Browsing by Subject "Emergency Service, Hospital"
Now showing 1 - 13 of 13
- Results Per Page
- Sort Options
Item Acceptability of Screening for Sexually Transmitted Infections in an Urban Pediatric Emergency Department in the Southern Region of the United States(2016-01-19) Pfaff, Jamie; Johnson, DawnBACKGROUND: Adolescents age 13 to 24 years old are the demographic most affected by sexually transmitted infections (STIs) in the USA. The CDC, USPSTF and the AAP recommend screening sexually active females less than 25 years old in all health care settings for Neisseria gonorrhea (GC) and Chlamydia trachomatis (CT) and all high-risk females of this age group also for HIV and Syphilis. In regions with a high prevalence of STIs, such as Dallas County, the diagnosis and treatment of STIs is a vital step toward reducing the spread of these communicable diseases in this population. METHODS: All adolescents age 13-24 presenting to the Pediatric Emergency Department (PED) during the study period who met the study criteria were asked to participate. A total of 197 adolescents and 198 parents, 183 of which comprised parent-child dyads, were enrolled and completed separate surveys. Participants answered questions about adolescent and parent acceptability of STI screening, STI risk behaviors, and adolescents' history of STI screening and treatment. RESULTS: Analysis thus far shows that non-invasive STI screening is acceptable to the majority of both adolescents (70%) and parents (84%). Among patient/parent dyads, 59% had positive responses from both. No demographic factors demonstrated statistical significance. However, some factors displayed greater variability than others. In terms of age, adolescents greater than 15 years old were more likely to indicate acceptance of STI testing (73%) than those younger than age 15 (62%). Breakdown by adolescent race and ethnicity demonstrated a range of acceptability with 83% for those who identified as White or Caucasian, 59% for those identifying as Black or African American, 64% for those identifying as Hispanic, and 100% of the five participants identifying outside of the previous categories, "other". CONCLUSIONS: These acceptability results are similar to those found in a study performed in Jefferson County, AL where adolescents reported a 71% acceptance rate for GC and CT screening. This suggests that implementation of STI screening in the PED would be successful and well tolerated by the majority of adolescents and their parents. The variation in acceptability demonstrated by age and race were not statistically significant but may be useful in determining the minimum age of PED intervention and preparing culturally sensitive answers for questions from adolescents and patients in future testing interventions. Implementation of new PED HIV screening protocols are utilizing evidence based on this study and will further be assessed for continued improvement of Dallas adolescent health.Item Demographics and Quality of Life in Unfunded Patients Receiving Regular Emergent Dialysis(2014-02-04) Hogan, Andrew; Rigdon, Daniel; Suter, RobertINTRODUCTION: Patients with End Stage Renal Disease (ESRD) must undergo hemodialysis several times per week for renal dysfunction. Chronic dialysis drastically affects the lifestyles of ESRD patients, as it is time-consuming and uncomfortable. A high number of unfunded ESRD patients present to the Emergency Department (ED) at Parkland Hospital for dialysis. These patients accounted for over 7300 ED visits in 2009. Providing emergent dialysis via the ED has been shown to be more costly than providing scheduled dialysis. To date, all psychometric analyses of demographics and quality of life in chronic dialysis patients focus on insured patients in traditional dialysis centers. This study attempts to acquire and analyze such data on the emergent dialysis population at Parkland Hospital. Data will ultimately be compared to control patients from the Parkland system. METHODS: A demographic survey developed at UT Southwestern and the established "Kidney Disease Quality Of Life (KDQOL(TM)) Instrument" were presented to ESRD patients seeking dialysis in the Parkland ED. A comprehensive list of 165 suitable patients was obtained from Parkland Nephrology. With a goal of 80% recruitment of those identified, patients were recruited upon presentation 24 hours a day, 7 days a week for a 4-week period beginning on July 8, 2013. In total, 55 data points from each patient were aggregated. RESULTS: Of 101 chronic dialysis patients approached during the initial 4 weeks, 88 completed the survey. Although 39% of listed patients were not surveyed by the end of the 4 weeks, raw data collection has recently been completed. Demographic data reveal a predominantly male, Hispanic, middle-aged, undocumented, and uninsured ESRD patient population seeking dialysis in the Parkland ED. The KDQOL data indicate a majority