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Academic literature on the topic 'ED triage'

Author: Grafiati

Published: 4 June 2021

Last updated: 10 February 2022

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Journal articles on the topic "ED triage"

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Allen, Casey J., Daniel J. Baldor, Carl I. Schulman, Louis R. Pizano, Alan S. Livingstone, and Nicholas Namias. "Assessing Field Triage Decisions and the International Classification Injury Severity Score (ICISS) at Predicting Outcomes of Trauma Patients." American Surgeon 83, no. 6 (June 2017): 648–52. http://dx.doi.org/10.1177/000313481708300632.

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Florida considers the International Classification Injury Severity Score (ICISS) from hospital discharges within a geographic region in the apportionment of trauma centers (TCs). Patients with an ICISS <0.85 are considered to require triage to a TC, yet many are triaged to an emergency department (ED). We assess outcomes of those with an ICISS <0.85 by the actual triage decision of emergency medical services (EMS). From October 2011 to October 2013, 39,021 consecutive admissions with injury ICD-9 codes were analyzed. ICISS was calculated from the product of the survival risk ratios for a patient's three worst injuries. Outcomes were compared between patients with ICISS <0.85 either triaged to the ED or its separate, neighboring, free-standing TC at a large urban hospital. A total of 32,191 (83%) patients were triaged to the ED by EMS and 6,827 (17%) were triaged to the TC. Of these, 2544 had an ICISS <0.85, with 2145 (84%) being triaged to the TC and 399 (16%) to the ED. In these patients, those taken to the TC more often required admission, and those taken to the ED had better outcomes. When the confounders influencing triage to an ED or a TC are eliminated, those triaged by EMS to the ED rather than the TC had better overall outcomes. EMS providers better identified patients at risk for mortality than did the retrospective application of ICISS. ICISS <0.85 does not identify the absolute need for TC as EMS providers were able to appropriately triage a large portion of this population to the ED.

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Kumar, R., S. Bhoi, S. Chauhan, T. P. Sinha, G. Adhikari, G. Sharma, and K. Shyamla. "(A264) Does the Implementation of Start Triage Criteria in the Emergency Department Reduce Over- and under-Triage of Patients?" Prehospital and Disaster Medicine 26, S1 (May 2011): s72—s73. http://dx.doi.org/10.1017/s1049023x11002482.

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BackgroundAppropriate triage shortens the delay in definitive care. this study examined whether the implementation of START triage criteria in emergency departments (ED) reduces over- and under-triage of patients. The purpose of this study was to examine the impact of START triage criteria on over and under-triage subjects.MethodsThe study was performed between 01 January to 15 September 2008. All patients presenting to the ED were recruited. A triage nurse tagged the patients with a red, yellow, and or green wristband, as per START triage protocol. Over-triage was defined as patients who were re-triaged from red (R) to yellow (Y) or Y to green (G) within 30 minutes of arrival. Under-triage was defined as patients re-triaged from Y to R or G to Y within 30 minutes of arrival.ResultsOf 25,928 patients, triage was performed for 25,468 (98.2%) subjects. A total of 8,303 were triaged during the morning shift, 6,994 during the evening shift, and 9,978 during the night shift. A total of 1,431 (5.6%) subjects were tagged as R, 10,634 (41.7%) with Y, and 13,424 (52.7%) were tagged as G. Four hundred seventy-four (1.9%) patients were over-triaged. Two hundred twenty (0.9%) were under-triaged.ConclusionsThe START triage criteria reduce over- and under-triage of patients.

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McMahon, Margaret M. "ED Triage." AJN, American Journal of Nursing 103, no. 3 (March 2003): 61–63. http://dx.doi.org/10.1097/00000446-200303000-00022.

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McLeod, S., J. McCarron, T. Ahmed, S. Scott, H. Ovens, N. Mittmann, and B. Borgundvaag. "LO70: Interrater agreement and time it takes to assign a Canadian Triage and Acuity Scale score pre and post implementation of eCTAS." CJEM 20, S1 (May 2018): S31—S32. http://dx.doi.org/10.1017/cem.2018.132.

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Introduction: In addition to its clinical utility, the Canadian Triage and Acuity Scale (CTAS) has become an administrative metric used by governments to estimate patient care requirements, ED funding and workload models. The Electronic Canadian Triage and Acuity Scale (eCTAS) initiative aims to improve patient safety and quality of care by establishing an electronic triage decision support tool that standardizes the application of national triage guidelines (CTAS) across Ontario. The objective of this study was to evaluate the implementation of eCTAS in a variety of ED settings. Methods: This was a prospective, observational study conducted in 7 hospital EDs, selected to represent a mix of triage processes (electronic vs. manual), documentation practices (electronic vs. paper), hospital types (rural, community and teaching) and patient volumes (annual ED census ranged from 38,000 to 136,000). An expert CTAS auditor observed on-duty triage nurses in the ED and assigned independent CTAS in real time. Research assistants not involved in the triage process independently recorded the triage time. Interrater agreement was estimated using unweighted and quadratic-weighted kappa statistics with 95% confidence intervals (CIs). Results: 1200 (738 pre-eCTAS, 462 post-implementation) individual patient CTAS assessments were audited over 33 (21 pre-eCTAS, 11 post-implementation) seven-hour triage shifts. Exact modal agreement was achieved for 554 (75.0%) patients pre-eCTAS, compared to 429 (93.0%) patients triaged with eCTAS. Using the auditors CTAS score as the reference standard, eCTAS significantly reduced the number of patients over-triaged (12.1% vs. 3.2%; 8.9, 95% CI: 5.7, 11.7) and under-triaged (12.9% vs. 3.9%; 9.0, 95% CI: 5.9, 12.0). Interrater agreement was higher with eCTAS (unweighted kappa 0.90 vs 0.63; quadratic-weighted kappa 0.79 vs. 0.94). Research assistants captured triage time for 4403 patients pre-eCTAS and 1849 post implementation of eCTAS. Median triage time was 304 seconds pre-eCTAS and 329 seconds with eCTAS ( 25 seconds, 95% CI: 18, 32 seconds). Conclusion: A standardized, electronic approach to performing CTAS assessments improves both clinical decision making and administrative data accuracy without substantially increasing triage time.

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Gravel, Jocelyn, Sergio Manzano, and Michael Arsenault. "Validity of the Canadian Paediatric Triage and Acuity Scale in a tertiary care hospital." CJEM 11, no. 01 (January 2009): 23–28. http://dx.doi.org/10.1017/s1481803500010885.

