scholarly journals Lessons Learned From an Active Shooter Full-Scale Functional Exercise In a Newly Constructed Emergency Department

2017 ◽  
Vol 11 (5) ◽  
pp. 522-525 ◽  
Author(s):  
Bryan Wexler ◽  
Avram Flamm
Keyword(s):  
Emergency Department ◽  
Patient Care ◽  
Primary Objective ◽  
Full Scale ◽  
Lessons Learned ◽  
Valuable Insight ◽  
Active Shooter ◽  
Functional Exercise ◽  
Temporary Closure ◽  
The Impact

AbstractObjectiveThe primary objective of this exercise was to conduct a full-scale functional exercise utilizing an active-shooter-based scenario to test and evaluate hospital response and coordination with local law enforcement.MethodsA multidisciplinary group, including community partners, formulated objectives in accordance with the Homeland Security Exercise and Evaluation Program and defined a scenario. A date to conduct the exercise was chosen on the basis of the expected completion of a large section of the new emergency department but prior to its opening for patient care.ResultsThe exercise highlighted several strengths, but more importantly, illuminated areas for improvement that might otherwise have been missed in tabletop exercises and smaller-scale drills. Educational opportunities to improve functional skills and protocol were recognized.ConclusionConducting a full-scale functional exercise of an active shooter in a newly constructed emergency department prior to opening for patient care provided valuable insight into areas for improvement while minimizing the impact such an exercise can have on daily operations. Should a similar opportunity arise as a result of new facilities being developed or renovations and maintenance requiring temporary closure, we advise hospitals to consider planning an exercise in the area prior to reopening for patient care. (Disaster Med Public Health Preparedness. 2017;11:522–525)

scholarly journals LO56: Novel role of physician navigators on performance indicators in the emergency department

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S47
Author(s):  
A. Leung ◽  
G. Puri ◽  
B. Chen ◽  
Z. Gong ◽  
E. Chan ◽  
...  
Keyword(s):  
Emergency Department ◽  
Patient Care ◽  
Mixed Linear Model ◽  
Primary Objective ◽  
Initial Assessment ◽  
Direct Patient Care ◽  
Healthcare Team ◽  
Left Without Being Seen ◽  
Before And After ◽  
The Impact

Introduction: Burnout rates for emergency physicians (EP) continue to be amongst the highest in medicine. One of the commonly cited sources of stress contributing to disillusionment is bureaucratic tasks that distract EPs from direct patient care in the emergency department (ED). The novel position of Physician Navigator was created to help EPs decrease their non-clinical workload during shifts, and improve productivity. Physician Navigators are non-licensed healthcare team members that assist in activities which are often clerical in nature, but directly impact patient care. This program was implemented at no net-cost to the hospital or healthcare system. Methods: In this retrospective study, 6845 clinical shifts worked by 20 EPs over 39 months from January 1, 2012 to March 31, 2015 were evaluated. The program was implemented on April 1, 2013. The primary objective was to quantify the effect of Physician Navigators on measures of EP productivity: patient seen per hour (Pt/hr), and turn-around-time (TAT) to discharge. Secondary objectives included examining the impact of Physician Navigators on measures of ED throughput for non-resuscitative patients: emergency department length of stay (LOS), physician-initial-assessment times (PIA), and left-without-being-seen rates (LWBS). A mixed linear model was used to evaluate changes in productivity measures between shifts with and without Physician Navigators in a clustered design, by EP. Autoregressive modelling was performed to compare ED throughput metrics before and after the implementation of Physician Navigators for non-resuscitative patients. Results: Across 20 EPs, 2469 shifts before, and 4376 shifts after April 1, 2013 were analyzed. Daily patient volumes increased 8.7% during the period with Physician Navigators. For the EPs who used Physician Navigators, Pt/hr increased by 1.07 patients per hour (0.98 to 1.16, p<0.001), and TAT to discharge decreased by 10.6 minutes (-13.2 to -8.0, p<0.001). After the implementation of the Physician Navigators, overall LOS for non-resuscitative patients decreased by 2.6 minutes (1.0%, p=0.007), and average PIA decreased by 7.4 minutes (12.0%, p<0.001). LBWS rates decreased by 43.9% (0.50% of daily patient volume, p<0.001). Conclusion: The use of a Physician Navigator was associated with increased EP productivity as measured by Pt/hr, and TAT to discharge, and reductions in ED throughput metrics for non-resuscitative patients.

