Emergency Department Staff Research Articles

Using a manifold-based approach to extract clinical codes associated with winter respiratory viruses at an emergency department

Every winter, respiratory viruses put most Emergency Departments (ED) around the world under intense pressure. To reduce the consequent stress for hospitals, anticipation of the massive increase of intakes for illness-based symptoms is essential. As the Covid-19 2020 pandemic clearly illustrates, patients are not systematically tested. The ED staff therefore has no real-time knowledge of the presence of the virus in the patients flow. To address this issue, we propose here to use the hospital’s laboratory-confirmed database as an attractor for the manifold-based approach for clustering the clinical codes associated with respiratory viruses. We propose a new framework based on the embedding of time series onto the Stiefel manifold, coupled with a density-based clustering algorithm (HDBSCAN) enhanced by a reduction of dimension (UMAP) for the clustering on that manifold. In particular, we show, based on real data sets of two academic hospitals in France, the significant benefits of using geometrical approaches for time series clustering as compared to traditional methods.

Interdisciplinary Simulation Training Reduces Restraint Use in the Emergency Department: A Pilot Study.

Introduction Safe and effective management of agitated patients poses multiple challenges for healthcare professionals. Patients placed in restraints because of agitated behavior are at a higher risk of complications, including death. This intervention was designed to provide emergency department staff a framework for de-escalation, improve teamwork, and reduce the use of violent physical restraints. Methods Emergency medicine nurses, patient support associates, and protective services officers underwent a 90-minute educational intervention in 2017. A 30-minute lecture focusing on communication and early use of medication for agitation was followed by a simulationusing standardized participants, then a structured debriefing. A standardized return-on-learning tool determined participants' reactions to and application of the educational intervention.Additionally, data was collected and reported as a ratio of number of restraints applied each month compared to total emergency department visits that month. Data were analyzed comparing the six months before the education and the subsequent six months after the education. Results A pilot group of 30 emergency department staff members completed the educational intervention.The intervention contributed to the overall decrease in restraint use in the department.Most participants (86%) felt more confident in their ability to manage agitated patients. Conclusion An interdisciplinary simulation-enhanced educational intervention successfully reduced use of restraints in the emergency department and improved staff attitudes toward de-escalation techniques for agitated patients.

Preoperative hip fracture analgesia: the case for nerve blocks—a retrospective audit and quality improvement project

Background: Hip fractures are associated with significant mortality1 within 1 month (10%) and 1 year (∼33%) with >65 000 hip fracture operations being carried out per year. Anaesthetists play crucial roles for these patients, including provision of effective analgesia to expedite postoperative ambulation (in-line with the DrEaMing concept2) and facilitation of effective multidisciplinary perioperative management, including rehabilitation. This is a retrospective audit of preoperative analgesia assessing prescriptions of paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), opioids, and fascia iliaca compartment blocks (FICB) against National Institute for Health and Care Excellence (NICE) recommendations.1 Methods: A total of 47 patients were retrospectively identified using the Nottingham Hip Fracture Database, between November and December 2021. Case notes were reviewed to assess frequency of pain assessments, analgesic prescriptions, and conduct of FICB. A literature review was conducted to review the role of ultrasound guidance in the performance of FICB. An online survey was distributed to Emergency Department (ED) clinicians regarding familiarity and operator confidence in performing nerve block for patients with hip fractures. Focus groups identified areas for lasting organisational change to facilitate best patient care. Results: Pain assessments were most reliably performed at patient presentation. Paracetamol and opioids were often co-administered for initial analgesia, although in 48.6% of these cases opioids were potentially avoidable. NSAIDs were not prescribed to any patient. Nerve blocks were often considered in relevant patients, but with suboptimal analgesic benefit. The literature review demonstrated that ultrasound guidance would likely result in a more effective and safe procedure, compared with a landmark technique. The ED staff survey highlighted a desire to learn about ultrasound-guided FICB. Conclusion: Scope for improvement across all areas was identified, with the hospital engaging thoroughly with the audit to optimise patient experience and outcomes. Analgesia prescribing should follow a step-wise approach to reduce side-effects of opioid analgesia. Nerve blocks should be considered more and should be performed with ultrasound guidance. Multi-departmental consensus was to promote nerve block performance; this is being achieved through teaching, updating of visual reminders for ultrasound nerve blocks, and updating relevant paperwork for procedure performance and clerking. We plan to re-audit in the future. 1.National Institute for Health and Care Excellence. 2011. Hip fracture: management. (NICE clinical guideline No. 124). Available from https://www.nice.org.uk/guidance/cg124 (accessed 20/03/23)2.Oliver CM, Warnakulasuriya S, McGuckin D, et al. Br J Anaesth 2022; 129: 114–26

A Qualitative Study of Emergency Physicians' and Nurses' Experiences Caring for Patients With Psychiatric Conditions and/or Substance Use Disorders.

