scholarly journals Can an emergency department clinical “triggers” program based on abnormal vital signs improve patient outcomes? – CORRIGENDUM

CJEM ◽  
2016 ◽  
Vol 19 (1) ◽  
pp. 80-80
Author(s):  
Jason Imperato ◽  
Tyler Mehegan ◽  
Daniel J. Henning ◽  
John Patrick ◽  
Chase Bushey ◽  
...  
Keyword(s):  
Emergency Department ◽  
Patient Outcomes ◽  
Vital Signs ◽  
Improve Patient

scholarly journals The association between abnormal vital sign groups and undesirable patient outcomes

2018 ◽  
Vol 25 (3) ◽  
pp. 137-145
Author(s):  
Marina Lee ◽  
David McD Taylor ◽  
Antony Ugoni
Keyword(s):  
Emergency Department ◽  
Confidence Interval ◽  
Patient Outcomes ◽  
Vital Sign ◽  
Odds Ratio ◽  
Medical Emergency Team ◽  
Vital Signs ◽  
Medical Emergency ◽  
Emergency Team ◽  
Abnormal Vital Sign

Introduction: To determine the association between both abnormal individual vital signs and abnormal vital sign groups in the emergency department, and undesirable patient outcomes: hospital admission, medical emergency team calls and death. Method: We undertook a prospective cohort study in a tertiary referral emergency department (February–May 2015). Vital signs were collected prospectively in the emergency department and undesirable outcomes from the medical records. The primary outcomes were undesirable outcomes for individual vital signs (multivariate logistic regression) and vital sign groups (univariate analyses). Results: Data from 1438 patients were analysed. Admission was associated with tachycardia, tachypnoea, fever, ≥1 abnormal vital sign on admission to the emergency department, ≥1 abnormal vital sign at any time in the emergency department, a persistently abnormal vital sign, and vital signs consistent with both sepsis (tachycardia/hypotension/abnormal temperature) and pneumonia (tachypnoea/fever) (p < 0.05). Medical emergency team calls were associated with tachycardia, tachypnoea, ≥1 abnormal vital sign on admission (odds ratio: 2.3, 95% confidence interval: 1.4–3.8), ≥2 abnormal vital signs at any time (odds ratio: 2.4, 95% confidence interval: 1.2–4.7), and a persistently abnormal vital sign (odds ratio: 2.7, 95% confidence interval: 1.6–4.6). Death was associated with Glasgow Coma Score ≤13 (odds ratio: 6.3, 95% confidence interval: 2.5–16.0), ≥1 abnormal vital sign on admission (odds ratio: 2.6, 95% confidence interval: 1.2–5.6), ≥2 abnormal vital signs at any time (odds ratio: 6.4, 95% confidence interval: 1.4–29.5), a persistently abnormal vital sign (odds ratio: 4.3, 95% confidence interval: 2.0–9.0), and vital signs consistent with pneumonia (odds ratio: 5.3, 95% confidence interval: 1.9–14.8). Conclusion: Abnormal vital sign groups are generally superior to individual vital signs in predicting undesirable outcomes. They could inform best practice management, emergency department disposition, and communication with the patient and family.

scholarly journals Living and Working in a Multisensory World: From Basic Neuroscience to the Hospital

2019 ◽  
Vol 3 (1) ◽  
pp. 2 ◽  
Author(s):  
Kendall Burdick ◽  
Madison Courtney ◽  
Mark Wallace ◽  
Sarah Baum Miller ◽  
Joseph Schlesinger
Keyword(s):  
Patient Outcomes ◽  
Music Theory ◽  
Healthcare Providers ◽  
Vital Signs ◽  
Clinical Information ◽  
False Alarms ◽  
Alarm System ◽  
Potential Solution ◽  
Alarm Fatigue ◽  
Improve Patient

The intensive care unit (ICU) of a hospital is an environment subjected to ceaseless noise. Patient alarms contribute to the saturated auditory environment and often overwhelm healthcare providers with constant and false alarms. This may lead to alarm fatigue and prevent optimum patient care. In response, a multisensory alarm system developed with consideration for human neuroscience and basic music theory is proposed as a potential solution. The integration of auditory, visual, and other sensory output within an alarm system can be used to convey more meaningful clinical information about patient vital signs in the ICU and operating room to ultimately improve patient outcomes.

Implementing Point-of-Care Testing in the Emergency Department to Improve Patient Outcomes

2008 ◽  
Vol 7 (3) ◽  
pp. 143
Author(s):  
Elizabeth-Lee Lewandrowski ◽  
James Flood ◽  
Donna MacMillan ◽  
Leonard Tochka ◽  
Kent Lewandrowski
Keyword(s):  
Emergency Department ◽  
Patient Outcomes ◽  
Point Of Care ◽  
Point Of Care Testing ◽  
Improve Patient

scholarly journals Can an emergency department clinical “triggers” program based on abnormal vital signs improve patient outcomes?

