designated teams in Danish emergency departments (EDs) has not been investigated. Our aim was to investigate the use and staffing of emergency teams in Danish EDs....

  6. Assigning treatment rooms at the Emergency Department

    NARCIS (Netherlands)

    Vrugt, van de Maartje; Boucherie, Richard J.

    2016-01-01

    Increasing efficiency at the Emergency Department (ED) reduces overcrowding. At the ED in typical Dutch Hospitals treatment rooms are mostly shared by two residents of different specialties: a Surgeon and an Internist. Each resident uses multiple rooms in parallel; while one patient awaits test resu

  7. Nurses’ Evaluation of a New Formalized Triage System in the Emergency Department

    DEFF Research Database (Denmark)

    Brehm Johansen, Mette; Forberg, Jakob Lundager

    2011-01-01

    Introduction: Formalized triage in the emergency department (ED) is not widely used in Denmark; this study explores the effects of introducing a five-level process triage system in a Danish ED. Material and methods: Semi-structured qualitative interviews were conducted with 15 emergency nurses....... The interviews were preceded by observations of the work of the ED nurses in which focus was on the triage process. Results: Formalized triage was experienced to improve the overview of patients and resources at the ED, and the nurses described that they felt more assured when prioritizing between patients....... Communication and coordination were also improved by the triage system. But more time spent on documentation and re-evaluation may cause the nurses to feel professionally inadequate if adequate resources are not provided. Furthermore, the triage system has reduced the focus on the humanistic and psychosocial...

  8. Drug Screens for Psychiatric Patients in the Emergency Department: Evaluation and Recommendations

    Science.gov (United States)

    Kroll, David S.; Smallwood, Jennifer; Chang, Grace

    2013-01-01

    Objective To better understand how toxicology screening for psychiatric patients in the emergency department (ED) setting affects diagnostic decisions. Methods Retrospective chart review of 439 ED visits of adult patients receiving psychiatry consultations at two hospitals, one an academic medical center (n = 224) and the other a community hospital (n = 220), between July 2008 and February 2009. Clinical, demographic, and ED length of stay (LOS) information was abstracted from the psychiatry consultation notes and the medical records. Results Positive urine toxicology results, when combined with a basic substance abuse history, were not associated independently with a patient’s receiving a substance-related diagnosis as part of the psychiatric assessment. By contrast, a positive blood alcohol level was associated independently with a patient’s receiving one of these diagnoses while a positive alcohol use history was not. Conclusions Urine toxicology screens do not add significant diagnostic value to all ED psychiatric evaluations when combined with standard substance use histories. PMID:23194932

  9. Overcoming Barriers to the Use of Osteopathic Manipulation Techniques in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Roberge, Raymond J

    2009-08-01

    Full Text Available Background: Osteopathic Manipulation Techniques (OMT have been shown to be effective therapeutic modalities in various clinical settings, but appear to be underutilized in the emergency department (ED setting.Objective: To examine barriers to the use of OMT in the ED and provide suggestions to ameliorate these barriers.Methods: Literature reviewResults: While the medical literature cites numerous obstacles to the use of OMT in the ED setting, most can be positively addressed through education, careful planning, and ongoing research into use of these techniques. Recent prospective clinical trials of OMT have demonstrated the utility of these modalities.Conclusion: Osteopathic Manipulation Techniques are useful therapeutic modalities that could be utilized to a greater degree in the ED. As the number of osteopathic emergency physicians increases, the opportunity to employ these techniques should increase.[WestJEM. 2009;10:184-189.

  10. Prospective Multicenter Study of Bronchiolitis: Predictors of an Unscheduled Visit After Discharge From the Emergency Department

    Science.gov (United States)

    Norwood, Agatha; Mansbach, Jonathan M.; Clark, Sunday; Waseem, Muhammad; Camargo, Carlos A.

    2012-01-01

    Objectives There is little evidence about which children with bronchiolitis will have worsened disease after discharge from the emergency department (ED). The objective of this study was to determine predictors of post-ED unscheduled visits. Methods The authors conducted a prospective cohort study of patients discharged from 2004 to 2006 at 30 EDs in 15 U.S. states. Inclusion criteria were diagnosis of bronchiolitis, age bronchiolitis within 2 weeks. Results Of 722 patients eligible for the current analysis, 717 (99%) had unscheduled visit data, of whom 121 (17%; 95% confidence interval [CI] = 14% to 20%) had unscheduled visits. Unscheduled visits were more likely for children age 0.10). Using multivariable logistic regression, independent predictors of unscheduled visits were age bronchiolitis, one of six children had unscheduled visits within 2 weeks of ED discharge. The three predictors of unscheduled visits were age under 2 months, male sex, and previous hospitalization. PMID:20370776

  11. Improving emergency department patient flow.

    Science.gov (United States)

    Jarvis, Paul Richard Edwin

    2016-06-01

    Emergency departments (ED) face significant challenges in delivering high quality and timely patient care on an ever-present background of increasing patient numbers and limited hospital resources. A mismatch between patient demand and the ED's capacity to deliver care often leads to poor patient flow and departmental crowding. These are associated with reduction in the quality of the care delivered and poor patient outcomes. A literature review was performed to identify evidence-based strategies to reduce the amount of time patients spend in the ED in order to improve patient flow and reduce crowding in the ED. The use of doctor triage, rapid assessment, streaming and the co-location of a primary care clinician in the ED have all been shown to improve patient flow. In addition, when used effectively point of care testing has been shown to reduce patient time in the ED. Patient flow and departmental crowding can be improved by implementing new patterns of working and introducing new technologies such as point of care testing in the ED.

  12. Trauma team activation varies across Dutch emergency departments: a national survey

    NARCIS (Netherlands)

    Egberink, Rolf; Otten, Harm-Jan; IJzerman, Maarten Joost; van Vugt, Arie B.; Doggen, Catharina Jacoba Maria

    2015-01-01

    Background Tiered trauma team response may contribute to efficient in-hospital trauma triage by reducing the amount of resources required and by improving health outcomes. This study evaluates current practice of trauma team activation (TTA) in Dutch emergency departments (EDs). Methods A survey was

  13. Trauma team activation varies across Dutch emergency departments: a national survey

    NARCIS (Netherlands)

    Egberink, Rolf; Otten, Harm-Jan; IJzerman, Maarten J.; Vugt, van Arie B.; Doggen, Carine J.M.

    2015-01-01

    Background Tiered trauma team response may contribute to efficient in-hospital trauma triage by reducing the amount of resources required and by improving health outcomes. This study evaluates current practice of trauma team activation (TTA) in Dutch emergency departments (EDs). Methods A survey w

  14. The Impact of Bundled Payment on Emergency Department Utilization: Alternative Quality Contract Effects After Year One

    Science.gov (United States)

    Sharp, Adam L.; Song, Zirui; Safran, Dana G.; Chernew, Michael E.; Fendrick, A. Mark

    2014-01-01

    Objective Identify the effect of the Alternative Quality Contract (AQC), a global payment system implemented by Blue Cross Blue Shield of Massachusetts (BCBS) in 2009, on emergency department (ED) utilization. Methods BCBS claims from 2006–2009 for 332,624 enrollees whose primary care physician (PCP) enrolled in the AQC, and 1,296,399 whose PCP was not enrolled in the AQC were evaluated. We used a pre-post, intervention-control, propensity scored difference-in-difference approach to isolate the AQC effect on ED utilization. The analysis adjusted for age, sex, health status and secular trends to compare ED utilization between the treatment and control groups. Results Overall, secular trends showed ED utilization decreased slightly for both treatment and control groups. The adjusted analysis of the AQC group showed decreases from 0.131 to 0.127 visits per member/quarter, and the control group decreased from 0.157 to 0.152 visits per member/quarter. The difference-in-difference analysis showed the AQC had no statistically significant effect on total ED utilization compared to the control group. Conclusion In its first year, the AQC had no significant effect on ED utilization. Similar global budget programs may not alter ED use in the initial implementation period. PMID:24050802

  15. Availability of Insurance Linkage Programs in U.S. Emergency Departments

    Directory of Open Access Journals (Sweden)

    Mia Kanak

    2014-07-01

    Full Text Available Introduction: As millions of uninsured citizens who use emergency department (ED services are now eligible for health insurance under the Affordable Care Act, the ED is ideally situated to facilitate linkage to insurance. Forty percent of U.S. EDs report having an insurance linkage program. This is the first national study to examine the characteristics of EDs that offer or do not offer these programs. Methods: This was a secondary analysis of data from the National Survey for Preventive Health Services in U.S. EDs conducted in 2008-09. We compared EDs with and without insurance programs across demographic and operational factors using univariate analysis. We then tested our hypotheses using multivariable logistic regression. We also further examined program capacity and priority among the sub-group of EDs with no insurance linkage program. Results: After adjustment, ED-insurance linkage programs were more likely to be located in the West (RR= 2.06, 95% CI = 1.33 – 2.72. The proportion of uninsured patients in an ED, teaching hospital status, and public ownership status were not associated with insurance linkage availability. EDs with linkage programs also offer more preventive services (RR = 1.87, 95% CI = 1.37–2.35 and have greater social worker availability (RR = 1.71, 95% CI = 1.12–2.33 than those who do not. Four of five EDs with a patient mix of ≥25% uninsured and no insurance linkage program reported that they could not offer a program with existing staff and funding. Conclusion: Availability of insurance linkage programs in the ED is not associated with the proportion of uninsured patients served by an ED. Policy or hospital-based interventions to increase insurance linkage should first target the 27% of EDs with high rates of uninsured patients that lack adequate program capacity. Further research on barriers to implementation and cost effectiveness may help to facilitate increased adoption of insurance linkage programs. [West J

  16. The efficacy of a continuous quality improvement (CQI) method in a radiological department: comparison with non-CQI control material

    Energy Technology Data Exchange (ETDEWEB)

    Laurila, J. [Oulu Univ. Central Hospital (Finland). Dept. of Radiology; Standertskjoeld-Nordenstam, C.G. [Helsinki Univ. Central Hospital (Finland). Dept. of Radiology; Suramo, I. [Oulu Univ. Central Hospital (Finland). Dept. of Radiology; Tolppanen, E.M. [Helsinki Univ. (Finland). Dept. of Public Health; Tervonen, O. [Oulu Univ. Central Hospital (Finland). Dept. of Radiology; Korhola, O. [Helsinki Univ. Central Hospital (Finland). Dept. of Radiology; Brommels, M. [Helsinki Univ. (Finland). Dept. of Public Health

    2000-01-01

    To study the efficacy of continuous quality improvement (CQI) compared to ordinary management in an on-duty radiology department. Because of complaints regarding delivery of on-duty radiological services, an improvement was initiated simultaneously at two hospitals, at the HUCH (Helsinki University Central Hospital) utilising the CQI-method, and at the OUH (Oulu University Hospital) with a traditional management process. For the CQI project, a team was formed to evaluate the process with flow-charts, cause and effect diagrams, Pareto analysis and control charts. Interventions to improve the process were based on the results of these analyses. The team at the HUCH implemented the following changes: A radiologist was added to the evening shift between 15:00 - 22:00 and a radiographer was moved from the morning shift to 15:00 - 22:00. A clear improvement was achieved in the turn-around time, but in the follow-up some of the gains were lost. Only minimal changes were achieved at the OUH, where the intervention was based on traditional management processes. CQI was an effective method for improving the quality of performance of a radiology department compared with ordinary management methods, but some of this improvement may be subsequently lost without a continuous measurement system.

  17. Advertising Emergency Department Wait Times

    Science.gov (United States)

    Weiner, Scott G.

    2013-01-01

    Advertising emergency department (ED) wait times has become a common practice in the United States. Proponents of this practice state that it is a powerful marketing strategy that can help steer patients to the ED. Opponents worry about the risk to the public health that arises from a patient with an emergent condition self-triaging to a further hospital, problems with inaccuracy and lack of standard definition of the reported time, and directing lower acuity patients to the higher cost ED setting instead to primary care. Three sample cases demonstrating the pitfalls of advertising ED wait times are discussed. Given the lack of rigorous evidence supporting the practice and potential adverse effects to the public health, caution about its use is advised. PMID:23599836

  18. Advertising emergency department wait times.

    Science.gov (United States)

    Weiner, Scott G

    2013-03-01

    Advertising emergency department (ED) wait times has become a common practice in the United States. Proponents of this practice state that it is a powerful marketing strategy that can help steer patients to the ED. Opponents worry about the risk to the public health that arises from a patient with an emergent condition self-triaging to a further hospital, problems with inaccuracy and lack of standard definition of the reported time, and directing lower acuity patients to the higher cost ED setting instead to primary care. Three sample cases demonstrating the pitfalls of advertising ED wait times are discussed. Given the lack of rigorous evidence supporting the practice and potential adverse effects to the public health, caution about its use is advised.

  19. Advanced musculoskeletal physiotherapists are effective and safe in managing patients with acute low back pain presenting to emergency departments.

    Science.gov (United States)

    Sayer, James M; Kinsella, Rita M; Cary, Belinda A; Burge, Angela T; Kimmel, Lara A; Harding, Paula

    2017-05-25

    Objective The aim of this study was to compare emergency department (ED) key performance indicators for patients presenting with low back pain and seen by an advanced musculoskeletal physiotherapist (AMP) with those seen by other non-AMP clinicians (ED doctors and nurse practitioners).Methods A retrospective audit (October 2012-September 2013) was performed of data from three metropolitan public hospital EDs to compare patients with low back pain seen by AMP and non-AMP clinicians. Outcome measures included ED length of stay, ED wait time, admission rates and re-presentation to the ED.Results One thousand and eighty-nine patients with low back pain were seen during AMP service hours (360 in the AMP group, 729 in the non-AMP group). Patients seen by the AMP had a significantly shorter ED wait time (median 13 vs 32min; Pback pain when managed by an AMP compared with patients seen by doctors and nurse practitioners.What is known about the topic? There is a growing body of literature regarding the role of AMPs in the Australian healthcare system in providing clinical services for patients with musculoskeletal conditions, including settings such as the ED. AMPs have proven to be safe and cost-effective, achieving high patient satisfaction and improved patient outcomes. However, there is little to no information regarding their effect on ED metrics, such as ED length of stay, wait time and admission rates for patients presenting to the ED with low back pain.What does this paper add? This paper demonstrates improved ED metrics for patients presenting to the ED with low back pain when seen by an AMP compared with patients seen by doctors and nurse practitioners. The specific improved metrics for these patients were decreased admission rates, decreased ED length of stay and decreased wait time.What are the implications for clinicians? This paper provides evidence that the AMPs effectively discharge patients admitted to the ED in a timely manner, without evidence of

  20. Use of the emergency department for less-urgent care among type 2 diabetics under a disease management program

    Directory of Open Access Journals (Sweden)

    Myers Leann

    2009-12-01

    Full Text Available Abstract Background This study analyzed the likelihood of less-urgent emergency department (ED visits among type 2 diabetic patients receiving care under a diabetes disease management (DM program offered by the Louisiana State University Health Care Services Division (LSU HCSD. Methods All ED and outpatient clinic visits made by 6,412 type 2 diabetic patients from 1999 to 2006 were extracted from the LSU HCSD Disease Management (DM Evaluation Database. Patient ED visits were classified as either urgent or less-urgent, and the likelihood of a less-urgent ED visit was compared with outpatient clinic visits using the Generalized Estimating Equation methodology for binary response to time-dependent variables. Results Patients who adhered to regular clinic visit schedules dictated by the DM program were less likely to use the ED for less urgent care with odds ratio of 0.1585. Insured patients had 1.13 to 1.70 greater odds of a less-urgent ED visit than those who were uninsured. Patients with better-managed glycated hemoglobin (A1c or HbA1c levels were 82 times less likely to use less-urgent ED visits. Furthermore, being older, Caucasian, or a longer participant in the DM program had a modestly lower likelihood of less-urgent ED visits. The patient's Charlson Comorbidity Index (CCI, gender, prior hospitalization, and the admitting facility showed no effect. Conclusion Patients adhering to the DM visit guidelines were less likely to use the ED for less-urgent problems. Maintaining normal A1c levels for their diabetes also has the positive impact to reduce less-urgent ED usages. It suggests that successful DM programs may reduce inappropriate ED use. In contrast to expectations, uninsured patients were less likely to use the ED for less-urgent care. Patients in the DM program with Medicaid coverage were 1.3 times more likely to seek care in the ED for non-emergencies while commercially insured patients were nearly 1.7 times more likely to do so. Further

  1. Support for Emergency Department Screening for Intimate Partner Violence Depends on Perceived Risk

    Science.gov (United States)

    Witting, Michael D.; Furuno, Jon P.; Hirshon, Jon Mark; Krugman, Scott D.; Perisse, Andre R. S.; Limcangco, Rhona

    2006-01-01

    Emergency department (ED) screening for intimate partner violence (IPV) faces logistic difficulties and has uncertain efficacy. We surveyed 146 ED visitors and 108 ED care providers to compare their support for ED IPV screening in three hypothetical scenarios of varying IPV risk. Visitor support for screening was 5 times higher for the high-risk…

  2. AN ANALYSIS OF PROVING METHODS FOR VALIDITY OF THE LOGICAL ARGUMENTS BY STUDENTS FROM THE DEPARTMENT OF MATHEMATICS EDUCATION

    Directory of Open Access Journals (Sweden)

    Lütfi İNCİKABI

    2013-06-01

    Full Text Available This study aimed to determine the methods to prove the validity of logical arguments used by the college students, from the department of mathematics education, and to reveal students’ reasons for selection of the method they used. Among the qualitative research designs, case study was the methodology of the current study. The participants of the study consisted of 76 students who were in their third year in college and who were registered for Introduction to Algebra course. One result of the study was that all three solution methods (classical mathematical operations, truth table, rules of inference were utilized by the students while the rules of inferences were the most preferred solution method among all. Moreover, the fact that students who applied the rules of inferences were more successful in reaching the correct solution than the rest also confirmed the efficacy of the method of rules of inferences. Another result of the study was that students’ reasons for selecting the method of rules of inferences mainly included that it requires less steps and that it is more applicable. Moreover, students utilizing the rules of inferences also stated that the rules of inferences helped them to reveal the concepts behind the logical arguments beside the fact that this method was more efficient in acquiring the solution. On the other hand, students using the truth table or classical mathematical operations techniques highlighted that their preferences were mainly due to their confidence in using these techniques since they were instructed on these techniques in their past courses.

  3. Methods to Strengthen the Triage Work of Emergency Department%加强急诊分诊工作方法的探讨

    Institute of Scientific and Technical Information of China (English)

    皇甫明放; 刘琼; 王冬; 孙金海; 王雷; 王占齐

    2012-01-01

    急诊科的特点是患者多、病情复杂、起病突然、变化快.急诊工作的性质决定了急诊分诊工作要做到忙而不乱,快而准.分诊工作的优劣,直接影响到急诊工作的医疗、护理质量.分诊工作能将患者准确地送到相应的科室,减小因各种会诊、检查而耽误治疗时间,避免出现病情变化而危及生命的现象.%The features of the patient in ED, including numerous patients, complex disease, the sudden attack and quick change, have determined that the triage work of ED ought to be busy but not chaotic, fast and accurate. Besides, the triage work also affects the quality of treatment and nursing directly. The triage work can diminish the time - wasting of treatment coursed by variety of consultation and inspection by sending patient to the appropriate departments accurately, which will avoid the life -threatening phenomenon caused by disease change.

  4. Children’s Mental Health Visits to the Emergency Department: Factors Affecting Wait Times and Length of Stay

    Directory of Open Access Journals (Sweden)

    Amanda S. Newton

    2014-01-01

    Full Text Available Objective. This study explores the association of patient and emergency department (ED mental health visit characteristics with wait time and length of stay (LOS. Methods. We examined data from 580 ED mental health visits made to two urban EDs by children aged ≤18 years from April 1, 2004, to March 31, 2006. Logistic regressions identified characteristics associated with wait time and LOS using hazard ratios (HR with 95% confidence intervals (CIs. Results. Sex (male: HR=1.48, 95% CI=1.20–1.84, ED type (pediatric ED: HR=5.91, 95% CI=4.16–8.39, and triage level (Canadian Triage and Acuity Scale (CTAS 2: HR=3.62, 95% CI=2.24–5.85 were statistically significant predictors of wait time. ED type (pediatric ED: HR=1.71, 95% CI=1.18–2.46, triage level (CTAS 5: HR=2.00, 95% CI=1.15–3.48, number of consultations (HR=0.46, 95% CI=0.31–0.69, and number of laboratory investigations (HR=0.75, 95% CI=0.66–0.85 predicted LOS. Conclusions. Based on our results, quality improvement initiatives to reduce ED waits and LOS for pediatric mental health visits may consider monitoring triage processes and the availability, access, and/or time to receipt of specialty consultations.

  5. Structured nursing intervention to geriatric patients discharged from Emergency Department

    DEFF Research Database (Denmark)

    Rosted, Elizabeth Emilie

    2010-01-01

    Background: Geriatric patients recently discharged from hospital are at risk of unplanned readmissions and admission to nursing home. When discharged directly from Emergency Department (ED) the risk increases, as time pressure often requires focus on the presenting problem, although 80 % of geria......Background: Geriatric patients recently discharged from hospital are at risk of unplanned readmissions and admission to nursing home. When discharged directly from Emergency Department (ED) the risk increases, as time pressure often requires focus on the presenting problem, although 80...... % of geriatric patients have complex and often unresolved caring needs. Objective: To investigate a structured nursing intervention’s impact on geriatric patients’ unresolved problems and their use of help from the community health centre. Method: We conducted a prospective descriptive study of selected...... geriatric patients with nursing intervention and 1 and 6 months follow-up. Included were geriatric patients 70+ years planned to be discharged to their home from ED October 2006-June 2008. Intervention: After detecting the geriatric patients planned to be discharged, the geriatric nurse in the ED did...

  6. The label method of the adult pluripotent stem cell neoblasts in planarian Dugesia japonica%EdU标记涡虫体内多能干细胞neoblast的方法

    Institute of Scientific and Technical Information of China (English)

    刘殿辰; 王玲燕; 赵博生

    2013-01-01

    BrdU(5-Bromo-2-deoxyuridine)是涡虫再生过程中成体多能干细胞(neoblasts)最常用的分子标记物,然而BrdU标记存在诸多缺陷.EdU(5-Ethynyl-2,-deoxyuridne)是胸腺嘧啶核苷的类似物,可以标记分裂期的细胞.通过对涡虫注射EdU和基于Apollo荧光染料的染色,利用激光共聚焦扫描显微镜检测到了EdU阳性信号.形态学观察确定其为涡虫成体干细胞neoblasts,从而证明了EdU可以作为neoblasts的分子标记物.同时对涡虫中部再生3h、6h和12h时体内neoblasts的数量进行了统计分析.

  7. The relationship between emergency department volume and patient complexity.

    Science.gov (United States)

    Hahn, Barry; Zuckerman, Batya; Durakovic, Milazim; Demissie, Seleshi

    2017-08-17

    Forecasting emergency department (ED) visits is a well-studied topic. The importance of understanding the complexity of patients along with the days and times of varying patient volumes is critical for planning medical and ancillary staffing. Though multiple studies stratify their results based on severity of disease, severity was determined by triage status. The goal of this study was to utilize a novel method to evaluate the correlation between daily emergency department patient complexity, based on Current Procedure Terminology (CPT) code, and day of the week. This was a retrospective study of subjects presenting to the ED between January 1, 2010 and December 31, 2015. We identified the correlation between subjects with each CPT code who were evaluated on a specific day of the week and evaluated the day before, the day of and the day after a legal holiday. During the study period 312,550 (48%) male and 336,348 (52%) female subjects were identified. No correlation between daily ED patient complexity, based on CPT code, and day of the week (p=0.75) or any legal holidays were identified. Individual significant differences were noted among day of the week and particular CPT code as well as legal holiday and particular CPT code with no appreciable trend or pattern. There was no correlation between daily ED patient complexity based on CPT code and day of the week or daily ED patient acuity and legal holiday. In light of these data, emergency department staffing and resource allocation patterns may need to be revisited. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Folic acid use in pregnant patients presenting to the emergency department

    OpenAIRE

    Steenblik, Jacob; Schroeder, Erika; Hatch, Burke; Groke, Steven; Broadwater-Hollifield, Camille; Mallin, Michael; Ahern, Matthew; Madsen, Troy

    2011-01-01

    Background The US Preventive Services Task Force has recommended daily folic acid supplementation for women planning on becoming pregnant in an effort to prevent fetal neural tube defects. We evaluated pregnant patients presenting to the emergency department to determine rates of folic acid supplementation. Methods We surveyed a convenience sample of pregnant patients who presented to the University of Utah Emergency Department (ED) between 1 January 2008, and 30 April 2009, regarding pregnan...

  9. Due etimologie venete ed istriane

    Directory of Open Access Journals (Sweden)

    Alberto Zamboni

    1991-12-01

    Full Text Available Un isolato dialetto del Medio Agordino (La Valle, BL attesta per 'ginepro' (Juniperus eommunis L., d'altronde compattamente designato come dzené(iver, deneore il termine bozičo che richiama il busicio dato già per l'area bellunese dal Soravia (1877, 108. II Pellegrini (1964, 28 enota 51 ne riscontra il perfetto corrispondente del Veneto orientale buzíčo documentato al p. 356 (S. Stino di Livenza dali' AIS 599 e l'accosta senz'altro al padovano (in realtà piuttosto veneziano di terraferma brusiehio (eh = (č! segnalato dal Patriarchi (1821, ma I'ed. 1775 e che si giustificherebbe con l'intrusione di 'bruciare' dal noto usodi bruciare le bacche della pianta per suffumigi, cfr. il ted. regionale Feuerbaum (su cui Marzell 2/1972, 1091 e anche il tipo brusìn dell'alta Val di Sole (Pedrotti-Bertoldi 1931, 206s.. Si osservi che anche il grande repertorio poliglotta del Nemnich (3/1794, 267 dà esplicitamente brusichio per Venezia. Sul tipo e sull'etimo il Pellegrini ritorna più avanti (1982, 185 riassumendo la bibliografia precedente e aggiungendo documentazioni dall' ASLEF: bo/ič al p. 172 (Chions, PN e ancora nel friulano occidentale (in pratica sempre nella zona di confine col veneto sbrodicio, sbradicio a Budoia (AppiSanson 1970, 28;

  10. Validation of a Syndromic Case Definition for Detecting Emergency Department Visits Potentially Related to Marijuana.

    Science.gov (United States)

    DeYoung, Kathryn; Chen, Yushiuan; Beum, Robert; Askenazi, Michele; Zimmerman, Cali; Davidson, Arthur J

    Reliable methods are needed to monitor the public health impact of changing laws and perceptions about marijuana. Structured and free-text emergency department (ED) visit data offer an opportunity to monitor the impact of these changes in near-real time. Our objectives were to (1) generate and validate a syndromic case definition for ED visits potentially related to marijuana and (2) describe a method for doing so that was less resource intensive than traditional methods. We developed a syndromic case definition for ED visits potentially related to marijuana, applied it to BioSense 2.0 data from 15 hospitals in the Denver, Colorado, metropolitan area for the period September through October 2015, and manually reviewed each case to determine true positives and false positives. We used the number of visits identified by and the positive predictive value (PPV) for each search term and field to refine the definition for the second round of validation on data from February through March 2016. Of 126 646 ED visits during the first period, terms in 524 ED visit records matched ≥1 search term in the initial case definition (PPV, 92.7%). Of 140 932 ED visits during the second period, terms in 698 ED visit records matched ≥1 search term in the revised case definition (PPV, 95.7%). After another revision, the final case definition contained 6 keywords for marijuana or derivatives and 5 diagnosis codes for cannabis use, abuse, dependence, poisoning, and lung disease. Our syndromic case definition and validation method for ED visits potentially related to marijuana could be used by other public health jurisdictions to monitor local trends and for other emerging concerns.

  11. Cognitive Impairment among Older Adults in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Hirschman, Karen

    2011-02-01

    Full Text Available Background: Within the next 30 years, the number of visits older adults will make to emergency departments (EDs is expected to double from 16 million, or 14% of all visits, to 34 million and comprise nearly a quarter of all visits.Objective: The objectives of this study were to determine prevalence rates of cognitive impairment among older adults in the ED and to identify associations, if any, between environmental factors unique to the ED and rates of cognitive impairment.Methods: A cross-sectional observational study of adults 65 and older admitted to the ED of a large, urban, tertiary academic health center was conducted between September 2007 and May 2008. Patients were screened for cognitive impairment in orientation, recall and executive function using the Six-Item Screen (SIS and the CLOX1, clock drawing task. Cognitive impairment among this ED population was assessed and both patient demographics and ED characteristics (crowding, triage time, location of assessment, triage class were compared through adjusted generalized linear models.Results: Forty-two percent (350/829 of elderly patients presented with deficits in orientation and recall as assessed by the SIS. An additional 36% of elderly patients with no impairment in orientation or recall had deficits in executive function as assessed by the CLOX1. In full model adjusted analyses patients were more likely to screen deficits in orientation and recall (SIS if they were 85 years or older (Relative Risk [RR]=1.63, 95% Confidence Interval [95% CI]=1.3-2.07, black (RR=1.85, 95% CI=1.5-2.4 and male (RR=1.42, 95% CI=1.2-1.7. Only age was significantly associated with executive functioning deficits in the ED screened using the clock drawing task (CLOX1 (75-84 years: RR=1.35, 95% CI= 1.2-1.6; 85+ years: RR=1.69, 95% CI= 1.5-2.0.Conclusion: These findings have several implications for patients seen in the ED. The SIS coupled with a clock drawing task (CLOX1 provide a rapid and simple method for

  12. Minor injury attendance times to the ED.

    LENUS (Irish Health Repository)

    Conlon, Ciaran

    2009-07-01

    The Health Service Executive (HSE) highlights the need for effective patient throughput and management, whilst providing appropriate staffing and therapeutic interventions. It acknowledges that patient need is integral to the development of a nurse led service and advocates planning staffing levels to reflect arrival times of patients. An observational study of all patients who presented to the emergency department in July 2005 and February 2006 was undertaken (n=7768). The study identified 1577 patients suitable for treatment by the Advanced Nurse Practitioner (ANP) in these two months, which represents 20% of all patient attendances to the ED in this time period. A data collection tool was devised collectively by the ANPs to identify appropriate patients. The findings of the study revealed that 73% of patients suitable for the ANP service presented between the hours of 0800 and 2000, of which 54% attended between 0800 and 1600 h. Sunday emerged as the busiest day in July 2005 whereas Monday was found to be the busiest day in February 2006. Friday was found to be consistently busy for both months.

  13. Chick embryo proliferation studies using EdU labeling.

    Science.gov (United States)

    Warren, Michelle; Puskarczyk, Karolina; Chapman, Susan C

    2009-04-01

    Cell proliferation studies are an important experimental tool. The most commonly used thymidine analogues, tritiated thymidine and bromodeoxyuridine (BrdU) label cells during S-phase. Both methods have significant drawbacks: low sensitivity in the case of tritiated thymidine and a denaturation step during BrdU detection that destroys most cellular epitopes, requiring careful optimization. The antibody against BrdU is also large and tissue penetration can be difficult. EdU (5'-ethynyl-2'-deoxyuridine) is closely chemically related to BrdU, with detection achieved by a copper catalyzed reaction requiring a small fluorescently conjugated azide. Cell cultures, flow cytometry and high throughput studies using EdU-labeled cells is exceptionally fast and does not require denaturation or antibodies. We have developed a tissue-labeling technique in chick embryos using EdU. Following EdU chemistry to detect proliferating cells, the tissue can undergo immunolabeling. We demonstrate fluorescent EdU chemistry followed by Tuj1 antibody staining resulting in multiplex fluorescent tissues.

  14. Improved neurologically intact survival with the use of an automated, load-distributing band chest compression device for cardiac arrest presenting to the emergency department

    OpenAIRE

    2012-01-01

    Introduction It has been unclear if mechanical cardiopulmonary resuscitation (CPR) is a viable alternative to manual CPR. We aimed to compare resuscitation outcomes before and after switching from manual CPR to load-distributing band (LDB) CPR in a multi-center emergency department (ED) trial. Methods We conducted a phased, prospective cohort evaluation with intention-to-treat analysis of adults with non-traumatic cardiac arrest. At these two urban EDs, systems were changed from manual CPR to...

  15. International perspectives on emergency department crowding.

    Science.gov (United States)

    Pines, Jesse M; Hilton, Joshua A; Weber, Ellen J; Alkemade, Annechien J; Al Shabanah, Hasan; Anderson, Philip D; Bernhard, Michael; Bertini, Alessio; Gries, André; Ferrandiz, Santiago; Kumar, Vijaya Arun; Harjola, Veli-Pekka; Hogan, Barbara; Madsen, Bo; Mason, Suzanne; Ohlén, Gunnar; Rainer, Timothy; Rathlev, Niels; Revue, Eric; Richardson, Drew; Sattarian, Mehdi; Schull, Michael J

    2011-12-01

    The maturation of emergency medicine (EM) as a specialty has coincided with dramatic increases in emergency department (ED) visit rates, both in the United States and around the world. ED crowding has become a public health problem where periodic supply and demand mismatches in ED and hospital resources cause long waiting times and delays in critical treatments. ED crowding has been associated with several negative clinical outcomes, including higher complication rates and mortality. This article describes emergency care systems and the extent of crowding across 15 countries outside of the United States: Australia, Canada, Denmark, Finland, France, Germany, Hong Kong, India, Iran, Italy, The Netherlands, Saudi Arabia, Catalonia (Spain), Sweden, and the United Kingdom. The authors are local emergency care leaders with knowledge of emergency care in their particular countries. Where available, data are provided about visit patterns in each country; however, for many of these countries, no national data are available on ED visits rates or crowding. For most of the countries included, there is both objective evidence of increases in ED visit rates and ED crowding and also subjective assessments of trends toward higher crowding in the ED. ED crowding appears to be worsening in many countries despite the presence of universal health coverage. Scandinavian countries with robust systems to manage acute care outside the ED do not report crowding is a major problem. The main cause for crowding identified by many authors is the boarding of admitted patients, similar to the United States. Many hospitals in these countries have implemented operational interventions to mitigate crowding in the ED, and some countries have imposed strict limits on ED length of stay (LOS), while others have no clear plan to mitigate crowding. An understanding of the causes and potential solutions implemented in these countries can provide a lens into how to mitigate ED crowding in the United States

  16. Ensamblaje de escarabajos Melolonthidae (Coleoptera: Scarabaeoidea asociados con pasturas en el departamento del Caquetá y su posible relación con la salubridad edáfica Melolonthidae (Coleoptera: Scarabaeoidea assemblage associated to pastures in the Caquetá Department (Colombia and its possible relationship with soil health

    Directory of Open Access Journals (Sweden)

    Luis Carlos Pardo-Locarno

    2011-07-01

    Full Text Available La zona de piedemonte caqueteño (Colombia forma parte de la región amazónica (3600 mm de precipitación anual, 260 m.s.n.m., 26 °C y presenta un ambiente megadiverso y ecológicamente frágil cuyos suelos están siendo afectados de manera creciente por la ganadería de tipo extensivo. En el presente trabajo se hizo un monitoreo de la biología y abundancia de escarabajos edafícolas en fincas ganaderas con pasturas degradadas, localizadas en los municipios de San Vicente del Caguán, El Doncello, Belén de los Andaquíes, Albania y Valparaíso, del departamento del Caquetá. Para el estudio se hicieron muestreos de adultos utilizando trampas de luz y de larvas en cuadrantes de suelo en parcelas de pasturas y relictos de selva durante épocas seca y húmeda. Se registraron 26 especies de Melolonthidae, ensamblaje de diversidad moderada, que incluye 16 nuevos registros para el departamento de Caquetá y dos nuevos registros para el país. Se recolectaron 475 ejemplares de larvas y 11 morfoespecies, cuya distribución y abundancia variaron significativamente según usos del suelo, épocas y localidades. Resalta la poca diversidad beta de la región (11 especies y alfa por municipios (cinco especies, de las cuales solo 33% fueron saprófagas (Cyclocephala, Euetheola, mientras que el resto (Phyllophaga, Plectris, Barybas, Bolax son rizófagas, lo que significa un balance expresivo del deterioro edáfico, presumiblemente causado por la declinación de la materia orgánica y afectación de las condiciones físicas del suelo como consecuencia de la ganadería extensiva. Se sugiere realizar estudios a mayor escala geográfica y reenfocar el uso del suelo hacia sistemas multiestratificados.The Caquetá hillsidezone is a part of the Colombian Amazon region (mean pluvial precipitation 3600 mm; 260 m.a.s.l., 26°C. It shows a mega diverse environment, ecologically fragile as the soils have been increasingly degraded. This research had the purpose of

  17. Facilitators and barriers to screening for child abuse in the emergency department

    Directory of Open Access Journals (Sweden)

    Louwers Eveline CFM

    2012-10-01

    Full Text Available Abstract Background To identify facilitators of, and barriers to, screening for child abuse in emergency departments (ED through interviews with ED staff, members of the hospital Board, and related experts. Methods This qualitative study is based on semi-structured interviews with 27 professionals from seven Dutch hospitals (i.e. seven pediatricians, two surgeons, six ED nurses, six ED managers and six hospital Board members. The resulting list of facilitators/barriers was subsequently discussed with five experts in child abuse and one implementation expert. The results are ordered using the Child Abuse Framework of the Dutch Health Care Inspectorate that legally requires screening for child abuse. Results Lack of knowledge of child abuse, communication with parents in the case of suspected abuse, and lack of time for development of policy and cases are barriers for ED staff to screen for child abuse. For Board members, lack of means and time, and a high turnover of ED staff are impediments to improving their child abuse policy. Screening can be promoted by training ED staff to better recognize child abuse, improving communication skills, appointing an attendant specifically for child abuse, explicit support of the screening policy by management, and by national implementation of an approved protocol and validated screening instrument. Conclusions ED staff are motivated to work according to the Dutch Health Care Inspectorate requirements but experiences many barriers, particularly communication with parents of children suspected of being abused. Introduction of a national child abuse protocol can improve screening on child abuse at EDs.

  18. Exploring patterns of health service use in older emergency department patients.

    Science.gov (United States)

    Hastings, S Nicole; Horney, Carolyn; Landerman, Lawrence R; Sanders, Linda L; Hocker, Michael B; Schmader, Kenneth E

    2010-10-01

    Study objectives were to identify groups of older patients with similar patterns of health care use in the 12 months preceding an index outpatient emergency department (ED) visit and to identify patient-level predictors of group membership.   Subjects were adults ≥ 65 years of age treated and released from an academic medical center ED. Latent cluster analysis (LCA) models were estimated to identify groups with similar numbers of primary care (PC), specialist, and outpatient ED visits and hospital days within 12 months preceding the index ED visit.   In this sample (n = 308), five groups with distinct patterns of health service use emerged. Low Users (35%) had fewer visits of all types and fewer hospital days compared to sample means. Low Users were more likely to be female and had fewer chronic health conditions relative to the overall sample (p < 0.05). The ED to Supplement Primary Care Provider (PCP) (23%) group had more PCP visits, but also significantly more ED visits. Specialist Heavy (22%) group members had twice as many specialist visits, but no difference in PCP visits. Members of this class were more likely to be white and male (p < 0.05). High Users (15%) received more care in all categories and had more chronic baseline health conditions (p < 0.05) but no differences in demographic characteristics relative to the whole sample. The ED and Hospital as Substitution Care (6%) group had fewer PC and specialist visits, but more ED visits and hospital days.   In this sample of older ED patients, five groups with distinct patterns of health service use were identified. Further study is needed to determine whether identification of these patient groups can add important information to existing risk-assessment methods. © 2010 by the Society for Academic Emergency Medicine.

  19. Quality of care in elder emergency department patients with pneumonia: a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Martin Daniel R

    2008-04-01

    Full Text Available Abstract Background The goals of the study were to assess the relationship between age and processes of care in emergency department (ED patients admitted with pneumonia and to identify independent predictors of failure to meet recommended quality care measures. Methods This was a prospective cohort study of a pre-existing database undertaken at a university hospital ED in the Midwest. ED patients ≥18 years of age requiring admission for pneumonia, with no documented use of antibiotics in the 24 hours prior to ED presentation were included. Compliance with Pneumonia National Quality Measures was assessed including ED antibiotic administration, antibiotics within 4 hours, oxygenation assessment, and obtaining of blood cultures. Odds ratios were calculated for elders and non-elders. Logistic regression was used to identify independent predictors of process failure. Results One thousand, three hundred seventy patients met inclusion criteria, of which 560 were aged ≥65 years. In multiple variable logistic regression analysis, age ≥65 years was independently associated with receiving antibiotics in the ED (odds ratio [OR] = 2.03, 95% CI 1.28–3.21 and assessment of oxygenation (OR = 2.10, 95% CI, 1.18–3.32. Age had no significant impact on odds of receiving antibiotics within four hours of presentation (OR 1.10, 95% CI 0.84–1.43 or having blood cultures drawn (OR 1.02, 95%CI 0.78–1.32. Certain other patient characteristics were also independently associated with process failure. Conclusion Elderly patients admitted from the ED with pneumonia are more likely to receive antibiotics while in the ED and to have oxygenation assessed in the ED than younger patients. The independent association of certain patient characteristics with process failure provides an opportunity to further increase compliance with recommended quality measures in admitted patients diagnosed with pneumonia.

  20. Screening for Fall Risks in the Emergency Department: A Novel Nursing-Driven Program

    Directory of Open Access Journals (Sweden)

    Jill M. Huded

    2015-12-01

    Full Text Available Introduction: Seniors represent the fasting growing population in the U.S., accounting for 20.3 million visits to emergency departments (EDs annually. The ED visit can provide an opportunity for identifying seniors at high risk of falls. We sought to incorporate the Timed Up & Go Test (TUGT, a commonly used falls screening tool, into the ED encounter to identify seniors at high fall risk and prompt interventions through a geriatric nurse liaison (GNL model. Methods: Patients aged 65 and older presenting to an urban ED were evaluated by a team of ED nurses trained in care coordination and geriatric assessment skills. They performed fall risk screening with the TUGT. Patients with abnormal TUGT results could then be referred to physical therapy (PT, social work or home health as determined by the GNL. Results: Gait assessment with the TUGT was performed on 443 elderly patients between 4/1/13 and 5/31/14. A prior fall was reported in 37% of patients in the previous six months. Of those screened with the TUGT, 368 patients experienced a positive result. Interventions for positive results included ED-based PT (n=63, 17.1%, outpatient PT referrals (n=56, 12.2% and social work consultation (n=162, 44%. Conclusion: The ED visit may provide an opportunity for older adults to be screened for fall risk. Our results show ED nurses can conduct the TUGT, a validated and time efficient screen, and place appropriate referrals based on assessment results. Identifying and intervening on high fall risk patients who visit the ED has the potential to improve the trajectory of functional decline in our elderly population.

