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Birnbaum, Marvin L., Elaine K. Daily, and Ann P. O’Rourke. "Research and Evaluations of the Health Aspects of Disasters, Part VII: The Relief/Recovery Framework." Prehospital and Disaster Medicine 31, no. 2 (February 3, 2016): 195–210. http://dx.doi.org/10.1017/s1049023x16000029.
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AbstractThe principal goal of research relative to disasters is to decrease the risk that a hazard will result in a disaster. Disaster studies pursue two distinct directions: (1) epidemiological (non-interventional); and (2) interventional. Both interventional and non-interventional studies require data/information obtained from assessments of function. Non-interventional studies examine the epidemiology of disasters. Interventional studies evaluate specific interventions/responses in terms of their effectiveness in meeting their respective objectives, their contribution to the overarching goal, other effects created, their respective costs, and the efficiency with which they achieved their objectives. The results of interventional studies should contribute to evidence that will be used to inform the decisions used to define standards of care and best practices for a given setting based on these standards. Interventional studies are based on the Disaster Logic Model (DLM) and are used to change or maintain levels of function (LOFs). Relief and Recovery interventional studies seek to determine the effects, outcomes, impacts, costs, and value of the intervention provided after the onset of a damaging event. The Relief/Recovery Framework provides the structure needed to systematically study the processes involved in providing relief or recovery interventions that result in a new LOF for a given Societal System and/or its component functions. It consists of the following transformational processes (steps): (1) identification of the functional state prior to the onset of the event (pre-event); (2) assessments of the current functional state; (3) comparison of the current functional state with the pre-event state and with the results of the last assessment; (4) needs identification; (5) strategic planning, including establishing the overall strategic goal(s), objectives, and priorities for interventions; (6) identification of options for interventions; (7) selection of the most appropriate intervention(s); (8) operational planning; (9) implementation of the intervention(s); (10) assessments of the effects and changes in LOFs resulting from the intervention(s); (11) determination of the costs of providing the intervention; (12) determination of the current functional status; (13) synthesis of the findings with current evidence to define the benefits and value of the intervention to the affected population; and (14) codification of the findings into new evidence. Each of these steps in the Framework is a production function that facilitates evaluation, and the outputs of the transformation process establish the current state for the next step in the process. The evidence obtained is integrated into augmenting the respective Response Capacities of a community-at-risk. The ultimate impact of enhanced Response Capacity is determined by studying the epidemiology of the next event.BirnbaumML, DailyEK, O’RourkeAP. Research and evaluations of the health aspects of disasters, part VII: the Relief/Recovery Framework. Prehosp Disaster Med. 2016;31(2):195–210.
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Birnbaum, Marvin L., Elaine K. Daily, Ann P. O’Rourke, and Jennifer Kushner. "Research and Evaluations of the Health Aspects of Disasters, Part VI: Interventional Research and the Disaster Logic Model." Prehospital and Disaster Medicine 31, no. 2 (February 2, 2016): 181–94. http://dx.doi.org/10.1017/s1049023x16000017.
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AbstractDisaster-related interventions are actions or responses undertaken during any phase of a disaster to change the current status of an affected community or a Societal System. Interventional disaster research aims to evaluate the results of such interventions in order to develop standards and best practices in Disaster Health that can be applied to disaster risk reduction. Considering interventions as production functions (transformation processes) structures the analyses and cataloguing of interventions/responses that are implemented prior to, during, or following a disaster or other emergency. Since currently it is not possible to do randomized, controlled studies of disasters, in order to validate the derived standards and best practices, the results of the studies must be compared and synthesized with results from other studies (ie, systematic reviews). Such reviews will be facilitated by the selected studies being structured using accepted frameworks. A logic model is a graphic representation of the transformation processes of a program [project] that shows the intended relationships between investments and results. Logic models are used to describe a program and its theory of change, and they provide a method for the analyzing and evaluating interventions. The Disaster Logic Model (DLM) is an adaptation of a logic model used for the evaluation of educational programs and provides the structure required for the analysis of disaster-related interventions. It incorporates a(n): definition of the current functional status of a community or Societal System, identification of needs, definition of goals, selection of objectives, implementation of the intervention(s), and evaluation of the effects, outcomes, costs, and impacts of the interventions. It is useful for determining the value of an intervention and it also provides the structure for analyzing the processes used in providing the intervention according to the Relief/Recovery and Risk-Reduction Frameworks.BirnbaumML, DailyEK, O’RourkeAP, KushnerJ. Research and evaluations of the health aspects of disasters, part VI: interventional research and the Disaster Logic Model. Prehosp Disaster Med. 2016;31(2):181–194.
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Osterman, Janet E., and Claude M. Chemtob. "Emergency Psychiatry: Emergency Intervention for Acute Traumatic Stress." Psychiatric Services 50, no. 6 (June 1999): 739–40. http://dx.doi.org/10.1176/ps.50.6.739.
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Pfefferbaum, Betty, Pascal Nitiéma, Elana Newman, and Anushka Patel. "The Benefit of Interventions to Reduce Posttraumatic Stress in Youth Exposed to Mass Trauma: A Review and Meta-Analysis." Prehospital and Disaster Medicine 34, no. 05 (August 28, 2019): 540–51. http://dx.doi.org/10.1017/s1049023x19004771.
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AbstractNumerous interventions to address posttraumatic stress (PTS) in youth exposed to mass trauma have been delivered and evaluated. It remains unclear, however, which interventions work for whom and under what conditions. This report describes a meta-analysis of the effect of youth mass-trauma interventions on PTS to determine if interventions were superior to inactive controls and describes a moderator analysis to examine whether the type of event, population characteristics, or income level of the country where the intervention was delivered may have affected the observed effect sizes. A comprehensive literature search identified randomized controlled trials (RCTs) of youth mass-trauma interventions relative to inactive controls. The search identified 2,232 references, of which 25 RCTs examining 27 trials (N = 4,662 participants) were included in this meta-analysis. Intervention effects were computed as Hedge’s g estimates and combined using a random effects model. Moderator analyses were conducted to explain the observed heterogeneity among effect sizes using the following independent variables: disaster type (political violence versus natural disaster); sample type (targeted versus non-targeted); and income level of the country where the intervention was delivered (high- versus middle- versus low-income). The correlation between the estimates of the intervention effects on PTS and on functional impairment was estimated. The overall treatment effect size was converted into a number needed to treat (NNT) for a practical interpretation. The overall intervention effect was statistically significant (g = 0.57; P < .0001), indicating that interventions had a medium beneficial effect on PTS. None of the hypothesized moderators explained the heterogeneity among the intervention effects. Estimates of the intervention effects on PTS and on functional impairment were positively correlated (Spearman’s r = 0.90; P < .0001), indicating a concomitant improvement in both outcomes. These findings confirm that interventions can alleviate PTS and enhance functioning in children exposed to mass trauma. This study extends prior research by demonstrating improvement in PTS with interventions delivered to targeted and non-targeted populations, regardless of the country income level. Intervention populations and available resources should be considered when interpreting the results of intervention studies to inform recommendations for practice.