of surveyed patients rate their current health negatively, while only 9% do so positively. Additional data quantifying the impact of chronic dialysis on patient lifestyles await analysis. DISCUSSION: The demographic data reveal that 68% of the chronic dialysis patients thus surveyed have lived in the USA for more than 5 years, yet only 15% received a diagnosis requiring dialysis over 5 years ago. This finding seems to contradict the currently accepted idea that the need for dialysis is the primary motivating factor bringing most of these patients to the USA. Quality of life data remains to be compared between the unfunded emergent population and the Nephrology clinic population. Descriptors for the emergent patients are expected to be more negative, or at best equivalent to those for the scheduled patients. Considering the higher cost of emergent dialysis, the results of this comparison are expected to support an argument for providing scheduled dialysis for unfunded ESRD patients.Item Determination of Respiratory Depression Measured by Capnography of Acutely Intoxicated Patients Presenting to an Urban Emergency Department(2015-01-26) Danko, Colin; Au, Vincent; Onisko, Nancy S.; Severson, Katie; Kleinschmidt, KurtINTRODUCTION: The standard of care for monitoring the respiratory status of patients with altered sensorium until recently has been pulse oximetry and observation. While pulse oximetry measures peripheral arterial oxygen saturation, it does not adequately detect hypoventilatory status. We hypothesized that intoxicated patients would demonstrate clinically significant signs of hypoventilation and that ETCO2 monitoring may detect these changes earlier than pulse oximetry. METHODS: This was a pilot observational data collection study of intoxicated patients presenting to a single urban emergency department between June 6, 2014 and August 1, 2014. Research assistants (RA's) monitored the ED tracking board for patients presenting with chief complaints suggesting possible intoxication with drugs or alcohol. Patients eligible for enrollment were between age 18-80 years, had a baseline Rikers Sedation Agitation Scale Score of < 3 and the treating ED physician believed that the patient's altered mental status was "possibly" or "probably" related to use of an intoxicant. Vital sign data and end-tidal CO2 readings were collected at Baseline, 30, 60, 90 and 120 minutes then hourly there after. End points for data collection were: 1) demonstration of alertness for at least 60 consecutive minutes 2) disposition to home or another hospital department or 3) decompensating respiratory status requiring bi-pap, c-pap or intubation. RESULTS: Seven hundred ninety four patients were screened. Thirty-five met all enrollment criteria and were assigned a de-identified patient number. Six patients were excluded from the final data analysis (5 for critical errors in ETCO2 data collection and 1 had AMS of non-intoxication etiology). Of the remaining 29 patients, 20 were male, 9 female. Ages ranged from 19-54 yrs. Alcohol was one of the intoxicants in almost half of patients. Other intoxicants included benzodiazepines, synthetic cannabinoids, cocaine, heroin and diet pills. Some patients had exposure to more than one intoxicant. ETCO2 values of > 45 mmHg were considered indicators of hypoventilatory state. There were a total of 19 episodes of hypoventilatory status as indicated by ETCO2 > 45 mmHg. Of the patients with multiple episodes (> 2) of hypoventilatory status, two had used heroin, one 62 mg lorazepam. Pulse oximetry reflected a normal oxygen saturation during at least 6 of the episodes. CONCLUSION: ETCO2 may detect hypoventilatory status before pulse oximetry and should be standard of care in patients presenting with intoxication associated with CNS depression.Item Empowering Patients: Simplifying Discharge Instructions(2019-03-28) DeSai, Charisma; Reed, W. Gary; Blomkalns, Andra; McDonald, SamuelBACKGROUND: Studies have shown that many patients leave the ED with partial comprehension of their visit and discharge instructions. Patients who are not adequately informed as to their discharge plans have decreased compliance with medications and treatment plans, decreased patient safety, increased Emergency Department (ED) recidivism, and poor patient satisfaction. The fast-paced and unpredictable environment of the ED makes thorough communication a challenge, so it is especially important to ensure that patients are given accessible and easy-to-understand information given the acuity and urgency of these patients' conditions. LOCAL PROBLEM: This project's objective is to develop and implement a method to assess and improve patient understanding of treatment and discharge plan at the Clements University Hospital Emergency Department, an academic urban hospital ED that sees approximately 43,500 patients per year. Written instructions provided to patients at the