Advances in Emergency Medicine The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Optimizing Simulated Multidisciplinary Team Training of Pediatric Emergencies: An Evaluation of Prerequisites for Transfer of Skills to Clinical Practice Mon, 26 Jan 2015 14:13:54 +0000 Introduction. Multidisciplinary simulation-based team training (STT) provides a powerful training method to train technical and team skills during emergencies. Effectiveness of STT depends on transfer of learned skills to clinical practice. In this study we examined three important prerequisites to enhance transfer from STT into clinical practice, intervention readiness, realism, and performance self-efficacy. Methods. For the quantitative part of the study, 131 participants (pediatric nurses and physicians) were asked to fill out an online questionnaire before and after training. For the qualitative part of the study we organized three one-hour focus group sessions in which participants were interviewed on attitude, realism, and self-efficacy. Results. Providing adequate preparation material and extensive debriefing of scenarios is important in creating this positive learning experience. The perspective of realism depends strongly on setting and learning goals. During STT team assembly and role playing can become more important to participants, while physical aspects become less important. Performance self-efficacy for all participants increases significantly regarding team skills. Conclusions. STT can be a very positive multidisciplinary learning experience, which creates the possibility of enhancing confidence, skills, and team performance within the clinical context. STT combines three important prerequisites for transfer of training to take place. E. H. A. J. Coolen, T. P. F. M. Klaassen, J. M. T. Draaisma, C. R. M. G. Fluit, M. Hogeveen, and J. L. Loeffen Copyright © 2015 E. H. A. J. Coolen et al. All rights reserved. Providing Care in Emergency Department Hallways: Demands, Dangers, and Deaths Thu, 25 Dec 2014 13:09:00 +0000 Emergency departments (ED) worldwide have experienced dramatic increases in crowding over the past 20 years that now have reached critical levels. One consequence of ED crowding has been the routine use of ED hallways for patient care. This includes ED patients who are awaiting care but are considered unstable to remain in the waiting room, patients who are undergoing active medical and trauma treatment, and patients who have been stabilized but await transfer to an inpatient bed (boarding) or another institution. Compared with licensed hospital or standard ED beds, care in ED hallways results in increased patient morbidity and mortality, as well as patient and staff dissatisfaction. Complications experienced by hallway patients include unrecognized sudden respiratory arrest or unstable cardiac arrhythmias, delay in time-sensitive procedures and laboratory testing, delay in receiving important medications, excessive or unrelieved pain, overall increased length of stay, increased disability, and exposure to traumatic psychological events. While much has been published on the general problems of ED crowding, only recently have studies focused exclusively on the issues of providing care in ED hallways. This review summarizes the current issues, challenges, and solutions for hallway care. John R. Richards, M. Christien van der Linden, and Robert W. Derlet Copyright © 2014 John R. Richards et al. All rights reserved. A Simulated Discrete-Event and Queuing Model to Reduce Transfers from the Emergency Department and to Optimize Hospital Bed Management Mon, 01 Dec 2014 08:51:02 +0000 Objectives. Emergency departments (EDs) and elective hospitalizations compete for beds. Our aim was to reduce hospital transfers using a queuing-model study. Methods. Macros were created to simulate four priority groups of patients according to hospitalization mode (elective, ED) and age (≥75 and <75 years), with randomization of number of admissions and length of stay (LOS). Those priorities were assigned regarding usual situations (ED admission with less priority than scheduled admission) not regarding clinical contexts. Simulations were based on actual data from an academic hospital. Models simulated ED boarder queue according to different scenarios based on number of hospital beds, LOS, and preventable hospitalizations. Results. Observed hospital-LOS was longer for patients ≥75 years (12.2 ± 3.6 days versus 11.4 ± 3.8 days; ) and for ED admissions (12.2 ± 0.6 versus 9.7 ± 0.6 days; ). In simulation models, two scenarios stabilized the beds demand after admissions: limitation of LOS to 30 days or 20% decrease in elective admissions among older patients. With these scenarios, the queue would be 25.2 patients for 361 beds (+2%) and 16.7 patients for 354 beds. Conclusions. Queuing models offer an interesting approach to bed management. A significant reduction in ED transfers is feasible, by limiting LOS to <30 days or by reducing elective hospitalizations of patients by 20%. M. Wargon, N. Taright, E. Casalino, D. Pateron, and B. Guidet Copyright © 2014 M. Wargon et al. All rights reserved. Trends in Demand for Acute Medical Care at Two Football Clubs over an Eighteen-Year Period Wed, 03 Sep 2014 12:25:21 +0000 Introduction. Following the Hillsborough disaster, there is a requirement for crowd doctors to be present during football matches. However, there are little data on long-term trends in utilisation of crowd doctor services at sporting events. Methods. A retrospective service evaluation of presentations to the crowd doctor for 18 consecutive English Football League seasons: 13 seasons at Northampton Town Football Club (NTFC) followed by five seasons at Leicester City Football Club (LCFC). Data were analysed to determine the reason for, and severity of, presentation and the magnitude of the intervention required. Results. There were 429 recorded presentations to the crowd doctor over the 18 seasons. Patients’ age ranged from 3 to 93 years. 