scholarly journals P054: Development of a hospital-wide program for simulation-based training in trauma care and management

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S96-S96
Author(s):  
R. Green ◽  
S. Minor ◽  
K. Hartlen ◽  
M. Erdogan
Keyword(s):  
Emergency Department ◽  
Operating Room ◽  
Tertiary Care ◽  
Trauma Team ◽  
Trauma Centre ◽  
Emergency Laparotomy ◽  
In Situ Simulation ◽  
Safety Issues ◽  
Care Services ◽  
The Impact

Introduction: The Queen Elizabeth II Health Sciences Centre (QEII HSC) is a Level I trauma center that provides tertiary care services to the province of Nova Scotia (pop. 940,592) and quaternary care services to Atlantic Canada (population > 2.4 million). The objective of this study was to describe and evaluate the development of an inter-professional hospital-wide trauma simulation that was performed at the QEII HSC in June of 2015. Methods: The simulation was performed in the dedicated trauma resuscitation bay in the emergency department of the trauma centre using SimMan equipment. The scenario involved a 35-year-old male pedestrian versus car at approximately 70 km. The patient required immediate resuscitation and transfer to the operating room for an emergency laparotomy. Evaluation of the simulation was through video feedback, time stamping, piloting of resident Trauma Team Activation evaluation, observation for latent safety issues, and participant feedback. Trauma team members were unaware of simulation prior to arrival. Results: Feedback received from simulation participants indicated that this exercise was incredibly “real” for them. Using the usual emergency department patient registration proved difficult in this simulation exercise, both for activation of the massive transfusion protocol and transfer of the patient to the operating room. Latent safety issues identified included a lack of communication with the operating room and unavailability of some resuscitation equipment. Debriefing after the event was felt to be important by all participants of the simulation. Having evaluators dedicated to observing specific aspects of the simulation would facilitate these exercises. Patient care was not interrupted in the emergency department or the operating room. Conclusion: The in situ simulation was a valuable experience for the trauma program, stakeholders, and all participants. Based on this trial simulation, additional simulations will be held within our trauma program. Further research is required to validate long-term retention of skills and knowledge, and to evaluate the impact of simulation training on staff performance and trauma patient outcomes.

scholarly journals LO095: Developing and implementing an interprofessional in-situ simulation program in an academic, tertiary-care emergency department: barriers, successes and the Ottawa Hospital experience

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S63-S63
Author(s):  
C. Poulin ◽  
B. Weitzman ◽  
G. Mastoras ◽  
L. Norman ◽  
A. Pozgay ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Patient Care ◽  
Financial Support ◽  
Tertiary Care ◽  
Simulation Program ◽  
In Situ Simulation ◽  
Simulation Center ◽  
The Impact

Introduction / Innovation Concept: During Emergency Department (ED) resuscitation of critically ill patients, effective teamwork and communication among various healthcare professionals is essential to ensure favorable patient outcomes and to minimize threats to patient safety. However, numerous individual and system factors create barriers to effective team functioning. Simulation center- based training has been used to improve Crisis Resource Management skills among physician and nursing trainees, but in-situ simulation is a relatively new concept in adult Emergency Medicine in North America. Methods: To enhance patient care and team effectiveness, an ED nursing and physician group was created to develop and implement a novel interprofessional in-situ simulation program in two Canadian, academic tertiary-care emergency departments. Departmental approval and financial support was obtained and sessions commenced in January 2015. Curriculum, Tool, or Material: Monthly high-fidelity simulation sessions are held in the ED resuscitation rooms at both campuses of our hospital. Each session is facilitated and debriefed by simulation-trained Emergency Medicine faculty and senior residents, a nurse educator and a research assistant. Technical support is provided by our simulation center staff. Participants are recruited from the physicians, residents, nurses, respiratory therapists and other support staff working in the ED. To minimize the impact on patient care, two additional nurses are scheduled to cover nursing assignments on “sim days”. Simulations are limited to fifteen minutes, followed by a twenty minute debriefing. Conclusion: We have successfully developed and implemented an interprofessional in-situ simulation program in our ED. Participant feedback has been overwhelmingly positive. Lack of financial support, reluctance of staff to participate, and overwhelmed resources are some of the challenges to running a program like this in a busy ED environment. However, there are clear benefits: empowering team members, culture change, identification of latent safety threats, and a perception of improved teamwork and communication.