  1. Improving service quality by understanding emergency department flow: a White Paper and position statement prepared for the American Academy of Emergency Medicine.

    Science.gov (United States)

    Eitel, Dave R; Rudkin, Scott E; Malvehy, M Albert; Killeen, James P; Pines, Jesse M

    2010-01-01

    Emergency Department (ED) crowding is a common problem in the United States and around the world. Process reengineering methods can be used to understand factors that contribute to crowding and provide tools to help alleviate crowding by improving service quality and patient flow. In this article, we describe the ED as a service business and then discuss specific methods to improve the ED quality and flow. Methods discussed include demand management, critical pathways, process-mapping, Emergency Severity Index triage, bedside registration, Lean and Six Sigma management methods, statistical forecasting, queuing systems, discrete event simulation modeling and balanced scorecards. The purpose of this review is to serve as a background for emergency physicians and managers interested in applying process reengineering methods to improving ED flow, reducing waiting times, and maximizing patient satisfaction. Finally, we present a position statement on behalf of the American Academy of Emergency Medicine addressing these issues.

  2. Reduction of Electron Channeling in EDS using Precession

    OpenAIRE

    Liao, Yifeng; Marks, Laurence D.

    2012-01-01

    We demonstrate that EDS measurement can be significantly improved by precessing the electron beam, thereby reducing electron channeling effects. For a SrTiO3 specimen orientated along [001] zone axis, the measured strontium to titanium atomic ratio was 0.74 – 0.80 using conventional EDS methods, and the ratio was improved to ~0.99 by precessing the electron beam for angles greater than 22.54 mRad. In ALCHEMI-like experiments in which the specimen was tilted to near two-beam condition, the str...

  3. Reduction of electron channeling in EDS using precession.

    Science.gov (United States)

    Liao, Yifeng; Marks, Laurence D

    2013-03-01

    We demonstrated that EDS measurement can be significantly improved by precessing the electron beam, thereby reducing electron channeling effects. For a SrTiO3 specimen orientated along the [001] zone axis, the measured strontium to titanium atomic ratio was 0.74-0.80 using conventional EDS methods, and the ratio was improved to ~0.99 by precessing the electron beam for angles greater than 22.54 mRad. In ALCHEMI-like experiments in which the specimen was tilted to near two-beam condition, the strontium to titanium ratio was insensitive to the deviation from the Bragg condition using a precessed electron beam. Similar reduction of electron channeling effects was also observed in precession-assisted EDS measurements for an L21-ordered Fe2MnAl intermetallic alloy tilted to the [011] zone axis as well as near two-beam conditions.

  4. Evaluation of emergency department performance

    DEFF Research Database (Denmark)

    Sørup, Christian Michel; Jacobsen, Peter; Forberg, Jakob Lundager

    2013-01-01

    Background Evaluation of emergency department (ED) performance remains a difficult task due to the lack of consensus on performance measures that reflects high quality, efficiency, and sustainability. Aim To describe, map, and critically evaluate which performance measures that the published lite...

  5. GeneEd -- A Genetics Educational Resource

    Science.gov (United States)

    ... Javascript on. Feature: Genetics 101 GeneEd — A Genetics Educational Resource Past Issues / Summer 2013 Table of Contents Science ... The Hereditary Material of Life / GeneEd — A Genetics Educational Resource / Using The Genetics Home Reference Website / Understanding the ...

  6. Review: Ulrike Freikamp, Matthias Leanza, Janne Mende, Stefan Müller, Peter Ullrich & Heinz-Jürgen Voß (Eds. (2008. Kritik mit Methode? Forschungsmethoden und Gesellschaftskritik [Criticism as an Approach? Research Methods and Social Criticism

    Directory of Open Access Journals (Sweden)

    Vanessa-Isabelle Reinwand

    2010-11-01

    Full Text Available The anthology "Criticism as an Approach? Research Methods and Social Criticism", edited by an interdisciplinary research team consisting of U. FREIKAMP, M. LEANZA, J. MENDE, S. MÜLLER, P. ULLRICH and H.-J. VOß, deals with a commonly disregarded topic: the relationship between research methods in the social and human sciences and social criticism. The sixteen articles are combined into four sections: 1 criticism relating to social structures, 2 critical consideration of subjects and their social position, 3 criticism on methods and science in relation to exemplary disciplines, and 4 dialectic as a critical method. Due to its comprehensive topic and wide appeal, this volume can generally be recommended for researchers in every scientific field. Certain articles, however, will prove more useful for specific discourses than for supporting general discussions on the critical capability of research methods and critiques of science. http://nbn-resolving.de/urn:nbn:de:0114-fqs110143

  7. Paramecium ED50 of Ketamine Determined with Glass Capillary Method%毛细玻璃管法测定草履虫氯胺酮半数麻醉有效浓度

    Institute of Scientific and Technical Information of China (English)

    阳慧; 庞雪花; 刘进; 廖大清

    2008-01-01

    目的:建立测定草履虫静脉麻醉药半数麻醉有效浓度(ED50)的方法.方法:139只运动状态良好的草履虫纳入本研究.以加药后4 min内虫体出现沿自身长轴的高速自转运动,维持时间长于1 min且在毛细玻璃管长轴的位移小于1 cm为终点指标.采用序贯法,通过把虫体置入含不同浓度氯胺酮的缓冲液中,用Dixon-Mood法计算出ED50.重复实验六次.观察48 h后虫体的存活情况.结果:六次实验测量草履虫的运动速度比较无统计学差异(P>0.05).六次实验测定的ED50值分别为1.517±0.207、1.600±0.226、1.800±0.055、1.650±0.245、1.700±0.105、1.417±0.175 g/L,无统计学差异(P>0.05).48 h后虫体均存活.结论:结果提示毛细玻璃管法稳定性较好,是一种可行的测定草履虫静脉麻醉药ED50的方法.

  8. Right to know: reducing risks of fecal pathogen exposure for ED patients and staff.

    Science.gov (United States)

    Delaney, Molly Bridget

    2014-07-01

    The purpose of this article is to review the literature regarding the multiple challenges that contribute to ED bedside toileting and examine best practices that will reduce fecal exposure, cross-contamination among patients, and employee splash injuries. We searched the Cumulative Index to Nursing and Allied Health Literature, MEDLINE, and Cochrane database for information about the multiple challenges involved in bedside toileting, using the following search terms: bedside toileting, gastroenteritis, macerator, sluice machine, fecal pathogen exposure, and splash injury. In addition, costs and benefits of reusable versus disposable bedside toileting equipment were compared and contrasted. Emergency departments have a higher exposure rate to fecal pathogens with current methods of bedside toileting. Short incubation periods may not allow the proper lead time needed for patients to access primary care providers. As a result, emergency departments and urgent care centers become a likely point of entry into the health care system. Although most inpatient rooms have built-in bathrooms, most emergency departments and outpatient examination rooms do not. Although many patients are ambulatory, restrictive monitoring equipment is required. For safety reasons, staff must bring toileting equipment to the bedsides of both ambulatory and non-ambulatory patients. Hopper dependence creates longer walking distances and delays. These delays may lead to incontinence events, skin breakdown, more frequent bed changes, and higher linen and labor costs. Reusable bedside toileting equipment is associated with at-risk behaviors. Examples are procrastination and sanitization shortcuts. These behaviors risk cross-contamination of patients especially when urgent situations require equipment to be reused in the interim. ED patients and staff are 5 times more likely to undergo fecal exposure. The 5 phases of ED bedside toileting at which risks occur are as follows: equipment setup, transport

  9. Review: Ulrike Freikamp, Matthias Leanza, Janne Mende, Stefan Müller, Peter Ullrich & Heinz-Jürgen Voß (Eds.) (2008). Kritik mit Methode? Forschungsmethoden und Gesellschaftskritik [Criticism as an Approach? Research Methods and Social Criticism

    OpenAIRE

    Vanessa-Isabelle Reinwand

    2010-01-01

    The anthology "Criticism as an Approach? Research Methods and Social Criticism", edited by an interdisciplinary research team consisting of U. FREIKAMP, M. LEANZA, J. MENDE, S. MÜLLER, P. ULLRICH and H.-J. VOß, deals with a commonly disregarded topic: the relationship between research methods in the social and human sciences and social criticism. The sixteen articles are combined into four sections: 1) criticism relating to social structures, 2) critical consideration of subjects and their so...

  10. Informed Consent Documentation for Lumbar Puncture in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Pankaj B. Patel

    2014-05-01

    Full Text Available Introduction: Informed consent is a required process for procedures performed in the emergency department (ED, though it is not clear how often or adequately it is obtained by emergency physicians. Incomplete performance and documentation of informed consent can lead to patient complaints, medico-legal risk, and inadequate education for the patient/guardian about the procedure. We undertook this study to quantify the incidence of informed consent documentation in the ED setting for lumbar puncture (LP and to compare rates between pediatric (<18 years and adult patients. Methods: In this retrospective cohort study, we reviewed the ED electronic health records (EHR for all patients who underwent successful LPs in three EDs between April 2010 and June 2012. Specific elements of informed consent documentation were reviewed. These elements included the presence of general ED and LP-specific consent forms, signatures of patient/guardian, witness, and physician, documentation of purpose, risks, benefits, alternatives, and explanation of the LP. We also reviewed the use of educational material about the LP and LP-specific discharge information. Results: Our cohort included 937 patients; 179 (19.1% were pediatric. A signed general ED consent form was present in the EHR for 809 (86% patients. A consent form for the LP was present for 524 (56% patients, with signatures from 519 (99% patients/guardians, 327 (62% witnesses, and 349 (67% physicians. Documentation rates in the EHR were as follows: purpose (698; 74%, risks (742; 79%, benefits (605; 65%, alternatives (635; 68%, and explanation for the LP (57; 6%. Educational material about the LP was not documented as having been given to any of the patients and LP-specific discharge information was documented as given to 21 (2% patients. No significant differences were observed in the documentation of informed consent elements between pediatric and adult patients. Conclusion: General ED consent was obtained in

  11. Emergency Department of a Rural Hospital in Ecuador

    Directory of Open Access Journals (Sweden)

    Tara Johnson, MD, MPH

    2016-01-01

    Full Text Available Introduction: There is a paucity of data studying patients and complaints presenting to emergency departments (EDs in low- and middle-income countries. The town of Pedro Vicente Maldonado (PVM is located in the northwestern highlands of Ecuador. Hospital PVM (HPVM is a rural teaching hospital providing family medicine residency training. These physicians provide around-the-clock acute medical care in HPVM’s ED. This study provides a first look at a functioning ED in rural Latin America by reviewing one year of ED visits to HPVM. Methods: All ED visits between April 14, 2013, and April 13, 2014, were included and analyzed, totaling 1,239 patient visits. Data were collected from their electronic medical record and exported into a de-identified Excel® database where it was sorted and categorized. Variables included age, gender, mode of arrival, insurance type, month and day of the week of the service, chief complaint, laboratory and imaging requests, and disposition. We performed descriptive statistics, and where possible, comparisons using Student’s T or chi-square, as appropriate. Results: Of the 1239 total ED visits, 48% were males and 52% females; 93% of the visits were ambulatory, and 7% came by ambulance. Sixty-three percent of the patients had social security insurance. The top three chief complaints were abdominal pain (25.5%, fever (15.1% and trauma (10.8%. Healthcare providers requested labs on 71.3% of patients and imaging on 43.2%. The most frequently requested imaging studies were chest radiograph (14.9%, upper extremity radiograph (9.4%, and electrocardiogram (9.0%. There was no seasonal or day-of-week variability to number of ED patients. The chief complaint of human or animal bite made it more likely the patient would be admitted, and the chief complaint of traumatic injury made it more likely the patient would be transferred. Conclusion: Analysis of patients presenting to a rural ED in Ecuador contributes to the global study

  12. Time series modelling and forecasting of emergency department overcrowding.

    Science.gov (United States)

    Kadri, Farid; Harrou, Fouzi; Chaabane, Sondès; Tahon, Christian

    2014-09-01

    Efficient management of patient flow (demand) in emergency departments (EDs) has become an urgent issue for many hospital administrations. Today, more and more attention is being paid to hospital management systems to optimally manage patient flow and to improve management strategies, efficiency and safety in such establishments. To this end, EDs require significant human and material resources, but unfortunately these are limited. Within such a framework, the ability to accurately forecast demand in emergency departments has considerable implications for hospitals to improve resource allocation and strategic planning. The aim of this study was to develop models for forecasting daily attendances at the hospital emergency department in Lille, France. The study demonstrates how time-series analysis can be used to forecast, at least in the short term, demand for emergency services in a hospital emergency department. The forecasts were based on daily patient attendances at the paediatric emergency department in Lille regional hospital centre, France, from January 2012 to December 2012. An autoregressive integrated moving average (ARIMA) method was applied separately to each of the two GEMSA categories and total patient attendances. Time-series analysis was shown to provide a useful, readily available tool for forecasting emergency department demand.

  13. Emergency department overcrowding: the Emergency Department Cardiac Analogy Model (EDCAM).

    Science.gov (United States)

    Richardson, Sandra K; Ardagh, Michael; Gee, Paul

    2005-01-01

    Increasing patient numbers, changing demographics and altered patient expectations have all contributed to the current problem with 'overcrowding' in emergency departments (EDs). The problem has reached crisis level in a number of countries, with significant implications for patient safety, quality of care, staff 'burnout' and patient and staff satisfaction. There is no single, clear definition of the cause of overcrowding, nor a simple means of addressing the problem. For some hospitals, the option of ambulance diversion has become a necessity, as overcrowded waiting rooms and 'bed-block' force emergency staff to turn patients away. But what are the options when ambulance diversion is not possible? Christchurch Hospital, New Zealand is a tertiary level facility with an emergency department that sees on average 65,000 patients per year. There are no other EDs to whom patients can be diverted, and so despite admission rates from the ED of up to 48%, other options need to be examined. In order to develop a series of unified responses, which acknowledge the multifactorial nature of the problem, the Emergency Department Cardiac Analogy model of ED flow, was developed. This model highlights the need to intervene at each of three key points, in order to address the issue of overcrowding and its associated problems.

  14. Course of Untreated High Blood Pressure in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Daniel J Feaster

    2011-05-01

    Full Text Available Introduction: No clear understanding exists about the course of a patient’s blood pressure (BP during an emergency department (ED visit. Prior investigations have demonstrated that BP can be reduced by removing patients from treatment areas or by placing patients supine and observing them for several hours. However, modern EDs are chaotic and noisy places where patients and their families wait for long periods in an unfamiliar environment. We sought to determine the stability of repeated BP measurements in the ED environment. Methods: A prospective study was performed at an urban ED. Research assistants trained and certified in BP measurement obtained sequential manual BPs and heart rates on a convenience sample of 76 patients, beginning with the patient arrival in the ED. Patients were observed through their stay for up to 2 hours, and BP was measured at 10-minute intervals. Data analysis with SAS PROC MIXED (SAS Institute, Cary, North Carolina for regression models with correlated data determined the shape of the curve as BP changed over time. Patients were grouped on the basis of their presenting BP as normal (less than 140/90, elevated (140–160/90–100, or severely elevated (greater than 160/100 for the regression analysis. Results: A statistically significant downward trend in systolic and diastolic BP was observed only for those patients presenting with severely elevated BPs (ie, greater than 160/100. Conclusion: We demonstrate a statistically significant decline in systolic and diastolic BP over time spent in the ED only for patients with severely elevated presenting BPs. [West J Emerg Med. 2011;12(4:421–425.

  15. Impact of an Expeditor on Emergency Department on Patient Throughput

    Directory of Open Access Journals (Sweden)

    Handel, Daniel A

    2011-05-01

    Full Text Available Objective: Our hypothesis was that an individual whose primary role was to assist with patient throughput would decrease emergency department (ED length of stay (LOS, elopements and ambulance diversion. The objective of this study was to measure how the use of an expeditor affected these throughput metrics.Methods: This pre- and post-intervention study analyzed ED patients > 21-years-old between June 2008 and June 2009, at a level one trauma center in an academic medical center with an annual ED census of 40,000 patients. We created the expeditor position as our study intervention in December 2008, by modifying the job responsibilities of an existing paramedic position. An expeditor was on duty from 1PM-1AM daily. The pre-intervention period was June to November 2008, and the post-intervention period was January to June 2009. We used multivariable to assess the impact of the expeditor on throughput metrics after adjusting for confounding variables.Results: We included a total of 13,680 visits in the analysis. There was a significant decrease in LOS after expeditor implementation by 0.4 hours, despite an increased average daily census (109 vs. 121, p<0.001. The expeditor had no impact on elopements. The probability that the ED experienced complete ambulance diversion during a 24-hour period decreased from 55.2% to 16.0% (OR:0.17, 95%CI:0.05-0.67.Conclusion: The use of an expeditor was associated with a decreased LOS and ambulance diversion. These findings suggest that EDs may be able to improve patient flow by using expeditors. This tool is under the control of the ED and does not require larger buy-in, resources, or overall hospital changes. [West J Emerg Med. 2011;12(2:198-203.

  16. Psychiatric service users, experiences of emergency departments: a CERQual review oaf qualitative studies

    DEFF Research Database (Denmark)

    Jensen, Lotte Groth; Carstensen, Kathrine; Lou, Stina

    2017-01-01

    Abstract Background: There is increased clinical and political attention towards integrating general and psychiatric emergency departments (ED). However, research into psychiatric service users’ experiences regarding general EDs is limited. Aim: To identify and summarize current, qualitative...

  17. Encountering anger in the emergency department: identification, evaluations and responses of staff members to anger displays

    NARCIS (Netherlands)

    A. Cheshin; A. Rafaeli; A. Eisenman

    2012-01-01

    Background. Anger manifestations in emergency departments (EDs) occur daily, interrupting workflow and exposing staff to risk. Objectives. How staff assess and recognize patients’ angry outbursts in EDs and elucidate responses to anger expressions, while considering effects of institution guidelines

  18. Emergency department crowding and risk of preventable medical errors.

    Science.gov (United States)

    Epstein, Stephen K; Huckins, David S; Liu, Shan W; Pallin, Daniel J; Sullivan, Ashley F; Lipton, Robert I; Camargo, Carlos A

    2012-04-01

    The objective of the study is to determine the association between emergency department (ED) crowding and preventable medical errors (PME). This was a retrospective cohort study of 533 ED patients enrolled in the National ED Safety Study (NEDSS) in four Massachusetts EDs. Individual patients' average exposure to ED crowding during their ED visit was compared with the occurrence of a PME (yes/no) for the three diagnostic categories in NEDSS: acute myocardial infarction, asthma exacerbation, and dislocation requiring procedural sedation. To accommodate site-to-site differences in available administrative data, ED crowding was measured using one of three previously validated crowding metrics (ED Work Index, ED Workscore, and ED Occupancy). At each site, the continuous measure was placed into site-specific quartiles, and these quartiles then were combined across sites. We found that 46 (8.6%; 95% confidence interval, 6.4-11.3%) of the 533 patients experienced a PME. For those seen during higher levels of ED crowding (quartile 4 vs. quartile 1), the occurrence of PMEs was more than twofold higher, both on unadjusted analysis and adjusting for two potential confounders (diagnosis, site). The association appeared non-linear, with most PMEs occurring at the highest crowding level. We identified a direct association between high levels of ED crowding and risk of preventable medical errors. Further study is needed to determine the generalizability of these results. Should such research confirm our findings, we would suggest that mitigating ED crowding may reduce the occurrence of preventable medical errors.

  19. What is the impact of an electronic test result acknowledgement system on Emergency Department physicians' work processes? A mixed-method pre-post observational study.

    Science.gov (United States)

    Georgiou, Andrew; McCaughey, Euan J; Tariq, Amina; Walter, Scott R; Li, Julie; Callen, Joanne; Paoloni, Richard; Runciman, William B; Westbrook, Johanna I

    2017-03-01

    To examine the impact of an electronic Results Acknowledgement (eRA) system on emergency physicians' test result management work processes and the time taken to acknowledge microbiology and radiology test results for patients discharged from an Emergency Department (ED). The impact of the eRA system was assessed in an Australian ED using: a) semi-structured interviews with senior emergency physicians; and b) a time and motion direct observational study of senior emergency physicians completing test acknowledgment pre and post the implementation of the eRA system. The eRA system led to changes in the way results and actions were collated, stored, documented and communicated. Although there was a non-significant increase in the average time taken to acknowledge results in the post period, most types of acknowledgements (other than simple acknowledgements) took less time to complete. The number of acknowledgements where physicians sought additional information from the Electronic Medical Record (EMR) rose from 12% pre to 20% post implementation of eRA. Given that the type of results are unlikely to have changed significantly across the pre and post implementation periods, the increase in the time physicians spent accessing additional clinical information in the post period likely reflects the greater access to clinical information provided by the integrated electronic system. Easier access to clinical information may improve clinical decision making and enhance the quality of patient care. For instance, in situations where a senior clinician, not initially involved in the care process, is required to deal with the follow-up of non-normal results. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  20. Using Queuing Theory and Simulation Modelling to Reduce Waiting Times in An Iranian Emergency Department

    Directory of Open Access Journals (Sweden)

    Hourvash Akbari Haghighinejad

    2016-01-01

    Full Text Available Background: Hospital emergencies have an essential role in health care systems. In the last decade, developed countries have paid great attention to overcrowding crisis in emergency departments. Simulation analysis of complex models for which conditions will change over time is much more effective than analytical solutions and emergency department (ED is one of the most complex models for analysis. This study aimed to determine the number of patients who are waiting and waiting time in emergency department services in an Iranian hospital ED and to propose scenarios to reduce its queue and waiting time. Methods: This is a cross-sectional study in which simulation software (Arena, version 14 was used. The input information was extracted from the hospital database as well as through sampling. The objective was to evaluate the response variables of waiting time, number waiting and utilization of each server and test the three scenarios to improve them. Results: Running the models for 30 days revealed that a total of 4088 patients left the ED after being served and 1238 patients waited in the queue for admission in the ED bed area at end of the run (actually these patients received services out of their defined capacity. The first scenario result in the number of beds had to be increased from 81 to179 in order that the number waiting of the “bed area” server become almost zero. The second scenario which attempted to limit hospitalization time in the ED bed area to the third quartile of the serving time distribution could decrease the numberwaiting to 586 patients. Conclusion: Doubling the bed capacity in the emergency department and consequently other resources and capacity appropriately can solve the problem. This includes bed capacity requirement for both critically ill and less critically ill patients. Classification of ED internal sections based on severity of illness instead of medical specialty is another solution.

  1. Department of Energy Technology.

    Science.gov (United States)

    1988-03-01

    I-AL95 6A4~LA 1 UWCL*SSZFZKD F/G LO/1 H?. . 12 113l2i 2 -lll 1 36 II IIlIg.- I1I25 11UG’-- 11.6 L 0 tRiso -R-559 Department of N Energy Technology...of neutron flux distribution and absolute thermal flux. - Neutron activation analysis . - Gamma spectroscopy with scintillation detector. - Measurements...Electric design, and a very detailed experimental program has been conduc’ed for the two first fuel cycles (General Electric, 1976 ), yielding a unique

  2. Marketing and public relations in the emergency department.

    Science.gov (United States)

    Mayer, T A; Tilson, W; Hemingway, J

    1987-02-01

    This article outlines the elements of successful ED marketing, as well as providing definitions for terms used within the marketing process. In today's competition and rapidly changing environment, marketing and public relations are tools that every ED Medical Director may want to consider. Because the marketing process requires a great deal of time and effort, as well as a high degree of intellectual honesty, it should never be entered into without a strong commitment. However, marketing the ED can be among the most productive, stimulating, and gratifying experiences for the ED Medical Director, the emergency department physicians, and all ED service personnel.

  3. Evaluation methods in soil protection. Documentation to the methodics database of the Lower Saxonian soil information system (NIBIS); 6. enl. ed.; Auswertungsmethoden im Bodenschutz. Dokumentation zur Methodenbank des Niedersaechsischen Bodeninformationssystems (NIBIS)

    Energy Technology Data Exchange (ETDEWEB)

    Mueller, U.

    1997-12-31

    Effective soil protection measures require a suitable database with information on the distribution and properties of soils. The Landesamt fuer Bodenforschung of Lower Saxony in Hannover stores this data in the `expert information system pedology` (`FIS BODEN`) of the Lower Saxonian soil information system (`NIBIS`) in digital form. It contains databases for point data (profile database, laboratory database) and for area data. Effective use of the database for thematic evaluations within the framework of planning and counseling requires the availability of evaluation methods for judging the sensitivity and tolerance of soils. The presented methods are based on relationships established empirically and expressed in linkage rules or formulas without exactly describing the processes taking place. This reduces demands on the nature of data, involving, on the other hand, restraints on the scale suitability and spatial applicability of different methods. This revised and enlarged version provides information on the appropriate range of scale and spheres of application. All linkage rules are amended and where necessary extended; some new methods have been included. (orig.) [Deutsch] Wirksame Bodenschutzmassnahmen erfordern eine geeignete Datenbasis mit Angaben ueber Verbreitung und Eigenschaften der Boeden. Im Niedersaechsischen Landesamt fuer Bodenforschung, Hannover, werden diese Daten im Fachinformationssystem Bodenkunde (FIS BODEN) des Niedersaechsischen Bodeninformationssystems (NIBIS) digital gehalten. Es enthaelt Datenbanken fuer Punktdaten (Profildatenbank, Labordatenbank) und fuer Flaechendaten. Die effektive Nutzung der Datenbasis fuer thematische Auswertungen im Rahmen von Planung und Beratung erfordert die Bereitstellung von Auswertungsmethoden zur Beurteilung der Empfindlichkeit und Belastbarkeit von Boeden. Die dargestellten Methoden beruhen auf der Grundlage empirisch ermittelter und in Verknuepfungsregeln oder Formeln beschriebener Zusammenhaenge, wobei

  4. Is warfarin usage a risk factor for osteoporotic fractures? A cohort study in the emergency department

    Directory of Open Access Journals (Sweden)

    Genady Drozdinsky

    2017-04-01

    Full Text Available Background Several studies have examined the association between warfarin sodium use and risk of osteoporotic fractures with conflicting results. Our study addresses this question, for the first time regarding patients attending emergency department (ED. Aims The aim of this study was to retrospectively detect whether there is higher rate of usage of warfarin sodium in patients with osteoporotic fractures attending an ED. Methods This is a retrospective study from patients' computerized charts. All individuals >65 years old who had an osteoporotic fracture and attended an ED in a tertiary hospital were compared with a similar group of elderly individuals >65 years old without an osteoporotic fracture who attended the ED for a cause other than an osteoporotic fracture. Results This study included 328 patients who were evaluated in the years 2005–2016. Overall, 164 individuals with a typical osteoporotic fracture (hip -66 patients (40 per cent, spine- 92 patients (56 per cent, humerus -4 patients (2 per cent, radius -13 patients (8 per cent were identified and compared with a matched group of elderly individuals who were evaluated in the ED for other complaints. Warfarin sodium was used in 61 individuals (19 per cent in the entire cohort, 34 in the fracture group and 27 in the non-fracture group (p=0.324. Conclusion In elderly patients, attending an ED, warfarin sodium use does not seem to be a risk factor for an osteoporotic fracture

  5. Depression Is Associated with Repeat Emergency Department Visits in Patients with Non-specific Abdominal Pain

    Directory of Open Access Journals (Sweden)

    Andrew Charles Meltzer

    2014-05-01

    Full Text Available Introduction: Patients with abdominal pain often return multiple times despite no definitive diagnosis. Our objective was to determine if repeat emergency department (ED use among patients with non-specific abdominal pain might be associated with a diagnosis of moderate to severe depressive disorder. Methods: We screened 987 ED patients for major depression during weekday daytime hours from June 2011 through November 2011 using a validated depression screening tool, the PHQ-9. Each subject was classified as either no depression, mild depression or moderate/ severe depression based on the screening tool. Within this group, we identified 83 patients with non-specific abdominal pain by either primary or secondary diagnosis. Comparing depressed patients versus non-depressed patients, we analyzed demographic characteristics and number of prior ED visits in the past year. Results: In patients with non-specific abdominal pain, 61.9% of patients with moderate or severe depression (PHQ9≥10 had at least one visit to our ED for the same complaint within a 365-day period, as compared to 29.2% of patients with no depression (PHQ9<5, (p=0.013. Conclusion: Repeat ED use among patients with non-specific abdominal pain is associated with moderate to severe depressive disorder. Patients with multiple visits for abdominal pain may benefit from targeted ED screening for depression.

  6. Online Health Information Impacts Patients’ Decisions to Seek Emergency Department Care

    Science.gov (United States)

    Pourmand, Ali; Sikka, Neal

    2011-01-01

    Objective: To investigate the impact of online health information (OHI) and patients’ decisions to seek emergency department (ED) care. Methods: We conducted a survey of a convenience sample of 489 ambulatory patients at an academic ED between February and September 2006. The primary measure was the prevalence of Internet use, and the secondary outcome was the impact of OHI on patients’ decision to seek ED care. Results: The study group comprised 175 (38%) males. Mean age was 33 years old; 222 (45.4%) patients were white, 189 (38.7%) patients were African American, and 33 (6.7%) were Hispanic. 92.6% had Internet access, and 94.5% used email; 58.7% reported that OHI was easy to locate, while 49.7% felt that it was also easy to understand. Of the subjects who had Internet access, 15.1% (1.6, 95% CI 1.3–2.0) stated that they had changed their decision to seek care in the ED. Conclusion: This study suggests that Internet access in an urban adult ED population may mirror reported Internet use among American adults. Many ED patients report that they are able to access and understand online health information, as well as use it to make decisions about seeking emergency care. PMID:21691522

  7. Online Health Information Impacts Patients’ Decisions to Seek Emergency Department Care

    Directory of Open Access Journals (Sweden)

    Pourmand, Ali

    2011-05-01

    Full Text Available Objective: To investigate the impact of online health information (OHI and patients’ decisions to seek emergency department (ED care.Methods: We conducted a survey of a convenience sample of 489 ambulatory patients at an academic ED between February and September 2006. The primary measure was the prevalence of Internet use, and the secondary outcome was the impact of OHI on patients’ decision to seek ED care.Results: The study group comprised 175 (38% males. Mean age was 33 years old; 222 (45.4% patients were white, 189 (38.7% patients were African American, and 33 (6.7% were Hispanic. 92.6% had Internet access, and 94.5% used email; 58.7% reported that OHI was easy to locate, while 49.7% felt that it was also easy to understand. Of the subjects who had Internet access, 15.1% (1.6, 95% CI 1.3-2.0 stated that they had changed their decision to seek care in the ED.Conclusion: This study suggests that Internet access in an urban adult ED population may mirror reported Internet use among American adults. Many ED patients report that they are able to access and understand online health information, as well as use it to make decisions about seeking emergency care. [West J Emerg Med. 2011; 12(2:174-177.

  8. An Online Tool for Nurse Triage to Evaluate Risk for Acute Coronary Syndrome at Emergency Department

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    Yuwares Sittichanbuncha

    2015-01-01

    Full Text Available Background. To differentiate acute coronary syndrome (ACS from other causes in patients presenting with chest pain at the emergency department (ED is crucial and can be performed by the nurse triage. We evaluated the effectiveness of the ED nurse triage for ACS of the tertiary care hospital. Methods. We retrospectively enrolled consecutive patients who were identified as ACS at risk patients by the ED nurse triage. Patients were categorized as ACS and non-ACS group by the final diagnosis. Multivariate logistic analysis was used to predict factors associated with ACS. An online model predictive of ACS for the ED nurse triage was constructed. Results. There were 175 patients who met the study criteria. Of those, 28 patients (16.0% were diagnosed with ACS. Patients with diabetes, patients with previous history of CAD, and those who had at least one character of ACS chest pain were independently associated with having ACS by multivariate logistic regression. The adjusted odds ratios (95% confidence interval were 4.220 (1.445, 12.327, 3.333 (1.040, 10.684, and 12.539 (3.876, 40.567, respectively. Conclusions. The effectiveness of the ED nurse triage for ACS was 16%. The online tool is available for the ED triage nurse to evaluate risk of ACS in individuals.

  9. An online tool for nurse triage to evaluate risk for acute coronary syndrome at emergency department.

    Science.gov (United States)

    Sittichanbuncha, Yuwares; Sanpha-Asa, Patchaya; Thongkrau, Theerayut; Keeratikasikorn, Chaiyapon; Aekphachaisawat, Noppadol; Sawanyawisuth, Kittisak

    2015-01-01

    Background. To differentiate acute coronary syndrome (ACS) from other causes in patients presenting with chest pain at the emergency department (ED) is crucial and can be performed by the nurse triage. We evaluated the effectiveness of the ED nurse triage for ACS of the tertiary care hospital. Methods. We retrospectively enrolled consecutive patients who were identified as ACS at risk patients by the ED nurse triage. Patients were categorized as ACS and non-ACS group by the final diagnosis. Multivariate logistic analysis was used to predict factors associated with ACS. An online model predictive of ACS for the ED nurse triage was constructed. Results. There were 175 patients who met the study criteria. Of those, 28 patients (16.0%) were diagnosed with ACS. Patients with diabetes, patients with previous history of CAD, and those who had at least one character of ACS chest pain were independently associated with having ACS by multivariate logistic regression. The adjusted odds ratios (95% confidence interval) were 4.220 (1.445, 12.327), 3.333 (1.040, 10.684), and 12.539 (3.876, 40.567), respectively. Conclusions. The effectiveness of the ED nurse triage for ACS was 16%. The online tool is available for the ED triage nurse to evaluate risk of ACS in individuals.

  10. Risk model for suspected acute coronary syndrome is of limited value in an emergency department

    DEFF Research Database (Denmark)

    Mogensen, Christian Backer; Christiansen, Maja; Jørgensen, Jess Bjerre

    2015-01-01

    INTRODUCTION: Among patients with acute chest pain, acute coronary syndrome (ACS) is seen only in a minority of the patients, which raises the question, whether it is possible to separate a group with a high risk of ACS for admission to a cardiac care unit (CCU) from those with a low risk who would...... be treated at an emergency department (ED). The aim of this study was to describe a risk stratification model for a Danish context. METHODS: This was a historic prospective cohort study of patients with suspicion of ACS. The patient was defined as a low-risk patient and admitted to the ED if: 1...

  11. A description of emergency department-related malpractice claims in The Netherlands: closed claims study 1993-2001.

    NARCIS (Netherlands)

    Elshove-Bolk, J.; Simons, M.P.; Cremers, J.; Vugt, A.B. van; Burg, M. van der

    2004-01-01

    BACKGROUND: The aim of this study was to assess the quality of care provided at emergency departments (ED) in the Netherlands by analysing medical liability insurance claims. METHODS: A retrospective study performed by reviewing records at MediRisk, presently the largest insurer for medical liabilit

  12. Increased 30-Day Emergency Department Revisits Among Homeless Patients with Mental Health Conditions

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    Chun Nok Lam

    2016-09-01

    Full Text Available Introduction: Patients with mental health conditions frequently use emergency medical services. Many suffer from substance use and homelessness. If they use the emergency department (ED as their primary source of care, potentially preventable frequent ED revisits and hospital readmissions can worsen an already crowded healthcare system. However, the magnitude to which homelessness affects health service utilization among patients with mental health conditions remains unclear in the medical community. This study assessed the impact of homelessness on 30-day ED revisits and hospital readmissions among patients presenting with mental health conditions in an urban, safety-net hospital. Methods: We conducted a secondary analysis of administrative data on all adult ED visits in 2012 in an urban safety-net hospital. Patient demographics, mental health status, homelessness, insurance coverage, level of acuity, and ED disposition per ED visit were analyzed using multilevel modeling to control for multiple visits nested within patients. We performed multivariate logistic regressions to evaluate if homelessness moderated the likelihood of mental health patients’ 30-day ED revisits and hospital readmissions. Results: Study included 139,414 adult ED visits from 92,307 unique patients (43.5±15.1 years, 51.3% male, 68.2% Hispanic/Latino. Nearly 8% of patients presented with mental health conditions, while 4.6% were homeless at any time during the study period. Among patients with mental health conditions, being homeless contributed to an additional 28.0% increase in likelihood (4.28 to 5.48 odds of 30-day ED revisits and 38.2% increase in likelihood (2.04 to 2.82 odds of hospital readmission, compared to non-homeless, non-mental health (NHNM patients as the base category. Adjusted predicted probabilities showed that homeless patients presenting with mental health conditions have a 31.1% chance of returning to the ED within 30-day post discharge and a 3

  13. Low-back pain at the emergency department: still not being managed?

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    Rizzardo A

    2016-02-01

    Full Text Available Alessandro Rizzardo,1 Luca Miceli,1 Rym Bednarova,2 Giovanni Maria Guadagnin,1 Rodolfo Sbrojavacca,3 Giorgio Della Rocca11Department of Anesthesia and Intensive Care, Academic Hospital of Udine, University of Udine, Udine, 2Pain Medicine and Palliative Care, Health Company Number 2, Gorizia, 3Emergency Department, Academic Hospital of Udine, Udine, ItalyBackground: Low-back pain (LBP affects about 40% of people at some point in their lives. In the presence of “red flags”, further tests must be done to rule out underlying problems; however, biomedical imaging is currently overused. LBP involves large in-hospital and out-of-hospital economic costs, and it is also the most common musculoskeletal disorder seen in emergency departments (EDs.Patients and methods: This retrospective observational study enrolled 1,298 patients admitted to the ED, including all International Classification of Diseases 10 diagnosis codes for sciatica, lumbosciatica, and lumbago. We collected patients’ demographic data, medical history, lab workup and imaging performed at the ED, drugs administered at the ED, ED length of stay (LOS, numeric rating scale pain score, admission to ward, and ward LOS data. Thereafter, we performed a cost analysis.Results: Mean numeric rating scale scores were higher than 7/10. Home medication consisted of no drug consumption in up to 90% of patients. Oxycodone–naloxone was the strong opioid most frequently prescribed for the home. Once at the ED, nonsteroidal anti-inflammatory drugs and opiates were administered to up to 72% and 42% of patients, respectively. Imaging was performed in up to 56% of patients. Mean ED LOS was 4 hours, 14 minutes. A total of 43 patients were admitted to a ward. The expense for each non-ward-admitted patient was approximately €200 in the ED, while the mean expense for ward-admitted patients was €9,500, with a mean LOS of 15 days.Conclusion: There is not yet a defined therapeutic care process for the

  14. Hospital Factors Impact Variation in Emergency Department Length of Stay more than Physician Factors

    Science.gov (United States)

    Krall, Scott P.; Cornelius, Angela P.; Addison, J. Bruce

    2014-01-01

    Introduction To analyze the correlation between the many different emergency department (ED) treatment metric intervals and determine if the metrics directly impacted by the physician correlate to the “door to room” interval in an ED (interval determined by ED bed availability). Our null hypothesis was that the cause of the variation in delay to receiving a room was multifactorial and does not correlate to any one metric interval. Methods We collected daily interval averages from the ED information system, Meditech©. Patient flow metrics were collected on a 24-hour basis. We analyzed the relationship between the time intervals that make up an ED visit and the “arrival to room” interval using simple correlation (Pearson Correlation coefficients). Summary statistics of industry standard metrics were also done by dividing the intervals into 2 groups, based on the average ED length of stay (LOS) from the National Hospital Ambulatory Medical Care Survey: 2008 Emergency Department Summary. Results Simple correlation analysis showed that the doctor-to-discharge time interval had no correlation to the interval of “door to room (waiting room time)”, correlation coefficient (CC) (CC=0.000, p=0.96). “Room to doctor” had a low correlation to “door to room” CC=0.143, while “decision to admitted patients departing the ED time” had a moderate correlation of 0.29 (p <0.001). “New arrivals” (daily patient census) had a strong correlation to longer “door to room” times, 0.657, p<0.001. The “door to discharge” times had a very strong correlation CC=0.804 (p<0.001), to the extended “door to room” time. Conclusion Physician-dependent intervals had minimal correlation to the variation in arrival to room time. The “door to room” interval was a significant component to the variation in “door to discharge” i.e. LOS. The hospital-influenced “admit decision to hospital bed” i.e. hospital inpatient capacity, interval had a correlation to

  15. Challenging the dominant logic of Emergency Departments: guidelines from chaos theory.

    Science.gov (United States)

    Chinnis, A; White, K R

    1999-01-01

    Chaos is order without predictability (1 ). Any unfortunate patient who has recently made a trek to an Emergency Department (ED) or even better, has watched the immensely popular TV show, ER, knows that the visit can be a frustrating and a time consuming experience. The waits are so protracted that one can observe all cycles of birth, death, love, and romance in the waiting room. The process is tedious for the patient who must tell one's tale to a triage nurse, a registration clerk, the primary nurse, the nursing care partner, and finally the emergency physician. Then, the patient must face more delays while being pushed, ineffectively, in a horizontal fashion, through vertical functional silos of care, such as laboratory and radiology. The mind-set or dominant logic of this system of ED patient flow assumes that waits are acceptable and unavoidable, and that the function of the ED is to care for only the truly emergent patient. This dominant logic, coupled with the market constraints of population-based versus case-based payment mechanisms, has led to a declining trend in ED visits for the first time in 20 years (2). In order to improve the quality of ED care as well as to increase acceptability for patient and payer, the dominant logic must be challenged. An understanding of chaos theory and perception of the Emergency Department as a complex adaptive system foster methods for challenging the dominant logic.

  16. FEM. Fundamentals and applications of Finite-Element-Method in the field of machine- and vehicle engineering. 7. rev. ed.; FEM. Grundlagen und Anwendungen der Finite-Element-Methode im Maschinen- und Fahrzeugbau

    Energy Technology Data Exchange (ETDEWEB)

    Klein, B. [Kassel Univ. (Germany). Leichbau, CAD und Entwicklungsmethodik

    2007-07-01

    Virtual product development at the workstation has become reality, creating a link between 3D-CAD, MKS, FEM, STRUOPT and Rapid Prototyping. Engineers must have good knowledge of computer-assisted techniques. The key element of CAE is the finite element method (FEM) which is a universal analytical tool providing deep insight into the elastic, dynamic, cinematic/kinetic, thermal, and fluid-mechanical characteristics of components and systems. On the basis of these simulations, reliable predictions are possible that will shorten innovation and trial periods and result in very short amortisation periods of FEM investments. This is shown by the textbook in a very clear and illustrative manner. Case studies are presented to enable the reader to deepen her knowledge by herself. (orig.)

