Emergency Department Staff Research Articles

Improving Time to Bleeding Disorder Treatment in the Emergency Department.

Knowledge of the guidelines for treating people with bleeding disorders (PwBD) is vital for emergency department (ED) staff, as PwBD rely on the ED for treatment of acute bleeding episodes or injuries. Unfamiliarity with these guidelines can delay treatment. We aimed to improve the timely treatment of PwBD seeking emergency care by reducing the mean time-to-factor administration in the ED by 20%, from the baseline of 110 to 88minutes. Our quality improvement (QI) initiative (2019-2024) used Plan-Do-Study-Analyze cycles. Weekly electronic health record (EHR) reports tracked PwBD's time of arrival, admission, clotting factor concentrate ordering, and administration. Interventions targeted delays identified in the process. Baseline data showed a 110-mean time-time-to-factor. Our aim of reducing the time-to-factor by 20% from the baseline of 110minutes was reached in May 2020. This improvement was exceeded and sustained throughout the project. At the conclusion, we achieved a 62% reduction in time-to-factor and a mean time-to-factor of 42minutes. By using an EHR tool, we were able to identify when during the ED visit process delays occurred, which helped us better target our interventions. Our educational-based interventions were adapted to reach our intended audiences while working around barriers related to the COVID-19 pandemic, such as high patient volumes and staff shortages. Our results show a decrease in time to factor in the ED and an increase in the PwBD receiving factor within 60minutes of arrival time. This has been a sustainable improvement.

The Effects of an ISOBAR-Structured Patient Handover Conversation Between Rescue Services and Emergency Department Staff: The COPTER Trial

The Effects of an ISOBAR-Structured Patient Handover Conversation Between Rescue Services and Emergency Department Staff: The COPTER Trial

Enhancing end-of-life care for advanced heart failure patients in Saudi Arabian emergency departments (EDs): Perspectives of ED staff on challenges

Enhancing end-of-life care for advanced heart failure patients in Saudi Arabian emergency departments (EDs): Perspectives of ED staff on challenges

P-330. Beneath the PPE: Perspectives on Infection Prevention from Emergency Department Healthcare Personnel

Abstract Background Adhering to best practices in infection prevention and control (IPC) can be challenging in emergency departments (EDs) due to high patient volumes, high acuity of illness, and limited initial information about patients’ history, among other factors. Understanding ED healthcare personnel’s (HCP) perceptions is important for improving IPC practices in this environment.Table 1.Demographics of interviewees. Methods Between August 2023 and November 2023, we conducted semi-structured interviews focused on IPC with HCP working in emergency departments across the United States. EDs were selected for inclusion via convenience sampling from a larger group of EDs selected for representative geographic, volume, and practice type variety. Our study solicited voluntary participation from staff in these EDs via their ED leaders. Each interview was recorded, transcribed, and subsequently coded across 19 themes by two independent raters. Each theme as sorted as either a facilitator or barrier to following recommended IPC practices in the ED. We then used content analysis to quantify the frequency of the identified themes, and stratified responses by role group.Table 2.All identified codes and frequencies in interviews. Codes identified in all interviews, sorted into promoters and barriers. Higher percentage is indicative of more mentions of each code across all interviews. Note: IPC = infection prevention and control; HH = hand hygiene; PPE = personal protective equipment. Results We conducted 25 interviews across four role groups (Table 1). Key barriers identified in the interviews included constraints related to time (25/25, 100%), attention (23/25, 92%), environment of care (23/25, 92%), and personal perceptions (23/25, 92%), while top promoters included IPC culture (24/25, 96%) and interpersonal dynamics (23/25, 92%) (Table 2). Stratified analyses indicated that there were variations among roles, with environmental staff emphasizing the importance of training, and nurses highlighting policies both as a promoter and barrier (Table 3).Table 3.Top codes stratified by role. Higher percentage is indicative of more mentions of each code across each group. Codes are stratified by healthcare personnel’s role (with transport and environmental services staff pooled to support staff) and promoter/barrier categorization. Note: IPC = infection prevention and control. Conclusion The main barriers to effective IPC measures perceived by ED staff are limited time and other demands on their attention in the ED environment. A strong culture promoting IPC and cohesive team dynamics were the primary IPC facilitators, suggesting potential targets for future interventions. Future research should explore interpersonal relationships further by conducting comparative studies across different types of hospital emergency departments, and longitudinally while testing strategies to improve IPC adherence. Disclosures All Authors: No reported disclosures