scholarly journals The impact of seasonal operating room closures on wait times for oral cancer surgery

2018 ◽  
Vol 25 (1) ◽  
pp. 67 ◽  
Author(s):  
N. Mundi ◽  
J. Theurer ◽  
A. Warner ◽  
J. Yoo ◽  
K. Fung ◽  
...  
Keyword(s):  
Oral Cavity ◽  
Cancer Patients ◽  
Operating Room ◽  
Oral Cavity Cancer ◽  
Tertiary Care ◽  
Wait Time ◽  
Disease Recurrence ◽  
Health Science ◽  
Wait Times ◽  
The Impact

Background Operating room slowdowns occur at specific intervals in the year as a cost-saving measure. We aim to investigate the impact of these slowdowns on the care of oral cavity cancer patients at a Canadian tertiary care centre.Methods A total of 585 oral cavity cancer patients seen between 1999 and 2015 at the London Health Science Centre (lhsc) Head and Neck Multidisciplinary Clinic were included in this study. Operating room hours and patient load from 2006 to 2014 were calculated. Our primary endpoint was the wait time from consultation to definitive surgery. Exposure variables were defined according to wait time intervals occurring during time periods with reduced operating room hours.Results Overall case volume rose significantly from 2006 to 2014 (p < 0.001), while operating room hours remained stable (p = 0.555). Patient wait times for surgery increased from 16.3 days prior to 2003 to 25.5 days in 2015 (p = 0.008). Significant variability in operating room hours was observed by month, with lowest reported for July and August (p = 0.002). The greater the exposure to these months, the more likely patients were to wait longer than 28 days for surgery (odds ratio per day [or]: 1.07, 95% confidence interval [ci]: 1.05 to 1.10, p < 0.001). Individuals seen in consultation preceding a month with below average operating room hours had a higher risk of disease recurrence and/or death (hazard ratio [hr]: 1.59, 95% ci: 1.10 to 2.30, p = 0.014).Conclusions Scheduled reductions in available operating room hours contribute to prolonged wait times and higher disease recurrence. Further work is needed to identify strategies maximizing efficient use of health care resources without negatively affecting patient outcomes.

scholarly journals Emergency Department Referral Profile of Traumatic Brain Injury Records at a Tertiary Care Hospital of Pakistan

2021 ◽  
Author(s):  
Maria Khan ◽  
Uzair Yaqoob ◽  
Zair Hassan ◽  
Muhammad Muizz Uddin
Keyword(s):  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Road Traffic ◽  
Tertiary Care ◽  
Initial Assessment ◽  
Care Hospital ◽  
Mild Tbi ◽  
Epidemiological Characteristics ◽  
The Impact