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Horn, Kimberly, Geri Dino, Candice Hamilton, N. Noerachmanto, and Jianjun Zhang. "Evidence-Based Review and Discussion Points." American Journal of Critical Care 17, no. 3 (May 1, 2008): 205–16. http://dx.doi.org/10.4037/ajcc2008.17.3.205.
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Background Traditional efficacy research alone is insufficient to move interventions from research to practice. Motivational interviewing has been adapted for brief encounters in a variety of health care settings for numerous problem behaviors among adolescents and adults. Some experts suggest that motivational interviewing can support a population health approach to reach large numbers of teen smokers without the resource demands of multisession interventions. Objectives To determine the reach, implementation fidelity, and acceptability of a brief motivational tobacco intervention for teens who had treatment in a hospital emergency department. Methods Among 74 teens 14 to 19 years old, 40 received a brief motivational tobacco intervention and 34 received brief advice/care as usual at baseline. Follow-up data were collected from the interventional group at 1, 3, and 6 months and from the control group at 6 months. For the interventional group, data also were collected from the teens’ parents, the health care personnel who provided the intervention, and emergency department personnel. Results Findings indicated low levels of reach, high levels of implementation fidelity, and high levels of acceptability for teen patients, their parents, and emergency department personnel. Data suggest that practitioners can operationalize motivational interventions as planned in a clinical setting and that patients and others with an interest in the outcomes may find the interventions acceptable. However, issues of reach may hinder use of the intervention among teens in clinical settings. Conclusions Further investigation is needed on mechanisms to reduce barriers to participation, especially barriers related to patient acuity.
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Veligotskii, N. N., A. N. Veligotskii, V. S. Strakhovetskii, D. A. Smetskov, and A. S. Chebotaryov. "Laparoscopic intervention in emergency surgery." Medicni perspektivi (Medical perspectives) 23, no. 4(part1) (December 3, 2018): 32–36. http://dx.doi.org/10.26641/2307-0404.2018.4(part1).145655.
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Furlan, Anthony J. "Emergency Stroke Intervention: Current Status." Journal of Vascular and Interventional Radiology 10, no. 2 (February 1999): 47–48. http://dx.doi.org/10.1016/s1051-0443(99)71021-3.
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Weldy, Marylou. "Emergency Care Assessment and Intervention." AORN Journal 41, no. 3 (March 1985): 546. http://dx.doi.org/10.1016/s0001-2092(07)62686-6.
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Sioka, Eleni, Matthaios Efthimiou, Charalambos Skoulakis, and Dimitrios Zacharoulis. "Thyroid Abscess Requiring Emergency Intervention." Journal of Emergency Medicine 43, no. 6 (December 2012): e455-e456. http://dx.doi.org/10.1016/j.jemermed.2011.06.054.
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Haq, Nowreen, Rona Stewart-Corral, Eric Hamrock, Jamie Perin, and Waseem Khaliq. "Emergency department throughput: an intervention." Internal and Emergency Medicine 13, no. 6 (January 15, 2018): 923–31. http://dx.doi.org/10.1007/s11739-018-1786-1.
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Gamberini, Lorenzo, Cosimo Picoco, Donatella Del Giudice, Corrado Zenesini, Marco Tartaglione, Carlo Coniglio, Federico Semeraro, Fabrizio Bizzi, Stefano Santini, and Giovanni Gordini. "Improving the Appropriateness of Advanced Life Support Teams’ Dispatch: A Before-After Study." Prehospital and Disaster Medicine 36, no. 2 (February 1, 2021): 195–201. http://dx.doi.org/10.1017/s1049023x21000030.
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AbstractBackground and Importance:The dispatch of Advanced Life Support (ALS) teams in Emergency Medical Services (EMS) is still a hardly studied aspect of prehospital emergency logistics. In 2015, the dispatch algorithm of Emilia Est Emergency Operation Centre (EE-EOC) was implemented and the dispatch of ALS teams was changed from primary to secondary based on triage of dispatched vehicles for high-priority interventions when teams with Immediate Life Support (ILS) skills were dispatched.Objectives:This study aimed to evaluate the effects on the appropriateness of ALS teams’ intervention and their employment time, and to compare sensitivity and specificity of the algorithm implementation.Design:This was a retrospective before-after observational study.Settings and Participants:Primary dispatches managed by EE-EOC involving ambulances and/or ALS teams were included. Two groups were created on the basis of the years of intervention (2013-2014 versus 2017-2018).Intervention:A switch from primary to secondary dispatch of ALS teams in case of high-priority dispatches managed by ILS teams was implemented.Outcomes:Appropriateness of ALS team intervention, total task time of ALS vehicles, and sensitivity and specificity of the algorithm were reviewed.Results:The study included 242,501 emergency calls that generated 56,567 red code dispatches. The new algorithm significantly increased global sensitivity and specificity of the system in terms of recognition of potential need of ALS intervention and the specificity of primary ALS dispatch. The appropriateness of ALS intervention was significantly increased; total tasking time per day for ALS and the number of critical dispatches without ALS available were reduced.Conclusion:The revision of the dispatch criteria and the extension of the two-tiered dispatch for ALS teams significantly increased the appropriateness of ALS intervention and reduced both the global tasking time and the number of high-priority dispatches without ALS teams available.
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Mizerska, Krystyna, Adrianna Kosior-Lara, and Viera Rusnáková. "LEGAL ASPECTS OF EMERGENCY PSYCHIATRIC INTERVENTION." Scientific Journal of Polonia University 25, no. 6 (December 28, 2017): 126. http://dx.doi.org/10.23856/2513.
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The purpose of this article is to discuss the legal aspects applicable in emergency psychiatric intervention. Therefore, inter alia, the provisions of the act on the protection of mental health (dated August 19, 1994) and the act on the rights of the patient and the Patient's Rights Ombudsman (6 November 2008) are recalled in this article. In addition, examples of the emergency states in which psychiatric interventions may take place are given in this paper. Moreover, the importance of the therapeutic-diagnostic contact with the patient with psychopathological disorders is taken into account. The article highlights the need for the knowledge of the aforementioned legal aspects since, in many cases, it can protect the life of the patient or the life of medical staff.
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Yasmin, Khalida, Adnan Yaqoob, and Hajra Sarwer. "Effect of Cognitive Behavioral Therapy (CBT) Based Intervention on Resilience and Burnout among Staff Nurses Working in Critical Care Departments." Pakistan Journal of Medical and Health Sciences 16, no. 3 (March 26, 2022): 295–98. http://dx.doi.org/10.53350/pjmhs22163295.
