Matching Items (6)

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Effective Utilization of HealthCare Resources: An Educational Intervention for Adult Patients

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.

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.

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Created

Date Created
  • 2019-05-04

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Implementing a Safety Plan and Using Follow-up Postcards to Mitigate Suicide Risk in Patients in the Emergency Department

Description

Suicide has become a national concern due to the increasing rates across the country. The 2012 National Strategy for Suicide Prevention aims to improve the area of clinical prevention. Emergency

Suicide has become a national concern due to the increasing rates across the country. The 2012 National Strategy for Suicide Prevention aims to improve the area of clinical prevention. Emergency departments (ED) play a key role in addressing this effort as they have multiple opportunities to connect with patients who are at risk. There exists a high-risk period of time immediately following a patient’s discharge from emergency care. To address this period of concern, a review of the literature was conducted on the effectiveness of follow-up contacts as a means to prevent suicide and suicide related attempts in this at-risk population.

Based on this review, a follow-up intervention was proposed to increase patients’ social support and knowledge on suicide prevention through a safety plan and the use of caring postcards. The aim was to evaluate the degree to which implementation of a safety plan and follow-up using postcards reduces suicide risk in the ED. ED suicide prevention practices such as safety planning and caring contacts with postcards have shown to be feasible and cost-effective methods to reduce patients’ risk of suicide as they provide education and address the high-risk period of time after discharge.

Using a quasi-experimental pre and post-test design, English speaking adults 18 years of age and older, admitted to an ED in the Phoenix Metropolitan area with suicidal ideation, were voluntarily recruited for two weeks. The self-rated Suicidal Behaviors Questionnaire-Revised (SBQ-R) was used as a baseline assessment along with the introduction of a safety plan. Participants were then followed with the receipt of postcards with caring messages over a two-week period, and a final SBQ-R. The SBQ-R has shown beneficial reliability and validity measuring suicidality in the adult population. Data from the pre-SBQ-R was analyzed using descriptive statistics as no post-SBQ-Rs were received. Outcomes for this project included a reduction in suicidal ideation and suicide risk.

This project provides insight into the implementation of a safety plan and follow-up intervention in the ED and their attempts to reduce acute suicide risk as well as highlight the value that post-ED support provides.

Keywords: suicide, prevention, safety plan, caring messages, postcards, emergency department, follow-up, contacts, brief intervention

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Created

Date Created
  • 2019-04-29

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Implementation of a Child Physical Abuse Screening Program in the Emergency Department

Description

Children often present to the emergency department (ED) for treatment of abuse-related injuries. ED healthcare providers (HCPs) do not consistently screen children for physical abuse, which may allow abuse to

Children often present to the emergency department (ED) for treatment of abuse-related injuries. ED healthcare providers (HCPs) do not consistently screen children for physical abuse, which may allow abuse to go undetected and increases the risk for re-injury and death. ED HCPs frequently cite lack of knowledge or confidence in screening for and detecting child physical abuse.

The purpose of this evidence-based quality improvement project was to implement a comprehensive screening program that included ED HCP education on child physical abuse, a systematic screening protocol, and use of the validated Escape Instrument. After a 20-minute educational session, there was a significant increase in ED HCP knowledge and confidence scores for child physical abuse screening and recognition (p < .001). There was no difference in diagnostic coding of child physical abuse by ED HCPs when evaluating a 30-day period before and after implementation of the screening protocol.

In a follow-up survey, the Escape Instrument and educational session were the most reported screening facilitators, while transition to a new electronic health system was the most reported barrier. The results of this project support comprehensive ED screening programs as a method of improving HCP knowledge and confidence in screening for and recognizing child physical abuse. Future research should focus on the impact of screening on the diagnosis and treatment of child physical abuse. Efforts should also be made to standardize child abuse screening programs throughout all EDs, with the potential for spread to other settings.

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Created

Date Created
  • 2018-04-09

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The Reality of Sepsis

Description

Background: Sepsis is a potentially life-threatening infection affecting millions of individuals. Nearly three million individuals are affected annually, killing one in every two to four individuals. Sepsis mortality rates are

Background: Sepsis is a potentially life-threatening infection affecting millions of individuals. Nearly three million individuals are affected annually, killing one in every two to four individuals. Sepsis mortality rates are highest in those 65 and older, making it the most expensive diagnosis paid by Medicare and worldwide at $24 billion dollars. Early goal directed therapy (EGDT), created by the International Surviving sepsis campaign, is a bundled protocol created to decrease mortality rates, however, utilization and completion remains a problem in the emergency department (ED).

Purpose: This project sought to evaluate the gap that exists between best practice and current practice, for sepsis identification and EGDT implementation.

