Use of the Emergency Room in a Community Hospital

Intravenous alteplase (i.v. t-PA) for ischemic stroke is most effective when given early after stroke onset. The current national treatment initiative, Target:Stroke aims to administer i.v. t-PA within 60 minutes of patient’s arrival to the ED. This goal is challenging for community based primary stroke centers that do not have 24 hours in-house neurologists or radiologists and who are not able to mix alteplase in the ED. In 2010, we conducted a focused review of Stroke Alert Timelines in two community based Primary Stroke Centers in Santa Clara, California. This review led to the hypothesis that door-to-needle times for i.v. alteplase in ischemic stroke could be reduced by improving communication between key responders and by expediting the delivery of i.v. alteplase from pharmacy to the ED. METHODS: In January 2011 we implemented a new Emergency Room protocol for management of patients with acute ischemic stroke ( Fig ) and compared its performance with recent historical data in two community hospital based PSCs. This protocol emphasizes prompt communication between ED physician, on-call neurologist and radiology and expedites the delivery of i.v. alteplase to the ED. FINDINGS: The average door to needle time for patients treated between January 2009 and December 2010 was 89.5 ± 35.7 min (median 77 min). During this period, two patients (3.1%) received the drug within 60 minutes of arrival to the ED. The average door to needle time for patients treated between January 2011 and July 2011, was 70.7 ± 28.9 min, (median 60 min, p < 0.02). During this period, fourteen patients (58.3%) received i.v. t-PA within 60 minutes of arrival to the ED. CONCLUSION: an improved management protocol that optimizes communication between ED physician, neurologist, radiologist and pharmacy and makes alteplase promptly available at bedside, can significantly improve the door to needle time for i.v. alteplase in community hospital based primary stroke centers.

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Factors Associated with Pediatric Emergency Room Utilization in an Urban Community Hospital in Santiago, Dominican Republic

Annals of Global Health ◽

10.5334/aogh.2327 ◽

2019 ◽

Vol 85 (1) ◽

Author(s):

Allison Lockwood ◽

Aparna Dandekar ◽

Margaret Arias ◽

Massiel Ovalles ◽

Suzanne Bentley

Keyword(s):

Dominican Republic ◽

Emergency Room ◽

Community Hospital ◽

Urban Community ◽

Pediatric Emergency ◽

Factors Associated

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A Comparative Analysis of Emergency Room Utilization Before and After TRICARE Implementation at Reynolds Army Community Hospital Fort Sill, Oklahoma.

10.21236/ada324269 ◽

1996 ◽

Author(s):

James M. Gamerl

Keyword(s):

Comparative Analysis ◽

Emergency Room ◽

Community Hospital ◽

Before And After

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Emergency room experience in a community hospital

The American Journal of Surgery ◽

10.1016/0002-9610(59)90261-2 ◽

1959 ◽

Vol 97 (5) ◽

pp. 663-666

Author(s):

Earl B. Sanborn

Keyword(s):

Emergency Room ◽

Community Hospital

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Now It's the Nurse Who Needs Emergency Care

Nursing, Law & Ethics ◽

10.1017/s0270663600001928 ◽

1981 ◽

Vol 2 (6) ◽

pp. 3-4

Author(s):

David B. Wilson

Keyword(s):

Social Change ◽

Emergency Room ◽

Emergency Care ◽

Women's Movement ◽

Community Hospital ◽

Nursing Shortage ◽

Family Doctor ◽

Feminist Literature ◽

Research Analysis ◽

Attractive Woman

She is an attractive woman around 30 with two sons, the same husband she started out with, their mortgage (not the same one they started out with), and a license to practice nursing in Massachusetts.And her story, anonymous but otherwise undisguised, will tell you more about the nursing shortage, the women's movement, the Medicaid crisis, the conservative revival and social change in America than any compilation of research, analysis, punditry and feminist literature. She is angry and the only reason she is going to take it any more is that she has not discovered a decent alternative.She works odd, inflexible hours, some nights and Sundays, in the emergency room of a community hospital outside Boston. It is the kind of place to which your kindly old family doctor, interrupting a weekend frolic with the new cookie, refers his less affluent patients.

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