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ABSTRACTObjective:We evaluated the validity of the Canadian Paediatric Triage and Acuity Scale (Paed-CTAS) for children visiting a pediatric emergency department (ED).Methods:This was a retrospective study evaluating all children who presented to a pediatric university-affiliated ED during a 1-year period. Data were retrieved from the ED database. Information regarding triage and disposition was registered in an ED database by a clerk following patient management. In the absence of a gold standard for triage, admission to hospital, admission to pediatric intensive care unit (PICU) and length of stay (LOS) in the ED were used as surrogate markers of severity. The primary outcome measure was the correlation between triage level (from 1 to 5) and admission to hospital. The correlation between triage level and dichotomous outcomes was evaluated by aχ2test and an analysis of variance (ANOVA) was used to evaluate the association between triage level and ED LOS.Results:Over the 1-year period, 58 529 patients were triaged in the ED. The proportion admitted to hospital was 63% for resuscitation (level 1), 37% for emergent (level 2), 14% for urgent (level 3), 2% for semiurgent (level 4) and 1% for nonurgent (level 5) (p< 0.001). There was also a good correlation between triage levels and LOS and admission to PICU (bothp< 0.001).Conclusion:This computerized version of PaedCTAS demonstrates a strong association with admission to hospital, admission to PICU and LOS in the ED. These results suggest that PaedCTAS is a valid tool for triage of children in a pediatric ED.

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Khursheed, M., K. Ejaz, and F. Hanif. "(A261) Evolution of Triage Services in the Emergency Department Aga Khan University Hospital- Karachi." Prehospital and Disaster Medicine 26, S1 (May 2011): s72. http://dx.doi.org/10.1017/s1049023x11002457.

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The history of triage started from the French battle field. In- hospital ED triage started in early 1960's from Baltimore. It is now an essential component of modern ED. Triage is not only to sort out patients as per their criticality, but it also serves the purpose of streamlining the patients so that the patient receives right treatment at the right time in the appropriate area. It helps to manage the ED overcrowding by better flow of patients. AKUH-ER experience of triage dates back to the year 2000, when triage was conducted by physicians and there used to be a manual documentation of patient's particulars such as complaints, vitals and BP. With the expansion of AKU-ED in 2008 responsibility of triage shifted to nursing services. Triage policy was drafted and implemented and for guidance and uniformity of care, triage protocols were developed. Another important development is replacement of register with triage data entry software. This help us to monitor some indicators like number of patients triaged, the time between triaging and actual bed assignment, triage categorization, length of stay, dispositions and return visits. The available information now helps us to make decisions based on evidence and also paves the way for future direction.

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Betz, Martin, James Stempien, Sachin Trevidi, and Rhonda Bryce. "A determination of emergency department pre-triage times in patients not arriving by ambulance compared to widely used guideline recommendations." CJEM 19, no. 04 (December 5, 2016): 265–70. http://dx.doi.org/10.1017/cem.2016.398.

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ABSTRACT Objectives Emergency department (ED) lengths of stay are measured from the time of patient registration or triage. The time that patients wait in line prior to registration and triage has not been well described. We sought to characterize pre-triage wait times and compare them to recommended physician response times, as per the Canadian Triage and Acuity Scale (CTAS). Methods This observational study documented the time that consenting patients entered the ED and the time that they were formally registered and triaged. Participants’ CTAS scores were collected from the electronic record. Patients arriving to the ED by ambulance were excluded. Results A total of 536 participants were timed over 13 separate intervals. Of these, 11 left without being triaged. Participants who scored either CTAS 1 or 2 (n=53) waited a median time of 3.1 (interquartile range [IQR]: 0.43, 11.1) minutes. Patients triaged as CTAS 3 (n=187) waited a median of 11.4 (IQR: 1.6, 24.9) minutes, CTAS 4 (n=139) a median of 16.6 (IQR: 6.0, 29.7) minutes, and CTAS 5 (n=146) a median of 17.5 (IQR: 6.8, 37.3) minutes. Of patients subsequently categorized as CTAS 1 or 2, 20.8% waited longer than the recommended time-to-physician of 15 minutes to be triaged. Conclusions All urban EDs closely follow patients’ wait times, often stratified according to triage category, which are assumed to be time-stamped upon a patient’s arrival in the ED. We note that pre-triage times exceed the CTAS recommended time-to-physician in a possibly significant proportion of patients. EDs should consider documenting times to treatment from the moment of patient arrival rather than registration.

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McLeod, S., J. McCarron, T. Ahmed, S. Scott, H. Ovens, N. Mittmann, and B. Borgundvaag. "LO81: Interrater agreement and time it takes to assign a Canadian Triage and Acuity Scale score pre and post implementation of eCTAS." CJEM 21, S1 (May 2019): S37. http://dx.doi.org/10.1017/cem.2019.123.

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Introduction: In addition to its clinical utility, the Canadian Triage and Acuity Scale (CTAS) has become an administrative metric used by governments to estimate patient care requirements, emergency department (ED) funding and workload models. The electronic Canadian Triage and Acuity Scale (eCTAS) initiative aims to improve patient safety and quality of care by establishing an electronic triage decision support tool that standardizes that application of national triage guidelines across Ontario. The objective of this study was to evaluate triage times and score agreement in ED settings where eCTAS has been implemented. Methods: This was a prospective, observational study conducted in 7 hospital EDs, selected to represent a mix of triage processes (electronic vs. manual), documentation practices (electronic vs. paper), hospital types (rural, community and teaching) and patient volumes (annual ED census ranged from 38,000 to 136,000). An expert CTAS auditor observed on-duty triage nurses in the ED and assigned independent CTAS in real time. Research assistants not involved in the triage process independently recorded triage time. Interrater agreement was estimated using unweighted and quadratic-weighted kappa statistics with 95% confidence intervals (CIs). Results: 1491 (752 pre-eCTAS, 739 post-implementation) individual patient CTAS assessments were audited over 42 (21 pre-eCTAS, 21 post-implementation) seven-hour triage shifts. Exact modal agreement was achieved for 567 (75.4%) patients pre-eCTAS, compared to 685 (92.7%) patients triaged with eCTAS. Using the auditor's CTAS score as the reference standard, eCTAS significantly reduced the number of patients over-triaged (12.0% vs. 5.1%; Δ 6.9, 95% CI: 4.0, 9.7) and under-triaged (12.6% vs. 2.2%; Δ 10.4, 95% CI: 7.9, 13.2). Interrater agreement was higher with eCTAS (unweighted kappa 0.89 vs 0.63; quadratic-weighted kappa 0.91 vs. 0.71). Research assistants captured triage time for 3808 patients pre-eCTAS and 3489 post implementation of eCTAS. Median triage time was 312 seconds pre-eCTAS and 347 seconds with eCTAS (Δ 35 seconds, 95% CI: 29, 40 seconds). Conclusion: A standardized, electronic approach to performing CTAS assessments improves both clinical decision making and administrative data accuracy without substantially increasing triage time.

