Emergency Health Care Research Articles

Advance directives in the emergency department–a systematic review of the status quo

BackgroundProviding individualised healthcare in line with patient wishes is a particular challenge for emergency healthcare professionals. Documentation of patient wishes (DPW), e.g. as advance directives, can guide clinicians in making end-of-life decisions that respect the patient’s wishes and autonomy. However, patient centered decisions are hindered by limited availability of DPWs in emergency settings.ObjectiveThis systematic review aims to congregate present data on recorded rates for DPW existence and availability in the emergency department (ED) as well as contributing factors for these rates.MethodsWe searched MEDLINE, Google Scholar, Embase and Web of Science databases in September 2023. Publications providing primary quantitative data on DPW in the ED were assessed. Publications referring only to a subset of ED patients (other than geriatric) and investigating DPW issued after admission were excluded.ResultsA total of 22 studies from 1996 to 2021 were included in the analysis. Most were from the US (n = 12), followed by Australia (n = 4), Canada (n = 2), South Korea, Germany, the United Kingdom and Switzerland (n = 1 each). In the general adult population presenting to the ED, 19.9–27.8% of patients reported having some form of DPW, but only in 6.8% or less it was available on presentation. In the geriatric population, DPW rates (2.6–79%) as well as their availability (1.1–48.8%) varied widely. The following variables were identified as positive predictors of having DPW, among others: higher age, poorer overall health, as well as sociodemographic factors, such as female gender, having children, being in a relationship, higher level of education or a recent previous presentation to hospital.ConclusionsExistence and availability of a recorded DPW among ED patients was low in general and even in geriatric populations mostly well below 50%. While we were able to gather data on prevalence and predictors, this was limited by heterogeneous data. We believe further research is needed to explore the quality of DPW and measures to increase both rates of existence and availability of DPW in the ED.

Evaluating the impact of genomic epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) on hospital infection prevention and control decisions.

Genomic epidemiology enhances the ability to detect and refute methicillin-resistant Staphylococcus aureus (MRSA) outbreaks in healthcare settings, but its routine introduction requires further evidence of benefits for patients and resource utilization. We performed a 12 month prospective study at Cambridge University Hospitals NHS Foundation Trust in the UK to capture its impact on hospital infection prevention and control (IPC) decisions. MRSA-positive samples were identified via the hospital microbiology laboratory between November 2018 and November 2019. We included samples from in-patients, clinic out-patients, people reviewed in the Emergency Department and healthcare workers screened by Occupational Health. We sequenced the first MRSA isolate from 823 consecutive individuals, defined their pairwise genetic relatedness, and sought epidemiological links in the hospital and community. Genomic analysis of 823 MRSA isolates identified 72 genetic clusters of two or more isolates containing 339/823 (41 %) of the cases. Epidemiological links were identified between two or more cases for 190 (23 %) individuals in 34/72 clusters. Weekly genomic epidemiology updates were shared with the IPC team, culminating in 49 face-to-face meetings and 21 written communications. Seventeen clusters were identified that were consistent with hospital MRSA transmission, discussion of which led to additional IPC actions in 14 of these. Two outbreaks were also identified where transmission had occurred in the community prior to hospital presentation; these were escalated to relevant IPC teams. We identified 38 instances where two or more in-patients shared a ward location on overlapping dates but carried unrelated MRSA isolates (pseudo-outbreaks); research data led to de-escalation of investigations in six of these. Our findings provide further support for the routine use of genomic epidemiology to enhance and target IPC resources.

Knowledge and Confidence Level among Emergency Healthcare Workers in Airway Management and Resuscitation of Suspected Covid-19 Patients: A Cross-Sectional Study in Penang and Kelantan

