Annals of emergency medicine
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We sought to initiate an emergency department (ED)-based ultrasound-guided regional anesthesia (UGRA) program in our community teaching hospital system. Here, we present our development process and protocol. We also sought to assess the types, indications, and associated adverse event rates for the UGRA procedures in this study. ⋯ We successfully initiated a robust ED-based UGRA program in our community teaching hospital system. Among patients with successful follow-up, no adverse events were identified.
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Editorial Comment Multicenter Study
Tenecteplase Versus Alteplase for Acute Stroke: Mortality and Bleeding Complications.
Intravenous thrombolysis with alteplase has been the foundation of initial treatment of acute ischemic stroke for several decades. Tenecteplase is a thrombolytic agent that offers logistical advantages in cost and administration relative to alteplase. There is evidence that tenecteplase has at least similar efficacy and safety outcomes compared with alteplase for stroke. In this study, we compared tenecteplase versus alteplase for acute stroke in a large retrospective US database (TriNetX) regarding the following 3 outcomes: (1) mortality, (2) intracranial hemorrhage, and (3) the need for acute blood transfusions. ⋯ In our large retrospective multicenter study using real-world evidence from large health care organizations, tenecteplase for the treatment of acute stroke demonstrated a lower mortality rate, decreased intracranial hemorrhage, and less significant blood loss. The favorable mortality and safety profiles observed in this large study, taken together with previous randomized controlled trial data and operational advantages in rapid dosing and cost-effectiveness, all support the preferential use of tenecteplase in patients with ischemic stroke.
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The length and redundancy of notes authored by clinicians has significantly increased, giving rise to the term "note bloat." We analyzed the impact of new coding guidelines and documentation best practices on the length of emergency department (ED) notes and the amount of time clinicians spent documenting. ⋯ Embracing new guidelines and practices, we reduced the length of ED provider notes by 872 words. Despite this, the time clinicians spent documenting did not change significantly. We provide an early report of success in reducing note bloat in the ED to help guide future efforts to reduce overall documentation burden.