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Objective: Pediatric patients with asthma are frequently cared for in the emergency department (ED). Many studies show early administration of corticosteroids (CS) can improve outcomes for children experiencing an asthma exacerbation. Despite the evidence, delays in care remain. The purpose of this study is to streamline the process for nurse-initiated,

Objective: Pediatric patients with asthma are frequently cared for in the emergency department (ED). Many studies show early administration of corticosteroids (CS) can improve outcomes for children experiencing an asthma exacerbation. Despite the evidence, delays in care remain. The purpose of this study is to streamline the process for nurse-initiated, triage-based CS administration and determine the effect on overall length of stay (LOS). Methods: For this quality improvement initiative, ED nurses at a large, freestanding, children’s emergency department in the southwestern United States were given education on inclusion and exclusion criteria for nurse-initiated CS in ED triage. Time to CS administration, LOS, and whether the ED nurse or provider ordered the CS were evaluated through chart reviews of patients presenting with a chief complaint of difficulty breathing. These metrics were compared to charts from the previous year during the same timeframe to evaluate for improved timeliness of CS delivery. Results: Time to CS administration decreased from a mean of 98.6 minutes to 57.6 minutes. LOS decreased from an average of 259.3 minutes to 169.6 minutes. The effect of timely CS on LOS was significant for December p =.003, January p =.002, and February p = <.001. Conclusion: A streamlined process for CS delivery to pediatric patients experiencing an asthma exacerbation can enable providers to achieve efficient and effective care in the ED and decrease a patient’s overall LOS.
Created2021-04-23
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Objective: Nearly 90% of sex trafficking victims will come into contact with an emergency department healthcare provider during his or her period of exploitation. Yet, victim identification by healthcare providers remains inadequate. The purpose of this quality improvement project is to improve emergency department healthcare providers’ confidence and ability to

Objective: Nearly 90% of sex trafficking victims will come into contact with an emergency department healthcare provider during his or her period of exploitation. Yet, victim identification by healthcare providers remains inadequate. The purpose of this quality improvement project is to improve emergency department healthcare providers’ confidence and ability to identify sex trafficking victims through staff education centered around sex trafficking. Method: A quality improvement project, guided by the Social Cognitive Theory, was implemented in an Arizona emergency department. ED staff were provided with a 40-minute education video about sex trafficking, including victim identification and appropriate responses. Participation in this project was open to all current healthcare workers employed at this emergency department. Stakeholders within the facility assisted with recruitment via weekly staff emails over a three-week period. A pre- and post-survey, consisting of a self-evaluation Likert scale, was used to assess confidence in identifying victims. Case studies were included to measure the participants’ ability to identify victims of trafficking. All aspects of this project were approved by Arizona State University’s and the organization’s Institutional Review Board. Results: One hundred percent of staff agreed to feeling confident in their ability to identify sex trafficking victims post intervention. However, there was no improvement in staff’s actual ability to identify victims through case studies post intervention. Conclusions: Education can be a valuable tool to improve confidence in identifying victims of sex trafficking in an emergency setting.
Created2021-04-28
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Description
Over the last ten years, a dramatic increase in Emergency Department (ED) visits has been prominent. Non-emergent chief complaints, such as repeat chronic care needs, are causing increased ED visits. The underutilization of primary care resources has been correlated with the overutilization of emergency care resources. ED overutilization is having