Understanding good communication in ambulance pre-alerts to the emergency department: findings from a qualitative study of UK emergency services

ObjectivesPrehospital notifications (pre-alerts) enable emergency department (ED) staff to prepare for the arrival of patients requiring a time-critical response. Effective communication of the pre-alert is key to enabling the ED...

Iowa emergency departments lack board-certified emergency physicians: A comprehensive statewide emergency department workforce study.

The emergency physician (EP) workforce has been a recent focus after a workforce projection predicted a surplus of EPs by 2030. A previous study of Iowa emergency departments (EDs) demonstrated wide variability in ED staffing patterns and attributed it to the lack of EP job candidates. With the recent increase in emergency medicine (EM) residency positions, the objectives of this study were to understand how Iowa ED physician staffing has changed in regard to presence of board-certified EPs and what operational differences in Iowa EDs may be associated with staffing to provide insight into what may be occurring in other predominantly rural states. An electronic and telephone survey of nonfederal Iowa EDs was conducted using a structured data collection instrument. Responses were collected from a leadership representative at each facility (medical director or nurse manager). The data collection included both objective staffing data and Likert-style questions about reasons for staffing and operational practices. We obtained hospital characteristics from the American Hospital Association and directly compared these results to a similar Iowa study conducted in 2013. Summary data were presented as counts and percentages, and physician staffing was compared between critical-access hospitals (CAHs) and non-CAHs. CAHs represent a type of rural hospital in the rural setting. Responses from 113 of 116 (97%) Iowa EDs were recorded. Of responding EDs, 19 (17%) were staffed exclusively by EM residency-trained and/or EM board-certified physicians (EPs), 72 (66%) were staffed by a combination of EPs and non-EPs (physicians who completed a residency other than EM), 19 (17%) were staffed exclusively by non-EPs, and 52 (46%) were staffed either fully or at times by advanced practice providers (APPs) without in-house supervision. In the subgroup of CAHs, only three (4%) staff only EPs, compared with 16 (42%) of non-CAHs (difference 38%, 95% confidence interval [CI] 24.6%-51.2%). Providers staffing CAHs were more likely than those at non-CAHs (88% vs. 63%, difference 25%, 95% confidence interval [CI] 9.5%-40.2%) to have responsibilities outside the ED, the most common being inpatient cardiac arrest management (n = 84, 74%). The most common reason for hiring EPs was the quality of care they provide (n = 47, 58%), and the most common reason for hiring non-EPs was low availability of EPs (n = 56, 70%). Compared to the 2013 Iowa ED workforce study, the proportion staffed by EPs only were similar (increased by 5.5%, 95% CI -14.7% to 3.7%) and by non-EPs only was similar (decreased by 10.5%, 95% CI -0.4% to 21.3%). EDs staffed solely by APPs decreased from decreased by 13.2% (95% CI 0.3%-26.2%) to 47% in 2023. Iowa EDs are predominantly staffed by non-EPs, and this remains unchanged despite a decade of increasing EM residency positions nationally. There remains a significant disparity between CAHs and non-CAHs. This study demonstrates that EM residency position increases have not penetrated rural Iowa EDs, where there remains both a substantial shortage and desire for EP staffing.

Exploring knowledge of first aid in epistaxis-25 years on.