Patients with psychiatric conditions and/or substance use disorders (SUDs) frequently seek care in emergency departments (EDs), where providing care for these populations can involve considerable challenges. This study aimed to develop a comprehensive data-driven model of the complex challenges and unique dynamics associated with caring for these populations in the ED, as well as the effect on patient care quality. We conducted a preplanned topical analysis of grounded theory data obtained from semistructured interviews with 86 ED physicians and nurses from 8 hospitals in the Northeastern USA. Participants provided detailed descriptions of their experiences and challenges in caring for patients with psychiatric conditions and/or SUDs. We identified themes inductively using constant comparative analysis and developed a grounded model of physicians' and nurses' perceptions of challenges, biases, and effects on patient care. Emergency physicians and nurses described emotional, diagnostic, and logistical challenges that patients with psychiatric conditions and/or SUDs present. These challenges are magnified by existing health care system issues and social structures, which fuel and reinforce negative attitudes, expectations, and biases. In combination, these processes create negative health care experiences for patients, physicians, and nurses and can adversely affect patient care quality and ED staff well-being. Our findings uncover a cyclical process whereby challenges and biases associated with patients with psychiatric conditions and/or SUDs can reciprocally threaten patient care quality. Systemic changes and localized interventions are urgently needed to mitigate challenges, reduce bias, improve patient care, and improve physicians' and nurses' experiences in the ED.

Left behind: Exploring the concerns of emergency department staff when personnel are utilised for inter-hospital transfer

BackgroundInter-Hospital Transfer (IHT) may require an escort from the referring hospital, either a Registered Nurse (RN), physician or both, leading to a sudden drop in staffing levels within the referring department potentially increasing risk to patients and staff. AimsTo explore the perspectives of RNs and physicians of differing experience levels when left behind due to an escorted IHT, and the decision-making protocols for IHT. MethodA qualitative exploratory approach of 5 RNs and 4 physicians selected using purposeful sampling. Data were collected through semi-structured interviews and thematically analysed.Findings: Five themes were identified: the impact of being left behind; the burden of transfer; missed care; a triangulation of competing needs upon the decision-making process; and the effect of inter-hospital transfers on staff with different experience levels. ConclusionIHT is described differently by less experienced RNs compared to their more experienced counterparts especially concerning safety and risk. Physicians described the department as vulnerable with ad-hoc decision-making protocols surrounding IHT the norm.

Emergency Medical Services handoff of patients in cardiac arrest in the Emergency Department: A retrospective video review study of duration and details of handoff

Study objectivesWe aimed to evaluate the duration and frequency of communication between EMS (Emergency Medical Services) and ED (Emergency Department) staff during handoff and the subsequent time to critical cardiac care (rhythm determination, defibrillation) using CA (cardiac arrest) video review. MethodsA single-center retrospective study of video-recorded adult CAs between August 2020 and December 2022 was performed. Two investigators assessed the communication of 17 data points, time intervals, EMS initiation of handoff, and type of EMS agency. Median times from initiation of handoff to first ED rhythm determination and defibrillation were compared between the groups above versus below the median number of data points communicated. ResultsOverall, 95 handoffs were reviewed. The handoff was initiated in a median of 2 seconds (interquartile range (IQR) 0–10) after arrival. EMS initiated handoff in 65 (69.2%) patients. The median number of data points communicated was 9 and median duration was 66 seconds (IQR 50–100). Age, location of arrest, estimated down time, and medications administered were communicated > 80% of the time, initial rhythm 79%, and bystander cardiopulmonary resuscitation and witnessed arrest < 50%. The median times from initiation of handoff to first ED rhythm determination and defibrillation were 188 (IQR 106–256) and 392 (IQR 247–725) seconds, though not statistically different between handoffs with <9 vs. ≥9 data points communicated (p > 0.40). ConclusionThere is no standardization for handoff reports from EMS to ED staff for CA patients. Using video review, we demonstrated the variable communication during handoff. Improvements to this process could reduce the time to critical cardiac care interventions.

