Taming the SRU

MARCH 12, 2024

The SQuID protocol (subcutaneous insulin in diabetic ketoacidosis): Impacts on ED operational metrics. ED visits per 1000 adults with diabetes based on 2018 data resulting in over 500,000 annual hospital days. This amounts to annual hospital costs of $5.1 Secondary outcomes included fidelity to and safety of the intervention.

Operations 96

Operations Hospitals Best Practices Wellness 96

American Medical Compliance

JUNE 12, 2024

These goals provide a framework for hospitals to identify and mitigate risks, ensuring that patients receive the safest care possible. This course equips hospital staff to enhance safety protocols, reduce errors, and improve patient outcomes. Ensuring patient safety is a cornerstone of high-quality healthcare.

Patient Safety 52

Patient Safety Hospitals Best Practices Outcomes 52

RebelEM

MAY 27, 2024

The primary outcomes are patient-centered and objectively measured, potentially ensuring relevance and reliability. The unblinded nature of the study could influence outcomes due to observer bias. Employing P-values to compare demographics between groups could mislead interpretations of the data’s relevance to the primary outcomes.

Outcomes 135

Outcomes Research Hospitals Operations 135

The Trauma Pro

OCTOBER 25, 2024

To sum up, both are equally effective in controlling hemorrhage, but the hospital costs for patients undergoing angioembolization are significantly less. This is probably because there is no need to perform repeated operations to insert and remove the preperitoneal packs when angiography is used.

Fractures 113

Fractures Head Injuries Operations Ultrasounds 113

The Trauma Pro

OCTOBER 4, 2024

Clinical outcomes assessed at 60 days included an unplanned return to the emergency department (ED), re-admission, complications, and development of new bleeding confirmed by surgery, ultrasound, or computed tomography (CT) at 60 days post-injury. Adherence to guidelines was assessed by a follow-up phone call two months after injury.

Pediatrics 113

Pediatrics Outcomes Operations Emergency Department 113

RebelEM

NOVEMBER 20, 2023

Comparator: The control group received standard care provided at a major trauma center, including intubation, blood product transfusion, interventions like tourniquet application, and early operative or endovascular hemorrhage control. Outcome: Primary Outcome: All-cause mortality at 90 days.

Resuscitation 91

Resuscitation Operations Outcomes Hospitals 91

EMDocs

SEPTEMBER 4, 2024

Disparities are measured differences in outcomes for people of different backgrounds. Literature shows disparity across the different outcomes, including wait times, triage levels and delivery of pain medications. Dr. Migita noted differences in admission rates for asthma and bronchiolitis based on race. Discuss as often as possible.

Pediatrics 81

Pediatrics Outcomes Operations Hospitals 81

The Skeptics' Guide to EM

MARCH 2, 2024

He is the Vice Chair of the Emergency Department at Nassau University Medical Center in East Meadow, NY, the safety net hospital for Nassau County. Arrangements are made for him to be transferred stat to the tertiary hospital while he is still stable. It is described as a ripping sensation that radiates to his back.

Emergency Department 119

Emergency Department Stroke Operations Hospitals 119

Emergency Medicine Journal

NOVEMBER 28, 2023

Background The regional emergency medical service (EMS) in Lombardy (Italy) developed clinical algorithms based on operator-based interviews to detect patients with COVID-19 and refer them to the most appropriate hospitals. Results The training set includes 264 976 patients, median age 74 (IQR 55–84).

Operations 52

Operations EMS Hospitals Outcomes 52

Don't Forget the Bubbles

NOVEMBER 29, 2023

A retrospective cohort analysis of the ED portion of the National Hospital Ambulatory Medical Care Survey from 2006 to 2009 in the US revealed that less than one-half of patients undergoing ETI in the ED received sedative drugs while in the ED. When there is an immediate threat to life (e.g., What are the potential physiological sequelae?

Airway Management 135

Airway Management Emergency Department Resuscitation Psychiatric 135

RebelEM

JUNE 19, 2023

PMID: 37314244 Clinical Question: In advanced trauma systems, does prehospital administration of TXA increase the rate of survival with a favorable neurologic outcome in patients at risk for trauma-induced coagulopathy? Primary Results Patients enrolled from 15 emergency medical services at 21 hospitals across 3 countries over 7 years.

Outcomes 105

Outcomes Blood Transfusions Administration Hyperthermia / Hypothermia 105

ACEP Now

JULY 7, 2023

Out-of-hospital cardiac arrest is a commonly encountered entity in U.S. emergency departments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. Out-of-hospital cardiac arrest is a commonly encountered entity in U.S.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

Don't Forget the Bubbles

DECEMBER 31, 2024

The skills needed to deliver the best possible outcomes for children and young people are multifaceted and constantly evolving. Reading Body language in tense meetings, phraseology when making referrals, and quick corridor conversations when hospital capacity is at a premium may all result in improved outcomes but are rarely intentional.