INTRODUCTION: COVID-19 cases in Malaysia have followed a never-ending course of spike and fall since it was first detected. Though the prominent role of infection control standard precautions were strictly applied, cases among emergency healthcare workers (EHCW) contracting the disease continue to rise. Our study aims to evaluate the knowledge and confidence level and the factors that may influence the knowledge and confidence level among EHCW in airway management and resuscitation of suspected COVID-19 patients. MATERIALS AND METHODS: This was a cross-sectional study conducted in tertiary hospitals in Penang and Kelantan using a validated questionnaire. The territories evaluated include the possible method of transmission, proper steps during resuscitation, airway management and intubation, intensive care management, and etiquette of personal protective equipment. RESULTS: Out of 543 EHCW eligible for the study, only 300 participants responded to the questionnaire. Our study showed only 15.3% of respondents had good knowledge and 62.3% had high confidence in airway management and resuscitation of suspected COVID-19 patients. Significant associations were seen in knowledge and confidence level among respondents with previous experience attending continuing medical education (F=7.041, P=0.008 and F=19.398, P<0.001 respectively). Significant associations were also demonstrated in confidence level among respondents with previous simulation training experience (F=13.905, P<0.001). CONCLUSION: Our study revealed that most EHCW had poor knowledge and moderately adequate confidence in the airway management and resuscitation of suspected COVID-19 patients. A more comprehensive and strategized training program needs to be conducted to help in improvement of the knowledge and confidence level among EHCW.

Adverse childhood event subtypes and routine diabetes care utilization among U.S. adults with Type 2 diabetes.

Adverse childhood events (ACEs) have significant impacts on adulthood health, including greater risk of Type 2 diabetes (T2D). While there is a known connection to increased use of outpatient and emergency healthcare services, the potential role of ACEs in routine diabetes care utilization remains unclear. This study uses ACE subtypes to explain pathways to routine diabetes care utilization among adults with T2D. Cross-sectional data were obtained from the 2019 Behavioral Risk Factor Surveillance System, a survey of a representative sample of U.S. adults. Eligible participants resided in a state that completed both the Adverse Childhood Experiences (ACEs) and Diabetes modules and were diagnosed with non-gestational diabetes (N = 9,904), of whom the majority were presumed to have T2D. Confirmatory factor analysis was used to test the measurement model for three ACE factors: household dysfunction, physical and emotional abuse, and sexual abuse. Structural equation modeling was used to relate factors to four routine diabetes care utilization outcomes. Factor loadings were strong, and fit indices indicated good measurement model and full structural model fits. In the full structural equation model, household dysfunction was associated with decreased likelihood of meeting frequency recommendations for A1C testing (β = -0.22, p < .05) and foot exams (β = -0.29, p < .01). Physical and emotional abuse were associated with greater likelihood of meeting A1C testing frequency recommendations (β = 0.21, p < .05). Specific types of ACEs may differentially relate to routine diabetes care utilization in adulthood. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Evaluation of different models of general practitioners working in or alongside emergency departments: a mixed-methods realist evaluation.

Emergency healthcare services are under intense pressure to meet increasing patient demands. Many patients presenting to emergency departments could be managed by general practitioners in general practitioner-emergency department service models. To evaluate the effectiveness, safety, patient experience and system implications of the different general practitioner-emergency department models. Mixed-methods realist evaluation. Phase 1 (2017-8), to understand current practice: rapid realist literature review, national survey and follow-up key informant interviews, national stakeholder event and safety data analysis. Phase 2 (2018-21), to collect and analyse qualitative (observations, interviews) and quantitative data (time series analysis); cost-consequences analysis of routine data; and case site data for 'marker condition' analysis from a purposive sample of 13 case sites in England and Wales. Phase 3 (2021-2), to conduct mixed-methods analysis for programme theory and toolkit development. General practitioners commonly work in emergency departments, but delivery models vary widely in terms of the scope of the general practitioner role and the scale of the general practitioner service. We developed a taxonomy to describe general practitioner-emergency department service models (Integrated with the emergency department service, Parallel within the emergency department, Outside the emergency department on the hospital site) and present a programme theory as principal output of the study to describe how these service models were observed to operate. Routine data were of variable quality, limiting our analysis. Time series analysis demonstrated trends across intervention sites for: increased time spent in the emergency department; increased emergency department attendances and reattendances; and mixed results for hospital admissions. Evidence on patient experience was limited but broadly supportive; we identified department-level processes to optimise the safety of general practitioner-emergency department models. The quality, heterogeneity and extent of routine emergency department data collection during the study period limited the conclusions. Recruitment was limited by criteria for case sites (time series requirements) and individual patients (with 'marker conditions'). Pandemic and other pressures limited data collection for marker condition analysis. Data collected and analysed were pre pandemic; new approaches such as 'telephone first' and their relevance to our findings remains unexplored. Findings suggest that general practitioner-emergency department service models do not meet the aim of reducing the overall emergency department waiting times and improving patient flow with limited evidence of cost savings. Qualitative data indicated that general practitioners were often valued as members of the wider emergency department team. We have developed a toolkit, based on our findings, to provide guidance for implementing and delivering general practitioner-emergency department services. The emergency care data set has since been introduced across England to help standardise data collection to facilitate further research. We would advocate the systematic capture of patient experience measures and patient-reported outcome measures as part of routine care. More could be done to support the development of the general practitioner in emergency department role, including a core set of competencies and governance structure, to reflect the different general practitioner-emergency department models and to evaluate the effectiveness and cost effectiveness to guide future policy. This study is registered as PROSPERO CRD42017069741. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 15/145/04) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 10. See the NIHR Funding and Awards website for further award information.

