Tertiary Care Emergency Research Articles

Barriers and facilitators to point-of-care ultrasound use in an academic emergency department by perceived usability

BackgroundWhile use of point-of-care ultrasound (POCUS) has become widespread in emergency medicine, its adoption and usage among emergency clinicians is variable. In this study, we explored the barriers and facilitators to POCUS use among emergency medicine clinicians in a tertiary care emergency department in the United States by clinical role and perceived usability of POCUS. MethodsWe initially administered a quantitative survey via REDCap and used a validated technology usability scale to categorize clinicians into tertiles of low, moderate, and high, based on perceived utility of POCUS. Subsequently, a purposeful sample in each category participated in semi-structured interviews until thematic saturation was reached (9–10 per category, 29 total). The qualitative interviews were analyzed using Braun and Clark's content analysis approach. A coding scheme was developed through initial review of 20 % of the transcripts, followed by operational definitions of codes, concept and category development, and selection of representative quotes. Analysis was supported by Dedoose software. ResultsWe identified 41 % (12/29) as high POCUS users, 31 % (9/29) as moderate, and 28 % (8/29) as low, based on perceived usability. Interviewees consisted of 24 % (7/29) attendings, 28 % (8/29) residents and 48 % (14/29) advanced practice providers (APPs). Attendings made up 50 % in the high POCUS group and 75 % of the low POCUS group were APPs. In the low group, the lack of prior and present POCUS training was a major barrier to POCUS use. The lack of time during clinical shifts was a major barrier to POCUS utility in the high and low groups. Availability of POCUS machines in clinical spaces was identified as a facilitator to POCUS use in the medium group. ConclusionsParticipants reported that POCUS facilitates patient disposition and clinical supervision enhances its use. Early POCUS education in professional school and continued POCUS training in clinical practice could facilitate POCUS use clinically. Structured POCUS courses and continued medical education programs may provide protected time to learn and practice POCUS. Moreover, accessible and standardized machines in the clinical environment could improve POCUS usage.

A quantitative needs assessment for a tele-ultrasound consult program in a tertiary care Emergency Department.

Point-of-care ultrasound (POCUS) has been shown to be beneficial in facilitating patient care, but its adoption is variable among emergency medicine (EM) clinicians. We identified the patterns of POCUS use and gaps in POCUS integration in a tertiary care emergency department (ED). These data provide a user-centered platform for subsequent development of a tele-ultrasound (tele-US) consultation program. We developed a 25-item needs assessment survey and used a 5-point Likert scale to assess current patterns of POCUS use and potential needs for POCUS among EM clinicians. Data were analyzed descriptively, and a chi-square analysis was used to assess for differences in POCUS use and comfort levels among clinicians. Overall, 48% (91/190) of eligible providers responded to the survey. Clinician responders included 38% (35/91) attendings (including fellows), 29% (26/91) residents, and 33% (30/91) advance practice providers (APPs). In assessing needs, 70% (58/83) of clinicians noted they would use POCUS more if they had more training. 76% (63/83) of clinicians felt comfortable with image acquisition and 68% (56/83) with image interpretation. APPs were less comfortable with POCUS image interpretation and clinical integration of POCUS findings compared to residents (χ2: 16.3, p < 0.0001 and χ2: 5.1, p = 0.02, respectively). 65% (54/83) of clinicians would use POCUS more if real-time supervision via tele-US was available for image acquisition and image interpretation. EM clinicians indicated a substantial need for further real-time POCUS training and supervision, especially for image interpretation. A clinician-centered strategy, such as tele-US, has potential to increase proficient use of POCUS.

263 Tele-Ultrasound Consult Implementation in a Tertiary Care Emergency Department: A Feasibility Study

263 Tele-Ultrasound Consult Implementation in a Tertiary Care Emergency Department: A Feasibility Study

Can clinical presentation predict radiologically confirmed cauda equina syndrome: retrospective case review of 530 cases at a tertiary emergency department