Leadership 140

Leadership Emergency Department Outcomes Operations 140

Emergency Medicine Journal

JULY 22, 2024

Methods Adult patients transported to a single ED by ambulances and subsequently admitted to the hospital between 1 January 2019 and 18 April 2019 were eligible for inclusion. The discriminative ability of the EWS scores was assessed using the area under the receiver operating characteristic curve (AUROC). male, mean age 68.7±17.5

Ambulance Services 52

Ambulance Services Hospitals Operations Emergency Department 52

The Skeptics' Guide to EM

DECEMBER 14, 2024

Clinical Question: How accurately can a new clinical decision rule (The Phoenix Sepsis Score) diagnose pediatric sepsis and septic shock in hospitalized children within the first 24 hours? Population: Children less than 18 years of age with suspected sepsis and septic shock who were admitted to one of ten hospitals in five countries.

Sepsis 81

Sepsis Pediatrics Shock Hospitals 81

PulmCCM

OCTOBER 16, 2024

Animal studies have suggested that the body could be prepped or trained to better withstand ischemic-reperfusion injury, by inducing mild ischemia in another tissue bed before the operation. This is a remarkable example of the differences between societies, which might influence the processes of clinical trials and their outcomes.

Outcomes 52

Outcomes Operations Research Hospitals 52

Don't Forget the Bubbles

JUNE 26, 2023

Whilst waiting for an operation, they need to be managed medically. Staged reconstructions are a topic in itself (click here for a nice summary by Children’s Hospital of Philadelphia), but here we focus on Stage 1. Six hours post-operatively, they become more mottled, with weak pulses – signs of poor systemic perfusion.

Operations 128

Operations Research Hyperthermia / Hypothermia Hospitals 128

RebelEM

AUGUST 12, 2024

What They Did: Double-blind, randomized, placebo controlled trial that ran from October 2019 through January 2024 Multinational study conducted at 22 centers in three European countries 3512 patients were enrolled and before surgery eligible patients were randomly assigned to one of the following two groups Amino Acid Group: 10% Isopuramin at a dose (..)

Outcomes 81

Outcomes Hospitals Operations Shock 81

RebelEM

APRIL 17, 2023

While operator dependent, the dynamic ability of POCUS augments bedside diagnosis and can assist with drainage. Additionally, potential increases in resource utilization, healthcare expense, and ED length of stay are also essential considerations. Ultrasound has become an extended part of our physical exam.

Ultrasounds 130

Ultrasounds Radiology Radiology Operations 130

Don't Forget the Bubbles

JUNE 30, 2023

The primary outcome measure was chest drain failure, i.e., retained haemothorax requiring a secondary interventional procedure. They stratified patients according to the ratio of FFP: PRBC received (1:1, 1:2, 1:3 and 1:3+) and performed logistic regression analyses for various outcomes. These procedures require an experienced operator.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

Taming the SRU

SEPTEMBER 25, 2023

Specifically, EM physicians should be able to recognize fractures that will likely require operative management and facilitate close follow up, such as a Maisonneuve fracture. Disruption of these structures yields an unstable ankle fracture, thus making close follow up for operative management imperative. screws for medial malleolus.

Fractures 100

Fractures Operations Emergency Department EMS 100

ACEP Now

SEPTEMBER 3, 2024

Hahnemann University Hospital in Philadelphia closed in 2019, a year and a half after it was acquired along with St. Christopher’s Hospital for Children by private equity (PE) firm Paladin Healthcare Capital for 170 million dollars. Christopher’s was able to find a buyer prior to bankruptcy but Hahnemann could not.

Hospitals 113

Hospitals Radiology Radiology Administration 113

ACEP Now

JUNE 21, 2023

The lack of differences in the observed outcomes do not suggest one EM training length is superior. The additional year may improve career trajectory or longevity, entrance into fellowship or academic practice, or other longer-term outcomes including successful development of a niche in the specialty. 11 What should we take away?

EMS 114

EMS Academics Telemedicine Operations 114

RebelEM

AUGUST 22, 2024

hours of symptom onset appears to be the most promising approach for improving visual outcomes, supported by multiple studies and meta-analyses. Moreover, there are multiple operational and patient-specific barriers rendering timely thrombolytic administration difficult. Paper: Lema GMC, De Leacy R, Fara MG, et al.