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Objective: The purpose of this study was to evaluate the effect of cognitive behavioral therapy (CBT) based intervention on resilience and burnout variables among staff nurses working in critical care department of the healthcare setting. Background: In the healthcare setting, emergency department is extremely risky unit where atmosphere frequently becomes unpredictable. In this environment emergency staff nurses most of the time taking persistent stress effect on mental well-being which lead to exhaustion. In critical care department’s nurses have potentially affected by anxiety due to stressful environment and workload which is the leading factor of negative outcome and result in burnout. Cognitive behavior therapy-based intervention (CBT) is one of the effective intervention to decrease self-reported burnout, as well as increased resilience Methods: A convenient sampling technique was performed collecting the demographic data and information during the face to face interview of 50 working nurse’s staff. The educational interventions, consisted of 08 manualized weekly 60-minute sessions. Data were collected at baseline and after intervention that measured stress, depressive symptoms, anxiety, healthy lifestyle beliefs and behaviors, and job satisfaction. Simple descriptive, paired sample T-test and Wilcoxon signed Rank test was applied for data analysis. Results: The intervention group scored significantly better with moderate to large positive effects on the burnout and resilience variables as well as healthy lifestyle behaviors after the 08 weeks of interventional sessions. Conclusions: The CBT including direct educational sessions has excellent potential as evidence-based interventions for improving the mental health, healthy lifestyle beliefs and behaviors related to job satisfaction in working staff nurses of emergency department. Keywords: Cognitive behavior, interventions, Burnout, Resilience, Nurses.
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Barbiere, CC. "Cardiac tamponade: diagnosis and emergency intervention." Critical Care Nurse 10, no. 4 (April 1, 1990): 20–22. http://dx.doi.org/10.4037/ccn1990.10.4.20.
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Erickson, Timothy B., Michael J. VanRooyen, Patricia Werbiski, Mark Mycyk*, and Paul Levy. "Emergency Medicine Education Intervention in Rwanda." Annals of Emergency Medicine 28, no. 6 (December 1996): 648–51. http://dx.doi.org/10.1016/s0196-0644(96)70088-4.
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Kruse-Elliott, Kris T. "Management and Emergency Intervention During Anesthesia." Veterinary Clinics of North America: Food Animal Practice 12, no. 3 (November 1996): 563–78. http://dx.doi.org/10.1016/s0749-0720(15)30389-3.
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Cohen, Neal L., and Sam Tsemberis. "Emergency psychiatric intervention on the street." New Directions for Mental Health Services 1991, no. 52 (1991): 3–16. http://dx.doi.org/10.1002/yd.23319915203.
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Anil, H. T., S. G. Smitha, and Nikitha Pillai. "Bilateral Pneumothorax Post Emergency Airway Intervention." Indian Journal of Otolaryngology and Head & Neck Surgery 71, S1 (November 2, 2018): 729–30. http://dx.doi.org/10.1007/s12070-018-1521-2.
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LISKOW, BARRY. "The Alcoholic Patient: Emergency Medical Intervention." American Journal of Psychiatry 150, no. 5 (May 1993): 834. http://dx.doi.org/10.1176/ajp.150.5.834.
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Kercher, Eugene E. "Crisis Intervention in the Emergency Department." Emergency Medicine Clinics of North America 9, no. 1 (February 1991): 219–32. http://dx.doi.org/10.1016/s0733-8627(20)30212-1.
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Sporer, Karl A., Alan M. Craig, Nicholas J. Johnson, and Clement C. Yeh. "Does Emergency Medical Dispatch Priority Predict Delphi Process-Derived Levels of Prehospital Intervention?" Prehospital and Disaster Medicine 25, no. 4 (August 2010): 309–17. http://dx.doi.org/10.1017/s1049023x00008244.
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AbstractObjective:The Medical Priority Dispatch System (MPDS) is an emergency medical dispatch system widely used to prioritize 9-1-1 calls and optimize resource allocation. This study evaluates whether the assigned priority predicts a Delphi process-derived level of prehospital intervention in each emergency medical dispatch category.Methods:All patients given a MPDS priority in a suburban California county from 2004–2006 were included. A Delphi process of emergency medical services (EMS) professionals in another system developed the following categories of prehospital treatment representing increasing acuity, which were adapted for this study: advanced life support (ALS) intervention, ALS–Stat, and ALS–Critical. The sensitivities and specificities of MPDS priority for level of prehospital intervention were determined for each MPDS category.Results:A total of 65,268 patients met inclusion criteria, representing 61% of EMS calls during the study period. The overall sensitivities of high-priority dispatch codes for ALS, ALS-Stat, and ALS-Critical interventions were 83% (95% confidence interval 83–84%), 83% (82–84%), and 94% (92–96%). Overall specificities were: ALS, 32% (31–32%); ALS-Stat, 31% (30–31%); and ALS-Critical 28% (28–29%). Compared to calls assigned to a low priority, calls with high-priority dispatch codes were more likely to receive ALS interventions by 22%, ALS-Stat by 20%, and ALS-Critical by 32%. A low priority dispatch code decreased the likelihood of ALS interventions by 48%, ALS-Stat by 45%, and ALS-Critical by 80%. Among high-priority dispatch codes, the rates of interventions were: ALS 26%, ALS-Stat 22%, and ALS-Critical 1.5%, all of which were significantly greater than low-priority calls (p <0.05) [ALS 13%, ALS-Stat 11%, and ALS-Critical 0.2%]. Major MPDS were categories with high sensitivities (>95%) for ALS interventions included breathing problems, cardiac or respiratory arrest/death, chest pain, stroke, and unconscious/fainting; these categories had an average specificity of 3%. Medical Priority Dispatch System categories such as back pain, unknown problem, and traumatic injury had sensitivities for ALS interventions <15%.Conclusions:The MPDS is moderately sensitive for the Delphi process derived ALS, ALS-Stat, and ALS-Critical intervention levels, but non-specific. A low MPDS priority is predictive of no prehospital intervention. A high priority, however, is of little predictive value for ALS, ALS-Stat, or ALSCritical interventions.
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De Freitas, Loren, Steve Goodacre, Rachel O’Hara, Praveen Thokala, and Seetharaman Hariharan. "Interventions to improve patient flow in emergency departments: an umbrella review." Emergency Medicine Journal 35, no. 10 (August 9, 2018): 626–37. http://dx.doi.org/10.1136/emermed-2017-207263.
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ObjectivesPatient flow and crowding are two major issues in ED service improvement. A substantial amount of literature exists on the interventions to improve patient flow and crowding, making it difficult for policymakers, managers and clinicians to be familiar with all the available literature and identify which interventions are supported by the evidence. This umbrella review provides a comprehensive analysis of the evidence from existing quantitative systematic reviews on the interventions that improve patient flow in EDs.MethodsAn umbrella review of systematic reviews published between 2000 and 2017 was undertaken. Included studies were systematic reviews and meta-analyses of quantitative primary studies assessing an intervention that aimed to improve ED throughput.ResultsThe search strategy yielded 623 articles of which 13 were included in the umbrella review. The publication dates of the systematic reviews ranged from 2006 to 2016. The 13 systematic reviews evaluated 26 interventions: full capacity protocols, computerised provider order entry, scribes, streaming, fast track and triage. Interventions with similar characteristics were grouped together to produce the following categories: diagnostic services, assessment/short stay units, nurse-directed interventions, physician-directed interventions, administrative/organisational and miscellaneous. The statistical evidence from 14 primary randomised controlled trials (RCTs) was evaluated to determine if correlation or clustering of observations was considered. Only the fast track intervention had moderate evidence to support its use but the RCTs that assessed the intervention did not use statistical tests that considered correlation.ConclusionsOverall, the evidence supporting the interventions to improve patient flow is weak. Only the fast track intervention had moderate evidence to support its use but correlation/clustering was not taken into consideration in the RCTs examining the intervention. Failure to consider the correlation of the data in the primary studies could result in erroneous conclusions of effectiveness.