PurposeCauda equina syndrome (CES) may have significant individual consequences if diagnostic delays occur. Our aim was to evaluate the presenting subjective and objective features of patients with suspected CES in comparison to those with radiologically confirmed cauda equina compression (CEC)..MethodsThis was a retrospective analysis of all cases presenting with suspected CES to a tertiary emergency care unit over a two-year period. CEC was defined as radiological confirmation of CEC by Consultant Musculoskeletal (MSK) Radiologist report (MSK-CEC) and by measured canal occupancy due to an acute disc extrusion (> 75%)[measured by a Senior Spinal Surgeon (SP-CEC)]. Routine data collection was compared between categories. Chi square, multivariate regression analyses and ROC analysis of multiple predictors was performed.Results530 patients were included in this analysis, 60 (11.3%) had MSK-CEC, and 470 had NO- CEC. Only 43/60 (71.7%) had emergent surgery. Those with MSK-CEC and SP-CEC were statistically more likely to present with bilateral leg pain [(MSK-CEC OR 2.6, 95%CI 1.2, 5.8; p = 0.02)(SP-CEC OR 4.7, 95%CI 1.7, 12.8; p = 0.003)]; and absent bilateral ankle reflexes [(MSK-CEC OR 4.3; 95% CI 2.0, 9.6; p < 0.001)(SP CEC OR 2.5; 95%CI 1.0, 6.19; p = 0.05)] on multivariate analysis. The ROC curve analysis acceptable diagnostic utility of having SP-CEC when both are present [Area under the curve 0.72 (95%CI 0.61, 0.83); p < 0.0001].ConclusionThis study suggests that in those presenting with CES symptoms, the presence of both bilateral leg pain and absent ankle reflexes pose an acceptable diagnostic tool to predict a large acute disc herniation on MRI scan..

Optimizing Infusate Flow Patterns for Minimizing Vein Wall Trauma: An Exploratory Study with a Modified off-Axis Catheter Tip Opening.

Modifying the PIVC tip to direct infusates toward areas of highest hemodilution may reduce vein wall damage. This study compared flow patterns between a traditional PIVC with a central opening and one with an off-axis aperture. This was an exploratory observational analysis conducted at a tertiary care emergency department (ED) comparing flow patterns of two intravenous catheters: PIVC 1 (2.95 cm 20 gauge [Autoguard, Becton Dickinson]) and PIVC 2 (3.68 cm 20 gauge [Osprey, SkyDance Vascular]). Adult ED patients with PIVCs placed via traditional palpation/visualization method and with ultrasound capturing the flushing were eligible participants. Ultrasounds were reviewed to determine vein, catheter, and flow characteristics. The primary outcome was angle of the infusate leaving the catheter. Secondary outcomes included direction of catheter tip against vein wall, distance away from vein wall, vasospasm, and laminar/turbulent flow. Data from December 2023 included 28 catheters (10 PIVC 1, 18 PIVC 2). The average patient age was 53.7 years; 53.6% were female. Vein diameter/depth were similar: 0.35 cm/0.41 cm for PIVC 1 and 0.37 cm/0.47 cm for PIVC 2. The catheter tip pointed posteriorly towards the vein wall in 60% of PIVC 1 vs 11.1% in PIVC 2 (P=0.018). The angle of infusate flow away from the vein wall was 0.20° (SD 0.63) for PIVC 1 and 7.61° (SD 5.71) for PIVC 2 (P<0.001). Flow at 0° occurred in 90% of PIVC 1 vs 16.7% in PIVC 2 (P<0.001). In this exploratory investigation, a peripheral vascular access device with an off-axis tip aperture of demonstrated a sharper infusate flow angle away from the vein wall compared to a traditional central opening device. This redirection may reduce vein wall trauma and complications, though further research is needed to pair clinical outcomes with this technology.

Mass Carbon Monoxide Poisoning at a Daycare: A Public Health Lesson.

Carbon monoxide (CO) poisoning is a leading cause of preventable toxicity-related deaths in the United States. We describe a case series of 16 individuals who were exposed to CO due to a malfunctioning furnace at a Pennsylvania daycare, a state which did not mandate CO detectors in daycares. An institutional review board-approved retrospective analysis was performed, and de-identified patient records were examined. Collected data included age, sex, race, ethnicity, CO concentrations, arrival time, time to hyperbaric oxygen center contact, and time to transfer and discharge. Emergency medical services transported 16 patients to a tertiary care emergency department (ED) with both adult and pediatric departments. Fourteen patients were 10 years of age or younger. Fifteen patients arrived within one hour. Sixty-two percent (N=10) were male, and 94% (N=15) identified as Hispanic. Emergency physicians, medical toxicologists, clinicians, interpreters, and volunteers from across the hospital system were mobilized to the ED to assist with management. This large-scale daycare CO poisoning represents a potentially avoidable mass casualty incident among children and daycare staff and necessitated significant coordination of care. CO detectors in Pennsylvania daycares would provide early warning for staff, prevent or minimize toxicity, inform first responders, and better prepare EDs to handle similar situations.