A qualitative assessment of barriers and facilitators of telemedicine volunteerism during the COVID-19 pandemic in India

BackgroundThe COVID-19 pandemic further propelled the recent growth of telemedicine in low-resource countries, with new models of telemedicine emerging, including volunteer-based telemedicine networks. By leveraging existing infrastructure and resources to allocate health personnel more efficiently, these volunteer networks eased some of the pandemic burden placed on health systems. However, there is insufficient understanding of volunteer-based telemedicine models, especially on the human resources engagement on such networks. This study aims to understand the motivations and barriers to health practitioner engagement on a volunteer telemedicine network during COVID-19, and the mechanisms that can potentially sustain volunteer engagement to address healthcare demands beyond the pandemic.MethodsIn-depth qualitative interviews were conducted with health practitioners volunteering on an Indian, multi-state telemedicine network during the COVID-19 pandemic. Data were analyzed using thematic content analysis methods.ResultsMost practitioners reported being motivated to volunteer by a sense of duty to serve during the pandemic. Practitioners suggested organizational-level measures to make the process more efficient and facilitate a more rewarding provider–patient interaction. These included screening calls, gathering patient information prior to consultations, and allowing for follow-up calls with patients to close the loop on consultations. Many practitioners stated that non-financial incentives are enough to maintain volunteer engagement. However, practitioners expressed mixed feelings about financial incentives. Some stated that financial incentives are needed to maintain long-term provider engagement, while others stated that financial incentives would devalue the volunteer experience. Most practitioners highlighted that telemedicine could increase access to healthcare, especially to the rural and underserved, even after the pandemic. Practitioners also expressed an interest in continuing to volunteer with the network if the need arose again.ConclusionOur study findings suggest that practitioners are highly intrinsically motivated to volunteer during large healthcare emergencies and beyond to address the healthcare needs of the underserved. Following the recommendations presented in the study, telemedicine networks can more successfully engage and maintain volunteer practitioners. Volunteer-based telemedicine networks have the potential to bridge shortages of health personnel in resource-constrained settings both in times of crises and beyond.

Enhancing emergency medical response through IoT: A focus on security and privacy

The healthcare industry is globally crucial. With an increasing demand for quality services, there is a need for innovative technologies like the Internet of Things (IoT) to enhance rapid and effective emergency response. This research explores IoT applications in emergency healthcare response, focusing on theoretical frameworks and design principles. It investigates the integration of IoT technologies into these systems while prioritising data security and privacy without relying on experimental data. The study offers innovative ideas for future research, highlighting the significance of addressing privacy and ethics in healthcare IoT usage. It emphasises protecting sensitive health data and promoting responsible IoT implementation in emergency healthcare settings. In conclusion, the study affirms the potential of IoT in enhancing emergency healthcare responses while emphasising the necessity of addressing privacy and ethical concerns within healthcare applications of these technologies. This research seeks to contribute to the ongoing development of IoT in healthcare by emphasising the importance of safeguarding patient information and ensuring that ethical considerations are at the forefront of implementation efforts.