Over the last ten years, a dramatic increase in Emergency Department (ED) visits has been prominent. Non-emergent chief complaints, such as repeat chronic care needs, are causing increased ED visits. The underutilization of primary care resources has been correlated with the overutilization of emergency care resources. ED overutilization is having a negative rippling effect on the ability of the US healthcare system to care for patients. Emergency department personnel and other resources are strained, leading to overcrowding and decreased quality of care. Health insurance and provider accessibility has been linked to the high rates of ED usage by adults age 18 – 64, with the highest rates seen in those under public health coverage, such as Medicaid, compared to those who were uninsured. To encourage primary care visits and discourage non-emergent ED usage, the United States health system includes patient education on the appropriate ED use, higher-copayment as financial disincentives, and encouragement of provider-patient relationships with Primary care providers (PCP). The public health clinics, including Federally Qualified Health Centers, provide patient education on the appropriate use of PCP versus ED resources, and offer extended office hours during evenings and weekends; trimming the rate of non-emergent ED visits can significantly reduce health care costs.
ContributorsMarcus, Toyin (Author) / Ochieng, Dr. Judith (Author, Thesis advisor)
Created2019-05-04
Description

PowerPoint presentation to the Santa Fe Institute, October 2004.

ContributorsBarton, C. Michael (Author)
Created2004
Description

Dramatic changes in land use were associated with the rise of agriculture in the mid Holocene in the Mediterranean region. Both surface properties and drainage networks were changed along with direct modifications to surface properties (vegetation removal and change, sediment liberation and compaction); consequent drainage alteration (terracing, canals) and u

Dramatic changes in land use were associated with the rise of agriculture in the mid Holocene in the Mediterranean region. Both surface properties and drainage networks were changed along with direct modifications to surface properties (vegetation removal and change, sediment liberation and compaction); consequent drainage alteration (terracing, canals) and up and downstream responses in the watersheds communicated these changes throughout the landscape.

The magnitude, rate, and feedbacks with the growing human populations are critical questions in our effort to assess human-landscape interactions. To investigate these relationships, recent field work in the Penaguila Valley of southeast Spain included landform mapping, alluvial deposit description, and sample collection emphasizing areas of active erosion, remnant land surfaces and their relation to archaeological sites.

We have updated our geomorphic maps by refining the delineation of alluvial terraces, steep-walled (40m deep) drainages ("barrancos"), and hollows ("barrancos de fondo plano"). Hollows are curved, elongate, flat-bottomed gullies with steep walls (2-30m tall) and extend headward from the main barrancos. This work enables more accurate terrace correlations necessary for both landscape evolution modeling and interpretation of the development history of the basin.

Alluvial terraces are crucial to this research because they record periods of past stable topography. In the Penaguila, sites dating back to late Mesolithic and early Neolithic (around 6600 BP) and subsequent periods (Chalcolithic and Bronze Age) are exposed on a prominent terrace surface mapped as Terrace A. This broad low relief surface is scarred by deep barrancos and hollow formation that expose bedrock marls and overlying alluvial deposits. Stratigraphic profiles and texture analyses of Terrace A deposits reveal overland flow facies and channel networks in reworked and CaCO3-encrusted marls, and several organic-rich paleosols. Small remnant surfaces mapped as Terrace Z (below Terrace A) were observed within the main barrancos and indicate a later, brief accumulation period with subsequent incision to the modern channel.

Holocene landscape development in the Penaguila appears to have progressed from a period of stability to slope denudation with aggradation (stream infilling) followed by rapid incision which initiated sometime near the time of occupation. This change from a low relief alluvial surface to one cut by narrow channels may have been an important shift for local populations. Their response to that environmental modification may be associated with the horticulturalist to agricultural intensification noted in the archaeological record. Tighter chronology and better understanding of the driving processes for barranco incision and hollow formation will improve our ability to correlate the changing landscape with land use practices. Such an improved correlation leads to better understanding of human-landscape interactions.

ContributorsDiMaggio, E. N. (Author) / La Roca, N. (Author) / Arrowsmith, J. Ramon (Author) / Diez-Castillo, A. (Author) / Bernabeu, J. (Author) / Barton, C. Michael (Author)
Description

Contributed paper presented at the 72st Annual Meeting of the Society for American Archaeology, Austin, TX.

ContributorsRempel, Sydney (Author) / Soto-Berelov, Mariela (Author) / Falconer, Steven E. (Author) / Fall, Patricia L. (Author)
Created2007