Pub Date : 2025-11-01DOI: 10.1016/j.jen.2025.07.002
Sarah Stuer MD, Cedric Dua MD, Eva Janssens MD, Philip Verdonck MD, Sabine Lemoyne MD, Ken Dewitte MD, Koenraad G. Monsieurs MD, PhD, Filip Haegdorens PhD, RN
Introduction
During the coronavirus disease 2019 pandemic, several clinical decision rules were promulgated to support triage and optimize resource allocation, particularly regarding intensive care unit admissions. This retrospective cohort study aimed to validate and compare the predictive performance of 3 such systems: the National Early Warning Score 2, the Pandemic Respiratory Infection Emergency System Triage score, and the American College of Emergency Physicians coronavirus disease 2019 severity classification. The primary outcome was intensive care unit admission within 24 hours after ED presentation.
Methods
Data were collected from unvaccinated patients with coronavirus disease 2019 presenting to the emergency department of Antwerp University Hospital between March 1, 2020 and June 27, 2021. The National Early Warning Score 2 was calculated during routine care, and the Pandemic Respiratory Infection Emergency System Triage and American College of Emergency Physicians coronavirus disease 2019 severity classification scores were calculated retrospectively. Diagnostic performance was assessed using the area under the receiver operating characteristic curve (AUC), positive likelihood ratio, and negative likelihood ratio.
Results
Among 490 patients, optimal cutoff values were National Early Warning Score 2 of ≥3, Pandemic Respiratory Infection Emergency System Triage score of ≥8, and American College of Emergency Physicians coronavirus disease 2019 severity classification of moderate severity. All scores demonstrated good discrimination: areas under the receiver operating characteristic curve were 0.885 (National Early Warning Score 2), 0.851 (Pandemic Respiratory Infection Emergency System Triage), and 0.892 (American College of Emergency Physicians coronavirus disease 2019 severity classification), with no significant differences. The American College of Emergency Physicians coronavirus disease 2019 severity classification had the highest positive likelihood ratio (3.79), significantly higher than the National Early Warning Score 2 (2.48; P<.001). The National Early Warning Score 2 had the lowest negative likelihood ratio (0.04), although differences were not statistically significant.
Discussion
Although the American College of Emergency Physicians coronavirus disease 2019 severity classification demonstrated superior rule-in characteristics, the National Early Warning Score 2 offered the best rule-out characteristics. Given its simplicity, widespread use, and rule-out potential, the National Early Warning Score 2 may offer the greatest practical value to predict intensive care unit admission 24 hours after ED presentation of unvaccinated patients with coronavirus disease 2019, particularly in a pandemic context.
{"title":"Evaluating Clinical Decision Tools for Intensive Care Unit Admission Prediction in Patients With Coronavirus Disease 2019","authors":"Sarah Stuer MD, Cedric Dua MD, Eva Janssens MD, Philip Verdonck MD, Sabine Lemoyne MD, Ken Dewitte MD, Koenraad G. Monsieurs MD, PhD, Filip Haegdorens PhD, RN","doi":"10.1016/j.jen.2025.07.002","DOIUrl":"10.1016/j.jen.2025.07.002","url":null,"abstract":"<div><h3>Introduction</h3><div>During the coronavirus disease 2019 pandemic, several clinical decision rules were promulgated to support triage and optimize resource allocation, particularly regarding intensive care unit admissions. This retrospective cohort study aimed to validate and compare the predictive performance of 3 such systems: the National Early Warning Score 2, the Pandemic Respiratory Infection Emergency System Triage score, and the American College of Emergency Physicians coronavirus disease 2019 severity classification. The primary outcome was intensive care unit admission within 24 hours after ED presentation.</div></div><div><h3>Methods</h3><div>Data were collected from unvaccinated patients with coronavirus disease 2019 presenting to the emergency department of Antwerp University Hospital between March 1, 2020 and June 27, 2021. The National Early Warning Score 2 was calculated during routine care, and the Pandemic Respiratory Infection Emergency System Triage and American College of Emergency Physicians coronavirus disease 2019 severity classification scores were calculated retrospectively. Diagnostic performance was assessed using the area under the receiver operating characteristic curve (AUC), positive likelihood ratio, and negative likelihood ratio.