Journal of Emergency Nursing最新文献

Delays in Sexual Assault Nurse Examiner Response Times: A Gap Analysis. 性侵犯护士审查员反应时间的延迟：差距分析。

IF 2.3 4区医学 Q2 EMERGENCY MEDICINE

Journal of Emergency Nursing

Pub Date : 2026-03-23 DOI: 10.1016/j.jen.2026.02.002

Lucy Robin Frank, Anne Derouin

Introduction: Emergency visits for sexual assault have surged 1533.0% since 2006. Sexual assault is linked to worsened health outcomes; outcomes worsen without timely care. Sexual assault nurse examiners are specially trained to improve health care services, enhance forensic evidence collection, and amplify rates of prosecution. National standards recommend 24/7 crisis care to preserve forensic evidence and timely treatment of sexual assault patients. A southeastern teaching hospital's part-time sexual assault nurse examiner program was audited for sexual assault nurse examiner delay length to establish recommendations.

Methods: This gap analysis used a retrospective chart review of 150 sexual assault nurse examiner cases from 2022 to 2024 to assess care delays. The 150 patients were selected using a random number generator. Data were gathered from Epic, SharePoint, and manual chart review. Sexual assault nurse examiner delays and patients with disruptions in care were identified. Quantitative data were analyzed using descriptive statistics, whereas reasons for delays were categorized and counted. The evaluation project adhered to national protocols and received an institutional review board exemption.

Results: Results showed average delays of 4.54 hours for sexual assault nurse examiner response times, with waits ranging from 0 to 30.7 hours; 6.37% of all 361 sexual assault nurse examiner cases either left or left and returned owing to sexual assault nurse examiner delays.

Discussion: Prolonged wait times risk negative medical, forensic, and psychological outcomes. To improve care, recommendations include expanding staffing, implementing a full-time program, streamlining processes, and achieving 24/7 sexual assault nurse examiner coverage. Delays in sexual assault nurse examiner response are 4 to 5 times standard recommendations, with only 23.33% of cases meeting the 60-minute goal.

导读：自2006年以来，因性侵犯而急诊的人数激增了1533.0%。性侵犯与健康状况恶化有关；如果不及时治疗，结果会恶化。性侵犯检查护士经过专门培训，以改善保健服务，加强法医证据收集，并提高起诉率。国家标准推荐全天候危机护理，以保存法医证据并及时治疗性侵犯患者。一家东南教学医院的兼职性侵犯护士审查员项目对性侵犯护士审查员延迟时间进行了审计，以建立建议。方法：采用回顾性图表分析2022年至2024年150例性侵犯护士审查员的护理延误情况，进行差距分析。使用随机数发生器选择150例患者。数据收集自Epic、SharePoint和手动图表审查。性侵犯护士检查延误和病人在护理中断被确定。定量数据使用描述性统计进行分析，而延迟的原因则进行分类和统计。该评价项目遵守国家议定书，并获得了机构审查委员会的豁免。结果：性侵护士审查员的平均反应延迟时间为4.54小时，等待时间为0 ~ 30.7小时；在361例性侵犯护士检查案件中，因性侵犯护士检查延误而离开或离开后又返回的占6.37%。讨论：长时间的等待会带来负面的医疗、法医和心理结果。为了改善护理，建议包括扩大人员配备，实施全职计划，简化流程，实现24/7性侵犯护士审查员覆盖。性侵犯护士审查员的反应延迟是标准建议的4到5倍，只有23.33%的病例达到60分钟的目标。

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引用次数: 0

Quantifying Risk: Workplace Violence as a Predictor of Nursing Burnout in Emergency Departments of 5 Tertiary General Hospitals in Shanghai-A Cross-Sectional Analysis. 量化风险：工作场所暴力对上海市5所三级综合医院急诊科护士职业倦怠的预测作用——横断面分析

IF 2.3 4区医学 Q2 EMERGENCY MEDICINE

Journal of Emergency Nursing

Pub Date : 2026-03-16 DOI: 10.1016/j.jen.2026.02.007

Zhiqiang He, Jian Liu, Hailiu Shi, Huan Zeng, Li Zen, Liya Zhang

Introduction: Workplace violence occurrs with high frequency in emergency departments. Research has confirmed an association between workplace violence and occupational burnout, although quantitative exploration of this relationship remains insufficient. This study aimed to investigate whether there is a threshold for workplace violence at which there is the least negative effect, providing a basis for developing targeted intervention strategies.