National Institute on Drug Abuse Clinical Trials Network Meeting Report: Advancing Emergency Department Initiation of Buprenorphine for Opioid Use Disorder

Opioid use disorder and opioid overdose deaths are a major public health crisis, yet highly effective evidence-based treatments are available that reduce morbidity and mortality. One such treatment, buprenorphine, can be initiated in the emergency department (ED). Despite evidence of efficacy and effectiveness for ED-initiated buprenorphine, universal uptake remains elusive. On November 15 and 16, 2021, the National Institute on Drug Abuse Clinical Trials Network convened a meeting of partners, experts, and federal officers to identify research priorities and knowledge gaps for ED-initiated buprenorphine. Meeting participants identified research and knowledge gaps in 8 categories, including ED staff and peer-based interventions; out-of-hospital buprenorphine initiation; buprenorphine dosing and formulations; linkage to care; strategies for scaling ED-initiated buprenorphine; the effect of ancillary technology-based interventions; quality measures; and economic considerations. Additional research and implementation strategies are needed to enhance adoption into standard emergency care and improve patient outcomes.

Evaluation of an Emergency Department-based Palliative Care Extender Program on Hospital and Patient Outcomes.

Boston Medical Center (BMC), a safety-net hospital, treated a substantial portion of the Boston cohort that was sick with COVID-19. Unfortunately, these patients experienced high rates of morbidity and mortality given the significant health disparities that many of BMC's patients face. Boston Medical Center launched a palliative care extender program to help address the needs of critically ill ED patients under crisis conditions. In this program evaluation our goal was to assess outcomes between those who received palliative care in the emergency department (ED) vs those who received palliative care as an inpatient or were admitted to an intensive care unit (ICU). We used a matched retrospective cohort study design to assess the difference in outcomes between the two groups. A total of 82 patients received palliative care services in the ED, and 317 patients received palliative care services as an inpatient. After controlling for demographics, patients who received palliative care services in the ED were less likely to have a change in level of care (P<0.001) or be admitted to an ICU (P<0.001). Cases had an average length of stay of 5.2 days compared to controls who stayed 9.9 days (P<0.001). Within a busy ED environment, initiating palliative care discussions by ED staff can be challenging. This study demonstrates that consulting palliative care specialists early in the course of the patient's ED stay can benefit patients and families and improve resource utilization.

Perspectives of Clinicians and Staff at Community-Based Opioid Use Disorder Treatment Settings on Linkages With Emergency Department–Initiated Buprenorphine Programs

An increasing number of emergency departments (EDs) are initiating buprenorphine for opioid use disorder (OUD) and linking patients to ongoing community-based treatment, yet community-based clinician and staff perspectives regarding this practice have not been characterized. To explore perspectives and experiences regarding ED-initiated buprenorphine among community-based clinicians and staff in geographically distinct regions. This qualitative study reports findings from Project ED Health, a hybrid type 3 effectiveness-implementation study designed to evaluate the impact of implementation facilitation on ED-initiated buprenorphine with referral to ongoing medication treatment. Clinicians and staff from community-based treatment programs were identified by urban academic EDs as potential referral sites for ongoing OUD treatment in 4 cities across the US in a formative evaluation as having the capability to continue medication treatment. Focus groups were held from April 1, 2018, to January 11, 2019, to examine community OUD treatment clinician and staff perspectives on accepting patients who have received ED-initiated buprenorphine. Data were analyzed from August 2020 to August 2022. Data collection and analysis were grounded in the Promoting Action on Research Implementation in Health Services (PARIHS) implementation science framework, focusing on domains including evidence, context, and facilitation. A total of 103 individuals (mean [SD] age, 45.3 [12.0] years; 76 female and 64 White) participated in 14 focus groups (groups ranged from 3-22 participants). Participants shared negative attitudes toward buprenorphine and variable attitudes toward ED-initiated buprenorphine. Prominent barriers included the community site treatment capacity and structure as well as payment and regulatory barriers. Perceived factors that could facilitate this model included additional substance use disorder training for ED staff, referrals and communication, greater inclusion of peer navigators, and addressing sociostructural marginalization that patients faced. In this study of community-based clinicians and staff positioned to deliver OUD treatment, participants reported many barriers to successful linkages for patients who received ED-initiated buprenorphine. Strategies to improve these linkages included educating communities and programs, modeling low-barrier philosophies, and using additional staff trained in addiction as resources to improve transitions from EDs to community partners.

