scholarly journals Management of Food-Related Diarrhea Outbreak in the Emergency Department: Lessons Learned from the German STEC O104:H4 Epidemic

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Friedhelm Sayk ◽  
Niels Henrik Asselborn ◽  
Nora Eisemann ◽  
Alexander Katalinic ◽  
Jörg Metzner ◽  
...  
Keyword(s):  
Emergency Department ◽  
Clinical Judgment ◽  
Lower Abdominal Pain ◽  
Lessons Learned ◽  
Northern Germany ◽  
Laboratory Findings ◽  
Defecation Rate ◽  
Public Media ◽  
Tertiary Hospitals ◽  
Foodborne Infections

Emergency department (ED) management of the German STEC O104:H4 outbreak in 2011 was not limited to patients being truly infected with STEC. In parallel to spread of alarming news in public media, patients suffering from diarrhea due to other reasons fearfully presented, equally. We retrospectively characterized these two cohorts for anamnestic, clinical, and laboratory findings at their first ED contact. From 15th of May to July 2011, 302 adult patients with diarrheal complaint presented at the EDs of two tertiary hospitals in Lubeck, northern Germany. Fecal testing for STEC was obtained in 245 (81%) patients: 105 were STEC-positive and 140 were STEC-negative. Anamnestic characteristics (defecation rate, visible bloody diarrhea, and lower abdominal pain), abdominal tenderness, and some laboratory findings were significantly different between both cohorts but not reliable to exclude STEC. In >90% of STEC-positive patients diarrheal symptoms had started in May, reflecting the retrospective nationwide peak of infections, whereas the majority of STEC-negative patients became symptomatic in June 2011. During the German STEC O104:H4 outbreak a definite distinction at initial ED contact between STEC-positive versus STEC-negative patients by clinical judgment alone was not reliable. Fecal testing in the ED, however, might survey the outbreak of foodborne infections with the utmost precision.

scholarly journals Comparative evaluation of the role of Sonography in diagnosis of Acute Appendicitis versus Surgeon`s clinical impression

2016 ◽  
Vol 9 (1) ◽  
Author(s):  
Ahsen Nazir Ahmad ◽  
Noor Fatima ◽  
Rana Amjad Hussain ◽  
Qadir SNR
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Clinical Evaluation ◽  
Clinical Judgment ◽  
Ultrasound Examination ◽  
Lower Abdominal Pain ◽  
Clinical Impression ◽  
Abdominal Sonography

A randomly selected group of patients presented in Accidents & Emergency department of Jinnah hospital Lahore with complaint of acute lower abdominal pain were subjected to abdominal sonography and those positive for acute appendicitis on ultrasound examination were operated. Another group of randomly selected patients with acute lower abdominal pain in Emergency department were clinically evaluated for acute appendicitis and surgery was done based on clinical impression (history and classical signs for acute appendicitis). Ultrasound examination showed the following parameters. Sensitivity 71.8%, specificity 62.5%, PPV 88.4%, NPV 35.7%. Clinical evaluation showed the sensitivity of 95.2%, specificity 77.7%, PPV 90.9%, NPV 87.5%. It was concluded on the basis of the results that clinical evaluation of the patient is more sensitive in correctly categorizing those who need appendicectomy than the ultrasound examination. Although the latter can be used in suspected cases and to rule out other pathological conditions resulting in acute abdomen. Limitations: Clinical judgment to a large extent rest on the experience and expertise of the surgeon and so is the quality of sonographic results, which depend on experience of sonographer & quality of ultrasound machine.

scholarly journals 5 It’s Time to Rethink How We Screen for Communicable Diseases in the Emergency Department: Lessons Learned From COVID-19

2021 ◽  
Vol 78 (2) ◽  
pp. S3
Author(s):  
M.A. DiLorenzo ◽  
M.R. Davis ◽  
J.N. Dugas ◽  
K.P. Nelson ◽  
R. Grochow Mishuris ◽  
...  
Keyword(s):  
Emergency Department ◽  
Communicable Diseases ◽  
Lessons Learned

Process and findings informing the development of a provincial emergency medicine network

2019 ◽  
Vol 32 (5) ◽  
pp. 253-258
Author(s):  
Riyad B. Abu-Laban ◽  
Sharla Drebit ◽  
Brandy Svendson ◽  
Natalie Chan ◽  
Kendall Ho ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Lessons Learned ◽  
Brand Identity ◽  
The Internet ◽  
Network Resources ◽  
Internet Resources ◽  
Scoping Literature Review ◽  
Key Informant ◽  
Medical Disciplines

We describe the process undertaken to inform the development of the recently launched British Columbia (BC) Emergency Medicine Network (EM Network). Five methods were undertaken: (1) a scoping literature review, (2) a survey of BC emergency practitioners and EM residents, (3) key informant interviews, (4) focus groups in sites across BC, and (5) establishment of a brand identity. There were 208 survey respondents: 84% reported consulting Internet resources once or more per emergency department shift; however, 26% reported feeling neutral, somewhat unsatisfied, or very unsatisfied with searching for information on the Internet to support their practice. Enthusiasm was expressed for envisioned EM Network resources, and the key informant interviews and focus group results helped identify and refine key desired components of the EM Network. In describing this, we provide guidance and lessons learned for health leaders and others who aspire to establish similar clinical networks, whether in EM or other medical disciplines.

