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Emergency Department Discharge Center Program Evaluation from a "Learning Organization" lens: Methods, Lessons Learned, and Future Directions 从 "学习型组织 "视角看急诊科出院中心项目评估:方法、经验教训和未来方向
Pub Date : 2024-08-01 DOI: 10.1101/2024.07.30.24310873
Bibi S Razack, Naya B Mahabir, Lisa Iyeke, Lindsay Jordan, Roland Hope, Emily Diaz, Lyze Barcia, Diana Fuzailov, Helena Willis, Marina Gizzi-Murphy, Frederick Davis, Adam Berman, Mark Richman, Nancy Kwon
Our ED's Discharge Center (EDDC) facilitates appointments and paper-based social determinants of health (SDoH) screening. No criteria guide EDDC utilization. The ED's provider-administrator-run, patient-satisfying follow-up call program contacts only ~25% of discharges. We describe Learning Organization-principle-guided evaluation of EDDC efficiency, aiming to create EDDC time to expand the follow-up program. We reviewed appointment-making, SDoH-screening, and follow-up program data. We surveyed patients to determine whether adopting SHOUT tool criteria (no home, no primary care physician, or insurance) might yield more-judicious EDDC utilization. EDDC staff's 20 minutes/patient yielded fewer ED returns and admissions. Most patients improved post-discharge and made appointments themselves; 6% met SHOUT criteria for EDDC assistance; 4.5% would benefit from SDoH screening.Adopting SHOUT criteria would create significant time for EDDC-staffed follow-up program expansion. QR-code-accessible SDoH surveys would screen thousands more patients, minimizing EDDC staff involvement, saving 95% of the effort while retaining 100% of the benefit.
我们的急诊室出院中心 (EDDC) 为预约和纸质健康社会决定因素 (SDoH) 筛查提供便利。EDDC 的使用不需要任何标准。急诊室由医疗服务提供者-管理员运营的、令患者满意的随访呼叫计划仅接触了约 25% 的出院患者。我们介绍了在学习型组织原则指导下对 EDDC 效率进行的评估,旨在为扩大随访计划创造 EDDC 时间。我们回顾了预约、SDoH 筛选和随访计划的数据。我们对患者进行了调查,以确定采用 SHOUT 工具标准(无家可归、无主治医生或无保险)是否能更明智地利用 EDDC。EDDC 工作人员为每位患者花费的 20 分钟减少了急诊室返院和入院人数。大多数患者在出院后病情有所好转,并自行预约了就诊时间;6% 的患者符合接受 EDDC 援助的 SHOUT 标准;4.5% 的患者将受益于 SDoH 筛查。使用 QR 码进行 SDoH 调查可筛查成千上万名患者,最大程度减少 EDDC 工作人员的参与,节省 95% 的工作量,同时保留 100% 的收益。
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引用次数: 0
Discussions about Goals of Care in the Emergency Department: a Qualitative Study of Emergency Physicians' Opinions Using the Normalization Process Theory 急诊科关于护理目标的讨论:利用规范化过程理论对急诊医生观点的定性研究
Pub Date : 2024-07-27 DOI: 10.1101/2024.07.26.24310500
Fannie Péloquin, Emile Marmen, Véronique Gélinas, Ariane Plaisance, Maude Linteau, Audrey Nolet, Nathalie Germain, Patrick Archambault
Purpose We explored emergency department (ED) physicians' opinions about the feasibility of leading goals of care discussions (GCD) in their daily practice. MethodThis qualitative study was based on the Normalization Process Theory (NPT). We conducted semi-structured interviews between April and May 2018 with a convenience sample of ten emergency physicians from one academic ED (Lévis, Canada) and aimed to reach data saturation. Using a mixed deductive and inductive thematic analysis, two authors codified the interviews under the four NPT constructs: coherence, cognitive participation, collective action, and reflexive monitoring. We calculated a kappa statistic to measure inter-rater agreement. ResultsWe interviewed 10 emergency physicians. No new ideas emerged after the ninth interview and the inter-rater agreement was substantial. Fourteen themes were identified as factors influencing the feasibility of implementing GCD: (1) interpersonal communication, (2) efficiency of care, (3) anxiety generated by the discussion, (4) identification of an acute deterioration leading to the GCD, (5) meeting of the clinician, patient, and family, (6) importance of knowing the patient's goals of care before medical handover, (7) lack of training, (8) availability of protocols, (9) heterogeneous prioritization for leading GCD, (10) need to take action before patients consult in the ED, (11) need to develop education programs, (12) need for legislation, (13) need to improve the ED environment and human resources, and (14) selective systematization of GCD for patients. ConclusionGoals of care discussions are possible and essential with selected ED patients. Physicians identified outstanding needs to normalize GCD in their practice: education for both themselves and patients on the concept of GCD, legislative action for the systematization of GCD for patients, and proactive documentation of patients' preferences pre-ED. Patient, clinician and system-level policy-making efforts remain necessary to address these needs and ensure the normalization of GCD in emergency physicians' daily practice as suggested by clinical guidelines.