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McLeod, S. L., J. McCarron, K. Stein, S. Scott, H. J. Ovens, N. Mittman, and B. Borgundvaag. "LO75: Interrater agreement and time it takes to assign a Canadian Triage and Acuity Scale score in 7 emergency departments." CJEM 19, S1 (May 2017): S54. http://dx.doi.org/10.1017/cem.2017.137.

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Introduction: The Canadian Triage and Acuity Scale (CTAS) is the standard used in all Canadian (and many international) emergency departments (EDs) for establishing the priority by which patients should be assessed. In addition to its clinical utility, CTAS has become an important administrative metric used by governments to estimate patient care requirements, ED funding and workload models. Despite its importance, the process by which CTAS scores are derived is highly variable. Emphasis on ED wait times has also drawn attention to the length of time the triage process takes. The primary objective of this study was to determine the interrater agreement of CTAS in current clinical practice. The secondary objective was to determine the time it takes to triage in a variety of ED settings. Methods: This was a prospective, observational study conducted in 7 hospital EDs, selected to represent a mix of triage processes (electronic vs. manual), documentation practices (electronic vs. paper), hospital types (rural, community and teaching) and patient volumes (annual ED census ranged from 38,000 to 136,000). An expert CTAS auditor observed on-duty triage nurses in the ED and assigned independent CTAS in real time. Research assistants not involved in the triage process independently recorded the triage time. Interrater agreement was estimated using unweighted and quadratic-weighted kappa statistics with 95% confidence intervals (CIs). Results: 738 consecutive patient CTAS assessments were audited over 21 seven-hour triage shifts. Exact modal agreement was achieved for 554 (75.0%) patients. Using the auditor’s CTAS score as the reference standard, on-duty triage nurses over-triaged 89 (12.1%) and under-triaged 95 (12.9%) patients. Interrater agreement was “good” with an unweighted kappa of 0.63 (95% CI: 0.58, 0.67) and quadratic-weighted kappa of 0.79 (95% CI: 0.67, 0.90). Research assistants captured triage time for 3808 patients over 69 shifts at 7 different EDs. Median (IQR) triage time was 5.2 (3.8, 7.3) minutes and ranged from 3.9 (3.1, 4.8) minutes to 7.5 (5.8, 10.8) minutes. Conclusion: Variability in the accuracy, and length of time taken to perform CTAS assessments suggest that a standardized approach to performing CTAS assessments would improve both clinical decision making, and administrative data accuracy.

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Dallaire, Clémence, Julien Poitras, Karine Aubin, André Lavoie, Lynne Moore, and Geneviève Audet. "Interrater agreement of Canadian Emergency Department Triage and Acuity Scale scores assigned by base hospital and emergency department nurses." CJEM 12, no. 01 (January 2010): 45–49. http://dx.doi.org/10.1017/s148180350001201x.

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ABSTRACTObjective:We sought to assess the applicability of the Canadian Emergency Department Triage and Acuity Scale (CTAS) in the prehospital setting by comparing CTAS scores assigned during ambulance transportation by base hospital (BH) nurses with CTAS scores given by emergency department (ED) nurses on patients' arrival.Methods:We recruited a prospective sample of consecutive patients who were transported to the ED by ambulance between December 2006 and March 2007 for whom a contact was made with the BH. Patients were triaged by the BH nurse with online communication and vital signs transmission. On arrival, patients were blindly triaged again by the ED nurse. We used the quadratic weighted κ statistic to measure the agreement between the 2 CTAS scores.Results:Ninety-four patients were triaged twice by 2 nursing teams (9 nurses at the BH and 39 nurses in the ED). The agreement obtained on prehospital and ED CTAS scores was moderate (κ = 0.50; 95% confidence interval 0.37–0.63).Conclusion:The moderate interrater agreement we obtained may be a result of the changing conditions of patients during transport or may indicate that CTAS scoring requires direct contact to produce reliable triage scores. Our study casts a serious doubt on the appropriateness of BH nurses performing triage with CTAS in the prehospital setting.

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Dissertations / Theses on the topic "ED triage"

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Charles-Hanmer, Mary-Margaret. "ED Triage Chest Pain Protocol." Mount St. Joseph University Dept. of Nursing / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=msjdn1619697945080865.

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Lvovschi, Virginie-Eve. "Titration morphinique inhalée aux Urgences : modernisation de la prise en charge des douleurs sévères de l'adulte Targeting moderate pain in healthy volunteers by individual calibration of a nociceptive flexion reflex model Proposer un "modèle" de douleur provoquée par Electromyogramme pour optimiser les outils antalgiques aux urgences Nebulized versus intravenous morphine titration for the initial treatment of severe acute pain in the emergency department : study protocol for a multicenter, prospective randomized and controlled trial, CLIN-AEROMORPH Inhaled versus intravenous opioid dosing for the initial treatment of severe acute pain in the emergency department : pharmacological intermediate results of the CLIN-AEROMORPH french study Toward new eligibility criteria for ontravenous morphine in the French Emergency Department : Evaluation of physicians' bedside rationalization of opioid titration protocols Analysis of bedside determinisms leading to under-prescription of morphine titration in the Emergency Department : EPIMORPH study Medico-economic study of pain in an emergency department : a targeted literature review Opioid reflex at triage is not a solution for opioid-naive patients in emergency departments A systemic approach to complete the multimodal assessment model of pain Intravenous morphine titration to treat severe pain in the ED Morphine consumption is not modified in patients with severe pain and classified by the DN4 score as neuropathic Prise en charge de la douleur aiguë spontanée de l'adulte aux urgences." Thesis, Normandie, 2020. http://www.theses.fr/2020NORMR013.

