Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Associations of Emergency Department Length-of-Stay with Publicly Reported Quality-of-Care Measures.
The Institute of Medicine identified emergency department (ED) crowding as a critical threat to patient safety. We assess the association between changes in publicly reported ED length of stay (LOS) and changes in quality-of-care measures in a national cohort of hospitals. ⋯ In this longitudinal study of hospitals across the United States, improvements in ED timeliness measures are associated with improvements in the patient experience.
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The emergency department (ED) has been recognized as a high-risk environment for workplace violence. Acutely agitated patients who perpetrate violence against healthcare workers represent a complex care challenge in the ED. Recommendations to improve safety are often based on expert opinion rather than empirical data. In this study we aim to describe the lived experience of staff members caring for this population to provide a broad perspective of ED patient violence. The findings of this study will contribute to the development of a comprehensive framework for ED agitated patient care that will guide safety interventions. ⋯ The experience of ED staff members while caring for agitated patients is complex and multidimensional. We identified issues that coalesced into four tiers of healthcare delivery at the individual, team, environment, and system levels. Future research is needed to determine applicability of our findings across institutions to build a comprehensive framework for ED agitated patient care.
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Randomized Controlled Trial
Lidocaine Pretreatment Reduces the Discomfort of Intranasal Midazolam Administration: A randomized, double-blind, placebo-controlled trial.
Intranasal (IN) midazolam is a commonly prescribed medication for pediatric sedation and anxiolysis. One of its most frequently encountered adverse effects is discomfort with administration. While it has been proposed that premedicating with lidocaine reduces this undesirable consequence, this combination has not been thoroughly researched. The objective of our study was to assess whether topical lidocaine lessens the discomfort associated with IN midazolam administration. ⋯ Premedication with topical lidocaine reduces the discomfort associated with administration of IN midazolam (ClinicalTrials.gov, NCT02396537).
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Comparative Study
Observation or inpatient: Impact of patient disposition on outcomes and utilization among emergency department patients with chest pain.
to compare healthcare utilization including coronary angiography, percutaneous coronary intervention (PCI), rehospitalization, and rate of subsequent acute myocardial infarction (AMI) within 30 days, among patients presenting to the emergency department (ED) with chest pain admitted as short-term inpatient (≤2 days) versus observation (in-ED observation units combined with in-hospital observation). ⋯ There were higher rates of cardiac catheterization and PCI among those admitted as a short inpatient compared to observation, while the incidence of subsequent AMI within 30 days was similar.
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The objective was to test for significant differences in subjective and objective pretest probabilities for acute coronary syndrome (ACS) in a large cohort of chest pain patients stratified by race or gender. Secondarily we wanted to test for any differences in rates of ACS, rates of 90-day returns, cost, and chest radiation exposure after these stratifications. ⋯ Despite consistently estimating the risk for ACS to be lower for both females and minorities concordantly with calculated objective pretest assessments, there does not appear to have been any significant decrease in subsequent evaluation of these perceived lower-risk groups when radiation exposure and costs are taken into account. Further studies on the impact of pretest assessments on gender and racial disparities in ED chest pain evaluation are needed.