The VExUS score and mortality in patients with Acute Kidney Injury: findings from a multidisciplinary prospective study.

The utility of the venous excess ultrasound (VExUS) score in predicting mortality remains uncertain in acute kidneyinjury (AKI) patients. This was a post-hoc study involving 246 AKI patients presenting to a tertiarycare emergency department. Venous ultrasound assessments were conducted to determine the VExUS score. Cox regressionanalysis was used to identify predictors of 6-month mortality. The study found no significant association between theVExUS score and 6-month mortality in AKI patients in the regression analyses. However, in the subgroup analyses, VExUSgrades 2-3 were associated with lower survival rates in the cardiorenal subgroup (HR: 3.98 [95% CI: 1.33-11.93]), and in AKIgrade 1 (HR: 4.07 [95% CI: 1.74-9.49]). This association was not present in other AKI subgroups. The predictors of mortalityincluded higher age (OR: 1.024; 95% CI 1.005-1.043), malignancy (OR: 2.186; 95% CI 1.408-3.392), lower systolic bloodpressure (OR: 0.990; 95% CI 0.982-0.998), elevated pulse (OR: 1.013; 95% CI 1.005-1.022), and higher lactate levels (OR:1.210; 95% CI 1.097-1.334). The VExUS score did not predict 6-month mortality in the general cohort of AKIpatients in the emergency department. However, VExUS grades 2-3 were associated with lower survival rates in the cardiorenalsubgroup and patients with AKI grade 1.

Quality improvement opportunities for urine culture follow-up in a tertiary care emergency department: A pilot study

Quality improvement opportunities for urine culture follow-up in a tertiary care emergency department: A pilot study

Factors influencing the use of Point Of Care Ultrasound (POCUS) on adult patients by Accident and Emergency Department (A&amp;amp;E) Doctors in Tertiary Care Hospitals in Colombo District, Sri Lanka; a Descriptive Cross-Sectional Study

Introduction:Point of care ultrasound (PoCUS) is an essential component of A&amp;E setting all over the world. It is used for diagnosis and assisting bedside procedures. Usage of PoCUS has been shown to improve quality of patient care. There are no formal studies in Sri Lankan A&amp;E setting to assess level of its usage and the barriers of using it. This study aimed to assess these aspects among ED doctors in three tertiary care hospitals in Colombo district.Methodology:This descriptive study was conducted by self-administered questionnaires distributed among 72 ED doctors working in the above setting. Questionnaire consisted of questions related to sociodemographics, types of PoCUS performed, barriers to PoCUS use etc. Ability to perform PoCUS was assessed by Likert grading from 1 to 5 based on operator’s own opinion. Statistical analysis was done using SPSS.Results: All the tertiary care emergency services had access to an ultrasound machine. PoCUS has been used for a wide variety of bedside scans and therapeutic procedures. Majority has been used to detect free fluid in peritoneal cavity (66.6%) and FAST scans (65.3%). Post graduate doctors (PG) were more confident in configuring PoCUS machine for procedures than non PG doctors (82.8% vs 5.4%). Ability to perform PoCUS was associated with post graduate exposure, &gt;1 year of experience using it and doing &gt;300 procedures in last 3 months (p=0.001). Main barriers identified for PoCUS usage were lack of training and lack of quality ultrasound machine.Discussion: Though PoCUS is mainly performed by PG doctors, important scans such as FAST, intra peritoneal free fluid assessment are done by non-PG doctors too. Compared to similar international studies, less number of latter doctors were capable of doing PoCUS in Sri Lanka. Empowering these doctors with PoCUS skills will improve the sustainably of this service in emergency care setup as they work in units for longer duration. A study where candidates’ skills are assessed by a third party would have provided more accurate reflection of PoCUS usage.Conclusion: Embracing updated technology and further improvement and availability of PoCUS training among ED doctors will enhance sustainable emergency patient care in Sri Lanka.