Coronavirus Disease 2019 Infections Among Emergency Health Care Personnel: Impact on Delivery of United States Emergency Medical Care, 2020

ObjectiveIn the early months of the COVID-19 pandemic and prior to vaccine availability, there were concerns that infected emergency department (ED) healthcare personnel (HCP) could present a threat to the delivery of emergency medical care. We examined how the pandemic affected staffing levels and whether COVID-19 positive staff were potentially infectious at work in a cohort of U.S. ED HCP in 2020. MethodsThe COVID-19 Evaluation of Risks in Emergency Departments (Project COVERED) project was a multicenter prospective cohort study of U.S. ED HCP conducted from May to December 2020. During surveillance, HCP completed weekly electronic surveys and underwent periodic serology and nasal RT-PCR testing for SARS-CoV-2, and investigators captured weekly data on healthcare facility COVID prevalence and HCP staffing. Surveys asked about symptoms, potential exposures, work attendance, personal protective equipment (PPE) use, and behaviors. ResultsWe enrolled 1,673 HCP who completed 29,825 person-weeks of surveillance. Eighty-nine (5.3%) HCP documented 90 (0.3%; 95% CI 0.2-0.4%) person-weeks of missed work related to documented or concerns for COVID-19 infection. HCP experienced symptoms of COVID-19 during 1,256 (4.2%) person-weeks and worked at least one shift while symptomatic during 1,042 (83.0%) of these periods. Seventy-five (4.5%) participants tested positive for SARS-CoV-2 during the surveillance period, including 43 (57.3%) who indicated they never experienced symptoms; 74 (98.7%; 95% CI 90.7%-99.9%) infected HCP worked at least one shift during the initial period of infection, and 71 (94.7%) continued working until laboratory confirmation of their infection. Physician staffing was not associated with the facility or community COVID-19 levels within any time frame studied (Kendall tau’s 0.02, 0.056, and 0.081 for no shift, one-week time-shift, and two-week time shift, respectively). ConclusionDuring the first wave of the pandemic, COVID-19 infections in ED HCP were infrequent, and the time lost from the workforce was minimal. HCP frequently reported for work while infected with SARS-CoV-2 prior to lab confirmation. ED staffing levels were poorly correlated with facility and community COVID-19 burden.

Emotional burnout, job satisfaction, and intention to leave among pre-hospital emergency healthcare workers during the COVID-19 pandemic.

With the onset of the COVID-19 pandemic, pre-hospital emergency healthcare workers (PHEHW) assumed critical responsibilities in controlling and preventing the spread of the virus. This descriptive study aimed to explore the emotional burnout, job satisfaction, and intention to leave among PHEHW during the COVID-19 pandemic. The study was conducted with 401 emergency medical technicians and paramedics. The Sociodemographic Data Form, the Emotional Burnout Scale, the Job Satisfaction Scale, the Intention to Leave the Profession Scale were used to collect data. The findings were assessed with a significance level set at p < 0.05 and a 95% confidence interval. The participants demonstrated moderate scores in emotional burnout, job satisfaction, and intention to leave the profession. The analysis revealed a negative correlation, indicating that as emotional burnout increased, job satisfaction decreased, and the intention to leave the profession heightened. Notably, the participants who had 6-9 years of service, lacked knowledge about COVID-19, had no COVID-19 training, underwent COVID-19 testing, and experienced the loss of a healthcare worker due to COVID-19 exhibited higher levels of burnout. Furthermore, those who had 6-9 years of service, lacked knowledge about COVID-19, had no COVID-19 training, and lost a healthcare worker due to COVID-19 reported lower levels of job satisfaction. Additionally, participants who had 6-9 years of service, lacked knowledge about COVID-19, had no COVID-19 training, and experienced the loss of a healthcare worker due to COVID-19 displayed a greater intention to leave the profession. It is important to implement improvement initiatives that will increase the motivation and job satisfaction of PHEHW. These include the regulation of working hours and shifts, augmenting staff numbers, enhancing working conditions, improving salaries, and implementing strategies aimed at fostering motivation and job satisfaction.

The epidemiological profile of incidence and mortality from epidemics in complex humanitarian emergencies from 1990 to 2022 - A scoping review.