Abstract Background: Traumatic Brain Injury (TBI) is the leading cause of morbidity and mortality all over the world and the impact is much worse in Pakistan. The objective here is to describe the epidemiological characteristics of patients with TBI in our country and to determine the immediate outcomes of patients with TBI after the presentation.Method: This was a cross-sectional study conducted at the Lady Reading Hospital, Peshawar, Pakistan. Data were extracted from the medical records from January 1st to December 31st, 2019. Patient age, sex, type of trauma, and immediate outcome of the referral to the Emergency Department were recorded. The severity of TBI was categorized based on Glasgow Coma Scale (GCS) in mild (GCS 13-15), moderate (GCS 9-12), and severe (GCS <8) classes. The Emergency Department referral profile was classified as admissions, disposed, detained and disposed, referred.Results: Out of 5047 patients, 3689 (73.1%) males and 1358 (26.9%) females. The most commonly affected age group was 0-10 years (25.6%) and 21-30 years (20.1%). Road Traffic accident was the predominant cause of injury (38.8%, n=1960) followed by fall (32.7%, n=1649). Most (93.6%, n=4710) of the TBIs were mild. After the full initial assessment and workup, and completing all first-aid management, the immediate outcome was divided into four, most frequent (67.2%, n=3393) of which was “disposed (discharged)”, and 9.3% (n=470) were admitted for further management.Conclusion: Our study represents a relatively commonplace picture of epidemiological data on the burden of TBI in Pakistan. As a large proportion of patients had a mild TBI, and there is a high risk of mild TBI being under-diagnosed, we warrant further investigation of mild TBI in population-based studies.

scholarly journals P139: The impact of a pancreatitis admission algorithm on emergency department length of stay in a tertiary care academic hospital

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S114-S115
Author(s):  
A. Albina ◽  
F. Kegel ◽  
F. Dankoff ◽  
G. Clark
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Tertiary Care ◽  
Physician Satisfaction ◽  
Academic Hospital ◽  
Before And After ◽  
Potential Applicability ◽  
The Mean ◽  
Algorithm Implementation ◽  
The Impact

Background: Emergency department (ED) overcrowding is associated with a broad spectrum of poor medical outcomes, including medical errors, mortality, higher rates of leaving without being seen, and reduced patient and physician satisfaction. The largest contributor to overcrowding is access block – the inability of admitted patients to access in-patient beds from the ED. One component to addressing access block involves streamlining the decision process to rapidly determine which hospital service will admit the patient. Aim Statement: As of Sep 2011, admission algorithms at our institution were supported and formalised. The pancreatitis algorithm clarified whether general surgery or internal medicine would admit ED patients with pancreatitis. We hypothesize that this prior uncertainty delayed the admission decision and prolonged ED length of stay (LOS) for patients with pancreatitis. Our project evaluates whether implementing a pancreatitis admission algorithm at our institution reduced ED time to disposition (TTD) and LOS. Measures & Design: A retrospective review was conducted in a tertiary care academic hospital in Montreal for all adult ED patients diagnosed with pancreatitis from Apr 2010 to Mar 2014. The data was used to plot separate run charts for ED TTD and LOS. Serial measurements of each outcome were used to monitor change and evaluate for special cause variation. The mean ED LOS and TTD before and after algorithm implementation were also compared using the Student's t test. Evaluation/Results: Over four years, a total of 365 ED patients were diagnosed with pancreatitis and 287 (79%) were admitted. The mean ED LOS for patients with pancreatitis decreased following the implementation of an admission algorithm (1616 vs. 1418 mins, p = 0.05). The mean ED TTD was also reduced (1171 vs. 899 mins, p = 0.0006). A non-random signal of change was suggested by a shift above the median prior to algorithm implementation and one below the median following. Discussion/Impact: This project demonstrates that in a busy tertiary care academic hospital, an admission algorithm helped reduce ED TTD and LOS for patients with pancreatitis. This proves especially valuable when considering the potential applicability of such algorithms to other disease processes, such as gastrointestinal bleeding and congestive heart failure, among others. Future studies demonstrating this external applicability, and the impact of such decision algorithms on physician decision fatigue and within non-academic institutions, proves warranted.

scholarly journals P035: Impact of EMS direct referral to community care on emergency department utilization

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S75
Author(s):  
A. Dukelow ◽  
M. Lewell ◽  
J. Loosley ◽  
S. Pancino ◽  
K. Van Aarsen
Keyword(s):  
Emergency Department ◽  
Home Care ◽  
Community Care ◽  
Home Care Services ◽  
Emergency Department Visits ◽  
Emergency Department Utilization ◽  
Care Services ◽  
Significant Difference ◽  
Ed Visits ◽  
The Impact

