Scheduling Non-Urgent Patient Transportation While Maximizing Emergency Coverage

P. L. van den Berg; J. T. van Essen

doi:10.1287/trsc.2018.0823

Risk Stratification in Acute Pulmonary Embolism: The Latest Algorithms

Seminars in Respiratory and Critical Care Medicine ◽

10.1055/s-0041-1722898 ◽

2021 ◽

Vol 42 (02) ◽

pp. 183-198

Author(s):

Georgios A. Triantafyllou ◽

Oisin O'Corragain ◽

Belinda Rivera-Lebron ◽

Parth Rali

Keyword(s):

Pulmonary Embolism ◽

Risk Stratification ◽

Prediction Models ◽

Bleeding Risk ◽

Hemodynamic Instability ◽

Reperfusion Therapy ◽

Mortality Prediction ◽

Risk Scores ◽

Short Term Mortality ◽

Urgent Patient

AbstractPulmonary embolism (PE) is a common clinical entity, which most clinicians will encounter. Appropriate risk stratification of patients is key to identify those who may benefit from reperfusion therapy. The first step in risk assessment should be the identification of hemodynamic instability and, if present, urgent patient consideration for systemic thrombolytics. In the absence of shock, there is a plethora of imaging studies, biochemical markers, and clinical scores that can be used to further assess the patients' short-term mortality risk. Integrated prediction models incorporate more information toward an individualized and precise mortality prediction. Additionally, bleeding risk scores should be utilized prior to initiation of anticoagulation and/or reperfusion therapy administration. Here, we review the latest algorithms for a comprehensive risk stratification of the patient with acute PE.

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P072: Exploring definitions of “unnecessary care” in emergency medicine: a qualitative analysis of physician survey responses

CJEM ◽

10.1017/cem.2017.274 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S102-S103

Author(s):

L. Krebs ◽

L. Gaudet ◽

L.B. Chartier ◽

B.R. Holroyd ◽

S. Dowling ◽

...

Keyword(s):

Qualitative Analysis ◽

System Level ◽

Free Text ◽

Emergency Physicians ◽

System Failures ◽

Canadian Association ◽

Urgent Patient ◽

Definition Of ◽

Evidenced Based ◽

Survey Responses

Introduction: Recently, campaigns placing considerable emphasis on improving emergency department (ED) care by reducing unnecessary tests, treatments, and/or procedures have been initiated. This study explored how Canadian emergency physicians (EPs) conceptualize unnecessary care in the ED. Methods: An online 60-question survey was distributed to EP-members of the Canadian Association of Emergency Physicians (CAEP) with valid emails. The survey explored respondents awareness/support for initiatives to improve ED care (i.e., reduce unnecessary tests, treatments and/or procedures) and asked respondents to define “unnecessary care” in the ED. Thematic qualitative analysis was performed on these responses to identify key themes and sub-themes and explore variation among EPs definitions of unnecessary care. Results: A total of 324 surveys were completed (response rate: 18%); 300 provided free-text definitions of unnecessary care. Most commonly, unnecessary ED care was defined as: 1) performing tests, treatments, procedures, and/or consults that were not indicated or potentially harmful (n=169) and/or 2) care that should have been provided within a non-emergent context for a non-urgent patient (n=143). Emergency physicians highlighted the role of system-level factors and system failures that result in ED presentations as definitions of unnecessary care (n=69). They also noted a distinction between providing necessary care for a non-urgent patient and performing inappropriate/non-evidenced based care. Finally, a tension emerged in their description of frustration with patient expectations (n=17) and/or non-ED referrals (n=24) for specific tests, treatments, and/or procedures. These frustrations were juxtaposed by participants who asserted that “in a patient-centred care environment, no care is unnecessary” (Participant 50; n=12). Conclusion: Variation in the definition of unnecessary ED care is evident among EPs and illustrates that EPs’ conceptualization of unnecessary care is more nuanced than current campaigns addressing ED care improvements represent. This may contribute to a perceived lack of uptake or support for these initiatives. Further exploring EPs perceptions of these campaigns has the potential to improve EP engagement and influence the language utilized by these programs.