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Kim, SeYoon, Daun Jeong, Mi-Hye Ryu, and Sohyune R. Sok. "Effects of Information Delivery Intervention for the Family of Patients Undergoing Surgery on Emergency in South Korea." SAGE Open 11, no. 2 (April 2021): 215824402110165. http://dx.doi.org/10.1177/21582440211016555.
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The family of emergency surgery patients experience psychological pressure due to the uncertainty of the surgery. The purpose of the study was to examine the effects of information delivery intervention provided by an operation theater nurse on anxiety and satisfaction levels of the family of emergency surgery patients. A quasi-experimental pretest–posttest control group design is used. A total of 60 participants were included in the study as the family of patients undergoing emergency surgery within 6 hr in the emergency room of K hospital in Seoul, Korea (intervention: n = 30, control: n = 30). The information delivery intervention consisted of information on the operating room environment and surgery progress. The tools included the Anxiety scale to examine the anxiety levels and Perioperative Family Needs Questionnaire (PFNQ) to measure family satisfaction levels. Participants in the intervention group had a lower anxiety level ( p < .001) and higher family satisfaction with the intervention ( p < .001) than that of the control group. The information delivery intervention provided by an operation theater nurse was effective. It decreased the anxiety level and increased the satisfaction for the family member of emergency surgery patients. These findings can be used as clinical evidence to explore nursing interventions or strategies for the patient’s family during an emergency surgery.
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Innes, Grant, Andrew McRae, Eric Grafstein, Michael Law, Joel M. H. Teichman, Bryce Weber, Kevin Carlson, Heidi Boyda, and James Andruchow. "Variability of renal colic management and outcomes in two Canadian cities." CJEM 20, no. 5 (April 4, 2018): 702–12. http://dx.doi.org/10.1017/cem.2018.31.
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ABSTRACTBackgroundSome centres favour early intervention for ureteral colic while others prefer trial of spontaneous passage, and relative outcomes are poorly described. Calgary and Vancouver have similar populations and physician expertise, but differing approaches to ureteral colic. We studied 60-day hospitalization and intervention rates for patients having a first emergency department (ED) visit for ureteral colic in these diverse systems.MethodsWe used administrative data and structured chart review to study all Vancouver and Calgary patients with an index visit for ureteral colic during 2014. Patient demographics, arrival characteristics and triage category were captured from ED information systems, while ED visits and admissions were captured from linked regional hospital databases. Laboratory results were obtained from electronic health records and stone characteristics were abstracted from diagnostic imaging reports. Our primary outcome was hospitalization or urological intervention from 0 to 60 days. Secondary outcomes included ED revisits, readmissions and rescue interventions. Time to event analysis was conducted and Cox Proportional Hazards modelling was performed to adjust for covariate imbalance.ResultsWe studied 3283 patients with CT-defined stones. Patient and stone characteristics were similar for the cities. Hospitalization or intervention occurred in 60.9% of Calgary patients and 31.3% of Vancouver patients (p<0.001). Calgary patients had higher index intervention rates (52.1% v. 7.5%), and experienced more ED revisits and hospital readmissions during follow-up. The data suggest that outcome events were associated with overtreatment of small stones in one city and undertreatment of large stones in the other.ConclusionsAn early interventional approach was associated with higher ED revisit, hospitalization and intervention rates. If these events are markers of patient disability, then a less interventional approach to small stones and earlier definitive management of large stones may reduce system utilization and improve outcomes for patients with acute ureteral colic.
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Chen, Daniel, Alex M. Torstrick, Robert Crupi, Joseph E. Schwartz, Ira Frankel, and Elizabeth Brondolo. "Reducing emergency department visits among older adults." Journal of Integrated Care 27, no. 1 (February 11, 2019): 37–49. http://dx.doi.org/10.1108/jica-02-2018-0011.
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Purpose There is mixed evidence regarding the efficacy of low-intensity integrated care interventions in reducing the use of emergency services and costs of care. The purpose of this paper is to examine the effects of a low-intensity intervention formulated for older adults and delivered in an urban medical center serving low-income individuals. Design/methodology/approach The intervention included an initial evaluation of stress, psychiatric symptomatology and health habits; potential referrals for lifestyle management and psychiatric treatment; and training for physicians about the impact of lifestyle change in older adults. Participants included older adults (at or above 50 years of age) seen as outpatients in an urban medical center serving a low-income community (n=945). Participants were entered into the intervention at any point during this two-year period. Mixed models analyses examined all visits for all enrolled individuals over a two-year period, comparing visits before the individual received the initial intervention evaluation to those received after this evaluation. Outcomes included total health care costs incurred, average cost per visit, and emergency department (ED) usage within the facility. Findings The intervention was associated with reduced likelihood of emergency department use and reduced costs per visit following the intervention. These effects were seen across all participants. Research limitations/implications Limitations of the study include the lack of control group. Practical implications This program is easy to disseminate and could improve the quality of care and costs. Originality/value This study is among the few available to document a decrease in medical costs, as well as decreased ED utilization following a low-intensity integrated care intervention.
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Najarian, Louis M. "Disaster Intervention: Long-term Psychosocial Benefits in Armenia." Prehospital and Disaster Medicine 19, no. 1 (March 2004): 79–85. http://dx.doi.org/10.1017/s1049023x00001515.
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AbstractThis paper describes a unique situation in which disaster intervention following a massive earthquake led to significant, uninterrupted, psychosocial benefits to the entire country, and an intervention program that continues to evolve. The mental health program initially provided service to the victims, and then, training to local professionals during which personnel simultaneously conducted clinical research. Members of the mental health team made a life-long commitment to the country, and continue their activities to expand its impact on public health policy. The difficult history and life circumstances of the Armenian people provided the opportunity for disaster interventions to have extensive psychosocial benefits.
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Sokullu, Onur, Numan Ali Aydemir, Erol Kurc, Batuhan Ozay, Fuat Bilgen, Murat Demirtas, and Serap Aykut Aka. "Emergency Management for Critical Left Main Coronary Artery Stenosis." Heart Surgery Forum 14, no. 1 (February 23, 2011): 12. http://dx.doi.org/10.1532/hsf98.20101057.