  17. [Cost of hospitalization by the Activity Based Costing method in the neonatal department of Principal Hospital of Dakar].

    Science.gov (United States)

    Tchamdja, T; Balaka, A; Tchandana, M; Agbétra, A

    2015-01-01

    To determine the cost of hospitalization per day in the neonatal department of Principal Hospital of Dakar. This prospective study took place during the month of July 2011 in the newborn unit. The activity-based costing method was used to analyze costs. During the study period, 52 newborns were hospitalized for a total of 590 days. The cost of the human resources during that month was 9,907,832 FCFA (US $ 19,815.66), the cost of depreciation of fixed assets was estimated at 571,952 FCFA (US $ 1143.90), and supplies at 112,084 FCFA (US $ 224.17). External services cost 386,753 FCFA (US $ 773.51) and support services 6,917,380.65 FCFA (US $ 13,834.7613). The monthly expenses incurred for the hospitalization of newborns totaled 17,896,002 FCFA (US $ 35,792), for a cost per patient per day of 30,332.20 FCFA (US $ 60.66) and an average cost of hospitalization 334,153.88 FCFA (US $ 668,31). This study is the first of its kind in Senegal and neighboring countries. By applying the ABC approach, we can obtain a more detailed and precise estimate of the cost of activities and services. Process improvements and corrective actions should make it possible to identify cost drivers, such as time.

  18. Differential cDNA cloning by enzymatic degrading subtraction (EDS).

    OpenAIRE

    1994-01-01

    We describe a new method, called enzymatic degrading subtraction (EDS), for the construction of subtractive libraries from PCR amplified cDNA. The novel features of this method are that i) the tester DNA is blocked by thionucleotide incorporation; ii) the rate of hybridization is accelerated by phenol-emulsion reassociation; and iii) the driver cDNA and hybrid molecules are enzymatically removed by digestion with exonucleases III and VII rather than by physical partitioning. We demonstrate th...

  19. Emergency Department Length of Stay for Maori and European Patients in New Zealand

    Directory of Open Access Journals (Sweden)

    David Prisk

    2016-06-01

    Full Text Available Introduction: Emergency department length of stay (ED LOS is currently used in Australasia as a quality measure. In our ED, Maori, the indigenous people of New Zealand, have a shorter ED LOS than European patients. This is despite Maori having poorer health outcomes overall. This study sought to determine drivers of LOS in our provincial New Zealand ED, particularly looking at ethnicity as a determining factor. Methods: This was a retrospective cohort study that reviewed 80,714 electronic medical records of ED patients from December 1, 2012, to December 1, 2014. Univariate and multivariate analyses were carried out on raw data, and we used a complex regression analysis to develop a predictive model of ED LOS. Potential covariates were patient factors, temporal factors, clinical factors, and workload variables (volume and acuity of patients three hours prior to and two hours after presentation by a baseline patient. The analysis was performed using R studio 0.99.467. Results: Ethnicity dropped out in the stepwise regression procedure; after adjusting for other factors, a specific ethnicity effect was not informative. Maori were, on average, younger, less likely to receive bloodwork and radiographs, less likely to go to our observation area, less likely to have a general practitioner, and more likely to be discharged and to self-discharge; all of these factors decreased their length of stay. Conclusion: Length of stay in our ED does not seem to be related to ethnicity alone. Patient factors had only a small impact on ED LOS, while clinical factors, temporal factors, and workload variables had much greater influence. [West J Emerg Med. 2017;17(4438-448.

  20. Emergency department physician training in Jamaica: a national public hospital survey

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    Williams Eric W

    2008-10-01

    Full Text Available Abstract Background Emergency Department (ED medical officers are often the first medical responders to emergencies in Jamaica because pre-hospital emergency response services are not universally available. Over the past decade, several new ED training opportunities have been introduced locally. Their precise impact on the health care system in Jamaica has not yet been evaluated. We sought to determine the level of training, qualifications and experience of medical officers employed in public hospital EDs across the nation. Methods A database of all medical officers employed in public hospital EDs was created from records maintained by the Ministry of Health in Jamaica. A specially designed questionnaire was administered to all medical officers in this database. Data was analyzed using SPSS Version 10.0. Results There were 160 ED medical officers across Jamaica, of which 47.5% were males and the mean age was 32.3 years (SD +/- 7.1; Range 23–57. These physicians were employed in the EDs for a mean of 2.2 years (SD +/- 2.5; Range 0–15; Median 2.5 and were recent graduates of medical schools (Mean 5.1; SD +/- 5.9; Median 3 years. Only 5.5% of the medical officers had specialist qualifications (grade III/IV, 12.8% were grade II medical officers and 80.5% were grade I house officers or interns. The majority of medical officers had no additional training qualifications: 20.9% were exposed to post-graduate training, 27.9% had current ACLS certification and 10.3% had current ATLS certification. Conclusion The majority of medical officers in public hospital EDs across Jamaica are relatively inexperienced and inadequately trained. Consultant supervision is not available in most public hospital EDs. With the injury epidemic that exists in Jamaica, it is logical that increased training opportunities and resources are required to meet the needs of the population.

  1. Ultrasound-Guided Peripheral Intravenous Access in the Emergency Department: Patient-Centered Survey

    Directory of Open Access Journals (Sweden)

    Keith Boniface

    2011-05-01

    Full Text Available Introduction: To assess characteristics, satisfaction, and disposition of emergency department (ED patients who successfully received ultrasound (US-guided peripheral intravenous (IV access. Methods: This is a prospective observational study among ED patients who successfully received US-guided peripheral IV access by ED technicians. Nineteen ED technicians were taught to use US guidance to obtain IV access. Training sessions consisted of didactic instruction and hands-on practice. The US guidance for IV access was limited to patients with difficult access. After successfully receiving an US-guided peripheral IV, patients were approached by research assistants who administered a 10-question survey. Disposition information was collected after the conclusion of the ED visit by accessing patients’ electronic medical record. Results: In total, 146 surveys were completed in patients successfully receiving US-guided IVs. Patients reported an average satisfaction with the procedure of 9.2 of 10. Forty-two percent of patients had a body mass index (BMI of greater than 30, and 17.8% had a BMI of more than 35. Sixty-two percent reported a history of central venous catheter placement. This patient population averaged 3 ED visits per year in the past year. Fifty-three percent of the patients were admitted. Conclusion: Patients requiring US-guided IVs in our ED are discharged home at the conclusion of their ED visit about half of the time. These patients reported high rates of both difficult IV access and central venous catheter placement in the past. Patient satisfaction with US-guided IVs was very high. These data support the continued use of US-guided peripheral IVs in this patient population. [West J Emerg Med. 2011;12(4:475–477.

  2. Interventions to reduce the risk of violence toward emergency department staff: current approaches

    Directory of Open Access Journals (Sweden)

    Ramacciati N

    2016-04-01

    Full Text Available Nicola Ramacciati,1,2 Andrea Ceccagnoli,2 Beniamino Addey,3 Enrico Lumini,4 Laura Rasero1,5 1Department of Experimental and Clinical Medicine, University of Florence, 2Emergency Department, S. Maria della Misericordia Hospital, 3Emergency Medical System, S. Maria della Misericordia Hospital, Perugia, 4Department of Health Sciences, University of Florence, 5Research and Development Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy Introduction: The phenomenon of workplace violence in health care settings, and especially in the emergency department (ED, has assumed the dimensions of a real epidemic. Many studies highlight the need for methods to ensure the safety of staff and propose interventions to address the problem. Aim: The aim of this review was to propose a narrative of the current approaches to reduce workplace violence in the ED, with a particular focus on evaluating the effectiveness of emergency response programs. Methods: A search was conducted between December 1, 2015 and December 7, 2015, in PubMed and CINAHL. Ten intervention studies were selected and analyzed. Results: Seven of these interventions were based on sectoral interventions and three on comprehensive actions. Conclusion: The studies that have attempted to evaluate the effectiveness of interventions have shown weak evidence to date. Further research is needed to identify effective actions to promote a safe work environment in the ED. Keywords: workplace violence, violence prevention and control, emergency department, aggression, security, review

  3. Applicability of the modified Emergency Department Work Index (mEDWIN) at a Dutch emergency department.

    Science.gov (United States)

    Brouns, Steffie H A; van der Schuit, Klara C H; Stassen, Patricia M; Lambooij, Suze L E; Dieleman, Jeanne; Vanderfeesten, Irene T P; Haak, Harm R

    2017-01-01

    Emergency department (ED) crowding leads to prolonged emergency department length of stay (ED-LOS) and adverse patient outcomes. No uniform definition of ED crowding exists. Several scores have been developed to quantify ED crowding; the best known is the Emergency Department Work Index (EDWIN). Research on the EDWIN is often applied to limited settings and conducted over a short period of time. To explore whether the EDWIN as a measure can track occupancy at a Dutch ED over the course of one year and to identify fluctuations in ED occupancy per hour, day, and month. Secondary objective is to investigate the discriminatory value of the EDWIN in detecting crowding, as compared with the occupancy rate and prolonged ED-LOS. A retrospective cohort study of all ED visits during the period from September 2010 to August 2011 was performed in one hospital in the Netherlands. The EDWIN incorporates the number of patients per triage level, physicians, treatment beds and admitted patients to quantify ED crowding. The EDWIN was adjusted to emergency care in the Netherlands: modified EDWIN (mEDWIN). ED crowding was defined as the 75th percentile of mEDWIN per hour, which was ≥0.28. In total, 28,220 ED visits were included in the analysis. The median mEDWIN per hour was 0.15 (Interquartile range (IQR) 0.05-0.28); median mEDWIN per patient was 0.25 (IQR 0.15-0.39). The EDWIN was higher on Wednesday (0.16) than on other days (0.14-0.16, poccupancy rate revealed an area under the curve (AUC) of 0.86 (95%CI 0.85-0.87). The AUC of mEDWIN compared with a prolonged ED-LOS (≥4 hours) was 0.50 (95%CI 0.40-0.60). The mEDWIN was applicable at a Dutch ED. The mEDWIN was able to identify fluctuations in ED occupancy. In addition, the mEDWIN had high discriminatory power for identification of a busy ED, when compared with the occupancy rate.

  4. Swedish emergency department triage and interventions for improved patient flows: a national update

    Directory of Open Access Journals (Sweden)

    Farrokhnia Nasim

    2011-12-01

    Full Text Available Abstract Background In Scandinavia, emergency department triage and patient flow processes, are under development. In Sweden, the triage development has resulted in two new triage scales, the Adaptive Process Triage and the Medical Emergency Triage and Treatment System. Both these scales have logistic components, aiming to improve patient flows. The aim of this study was to report the development and current status of emergency department triage and patient flow processes in Sweden. Methods In 2009 and 2010 the Swedish Council on Health Technology Assessment sent out a questionnaire to the ED managers in all (74 Swedish hospital emergency departments. The questionnaire comprised questions about triage and interventions to improve patient flows. Results Nearly all (97% EDs in Sweden employed a triage scale in 2010, which was an increase from 2009 (73%. Further, the Medical Emergency Triage and Treatment System was the triage scale most commonly implemented across the country. The implementation of flow-related interventions was not as common, but more than half (59% of the EDs have implemented or plan to implement nurse requested X-ray. Conclusions There has been an increase in the use of triage scales in Swedish EDs during the last few years, with acceleration for the past two years. Most EDs have come to use the Medical Emergency Triage and Treatment System, which also indicates regional co-operation. The implementation of different interventions for improved patient flows in EDs most likely is explained by the problem of crowding. Generally, more studies are needed to investigate the economical aspects of these interventions.

  5. Expanding The INSPIRED COPD Outreach ProgramTM to the emergency department: a feasibility assessment

    Directory of Open Access Journals (Sweden)

    Gillis D

    2017-05-01

    Full Text Available Darcy Gillis,1 Jillian Demmons,1 Graeme Rocker1,2 1Division of Respirology, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, Halifax, NS, Canada; 2Division of Respirology, Nova Scotia Health Authority, Dalhousie University, Halifax, NS, Canada Background: The Halifax-based INSPIRED COPD Outreach Program™ is a facility-to-community home-based novel clinical initiative that through improved care transitions, self-management, and engagement in advance care planning has demonstrated a significant (60%–80% reduction in health care utilization with substantial cost aversion. By assessing the feasibility of expanding INSPIRED into the emergency department (ED we anticipated extending reach and potential for positive impact of INSPIRED to those with acute exacerbation of chronic obstructive pulmonary disease (AECOPD who avoid hospital admission.Methods: Patients were eligible for the INSPIRED-ED study if >40 years of age, diagnosed with AECOPD and discharged from the ED, willing to be referred, community dwelling with at least one of: previous use of the ED services, admission to Intermediate Care Unit/Intensive Care Unit, or admission to hospital with AECOPD in the past year. We set feasibility objectives for referral rates, completion of action plans, advance care planning participation, and reduction in ED visit frequency.Results: Referral rates were 0.5/week. Among eligible patients (n=174 33 (19% were referred of whom 15 (M=4, F=11 enrolled in INSPIRED-ED. Mean (SD age was 68 (7 years, post-bronchdilator FEV1 44.2 (15.5 % predicted, and Medical Research Council (MRC dyspnea score 3.8 (0.41. We met feasibility objectives for action plan and advance care planning completion. Frequency of subsequent ED visits fell by 54%. Mean (SD Care Transition Measure (CTM-3 improved from 8.6 (2.0 to 11.3 (1.3, P=0.0004, and of 14 patients responding 12 (86% found the program very helpful. An additional 34

  6. 视觉模拟评分法评估急诊科拥挤度研究%Bland-Altman analysis for determining the coincidence between two methods for measuring emergency department crowding: visual analogue scale versus national emergency department overcrowding scale

    Institute of Scientific and Technical Information of China (English)

    周文华; 孙红; 刘继海; 杜铁宽; 于学忠; 徐腾达

    2015-01-01

    目的 急诊科拥挤度测量方法是当前急诊科拥挤研究的瓶颈.本研究通过急诊科拥挤度主观评分(视觉模拟评分法,VAS)与国家急诊科拥挤度评分(NEDOCS)进行相关分析和一致性验证,旨在初步构建中国急诊科拥挤度评估系统.方法 对一家年急诊患者流量11万、2 000张住院病床的临床教学医院急诊科进行为期6个月的研究,研究期间每隔8 h (1:00,9:00,17:00)采集急诊科拥挤度评估数据,对拥挤度测量方法进行相关分析和Bland-Altman法进行一致性检验.结果 视觉模拟评分法(VAS)中,医师VAS (VAS-p)值显著低于护士VAS (VAS-n)值[(6.49±1.82) vs.(7.12±1.78),P<0.01];信度检验(Kappa检验)显示,Kappa值为0.112 (P<0.01),提示两者一致性强度微弱.医师和护士VAS均数(VAS-m)与NEDOCS具有显著相关性(r =0.714,P<0.01),但Bland-Altman法一致性检验结果显示,95%的一致性界限为-32.47至71.42,其范围明显超过40分(一个拥挤度评分等级),提示两种方法的一致性差.结论 视觉模拟评分法存在明显不足,医师与护士VAS评分一致性差;VAS与NEDOCS两种测量方法间一致性也不理想,提示NEDOCS评分值与急诊工作人员对急诊科拥挤问题的主观感受并不一致,有必要对NEDOCS评估模型进行修订.%Objective To establish a practicable and easily mastered emergency department overcrowding (EDO) assessment system suitable for domestic ED setting by determining the validity and usefulness of the national emergency department over-crowding study (NEDOCS) tool in a 2000-bed tertiary care academic institution in China in comparison with visual analogue scale (VAS) in order to address the worldwide grave concern of EDO.Methods In a period of 6 months,data of subjective and objective EDO assessed simultaneously three times a day (1:00,9:00,17:00) were collected.The data were analyzed by using Bland-altmann method and Kappa test to determine the coincidence between VAS

  7. Failure Mode and Effect Analysis in Increasing the Revenue of Emergency Department

    Directory of Open Access Journals (Sweden)

    Farhad Rahmati

    2015-02-01

    Full Text Available Introduction: Successful performance of emergency department(ED is one of the important indications of increasing the satisfaction among referees. The insurance of such successful performance is fiscal discipline and avoiding from non-beneficial activities in this department. Therefore, the increasing revenue of emergency department is one of the interested goals of hospital management system. According to above-mentioned, the researchers assessed problems lead to loss the revenue of ED and eliminate them by using failure mode and effects analysis (FMEA.Methods: This was the prospective cohort study performed during 18 months, set in 6 phases. In the first phase, the failures were determined and some solutions suggested to eliminate them. During 2-5 phases, based on the prioritizing the problems, solutions were performed. In the sixth phase, final assessment of the study was done. Finally, the feedback of system’s revenue was evaluated and data analyzed using repeated measure ANOVA.Results: Lack of recording the consuming instrument and attribution of separate codes for emergency services of hospitalized patients were the most important failures that lead to decrease the revenue of ED. Such elimination caused to 75.9% increase in revenue within a month (df = 1.6; F = 84.0; p<0.0001.  Totally, 18 months following the eliminating of failures caused to 328.2% increase in the revenue of ED (df = 15.9; F = 215; p<0.0001.Conclusion: The findings of the present study shows that failure mode and effect analysis, can be used as a safe and effected method to reduce the expenses of ED and increase its revenue.

  8. [SWOT analysis: the analytical method in the process of planning and its application in the development of orthopaedic hospital department].

    Science.gov (United States)

    Terzić, Zorica; Vukasinović, Zoran; Bjegović-Mikanović, Vesna; Jovanović, Vesna; Janicić, Radmila

    2010-01-01

    SWOT analysis is a managerial tool used to evaluate internal and external environment through strengths and weaknesses, opportunities and threats. The aim was to demonstrate the application of the SWOT analysis on the example of the Department for Paediatric Orthopaedics and Traumatology at the Institute of Orthopaedic Surgery "Banjica" in Belgrade. Qualitative research was conducted during December 2008 at the Department for Paediatric Orthopaedics and Traumatology of the Institute of Orthopaedic Surgery "Banjica" by applying the focus group technique. Participants were members of the medical staff and patients. In the first phase of the focus group brainstorming was applied to collect the factors of internal and external environment, and to identify strengths and weaknesses, opportunities and threats, respectively. In the second phase the nominal group technique was applied in order to reduce the list of factors. The factors were assessed according to their influence on the Department. Factors ranked by the three point Likert scale from 3 (highest impact) to 1 (lowest impact). The most important strengths of the Department are competent and skilled staff, high quality of services, average hospital bed utilization, the Department providing the educational basis of the School of Medicine, satisfied patients, pleasant setting, and additional working hours. The weaknesses are: poor spatial organization, personnel unmotivated to refresh knowledge, lack of specifically trained personnel, inadequate sanitary facilities, and uncovered services by the Insurance Fund, long average hospital stay, and low economic status of patients. The opportunities are: legislative regulations, formed paediatric traumatology service at the City level, good regional position of the Institute, and extension of referral areas. The threats are: absent Department autonomy in the personnel policy of the Institute, competitions within the Institute, impossibility to increase the Department

  9. ED151, A Flawed Approach

    Directory of Open Access Journals (Sweden)

    Brian Andrew

    2007-09-01

    Full Text Available This paper argues the recent proposals expressed by the Australian Accounting StandardBoard in Exposure Draft 151 contradicts the historical trend of standard setters attemptingto achieve the objective of financial reporting, that is, the provision of decision-usefulinformation for users of general purpose financial reports. Historically, standard settershave tried to achieve this objective by reducing alternative treatments in accountingstandards and providing increasing levels of information for users. Exposure Draft 151affects many standards, however, this paper focuses on the proposal to allow preparers theoption of selecting between the direct or indirect method of presenting cash flows fromoperations in the statement of cash flows. We argue that this discretion contradicts thestated objective of financial reporting, as stated in the Conceptual Framework, as it will leadto the widespread adoption of the less informative indirect method, due to a structural biasin the requirements of AASB 107 and IASB 7, the relevant standards relating to thestatement of cash flows.

  10. Out of hours care: a profile analysis of patients attending the emergency department and the general practitioner on call

    Directory of Open Access Journals (Sweden)

    Buylaert Walter

    2010-11-01

    Full Text Available Abstract Background Overuse of emergency departments (ED is of concern in Western society and it is often referred to as 'inappropriate' use. This phenomenon may compromise efficient use of health care personnel, infrastructure and financial resources of the ED. To redirect patients, an extensive knowledge of the experiences and attitudes of patients and their choice behaviour is necessary. The aim of this study is to quantify the patients and socio-economical determinants for choosing the general practitioner (GP on call or the ED. Methods Data collection was conducted simultaneously in 4 large cities in Belgium. All patients who visited EDs or used the services of the GP on call during two weekends in January 2005 were enrolled in the study in a prospective manner. We used semi-structured questionnaires to interview patients from both services. Results 1611 patient contacts were suitable for further analysis. 640 patients visited the GP and 971 went to the ED. Determinants that associated with the choice of the ED are: being male, having visited the ED during the past 12 months at least once, speaking another language than Dutch or French, being of African (sub-Saharan as well as North African nationality and no medical insurance. We also found that young men are more likely to seek help at the ED for minor trauma, compared to women. Conclusions Patients tend to seek help at the service they are acquainted with. Two populations that distinctively seek help at the ED for minor medical problems are people of foreign origin and men suffering minor trauma. Aiming at a redirection of patients, special attention should go to these patients. Informing them about the health services' specific tasks and the needlessness of technical examinations for minor trauma, might be a useful intervention.

  11. Noise Levels in Two Emergency Departments Before and After the Introduction of Electronic Whiteboards

    DEFF Research Database (Denmark)

    Hertzum, Morten

    2013-01-01

    Purpose: Hospital work generates noise. This article investigates the noise level in emergency departments (EDs) to assess the need to address this aspect of the work environment and to investigate whether the replacement of dry-erase with electronic whiteboards lowers the noise level. Method......: In Study I we measured the noise level at the three coordination centres of an ED while it was still using dry-erase whiteboards and after it had switched to electronic whiteboards. In Study II we made similar noise measurements at another ED, supplemented with observation. Results: The median daily...... equivalent continuous noise levels were 60.0, 55.3, and 55.4 dB(A) at the three coordination centres in Study I and 56.5 dB(A) at the coordination centre in Study II. In both studies the noise levels were higher during workdays than weekends and higher during day and evening shifts than during night shifts...

  12. Plant immunity: the EDS1 regulatory node.

    Science.gov (United States)

    Wiermer, Marcel; Feys, Bart J; Parker, Jane E

    2005-08-01

    ENHANCED DISEASE SUSCEPTIBILITY 1 (EDS1) and its interacting partner, PHYTOALEXIN DEFICIENT 4 (PAD4), constitute a regulatory hub that is essential for basal resistance to invasive biotrophic and hemi-biotrophic pathogens. EDS1 and PAD4 are also recruited by Toll-Interleukin-1 receptor (TIR)-type nucleotide binding-leucine rich repeat (NB-LRR) proteins to signal isolate-specific pathogen recognition. Recent work points to a fundamental role of EDS1 and PAD4 in transducing redox signals in response to certain biotic and abiotic stresses. These intracellular proteins are important activators of salicylic acid (SA) signaling and also mediate antagonism between the jasmonic acid (JA) and ethylene (ET) defense response pathways. EDS1 forms several molecularly and spatially distinct complexes with PAD4 and a newly discovered in vivo signaling partner, SENESCENCE ASSOCIATED GENE 101 (SAG101). Together, EDS1, PAD4 and SAG101 provide a major barrier to infection by both host-adapted and non-host pathogens.

  13. Nonurgent patients in the emergency department? A French formula to prevent misuse

    Directory of Open Access Journals (Sweden)

    Gainotti Sabina

    2010-03-01

    Full Text Available Abstract Background Overcrowding in emergency department (EDs is partly due to the use of EDs by nonurgent patients. In France, the authorities responded to the problem by creating primary care units (PCUs: alternative structures located near hospitals. The aims of the study were to assess the willingness of nonurgent patients to be reoriented to a PCU and to collect the reasons that prompted them to accept or refuse. Methods We carried out a cross sectional survey on patients' use of EDs. The study was conducted in a French hospital ED. Patients were interviewed about their use of health services, ED visits, referrals, activities of daily living, and insurance coverage status. Patients' medical data were also collected. Results 85 patients considered nonurgent by a triage nurse were asked to respond to a questionnaire. Sex ratio was 1.4; mean age was 36.3 +/- 11.7 years. Most patients went to the ED autonomously (76%; one third (31.8% had consulted a physician. The main reasons for using the ED were difficulty to get an appointment with a general practitioner (22.3%, feelings of pain (68.5%, and the availability of medical services in the ED, like imaging, laboratory tests, and drug prescriptions (37.6%. Traumatisms and wounds were the main medical reasons for going to the ED (43.5%. More than two-thirds of responders (68% were willing to be reoriented towards PCUs. In the multivariate analysis, only employment and the level of urgency perceived by the patient were associated with the willingness to accept reorientation. Employed persons were 4.5 times more likely to accept reorientation (OR = 4.5 CI (1.6-12.9. Inversely, persons who perceived a high level of urgency were the least likely to accept reorientation (OR = 0.9 CI (0.8-0.9. Conclusions Our study provides information on the willingness of ED patients to accept reorientation and shows the limits of its feasibility. Alternative structures such as PCUs near the ED seem to respond

  14. Emergency Department Use among Adults with Autism Spectrum Disorders (ASD)

    Science.gov (United States)

    Vohra, Rini; Madhavan, Suresh; Sambamoorthi, Usha

    2016-01-01

    A cross-sectional analyses using Nationwide Emergency Department Sample (2006-2011) was conducted to examine the trends, type of ED visits, and mean total ED charges for adults aged 22-64 years with and without ASD (matched 1:3). Around 0.4% ED visits (n = 25,527) were associated with any ASD and rates of such visits more than doubled from 2006 to…

  15. Medical identity theft in the emergency department: awareness is crucial.

    Science.gov (United States)

    Mancini, Michelino

    2014-11-01

    Medical identity theft in the emergency department (ED) can harm numerous individuals, and many frontline healthcare providers are unaware of this growing concern. The two cases described began as typical ED encounters until red flags were discovered upon validating the patient's identity. Educating all healthcare personnel within and outside the ED regarding the subtle signs of medical identity theft and implementing institutional policies to identify these criminals will discourage further fraudulent behavior.

  16. A National Survey of Emergency Department Triage in Sweden

    Science.gov (United States)

    Göransson, Katarina; Ehrenberg, Anna; Ehnfors, Margareta

    2003-01-01

    The aim of this study was to identify the organisation of and knowledge about triage work in Swedish emergency departments (ED) as a first step to understanding what is necessary for decision support in ED triage systems in Sweden. A national survey using telephone interviews for data collection was used. Results showed great variety in how work regarding ED triage is organised and performed. The variety occurs in several areas including education, personnel performing triage, facilities available and scales used. PMID:14728356

  17. Radiation doses of employees of a Nuclear Medicine Department after implementation of more rigorous radiation protection methods.

    Science.gov (United States)

    Piwowarska-Bilska, Hanna; Supinska, Aleksandra; Listewnik, Maria H; Zorga, Piotr; Birkenfeld, Bozena

    2013-11-01

    The appropriate radiation protection measures applied in departments of nuclear medicine should lead to a reduction in doses received by the employees. During 1991-2007, at the Department of Nuclear Medicine of Pomeranian Medical University (Szczecin, Poland), nurses received on average two-times higher (4.6 mSv) annual doses to the whole body than those received by radiopharmacy technicians. The purpose of this work was to examine whether implementation of changes in the radiation protection protocol will considerably influence the reduction in whole-body doses received by the staff that are the most exposed. A reduction in nurses' exposure by ~63 % took place in 2008-11, whereas the exposure of radiopharmacy technicians grew by no more than 22 % in comparison with that in the period 1991-2007. Proper reorganisation of the work in departments of nuclear medicine can considerably affect dose reduction and bring about equal distribution of the exposure.

  18. Risk Factors for Emergency Department Short Time Readmission in Stratified Population

    Directory of Open Access Journals (Sweden)

    Ariadna Besga

    2015-01-01

    Full Text Available Background. Emergency department (ED readmissions are considered an indicator of healthcare quality that is particularly relevant in older adults. The primary objective of this study was to identify key factors for predicting patients returning to the ED within 30 days of being discharged. Methods. We analysed patients who attended our ED in June 2014, stratified into four groups based on the Kaiser pyramid. We collected data on more than 100 variables per case including demographic and clinical characteristics and drug treatments. We identified the variables with the highest discriminating power to predict ED readmission and constructed classifiers using machine learning methods to provide predictions. Results. Classifier performance distinguishing between patients who were and were not readmitted (within 30 days, in terms of average accuracy (AC. The variables with the greatest discriminating power were age, comorbidity, reasons for consultation, social factors, and drug treatments. Conclusions. It is possible to predict readmissions in stratified groups with high accuracy and to identify the most important factors influencing the event. Therefore, it will be possible to develop interventions to improve the quality of care provided to ED patients.

  19. Risk stratification for arrhythmic death in an emergency department cohort: a new method of nonlinear PD2i analysis of the ECG

    Directory of Open Access Journals (Sweden)

    James E Skinner

    2008-09-01

    Full Text Available James E Skinner1, Michael Meyer2, William C Dalsey3, Brian A Nester4, George Ramalanjaona5, Brian J O’Neil6, Antoinette Mangione7, Carol Terregino8, Abel Moreyra9, Daniel N Weiss10, Jerry M Anchin1, Una Geary11, Pamela Taggart121Vicor Technologies, Inc, Boca Raton, FL, USA; 2Max Planck Institute for Experimental Physiology, Goettingen, Germany; 3Kimbal Medical Center, Lakewood, NJ, USA; 4Lehigh Valley Hospital and Health Network, Allentown, PA, USA; 5St. Michaels Hospital, Newark, NJ, USA; 6William Beaumont Hospital, Royal Oak, MI, USA; 7Luitpolb Pharmaceuticals, Inc., Norristown, PA, USA; 8Cooper Medical Center, Camden, NJ, USA; 9Robert Wood Johnson Medical School, New Brunswick, NJ, USA; 10Florida Arrhythmia Consultants, Ft. Lauderdale, FL, USA; 11St. James Hospital, Dublin, Ireland; 12Albert Einstein Medical Center, Philadelphia, PA, USAAbstract: Heart rate variability (HRV reflects both cardiac autonomic function and risk of sudden arrhythmic death (AD. Indices of HRV based on linear stochastic models are independent risk factors for AD in postmyocardial infarction (MI cohorts. Indices based on nonlinear deterministic models have a higher sensitivity and specificity for predicting AD in retrospective data. A new nonlinear deterministic model, the automated Point Correlation Dimension (PD2i, was prospectively evaluated for prediction of AD. Patients were enrolled (N = 918 in 6 emergency departments (EDs upon presentation with chest pain and being determined to be at risk of acute MI (AMI >7%. Brief digital ECGs (>1000 heartbeats, ∼15 min were recorded and automated PD2i results obtained. Out-of-hospital AD was determined by modified Hinkle-Thaler criteria. All-cause mortality at 1 year was 6.2%, with 3.5% being ADs. Of the AD fatalities, 34% were without previous history of MI or diagnosis of AMI. The PD2i prediction of AD had sensitivity = 96%, specificity = 85%, negative predictive value = 99%, and relative risk >24.2 (p ≤ 0.001. HRV

  20. Shifts Scheduling Method for Physicians in Emergency Department with Time-Varying Demand%面向动态时变需求的急诊科医生排班研究

    Institute of Scientific and Technical Information of China (English)

    刘强; 谢晓岚; 刘冉; 陈尔真; 杨之涛

    2015-01-01

    急诊室的病人到达率是随时间动态变化而非恒定的,因此急诊室在病人到达的高峰时刻会出现病人拥挤、等待时间过长等现象,而在病人达到率低的时期内医生的工作时间利用率又相对较低。设计针对病人时变到达率的人员排班计划,能够缓解病人等待时间长、医生工作时间利用率低等问题。针对上述实际问题,首先提出了一种可以估计动态需求系统中顾客等待时间的方法,该方法利用 M/M/c 排队论理论对病人的等待时间加以近似表达。基于此方法构造了急诊室医生排班的混合整数规划模型并加以求解,数值仿真试验显示得到的结果明显优于目前医院实际的医生排班方案。%Significant variation in patient arrival rate is a key feature of emergency department (ED)and a main cause of the paradox between congestion in rush hours and resource redundancy in less busy hours.Appropriate personnel scheduling can help to relief this phenomenon.In this paper,we develop a mix integer programming model for daily personnel scheduling for EDs with non-stationary patient arrival over time.The goal is to minimize the total expected waiting time which is estimated by a combination of steady-state analysis of M/M/c queues and inventory-like flow balance equations.We then develop an improved estimation method and analyze the new model based on it.Numerical experiments and simulations are performed to validate the proposed models.

  1. Radiotherapy. 2. rev. ed.; Strahlentherapie

    Energy Technology Data Exchange (ETDEWEB)

    Wannenmacher, Michael; Debus, Juergen [Radiologische Klinik, Heidelberg (Germany). Abteilung fuer Radioonkologie und Strahlentherapie; Wenz, Frederik (ed.) [Universitaetsmedizin Mannheim (Germany). Klinik fuer Strahlentherapie und Radioonkologie

    2013-07-01

    The purpose of this medical specialty book, besides presenting the state of the art in clinical radiotherapy and radiooncology, is to explain the basic principles of medical physics and radiobiology. Following a number of chapters on general topics and theory it provides detailed coverage of the individual organ systems, briefly addressing future aspects in the process. The authors relate their view that radiooncology as a medical specialty will continue to be under pressure to change and that it will take continuous innovation to secure its status within the interdisciplinary context around the treatment of cancer patients. The authors of this, the textbook's second edition, have dedicated much space to modern methods and techniques in order to do justice to these developments.

  2. ED services: the impact of caring behaviors on patient loyalty.

    Science.gov (United States)

    Liu, Sandra S; Franz, David; Allen, Monette; Chang, En-Chung; Janowiak, Dana; Mayne, Patricia; White, Ruth

    2010-09-01

    This article describes an observational study of caring behaviors in the emergency departments of 4 Ascension Health hospitals and the impact of these behaviors on patient loyalty to the associated hospital. These hospitals were diverse in size and geography, representing 3 large urban community hospitals in metropolitan areas and 1 in a midsized city. Research assistants from Purdue University (West Lafayette, IN) conducted observations at the first study site and validated survey instruments. The Purdue research assistants trained contracted observers at the subsequent study sites. The research assistants conducted observational studies of caregivers in the emergency departments at 4 study sites using convenience sampling of patients. Caring behaviors were rated from 0 (did not occur) to 5 (high intensity). The observation included additional information, for example, caregiver roles, timing, and type of visit. Observed and unobserved patients completed exit surveys that recorded patient responses to the likelihood-to-recommend (loyalty) questions, patient perceptions of care, and demographic information. Common themes across all study sites emerged, including (1) the area that patients considered most important to an ED experience (prompt attention to their needs upon arrival to the emergency department); (2) the area that patients rated as least positive in their actual ED experience (prompt attention to their needs upon arrival to the emergency department); (3) caring behaviors that significantly affected patient loyalty (eg, making sure that the patient is aware of care-related details, working with a caring touch, and making the treatment procedure clearly understood by the patient); and (4) the impact of wait time to see a caregiver on patient loyalty. A number of correlations between caring behaviors and patient loyalty were statistically significant (P loyalty but that occurred least frequently. The study showed through factor analysis that some caring

  3. TED-Ed lessons & TED-Ed clubs: Educational activities to amplify students' voices

    Science.gov (United States)

    Villias, Georgios

    2017-04-01

    TED-Ed lessons and TED-Ed clubs are two powerful educational tools that can be used in today's school classrooms in order to create an educational environment that is engaging for the students and favors their active participation, created and fostered by TED-Ed. TED-Ed is TED's educational initiative, committed to create lessons worth sharing and amplify the voices and ideas of teachers and students around the world. TED-Ed animated lessons are fully organized lessons structured around an animated video that introduces new topics to learners in an exciting, thought-provoking way. These lessons have been created as a result of the cooperation between expert educators and animators and have been uploaded at the TED-Ed platform (http://ed.ted.com). On the other hand, TED-Ed Clubs are also an interesting way to offer students the chance, the voice and the opportunity to express their thoughts, engage actively on these matters and connect with each other, both at a local, as well as at an international level (http://ed.ted.com/clubs). By developing new TED-Ed lessons or by customizing appropriately existing animated TED-Ed lessons (translating, modifying the questions asked, introducing new discussion topics), I have created and implemented in my student-centered, didactic approach, a series of TED-ED animated lessons directly connected with the Greek national science syllabus that were used to spark students curiosity and initiate a further analytical discussion or introduce other relevant educational activities (http://gvillias.wixsite.com/education). Furthermore, at my school, we established Varvakeio TED-Ed Club, an environment that supports and empowers our students to research, develop and disseminate their own personal ideas that worth spreading. During the year, our members were inspired by watching TED talks presented by experts on their field on various different areas, including social, economical, environmental and technological-scientific issues. Our aim

  4. Biofuel technology handbook. 2. ed.

    Energy Technology Data Exchange (ETDEWEB)

    Rutz, Dominik; Janssen, Rainer

    2008-01-15

    This comprehensive handbook was created in order to promote the production and use of biofuels and to inform politicians, decision makers, biofuel traders and all other relevant stakeholders about the state-of-the-art of biofuels and relevant technologies. The large variety of feedstock types and different conversion technologies are described. Explanations about the most promising bio fuels provide a basis to discuss about the manifold issues of biofuels. The impartial information in this handbook further contributes to diminish existing barriers for the broad use of biofuels. Emphasis of this handbook is on first generation biofuels: bio ethanol, Biodiesel, pure plant oil, and bio methane. It also includes second generation biofuels such as BTL-fuels and bio ethanol from lingo-cellulose as well as bio hydrogen. The whole life cycle of bio fuels is assessed under technical, economical, ecological, and social aspect. Characteristics and applications of bio fuels for transport purposes are demonstrated and evaluated. This is completed by an assessment about the most recent studies on biofuel energy balances. This handbook describes the current discussion about green house gas (GHG) balances and sustainability aspects. GHG calculation methods are presented and potential impacts of biofuel production characterized: deforestation of rainforests and wetlands, loss of biodiversity, water pollution, human health, child labour, and labour conditions.

  5. Emergency Department Overcrowding and Ambulance Turnaround Time.

    Science.gov (United States)

    Lee, Yu Jin; Shin, Sang Do; Lee, Eui Jung; Cho, Jin Seong; Cha, Won Chul

    2015-01-01

    The aims of this study were to describe overcrowding in regional emergency departments in Seoul, Korea and evaluate the effect of crowdedness on ambulance turnaround time. This study was conducted between January 2010 and December 2010. Patients who were transported by 119-responding ambulances to 28 emergency centers within Seoul were eligible for enrollment. Overcrowding was defined as the average occupancy rate, which was equal to the average number of patients staying in an emergency department (ED) for 4 hours divided by the number of beds in the ED. After selecting groups for final analysis, multi-level regression modeling (MLM) was performed with random-effects for EDs, to evaluate associations between occupancy rate and turnaround time. Between January 2010 and December 2010, 163,659 patients transported to 28 EDs were enrolled. The median occupancy rate was 0.42 (range: 0.10-1.94; interquartile range (IQR): 0.20-0.76). Overcrowded EDs were more likely to have older patients, those with normal mentality, and non-trauma patients. Overcrowded EDs were more likely to have longer turnaround intervals and traveling distances. The MLM analysis showed that an increase of 1% in occupancy rate was associated with 0.02-minute decrease in turnaround interval (95% CI: 0.01 to 0.03). In subgroup analyses limited to EDs with occupancy rates over 100%, we also observed a 0.03 minute decrease in turnaround interval per 1% increase in occupancy rate (95% CI: 0.01 to 0.05). In this study, we found wide variation in emergency department crowding in a metropolitan Korean city. Our data indicate that ED overcrowding is negatively associated with turnaround interval with very small practical significance.

  6. 联合应用顺阿曲库铵与维库溴铵后ED50和ED95的改变%The change of ED50 and ED95 for combination of cisatracurium and ve-curonium

    Institute of Scientific and Technical Information of China (English)

    葛培青; 叶照君; 陶伟平; 梁伟民

    2014-01-01

    目的:观察顺式阿曲库铵联合维库溴铵用药后ED50和ED95的变化。方法将75例择期手术患者(ASAⅠ~Ⅱ级)随机分为3组:顺式阿曲库铵组、维库溴铵组和顺式阿曲库铵+维库溴铵组,每组各25例。麻醉诱导后,以单次给药法观察起效时间和T1达到最大抑制的时间,描绘3组患者的量-效曲线,求得各自的ED50和ED95值,并运用等效图法和代数法对两药相互作用进行分析。结果单用顺式阿曲库铵组、维库溴铵组ED50值分别为32.35、28.78μg/kg,ED95值分别为52.67、51.20μg/kg。联合用药时ED50值为16.81、12.17μg/kg,ED95值为23.49、22.16μg/kg,与单独用药相比,差异均有统计学意义。联合用药时ED50和ED95的合用代数值分别为0.942、0.879。结论联合使用顺式阿曲库铵和维库溴铵具有协同作用,且量-效曲线产生左移。%Objective To observe the change of ED50 and ED95 for the treatment with cisatracurium and vecuronium. Methods 75 cases of patients undergoing elective surgery (ASA Ⅰ to II level) were ramdomly divided into three groups:cisatracurium group,vecuronium group and cisatracurium+vecuronium group,each group of 25 cases.The onset time and T1 maximum inhibition time were determined by the single-injection doseresponse technique after anesthesia induction.Their respective ED50 of ED95 values were caculated by the depicted dose-response curve among the three groups of patients.The two medicine interaction analysis was caculated by the equivalent diagram method and algebraic method. Results ED50 was 32.35,28.78 μg/kg and ED95 was 52.67,51.20 μg/kg when patients were given single dose of atracurium or vecuronium.ED50 was 16.81,12.17 μg/kg and ED95 was 23.49,22.16 μg/kg when it combined the both two groups.Compared with other group,the differences in cisatracurium+vecuronium group were statistically significant.The combinational value of ED50 and ED95 was 0.942 and 0.879,respectively

  7. Adverse events related to emergency department care: a systematic review.

    Directory of Open Access Journals (Sweden)

    Antonia S Stang

    Full Text Available OBJECTIVE: To systematically review the literature regarding the prevalence, preventability, severity and types of adverse events (AE in the Emergency Department (ED. METHODS: We systematically searched major bibliographic databases, relevant journals and conference proceedings, and completed reference reviews of primary articles. Observational studies (cohort and case-control, quasi-experimental (e.g. before/after studies and randomized controlled trials, were considered for inclusion if they examined a broad demographic group reflecting a significant proportion of ED patients and described the proportion of AE. Studies conducted outside of the ED setting, those examining only a subpopulation of patients (e.g. a specific entrance complaint or receiving a specific intervention, or examining only adverse drug events, were excluded. Two independent reviewers assessed study eligibility, completed data extraction, and assessed study quality with the Newcastle Ottawa Scale. RESULTS: Our search identified 11,624 citations. Ten articles, representing eight observational studies, were included. Methodological quality was low to moderate with weaknesses in study group comparability, follow-up, and outcome ascertainment and reporting. There was substantial variation in the proportion of patients with AE related to ED care, ranging from 0.16% (n = 9308 to 6.0% (n = 399. Similarly, the reported preventability of AE ranged from 36% (n = 250 to 71% (n = 24. The most common types of events were related to management (3 studies, diagnosis (2 studies and medication (2 studies. CONCLUSIONS: The variability in findings and lack of high quality studies on AE in the high risk ED setting highlights the need for research in this area. Further studies with rigorous, standardized outcome assessment and reporting are required.