This study aimed to investigate the impact of communicable diseases with epidemic potential in complex emergency (CE) situations, focusing on the epidemiological profile of incidence and mortality and exploring underlying factors contributing to increased epidemic risks. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Review (PRISMA-ScR) guidelines, we conducted a scoping review of articles published between 1990 and 2022. The search included terms related to complex emergencies, communicable diseases, outbreaks, and epidemics. We identified 92 epidemics related to CE occurring in 32 different countries. Communicable diseases like Shigellosis, Cholera, Measles, Meningococcal meningitis, Yellow Fever, and Malaria caused significant morbidity and mortality. Diarrhoeal diseases, particularly Cholera and Shigellosis, had the highest incidence rates. Shigella specifically had an incidence of 241.0 per 1000 (people at risk), with a mortality rate of 11.7 per 1000, while Cholera's incidence was 13.0 per 1000, with a mortality rate of 0.22 per 1000. Measles followed, with an incidence of 25.0 per 1000 and a mortality rate of 0.76 per 1000. Meningococcal Meningitis had an incidence rate of 1.3 per 1000 and a mortality rate of 0.13 per 1000. Despite their lower incidences, yellow fever at 0.8 per 1000 and malaria at 0.4 per 1000, their high case fatality rates of 20.1% and 0.4% remained concerning in CE. The qualitative synthesis reveals that factors such as water, sanitation, and hygiene, shelter and settlements, food and nutrition, and public health and healthcare in complex emergencies affect the risk of epidemics. Epidemics during complex emergencies could potentially lead to a public health crisis. Between 1990 and 2022, there have been no statistically significant changes in the trend of incidence, mortality, or fatality rates of epidemic diseases in CE. It is crucial to understand that all epidemics identified in CE are fundamentally preventable.

Co-located Heroin Assisted Treatment within primary care: A preliminary analysis of the implications for healthcare access, cost, and treatment delivery in the UK

BackgroundThe UK is experiencing its highest rate of drug related deaths in 25 years. Poor and inconsistent access to healthcare negatively impacts health outcomes for people who use drugs. Innovation in models of care which promote access and availability of physical treatment is fundamental. Heroin Assisted Treatment (HAT) is a treatment modality targeted at the most marginalised people who use drugs, at high risk of mortality and morbidity. The first service-provider initiated HAT service in the UK ran between October 2019 and November 2022 in Middlesbrough, England. The service was co-located within a specialist primary care facility offering acute healthcare treatment alongside injectable diamorphine. MethodsAnalysis of anonymised health records for healthcare costs (not including drug treatment) took place using descriptive statistics prior and during engagement with HAT, at both three (n=15) and six (n=12) months. Primary outcome measures were incidents of wound care, skin and soft tissue infections (SSTIs), overdose (OD) events, unplanned overnight stays in hospital, treatment engagement (general and within hospital care settings) and ambulance incidents. Secondary outcome measures were costs associated with these events. ResultsA shift in healthcare access for participants during HAT engagement was observed. HAT service attendance appeared to support health promoting preventative care, and reduce reactive reliance on emergency healthcare systems. At three and six months, engagement for preventative wound care and treatment for SSTIs increased at the practice. Unplanned emergency healthcare interactions for ODs, overnight hospital stays, serious SSTIs, and ambulance incidents reduced, and there was an increase in treatment engagement (i.e. a reduction in appointments which were not engaged with). There was a decrease in treatment engagement in hospital settings. Changes in healthcare utilisation during HAT translated to a reduction in healthcare costs of 58% within six months compared to the same timeframe from the period directly prior to commencing HAT. ConclusionThis exploratory study highlights the potential for innovative harm reduction interventions such as HAT, co-located with primary care services, to improve healthcare access and engagement for a high-risk population. Increased uptake of primary healthcare services translated to reductions in emergency healthcare use and associated costs. Although costs of HAT provision are substantial, the notable cost-savings in health care should be an important consideration in service implementation planning.

Impact of the COVID-19-pandemic and perception of self-efficacy on the mental health of out-of-hospital emergency healthcare professionals by modality of care.