Methods: This cross-sectional study used convenience sampling to select 231 nursing staff from the emergency departments of 5 tertiary care general hospitals in Shanghai between January and December 2024 as the study population. Then, logistic regression and restricted cubic spline models were used to analyze the dose-response relationship between the frequency of workplace violence and nurse burnout.

Results: The total workplace violence score of emergency nurses was significantly correlated with the 3 dimensions of burnout (P<.01). A critically significant nonlinear trend was found between workplace violence and emotional exhaustion (P=.053; nonlinear test). No significant nonlinearity was found observed workplace violence and depersonalization (P = .148; nonlinear test). A significant nonlinear relationship was observed between workplace violence and personal fulfillment (P=.020; nonlinear test), thus indicating a possible non-linear inflection point around a total violence score of 30 points.

Discussion: Workplace violence is a direct and quantifiable risk factor for burnout, positively correlated with emotional exhaustion and depersonalization, and negatively correlated with personal fulfillment. This provides a basis for reducing the incidence of burnout among nurses in the emergency department and improves the health management of nurses and the quality of emergency care.

工作场所暴力在急诊科的发生频率较高。研究证实了工作场所暴力和职业倦怠之间的联系，尽管对这种关系的定量探索仍然不足。本研究旨在探讨职场暴力是否存在负面影响最小的阈值，为制定有针对性的干预策略提供依据。方法：采用方便抽样的横断面研究方法，选取2024年1 - 12月上海市5家三级综合医院急诊科231名护理人员作为研究人群。运用logistic回归和限制三次样条模型分析了工作场所暴力发生频率与护士职业倦怠的剂量-反应关系。结果：急诊护士工作场所暴力总分与职业倦怠三个维度显著相关(p)。讨论：工作场所暴力是职业倦怠的直接、可量化的危险因素，与情绪耗竭、人格解体呈正相关，与个人成就感负相关。为降低急诊科护士职业倦怠发生率，提高护士健康管理水平和急诊护理质量提供依据。

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引用次数: 0

Triage Nurses' Perceptions of Artificial Intelligence: A Cross-Sectional Study. 分诊护士对人工智能的认知：一项横断面研究。

IF 2.3 4区医学 Q2 EMERGENCY MEDICINE

Journal of Emergency Nursing

Pub Date : 2026-03-06 DOI: 10.1016/j.jen.2026.02.001

Alessandro Ciulli, Leonardo Ceccanti, Flavio Gheri

Introduction: Emergency department crowding and increasing patient complexity challenge traditional triage models. Artificial intelligence may support triage decision making, but nurses' perceptions shape real-world adoption.

Methods: We conducted a cross-sectional online survey (February to April 2024) among triage nurses from 7 emergency departments within the USL Toscana Centro, Italy. The questionnaire assessed 5 artificial intelligence dimensions, affidability (reliability), applicability, training, relational impact, and safety (binary items), and a composite "Total Challenges" score (0-5). Descriptive statistics, chi-square tests with Cramer's V, Mann-Whitney U, and Welch analysis of variance were applied (α = 0.05).

Results: Eighty-four nurses participated (73.8% female; largest age group, 35-54 years; 48.8%). Positive perceptions were as follows: relational impact, 63.1%; affidability (reliability), 48.8%; applicability, 47.6%; training, 36.9%; and safety, 36.9%. The mean of total challenges was 2.33 (SD = 1.23; range, 1-5). Age was associated with training (χ² = 7.122; degrees of freedom = 2; P = .028; V = 0.291), with older nurses reporting lower positive perceptions. Total challenges differed by age group (Welch analysis of variance, F[2, 46.042] = 4.106; P = .023), indicating higher perceived barriers among nurses aged 55 years or older. No significant associations emerged for sex or years of experience.