Introduction: The Community Referral by Emergency Medical Services (CREMS) program was implemented in January 2015 in Southwestern Ontario. The program allows Paramedics interacting with a patient to directly refer those in need of home care support to their local Community Care Access Centre (CCAC) for needs assessment. If indicated, subsequent referrals are made to specific services (e.g. nursing, physiotherapy and geriatrics) by CCAC. Ideally, CREMS connects patients with appropriate, timely care, supporting individual needs. Previous literature has indicated CREMS results in an increase of home care services provided to patients. Methods: The primary objective of this project is to evaluate the impact of the CREMS program on Emergency Department utilization. Data for all CCAC referrals from London-Middlesex EMS was collected for a thirteen month period (February 2015-February 2016). For all patients receiving a new or increased service from CCAC the number of Emergency Department visits 2 years before referral and 2 years after referral were calculated. A related samples Wilcoxon Signed Rank Test was performed to examine the difference in ED visits pre and post referral to CCAC. Results: There were 213 individuals who received a new or increased service during the study timeframe. Median [IQR] patient age was 77 [70-85.5]. 113/213 (53%) of patients were female. The majority of patients 135/213 (63.4%) were a new referral to CCAC. The median [IQR] number of hospital visits before referral was 3 [1-5] and after referral was 2 [0-4]. There was no significant difference in the overall number of ED visits before versus after referral (955 vs 756 visits, p = 0.051). Conclusion: Community based care can improve patient experience and health outcomes. Paramedics are in a unique position to assess patients in their home to determine who might benefit from home care services. CREMS referrals for this patient group showed a trend towards decreased ED visits after referral but the trend was not statistically significant.

Impact of clinical guidance and rapid molecular pathogen detection on evaluation and outcomes of febrile or hypothermic infants

2020 ◽  
Vol 41 (11) ◽  
pp. 1285-1291
Author(s):  
Jennifer Crook ◽  
Meng Xu ◽  
James C. Slaughter ◽  
Jeremy Willis ◽  
Whitney Browning ◽  
...  
Keyword(s):  
Emergency Department ◽  
Clinical Guideline ◽  
Young Infant ◽  
Tertiary Care ◽  
Admission Rate ◽  
Entire Study ◽  
Clinical Guidance ◽  
Period 2 ◽  
Ancillary Test ◽  
The Impact

AbstractObjective:To quantify the impact of clinical guidance and rapid respiratory and meningitis/encephalitis multiplex polymerase chain reaction (mPCR) testing on the management of infants.Design:Before-and-after intervention study.Setting:Tertiary-care children’s hospital.Patients:Infants ≤90 days old presenting with fever or hypothermia to the emergency department (ED).Methods:The study spanned 3 periods: period 1, January 1, 2011, through December 31, 2014; period 2, January 1, 2015, through April 30, 2018; and period 3, May 1, 2018, through June 15, 2019. During period 1, no standardized clinical guideline had been established and no rapid pathogen testing was available. During period 2, a clinical guideline was implemented, but no rapid testing was available. During period 3, a guideline was in effect, plus mPCR testing using the BioFire FilmArray respiratory panel 2 (RP 2) and the meningitis encephalitis panel (MEP). Outcomes included antimicrobial and ancillary test utilization, length of stay (LOS), admission rate, 30-day mortality. Outcomes were compared across periods using Kruskal-Wallis and Pearson tests and interrupted time series analysis.Results:Overall 5,317 patients were included: 2,514 in period 1, 2,082 in period 2, and 721 in period 3. Over the entire study period, we detected reductions in the use of chest radiographs, lumbar punctures, LOS, and median antibiotic duration. After adjusting for temporal trends, we observed that the introduction of the guideline was associated with reductions in ancillary tests and lumbar punctures. Use of mPCR testing with the febrile infant clinical guideline was associated with additional reductions in ancillary testing for all patients and a higher proportion of infants 29–60 days old being managed without antibiotics.Conclusions:Use of mPCR testing plus a guideline for young infant evaluation in the emergency department was associated with less antimicrobial and ancillary test utilization compared to the use of a guideline alone.