Epistaxis is the most common acute disorder managed by ENT services. A 1998 survey (Strachan and England) demonstrated widespread ignorance of correct first aid amongst the public with only 11% of respondents applying correct first aid techniques. Here we repeated and expanded the 1998 study to investigate whether understanding of correct first aid in epistaxis amongst the public and emergency department staff has improved in the last 25 years. Posters with links to surveys were displayed in ED waiting rooms, anticoagulation clinics and ED staff rooms in multiple UK centres. Responders were asked three first aid questions: pinch position, head position, and plugging nostrils. A prospective audit was carried out in a single centre over four weeks recording the first aid was being applied at the point of ENT review for patients referred with epistaxis. 129 members of public responded. 83% do not have correct first aid technique including 77% of those on anticoagulants or aspirin. 116 ED staff responded. 64% do not use correct first aid. Over four weeks 19 patients were referred to ENT with epistaxis and of these, nine were bleeding at the point of ENT review. Adequate first aid was not being applied in 56% of those cases. Despite the morbidity of epistaxis, and the simplicity of first aid steps, there is concerning lack of understanding amongst the public and ED staff. Education (particularly for staff and the anticoagulated) may reduce emergency attendance in epistaxis patients.

The impact of an All-Hazard mass casualty event on emergency department operations: A retrospective study.

Mass Casualty Events (MCI) which have a direct and persisting impact on the safety and well-being of an emergency department (ED) and its staff, secondary to specific targeting of the healthcare setting, represent a distinct and complex operational challenge. ED physicians may be faced with the prospect of providing ongoing patient care while simultaneously experiencing direct threats to their own health or physical safety. In our study we considered the unique operational challenges encountered, and management strategies adopted, by the ED staff and its leadership to an all-hazard MCI impacting an academic urban emergency department. We conducted a retrospective, observational study of data from a tertiary academic medical center of patients arriving to the ED during a protracted MCI lasting from May 11th to May 21st, 2021. No arriving patients were excluded from analysis. Patient demographics, ED resource utilization, throughput, disposition and other pertinent data were considered. Analysis was done of three distinct patient populations including the event-group (EG), a non-event-group (NEG) and a control group (CG). Descriptive statistics were used to evaluating observational findings. We reviewed the records of 8527 total patients presenting to the Shamir Medical Center ED during the event and control periods. Of those, 283 patients were identified as an EG consisting of casualties from the MCI. 3563 patients were identified as the NEG presenting with complaints not related to the event. Our CG consisted of the 4681 patients who presented in the two weeks prior to the MCI. EG patients were noted to have important characteristics including higher relative numbers of men n=173 (61.6%), higher CTAS triage acuities [n=10 (3.8%), classified as CTAS 1], and an increase utilization of specialty consultation and admission consistent with observed injury patterns, most notably for the orthopedic services [orthopedic consultations: n=126 (44.5%) / orthopedic admissions: n=13 (4.6%)]. Findings from our observational study suggested that in the absence of larger public health interventions a manmade MCI, with direct threats to an ED and its staff, could force EDs to concurrently address the unique clinical needs of two distinct patient populations while simultaneously needing to take measures to protect hospital staff. Additionally, a higher burden of patient volumes and clinical acuity are likely to be encountered by select specialty consultation services. Further studies could focus on quantitative analysis to better understand the operational impact of these types of events on both patients and staff.

Stochastic model for physician staffing and scheduling in emergency departments with multiple treatment stages

Stochastic model for physician staffing and scheduling in emergency departments with multiple treatment stages

Assessment of Hospital Anxiety and Depression Scale in Emergency Department in Iraq

Depression is (a serious medical condition that affects a person’s feelings, thought, and how to behaves. It causes sadness, hopelessness, and helplessness, interfering with daily activities) (1). Anxiety is a normal emotion that anyone experiences from time to time that range from mild to severe of worry or fear. The study's objective was to assess anxiety and depression in a sample of worker in an emergency Department worker in middle and south of Iraq. The workers in an emergency department in hospitals of middle and south of Iraq who deal with a lot of stress and under pressure most of day are sample of this study which designs to assess anxiety and depression in these workers, surely who accepted to participate in this study between Jan to May 2023 by using Hospital anxiety and depression scale (HADs) in Arabic was employed. The workers in an emergency department were more than half of them associated with significant anxiety and depression due to their works under pressure in hospitals. In conclusion, this study showed elevated risk of depression and anxiety among the emergency Department staff, and this elevated directly proportional to nature of work, Economic status, age and Level of education for worker.