Access block and overcrowding at the emergency department at Tupua Tamasese Meaole Hospital in Samoa

BackgroundAccess block and overcrowding are known to adversely impact on patient outcomes, service delivery, and patient experiences within emergency departments (ED) worldwide. There are no studies on access block or overcrowding from the Pacific Islands. The aim of the present study is to provide preliminary data on access block and overcrowding in the ED of the national tertiary hospital of Samoa.MethodsMixed methods study design. Data collection was performed in March 2020. The quantitative strand calculated (1) the point prevalence of patients impacted by access block in the ED, and (2) the ED bed occupancy rate to assess for overcrowding. The qualitative strand used thematic analysis of two focus group interviews exploring access block and overcrowding with ED medical and nursing staff members.ResultsOn the day of data collection, a total of 60 patients presented through the ED triage system. Of the 20 patients who were admitted into ED, 80% were triaged as ‘see without delay’ (CAT1), ‘emergency’ (CAT2) or ‘urgent’ (CAT3). For patients requiring admission to hospital wards, 100% waited 4 + h in ED, and 100% waited 8 + h, suggesting the presence of access block. Overcrowding in the ED setting was also evident, with an ED bed occupancy rate of 0.95, and an adjusted bed occupancy rate of 1.43. The major themes emerging from the ED staff focus groups and individual in-depth interviews were (1) the adverse impacts of access block and overcrowding, i.e., violence towards ED staff members, (2) the preventable contributing factors, i.e., lack of physical beds in the ED, and (3) practical recommendations to improve patient flow through the ED, i.e., improved collaboration between ED, outpatient services, and the hospital wards.ConclusionsPreliminary evidence suggested the presence of access block and overcrowding in the ED of the national tertiary hospital of Samoa. ED staff interviews provided insight into the ED frontline challenges and offered practical recommendations for ED health service improvement.

Perspectives on and experiences of emergency department–initiated buprenorphine among clinical pharmacists: A multi-site qualitative study

IntroductionClinical pharmacists are well positioned to enhance efforts to promote emergency department (ED)-initiated buprenorphine to treat opioid use disorder (OUD). Among clinical pharmacists in urban EDs, we sought to characterize barriers and facilitators for ED-initiated buprenorphine to inform future implementation efforts and enhance access to this highly effective OUD treatment. MethodsThis study was conducted as a part of Project ED Health (CTN-0069, NCT03023930), a multisite effectiveness-implementation study aimed at promoting ED-initiated buprenorphine that was conducted between April 2017 and July 2020. Data collection and analysis were grounded in the Promoting Action on Research Implementation in Health Services (PARIHS) framework to assess perspectives on the relationship between 3 elements: evidence for buprenorphine, the ED context, and facilitation needs to promote ED-initiated buprenorphine. The study used an iterative coding process to identify overlapping themes within these 3 domains. ResultsThe study conducted eight focus groups/interviews across four geographically disparate EDs with 15 pharmacist participants. We identified six themes. Themes related to evidence included (1) varied levels of comfort and experience among pharmacists with ED-initiated buprenorphine that increased over time and (2) a perception that patients with OUD have unique challenges that require guidance to optimize ED care. With regards to context, clinical pharmacists identified: (3) their ability to clarify scope of ED care in the context of unique pharmacology, formulations, and regulations of buprenorphine to ED staff, and that (4) their presence promotes successful program implementation and quality improvement. Participants identified facilitation needs including: (5) training to promote practice change and (6) ways to leverage already existing pharmacy resources outside of the ED. ConclusionClinical pharmacists play a unique and critical role in the efforts to promote ED-initiated buprenorphine. We identified 6 themes that can inform pharmacist-specific interventions that could aid in the successful implementation of this practice.