Initial evaluation of patients diagnosed with pancreatic cancer within a community health system.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 269-269
Author(s):  
Kathryn Tzung-Kai Chen
Keyword(s):  
Pancreatic Cancer ◽  
Emergency Department ◽  
Health System ◽  
Community Health ◽  
Outpatient Clinic ◽  
Care Center ◽  
Tertiary Care ◽  
Initial Evaluation ◽  
Entire Cohort ◽  
The Impact

269 Background: The management of pancreatic patients who are referred to a tertiary care center is well described. However, many patients receive their initial evaluation and care at community health systems. We sought to describe how patients present within the community, the patterns of initial evaluation, and the impact on management. Methods: In a period spanning 3 years (2010-2013), 82 patients were newly diagnosed with pancreatic cancer, as identified by a cancer registry at a community health system. Under IRB approval, data regarding patient characteristics, initial evaluation, and management were retrospectively collected from the electronic medical record (EMR) and analyzed. Results: Of the 82 patients, 68 patients had sufficient data available in the EMR for analysis. Thirty-two patients (47%) initially presented to outpatient clinic, and 36 patients (53%) presented to the emergency department. The presenting complaint was identified as abdominal pain in 33 patients (49%), jaundice in 20 patients (29%), and general malaise in 9 patients (13%). Patients who presented through outpatient clinic vs. emergency department received similar initial imaging studies upfront, including CT of the abdomen and pelvis (61% vs. 72%) and abdominal ultrasound (27% vs. 17%). Sixteen percent of those patients evaluated in outpatient clinic were subsequently admitted, compared to 94% of those patients evaluated in the emergency department. Finally, 31% of those presenting in outpatient clinic eventually underwent surgical resection, compared to 8% of those presenting through the ER, and the median time to surgery for the entire cohort was 1.1 months. Conclusions: Within the community, half of all patients present through the emergency department, and the majority of these are admitted for work up and management of symptoms. In contrast, those patients who present through outpatient clinic are less likely to be admitted, and are more likely to undergo definitive resection. This likely represents a disparity on several levels: the acuity of patients presenting to the emergency department vs. clinic, and how they are managed in each setting.

scholarly journals (P2-74) Does Implementation of Protocols Improve the Red Area Disposition Time of Emergency Department at a Level-1 Trauma Center?

2011 ◽  
Vol 26 (S1) ◽  
pp. s160-s160
Author(s):  
R. Kumar ◽  
K. Shyamla ◽  
S. Bhoi ◽  
T.P. Sinha ◽  
S. Chauhan ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Trauma Center ◽  
Safety Issues ◽  
Ed Visits ◽  
Level 1 ◽  
The Impact ◽  
Level 1 Trauma Center ◽  
Final Disposition ◽  
Disposition Time

BackgroundAcute care addresses immediate resuscitation and early disposition to definitive care. Delay in final disposition from the emergency department (ED) affects outcomes in terms of morbidity and mortality. An audit was performed to assess the impact of protocols on red area disposition time.MethodsAn audit of red (resuscitation) area disposition time was performed among patients with compromised airway, breathing, and circulation. The red area disposition time was defined as the time from ED arrival to red area disposition. Pre-protocol data from nursing report books were reviewed for ED to operating room (OR), ED to intensive care unit (ICU), and overall disposition time between September 2007 and January 2008. Similar outcomes were documented after implementation of protocols during February to December 2008.ResultsIn the pre-protocol period, 992 red area patients were enrolled out of 10,000 ED visits. Out of which 527 (53.1%) were shifted to the OR and 222 (22.3%) to ICU. The average ED disposition time was 3.5 hours (range 2–5). Similarly, 1797 red area patients were enrolled in the post-protocol period out of 25,928. Of these, 453 (25.2%) patients were shifted to the OR, and 423 (23.7%) were shifted to the ICU. The average ED disposition time was 1.5 hours (range 10 minutes–3 hours).ConclusionsImplementation of protocols improves the red area disposition time of the ED. Auditing is an important tool to address patient safety issues.

