Hospital Emergency Department Setting Research Articles

Diagnostic Performance, Triage Safety, and Usability of a Clinical Decision Support System Within a University Hospital Emergency Department: Algorithm Performance and Usability Study.

Computerized clinical decision support systems (CDSSs) are increasingly adopted in health care to optimize resources and streamline patient flow. However, they often lack scientific validation against standard medical care. The purpose of this study was to assess the performance, safety, and usability of a CDSS in a university hospital emergency department setting in Kuopio, Finland. Patients entering the emergency department were asked to voluntarily participate in this study. Patients aged 17 years or younger, patients with cognitive impairments, and patients who entered the unit in an ambulance or with the need for immediate care were excluded. Patients completed the CDSS web-based form and usability questionnaire when waiting for the triage nurse's evaluation. The CDSS data were anonymized and did not affect the patients' usual evaluation or treatment. Retrospectively, 2 medical doctors evaluated the urgency of each patient's condition by using the triage nurse's information, and urgent and nonurgent groups were created. The International Statistical Classification of Diseases, Tenth Revision diagnoses were collected from the electronic health records. Usability was assessed by using a positive version of the System Usability Scale questionnaire. In total, our analyses included 248 patients. Regarding urgency, the mean sensitivities were 85% and 19%, respectively, for urgent and nonurgent cases when assessing the performance of CDSS evaluations in comparison to that of physicians. The mean sensitivities were 85% and 35%, respectively, when comparing the evaluations between the two physicians. Our CDSS did not miss any cases that were evaluated to be emergencies by physicians; thus, all emergency cases evaluated by physicians were evaluated as either urgent cases or emergency cases by the CDSS. In differential diagnosis, the CDSS had an exact match accuracy of 45.5% (97/213). The usability was good, with a mean System Usability Scale score of 78.2 (SD 16.8). In a university hospital emergency department setting with a large real-world population, our CDSS was found to be equally as sensitive in urgent patient cases as physicians and was found to have an acceptable differential diagnosis accuracy, with good usability. These results suggest that this CDSS can be safely assessed further in a real-world setting. A CDSS could accelerate triage by providing patient-provided data in advance of patients' initial consultations and categorize patient cases as urgent and nonurgent cases upon patients' arrival to the emergency department.

Healthcare resource use and cost implications of low dose methoxyflurane for severe trauma-related pain: a qualitative study

Aims Management of moderate-to-severe trauma-associated pain is often reported as suboptimal, due in part to limitations associated with frequently used analgesics. Low-dose methoxyflurane (LDM) is an inhaled, non-opioid analgesic, recently approved for emergency relief of moderate-to-severe trauma-associated pain in conscious adults. This study assessed the perspective of healthcare professionals (HCPs) with regard to the time to analgesia and healthcare cost of LDM versus morphine IV, for patients with severe trauma-related pain receiving emergency care in Belgium. Materials and methods Interviews and questionnaires were completed by four healthcare HCPs providing emergency care at different hospitals in Belgium. Processes describing analgesic provision in pre-hospital and hospital emergency department (ED) settings were qualitatively mapped and a cost model applied which included reimbursed analgesic costs, time spent by HCPs making analgesic treatment decisions, preparing and administering the analgesic, and post-dose monitoring and management of analgesic-related adverse events (AEs). Results LDM was associated with substantial time and costs savings per patient, largely due to no requirement for AE monitoring. Compared with morphine IV, LDM in the hospital ED was associated with a time saving of 4 minutes to analgesic provision (35 vs 39 min) and ≥224 min in total (35 vs ≥259 min; including monitoring and managing AEs). In the pre-hospital setting, LDM was also associated with a time saving of 4 minutes to analgesic provision (21 vs 25 min) and 198 minutes in total. The corresponded total cost savings with LDM vs morphine IV were ≥€27.32 and ≥€17.95 in the ED or prehospital setting, respectively. Conclusions The cost model showed that LDM was associated with substantial time and costs savings versus morphine IV for severe trauma-related emergency pain in pre-hospital and hospital ED settings in Belgium.

Taking Matters into Your Own Hands.

Taking Matters into Your Own Hands.

Non-interventional study evaluating exposure to inhaled, low-dose methoxyflurane experienced by hospital emergency department personnel in France

ObjectivesLow-dose methoxyflurane is a non-opioid, inhaled analgesic administered via the Penthrox inhaler and was recently licensed in Europe for emergency relief of moderate-to-severe trauma-associated pain in conscious adults. This non-interventional...

63 The Incidence and Downstream Effect of Guideline Non-Adherence: The HEART Score in the Community Hospital Emergency Department Setting

Overutilization of hospital resources in low risk chest pain patients (LOWCPs) is a serious issue that has been addressed in multiple previous studies. It has been found that the implementation of accelerated diagnostic protocols for chest pain have shown substantial improvement in the utilization of health care resources. The development and subsequent validation of the history, electrocardiogram, age, risk factors, and troponin (HEART) score to identify ED chest pain patients who can safely be discharged without emergent provocative testing represents a potential breakthrough in the management of LOWCPs.