Would provision of Take Home Naloxone Kits by Emergency Medical Services be perceived as acceptable to people at risk of opioid overdose? A qualitative study

ABSTRACT OBJECTIVES Take home naloxone kits can reduce mortality, but we know little about how they are perceived by people with lived experience of opioid use. Provision of naloxone in the community has been shown to significantly reduce mortality from opioid overdose. Currently, this is predominantly through drug treatment support services but expanding provision through other services might be effective in increasing kit take-up and mortality reduction. This study aimed to examine participants' experiences of opiate overdose and acceptability of provision of naloxone kits through ambulance/paramedic emergency services (EMS) and hospital Emergency Departments (ED). METHODS Qualitative interviews were conducted with 26 people who had direct experience of opioid use. Participants were recruited at two substance-use treatment centres and a third sector support organisation in three large cities in the United Kingdom. Interviews examined respondents’ experiences of opioid use and opioid overdose, access and personal use of naloxone kits, and opinions about kit provision from EMS and hospital ED staff. Interview data were thematically analysed using a constant comparative method. RESULTS Four key themes were identified during analysis: 1) High levels of overdose experience and knowledge of naloxone and naloxone kits; 2) naloxone kits were perceived as effective and easy to use 3) There were some concerns around the risks of administering naloxone, such as peer aggression during withdrawal. 4) Participants supported much wider personal, family and peer provision of naloxone kits from community support organisations as well as from EMS. CONCLUSIONS Participants felt naloxone kits were an important resource and they wanted increased provision across a range of services including EMS and hospital ED staff as well as community pharmacies and needle exchange centres. Participants wanted naloxone kit provision to be extended to peers, family and friends.

Information Mode-Dependent Success Rates of Obtaining German Medical Informatics Initiative-Compliant Broad Consent in the Emergency Department: Single-Center Prospective Observational Study.

The broad consent (BC) developed by the German Medical Informatics Initiative is a pivotal national strategy for obtaining patient consent to use routinely collected data from electronic health records, insurance companies, contact information, and biomaterials for research. Emergency departments (EDs) are ideal for enrolling diverse patient populations in research activities. Despite regulatory and ethical challenges, obtaining BC from patients in ED with varying demographic, socioeconomic, and disease characteristics presents a promising opportunity to expand the availability of ED data. This study aimed to evaluate the success rate of obtaining BC through different consenting approaches in a tertiary ED and to explore factors influencing consent and dropout rates. A single-center prospective observational study was conducted in a German tertiary ED from September to December 2022. Every 30th patient was screened for eligibility. Eligible patients were informed via one of three modalities: (1) directly in the ED, (2) during their inpatient stay on the ward, or (3) via telephone after discharge. The primary outcome was the success rate of obtaining BC within 30 days of ED presentation. Secondary outcomes included analyzing potential influences on the success and dropout rates based on patient characteristics, information mode, and the interaction time required for patients to make an informed decision. Of 11,842 ED visits, 419 patients were screened for BC eligibility, with 151 meeting the inclusion criteria. Of these, 68 (45%) consented to at least 1 BC module, while 24 (15.9%) refused participation. The dropout rate was 39.1% (n=59) and was highest in the telephone-based group (57/109, 52.3%) and lowest in the ED group (1/14, 7.1%). Patients informed face-to-face during their inpatient stay following the ED treatment had the highest consent rate (23/27, 85.2%), while those approached in the ED or by telephone had consent rates of 69.2% (9/13 and 36/52). Logistic regression analysis indicated that longer interaction time significantly improved consent rates (P=.03), while female sex was associated with higher dropout rates (P=.02). Age, triage category, billing details (inpatient treatment), or diagnosis did not significantly influence the primary outcome (all P>.05). Obtaining BC in an ED environment is feasible, enabling representative inclusion of ED populations. However, discharge from the ED and female sex negatively affected consent rates to the BC. Face-to-face interaction proved most effective, particularly for inpatients, while telephone-based approaches resulted in higher dropout rates despite comparable consent rates to direct consenting in the ED. The findings underscore the importance of tailored consent strategies and maintaining consenting staff in EDs and on the wards to enhance BC information delivery and consent processes for eligible patients. German Clinical Trials Register DRKS00028753; https://drks.de/search/de/trial/DRKS00028753.