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Assessment of emergency physician knowledge of spinal cord medicine: managing the urgent patient

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2004.07.265 ◽

2004 ◽

Vol 44 (4) ◽

pp. S80-S81

Author(s):

M.T. Edwards ◽

C.M. Curtin ◽

K.G. Engel ◽

T. Kowalenko

Keyword(s):

Spinal Cord ◽

Emergency Physician ◽

Physician Knowledge ◽

Urgent Patient

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Can Paramedics Safely Refuse Transport of Non-Urgent Patients?

Prehospital and Disaster Medicine ◽

10.1017/s1049023x16000935 ◽

2016 ◽

Vol 31 (6) ◽

pp. 667-674 ◽

Cited By ~ 5

Author(s):

Alex J. Fraess-Phillips

Keyword(s):

Publication Type ◽

Pilot Studies ◽

Care Services ◽

Manual Search ◽

Emergency Department Staff ◽

Triage Protocol ◽

Urgent Patient ◽

Narrative Literature ◽

Primary Care Patients ◽

Narrative Literature Review

AbstractObjectiveThe goal of this search was to review the current literature regarding paramedic triage of primary care patients and the safety of paramedic-initiated non-transport of non-urgent patients.MethodsA narrative literature review was conducted using the Medline (Medline Industries, Inc.; Mundelein, Illinois USA) database and a manual search of Google Scholar (Google; Mountain View, California USA).ResultsOnly 11 studies were found investigating paramedic triage and safety of non-transport of non-urgent patients. It was found that triage agreement between paramedic and emergency department staff generally is poor and that paramedics are limited in their abilities to predict the ultimate admission location of their patients. However, these triage decisions and admission predictions are much more accurate when the patient’s condition is the result of trauma and when the patient requires critical care services. Furthermore, the literature provides very limited support for the safety of paramedic triage in the refusal of non-urgent patient transport, especially without physician oversight. Though many non-transported patients are satisfied with the quality of non-urgent treatment that they receive from paramedics, the rates of under-triage and subsequent hospitalization reported in the literature are too high to suggest that this practice can be adopted widely.ConclusionThere is insufficient evidence to suggest that non-urgent patients can safely be refused transport based on paramedic triage alone. Further attempts to implement paramedic-initiated non-transport of non-urgent patients should be approached with careful triage protocol development, paramedic training, and pilot studies. Future primary research and systematic reviews also are required to build on the currently limited literature.Fraess-PhillipsAJ. Can paramedics safely refuse transport of non-urgent patients?Prehosp Disaster Med. 2016;31(6):667–674.

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Use of a Novel Application to Optimize Aircraft Utilization for Non-Urgent Patient Transfers

Air Medical Journal ◽

10.1016/j.amj.2011.07.009 ◽

2011 ◽

Vol 30 (5) ◽

pp. 255 ◽

Cited By ~ 2

Author(s):

Russell MacDonald ◽

Mahvareh Ahghari ◽

Tim A. Carnes ◽

Shane G. Henderson ◽

David B. Shmoys

Keyword(s):

Patient Transfers ◽

Urgent Patient

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Night-time communication at Stanford University Hospital: perceptions, reality and solutions

BMJ Quality & Safety ◽

10.1136/bmjqs-2017-006727 ◽

2017 ◽

Vol 27 (2) ◽

pp. 156-162 ◽

Cited By ~ 4

Author(s):

Andrew Jordan Sun ◽

Libo Wang ◽

Minjoung Go ◽

Zac Eggers ◽

Raymond Deng ◽

...

Keyword(s):

University Hospital ◽

Night Time ◽

Record System ◽

Alarm Fatigue ◽

Charge Nurses ◽

Patient Status ◽

Resident Work ◽

Urgent Patient ◽

Work Hour ◽

Priority Order

BackgroundResident work hour restrictions have led to the creation of the ‘night float’ to care for the patients of multiple primary teams after hours. These residents are often inundated with acute issues in the numerous patients they cover and are less able to address non-urgent issues that arise at night. Further, non-urgent pages may contribute to physician alarm fatigue and negatively impact patient outcomes.ObjectiveTo delineate the burden of non-urgent paging at night and propose solutions.MethodsWe performed a resident review and categorisation of 1820 pages to night floats between September 2014 and December 2014. Both attending and nursing review of 10% of pages was done and compared.ResultsOf reviewed pages, 62.1% were urgent and 27.7% were non-urgent. Attending review of random page samples correlated well with resident review. Common reasons for non-urgent pages were non-urgent patient status updates, low-priority order requests and non-critical lab values.ConclusionsA significant number of non-urgent pages are sent at night. These pages likely distract from acute issues that arise at night and place an unnecessary burden on night floats. Both behavioural and systemic adjustments are needed to address this issue. Possible interventions include integrating low-priority messaging into the electronic health record system and use of charge nurses to help determine urgency of issues and batch non-urgent pages.