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Background: Increased experience and improvements in technology seem to have encouraged the use of percutaneous interventions for left main coronary artery (LMCA) occlusions. There is no consensus, however, and the data are inadequate on whether surgery or percutaneous procedures should be the intervention of choice for critical occlusions.Methods: From January 2002 to December 2006, 108 patients with unprotected LMCA stenosis >80% were treated at our center. Eighty-three patients (77%) underwent bypass grafting and 20 (18%) underwent percutaneous intervention for the purpose of myocardial revascularization. We analyzed parameters demonstrated as risk factors for myocardial revascularization and their predicted effects on outcome.Results: Five patients (5%) died following emergency cardiopulmonary resuscitation before any intervention was performed. The early survival rate was 84.1% in the coronary bypass group and 63% in the percutaneous intervention group. The mean (SD) survival time was 55.7 2.6 months in the bypass group and 7.6 1.3 months in the percutaneous group. The late-survival rate was also significantly higher in the bypass group. The mean late-survival time was 44.5 3.6 months in the bypass group and 2.3 0.8 months in the percutaneous group.Conclusion: Although emergency percutaneous interventions are lifesaving in some cases, these results clearly demonstrate that coronary bypass grafting should be the intervention of choice for myocardial revascularization in patients with critical LMCA occlusion.
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Barnaby, William. "Stroke Intervention." Emergency Medicine Clinics of North America 8, no. 2 (May 1990): 267–80. http://dx.doi.org/10.1016/s0733-8627(20)30280-7.
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Damsa, Cristian, Christopher Hummel, Vedat Sar, Thierry Di Clemente, Susanne Maris, Coralie Lazignac, Odile Massarczyk, and Charles Pull. "Economic impact of crisis intervention in emergency psychiatry: a naturalistic study." European Psychiatry 20, no. 8 (December 2005): 562–66. http://dx.doi.org/10.1016/j.eurpsy.2005.05.003.
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AbstractObjectiveThis is a naturalistic study comparing the outcomes of all emergency psychiatric interventions in the Hospital Center of Luxemburg during two periods of six months each, before and after the introduction of a crisis intervention program. The aim of the study was to investigate the clinical and economic impact of crisis intervention on psychiatric emergency admissions.MethodsAll subjects admitted to the emergency psychiatric unit during the two study periods were considered for participation. Data were collected retrospectively and comparisons were made between patients before (September 1, 2001 to February 28, 2002) and after (September 1, 2002 to February 28, 2003) crisis intervention programs were established.ResultsA comparison between the two patient groups demonstrated a significant decrease in the rate of voluntary hospitalizations after crisis intervention, and a significant increase in the number of patients with subsequent outpatient consultations. The cost increase due to ambulatory follow-ups was widely compensated for by the cost decrease due to hospitalization avoidance.ConclusionThese preliminary findings suggest that crisis intervention leads to a shift from hospitalization to outpatient psychotherapeutic management in emergency psychiatric services, which has a significant economic impact.
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Chhabra, Shawn, Debra Eagles, Edmund S. H. Kwok, and Jeffrey J. Perry. "Interventions to reduce emergency department door-to- electrocardiogram times: A systematic review." CJEM 21, no. 5 (May 15, 2019): 607–17. http://dx.doi.org/10.1017/cem.2019.342.
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ABSTRACTObjectivesWe sought to identify emergency department interventions that lead to improvement in door-to-electrocardiogram (ECG) times for adults presenting with symptoms suggestive of acute coronary syndrome.MethodsTwo reviewers searched Medline, Embase, CINAHL, and Cochrane CENTRAL from inception to April 2018 for studies in adult emergency departments with an identifiable intervention to reduce median door-to-ECG times when compared with the institution's baseline. Quality was assessed using the Quality Improvement Minimum Quality Criteria Set critical appraisal tool. The primary outcome was the absolute median reduction in door-to-ECG times as calculated by the difference between the post-intervention time and pre-intervention time.ResultsTwo reviewers identified 809 unique articles, yielding 11 before-after quality improvement studies that met eligibility criteria (N = 15,622 patients). The majority of studies (10/11) reported bundled interventions, and most (10/11) showed statistical improvement in door-to-ECG times. The most common interventions were having a dedicated ECG machine and technician in triage (5/11); improved triage education (4/11); improved triage disposition (2/11); and data feedback mechanisms (2/11).ConclusionsThere are multiple interventions that show potential for reducing emergency department door-to-ECG times. Effective bundled interventions include having a dedicated ECG technician, triage education, and better triage disposition. These changes can help institutions attain best practice guidelines. Emergency departments must first understand their local context before adopting any single or group of interventions.
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Hughes, Cathy. "Health Intervention Research Sidani Souraya Health Intervention Research264pp £26.99 Sage 9781446256176 1446256170." Emergency Nurse 23, no. 9 (February 8, 2016): 10. http://dx.doi.org/10.7748/en.23.9.10.s11.
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Kirubarajan, A., A. Taher, S. Khan, and S. Masood. "P071: Artificial intelligence in emergency medicine: A scoping review." CJEM 22, S1 (May 2020): S90. http://dx.doi.org/10.1017/cem.2020.277.
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Introduction: The study of artificial intelligence (AI) in medicine has become increasingly popular over the last decade. The emergency department (ED) is uniquely situated to benefit from AI due to its power of diagnostic prediction, and its ability to continuously improve with time. However, there is a lack of understanding of the breadth and scope of AI applications in emergency medicine, and evidence supporting its use. Methods: Our scoping review was completed according to PRISMA-ScR guidelines and was published a priori on Open Science Forum. We systematically searched databases (Medline-OVID, EMBASE, CINAHL, and IEEE) for AI interventions relevant to the ED. Study selection and data extraction was performed independently by two investigators. We categorized studies based on type of AI model used, location of intervention, clinical focus, intervention sub-type, and type of comparator. Results: Of the 1483 original database citations, a total of 181 studies were included in the scoping review. Inter-rater reliability for study screening for titles and abstracts was 89.1%, and for full-text review was 77.8%. Overall, we found that 44 (24.3%) studies utilized supervised learning, 63 (34.8%) studies evaluated unsupervised learning, and 13 (7.2%) studies utilized natural language processing. 17 (9.4%) studies were conducted in the pre-hospital environment, with the remainder occurring either in the ED or the trauma bay. The majority of interventions centered around prediction (n = 73, 40.3%). 48 studies (25.5%) analyzed AI interventions for diagnosis. 23 (12.7%) interventions focused on diagnostic imaging. 89 (49.2%) studies did not have a comparator to their AI intervention. 63 (34.8%) studies used statistical models as a comparator, 19 (10.5%) of which were clinical decision making tools. 15 (8.3%) studies used humans as comparators, with 12 of the 15 (80%) studies showing superiority in favour of the AI intervention when compared to a human. Conclusion: AI-related research is rapidly increasing in emergency medicine. AI interventions are heterogeneous in both purpose and design, but primarily focus on predictive modeling. Most studies do not involve a human comparator and lack information on patient-oriented outcomes. While some studies show promising results for AI-based interventions, there remains uncertainty regarding their superiority over standard practice, and further research is needed prior to clinical implementation.