目的 我们探讨了急诊科(ED)医生对在日常工作中引导护理目标讨论(GCD)可行性的看法。方法这项定性研究基于规范化过程理论(NPT)。我们在 2018 年 4 月至 5 月期间对一家学术性急诊室(加拿大莱维斯)的 10 名急诊医生进行了半结构化访谈,旨在达到数据饱和。两位作者采用混合演绎和归纳的主题分析方法,在四个 NPT 构建下对访谈进行了编码:一致性、认知参与、集体行动和反思性监控。我们计算了卡帕统计量来衡量评分者之间的一致性。结果我们采访了 10 名急诊医生。在第九次访谈后,没有出现新的观点,而且评分者之间的一致性很高。有 14 个主题被确定为影响实施 GCD 可行性的因素:(1)人际沟通;(2)护理效率;(3)讨论产生的焦虑;(4)识别导致 GCD 的急性恶化;(5)临床医生、患者和家属的会面;(6)在医疗交接前了解患者护理目标的重要性;(7)缺乏培训、(10) 需要在患者到急诊室就诊前采取行动,(11) 需要制定教育计划,(12) 需要立法,(13) 需要改善急诊室环境和人力资源,(14) 有选择性地为患者提供系统化的 GCD。结论对选定的急诊室患者进行护理目标讨论是可能的,也是必要的。医生们指出了在实践中使 GCD 正常化的突出需求:对医生和患者进行有关 GCD 概念的教育,采取立法行动使患者的 GCD 系统化,以及在急诊前主动记录患者的偏好。患者、临床医生和系统层面的政策制定工作仍有必要解决这些需求,并确保急诊医生在日常工作中按照临床指南的建议将 GCD 正常化。
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引用次数: 0
Risk of Delayed Percutaneous Coronary Intervention for STEMI in the Southeast United States 美国东南部 STEMI 患者延迟经皮冠状动脉介入治疗的风险
Pub Date : 2024-07-12 DOI: 10.1101/2024.07.11.24310307
Maxwell C Messinger, Nicklaus Ashburn, Joshua S Chait, Anna C Snavely, Siena Hapig-Ward, Jason P Stopyra, Simon A. Mahler
BackgroundEmergent reperfusion by percutaneous coronary intervention (PCI) within 90 minutes of first medical contact (FMC) is indicated in patients with ST-segment elevation myocardial infarction (STEMI). However, long transport times in rural areas in the Southeast US make meeting this goal difficult. The objective of this study was to determine the number of Southeast US residents with prolonged transport times to the nearest 24/7 primary PCI (PPCI) center. MethodsA cross-sectional study of residents in the Southeastern US was conducted based on geographical and 2022 5-Year American Community Survey data. The geographic information system (GIS) ArcGIS Pro was used to estimate Emergency Medical Services (EMS) transport times for Southeast US residents to the nearest PPCI center. All 24/7 PPCI centers in North Carolina, South Carolina, Georgia, Florida, Mississippi, Alabama, and Tennessee were included in the analysis, as well as nearby PPCI centers in surrounding states. To identify those at risk of delayed FMC-to-device time, the primary outcome was defined as a >30-minute transport time, beyond which most patients would not have PCI within 90 minutes. A secondary outcome was defined as transport >60 minutes, the point at which FMC-to-device time would be >120 minutes most of the time. These cutoffs are based on national median EMS scene times and door-to-device times. ResultsWithin the Southeast US, we identified 62,880,528 residents and 350 PPCI centers. Nearly 11 million people living in the Southeast US reside greater than 30 minutes from a PPCI center (17.3%, 10,866,710, +/- 58,143 ), with 2% (1,271,522 +/- 51,858/62,880,528) living greater than 60 minutes from a PPCI hospital. However, most patients reside in short transport zones; 82.7% (52,013,818 +/- 98,741). Within the Southeast region, 8.4% (52/616) of counties have more than 50% of their population in a long transport zone and 42.3% (22/52) of those have more than 90% of their population in long transport areas. ConclusionsNearly 11 million people in the Southeast US do not have access to timely PCI for STEMI care. This disparity may contribute to increased morbidity and mortality.