Stroke 85

Stroke Administration Outcomes Documentation/Coding 85

RebelEM

NOVEMBER 25, 2024

Included patients from out-of-hospital, emergency department, intensive care unit, and operating-room intubations. Intubation performed in all settings (out-of-hospital, emergency department, ICU, and operating room). Secondary Outcomes: First-attempt success without clinically important complications (e.g.,

Outcomes 77

Outcomes Emergency Department Operations Hospitals 77

Emergency Medicine Journal

MAY 23, 2023

We validated the score in a large patient data set and constructed a model that allows early prediction of the probability of clinical outcomes based on the individual’s NEWS+L Score. The outcomes were hospital death or a composite of hospital death and intensive care unit admission at 24 hours, 48 hours and 72 hours.

Outcomes 40

Outcomes Emergency Department Academics Operations 40

RebelEM

APRIL 29, 2024

Many clinicians don’t consider IO placement while others consider it a last resort or only a pre-hospital procedure. Intravenous vs.intraosseous vascular access during out-of-hospital cardiac arrest – protocol for a randomized clinical trial. PMID: 33350794 10 Meilandt C. Resusc Plus. 2023 PMID: 37502742 11 Schwalbach KT et al.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

Taming the SRU

NOVEMBER 3, 2023

The primary outcome in this study was a change in pain score at rest 60 minutes after block. Secondary outcomes were changes in pain scores at rest at 15 minutes, during incentive spirometry at both time points and then change in maximum vital capacity. Mean and median pain score at rest prior to SAPB were 5.4 (SD SD 3.28) and 6.5,

Fractures 97

Fractures Ultrasounds Outcomes Research 97

Don't Forget the Bubbles

JUNE 19, 2024

Children in the validation cohort were admitted to the intensive care unit or operating room less frequently than those in the derivation cohort. This may limit the generalisability of the results in regional/community hospital settings. Were the predictor variables and the outcome evaluated in a blinded fashion?

CPR 124

CPR Research Outcomes Documentation/Coding 124

Don't Forget the Bubbles

OCTOBER 10, 2024

This time the team from Bristol Royal Children’s Hospital ED tell us what is new in the world of paediatric literature… Led by Dr John Coveney a Paediatric Emergency Medicine Trainee in Bristol who has revived The Journal Club at Bristol Royal Children’s Hospital ED on a monthly basis. 2023 Mar 30;110(4):432-438.

Emergency Department 75

Emergency Department Outcomes Research Operations 75

PulmCCM

JUNE 5, 2023

veterans’ hospitals did not show a mortality reduction from low-dose methylprednisolone. Patients receiving hydrocortisone required more insulin, but did not have higher observed rates of hospital-acquired infections or gastrointestinal bleeding. iatrogenic or hospital-acquired) were excluded. In the U.S.,

Advances Cardiac Life Support (ACLS) 96

Advances Cardiac Life Support (ACLS) Documentation/Coding CPR Shock 96

RebelEM

AUGUST 7, 2023

What They Did: Prospective randomized clinical trial Patients randomized to: Delayed Sequence Intubation (DSI): IV ketamine 1.5mg/kg in 0.5 What They Did: Prospective randomized clinical trial Patients randomized to: Delayed Sequence Intubation (DSI): IV ketamine 1.5mg/kg in 0.5

Head Injuries 97

Head Injuries Airway Management Outcomes Burns 97

RebelEM

JUNE 8, 2023

Assessed clinical practice, outcome, length of stay, safety, and efficacy of both phenylephrine and epinephrine peripherally administered through a push dose.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

Taming the SRU

MARCH 11, 2024

Reducing the total ischemic time in patients with vascular injury is the single most important variable in improving outcomes and reducing the risk of amputation; an ischemic time of >8 hours is associated with amputation rates of up to 85%, compared with <20% in those with ischemic time of <8 hours (2).

Dislocations 107

Dislocations Emergency Department Fractures Operations 107

Taming the SRU

MAY 11, 2024

Guidelines also support not administering HTS in the pre-hospital setting, yet the available data is weak. Usually presents consistent with failure of that organ. For mid-shaft femur fractures, traction appears to may reduce blood loss and pulmonary complications, but the available data is very scarce. What do we do at UC?

Administration 91

Administration Resuscitation Fluid Resuscitation Research 91

Don't Forget the Bubbles

JANUARY 1, 2024

The Bubble Wrap Plus is a monthly paediatric Journal Club reading list from Professor Jaan Toelen (University Hospitals Leuven) and Dr Anke Raaijmakers (Sydney Children’s Hospital). However, children who had an operation experienced improvements in behaviour, symptoms, and quality of life and had lower blood pressure.

Pediatrics 98

Pediatrics Ultrasounds Blood Transfusions Sepsis 98

ACEP Now

JULY 7, 2024

Traumatic aortic injury (TAI) is the second most common cause of mortality in non-penetrating traumatic injury; nearly 80 percent of cases die before hospitalization, and, of those who are hospitalized, mortality remains greater than 45 percent, with untreated mortality increasing one percent per hour. Click to enlarge.)

Operations 59

Operations Hospitals Administration Outcomes 59