  8. The Effect of Anthrax Bioterrorism on Emergency Department Presentation

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    Rodriguez, Robert M

    2005-01-01

    Full Text Available Study Objective: From September through December 2001, 22 Americans were diagnosed with anthrax, prompting widespread national media attention and public concern over bioterrorism. The purpose of this study was to determine the effect of the threat of anthrax bioterrorism on patient presentation to a West Coast emergency department (ED. Methods: This survey was conducted at an urban county ED in Oakland, CA between December 15, 2001 and February 15, 2002. During random 8-hour blocks, all adult patients presenting for flu or upper respiratory infection (URI symptoms were surveyed using a structured survey instrument that included standard visual numerical and Likert scales. Results: Eighty-nine patients were interviewed. Eleven patients (12% reported potential exposure risk factors. Eighty percent of patients watched television, read the newspaper, or listened to the radio daily, and 83% of patients had heard about anthrax bioterrorism. Fifty-five percent received a chest x-ray, 10% received either throat or blood cultures, and 28% received antibiotics. Twenty-one percent of patients surveyed were admitted to the hospital. Most patients were minimally concerned that they may have contracted anthrax (mean=3.3±3.3 where 0=no concern and 10=extremely concerned. Patient concern about anthrax had little influence on their decision to visit the ED (mean=2.8±3.0 where 0=no influence and 10=greatly influenced. Had they experienced their same flu or URI symptoms one year prior to the anthrax outbreak, 91% of patients stated they would have sought medical attention. Conclusions: After considerable exposure to media reports about anthrax, most patients in this urban West Coast ED population were not concerned about anthrax infection. Fear of anthrax had little effect on decisions to come to the ED, and most would have sought medical help prior to the anthrax outbreak.

  9. Impact of prospective verification of intravenous antibiotics in an ED.

    Science.gov (United States)

    Hunt, Allyson; Nakajima, Steven; Hall Zimmerman, Lisa; Patel, Manav

    2016-12-01

    Delay in appropriate antibiotic therapy is associated with an increase in mortality and prolonged length of stay. Automatic dispensing machines decrease the delivery time of intravenous (IV) antibiotics to patients in the emergency department (ED). However, when IV antibiotics are not reviewed by pharmacists before being administered, patients are at risk for receiving inappropriate antibiotic therapy. The objective of this study was to determine if a difference exists in the time to administration of appropriate antibiotic therapy before and after implementation of prospective verification of antibiotics in the ED. This retrospective, institutional review board-approved preimplementation vs postimplementation study evaluated patients 18years or older who were started on IV antibiotics in the ED. Patients were excluded if pregnant, if the patient is a prisoner, if no cultures were drawn, or if the patient was transferred from an outside facility. Appropriate antibiotic therapy was based on empiric source-specific evidence-based guidelines, appropriate pharmacokinetic and pharmacodynamic properties, and microbiologic data. The primary end point was the time from ED arrival to administration of appropriate antibiotic therapy. Of the 1628 evaluated, 128 patients met the inclusion criteria (64 pre vs 64 post). Patients were aged 65.2±17.0years, with most of infections being pneumonia (44%) and urinary tract infections (18%) and most patients being noncritically ill. Time to appropriate antibiotic therapy was reduced in the postgroup vs pregroup (8.1±8.6 vs 15.2±22.8hours, respectively, P=.03). In addition, appropriate empiric antibiotics were initiated more frequently after the implementation (92% post vs 66% pre; P=.0001). There was no difference in mortality or length of stay between the 2 groups. Prompt administration of the appropriate antibiotics is imperative in patients with infections presenting to the ED. The impact of prospective verification of

  10. Urgent Care Transfers to an Academic Pediatric Emergency Department.

    Science.gov (United States)

    McCarthy, Jennifer L; Clingenpeel, Joel M; Perkins, Amy M; Eason, Margaret K

    2017-10-02

    The aim of this study was to investigate the hypothesis that a significant percentage of urgent care center to pediatric ED transfers can be discharged home without emergency department (ED) resource utilization. A retrospective chart review was completed for a 6-month period on all patients transferred from urgent care centers. A data collection tool focusing on demographics, diagnoses, reason for transfer, ED resource utilization, ED disposition, and 72-hour ED return was used. Each encounter was classified as "urgent" or "nonurgent" based on resource utilization criteria. Descriptive statistics were reported for demographics, encounter data, and 72-hour ED return stratified by nonurgent versus urgent classification. Two-sample t, χ, and Fisher exact tests were used to assess differences in characteristics between the nonurgent and urgent groups. One hundred nine patients met inclusion criteria. Of these, 93 (85%) were discharged from the ED. Twenty nine (27%) of the transferred patients were discharged without ED resource utilization. Seventy-two-hour return was noted for only 1 patient who was again discharged at the subsequent encounter. A large proportion of patients transferred from urgent care centers were directly discharged from the ED without any ED resource utilization. Eliminating or reducing such transfers has the potential to limit the amount of nonurgent ED visits, thus producing cost savings and better patient care.

  11. The nature and causes of unintended events reported at ten emergency departments

    Directory of Open Access Journals (Sweden)

    van der Wal Gerrit

    2009-09-01

    Full Text Available Abstract Background Several studies on patient safety have shown that a substantial number of patients suffer from unintended harm caused by healthcare management in hospitals. Emergency departments (EDs are challenging hospital settings with regard to patient safety. There is an increased sense of urgency to take effective countermeasures in order to improve patient safety. This can only be achieved if interventions tackle the dominant underlying causes. The objectives of our study are to examine the nature and causes of unintended events in EDs and the relationship between type of event and causal factor structure. Methods Study at EDs of 10 hospitals in the Netherlands. The study period per ED was 8 to 14 weeks, in which staff were asked to report unintended events. Unintended events were broadly defined as all events, no matter how seemingly trivial or commonplace, that were unintended and could have harmed or did harm a patient. Reports were analysed with a Root Cause Analysis tool (PRISMA by an experienced researcher. Results 522 unintended events were reported. Of the events 25% was related to cooperation with other departments and 20% to problems with materials/equipment. More than half of the events had consequences for the patient, most often resulting in inconvenience or suboptimal care. Most root causes were human (60%, followed by organisational (25% and technical causes (11%. Nearly half of the root causes was external, i.e. attributable to other departments in or outside the hospital. Conclusion Event reporting gives insight into diverse unintended events. The information on unintended events may help target research and interventions to increase patient safety. It seems worthwhile to direct interventions on the collaboration between the ED and other hospital departments.

  12. Execution of diagnostic testing has a stronger effect on emergency department crowding than other common factors: a cross-sectional study.

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    Takahisa Kawano

    Full Text Available STUDY OBJECTIVE: We compared the effects of execution of diagnostic tests in the emergency department (ED and other common factors on the length of ED stay to identify those with the greatest impacts on ED crowding. METHODS: Between February 2010 and January 2012, we conducted a cross-sectional, single-center study in the ED of a large, urban, teaching hospital in Japan. Patients who visited the ED during the study period were enrolled. We excluded (1 patients scheduled for admission or pharmaceutical prescription, and (2 neonates requiring intensive care transferred from other hospitals. Multivariate linear regression was performed on log-transformed length of ED stay in admitted and discharged patients to compare influence of diagnostic tests and other common predictors. To quantify the range of change in length of ED stay given a unit change of the predictor, a generalized linear model was used for each group. RESULTS: During the study period, 55,285 patients were enrolled. In discharged patients, laboratory blood tests had the highest standardized β coefficient (0.44 among common predictors, and increased length of ED stay by 72.5 minutes (95% CI, 72.8-76.1 minutes. In admitted patients, computed tomography (CT had the highest standardized β coefficient (0.17, and increased length of ED stay by 32.7 minutes (95% CI, 40.0-49.9 minutes. Although other common input and output factors were significant contributors, they had smaller standardized β coefficients in both groups. CONCLUSIONS: Execution of laboratory blood tests and CT had a stronger influence on length of ED stay than other common input and output factors.

  13. Effect of the influenza virus rapid antigen test on a physician's decision to prescribe antibiotics and on patient length of stay in the emergency department.

    Directory of Open Access Journals (Sweden)

    Hye Won Jeong

    Full Text Available BACKGROUND: Influenza virus infection is a common reason for visits to the emergency department (ED during the influenza season. A rapid and accurate diagnosis of influenza virus infection is important to reduce unnecessary antibiotic prescription and to improve patient care. The aim of this study was to examine whether using the Influenza Virus Rapid Antigen Test (IVRAT in the ED affects the decision to prescribe antibiotics or the length of hospital stay (LOS. METHODS: Data from patients suffering from an influenza-like illness (ILI and who were discharged after visiting the ED at Chungbuk National University Hospital were reviewed over two influenza seasons: 2010-2011, when IVRAT was not used in the ED, and 2011-2012, when it was. The numbers of antibiotic prescriptions issued and the ED LOS during these two seasons were then compared. RESULTS: The number of antibiotic prescriptions was significantly lower in 2011-2012 (54/216, 25.0% than in 2010-2011 (97/221, 43.9%; P<0.01. However, the median ED LOS for patients in 2011-2012 was much longer than that of patients in 2010-2011 (213 minutes vs. 257 minutes; P<0.01. During the 2011-2012 influenza season, 73 ILI patients showed a positive IVRAT result whereas 123 showed a negative result. Upon discharge, antibiotics were given to 42/123 (34.1% ILI patients with a negative IVRAT result, but to only 7/73 (9.6% patients with a positive IVRAT result (P<0.01. CONCLUSIONS: Performing IVRAT in the ED reduced the prescription of antibiotics to ILI patients discharged after ED care. However, the ED LOS for patients who underwent IVRAT was longer than that for patients who did not. Thus, performing IVRAT in the ED reduces the unnecessary prescription of antibiotics to ILI patients during the influenza season.

  14. Unscheduled return visits to a Dutch inner-city emergency department

    NARCIS (Netherlands)

    M.C. van der Linden (M. Christien); R. Lindeboom (Robert); R.J. de Haan (Rob); N. van der Linden (Naomi); E.R. de Deckere (Ernie RJT); C. Lucas (Cees); S. Rhemrev (Steven); J.C. Goslings (Carel)

    2014-01-01

    textabstractBackground Unscheduled return visits to the emergency department (ED) may reflect shortcomings in care. This study characterized ED return visits with respect to incidence, risk factors, reasons and post-ED disposition. We hypothesized that risk factors for unscheduled return and reasons

  15. Unscheduled return visits to a Dutch inner-city emergency department

    NARCIS (Netherlands)

    M.C. van der Linden (M. Christien); R. Lindeboom (Robert); R.J. de Haan (Rob); N. van der Linden (Naomi); E.R. de Deckere (Ernie RJT); C. Lucas (Cees); S. Rhemrev (Steven); J.C. Goslings (Carel)

    2014-01-01

    textabstractBackground Unscheduled return visits to the emergency department (ED) may reflect shortcomings in care. This study characterized ED return visits with respect to incidence, risk factors, reasons and post-ED disposition. We hypothesized that risk factors for unscheduled return and reasons

  16. Canadian EdGEO National Workshop Program

    Science.gov (United States)

    Clinton, L. A.; Haidl, F. M.; Hymers, L. A.; van der Flier-Keller, E.

    2009-05-01

    Established in the early 1970s, EdGEO supports locally driven geosciences workshops for Canadian teachers. Workshops are organized by geoscientists and teachers, and typically have field, laboratory and classroom components. Grants of up to $3000 per workshop are available from the National EdGEO Program. By providing educational opportunities for today's teachers and, through them, their students, EdGEO seeks to cultivate a heightened awareness of our planet. EdGEO workshops provide teachers with potential fieldtrip sites for their students and the knowledge, enthusiasm and materials to inspire their students to engage in geoscience. Networking opportunities with local experts promote the importance of the geoscience profession. The expected result is an improved capacity on the part of Canadians to understand the Earth and to make informed decisions, especially with regard to the use of mineral and energy resources, the maintenance and remediation of the environment, and response to geological hazards. There exists a critical need to provide teachers with training and resources to tackle their Earth science curricula. In 2008, EdGEO supported fourteen workshops, with an unprecedented 521 teachers attending. These teachers then used our resources to reach an estimated 14,000 students during that single academic year. EdGEO workshops are locally driven and are therefore very diverse. Workshops are strongly tied to the provincial curriculum, focus on a specific geoscience topic, or may be largely field-based to demonstrate and practice how field activities could be incorporated into Earth science teaching. Many strive to include all of these important components. Geoscientists and teachers work collaboratively to develop and deliver EdGEO workshops to ensure that the activities can be effectively used in the classroom. The length of these professional development opportunities range from two-hour sessions to several days, and can generally accommodate up to twenty

  17. RT-PCR Analysis of ED-A,ED-B, and IIICS Fibronectin Domains: A New Screening Marker For Bladder Cancer

    Directory of Open Access Journals (Sweden)

    M Ahmadi Javid

    2004-12-01

    Full Text Available Background: Fibronectin seems to play a very important role in the progression and invasion of bladder cancer. EDA, EDB, and IIICS domains of fibronectin are not expressed in the adult persons but they’re expressed in different cancers. The aim of this study is to investigate the mRNA of fibronectin in transitional carcinoma cells (TCC of bladder to study these domains. Methods: A total of 20 patients with known bladder cancer were studied. Two of them excluded since their excised tissues were not enough for both the pathological examination and RNA study. Another 20 (control group were normal volunteers who needed bladder operations. The excised tissue was immediately transferred to RNAlater (Ambion,TX. RNA was extracted via RNAWIZ (Ambion, TX. cDNA was made via RevertAid First Strand cDNA Synthesis Kit (Fermentas. PCR of the cDNAs was performed using primers for EDA, EDB, and IIICS (Eurogentec,Belgium. Results: For the first time, we present the expression of the oncofetal fibronectin mRNA in the transitional cell carcinoma of bladder. The high grade muscle invasive (G3T2 tumor, expressed ED-A, ED-B, and IIICS. Expression of ED-A, ED-B, and IIICS was confirmed in the two patients with G3T1 TCC. The four patients with G2Ta and G3Ta expressed both ED-A and ED-B. The four patients with G1T1 tumor expressed ED-A only, similar to the nine patients with G1Ta tumor. None of the normal volunteers expressed the oncofetal extra domains. The sensitivity of ED-A positive fibronectin RNA for detecting TCC of any kind is 100%, and of ED-B was only 35%. The specificity of ED-B positive fibronectin RNA for the high grade TCC is 100%. Conclusion: ED-A, ED-B, and IIICS could be used as useful markers for the diagnosis and following up of bladder carcinoma. Keywords: Transitional Cell Carcinoma, bladder cancer, fibronectin, RT-PCR, oncofetal.

  18. Nanoscale voxel spectroscopy by simultaneous EELS and EDS tomography.

    Science.gov (United States)

    Haberfehlner, Georg; Orthacker, Angelina; Albu, Mihaela; Li, Jiehua; Kothleitner, Gerald

    2014-11-01

    Extending the capabilities of electron tomography with advanced imaging techniques and novel data processing methods, can augment the information content in three-dimensional (3D) reconstructions from projections taken in the transmission electron microscope (TEM). In this work we present the application of simultaneous electron energy-loss spectroscopy (EELS) and energy-dispersive X-ray spectroscopy (EDS) to scanning TEM tomography. Various tools, including refined tilt alignment procedures, multivariate statistical analysis and total-variation minimization enable the 3D reconstruction of analytical tomograms, providing 3D analytical metrics of materials science samples at the nanometer scale. This includes volumetric elemental maps, and reconstructions of EDS, low-loss and core-loss EELS spectra as four-dimensional spectrum volumes containing 3D local voxel spectra. From these spectra, compositional, 3D localized elemental analysis becomes possible opening the pathway to 3D nanoscale elemental quantification.

  19. Tobacco smoking by adult emergency department patients in Australia: a point-prevalence study.

    Science.gov (United States)

    Weiland, Tracey; Jelinek, George A; Taylor, Simone E; Taylor, David McD

    2016-07-15

    Objectives and importance of study: Tobacco smoking is the leading single cause of preventable death. International findings suggest that rates of smoking are higher among emergency department (ED) patients than the general population, suggesting that the ED may be a strategic location in which to initiate smoking cessation programs. We aimed to determine the prevalence of smoking among adult ED patients in Australia, their desire for smoking cessation and preferred methods of cessation. Point-prevalence survey Method: A sample of adult ED patients was recruited from two tertiary referral hospital EDs. Participants were asked whether or not they currently smoked. Smokers were asked 15 additional questions, including about their readiness for smoking cessation. Demographics were collected from patients, and ED presentation characteristics were collected from medical records. Of 443 consecutive ED patients, 348 were eligible and 338 consented to participate. Data for 335 participants were available for analysis and 78 (23.3%; 95% confidence interval [CI] 19.1, 28.1) reported being current smokers. The mean age of smokers was 42.1 years, and 64.1% were male. Forty-one per cent (31/75) reported difficulty refraining from smoking, 78.1% (57/73) anticipated health problems because of smoking and 69.7% (53/76) had a desire to quit. Overall, 23/61 (37.7% of smokers) had a desire to cease smoking in the next month. The majority (44/73, 60.3%) were willing to undergo brief counselling. Multisession face-to-face counselling was most commonly preferred (22/55, 40.0%) and more than one-third (20/55, 36.4%) preferred group counselling. A session with an ED doctor (6/55, 10.9%) and multiple telephone-delivered interventions (7/55, 12.7%) were least preferred. Smoking is more prevalent among ED patients than statistics reported for the general population. Delivery of appropriate brief interventions suited to the stage of change should be trialled, along with referral from ED to

  20. Development and Testing of Emergency Department Patient Transfer Communication Measures

    Science.gov (United States)

    Klingner, Jill; Moscovice, Ira

    2012-01-01

    Purpose: Communication problems are a major contributing factor to adverse events in hospitals. The contextual environment in small rural hospitals increases the importance of emergency department (ED) patient transfer communication quality. This study addresses the communication problems through the development and testing of ED quality…

  1. Metallurgy Department

    DEFF Research Database (Denmark)

    Risø National Laboratory, Roskilde

    The activities of the Metallurgy Department at Risø during 1981 are described. The work is presented in three chapters: General Materials Research, Technology and Materials Development, Fuel Elements. Furthermore, a survey is given of the department's participation in international collaboration...

  2. Working Together to Connect Care: a metropolitan tertiary emergency department and community care program.

    Science.gov (United States)

    Harcourt, Debra; McDonald, Clancy; Cartlidge-Gann, Leonie; Burke, John

    2017-03-02

    Objective Frequent attendance by people to an emergency department (ED) is a global concern. A collaborative partnership between an ED and the primary and community healthcare sectors has the potential to improve care for the person who frequently attends the ED. The aims of the Working Together to Connect Care program are to decrease the number of presentations by providing focused community support and to integrate all healthcare services with the goal of achieving positive, patient-centred and directed outcomes.Methods A retrospective analysis of ED data for 2014 and 2015 was used to ascertain the characteristics of the potential program cohort. The definition used to identify a 'frequent attendee' was more than four presentations to an ED in 1 month. This analysis was used to develop the processes now known as the Working Together to Connect Care program. This program includes participant identification by applying the definition, flagging of potential participants in the ED IT system, case review and referral to community services by ED staff, case conferencing facilitated within the ED and individualised, patient centred case management provided by government and non-government community services.Results Two months after the date of commencement of the Working Together to Connect Care program there are 31 active participants in the program: 10 are on the Mental Health pathway, and one is on the No Consent pathway. On average there are three people recruited to the program every week. The establishment of a new program for supporting frequent attendees of an ED has had its challenges. Identifying systems that support people in their community has been an early positive outcome of this project.Conclusion It is expected that data regarding the number of ED presentations, potential fiscal savings and client outcomes will be available in 2017.What is known about the topic? Frequent attendance at EDs is a global issue and although the number of 'super users' is

  3. Computed radiography in an emergency department setting

    Science.gov (United States)

    Andriole, Katherine P.; Gould, Robert G.; Arenson, Ronald L.

    1997-05-01

    Evaluation of radiologist and non-radiologist physician acceptance of computed radiography (CR) as an alternative to film-based radiography in an emergency department (ED) is performed. All emergency department radiographs are performed using photostimulable phosphor plates and rad by a computed radiography laser reader placed in the former emergency department darkroom. Soft copy images are simultaneously transmitted to high- and medium-resolution dual-monitor display stations located in radiology and ED reading rooms respectively. The on-call radiologist is automatically paged by the Radiology Information System (RIS) upon exam completion, to read the new ED imaging study. Patient demographic information including relevant clinical history is conveyed to the radiologist via the RIS. A 'wet read' preliminary radiology report is immediately transmitted back to the ED. Radiology and ED physicians are surveyed to ascertain preferences for CR or traditional screen-film, based on system implementation, image viewing and clinical impact issues. Preliminary results indicate a preference for filmless CR among the ED physicians if digital reliability and speed issues are met. This preference appears to be independent of physician level of experience. Inexperienced radiologists-in-training appear to have less comfort with softcopy reading for primary diagnosis. However, additional training in softcopy reading techniques can improve confidences. Image quality issues are most important tot he radiologist, while speed and reliability are the major issues for ED physicians. Reasons for CR preference include immediate access to images on display stations, near-zero exam retake rates, and improved response time and communication between radiology and the emergency department clinician.

  4. A Comparison of Earned Value and Earned Schedule Duration Forecast Methods on Department of Defense Major Defense Acquisition Programs

    OpenAIRE

    Bruchey, William J.

    2012-01-01

    Approved for public release; distribution is unlimited Earned value management is a project management tool that integrates project scope with cost, schedule, and performance elements for optimum project planning and control. Earned value management is required by the Department of Defense for cost and incentive type contracts equal or greater than $20 million as part of a comprehensive approach to improving critical acquisitions. It is used to forecast the programs schedule performance us...

  5. Rapid Primary Care Follow-up from the ED to Reduce Avoidable Hospital Admissions.

    Science.gov (United States)

    Carmel, Amanda S; Steel, Peter; Tanouye, Robert; Novikov, Aleksey; Clark, Sunday; Sinha, Sanjai; Tung, Judy

    2017-08-01

    Hospital admissions from the emergency department (ED) now account for approximately 50% of all admissions. Some patients admitted from the ED may not require inpatient care if outpatient care could be optimized. However, access to primary care especially immediately after ED discharge is challenging. Studies have not addressed the extent to which hospital admissions from the ED may be averted with access to rapid (next business day) primary care follow-up. We evaluated the impact of an ED-to-rapid-primary-care protocol on avoidance of hospitalizations in a large, urban medical center. We conducted a retrospective review of patients referred from the ED to primary care (Weill Cornell Internal Medicine Associates - WCIMA) through a rapid-access-to-primary-care program developed at New York-Presbyterian / Weill Cornell Medical Center. Referrals were classified as either an avoided admission or not, and classifications were performed by both emergency physician (EP) and internal medicine physician reviewers. We also collected outcome data on rapid visit completion, ED revisits, hospitalizations and primary care engagement. EPs classified 26 (16%) of referrals for rapid primary care follow-up as avoided admissions. Of the 162 patients referred for rapid follow-up, 118 (73%) arrived for their rapid appointment. There were no differences in rates of ED revisits or subsequent hospitalizations between those who attended the rapid follow-up and those who did not attend. Patients who attended the rapid appointment were significantly more likely to attend at least one subsequent appointment at WCIMA during the six months after the index ED visit [N=55 (47%) vs. N=8 (18%), P=0.001]. A rapid-ED-to-primary-care-access program may allow EPs to avoid admitting patients to the hospital without risking ED revisits or subsequent hospitalizations. This protocol has the potential to save costs over time. A program such as this can also provide a safe and reliable ED discharge option

  6. Ed Deutschman Visit Images, May 2, 2011

    OpenAIRE

    Deutschman, Ed

    2011-01-01

    Background: Ed Deutschman was a Navy cadet at the Del Monte Pre-Flight School, located at the now (2013) Naval Postgraduate School. Mr Deutschman visited the Dudley Knox Library on May 2, 2011, and spoke about his service in World War II as a Corsair fighter pilot in the Pacific.

  7. Analysis of Adult Trauma Patients Admitted to Emergency Department

    Directory of Open Access Journals (Sweden)

    Sema Puskulluoglu

    2015-09-01

    Full Text Available Purpose: Trauma is one of the most common reason of admissions to emergency departments. In this study, it was aimed to determine the demographic characteristics, etiology, morbidity and mortality rates and prognosis of adult trauma patients admitted to our emergency department (ED. Materials and Methods: Patients over the age of 18 years, who admitted to ED between 01 March 2011 and 31 August 2011 were included in this retrospective study. Patient examination cards, hospitalization files and records entered with ICD 10 codes to hospital automation system were analyzed. Patients with inaccessible data were excluded from the study. Results: During the study period, total number of 110495 patients admitted to ED, and 13585 (12,29% of them admitted with trauma. Simple extremity injuries (38,28% and falls (31,7% were most common etiological factors. Glasgow coma scales of 99,71% of the patients were between 13 and 15. Of the patients with trauma, 9,6% had a Computed Tomography (CT scan, and 84,5% of CT scans were evaluated as normal, and cranial CT was the most requested one. Only 6% of the patients were hospitalized, and 0,9% of the trauma patients died. Falls from height in females and traffic accidents in males were the leading causes of death. Conclusion: Most of the patients with simple traumas admitted to ED can be discharged from the hospital with a complete history and careful examination. The rate of unnecessary medical tests, loss of time and waste money should be reduced, and the time and labor allocated to severe patients can be increased by this way. [Cukurova Med J 2015; 40(3.000: 569-579

  8. Access to primary care and visits to emergency departments in England: a cross-sectional, population-based study.

    Directory of Open Access Journals (Sweden)

    Thomas E Cowling

    Full Text Available BACKGROUND: The number of visits to hospital emergency departments (EDs in England has increased by 20% since 2007-08, placing unsustainable pressure on the National Health Service (NHS. Some patients attend EDs because they are unable to access primary care services. This study examined the association between access to primary care and ED visits in England. METHODS: A cross-sectional, population-based analysis of patients registered with 7,856 general practices in England was conducted, for the time period April 2010 to March 2011. The outcome measure was the number of self-referred discharged ED visits by the registered population of a general practice. The predictor variables were measures of patient-reported access to general practice services; these were entered into a negative binomial regression model with variables to control for the characteristics of patient populations, supply of general practitioners and travel times to health services. MAIN RESULT AND CONCLUSION: General practices providing more timely access to primary care had fewer self-referred discharged ED visits per registered patient (for the most accessible quintile of practices, RR = 0.898; P<0.001. Policy makers should consider improving timely access to primary care when developing plans to reduce ED utilisation.

  9. Access to Primary Care and Visits to Emergency Departments in England: A Cross-Sectional, Population-Based Study

    Science.gov (United States)

    Cowling, Thomas E.; Cecil, Elizabeth V.; Soljak, Michael A.; Lee, John Tayu; Millett, Christopher; Majeed, Azeem; Wachter, Robert M.; Harris, Matthew J.

    2013-01-01

    Background The number of visits to hospital emergency departments (EDs) in England has increased by 20% since 2007-08, placing unsustainable pressure on the National Health Service (NHS). Some patients attend EDs because they are unable to access primary care services. This study examined the association between access to primary care and ED visits in England. Methods A cross-sectional, population-based analysis of patients registered with 7,856 general practices in England was conducted, for the time period April 2010 to March 2011. The outcome measure was the number of self-referred discharged ED visits by the registered population of a general practice. The predictor variables were measures of patient-reported access to general practice services; these were entered into a negative binomial regression model with variables to control for the characteristics of patient populations, supply of general practitioners and travel times to health services. Main Result and Conclusion General practices providing more timely access to primary care had fewer self-referred discharged ED visits per registered patient (for the most accessible quintile of practices, RR = 0.898; P<0.001). Policy makers should consider improving timely access to primary care when developing plans to reduce ED utilisation. PMID:23776694

  10. Managing the advanced cancer patient in the Australian emergency department environment : Findings from a national survey of emergency department clinicians

    NARCIS (Netherlands)

    T.J. Weiland (Tracey); Lane, H. (Heather); G.A. Jelinek; C.H.L. Marck (Claudia); Weil, J. (Jennifer); M. Boughey (Mark); Philip, J. (Jennifer)

    2015-01-01

    textabstractBackground: Delivery of care to people with advanced cancer in the emergency department (ED) is complicated by competing service demands, workloads and physical design constraints. We explored emergency clinicians’ attitudes to the ED environment when caring for patients who present with

  11. The reliability and validity of passive leg raise and fluid bolus to assess fluid responsiveness in spontaneously breathing emergency department patients

    DEFF Research Database (Denmark)

    Duus, Nicolaj; Shogilev, Daniel J; Skibsted, Simon

    2015-01-01

    PURPOSE: We investigated the reproducibility of passive leg raise (PLR) and fluid bolus (BOLUS) using the Non-Invasive Cardiac Output Monitor (NICOM; Cheetah Medical, Tel Aviv, Israel) for assessment of fluid responsiveness (FR) in spontaneously breathing emergency department (ED) patients. METHODS...

  12. Voluntary Medical Incident Reporting Tool to Improve Physician Reporting of Medical Errors in an Emergency Department

    Directory of Open Access Journals (Sweden)

    Nnaemeka G. Okafor

    2015-12-01

    Full Text Available Introduction: Medical errors are frequently under-reported, yet their appropriate analysis, coupled with remediation, is essential for continuous quality improvement. The emergency department (ED is recognized as a complex and chaotic environment prone to errors. In this paper, we describe the design and implementation of a web-based ED-specific incident reporting system using an iterative process. Methods: A web-based, password-protected tool was developed by members of a quality assurance committee for ED providers to report incidents that they believe could impact patient safety. Results: The utilization of this system in one residency program with two academic sites resulted in an increase from 81 reported incidents in 2009, the first year of use, to 561 reported incidents in 2012. This is an increase in rate of reported events from 0.07% of all ED visits to 0.44% of all ED visits. In 2012, faculty reported 60% of all incidents, while residents and midlevel providers reported 24% and 16% respectively. The most commonly reported incidents were delays in care and management concerns. Conclusion: Error reporting frequency can be dramatically improved by using a web-based, userfriendly, voluntary, and non-punitive reporting system.

  13. Pain management in the emergency department and its relationship to patient satisfaction

    Directory of Open Access Journals (Sweden)

    Downey La Vonne

    2010-01-01

    Full Text Available Background : Pain is the most common reason due to which patients come to the emergency department (ED. Aim : The purpose of this study was to measure the correlation, if any, between pain reduction and the level of satisfaction in patients who presented to the ED with pain as their chief complaint. Materials and Methods : This study used a randomly selected group of patients who presented to the ED with pain of 4 or more on the Visual Analogue Pain Scale (VAS as their chief complaint to a level one adult and pediatric trauma center. Instruments that were used in this study were the VAS, Brief Pain Inventory (BPI, and the Medical Interview Satisfaction Scale (MISS. They were administered to patients by research fellows in the treatment rooms. Statistical analysis included frequencies, descriptive, and linear regression. This study was approved by the Internal Review Board. Results : A total of 159 patients were enrolled in the study. All patients were given some type of treatment for their pain upon arrival to the ED. A logistic regression showed a significant relationship to reduction in pain by 40% or more and customer service questions. Conclusions : A reduction in perceived pain levels does directly relate to several indicators of customer service. Patients who experienced pain relief during their stay in the ED had significant increases in distress relief, rapport with their doctor, and intent to comply with given instructions.

  14. Interprofessional communication supporting clinical handover in emergency departments: An observation study.

    Science.gov (United States)

    Redley, Bernice; Botti, Mari; Wood, Beverley; Bucknall, Tracey

    2017-08-01

    Poor interprofessional communication poses a risk to patient safety at change-of-shift in emergency departments (EDs). The purpose of this study was to identify and describe patterns and processes of interprofessional communication impacting quality of ED change-of-shift handovers. Observation of 66 change-of-shift handovers at two acute hospital EDs in Victoria, Australia. Focus groups with 34 nurse participants complemented the observations. Qualitative data analysis involved content and thematic methods. Four structural components of ED handover processes emerged represented by (ABCD): (1) Antecedents; (2) Behaviours and interactions; (3) Content; and (4) Delegation of ongoing care. Infrequent and ad hoc interprofessional communication and discipline-specific handover content and processes emerged as specific risks to patient safety at change-of-shift handovers. Three themes related to risky and effective practices to support interprofessional communications across the four stages of ED handovers emerged: 1) standard processes and practices, 2) teamwork and interactions and 3) communication activities and practices. Unreliable interprofessional communication can impact the quality of change-of-shift handovers in EDs and poses risk to patient safety. Structured reflective analysis of existing practices can identify opportunities for standardisation, enhanced team practices and effective communication across four stages of the handover process to support clinicians to enhance local handover practices. Future research should test and refine models to support analysis of practice, and identify and test strategies to enhance ED interprofessional communication to support clinical handovers. Copyright © 2017 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.

  15. A cross-sectional study of the self-report of stress among emergency department patients

    Directory of Open Access Journals (Sweden)

    Nirenberg Ted

    2009-01-01

    Full Text Available Background: There is a lack of information about the prevalence of stress and types of stressors experienced by Emergency Department (ED patients. Objective: The present aim is to study the prevalence of stress, types of stressful situations and the relationship with other health issues within the ED population. Materials and Methods: This is a cross-sectional study performed in an ED at a level-1 urban trauma center for four months. An anonymous survey was offered to adult non critically ill patients who were admitted in the ED. They were divided on the basis of gender, age and level of stress and were asked about their demographics, reasons for their ED visit and health issues including stress, tobacco, alcohol and marijuana use, weight concern and health. Chi-square for the categorical variables and unpaired t-tests for continuous variables were conducted. Results: We interviewed 1797 patients, over 66% reported that they felt stressed on at least a weekly basis, and over 45% indicated that they felt stressed more than twice per week. While both young and old were equally stressed, females reported significantly more stress. Family, finances and work are the most frequently cited stressors. Different age groups reported different types of stressors. Overall, those patients reporting being stressed more frequently reported more high risk behaviors including cigarette and marijuana use and health problems including being overweight, being depressed, and having sleeping problems and chronic fatigue. Conclusions: Considering the high frequency of ED patients that report frequent stress and high risk behaviors, their ED visit may be an excellent opportunity to provide a referral or an intervention for stress reduction.

  16. Contrasting treatment and outcomes of septic shock: presentation on hospital floors versus emergency department

    Institute of Scientific and Technical Information of China (English)

    WANG Zhen; Chrism Schorr; Krystal Hunter; R. Phillip Dellinger

    2010-01-01

    Background Patients with septic shock have a high mortality. This study used the Surviving Sepsis Campaign (SSC)database to compare characteristics, treatments and outcomes of septic shock patients diagnosed in the emergency department (ED) to patients developing septic shock on hospital floors (HF).Methods The studied population included patients admitted to the intensive care unit (ICU) of an urban tertiary care medical center over an 18-month period. Acute physiology and chronic health evaluation (APACHE Ⅱ) scores, need for mechanical ventilation (MV), performance on four of the SSC resuscitation bundle indicators, ICU length of stay (LOS),hospital LOS and in-hospital mortality were ascertained.Results Sixty-six ED and 27 HF septic shock patients were included in this study. Urinary tract infections (UTI) and pneumonia were the two most common sites of infection in the ED patients. The sources of infection for HF septic shock patients were fairly well distributed across etiologies. The time to achieve superior vena cava oxygen saturation (ScvO2)> 70% in HF patients ((10.8±9.1) hours) was longer when compared to the ED patients ((6.6±-6.1) hours) (P <0.05).Hospital mortality for the ED and HF patients were 25.8% and 59.3%, respectively (P <0.05). Use of MV during the first 24 hours of shock was 44% in the ED patients and 70% in the HF patients (P <0.05) and was linked to mortality.Conclusions When compared to HF patients, ED septic shock patients have lower in-hospital mortality, there was less use of MV during the first 24 hours following onset of septic shock and the HF patients required a longer time to achieve target ScvO2. The need for mechanical ventilation is independently associated with increased mortality.

  17. Patient and Physician Willingness to Use Personal Health Records in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Anil S. Menon, MD, MS, MPH

    2012-05-01

    Full Text Available Introduction: Patient care in the emergency department (ED is often complicated by the inability toobtain an accurate prior history even when the patient is able to communicate with the ED staff.Personal health records (PHR can mitigate the impact of such information gaps. This study assessesED patients’ willingness to adopt a PHR and the treating physicians’ willingness to use that information.Methods: This cross-sectional study was answered by 184 patients from 219 (84% surveysdistributed in an academic ED. The patient surveys collected data about demographics, willingnessand barriers to adopt a PHR, and the patient’s perceived severity of disease on a 5-point scale. Eachpatient survey was linked to a treating physician survey of which 210 of 219 (96% responded.Results: Of 184 surveys completed, 78% of respondents wanted to have their PHR uploaded onto theInternet, and 83% of providers felt they would access it. Less than 10% wanted a software company, aninsurance company, or the government to control their health information, while over 50% wanted ahospital to control that information. The patients for whom these providers would not have used a PHRhad a statistically significant lower severity score of illness as determined by the treating physician fromthose that they would have used a PHR (1.5 vs 2.4, P , 0.01. Fifty-seven percent of physicians wouldonly use a PHR if it took less than 5 minutes to access.Conclusion: The majority of patients and physicians in the ED are willing to adopt PHRs, especially ifthe hospital participates. ED physicians are more likely to check the PHRs of more severely ill patients.Speed of access is important to ED physicians.

  18. Time Series Analysis of Emergency Department Length of Stay per 8-Hour Shift

    Directory of Open Access Journals (Sweden)

    Niels K. Rathlev, MD

    2012-05-01

    Full Text Available Introduction: The mean emergency department (ED length of stay (LOS is considered a measure ofcrowding. This paper measures the association between LOS and factors that potentially contribute toLOS measured over consecutive shifts in the ED: shift 1 (7:00 AM to 3:00 PM, shift 2 (3:00 PM to 11:00PM, and shift 3 (11:00 PM to 7:00 AM.Methods: Setting: University, inner-city teaching hospital. Patients: 91,643 adult ED patients betweenOctober 12, 2005 and April 30, 2007. Design: For each shift, we measured the numbers of (1 EDnurses on duty, (2 discharges, (3 discharges on the previous shift, (4 resuscitation cases, (5admissions, (6 intensive care unit (ICU admissions, and (7 LOS on the previous shift. For each 24-hour period, we measured the (1 number of elective surgical admissions and (2 hospital occupancy.We used autoregressive integrated moving average time series analysis to retrospectively measurethe association between LOS and the covariates.Results: For all 3 shifts, LOS in minutes increased by 1.08 (95% confidence interval 0.68, 1.50 forevery additional 1% increase in hospital occupancy. For every additional admission from the ED, LOSin minutes increased by 3.88 (2.81, 4.95 on shift 1, 2.88 (1.54, 3.14 on shift 2, and 4.91 (2.29, 7.53 onshift 3. LOS in minutes increased 14.27 (2.01, 26.52 when 3 or more patients were admitted to the ICUon shift 1. The numbers of nurses, ED discharges on the previous shift, resuscitation cases, andelective surgical admissions were not associated with LOS on any shift.Conclusion: Key factors associated with LOS include hospital occupancy and the number of hospitaladmissions that originate in the ED. This particularly applies to ED patients who are admitted to theICU.

  19. Consensus statement on advancing research in emergency department operations and its impact on patient care.

    Science.gov (United States)

    Yiadom, Maame Yaa A B; Ward, Michael J; Chang, Anna Marie; Pines, Jesse M; Jouriles, Nick; Yealy, Donald M

    2015-06-01

    The consensus conference on "Advancing Research in Emergency Department (ED) Operations and Its Impact on Patient Care," hosted by The ED Operations Study Group (EDOSG), convened to craft a framework for future investigations in this important but understudied area. The EDOSG is a research consortium dedicated to promoting evidence-based clinical practice in emergency medicine. The consensus process format was a modified version of the NIH Model for Consensus Conference Development. Recommendations provide an action plan for how to improve ED operations study design, create a facilitating research environment, identify data measures of value for process and outcomes research, and disseminate new knowledge in this area. Specifically, we call for eight key initiatives: 1) the development of universal measures for ED patient care processes; 2) attention to patient outcomes, in addition to process efficiency and best practice compliance; 3) the promotion of multisite clinical operations studies to create more generalizable knowledge; 4) encouraging the use of mixed methods to understand the social community and human behavior factors that influence ED operations; 5) the creation of robust ED operations research registries to drive stronger evidence-based research; 6) prioritizing key clinical questions with the input of patients, clinicians, medical leadership, emergency medicine organizations, payers, and other government stakeholders; 7) more consistently defining the functional components of the ED care system, including observation units, fast tracks, waiting rooms, laboratories, and radiology subunits; and 8) maximizing multidisciplinary knowledge dissemination via emergency medicine, public health, general medicine, operations research, and nontraditional publications. © 2015 by the Society for Academic Emergency Medicine.