背景ST段抬高型心肌梗死(STEMI)患者应在首次医疗接触(FMC)后 90 分钟内接受经皮冠状动脉介入治疗(PCI),进行紧急再灌注。然而,由于美国东南部农村地区的转运时间较长,因此很难实现这一目标。本研究的目的是确定美国东南部居民中有多少人到最近的全天候初级 PCI(PPCI)中心的转运时间过长。方法 根据地理数据和 2022 年 5 年期美国社区调查数据,对美国东南部居民进行横断面研究。研究人员使用地理信息系统(GIS)ArcGIS Pro估算了美国东南部居民从急诊医疗服务(EMS)转运到最近的PPCI中心所需的时间。北卡罗来纳州、南卡罗来纳州、佐治亚州、佛罗里达州、密西西比州、阿拉巴马州和田纳西州的所有全天候 PPCI 中心以及周边州的 PPCI 中心均被纳入分析范围。为了确定那些存在从急救中心到设备时间延迟风险的患者,主要结果被定义为30分钟的转运时间,超过这个时间,大多数患者将无法在90分钟内完成PCI。次要结果被定义为转运时间为 60 分钟,在大多数情况下,FMC 到设备的时间为 120 分钟。这些临界值基于全国急救医疗现场时间和门到设备时间的中位数。结果在美国东南部,我们确定了 62,880,528 名居民和 350 个 PPCI 中心。美国东南部有近 1100 万人居住在距离重症监护中心 30 分钟车程以上的地方(17.3%,10,866,710 人,+/- 58,143 人),2%(1,271,522 人 +/- 51,858/62,880,528 人)居住在距离重症监护医院 60 分钟车程以上的地方。然而,大多数患者居住在短途交通区;占 82.7%(52,013,818 +/- 98,741)。在东南部地区,8.4%(52/616)的县有 50% 以上的人口居住在长距离交通区,其中 42.3%(22/52)的县有 90% 以上的人口居住在长距离交通区。结论美国东南部有近 1100 万人无法及时获得 STEMI PCI 治疗。这种差异可能会导致发病率和死亡率上升。
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引用次数: 0
A qualitative study exploring Emergency Department Staff attitudes to COVID-19 research 探索急诊科员工对 COVID-19 研究态度的定性研究
Pub Date : 2024-07-07 DOI: 10.1101/2024.07.04.24309781
Joanna Quinn, Antonia Ho, Andrew Blunsum, David J Lowe
Introduction: Research conducted in the Emergency Department (ED) is essential for improving patient care and advancing evidence-based practice. However, there are several challenges to research engagement in the ED, including lack of time, awareness of research opportunities, and concerns about the impact on clinical duties. This study aimed to explore the attitudes and perceptions of ED staff involved in an enhanced syndromic surveillance of hospitalised severe acute respiratory illness (CHARISMA study) during the COVID-19 pandemic. Methods: This qualitative study utilised semi-structured interviews with a mix of nursing and medical staff with a range of experience levels. Thematic analysis was then undertaken. Results: 9 respondents informed our four key themes: the value of research, the user experience of the study tools, clinician research engagement and improvement recommendations for future iterations of the study. Our findings reveal that ED staff value research and recognise its importance in improving patient care and evidence-based practice. However, they also face significant challenges in participating in research due to time constraints, lack of awareness of research opportunities, and concerns about the impact on clinical duties. Conclusion: To address these challenges, we propose strategies to enhance research engagement in the ED, including providing more support from senior staff, more transparent communication about research studies, training on research methods and tools, and opportunities for feedback and input. Implementing these measures, we can enhance the environment for research in the ED, enabling wider staff contribution.