Discussion: Triage nurses showed cautious optimism toward artificial intelligence, valuing potential relational benefits but expressing concerns about training and safety. Older age was linked to greater perceived barriers. Targeted, competency-based education and clear governance are needed to support safe, human-centered artificial intelligence integration in emergency triage.

急诊科拥挤和患者复杂性的增加挑战了传统的分诊模式。人工智能可能会支持分诊决策，但护士的看法会影响现实世界的采用。方法：我们对意大利托斯卡纳中心医院7个急诊科的分诊护士进行了横断面在线调查（2024年2月至4月）。该问卷评估了5个人工智能维度，可信赖性（可靠性）、适用性、训练、关系影响和安全性（二元项目），以及一个综合的“总挑战”得分（0-5）。采用描述性统计、Cramer’s V卡方检验、Mann-Whitney U卡方检验和Welch方差分析（α = 0.05）。结果：84名护士参与调查，其中女性占73.8%，最大年龄组为35 ~ 54岁，占48.8%。积极看法如下：关系影响，63.1%；Affidability（可靠性），48.8%；适用性,47.6%;培训,36.9%;安全，36.9%。总攻毒次数平均为2.33次（SD = 1.23，范围1-5）。年龄与培训相关（χ2 = 7.122；自由度= 2;P = 0.028; V = 0.291），年龄较大的护士报告的积极看法较低。总挑战因年龄组而异（Welch方差分析，F[2,46.042] = 4.106; P = 0.023），表明55岁及以上的护士感知障碍较高。性别和工作年限没有明显的关联。讨论：分诊护士对人工智能表现出谨慎的乐观态度，重视潜在的关系效益，但对培训和安全表示担忧。年龄越大，感知障碍越大。需要有针对性的、基于能力的教育和明确的治理，以支持在紧急分类中安全、以人为本的人工智能整合。

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引用次数: 0

Culturally Responsive Emergency Nursing: From Triage to Discharge 文化响应紧急护理：从分诊到出院。

IF 2.3 4区医学 Q2 EMERGENCY MEDICINE

Journal of Emergency Nursing

Pub Date : 2026-03-01 Epub Date: 2025-06-03 DOI: 10.1016/j.jen.2025.04.017

Layla Abubshait MD, FACEP, Jamla Rizek DNPc, MBA, MSN, RN, CEN, CPEN, NHDP-BC, NRP

Caring for patients in the emergency department requires health care providers to seamlessly integrate clinical expertise with cultural awareness. As communities grow increasingly diverse, delivering culturally sensitive care alongside acute management has become essential to effective emergency response. Traditional emergency frameworks, primarily developed within Western medical contexts, often require adaptation to accommodate populations whose cultural beliefs shape their engagement with triage systems, medical interventions, and health care communication during critical situations.

This paper examines how emergency nurses can uphold cultural sensitivity while delivering time-critical care, illustrated through 3 real-world case scenarios. We explore practical strategies for rapid cultural assessment, effective communication systems, and adaptive care practices that can be implemented in high-stress situations. Through an analysis of current evidence and best practices, we provide frameworks for health care providers to deliver effective, culturally appropriate care while balancing the competing demands of time-sensitive interventions.

在急诊科照顾病人需要医疗保健提供者将临床专业知识与文化意识无缝地结合起来。随着社区日益多样化，提供具有文化敏感性的护理和急症管理对于有效的应急反应至关重要。传统的应急框架主要是在西方医学背景下发展起来的，往往需要进行调整，以适应那些文化信仰影响他们在危急情况下参与分诊系统、医疗干预和卫生保健沟通的人群。本文探讨了急诊护士如何在提供时间紧迫的护理时保持文化敏感性，并通过3个真实案例进行了说明。我们探索了快速文化评估的实用策略，有效的沟通系统，以及可在高压力情况下实施的适应性护理实践。通过对现有证据和最佳做法的分析，我们为卫生保健提供者提供框架，以提供有效的、文化上适当的护理，同时平衡对时间敏感的干预措施的竞争需求。

