Study In Emergency Department Research Articles

Time to initial physician contact: Operational changes assessment

Background: The time to initial physician contact or time for medical doctor (tMD) is one of the crucial key performance indicators for the emergency department (ED). The “tMD” helps in improving medical care, administrative benefits, and operational changes. The main aim of this study was to assess the effects of different operational changes on tMD. Methods: The study was a prospectively designed analysis for one year. Data were collected via the study center's electronic records. The study was divided into three operational events (increase in number of consultants, change of shift timings, and increase in consultants covering a shift) in comparison with the baseline (prestudy) period. Data were then downloaded and imported into the statistical software package Stata for a detailed analysis. Results: The study commenced on July 1, 2016, with a 52-week period and 418,899 patient encounters. The coefficient for tMD slope improvement as compared with baseline with confidence interval (CI) and p value was: Phase 1: −2.5 [CI: −4.1 to −0.97 (p = 0.002)]; Phase 2: −1.6 [CI: −2.8 to −0.37 (p = 0.031)]; and Phase 3: −2.4 [CI: −3.4 to −1.4 (p < 0.001)]. The study phases showed a significant improvement over the baseline study period. Conclusion: The study results indicate that different types of interventions (e.g.,., changing shift times, increasing total hours of MD coverage throughout the day) had demonstrated different apparent effects in this study's ED. Further work in this study's ED should aim to continue to reduce absolute tMD and decrease variation by homogenizing dispersion as much as possible across the 24 hours of a day. ED has no control over the concentration or spread of visitors over the period of the day. The data were useful for guiding operations planning both during the study period and thereafter, as operations continue to focus on optimizing tMD.

The effect of brief case management on emergency department use of frequent users in mental health: Findings of a randomized controlled trial.

Frequent users of hospital emergency departments (EDs) are a medically and socially vulnerable population. The Coordinated Access to Care from Hospital EDs (CATCH-ED) study examined the effectiveness of a brief case management intervention in reducing ED use and improving health outcomes among frequent ED users with mental health or addiction challenges in a large urban centre. Adults (≥18 years of age) who had five or more ED visits in the past 12-months, with at least one visit for mental health or addictions problems were randomized to either brief case management (N = 83) or usual care (N = 83) and followed for 12 months. The primary outcome of effectiveness was the frequency of ED visits during 12 months after study enrolment. Secondary outcomes included days in hospital, mental health and addiction symptom severity and health-related quality of life, measured by the SF-12. Compared to usual care, CATCH-ED participants saw a 14% reduction in frequency of ED visits during the 12-month post-randomization period [rate ratio (RR) = 0.86, 95% CI 0.64–1.15)], however, this finding did not reach statistical significance. There were also no statistically significant differences between the groups at 12 months in the number of days spent in hospital (RR = 1.16, 95% CI 0.59–2.29), physical (1.50, 95% CI -2.15–5.15) or mental (-3.97, 95% CI -8.13–0.19) component scores of the SF-12, severity of psychiatric symptoms (-0.41, 95% CI -2.30–1.49), alcohol (0.053 95% -0.017–0.12) or drug (-0.0027, 95% CI -0.0028–0.023) use. Compared to usual care, a brief case management intervention did not result in significantly reduced ED use or improved health outcomes among frequent ED users with mental health or addictions challenges in a large urban centre in Canada. Future studies need to evaluate the availability and accessibility of community-based resources for individuals with frequent ED use.

Peripheral Intravenous Line Placement and Utilization in an Academic Emergency Department

BackgroundRising health care costs and increased scrutiny concerning spending have prompted providers and hospitals to identify unnecessary procedures and waste. Peripheral intravenous line (pIV) placement is one of the most common medical procedures performed. A recent study reported that 50% of intravenous lines placed in the emergency department (ED) went unused. If half of all pIVs placed in EDs systemically go unused, the costs and complications associated with pIV placement are unacceptably high. ObjectivesOur study aims to ascertain the frequency of pIV placement and usage in an urban ED. MethodsThis was a retrospective review of medical records for consecutive patients seen in an academic ED in June 2014. The following data points were recorded: age, sex, chief complaint, acuity level on admission, pIV placement both prehospital and in the ED, and pIV utilization (for fluids, medications, or contrast administration). ResultsThere were 509 charts reviewed, with a median patient age of 40 years. Common chief complaint categories included neurologic, cardiac, and skin/soft tissue. Triage acuity was varied, with a mean of 3.3. A pIV was placed in 55% of subjects. Prehospital providers placed 19%. Of all pIVs placed, 72% were used for the administration of medications, 19% for contrast, and 67% for fluids. Eighty-five percent of pIVs were used; 51% of patients with a pIV were admitted from the ED. ConclusionIn this study's ED, 85% of pIVs were used prior to discharge. Strategies to lower pIV placement rates should focus on alternative routes of medication and fluid administration.

Do patients receive adequate pain control after discharge from the ED?

Studies on the effectiveness of pain management have uniformly concluded that health care providers underestimate or undertreat pain. In the emergency department (ED) in which this study was conducted, physicians receive formal didactic and bedside teaching on pain recognition and management in order to heighten the awareness of patient's need for pain control. The purpose of this study was to determine if this outpatient pain management of patients with acute, painful conditions is better than that reported in the medical literature. In this prospective study, 110 adult patients who had an acute, painful diagnosis were telephoned 48 hours after discharge from the ED and asked if they felt their pain at home was well controlled. Patient satisfaction with pain control was higher (91%) than that reported in the medical literature. Also, pain medication was provided more frequently by this study's ED (95%). Education on pain awareness and treatment is a way to improve pain management.