scholarly journals Effectiveness of early assessment and intervention by interdisciplinary teams including health and social care professionals in the emergency department: protocol for a systematic review

BMJ Open ◽  
2018 ◽  
Vol 8 (7) ◽  
pp. e023464 ◽  
Author(s):  
Marica Cassarino ◽  
Katie Robinson ◽  
Rosie Quinn ◽  
Breda Naddy ◽  
Andrew O’Regan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Patient Care ◽  
Systematic Reviews ◽  
Social Care ◽  
Interdisciplinary Teams ◽  
Cochrane Library ◽  
Early Assessment ◽  
Health And Social Care ◽  
The Impact

IntroductionFinding cost-effective strategies to improve patient care in the emergency department (ED) is an increasing imperative given growing numbers of ED attendees. Encouraging evidence indicates that interdisciplinary teams including health and social care professionals (HSCPs) enhance patient care across a variety of healthcare settings. However, to date no systematic reviews of the effectiveness of early assessment and/or interventions carried by such teams in the ED exist. This systematic review aims to explore the impact of early assessment and/or intervention carried out by interdisciplinary teams including HSCPs in the ED on the quality, safety and cost-effectiveness of care, and to define the content of the assessment and/or intervention offered by HSCPs.Methods and analysisUsing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses standardised guidelines, we will conduct a systematic review of randomised controlled trials (RCTs), non-RCTs, controlled before–after studies, interrupted time series and repeated measures studies that report the impact of early assessment and/or intervention provided to adults aged 18+ by interdisciplinary teams including HSCPs in the ED. Searches will be carried in Cumulative Index of Nursing and Allied Health Literature, Embase, Cochrane Library and MEDLINE from inception to March 2018. We will also hand-search the reference lists of relevant studies. Following a two-step screening process, two independent reviewers will extract data on the type of population, intervention, comparison, outcomes and study design. The quality of the studies will be appraised using the Cochrane Risk of Bias Tool. The findings will be synthesised in a narrative summary, and a meta-analysis will be conducted where appropriate.Ethics and disseminationEthical approval will not be sought since it is not required for systematic reviews. The results of this review will be disseminated through publication in a peer-review journal and presented at relevant conferences.Trial registration numberCRD42018091794.

P035: Development of a province-wide audit program for return visits to the emergency department

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S89-S90
Author(s):  
L.B. Chartier ◽  
O. Ostrow ◽  
I. Yuen ◽  
S. Kutty ◽  
B. Davis ◽  
...  
Keyword(s):  
Emergency Department ◽  
Patient Care ◽  
Quality Care ◽  
Improve Patient Care ◽  
Lessons Learned ◽  
Quality And Safety ◽  
Term Care ◽  
Clinical Observations ◽  
Quality Program ◽  
Physician Leaders