scholarly journals An Assessment of Emergency Department Throughput and Provider Satisfaction after the Implementation of a Scribe Program

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Brandon Allen ◽  
Ben Banapoor ◽  
Emily C. Weeks ◽  
Thomas Payton
Keyword(s):  
Emergency Department ◽  
Program Implementation ◽  
Tertiary Care ◽  
Care Facility ◽  
Workplace Satisfaction ◽  
Electronic Survey ◽  
Left Without Being Seen ◽  
Tertiary Care Facility ◽  
Discharged Patients ◽  
The Impact

Objectives. To assess the impact of a scribe program on an academic, tertiary care facility. Methods. A retrospective analysis of emergency department (ED) data, prior to and after scribe program implementation, was used to quantitatively assess the impact of the scribe program on measures of ED throughput. An electronic survey was distributed to all emergency medicine residents and advanced practice providers to qualitatively assess the impact of the scribe program on providers. Results. Several throughput time measures were significantly lower in the postscribe group, compared to prescribe implementation, including time to disposition. The left without being seen (LWBS) decrease was not statistically significant. A total of 30 providers responded to the survey. 100% of providers indicated scribes are a valuable addition to the department and they enjoy working with scribes. 90% of providers indicated scribes increase their workplace satisfaction and quality of life. Conclusions. Through evaluation of prescribe and postscribe implementation, the postscribe time period reflects many throughput improvements not present before scribes began. Scribe Program implementation led to improved ED throughput for discharged patients with further system-wide challenges needing to be addressed for admitted patients.

scholarly journals Radiation Exposure From CT Scanning in the Resuscitative Phase of Trauma Care: A Level One Trauma Centre Experience

CJEM ◽  
2015 ◽  
Vol 17 (6) ◽  
pp. 617-623 ◽  
Author(s):  
Lorri Beatty ◽  
Elizabeth Furey ◽  
Cupido Daniels ◽  
Avery Berman ◽  
John M. Tallon
Keyword(s):  
Radiation Exposure ◽  
Tissue Injury ◽  
Tertiary Care ◽  
Trauma Team ◽  
Trauma Centre ◽  
Whole Body ◽  
Trauma Patients ◽  
X Rays ◽  
Imaging Data ◽  
Trauma Team Activation

AbstractObjectivesThe initial management of a trauma patient often involves imaging in the form of x-rays, computed tomography (CT) and other radiographic studies, which expose the patient to ionizing radiation, an entity known to cause tissue injury and malignancy at high doses. The purpose of this study was to use a calculation-based method to determine the radiation exposure of trauma patients undergoing trauma team activation in a Canadian tertiary-care trauma centre.MethodsA retrospective chart review was conducted using the Nova Scotia Provincial Trauma Registry. All patients age 16 years old and over who underwent trauma team activation between March 1, 2008 and March 1, 2009 were included. Patients who died prior to imaging tests were excluded. Dose reports for each CT were used to calculate a whole-body radiation dose for each patient.ResultsThere were 230 trauma team activations during the study period, of which 206 had CT imaging. Data were available for 162 patients. The mean whole-body radiation exposure for all patients was 24.4±10.3 mSv, which may correlate to one additional cancer death for every 100 trauma patients scanned.ConclusionsTrauma patients are exposed to significant amounts of radiation during their initial trauma work-up, which may increase the risk of fatal cancer. Clinicians who care for these patients must be aware of the radiation exposure, and take measures to limit radiation exposure of trauma patients.

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