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Notre objectif était d’optimiser la prise en charge de la douleur aiguë sévère en médecine d’urgence. La titration morphinique intraveineuse qui fait actuellement référence doit se moderniser pour répondre aux nouveaux enjeux de la pratique en même temps que l’on doit garantir une balance bénéfice risque inchangée dans la lutte contre l’oligoanalgésie. Le travail décrit dans cette thèse, constitue une première étape d’évaluation d’une alternative nébulisée à la titration morphinique, à travers 3 études cliniques (AEROMORPH1, CLIN-AEROMORPH, EPIMORPH) et l’étude de son contexte dans la littérature. Des travaux chez le volontaire sain ont permis d’établir un mode opératoire avec une technique aérosol simple et accessible, de courte durée (5 min), que l’on peut répéter en titration (toutes les 10 min). Sa faisabilité est en voie d’être confirmée à grande échelle dans une étude multicentrique clinique et sa non-infériorité en termes d’efficacité est en cours d’évaluation. Des données pharmacologiques chez le volontaire sain et chez les patients confirment une concentration sanguine en morphine proche des concentrations efficaces observées en intraveineux (1 à 120 ng/ml dans CLIN-AEROMORPH), ce qui est déjà un résultat positif démontré par nos travaux. Par ailleurs, sur le plan de son éligibilité, nos données observationnelles et de simulation de décision, associées aux données médico-économiques que nous avons analysées dans la littérature, suggèrent la nécessité de baser son indication autrement que sur la simple évaluation par EVA/EN à l’accueil. Dans ce travail nous montrons que la pratique des praticiens témoigne aujourd’hui de leur manque d’adhésion au déclenchement systématique de la prescription d’opiacés Iv titrés par l’autoévaluation de la douleur sévère (de 6 à 20% de respect des critères SFMU, 61% de réinterprétation des scores EVA/EN). Si la titration aérosol est uniquement proposée en starter de la titration morphinique sans moderniser les algorithmes de décision de prescription opiacée dans les protocoles d’urgences, il est probable que cette nouvelle proposition thérapeutique ne résoudra qu’une partie de la problématique actuellement posée. Une prise en charge pharmacologique la plus individualisée possible est plus que jamais pertinente, avec une prescription ciblée de la titration morphinique selon la typologie du patient, en plus d’une priorisation par typologie douloureuse. En développant un « modèle douleur » original chez le volontaire sain, nous avons d’ailleurs mis en lumière des profils de patients « hyperesthésiques » et « endurants », sur le plan neurophysiologique et biochimique, qui sont sûrement retrouvés en pratique clinique quotidienne. L’ensemble de ces éléments doivent donc être pris en compte pour améliorer la prise en charge de la douleur en médecine d’urgence, avec une vision plus systémique, et davantage d’études dédiées, utilisant des méthodes d’évaluation innovantes mêlant critères quantitatifs robustes et qualitatifs exhaustifs
Our goal was to optimize the management of severe acute pain in emergency medicine. Intravenous morphine titration, which is currently the referent method, must be modernised to meet the new challenges of practice while at the same time, we must keep guaranteeing an unchanged risk-benefit balance in the fight against oligoanalgesia. Our work, described in this thesis, has been a cornerstone for the evaluation of a nebulized alternative solution to emergencies through 3 clinical studies, (AEROMORPH1, CLIN-AEROMORPH, EPIMORPH), and study of its contextualisation in literature. Work in healthy volunteers allowed us to establish a simple and accessible procedure for aerosol, of short duration (5 min), which can be repeated in titration procedures (every 10 min). Its feasibility is likely to be confirmed on our multicentre clinical study at a large scale and its efficacy, by a non-inferiority design of study is being evaluated. Pharmacological data in healthy volunteers and in patients confirm a blood morphine concentration close to the effective blood concentrations observed by intravenous administration (CLIN-AEROMORPH: 1-20 ng/ml), which is already a positive result demonstrated by our work. Moreover, regarding eligibility, our observational study, combined to a experiment about decision mechanisms, combined with the analysis of medico-economic data in literature, suggest the need to base its indication on more than just the simple VAS/NRS assessment at triage. In this work we showed that emergency practitioners’ practice today underlines their lack of adherence to the systematic initiation of intravenous morphine titration by patient self-assessment of severe pain (compliance with SFMU criteria 6 to 20%, re-assessment of VAS/NRS scores 61%). If nebulized morphine titration is only proposed as a starter for morphine titration without modernising the algorithms for opiate prescription decision in emergency protocols, it is likely that this new therapeutic proposal will only solve part of the current problem. Targeted pharmacological management, as individualised as possible, is more relevant than ever, with prescription of morphine titration according to the patient's typology, in addition to prioritisation by pain typology. By developing an original pain model in healthy volunteers, we have also highlighted profiles of "pain sensitive" and "enduring" patients, according to neurophysiological and biochemical data, that are certainly represented in daily clinical practice. Therefore, all these components should be taken into account to improve pain management in emergency medicine, with a more systemic vision and more dedicated studies using innovative evaluation methods, combining robust quantitative criteria with comprehensive qualitative criteria

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Tiu, Ellice Jane J., and 張純潔. "Development of ED Triage Tool for Acute Coronary Syndrome (ACS) – Assessing the Use of Logistic Regression for Model Development." Thesis, 2019. http://ndltd.ncl.edu.tw/handle/x7pa3c.

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碩士
元智大學
工業工程與管理學系
107
Acute Coronary Syndrome (ACS) patient management in the Emergency Department (ED) is known to be a challenging task as majority of patients do not present clear-cut evidence of this condition. This leads to difficulty in identifying patients who should be prioritized for thorough diagnoses in the Observation Unit (OU) and who can safely wait in the regular ED queue. This study aimed to validate and use Logistic Regression as the method for developing a set of triaging criteria which can identify patients with considerable or negligible risk of ACS upon presentation. At the same time, evaluate the effectiveness of having a separate triage model for patients arriving via ambulance (119) or self-arrival patients. Validation for Logistic Regression was done through the implementation of the ACS Triage Tool, previously developed by Tsai et al. (2018), on a new dataset and compared its consistency with the previously published result. Since the ACS Triage Tool previously utilized patient data which was not truly representative of the ED population, a new model using a more valid dataset was developed using Logistic Regression along with physician’s decision for triaging as basis for prediction. Validation of this newly developed model was done through comparing it with other Logistic Regression models formulated with a larger training dataset as well as prediction based on ACS discharge diagnosis. Individual Logistic Regression models for patients arriving via ambulance and self-transportation were also developed and compared with the general model. The ACS Triage Tool proved to have consistent results with its published results indicating that Logistic Regression is a reliable method for model development. The new Logistic Regression model which used a more inclusive set of patient data was comprised of 6 significant predictors and expressed as: Odds Ratio = - 4.566+ 1.056#westeur024#Age + 0.778#westeur024#Male + 2.24#westeur024#Chest Discomfort + 1.365#westeur024#Shock + 0.805#westeur024#Proximal Radiation Pain -1.308#westeur024#Arrhythmia with threshold value of 0.13 for Probability (ACS suspicion). This yielded a performance of 95% sensitivity, 13% specificity, and Area Under Curve of 65% for triaging ACS cases which were superior than other 6 models tested (Chest Pain Strategy, Triage Flowchart, Zarich’s Strategy, HBI Checklist and Modified HBI Checklist 1&2). Furthermore, the logistic regression model proved to be sufficient as developed models with increased training dataset and ACS discharge diagnosis-based model did not result to significant improvements (p>0.05). Meanwhile, a dedicated triage model for patients arriving via a specific mode-of-arrival (self-arrival and ambulance/119) is projected to have good potential in performance improvement. Current results have to be proceeded with caution due to the small amount of data available on-hand for patients arriving via ambulance (119). Therefore, further collection of data for 119 patients for model development is seen to be beneficial. This is foreseen to improve the reliability of the model and develop a dedicated 119 triage model with enhanced triaging capabilities.