Models of Field Hospital Emergency Departments: The Israeli Experience.

The World Health Organization has classified Emergency Medical Teams (EMTs) into 3 types for international disaster response. They range from those that operate as daytime clinic facilities to those that have complete hospital capabilities that can provide 24/7 inpatient care. The most complex EMT (Type 3) includes a full-scale emergency department (ED), operating rooms, a medical/surgical ward, an intensive care unit, and laboratory services. The Israel Defense Forces Field Hospital was the first to be officially designated as a Type 3 EMT. Two models have been used by the Israeli EMT depending on the disaster response: standalone and hybrid. The standalone model is where the ED and hospital are set up in tents independent of any existing health care facilities. The hybrid model is where the equipment and personnel are combined with existing structures. Pediatric patients are examined in either a designated area staffed by specialized pediatric emergency physicians and nurses or integrated into the general ED. Models of ED layout, staffing, scheduling, and equipment are also described. While the Israeli team is a Type 3 EMT, the different models of ED organization can also be applied to other types of field hospitals to maximize care in the disaster setting.

Use of Standardized Dosing Sheets in Pediatric Emergency Care: Experience in a Third-Level Hospital.

Medication errors are one of the main causes of avoidable injuries in health care. With the aim of reducing them, a set of sheets with precalculated doses (by weight intervals) and preparation guidelines of the most common drugs in emergencies (Farmacards) was implemented in a Pediatric Emergency Department, replacing the previous manual calculation system. The aim of the study is to assess the staff's perception of safety and usefulness of the new dosing system. Pre-post intervention comparative analysis was performed by distributing an opinion questionnaire to pediatric emergency department staff in 2017 (manual calculation in situ) and 2023 (Farmacards). We obtained 60 and 55 responses, respectively, and analyzed the characteristics of the sample and the perception of the new method. Five years after its introduction, 88.5% were aware of its existence, 86.9% knew where to find it, and 76% used it "always or almost always" for critically ill patients. Greater use was observed among personnel with more years of work experience (Spearman, P = .057) and among nurses (Mann-Whitney, P < .001). The new method improved the level of perceived safety, especially for nurses (Mann-Whitney, P = .008). Standardized medication dosing systems in emergency situations aim to reduce medical errors and minimize iatrogenesis, participating in safety culture. According to the results of our study, the implementation of Farmacards shows a good acceptance by the staff and in the perception of patient safety, which is a good starting point to further optimize the quality of care. specialties: emergency medicine, general pediatrics, toxicology, and critical care.

Introduction of a LAT gel and low-dose midazolam sedo-analgesia protocol for pediatric skin suture in the emergency department: simpler is better.

skin lacerations are one of the main causes of children's referral to the emergency department (ED). We introduced in our general ED a pediatric sedo-analgesia protocol (SAP) for suturing skin wounds using LAT gel, a local anesthetic solution of lidocaine, adrenaline and tetracaine, with or without low-dose oral midazolam according to patient's age, to improve the experience of laceration repair. Primary outcomes were improvement of suturing experience for ED operators (as a reduction in the desire to avoid the procedure) and of the adequacy of sedo-analgesia provided, investigated through two different surveys administered to the ED staff before and after the introduction of the SAP. Children's parents were asked about satisfaction with the sedo-analgesia provided. Data were collected prospectively. The analysis included 85 and 60 healthcare professionals involved in the suture of skin wounds in children, respectively before and after the introduction of our SAP. The introduction of the SAP reduced ED operators' stress and improved the entire suturing experience. The pre-post analysis showed a statistically significant improvement in the perceived adequacy of the provided sedo-analgesia (p < 0.0001) and a significant reduction of operators who would have avoided the procedure (p < 0.0001). The great majority of children's parents expressed a high level of satisfaction. The introduction of a LAT gel and low-dose oral midazolam SAP allows an improvement of both the sedo-analgesia provided and the ED operators' suturing experience of skin lacerations in children. Our SAP appeared to be safe and effective, with low cost and high tolerability.