Protocol-based management of acute chest pain to reduce door-to-balloon time: insights from a tertiary care emergency department

Abstract Background: Chest pain is among the most common reasons patients visit the emergency department (ED). Any new onset of chest pain or any change in the pattern, intensity, or duration of pain in patients with preexisting symptoms must be evaluated to rule out acute coronary syndrome (ACS). Materials and Methods: This study was conducted at the ED of a 250-bed tertiary care center in North India. All patients presenting to the ED with acute chest pain were evaluated using a strictly protocolized approach. The study lasted from October 1, 2021, to December 31, 2022. Patients diagnosed with ST-segment elevation myocardial infarction (STEMI) were included in the study. Key timelines recorded included the time of patient arrival, time to electrocardiogram (ECG), time to transfer to the cardiac catheterization laboratory (CCL), and time to catheterization in the CCL. Results: A total of 208 patients presenting to the ED with acute chest pain were diagnosed with STEMI. The mean door-to-ECG time was 2.96 min, door-to-CCL time was 35.02 min, and door-to-balloon (DTB) time was 65.36 min. Additionally, 86.1% of patients had a DTB time of &lt;90 min. Conclusion: STEMI patients are considered the most vulnerable among those with ACS. Nearly three million STEMI cases occur in India each year. Hospitals providing STEMI care can strengthen protocols to meet recommended timelines and ensure better patient care. Utilizing technology and adapting to local needs can help improve STEMI outcomes and contribute to developing an integrated national policy.

Evaluation of Tetanus Cases Presenting to the Emergency Department at a Tertiary hospital in Somalia

Aim: Tetanus is an infection characterized by muscle spasms and trismus caused by toxins produced by Clostridium tetani. Although tetanus is a vaccine-preventable disease, it continues to be a public health problem in developing countries with high mortality rates. This study was conducted to evaluate the clinical profile and outcome of tetanus patients and determine the factors affecting the hospitalization unit, the length of hospital stay, and mortality. Materials and Methods: This is a retrospective cross-sectional study conducted with patients diagnosed with tetanus in a Tertiary care emergency department (ED) in Somalia. The relationship of demographic data, symptoms, laboratory findings, applied treatment methods with the hospitalization unit (regular inpatient floor/intensive care unit), length of hospital stay, and mortality were analyzed. Results: Sixty-seven patients diagnosed with tetanus during a 4-year study period were included. The mean patient age was 12,8±14,89 years, and 73,1% were males. Generalized muscle spasm (85,7%) was the most common symptom, benzodiazepines (95,5%.) were the most commonly used medications, and the mean length of hospital stay was 10.73±8.15 days. The rate of patients hospitalized in the ICU was 20,9%. The overall mortality rate was calculated as 19,5%. The presence of opisthotonos, neck stiffness, risus sardonicus, generalized muscle spasm, and dyspnea significantly correlated with mortality (p

Impact of the COVID-19 Pandemic on Therapy and Outcome of Acute Exacerbations of Chronic Obstructive Lung Disease at the Emergency Department.

This study compared the treatment outcomes of acute exacerbation of COPD (AECOPD) at an academic tertiary care emergency department before and during the COVID-19 pandemic. Analyzing data from 976 patients, our study showed a significant surge in overall respiratory therapy interventions amidst the noticeable decline in the total number of AECOPD cases during the pandemic. The marked increase in the utilization of non-invasive ventilation (NIV) was particularly important, soaring from 12% to 18% during the pandemic. Interestingly, this heightened reliance on NIV stood in contrast to the stability observed in other therapeutic modalities, including oxygen insufflation alone, high-flow nasal cannulas, and invasive ventilation. This distinctive treatment pattern underscores the adaptability of healthcare providers in the face of novel challenges, with a discernible emphasis on the strategic utilization of NIV. The shift in patient acuity during the pandemic became evident as the data showed a cohort of individuals presenting with AECOPD who were more severely ill. This was reflected in the increased use of NIV and, notably, a statistically significant rise in one-year mortality rates-from 32% before the pandemic to 38% during the pandemic (p = 0.046). These findings underscore the intricate balance healthcare providers must strike in navigating the complexities of patient care during a public health crisis. A closer examination of the longitudinal trajectory revealed a subtle decrease in re-admission rates from 65% to 60%. The increased reliance on NIV, a key finding of this investigation, reflects a strategic response to the unique demands of the pandemic, potentially influenced by both medical considerations and non-medical factors, such as the prevalent "fear of aerosols" and the imperative to navigate transmission risks within the healthcare setting. These insights contribute to understanding the evolving dynamics of AECOPD management during public health crises.