导言:急诊科 (ED) 开展的研究对于改善患者护理和推进循证实践至关重要。然而,在急诊科开展研究面临着一些挑战,包括缺乏时间、对研究机会的认识以及担心对临床职责的影响。本研究旨在探讨在 COVID-19 大流行期间,参与住院重症急性呼吸道疾病强化综合征监测(CHARISMA 研究)的急诊室工作人员的态度和看法。研究方法:这项定性研究采用半结构式访谈法,访谈对象包括具有不同经验水平的护理人员和医务人员。然后进行了主题分析。结果9 位受访者为我们提供了四个关键主题:研究的价值、研究工具的用户体验、临床医生的研究参与度以及对未来研究迭代的改进建议。我们的调查结果显示,急诊室工作人员重视研究,并认识到研究在改善患者护理和循证实践方面的重要性。然而,由于时间限制、缺乏对研究机会的认识以及担心对临床职责的影响,他们在参与研究时也面临着巨大挑战。结论:为了应对这些挑战,我们提出了加强急诊科研究参与度的策略,包括提供更多来自资深员工的支持、就研究项目进行更透明的沟通、就研究方法和工具进行培训,以及提供反馈和意见的机会。通过实施这些措施,我们可以改善急诊科的研究环境,让更多员工参与其中。
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引用次数: 0
Does Emergency Department point-of-care ultrasound in the evaluation of possible small bowel obstruction lead to meaningful improvements in patient-centric milestones? 急诊科护理点超声检查在评估可能的小肠梗阻时是否能显著改善以患者为中心的里程碑?
Pub Date : 2024-07-03 DOI: 10.1101/2024.07.01.24309689
Yi-Ru Chen, Melva Morales Sierra, Rida Nasir, Naya Mahabir, Lisa Iyeke, Lindsay Jordan, Trupti Shah, Kevin Burke, Matthew Friedman, Daniel Dexeus, Athena Mihailos, Mark Richman, Joshua Guttman
Introduction: Point-of-care ultrasound (POCUS) has 90-95% sensitivity and specificity for small bowel obstruction (SBO) compared with computed tomography (CT). ED clinicians might reasonably use a positive POCUS to progress to patient-centric milestones (eg, nasogastric tube (NGT) placement, general surgery consult, and disposition). Awaiting CT performance and interpretation before moving to such milestones may delay care. Literature is limited concerning the effects of POCUS vs. CT alone on such patient-centric milestones for patients with SBO. This study compared time to patient-centric milestones (NGT, general surgery consult, and disposition) among ED patients suspected of having SBO who underwent POCUS vs. CT only in their SBO diagnostic process. Methods: Data from 11,801 SBO patients seen among 14 EDs between 2017-2022 was queried. Patients were categorized into two groups according to diagnostic method (POCUS + CT vs. CT alone). Patients were included if they had a POCUS positive for SBO and an ED diagnosis of SBO; they were excluded from analysis of any specific/particular milestone (NGT, general surgery consult, or disposition) if they had that milestone prior to POCUS. Median time from ED arrival to each milestone was calculated for both groups (POCUS + CT vs. CT alone). Results: Compared to CT-only patients, patients with POCUS plus CT had a non-statistically-significant longer wait time from ED arrival to NGT (414 vs. 390, p=0.7) and from ED arrival to general surgery consult (487.5 vs. 442 minutes, p = 0.07). They had statistically-significantly longer time to from ED arrival to disposition (475.5 vs. 377 minutes, p=0.009). Among cases in which POCUS was performed, 80% of the time the NGT was placed, 77% of the time the general surgery consult was performed, and 100% of time disposition was made only after CT result rather than after POCUS but before CT result. Conclusion:Use of POCUS was not associated with earlier achievement of patient-centric milestones (NGT or general surgery consult) and was associated with longer time to disposition. This is most-likely because, despite POCUS suggesting SBO, clinicians waited for CT results prior to placing the NGT, consulting general surgery, and entering the disposition. Such results suggest that, despite POCUS's high sensitivity and specificity, ED and/or general surgery clinicians rely on CT scan results to confirm SBO, delaying patient-centric milestones.