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Louie, Jeffrey Paul, Joseph Alfano, Thuy Nguyen-Tran, Hai Nguyen-Tran, Ryan Shanley, Tara Holm, and Ronald A. Furnival. "Reduction of paediatric head CT utilisation at a rural general hospital emergency department." BMJ Quality & Safety 29, no. 11 (February 28, 2020): 912–20. http://dx.doi.org/10.1136/bmjqs-2019-010322.
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BackgroundBlunt head injury is a common pediatric injury and often evaluated in general emergency departments. It estimated that 50% of children will undergo a head computed tomography (CT), often unnecessarily exposing the child to ionizing radiation. Pediatric academic centers have shown quality improvement (QI) measures can reduce head CT rates within their emergency departments. We aimed to reduce head CT utilization at a rural community emergency department.MethodsChildren presenting with a complaint of blunt head injury and were evaluated with or without a head CT. Head CT rate was the primary outcome. We developed a series of interventions and presented these to the general emergency department over the duration of the study. The pre and intervention data was analysed with control charts.ResultsThe preintervention and intervention groups consisted of 576 children: 237 patients with a median age of 8.0 years and 339 patients with a median age of 9.00 years (p=0.54), respectively. The preintervention HCT rate was 41.8% (95% CI 35.6% to 48.1%) and the postintervention rate was 27.7% (95% CI 23.3% to 32.7%), a decrease of 14.1% (95% CI 6.2% to 21.9%, p=0.0004). During the intervention period, there was a decrease in HCT rate of one per month (OR 0.96, 95% CI 0.92 to 1.00, p=0.07). The initial series of interventions demonstrated an incremental decrease in HCT rates corresponding with a special cause variation.ConclusionThe series of interventions dispersed over the intervention period was an effective methodology and successfully reduced HCT utilisation among children with blunt head injury at a rural community emergency department.
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Farchi, M. U. "(A65) Stress & Trauma Studies Program (STSP): Theoretical & Practical Emergency Mental Health Interventions Studies for BA Social Work Students." Prehospital and Disaster Medicine 26, S1 (May 2011): s18. http://dx.doi.org/10.1017/s1049023x11000720.
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The Tel Hai college Department of Social Work established this program as part of its community commitment to ensure that persons with skills in emergency mental health / trauma intervention will be available to the community as first responders when needed. The main goal of the STSP: Training Social work students As First Responders with Very High Professional Standards of Emergency as well as Long Term Mental Health Interventions Qualifications. This program enables the students to integrate between theory and hands-on basic and advanced skills in stress & trauma interventions – from the help to a single traumatized person to mass disasters involving more complex interventions. In addition, program underlines and empowers the students self efficacy and resilience. The studies are carried out in 4 main channels: A. Academic studies and advanced professional workshops. B. Outdoor drills with other help and rescue units: MDA (EMS), IDF, Police, Israel fire and rescue services, local and national rescue units) C. Volunteering in community trauma / first responder units D. Emergency mental health interventions during real time events (Last one: Emergency interventions among the evacuated families during the mount Carmel bushfire) Student's Skills Acquired During the STSP • Theoretical & practical knowledge of the stress & trauma development process. • Differentional diagnosis of the trauma stages (From ASR to C-PTSD). • Identifying all sources of resilience and coping strategies. • Basic & advanced crisis and disaster intervention methods. • Crisis & disaster management & command • Professional self confidence, Independency & Creativity, leadership and leading capabilities. The program, its benefits and latest drills and real time intervention will be discussed as well as demonstrated with videos.
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Chhabra, S., D. Eagles, E. Kwok, and J. Perry. "P021: Interventions to reduce emergency department door-to-ECG times: a systematic review." CJEM 21, S1 (May 2019): S70. http://dx.doi.org/10.1017/cem.2019.212.
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Introduction: We wished to identify emergency department interventions that lead to improvement in door-to-ECG times for adults presenting with symptoms suggestive of acute coronary syndrome (ACS). Methods: Two reviewers searched Medline, Embase, CINAHL and Cochrane CENTRAL from inception to April 2018 for studies in adult emergency departments with an identifiable intervention to reduce median door-to-ECG times when compared to the institution's baseline. Quality was assessed using the ‘Quality Improvement Minimum Quality Criteria Set’ (QI-MQCS) critical appraisal tool. The primary outcome was the absolute median reduction in door-to-ECG times as calculated by the difference between the post-intervention time and pre-intervention time. Results: Two reviewers identified 809 unique articles, yielding 11 before-after quality improvement studies that met eligibility criteria (N = 15,622 patients). The majority of studies (10/11) reported bundled interventions and most (10/11) showed statistical improvement in door-to-ECG times. The most common interventions were: having a dedicated ECG machine and technician in triage (5/11); improved triage education (4/11); improved triage disposition (2/11); and data feedback mechanisms (1/11). Conclusion: There are multiple interventions that show promise for reducing emergency department door-to-ECG times. Effective bundled interventions include having a dedicated ECG technician, triage education and better triage disposition. These changes, bundled together, can help intuitions attain best practice guidelines. Emergency departments must first understand their local context before adopting any single or group of interventions.
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Claudius, Ilene, and Chun Nok Lam. "Level of Acuity in Pediatric Patients with Recurrent Emergency Department Visits." Journal of Hospital Administration 1, no. 2 (August 29, 2012): 1. http://dx.doi.org/10.5430/jha.v1n2p1.
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Introduction: Recurrent ED utilizers account for a substantial proportion of ED visits, yet little data exists on children with multiple visits. The objective of this study was to compare the need for interventions and triage acuity of recurrent utilizers of a pediatric emergency department to that of non-recurrent utilizers. Methods: This is a retrospective analysis of children presenting to a pediatric emergency department. Children were classified as recurrent utilizers if they had 4 or more visits to the ED per year and non-recurrent utilizers if they had less than 4 visits. Data was collected and inter-group comparison performed on critical interventions received (admission, consultation, intravenous fluid therapy, observation, and performance of procedures), all interventions received (including critical interventions as well as laboratories, radiographs, and medications), and triage acuity for the index visit. Results: Two-hundred thirty patients were included, of whom, 15% were classified as recurrent utilizers. This group had significantly lower rates of requiring a critical intervention (8.6% vs. 51.4%, p=.001), lower rates of any intervention (51.4% vs. 74.4%, p=.007), and less urgent triage acuity (3.3 vs. 3.1, p=.029). Conclusions: Recurrent utilizers of the pediatric emergency department had significantly lower need for intervention and less urgent mean triage acuity when compared with non-recurrent utilizers.
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Peng, Leong Shian, Azhana Hassan, Aida Bustam, Muhaimin Noor Azhar, and Rashidi Ahmad. "Using modified early warning score to predict need of lifesaving intervention in adult non-trauma patients in a tertiary state hospital." Hong Kong Journal of Emergency Medicine 25, no. 3 (February 2, 2018): 146–51. http://dx.doi.org/10.1177/1024907917751980.