  20. Patients Hospitalized in General Wards via the Emergency Department: Early Identification of Predisposing Factors for Death or Unexpected Intensive Care Unit Admission—A Historical Prospective

    Directory of Open Access Journals (Sweden)

    Thierry Boulain

    2014-01-01

    Full Text Available Background. To identify, upon emergency department (ED admission, predictors of unexpected death or unplanned intensive care/high dependency units (ICU/HDU admission during the first 15 days of hospitalization on regular wards. Methods. Prospective cohort study in a medical-surgical adult ED in a teaching hospital, including consecutive patients hospitalized on regular wards after ED visit, and identification of predictors by logistic regression and Cox proportional hazards model. Results. Among 4,619 included patients, 77 (1.67% target events were observed: 32 unexpected deaths and 45 unplanned transfers to an ICU/HDU. We identified 9 predictors of the target event including the oxygen administration on the ED, unknown current medications, and use of psychoactive drug(s. All predictors put the patients at risk during the first 15 days of hospitalization. A logistic model for hospital mortality prediction (death of all causes still comprised oxygen administration on the ED, unknown current medications, and the use of psychoactive drug(s as risk factors. Conclusion. The “use of oxygen therapy on the ED,” the “current use of psychoactive drug(s”, and the “lack of knowledge of current medications taken by the patients” were important predisposing factors to severe adverse events during the 15 days of hospitalization on regular wards following the ED visit.

  1. Estimation of the prevalence of undiagnosed and diagnosed HIV in an urban emergency department.

    Directory of Open Access Journals (Sweden)

    William M Reichmann

    Full Text Available OBJECTIVE: To estimate the prevalence of undiagnosed HIV, the prevalence of diagnosed HIV, and proportion of HIV that is undiagnosed in populations with similar demographics as the Universal Screening for HIV in the Emergency Room (USHER Trial and the Brigham and Women's Hospital (BWH Emergency Department (ED in Boston, MA. We also sought to estimate these quantities within demographic and risk behavior subgroups. METHOD: We used data from the USHER Trial, which was a randomized clinical trial of HIV screening conducted in the BWH ED. Since eligible participants were HIV-free at time of enrollment, we were able to calculate the prevalence of undiagnosed HIV. We used data from the Massachusetts Department of Public Health (MA/DPH to estimate the prevalence of diagnosed HIV since the MA/DPH records the number of persons within MA who are HIV-positive. We calculated the proportion of HIV that is undiagnosed using these estimates of the prevalence of undiagnosed and diagnosed HIV. Estimates were stratified by age, sex, race/ethnicity, history of testing, and risk behaviors. RESULTS: The overall expected prevalence of diagnosed HIV in a population similar to those presenting to the BWH ED was 0.71% (95% CI: 0.63%, 0.78%. The prevalence of undiagnosed HIV was estimated at 0.22% (95% CI: 0.10%, 0.42% and resultant overall prevalence was 0.93%. The proportion of HIV-infection that is undiagnosed in this ED-based setting was estimated to be 23.7% (95% CI: 11.6%, 34.9% of total HIV-infections. CONCLUSIONS: Despite different methodology, our estimate of the proportion of HIV that is undiagnosed in an ED-setting was similar to previous estimates based on national surveillance data. Universal routine testing programs in EDs should use these data to help plan their yield of HIV detection.

  2. Procedures and Collaborative Information Seeking: A Study of Emergency Departments

    DEFF Research Database (Denmark)

    Hertzum, Morten; Reddy, Madhu

    2015-01-01

    Information seeking is a central and inherently collaborative activity in the emergency department (ED) which is the common entry point to hospitals for nearly all acute patients. In this paper, we investigate how ED clinicians’ collabo-rative information seeking (CIS) is shaped by the procedures...... that the clinicians follow in the ED. Based on observations in two Danish EDs, we identify four pro-cedures prominent to how CIS is accomplished: the triage procedure, the timeouts, the coordinating nurse, and the recurrent opportunities for information seeking at the whiteboard. We then discuss how CIS activities...

  3. Procedures and Collaborative Information Seeking: A Study of Emergency Departments

    DEFF Research Database (Denmark)

    Hertzum, Morten; Reddy, Madhu

    2015-01-01

    Information seeking is a central and inherently collaborative activity in the emergency department (ED) which is the common entry point to hospitals for nearly all acute patients. In this paper, we investigate how ED clinicians’ collabo-rative information seeking (CIS) is shaped by the procedures...... that the clinicians follow in the ED. Based on observations in two Danish EDs, we identify four pro-cedures prominent to how CIS is accomplished: the triage procedure, the timeouts, the coordinating nurse, and the recurrent opportunities for information seeking at the whiteboard. We then discuss how CIS activities...

  4. Stress in emergency departments: experiences of nurses and doctors.

    LENUS (Irish Health Repository)

    Healy, Sonya

    2012-01-31

    The effects of stressful incidents on emergency department (ED) staff can be profound. Witnessing aggression, violence or the death of patients, or participating in resuscitation, can be emotionally and physically demanding. Despite the frequency of these events, ED staff do not become immune to the stress they cause, and are often ill prepared and under supported to cope with them. This article reports on a study of nurses\\' and doctors\\' attitudes to, and experiences of, workplace stress in three EDs in Ireland, and offers some suggestions on how stress among ED staff can be reduced.

  5. Predictive score for mortality in patients with COPD exacerbations attending hospital emergency departments

    Science.gov (United States)

    2014-01-01

    Background Limited information is available about predictors of short-term outcomes in patients with exacerbation of chronic obstructive pulmonary disease (eCOPD) attending an emergency department (ED). Such information could help stratify these patients and guide medical decision-making. The aim of this study was to develop a clinical prediction rule for short-term mortality during hospital admission or within a week after the index ED visit. Methods This was a prospective cohort study of patients with eCOPD attending the EDs of 16 participating hospitals. Recruitment started in June 2008 and ended in September 2010. Information on possible predictor variables was recorded during the time the patient was evaluated in the ED, at the time a decision was made to admit the patient to the hospital or discharge home, and during follow-up. Main short-term outcomes were death during hospital admission or within 1 week of discharge to home from the ED, as well as at death within 1 month of the index ED visit. Multivariate logistic regression models were developed in a derivation sample and validated in a validation sample. The score was compared with other published prediction rules for patients with stable COPD. Results In total, 2,487 patients were included in the study. Predictors of death during hospital admission, or within 1 week of discharge to home from the ED were patient age, baseline dyspnea, previous need for long-term home oxygen therapy or non-invasive mechanical ventilation, altered mental status, and use of inspiratory accessory muscles or paradoxical breathing upon ED arrival (area under the curve (AUC) = 0.85). Addition of arterial blood gas parameters (oxygen and carbon dioxide partial pressures (PO2 and PCO2)) and pH) did not improve the model. The same variables were predictors of death at 1 month (AUC = 0.85). Compared with other commonly used tools for predicting the severity of COPD in stable patients, our rule was significantly better

  6. The Clinical Epidemiology and 30-Day Outcomes of Emergency Department Patients With Acute Kidney Injury

    Directory of Open Access Journals (Sweden)

    Frank Xavier Scheuermeyer

    2017-04-01

    Full Text Available Background: Acute kidney injury (AKI is associated with increased mortality and dialysis in hospitalized patients but has been little explored in the emergency department (ED setting. Objective: The objective of this study was to describe the risk factors, prevalence, management, and outcomes in the ED population, and to identify the proportion of AKI patients who were discharged home with no renal-specific follow-up. Design: This is a retrospective cohort study using administrative and laboratory databases. Setting: Two urban EDs in Vancouver, British Columbia, Canada. Patients: We included all unique ED patients over a 1-week period. Methods: All patients had their described demographics, comorbidities, medications, laboratory values, and ED treatments collected. AKI was defined pragmatically, based upon accepted guidelines. The cohort was then probabilistically linked to the provincial renal database to ascertain renal replacement (transplant or dialysis and the provincial vital statistics database to obtain mortality. The primary outcome was the prevalence of AKI; secondary outcomes included (1 the proportion of AKI patients who were discharged home with no renal-specific follow-up and (2 the combined 30-day rate of death or renal replacement among AKI patients. Results: There were 1651 ED unique patients, and 840 had at least one serum creatinine (SCr obtained. Overall, 90 patients had AKI (10.7% of ED patients with at least one SCr, 95% confidence interval [CI], 8.7%-13.1%; 5.5% of all ED patients, 95% CI, 4.4%-6.7% with a median age of 74 and 70% male. Of the 31 (34.4% AKI patients discharged home, 4 (12.9% had renal-specific follow-up arranged in the ED. Among the 90 AKI patients, 11 died and none required renal replacement at 30 days, for a combined outcome of 12.2% (95% CI, 6.5%-21.2%. Limitations: Sample sizes may be small. Nearly half of ED patients did not obtain an SCr. Many patients did not have sequential SCr testing, and a

  7. Timeliness of interfacility transfer for ED patients with ST-elevation myocardial infarction.

    Science.gov (United States)

    Ward, Michael J; Kripalani, Sunil; Storrow, Alan B; Liu, Dandan; Speroff, Theodore; Matheny, Michael; Thomassee, Eric J; Vogus, Timothy J; Munoz, Daniel; Scott, Carol; Fredi, Joseph L; Dittus, Robert S

    2015-03-01

    Most US hospitals lack primary percutaneous coronary intervention (PCI) capabilities to treat patients with ST-elevation myocardial infarction (STEMI) necessitating transfer to PCI-capable centers. Transferred patients rarely meet the 120-minute benchmark for timely reperfusion, and referring emergency departments (EDs) are a major source of preventable delays. We sought to use more granular data at transferring EDs to describe the variability in length of stay at referring EDs. We retrospectively analyzed a secondary data set used for quality improvement for patients with STEMI transferred to a single PCI center between 2008 and 2012. We conducted a descriptive analysis of the total time spent at each referring ED (door-in-door-out [DIDO] interval), periods that comprised DIDO (door to electrocardiogram [EKG], EKG-to-PCI activation, and PCI activation to exit), and the relationship of each period with overall time to reperfusion (medical contact-to-balloon [MCTB] interval). We identified 41 EDs that transferred 620 patients between 2008 and 2012. Median MCTB was 135 minutes (interquartile range [IQR] 114,172). Median overall ED DIDO was 74 minutes (IQR 56,103) and was composed of door to EKG, 5 minutes (IQR 2,11); EKG-to-PCI activation, 18 minutes (IQR 7,37); and PCI activation to exit, 44 minutes (IQR 34,56). Door-in door-out accounted for the largest proportion (60%) of overall MCTB and had the largest variability (coefficient of variability, 1.37) of these intervals. In this cohort of transferring EDs, we found high variability and substantial delays after EKG performance for patients with STEMI. Factors influencing ED decision making and transportation coordination after PCI activation are a potential target for intervention to improve the timeliness of reperfusion in patients with STEMI. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Evaluation of a New Noninvasive Device in Determining Hemoglobin Levels in Emergency Department Patients

    Directory of Open Access Journals (Sweden)

    Tristan Knutson

    2013-05-01

    Full Text Available Introduction: The Masimo Radical-7 Pulse CO-Oximeter is a medical device recently approved by the US Food and Drug Administration that performs noninvasive oximetry and estimated venous or arterial hemoglobin measurements. A portable, noninvasive device that rapidly measures hemoglobin concentration could be useful in both austere and modern hospital settings. The objective of this study is to determine the degree of variation between the device’s estimated hemoglobin measurement and the actual venous hemoglobin concentration in undifferentiated emergency department (ED patients.Methods: We conducted a prospective, observational, cross-sectional study of adult patients presenting to the ED. The subjects consisted of a convenience sample of adult ED patients who required a complete blood count as part of their care in the ED. A simultaneous probe hemoglobin was obtained and recorded.Results: Bias between probe and laboratory hemoglobin measurements was _0.5 (95% confidence interval,_0.8 to_0.1 but this was not statistically significant from 0 (t 0.05,124¼0.20, P . 0.5. The limits of agreement were _4.7 and 3.8, beyond the clinically relevant standard of equivalency of 6 1 g/dL.Conclusion: These data suggest that noninvasive hemoglobin determination is not sufficiently accurate for emergency department use. [West J Emerg Med. 2013;14(3:283–286.

  9. Establishing a nationwide emergency department-based syndromic surveillance system for better public health responses in Taiwan

    Directory of Open Access Journals (Sweden)

    Chiu Chan-Hsien

    2008-01-01

    Full Text Available Abstract Background With international concern over emerging infectious diseases (EID and bioterrorist attacks, public health is being required to have early outbreak detection systems. A disease surveillance team was organized to establish a hospital emergency department-based syndromic surveillance system (ED-SSS capable of automatically transmitting patient data electronically from the hospitals responsible for emergency care throughout the country to the Centers for Disease Control in Taiwan (Taiwan-CDC starting March, 2004. This report describes the challenges and steps involved in developing ED-SSS and the timely information it provides to improve in public health decision-making. Methods Between June 2003 and March 2004, after comparing various surveillance systems used around the world and consulting with ED physicians, pediatricians and internal medicine physicians involved in infectious disease control, the Syndromic Surveillance Research Team in Taiwan worked with the Real-time Outbreak and Disease Surveillance (RODS Laboratory at the University of Pittsburgh to create Taiwan's ED-SSS. The system was evaluated by analyzing daily electronic ED data received in real-time from the 189 hospitals participating in this system between April 1, 2004 and March 31, 2005. Results Taiwan's ED-SSS identified winter and summer spikes in two syndrome groups: influenza-like illnesses and respiratory syndrome illnesses, while total numbers of ED visits were significantly higher on weekends, national holidays and the days of Chinese lunar new year than weekdays (p Conclusion Taiwan's ED-SSS represents the first nationwide real-time syndromic surveillance system ever established in Asia. The experiences reported herein can encourage other countries to develop their own surveillance systems. The system can be adapted to other cultural and language environments for better global surveillance of infectious diseases and international collaboration.

  10. Domestic violence in an inner-city ED.

    Science.gov (United States)

    Ernst, A A; Nick, T G; Weiss, S J; Houry, D; Mills, T

    1997-08-01

    A confidential written survey was conducted at the emergency department (ED) of Charity Hospital in New Orleans to determine the prevalence of domestic violence (DV) for male and female ED patients and to determine the demographics of DV. Four violence parameters were calculated for patients who had a partner at the time of presentation: 1) present physical; 2) present nonphysical; 3) past physical; and 4) past nonphysical. Out of the 516 patients enrolled, 283 were women and 233 were men. On the basis of Index of Spouse Abuse scoring, 14% of men and 22% of women had experienced past nonphysical violence, and 28% of men and 33% of women had experienced past physical violence. Of the 157 men and 207 women with partners at the time of presentation, 11% men and 15% women reported present nonphysical violence, and 20% men and 19% of the women reported present physical violence. Logistic-regression models demonstrated that women experienced significantly more past and present nonphysical violence but not physical violence than men. Alcohol, drug use, and suicidal ideation were found to be significant predictors associated with DV. In conclusion, DV rates were high in the New Orleans population, with nearly equal rates of past and present physical violence for men and women.

  11. Department of Education

    Science.gov (United States)

    ... MORE NEWS > John B. King, Jr. Secretary of Education Bio Speeches @JohnKingatED How Do I Find...? Student ... Succeeds Act (ESSA) FERPA Civil Rights Data & Research Education Statistics Postsecondary Education Data ED Data Express Nation's ...

  12. Criminal correlates of injury-related emergency department recidivism.

    Science.gov (United States)

    Claassen, Cynthia A; Larkin, Gregory Luke; Hodges, Gayle; Field, Craig

    2007-02-01

    To investigate criminal and high-risk lifestyle factors that predict emergency department (ED) recidivism, a longitudinal (8-year) cohort study of ED trauma patients was conducted. Study patients provided risk and lifestyle behavior information via semi-structured interview. ED revisit and re-injury rates for 1995-2003 were acquired through hospital record review. Lifetime criminal arrest data were obtained for each study subject via record linkage from PublicData.com, an internet-based service. The 8-year ED re-visit rate was 47% (75/161), but revisits were more often medical than injury-related (30% vs. 17%, respectively). Over half (58%) of all injured ED patients had a documented arrest history, and arrests were significantly more common in those who came back to the ED for repeat trauma vs. those who did not revisit the ED (70.4% vs. 55.9%, respectively; p violence-related crimes, 23% (37/161) of 98 drug-related offenses, and 17.4% (28/161) of 89 other non-traffic-related crimes. ED recidivism for trauma care was associated with multiple substance abuse behaviors and drug-related arrests. Significant risk factors for ED recidivism seem to be high-risk substance-abuse-related behaviors and criminal activity, constituting important targets for effective ED-based intervention, referral, and follow-up.

  13. Cytoplasmic Streaming - Skylab Student Experiment ED-63

    Science.gov (United States)

    1973-01-01

    This chart describes the Skylab student experiment (ED-63), Cytoplasmic Streaming, proposed by Cheryl A. Peitz of Arapahoe High School, Littleton, Colorado. Experiment ED-63 was to observe the effect of zero-gravity on cytoplasmic streaming in the aquatic plant named Elodea, commonly called water weed or water thyme. The phenomenon of cytoplasmic streaming is not well understood, but it is recognized as the circulation mechanism of the internal materials or cytoplasm of a cell. Cytoplasm is a gelatinous substance that has the ability to change its viscosity and flow, carrying various cell materials with it. The activity can be stimulated by sunlight or heat. In March 1972, NASA and the National Science Teachers Association selected 25 experiment proposals for flight on Skylab. Science advisors from the Marshall Space Flight Center aided and assisted the students in developing the proposals for flight on Skylab.

  14. Impact of the ABCDE triage in primary care emergency department on the number of patient visits to different parts of the health care system in Espoo City

    Directory of Open Access Journals (Sweden)

    Kantonen Jarmo

    2012-01-01

    Full Text Available Abstract Background Many Finnish emergency departments (ED serve both primary and secondary health care patients and are therefore referred to as combined emergency departments. Primary care doctors are responsible for the initial assessment and treatment. They, thereby, also regulate referral and access to secondary care. Primary health care EDs are easy for the public to access, leading to non-acute patient visits to the emergency department. This has caused increased queues and unnecessary difficulties in providing immediate treatment for urgent patients. The primary aim of this study was to assess whether the flow of patients was changed by implementing the ABCDE-triage system in the EDs of Espoo City, Finland. Methods The numbers of monthly visits to doctors were recorded before and after intervention in Espoo primary care EDs. To study if the implementation of the triage system redirects patients to other health services, the numbers of monthly visits to doctors were also scored in the private health care, the public sector health services of Espoo primary care during office hours and local secondary health care ED (Jorvi hospital. A face-to-face triage system was applied in the primary care EDs as an attempt to provide immediate treatment for the most acute patients. It is based on the letters A (patient sent directly to secondary care, B (to be examined within 10 min, C (to be examined within 1 h, D (to be examined within 2 h and E (no need for immediate treatment for assessing the urgency of patients' treatment needs. The first step was an initial patient assessment by a health care professional (triage nurse. The introduction of this triage system was combined with information to the public on the "correct" use of emergency services. Results After implementation of the ABCDE-triage system the number of patient visits to a primary care doctor decreased by up to 24% (962 visits/month as compared to the three previous years in the EDs

  15. Case Study:EDS in China

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    @@ Asign that China is quickly moving up the global service outsourcing ranking came earlier this year when EDS (Electronic Data Services), one of the world's leading IT outsourcing companies,announced it would be moving its Asia headquarters to Shanghai from Australia. Recognizing the growing potential of China in this area, the company also announced it would shortly be launching at least two offshore software development centers in the country, with the first location due to be announced at the begining of November.

  16. Emergency Department Visits by Older Adults for Motor Vehicle Collisions

    Directory of Open Access Journals (Sweden)

    Vogel, Jody A.

    2013-11-01

    Full Text Available Introduction: To describe the epidemiology and characteristics of emergency department (ED visits by older adults for motor vehicle collisions (MVC in the United States (U.S..Methods: We analyzed ED visits for MVCs using data from the 2003–2007 National Hospital Ambulatory Medical Care Survey (NHAMCS. Using U.S. Census data, we calculated annual incidence rates of driver or passenger MVC-related ED visits and examined visit characteristics, including triage acuity, tests performed and hospital admission or discharge. We compared older (65+ years and younger (18-64 years MVC patients and calculated odds ratios (OR and 95% confidence intervals (CIs to measure the strength of associations between age group and various visit characteristics. Multivariable logistic regression was used to identify independent predictors of admissions for MVC-related injuries among older adults.Results: From 2003–2007, there were an average of 237,000 annual ED visits by older adults for MVCs. The annual ED visit rate for MVCs was 6.4 (95% CI 4.6-8.3 visits per 1,000 for older adults and 16.4 (95% CI 14.0-18.8 visits per 1,000 for younger adults. Compared to younger MVC patients, after adjustment for gender, race and ethnicity, older MVC patients were more likely to have at least one imaging study performed (OR 3.69, 95% CI 1.46-9.36. Older MVC patients were not significantly more likely to arrive by ambulance (OR 1.47; 95% CI 0.76–2.86, have a high triage acuity (OR 1.56; 95% CI 0.77-3.14, or to have a diagnosis of a head, spinal cord or torso injury (OR 0.97; 95% CI 0.42-2.23 as compared to younger MVC patients after adjustment for gender, race and ethnicity. Overall, 14.5% (95% CI 9.8-19.2 of older MVC patients and 6.1% (95% CI 4.8-7.5 of younger MVC patients were admitted to the hospital. There was also a non-statistically significant trend toward hospital admission for older versus younger MVC patients (OR 1.78; 95% CI 0.71-4.43, and admission to the ICU if

  17. An inventory of VHA emergency departments' resources and processes for caring for women.

    Science.gov (United States)

    Cordasco, Kristina M; Zephyrin, Laurie C; Kessler, Chad S; Mallard, Meri; Canelo, Ismelda; Rubenstein, Lisa V; Yano, Elizabeth M

    2013-07-01

    More women are using Veterans' Health Administration (VHA) Emergency Departments (EDs), yet VHA ED capacities to meet the needs of women are unknown. We assessed VHA ED resources and processes for conditions specific to, or more common in, women Veterans. Cross-sectional questionnaire of the census of VHA ED directors Resources and processes in place for gynecologic, obstetric, sexual assault and mental health care, as well as patient privacy features, stratified by ED characteristics. All 120 VHA EDs completed the questionnaire. Approximately nine out of ten EDs reported having gynecologic examination tables within their EDs, 24/7 access to specula, and Gonorrhea/Chlamydia DNA probes. All EDs reported 24/7 access to pregnancy testing. Fewer than two-fifths of EDs reported having radiologist review of pelvic ultrasound images available 24/7; one-third reported having emergent consultations from gynecologists available 24/7. Written transfer policies specific to gynecologic and obstetric emergencies were reported as available in fewer than half of EDs. Most EDs reported having emergency contraception 24/7; however, only approximately half reported having Rho(D) Immunoglobulin available 24/7. Templated triage notes and standing orders relevant to gynecologic conditions were reported as uncommon. Consistent with VHA policy, most EDs reported obtaining care for victims of sexual assault by transferring them to another institution. Most EDs reported having some access to private medical and mental health rooms. Resources and processes were found to be more available in EDs with more encounters by women, more ED staffed beds, and that were located in more complex facilities in metropolitan areas. Although most VHA EDs have resources and processes needed for delivering emergency care to women Veterans, some gaps exist. Studies in non-VA EDs are required for comparison. Creative solutions are needed to ensure that women presenting to VHA EDs receive efficient, timely, and

  18. Improved Pharmacy Department Workflow with New Method of Order Entry for Single-Agent, High-Dose Methotrexate

    Science.gov (United States)

    VanDyke, Thomas H.; Athmann, Paul W.; Mills, Lisa B.; Bonter, Michael P.; Bremer, Matthew W.; Dougherty, Mary L.; Foster, Ryan W.; Knight, Sandra K.; Slot, Martha G.; Steinmetz-Malato, Laura L.

    2014-01-01

    Purpose: To determine whether a process change impacted the proportion of orders for single-agent, high-dose methotrexate entered by chemotherapy pharmacists instead of general pharmacy staff. Coordination of antiemetic premedication and leucovorin rescue with the new method of order entry was evaluated. Methods: Adults treated with single-agent, high-dose methotrexate were identified retrospectively. Order entry of methotrexate and ancillary medications was examined to determine whether the old or new method was used and whether it was performed by a chemotherapy pharmacist. The fundamental difference between the old and new methods for order entry is use of the “unscheduled” frequency of medication administration to replace the administration frequency of “once” with a specified date and time. Timing of antiemetic premedication and leucovorin rescue relative to methotrexate administration were tallied for the new method. Chi-square analysis was performed for the primary objective. Observational statistics were performed otherwise. Results: The number of evaluable encounters identified was 158. A chemotherapy pharmacist entered a greater proportion of orders when the new method was utilized (P < .0001). The proportion of orders entered by a chemotherapy pharmacist increased during the hours of 0700 and 2259 with the new method. Appropriate coordination of antiemetic and leucovorin administration was documented for 96% and 100% of cases with the new method of order entry. Conclusion: The proportion of orders for single-agent, high-dose methotrexate entered by a chemotherapy pharmacist was significantly greater with the use of the new method. Administration of antiemetic premedication and leucovorin rescue were appropriately coordinated with the use of the new method for order entry of single-agent, high-dose methotrexate. PMID:25673893

  19. Regional Energy Deployment System (ReEDS)

    Energy Technology Data Exchange (ETDEWEB)

    Short, W.; Sullivan, P.; Mai, T.; Mowers, M.; Uriarte, C.; Blair, N.; Heimiller, D.; Martinez, A.

    2011-12-01

    The Regional Energy Deployment System (ReEDS) is a deterministic optimization model of the deployment of electric power generation technologies and transmission infrastructure throughout the contiguous United States into the future. The model, developed by the National Renewable Energy Laboratory's Strategic Energy Analysis Center, is designed to analyze the critical energy issues in the electric sector, especially with respect to potential energy policies, such as clean energy and renewable energy standards or carbon restrictions. ReEDS provides a detailed treatment of electricity-generating and electrical storage technologies and specifically addresses a variety of issues related to renewable energy technologies, including accessibility and cost of transmission, regional quality of renewable resources, seasonal and diurnal generation profiles, variability of wind and solar power, and the influence of variability on the reliability of the electrical grid. ReEDS addresses these issues through a highly discretized regional structure, explicit statistical treatment of the variability in wind and solar output over time, and consideration of ancillary services' requirements and costs.

  20. Where Do Freestanding Emergency Departments Choose to Locate? A National Inventory and Geographic Analysis in Three States.

    Science.gov (United States)

    Schuur, Jeremiah D; Baker, Olesya; Freshman, Jaclyn; Wilson, Michael; Cutler, David M

    2017-04-01

    We determine the number and location of freestanding emergency departments (EDs) across the United States and determine the population characteristics of areas where freestanding EDs are located. We conducted a systematic inventory of US freestanding EDs. For the 3 states with the highest number of freestanding EDs, we linked demographic, insurance, and health services data, using the 5-digit ZIP code corresponding to the freestanding ED's location. To create a comparison nonfreestanding ED group, we matched 187 freestanding EDs to 1,048 nonfreestanding ED ZIP codes on land and population within state. We compared differences in demographic, insurance, and health services factors between matched ZIP codes with and without freestanding EDs, using univariate regressions with weights. We identified 360 freestanding EDs located in 30 states; 54.2% of freestanding EDs were hospital satellites, 36.6% were independent, and 9.2% were not classifiable. The 3 states with the highest number of freestanding EDs accounted for 66% of all freestanding EDs: Texas (181), Ohio (34), and Colorado (24). Across all 3 states, freestanding EDs were located in ZIP codes that had higher incomes and a lower proportion of the population with Medicaid. In Texas and Ohio, freestanding EDs were located in ZIP codes with a higher proportion of the population with private insurance. In Texas, freestanding EDs were located in ZIP codes that had fewer Hispanics, had a greater number of hospital-based EDs and physician offices, and had more physician visits and medical spending per year than ZIP codes without a freestanding ED. In Ohio, freestanding EDs were located in ZIP codes with fewer hospital-based EDs. In Texas, Ohio, and Colorado, freestanding EDs were located in areas with a better payer mix. The location of freestanding EDs in relation to other health care facilities and use and spending on health care varied between states. Copyright © 2016 American College of Emergency Physicians

  1. A prospective, non-interventional study of assessment and treatment adequacy of pain in the emergency department of a tertiary care cancer hospital

    Directory of Open Access Journals (Sweden)

    P N Jain

    2013-01-01

    Full Text Available Introduction: Pain is the most common reason for emergency department (ED visits by the cancer patients. Treatment inconsistency and inadequacy are reported worldwide in the management of ED pain. We conducted a non-interventional observational study of 100 patients visiting ED with moderate to severe pain in a tertiary care cancer center. Aims: The goal of this study was to describe the characteristics of pain and its treatment by oncologists in ED. Materials and Methods: Management of 100 adult patients with complaints of moderate to severe pain was observed by the investigator in ED. Treatment was provided by the doctors of respective oncological services. Later, patients were interviewed by the investigator to collect data about the details of their pain and treatment adequacy. Results: On arrival to ED, about 65% patients reported severe pain, however no formal pain assessment was performed and no patient received strong opioids. Poor compliance for prescribed analgesic medications was noted in a large number of patients (31%, primarily due to suboptimal pain relief and lack of awareness. Protocol based analgesic treatment was non-existent in ED. Majority of patients remained in significant pain after 30 min of analgesic administration and 24% patients could never achieve more than 50% pain relief at the time of discharge. Conclusion: Due to lack of formal pain assessment and laid down protocols, suboptimal pain management is commonly prevalent in ED. Use of strong opioids continues to be scarce in management of severe pain. There is a need to formulate pain management protocols for ED pain.

  2. Department of

    African Journals Online (AJOL)

    USER

    2014-08-27

    Aug 27, 2014 ... Ethiopian Journal of Environmental Studies & Management 7(5): 468 – 477, 2014 ... Department of Planning, Kwame Nkrumah University of Science and Technology .... Anglican and Presbyterian schools have all been mined; exposing school children to dust and .... the district office of the National Disaster.

  3. Availability of mobile phones for discharge follow-up of pediatric Emergency Department patients in western Kenya

    Directory of Open Access Journals (Sweden)

    Darlene R. House

    2015-03-01

    Full Text Available Objective. Mobile phones have been successfully used for Emergency Department (ED patient follow-up in developed countries. Mobile phones are widely available in developing countries and may offer a similar potential for follow-up and continued care of ED patients in low and middle-income countries. The goal of this study was to determine the percentage of families with mobile phones presenting to a pediatric ED in western Kenya and rate of response to a follow-up phone call after discharge.Methods. A prospective, cross-sectional observational study of children presenting to the emergency department of a government referral hospital in Eldoret, Kenya was performed. Documentation of mobile phone access, including phone number, was recorded. If families had access, consent was obtained and families were contacted 7 days after discharge for follow-up.Results. Of 788 families, 704 (89.3% had mobile phone access. Of those families discharged from the ED, successful follow-up was made in 83.6% of cases.Conclusions. Mobile phones are an available technology for follow-up of patients discharged from a pediatric emergency department in resource-limited western Kenya.

  4. Availability of mobile phones for discharge follow-up of pediatric Emergency Department patients in western Kenya.

    Science.gov (United States)

    House, Darlene R; Cheptinga, Philip; Rusyniak, Daniel E

    2015-01-01

    Objective. Mobile phones have been successfully used for Emergency Department (ED) patient follow-up in developed countries. Mobile phones are widely available in developing countries and may offer a similar potential for follow-up and continued care of ED patients in low and middle-income countries. The goal of this study was to determine the percentage of families with mobile phones presenting to a pediatric ED in western Kenya and rate of response to a follow-up phone call after discharge. Methods. A prospective, cross-sectional observational study of children presenting to the emergency department of a government referral hospital in Eldoret, Kenya was performed. Documentation of mobile phone access, including phone number, was recorded. If families had access, consent was obtained and families were contacted 7 days after discharge for follow-up. Results. Of 788 families, 704 (89.3%) had mobile phone access. Of those families discharged from the ED, successful follow-up was made in 83.6% of cases. Conclusions. Mobile phones are an available technology for follow-up of patients discharged from a pediatric emergency department in resource-limited western Kenya.

  5. RESEARCH FOR TEACHİNG METHODS AND MEASURING AND EVALUATION CRİTERİA APPLİED İN PHYSICAL TRANING AND SPORTS CLASSES İN PRIMARY EDUCATION SCHOOLS.

    Directory of Open Access Journals (Sweden)

    Ahmet ŞİRİNKAN

    2009-12-01

    Full Text Available The aim of this study is search for teaching methods and measuring and evaluation scales in primary education physical traning and sports teaching program. 284 physical training and sports teachers working in provinces of Turkey’s seven regions took place in our research. with the permission of the Ministry of Education, the survey was conducted to test subject and finding were construed by being analyzed in SPSS 10.0 program. At the end of the research, it was found out that command method, exercise method, working in pairs method and self evaluation method are the most common method. Physical education and sports teachers stated that they mostly apply to applied and oral exams while evaluating students.

  6. Emergency Department Utilization in the Texas Medicaid...

    Data.gov (United States)

    U.S. Department of Health & Human Services — There were 44,246 individuals enrolled in TexKat in 2005. Roughly 13 percent of these enrollees had at least one ED visit during the sample period, with one quarter...

  7. Emergency Department Utilization in the Texas Medicaid...

    Data.gov (United States)

    U.S. Department of Health & Human Services — There were 44,246 individuals enrolled in TexKat in 2005. Roughly 13 percent of these enrollees had at least one ED visit during the sample period, with one quarter...

  8. Recruitment and retention benefits of EMT--paramedic utilization during ED nursing shortages.

    Science.gov (United States)

    Oglesby, Ryan

    2007-02-01

    ED nursing shortages have been widely documented in the literature; however, there has been little exploration of the benefits of using Emergency Medical Technicians-Paramedics (EMT-Ps) in the recruitment and retention of experienced ED registered nurses (RNs). This article will discuss the functionality of EMT-Ps in the nontraditional emergency care setting and the impact of their utilization against a background of nursing shortages. The proposed benefit from use of EMT-Ps in the emergency department will most certainly be lost without the input from the bedside RN. ED RNs play an integral part in the decision making and evaluation of all nontraditional roles that effect their departmental staffing, and their involvement in the process is critical to its success.

  9. Capital Budgeting: Do Private Sector Methods of Budgeting for Capital Assets Have Applicability to the Department of Defense

    Science.gov (United States)

    2005-12-01

    Professor Michael Porter and recognize the strategic importance of conducting a Strengths, Weaknesses, Opportunities, and Threats ( SWOT ) analysis as part...business use and not 28 expected to be converted to cash in the current or upcoming fiscal year, such as manufacturing equipment, real estate , etc... ANALYSIS .......................................................................5 A. DOD CAPITAL BUDGETING PRINCIPLES AND METHODS..............5 1

  10. Effectiveness of Mathematics Teaching and Learning Experiences through Wireless Technology as Recent Style to Enhance B.Ed. Trainees

    Science.gov (United States)

    Joan, D. R. Robert

    2015-01-01

    The objective of the study was to find out the effect of learning through Wireless technologies and the traditional method in teaching and learning Mathematics. The investigator adopted experimental research to find the effectiveness of implementing Wireless technologies in the population of B.Ed. trainees. The investigator selected 32 B.Ed.…

  11. Effectiveness of Mutual Learning Approach in the Academic Achievement of B.Ed Students in Learning Optional II English

    Science.gov (United States)

    Arulselvi, Evangelin

    2013-01-01

    The present study aims at finding out the effectiveness of Mutual learning approach over the conventional method in learning English optional II among B.Ed students. The randomized pre-test, post test, control group and experimental group design was employed. The B.Ed students of the same college formed the control and experimental groups. Each…

  12. Current use of intraosseous infusion in Danish emergency departments: a cross-sectional study

    DEFF Research Database (Denmark)

    Molin, Rune; Hallas, Peter; Brabrand, Mikkel;

    2010-01-01

    Intraosseous infusion (IOI) is recommended when intravenous access cannot be readily established in both pediatric and adult resuscitation. We evaluated the current use of IOI in Danish emergency departments (EDs).......Intraosseous infusion (IOI) is recommended when intravenous access cannot be readily established in both pediatric and adult resuscitation. We evaluated the current use of IOI in Danish emergency departments (EDs)....

  13. Factors associated with patient visits to the emergency department for asthma therapy

    Directory of Open Access Journals (Sweden)

    AL-Jahdali Hamdan

    2012-12-01

    Full Text Available Abstract Background Acute asthma attacks remain a frequent cause of emergency department (ED visits and hospital admission. Many factors encourage patients to seek asthma treatment at the emergency department. These factors may be related to the patient himself or to a health system that hinders asthma control. The aim of this study was to identify the main factors that lead to the frequent admission of asthmatic patients to the ED. Methods A cross-sectional survey of all the patients who visited the emergency room with bronchial asthma attacks over a 9-month period was undertaken at two major academic hospitals. The following data were collected: demographic data, asthma control in the preceding month, where and by whom the patients were treated, whether the patient received education about asthma or its medication and the patients’ reasons for visiting the ED. Result Four hundred fifty (N = 450 patients were recruited, 39.1% of whom were males with a mean age of 42.3 ± 16.7. The mean duration of asthma was 155.90 ± 127.13 weeks. Approximately half of the patients did not receive any information about bronchial asthma as a disease, and 40.7% did not receive any education regarding how to use asthma medication. Asthma was not controlled or partially controlled in the majority (97.7% of the patients preceding the admission to ED. The majority of the patients visited the ED to receive a bronchodilator by nebuliser (86.7% and to obtain oxygen (75.1%. Moreover, 20.9% of the patients believed that the ED managed them faster than the clinic, and 21.1% claimed that their symptoms were severe enough that they could not wait for a clinic visit. No education about asthma and uncontrolled asthma are the major factors leading to frequent ED visits (three or more visits/year, p-value = 0.0145 and p-value = 0.0003, respectively. Asthma control also exhibited a significant relationship with inhaled corticosteroid ICS use (p-value =0

  14. Triple Rule Out versus CT Angiogram Plus Stress Test for Evaluation of Chest Pain in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Kelly N. Sawyer

    2015-10-01

    Full Text Available Introduction: Undifferentiated chest pain in the emergency department (ED is a diagnostic challenge. One approach includes a dedicated chest computed tomography (CT for pulmonary embolism or dissection followed by a cardiac stress test (TRAD. An alternative strategy is a coronary CT angiogram with concurrent chest CT (Triple Rule Out, TRO. The objective of this study was to describe the ED patient course and short-term safety for these evaluation methods. Methods: This was a retrospective observational study of adult patients presenting to a large, community ED for acute chest pain who had non-diagnostic electrocardiograms (ECGs and normal biomarkers. We collected demographics, ED length of stay, hospital costs, and estimated radiation exposures. We evaluated 30-day return visits for major adverse cardiac events. Results: A total of 829 patients underwent TRAD, and 642 patients had TRO. Patients undergoing TRO tended to be younger (mean 52.3 vs 56.5 years and were more likely to be male (42.4% vs. 30.4%. TRO patients tended to have a shorter ED length of stay (mean 14.45 vs. 21.86 hours, to incur less cost (median $449.83 vs. $1147.70, and to be exposed to less radiation (median 7.18 vs. 16.6mSv. No patient in either group had a related 30-day revisit. Conclusion: Use of TRO is feasible for assessment of chest pain in the ED. Both TRAD and TRO safely evaluated patients. Prospective studies investigating this diagnostic strategy are needed to further assess this approach to ED chest pain evaluation.

  15. Pediatric Emergency Department Return: A Literature Review of Risk Factors and Interventions.

    Science.gov (United States)

    Tran, Quincy Khoi; Bayram, Jamil D; Boonyasai, Romsai T; Case, Meredith A; Connor, Christine; Doggett, David; Fawole, Oluwakemi A; Ijagbemi, O Mayowa; Levin, Scott; Wu, Albert W; Pham, Julius Cuong

    2016-08-01

    Children discharged from emergency departments (EDs) are often at risk for ED return. The objective was to identify risk factors and interventions to mitigate or prevent ED return among this patient population. Structured literature review of PubMed and clinicaltrials.gov was conducted to identify relevant studies. Inclusion criteria were studies evaluating ED returns by identifying risk factors and interventions in the pediatric population. Emergency department return was defined as returning to the ED within 1 year after initial visit. Abstract and full text articles were reviewed, and data were abstracted by 2 independent authors. A total of 963 articles were screened and yielded 42 potential relevant articles involving pediatric population. After full text review, a total of 12 articles were included in the final analysis (6 on risk factors and 6 on interventions). Risk factors for pediatric ED return included behavioral/psychiatric problems, younger age, acuity of illness, medical history of asthma, and social factors. Interventions included computer-generated instructions, postdischarge telephone coaching, ED-made appointments, case management, and home environment intervention. Emergency department-made appointments and postdischarge telephone coaching plus monetary incentive improved outpatient follow-up rate but not ED return. Home environment assessment coupled with case management reduced ED returns specifically among asthma patients. Several patient and visit characteristics can help predict children at risk for ED return. Although some interventions are successful at improving postdischarge follow-up, most did not reduce ED returns.

  16. edX e-learning course development

    CERN Document Server

    Gilbert, Matthew A

    2015-01-01

    If you are an educator creating a course for edX or a corporate trainer using Open edX for large-scale learning and development initiatives, then edX E-Learning Course Development is the ideal book for you.

  17. Discordance between patient report and chart review of risk factors for antimicrobial resistance in ED patients.

    Science.gov (United States)

    Caterino, Jeffrey M; Graham, Lauren; King, Andrew; Hoppes, Tyler

    2013-09-01

    The objective of this study is to identify the level of agreement between patient self-report and chart review for presence of antimicrobial resistance (AR) risk factors in emergency department (ED) patients. This is a cross-sectional analysis of adult ED patients from July 2010 to January 2011. All ED patients 18 years or older were eligible. Exclusion criteria included pregnant women, prisoners, altered mental status, non-English speakers, traumas, and patients unable to provide consent. Data were obtained by ED patient interview and review of the preceding 3 months of the medical record. We report the difference between patient self-report and chart review of identifying 1 or more AR risk factors using McNemar's χ(2). The test statistic was also calculated for individual risk factors and significance adjusted for multiple comparisons (P care utilization, current indwelling devices, and medical history. Among 289 patients, 1 or more risk factors were reported by 68% (95% CI, 63%-74%) of patients and found in 59% (95% CI, 53%-65%) of charts, a difference of 9.7% (95% CI, 5.3%-14%) (P care and results of ED research studies relying on chart reviews. Patient self-report identifies a greater number of AR risk factors than chart review. © 2013.