Methods: The project was completed over a four-month period with prior Institutional Review Board (IRB) approval and consisted of evaluation of sepsis knowledge and barriers to EGDT. Questionnaires included demographics, sepsis knowledge, barriers to EGDT and AHRQ quality indicators toolkit.

Results: Sample (N=16) included registered nurses (RN) and healthcare providers. Descriptive statistics were utilized for evaluation of questionnaires. Results indicate staff have sound understanding of signs and symptoms of sepsis, however application through case studies demonstrated lower performance. Overall system barriers were minimal, with greatest barriers in central line monitoring and staff shortages. High level unit teamwork exists within the ED, however collaboration is lacking between ED staff and upper management. Results demonstrate moderate disengagement between upper management and staff leading to miscommunication. Recommendations included increased, consistent sepsis education, utilization of Institution for Healthcare Improvement (IHI) triple aim framework for evaluating systems, implementing a closed loop approach to communication, and having a staff champion for sepsis be included in meetings with upper management.

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Created

Date Created
  • 2018-04-30

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Scents of efficiency: discovering how olfactory stimuli affect caregiver performance in a simulated emergency department

Description

Research has shown that the ability to smell is the most direct sense an individual can experience. With every breath a person takes, the brain recognizes thousands of molecules and

Research has shown that the ability to smell is the most direct sense an individual can experience. With every breath a person takes, the brain recognizes thousands of molecules and makes connections with our memories to determine their composition. With the amount of research looking into how and why we smell, researchers still have little understanding of how the nose and brain process an aroma, and how emotional and physical behavior is impacted. This research focused on the affects smell has on a caregiver in a simulated Emergency Department setting located in the SimET of Banner Good Samaritan Medical Center in Phoenix, Arizona. The study asked each participant to care for a programmed mannequin, or "patient", while performing simple computer-based tasks, including memory and recall, multi-tasking, and mood-mapping to gauge physical and mental performance. Three different aromatic environments were then introduced through diffusion and indirect inhalation near the participants' task space: 1) a control (no smell), 2) an odor (simulated dirty feet), and 3) an aroma (one of four true essential oils plus a current odor-eliminating compound used in many U.S. Emergency Departments). This study was meant to produce a stressful environment by leading the caregiver to stay in constant movement throughout the study through timed tasks, uncooperative equipment, and a needy "patient". The goal of this research was to determine if smells, and of what form of pleasantness and repulsiveness, can have an effect on the physical and mental performance of emergency caregivers. Findings from this study indicated that the "odor eliminating" method currently used in typical Emergency Departments, coffee grounds, is more problematic than helpful, and the introduction of true essential oils may not only reduce stress, but increase efficiency and, in turn, job satisfaction.

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Created

Date Created
  • 2013

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An exploratory study: examining emergency department design-layout and nursing physical fatigue

Description

ABSTRACT Nursing physical fatigue is a critical issue that may lead to degradation of care delivery and ultimately result in medical errors. This issue is equally relevant due to the

ABSTRACT Nursing physical fatigue is a critical issue that may lead to degradation of care delivery and ultimately result in medical errors. This issue is equally relevant due to the looming shortage of nurses, which has been linked to the physical demands and potential occupational hazards intrinsic to the profession; as well as to the graying of the nursing workforce who experiences gradual loss of strength and agility that accompanies aging as time in the career advances. In a hospital Emergency Department, the level of nursing physical fatigue can potentially reach its threshold in light of challenging workloads, scope of job assignments and demanding schedules. While in other safety-sensitive industries such as aviation and nuclear plants, similar concerns have been the object of systematic research and addressed with consequent regulations, just recently, the healthcare sector has been engaged in further investigations. This study proposed to explore the linkage between Emergency Department design-layout and nursing physical fatigue. It was expected that further understanding on this relationship would support evidence-based design propositions linking nursing wellness, job satisfaction, and performance to a higher quality of care and improved patient safety levels. To this end, data collection was performed during four weeks in a community-based hospital. A convenience sample of twenty-four eligible nurses was invited to participate in this two-part study. The first section consisted of the completion of a self-administered questionnaire, which assessed nurses' perception of the impact of working conditions on nursing physical fatigue. The second section included the monitoring, through the use of accelerometers, of nurses' actual activity intensity levels during three consecutive shifts. Among other findings, data demonstrated that nurses perceive several attributes or components of the built environment as potential contributors to physical fatigue. In addition, various operational practices and organizational protocols were linked to physical fatigue. Contrary to nurses' perception of physical fatigue, their actual physical activity levels fell mostly between sedentary or light intensity ranges. This paradox offers the opportunity for design interventions that, in alignment with operational practices and organizational protocols will enhance nurses' performance and improve nurses' retention.

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Agent

Created

Date Created
  • 2011