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引用次数: 0

Decreasing Door-to-Analgesia Time: Increasing Use of Sickle Cell Pain Management Pathway 减少门到镇痛时间：增加镰状细胞疼痛管理途径的使用。

IF 2.3 4区医学 Q2 EMERGENCY MEDICINE

Journal of Emergency Nursing

Pub Date : 2026-03-01 Epub Date: 2026-01-14 DOI: 10.1016/j.jen.2025.11.007

Britney Daniels DNP, RN, Maria V. Hughes DNP, MHA, RN, NEA-BC, CNE, ACUE, Patti Ludwig-Beymer PhD, RN, CTN-A, NEA-BC, CPPS, FTNSS, FAAN, Tom Houchins DNP, RN, CCRN-K, NE-BC, Melissa Burke MSN, MBA, RN, CEN, CPEN

Introduction

Individuals living with sickle cell disease often experience episodes of acute pain, prompting them to seek care in the emergency department. These patients frequently encounter prolonged wait times and invasive procedures before receiving analgesia. This evidence-based quality improvement project aimed to enhance the timely management of sickle cell–related pain by increasing adherence to an existing pain management pathway. The initiative focuses on promoting the use of intranasal fentaNYL as a first-line analgesic.

Methods

To promote consistent use of the established pathway, multiple interventions were implemented. These included a standard operating procedure to promote safe use of intranasal fentaNYL, a best practice advisory in the electronic health record prompting staff to notify a physician for an intranasal fentaNYL order, the development of a quick-reference badge card, and the creation of educational materials for patients and families addressing the safety and benefits of intranasal fentaNYL use.

Results

The amount of time before pain medicine administration for the preintervention group varied from 12 minutes to 244 minutes. Administration of pain medication in the postintervention period showed a narrower spread: values ranged from 9 minutes to 193 minutes. Comparing the 2 groups, the mean time to pain medication administration dropped from 82.2 to 67.7 minutes and the median time to pain medication decreased from 65 to 59. These findings may have clinical implications; however, the change did not reach statistical significance (P = .2201).

Discussion

This quality improvement initiative demonstrated that increased use of a pre-established intranasal fentaNYL protocol yielded a reduction in time to opioid administration for pediatric patients with sickle cell disease in vaso-occlusive crises. These results align with existing literature emphasizing the benefits of standardized pain pathways in improving efficiency and equity in practice.

简介：镰状细胞病患者经常经历急性疼痛发作，促使他们在急诊科寻求护理。这些患者在接受镇痛治疗前经常遇到长时间的等待和侵入性手术。这个基于证据的质量改进项目旨在通过增加对现有疼痛管理途径的依从性来加强镰状细胞相关疼痛的及时管理。该倡议的重点是促进使用鼻内芬太尼作为一线镇痛药。方法：为了促进既定途径的一致性使用，实施了多种干预措施。其中包括促进鼻内芬太尼安全使用的标准操作程序，电子健康记录中的最佳实践咨询，促使工作人员通知医生开具鼻内芬太尼处方，开发快速参考徽章卡，以及为患者和家属编写教育材料，说明鼻内芬太尼使用的安全性和益处。结果：干预前组给药时间为12 ~ 244分钟。在干预后的时间段内，止痛药的使用表现出较小的差异：数值范围从9分钟到193分钟。两组患者平均用药时间由82.2分钟缩短至67.7分钟，中位用药时间由65分钟缩短至59分钟。这些发现可能具有临床意义；但差异无统计学意义（P = .2201）。讨论：这一质量改进倡议表明，增加使用预先建立的芬太尼鼻内方案，可减少血管闭塞危象中镰状细胞病儿科患者到阿片类药物给药的时间。这些结果与现有文献一致，强调标准化疼痛通路在提高实践效率和公平性方面的好处。

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引用次数: 0

Experiences of Trans and Gender Diverse Youth Accessing Emergency Departments: Results of a Community-Designed Questionnaire 跨性别和性别不同的青少年访问急诊科的经验：社区设计问卷的结果。

IF 2.3 4区医学 Q2 EMERGENCY MEDICINE

Journal of Emergency Nursing

Pub Date : 2026-03-01 Epub Date: 2026-01-22 DOI: 10.1016/j.jen.2025.10.017

Sophie Lightfoot PhD, RN, Hannah Kia PhD, RCSW, Elijah Foran MA, Wendy Gifford PhD, RN, Patrick O’Byrne PhD, NP, Amanda Vandyk PhD, RN

Introduction

This exploratory study aimed to provide preliminary insights into how trans and gender diverse youth rate their care in emergency departments, which factors they perceive as influencing their experiences, and whether the concept of ED avoidance, identified in research with trans and gender diverse adults, is relevant to trans and gender diverse youth.