Introduction: Routine auditing of charts of patients with an emergency department (ED) return visit (RV) resulting in hospital admission can uncover quality and safety gaps in care. This feedback can be helpful to clinicians, administrators, and leaders working to improve clinical outcomes, increase patient satisfaction, and promote high-value care. Health Quality Ontario (HQO) has been tasked by Ontario’s Ministry of Health and Long-Term Care (MOHLTC) to manage the newly created ED RV Quality Program (RVQP), which mandates EDs participating in the Pay-for-Results (P4R) program to audit a minimum of 25-50 RVs/year. The goal of the first-ever ED-specific province-wide Quality Improvement (QI) initiative of this kind is to promote a culture of QI that will lead to improved patient care. Methods: Participating hospitals receive quarterly confidential reports from Access to Care (ATC) that show their and other hospitals’ rates of RVs, as well as identifying information for patients meeting RV inclusion criteria at their ED (within 72 hrs of index visit, or within 7 days with specific diagnoses). HQO has partnered with QI experts and ED physician-leaders to develop various guidance materials. These materials have been disseminated through various media. Hospitals are conducting audits to identify underlying quality issues, take steps to address the underlying causes, and submit reports to HQO. A taskforce will then analyze clinical observations, summarize key findings and lessons learned, and share improvements at a provincial level through an annual report. Results: Since its launch in April 2016, 73 P4R and 16 voluntarily enrolled non-P4R hospitals (which collectively receive approximately 90% of ED visits in the province) are participating in the RVQP. ED leaders have engaged their hospital’s leadership to leverage interest and resources to improve patient care in the ED. To date, hospitals have conducted thousands of audits and have identified quality and safety gaps to address, which will be analyzed in February 2017 for reporting shortly thereafter. These will inform QI endeavours locally and provincially, and be the largest source of such data ever created in Ontario. Conclusion: The ED RVQP aims to create a culture of continuous QI in the Ontario health care system, which provides care to over 13.8 million people. Other jurisdictions can replicate this model to promote high-quality care.

scholarly journals Interventions to reduce emergency department consultation time: A systematic review of the literature

CJEM ◽  
2019 ◽  
Vol 22 (1) ◽  
pp. 56-64
Author(s):  
Weiwei Beckerleg ◽  
Krista Wooller ◽  
Delvina Hasimjia
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Length Of Stay ◽  
Decision Time ◽  
Primary Objective ◽  
Audit And Feedback ◽  
Post Intervention ◽  
Consultation Process ◽  
Admission Process ◽  
The Impact

ABSTRACTObjectivesOvercrowding in the emergency department (ED) is associated with increased morbidity and mortality. Studies have shown that consultation to decision time, defined as the time when a consultation has been accepted by a specialty service to the time when disposition decision is made, is one important contributor to the overall length of stay in the ED.The primary objective of this review is to evaluate the impact of workflow interventions on consultation to decision time and ED length of stay in patients referred to consultant services in teaching centres, and to identify barriers to reducing consultation to decision time.MethodsThis systematic review was performed in accordance with the PRISMA guidelines. An electronic search was conducted to identify relevant studies from MEDLINE, EMBASE, Cochrane Central, and CINAHL databases. Study screening, data extraction, and quality assessment were carried out by two independent reviewers.ResultsA total of nine full text articles were included in the review. All studies reported a decrease in consultation to decision time post intervention, and two studies reported cost savings. Interventions studied included short messaging service (SMS) messaging, education with audit and feedback, standardization of the admission process, implementation of institutional guideline, modification of the consultation process, and staffing schedules. Overall study quality was fair to poor.ConclusionsThe limited evidence suggests that audit and feedback in the form of SMS messaging, direct consultation to senior physicians, and standardization of the admission process may be the most effective and feasible interventions. Additional high-quality studies are required to explore sustainable interventions aimed at reducing consultation to decision time.

scholarly journals 79 Acceptability and impact of psychosocial screening in the emergency department

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e33-e33
Author(s):  
Elizabeth Hankinson ◽  
Quynh Doan ◽  
Bruce Wright ◽  
Amanbir Atwal ◽  
Punit Virk ◽  
...  
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Psychosocial Care ◽  
Primary Objective ◽  
Psychosocial Needs ◽  
Self Assessment ◽  
Psychosocial Screening ◽  
Psychosocial Resource ◽  
The Impact ◽  
Clinician Assessment