Emergency Department Healthcare Providers’ Knowledge and Attitudes regarding Appropriate Indications for Indwelling Urinary Catheter Use

Abstract Introduction: Indwelling urinary catheters (IUCs) are frequently used in emergency departments (EDs), but many insertions lack clear indications, leading to potential overuse. This overuse contributes to catheter-associated urinary tract infections (CAUTIs), costing billions in preventable healthcare expenses. Campaigns such as Choosing Wisely and Centers for Disease Control and Prevention guidelines aim to reduce unnecessary IUC use, improve patient outcomes and prevent CAUTIs. Materials and Methods: A cross-sectional survey and retrospective chart review were conducted at an academic tertiary care centre. The survey targeted ED providers, including physicians and nurses, while the chart review encompassed all adult ED patients in 2022. The survey covered demographic information, self-reported understanding and attitudes towards urinary catheters, including clinical scenarios, to evaluate the knowledge of appropriate indications for IUC insertion. The data analysis was performed using NCSS software and involved t-tests or one-way analysis of variance to explore associations between sample characteristics and knowledge scores. The significance level for all analyses was set at P &lt; 0.05. Results: A total of 96 of the 198 ED staff members participated in the survey. The confidence rate for knowledge of appropriate indications for IUC insertion was 100% among physicians and 97.8% among nurses. However, the results from the clinical scenarios in the survey showed that participants incorrectly answered in a range of 8%–75%. The mean scores of correct answers among consultants, residents and nurses were 65%, 67% and 66%, respectively. Conclusion: There is a considerable gap between ED healthcare providers’ subjective knowledge and attitudes and objective knowledge of appropriate IUC placement, which serves as a basis for an intervention to reduce the potential for inappropriate IUC insertion.

RESCUE - Rapid, Effective, Safe Communication in Emergency Departments: A cross-sectional e-survey.

Effective staff-to-staff and patient-provider communication in the Emergency Department (ED) is essential for safe, quality care. Routine wearing of Personal-Protective-Equipment (PPE) has introduced new challenges to communication. We aimed to understand the perspectives of ED staff about communicating while wearing PPE, and to identify factors contributing to communication success, breakdown, and repair. Study design was a descriptive cross-sectional online survey with convenience sampling. Categorical data were analysed using descriptive statistics and qualitative data analysed using content thematic analysis. Across nursing, medical and allied health, 78 staff responded with mean age= 38.8 years and mean ED clinical experience= 8.8 years). Respondents reported PPE impacted communication with patients/family members (81 %) and staff (61 %), with almost three-quarters of patient interactions rated as "somewhat difficult" or "extremely difficult". Content themes were: (i) impacts of mask-wearing on communication, (ii) impacts of mask-wearing on patient care quality and safety, and (iii) strategies for repairing communication breakdown. Health impacts of communicating in PPE (50 %) included voice fatigue, skin irritation, and throat dryness. ED staff perceived that wearing PPE impacted communication and compromised safe and efficient quality care delivery. Staff reported using increased voice volume, repetition, gestures, increased proximity, and emphasised facial movements to enhance their communication.

Generation of Trauma Rush Call in Managing Patients With Road Traffic Injuries Visiting the Emergency Department: A Retrospective Analysis.