Methods

This exploratory cross-sectional survey and online questionnaire was codesigned by a research team that comprised academic members and trans and gender diverse youth. The study was open to youth across Canada and collected both sociodemographic information and experiential data using short-answer and Likert-type scales paired with comment boxes.

Results

The participants (n = 28), aged 16 to 25 years, reported highly variable experiences in the emergency department, ranging from 0 (very poor) to 8.5 of 10 (excellent) with a mean of 4.3. Furthermore, half (n = 14; 50%) avoided seeking needed care out of concern for how they would be treated. The results of this study suggest that there are a number of factors, such as the trans-competence of the provider, the patient’s co-occurring positionality, and the type of chief complaint, that may contribute to the poor experiences of trans and gender diverse youth and their subsequent ED avoidance.

Discussion

These findings provide preliminary insights into the experiences of trans and gender diverse youth accessing and receiving care in emergency departments and suggest that ED avoidance is a salient concept for this age/developmental stage.

简介：本探索性研究旨在初步了解跨性别和性别多元化青年如何评价他们在急诊科的护理，他们认为哪些因素会影响他们的经历，以及在跨性别和性别多元化成人研究中发现的ED回避概念是否与跨性别和性别多元化青年相关。方法：本研究由学术界人士及跨性别及多元性别青年共同设计探索性横断面调查及在线问卷。这项研究对加拿大各地的年轻人开放，并使用简答题和李克特式量表与评论框配对，收集了社会人口统计信息和经验数据。结果：参与者（n = 28），年龄在16至25岁之间，在急诊科的经历变化很大，从0分（非常差）到8.5分（满分10分），平均为4.3分。此外，有一半（n = 14; 50%）由于担心自己会受到怎样的对待而避免寻求所需的护理。这项研究的结果表明，有许多因素，如提供者的跨性别能力，患者的共同发生的位置，主诉的类型，可能导致跨性别和性别多元化青年的不良经历和他们随后的ED回避。讨论：这些发现为跨性别和性别多样化的青少年在急诊科获得和接受护理的经历提供了初步的见解，并表明在这个年龄/发展阶段，避免急诊科是一个重要的概念。

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引用次数: 0

Emergency Nurses’ Knowledge, Attitudes, and Behaviors Related to Patients Presenting to Triage With Pain: A Mixed Methods Study 急诊护士对疼痛分诊患者的知识、态度和行为：一项混合方法研究。

IF 2.3 4区医学 Q2 EMERGENCY MEDICINE

Journal of Emergency Nursing

Pub Date : 2026-03-01 Epub Date: 2026-02-06 DOI: 10.1016/j.jen.2025.12.013

Lisa Wolf PhD, RN, CEN, FAEN, FAAN, Hannah S. Noblewolf PhD

Introduction

The effective assessment and management of pain in patients presenting to the emergency department are challenged by individual and institutional factors. The literature suggests that triage nurses do not accept patients’ descriptions of their pain and often use a number of tactics to legitimize the pain or bring the patients’ statements about pain into alignment with their judgment of the severity or nature of the pain. This study explored the knowledge and decision-making processes of emergency triage nurses related to pain assessment and management and the contribution of pain to the perception of triage acuity.

Methods

A mixed methods approach, using survey data from the Nurses’ Knowledge and Attitudes Survey Regarding Pain and triangulated with focus group and interview data, was used. The Good Reporting of a Mixed Methods Study tool was used in the reporting of this study.

Results

Although emergency nurses responding to the survey state that patient reports of pain are valid and should be managed, qualitative data suggest that emergency nurses use a process of confirmation and challenge to determine the credibility of patients’ pain reports and thus both acuity and management.