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Background: Modified early warning score has been validated in many uses in the emergency department. We propose that the modified early warning score performs well in predicting the need of lifesaving interventions in the emergency department, as a predictor of patients who are critically ill. Objective: The study aims to evaluate the use of modified early warning score in sorting out critically ill patients in the emergency department. Methods: The patients’ demographic data and first vital signs (blood pressure, heart rate, temperature, respiratory rate, and level of consciousness) were collected prospectively. Individual modified early warning score was calculated. The outcome was a patient received one or more lifesaving interventions toward the end of stay in emergency department. Multivariate logistic regression analysis was utilized to assess the association between modified early warning score and other potential predictors with outcome. Results: There are a total of 259 patients enrolled into the study. The optimal modified early warning score in predicting lifesaving intervention was ≥4 with a sensitivity of 95% and specificity of 81%. Modified early warning score ≥4 (odds ratio = 96.97, 95% confidence interval = 11.82–795.23, p < 0.001) was found to significantly increase the risk of receiving lifesaving intervention in the emergency department. Conclusion: Modified early warning score is found to be a good predictor for patients in need of lifesaving intervention in the emergency department.
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Schwarz, Konstantin, Tahir Ahmad, Anthony J. Scriven, and Helen C. Routledge. "Emergency visits after recent percutaneous coronary intervention." Clinical Medicine 11, no. 3 (June 2011): 301.2–302. http://dx.doi.org/10.7861/clinmedicine.11-3-301a.
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Hyden, Philip W., and Tracy A. Gallagher. "Child Abuse Intervention in the Emergency Room." Pediatric Clinics of North America 39, no. 5 (October 1992): 1053–81. http://dx.doi.org/10.1016/s0031-3955(16)38407-3.
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Luckock, Barry. "Protecting Powers: Emergency Intervention for Children's Protection." Child & Family Social Work 12, no. 4 (November 2007): 442–43. http://dx.doi.org/10.1111/j.1365-2206.2007.00522.x.
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Kyranis, S., R. Markham, N. Aroney, M. Webber, M. Savage, W. Lee, M. Whitby, D. Walters, and J. Crowhurst. "Radiation Exposure in Emergency Percutaneous Coronary Intervention." Heart, Lung and Circulation 27 (2018): S473. http://dx.doi.org/10.1016/j.hlc.2018.06.976.
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Farchi, M. U., and E. Shahar. "(A67) Empowerment Model for Community Disaster (EMCD)." Prehospital and Disaster Medicine 26, S1 (May 2011): s18—s19. http://dx.doi.org/10.1017/s1049023x11000744.
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The earthquake in Haiti and its consequences highlighted the need to enhance knowledge and skills for community intervention in situations of disaster and acute trauma. The large number of homeless people concentrated in enormous refugee camps has made such an investigation possible. In the lecture, we will present a model for empowerment intervention with victims of community disasters. The model is based on analyses of three cases in which psychosocial interventions were conducted by the investigators: the Tsunami in Sri Lanka, work at refugee camps in Georgia, and the earthquake in Haiti. Principles of the Model The more extensive the casualties are, the less relevant individual intervention will be. Entering an unfamiliar culture requires collaborative professional work with local residents. Intervention in a large-scale disaster needs to be based on an interdisciplinary perspective in terms of planning, preparation, and implementation. It is assumed that the intervention will be short-term, and a specific length of time is allocated for therapeutic agents to provide assistance. This approach was adopted in light of the limited resources at our disposal, and in an attempt to minimize dependence in the relationships between the therapeutic agents and the victims. An attempt is made to enhance efficacy for effective coping with changing needs that emerge in the wake of the disaster. An attempt is made to prevent CPTSD, which can inhibit the functioning of the community residents. We will present these principles and describe how they were implemented in community intervention at two refugee camps in Haiti following the earthquake there, and at a refugee camp in Georgia.
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Saku, S. A., R. Linko, and R. Madanat. "Outcomes of Triggering the Emergency Response Team at a High-Volume Arthroplasty Center." Scandinavian Journal of Surgery 109, no. 4 (June 19, 2019): 336–42. http://dx.doi.org/10.1177/1457496919857263.
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Background and Aims: Emergency Response Teams have been employed by hospitals to evaluate and manage patients whose condition is rapidly deteriorating. In this study, we aimed to assess the outcomes of triggering the Emergency Response Teams at a high-volume arthroplasty center, determine which factors trigger the Emergency Response Teams, and investigate the main reasons for an unplanned intensive care unit admission following Emergency Response Team intervention. Material and Methods: We gathered data by evaluating all Emergency Response Team forms filled out during a 4-year period (2014–2017), and by assessing the medical records. The collected data included age, gender, time of and reason for the Emergency Response Teams call, and interventions performed during the Emergency Response Teams intervention. The results are reported as percentages, mean ± standard deviation, or median (interquartile range), where appropriate. All patients were monitored for 30 days to identify possible intensive care unit admissions, surgeries, and death. Results: The mean patient age was 72 (46–92) years and 40 patients (62%) were female. The Emergency Response Teams was triggered a total of 65 times (61 patients). The most common Emergency Response Team call criteria were low oxygen saturation, loss or reduction of consciousness, and hypotension. Following the Emergency Response Team call, 36 patients (55%) could be treated in the ward, and 29 patients (45%) were transferred to the intensive care unit. The emergency that triggered the Emergency Response Teams was most commonly caused by drug-related side effects (12%), pneumonia (8%), pulmonary embolism (8%), and sepsis (6%). Seven patients (11%) died during the first 30 days after the Emergency Response Teams call. Conclusion: Although all 65 patients met the Emergency Response Teams call criteria, potentially having severe emergencies, half of the patients could be treated in the arthroplasty ward. Emergency Response Team intervention appears useful in addressing concerns that can potentially lead to unplanned intensive care unit admission, and the Emergency Response Teams trigger threshold seems appropriate as only 3% of the Emergency Response Teams calls required no intervention.
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Greene, M. Todd, Mohamad G. Fakih, Sam R. Watson, David Ratz, and Sanjay Saint. "Reducing Inappropriate Urinary Catheter Use in the Emergency Department: Comparing Two Collaborative Structures." Infection Control & Hospital Epidemiology 39, no. 1 (December 18, 2017): 77–84. http://dx.doi.org/10.1017/ice.2017.256.