To analyse the influence of the COVID-19 pandemic and the perception of self-efficacy on the health professionals of the Spanish out-of-hospital emergency services. Observational, cross-sectional and descriptive with a survey methodology of 1710 participants from Spain (1 February-30 April, 2021). The mental health of healthcare workers was assesed in terms of stress, anxiety and depression, as well as their self-efficacy. Linear and logistic regression models were fitted to predict these variables. A moderation analysis was conducted to determine the effect of self-efficacy on mental health. The means of the sample for stress, anxiety, depression and self-efficacy were 20.60, 15.74, 13.07 and 70.87, respectively. In the regression models, being a woman was the most significant factor for severe mental health impairment. Female gender was also a relevant factor for self-efficacy. Self-efficacy had a direct effect on the mental health for working in patient care. Healthcare workers showed moderate stress, severe anxiety, mild depression and good self-efficacy. Direct patient care was associated with more stress and severe anxiety. Age, female gender, job changes and job adjustment were associated with levels of stress, anxiety and depression. Self-efficacy is a determining factor of mental health in the direct care modality. The mental health of healthcare workers has been of great importance in the aftermath of the pandemic, but out-of-hospital emergency workers have been neglected in research. The levels of stress, anxiety and depression during the pandemic justify the creation of prevention and early diagnosis programmes, as they are essential in a health disaster. Surprisingly, their high level of perceived self-efficacy directly impact on the mental health of patient helthcare workers, so improving it will reduce the psychological risk. We have followed the STROBE guidelines. It has been partially funded by the Asistencia Sanitanitaria Interprovincial de Seguros - ASISA Foundation (Spain). PATIENT OR PUBLIC CONTRIBUTION: 'No patient or public involvement'.

Estimation of Pro-Inflammatory Markers In Night Shift Healthcare Workers And Identify Risk Factors Associated With It

Shift labor, with hours outside of the regular diurnal work cycle, is used to facilitate round-the-clock emergency healthcare services. This impacts the circadian rhythm, which can potentially activate the pro-inflammatory responses of the immune system. This study aimed to find out the levels of pro-inflammatory markers in night shift healthcare workers and find risk factors associated with their increase. 303 participants (doctors, nurses, technicians, health care aids) were recruited with 169 participants nightshift and 134 dayshift workers. Pro-inflammatory markers Highly Sensitive C-Reactive Protein (hsCRP) and Total Leukocyte Count (TLC)] were estimated. Factors were compared by t test, Wilcoxon Rank Sum test and Chi square test. Risk factors for hsCRP elevation were identified by logistic regression analysis. Pro-inflammatory markers like hsCRP and TLC were significantly increased in night shift health workers in comparison to the day shift workers (hsCRP 0.30± 0.33 mg/dl vs 0.10± 0.09 mg/dl, TLC 8181.06± 1181.53 /cu mm vs 7473.80± 1018.81 /cu mm) respectively. Multivariate logistic regression analysis showed night shift work (OR 48.20 95% CI (4.99-465.61), age (OR 1.13 95% CI (1.01-1.26)) and BMI (OR 1.18 95% CI (1.06-1.32)) as independent predictors of elevated hsCRP after adjusting for other risk factors. Hence, night-shift work is an independent risk factor for a rise in pro-inflammatory markers. These findings might aid health care workers and policymakers strategize methods to tackle the challenges through providing support programs, counselling sessions to avoid ailments and deliver health services in a better way.

Towards more realistic measures of accessibility to emergency departments in Sweden

BackgroundAssuring that emergency health care (EHC) is accessible is a key objective for health care planners. Conventional accessibility analysis commonly relies on resident population data. However, the allocation of resources based on stationary population data may lead to erroneous assumptions of population accessibility to EHC.MethodTherefore, in this paper, we calculate population accessibility to emergency departments in Sweden with a geographical information system based network analysis. Utilizing static population data and dynamic population data, we investigate spatiotemporal patterns of how static population data over- or underestimates population sizes derived from temporally dynamic population data.ResultsOur findings show that conventional measures of population accessibility tend to underestimate population sizes particularly in rural areas and in smaller ED’s catchment areas compared to urban, larger ED’s—especially during vacation time in the summer.ConclusionsPlanning based on static population data may thus lead to inequitable distributions of resources. This study is motivated in light of the ongoing centralization of ED’s in Sweden, which largely depends on population sizes in ED’s catchment areas.

Integrating Fall Prevention Strategies into EMS Services to Reduce Falls and Associated Healthcare Costs for Older Adults.