Discussion

There is a significant tension between what emergency nurses state related to knowledge, attitudes, and behaviors about pain assessment and management and how they describe the process of assigning acuity when pain is the primary concern. Further research on the impact of both education related to pain assessment and management and bias training on the decision-making processes of emergency nurses related to acuity is warranted.

对急诊科患者疼痛的有效评估和管理受到个人和机构因素的挑战。文献表明，分诊护士不接受病人对疼痛的描述，并经常使用一些策略来使疼痛合法化，或使病人对疼痛的陈述与他们对疼痛的严重程度或性质的判断一致。本研究探讨急症分诊护士对疼痛评估与管理的相关知识与决策过程，以及疼痛对分诊敏锐度感知的贡献。方法：采用“护士疼痛知识和态度调查”的调查数据，结合焦点小组和访谈数据，采用混合方法。本研究的报告使用了混合方法研究的良好报告工具。结果：虽然急诊护士对调查的回应表明病人的疼痛报告是有效的，应该得到管理，定性数据表明，急诊护士使用一个确认和质疑的过程来确定病人的疼痛报告的可信度，从而确定敏锐度和管理。讨论：在急诊护士对疼痛评估和管理的知识、态度和行为的陈述，以及当疼痛是主要关注的问题时，他们如何描述分配敏锐度的过程之间存在着显著的紧张关系。有必要进一步研究疼痛评估和管理相关教育和偏见培训对急诊护士敏锐度相关决策过程的影响。

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引用次数: 0

A Mixed Methods Exploration of Compassion Satisfaction, Compassion Fatigue, and Emergency Nurses’ Caring Ability 同情满意度、同情疲劳与急救护士关怀能力的混合方法探讨。

IF 2.3 4区医学 Q2 EMERGENCY MEDICINE

Journal of Emergency Nursing

Pub Date : 2026-03-01 Epub Date: 2025-06-03 DOI: 10.1016/j.jen.2025.05.003

Tracey C. Arnold PhD, RN, CPEN, E. Carol Polifroni EdD, CNE, RN, NEA-BC, ANEF, Cheryl Tatano Beck DNSc, CNM, FAAN, Vicki J. Magley PhD

Introduction

A more comprehensive understanding of the relationship between the positive and negative factors of professional quality of life and the emergency nurse’s caring ability is imperative given that the care a nurse gives has lasting effects on their patients. This study aimed to examine the effects of professional quality of life constructs on caring ability in emergency nurses.

Methods

A sample of emergency nurses (n = 238) in the United States participated. Using a convergent mixed method approach with quantitative priority, bivariate associations were explored, and a model of caring ability was obtained via multiple regression analysis incorporating the independent variables to answer the research questions. A final regression model of caring ability was obtained using the independent variables in conjunction with adjustment for significant demographic characteristics. Using a qualitative descriptive design, the qualitative data were subjected to content analysis. Themes were derived and qualitative data was quantitized for a better understanding of the phenomena under study.

Results

Most participants reported low levels of compassion satisfaction, secondary traumatic stress, burnout, and caring ability. A multiple regression analysis identified compassion satisfaction as the strongest predictor for caring ability in emergency nurses. Content analysis revealed 3 themes: (1) I Love My Job But…; (2) Quantity Versus Quality: I Want What is Best, But I Cannot Provide it; and (3) The Abuse: Make it Stop. The results from the qualitative strand in this study confirmed the quantitative findings. Given that compassion satisfaction had the highest predictive value for caring ability, this variable was quantitized from the qualitative strand with 30% of participants endorsing feeling compassion satisfaction in their qualitative information.

Discussion

This novel study concludes that promoting the nurse’s purpose in their work, meaning and joy in their work, and feelings of pleasure in their work has the potential to augment their caring ability resulting in a greater likelihood of quality outcomes for patients in the emergency department.

