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Approach to Acute Dizziness/Vertigo in the Emergency Department: Selected Controversies Regarding Specialty Consultation
No full textAcute dizziness and vertigo are common emergency department presentations (≈4% of annual visits) and sometimes, a life-threatening diagnosis like stroke is missed. Recent literature reviews the challenges in evaluation of these symptoms and offers guidelines for diagnostic approaches. Strong evidence indicates that when well-trained providers perform a high-quality bedside neurovestibular examination, accurate diagnosis of peripheral vestibular disorders and stroke increases. However, it is less clear who can and should be performing these assessments on a routine basis. This article offers a focused debate for and against routine specialty consultation for patients with acute dizziness or vertigo in the emergency department as well as a potential path forward utilizing new portable technologies to quantify eye movements
Program Signaling in Emergency Medicine: The 2022-2023 Program Director Experience
No full textINTRODUCTION: Program signaling (PS), which enables residency applicants to signal their preference for a specific program, was introduced in emergency medicine (EM) in the 2022-2023 residency application cycle. In this study we evaluated EM program directors\u27 (PD) utilization of PS in application review and ranking. This study also explores the relationship between program characteristics and number of signals received as well as the relative importance and utilization of signals related to the number of signals received. METHODS: This is an institutional review board-approved, cross-sectional study of PDs at Accreditation Council for Graduate Medical Education-accredited EM residency programs. We used descriptive statistics to describe the characteristics of residency programs and practices around PS. Measures of central tendency and dispersion summarized continuous variables. We used chi-square analysis or the Fisher exact test for comparisons between groups for categorical variables. Comparisons for continuous variables were made using the t-test for independent samples or analysis of variance. RESULTS: The response rate was 41% (n = 113/277 EM programs). Most programs participated in PS (n = 261/277 EM programs, 94.2%). Mean number of signals received was 60 (range 2-203). Signals received varied based on program characteristics including geographic location and program type, duration, environment, and longevity. Most used PS in holistic review (52.2%), but other uses varied by proportion of applications that were signaled. The importance of PS in application review (mean 2.9; 1-5 scale, 1 = not important, 5 = extremely important) and rank list preparation (2.1) was relatively low compared to other application elements such as standardized letters of evaluation (4.97 for review, 4.90 for ranking). CONCLUSION: The study provides insights into PS utilization in EM\u27s inaugural year. We have identified patterns of signal use based on program characteristics and number of signals received that can inform signal allocation and utilization on an individual applicant and program level. A more nuanced understanding of signal use can provide valuable insight as the specialty of EM grapples with fluctuations in its applicant numbers and shifting demographics of its applicant pool
How will the use of a black out hour and the improvement in handoff communication increase patient safety when arriving on the medical surgical units?
Get PDFBackground: Change of shift admissions also increase nurse\u27s frustration and workload. Most importantly change of shift admissions pose a risk for patient safety. On this unit specifically there are frequent change of shift admissions that occur.https://knowledgeconnection.mainehealth.org/nurseresidency/1026/thumbnail.jp
The Impact of Clustered Nursing on Adult Patients in the ICU
Get PDFBackground: Patients in the intensive care unit (ICU) are at risk of developing many different complications due to the complex nature of their health conditions as well as the care required in the critical care environment. Among the different complications that can occur in this population, delirium and issues associated with mechanical ventilation are especially concerning.https://knowledgeconnection.mainehealth.org/nurseresidency/1025/thumbnail.jp
Process Improvement Initiative to Reduce Average Length of Stay in a Community Hospital – A Preliminary Report
Get PDFIntroduction: Average length of stay (ALOS) has increased in many US hospitals in the post-COVID-19-pandemic world. We undertook a process improvement initiative to reduce the ALOS in our community hospital.
Methods: Three core tactics were developed with a goal of reducing our ALOS by 10%. These tactics were early mobilization, Interprofessional Partnership to Advance Care and Education rounding, and structured interdisciplinary care rounds. Workgroups in each of these domains designed the improvement, devised measures of success, and implemented the tactic. A process improvement specialist worked with each workgroup using elements of the Model for Improvement. Process measures were reported weekly. Outcome measures (ALOS, observed vs expected LOS) were reported weekly. A central steering committee oversaw the initiative. All tactics were fully implemented by February 2023.
Results: For the first 6 months after implementing our tactics, the ALOS on our inpatient medical units decreased from 6.3 to 5.5 days (13.7%) when compared with the same 6-month period in the prior year (P \u3c .01).