A standardized educational program to improve peripheral vascular access outcomes in the emergency department: A quasi-experimental pre-post trial.

Difficult intravenous access (DIVA) patients are known to have disproportionately poorer vascular access outcomes. The impact of education and training on vascular access outcomes in this vulnerable population is unclear. We aim to demonstrate the success of a program (Operation (O) STICK) on improving vascular access outcomes in DIVA patients. This was a quasi-experimental pre-post interventional study conducted at a tertiary care emergency department (ED) with 120,000 annual visits and 1100 hospital beds. Adult patients requiring an ultrasound-guided (US) peripheral intravenous catheter (PIVC) in the ED were eligible participants. Traditional (palpation method) insertions were excluded. Using multivariable linear regression and inverse probability weighted (IPW) linear regression, the standard group inclusive of PIVCs inserted by staff without formalized OSTICK training were compared to the interventional group inclusive of PIVCs inserted by staff with training and competency in the OSTICK training model. Data were collected over two time intervals: 4/1/21-9/30/21 (pre; non-OSTICK) and 10/1/22-3/31/23 (post; OSTICK). 2375 DIVA patients included 1035 (43.6%) non-OSTICK and 1340 (56.4%) OSTICK PIVCs. Overall, OSTICK PIVCs had a higher proportion of upper arm or forearm placements (94.6% vs 57.4%; p < 0.001), 20 gauge catheters (97.1% vs 92.3%; p < 0.001), and left-sided placements (54.4% vs 43.5%; p < 0.001). 62.7% of OSTICK PIVCs were placed by ED technicians, compared to 25.5% in the non-OSTICK group (p < 0.001). OSTICK PIVCs were placed on the first attempt 86.2% of the time and by the second attempt 95.4% of the time. In a subanalysis of 1343 hospitalized patients (689 (51.3%) OSTICK vs 654 (48.7%) non-OSTICK), OSTICK PIVCs survived for a median of 92% of the patient's hospital length of stay, compared to non-OSTICK PIVCs at 74% (p < 0.001). Formalized vascular access training in the ED leads to improved adherence to best practices for PIVC insertion, high success of cannulation with minimal attempts, and improved PIVC functionality during hospitalization for DIVA patients. Importantly, these outcomes are sustainable as they were captured 12 months after implementation of the program.

Impact of Rising Summer Temperatures on Government Sector Tertiary Care Emergency Centers: Addressing Heatstroke and Associated Death Rates in Karachi, Pakistan.

Rising summer temperatures pose significant challenges to healthcare systems, particularly in low-resource settings. This article examines the impact of heatwaves on government sector tertiary care emergency centers in Karachi, Pakistan and addresses the alarming increases in heatstroke cases and associated mortality during extreme heat events. The study signifies the urgent need for adaptive measures to enhance emergency preparedness, public awareness, and heat mitigation strategies. Addressing heat-related illnesses requires collaborative efforts from healthcare providers, policymakers, and community leaders. Effective interventions can mitigate the impact of rising temperatures on vulnerable populations and reduce heat-associated mortality.

Epidemiology and clinical characteristics of adult patients presenting to a low resource, tertiary care emergency department in Pakistan: Challenges & Outcomes.

Emergency Departments (EDs) play a major role in managing acute and chronic illnesses, especially in low-to-middle-income countries like Pakistan, which lacks effective primary healthcare. This study reports the epidemiology and clinical characteristics of patients presenting over a two-year period at the Indus Hospital and Health Network (IHHN) adult ED in Karachi, Pakistan. This is a retrospective observational study conducted through chart review of 264,859 patients, aged 16 years and above, who presented to the IHHN ED, Korangi Campus, from January 2019 to December 2020 after obtaining approval from IHHN IRB. Men were found to be the predominant presenting gender, with a slight rise in the number of women in 2020. The most frequent age group in 2019 was 15-25 (27.7%), whereas it was 25-35 years in 2020 (24.1%), with a decline in total number of elderly visits seen in comparison to previous years. The most frequently seen disposition was 'referral to clinic' in 2019 (48.4%) and 'discharged' in 2020 (39%). Out of all dispositions, maximum Length of stay (LOS) was seen in patients who left against medical advice in both years. Patient acuity showed the highest number of P3 (moderately ill) patients in both years. Infectious diseases accounted for greater than 10% of patients in both years (17.2% and16.5%), followed by gastrointestinal complaints (15.7% and 11.3%), genitourinary complaints (14.9% and 7.9%), and trauma (11.9% and 12.4%). Knowledge of epidemiology and clinical characteristics of patients can help facilitate timely planning of staff deployment and allocation of resources to avoid overcrowding, improve patient outcomes, and increase patient satisfaction through timely management.