</div></div><div><h3>Results</h3><div>Among 490 patients, optimal cutoff values were National Early Warning Score 2 of ≥3, Pandemic Respiratory Infection Emergency System Triage score of ≥8, and American College of Emergency Physicians coronavirus disease 2019 severity classification of moderate severity. All scores demonstrated good discrimination: areas under the receiver operating characteristic curve were 0.885 (National Early Warning Score 2), 0.851 (Pandemic Respiratory Infection Emergency System Triage), and 0.892 (American College of Emergency Physicians coronavirus disease 2019 severity classification), with no significant differences. The American College of Emergency Physicians coronavirus disease 2019 severity classification had the highest positive likelihood ratio (3.79), significantly higher than the National Early Warning Score 2 (2.48; <em>P</em><.001). The National Early Warning Score 2 had the lowest negative likelihood ratio (0.04), although differences were not statistically significant.</div></div><div><h3>Discussion</h3><div>Although the American College of Emergency Physicians coronavirus disease 2019 severity classification demonstrated superior rule-in characteristics, the National Early Warning Score 2 offered the best rule-out characteristics. Given its simplicity, widespread use, and rule-out potential, the National Early Warning Score 2 may offer the greatest practical value to predict intensive care unit admission 24 hours after ED presentation of unvaccinated patients with coronavirus disease 2019, particularly in a pandemic context.</div></div>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":"51 6","pages":"Pages 1084-1096.e3"},"PeriodicalIF":2.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.jen.2025.08.001
Dawn Peta BN, RN, ENC(C), Judith Young Bradford DNS, RN, FAEN
{"title":"Staffing and Productivity in the Emergency Department","authors":"Dawn Peta BN, RN, ENC(C), Judith Young Bradford DNS, RN, FAEN","doi":"10.1016/j.jen.2025.08.001","DOIUrl":"10.1016/j.jen.2025.08.001","url":null,"abstract":"","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":"51 6","pages":"Pages 1009-1014"},"PeriodicalIF":2.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145428498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.jen.2025.06.005
Harun Yildirim MD, Ertan Sonmez MD, Murtaza Kaya MD
Introduction
Flail chest is defined by the fracture of 3 or more ribs at 2 or more sites, resulting in a segment of the chest wall that loses its mechanical integrity, creating a “floating” segment. It occurs in 5% to 13% of patients with chest wall injuries. A very rare form of flail chest, sternal flail, refers to the separation of the sternum from the hemithoraxes and is usually associated with multiple anterior cartilage or rib fractures. Contrary to common impression, it has more than 1 form and each varies in severity.
Case Presentation
A 44-year-old male patient presented to the emergency department with blunt trauma. Imaging studies revealed a third rib fracture with flail chest on the right side, along with multiple rib fractures and a pneumothorax on the left. The lungs showed bilateral contusions. The patient also sustained compression fractures of the third and fifth thoracic vertebrae, a sternal fracture, and a nondisplaced distal radius fracture on the right. The clinical team inserted a chest tube into the left hemithorax to manage the pneumothorax. The patient remained stable and did not require mechanical ventilation. Oxygen therapy was administered via nasal cannula, accompanied by the administration of normal saline and analgesic treatment. Arterial blood gas analysis demonstrated mild lactic acidosis, whereas serial hemogram assessments revealed no clinically significant decline in hemoglobin levels. The patient was subsequently admitted to the department of thoracic surgery for conservative management and close observation, with no immediate indication for surgical intervention. Clinical course remained uneventful, and the patient was discharged on the seventh day in stable condition without complications.
Conclusion
Flail chest may result from a single rib fracture in combination with a sternal fracture. Patients presenting with atypical manifestations of flail chest can be discharged without complications within a short period when early diagnosis, appropriate supportive care, and timely treatment are provided.
