Advanced Emergency Nursing Journal最新文献

Objective: This quality improvement initiative was conducted to determine if a provider in triage and split flow model could decrease the length of stay (LOS) of discharged patients seen in a community hospital emergency department (ED).

Background: Extended LOSs within the ED lead to delays in the care of patients, increase the number of patients who leave without being seen by a provider, decrease patient satisfaction, and cause a loss of revenue for health care organizations. Using a provider in triage and a split flow model, where patients can be seen and dispositioned without delays, can improve ED throughput and decrease the overall LOS.

Methods: Through a structured, interdisciplinary approach using the Plan-Do-Study-Act Shewhart Cycle of Process Improvement, a provider was placed in triage, and an interior waiting room was used to evaluate emergency severity index level 3 and 4 patients to expedite diagnostic testing and perform procedures. This model allowed lower acuity patients to be cared for separately from higher acuity patients, who were being treated in the main ED. In addition, the median arrival to provider, arrival to bed, and LOS from arrival to departure of discharged patients were compared to the current departmental processes.

Results: There was a significant improvement in the LOS of discharged patients and the time of arrival to triage, arrival to bed, and arrival to provider using a provider in triage and a split flow model compared to the current intake.

Conclusion: Implementation of a provider in triage and a split flow model can demonstrate a decrease in the LOS of discharged patients along with other ED metrics and improve efficiencies in patient care within a community hospital.

Atrial flutter is a supraventricular cardiac arrhythmia commonly characterized by two or three rapid atrial contractions for every ventricular contraction and a rapid ventricular rate that can be identified by a sawtooth pattern on an electrocardiogram. Patients often present with symptoms of heart failure and face the risk of atrial thrombus with a potential for systemic embolization. As such, pharmacologic rate and rhythm control, transesophageal echocardiogram, direct current cardioversion, and anticoagulation therapies may all be required for patient management. This case study provides an example of the patient presentation, exam findings, diagnostic results, and intervention modalities required for the health care provider to manage atrial flutter correctly in the emergency department setting.

Procedural sedation and analgesia is an essential activity in the emergency department for managing pain and anxiety during a variety of medical procedures. Various pharmacotherapy options, including opioid analgesics, antiemetics, anticholinergics, sedatives, and ketamine have been utilized, all with their unique efficacy and safety profiles. This review highlights the challenges associated with using certain agents and discusses emerging trends such as the use of newer synthetic opioids and the expanding use of dexmedetomidine. Overall, the selection of the optimal agents for procedural sedation and analgesia should be guided based on the unique characteristics of each agent tailored to the needs of the specific procedure, along with consideration for individual patient characteristics.

The aim of the Research to Practice column is to enhance the research critique abilities of both advanced practice registered nurses and emergency nurses (RNs), while also aiding in the translation of research findings into clinical practice. Each column focuses on a specific topic and research study. In this article, we used two patient scenarios as a framework to delve into the 2023 secondary analysis of Papp and Emerman's study on "Disparities in Emergency Department Naloxone and Buprenorphine Initiation."

The purpose of this case study on local anesthetic systemic toxicity (LAST), a potentially life-threatening complication of local anesthetic, is to ensure that emergency nurse practitioners (ENPs) are knowledgeable on this disease process. Local anesthetics are used frequently, often daily, by ENPs, as well as multiple other health care providers for various procedures. They should be knowledgeable of the steps to resuscitate a patient who may have severe LAST. This case study reviews the emergency management of LAST, including pharmacologic treatment, deviations from routine advanced resuscitative guidelines, and disposition of the patient upon successful resuscitation. Additionally, risk assessment and clinical manifestations will be discussed. After reviewing this case study, ENPs should be able to recognize the presentation of LAST and provide emergent management to reduce complications, comorbidities, and death.

Hamate fractures are uncommon, but early and accurate diagnosis is critical to prevent negative outcomes. Hamate fractures may present initially to emergency departments, and diagnosis can be challenging. This case report of a common hamate fracture may aid in increasing emergency advanced practice nurse knowledge to identify these fractures in practice.

Human trafficking is a global public health problem affecting millions of people worldwide. In the United States, many trafficking victims seek medical care for physical, sexual, and mental health concerns. Unfortunately, many of these individuals go unrecognized by health care providers as being victims of human trafficking and return to their trafficker without interventions for their safety and protection. To provide effective quality care for this patient population, health care providers must be knowledgeable regarding the identification of signs of trafficking, trauma-informed interventions to ensure the safety and protection of the victim(s), and methods to collaborate with interprofessional partners for the provision of appropriate medical and socioeconomic care following the exit from their trafficking situation. The purpose of this pilot study was to evaluate best practices in teaching Family Nurse Practitioner (FNP) students to identify and implement appropriate interventions for victims of human trafficking. The study was conducted in two phases using a mixed-method research design with repeated measures. In the first phase, education was provided through the validated HOPE Training modules produced by the Safe House Project using a pretest, posttest design. In the second phase, the students observed an interprofessional simulation followed by focus groups using a phenomenological approach to explore students' perceptions. Knowledge and confidence increased significantly following the implementation of this study. The results provide essential information regarding incorporating human trafficking education into FNP curricula. This study also contributes to the body of knowledge regarding the vital role that nurse practitioners play in the interprofessional management of human trafficking victims.