  18. The Relationship Between the Use of a Worksite Medical Home and ED Visits or Hospitalizations

    Directory of Open Access Journals (Sweden)

    Marissa Stroo BS

    2015-10-01

    Full Text Available Worksite medical homes may be a good model for improving employee health. The aim of this study was to compare the likelihood of being seen in the emergency department (ED or being hospitalized by level of use (no use, occasional use, or primary care of a worksite medical home, overall and by type of user (employee, adult dependent, or pediatric dependent. This was a retrospective analysis of claims data, using covariate-adjusted logistic regression models for ED visits and inpatient hospitalizations. Secondary data for the years 2006 to 2008 from a company that offers an on-site health care center (HCC were used. Analyses were based on a data set that combines health plan claims and human resources demographic data. Overall, people who did not use the HCC were more likely to be seen in the ED (adjusted odds ratio [OR] = 1.20, 95% confidence interval or CI [1.06, 1.37], P = .005 or to be hospitalized (adjusted OR = 1.58; 95% CI [1.34, 1.86]; P < .0001 compared with those who used the HCC for primary care. Both ED visits and hospitalizations for employees and dependents in this study were lower among those who used the worksite medical home for primary care. Worksite medical homes can improve chronic disease management and thus reduce ED visits and hospitalizations. These findings contribute to growing evidence that worksite medical homes are potentially cost-effective.

  19. Prevalence of victims of violence admitted to an emergency department

    Science.gov (United States)

    Hofner, M; Python, N; Martin, E; Gervasoni, J; Graz, B; Yersin, B

    2005-01-01

    Objective: To collect data on the consultation frequency and demographic profile of victims of violence attending an emergency department (ED) in Switzerland. Methods: We undertook screening of all admitted adult patients (>16 years) in the ED of the CHUV, Lausanne, Switzerland, over a 1 month period, using a modified version of the Partner Violence Screen questionnaire. Exclusionary criteria were: life threatening injury (National Advisory Committee on Aeronautics score ⩾4), or inability to understand or speak French, to give oral informed consent, or to be questioned without a family member or accompanying person being present. Data were collected on history of physical and/or psychological violence during the previous 12 months, the type of violence experienced by the patient, and if violence was the reason for the current consultation. Sociodemographic data were obtained from the registration documents. Results: The final sample consisted of 1602 patients (participation rate of 77.2%), with a refusal rate of 1.1%. Violence during the past 12 months was reported by 11.4% of patients. Of the total sample, 25% stated that violence was the reason for the current consultation; of these, 95% of patients were confirmed as victims of violence by the ED physicians. Patients reporting violence were more likely to be young and separated from their partner. Men were more likely to be victims of public violence and women more commonly victims of domestic violence. Conclusions: Based on this monthly prevalence rate, we estimate that over 3000 adults affected by violence consult our ED per annum. This underlines the importance of the problem and the need to address it. Health services organisations should establish measures to improve quality of care for victims. Guidelines and educational programmes for nurses and physicians should be developed in order to enhance providers' skills and basic knowledge of all types of violence, how to recognise and interact appropriately

  20. True Vertigo Patients in Emergency Department; an Epidemiologic Study

    Directory of Open Access Journals (Sweden)

    Ali Shahrami

    2016-01-01

    Full Text Available Introduction: Vertigo prevalence is estimated to be 1.8% among young adults and more than 30% in the elderly. 13-38% of the referrals of patients over 65 years old in America are due to vertigo. Vertigo does not increase the risk of mortality but it can affect the patient’s quality of life. Therefore, this study was designed to evaluate the epidemiologic characteristics of vertigo patients referred to the emergency department (ED. Methods: In this 6-month retrospective cross-sectional study, the profiles of all vertigo patients referred to the ED of Imam Hossein Hospital, Tehran, Iran, from October 2013 to March 2014 were evaluated. Demographic data and baseline characteristics of the patients were recorded and then patients were divided into central and peripheral vertigo. The correlation of history and clinical examination with vertigo type was evaluated and screening performance characteristics of history and clinical examination in differentiating central and peripheral vertigo were determined. Results: 379 patients with the mean age of 50.69 ± 11.94 years (minimum 18 and maximum 86 were enrolled (58.13% female. There was no sex difference in vertigo incidence (p = 0.756. A significant correlation existed between older age and increase in frequency of central cases (p < 0.001. No significant difference was detected between the treatment protocols regarding ED length of stay (p = 0.72. There was a significant overlap between the initial diagnosis and the final decision based on imaging and neurologist’s final opinion (p < 0.001. In the end, 361 (95.3% patients were discharged from ED, while 18 were disposed to the neurology ward. No case of mortality was reported. Conclusion: Sensitivity and specificity of history and clinical examination in differentiating central and peripheral vertigo were 99 (95% CI: 57-99 and 99 (95% CI: 97-99, respectively.

  1. La Costituzione Islandese: storia ed evoluzione

    Directory of Open Access Journals (Sweden)

    Fabio Quartino

    2011-03-01

    Full Text Available "La Costituzione Islandese: storia ed evoluzione" is a degree thesis defended on 15th July 2009 by Fabio Quartino under the supervision of Prof. Andrea Canepa of the University of Genoa, Italy. It offers an extensive overview of Icelandic history aimed at finding out the roots of the nation's constitutional order, which is currently in the process of being revised by the first ever elected constitutional assembly in the life of the country. Fabio Quartino's work wishes to be a source of useful information for Italian-speaking scholars who have an interest in Iceland's constitutional history and may not have access to comprehensive overviews in their native tongue.

  2. Depth contours for NOS Chart 11013, 39th Ed., 1992-04-25 for South Florida, Cuba, and the Bahamas in GIS vector form (NODC Accession 0000459)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — GIS line coverage of depth contours (bathymetry) for the area shown in National Ocean Service (NOS) chart 11013, 39th Ed., 25 Apr 1992. Area covers South Florida,...

  3. Characteristics of frequent emergency department presenters to an Australian emergency medicine network

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    Markham Donna

    2011-12-01

    Full Text Available Abstract Background To describe the characteristics of emergency department (ED patients defined as frequent presenters (FP presenting to an Australian emergency department network and compare these with a cohort of non-frequent presenters (NFP. Method A retrospective chart review utilising an electronic emergency medicine patient medical record database was performed on patients presenting to Southern Health EDs from March 2009 to March 2010. Non-frequent presenters were defined as patients presenting less than 5 times and frequent presenters as presenting 8 or more times in the study period. Characteristics of both groups were described and compared. Results During the 12-month study period there were 540 FP patients with 4549 admissions and 73,089 NFP patients with 100,943 admissions. FP patients were slightly older with a significant increase in frequency of patients between the ages of 70 to 79 years and they were more likely to be divorced or separated than NFP patients. Frequent presenters to the emergency department were more likely to utilise the ambulance service to arrive at the hospital, or in the custody of police than NFP patients. FPs were more likely to be admitted to hospital, more likely to have an admission to a mental health bed than NFP patients and more likely to self-discharge from the emergency department while waiting for care. Conclusions There are major implications for the utilisation of limited ED resources by frequent presenters. By further understanding the characteristics of FP we may be able to address the specific health care needs of this population in more efficient and cost effective ways. Further research analysing the effectiveness of targeted multidisciplinary interventions aiming to reduce the frequency of ED attendances may be warranted.

  4. Emergency Department Use Among Older Adults With Dementia.

    Science.gov (United States)

    LaMantia, Michael A; Stump, Timothy E; Messina, Frank C; Miller, Douglas K; Callahan, Christopher M

    2016-01-01

    Although persons with dementia are frequently hospitalized, relatively little is known about the health profile, patterns of health care use, and mortality rates for patients with dementia who access care in the emergency department (ED). We linked data from our hospital system with Medicare and Medicaid claims, Minimum Data Set, and Outcome and Assessment Information Set data to evaluate 175,652 ED visits made by 10,354 individuals with dementia and 15,020 individuals without dementia over 11 years. Survival rates after ED visits and associated charges were examined. Patients with dementia visited the ED more frequently, were hospitalized more often than patients without dementia, and had an increased odds of returning to the ED within 30 days of an index ED visit compared with persons who never had a dementia diagnosis (odds ratio, 2.29; Pdementia status (Pdementia. These results show that older adults with dementia are frequent ED visitors who have greater comorbidity, incur higher charges, are admitted to hospitals at higher rates, return to EDs at higher rates, and have higher mortality after an ED visit than patients without dementia.

  5. Effects of emergency department crowding on the delivery of timely care in an inner-city hospital in the Netherlands

    NARCIS (Netherlands)

    N. van der Linden (Naomi); M.C. van der Linden (M. Christien); J. Richards (John); R. Derlet (Robert); Grootendorst, D.C. (Diana C.); C.L. van den Brand (Crispijn)

    2016-01-01

    textabstractBackground The impact of delays in emergency department (ED) care has not been described in European countries where ED crowding is not universally recognized. The aim of this study was to determine the relationship of ED crowding with delays in triage and treatment, and 24-h mortality i

  6. Alcohol Use as Risk Factors for Older Adults’ Emergency Department Visits: A Latent Class Analysis

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    Namkee G. Choi, PhD

    2015-12-01

    Full Text Available Introduction: Late middle-aged and older adults’ share of emergency department (ED visits is increasing more than other age groups. ED visits by individuals with substance-related problems are also increasing. This paper was intended to identify subgroups of individuals aged 50+ by their risk for ED visits by examining their health/mental health status and alcohol use patterns. Methods: Data came from the 2013 National Health Interview Survey’s Sample Adult file (n=15,713. Following descriptive analysis of sample characteristics by alcohol use patterns, latent class analysis (LCA modeling was fit using alcohol use pattern (lifetime abstainers, ex-drinkers, current infrequent/light/ moderate drinkers, and current heavy drinkers, chronic health and mental health status, and past-year ED visits as indicators. Results: LCA identified a four-class model. All members of Class 1 (35% of the sample; lowest-risk group were infrequent/light/moderate drinkers and exhibited the lowest probabilities of chronic health/ mental health problems; Class 2 (21%; low-risk group consisted entirely of lifetime abstainers and, despite being the oldest group, exhibited low probabilities of health/mental health problems; Class 3 (37%; moderate-risk group was evenly divided between ex-drinkers and heavy drinkers; and Class 4 (7%; high-risk group included all four groups of drinkers but more ex-drinkers. In addition, Class 4 had the highest probabilities of chronic health/mental problems, unhealthy behaviors, and repeat ED visits, with the highest proportion of Blacks and the lowest proportions of college graduates and employed persons, indicating significant roles of these risk factors. Conclusion: Alcohol nonuse/use (and quantity of use and chronic health conditions are significant contributors to varying levels of ED visit risk. Clinicians need to help heavy-drinking older adults reduce unhealthy alcohol consumption and help both heavy drinkers and ex

  7. US-Based Emergency Department Visits for Fluoroquinolone-Associated Hypersensitivity Reactions

    Science.gov (United States)

    Jones, S. Christopher; Budnitz, Dan; Sorbello, Alfred; Mehta, Hina

    2015-01-01

    Purpose To estimate the rate of hypersensitivity reactions per 100,000 prescription dispensings of fluoroquinolones based on care rendered in a nationally-representative sample of US hospital emergency departments (ED). Methods We analyzed the frequency of fluoroquinolone-associated hypersensitivity reactions using the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance system (2004–2010) in conjunction with US retail outpatient prescription data from IMS Health (2004–2010). We further categorized reaction severity into three subgroups (mild, moderate, severe). Results Based on 1,422 cases of fluoroquinolone-associated hypersensitivity reactions and national drug utilization projections, we estimated risk of hypersensitivity reactions for moxifloxacin, ciprofloxacin, and levofloxacin. The absolute risk of a fluoroquinolone-related hypersensitivity reaction of any severity was low (44.0 (95% CI 34.8–53.3) ED visits/100,000 prescriptions; however, we identified a statistically significant difference in the relative risk (rate ratios) of seeking care in an ED attributed to moxifloxacin hypersensitivity compared to either levofloxacin or ciprofloxacin. For all reaction severities, the estimated ED visits/100,000 prescriptions were 141.3 (95% CI 99.9–182.7) for moxifloxacin, 40.8 (95% CI 31.5–50.0) for levofloxacin, and 26.3 (95% CI 20.8–31.9) for ciprofloxacin. When the rates were stratified by reaction severity category (mild or moderate-severe), moxifloxacin continued to be implicated in more ED visits per 100,000 prescriptions dispensed than either levofloxacin or ciprofloxacin. Conclusion Fluoroquinolones may cause hypersensitivity reactions requiring care in an ED, and relative to use, the rate of moxifloxacin-related hypersensitivity reactions is higher than comparator fluoroquinolones. PMID:23963962

  8. Application of a Proactive Risk Analysis to Emergency Department Sickle Cell Care

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    Victoria L. Thornton

    2014-07-01

    Full Text Available Introduction: Patients with sickle cell disease (SCD often seek care in emergency departments (EDs for severe pain. However, there is evidence that they experience inaccurate assessment, suboptimal care, and inadequate follow-up referrals. The aim of this project was to 1 explore the feasibility of applying a failure modes, effects and criticality analysis (FMECA in two EDs examining four processes of care (triage, analgesic management, high risk/high users, and referrals made for patients with SCD, and 2 report the failures of these care processes in each ED. Methods: A FMECA was conducted of ED SCD patient care at two hospitals. A multidisciplinary group examined each step of four processes. Providers identified failures in each step, and then characterized the frequency, impact, and safeguards, resulting in risk categorization. Results: Many “high risk” failures existed in both institutions, including a lack of recognition of high-risk or high-user patients and a lack of emphasis on psychosocial referrals. Specific to SCD analgesic management, one setting inconsistently used existing analgesic policies, while the other setting did not have such policies. Conclusion: FMECA facilitated the identification of failures of ED SCD care and has guided quality improvement activities. Interventions can focus on improvements in these specific areas targeting improvements in the delivery and organization of ED SCD care. Improvements should correspond with the forthcoming National Heart, Lung and Blood-sponsored guidelines for treatment of patients with sickle cell disease. [West J Emerg Med. 2014;15(4:446–458.

  9. Effect of advanced age and vital signs on admission from an emergency department observation unit

    Science.gov (United States)

    Caterino, Jeffrey M.; Hoover, Emily; Moseley, Mark G.

    2012-01-01

    Objectives The primary objective was to determine the relationship between advanced age and need for admission from an emergency department (ED) observation unit. The secondary objective was to determine the relationship between initial ED vital signs and admission. Methods We conducted a prospective, observational cohort study of ED patients placed in an ED-based observation unit. Multivariable penalized maximum likelihood logistic regression was used to identify independent predictors of need for hospital admission. Age was examined continuously and at a cutoff of ≥65 years. Vital signs were examined continuously and at commonly accepted cutoffs. We additionally controlled for demographics, co-morbid conditions, laboratory values, and observation protocol. Results Three hundred patients were enrolled, 12% (n=35) ≥65 years old and 11% (n=33) requiring admission. Admission rates were 2.9% (95% confidence interval [CI], 0.07-14.9%) in older adults and 12.1% (95% CI, 8.4-16.6%) in younger adults. In multivariable analysis, age was not associated with admission (odds ratio [OR] 0.30, 95% CI 0.05-1.67). Predictors of admission included: systolic pressure ≥180 mmHg (OR 4.19, 95% CI 1.08-16.30), log Charlson co-morbidity score (OR 2.93, 95% CI 1.57-5.46), and white blood cell count ≥14,000/mm3 (OR11.35, 95% CI 3.42-37.72). Conclusions Among patients placed in an ED observation unit, age ≥65 years is not associated with need for admission. Older adults can successfully be discharged from these units. Systolic pressure≥180 mmHg was the only predictive vital sign. In determining appropriateness of patients selected for an ED observation unit, advanced age should not be an automatic disqualifying criterion. PMID:22386358

  10. Monitoring the quality of total hip replacement in a tertiary care department using a cumulative summation statistical method (CUSUM).

    Science.gov (United States)

    Biau, D J; Meziane, M; Bhumbra, R S; Dumaine, V; Babinet, A; Anract, P

    2011-09-01

    The purpose of this study was to define immediate post-operative 'quality' in total hip replacements and to study prospectively the occurrence of failure based on these definitions of quality. The evaluation and assessment of failure were based on ten radiological and clinical criteria. The cumulative summation (CUSUM) test was used to study 200 procedures over a one-year period. Technical criteria defined failure in 17 cases (8.5%), those related to the femoral component in nine (4.5%), the acetabular component in 32 (16%) and those relating to discharge from hospital in five (2.5%). Overall, the procedure was considered to have failed in 57 of the 200 total hip replacements (28.5%). The use of a new design of acetabular component was associated with more failures. For the CUSUM test, the level of adequate performance was set at a rate of failure of 20% and the level of inadequate performance set at a failure rate of 40%; no alarm was raised by the test, indicating that there was no evidence of inadequate performance. The use of a continuous monitoring statistical method is useful to ensure that the quality of total hip replacement is maintained, especially as newer implants are introduced.

  11. Review: Reiner Keller, Andreas Hirseland, Werner Schneider & Willy Viehöver (Eds. (2006. Handbuch Sozialwissenschaftliche Diskursanalyse. Band I: Theorien und Methoden [Handbook on Discourse Analysis in Social Sciences. Theories and Methods

    Directory of Open Access Journals (Sweden)

    Steffen Großkopf

    2008-01-01

    Full Text Available The handbook gives a general overview of the established—but increasingly complex—theoretical and methodological practice of discourse analysis. The attempt is made to systematize the diversity of discourse analysis, with its different historical roots and fields of research in the social sciences, even though the focus is mainly on FOUCAULT's approach. Thus, the handbook has to be understood as an important step towards a insertion of discourse analysis into social science. Although there are unavoidable contradictions between the articles—almost because of the open theoretical foundations—the handbook characterizes, as a whole, discourse analysis as a heterogeneous strategy of research rather than as a stringent method. With this approach, it can be a helpful guide for the reader’s own research projects. However, if one is looking for a precise method, the investment of time in discourse analysis could be wasted. URN: urn:nbn:de:0114-fqs0801143

  12. C14-Crash. The C14-method and dendrochronology, unveiling the illusion. 2. rev. ed.; C14-Crash. Das Ende der Illusion, mit Radiokarbonmethode und Dendrochronologie datieren zu koennen

    Energy Technology Data Exchange (ETDEWEB)

    Bloess, C.; Niemitz, H.U.

    2000-07-01

    In this second edition of the book, which was published almost three years after the first edition, the authors reiterate and substantiate their doubts as to the basic theories underlying the radiocarbon dating method and the applicability of dendrochronology. (orig/CB) [German] In dieser zweiten Auflage des Buches, die knapp drei Jahre nach der ersten erschien, vertiefen die Autoren ihre Zweifel an den grundlegenden Theorien und den bisherigen Resultaten der Radiokarbonmethode und der Dendrochronologie. (orig./CB)

  13. Lean techniques for the improvement of patients’ flow in emergency department

    Science.gov (United States)

    Chan, HY; Lo, SM; Lee, LLY; Lo, WYL; Yu, WC; Wu, YF; Ho, ST; Yeung, RSD; Chan, JTS

    2014-01-01

    BACKGROUND: Emergency departments (EDs) face problems with overcrowding, access block, cost containment, and increasing demand from patients. In order to resolve these problems, there is rising interest to an approach called “lean” management. This study aims to (1) evaluate the current patient flow in ED, (2) to identify and eliminate the non-valued added process, and (3) to modify the existing process. METHODS: It was a quantitative, pre- and post-lean design study with a series of lean management work implemented to improve the admission and blood result waiting time. These included structured re-design process, priority admission triage (PAT) program, enhanced communication with medical department, and use of new high sensitivity troponin-T (hsTnT) blood test. Triage waiting time, consultation waiting time, blood result time, admission waiting time, total processing time and ED length of stay were compared. RESULTS: Among all the processes carried out in ED, the most time consuming processes were to wait for an admission bed (38.24 minutes; SD 66.35) and blood testing result (mean 52.73 minutes, SD 24.03). The triage waiting time and end waiting time for consultation were significantly decreased. The admission waiting time of emergency medical ward (EMW) was significantly decreased from 54.76 minutes to 24.45 minutes after implementation of PAT program (Plean management can improve the patient flow in ED. Acquiescence to the principle of lean is crucial to enhance high quality emergency care and patient satisfaction. PMID:25215143

  14. The Deployed Warfighter Protection Research Program: Finding New Methods to Vanquish Old Foes (The United States Army Medical Department Journal, April-June 2008)

    Science.gov (United States)

    2008-06-01

    searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments...Diptera: Psychodidae). J Med Entomol. 2007;44(2):171-174. 51. Mascari TM, Mitchell MA, Rowton ED, Foil LD. Ivermectin as a rodent feed-through

  15. Impact of the ABCDE triage on the number of patient visits to the emergency department

    Directory of Open Access Journals (Sweden)

    Menezes Ricardo

    2010-06-01

    Full Text Available Abstract Background Many Finnish emergency departments (ED serve both primary and secondary health care patients and are therefore referred to as combined emergency departments. Primary care specialists are responsible for the initial assessment and treatment. They, thereby, also regulate referral and access to tertiary care. Primary health care EDs are easy for the public to access, leading to non-acute patient visits to the emergency department. This has caused increased queues and unnecessary difficulties in providing immediate treatment for those patients who need it the most. Methods A face-to-face triage system based on the letters A (patient directly to secondary care, B (to be examined within 10 min, C (to be examined within 1 h, D (to be examined within 2 h and E (no need for immediate treatment for assessing the urgency of patients' treatment needs was applied in the main ED in the City of Vantaa, Finland (Peijas Hospital as an attempt to provide immediate treatment for the most acute patients. The first step was an initial patient assessment by a health care professional (triage nurse. If the patient was not considered to be in need of immediate care (i.e. A-D he was allocated to group E and examined after the more urgent patients were treated. The introduction of this triage system was combined with information to the public on the "correct" use of emergency services. The primary aim of this study was to assess whether the flow of patients was changed by implementing the ABCDE-triage system in the combined ED. To study the effect of the intervention on patient flow, numbers monthly visits to doctors were recorded before and after intervention in Peijas ED and, simultaneously, in control EDs (Myyrmäki in Vantaa, Jorvi and Puolarmetsä in Espoo. To study does the implementation of the triage system redirect patients to other health services, numbers of monthly visits to doctors were also scored in the private health care and public

  16. Using Video Conferencing to Deliver a Brief Motivational Intervention for Alcohol and Sex Risk to Emergency Department Patients: A Proof-of-Concept Pilot Study.

    Science.gov (United States)

    Celio, Mark A; Mastroleo, Nadine R; DiGuiseppi, Graham; Barnett, Nancy P; Colby, Suzanne M; Kahler, Christopher W; Operario, Don; Suffoletto, Brian; Monti, Peter M

    2017-01-01

    Brief motivational intervention (MI) is an efficacious approach to reduce heavy drinking and associated sexual risk behavior among Emergency Department (ED) patients, but the intensity of demands placed on ED staff makes the implementation of in-person MIs logistically challenging. This proof-of-concept pilot study examined the acceptability and logistic feasibility of using video-conferencing technology to deliver an MI targeting heavy drinking and risky sexual behavior to patients in an ED setting. Rigorous screening procedures were employed to ensure that the pilot sample represents the target portion of ED patients who would benefit from this multi-target MI. Mixed qualitative and quantitative data from a sample of seven ED patients (57% Female; Mage = 35 years) who received MI by video conference consistently demonstrated high levels of satisfaction, engagement, and acceptability. The observed completion rate supports logistic feasibility, and patient feedback identified methods to improve the experience by using high-definition hardware, ensuring stronger network connectivity, and effectively communicating information regarding protection of privacy. Post-intervention patient ratings and independent ratings of the audio-recorded sessions (using the Motivational Interviewing Skills Coding system) were very high, suggesting that intervention fidelity and MI adherence was not compromised by delivery modality. Collectively, these data suggest video conferencing is a viable technology that can be employed to implement brief evidence-based MIs in ED settings.

  17. Technical and clinical analysis of microEEG: a miniature wireless EEG device designed to record high-quality EEG in the emergency department

    OpenAIRE

    Omurtag, Ahmet; Baki, Samah G Abdel; Chari, Geetha; Cracco, Roger Q; Zehtabchi, Shahriar; Fenton, André A.; Grant, Arthur C

    2012-01-01

    Background We describe and characterize the performance of microEEG compared to that of a commercially available and widely used clinical EEG machine. microEEG is a portable, battery-operated, wireless EEG device, developed by Bio-Signal Group to overcome the obstacles to routine use of EEG in emergency departments (EDs). Methods The microEEG was used to obtain EEGs from healthy volunteers in the EEG laboratory and ED. The standard system was used to obtain EEGs from healthy volunteers in the...

  18. Diagnostic accuracy of PAT-POPS and ManChEWS for admissions of children from the emergency department

    OpenAIRE

    Cotterill, Sarah; Rowland, Andrew G; Kelly, Jacqueline; Lees, Helen; Kamara, Mohammed

    2016-01-01

    Background The Pennine Acute Trust (PAT) Paediatric Observation Priority Score (PAT-POPS) is a specific emergency department (ED) physiological and observational aggregate scoring system, with scores of 0–18. A higher score indicates greater likelihood of admission. The Manchester Children's Early Warning System (ManChEWS) assesses six physiological observations to create a trigger score, classified as Green, Amber or Red. Methods Prospectively collected data were used to calculate PAT-POPS a...

  19. Reduction in Door-to-Needle Time after Transfer of Thrombolysis Site from CCU to Emergency Department

    Directory of Open Access Journals (Sweden)

    Osama Mohammed

    2013-01-01

    Full Text Available Objective. Early restoration of coronary perfusion by thrombolysis or percutaneous coronary intervention is the main modality of treatment to salvage the ischemic myocardium. The earlier the procedure is completed, the greater the benefit is in saving myocardium and restoring its functions. The aim of the study is to compare the door-to-needle time (DNT in acute ST elevation myocardial infarction (STEMI in the period prior to December 2008 when the site of thrombolysis was in coronary care unit (CCU and the period after that when the site was shifted to emergency department (ED. Methods. A retrospective, descriptive study was conducted at Al Khor Hospital, Qatar, in patients with acute STEMI who underwent thrombolysis at CCU and ED from April 2005 until December 2011, to compare the DNT, duration of hospitalization, and mortality. Results. A total of 211 patients with acute STEMI were eligible for thrombolysis; 58 patients were thrombolysed in the CCU and 153 in ED. The median DNT was reduced from 33.5 minutes in the CCU to 17 minutes in the ED representing a reduction of more than 50% with a P value of < 0.0001. Conclusion. The transfer of the thrombolysis site from CCU to the ED was associated with a dramatic and significant reduction in median door-to-needle time by more than half.

  20. Nighttime assaults: using a national emergency department monitoring system to predict occurrence, target prevention and plan services

    Directory of Open Access Journals (Sweden)

    Bellis Mark A

    2012-09-01

    Full Text Available Abstract Background Emergency department (ED data have the potential to provide critical intelligence on when violence is most likely to occur and the characteristics of those who suffer the greatest health impacts. We use a national experimental ED monitoring system to examine how it could target violence prevention interventions towards at risk communities and optimise acute responses to calendar, holiday and other celebration-related changes in nighttime assaults. Methods A cross-sectional examination of nighttime assault presentations (6.01 pm to 6.00 am; n = 330,172 over a three-year period (31st March 2008 to 30th March 2011 to English EDs analysing changes by weekday, month, holidays, major sporting events, and demographics of those presenting. Results Males are at greater risk of assault presentation (adjusted odds ratio [AOR] 3.14, 95% confidence intervals [CIs] 3.11-3.16; P 2 = 0.918; P  Conclusions To date, the role of ED data has focused on helping target nightlife police activity. Its utility is much greater; capable of targeting and evaluating multi-agency life course approaches to violence prevention and optimising frontline resources. National ED data are critical for fully engaging health services in the prevention of violence.

  1. Management of traumatic wounds in the Emergency Department: a secondary publication

    Directory of Open Access Journals (Sweden)

    Carolina Prevaldi

    2016-11-01

    Full Text Available Traumatic wounds are among the most common problems leading people to the Emergency Department (ED, accounting for approximately 5.4% of all the visits, and up to 24% of all the medical lawsuits. In order to provide a standardized method for wound management in the ED, we have organized a workshop, involving several Italian and European experts. Later, all the discussed statements have been submitted for external validation to a multidisciplinary expert team, based on the so-called Delphi method. Eight main statements have been established, each of them comprising different issues, covering the fields of wound classification, infectious risk stratification, tetanus and rabies prophylaxis, wound cleansing, pain management, and suture. Here we present the results of this work, shared by the Academy of Emergency Medicine and Care and the World Society of Emergency Surgery.

  2. Identification of women exposed to acute physical intimate partner violence in an emergency department setting in Finland.

    Science.gov (United States)

    Leppäkoski, Tuija; Astedt-Kurki, Päivi; Paavilainen, Eija

    2010-12-01

    Intimate partner violence (IPV) is seen as a serious health risk factor for women with significant acute and long-term health consequences and it affects women from all ethnic and socioeconomic groups. Knowledge of these consequences of IPV may help emergency department (ED) professionals to identify these women and provide them with appropriate care, including information on a variety of community services, and refer those women to such services if necessary. The study aimed to describe the frequency of ED visits by women exposed to physical intimate partner violence as estimated by ED professionals (nurses, practical nurses, emergency medical technicians) and identification of acute IPV. In this study 'partner' is defined as a woman's husband, former husband, current or former cohabitant or partner. This design was used as part of a larger, descriptive, cross-sectional multi-centre and multi-method study. Data were collected from 28 EDs in 13 Finnish hospital districts. Altogether 488 questionnaires were returned, which yielded a response rate of 51%. The data were analysed using descriptive statistics and quantitative content analysis. Findings showed that 48% (n = 231) of the ED professionals reported that they encountered women in IPV relationships at least once a month. Over one-fifth of the ED professionals reported having repeatedly encountered the same women visiting the ED for IPV related injuries. Over half of the participants reported having problems 'often' or 'now and then' when identifying women exposed to IPV. Those with training on IPV estimated that they had identified women exposed to IPV more often. To conclude, the research suggests that improvement of identification of acute IPV requires that training be arranged and jointly agreed written procedures for handling IPV be introduced. © 2010 The Authors. Scandinavian Journal of Caring Sciences © 2010 Nordic College of Caring Science.

  3. Use of a midstream clean catch mobile application did not lower urine contamination rates in an emergency department.

    Science.gov (United States)

    Jacob, Mary S; Kulie, Paige; Benedict, Cameron; Ordoobadi, Alexander J; Sikka, Neal; Steinmetz, Erika; McCarthy, Melissa L

    2017-07-08

    Urine microscopy is a common test performed in emergency departments (EDs). Urine specimens can easily become contaminated by different factors, including the collection method. The midstream clean-catch (MSCC) collection technique is commonly used to reduce urine contamination. The urine culture contamination rate from specimens collected in our ED is 30%. We developed an instructional application (app) to show ED patients how to provide a MSCC urine sample. We hypothesized that ED patients who viewed our instructional app would have significantly lower urine contamination rates compared to patients who did not. We prospectively enrolled 257 subjects with a urinalysis and/or urine culture test ordered in the ED and asked them to watch our MSCC instructional app. After prospective enrollment was complete, we retrospectively matched each enrolled subject to an ED patient who did not watch the instructional app. Controls were matched to cases based on gender, type of urine specimen provided, ED visit date and shift. Urinalysis and urine culture contamination results were compared between the matched pairs using McNemar's test. The overall urine culture contamination rate of the 514 subjects was 38%. The majority of the matched pairs had a urinalysis (63%) or urinalysis plus urine culture (35%) test done. There were no significant differences in our urine contamination rates between the matched pairs overall or when stratified by gender, by prior knowledge of the clean catch process or by type of urine specimen. We did not see a lower contamination rate for patients who viewed our instructional app compared to patients who did not. It is possible that MSCC is not effective for decreasing urine specimen contamination. Copyright © 2017. Published by Elsevier Inc.

  4. Triple Rule Out versus CT Angiogram Plus Stress Test for Evaluation of Chest Pain in the Emergency Department.

    Science.gov (United States)

    Sawyer, Kelly N; Shah, Payal; Qu, Lihua; Kurz, Michael C; Clark, Carol L; Swor, Robert A

    2015-09-01

    Undifferentiated chest pain in the emergency department (ED) is a diagnostic challenge. One approach includes a dedicated chest computed tomography (CT) for pulmonary embolism or dissection followed by a cardiac stress test (TRAD). An alternative strategy is a coronary CT angiogram with concurrent chest CT (Triple Rule Out, TRO). The objective of this study was to describe the ED patient course and short-term safety for these evaluation methods. This was a retrospective observational study of adult patients presenting to a large, community ED for acute chest pain who had non-diagnostic electrocardiograms (ECGs) and normal biomarkers. We collected demographics, ED length of stay, hospital costs, and estimated radiation exposures. We evaluated 30-day return visits for major adverse cardiac events. A total of 829 patients underwent TRAD, and 642 patients had TRO. Patients undergoing TRO tended to be younger (mean 52.3 vs 56.5 years) and were more likely to be male (42.4% vs. 30.4%). TRO patients tended to have a shorter ED length of stay (mean 14.45 vs. 21.86 hours), to incur less cost (median $449.83 vs. $1147.70), and to be exposed to less radiation (median 7.18 vs. 16.6 mSv). No patient in either group had a related 30-day revisit. Use of TRO is feasible for assessment of chest pain in the ED. Both TRAD and TRO safely evaluated patients. Prospective studies investigating this diagnostic strategy are needed to further assess this approach to ED chest pain evaluation.

  5. Differences in police, ambulance, and emergency department reporting of traffic injuries on Karachi-Hala road, Pakistan

    Directory of Open Access Journals (Sweden)

    Lagarde Emmanuel

    2011-03-01

    Full Text Available Abstract Background Research undertaken in developing countries has assessed discrepancies in police reporting of Road Traffic Injury (RTI for urban settings only. The objective of this study was to assess differences in RTI reporting across police, ambulance, and hospital Emergency Department (ED datasets on an interurban road section in Pakistan. Methods The study setting was the 196-km long Karachi-Hala road section. RTIs reported to the police, Edhi Ambulance Service (EAS, and five hospital EDs in Karachi during 2008 (Jan to Dec were compared in terms of road user involved (pedestrians, motorcyclists, four-wheeled vehicle occupants and outcome (died or injured. Further, records from these data were matched to assess ascertainment of traffic injuries and deaths by the three datasets. Results A total of 143 RTIs were reported to the police, 531 to EAS, and 661 to hospital EDs. Fatality per hundred traffic injuries was twice as high in police records (19 per 100 RTIs than in ambulance (10 per 100 RTIs and hospital ED records (9 per 100 RTIs. Pedestrian and motorcyclist involvement per hundred traffic injuries was lower in police records (8 per 100 RTIs than in ambulance (17 per 100 RTIs and hospital ED records (43 per 100 RTIs. Of the 119 deaths independently identified after matching, police recorded 22.6%, EAS 46.2%, and hospital ED 50.4%. Similarly, police data accounted for 10.6%, EAS 43.5%, and hospital ED 54.9% of the 1 095 independently identified injured patients. Conclusions Police reporting, particularly of non-fatal RTIs and those involving vulnerable road users, should be improved in Pakistan.

  6. Supervision and feedback for junior medical staff in Australian emergency departments: findings from the emergency medicine capacity assessment study

    Directory of Open Access Journals (Sweden)

    Weiland Tracey J

    2010-11-01

    Full Text Available Abstract Background Clinical supervision and feedback are important for the development of competency in junior doctors. This study aimed to determine the adequacy of supervision of junior medical staff in Australian emergency departments (EDs and perceived feedback provided. Methods Semi-structured telephone surveys sought quantitative and qualitative data from ED Directors, Directors of Emergency Medicine Training, registrars and interns in 37 representative Australian hospitals; quantitative data were analysed with SPSS 15.0 and qualitative data subjected to content analysis identifying themes. Results Thirty six of 37 hospitals took part. Of 233 potential interviewees, 95 (40.1% granted interviews including 100% (36/36 of ED Directors, and 96.2% (25/26 of eligible DEMTs, 24% (19/81 of advanced trainee/registrars, and 17% (15/90 of interns. Most participants (61% felt the ED was adequately supervised in general and (64.2% that medical staff were adequately supervised. Consultants and registrars were felt to provide most intern supervision, but this varied depending on shift times, with registrars more likely to provide supervision on night shift and at weekends. Senior ED medical staff (64% and junior staff (79% agreed that interns received adequate clinical supervision. Qualitative analysis revealed that good processes were in place to ensure adequate supervision, but that service demands, particularly related to access block and overcrowding, had detrimental effects on both supervision and feedback. Conclusions Consultants appear to provide the majority of supervision of junior medical staff in Australian EDs. Supervision and feedback are generally felt to be adequate, but are threatened by service demands, particularly related to access block and ED overcrowding.

  7. The financial consequences of lost demand and reducing boarding in hospital emergency departments.

    Science.gov (United States)

    Pines, Jesse M; Batt, Robert J; Hilton, Joshua A; Terwiesch, Christian

    2011-10-01

    Some have suggested that emergency department (ED) boarding is prevalent because it maximizes revenue as hospitals prioritize non-ED admissions, which reimburse higher than ED admissions. We explore the revenue implications to the overall hospital of reducing boarding in the ED. We quantified the revenue effect of reducing boarding-the balance of higher ED demand and the reduction of non-ED admissions-using financial modeling informed by regression analysis and discrete-event simulation with data from 1 inner-city teaching hospital during 2 years (118,000 ED visits, 22% ED admission rate, 7% left without being seen rate, 36,000 non-ED admissions). Various inpatient bed management policies for reducing non-ED admissions were tested. Non-ED admissions generated more revenue than ED admissions ($4,118 versus $2,268 per inpatient day). A 1-hour reduction in ED boarding time would result in $9,693 to $13,298 of additional daily revenue from capturing left without being seen and diverted ambulance patients. To accommodate this demand, we found that simulated management policies in which non-ED admissions are reduced without consideration to hospital capacity (ie, static policies) mostly did not result in higher revenue. Many dynamic policies requiring cancellation of various proportions of non-ED admissions when the hospital reaches specific trigger points increased revenue. The optimal strategies tested resulted in an estimated $2.7 million and $3.6 in net revenue per year, depending on whether left without being seen patients were assumed to be outpatients or mirrored ambulatory admission rates, respectively. Dynamic inpatient bed management in inner-city teaching hospitals in which non-ED admissions are occasionally reduced to ensure that EDs have reduced boarding times is a financially attractive strategy. Copyright © 2010 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

  8. Things that go beep: experience with an ED guideline for use of a handheld metal detector in the management of ingested non‐hazardous metallic foreign bodies

    Science.gov (United States)

    Ramlakhan, S L; Burke, D P; Gilchrist, J

    2006-01-01

    Objectives To review compliance with our emergency department (ED) guideline on the imaging of ingested non‐hazardous metallic foreign bodies in children, investigate adverse outcomes, and make suggestions for improving the guideline. Methods Retrospective analysis of patients presenting in a 3 year period to a paediatric ED with a history of possible metallic foreign body (MFB) ingestion, who were managed according to an ED guideline. Results We identified 430 episodes of possible MFB ingestion, of which 422 were eligible for inclusion in the study. Compliance with the guideline was 77.8% with no significant adverse events. The exclusion of symptoms as a criterion for x ray results in a reduction in the x ray rate of 56% in the symptomatic group with no increase in adverse events. Conclusion A handheld metal detector (HMD) can be safely and reliably used in lieu of plain radiography to investigate children with a history of MFB ingestion, irrespective of symptoms and without incurring any significant adverse events. PMID:16714508

  9. Management of angioedema without urticaria in the emergency department.

    Science.gov (United States)

    Pedrosa, Maria; Prieto-García, Alicia; Sala-Cunill, Anna

    2014-12-01

    Angioedema refers to a localized, transient swelling of the deep skin layers or the upper respiratory or gastrointestinal mucosa. It develops as a result of mainly two different vasoactive peptides, histamine or bradykinin. Pathophysiology, as well as treatment, is different in each case; nevertheless, the resulting signs and symptoms may be similar and difficult to distinguish. Angioedema may occur at any location. When the affected area involves the upper respiratory tract, both forms of angioedema can lead to an imminent upper airway obstruction and a life-threatening emergency. Emergency physicians must have a basic understanding of the pathophysiology underlying this process. Angioedema evaluation in the emergency department (ED) should aim to distinguish between histamine- and bradykinin-induced angioedema, in order to provide appropriate treatment to patients. However, diagnostic methods are not available at the ED setting, neither to confirm one mechanism or the other, nor to identify a cause. For this reason, the management of angioedema should rely on clinical data depending on the particular features of the episode and the patient in each case. The history-taking should be addressed to identify a possible etiology or triggering agent, recording complete information for an ulterior diagnostic study in the outpatient clinic. It is mandatory quickly to recognize and treat a potential life-threatening upper airway obstruction or anaphylaxis. This review focuses on the underlying mechanisms and management of histamine- and bradykinin-induced angioedema at the emergency department and provides an update on the currently available treatments.