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 308. Slow Adoption of a Nurse-Driven Protocol for Universal Hepatitis C Virus Screening in a Hospital Emergency Department: Lessons Learned

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S165-S165
Author(s):  
Zainab Wasti ◽  
Dagan Coppock ◽  
Zsofia Szep ◽  
Tiffany Scott ◽  
Taneesa Franks ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Baby Boomers ◽  
Public Health Intervention ◽  
Lessons Learned ◽  
Seroprevalence Rate ◽  
Screening Protocol ◽  
Hcv Screening ◽  
Hcv Testing

Abstract Background In areas with a high prevalence of hepatitis C virus (HCV) infection, emergency department (ED) visits may provide unique opportunities for screening. The catchment area for Hahnemann University Hospital (HUH) has an HCV seroprevalence rate of >20%. However, limited data exist addressing HCV testing strategies in the ED. This study describes the experience of piloting a nurse-driven HCV screening protocol in an urban hospital ED. Methods A nurse-driven HCV screening protocol was developed and implemented on August 1, 2018. We performed a retrospective analysis of the protocol’s performance from July 1, 2018, through December 31, 2018. Patients who were evaluated in the ED and had blood collected were analyzed. We provided universal HCV screening regardless of age or risk factors. If HCV-positive by antibody screen and viral load confirmation, an attempt was made to link patients to care. Linkage was defined as having received an inpatient evaluation by either infectious diseases or hepatology physician. Results Among 20,705 unique patients seen in the ED, 7841 (38%) had blood work collected. 821 (10.5%) patients had HCV antibody testing. After the implementation of the nurse-driven protocol, the testing rate increased from 68/1340 (5.1%) to 753/6501 (11.6%). 260 Baby Boomers (born between 1945–1965) were screened, of which 60 (23.1%) had positive screens. 561 non-Baby Boomers were screened, of which 30 (5.4%) had positive screens. Barriers of implementing nurse-driven protocol were: (1) multiple steps of the ordering process in the electronic medical record (EMR), (2) the complexity of staff schedules, and (3) staff concerns regarding the disclosure of HCV test results. Among the patients who were diagnosed with chronic HCV, 60 % were linked to care for treatment. Conclusion We piloted a nurse-driven universal HCV testing protocol in the ED of a hospital with high HCV prevalence. Though the screening rate doubled, it was still low. We identified barriers that may be addressed to improve future screening rates. In areas with a high seroprevalence of HCV, universal screening may be an excellent public health intervention to identify asymptomatic HCV-infected patients. Disclosures All authors: No reported disclosures.

scholarly journals The role of emergency department HIV care in resource-poor settings: lessons learned in western Kenya

2008 ◽  
Vol 1 (4) ◽  
pp. 317-320 ◽  
Author(s):  
Michael J. Waxman ◽  
Paul Muganda ◽  
E. Jane Carter ◽  
Neford Ongaro
Keyword(s):  
Emergency Department ◽  
Lessons Learned ◽  
Hiv Care ◽  
Western Kenya ◽  
Resource Poor

scholarly journals Modification of Glasgow-Blatchford scoring with lactate in predicting the mortality of patients with upper gastrointestinal bleeding in emergency department

2018 ◽  
Vol 26 (1) ◽  
pp. 31-38
Author(s):  
Zeynep Konyar ◽  
Ozlem Guneysel ◽  
Fatma Sari Dogan ◽  
Eren Gokdag
Keyword(s):  
Emergency Department ◽  
Blood Transfusion ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Venous Blood ◽  
Erythrocyte Suspension ◽  
Laboratory Findings ◽  
Significant Difference ◽  
Lactate Levels ◽  
Upper Gastrointestinal

Background: Gastrointestinal bleeding is a commonly seen multidisciplinary clinical condition in emergency departments which has high treatment cost and mortality in company with hospital admission. Risk evaluation before endoscopy is based on clinical and laboratory findings at patient’s emergency visit. Objective: The purpose of this study is to investigate the efficacy of “Glasgow-Blatchford scale + lactate levels” to predict the mortality of patients detected with gastrointestinal bleeding in the emergency department. Methods: A total of 107 patients with preliminary diagnosis of upper gastrointestinal bleeding included in the study after approval of the ethics committee were prospectively evaluated. Glasgow-Blatchford scale scores were calculated and venous blood lactate levels were assessed. Need for blood transfusion in the follow-up, the amount of transfusion, and mortality in the next 6 months were evaluated. Results: A statistically significant difference was found in mortality rates between the lactate and Glasgow-Blatchford scale cohorts in our study (p = 0.001 and p < 0.01, respectively). The mortality rate was significantly higher in the lactate(+) GBS(+) cases compared to the lactate(–) GBS(+), lactate(+) GBS(–), and lactate(–) GBS(–) cases compared to the bilateral comparisons (p = 0.004, p = 0.001, p = 0.001, and p < 0.01, respectively). There was a statistically significant relationship between the rate of erythrocyte suspension replacement in the cases according to Glasgow-Blatchford scale levels (p = 0.001 and p < 0.01, respectively). The incidence of erythrocyte suspension replacement was 7.393 times greater in patients with Glasgow-Blatchford scale score of 12 and above. Conclusion: Glasgow-Blatchford scale is highly sensitive to the determination of mortality risk and the need for blood transfusion in upper gastrointestinal bleeding. Glasgow-Blatchford scale with lactate evaluation is more sensitive and more significant than Glasgow-Blatchford scale alone. This significance provides us to establish “modified Glasgow-Blatchford scale.” In the future, studies which will use Glasgow-Blatchford scale supported by lactate could be increased and the results should be supported more.

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