Road traffic injuries (RTIs) are currently the ninth most common cause of mortality and are expected to increase in the future. RTIs rank in the top three reasons why young people die. Because of the high incidence and mortality risk, proper trauma care has been prioritized for RTI patients who present to the emergency department. Making appropriate and prompt trauma emergency calls can save lives. Poor resource use and an increased burden of inquiry can result from the inappropriate development of trauma rush calls (TRCs). Therefore, this study aims to evaluate the appropriate generation of TRCs to manage patients with RTIs presenting to the emergency department (ED). A retrospective analysis was conducted at the ED of the private tertiary care hospital in Karachi, Pakistan. Patients with RTIs and TRCs generated for the management were included. Dead on arrival was excluded. A total of 322 patients were enrolled using convenient sampling. A standard Performa was developed to collect the data from medical records, including demographics, clinical characteristics, radiological findings, TRC characteristics, and disposition. Multivariable logistic regression analysis was applied to determine the TRC justified using odds ratios, considering a p-value ≤0.05 as significant. Of the total 322 patients, the majority were males (n=266, 82.61%) between 21 and 40 years of age. Most patients reported injury/accident through high-speed vehicle crash (n=102, 31.68%). A Glasgow Coma Scale (GCS) score of <14 was recorded in 119 (36.96%) patients, and of 208 patients, 153 (73.55%) had positive computed tomography (CT) head findings, majorly subdural hematoma (n=43, 28.10%). CT cervical spine showed fractures in 14 patients (11.29%). Only one patient had both a positive CT abdomen and focused assessment with sonography in trauma (FAST), with a low systolic blood pressure (SBP) of 85 mmHg, and the CT abdomen showed a grade 3 spleen laceration. TRC was justified in 248 (77.01%) patients. Multivariable analysis showed that a GCS <14 [adjusted odds ratio (aOR) 3.03 (95% CI: 2.58-5.04)] and cervical collar [aOR 3.12 (95% CI: 1.63-5.98)] were the significant predictors for the TRC justified. A GCS <14 and cervical collar significantly justify the generation of TRC. These findings are crucial in educating ED staff regarding optimal care delivery. The future deployment of resources depends on these findings for skill development.

GEAR 2.0 ‐ Detection of Dementia and Cognitive Impairment

AbstractOlder adults use the emergency department (ED) as an important source of acute medical care, making 20+ million visits annually. Persons living with dementia are twice as likely to use the ED and 1.5 times more likely to have an avoidable visit. When in the ED, they often struggle with the fast‐paced setting and may not be able to give a complete medical history. These challenges, along with other adverse events, put patients with dementia at greater risk for poor outcomes. Yet emergency care for older adults is suboptimal, and care is especially poor for older adults with dementia, even though these adults seek ED‐based care more regularly than matched controls.Three decades of research has shown that dementia is under‐recognized in emergency departments, despite a proliferation of screening tools. Under‐recognition of dementia in the ED leads to under‐recognition in inpatient services, which has broad‐reaching consequences, such as longer hospital stays, lower patient satisfaction, accelerated cognitive declines, and increased health care costs. Better detection of dementia may improve the ED staff’s ability to implement interventions that can reduce the rate of cognitive decline and improve care coordination and patient safety.This session will review the literature of current and past dementia detection approaches and discuss top research questions generated by the patients, care partners and members of the transdisciplinary GEAR Detection Work Group.

Navigating Risks in the Emergency Room: A Comprehensive Review of Patient-Related Violence Against Medical Workers in Emergency Departments

Patient-related violence against healthcare workers in emergency departments (EDs) has become a growing concern worldwide, impacting the safety and well-being of medical staff, the quality of patient care, and the overall healthcare system. This review provides a comprehensive analysis of the prevalence, types, and contributing factors of patient-related violence in ED settings, including environmental stressors, patient conditions, organizational policies, and social influences. The physical and psychological impact on ED workers, such as injury, stress, burnout, and job dissatisfaction, is also explored. Furthermore, current prevention and management strategies are reviewed, including security measures, training programs, policy frameworks, and support systems. The article identifies challenges, including underreporting and research gaps, and offers recommendations for improved reporting systems, policy reforms, and targeted training to equip ED staff to handle aggressive behavior. By highlighting these key insights, this review underscores the urgent need for evidence-based interventions to protect healthcare workers in EDs and improve workplace safety and patient care outcomes.