Probabilistic forecasting of hourly emergency department arrivals

ABSTRACT An accurate forecast of Emergency Department (ED) arrivals by an hour of the day is critical to meet patients’ demand. It enables planners to match ED staff to the number of arrivals, redeploy staff, and reconfigure units. In this study, we develop a model based on Generalised Additive Models and an advanced dynamic model based on exponential smoothing to generate an hourly probabilistic forecast of ED arrivals for a prediction window of 48 hours. We compare the forecast accuracy of these models against appropriate benchmarks, including TBATS, Poisson Regression, Prophet, and simple empirical distribution. We use Root Mean Squared Error to examine the point forecast accuracy and assess the forecast distribution accuracy using Quantile Bias, PinBall Score and Pinball Skill Score. Our results indicate that the proposed models outperform their benchmarks. Our developed models can also be generalised to other services, such as hospitals, ambulances or clinical desk services.

Evaluating the Effect of Brief Disaster Education on Emergency Department Staff: Can Short, Low-cost Education Improve Disaster Readiness of Non-DMAT Healthcare Personnel?

Introduction:Some incidents require early deployment of emergency department personnel not designated as disaster medical assistance team (DMAT). Although not as trained as DMAT members, they should be aware of basic disaster response concepts and knowledge. Educating disaster readiness to every healthcare staff in emergency departments would be ideal but it is very costly in both time and expense. To overcome this problem, we tried to evaluate the effectiveness of teaching basic concept and knowledge to non-designated personnel in a short-session and measure the effect.Method:This study is a before-and-after comparison study. From July 2020 to July 2022, a two-hour education was given to volunteers among doctors, nurses, paramedics and administrative staff working in emergency departments across four hospitals in Korea. Educational sessions consisted of basic disaster concept, pre-deployment DMAT preparations, initial actions required on incident site, key elements of incident response (command, control, safety, communication), and triage. Attendees were given a pretest before the session and another test after the session. Chi-square test and Wilcoxon rank test were used to compare the results.Results:Total of 105 volunteers participated in the study. Participants were mostly nurses (62.9%) followed by paramedics (23.8%). Overall knowledge level reported to be increased, including knowledge regarding DMAT deployment (29.5% to 93.3%, p&lt;0.001), DMAT personnel (26.7% to 94.3%, p&lt;0.001), DMAT-designated equipment (23.8% to 60.0%, p&lt;0.001), initial response (27.6% to 69.5%, p&lt;0.001) and patient transport priority (74.3% to 94.3%, p&lt;0.001). Questions testing triage and rate of participants answering every question showed improvement with post-test median score of 67% and rate of 1.0% to post-test median score of 100% and rate of 35.2%, respectively (both p&lt;0.001).Conclusion:Educating non-DMAT personnel in emergency departments with a short session showed significant improvement in basic knowledge of disaster response. It may help institutions with limited resources.

Potential System Utilization and Cost Savings of Advanced Microbial Testing for Urinary Tract Infections

Management of chronic and complex urinary tract infections can be a challenging problem for urologists, emergency department staff, and primary providers. A recent study evaluated the utility of a multiplex polymerase chain reaction–based urinary tract infection analysis, showing noninferiority to classic urine culture testing and possible improvement in identifying polymicrobial infections.1 In addition, this testing benefits from a shorter time to diagnosis with sensitivity testing than traditional culture. Questions remain regarding how this testing might improve patient outcomes and health care utilization. The authors should be commended on their efforts to answer these difficult questions. Ko et al2 found that using polymerase chain reaction technology with pooled antibiotic testing (mPCR/P-AST) in patients with recurrent or complicated urinary tract infections may lead to decreased inpatient utilization and cost savings for the systems compared with standard urine cultures. The average treatment cost for urinary tract infection–related care was decreased by $500 in the mPCR/P-AST group. In addition, 23 percent of patients undergoing the mPCR/P-AST population were able to be treated as an outpatient compared with 53 percent of patients undergoing standard urine cultures. The authors conclude that the mPCR/P-AST approach is associated with reduced resource utilization and costs. Using a matched case-control design, the researchers examined the potential of using mPCR/P-AST in a real-world analysis of a retrospective sample of Medicare beneficiaries with recurrent or complicated urinary tract infections. After an index infection, patients using either the mPCR/P-AST or the standard urine culture exclusively were compared for the following year. The researchers used propensity score matching to mimic randomization by selecting appropriate controls (patients with standard urine culture). They used different statistical models to compare multiple outcomes, including additional urinary tract infections, urinary tract infection–related medical resource utilization, and urinary tract infection–related costs. The ultimate goal of mPCR/P-AST is to improve the care of patients with complex infections by offering faster and possibly improved diagnosis. The primary finding here is an improved rate of outpatient management between testing modalities; however, there is no improvement in rate or number of additional infections. Given the goal of more rapid diagnosis, this shift to outpatient management may hint at earlier microbe-directed treatment of infections compared with a traditional culture, thus preventing hospital admission. However, there is bias introduced by the retrospective design as providers selected their testing modality. A complicated infection may not trigger the need for a PCR test like a chronically catheterized patient with a recurrent infection because of the possibility for improved polymicrobial identification. Thus, selection bias may exist that could lead to inherent management differences between populations. Although the propensity score analysis attempts to address this bias, it can only account for variables measured in the data set and cannot account for unmeasured confounding. Second, the authors found that there was a reduction in costs on a systems level associated with the introduction of polymerase chain reaction testing. They conclude that the use of this method will help to reduce cost secondary to reduction in hospitalization for patients managed with this modality. As this was a study intended to examine resource utilization, the authors elected not to include the cost of the polymerase chain reaction testing in their final costs. Although increased outpatient utilization is a benefit from the patient perspective, the increased cost of testing, upward of $1,000, may be prohibitive to payers. Additional cost-benefit analyses are warranted. This study takes on the admirable challenge of evaluating a real-world population with thoughtful population definitions and analyses. There is undoubtedly a potential benefit to more efficient testing both for patients and the health care system; however, further study is necessary to confirm these findings.