CJEM ◽  
2016 ◽  
Vol 19 (04) ◽  
pp. 249-255 ◽  
Author(s):  
Jason Imperato ◽  
Tyler Mehegan ◽  
Daniel J. Henning ◽  
John Patrick ◽  
Chase Bushey ◽  
...  
Keyword(s):  
Emergency Department ◽  
Inpatient Care ◽  
Rapid Assessment ◽  
Vital Signs ◽  
Special Care ◽  
Special Care Unit ◽  
Post Intervention ◽  
Care Level ◽  
Inpatient Outcomes ◽  
Improve Patient

AbstractBackgroundBecause abnormal vital signs indicate the potential for clinical deterioration, it is logical to make emergency physicians immediately aware of those patients who present with abnormal vital signs.ObjectivesTo determine if a clinical triggers program in the emergency department (ED) setting that utilized predetermined abnormal vital signs to activate a rapid assessment by an emergency physician-led multidisciplinary team had a measurable effect on inpatient hospital metrics.MethodsThe study design was a retrospective pre and post intervention study. The intervention was the implementation of an ED clinical “triggers” program. Abnormal vital sign criteria that warranted a trigger response included: heart rate &lt;40 beats/minute or&gt;130 beats/minutes, respiratory rate &lt;8 breaths/minute or&gt;30 breaths/minute, systolic blood pressure &lt;90 mm Hg, or oxygen saturation &lt;90% on room air. The primary outcome investigated was the median days admitted with secondary outcomes of median days in special care unit, in-hospital 30-day mortality and proportion of patients who required an upgrade in inpatient care level.ResultsThere was no difference in median days admitted for inpatient care (3.8 v. 4.0 days,p=0.21) or median days spent in a special care unit (5.0 v. 5.6 days,p=0.42) between the groups. There was no difference in the percentage of in-hospital patient deaths (6.0% v. 5.6%,p=0.66) or frequency of upgrade in level of care within 24 hours (4.9% v. 4.0%,p=0.52).ConclusionsIn our study, the implementation of an ED clinical triggers program did not result in a significant change in measured inpatient outcomes.

scholarly journals Ultrasound Utility in the Diagnosis of a Morel-Lavallée Lesion

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Scott LaTulip ◽  
Rameshwar R. Rao ◽  
Alan Sielaff ◽  
Nik Theyyunni ◽  
John Burkhardt
Keyword(s):  
Emergency Department ◽  
Patient Outcomes ◽  
Imaging Technique ◽  
Point Of Care ◽  
Cost Effective ◽  
Rapid Diagnosis ◽  
Point Of Care Ultrasound ◽  
Ultrasound Findings ◽  
Specialized Equipment ◽  
Improve Patient

Morel-Lavallée lesions are uncommon injuries that can be associated with significant comorbidities if not detected early. Rapid diagnosis in the Emergency Department could significantly improve patient outcomes. We describe the diagnosis of such a lesion through the use of ultrasound imaging in the Emergency Department to utilize a fast, cost-effective imaging technique that does not subject the patient to radiation exposure. Our patient received surgical consultation but improved with conservative management. Ultrasound findings associated with this lesion do not require specialized equipment and should be considered when evaluating soft tissue lesions using point of care ultrasound.

scholarly journals Management of children visiting the emergency department during out-of-office hours: an observational study

2020 ◽  
Vol 4 (1) ◽  
pp. e000687
Author(s):  
Gina Schinkelshoek ◽  
Dorine M Borensztajn ◽  
Joany M Zachariasse ◽  
Ian K Maconochie ◽  
Claudio F Alves ◽  
...  
Keyword(s):  
Emergency Department ◽  
Patient Outcomes ◽  
Paediatric Intensive Care Unit ◽  
Vital Signs ◽  
Patient Characteristics ◽  
Electronic Health Record Data ◽  
Manchester Triage System ◽  
Record Data ◽  
Seriously Ill ◽  
Night Shifts

BackgroundThe aim was to study the characteristics and management of children visiting the emergency department (ED) during out-of-office hours.MethodsWe analysed electronic health record data from 119 204 children visiting one of five EDs in four European countries. Patient characteristics and management (diagnostic tests, treatment, hospital admission and paediatric intensive care unit admission) were compared between children visiting during office hours and evening shifts, night shifts and weekend day shifts. Analyses were corrected for age, gender, Manchester Triage System urgency, abnormal vital signs, presenting problems and hospital.ResultsPatients presenting at night were younger (median (IQR) age: 3.7 (1.4–8.2) years vs 4.8 (1.8–9.9)), more often classified as high urgent (16.3% vs 9.9%) and more often had ≥2 abnormal vital signs (22.8% vs 18.1%) compared with office hours. After correcting for disease severity, laboratory and radiological tests were less likely to be requested (adjusted OR (aOR): 0.82, 95% CI 0.78–0.86 and aOR: 0.64, 95% CI 0.60–0.67, respectively); treatment was more likely to be undertaken (aOR: 1.56, 95% CI 1.49–1.63) and patients were more likely to be admitted to the hospital (aOR: 1.32, 95% CI 1.24–1.41) at night. Patterns in management during out-of-office hours were comparable between the different hospitals, with variability remaining.ConclusionsChildren visiting during the night are relatively more seriously ill, highlighting the need to keep improving emergency care on a 24-hour-a-day basis. Further research is needed to explain the differences in management during the night and how these differences affect patient outcomes.

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