{"title":"Flail Chest as a Rare Manifestation of Single Rib Fracture: A Case Report","authors":"Harun Yildirim MD, Ertan Sonmez MD, Murtaza Kaya MD","doi":"10.1016/j.jen.2025.06.005","DOIUrl":"10.1016/j.jen.2025.06.005","url":null,"abstract":"<div><h3>Introduction</h3><div><span>Flail chest is defined by the fracture of 3 or more ribs at 2 or more sites, resulting in a segment of the chest wall that loses its mechanical integrity, creating a “floating” segment. It occurs in 5% to 13% of patients with chest wall injuries. A very rare form of flail chest, sternal flail, refers to the separation of the </span>sternum<span> from the hemithoraxes and is usually associated with multiple anterior cartilage or rib fractures. Contrary to common impression, it has more than 1 form and each varies in severity.</span></div></div><div><h3>Case Presentation</h3><div><span>A 44-year-old male patient presented to the emergency department<span> with blunt trauma. Imaging studies revealed a third rib fracture with flail chest on the right side, along with multiple rib fractures and a pneumothorax<span> on the left. The lungs showed bilateral contusions. The patient also sustained compression fractures of the third and fifth </span></span></span>thoracic vertebrae<span><span><span>, a sternal fracture, and a nondisplaced distal radius fracture<span> on the right. The clinical team inserted a chest tube into the left hemithorax to manage the pneumothorax. The patient remained stable and did not require mechanical ventilation<span>. Oxygen therapy was administered via nasal cannula, accompanied by the administration of normal saline and </span></span></span>analgesic treatment. </span>Arterial blood gas analysis<span><span> demonstrated mild lactic acidosis, whereas serial hemogram assessments revealed no clinically significant decline in hemoglobin levels. The patient was subsequently admitted to the department of </span>thoracic surgery for conservative management and close observation, with no immediate indication for surgical intervention. Clinical course remained uneventful, and the patient was discharged on the seventh day in stable condition without complications.</span></span></div></div><div><h3>Conclusion</h3><div>Flail chest may result from a single rib fracture in combination with a sternal fracture. Patients presenting with atypical manifestations of flail chest can be discharged without complications within a short period when early diagnosis, appropriate supportive care, and timely treatment are provided.</div></div>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":"51 6","pages":"Pages 1021-1027"},"PeriodicalIF":2.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.jen.2025.06.006
WonJin Kwak MSN, Gyuli Baek PhD, EunJu Lee PhD
Introduction
With the rise in chronic diseases and an aging population, the complexity of hospital environments has increased, leading to a higher incidence of patient safety events. Improving patient safety and minimizing safety–related issues have become essential responsibilities for emergency department health care professionals. This study, using a cross-sectional survey design, aimed to explore the factors influencing emergency nurses’ patient safety nursing activities, focusing on safety control, patient safety knowledge and attitude (key components of patient safety competency), patient safety culture, and demographic and educational factors.
Methods
This study analyzed data from 165 emergency nurses across 8 hospitals in South Korea, including 3 regional emergency medical centers, 3 local emergency medical centers, and 2 local emergency medical facilities. The data collection took place between February 22 and August 28, 2021.
Results
Stepwise multiple regression analysis identified several key factors that influence patient safety nursing activities among emergency nurses. These factors include safety control and patient safety knowledge and attitude, both of which are components of patient safety competency. Other influential factors were receiving 11 or more sessions of patient safety–related education, maintaining a strong patient safety culture, engaging in monthly or biannual patient safety education, and being married. Together, these factors explained 69% of the variance in patient safety nursing activities.
Discussion
To improve patient safety nursing activities among emergency nurses, targeted strategies should focus on enhancing safety control and patient safety knowledge. Raising awareness of patient safety is also essential. In addition, organizational-level efforts—such as policies and procedures aimed at fostering a culture of patient safety—are crucial for sustained improvement.