beginning of the study were found to be long and tedious, and important information was often difficult to find. METHODS: The PDSA (Plan, Do, Study, Act) cycle was employed throughout the project. Planning occupied a large portion of the project, with the determination of stakeholders, mapping of the current state, and developing an algorithm for assessment of patient understanding. ED discharge process was mapped with a flow diagram to understand the process of educating patients upon discharge from Clements University Hospital. The authors developed a questionnaire to assess patient knowledge using CMS OP-19 Transfer Record and Joint Commission recommendations, areas of communication deficits reported in other papers, and ED staff and provider input. A baseline study was conducted with fifty patients to measure patient understanding of their discharge instructions (Do). Responses from patient interviews were then scored against the medical record (Study). Three scorers graded all patient responses, and inter-rater reliability was calculated using the kappa statistic. INTERVENTIONS: Based on patient scores in the baseline study, stakeholder interviews, and fishbone diagrams examining reasons for lower scores, a decision matrix was created to decide on the most effective intervention (Act, Plan). The intervention chosen was creating a new, short discharge document. We developed the one-page Simplified Information Page (SIP) targeted to teach patients their most relevant discharge instructions. Next, we tested the SIP on one hundred eighteen patients to see its effect on patient understanding (Do). RESULTS: None (0%) of the fifty patients in the initial survey had complete comprehension of their ED visit and discharge instructions, although most patients stated they understood their discharge instructions and thought that their discharge instructions were useful. The lowest scoring questions were medication instructions (dosing and frequency) and indications to return to the ED. Median score improved after implementation of the SIP, with statistically significant changes in score distribution across all questions assessed with the Wilcoxon signed-rank test. Repeated measures ANOVA did not reveal any significant relationship between improvement in scores and any demographic criteria. Inter-rater reliability between scorers was high (kappa = 0.84). CONCLUSION: Healthcare providers often spend valuable time educating their patients, and it is important to assess the effectiveness of this teaching to identify areas in which we may improve health literacy and patient understanding. We found that the majority of patients do not fully comprehend their ED discharge instructions. Our project has shown that a simple, easy-to-read page with patient input significantly improved ED discharge knowledge.Item The Incidence of Post-Intubation Hypotension in Trauma Patients after Etomidate Administration(2015-01-26) Glidewell, Ryan; Cooper, Benjamin; Kendall, Brian; Knepper, Scott; Kim, Jaehyun; Hynan, Linda; Roppolo, Lynn P.BACKGROUND: Post-intubation hypotension (PIH) is found in up to 44% of patients emergently intubated in the ED. Etomidate is a popular agent used in rapid sequence induction (RSI) for emergency intubations due to its stable hemodynamic profile. The purpose of this study was to prospectively investigate the incidence of PIH in trauma patients requiring emergent intubation using etomidate as the induction agent. METHODS: All patients intubated in the emergency department (ED) who were induced using etomidate were prospectively recruited for this study. Serial vital signs were recorded just prior to RSI drug administration and every 5 minutes after for 20 minutes. RESULTS: 20 adult patients were recruited for this study over an 8-week period, 12 (80%) medical and 8 (89%) trauma. Each patient received an average dose of 22 mg. See Table 1 and Figure 1 a comparison of MAP changes observed in medical patients verses trauma patients just prior to the administration of RSI medications and at 5, 10, 15, and 20 minutes intervals. CONCLUSION: Etomidate can significantly reduce the MAP in trauma patients. One plausible explanation in the immediate post-intubation period is the reduced sympathetic stimulation that results once unconsciousness is induced. Critically ill trauma patients who require emergent intubation are likely to have concomitant injuries and are at risk for hemorrhagic shock or worsening cerebral injury from precipitous decreases in blood pressure. Resuscitative measures should be cautiously instituted to mitigate any adverse effects of hypoperfusion from PIH in these critically ill patients.Item [News](1990-12-12) Donovan, JenniferItem Prevalence and Characteristics of Violence Against Persons at Parkland Hospital(2022-02-01) Kalra, Anjali; Beauchamp, Alaina; Scroggins, Heather; Pahl, Brittany; Pitt, Amanda; Skaliks, Andrea; Jetelina, KatelynBACKGROUND: Violence against persons (VAP) including interpersonal violence and human trafficking is a significant public health problem in the United States that affected 1.6% of the population in 2020. Systematic screening for VAP is inconsistent across hospital systems and often targets limited populations (i.e. pregnant women, homeless youth), resulting in inadequate broad detection of VAP. This study examined the prevalence of VAP and evaluated characteristics of VAP-positive patient encounters at a large safety-net hospital after implementation of an expanded screening program. METHODS: We conducted an analysis of the first six months of an expanded VAP screening program in the Emergency Department (ED) at Parkland Health and Hospital system from January to July 2021. The program involved: 1) a mixed four-question survey and observational procedure 2) strengthening referral pathways to Parkland's Victim Intervention Program/Rape Crisis Center (VIP), and 3) clinical education on VAP. A prospective chart analysis was conducted using Electronic Health Records (EHR) data for all patients who received the new screening. RESULTS: A total of 67,535 patient encounters were screened, out of which 1,349 (2.00%) were positive for VAP. On average, VAP positive patients were six years younger than VAP negative patients (38 vs 44 years respectively). VAP positive patients were more likely to be female (69.61%) than male (30.39%), and more likely to identify as Non-Hispanic Black (43.58%). VAP positive patients spent 28 less minutes in the ED in comparison to VAP-negative patients. The most prevalent VAP was physical abuse (71.76%), followed by psychological VAP (39.21%), observational signs VAP (37.06%), sexual VAP (31.36%), and control of food or money VAP (18.68%). The most referred VAP was physical with 48.33% of positive VAP encounters referred to VIP. CONCLUSIONS: Our results showed evidence of successful implementation of a broad screening program for VAP at a safety-net hospital. The rate of VAP identified in screening our population was greater than the national average. Furthermore, demographic data showed a higher prevalence of VAP in patients who are young, female, or Non-Hispanic Black, highlighting the need for further research on compounded effects of gender and race on VAP.Item Prevalence of Prescription Medication Misuse in Patients Presenting to the Emergency Department(2015-01-26) Davis, Jennifer; Schaeffer, Thomas; Kleinschmidt, Kurt; Wax, Paul; Young, Amy; Drake, Kelsey; Furmaga, JakubIn the early 1990s multiple studies displayed the inadequate treatment of acute pain for patients presenting to Emergency Departments across the U.S. As a result, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) modified the standard of care in regards to acute pain management, which required more consistent assessments and diligent treatments. Subsequently, the average number of prescribed opioid analgesics in the U.S. increased from 96 mg of morphine equivalents per person in 1997 to approximately 700 mg per person in 2007. Furthermore, the number of unintentional opioid drug overdose deaths increased from 3,000 to 12,000 per year. Clinicians and policy makers are now working to reduce the effects of this new prescription drug epidemic. Data for this study was collected from patients presenting to the ED of Parkland Memorial Hospital (PMH) with a chief complaint of 'back pain' or 'back injury' via a confidential, self-reporting survey designed to obtain demographic information, a brief medical history, and pain and anxiety medication use habits. Statistical analysis of 132 patients revealed that 71 (53.8%) patients have used prescription pain or anxiety drugs in the past 3 months, with 30 (22.7%) utilizing them on a daily or near daily basis. Although only 6 (4.6%) patients admitted to struggling with pain or anxiety medication misuse and 0 (0%) admitted to utilizing current prescription medications for recreational purposes, 12 (9.1%) reported personal troubles, 12 (9.1%) reported a failure to do what was normally expected of them at some point in the past 3 months, and 9 (6.8%) reported a friend or relative expressing concern about substance use. 24 patients reported having a current prescription for pain or anxiety medication. Of these, 17 (70.8%) were obtained from either ED or primary care physicians. A number of relationships were also analyzed in order to determine at-risk individuals. Education level showed a statistically significant association with pain or anxiety medication use in the past 3 months (p=0.003), while a history of chemical dependence therapy was correlated with the expression of concern from friends or family in regard to substance use (p=0.02). This data may be used to determine the prevalence and cause of prescription drug misuse among patients presenting to EDs, providing clinicians with promising areas of