Discussion: We used 3 interventions to impact the ALOS in our community hospital. Preliminary data show a significant improvement. We cannot isolate the independent contribution of each intervention and did not control for confounders.
Conclusions: Our interdisciplinary team developed and implemented tactics to reduce the ALOS in our community hospital by 13.7%
Rate and setting of neurodevelopmental and psychosocial encounters for children with CHD
No full textBACKGROUND: In North America, less than 30% of children with complex CHD receive recommended follow-up for neurodevelopmental and psychosocial care. While rates of follow-up care at surgical centres have been described, little is known about similar services outside of surgical centres. METHODS: This cohort study used Maine Health Data Organization\u27s All Payer Claims Data from 2015 to 2019 to identify developmental and psychosocial-related encounters received by children 0-18 years of age with complex CHD. Encounters were classified as developmental, psychological, and neuropsychological testing, mental health assessment interventions, and health and behaviour assessments and interventions. We analysed the association of demographic and clinical characteristics of children and the receipt of any encounter. RESULTS: Of 799 unique children with complex CHD (57% male, 56% Medicaid, and 64% rural), 185 (23%) had at least one developmental or psychosocial encounter. Only 13 children (1.6%) received such care at a surgical centre. Developmental testing took place at a mix of community clinics/private practices (39%), state-based programmes (31%), and hospital-affiliated clinics (28%) with most encounters billing Medicaid (86%). Health and behavioural assessments occurred exclusively at hospital-affiliated clinics, predominately with Medicaid claims (82%). Encounters for mental health interventions, however, occurred in mostly community clinics/private practices (80%) with the majority of encounters billing commercial insurance (64%). CONCLUSION: Children with complex CHD in Maine access developmental and psychosocial services in locations beyond surgical centres. To better support the neurodevelopmental outcomes of their patients, CHD centres should build partnerships with these external providers
Assessment of sous vide water baths in the acute rewarming of frostbitten extremities: A multicenter study
No full textHealth Sciences Libraries: A Changing Landscape
Get PDFHealth sciences libraries provide specialized resources and services to learners, clinicians, patients and the community. The authors describe how health sciences libraries continue to evolve in a changing healthcare system landscape. New technologies, roles, educational resources and learner expectations provide challenges and opportunities for health sciences libraries
Awake Supraglottic Airway Placement in Pediatric Patients for Airway Obstruction or Difficult Intubation: Insights From an International Airway Registry (PeDI)
No full textBACKGROUND: Small case series have described awake supraglottic airway placement in infants with significant airway obstruction and difficult intubations. We conducted this study to determine outcomes when supraglottic airways were placed in awake children enrolled in the international Pediatric Difficult Intubation Registry including success of ventilation, success of tracheal intubation, and complications. METHODS: We reviewed the Pediatric Difficult Intubation Registry to identify all cases of awake supraglottic airway placement before planned tracheal intubation from August 2012 to September 2023 with subsequent review of details of awake supraglottic airway placement in the medical record. We present descriptive statistics of patient demographics, ventilation and intubation outcomes, and complications. RESULTS: A supraglottic airway was placed in an awake child in 95 of 8061 (1.2%) cases in the Pediatric Difficult Intubation Registry. Median age was 37 days (range 0-17.6 years) and median weight was 3.7 kg (1.6-46.7 kg). Sixteen (17%) cases were in patients older than 2 years and 7 (7%) were in adolescents. Adequate ventilation via a supraglottic airway was achieved in 81/95 (85%, 95% confidence interval [CI], 77%-93%) encounters. Inadequate (n = 13) or impossible (n = 1) ventilation occurred in 14/95 (15%). No complications were reported with supraglottic airway placement. For subsequent intubation, there was a 35% (33/95) first-attempt success rate and 99% (94/95) eventual success, with 1 patient awakened after failed attempts at tracheal intubation. Hypoxia occurred during the first intubation attempt in 9/95 (9%) encounters. The incidence of hypoxia was lower in encounters in which ventilation via the supraglottic airway was adequate (4/81, 5%) than in encounters in which ventilation via the supraglottic airway was inadequate or impossible (5/14, 36%). CONCLUSIONS: Although infrequently attempted, awake placement of a supraglottic airway in children with difficult airways achieved adequate ventilation and provided a conduit for oxygenation and ventilation after induction of anesthesia across a spectrum of ages