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Books on the topic "ED triage"

1

Tempo di peste: Magistrati ed untori nel 1630 a Milano. [Roma]: Sapere 2000, 1985.

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McBain, Ed. Cinderella: By Ed McBain. London: Hamilton, 1986.

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Virgilio, Alberto. Profili ideologici ed evolutivi dell'udienza preliminare. Napoli: Jovene, 2007.

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Botta, Fabio. Legittimazione, interesse ed incapacità all'accusa nei publica iudicia. Cagliari: AV, 1996.

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Neri, Indro. Troppa trippa: Sull'antico mestiere del trippaio a Firenze ed i mille modi di cucinare la trippa nel mondo. Firenze: Neri, 1996.

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Schepisi, Cristina. Rinvio pregiudiziale obbligatorio ed effettività della tutela giurisdizionale. Trieste, Italia: Università degli studi di Trieste, 2003.

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Adee, Ellis. Jonathan & Abigail's treasury of trials / by "Ed" and D.J. Adee ; Ardis Comfort , [cover artist and illustrator]. Minneapolis, Kan: Harvest Publications, 2006.

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Romano, Davide. Il processo di Gesù: Appunti per una collocazione storico-giuridica degli avvenimenti relativi al processo ed alla condanna di Gesù di Nazareth. Bari: Palomar, 1992.

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Romano, Davide. Il processo di Gesù: Appunti per una collocazione storico-giuridica degli avvenimenti relativi al processo ed alla condanna di Gesù di Nazareth. Bari: Palomar, 1992.

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Vigni, Benito Li. Stragi: Da Ustica a Bologna, le verità nascoste : i depistaggi hanno occultato mandanti ed esecutori ma soprattutto le responsabilità politiche. Roma: Sovera edizioni, 2014.

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Book chapters on the topic "ED triage"

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Grossmann, Florian F., and Christian Nickel. "Triage of Older ED Patients." In Geriatric Emergency Medicine, 17–22. Cham: Springer International Publishing, 2017. http://dx.doi.org/10.1007/978-3-319-19318-2_2.

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Bjørn, Pernille, and Carsten Østerlund. "Transforming the Sociomateriality of the Triage Template: Canadian ED." In Sociomaterial-Design, 77–81. Cham: Springer International Publishing, 2014. http://dx.doi.org/10.1007/978-3-319-12607-4_6.

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Cooper, Harris. "Reporting other design features: Longitudinal studies, replication studies, studies with one subject, and clinical trials." In Reporting quantitative research in psychology: How to meet APA Style Journal Article Reporting Standards (2nd ed.)., 109–37. Washington: American Psychological Association, 2018. http://dx.doi.org/10.1037/0000103-006.

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Cooper, Harris. "Reporting other design features: Longitudinal studies, replication studies, studies with one subject, and clinical trials." In Reporting quantitative research in psychology: How to meet APA Style Journal Article Reporting Standards (2nd ed.)., 109–37. Washington: American Psychological Association, 2020. http://dx.doi.org/10.1037/0000178-006.

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Logaras, Evangelos, Antonis Billis, Georgios Petridis, Charalampos Bratsas, and Panagiotis D. Bamidis. "Semantic Representation of Patient Triage Data Collected in Emergency Departments." In Studies in Health Technology and Informatics. IOS Press, 2021. http://dx.doi.org/10.3233/shti210362.

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Emergency Department (ED) overcrowding is a major issue for the efficient management of patients. To this end, triage algorithms have been developed to support the task of patient prioritization. In this paper an ontology was designed to represent the knowledge about patient triage procedure in EDs.

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Gupta, Pawan. "General Approach." In Oxford Assess and Progress: Emergency Medicine. Oxford University Press, 2011. http://dx.doi.org/10.1093/oso/9780199599530.003.0010.

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This chapter will focus on the day-to-day issues encountered in the ED for an overall understanding of the scenarios new doctors are expected to face on the very first day of their exciting career. The first issue dealt with in this chapter is triage. Triage is the hub of clinical practice and used on a regular basis in one form or another. Although some departments have gradually developed the service of ‘see and treat’ and escaping triage, it is still applied formally or informally by a practising clinician. It is vital to prioritize patients attending with a wide range of clinical presentations. A few questions on this topic are included to give a flavour of what to expect when you join the ED. The other issue discussed in this chapter is legal medicine, which again a newly qualified doctor may encounter on their first entry to the ED. But, it must be emphasized that plenty of support is provided to newcomers to put them at ease so that they may use their initial few days for settling into the department. To overcome the dilemma of ethical and legal issues, doctors can also contact medical defence organizations (the Medical Defence Union, the Medical Protection Society, etc.) and almost every doctor subscribes to one of the unions for this kind of support. It is increasingly recognized that an appropriate level of communication is of the utmost importance for the safer and effective care of patients attending the ED. There is always the issue of when to refer a borderline case to a specialty peer for possible admission and further care. I am sure there are innumerable examples of a junior doctor feeling pressured to send a patient home inappropriately. Therefore the system of SBAR has been included in this chapter to remind every junior doctor as to how best to make effective referrals, no matter at what stage of their career they are or the clinical setting in which they work. Lastly, dealing with a situation involving a major incident or disaster is always at the heart of every ED.

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Croskerry, Pat. "Postpartum Puzzler." In The Cognitive Autopsy, edited by Pat Croskerry, 95–98. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780190088743.003.0014.