Comparison of the diagnostic utility of CHOKAI, STONE and STONE PLUS scores in predicting ureteral stones larger than 5 mm

Objective: The objective of this study is to assess the diagnostic accuracy of CHOKAI, STONE, and STONE plus scores in detecting ureteral stones larger than 5 mm. Methods: This comparative diagnostic accuracy study was performed in a tertiary care emergency department (ED) and included consecutive patients who presented to the ED with flank pain over a 1-year period. The performance of these scoring scales in detecting ureteral stones measuring &gt;5 mm was determined by area under the receiver operating characteristics (AUROC) comparison. Results: Ureteral stones were detected in 270 (70.3%) of 384 patients included in the study. While 146 patients (54.1%) had ureteral stones measuring &lt;5 mm, 124 patients (54.1%) had stones measuring 5 mm or more in size. The performance of the CHOKAI score in predicting ureteral stones was superior to that of the STONE PLUS score; STONE PLUS score was also superior to STONE score ( p &lt; 0.001). Analysis of the diagnostic value of CHOKAI score and STONE PLUS scores in predicting &gt;5-mm stones showed no statistically significant difference ( p = 0.59). Conclusion: CHOKAI and STONE PLUS scores are useful in predicting &gt;5-mm ureteral stones and have similar diagnostic utility to each other. STONE score does not provide accurate diagnostic information about ureteral stones larger than 5 mm. Level of evidence: Level 2b

91. Implementation of a blood culture algorithm in emergency department patients as a diagnostic stewardship intervention

Abstract Background Blood cultures (BCx) are commonly ordered for patients at low risk of bacteremia. Liberal ordering can increase false-positive results due to contamination, along with increasing length of stay, excess antibiotics, and unnecessary diagnostic procedures. We implemented an algorithm for appropriate blood culture obtainment (Figure 1) in an academic tertiary care emergency department (ED) and assessed the intervention’s impact on various operational, clinical, and safety metrics.Figure 1:ED Blood culture algorithm Methods We performed a prospective cohort study in the Duke University Hospital ED from 12/2022 to 3/2023 using historical controls from 12/2020-11/2022. The BCx algorithm was disseminated in-person, electronically, and accessible online. Weekly chart review of all eligible patients for algorithm adherence was completed by 7 ED clinicians with monthly feedback provided to all ED providers. We defined a BCx event as 1 or more BCx sets within 24 hours. We excluded patients &amp;lt; 18 years, absolute neutrophil count &amp;lt; 500 109/L, and heart and lung transplant recipients. We measured BCx order volume, indication, algorithm adherence, BCx positivity rate, antibiotic days of therapy (DOT), and 30-day hospital readmission. Results Average monthly BCx volume was 1387 pre-intervention compared to 1226 post-intervention (p= 0.046). An increase in culture positivity was see post-intervention with a rate of 13.9% compared to 11.23% in the pre-intervention group (Figure 2, p&amp;lt; 0.001). The majority of the 2168 BCx adhered to the algorithm. (Figure 3). The most common reasons for non-adherence were isolated fever or leukocytosis (29%), non-severe community-acquired pneumonia or healthcare-associated pneumonia (6.9%) and non-severe cellulitis (4%). No change in DOT (786 vs. 783 days of therapy per 1000 patient days, p-value 0.85) (Figure 4) or monthly 30-day hospital readmission (21.1% vs 19.6%, p-value 0.30) was observed.Figure 2:Blood cultures drawn per month and % appropriate pre/post-intervention (N=2168)Figure 3:Algorithm Adherent vs. Algorithm Non-Adherent blood cultures per month (N=2168)Figure 4:Emergency Department anti-bacterial days of antibiotic therapy per 1000 patient days Conclusion Introduction of a BCx algorithm in an academic tertiary care ED, resulted in a decrease in BCx volume, increase in BCx positivity rate, and no increase in DOT or readmission was observed. (Table 1)Table 1:Blood culture volume, positivity rate, days of antibiotic therapy, and 30-day readmission Disclosures Jessica Seidelman, MD, MPH, Uptodate: content editor for pelvic osteomyelitis page

Survey of Vaccine Hesitancy in Patients Visiting Three Tertiary-care Emergency Departments in Southeast Louisiana.