引言：鉴于护士对病人的护理具有持久的影响，更全面地了解职业生活质量的积极因素和消极因素与急诊护士护理能力之间的关系是必不可少的。本研究旨在探讨职业生活品质建构对急诊护士护理能力的影响。方法：选取美国急诊护士（238名）为研究对象。采用具有定量优先性的收敛混合方法，探讨了关爱能力的双变量关联，并通过纳入自变量的多元回归分析得到关爱能力模型来回答研究问题。利用自变量结合显著人口统计学特征的调整，得到照顾能力的最终回归模型。采用定性描述设计，对定性数据进行内容分析。为了更好地理解所研究的现象，我们推导了主题，并对定性数据进行了量化。结果：大多数参与者报告的同情满意度、继发性创伤应激、倦怠和关怀能力水平较低。多元回归分析发现同情心满意度是急诊护士关怀能力的最强预测因子。内容分析揭示了三个主题：(1)我热爱我的工作，但是……；(2)数量与质量：我想要最好的，但我不能提供；(3)虐待：让它停止。本研究的定性链结果证实了定量的发现。考虑到同情满意度对关怀能力的预测价值最高，该变量从定性链中量化，30%的参与者在定性信息中赞同同情满意度。讨论：这项新颖的研究得出结论，促进护士在工作中的目的、工作的意义和乐趣，以及工作中的愉悦感，有可能增强他们的护理能力，从而更有可能为急诊科的患者提供高质量的治疗结果。

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引用次数: 0

Improving Antibiotic Administration Time in At-Risk Pediatric Populations: A Quality Improvement Project 改善高危儿科人群抗生素给药时间：质量改进项目。

IF 2.3 4区医学 Q2 EMERGENCY MEDICINE

Journal of Emergency Nursing

Pub Date : 2026-03-01 Epub Date: 2025-09-19 DOI: 10.1016/j.jen.2025.08.004

Virginia Elizondo BSN, RN, CPEN, Nicole Bizzack BSN, RN, CPEN, Angelica Rodick BSN, RN, CPEN, Amber Albiar BSN, RN, CPEN, Amber Dayton BSN, RN, CPEN, Ashley Collins BSN, RN, CPEN, Georgina Hernandez BSN, RN, Pauline Chen MPH, CPH, BS

Introduction

Bacterial sepsis is a life-threatening concern for pediatric patients with a history of sickle cell disease, oncological disease, and/or neutropenia who present with fever. Prompt antibiotic administration is critical. However, studies show that many hospitals fail to meet the 60-minute benchmark for high-risk patients, despite its known benefits.

Methods

This quality improvement initiative aimed to ensure that at least 80% of the target population received antibiotics within 60 minutes of emergency department registration. The Plan-Do-Study-Act model was used, and data were collected through electronic medical record audits, measuring time to antibiotics from registration to administration. SPSS 27 and a 2-proportion z-test analyzed time to antibiotics improvement.

Results

Pre- (n = 137) and postintervention groups (n = 638) were demographically similar. The mean age was 6.5 years before and 7.4 years after intervention, with a balanced sex distribution. Most patients were Black or African American, with clinical presentations including hematology with fever (9.6%), oncology with fever (40.4%), or sickle cell disease with fever (50%). Significant improvement was noted in the proportion of targeted patients receiving antibiotics in <60 minutes between January 2022 and May 2024. The time to antibiotics within goal of patients with oncology improved from 45.2% to 90%, patients with hematology from 42.9% to 81.6%, and patients with sickle cell disease from 44% to 85.1%. Overall time to antibiotics improved from 44.4% to 86.7%.

Discussion

The initiative significantly improved timely antibiotic administration. By 2024, 95% of patients received antibiotics within 60 minutes. Enhanced nursing autonomy and team-based strategies were key drivers of success, promoting safer care and sustained quality improvement.