  10. Analysis of EDS Fingerprint Spectra of Mineral Drug Montmorillonite Powder Relying on Dual Index Grade Sequence Individualized Pattern Recognition Method and their Quickly Quality Evaluation%矿物药蒙脱石散EDS指纹图谱双指标等级序列个性化模式识别分析及快速质量评价

    Institute of Scientific and Technical Information of China (English)

    邹华彬; 阿依古再丽·阿不力米提; 翟红

    2013-01-01

    EDS(energy dispersive spectrometer )element fingerprint spectra is able to quickly measure the kinds and the contents of elements in any mineral drug .In dual index grade sequence individualized pattern recognition method ,common (quantity) in-dex and variation (quantity) index ratios of any two samples’ fingerprint spectra are calculated ,and the individualized dual index sequence of each sample is constructed relying on its own EDS fingerprint spectra as the reference .Then the mean common (quantity ) index ratio P and the standard deviation S of all samples in each sample’s individualized dual index sequence are com-puted .On this basis ,for each sample ,its own similarity scale function P≥ P+ xS is built up .By this function ,the optimum x suitable for optimized classification/cluster of all samples is determined ,and the individualized characteristics sequence of one sample ,to which samples in the individualized characteristics sequence are significantly similar ,is decided also .Finally ,depen-ding on these individualized characteristics sequences ,the optimized classification/cluster of all samples can be carried out per-fectly without any prior knowledge related to them .This method is not only suitable for the quantitative analysis on fingerprint spectra being of only common peaks ,but also fits for that being of both common and variant peaks .In this study ,the EDS ele-ment fingerprint spectra of seven mineral drug montmorillonite powder samples from different companies were detected .Then common (quantity) index and variant (quantity) index ratios of peak area (or contents of majorly active element Fe ,Al ,Ca , Mg ,Si) among different EDS fingerprint spectra were obtained .In the similarity scale function P≥ P+ xS ,when x=0.5 ,these seven mineral drug montmorillonite powder samples could be quickly identified with high resolution , be classified into two groups ,and their quality could be evaluated precisely .In general EDS element fingerprint

  11. The collection of MicroED data for macromolecular crystallography.

    Science.gov (United States)

    Shi, Dan; Nannenga, Brent L; de la Cruz, M Jason; Liu, Jinyang; Sawtelle, Steven; Calero, Guillermo; Reyes, Francis E; Hattne, Johan; Gonen, Tamir

    2016-05-01

    The formation of large, well-ordered crystals for crystallographic experiments remains a crucial bottleneck to the structural understanding of many important biological systems. To help alleviate this problem in crystallography, we have developed the MicroED method for the collection of electron diffraction data from 3D microcrystals and nanocrystals of radiation-sensitive biological material. In this approach, liquid solutions containing protein microcrystals are deposited on carbon-coated electron microscopy grids and are vitrified by plunging them into liquid ethane. MicroED data are collected for each selected crystal using cryo-electron microscopy, in which the crystal is diffracted using very few electrons as the stage is continuously rotated. This protocol gives advice on how to identify microcrystals by light microscopy or by negative-stain electron microscopy in samples obtained from standard protein crystallization experiments. The protocol also includes information about custom-designed equipment for controlling crystal rotation and software for recording experimental parameters in diffraction image metadata. Identifying microcrystals, preparing samples and setting up the microscope for diffraction data collection take approximately half an hour for each step. Screening microcrystals for quality diffraction takes roughly an hour, and the collection of a single data set is ∼10 min in duration. Complete data sets and resulting high-resolution structures can be obtained from a single crystal or by merging data from multiple crystals.

  12. Test–retest reliability of multidimensional dyspnea profile recall ratings in the emergency department: a prospective, longitudinal study

    Directory of Open Access Journals (Sweden)

    Parshall Mark B

    2012-07-01

    Full Text Available Abstract Background Dyspnea is among the most common reasons for emergency department (ED visits by patients with cardiopulmonary disease who are commonly asked to recall the symptoms that prompted them to come to the ED. The reliability of recalled dyspnea has not been systematically investigated in ED patients. Methods Patients with chronic or acute cardiopulmonary conditions who came to the ED with dyspnea (N = 154 completed the Multidimensional Dyspnea Profile (MDP several times during the visit and in a follow-up visit 4 to 6 weeks later (n = 68. The MDP has 12 items with numerical ratings of intensity, unpleasantness, sensory qualities, and emotions associated with how breathing felt when participants decided to come to the ED (recall MDP or at the time of administration (“now” MDP. The recall MDP was administered twice in the ED and once during the follow-up visit. Principal components analysis (PCA with varimax rotation was used to assess domain structure of the recall MDP. Internal consistency reliability was assessed with Cronbach’s alpha. Test–retest reliability was assessed with intraclass correlation coefficients (ICCs for absolute agreement for individual items and domains. Results PCA of the recall MDP was consistent with two domains (Immediate Perception, 7 items, Cronbach’s alpha = .89 to .94; Emotional Response, 5 items; Cronbach’s alpha = .81 to .85. Test–retest ICCs for the recall MDP during the ED visit ranged from .70 to .87 for individual items and were .93 and .94 for the Immediate Perception and Emotional Response domains. ICCs were much lower for the interval between the ED visit and follow-up, both for individual items (.28 to .66 and for the Immediate Perception and Emotional Response domains (.72 and .78, respectively. Conclusions During an ED visit, recall MDP ratings of dyspnea at the time participants decided to seek care in the ED are reliable and sufficiently stable, both for

  13. 营养不良的保健指导方法及健康教育的应用研究%Poor Nutrition Health Guidance Method and the Application of Health Ed-ucation Research

    Institute of Scientific and Technical Information of China (English)

    朱峰林

    2015-01-01

    Objective Analysis to study the infantile malnutrition health guidance method and the application effect of health education. Methods Select our hospital malnourished children with 80 cases as the research object, treated time in February 2013 to February 2014, using a digital lottery method it is divided into experimental group and control group 80 cases, 40 cases in each group have children, the control group given conventional food intervention guide, the experimental group to guide targeted care combined with health education family nutritional guidance, and at the end of the two groups of children with family after health education, compared to the ratings of body mass index (bmi), health knowledge, health be-havior score and nutrition success rate. Results The experimental group of body mass index (bmi), health knowledge score, health behavior score were higher than control group(P<0.05), statistically significant difference; The experimental group of children nutrition success rate was 95.00%, far higher than the control group 70.00%(P<0.05), the difference is statistically significant. Conclusion To give health guidance to malnutrition children science and health education has significant clini-cal value, can effectively improve the patient's physical condition, improve the patient's health knowledge grading and health behavior scale, improve the patient's nutrition success rate, is worth in the clinical practice in the process of applica-tion and popularization.%目的 分析探讨小儿营养不良的保健指导方法及健康教育的应用效果.方法 选择该院收治的营养不良患儿80例作为研究对象,使用数字抽签法将这80例患儿分成实验组和对照组,每组各有患儿40例,对照组给予常规食物干预指导,实验组给予针对性保健指导结合健康教育家庭营养指导,并在两组患儿结束家庭健康教育后,对比其体质量指数、健康知识评分、健康行为评分及营养达标率. 结果

  14. Evaluation of Pharmacist Impact on Culture Review Process for Patients Discharged From the Emergency Department.

    Science.gov (United States)

    Santiago, Ruben D; Bazan, Jose A; Brown, Nicole V; Adkins, Eric J; Shirk, Mary Beth

    2016-10-01

    Background: Accurate and timely review of microbiological test results is a core component of antimicrobial stewardship. There is documented success of these programs in the inpatient setting; however, emergency department (ED) patients are typically not included in these initiatives. Objectives: To assess the impact of an emergency medicine pharmacist (EMP)-facilitated review process of positive microbiological test results from patients discharged from the ED as measured by time to positive result review and number of indicated interventions completed. Methods: This was a retrospective study that compared EMP-facilitated to ED charge nurse (CN)-facilitated physician review of randomly selected positive microbiological test results. Groups were compared concurrently within the time frame of July 1, 2012 through December 31, 2012. Results: One hundred seventy-eight positive microbiological test results were included (EMP, n = 91; CN, n = 87). The median (IQR) time to initial review was 3 (1.0-6.3) hours for the EMP and 2 (0.3-5.5) hours for the CN group (p = .35). Four percent (1/25) of indicated interventions were not completed in the EMP group versus 47% (14/30) in the CN group (p = .0004). Conclusion: An EMP was significantly less likely to miss an intervention when indicated with no difference in time to review of positive microbiological results. These findings support the role of the EMP in antimicrobial stewardship in the ED.

  15. Patients with worsening chronic heart failure who present to a hospital emergency department require hospital care

    Directory of Open Access Journals (Sweden)

    Shafazand Masoud

    2012-03-01

    Full Text Available Abstract Background Chronic heart failure (CHF is a major public health problem characterised by progressive deterioration with disabling symptoms and frequent hospital admissions. To influence hospitalisation rates it is crucial to identify precipitating factors. To characterise patients with CHF who seek an emergency department (ED because of worsening symptoms and signs and to explore the reasons why they are admitted to hospital. Method Patients (n = 2,648 seeking care for dyspnoea were identified at the ED, Sahlgrenska University Hospital/Östra. Out of 2,648 patients, 1,127 had a previous diagnosis of CHF, and of these, 786 were included in the present study with at least one sign and one symptom of worsening CHF. Results Although several of the patients wanted to go home after acute treatment in the ED, only 2% could be sent home. These patients were enrolled in an interventional study, which evaluated the acute care at home compared to the conventional, in hospital care. The remaining patients were admitted to hospital because of serious condition, including pneumonia/respiratory disease, myocardial infarction, pulmonary oedema, anaemia, the need to monitor cardiac rhythm, pathological blood chemistry and difficulties to communicate. Conclusion The vast majority of patients with worsening CHF seeking the ED required hospital care, predominantly because of co-morbidities. Patients with CHF with symptomatic deterioration may be admitted to hospital without additional emergency room investigations.

  16. Physician and Nurse Acceptance of Technicians to Screen for Geriatric Syndromes in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Brian F Gage

    2011-05-01

    Full Text Available Introduction: The objective of this study was to evaluate emergency medicine physician and nurse acceptance of nonnurse, nonphysician screening for geriatric syndromes. Methods: This was a single-center emergency department (ED survey of physicians and nurses after an 8-month project. Geriatric technicians were paid medical student research assistants evaluating consenting ED patients older than 65 years for cognitive dysfunction, fall risk, or functional decline. The primary objective of this anonymous survey was to evaluate ED nurse and physician perceptions about the geriatric screener feasibility and barriers to implementation. In addition, as a secondary objective, respondents reported ongoing geriatric screening efforts independent of the research screeners. Results: The survey was completed by 72% of physicians and 33% of nurses. Most nurses and physicians identified geriatric technicians as beneficial to patients without impeding ED throughput. Fewer than 25% of physicians routinely screen for any geriatric syndromes. Nurses evaluated for fall risk significantly more often than physicians, but no other significant differences were noted in ongoing screening efforts. Conclusion: Dedicated geriatric technicians are perceived by nurses and physicians as beneficial to patients with the potential to improve patient safety and clinical outcomes. Most nurses and physicians are not currently screening for any geriatric syndromes. [West J Emerg Med. 2011;12(4:489–495.

  17. Methods for staging non-small cell lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines.

    Science.gov (United States)

    Silvestri, Gerard A; Gonzalez, Anne V; Jantz, Michael A; Margolis, Mitchell L; Gould, Michael K; Tanoue, Lynn T; Harris, Loren J; Detterbeck, Frank C

    2013-05-01

    Correctly staging lung cancer is important because the treatment options and prognosis differ significantly by stage. Several noninvasive imaging studies and invasive tests are available. Understanding the accuracy, advantages, and disadvantages of the available methods for staging non-small cell lung cancer is critical to decision-making. Test accuracies for the available staging studies were updated from the second iteration of the American College of Chest Physicians Lung Cancer Guidelines. Systematic searches of the MEDLINE database were performed up to June 2012 with the inclusion of selected meta-analyses, practice guidelines, and reviews. Study designs and results are summarized in evidence tables. The sensitivity and specificity of CT scanning for identifying mediastinal lymph node metastasis were approximately 55% and 81%, respectively, confirming that CT scanning has limited ability either to rule in or exclude mediastinal metastasis. For PET scanning, estimates of sensitivity and specificity for identifying mediastinal metastasis were approximately 77% and 86%, respectively. These findings demonstrate that PET scanning is more accurate than CT scanning, but tissue biopsy is still required to confirm PET scan findings. The needle techniques endobronchial ultrasound-needle aspiration, endoscopic ultrasound-needle aspiration, and combined endobronchial ultrasound/endoscopic ultrasound-needle aspiration have sensitivities of approximately 89%, 89%, and 91%, respectively. In direct comparison with surgical staging, needle techniques have emerged as the best first diagnostic tools to obtain tissue. Based on randomized controlled trials, PET or PET-CT scanning is recommended for staging and to detect unsuspected metastatic disease and avoid noncurative resections. Since the last iteration of the staging guidelines, PET scanning has assumed a more prominent role both in its use prior to surgery and when evaluating for metastatic disease. Minimally invasive

  18. Citar e referenciar : APA 6ª ed.

    OpenAIRE

    Marcos, Isabel Marques

    2016-01-01

    A elaboração correta dos trabalhos científicos pressupõe o respeito por um conjunto de princípios normativos de citação e referenciação bibliográfica que salvaguardam os autores das criações intelectuais do uso indevido das mesmas. Partindo de três conceitos: citação, referência bibliográfica e lista de referências apresentam-se as normas da APA 6ª ed. nos seus elementos essenciais. Estas normas, da área da informação e documentação, definem regras para a normalização das referências bibliogr...

  19. Accuracy of Handheld Point-of-Care Fingertip Lactate Measurement in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Gaieski, David G

    2013-02-01

    Full Text Available Introduction: Early recognition of elevated lactate levels in sepsis may hasten the detection of those patients eligible for aggressive resuscitation. Point-of-care (POC testing is now increasingly available for use in the emergency department (ED. We examined the accuracy and time-saving effect of a handheld POC device for the measurement of fingertip and whole blood lactate as compared with reference laboratory testing in critically ill ED patients.Methods: A convenience sample of adult ED patients receiving serum lactate testing was prospectively enrolled at an urban, tertiary care US hospital. Consenting patients underwent fingertip POC lactate measurement with a portable device and simultaneous whole blood sampling for analysis by both the POC device and standard laboratory analyzer (‘‘reference method’’. Lactate measurements were compared by intraclass correlation (ICC and Bland and Altman plots. Differences in time to test result were compared by paired t test.Results: Twenty-four patients, 19 (79% with sepsis and 21 (88% with lactate levels below 4 mmol/L, were included from April 2005 to May 2005. Fingertip POC and whole blood POC lactate measurements each correlated tightly with the reference method (ICC ¼ 0.90 and ICC ¼ 0.92, respectively. Mean time between obtaining fingertip lactate samples and whole blood reference lactate samples was 8 6 13 minutes. Mean time between obtaining POC and reference laboratory lactate results was 65 minutes (95% confidence interval, 30–103.Conclusion: Fingertip POC lactate measurement is an accurate method to determine lactate levels in infected ED patients with normal or modestly elevated lactate values and significantly decreases time to test results. These findings should be verified in a larger, more critically ill, ED population. [West J Emerg Med. 2013;14(1:58-62.

  20. Pareto vs Simmel: residui ed emozioni

    Directory of Open Access Journals (Sweden)

    Silvia Fornari

    2017-08-01

    Full Text Available A cento anni dalla pubblicazione del Trattato di sociologia generale (Pareto 1988 siamo a mantenere vivo ed attuale lo studio paretiano con una rilettura contemporanea del suo pensiero. Ricordato per la grande versatilità intellettuale dagli economisti, rimane lo scienziato rigoroso ed analitico i cui contributi sono ancora discussi a livello internazionale. Noi ne analizzeremo gli aspetti che l’hanno portato ad avvicinarsi all’approccio sociologico, con l’introduzione della nota distinzione dell’azione sociale: logica e non-logica. Una dicotomia utilizzata per dare conto dei cambiamenti sociali riguardanti le modalità d’azione degli uomini e delle donne. Com’è noto le azioni logiche sono quelle che riguardano comportamenti mossi da logicità e raziocinio, in cui vi è una diretta relazione causa-effetto, azioni oggetto di studio degli economisti, e di cui non si occupano i sociologi. Le azioni non-logiche riguardano tutte le tipologie di agire umano che rientrano nel novero delle scienze sociali, e che rappresentano la parte più ampia dell’agire sociale. Sono le azioni guidate dai sentimenti, dall’emotività, dalla superstizione, ecc., illustrate da Pareto nel Trattato di sociologia generale e in saggi successivi, dove riprende anche il concetto di eterogenesi dei fini, formulato per la prima volta da Giambattista Vico. Concetto secondo il quale la storia umana, pur conservando in potenza la realizzazione di certi fini, non è lineare e lungo il suo percorso evolutivo può accadere che l’uomo nel tentativo di raggiungere una finalità arrivi a conclusioni opposte. Pareto collega la definizione del filosofo napoletano alle tipologie di azione sociale e alla loro distinzione (logiche, non-logiche. L’eterogenesi dei fini per Pareto è dunque l’esito di un particolare tipo di azione non-logica dell’essere umano e della collettività.

  1. Commercial Orange Juice Beverages Detection by Fluorescence Spectroscopy Combined with PCA-ED and PLSR Methods%荧光光谱结合PCA-ED与PLSR方法检测市售橙汁饮品

    Institute of Scientific and Technical Information of China (English)

    胡扬俊; 朱纯; 陈国庆; 张咏; 孔凡标; 李润; 朱焯炜; 王旭; 高淑梅

    2014-01-01

    In order to classify the orange juice beverages effectively,the fluorescence character differences of two kinds of orange juice beverages including 100% orange juice and orange drink were analyzed and compared,principal component analysis com-bined with Euclidean distance was adopted to classify two kinds of orange juice beverages,and ideal classification results were obtained.Meanwhile,the orange juice content estimation model was established by using fluorescence spectroscopy combined with partial least squares regression method,and the correlation coefficient R,root mean square error of calibration RMSEC and root mean square error of prediction RMSEP were 0. 997,0. 87% and 2. 05%,respectively.The experimental results indicate that the calibration model offers comparatively accurate content estimation,which reflect the actual orange juice content in the commercial orange juice beverages.The exploration to classify orange juice beverages was carried out from two aspects of quali-tative and quantitative analysis by employing fluorescence spectroscopy combined with chemometrics method,which can provide a new idea for the classification and adulteration detection of commercial orange juice beverages,and also can give certain refer-ence basis for the quality control of orange juice raw material.%为实现市售橙汁饮品的有效鉴别,在分析与比较100%橙汁与橙汁饮料两类饮品荧光特性差异的基础上,采用主成分分析结合欧氏距离(PCA-ED)的方法对市售橙汁饮品进行定性鉴别,效果良好。同时,利用荧光光谱结合偏最小二乘回归(PLSR)方法建立市售橙汁饮品中橙汁含量的估测模型,PLSR多元校正模型的相关系数r为0.997,校正均方根误差为0.87%,预测均方根误差为2.05%,实验结果表明,校正模型较准确地反映了市售橙汁饮品中的真实橙汁含量。通过采用荧光光谱结合化学计量学方法从定性与定量两方面对

  2. Forecasting emergency department visits using internet data.

    Science.gov (United States)

    Ekström, Andreas; Kurland, Lisa; Farrokhnia, Nasim; Castrén, Maaret; Nordberg, Martin

    2015-04-01

    Using Internet data to forecast emergency department (ED) visits might enable a model that reflects behavioral trends and thereby be a valid tool for health care providers with which to allocate resources and prevent crowding. The aim of this study is to investigate whether Web site visits to a regional medical Web site, the Stockholm Health Care Guide, a proxy for the general public's concern of their health, could be used to predict the ED attendance for the coming day. In a retrospective, observational, cross-sectional study, a model for forecasting the daily number of ED visits was derived and validated. The model was derived through regression analysis, using visits to the Stockholm Health Care Guide Web site between 6 pm and midnight and day of the week as independent variables. Web site visits were measured with Google Analytics. The number of visits to the ED within the region was retrieved from the Stockholm County Council administrative database. All types of ED visits (including adult, pediatric, and gynecologic) were included. The period of August 13, 2011, to August 12, 2012, was used as a training set for the model. The hourly variation of visits was analyzed for both Web site and the ED visits to determine the interval of hours to be used for the prediction. The model was validated with mean absolute percentage error for August 13, 2012, to October 31, 2012. The correlation between the number of Web site visits between 6 pm and midnight and ED visits the coming day was significant (r=0.77; Pforecasting results for ED visits were achieved for the entire county, with a mean absolute percentage error of 4.8%. The result for the individual hospitals ranged between mean absolute percentage error 5.2% and 13.1%. Web site visits may be used in this fashion to predict attendance to the ED. The model works both for the entire region and for individual hospitals. The possibility of using Internet data to predict ED visits is promising. Copyright © 2014

  3. Using process indicators to optimize service completion of an ED drug and alcohol brief intervention program.

    Science.gov (United States)

    Akin, Joanna; Johnson, J Aaron; Seale, J Paul; Kuperminc, Gabriel P

    2015-01-01

    The strongest evidence for effectiveness of screening, brief intervention, and referral to treatment (SBIRT) programs is in primary care settings. Emergency department (ED) studies have shown mixed results. Implementation of SBIRT into ED settings is complicated by the type of patients seen and the fast-paced, high-throughput nature of the ED environment that makes it difficult to reach patients flagged for SBIRT services. This study uses data from an ED-based SBIRT program to examine the relationship between screen-positive rate, ED patient flow, and SBIRT service delivery. Data for the study (N = 67137) were derived from weekly reports extracted directly from one hospital's electronic health record. Measures included time and day of patient entry, drug/alcohol screen result (positive or negative), and whether the patient was reached by SBIRT specialists. Factorial analysis of variance compared variations in screen-positive rates by day and time and the percentage of patients reached by SBIRT specialists during these periods. Overall, 56% of screen-positive patients received SBIRT services. Only 5% of patients offered SBIRT services refused. Day and time of entry had a significant interaction effect on the reached rate (F12,14166 =3.48, P < .001). Although patient volume was lowest between 11 pm and 7 am, screen-positive rates were highest during this period, particularly on weekends; and patients were least likely to be reached during these periods. When implementing an ED-based SBIRT program, thoughtful consideration should be given to patient flow and staffing to maximize program impact and increase the likelihood of sustainability. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. Medication errors recovered by emergency department pharmacists.

    Science.gov (United States)

    Rothschild, Jeffrey M; Churchill, William; Erickson, Abbie; Munz, Kristin; Schuur, Jeremiah D; Salzberg, Claudia A; Lewinski, Daniel; Shane, Rita; Aazami, Roshanak; Patka, John; Jaggers, Rondell; Steffenhagen, Aaron; Rough, Steve; Bates, David W

    2010-06-01

    We assess the impact of emergency department (ED) pharmacists on reducing potentially harmful medication errors. We conducted this observational study in 4 academic EDs. Trained pharmacy residents observed a convenience sample of ED pharmacists' activities. The primary outcome was medication errors recovered by pharmacists, including errors intercepted before reaching the patient (near miss or potential adverse drug event), caught after reaching the patient but before causing harm (mitigated adverse drug event), or caught after some harm but before further or worsening harm (ameliorated adverse drug event). Pairs of physician and pharmacist reviewers confirmed recovered medication errors and assessed their potential for harm. Observers were unblinded and clinical outcomes were not evaluated. We conducted 226 observation sessions spanning 787 hours and observed pharmacists reviewing 17,320 medications ordered or administered to 6,471 patients. We identified 504 recovered medication errors, or 7.8 per 100 patients and 2.9 per 100 medications. Most of the recovered medication errors were intercepted potential adverse drug events (90.3%), with fewer mitigated adverse drug events (3.9%) and ameliorated adverse drug events (0.2%). The potential severities of the recovered errors were most often serious (47.8%) or significant (36.2%). The most common medication classes associated with recovered medication errors were antimicrobial agents (32.1%), central nervous system agents (16.2%), and anticoagulant and thrombolytic agents (14.1%). The most common error types were dosing errors, drug omission, and wrong frequency errors. ED pharmacists can identify and prevent potentially harmful medication errors. Controlled trials are necessary to determine the net costs and benefits of ED pharmacist staffing on safety, quality, and costs, especially important considerations for smaller EDs and pharmacy departments. Copyright (c) 2009 American College of Emergency Physicians

  5. Emergency department visits, ambulance calls, and mortality associated with an exceptional heat wave in Sydney, Australia, 2011: a time-series analysis

    Directory of Open Access Journals (Sweden)

    Schaffer Andrea

    2012-01-01

    Full Text Available Abstract Background From January 30-February 6, 2011, New South Wales was affected by an exceptional heat wave, which broke numerous records. Near real-time Emergency Department (ED and ambulance surveillance allowed rapid detection of an increase in the number of heat-related ED visits and ambulance calls during this period. The purpose of this study was to quantify the excess heat-related and all-cause ED visits and ambulance calls, and excess all-cause mortality, associated with the heat wave. Methods ED and ambulance data were obtained from surveillance and administrative databases, while mortality data were obtained from the state death registry. The observed counts were compared with the average counts from the same period from 2006/07 through 2009/10, and a Poisson regression model was constructed to calculate the number of excess ED visits, ambulance and deaths after adjusting for calendar and lag effects. Results During the heat wave there were 104 and 236 ED visits for heat effects and dehydration respectively, and 116 ambulance calls for heat exposure. From the regression model, all-cause ED visits increased by 2% (95% CI 1.01-1.03, all-cause ambulance calls increased by 14% (95% CI 1.11-1.16, and all-cause mortality increased by 13% (95% CI 1.06-1.22. Those aged 75 years and older had the highest excess rates of all outcomes. Conclusions The 2011 heat wave resulted in an increase in the number of ED visits and ambulance calls, especially in older persons, as well as an increase in all-cause mortality. Rapid surveillance systems provide markers of heat wave impacts that have fatal outcomes.

  6. Multicolor flow cytometry analysis of the proliferations of T-lymphocyte subsets in vitro by EdU incorporation.

    Science.gov (United States)

    Sun, Yanli; Sun, Yu; Lin, Guigao; Zhang, Rui; Zhang, Kuo; Xie, Jiehong; Wang, Lunan; Li, Jinming

    2012-10-01

    EdU (5-ethynyl-2'-deoxyuridine) incorporation has proved advantageous in the studies of cell kinetics, DNA synthesis, and cellular proliferation in vitro and in vivo compared to [(3) H]thymidine incorporation and BrdU (5-bromo-2'-deoxyuridine) incorporation. Here, we describe a method that combines EdU incorporation and immunostaining with flow cytometric analysis to detect the proliferations of T lymphocyte subsets in vitro and optimized the assay's conditions. We found that the number of EdU(+) cells were associated with EdU concentration, incubation time, and the volume of Click reaction solution, the best EdU concentration 10-50 μM, the optimal incubation time 8-12 h and the proper volume of Click volume 100 μl for labeling 1 × 10(6) lymphocytes. Fixation was better to be performed before permeabilization, not together with. Furthermore, the permeabilization detergent reagent, PBS with 0.05% saponin was better than Tris buffer saline (TBS) with 0.1% Triton X-100. In addition, sufficient wash with PBS with 0.05% saponin has no influence on the staining of EdU(+) cells. Also, the lymphocytes incorporating EdU could be stored at 4°C, -80°C, and in liquid nitrogen up to 21 days. The present study will aid in optimization of flow cytometry assay to detect the proliferations of T cell subsets by EdU incorporation and the labeling of cell surface antigens.

  7. Lack of Gender Disparities in Emergency Department Triage of Acute Stroke Patients

    Directory of Open Access Journals (Sweden)

    Madsen, Tracy E.

    2014-12-01

    Full Text Available Introduction: Previous literature has shown gender disparities in the care of acute ischemic stroke. Compared to men, women wait longer for brain imaging and are less likely to receive intravenous (IV tissue plasminogen activator (tPA. Emergency department (ED triage is an important step in the rapid assessment of stroke patients and is a possible contributor to disparities. It is unknown whether gender differences exist in ED triage of acute stroke patients. Our primary objective was to determine whether gender disparities exist in the triage of acute stroke patients as defined by Emergency Severity Index (ESI levels and use of ED critical care beds. Methods: This was a retrospective, observational study of both ischemic and hemorrhagic stroke patients age ≥18 years presenting to a large, urban, academic ED within six hours of symptom onset between January 2010, and December 2012. Primary outcomes were triage to a non-critical ED bed and Emergency Severity Index (ESI level. Primary outcome data were extracted from electronic medical records by a blinded data manager; secondary outcome data and covariates were abstracted by trained research assistants. We performed bivariate and multivariate analyses. Logistic regression was performed using age, race, insurance status, mode of and time to arrival, National Institutes of Health Stroke Scale, and presence of atypical symptoms as covariates. Results: There were 537 patients included in this study. Women were older (75.6 vs. 69.5, p<0.001, and more women had a history of atrial fibrillation (39.8% vs. 25.3%, p<0.001. Compared to 9.5% of men, 10.3% of women were triaged to a non-critical care ED bed (p=0.77; 92.1% of women were triaged as ESI 1 or 2 vs. 93.6% of men (p=0.53. After adjustment, gender was not associated with triage location or ESI level, though atypical symptoms were associated with higher odds of being triaged to a non-critical care bed (aOR 1.98, 95%CI [1.03 – 3.81] and 3

  8. Implementing Data Definition Consistency for Emergency Department Operations Benchmarking and Research.

    Science.gov (United States)

    Yiadom, Maame Yaa A B; Scheulen, James; McWade, Conor M; Augustine, James J

    2016-07-01

    The objective was to obtain a commitment to adopt a common set of definitions for emergency department (ED) demographic, clinical process, and performance metrics among the ED Benchmarking Alliance (EDBA), ED Operations Study Group (EDOSG), and Academy of Academic Administrators of Emergency Medicine (AAAEM) by 2017. A retrospective cross-sectional analysis of available data from three ED operations benchmarking organizations supported a negotiation to use a set of common metrics with identical definitions. During a 1.5-day meeting-structured according to social change theories of information exchange, self-interest, and interdependence-common definitions were identified and negotiated using the EDBA's published definitions as a start for discussion. Methods of process analysis theory were used in the 8 weeks following the meeting to achieve official consensus on definitions. These two lists were submitted to the organizations' leadership for implementation approval. A total of 374 unique measures were identified, of which 57 (15%) were shared by at least two organizations. Fourteen (4%) were common to all three organizations. In addition to agreement on definitions for the 14 measures used by all three organizations, agreement was reached on universal definitions for 17 of the 57 measures shared by at least two organizations. The negotiation outcome was a list of 31 measures with universal definitions to be adopted by each organization by 2017. The use of negotiation, social change, and process analysis theories achieved the adoption of universal definitions among the EDBA, EDOSG, and AAAEM. This will impact performance benchmarking for nearly half of US EDs. It initiates a formal commitment to utilize standardized metrics, and it transitions consistency in reporting ED operations metrics from consensus to implementation. This work advances our ability to more accurately characterize variation in ED care delivery models, resource utilization, and performance. In

  9. Technical Analysis of IEC 61850 Ed 2.0%IEC 61850 Ed 2.0技术分析

    Institute of Scientific and Technical Information of China (English)

    任雁铭; 操丰梅; 张军

    2013-01-01

    对IEC 61850 Ed 2.0的文件构成和技术路线进行了介绍.对比IEC 61850 Ed 1.0,从数据模型、工程配置语言和一致性测试3个方面,对IEC 61850 Ed 2.0的技术特点进行了技术分析.从设备制造商和检测中心2个方面,讨论了如何从IEC 61850 Ed 1.0迁徙到IEC 61850 Ed 2.0.%The profile and technical philosophy of IEC 61850 Ed 2.0 are described. By comparison with IEC 61850 Ed 1.0, an analysis is made of the technical features of IEC 61850 Ed 2.0 data model, substation configuration language and conformance test. A discussion is made of shifting from IEC 61850 Ed 1.0 to IEC 61850 Ed 2.0 with respect to the manufacturer and testing organization.

  10. Take steps to curb violence, improve safety for ED personnel.

    Science.gov (United States)

    2011-10-01

    While violent eruptions are well documented in the ED, there is a not a lot of research into what strategies are most effective at both curbing violence and managing incidents when they do occur. Experts suggest that ED managers should consider staff training and visible security measures when developing procedures for dealing with violence. In one survey of ED physicians, more than three-quarters reported at least one incident of workplace violence in the previous 12 months. Researchers report that many EDs post security at the point of entry, but lack security coverage in patient care areas. Experts suggest that verbal de-escalation techniques can be helpful in lowering anxiety levels.They also urge ED managers to bring in assistance when the ED is crowded or waiting times are long.

  11. Medical Identity Theft in the Emergency Department: Awareness is Crucial

    Directory of Open Access Journals (Sweden)

    Michelino Mancini

    2014-11-01

    Full Text Available Medical Identity theft in the emergency department (ED can harm numerous individuals, and many frontline healthcare providers are unaware of this growing concern. The two cases described began as typical ED encounters until red flags were discovered upon validating the patient’s identity. Educating all healthcare personnel within and outside the ED regarding the subtle signs of medical identity theft and implementing institutional policies to identify these criminals will discourage further fraudulent behavior. [West J Emerg Med. 2014;15(7:–0.

  12. ED50 and ED95 of Intrathecal Bupivacaine Coadministered with Sufentanil for Cesarean Delivery Under Combined Spinal-epidural in Severely Preeclamptic Patients

    Institute of Scientific and Technical Information of China (English)

    Fei Xiao; Wen-Ping Xu; Xiao-Min Zhang; Yin-Fa Zhang; Li-Zhong Wang; Xin-Zhong Chen

    2015-01-01

    Background:Spinal anesthesia was considered as a reasonable anesthetic option in severe preeclampsia when cesarean delivery is indicated,and there is no indwelling epidural catheter or contraindication to spinal anesthesia.However,the ideal dose of intrathecal bupivacaine has not been quantified for cesarean delivery for severe preeclamptic patients.This study aimed to determine the ED50 and ED95 of intrathecal bupivacaine for severely preeclamptic patients undergoing elective cesarean delivery.Methods:Two hundred severely preeclamptic patients are undergoing elective cesarean delivery under combined spinal-epidural anesthesia enrolled in this randomized,double-blinded,dose-ranging study.Patients received 4 mg,6 mg,8 mg,or 10 mg intrathecal hyperbaric bupivacaine with 2.5 μg sufentanil.Successful spinal anesthesia was defined as a T6 sensory level achieved within 10 minutes after intrathecal drug administration and/or no epidural supplement was required during the cesarean section.The ED50 and ED95 were calculated with a logistic regression model.Results:ED50 and ED95 ofintrathecal bupivacaine for successful spinal anesthesia were 5.67 mg (95% confidence interval [CI]:5.20-6.10 mg) and 8.82 mg (95% CI:8.14-9.87 mg) respectively.The incidence of hypotension in Group 8 mg and Group 10 mg was higher than that in Group 4 mg and Group 6 mg (P < 0.05).The sensory block was significantly different among groups 10 minutes after intrathecal injection (P < 0.05).The use of lidocaine in Group 4 mg was higher than that in other groups (P < 0.05).The use of phenylephrine in Group 8 mg and Group 10 mg was higher than that in the other two groups (P < 0.05).The lowest systolic blood pressure before the infant delivery of Group 8 mg and Group 10 mg was lower than the other two groups (P < 0.05).The satisfaction of muscle relaxation in Group 4 mg was lower than other groups (P < 0.05).There was no significant difference in patients' satisfaction and the newborns

  13. Flow cytometric analysis of T lymphocyte proliferation in vivo by EdU incorporation.

    Science.gov (United States)

    Sun, Xiaojing; Zhang, Chunpan; Jin, Hua; Sun, Guangyong; Tian, Yue; Shi, Wen; Zhang, Dong

    2016-12-01

    Monitoring T lymphocyte proliferation, especially in vivo, is essential for the evaluation of adaptive immune reactions. Flow cytometry-based proliferation assays have advantages in measuring cell division of different T lymphocyte subsets at the same time by multicolor labelling. In this study, we aimed to establish the use of 5-Ethynyl-2'-deoxyuridine (EdU) incorporation in vivo to monitor T lymphocyte proliferation by flow cytometry with an adoptive transfer model. We found that fixation followed by permeabilization preserved T cell surface antigens and had no obvious effects on the fluorescence intensity of APC, PE, PE-Cy7, FITC and PerCP-Cy5.5 when the concentration of the permeabilization reagents was optimized. However, the click reaction resulted in a significant decrease in the fluorescence intensity of PE and PE-Cy7, and surface staining after the click reaction improved the fluorescence intensity. Thus, an extra step of blocking with PBS with 3% FBS between the click reaction and cell surface staining is needed. Furthermore, the percentage of EdU-positive cells increased in a dose-dependent manner, and the saturated dose of EdU was 20mg/kg. Intraperitoneal and intravenous injection had no differences in lymphocyte proliferation detection with EdU in vivo. In addition, T cell proliferation measured by EdU incorporation was comparable to BrdU but was lower than CFSE labelling. In conclusion, we optimized the protocols for EdU administration in vivo and staining in vitro, providing a feasible method for the measurement of T lymphocyte proliferation with EdU incorporation by flow cytometry in vivo.

  14. An integrative review: triage protocols and the effect on ED length of stay.

    Science.gov (United States)

    Robinson, Dana J

    2013-07-01

    The purpose of this integrative review is to identify the effectiveness of using triage protocols to decrease ED length of stay. The review method described by Ganong was used to guide the review process. Data sources included CINAHL (Cumulative Index to Nursing and Allied Health Literature), Medline, the Cochrane Library, Mosby's Nursing Consult, and the National Guideline Clearinghouse. In addition, reference lists of all articles were reviewed, 3 authors of previous articles were contacted for more current or updated work, and a hand search of the Journal of Emergency Nursing was conducted. The search generated 56 articles, 8 of which met inclusion criteria. Data were interpreted and evaluated by use of a data summary sheet. Key conclusions drawn from the appraisals included that a decrease in length of stay was related to protocol use and nurses were able to initiate diagnostic testing and treatments appropriately. These conclusions apply to acuity levels 3 and 4, which require either little or no testing or require testing to facilitate a disposition decision. The implications for nursing are that appraisals of evidence lead to better practice decisions, protocols can provide greater nursing autonomy and satisfaction, and protocols are able to increase the facilitation of patient care in the emergency department.

  15. EDs trying not to let the bed bugs bite.

    Science.gov (United States)

    2010-09-01

    As bed bugs have emerged as a growing problem for EDs, managers have developed strategies for prevention and decontamination. Here are some of the approaches they have shared with ED Management: Educate your staff on what they should look for on patients and in rooms that would indicate the presence of bed bugs. Be proactive. Have an exterminator examine your ED on a regular basis. A decontamination room on the outside of the building will prevent the spread of these bugs in your ED.

  16. SEM-EDS analysis and discrimination of forensic soil.

    Science.gov (United States)

    Cengiz, Salih; Cengiz Karaca, Ali; Cakir, Ismail; Bülent Uner, H; Sevindik, Aytekin

    2004-04-20

    Soils vary among different areas, and have some characteristics because of the natural effects and transfers made by human and other living beings in time. So that forensic examination of soil is not only concerned with the analysis of naturally occurring rocks, minerals, vegetation, and animal matter. It also includes the detection of such manufactured materials such as ions from synthetic fertilizers and from different environments (e.g., nitrate, phosphate, and sulfate) as environmental artifacts (e.g., lead or objects as glass, paint chips, asphalt, brick fragments, and cinders) whose presence may impart soil with characteristics that will make it unique to a particular location. Many screening and analytical methods have been applied for determining the characteristics which differentiate and discriminate the forensic soil samples but none of them easily standardized. Some of the methods that applied in forensic laboratories in forensic soil discrimination are the color comparison of the normal air-dried (dehumidified) and overheated soil samples, macroscopic observation, and low-power stereo-microscopic observation, determination of anionic composition by capillary electrophoresis (CE), and the elemental composition by scanning electron microscope (SEM)-energy dispersive X-ray spectrometer (EDS) and other high sensitivity techniques. The objective of this study was to show the effect of the application of 9 tonnes/cm2 pressure on the elemental compositions obtained by SEM-EDS technique and comparing the discrimination power of the pressed-homogenized and not homogenized forensic soil samples. For this purpose soil samples from 17 different locations of Istanbul were collected. Aliquots of the well mixed samples were dried in an oven at 110-120 degrees C and sieved by using 0.5 mm sieve and then the undersieve fraction(JEO-JSM-5600 equipped with an energy dispersive X-ray spectrometer OXFORD Link-ISIS-300. The samples from top of the sieves were examined with

  17. Use of the emergency department for dermatologic care in the United States by ethnic group.

    Science.gov (United States)

    Abokwidir, Manal; Davis, Scott A; Fleischer, Alan B; Pichardo-Geisinger, Rita O

    2015-01-01

    The emergency department (ED) is not the ideal setting for dermatologic care, but may be widely used, especially among disadvantaged ethnic minorities. This study was performed to characterize the role of the ED in providing dermatologic care for each racial and ethnic group in the United States. We analyzed visits from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey from 1993 to 2010. Settings (office-based, outpatient department or ED), diagnoses and race/ethnicity were assessed to compare usage of the ED across groups. Usage of the ED for dermatologic conditions increased over time (p dermatologic care of black (18.3%) and Hispanic (10.5%) patients than for white patients (5.9%) and were used most in rural or small metropolitan areas. Providing better insurance, more dermatologists in rural areas and better dermatologic training for family physicians may help improve care for underserved populations and reduce inappropriate use of the ED.

  18. Mechatronics. Components - methods - examples. 2. ed.; Mechatronik. Komponenten - Methoden - Beispiele

    Energy Technology Data Exchange (ETDEWEB)

    Heimann, B.; Popp, K. [Hannover Univ. (Germany). Inst. fuer Mechanik; Gerth, W. [Hannover Univ. (Germany). Inst. fuer Regelungstechnik

    2001-07-01

    Mechatronics combines the main disciplines electrical- and mechanical engineering and informatics. Its increasing importance occurs in all kind of on-line control systems, process control, sensor guided robots, magnetic bearings, automobile engineering etc. This book addresses students in all this fields. The main topics are: actuators, sensors, signal processing, data processing, simulation of multibody systems, planning of trajectories, control of mechatronic systems and as an attachment mathematical fundamentals.(GL) [German] Die Mechatronik vereinigt die Hauptfachgebiete Elektrotechnik, Maschinenbau und Informatik. Ihre wachsende Bedeutung findet sich wieder in der gesamten Leittechnik, Verfahrenstechnik, sensorgefuehrte Roboter, Magnetlager, Fahrzeugtechnik usw. Dieses Buch spricht Studenten in all diesen Fachgebieten an. Inhaltliche Hauptkapitel sind: Aktoren, Sensoren, Signalverarbeitung, Prozessdatenverarbeitung, Modellbildung von Mehrkoerpersystemen, Trajektorplanung, Regelung mechatronischer Systeme mit ausfuehrlichen Beispielen und schliesslich ein Anhang mit mathematischen Grundlagen.(GL)

  19. Osteoporosis among Fallers without Concomitant Fracture Identified in an Emergency Department: Frequencies and Risk Factors

    DEFF Research Database (Denmark)

    Glintborg, Bente; Hesse, Ulrik; Houe, Thomas

    2011-01-01

    aged 50-80 years sustaining a low-energy fall without fracture were identified from an ED (n = 199). Patients answered a questionnaire on risk factors and underwent osteodensitometry. Data was compared to a group of patients routinely referred to osteodensitometry from general practice (n = 201......We aimed to determine whether the Emergency Department (ED) is a suitable entrance point for osteoporosis screening among fallers without concomitant fracture compared to referral from general practice. Furthermore, to identify factors associated with osteoporosis among fallers. Methods. Patients......). Results. Among the 199 included fallers, 41 (21%) had osteoporosis. Among these, 35 (85%) reported either previous fracture or reduced body height (>3¿cm). These two risk factors were more frequent among fallers with osteoporosis compared to fallers with normal bone mineral density or osteopenia (previous...