Abstract Background Psychosocial concerns in youth are prevalent and undertreated. Early identification through screening may promote appropriate management before youth present in crisis. Objectives Our primary objective was to assess the acceptability of psychosocial screening in the pediatric emergency department (ED) setting. Secondarily, we report the prevalence of psychosocial issues among youth with non-psychiatric ED presentations, and the impact of screening on mental health resource-seeking behaviour. Design/Methods We conducted a prospective cohort study of youth aged 10-17 years at two pediatric EDs. Youth with a mental health-related reason for visiting the ED were excluded. Eligible and consenting youth (and their families) completed a comprehensive psychosocial self-assessment delivered on an electronic tablet, followed by standardized clinician assessment. Consent to participate in the study was used as a proxy measure for acceptability of screening. Participants with identified psychosocial resource needs were followed up at 30 days with a semi-structured telephone/email interview to assess whether they had sought recommended resources and to explore barriers to accessing care. Results Of the 1432 eligible youth given the opportunity to enrol, 795 consented. Among the 637 youth who declined enrolment, 467 specified that they declined for reasons other than not wanting to conduct a psychosocial self-assessment. This suggests that at least 55.5% (95% CI = 52.9%, 58.1%) and up to 88.1% (95% CI = 86.4%, 89.8%) find screening acceptable. Among the 760 participants who completed clinician assessment, 276 (36.3%) were identified as having a psychosocial resource need. Resources were already in place for 105 youth, leaving 171 (22.5%) with newly identified or unmet psychosocial needs. Only 41 (33.1%) of the 124 participants and/or their families who completed a 30-day follow up interview reported attempting to access the recommended resources, despite 92 (74.2%) stating they agreed with the original recommendations. The most common reason for not accessing care was the belief that the recommendations were not yet necessary or were not a priority. Of those who had attempted to access resources, 18 (43.9%) were unsuccessful at the time of interview, with the most common barrier being access delay (e.g. on a waitlist). Conclusion We found that previously unidentified/unmet psychosocial needs are prevalent among youth in the ED, and that screening is generally acceptable. However, a limited number of those who screened positive attempted to access resources, and when they did, access was often unsuccessful or delayed. More work is needed to address barriers to timely psychosocial care.

An In Situ Simulation-Based Training Approach to Active Shooter Response in the Emergency Department

2018 ◽  
Vol 13 (02) ◽  
pp. 345-352 ◽  
Author(s):  
Mark S. Mannenbach ◽  
Carol J. Fahje ◽  
Kharmene L. Sunga ◽  
Matthew D. Sztajnkrycer
Keyword(s):  
Emergency Department ◽  
Emergency Departments ◽  
Low Frequency ◽  
Training Model ◽  
The United States ◽  
Lessons Learned ◽  
Added Value ◽  
Active Shooter ◽  
In Situ Simulation

ABSTRACTWith an increased number of active shooter events in the United States, emergency departments are challenged to ensure preparedness for these low frequency but high stakes events. Engagement of all emergency department personnel can be very challenging due to a variety of barriers. This article describes the use of an in situ simulation training model as a component of active shooter education in one emergency department. The educational tool was intentionally developed to be multidisciplinary in planning and involvement, to avoid interference with patient care and to be completed in the true footprint of the work space of the participants. Feedback from the participants was overwhelmingly positive both in terms of added value and avoidance of creating secondary emotional or psychological stress. The specific barriers and methods to overcome implementation are outlined. Although the approach was used in only one department, the approach and lessons learned can be applied to other emergency departments in their planning and preparation. (Disaster Med Public Health Preparedness. 2019;13:345–352)

scholarly journals The impact of a pulmonary embolism response team on the efficiency of patient care in the emergency department

2019 ◽  
Vol 48 (2) ◽  
pp. 331-335 ◽  
Author(s):  
Colin Wright ◽  
Ayman Elbadawi ◽  
Yu Lin Chen ◽  
Dhwani Patel ◽  
Justin Mazzillo ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pulmonary Embolism ◽  
Patient Care ◽  
Response Team ◽  
The Impact ◽  
Pulmonary Embolism Response Team