The purpose of this study is to detail the implementation of fall prevention initiatives through emergency medical services (EMS) and associated outcomes. Paramedics with MedStar Mobile Healthcare utilized the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) fall prevention model to screen and direct intervention through 9-1-1 emergency response, High Utilization Group (HUG), and 30-day Hospital Readmission Avoidance (HRA) programs. Outcomes from 9-1-1 calls measured the number of older adults screened for falls and identified risk factors. The HUG and HRA programs measured change in quality of life with EuroQol-5D, referral service utilization, falls, emergent healthcare utilization, and hospital readmission data. Analysis included costs associated with reduced healthcare usage. Emergency paramedics provided fall risk screening for 50.5% (n=45,090) of adults aged 65 and older and 59.3% were at risk of falls, with 48.1% taking medications known to increase the risk of falls. Services provided through the HUG and HRA programs, along with additional needed referral services, resulted in a 37.2% reduction in fall-related 9-1-1 calls and a 29.5% increase in overall health status related to quality of life. Analysis of the HUG program revealed potential savings of over $1 million with a per-patient enrolled savings of $19,053. The HRA program demonstrated a 16.4% hospital readmission rate, in comparison to a regional average of 30.2%, and a cost-savings of $4.95 million or $15,618 per enrolled patient. Implementation of the STEADI model into EMS services provides an effective and cost-saving model for addressing fall prevention for older adults, provides meaningful and impactful improvement for older adults, and could serve as a model for other EMS programs.

Ethical Awareness and Practices Among Emergency Department Personnel in Riyadh's Tertiary Hospitals: A Cross-Sectional Analysis.

Ethical dilemmas in healthcare, particularly in emergency medical services (EMS), present significant challenges for healthcare workers (HCWs), necessitating a profound understanding of ethics and decision-making. This study assesses the ethical awareness and practices among HCWs in emergency departments of tertiary hospitals in Saudi Arabia, aiming to identify areas of strength and opportunities for improvement. A cross-sectional survey was conducted among 256 HCWs, including physicians, nurses, and administrative staff, in emergency departments across tertiary hospitals in Riyadh, Saudi Arabia. The questionnaire evaluated participants' knowledge of healthcare ethics, their experiences with ethical dilemmas, and the sources from which they derived their ethical understanding. The majority of participants exhibited a commendable level of ethical knowledge and practice, with frequent encounters of ethical or legal issues highlighting the pervasive nature of ethical challenges in emergency healthcare settings. Key sources of ethical knowledge included experiential learning and academic lectures, with a notable emphasis on practical experience. Despite the satisfactory level of ethical awareness, areas requiring further educational focus were identified, emphasizing the need for enhanced ethics training tailored to the emergency medical context. The findings underline the critical importance of incorporating ethics into the core of healthcare education and ongoing professional development for HCWs. Establishing a culture of continuous ethical dialogue and learning is essential for fostering patient-centered care and making informed ethical decisions in the fast-paced environment of emergency services. The study advocates for revising current ethics training programs to ensure they are comprehensive, relevant, and accessible, preparing HCWs to effectively address both current and future ethical challenges.

A Critical Evaluation of Government Role in Spatial Data Infrastructures for Healthcare Decision-Making

This study critically examines the government&amp;apos;s pivotal role in promoting and regulating Spatial Data Infrastructures (SDIs), with a special focus on the healthcare sector. Through an in-depth analysis of global practices, our research highlights the indispensable value of SDIs in enhancing healthcare decision-making, emergency management, and public health monitoring by facilitating the integration and analysis of geospatial and healthcare data. Despite the evident benefits, the integration of diverse geospatial data sources poses significant challenges, including issues of data standardization, privacy, and interoperability across various stakeholders. Our findings underscore the balance governments must achieve in promoting SDI growth while ensuring data security, privacy, and open access. The study draws on a comprehensive review of literature and case studies to explore the effectiveness of current government strategies in advancing SDI capabilities, while also addressing the ethical considerations and potential barriers to innovation that stringent regulation might impose. By advocating for a collaborative ecosystem that supports data standardization alongside flexibility for innovation, this paper aims to provide insights into how governments can optimize the utility of spatially enabled data in healthcare and beyond. Our conclusion calls for strategic government action to promote a balanced approach to SDI governance, highlighting the importance of public-private partnerships, robust data security frameworks, and the fostering of an environment conducive to data sharing and innovation. This research contributes to the discourse on the critical intersection of technology, healthcare decision-making, and governance, offering valuable recommendations for policymakers, healthcare professionals, and stakeholders in the digital and geospatial domains.