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Can Surgical Registrars Accurately Identify the Urgent from the Non-Urgent Patient Presenting with Acute Abdominal Pain?

European Surgical Research ◽

10.1159/000496021 ◽

2019 ◽

Vol 60 (1-2) ◽

pp. 24-30 ◽

Cited By ~ 1

Author(s):

Kirsten J. de Burlet ◽

Anna B.M. Lam ◽

Simon J. Harper ◽

Peter D. Larsen ◽

Elizabeth R. Dennett

Keyword(s):

Abdominal Pain ◽

Patient Outcomes ◽

Acute Abdominal Pain ◽

Final Diagnosis ◽

Initial Assessment ◽

Wide Range ◽

Urgent Patient ◽

Hospital Resources ◽

A Prospective Study ◽

Diagnostic Skill

Background: Acute abdominal pain is a common surgical presentation with a wide range of causes. Differentiating urgent patients from non-urgent patients is important to optimise patient outcomes and the use of hospital resources. The aim of this study was to determine how accurately urgent and non-urgent patients presenting with abdominal pain can be identified. Methods: A prospective study of consecutive patients admitted with abdominal pain was undertaken. Urgent patients were classified as requiring treatment (theatre, intensive care unit, endoscopy, or radiologic drainage) within 24 h. Differentiation between urgent and non-urgent was made on the basis of the initial assessment prior to the use of advanced imaging. Outcomes were compared to a final classification based on final diagnosis as adjudicated by an expert panel. Results: Of the 301 patients included, 93 (30.9%) were deemed urgent based on initial assessment, compared to 83 (27.6%) on final diagnosis. Overall sensitivity for recognising urgent patients was 74.7% and specificity 89.9%, and overall accuracy was higher for senior registrars compared to junior registrars (p = 0.015). Urgent patients more often looked unwell or had peritonism on examination (39.8 vs. 17.4% and 56.6 vs. 14.7%, respectively, p < 0.001 for both). Conclusions: Registrars can accurately differentiate urgent from non-urgent patients with acute abdominal pain in the majority of cases. Accuracy was higher amongst senior registrars. The “end-of-the-bed-o-gram” and clinical examination are the most important features used for making this differentiation. This demonstrates that there is no substitute for exposure to acute presentations to improve a trainee’s diagnostic skill.

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A local dental network approach to COVID-19 pandemic: innovation through collaboration

Primary Dental Journal ◽

10.1177/2050168420980979 ◽

2020 ◽

pp. 205016842098097

Author(s):

Simon Hearnshaw ◽

Stefan Serban ◽

Imran Suida ◽

Mohammed Ajmal Zubair ◽

Deksha Jaswal ◽

...

Keyword(s):

Geographical Area ◽

Critical Evaluation ◽

Integrated Network ◽

Policy Makers ◽

Care Services ◽

Large Geographical Area ◽

Urgent Patient ◽

Collaborative Structures ◽

Set Up ◽

The Uk

The coronavirus pandemic has had significant effects on individuals, healthcare systems and governments. In the UK, whilst routine dentistry was suspended, an urgent dental care system was required to support urgent patient need. Using an adapted model of Donabedians’ framework, a critical evaluation of the services developed and implemented is provided and the various innovative approaches involved in this work are discussed. The three domains of the framework are structure, process and outcome. Structure: We present the principles for selecting and initiating hubs, the integration with secondary care services and the supply of personal protective equipment. Process: The main elements are communication, the development of referral processes to manage complex cases and data collection. Outcome: Through work with local dental stakeholders, 23 clusters and 36 hubs were set up covering a large geographical area. The integrated network of hubs and clusters has strengthened collaboration between providers and policy makers. Various leadership approaches facilitated the readiness for the transition to recovery. The new local collaborative structures could be used to support local programmes such as flexible commissioning, peer-led learning and integration with primary care networks.

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