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In this case, a 24-year-old female presents to the emergency department (ED) of a community hospital late in the evening. At triage, she is weeping, distressed, very anxious, and complaining of paresthesias in her extremities. She had a normal vaginal delivery approximately 4 weeks ago and has been healthy since. The ED physician is asked to do a quick assessment as the ED is about to close. A consensus quickly develops among the staff that the patient probably has postpartum depression and could be managed through the mental health crisis team in daytime hours the following day. Her physical exam is normal other than some weakness in both legs. The physician feels uncomfortable with the patient’s presentation and considers the possibility of an uncommon neurological disorder. The neurology service reluctantly accepts the patient though doubting the physician’s diagnosis. He later learns that his zebra was correct.

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Graham, Blair. "Emergency medicine." In Oxford Handbook of Clinical Specialties, 568–623. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780198827191.003.0009.

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This chapter in the Oxford Handbook of Clinical Specialties explores the specialty of emergency medicine. It describes the work of a doctor in the emergency department (ED), including an overview of emergency medicine and ED teams, triage, crowding, exit block, clinical decision-making, patient expectations, and patient assessment. It investigates common procedures in depth, including advanced life support and management of pain and sedation. It discusses commonly encountered problems such as shock, the unwell child, and major trauma from brain injury to thoracic, abdominal, and pelvic trauma, as well as major burns, environmental emergencies, emergency toxicology, sepsis, loss of consciousness, stroke, acute severe headache, chest pain, acute shortness of breath, abdominal pain, atraumatic back pain, extremity problems, common limb injuries, bites and stings, foreign body ingestion, and wound care.

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Wyatt, Jonathan P., Robert G. Taylor, Kerstin de Wit, Emily J. Hotton, Robin J. Illingworth, and Colin E. Robertson. "General approach." In Oxford Handbook of Emergency Medicine, 1–42. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780198784197.003.0001.

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This chapter in the Oxford Handbook of Emergency Medicine is an introduction to the emergency department (ED). It discusses the practice of emergency medicine both within the ED and beyond. It explores patient flow, patient safety, and note keeping. It discusses the art of radiological request, triage, discharge, referral, and handover, as well as liaising with general practitioners (GPs) and the ambulance crew, giving telephone advice, and coping as a junior doctor. It examines inappropriate attenders, as well as the patient with a label, the difficult patient, special patient groups, and patient transfer. It explores the patient with learning difficulties, and assessment and discharge of the elderly patient. It discusses end-of-life care, including breaking bad news and what to do after death. Medicolegal aspects are examined, on both how to avoid trouble and duty under the law. Infection control and prevention, roadside emergency, and major incidents are also discussed.

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Gupta, Pawan. "Analgesia and Anaesthesia." In Oxford Assess and Progress: Emergency Medicine. Oxford University Press, 2011. http://dx.doi.org/10.1093/oso/9780199599530.003.0016.

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Seventy per cent of patients who present to the ED have pain as their main complaint—and most of the time as a sign of injury or inflammation. Therefore, early assessment by scoring at the point of triage and offering the appropriate analgesia are the first steps towards the management of such patients. The College of Emergency Medicine guidelines suggest that at least 98% of patients in severe pain (pain score of 7–10) should be offered appropriate analgesia within 60min of arrival, or triage, whichever is earlier. In 90% of these patients, the status of pain should be re-evaluated within 60min of receiving the first dose of the analgesic. Despite this clear-cut standard and the availability of a wide variety of analgesics, achieving such a target remains, occasionally, elusive. It must also be realized that a positive experience for the patient largely depends on relief of pain as early as possible. Consequently, one of the primary areas for a new FY1 to focus on is the pain management. Remember it is simple and straightforward in most circumstances. GA may be required in the ED for various clinical indications, for example, cardioversion, facial trauma or burns, and acute respiratory failure (such as in asthma). In an emergency situation it may be a challenging procedure even for an experienced anaesthetist and could be dangerous for the patients. An FY1/2 will never be expected to perform this, but it is important to know when to call for help when the situation demands. Local anaesthesia is widely used in the ED, and is one of the skills foundation trainees learn in the early days. It is comparatively safe if the doctor is aware of how to perform the procedure and the upper limit of the dose for a particular patient. Finally, conscious sedation is also widely used in the ED for reducing fractures and/or dislocations and minor operations. However, it carries the same risks as GA and should be carried out by a doctor who is trained in the procedure as well as in resuscitation. A risk assessment should be performed as a patient with high risks (previous cardiac or respiratory diseases) must be sedated with extreme caution.

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Conference papers on the topic "ED triage"

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McLean, S. R., J. R. Bledsoe, T. L. Allen, S. M. Brown, and I. D. Peltan. "Lower Triage Acuity Scores Are Associated with Delayed Antibiotics in ED Sepsis." In American Thoracic Society 2019 International Conference, May 17-22, 2019 - Dallas, TX. American Thoracic Society, 2019. http://dx.doi.org/10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a5986.

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Joubert, Etienne, Marie-Alix Espinasse, and Michel Nakhla. "Patients flow optimization in ED: An operational research on the impacts of physician triage." In 2015 International Conference on Industrial Engineering and Systems Management (IESM). IEEE, 2015. http://dx.doi.org/10.1109/iesm.2015.7380220.

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Ingram, S. "38 Transforming post triage assessment of chest pain in a busy emergency department (ED), from ED doctor to advanced nurse practitioner (ANP) direct; the impact on patient experience times (PET)." In Irish Cardiac Society Annual Scientific Meeting & AGM (Virtual), October 1st – 3rd 2020. BMJ Publishing Group Ltd and British Cardiovascular Society, 2020. http://dx.doi.org/10.1136/heartjnl-2020-ics.38.

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Cruz, Jazmin, Mario Garcia, Elizabeth Jackson, and James Yang. "Perineum Pressure Distribution Among Various Bicycle Saddles." In ASME 2020 International Design Engineering Technical Conferences and Computers and Information in Engineering Conference. American Society of Mechanical Engineers, 2020. http://dx.doi.org/10.1115/detc2020-22688.

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Abstract Cycling is a widely popular exercise that is known to provide great health benefits. However, it has been questioned if cycling is responsible for genital numbness or Erectile Dysfunction (ED) due to compression of the perineum between the rider and the bicycle saddle. This study compares the perineal pressure distribution between three saddles (ISM, 3 West, and Fizik) for healthy, active male cyclists and a saddle recommendation is made. Using their own bikes, participants perform six randomized cycling trials (two per saddle) while sitting on a piezo-resistive pressure mat. Participants were asked to qualitatively rate the saddles after each trial. The quantitative results favor the ISM saddle due to its lower perineal pressure values, but the qualitative perceived comfort from the cyclists is split.