简介:与计算机断层扫描(CT)相比,床旁超声检查(POCUS)对小肠梗阻(SBO)的敏感性和特异性高达 90-95% 。急诊室临床医生可以合理地利用 POCUS 阳性结果来推进以患者为中心的里程碑(例如,鼻胃管 (NGT) 置入、普外科会诊和处置)。在进入此类里程碑之前等待 CT 的表现和解释可能会延误治疗。有关 POCUS 与单纯 CT 对 SBO 患者以患者为中心的里程碑的影响的文献很有限。本研究比较了在 SBO 诊断过程中接受 POCUS 与仅接受 CT 的疑似 SBO 急诊患者达到以患者为中心的里程碑(NGT、普外科会诊和处置)所需的时间。方法:查询了2017-2022年间14家急诊室接诊的11801名SBO患者的数据。根据诊断方法(POCUS + CT vs. 仅 CT)将患者分为两组。如果患者的 POCUS 检查结果为 SBO 阳性,且 ED 诊断为 SBO,则纳入该组患者;如果患者在 POCUS 检查之前就有任何特定/具体的里程碑(NGT、普外科会诊或处置),则不纳入该里程碑的分析。计算了两组患者(POCUS + CT 与单用 CT)从到达急诊室到每个里程碑的中位时间。结果:与仅使用 CT 的患者相比,使用 POCUS + CT 的患者从急诊室到达到 NGT 的等待时间(414 分钟对 390 分钟,P=0.7)和从急诊室到达到普外科会诊的等待时间(487.5 分钟对 442 分钟,P=0.07)较长,但无统计学意义。从急诊室到达到处置的时间(475.5 分钟对 377 分钟,P=0.009),他们的时间明显更长。在实施了 POCUS 的病例中,80% 的病例放置了 NGT,77% 的病例进行了普外科会诊,100% 的病例在 CT 结果出来后才进行处置,而不是在 POCUS 之后、CT 结果出来之前进行处置。结论:使用 POCUS 与更早实现以患者为中心的里程碑(NGT 或普外科会诊)无关,与更长的处置时间有关。这很可能是因为,尽管 POCUS 提示有 SBO,但临床医生在放置 NGT、咨询普外科和做出处置之前仍在等待 CT 结果。这些结果表明,尽管 POCUS 具有很高的灵敏度和特异性,但急诊室和/或普外科临床医生仍依赖 CT 扫描结果来确认 SBO,从而延误了以患者为中心的里程碑。
{"title":"Does Emergency Department point-of-care ultrasound in the evaluation of possible small bowel obstruction lead to meaningful improvements in patient-centric milestones?","authors":"Yi-Ru Chen, Melva Morales Sierra, Rida Nasir, Naya Mahabir, Lisa Iyeke, Lindsay Jordan, Trupti Shah, Kevin Burke, Matthew Friedman, Daniel Dexeus, Athena Mihailos, Mark Richman, Joshua Guttman","doi":"10.1101/2024.07.01.24309689","DOIUrl":"https://doi.org/10.1101/2024.07.01.24309689","url":null,"abstract":"Introduction: Point-of-care ultrasound (POCUS) has 90-95% sensitivity and specificity for small bowel obstruction (SBO) compared with computed tomography (CT). ED clinicians might reasonably use a positive POCUS to progress to patient-centric milestones (eg, nasogastric tube (NGT) placement, general surgery consult, and disposition). Awaiting CT performance and interpretation before moving to such milestones may delay care. Literature is limited concerning the effects of POCUS vs. CT alone on such patient-centric milestones for patients with SBO. This study compared time to patient-centric milestones (NGT, general surgery consult, and disposition) among ED patients suspected of having SBO who underwent POCUS vs. CT only in their SBO diagnostic process. Methods: Data from 11,801 SBO patients seen among 14 EDs between 2017-2022 was queried. Patients were categorized into two groups according to diagnostic method (POCUS + CT vs. CT alone). Patients were included if they had a