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Logistics Programs Benefit ED Wait Times

Logistics Programs Benefit ED Wait Times

A Focus on Improving Patient Flow With ED crowding continuing to be an important public health issue, hospitals across the United States are scrambling to pursue aggressive strategies that improve patient flow in EDs. A logistics management program (LMP) has been initiated in some EDs. The program expands the bed management process to include a systematic approach to patient flow throughout the facility. With LMPs, a clinical liaison or field agent drives throughput at all points of care. For a recent study, investigators sought to examine the effects of an LMP on ED length of stay (LOS) and inpatient LOS. The quasi-experimental study involved 28,684 ED admissions in a suburban, tertiary medical center and analyzed data before and after implementing an LMP. According to findings, the median ED evaluation time was 219 minutes prior to implementing an LMP but decreased to 207 minutes after implementation. The median ED placement time decreased from 219 minutes before implementation to 193 minutes after it was implemented. After implementing the LMP, the median inpatient LOS decreased from 3.93 days to 3.83 days, representing a reduction of 1,483 inpatient days. The research team indicated that their results provide strong evidence to support the impact of an LMP on decreasing ED evaluation times, ED placement times, and inpatient LOS. They added, however, that more studies are needed to examine the program as a potential best practice and to assess its applicability for other...
Diagnosing Stroke in the ED

Diagnosing Stroke in the ED

Studies suggest that there are missed opportunities to diagnose cerebrovascular causes for stroke symptoms. “While traditional stroke symptoms are rarely missed,” says David E. Newman-Toker, MD, PhD, “clinicians can sometimes overlook or discount non-specific symptoms, such as dizziness or headache.” Quantifying Misdiagnoses In the journal Diagnosis, Dr. Newman-Toker and colleagues recently published a study estimating the likelihood of missed stroke in the ED. The study also looked at associations with patient, hospital, and ED visit characteristics and calculated the odds of missed stroke within those domains. Using federal healthcare data, the researchers identified adults admitted for stroke with a treat-and-release ED visit in the prior 30 days. Up to 12.7% of patients who were later admitted for stroke had been potentially misdiagnosed and erroneously sent home from the ED in the 30 days before being hospitalized for stroke. “Patients who were misdiagnosed for stroke disproportionately presented with dizziness or headaches,” says Dr. Newman-Toker. About half of the unexpected returns for stroke occurred within 7 days, and more than half occurred in the first 48 hours. Women and minorities were more likely to be misdiagnosed. People younger than 45 were about seven times more likely to be given an incorrect diagnosis and sent home without treatment. “Based on our data, the estimated number of missed strokes resulting in harm to patients in the U.S. could be anywhere between 15,000 and 165,000 annually,” says Dr. Newman-Toker. “That’s a wide range, but the number is likely between 50,000 and 100,000 per year when all of the variables are taken into consideration.” He notes that it is challenging to ascertain more specific estimates...
CPR Knowledge & Performance in the ED

CPR Knowledge & Performance in the ED

Despite advances in cardiopulmonary resuscitation (CPR), survival and recovery for patients receiving this care remain suboptimal, according to recent reports. Studies indicate that early and effective CPR can improve survival after cardiopulmonary arrest, but out-of-hospital and in-hospital providers often have difficulty performing high-quality CPR. Research has shown that providing poor-quality CPR has similar outcomes to not performing CPR at all. Recent recommendations have focused on chest compressions as an important focus to optimizing CPR, and some of the specific components of these compressions—including rate, depth, and recoil—have been found to affect outcome measures. “Chest compression technique in CPR is important,” says Thomas E. Terndrup, MD. “While ED personnel are trained in effective CPR techniques, they often struggle to perform chest compressions that adhere to American Heart Association (AHA) guidelines for CPR and emergency cardiovascular care.” Studies have also shown that knowledge of these guidelines and motor skills for CPR are not well retained, even within a year of training. However, other factors may improve performance, including having more CPR training and having more experience performing CPR. Analyzing Provider Performance Dr. Terndrup and colleagues had a study published in the Western Journal of Emergency Medicine that evaluated CPR knowledge and how well chest compressions were performed by a group of in-hospital providers with different levels of training and experience. “Most studies evaluating the performance of CPR have looked at personnel who provide care outside the hospital,” Dr. Terndrup says. “We wanted to see how well medical students and ED personnel with current CPR certification knew and understood CPR parameters and how this knowledge affected performance of chest compressions.” Dr. Terndrup...
The Ambulance Drone

The Ambulance Drone

Each year nearly a million people in Europe suffer from a cardiac arrest. A mere 8% survives due to slow response times of emergency services. The ambulance drone is capable of saving lives with an integrated defibrillator. The goal is to improve existing emergency infrastructure with a network of drones. This new type of drones can go over 100 km/h and reaches its destination within an average of 1 minute, which has the potential to increase the chance of cardiac arrest survival from 8% to 80%! This drone folds up and becomes a toolbox for all kinds of emergency supplies. Future implementations will also serve other cases such as drowning, diabetes, respiratory issues, and traumas.Source: TU...
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