{"title":"Factors Influencing Patient Safety Activities Among Emergency Nurses","authors":"WonJin Kwak MSN, Gyuli Baek PhD, EunJu Lee PhD","doi":"10.1016/j.jen.2025.06.006","DOIUrl":"10.1016/j.jen.2025.06.006","url":null,"abstract":"<div><h3>Introduction</h3><div>With the rise in chronic diseases and an aging population, the complexity of hospital environments has increased, leading to a higher incidence of patient safety events. Improving patient safety and minimizing safety–related issues have become essential responsibilities for emergency department health care professionals. This study, using a cross-sectional survey design, aimed to explore the factors influencing emergency nurses’ patient safety nursing activities, focusing on safety control, patient safety knowledge and attitude (key components of patient safety competency), patient safety culture, and demographic and educational factors.</div></div><div><h3>Methods</h3><div>This study analyzed data from 165 emergency nurses across 8 hospitals in South Korea, including 3 regional emergency medical centers, 3 local emergency medical centers, and 2 local emergency medical facilities. The data collection took place between February 22 and August 28, 2021.</div></div><div><h3>Results</h3><div>Stepwise multiple regression analysis identified several key factors that influence patient safety nursing activities among emergency nurses. These factors include safety control and patient safety knowledge and attitude, both of which are components of patient safety competency. Other influential factors were receiving 11 or more sessions of patient safety–related education, maintaining a strong patient safety culture, engaging in monthly or biannual patient safety education, and being married. Together, these factors explained 69% of the variance in patient safety nursing activities.</div></div><div><h3>Discussion</h3><div>To improve patient safety nursing activities among emergency nurses, targeted strategies should focus on enhancing safety control and patient safety knowledge. Raising awareness of patient safety is also essential. In addition, organizational-level efforts—such as policies and procedures aimed at fostering a culture of patient safety—are crucial for sustained improvement.</div></div>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":"51 6","pages":"Pages 1150-1166"},"PeriodicalIF":2.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/S0099-1767(25)00390-3
{"title":"Information for Readers","authors":"","doi":"10.1016/S0099-1767(25)00390-3","DOIUrl":"10.1016/S0099-1767(25)00390-3","url":null,"abstract":"","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":"51 6","pages":"Page A8"},"PeriodicalIF":2.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145428602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div><h3>Introduction</h3><div>The Emergency Department (ED) serves as a vital gateway to acute care, where timely and accurate triage decisions are essential to ensure appropriate patient prioritisation and efficient use of limited resources. Triage nurses operate in high-pressure environments and must make rapid decisions, often under conditions of uncertainty, relying on a blend of analytical reasoning and intuitive judgement. However, this complex decision-making process is susceptible to a range of challenges, including cognitive biases, communication breakdowns, procedural inconsistencies, fatigue, and stress, all of which can compromise patient safety and care quality. This study explores the multifaceted nature of triage decision-making, focusing on the influencing factors, cognitive processes, and real-world challenges experienced by nurses. By deepening our understanding of these elements, the paper lays the groundwork for the development of effective Clinical Decision Support Systems (CDSS) that can enhance clinical judgement and support nurses in delivering safe, timely, and efficient emergency care.</div></div><div><h3>Methods</h3><div>The study used cognitive task analysis through interviews and observations to capture the cognitive strategies used by nurses during triage. This approach provided detailed insights into how nurses assess patient acuity, handle uncertainty, verify decisions, and manage challenges.</div></div><div><h3>Results</h3><div>This study identified 26 themes from interviews and observations, illustrating how nurses use experience and protocols such as the Emergency Severity Index to manage patient flow. Key challenges encountered in triage included overcrowding, staff shortages, high patient acuity, communication barriers, frequent interruptions, and multitasking demands. Despite these hurdles, nurses adapted through prioritization and collaboration.</div></div><div><h3>Discussion</h3><div>The findings highlight significant implications for emergency health care, mainly the need for improvements in triage decision making, resource utilization, and patient safety. Data-driven clinical decision support systems can enhance decision making, streamline assessments, reduce delays, and improve safety and equity in triage, particularly in high-stress, resource-constrained environments.</div></div><div><h3>Relevance to Clinical Practice</h3><div>This study has significant implications for clinical practice, particularly in emergency care settings where effective triage is critical for patient outcomes. By exploring the cognitive processes and challenges faced by triage nurses, the research provides valuable insights into the complexities of decision making under pressure. The findings emphasize the importance of clinical decision support systems to enhance decision accuracy, reduce cognitive load, and mitigate the risk of errors. Implementing data-driven technologies and refining triage protocols can lead to more efficie