POCUS positive for SBO and an ED diagnosis of SBO; they were excluded from analysis of any specific/particular milestone (NGT, general surgery consult, or disposition) if they had that milestone prior to POCUS. Median time from ED arrival to each milestone was calculated for both groups (POCUS + CT vs. CT alone). Results: Compared to CT-only patients, patients with POCUS plus CT had a non-statistically-significant longer wait time from ED arrival to NGT (414 vs. 390, p=0.7) and from ED arrival to general surgery consult (487.5 vs. 442 minutes, p = 0.07). They had statistically-significantly longer time to from ED arrival to disposition (475.5 vs. 377 minutes, p=0.009). Among cases in which POCUS was performed, 80% of the time the NGT was placed, 77% of the time the general surgery consult was performed, and 100% of time disposition was made only after CT result rather than after POCUS but before CT result. Conclusion:\u0000Use of POCUS was not associated with earlier achievement of patient-centric milestones (NGT or general surgery consult) and was associated with longer time to disposition. This is most-likely because, despite POCUS suggesting SBO, clinicians waited for CT results prior to placing the NGT, consulting general surgery, and entering the disposition. Such results suggest that, despite POCUS's high sensitivity and specificity, ED and/or general surgery clinicians rely on CT scan results to confirm SBO, delaying patient-centric milestones.","PeriodicalId":501290,"journal":{"name":"medRxiv - Emergency Medicine","volume":"120 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141551823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effects of trauma quality improvement program implementation on mortality: A multi-center controlled interrupted time-series study 创伤质量改进计划的实施对死亡率的影响:多中心对照中断时间序列研究
Pub Date : 2024-05-27 DOI: 10.1101/2024.05.27.24307748
Johanna Berg, Siddarth David, Girish D. Bakhshi, Debojit Basak, Shamita Chatterjee, Kapil Dev Soni, Ulf Ekelund, Li Felländer-Tsai, Manjul Joshipura, Tamal Khan, Monty Khajanchi, Mohan L N, Anurag Mishra, Max Petzold, Sendhil Rajan, Nobhojit Roy, Rajdeep Singh, Martin Gerdin Wärnberg
Importance Trauma causes over four million deaths annually, the majority of these in low- and middle-income countries. Implementing trauma quality improvement programs may improve outcomes, and though extensively used, high-quality evidence of their effectiveness is scarce.