Vaccine hesitancy has been a barrier to achieving herd immunity during the coronavirus 2019 (COVID-19) pandemic. Having low socioeconomic status and education levels, and being a person of color, are associated with higher COVID-19 infection risk and worse outcomes. These same groups are associated with higher vaccine hesitancy. The state of Louisiana has one of the lowest vaccination rates in the country. In this study we aimed to identify demographic, perspective, and health behavior factors associated with vaccine hesitancy in emergency departments (ED) in Southeast Louisiana. A cross-sectional survey was distributed at three tertiary-care hospital EDs. Patients >18years old and not in acute distress were recruited between April-July 2021. The 37-item questionnaire addressed socioeconomic demographics, social determinants of health, COVID-19 safety practices, thoughts and perceptions on COVID-19 and vaccines, sources of COVID-19 and vaccine information, and trust in the healthcare system. Overall, 247 patients completed our survey. Of those, 29.6% reported they were vaccine hesitant. These respondents were significantly more likely, when compared to vaccine-acceptant respondents, to never have married, to have some college education, make less than <$25,000 in household earnings yearly, be unsure whether vaccines prevent disease, not have discussed the COVID-19 vaccine with their primary care doctor, and to prefer to do their own research for COVID-19 vaccine information. We observed no statistically significant differences based on gender, race/ethnicity, parental status, area of living, or their perceived risk of needing hospitalization for treatment or dying from the virus. Vaccine hesitancy was associated with multiple socioeconomic factors, perspectives, and beliefs. Vaccine-hesitant individuals were more uncertain about the safety of the COVID-19 vaccine, the feasibility of obtaining the vaccine, and its efficacy. Public health interventions aimed at these findings and improving public trust in healthcare systems are needed to increase vaccine acceptance.

Association between Intraoperative Early Warning Score and Mortality and In-Hospital Stay in Lower Gastrointestinal Spontaneous Perforation.

Early warning scores (EWSs) can be easily calculated from physiological indices; however, the extent to which intraoperative EWSs and the corresponding changes are associated with patient prognosis is unknown. In this study, we investigated whether EWS and the corresponding time-related changes are associated with patient outcomes during the anesthetic management of lower gastrointestinal perforation. This was a single-center, retrospective cohort study conducted at a tertiary emergency care center. Adult patients who underwent surgery for spontaneous lower gastrointestinal perforations between September 1, 2012, and December 31, 2019, were included. The National Early Warning Score (NEWS) and Modified Early Warning Score (MEWS) were calculated based on the intraoperative physiological indices, and the associations with in-hospital death and length of hospital stay were investigated. A total of 101 patients were analyzed. The median age was 70 years, and there were 11 cases of in-hospital death (mortality rate: 10.9%). There was a significant association between the intraoperative maximum NEWS and in-hospital death (odds ratio (OR): 1.60, 95% confidence interval (CI): 1.10-2.32, p=0.013) and change from initial to maximum NEWS (OR: 1.60, 95% CI: 1.07-2.40, p=0.023) in the crude analysis. However, when adjustments were made for confounding factors, no statistically significant associations were found. Other intraoperative EWS values and changes were not significantly associated with the investigated outcomes. The preoperative sepsis-related organ failure assessment score and the intraoperative base excess value were significantly associated with in-hospital death. No clear association was observed between EWSs and corresponding changes and in-hospital death in cases of lower gastrointestinal perforation. The preoperative sepsis-related organ failure assessment score and intraoperative base excess value were significantly associated with in-hospital death.

FRI-180 - Hepatitis C seroprevalence screening and linkage to care of unknown infected patients admitted to a tertiary care emergency departement: on the road to achieve the WHO 2030 virus elimination target

FRI-180 - Hepatitis C seroprevalence screening and linkage to care of unknown infected patients admitted to a tertiary care emergency departement: on the road to achieve the WHO 2030 virus elimination target