{"title":"A Cognitive Task Analysis for Developing a Clinical Decision Support System for Emergency Triage","authors":"Steve Agius BSc, MBA, Caroline Magri MD, MRCP, MPhil, MSc, PhD, PG Cert EBM, MSc, Vincent Cassar BA, MSc, PhD, CPsychol, CSci, AFBPsS","doi":"10.1016/j.jen.2025.05.013","DOIUrl":"10.1016/j.jen.2025.05.013","url":null,"abstract":"<div><h3>Introduction</h3><div>The Emergency Department (ED) serves as a vital gateway to acute care, where timely and accurate triage decisions are essential to ensure appropriate patient prioritisation and efficient use of limited resources. Triage nurses operate in high-pressure environments and must make rapid decisions, often under conditions of uncertainty, relying on a blend of analytical reasoning and intuitive judgement. However, this complex decision-making process is susceptible to a range of challenges, including cognitive biases, communication breakdowns, procedural inconsistencies, fatigue, and stress, all of which can compromise patient safety and care quality. This study explores the multifaceted nature of triage decision-making, focusing on the influencing factors, cognitive processes, and real-world challenges experienced by nurses. By deepening our understanding of these elements, the paper lays the groundwork for the development of effective Clinical Decision Support Systems (CDSS) that can enhance clinical judgement and support nurses in delivering safe, timely, and efficient emergency care.</div></div><div><h3>Methods</h3><div>The study used cognitive task analysis through interviews and observations to capture the cognitive strategies used by nurses during triage. This approach provided detailed insights into how nurses assess patient acuity, handle uncertainty, verify decisions, and manage challenges.</div></div><div><h3>Results</h3><div>This study identified 26 themes from interviews and observations, illustrating how nurses use experience and protocols such as the Emergency Severity Index to manage patient flow. Key challenges encountered in triage included overcrowding, staff shortages, high patient acuity, communication barriers, frequent interruptions, and multitasking demands. Despite these hurdles, nurses adapted through prioritization and collaboration.</div></div><div><h3>Discussion</h3><div>The findings highlight significant implications for emergency health care, mainly the need for improvements in triage decision making, resource utilization, and patient safety. Data-driven clinical decision support systems can enhance decision making, streamline assessments, reduce delays, and improve safety and equity in triage, particularly in high-stress, resource-constrained environments.</div></div><div><h3>Relevance to Clinical Practice</h3><div>This study has significant implications for clinical practice, particularly in emergency care settings where effective triage is critical for patient outcomes. By exploring the cognitive processes and challenges faced by triage nurses, the research provides valuable insights into the complexities of decision making under pressure. The findings emphasize the importance of clinical decision support systems to enhance decision accuracy, reduce cognitive load, and mitigate the risk of errors. Implementing data-driven technologies and refining triage protocols can lead to more efficie","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":"51 6","pages":"Pages 1028-1045.e4"},"PeriodicalIF":2.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.jen.2025.05.006
Tina Morris DNP, RN
Introduction
Patients with left ventricular assist devices are a high-risk, low-volume patient population with up to 72% admission rates. This project aimed to enhance emergency staff knowledge and reduce the door-to-consult times for patients with left ventricular assist devices presenting to the emergency department by implementing a bundled care approach.
Methods
To better support patients with left ventricular assist devices, the project team collaborated with emergency clinical staff to implement a comprehensive care bundle. This included a clear pathway for patients with left ventricular assist devices upon arrival to the emergency department, targeted education for clinical staff (with pre- and post-education survey), and a transportation checklist for admission cases. Data were collected and analyzed using SAS Statistics to summarize the results and improve patient outcomes.
Results
Patients with left ventricular assist devices experienced significant improvements in care after the implementation of this care bundle. After education, patients benefited from increased staff confidence, better identification of alarms, and improved access to educational resources. The bundle approach also dramatically reduced the time it took for patients with left ventricular assist devices to see the advanced heart failure team in the emergency department, decreasing door-to-consult times from 245 minutes to just 35 minutes.
Discussion
A bundled care approach for patients with left ventricular assist devices in the emergency department improves care by decreasing door-to-consult and increasing the staff’s knowledge in this patient population.