重要性 外伤每年造成四百多万人死亡,其中大部分发生在中低收入国家。实施创伤质量改进计划可改善治疗效果,尽管这些计划已被广泛使用,但有关其有效性的高质量证据却很少。
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引用次数: 0
The Role of Sepsis Care in Rural Emergency Departments: A Qualitative Study of Emergency Department User Perspectives 败血症护理在农村急诊科中的作用:急诊科用户观点定性研究
Pub Date : 2024-05-06 DOI: 10.1101/2024.05.05.24306891
Nicholas M. Mohr, Kimberly A.S. Merchant, Brian M. Fuller, Brett Faine, Luke Mack, Amanda Bell, Katie DeJong, Edith A. Parker, Keith Mueller, Elizabeth Chrischilles, Christopher R. Carpenter, Michael P. Jones, Steven Q. Simpson, Marcia M. Ward
Objective Sepsis is a leading cause of hospitalization and death in the United States, and rural patients are at particularly high risk. Telehealth has been proposed as one strategy to narrow rural-urban disparities. The objective of this study was to understand why staff use provider-to-provider telehealth in rural emergency departments (tele-ED) and how tele-ED care changes the care for rural patients with sepsis.
目的 败血症是美国住院和死亡的主要原因,而农村患者的风险尤其高。远程医疗被认为是缩小城乡差别的一种策略。本研究的目的是了解农村急诊科(tele-ED)工作人员使用医疗服务提供者间远程医疗的原因,以及远程急诊科护理如何改变对农村脓毒症患者的护理。
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引用次数: 0
A disposable female urinal bottle (the EasyWee tm pending) improves patient experience for immobilised females with lower limb fractures 一次性女用小便瓶(EasyWee tm 待定)改善了下肢骨折固定女性患者的就医体验
Pub Date : 2024-05-06 DOI: 10.1101/2024.05.06.24306419
Siân Thomas, Sophy Booth, Peter Ellis, Savneet Lochab, Mark D Lyttle, James Pegrum
Female patients with lower limb fractures often experience pain and loss of dignity when manoeuvred onto a bedpan. Poor bladder management, including urinary catheterisation for convenience, can lead to longer hospital stays and eventual loss of independence. Disposable pulp male urinal bottles have been modified into a shape that accommodates the female perineum but they have not been used consistently, the design has varied depending on the fabricator and no formal evidence supported their use.
下肢骨折的女性患者在使用便盆时往往会感到疼痛和失去尊严。膀胱管理不善,包括为了方便而使用导尿管,会导致住院时间延长,最终丧失独立能力。一次性纸浆男用尿瓶已被改装成适合女性会阴部的形状,但这种尿瓶的使用并不一致,其设计因制造商而异,而且没有正式的证据支持其使用。
{"title":"A disposable female urinal bottle (the EasyWee tm pending) improves patient experience for immobilised females with lower limb fractures","authors":"Siân Thomas, Sophy Booth, Peter Ellis, Savneet Lochab, Mark D Lyttle, James Pegrum","doi":"10.1101/2024.05.06.24306419","DOIUrl":"https://doi.org/10.1101/2024.05.06.24306419","url":null,"abstract":"Female patients with lower limb fractures often experience pain and loss of dignity when manoeuvred onto a bedpan. Poor bladder management, including urinary catheterisation for convenience, can lead to longer hospital stays and eventual loss of independence. Disposable pulp male urinal bottles have been modified into a shape that accommodates the female perineum but they have not been used consistently, the design has varied depending on the fabricator and no formal evidence supported their use.","PeriodicalId":501290,"journal":{"name":"medRxiv - Emergency Medicine","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140938726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Numerical Cincinnati Stroke Scale versus Stroke Severity Screening Tools for the Prehospital Determination of LVO 用于院前判断左心室积液的辛辛那提卒中数字量表与卒中严重程度筛查工具的比较
Pub Date : 2024-05-04 DOI: 10.1101/2024.05.02.24306794
Holden M. Wagstaff, Remle P. Crowe, Scott T. Youngquist, H. Hill Stoecklein, Ali Treichel, Yao He, Jennifer J. Majersik
Background Previous research demonstrated that the numerical Cincinnati Prehospital Stroke Scale (CPSS) identifies large vessel occlusion (LVO) at similar rates compared to a limited number of stroke severity screening tools. We aimed to compare numerical CPSS to additional stroke scales using a national EMS database.