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Mapel, D. W., M. Bogart, G. J. Criner, M. T. Dransfield, N. Gaeckle, M. Gotfried, D. M. G. Halpin, et al. "Reduction in Emergency Department (ED) Visits in Patients with Chronic Obstructive Pulmonary Disease (COPD): Analysis of the IMPACT Trial." In American Thoracic Society 2021 International Conference, May 14-19, 2021 - San Diego, CA. American Thoracic Society, 2021. http://dx.doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2242.

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Ourives, Eliete Auxiliadora, Attilio Bolivar Ourives de Figueiredo, Luiz Fernando Gonçalves de Figueiredo, Milton Luiz Horn Vieira, Isabel Cristina Victoria Moreira, and Francisco Gómez Castro. "A IMPORTÂNCIA DA ABORDAGEM SISTÊMICA NA ERGONOMIA PARA UM DESIGN FUNCIONAL." In Systems & Design 2017. Valencia: Universitat Politècnica València, 2017. http://dx.doi.org/10.4995/sd2017.2017.6648.

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RESUMO A abordagem sistêmica é um processo interdisciplinar, cujo princípio primordial é compreender a interdependência recíproca e relações de todas as áreas e da necessidade de sua integração, permitindo maior aproximação entre os seus limites de estudo. Nesse contexto o olhar sistêmico, da ergonomia, sobretudo no que se refere à segurança, ao conforto e à eficácia de uso, de funcionalidade e de operacionalidade dos objetos, considerando todos os produtos ou sistemas de produtos, como sistema de uso, desde os mais simples aos mais complexos ou sistêmicos, tem como objetivo adequá-los aos seres humanos, tendo em vista as atividades e tarefas exercidas por eles. No que se refere ao design funcional, os conhecimentos da ergonomia, nessa visão sistêmica, relativos à sua metodologia de projeto, são absolutamente necessários, e a sua aplicação aponta a melhor adequação dos produtos aos seus usuários. Como é o caso do vestuário feminino funcional, sobretudo no que se refere a proteção das mamas, que são peças convencionais que necessitam de um correto dimensionamento e especificação dos tecidos e de outros materiais. É um tipo de vestuário que apresenta funcionalidade diversa, como para a proteção física, o aumento do volume da mama, enchimento no bojo de pano, de água, de óleo, estruturado com arame, etc.; para amamentação (sutiã que se abre na frente, em parte ou totalmente); para o design inclusivo (pessoas com deficiência e mobilidade reduzida, no caso de mamas com prótese ou órtese) facilitando com fechamentos e aberturas colocadas em peças de roupas difíceis de manusear, roupas confortáveis e fáceis de vestir. São peças usadas por pessoas com biótipos e percentis antropométricos variáveis e com características corporais que mudam significativamente nas passagens para a adolescência, idade adulta e idosa. As mudanças corporais apresentam diferenças significativas em termos de volume das mamas, nas quais as soluções ergonômicas por uma abordagem sistêmicas que se evidencia mais para a complexidade de uso, são as mais necessárias em termos de atributos como, segurança, conforto, comodidade corporal, facilidade do vestir, funcionalidade, além da estética. Esta pesquisa, embora exploratória e descritiva, não isenta de desafios, tem por objetivo, por meio de dados e informações ergonômicas sistêmicas contribuir com o design funcional, de modo a oferecer subsídios para a confecção de roupas funcionais ou tecnologia vestível, com os atributos citados, respeitando a diversidade e inclusão das pessoas em todas as fases de sua vida, atendendo assim os princípios formais do design. Palavra-chave: Abordagem sistêmica, Ergonomia, Design funcional. REFERENCIAS AROS, Kammiri Corinaldesi. Elicitação do processo projetual do Núcleo de Abordagem Sistêmica do Design da Universidade Federal de Santa Catarina. Orientador: Luiz Fernando Gonçalves de Figueiredo – Florianópolis, SC, 2016. BERTALANFFY, Ludwig V. Teoria geral dos sistemas: fundamentos, desenvolvimento e aplicações. 3. ed. Petrópolis, RJ: Vozes, 2008. BEST, Kathryn. Fundamentos de gestão do design. Porto Alegre: Bookman, 2012. 208 p. CHIAVENATO, I. Gestão de pessoas. 3ª ed. Rio de Janeiro: Elsevier, 2010. CORRÊA, Vanderlei Moraes; BOLETTI, Rosane Rosner. Ergonomia: fundamentos e aplicações. Bookman Editora, 2015.MERINO, Eugenio. Fundamentos da ergonomia. 2011. Disponível em: <https://moodle.ufsc.br/pluginfile.php/2034406/mod_resource/content/1/Ergo_Fundamentos.pdf>. Acesso em: 24 Mar 2017. DIAS E. C. Condições de vida, trabalho, saúde e doença dos trabalhadores rurais no Brasil. In: Pinheiro TMM, organizador. Saúde do trabalhador rural –RENAST. Brasília: Ministério da Saúde; 2006.p. 1-27. GIL, A. C. Como elaborar projetos de pesquisa. 4. ed. São Paulo: Atlas, 2010. GOMES FILHO, J. Ergonomia do objeto: sistema técnico de leitura ergonômica. São Paulo: Escrituras Editora, 2003. GUIMARÃES, L. B. M. (ed). Ergonomia de Processo. Porto Alegre, v.2, PPGE/UFRGS, 2000. IIDA, I. Ergonomia: projeto e produção. 2ª ed rev. e ampl. – São Paulo: Edgard Blucher, 2005. MANZINI, Ezio. Design para inovação social e sustentabilidade: comunidades criativas, organizações colaborativas e novas redes projetuais. Rio de Janeiro: E-Papers, 2008, 104p. MARCONI, M. A.; Lakatos, E. M. Fundamentos de metodologia científica. São Paulo: Atlas, 2007. Pandarum, R., Yu, W., and Hunter, L., 2011. 3-D breast anthropometry of plus-sized women in South Africa. Ergonomics, 54(9), 866–875. McGhee, D.E., Steele, J.R., and Munro, B.J., 2008. Sports bra fitness. Wollongong (NSW): Breast Research Australia. McGhee, D.E., Steele, J.R., and Munro, B.J., 2010. Education improves bra knowledge and fit, and level of breast support in adolescent female athletes: a cluster-randomised trial. Journal of Physiotherapy, 56, 19–24. Pechter, E.A., 1998. A new method for determining bra size and predicting postaugmentation breast size. Plastic and Reconstructive Surgery, 102 (4), 1259–1265. RICHARDSON, R. J. Pesquisa social: métodos e técnicas. 3 ed. São Paulo: Atlas, 2008. RIO, R. P. DO; PIRES, L. Ergonomia: fundamentos da prática ergonômica, 3ª Ed., Editora LTr, 2001. SANTOS, N. ET AL. Antropotecnologia: A Ergonomia dos sistemas de Produção. Curitiba: Gênesis, 1997. VASCONCELLOS, Maria José Esteves de. Pensamento sistêmico: O novo paradigma da ciência. 10ª ed. Campinas, SP: Papirus, 2013. WEERDMEESTER, J. D. e B. Ergonomia Prática. São Paulo: Edgard Blucher, 2001. WHITE, J.; SCURR, J. Evaluation of professional bra fitting criteria for bra selection and fitting in the UK. Ergonomics, 1–8. 2012. WHITE, J.;SCURR, J.; SMITH, N. The effect of breast support on kinetics during overground running performance. Ergonomics, Taylor & Francis. 52 (4), 492–498. 2009.