{"title":"Care of the Patient With Left Ventricular Assist Device in the Emergency Department: A Bundled Care Approach","authors":"Tina Morris DNP, RN","doi":"10.1016/j.jen.2025.05.006","DOIUrl":"10.1016/j.jen.2025.05.006","url":null,"abstract":"<div><h3>Introduction</h3><div>Patients with left ventricular assist devices<span><span> are a high-risk, low-volume patient population with up to 72% admission rates. This project aimed to enhance emergency staff knowledge and reduce the door-to-consult times for patients with left ventricular assist devices presenting to the </span>emergency department by implementing a bundled care approach.</span></div></div><div><h3>Methods</h3><div>To better support patients with left ventricular assist devices, the project team collaborated with emergency clinical staff to implement a comprehensive care bundle. This included a clear pathway for patients with left ventricular assist devices upon arrival to the emergency department, targeted education for clinical staff (with pre- and post-education survey), and a transportation checklist for admission cases. Data were collected and analyzed using SAS Statistics to summarize the results and improve patient outcomes.</div></div><div><h3>Results</h3><div>Patients with left ventricular assist devices experienced significant improvements in care after the implementation of this care bundle. After education, patients benefited from increased staff confidence, better identification of alarms, and improved access to educational resources. The bundle approach also dramatically reduced the time it took for patients with left ventricular assist devices to see the advanced heart failure team in the emergency department, decreasing door-to-consult times from 245 minutes to just 35 minutes.</div></div><div><h3>Discussion</h3><div>A bundled care approach for patients with left ventricular assist devices in the emergency department improves care by decreasing door-to-consult and increasing the staff’s knowledge in this patient population.</div></div>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":"51 6","pages":"Pages 1046-1053"},"PeriodicalIF":2.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Emergency departments are often the first point of contact for individuals with self-harm or suicide attempts. Interventions initiated in emergency departments have the potential to prevent suicidal behavior. However, the scope and nature of available interventions remain unclear.
Methods
A scoping review was conducted to explore the extent and nature of the literature on suicide prevention interventions in emergency departments. A search strategy based on the population, concept, and context framework was applied to 6 databases.
Results
A total of 10,415 studies were retrieved, and 16 met eligibility criteria after full-text screening. Interventions were categorized into organizational interventions, safety planning interventions, psychological interventions, and psychotherapeutic interventions. Organizational interventions (n = 6) and safety planning interventions (n = 5) were most commonly reported, followed by psychological (n = 3) and psychotherapeutic interventions (n = 2). Organizational and safety planning interventions demonstrated positive outcomes, including enhanced follow-up, care coordination, and reduced readmissions for suicidal behaviors. Psychological and psychotherapeutic interventions showed mixed results.
Discussion
This review highlights the range of emergency department–based suicide prevention interventions and their potential to reduce suicidal behaviors and improve patient outcomes. Organizational coordination and safety planning interventions emerged as feasible and effective strategies. Educational efforts to enhance emergency department staff knowledge and attitudes may help to facilitate the implementation of the identified interventions. By mapping existing interventions, this review underscores the critical role of emergency departments in comprehensive suicide prevention efforts.