细菌性败血症对于有镰状细胞病、肿瘤疾病和/或中性粒细胞减少病史并伴有发热的儿科患者是一种危及生命的问题。及时使用抗生素至关重要。然而，研究表明，尽管已知60分钟的好处，但许多医院未能达到高风险患者的基准。方法：这项质量改进倡议旨在确保至少80%的目标人群在急诊室登记后60分钟内获得抗生素。采用计划-执行-研究-行动模型，通过电子病历审计收集数据，测量从注册到给药到使用抗生素的时间。SPSS 27和双比例z检验分析抗生素改善的时间。结果：干预前组（n = 137）和干预后组（n = 638）在人口统计学上相似。干预前的平均年龄为6.5岁，干预后的平均年龄为7.4岁，性别分布均衡。大多数患者为黑人或非裔美国人，临床表现包括血液学伴发热（9.6%）、肿瘤学伴发热（40.4%）或镰状细胞病伴发热（50%）。在讨论中，目标患者接受抗生素的比例显著改善：该倡议显著改善了抗生素的及时给药。到2024年，95%的患者在60分钟内接受抗生素治疗。增强护理自主权和团队为基础的战略是成功的关键驱动因素，促进更安全的护理和持续的质量改进。

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引用次数: 0

Safe Discharge Planning for Unhoused Patients in Emergency Departments: Addressing Vulnerability and Continuity of Care 急诊科无家可归病人的安全出院计划：解决护理的脆弱性和连续性。

IF 2.3 4区医学 Q2 EMERGENCY MEDICINE

Journal of Emergency Nursing

Pub Date : 2026-03-01 Epub Date: 2026-01-28 DOI: 10.1016/j.jen.2025.12.008

Daniell Kempton MSN, APRN, ACCNS-AG, CCRN-CSC, TCRN, Jennifer Poole MSN, RN, CEN, Andrew Smith BSN, RN, CCRN, CEN, K. Cheli Miga DNP, APRN, ACCNS-AG, CCRN, Manpreet Saran BS, BSN, RN, PCCN, Elisabeth Ashleigh Teague MSN, RN, CPN, SANE-A, Bridgette Barnes MSN, RN, CEN

Introduction

Unhoused patients or people experiencing homelessness may rely on emergency departments for care. Often, they face challenges at discharge owing to a lack of stable housing, limited access to follow-up care, and complex social needs. This quality improvement project aimed to evaluate discharge practices for people experiencing homelessness with mobility deficits and identify opportunities for improving continuity of care.

Methods

A safe discharge process and checklist were created with an interdisciplinary team. Concurrent with implementation, daily reports and chart reviews were conducted of people experiencing homelessness identified in the emergency department between September 2024 and February 2025. Data collected included consultations to case management, consultation completion, mobility concerns, and discharge disposition.

Results

Only 3.8% of identified people experiencing homelessness who met the criteria for people experiencing homelessness with mobility deficits were referred to case management or social services for the safe discharge checklist. There was a completion percentage of 35% overall; however, upon reevaluation of the inclusion criteria for patients experiencing homelessness with mobility deficits, there was a completion status of 100% of the safe discharge process.

Discussion

Discharge planning for people experiencing homelessness remains inconsistent, with limited linkage to outpatient care and support services. These findings highlight the need for standardized discharge protocols, integration of case management services, and partnerships with community organizations to reduce emergency department recidivism and improve outcomes for this vulnerable population.

简介：无家可归的病人或无家可归的人可能依赖于急诊部门的护理。由于缺乏稳定的住房、获得后续护理的机会有限以及复杂的社会需求，他们往往在出院时面临挑战。这一质量改进项目旨在评估行动不便的无家可归者的出院做法，并确定改善护理连续性的机会。方法：与跨学科团队合作制定安全出院流程和检查表。在实施的同时，对2024年9月至2025年2月期间在急诊科发现的无家可归者进行了每日报告和图表审查。收集的数据包括对病例管理的咨询，咨询完成情况，流动性问题和出院处理。结果：只有3.8%的确定的无家可归者符合行动不便的无家可归者的标准，被转介到病例管理或社会服务部门，以获得安全出院清单。总体完成率为35%；然而，在重新评估有行动障碍的无家可归患者的纳入标准后，安全出院过程的完成率为100%。讨论：无家可归者的出院计划仍然不一致，与门诊护理和支持服务的联系有限。这些发现强调了标准化出院协议、整合病例管理服务以及与社区组织合作的必要性，以减少急诊科的再犯并改善这一弱势群体的预后。

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引用次数: 0