Impact of an innovative partnership in patient care between an academic medical center department of pharmacy and a school of pharmacy

2019 ◽  
Vol 76 (24) ◽  
pp. 2070-2076
Author(s):  
Mary-Haston Vest ◽  
Mary G Petrovskis ◽  
Scott W Savage ◽  
Nicole R Pinelli ◽  
Ashley L Pappas ◽  
...  
Keyword(s):  
Patient Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
Lessons Learned ◽  
Residency Programs ◽  
Pharmacy Department ◽  
Academic Medical ◽  
American Society ◽  
The Impact ◽  
The Relationship

Abstract Purpose Pharmacy departments and schools of pharmacy have long held professional affiliations. However, the success of each entity is often not interdependent and aligned. In 2010, our institutions found ourselves in a position where the complementary motivations of each aligned to support a more meaningful and committed engagement, leading to the development of the Partnership in Patient Care. The impact of the partnership was evaluated 7 years postimplementation, and both the successes realized and the lessons learned are described. Summary The partnership provided many advantages to our pharmacy department and the school of pharmacy. This initial iteration of the partnership was a strong proof of concept that an intentional approach to the relationship between a school of pharmacy and a pharmacy department can lead to substantive improvements in a wide array of meaningful outcomes. We experienced an increase in the number of student rotation months completed, growth in the American Society of Health-System Pharmacists–accredited residency programs, and enhanced clinical services. However, the partnership was not without challenges. For instance, lack of a formalized tracking method made certain outcomes difficult to track. Conclusion The purposeful establishment of the Partnership in Patient Care, built on the needs of a school of pharmacy and an academic medical center pharmacy department, allowed our institutions to develop an intertwined mission and vision. Over the initial years of the partnership, many successes were realized and lessons were learned. Both the successes and the challenges are serving as the foundation for future iterations of the partnership.

scholarly journals Adjunct Analgesic Use for Acute Pain in the Emergency Department

2017 ◽  
Vol 52 (2) ◽  
pp. 138-143 ◽  
Author(s):  
James Priano ◽  
Brian Faley ◽  
Gabrielle Procopio ◽  
Kevin Hewitt ◽  
Joseph Feldman
Keyword(s):  
Emergency Department ◽  
Acute Pain ◽  
Rating Scale ◽  
Medical Center ◽  
Academic Medical Center ◽  
Primary Objective ◽  
Opioid Dose ◽  
Nonopioid Analgesics ◽  
The Impact ◽  
Nonopioid Analgesic

Purpose Multimodal analgesia is common practice in the postoperative setting, but the utility of adjunctive analgesia in the emergency department (ED) is less understood. The primary objective of this study was to analyze ED prescriber ordering habits for adjunct nonopioid pain medication for opioid-naïve patients who require intravenous (IV) morphine or hydromorphone for acute pain. Secondary objectives were to assess initial and total opioid consumption in morphine equivalent units (MEU), pain scores, and ED length of stay (LOS) between groups. Methods A retrospective chart review of adult patients who presented to the ED at a large academic medical center and received IV morphine or hydromorphone for acute pain was conducted. Patients were analyzed according to initial opioid received and presence or absence of adjunct nonopioid analgesics. Results A total of 102 patient charts were analyzed. Adjunctive nonopioid analgesics were ordered on 38% of patients. Patients who received an adjunct nonopioid analgesic received a smaller mean initial opioid dose than those who did not (4.73 vs 5.48 MEU, p = .08). Initial pain score reduction on the 11-point Numeric Rating Scale (NRS) did not differ between patients who received adjunct analgesics versus those who did not (3 vs 4, p = .75). Patients who received adjunct analgesics were associated with a decreased ED LOS (294 vs 342 minutes, p = .04). Conclusion A small proportion of patients with acute pain received a nonopioid analgesic in conjunction to IV opioids. Further studies are warranted to assess the impact of adjunct analgesics for patients with acute pain.

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