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BACKGROUNDUrinary catheters, many of which are placed in the emergency department (ED) setting, are often inappropriate, and they are associated with infectious and noninfectious complications. Although several studies evaluating the effect of interventions have focused on reducing catheter use in the ED setting, the organizational contexts within which these interventions were implemented have not been compared.METHODSA total of 18 hospitals in the Ascension health system (ie, system-based hospitals) and 16 hospitals in the state of Michigan (ie, state-based hospitals led by the Michigan Health and Hospital Association) implemented ED interventions focused on reducing urinary catheter use. Data on urinary catheter placement in the ED, indications for catheter use, and presence of physician order for catheter placement were collected for interventions in both hospital types. Multilevel negative binomial regression was used to compare the system-based versus state-based interventions.RESULTSA total of 13,215 patients (889 with catheters) from the system-based intervention were compared to 12,104 patients (718 with catheters) from the state-based intervention. Statistically significant and sustainable reductions in urinary catheter placement (incidence rate ratio, 0.79;P=.02) and improvements in appropriate use of urinary catheters (odds ratio [OR], 1.86;P=.004) in the ED were observed in the system-based intervention, compared to the state-based intervention. Differences by collaborative structure in changes in presence of physician order for urinary catheter placement (OR, 1.14;P=.60) were not observed.CONCLUSIONSAn ED intervention consisting of establishing institutional guidelines for appropriate catheter placement and identifying clinical champions to promote adherence was associated with reducing unnecessary urinary catheter use under a system-based collaborative structure.Infect Control Hosp Epidemiol2018;39:77–84
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Holt, Lynda. "Prompt intervention reduces hospital deaths." Emergency Nurse 10, no. 1 (April 2002): 6. http://dx.doi.org/10.7748/en.10.1.6.s13.
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Somes, Joan, and Deborah L. Bergman. "ABCDs of Acute Stroke Intervention." Journal of Emergency Nursing 33, no. 3 (June 2007): 228–34. http://dx.doi.org/10.1016/j.jen.2006.12.010.
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de Wit, Kerstin, Janet Curran, Brent Thoma, Shawn Dowling, Eddy Lang, Nebojsa Kuljic, Jeffrey J. Perry, and Laurie Morrison. "Review of implementation strategies to change healthcare provider behaviour in the emergency department." CJEM 20, no. 3 (February 12, 2018): 453–60. http://dx.doi.org/10.1017/cem.2017.432.
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AbstractObjectivesAdvances in emergency medicine research can be slow to make their way into clinical care, and implementing a new evidence-based intervention can be challenging in the emergency department. The Canadian Association of Emergency Physicians (CAEP) Knowledge Translation Symposium working group set out to produce recommendations for best practice in the implementation of a new science in Canadian emergency departments.MethodsA systematic review of implementation strategies to change health care provider behaviour in the emergency department was conducted simultaneously with a national survey of emergency physician experience. We summarized our findings into a list of draft recommendations that were presented at the national CAEP Conference 2017 and further refined based on feedback through social media strategies.ResultsWe produced 10 recommendations for implementing new evidence-based interventions in the emergency department, which cover identifying a practice gap, evaluating the evidence, planning the intervention strategy, monitoring, providing feedback during implementation, and desired qualities of future implementation research.ConclusionsWe present recommendations to guide future emergency department implementation initiatives. There is a need for robust and well-designed implementation research to guide future emergency department implementation initiatives.
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Mollen, Cynthia J., Frances K. Barg, Katie L. Hayes, Marah Gotcsik, Nakeisha M. Blades, and Donald F. Schwarz. "Adolescent Input for Designing an Emergency Department-Based Intervention About Emergency Contraception." Pediatric Emergency Care 25, no. 10 (October 2009): 625–28. http://dx.doi.org/10.1097/pec.0b013e3181b92009.
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Linzey, Joseph R., Craig Williamson, Venkatakrishna Rajajee, Kyle Sheehan, B. Gregory Thompson, and Aditya S. Pandey. "Twenty-four–hour emergency intervention versus early intervention in aneurysmal subarachnoid hemorrhage." Journal of Neurosurgery 128, no. 5 (May 2018): 1297–303. http://dx.doi.org/10.3171/2017.2.jns163017.
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OBJECTIVERecent observational data suggest that ultra-early treatment of ruptured aneurysms prevents rebleeding, thus improving clinical outcomes. However, advances in critical care management of patients with ruptured aneurysms may reduce the rate of rebleeding in comparison with earlier trials, such as the International Cooperative Study on the Timing of Aneurysm Surgery. The objective of the present study was to determine if an ultra-early aneurysm repair protocol will or will not significantly reduce the number of incidents of rebleeding following aneurysmal subarachnoid hemorrhage (SAH).METHODSA retrospective analysis of data from a prospectively collected cohort of patients with SAH was performed. Rebleeding was diagnosed as new or expanded hemorrhage on CT, which was determined by independent review conducted by multiple physicians. Preventability of rebleeding by ultra-early aneurysm clipping or coiling was also independently reviewed. Standard statistics were used to determine statistically significant differences between the demographic characteristics of those with rebleeding compared with those without.RESULTSOf 317 patients with aneurysmal SAH, 24 (7.6%, 95% CI 4.7–10.5) experienced rebleeding at any time point following initial aneurysm rupture. Only 1/24 (4.2%, 95% CI −3.8 to 12.2) incidents of rebleeding could have been prevented by a 24-hour ultra-early aneurysm repair protocol. The other 23 incidents could not have been prevented for the following reasons: rebleeding prior to admission to the authors’ institution (14/23, 60.9%); initial diagnostic angiography negative for aneurysm (4/23, 17.4%); postoperative rebleeding (2/23, 8.7%); patient unable to undergo operation due to medical instability (2/23, 8.7%); intraoperative rebleeding (1/23, 4.3%).CONCLUSIONSAt a single tertiary academic center, the overall rebleeding rate was 7.6% (95% CI 4.7–10.5) for those presenting with ruptured aneurysms. Implementation of a 24-hour ultra-early aneurysm repair protocol would only result in, at most, a 0.3% (95% CI −0.3 to 0.9) reduction in the incidence of rebleeding.
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Olszynski, Paul A., Tim Harris, Patrick Renihan, Marcel D’Eon, and Kalyani Premkumar. "Ultrasound during Critical Care Simulation: A Randomized Crossover Study." CJEM 18, no. 3 (August 26, 2015): 183–90. http://dx.doi.org/10.1017/cem.2015.87.
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AbstractObjectivesWe sought to compare two ultrasound simulation interventions used during critical care simulation. The primary outcome was trainee and instructor preference for either intervention. Secondary outcomes included the identification of strengths and weaknesses of each intervention as well as overall merits of ultrasound simulation during high-fidelity, critical care simulation. The populations of interest included emergency medicine trainees and physicians.MethodsThis was a randomized crossover study with two ultrasound simulation interventions. 25 trainees and eight emergency physician instructors participated in critical-care simulation sessions. Instructors were involved in session debriefing and feedback. Pre- and post-intervention responses were analyzed for statistically significant differences usingttest analyses. Qualitative data underwent thematic analysis and triangulation.ResultsBoth trainees and instructors deemed ultrasound simulation valuable by allowing trainees to demonstrate knowledge of indications, correct image interpretation, and clinical integration (p<0.05). Trainees described increased motivation to develop and use ultrasound skills. The edus2 was the preferred intervention, as it enabled functional fidelity and the integration of ultrasound into resuscitation choreography. Instructors preferred the edus2, as it facilitated better assessment of trainees’ skills, thus influencing feedback.ConclusionsThese findings support the use of ultrasound simulation during critical care simulations. The increased functional fidelity associated with edus2 suggests that it is the preferred intervention. Further study of the impact on clinical performance is warranted.