背景 以前的研究表明,与有限的几种卒中严重程度筛查工具相比,辛辛那提院前卒中量表(CPSS)识别大血管闭塞(LVO)的比率相似。我们的目的是利用国家急救服务数据库将数字式 CPSS 与其他卒中量表进行比较。
{"title":"Numerical Cincinnati Stroke Scale versus Stroke Severity Screening Tools for the Prehospital Determination of LVO","authors":"Holden M. Wagstaff, Remle P. Crowe, Scott T. Youngquist, H. Hill Stoecklein, Ali Treichel, Yao He, Jennifer J. Majersik","doi":"10.1101/2024.05.02.24306794","DOIUrl":"https://doi.org/10.1101/2024.05.02.24306794","url":null,"abstract":"<strong>Background</strong> Previous research demonstrated that the numerical Cincinnati Prehospital Stroke Scale (CPSS) identifies large vessel occlusion (LVO) at similar rates compared to a limited number of stroke severity screening tools. We aimed to compare numerical CPSS to additional stroke scales using a national EMS database.","PeriodicalId":501290,"journal":{"name":"medRxiv - Emergency Medicine","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140889762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Sepsis in patients with vs. without mental illness: a comparison of demographic, insurance, comorbidity, and infection source characteristics 患有与未患有精神疾病的败血症患者:人口统计学、保险、合并症和感染源特征的比较
Pub Date : 2024-04-16 DOI: 10.1101/2024.04.15.24305016
Yi-Ru Chen, Melva Morales Sierra, Jaime Jacob, Lisa Iyeke, Lindsay Jordan, Khatija Paperwalla, Mark Richman
Background Adherence to the Surviving Sepsis Campaign’s 3- and 6-hour bundles (blood cultures/serum lactate/antibiotics/IV fluids/vasopressors) improves mortality. Septic patients with mental health illness may not receive optimal care, being unable to explain symptoms, understand/accept their condition/care, or remain calm. We compare characteristics of ED septic patients with vs without mental health illnesses in their demographics, insurance, housing status, comorbidities, and infected organs, part of a larger, retrospective study seeking to compare such patients’ sepsis care quality (bundle adherence, length-of-stay (LOS)).
背景 坚持 "脓毒症生存运动 "的 3 小时和 6 小时束(血液培养/血清乳酸/抗生素/静脉输液/血管加压)可提高死亡率。患有精神疾病的败血症患者可能无法获得最佳护理,因为他们无法解释症状、理解/接受自己的病情/护理或保持冷静。我们比较了患有与未患有精神疾病的急诊科脓毒症患者在人口统计学、保险、住房状况、合并症和感染器官方面的特征,这是一项大型回顾性研究的一部分,旨在比较此类患者的脓毒症护理质量(捆绑护理坚持度、住院时间(LOS))。
{"title":"Sepsis in patients with vs. without mental illness: a comparison of demographic, insurance, comorbidity, and infection source characteristics","authors":"Yi-Ru Chen, Melva Morales Sierra, Jaime Jacob, Lisa Iyeke, Lindsay Jordan, Khatija Paperwalla, Mark Richman","doi":"10.1101/2024.04.15.24305016","DOIUrl":"https://doi.org/10.1101/2024.04.15.24305016","url":null,"abstract":"<strong>Background</strong> Adherence to the Surviving Sepsis Campaign’s 3- and 6-hour bundles (blood cultures/serum lactate/antibiotics/IV fluids/vasopressors) improves mortality. Septic patients with mental health illness may not receive optimal care, being unable to explain symptoms, understand/accept their condition/care, or remain calm. We compare characteristics of ED septic patients with vs without mental health illnesses in their demographics, insurance, housing status, comorbidities, and infected organs, part of a larger, retrospective study seeking to compare such patients’ sepsis care quality (bundle adherence, length-of-stay (LOS)).","PeriodicalId":501290,"journal":{"name":"medRxiv - Emergency Medicine","volume":"90 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140625005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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medRxiv - Emergency Medicine
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