  20. The effect of practitioner characteristics on patient pain and embarrassment during ED internal examinations.

    Science.gov (United States)

    Patton, Kenneth R; Bartfield, Joel M; McErlean, Mara

    2003-05-01

    The objective was to determine if practitioner characteristics influence patients' pain and embarrassment during an emergency department (ED) internal pelvic examination (IPE). This prospective, comparative study was performed in an urban, university teaching hospital ED with an annual census of 64,000. The study population consisted of a convenience sample of patients who required an IPE as part of her ED evaluation. Information gathered included patient age and final diagnosis, as well as examiner gender and level of training (LOT). Immediately after IPE, the patient was asked to rate both pain and embarrassment of the examination using a previously validated 100-mm visual analog scale (VAS). Finally, each subject was asked to indicate her practitioner gender preference for IPE. The influence of examiner gender and LOT on patient pain and embarrassment was assessed using a t-test or ANOVA with significance defined as P embarrassment scores were 29.7 and 17.5 respectively. Examiner gender, examiner LOT and patient age did not predict pain and embarrassment scores. Overall, 173 (62%) patients had no practitioner gender preference, whereas 93 (34%) preferred women and 11 (4%) preferred men. Examiner characteristics do not influence either the pain or the embarrassment associated with IPE in the ED.

  1. Application Method of Department of Orthopedics, Robot Navigation and Positioning System%骨科机器人导航定位系统的应用方法

    Institute of Scientific and Technical Information of China (English)

    曾田勇

    2015-01-01

    目的:介绍骨科机器人导航定位系统(Galen GD-2000型)的工作原理;探讨骨科机器人在股骨颈骨折闭合复位空心钉内固定手术中的应用及配合模式。方法:对我院2013年7月至2014年10月施行的骨科机器人微创手术进行临床应用总结。结果:骨科机器人辅助手术定位精确,固定复位可靠,操作安全,明显减少C臂照射次数及时间;但系统操作复杂、精度要求高,且设备价格昂贵,医务人员使用、维护及保养难度大。结论:该系统显著提高了股骨颈闭合复位内固定的治疗效果,并有利于维护医患双方健康;加强医务人员培训,掌握仪器设备性能,规范手术操作,提高配合质量,实施细节管理及优化服务意识。%Objective: To Introduction the Department of orthopedics robot navigation positioning system (Galen GD-2000) principle of work;to explore the Department of orthopedics robot fractures treated by close reduction and cannulated screw ifxation in operation and cooperation mode in femoral neck.Method: Minimaly invasive operation in Department of orthopedics in our hospital in 2013 July to 2014 robot October implementation of the clinical application of summary.Result: Department of orthopedics, robot assisted operation of accurate positioning, reposition, reliable, safe operation, signiifcantly reduce the C arm irradiation times and time; but the system operation is complex, high precision, and expensive equipment, medical personnel to use, maintenance and maintenance diffcult.Conclusion: The system signiifcantly improves the femoral neck closed reduction and internal ifxation treatment effect, and is beneifcial to the maintenance of both doctors and patients health; strengthen the medical personnel training, to master the instrument and equipment performance, standardized operation, improve the quality of ift, the implementation details of management and optimization of service

  2. Screening for Sexual Orientation in Psychiatric Emergency Departments

    Directory of Open Access Journals (Sweden)

    Currier, Glenn W.

    2015-01-01

    Full Text Available Introduction: Our goal was to explore whether emergency department (ED patients would disclose their sexual orientation in a research evaluation and to examine demographic and clinical characteristics of patients by self-identified sexual orientation. Methods: Participants (n=177 presented for psychiatric treatment at three urban EDs in New York City, Rochester, NY, and Philadelphia, PA. Participants were interviewed in the context of a larger study of a standardized suicide risk assessment. We assessed participants’ willingness to answer questions regarding sexual orientation along three dimensions: a self-description of sexual orientation, a self-description of sexual attraction, and the gender of any prior sexual partners. Results: No participants (0/177 refused to respond to the categorical question about sexual orientation, 168/177 (94.9% agreed to provide information about prior sexual partners, and 100/109 (91.7% provided information about current sexual attraction toward either gender. Of all 177 participants, 154 (87.0% self-identified as heterosexual, 11 (6.2% as bisexual, 10 (5.6% as gay or lesbian, and 2 (1.1% indicated they were not sure. As compared with heterosexual patients, lesbian, gay and bisexual (LGB patients were significantly younger and more likely to be non-white, but did not differ significantly in terms of education, income, employment, or religious affiliation or participation. Further, LGB participants did not differ from self-identified heterosexual participants for lifetime suicide attempt rate or lifetime history of any mood, substance-related, psychotic spectrum, or other Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV Axis I disorder. Of self-identified heterosexual participants 5.6% (5/89 reported sexual attraction as other than ‘only opposite sex,’ and 10.3% (15/142 of sexually active ‘heterosexual’ participants reported previous same-gender sexual partners. Conclusion

  3. Nursing Assessment and Intervention to Geriatric Patients Discharged from Emergency Departments

    DEFF Research Database (Denmark)

    Rosted, Elizabeth Emilie; Poulsen, Ingrid; Hendriksen, Carsten

    2011-01-01

    Background: Geriatric patients recently discharged from hospital are at risk of unplanned readmissions and admission to nursing home. When discharged directly from Emergency Department (ED) the risk increases, as time pressure often requires focus on the presenting problem, although 80% of geriat......Background: Geriatric patients recently discharged from hospital are at risk of unplanned readmissions and admission to nursing home. When discharged directly from Emergency Department (ED) the risk increases, as time pressure often requires focus on the presenting problem, although 80......% of geriatric patients have complex and often unresolved caring needs. Objective: To investigate a structured nursing intervention’s impact on geriatric patients’ unresolved problems and their use of help from the community health centre. Method: We conducted a prospective descriptive study of selected...... geriatric patients with nursing intervention at discharge and 1 and 6 months follow-up. Included were geriatric patients 70+ years discharged to their home October 2006-June 2008. Intervention: After detecting the geriatric patients planned to be discharged, the geriatric nurse in the ED did a brief...

  4. Nursing Assessment and Intervention to Geriatric Patients Discharged From Emergency Department

    DEFF Research Database (Denmark)

    Rosted, Elizabeth Emilie; Poulsen, Ingrid; Hendriksen, Carsten

    Background: Geriatric patients recently discharged from hospital are at risk of unplanned readmissions and admission to nursing home. When discharged directly from Emergency Department (ED) the risk increases, as time pressure often requires focus on the presenting problem, although 80 % of geria......Background: Geriatric patients recently discharged from hospital are at risk of unplanned readmissions and admission to nursing home. When discharged directly from Emergency Department (ED) the risk increases, as time pressure often requires focus on the presenting problem, although 80...... % of geriatric patients have complex and often unresolved caring needs. Objective: To examine the effect of a two-stage nursing assessment and intervention to address the patients uncompensated problems given just after discharge from ED and one and six months after. Method: We conducted a prospective...... nursing assessment comprising a checklist of 10 physical, mental, medical and social items. The focus was on unresolved problems which require medical intervention, new or different home care services, or comprehensive geriatric assessment. Following this the nurses made relevant referrals...

  5. The 4-hour standard is a meaningful quality indicator: correlation of performance with emergency department crowding.

    Science.gov (United States)

    Higginson, Ian; Kehoe, Anthony; Whyatt, Justin; Smith, Jason E

    2017-02-01

    The 4-h standard performance is a controversial quality indicator. Crowding in emergency departments (EDs) causes increased patient morbidity and mortality. The aim of this study was to investigate the relationship between 4-h standard performance and ED crowding as measured by occupancy. A retrospective observational study was carried out using the computerized Emergency Department Information System. Daily occupancy was considered in three ways: as minutes per day spent at occupancy thresholds of 70, 80, 90 and 100%; as the peak occupancy of resuscitation and majors beds at any point in the day; and as a percentage of the total potential ED bed minutes used during the day. An inverse relationship was observed between occupancy and 4-h standard performance using each method. Performance could be sustained at 70% occupancy, but deteriorated in a linear manner at a progressively increasing rate at 80, 90 and 100% occupancy (all Poccupancy (Poccupancy (Poccupancy may play a role in improving the quality of care delivered within the urgent care system.

  6. Counselor-Versus Provider-Based HIV Screening in the Emergency Department: Results From the Universal Screening for HIV Infection in the Emergency Room (USHER) Randomized Controlled Trial

    Science.gov (United States)

    Walensky, Rochelle P.; Reichmann, William M.; Arbelaez, Christian; Wright, Elizabeth; Katz, Jeffrey N.; Seage, George R.; Safren, Steven A.; Hare, Anna Q.; Novais, Anna; Losina, Elena

    2012-01-01

    Objective We compare rates of rapid HIV testing, test offer, and acceptance in an urban emergency department (ED) when conducted by dedicated HIV counselors versus current members of the ED staff. Methods The Universal Screening for HIV Infection in the Emergency Room [USHER] trial is a prospective randomized controlled trial that implemented an HIV screening program in the ED of an urban tertiary medical center. ED patients were screened and consented for trial enrollment by an USHER research assistant. Eligible subjects were randomized to rapid HIV testing (oral OraQuick) offered by a dedicated counselor (counselor arm) or by an ED provider (provider arm). In the counselor arm, counselors—without other clinical responsibilities—assumed nearly all testing-related activities (consent, counseling, delivery of test results). In the provider arm, trained ED emergency service assistants (nursing assistants) consented and tested the participant in the context of other ED-related responsibilities. In this arm, ED house officers, physician assistants, or attending physicians provided HIV test results to trial participants. Outcome measures were rates of HIV testing and test offer among individuals consenting for study participation. Among individuals offered the test, test acceptance was also measured. Results From February 2007 through July 2008, 8,187 eligible patients were approached in the ED, and 4,855 (59%) consented and were randomized to trial participation. The mean age was 37 years, 65% were women, and 42% were white. The overall testing rate favored the counselor arm (57% versus 27%; P < .001); 80% (1,959/2,446) of subjects in the counselor arm were offered an HIV test compared with 36% (861/2,409) in the provider arm (P < .001). HIV test acceptance was slightly higher in the provider arm (counselor arm 71% versus provider arm 75%; P = .025). Conclusion Routine rapid HIV testing in the ED was accomplished more frequently by dedicated HIV counselors than by

  7. Wind Energy Department annual progress report 2002

    Energy Technology Data Exchange (ETDEWEB)

    Johansen, B.D.; Riis, U. (eds.)

    2003-12-01

    Research and development activities of the Wind Energy Department range from boundary layer meteorology, fluid dynamics, and structural mechanics to power and control engineering as well as wind turbine loading and safety. The overall purpose of our work is to meet the needs for knowledge, methods and procedures from government, the scientific community, and the wind turbine industry in particular. Our assistance to the wind turbine manufacturers serve to pave the way for technological development and thus further the exploitation of wind energy worldwide. We do this by means of research and innovation, education, testing and consultancy. In providing services for the wind turbine industry, we are involved in technology development, design, testing, procedures for operation and maintenance, certification and international wind turbine projects s as well as the solution of problems encountered in the application of wind energy, e.g. grid connection. A major proportion of these activities are on a commercial basis, for instance consultancy, software development, accredited testing of wind turbines and blades as well as approval and certification in co-operation with Det Norske Veritas. The departments activities also include research into atmospheric physics and environmental issues related to the atmosphere. One example is the development of online warning systems for airborne bacteria and other harmful substances. The department is organized in programmes according to its main scientific and technical activities. Research programmes: 1) Aeroelastic Design, AED; 2) Atmospheric Phyrics, ATM; 3) Electrical DEsign and Control, EDS; 4) Wind Power Meteorology, VKM; 5) Wind Turbines, VIM; 6) Wind Turbine Diagnostics, VMD. Commercial programmes: 1) The Test Station for Large Wind Turbines, Hoevsoere, HOeV; 2) Risoe Wind Consult, INR; 3) Wind Turbine Testing; 4) Sparkaer Blade Test Centre.(au)

  8. Web-Based Predictive Analytics to Improve Patient Flow in the Emergency Department

    Science.gov (United States)

    Buckler, David L.

    2012-01-01

    The Emergency Department (ED) simulation project was established to demonstrate how requirements-driven analysis and process simulation can help improve the quality of patient care for the Veterans Health Administration's (VHA) Veterans Affairs Medical Centers (VAMC). This project developed a web-based simulation prototype of patient flow in EDs, validated the performance of the simulation against operational data, and documented IT requirements for the ED simulation.

  9. Supporting Patient Care in the Emergency Department with a Computerized Whiteboard System

    OpenAIRE

    Aronsky, Dominik; Jones, Ian; Lanaghan, Kevin; Slovis, Corey M.

    2008-01-01

    Efficient information management and communication within the emergency department (ED) is essential to providing timely and high-quality patient care. The ED whiteboard (census board) usually serves as an ED’s central access point for operational and patient-related information. This article describes the design, functionality, and experiences with a computerized ED whiteboard, which has the ability to display relevant operational and patient-related information in real time. Embedded functi...

  10. Enhanced monitoring of abnormal emergency department demands

    KAUST Repository

    Harrou, Fouzi

    2016-06-13

    This paper presents a statistical technique for detecting signs of abnormal situation generated by the influx of patients at emergency department (ED). The monitoring strategy developed was able to provide early alert mechanisms in the event of abnormal situations caused by abnormal patient arrivals to the ED. More specifically, This work proposed the application of autoregressive moving average (ARMA) models combined with the generalized likelihood ratio (GLR) test for anomaly-detection. ARMA was used as the modelling framework of the ARMA-based GLR anomaly-detection methodology. The GLR test was applied to the uncorrelated residuals obtained from the ARMA model to detect anomalies when the data did not fit the reference ARMA model. The ARMA-based GLR hypothesis testing scheme was successfully applied to the practical data collected from the database of the pediatric emergency department (PED) at Lille regional hospital center, France. © 2015 IEEE.

  11. Rates of TBI-related Emergency Department Visits, Hospitalizations, and Deaths — United States, 2001–2010

    Data.gov (United States)

    U.S. Department of Health & Human Services — In general, total combined rates for traumatic brain injury (TBI)-related emergency department (ED) visits, hospitalizations and deaths have increased over the past...

  12. Replica location mechanism in data grid based on ED-Chord

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    A peer-to-peer hierarchical replica location mechanism(PRLM)was designed for data grids to provide better load balancing capability and scalability.Global replica indexes of the PRLM are organized based on even distributed Chord(ED-Chord)structure.The locality can optimize queries on local replica indexes of virtual organizations.ED-Chord protocol collects the node identifiers information using a distributed method and assigns optimal identifiers for new nodes to make them more uniformly distributed in the entire identifier space.Theoretical analysis and simulations show that PRLM provides good performance,scalability and load balancing capability for replica location in data grids.

  13. Morphology and Composition of Nanocrystalline Stabilized Zirconia using Sem-Eds System

    Directory of Open Access Journals (Sweden)

    Sunday Adesunloye JONAH

    2011-12-01

    Full Text Available Bismuth oxide of known mole percentages has been incorporated into zirconia matrix via co-precipitation method. The co-precipitated powders containing mixed oxides of bismuth and zirconium are dried and calcined in air at 200°C and 800°C respectively to obtain nanosized-stabilized zirconia. The microstructures and the composition of the nanosized-stabilized zirconia are investigated using Scanning Electron Microscopy (SEM coupled with Energy Dispersive X-ray Spectroscopy (EDS at a low accelerating voltage of 5kV. The results revealed that the powders are homogenously sintered with particle size having typical dimensions in the range of ~1.0-255µm. Energy dispersive X-ray spectroscopic (EDS analysis of the solid solutions confirm a predominance in the concentration of bismuth and zirconium while sodium, chlorine, and oxygen are present in minor concentration. The quantitative analytic results from EDS were used to determine Zr/Bi ratio.

  14. ED Strengthens Credit Management and Debt Collection.

    Science.gov (United States)

    Olmo, Ralph J.

    1982-01-01

    This interview with the comptroller for the U.S. Department of Education focuses on efforts to improve credit management and debt collection. Topics discussed are the credit management initiative, the extent of the problem, improvements, the Housing and Facilities Loan Program, and the significance of the Debt Collection Act of 1982. (JOW)

  15. Screening for Violence Risk Factors Identifies Young Adults at Risk for Return Emergency Department Visit for Injury

    Directory of Open Access Journals (Sweden)

    Abigail Hankin

    2014-08-01

    Full Text Available Introduction: Homicide is the second leading cause of death among youth aged 15–24. Prior crosssectional studies, in non-healthcare settings, have reported exposure to community violence, peer behavior, and delinquency as risk factors for violent injury. However, longitudinal cohort studies have not been performed to evaluate the temporal or predictive relationship between these risk factors and emergency department (ED visits for injuries among at-risk youth. The objective was to assess whether self-reported exposure to violence risk factors in young adults can be used to predict future ED visits for injuries over a 1-year period. Methods: This prospective cohort study was performed in the ED of a Southeastern US Level I trauma center. Eligible participants were patients aged 18–24, presenting for any chief complaint. We excluded patients if they were critically ill, incarcerated, or could not read English. Initial recruitment occurred over a 6-month period, by a research assistant in the ED for 3–5 days per week, with shifts scheduled such that they included weekends and weekdays, over the hours from 8AM-8PM. At the time of initial contact in the ED, patients were asked to complete a written questionnaire, consisting of previously validated instruments measuring the following risk factors: a aggression, b perceived likelihood of violence, c recent violent behavior, d peer behavior, e community exposure to violence, and f positive future outlook. At 12 months following the initial ED visit, the participants’ medical records were reviewed to identify any subsequent ED visits for injury-related complaints. We analyzed data with chisquare and logistic regression analyses. Results: Three hundred thirty-two patients were approached, of whom 300 patients consented. Participants’ average age was 21.1 years, with 60.1% female, 86.0% African American. After controlling for participant gender, ethnicity, or injury complaint at time of first

  16. Measuring the Fidelity of Re-ED Programs.

    Science.gov (United States)

    Meadowcroft, Pamela; Cantrell, Mary Lynn; Cantrell, Robert P.

    2002-01-01

    The effectiveness of a comprehensive intervention like Re-ED (Reeducation of Emotional Disturbed Children) requires a clear definition of the essential components of the model. This article describes an ongoing process to create a program assessment tool for Re-ED. Program fidelity requires being able to specify precisely what is meant by certain…

  17. Effects of EdU labeling on mesenchymal stem cells

    OpenAIRE

    Ning, Hongxiu; Albersen, Maarten; Lin, Guiting; Lue, Tom F.; Lin, Ching-Shwun

    2013-01-01

    Thymidine analog 5-ethynyl-2-deoxyuridine (EdU) has recently been used for tracking mesenchymal stem cells (MSCs). In the present study, we tested whether EdU was cytotoxic and whether it interfered with differentiation, cytokine secretion and migration of MSCs.

  18. Medical clearance of the psychiatric patient in the emergency department.

    Science.gov (United States)

    Janiak, Bruce D; Atteberry, Suzanne

    2012-11-01

    As part of the emergency department (ED) evaluation of patients with psychiatric complaints, emergency physicians are often asked to perform screening laboratory tests prior to admitting psychiatric patients, the value of which is questionable. To determine if routine screening laboratory studies performed in the ED on patients with a psychiatric chief complaint would alter ED medical clearance (evaluation, management or disposition) of such patients. In this retrospective chart review, the patient charts were reviewed for triage notes, history and physical examination, laboratory study results, and patient disposition. The study investigators subjectively determined if any of the laboratory abnormalities identified after admission would have changed ED management or disposition of the patient had they been identified in the ED. Subjects were 519 consecutive adult patients (18 years of age and older) admitted to the Medical College of Georgia's inpatient psychiatric ward through the ED. There were 502 patients who met inclusion criteria, and 50 of them had completely normal laboratory studies. Laboratory studies were performed in the ED for 148 patients. The most common abnormalities identified were positive urine drug screen (n = 221), anemia (n = 136), and hyperglycemia (n = 139). There was one case (0.19%) identified in which an abnormal laboratory value would have changed ED management or disposition of the patient had it been found during the patient's ED visit. Patients presenting to the ED with a psychiatric chief complaint can be medically cleared for admission to a psychiatric facility by qualified emergency physicians using an appropriate history and physical examination. There is no need for routine medical screening laboratory tests. Copyright © 2012 Elsevier Inc. All rights reserved.

  19. Ileus and Small Bowel Obstruction in an Emergency Department Observation Unit: Are there Outcome Predictors?

    Directory of Open Access Journals (Sweden)

    Charles L. Emerman

    2011-05-01

    Full Text Available Introduction: The purpose of our study was to describe the evaluation and outcome of patients with ileus and bowel obstruction admitted to an emergency department (ED observation unit (OU and to identify predictors of successful management for such patients. Methods: We performed a retrospective chart review of 129 patients admitted to a university-affiliated, urban, tertiary hospital ED OU from January 1999 through November 2004. Inclusion criteria were all adult patients admitted to the OU with an ED diagnosis of ileus, partial small bowel obstruction, or small bowel obstruction, and electronic medical records available for review. The following variables were examined: ED diagnosis, history of similar admission, number of prior abdominal surgeries, surgery in the month before, administration of opioid analgesia at any time after presentation, radiographs demonstrating air–fluid levels or dilated loops of small bowel, hypokalemia, use of nasogastric decompression, and surgical consultation. Results: Treatment failure, defined as hospital admission from the OU, occurred in 65 (50.4% of 129 patients. Only the use of a nasogastric tube was associated with OU failure (21% discharged versus 79% requiring admission, P ¼ 0.0004; odds ratio, 5.294; confidence interval, 1.982–14.14. Conclusion: Half of the patients admitted to our ED OU with ileus or varying degrees of small bowel obstruction required hospital admission. The requirement of a nasogastric tube in such patients was associated with a greater rate of observation unit failure. [West J Emerg Med. 2011;12(4:404–407.

  20. Prevalence and risk factor analysis of resistant Escherichia coli urinary tract infections in the emergency department.

    Directory of Open Access Journals (Sweden)

    Bailey AM

    2013-06-01

    Full Text Available Background: Escherichia coli (E. coli is a frequent uropathogen in urinary tract infections (UTI. Widespread resistance to sulfamethoxazole-trimethoprim (SMX-TMP and increasing resistance to fluoroquinolones amongst these isolates has been recognized. There are limited data demonstrating risk factors for resistance to both SMX-TMP and fluoroquinolones.Objectives: This study was conducted to assess for the prevalence of community resistance amongst E. coli isolates to SMX-TMP and levofloxacin in ambulatory patients discharged from the emergency department (ED.Methods: Adults presenting for evaluation and discharged from the ED with a diagnosis of an E. coli UTI were retrospectively reviewed. Utilizing demographic and clinical data the prevalence of E. coli resistance and risk factors associated with SMX-TMP- and fluoroquinolone-resistant infection were determined. Results: Among the 222 patients, the mean rates of E. coli susceptibility to levofloxacin and SMX-TMP were 82.4% and 72.5%, respectively. Significant risk factors for resistance to SMX-TMP included prior antibiotic use (p=0.04 and prior diagnosis of UTI (p= 0.01. Significant risk factors for resistance to levofloxacin included: male gender, age, presence of hypertension, diabetes, chronic respiratory disease, nursing home resident, previous antibiotic use, previous diagnosis of UTI, existence of renal or genitourinary abnormalities, and prior surgical procedures (p <0.05 for all comparisons. The number of hospital days prior to initial ED evaluation (p<0.001 was determined to be a predictive factor in hospital and ED readmission. Conclusions: These results suggest that conventional approaches to monitoring for patterns of susceptibility may be inadequate. It is imperative that practitioners develop novel approaches to identifying patients with risk factors for resistance. Identification of risk factors from this evaluation should prompt providers to scrutinize the use of these agents in

  1. Advancing the Use of Emergency Department Syndromic Surveillance Data, New York City, 2012-2016.

    Science.gov (United States)

    Lall, Ramona; Abdelnabi, Jasmine; Ngai, Stephanie; Parton, Hilary B; Saunders, Kelly; Sell, Jessica; Wahnich, Amanda; Weiss, Don; Mathes, Robert W

    The use of syndromic surveillance has expanded from its initial purpose of bioterrorism detection. We present 6 use cases from New York City that demonstrate the value of syndromic surveillance for public health response and decision making across a broad range of health outcomes: synthetic cannabinoid drug use, heat-related illness, suspected meningococcal disease, medical needs after severe weather, asthma exacerbation after a building collapse, and Ebola-like illness in travelers returning from West Africa. The New York City syndromic surveillance system receives data on patient visits from all emergency departments (EDs) in the city. The data are used to assign syndrome categories based on the chief complaint and discharge diagnosis, and analytic methods are used to monitor geographic and temporal trends and detect clusters. For all 6 use cases, syndromic surveillance using ED data provided actionable information. Syndromic surveillance helped detect a rise in synthetic cannabinoid-related ED visits, prompting a public health investigation and action. Surveillance of heat-related illness indicated increasing health effects of severe weather and led to more urgent public health messaging. Surveillance of meningitis-related ED visits helped identify unreported cases of culture-negative meningococcal disease. Syndromic surveillance also proved useful for assessing a surge of methadone-related ED visits after Superstorm Sandy, provided reassurance of no localized increases in asthma after a building collapse, and augmented traditional disease reporting during the West African Ebola outbreak. Sharing syndromic surveillance use cases can foster new ideas and build capacity for public health preparedness and response.

  2. Gender Differences in Emergency Department Visits and Detox Referrals for Illicit and Nonmedical Use of Opioids

    Directory of Open Access Journals (Sweden)

    Hyeon-Ju Ryoo

    2016-05-01

    Full Text Available Introduction: Visits to the emergency department (ED for use of illicit drugs and opioids have increased in the past decade. In the ED, little is known about how gender may play a role in drug-related visits and referrals to treatment. This study performs gender-based comparison analyses of drug-related ED visits nationwide. Methods: We performed a cross-sectional analysis with data collected from 2004 to 2011 by the Drug Abuse Warning Network (DAWN. All data were coded to capture major drug categories and opioids. We used logistic regression models to find associations between gender and odds of referral to treatment programs. A second set of models were controlled for patient “seeking detox,” or patient explicitly requesting for detox referral. Results: Of the 27.9 million ED visits related to drug use in the DAWN database, visits by men were 2.69 times more likely to involve illicit drugs than visits by women (95% CI [2.56, 2.80]. Men were more likely than women to be referred to detox programs for any illicit drugs (OR 1.12, 95% CI [1.02-1.22], for each of the major illicit drugs (e.g., cocaine: OR 1.27, 95% CI [1.15-1.40], and for prescription opioids (OR 1.30, 95% CI [1.17-1.43]. This significant association prevailed after controlling for “seeking detox.” Conclusion: Women are less likely to receive referrals to detox programs than men when presenting to the ED regardless of whether they are “seeking detox.” Future research may help determine the cause for this gender-based difference and its significance for healthcare costs and health outcomes.

  3. Use of BPPV processes in Emergency Department Dizziness Presentations: A Population-Based Study

    Science.gov (United States)

    Kerber, Kevin A.; Burke, James F.; Skolarus, Lesli E.; Meurer, William J.; Callaghan, Brian C.; Brown, Devin L.; Lisabeth, Lynda D.; McLaughlin, Thomas J.; Fendrick, A. Mark; Morgenstern, Lewis B.

    2013-01-01

    Objective A common cause of dizziness, benign paroxysmal positional vertigo (BPPV), is effectively diagnosed and cured with the Dix-Hallpike test (DHT) and the canalith repositioning maneuver (CRM). We aimed to describe the use of these processes in Emergency Departments (ED), to assess for trends in use over time, and to determine provider level variability in use. Design Prospective population-based surveillance study Setting EDs in Nueces County, Texas, January 15, 2008 to January 14, 2011 Subjects and Methods Adult patients discharged from EDs with dizziness, vertigo, or imbalance documented at triage. Clinical information was abstracted from source documents. A hierarchical logistic regression model adjusting for patient and provider characteristics was used to estimate trends in DHT use and provider level variability. Results 3,522 visits for dizziness were identified. A DHT was documented in 137 visits (3.9%). A CRM was documented in 8 visits (0.2%). Among patients diagnosed with BPPV, a DHT was documented in only 21.8% (34 of 156) and a CRM in 3.9% (6 of 156). In the hierarchical model (c statistic = 0.93), DHT was less likely to be used over time (odds ratio, 0.97, 95% CI [0.95, 0.99]) and the provider level explained 50% (ICC, 0.50) of the variance in the probability of DHT use. Conclusion BPPV is seldom examined for, and when diagnosed, infrequently treated in this ED population. DHT use is decreasing over time, and varies substantially by provider. Implementation research focused on BPPV care may be an opportunity to optimize management in ED dizziness presentations. PMID:23264119

  4. The Effect of Intravenous Ketamine in Suicidal Ideation of Emergency Department Patients

    Directory of Open Access Journals (Sweden)

    Parvin Kashani

    2014-03-01

    Full Text Available Introduction: Suicidal ideation is an emergent problem in the Emergency Department (ED that often complicates patient disposition and discharge. It has been shown that ketamine possesses fast acting antidepressant and anti-suicidal effects. This study was conducted to examine the effects of a single intravenous bolus of ketamine on patients with suicidal ideations in ED. Methods: Forty-nine subjects with suicidal ideations with or without an unsuccessful suicide attempt, received 0.2 mg/kg of ketamine. Scale for suicidal ideation (SSI and Montgomery-Abserg depression rating scale (MADRS were evaluated before and 40, 80 and 120 minutes after drug intervention. The results were compared using the paired t-test and patients were followed up 10 days after ED admission for remnant suicide ideation. Results: SSI (df: 3, 46; F=80.7; p<0.001 and MADRS (df: 3, 46; F=87.2; p<0.001 scores significantly dropped after ketamine injection; the SSI score before and after 20, 40, and 80 minutes of ketamine injection were 23.0±6.7, 16.2±5.2, 14.3±4.3, and 13.6±4.0 respectively. The MADRS scores were 38.2±9.3, 25.6±7.1, 22.7±6.3, and 22.1±5.95 at the same time intervals. 25.5% of patients were hospitalized, 63.3% received medications and 12.2% discharged. 6.2% of patients had suicidal ideations ten days after ED disposition.  Conclusion: It seems that Ketamine couldn't be a good choice for fast reduction of suicidal ideations in ED patients. Further studies are needed to determine the optimal dose of ketamine for different patients.

  5. Text mining approach to predict hospital admissions using early medical records from the emergency department.

    Science.gov (United States)

    Lucini, Filipe R; S Fogliatto, Flavio; C da Silveira, Giovani J; L Neyeloff, Jeruza; Anzanello, Michel J; de S Kuchenbecker, Ricardo; D Schaan, Beatriz

    2017-04-01

    Emergency department (ED) overcrowding is a serious issue for hospitals. Early information on short-term inward bed demand from patients receiving care at the ED may reduce the overcrowding problem, and optimize the use of hospital resources. In this study, we use text mining methods to process data from early ED patient records using the SOAP framework, and predict future hospitalizations and discharges. We try different approaches for pre-processing of text records and to predict hospitalization. Sets-of-words are obtained via binary representation, term frequency, and term frequency-inverse document frequency. Unigrams, bigrams and trigrams are tested for feature formation. Feature selection is based on χ(2) and F-score metrics. In the prediction module, eight text mining methods are tested: Decision Tree, Random Forest, Extremely Randomized Tree, AdaBoost, Logistic Regression, Multinomial Naïve Bayes, Support Vector Machine (Kernel linear) and Nu-Support Vector Machine (Kernel linear). Prediction performance is evaluated by F1-scores. Precision and Recall values are also informed for all text mining methods tested. Nu-Support Vector Machine was the text mining method with the best overall performance. Its average F1-score in predicting hospitalization was 77.70%, with a standard deviation (SD) of 0.66%. The method could be used to manage daily routines in EDs such as capacity planning and resource allocation. Text mining could provide valuable information and facilitate decision-making by inward bed management teams. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  6. Assessing hospital performance for acute myocardial infarction: how should emergency department transfers be attributed.

    Science.gov (United States)

    Samadashvili, Zaza; Hannan, Edward L; Cozzens, Kimberly; Walford, Gary; Jacobs, Alice K; Berger, Peter B; Holmes, David R; Venditti, Ferdinand J; Curtis, Jeptha

    2015-03-01

    The Centers for Medicare and Medicaid Services publicly reports risk-standardized mortality rates (RSMRs) to assess quality of care for hospitals that treat acute myocardial infarction patients, and the outcomes for inpatient transfers are attributed to transferring hospitals. However, emergency department (ED) transfers are currently ignored and therefore attributed to receiving hospitals. New York State administrative data were used to develop a statistical model similar to the one used by Centers for Medicare and Medicaid Services to risk-adjust hospital 30-day mortality rates. RSMRs were calculated and outliers were identified when ED transfers were attributed to: (1) the transferring hospital and (2) the receiving hospital. Differences in hospital outlier status and RSMR tertile between the 2 attribution methods were noted for hospitals performing and not performing percutaneous coronary interventions (PCIs). Although both methods of attribution identified 3 high outlier non-PCI hospitals, only 2 of those hospitals were identified by both methods, and each method identified a different hospital as a third outlier. Also, when transfers were attributed to the referring hospital, 1 non-PCI hospital was identified as a low outlier, and no non-PCI hospitals were identified as a low outlier with the other attribution method. About one sixth of all hospitals changed their tertile status. Most PCI hospitals (89%) that changed status moved to a higher (worse RSMR) tertile, whereas the majority of non-PCI hospitals (68%) that changed status were moved to a lower (better) RSMR tertile when ED transfers were attributed to the referring hospital. Hospital quality assessments for acute myocardial infarction are affected by whether ED transfers are assigned to the transferring or receiving hospital. The pros and cons of this choice should be considered.

  7. Emergency Department: Basic Prerequisites for the Upgrade of the NHS

    Directory of Open Access Journals (Sweden)

    Georgios Charalambous

    2012-01-01

    Full Text Available The Emergency Department is an autonomous hospital unit comprised of doctors, nurses and paramedics, who deliver emergency care on a 24-hour basis. It provides an interface between patients and their specialized treatment, as well as a point of contact between primary and tertiary care. The need for medical services has increased disproportionately to the available resources for medical care; a fact that has given rise to difficulties in maintaining the effective function of the Emergency Department. As a result, the provision of high standard services is not ensured. In order to help establish and maintain the effective operation of the Emergency Department, new methods should be established which efficiently utilize existing and up-and-coming information and communication technologies. This will allow for the acceleration of the Department’s operational procedures, more effective treatment of emergency cases, and ultimately assists in maintaining a high level of patient satisfaction. The expansion and development of specific services offered by the ED will also assist in the Department becoming a system of qualitative assessment for primary care. This would lead to a better outcome for emergency cases as a result of fast, spherical and effective treatment.

  8. TechEdSat Nano-Satellite Series Fact Sheet

    Science.gov (United States)

    Murbach, Marcus; Martinez, Andres; Guarneros Luna, Ali

    2014-01-01

    TechEdSat-3p is the second generation in the TechEdSat-X series. The TechEdSat Series uses the CubeSat standards established by the California Polytechnic State University Cal Poly), San Luis Obispo. With typical blocks being constructed from 1-unit (1U 10x10x10 cm) increments, the TechEdSat-3p has a 3U volume with a 30 cm length. The project uniquely pairs advanced university students with NASA researchers in a rapid design-to-flight experience lasting 1-2 semesters.The TechEdSat Nano-Satellite Series provides a rapid platform for testing technologies for future NASA Earth and planetary missions, as well as providing students with an early exposure to flight hardware development and management.

  9. "How much will I get charged for this?" Patient charges for top ten diagnoses in the emergency department.

    Directory of Open Access Journals (Sweden)

    Nolan Caldwell

    Full Text Available OBJECTIVES: We examined the charges, their variability, and respective payer group for diagnosis and treatment of the ten most common outpatient conditions presenting to the Emergency department (ED. METHODS: We conducted a cross-sectional study of the 2006-2008 Medical Expenditure Panel Survey. Analysis was limited to outpatient visits with non-elderly, adult (years 18-64 patients with a single discharge diagnosis. RESULTS: We studied 8,303 ED encounters, representing 76.6 million visits. Median charges ranged from $740 (95% CI $651-$817 for an upper respiratory infection to $3437 (95% CI $2917-$3877 for a kidney stone. The median charge for all ten outpatient conditions in the ED was $1233 (95% CI $1199- $1268, with a high degree of charge variability. All diagnoses had an interquartile range (IQR greater than $800 with 60% of IQRs greater than $1550. CONCLUSION: Emergency department charges for common conditions are expensive with high charge variability. Greater acute care charge transparency will at least allow patients and providers to be aware of the emergency department charges patients may face in the current health care system.

  10. Pediatric overtriage as a consequence of the tachycardia responses of children upon ED admission.

    Science.gov (United States)

    Chang, Yu-Che; Ng, Chip-Jin; Wu, Chang-Teng; Chen, Li-Chin; Chen, Jih-Chang; Hsu, Kuang-Hung

    2015-01-01

    Overtriage has been observed among pediatric patients in emergency departments (EDs) under 5-level acuity pediatric triage systems. This study aimed to investigate the causes of overtriage and to provide suggestions for future amendments to such systems. This study has a retrospective follow-up design in which 42000 pediatric patients who were admitted to the ED of the largest medical center in Taiwan between January and December of 2010 were recruited. The study variables included patient demographics, chief concerns, individual vital signs (ie, blood pressure, heart rate, body temperature, respiratory rate, and O2 saturation), triage level, ED final disposition, ED expenses, and total medical expenses. A logistic regression model was applied to explore the causes of overtriage and the effectiveness of a modified acuity system. Approximately 13.6% of the pediatric ED visits were upgraded to acuity level 1 based on vital signs that included heart rate (97.3%). The strength of the trend association (odds ratio) between decreasing acuity urgency (from levels 1 to 5) and hospitalization increased from 0.73 (95% confidence interval, 0.72-0.75) with the Pediatric Triage and Acuity System (Ped-TTAS) to 0.57 (95% confidence interval, 0.55-0.59) with the modified Ped-TTAS, which downgraded acuity levels by excluding the weighting of vital signs. Further validation was accomplished by comparing the trend association between decreasing acuity urgency and total medical expenses (Ped-TTAS: β = -0.13; modified Ped-TTAS: β = -0.18). Heart rate is prone to be affected by emotional responses among pediatric patients in certain specific age groups. Appropriate revisions of the pediatric triage system are suggested. Copyright © 2014 Elsevier Inc. All rights reserved.

  11. Forecasting the Emergency Department Patients Flow.

    Science.gov (United States)

    Afilal, Mohamed; Yalaoui, Farouk; Dugardin, Frédéric; Amodeo, Lionel; Laplanche, David; Blua, Philippe

    2016-07-01

    Emergency department (ED) have become the patient's main point of entrance in modern hospitals causing it frequent overcrowding, thus hospital managers are increasingly paying attention to the ED in order to provide better quality service for patients. One of the key elements for a good management strategy is demand forecasting. In this case, forecasting patients flow, which will help decision makers to optimize human (doctors, nurses…) and material(beds, boxs…) resources allocation. The main interest of this research is forecasting daily attendance at an emergency department. The study was conducted on the Emergency Department of Troyes city hospital center, France, in which we propose a new practical ED patients classification that consolidate the CCMU and GEMSA categories into one category and innovative time-series based models to forecast long and short term daily attendance. The models we developed for this case study shows very good performances (up to 91,24 % for the annual Total flow forecast) and robustness to epidemic periods.

  12. Deconstructing Stereotypes : Ed Bullins' the Taking of Miss Janie = Ed Bullins'in

    Directory of Open Access Journals (Sweden)

    Çiğdem Pala MULL

    2004-06-01

    Full Text Available African-American playwright Ed Bullins is one of the most significant figures to emerge from the Black Arts Movement of the 1960s. His 1975 play The Taking of Miss Janie is a dramatic portrait of the specific events and ideas that created the 1960s, and their impact on the individual consciousnesses of the characters. The play brings into the foreground many issues related to race and ethnicity in America. Even though the general tone of The Taking of Miss Janie is one of violence and gloom, this reading focuses on those moments where love and human affection outshine the sense of destruction predominant in the play.

  13. Is culture associated with patient safety in the emergency department? A study of staff perspectives.

    NARCIS (Netherlands)

    Verbeek-van Noord, I.; Wagner, C.; Dyck, C. van; Twisk, J.W.R.; Bruijne, M.C. de

    2014-01-01

    Objective: To describe the patient safety culture of Dutch emergency departments (EDs), to examine associations between safety culture dimensions and patient safety grades as reported by ED staff and to compare these associations between nurses and physicians. DESIGN: Cross-sectional survey conducte

  14. Pharmacist advice is accepted more for medical than for surgical patients in an emergency department

    DEFF Research Database (Denmark)

    Backer Mogensen, Christian; Olsen, Inger; Thisted, Anette Rehn

    2013-01-01

    Pharmacists' advice may reduce medication errors in the emergency department (ED). However, pharmacists' recommendations are of little value if not acknowledged by physicians. The aim of the present study was to analyze how often and which categories of pharmacist recommendations were taken...... into account by the physicians in a Danish ED. Special attention is paid to problems of significant or vital importance....

  15. Pain prevalence and pain relief in trauma patients in the Accident & Emergency department.

    NARCIS (Netherlands)

    Berben, S.A.; Meijs, T.H.; Dongen, R.T.M. van; Vugt, A.B. van; Vloet, L.C.M.; Mintjes-de Groot, J.J.; Achterberg, T. van

    2008-01-01

    BACKGROUND: Acute pain in the A&E department (ED) has been described as a problem, however insight into the problem for trauma patients is lacking. OBJECTIVE: This study describes the prevalence of pain, the pain intensity and the effect of conventional pain treatment in trauma patients in the ED. M

  16. What Drives Emergency Department Patient Satisfaction? An Empirical Test using Structural Equation Modeling

    DEFF Research Database (Denmark)

    Sørup, Christian Michel; Jacobsen, Peter

    2013-01-01

    Patient satisfaction determinants in emergency departments (EDs) have for decades been heavily investigated. Despite great focus, a lack of consensus about which parameters are deemed most important remains. This study proposes an integrated framework for ED patient satisfaction, testing four key...

  17. Nurse-administered early warning score system can be used for emergency department triage

    DEFF Research Database (Denmark)

    Christensen, Dorthea; Jensen, Nanna Martin; Maaløe, Rikke;

    2011-01-01

    Studies have shown that early warning score systems can identify in-patients at high risk of catastrophic deterioration and this may p