Sickle Cell Disease in an Older Adult Population: A Retrospective Review of Health Care Resource Utilization.

Sickle cell disease (SCD) has a history of health inequity, as patients with SCD are primarily Black and often marginalized from the health care system. Although recent health care and treatment advancements have prolonged life expectancy, it may be insufficient to support the complex needs of the growing population of older adults with SCD. This retrospective study used a cohort (N = 812) of Medicare Advantage beneficiaries 45 years and older (ages: 45-54, 55-64, 65-74, 75-89) with SCD to identify associations of SCD-related complications and comorbidities with emergency department (ED) visits, potentially avoidable ED visits, all-cause hospitalization, and potentially avoidable hospitalizations, 2018-2020. The 75-89 age group had lower odds of an ED visit (OR 0.56; 95% CI 0.32-1.00), 65-74 age group had lower odds of an ED visit (OR 0.49; 95% CI 0.31-0.78) and hospitalization (OR 0.50; 95% CI 0.31-0.79), compared with the 45-54 age group. Acute chest syndrome was associated with increased odds of an ED visit (OR 2.02; 95% CI 1.10-3.71), avoidable ED visit (OR 1.87; 95% CI 1.14-3.06), and hospitalization (OR 3.61; 95% CI 2.06-6.31). Pain was associated with increased odds of an ED visit (OR 2.64; 95% CI 1.85-3.76), an avoidable ED visit (OR 3.08; 95% CI 1.90-4.98), hospitalization (OR 1.51; 95% CI 1.02-2.24), and avoidable hospitalization (OR 6.42; 95% CI 1.74-23.74). Older adults with SCD have been living with SCD for decades, often while managing pain crises and complications associated increased incidence of an ED visit and hospitalization. The characteristics and needs of this population must continue to be examined to increase preventative care and reduce costly emergent health care resource utilization.

HRVEST: a novel data solution for using wearable smart technology to measure physiologic stress variables during a randomized clinical trial

The purpose of this study was to address the logistical and data challenges of using wearable technologies in the context of a clinical trial to measure heart rate variability (HRV) as a marker of physiologic stress in emergency healthcare providers during the COVID-19 pandemic. When using these wearable smart garments, the dilemma is two-fold: (1) the volume of raw physiological data produced is enormous and is recorded in formats not easily portable in standard analytic software, and (2) the commensurate data analysis often requires proprietary software. Our team iteratively developed a novel algorithm called HRVEST that can successfully process enormous volumes of physiologic raw data generated by wearable smart garments and meet the specific needs of HRV analyses. HRVEST is a noise-filtering and data-processing algorithm that allows the precise measurements of heart rate variability (HRV) of clinicians working in an Emergency Department (ED). HRVEST automatically processed the biometric data derived from 413 electrocardiogram (ECG) recordings in just over 15 min. Furthermore, throughout this study, we identified unique challenges of working with these technologies and proposed solutions that may facilitate future use in broader contexts. With HRVEST, using wearable smart garments to monitor HRV over long periods of time becomes logistically and feasibly viable for future studies. We also see the potential for real-time feedback to prophylactically reduce emergency physician stress, like informing optimal break-taking or short meditation sessions to lower heart rate. This could improve emotional wellbeing and, subsequently, clinical decision-making and patient outcomes.

Examination of workload perception, burnout, and perceived organizational support in emergency healthcare professionals: A structural equation model.

Job stress is one of the important factors affecting employee behavior. One of the most important factors in reducing burnout caused by stress is organizational support. In this context, the aim of this study is to identify the moderating role of perceived organizational support in the effect of workload perception on burnout within the emergency healthcare professionals' universe. The data for this study were collected from 703 health professionals working in emergency health services in three major cities of Turkey. The relationships and the model of the study is analyzed by the Structural Equation Model technique. The results indicate that perceived workload is a factor that causes employee burnout, and perceived organizational support is a factor that reduces employee burnout. This study contributes to researchers and health managers by revealing the importance of workload planning and organizational activities that support employees to reduce burnout in health workers.