The Utilization of Hospital-Based Decontamination Facility for Chemical Incidents

Introduction:The constraints of performing prehospital decontamination in mass casualty incidents involving the release of chemical agents at disaster sites in modern cities are notable. Compounding this are highly built-up urban areas with significantly high population density and traffic congestion. This places the burden of performing such decontamination on nearby healthcare facilities. Based on this need, public hospitals in Singapore have been equipped with decontamination facilities. We present a review of the utilization of this facility at our institution.Method:A retrospective review of the utilization of the hospital decontamination station (HDS) was carried out, noting its frequency, purpose, and outcomes.Results:Since its construction, the HDS has been deployed successfully many times a year for both routine training and disaster preparedness exercises. Despite the lockdown measures due to Covid-19, with concomitant reduction in social and economic activity, the HDS was activated five times for decontamination of chemical contaminated casualties. It is fortunate that, although HDS training activities were curtailed during this period, emergency department (ED) staff were still able to function effectively using prior experience, donning chemical protective suits, and performing decontamination. The semi-automated HDS facilitated rapid deployment which contributed to ease of use of this resource for timely decontamination of casualties with good outcomes.Conclusion:Chemical incidents resulting in contaminated casualties are uncommon events. Nonetheless hospitals must be prepared to deal with this situation in a timely manner. The rapidly deployable HDS has become an important resource and an operationally ready solution for dealing with chemical contaminated casualties presenting at short notice to the ED. Regular training and deployment exercises utilizing the HDS provide staff familiarity critical to overall readiness for chemical incidents. This strategy provides a reliable countermeasure in an all-hazards approach to disaster preparedness at the hospital.

CBRN Disaster Hospital Response and Preparedness. An Italian Civilian Military Cooperation Teaching Model

Introduction:Chemical, Biological, Radiological, and Nuclear (CBRN) emergencies need specific hospital preparedness and resource availability.Preparing to evaluate and manage victims from CBRN exposure events in one aspect of hospital preparedness, is often underestimated. Specific skills and capabilities are required to manage these events. Emergency department (ED) and hospital staff need adequate training to provide safe and effective care.Method:The Hospital Complex of Valtellina and Alto Lario (with three hospitals), in consideration of the geographic location amid mountains, far from urban hospital centers, decided to develop an intensive training program for the hospital emergency staff. Firstly, it was based on an eight-hour initial training program, using a combined civilian military approach that included hazard recognition, substance identification, site safety, response roles, PPE use, and decontamination procedures. The CBRN Operational Unit (for prevention of chemical-biological-radiological-nuclear risks) of the 1st Territorial Unit of the Auxiliary Military Corps of the Order of Malta Italy led such training session showing that a military approach to CBRN threats can be used with civilian and military competencies and tools in managing specific hazardous events hospital first responders may face.Results:A drill exercise was performed on a radiological fall-out incident to test the hospital’s emergency response staff preparedness. Hospital management and decontamination procedures were analyzed to treat victims as well as first responders and to train hospital staff with few resources available.Conclusion:Hospitals need a specific level of preparedness to enable an effective response to CBRN emergencies. Skills and competencies of military personnel can be a resource in these kinds of events to train civilian personnel who are not normally acquainted to or confident to manage this kind of CBRN events, and can represent a new model and challenge of interagency cooperation in the disaster management of complex emergencies involving hazardous materials.