Data-Driven Percentile Optimization for Multiclass Queueing Systems with Model Ambiguity: Theory and Application

Multiclass queueing systems widely used in operations research and management typically experience ambiguity in real-world settings in the form of unknown parameters. For such systems, we incorporate robustness in the control policies by applying a data-driven percentile optimization technique that allows for (a) expressing a controller’s optimism level toward ambiguity and (b) utilizing incoming data to learn the true system parameters. We show that the optimal policy under the percentile optimization objective is related to a closed-form, priority-based policy. We also identify connections between the optimal percentile optimization and c µ-like policies, which, in turn, enables us to establish effective but easy-to-use heuristics for implementation in complex systems. Using real-world data collected from a leading U.S. hospital, we also apply our approach to a hospital emergency department setting and demonstrate the benefits of using our framework for improving current patient flow policies.

Hypoglycemia secondary to factitious hyperinsulinism in a foster care adolescent - a case report of munchausen syndrome in a community hospital emergency department setting

BackgroundFactitious disorder causing hypoglycemia is a psychiatric condition in which patients deliberately use blood sugar lowering medications to cause severe symptoms for the purposes of hospitalization or other primary gains.Case presentationWe report a case of factitious hypoglycemia in a 19-year-old foster care adolescent female who presented to the Emergency Department with recurrent hypoglycemic episodes, to the degree that the patient required large amounts of dextrose and further management by intensive care unit hospitalization. Further inquiry revealed that the patient intentionally injected herself with large doses of insulin for the purposes of seeking hospital admission.ConclusionFactitious disorder in the setting of recurrent hypoglycemia episodes may warrant a psychiatric referral and appropriate discharge follow-up to avoid multiple hospitalizations. Presentation in a non-diabetic patient from insulin use is a type of illness that is a challenge for emergency department physicians to appropriately diagnose and treat. Classic findings include a low blood sugar level, suppressed C-peptide level, and an inappropriately elevated insulin level. Recognizing these psychiatric presentations is crucial in order to stabilize patients and prevent unnecessary testing.

Mobile nucleic acid amplification testing (mobiNAAT) for Chlamydia trachomatis screening in hospital emergency department settings

Management of curable sexually-transmitted infections (STI) such as Chlamydia can be revolutionized by highly sensitive nucleic acid testing that is deployable at the point-of-care (POC). Here we report the development of a mobile nucleic acid amplification testing (mobiNAAT) platform utilizing a mobile phone and droplet magnetofluidics to deliver NAAT in a portable and accessible format. By using magnetic particles as a mobile substrate for nucleic acid capture and transport, fluid handling is reduced to particle translocation on a simple magnetofluidic cartridge assembled with reagents for nucleic acid purification and amplification. A mobile phone user interface operating in tandem with a portable Bluetooth-enabled cartridge-processing unit facilitates process integration. We tested 30 potentially Chlamydia trachomatis (CT)-infected patients in a hospital emergency department and confirmed that mobiNAAT showed 100% concordance with laboratory-based NAAT. Concurrent evaluation by a nontechnical study coordinator who received brief training via an embedded mobile app module demonstrated ease of use and reproducibility of the platform. This work demonstrates the potential of mobile nucleic acid testing in bridging the diagnostic gap between centralized laboratories and hospital emergency departments.

The risk of chronic kidney disease and mortality are increased after community-acquired acute kidney injury

We investigated whether community-acquired acute kidney injury encountered in a tertiary hospital emergency department setting increases the risk of chronic kidney disease (CKD) and mortality, and whether plasma biomarkers could improve the prediction of those adverse outcomes. In a prospective cohort study, we enrolled 616 patients at admission to the emergency department and followed them for a median of 62.1 months. Within this cohort, 130 patients were adjudicated as having acute kidney injury, 159 transient azotemia, 15 stable CKD, and 312 normal renal function. Serum cystatin C and plasma neutrophil gelatinase-associated lipocalin (NGAL) were measured at index admission. After adjusting for clinical variables, the risk of developing CKD stage 3, as well as the risk of death, were increased in the acute kidney injury group (hazard ratio [HR], 5.7 [95% confidence interval, 3.8-8.7] and HR, 1.9 [95% confidence interval, 1.3-2.8], respectively). The addition of serum cystatin C increased the ability to predict the risk of developing CKD stage 3, and death (HR, 1.5 [1.1-2.0] and 1.6 [1.1-2.3], respectively). The addition of plasma NGAL resulted in no improvement in predicting CKD stage 3 or mortality (HR, 1.0 [0.7-1.5] and 1.2 [0.8-1.8], respectively). The risk of developing CKD stage 3 was also significantly increased in the transient azotemia group (HR, 2.4 [1.5-3.6]). Thus, an episode of community acquired acute kidney injury markedly increases the risk of CKD, and moderately increases the risk of death. Our findings highlight the importance of follow-up of patients with community acquired acute kidney injury, for potential early initiation of renal protective strategies.

Influence of Otitis Media on the Correlation Between Rectal and Auditory Canal Temperatures

In a noninterventional, controlled, single-blinded trial, 251 children were examined in a university hospital emergency department setting to study the influence of acute otitis media on the relationship between rectal and auditory canal temperatures. Bilateral auditory canal temperatures were measured using an infrared detection probe and microprocessor by nursing staff blinded to the presence of acute otitis media. Correlation between rectal and auditory canal temperatures in children with (r = .81) and without (r = .75) acute otitis media were not significantly different. There was no significant difference between infected (38.1 degrees C +/- 1.0 degree C) and uninfected ears (38.0 degrees C +/- 1.0 degree C) with unilateral otitis (n = 75). Although significantly higher than in uninfected children, auditory canal temperatures of children with acute otitis media reflected elevated rectal temperatures and not differences in auditory canal temperatures between ears.