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Sandanaraj, Edwin, Scott P. Myrand, Amit Aggarwal, Susan C. Guba, David Ohannesian, Jian WJ Wang, Yong YY Yang, Giorgio V. Scagliotti, and Egbert F. Smit. "Abstract LB-396: Molecular characterization of ED-SCLC: high-resolution SNP 6.0 arrays, mRNA expression, and miRNA arrays from the phase III GALES trial." In Proceedings: AACR 103rd Annual Meeting 2012‐‐ Mar 31‐Apr 4, 2012; Chicago, IL. American Association for Cancer Research, 2012. http://dx.doi.org/10.1158/1538-7445.am2012-lb-396.

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Jackson, K. E., L. Wang, J. D. Casey, W. H. Self, T. W. Rice, and M. W. Semler. "Effect of Controlling Fluid Choice in the ED and ICU Versus ICU Only on Sepsis Outcomes in a Clinical Trial of Balanced Crystalloids Versus Saline." In American Thoracic Society 2020 International Conference, May 15-20, 2020 - Philadelphia, PA. American Thoracic Society, 2020. http://dx.doi.org/10.1164/ajrccm-conference.2020.201.1_meetingabstracts.a6309.

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Srinidhi, R., Vishal Sharma, M. Sukumar, and C. S. Venkatesha. "Correlative Flank Wear Analysis of Single Point Turning Inserts Using Acoustic Emission and Artificial Intelligence Techniques." In ASME 2008 International Mechanical Engineering Congress and Exposition. ASMEDC, 2008. http://dx.doi.org/10.1115/imece2008-67543.

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Wear mechanism of a cutting tool is highly complex in that the processes of tool wear results from interacting effect of machining configurations. Various output generated by the study and analysis of each tool is extremely useful in analyzing the tool characteristics in general and to make efforts to obtain the estimated tool life in particular. The gradual process of tool wear has adverse influence on the quality of the surface generated and on the design specifications in the work piece dimensions and geometry, and causes, at the worst case, machine breakdown. Advanced manufacturing demands proper use of the right tool and emphasizes the need to check the wear rate. A scientific method of obtaining conditions for an optimal machining process with proper tools and control of machining parameters is essential in the present day manufacturing processes. Many problems that affect optimization are related to the diminished machine performance caused by worn out tools. One of the indirect methods of tool wear analysis and monitoring is based on the acoustic emission (AE) signals. The generation of the AE signals directly in the cutting zone makes them very sensitive to changes in the cutting process and provides a means of evaluating the wear of cutting tools. Wear parameters obtained in the process are analyzed with the output generated by using Multi Layer Perceptron (MLP) based back propagation technique and Adaptive Neuro Fuzzy Interference System (ANFIS). The results obtained from these methods are correlated for the actual and predicted wear. Experiments have been conducted on EN8 and, EN24 using Uncoated Carbide, Coated carbide and Ceramic inserts (Kennametal, India make) on a high speed lathe for the most appropriate cutting conditions. The AE signal analysis (considering signal parameters such as, ring down count (RDC), rise time (RTT), event duration (ED) and energy (EG). Flank wear in tools and corresponding cutting forces for each of the trials are measured and are correlated for various combinations of tools and materials of work piece.

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Zavrel, Erik A., and Matthew R. Ebben. "A Novel Two-Degree-of-Freedom Mechatronic Bed for Insomnia Treatment." In 2017 Design of Medical Devices Conference. American Society of Mechanical Engineers, 2017. http://dx.doi.org/10.1115/dmd2017-3534.

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The population prevalence of insomnia has been surveyed numerous times and is among the most common medical complaints. This common problem has wide ranging psychological and physiological health consequences. Ample anecdotal evidence exists that motion promotes sleep: automobile and train passengers are routinely observed becoming drowsy and falling asleep [1]. The sleep-inducing effect of motion has long been appreciated in the scientific community as well. For example, rocking effectively produces sleep in infants [2]. Sleepiness is also a primary symptom of motion sickness and in some cases may be its sole manifestation [3]. To date, three studies have attempted to determine whether vestibular stimulation promotes sleepiness in adults. Two of these studies involved rocking beds. In one study, investigators found that regular, periodic motion achieved using a rocking bed reduced sleep onset latency (SOL) and increased REM in normal sleepers [4]. In another study, normal sleepers napped in a swinging bed of the same design. The study showed that rocking motion promotes sleep onset and transition to deeper, more restful stages of sleep [5]. In another study, investigators employed electrical stimulation of the inner ear in an attempt to decrease SOL, finding a significant reduction in a subset of participants whose SOL was elevated at baseline [6]. This illustrates that insomniacs may be particularly responsive to vestibular stimulation. The non-pharmacological promotion of sleep is an active commercial pursuit with numerous related patents filed and commercial products introduced in recent years; however, existing devices suffer serious shortcomings. Previous experimental and current commercial designs intended for adults function(ed) as a pendulum, requiring a custom bed (and associated custom linens) along with a special overarching scaffolding installation to suspend the bed [7]. An advanced robotic infant seat [8], while elegantly designed, utilizes active load support, severely limiting the maximum weight capacity and excluding the possibility that a similar implementation could be used for adults. Phillips Respironics developed the SleepWave, a non-invasive (clip-on) device to electrically stimulate the vestibular nerve to generate the sensation of motion, which has undergone promising clinical trials but is not yet commercially available [9]. The motivation for a mechatronic bed as a treatment for insomnia is based on the demonstrated link between motion-induced vestibular stimulation and sleep induction. To date, no design has been proposed that is practical to implement or capable of being incorporated into existing beds: cost, necessary dedicated physical space, and convenience represent substantial barriers to acceptance.

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