The Evaluation of a Domestic Abuse Response Team Program in an Emergency Department.

Domestic abuse (e.g., family violence) occurs globally and increases the risk for lifelong adverse health outcomes for all members involved. Although victims of domestic abuse often refrain from seeking support due to various reasons (e.g., fear), health centers such as emergency departments (EDs) can serve as outlets for assistance. The Domestic Abuse Response Team (DART) is a program working collaboratively with a regional hospital center in Alberta, Canada, uniquely providing immediate, expert, and patient-oriented services (e.g., safety plans) to domestic abuse victims within the ED. This study aimed to evaluate the DART program by: (1) using administrative data to characterize ED and DART patient characteristics and (2) examining staff perceptions about DART's operations, effectiveness, challenges, and improvements. A mixed-methods approach was used to collect data from April 1st, 2019 to March 31st, 2020. Quantitative data consisted of descriptive statistics on patient and staff characteristics and qualitative data was collected through two surveys to determine perceptions of the DART program. Approximately 60% of ED patients were screened for domestic abuse and 1% were referred to DART, of which 86% were female. All referrals received support within an hour and were provided patient-oriented assistance. Qualitative data revealed that the DART program offers important support to patient victims, increases comfort around dealing with domestic abuse, and decreases ED staff workloads. The DART program offers valuable support to domestic abuse victims. Staff reported that DART is effective in providing victims with immediate care and services while also supporting ED staff.

Changes in cultural competency among emergency department staff in a large urban hospital following the implementation of an Indigenous Cultural Safety education program

Changes in cultural competency among emergency department staff in a large urban hospital following the implementation of an Indigenous Cultural Safety education program

Emergency Department Overcrowding and Its Potential Impact on Care Processes: A Literature Review

Emergency department overcrowding was a obstacle of providing timely and effective care in emergency department. This condition had negatively impact on many aspect of care proccess. There were different finding related to impact of emergency department overcrowding in care process. The aim of the study was to analyze research articles that discusses emergency department overcrowding and its potential impact on care proccess. The study was literature review using database journal resources from PubMed, Proquest, and ScienceDirect. Emergency department (ED), Overcrowding, and impact we used as keyword. Inclusion criteria of the study were original article, Published at 10 years later (2012-2022), written in english language, focus on patient, staff, or health care system level. Whereas, the exclusion criteria were overcrowding because of other condition (endemic or infection disease), and not focus on patient, staff, or health care system. 9 selected articles that met inclusion criteria were analysed based on author, years, title, and main idea of the study. The finding of the study were emergency department overcrowding had negatively impact on care process including patients, staff, and healthcare system. Impact on patients including increasing mortality and admission rate, impact on staff including increasing workload and non-adherence for practicing best guidelines, meanwhile impact on healthcare system including innapropriate triage proccess and increasing Length of Stay (LOS). Need an effort to decrease impact of ED overcrowding especially on patient, staff, and healthcare system. The result of the study could be used as considering to formulate an effort to reduce impact of ED overcrowding by controlling patient, staff, and healthcare system factors.

Team Approach to Delayed Pediatric Vestibular Diagnosis: A Case Study.

This report highlights the challenges of diagnosing pediatric vestibular neuritis following dental treatment and addressing fear avoidance behaviors. An 11-year-old boy came to physical therapy with vestibular dysfunction following dental treatment that was unable to be diagnosed by emergency department staff. The participant received multispecialty treatment for 6 weeks. Computerized Dynamic Posturography, Limits of Stability, Dizziness Handicap Inventory, Functional Gait Assessment, Dynamic Visual Acuity, and Modified Clinical Test of Sensory Interaction on Balance. Most notable improvements were seen in Limits of Stability and Computerized Dynamic Posturography. The participant made a full return to school and sport. The difficulty of pediatric vestibular neuritis diagnosis led to fear avoidance behaviors that were addressed by a collaborative specialty approach. This is the first documented case of pediatric vestibular neuritis as a complication of a dental procedure with intervention focused on fear avoidance behaviors.