Risk Factors for Unplanned Transfer to the ICU after ED Admission

MedicalResearch.com Interview with:
Marleen Boerma MD
Department of Emergency Medicine
Elisabeth-Tweesteden Hospital
Tilburg, The Netherlands

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Unplanned Intensive Care Unit (ICU) admission has been used as a surrogate marker of adverse events, and is used by the Australian Council of Healthcare Accreditation as a reportable quality indicator. If we can identify independent variables predicting deterioration which require ICU transfer within 24 hours after emergency department (ED) admission, direct ICU admission should be considered. This may improve patient safety and reduce adverse events by appropriate disposition of patients presenting to the ED.

This study shows that there were significantly more hypercapnia patients in the ICU admission group (n=17) compared to the non-ICU group (n=5)(p=0.028). There were significantly greater rates of tachypnea in septic patients (p=0.022) and low oxygen saturation for patients with pneumonia (p=0.045). The level of documentation of respiratory rate was poor.

Continue reading

Six Sigma Lean Models Applicable To Emergency Room Care

MedicalResearch.com Interview with:

Devon A. Klein, MD, MPH Asst. Professor of Radiology and Orthopaedics Hofstra Northwell School of Medicine Associate Chairman, Radiology Lenox Hill Hospital New York, NY 10075

Dr. Devon A. Klein

Devon A. Klein, MD, MPH
Asst. Professor of Radiology and Orthopaedics
Hofstra Northwell School of Medicine
Associate Chairman, Radiology
Lenox Hill Hospital
New York, NY 10075

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: As our Emergency Department continued to grow our Radiology Department was challenged to accommodate the resultant increased volume with fixed resources (i.e. CT Scanners) and maintain CT scan throughput. Uncoordinated insular efforts within the Department of Radiology failed to resolve the problem. A collaborative approach utilizing Six Sigma lean and involving stakeholders from the Departments of Radiology, Emergency, Medicine, and Patient Transportation was able to better illustrate the “bottlenecks” and devise solutions.

Continue reading

Opportunities for Improvement in Pediatric Resuscitation Across US EDs

MedicalResearch.com Interview with:
Marc Auerbach, MD, FAAP, MSc
Associate Professor of Pediatrics (Emergency Medicine) and of Emergency Medicine
Co-chair INSPIRE (International Network for Simulation Based Pediatric Innovation Research and Education)
Director, Pediatric Simulation
Yale Center for Medical Simulation;

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Severely ill infants and children present to any of over 5000 United States Emergency Departments every day. A direct comparison of the quality of resuscitative care across EDs is challenging due to the low frequency of these high stakes events in individual EDs. This study utilized in-situ simulation-based measurement to compare the quality of resuscitative care delivered to two infants and one child by 58 distinct interprofessional teams across 30 EDs. Composite quality scores correlated with annual pediatric patient volume, with higher volume departments demonstrating higher scores.

The pediatric readiness score measures compliance with guidelines created by the American Academy of Pediatrics, the American College of Emergency Physicians and the Emergency Nurses Association. The pediatric readiness score correlated with composite quality scores measured by simulation.

Continue reading

Model Predicts Children At High Risk For Asthma Related Acute Care Visits

MedicalResearch.com Interview with:
Jill Hanson, MD
Children’s Mercy Hospital
Kansas City MO 

Background from the American College of Allergy, Asthma & Immunology

“Asthma is the most common chronic disease in children, and one of the most difficult to manage, which is one of the reasons there are so many emergency department visits for asthma sufferers in the US.”

Medical Research: What are the main findings of this study?

Dr. Hanson: Our study of asthmatic children found that the number of historical asthma-related acute care visits (i.e. urgent care, emergency department and inpatient admissions) was predictive of future asthma-related acute care visits. 

Continue reading

Asians and Hispanics May Underutilize EMS Services For Stroke Symptoms

Heidi Mochari-Greenberger Ph.D., M.P.H Associate research scientist Columbia University Medical Center New York, N.YMedicalResearch.com Interview with:
Heidi Mochari-Greenberger Ph.D., M.P.H
Associate research scientist
Columbia University Medical Center
New York, N.Y

MedicalResearch: What is the background for this study?

Dr. Mochari-Greenberger: Differences in activation of emergency medical services (EMS) may contribute to race/ethnic and sex disparities in stroke outcomes. The purpose of this study was to determine whether EMS use varied by race/ethnicity or sex among a contemporary, diverse national sample of hospitalized acute stroke patients.

MedicalResearch: What are the main findings?

Dr. Mochari-Greenberger: Use of EMS transport among hospitalized stroke patients was less than 60% and varied by race/ethnicity and sex; EMS use was highest among white females and lowest among Hispanic males. Our analyses showed that Hispanic and Asian men and women were significantly less likely than their white counterparts to use EMS; black females were less likely than white females to use EMS, but black men had a similar rate to white men. These observed associations between race/ethnicity and sex with EMS use persisted after adjustment for stroke symptoms and other factors known to be associated with EMS use, indicating they were not driven solely by stroke symptom differences.

Continue reading