{"title":"Suicide Prevention Interventions in the Emergency Department: A Scoping Review","authors":"Mette Valdersdorf Jensen PhD, MSc, RN, Kerrie Gallagher MSc, Michelle O’Driscoll PhD, MSc, Christina Østervang PhD, MSc, RN, Erik Christiansen PhD, MSc, Elsebeth Stenager MD","doi":"10.1016/j.jen.2025.05.002","DOIUrl":"10.1016/j.jen.2025.05.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Emergency departments are often the first point of contact for individuals with self-harm or suicide attempts. Interventions initiated in emergency departments have the potential to prevent suicidal behavior. However, the scope and nature of available interventions remain unclear.</div></div><div><h3>Methods</h3><div>A scoping review was conducted to explore the extent and nature of the literature on suicide prevention interventions in emergency departments. A search strategy based on the population, concept, and context framework was applied to 6 databases.</div></div><div><h3>Results</h3><div>A total of 10,415 studies were retrieved, and 16 met eligibility criteria after full-text screening. Interventions were categorized into organizational interventions, safety planning interventions, psychological interventions, and psychotherapeutic interventions. Organizational interventions (n = 6) and safety planning interventions (n = 5) were most commonly reported, followed by psychological (n = 3) and psychotherapeutic interventions (n = 2). Organizational and safety planning interventions demonstrated positive outcomes, including enhanced follow-up, care coordination, and reduced readmissions for suicidal behaviors. Psychological and psychotherapeutic interventions showed mixed results.</div></div><div><h3>Discussion</h3><div>This review highlights the range of emergency department–based suicide prevention interventions and their potential to reduce suicidal behaviors and improve patient outcomes. Organizational coordination and safety planning interventions emerged as feasible and effective strategies. Educational efforts to enhance emergency department staff knowledge and attitudes may help to facilitate the implementation of the identified interventions. By mapping existing interventions, this review underscores the critical role of emergency departments in comprehensive suicide prevention efforts.</div></div>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":"51 6","pages":"Pages 1097-1113.e3"},"PeriodicalIF":2.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.jen.2025.08.006
Austin DesJardin MSN, RN, CNE
Background
Emergency nurses face high-intensity situations that heighten their risk of mental health concerns, including compassion fatigue and post-traumatic stress symptoms. They report significantly higher levels of depression, anxiety, and secondary stress syndrome than other health care workers, which can negatively affect their well-being and patient care, leading to increased burnout and medical errors. This integrative review aimed to examine the mental health concerns of emergency nurses who care for patients who die unexpectedly.
Methods
This integrative review followed Whittemore and Knafl’s 5-step framework. A narrative synthesis was then completed, and data were analyzed using the Mixed Methods Appraisal Tool to mitigate biases. Four databases were systematically searched with specified search terms and without date restrictions.
Results
Fifteen studies were included, focusing on clinical events such as traumas, gunshot wounds, and motor vehicle accidents. The themes identified throughout the studies included coping mechanisms, end-of-life care education, and peer and managerial support. Symptoms reported by nurses included avoidance, substance abuse, and sleep disturbances.
Conclusion
Emergency nurses are vulnerable to the psychological impact of unexpected or traumatic deaths, increasing their risk of mental health concerns that affect their own health and patient outcomes. There is a need for intervention studies to address these issues and improve outcomes for nurses facing unexpected death.
{"title":"The Mental Health of Emergency Nurses Exposed to Unexpected Death: An Integrative Review","authors":"Austin DesJardin MSN, RN, CNE","doi":"10.1016/j.jen.2025.08.006","DOIUrl":"10.1016/j.jen.2025.08.006","url":null,"abstract":"<div><h3>Background</h3><div>Emergency nurses face high-intensity situations that heighten their risk of mental health concerns, including compassion fatigue and post-traumatic stress symptoms. They report significantly higher levels of depression, anxiety, and secondary stress syndrome than other health care workers, which can negatively affect their well-being and patient care, leading to increased burnout and medical errors. This integrative review aimed to examine the mental health concerns of emergency nurses who care for patients who die unexpectedly.</div></div><div><h3>Methods</h3><div>This integrative review followed Whittemore and Knafl’s 5-step framework. A narrative synthesis was then completed, and data were analyzed using the Mixed Methods Appraisal Tool to mitigate biases. Four databases were systematically searched with specified search terms and without date restrictions.</div></div><div><h3>Results</h3><div>Fifteen studies were included, focusing on clinical events such as traumas, gunshot wounds, and motor vehicle accidents. The themes identified throughout the studies included coping mechanisms, end-of-life care education, and peer and managerial support. Symptoms reported by nurses included avoidance, substance abuse, and sleep disturbances.</div></div><div><h3>Conclusion</h3><div>Emergency nurses are vulnerable to the psychological impact of unexpected or traumatic deaths, increasing their risk of mental health concerns that affect their own health and patient outcomes. There is a need for intervention studies to address these issues and improve outcomes for nurses facing unexpected death.</div></div>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":"51 6","pages":"Pages 1054-1069"},"PeriodicalIF":2.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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