76% of presentations were due to an injury or illness arising at the match. The majority of presentations were with minor ailments (76%) requiring only minor intervention (88%); there were a small number of life-threatening presentations (1%) including three cardiac arrests. Conclusion. Crowd doctors may see patients in all age groups, presenting in a variety of ways. Most patients will have minor symptoms, but occasionally patients present with life-threatening problems. The crowd doctor must be competent assessing and treating all of these potential patient groups and pathologies. Thomas P. Heinink, Andrew W. Fogarty, and Matthew D. Wiles Copyright © 2014 Thomas P. Heinink et al. All rights reserved. Does Using a Standardised Mental Health Triage Assessment Alter Nurses Assessment of Vignettes of People Presenting with Deliberate Self-Harm Wed, 03 Sep 2014 09:24:29 +0000 Background. The Manchester Triage Scale is used in Irish emergency departments. This fails to provide guidance on triaging psychiatric presentations. A Mental Health Triage scale is recommended by the National Institute of Clinical Excellence. Aim. To examine the effectiveness of a Mental Health Triage scale in assessing patients presenting with self-harm. Method. Ten vignettes were created, detailing cases of deliberate self-harm. Nurses () were given five vignettes and asked to assign each vignette to a triage category, using The Manchester Triage Scale. Each nurse was subsequently asked to reevaluate the same vignettes using the Mental Health Triage Scale. Triage with each method was deemed safe or unsafe, using the benchmark triage categories assigned by a consultant in psychiatry and a consultant in emergency medicine departments. Results. 245 cases were triaged. There was a significant change in the categories assigned when the Mental Health Triage scale was in use, . The triage categories assigned using the Mental Health Triage scale were significantly safer than under the Manchester Triage Scale (79% versus 60% safe, respectively, ). Richard Tanner, Eugene Cassidy, and Iomhar O’Sullivan Copyright © 2014 Richard Tanner et al. All rights reserved. An Assessment of Emergency Department Throughput and Provider Satisfaction after the Implementation of a Scribe Program Wed, 03 Sep 2014 00:00:00 +0000 Objectives. To assess the impact of a scribe program on an academic, tertiary care facility. Methods. A retrospective analysis of emergency department (ED) data, prior to and after scribe program implementation, was used to quantitatively assess the impact of the scribe program on measures of ED throughput. An electronic survey was distributed to all emergency medicine residents and advanced practice providers to qualitatively assess the impact of the scribe program on providers. Results. Several throughput time measures were significantly lower in the postscribe group, compared to prescribe implementation, including time to disposition. The left without being seen (LWBS) decrease was not statistically significant. A total of 30 providers responded to the survey. 100% of providers indicated scribes are a valuable addition to the department and they enjoy working with scribes. 90% of providers indicated scribes increase their workplace satisfaction and quality of life. Conclusions. Through evaluation of prescribe and postscribe implementation, the postscribe time period reflects many throughput improvements not present before scribes began. Scribe Program implementation led to improved ED throughput for discharged patients with further system-wide challenges needing to be addressed for admitted patients. Brandon Allen, Ben Banapoor, Emily C. Weeks, and Thomas Payton Copyright © 2014 Brandon Allen et al. All rights reserved. Mathematical Modeling of the Impact of Hospital Occupancy: When Do Dwindling Hospital Beds Cause ED Gridlock? Tue, 15 Jul 2014 08:38:11 +0000 Objectives. The time emergency department (ED) patients spend from presentation to admittance is known as their length of stay (LOS). This study aimed to quantify the inpatient occupancy rate (InptOcc)/ED LOS relationship and develop a methodology for identifying resource-allocation triggers using InptOcc-LOS association-curve inflection points. Methods. This study was conducted over 200 consecutive days at a 700-bed hospital with an annual ED census of approximately 50,000 using multivariate spline (piecewise) regression to model the InptOcc/LOS relationship while adjusting for confounding covariates. Nonlinear modeling was used to assess for InptOcc/LOS associations and determine the inflection point where InptOcc profoundly impacted LOS. Results. At lower InptOcc, there was no association. Once InptOcc reached ≥88%, there was a strong InptOcc/LOS association; each 1% InptOcc increase predicted a 16-minute (95% CI, 12–20 minutes) LOS prolongation, while the confounder-adjusted analysis showed each 1% InptOcc increase >89% precipitating a 13-minute (95% CI, 10–16 minutes) LOS prolongation. Conclusions. The study hospital’s InptOcc was a significant predictor of prolonged ED LOS beyond the identified inflection point. Spline regression analysis identified a clear inflection point in the InptOcc-LOS curve that potentially identified a point at which to optimize inpatient bed availability to prevent increased costs of prolonged LOS. Lori Whelan, Boyd Burns, Michael Brantley, Tyler Haas, Annette O. Arthur, and Stephen H. Thomas Copyright © 2014 Lori Whelan et al. All rights reserved. The State of Healthcare Disaster Plans in New Zealand and the Sultanate of Oman: An International Comparative Analysis Sun, 22 Jun 2014 00:00:00 +0000 Aim. The aim of this study was to carry out an audit of healthcare plans in New Zealand and Oman. Methods. The study utilizes a deductive content analysis method. Written plans from New Zealand District Health Boards (DHBs) and the Omani secondary and tertiary hospitals were analyzed. A checklist was used to score the plans against twelve elements which are command and control, hazard analysis, surge capability, communication, standard operating procedures (SOPs), life-line backups, public and media, training, welfare, coordination, and recovery. Results. There were 14 plans from New Zealand and 7 plans from Oman analysed. The overall coverage of New Zealand plans was 67.5% compared to 53.3% in Oman. Plans from both countries scored similarly in “command and control,” “hazard analysis,” “surge,” and “communication” elements. Omani plans scored lower than those of New Zealand in “media and the publicv” “training,” “coordination,” and “recovery.” Both countries scored very low in addressing the welfare of responders. Conclusion. This study highlighted the value of health emergency plans in New Zealand as reflected by the high score of DHBs’ coordination. Therefore, a similar approach in Oman will enhance emergency preparedness. Responders’ welfare is an issue that needs to be addressed by emergency preparedness plans in both countries. Sultan Al-Shaqsi, Robin Gauld, David McBride, Ammar Al-Kashmiri, and Abdullah Al-Harthy Copyright © 2014 Sultan Al-Shaqsi et al. All rights reserved. Validation of a Decision Rule and Derivation of a Modified Rule to Obtain Chest Radiograph in Patients with Nontraumatic Chest Pain in the Emergency Department Thu, 12 Jun 2014 07:42:23 +0000 Objectives. We sought to validate and refine a decision rule for chest X-ray (CXR) utilization in nontraumatic chest pain (CP) patients presenting to the emergency department (ED). Methods. Retrospective review of ED patients presenting with CP who had CXR performed during three nonconsecutive months was performed. The presence of 18 variables derived from history and exam was ascertained. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the original rule were calculated. Refinement using additional variables was performed. Results. 967 patient charts were reviewed. 89.9% of CXR were normal, 5.2% had insignificant findings, and 5.1% had significant findings. Application of the criteria had a sensitivity/specificity of 74%/59% and a PPV/ NPV of 9%/98%. Rule modification to obtain CXR for age ≥ 65 years, history of congestive heart failure and alcohol abuse, and exam findings of decreased breath sounds, fever, and tachypnea maintained sensitivity while improving specificity to 69%. Conclusions. Most CP patients have normal CXRs. Narrowing a decision rule to obtain CXR in patients with age ≥ 65 years, history of congestive heart failure and alcohol abuse, and exam findings of decreased breath sounds, fever, and tachypnea maintain sensitivity while improving specificity and NPV. Case Newsom, Rebecca Jeanmonod, Karl Weller, Nabil Boutros, Mark Reiter, and Donald Jeanmonod Copyright © 2014 Case Newsom et al. All rights reserved. Common Presenting Problems for Young People Attending the Emergency Department Tue, 25 Mar 2014 09:23:11 +0000 Objective. To determine the common presenting problems for young people attending the emergency department. Design. A retrospective review of electronic patient records of all young people between the ages of 13 and 17 who attended a UK University Hospital ED between 07/02/2007 and 06/02/2008 (). Results. All emergency department attendances for young people over a one-year period were studied in order to determine the common presenting problems. There were a total of 10455 attendances by 8303 young people. The presenting problem in 7505 (71.8%) was classified as injury. Of the remainder the commonest presenting problems reported for young people were abdominal pain (480, 16.3%), self-harm (314, 10.6%), fits, faints and funny turns (308, 10.4%), breathing difficulty (213, 7.2%), and intoxication (178, 6.0%). Ten presenting problems accounted for 72% of noninjury related attendances. Conclusions. Clinical guidelines and pathways developed for young people attending the emergency department should target the commonest presenting problems. In our cohort ten presenting problems account for almost three-quarters of all noninjury attendances for young people. The presenting problems are different to those described in younger children in previous studies. These results will inform the development of clinical pathways in order to improve emergency care. Dhurgshaarna Shanmugavadivel, Rebecca Sands, and Damian Wood Copyright © 2014 Dhurgshaarna Shanmugavadivel et al. All rights reserved.