intervention. Understanding the scope of the issue, coupled with the ability to prevent habitual drug misuse prior to its initiation, may serve to alleviate some of the negative effects associated with this new epidemic.Item Providing high value care to patients with acute chest pain(2019-06-14) Vigen, RebeccaItem The Roles of Infection Risk and Caretaker Education in Reducing Emergency Department Readmissions Among Pediatric Tracheostomy Patients(2022-02-01) Beams, Dylan R.; Chorney, Stephen R.; Kou, Yann-Fuu; Teplitzky, Taylor B.; Wynings, Erin; Johnson, Romaine F.OBJECTIVES: To determine factors associated with frequent emergency department (ED) visits and hospitalizations among pediatric tracheostomy patients. METHODS: A longitudinal cohort of children with tracheostomies were followed for the first 24 months after index discharge. Multiple logistic regression analyses identified associated factors for frequent health care utilization (> 4 visits in 24 months). RESULTS: 239 children requiring 1285 total visits to the ED or hospital after index discharge were included, with 112 children (46.7%) having four or more visits. Respiratory-related illness was the most common indication (N=699 visits, 54%), followed by gastrostomy tube issues (N = 119, 9.3%). Variables predicting frequent utilization on regression analysis included Black race (OR = 2.01, 95% CI = 1.18 - 3.70), mechanical ventilation (OR = 2.74, 95% CI = 1.35 - 5.59), and Spanish language (OR = 3.86, 95% CI = 1.47 - 10.11). There were no predictors of visits for tracheostomy-related complications, which accounted for 4.8% of all encounters. A sub-analysis showed that Hispanic race and gestational age predicted visits for respiratory failure. CONCLUSION: 47% of pediatric tracheostomy patients necessitate frequent ED and hospital utilization in the first two years after placement. Strategies related to reducing respiratory- and gastrostomy-related admissions may have the most impact given their high frequency. The significance of primary Spanish language and mechanical ventilation may emphasize the importance of quality caretaker education prior to patient discharge.Item [Southwestern News](2005-01-13) Lenocker, KaraItem Suicide Risk Assessment in the Emergency Department Setting(2015-08-31) Danko, Mary McCormick; Roaten, Kimberly Dayle; North, Carol S.; Westers, NicholasSuicide is a prominent problem that has far-reaching effects. In 2013, 41,149 suicides were reported in the United States, a rate of 13.0 per 100,000. Suicide was the tenth leading cause of death for Americans with someone in the country committing suicide every 12.8 minutes. The World Health Organization estimates that by the year 2020 roughly 1.53 million people will commit suicide annually, and 10-20 times more will attempt suicide. This translates to one death due to suicide every 20 seconds and one suicide attempt every 1-2 seconds (World Health Organization, 1999, 2006). Given these trends, it is becoming even more important to develop and utilize screening and assessment measures to assist in identifying individuals who are at risk for suicide in order to implement appropriate treatment. Emergency departments (ED) are responsible for providing medical and surgical care to patients in need of immediate treatment upon arriving at hospitals. As such, EDs are a primary point of access for individuals immediately following a suicide attempt. Previous studies have investigated the prevalence of suicidal ideation in patients presenting to the ED for non-psychiatric reasons and found that increased suicide-related risk for nearly all of the patients was undetected during routine care. Given these findings, it is highly important that ED providers understand how to perform a proper suicide risk assessment to evaluate for intensity and severity of risk and develop an appropriate care plan.Item The Use of Vapocoolant in the Adult Population to Improve Patient Perception of Pain with Peripheral Intravascular Access(2015-01-26) Tausiani, Jacob; Yau, Alexander; Serrano, David; Youngman, Tyler; Knepper, Scott; Noah, Christina; Edwards, Courtney; Hynan, Linda; Pease, John P.IMPORTANCE: Patient anxiety and perception of pain during peripheral intravenous (PIV) cannulation can unfavorably impact both patients and treatment provided. Topical analgesics are rarely used due to a long time to effectiveness and treatment delay, but vapocoolant has a more immediate effect. OBJECTIVE: To investigate whether the use of a topical vapocoolant anesthetic spray at the site of intravenous access reduces pain and anxiety associated with PIV insertion in an adult emergency room population. DESIGN, SETTING AND PARTICIPANTS: A randomized, doubleblind, placebo-controlled, single-center trial, conducted from July 2014 to August 2014 in an emergency department with 72 patients with orders for PIV placement receiving either topical vapocoolant spray (n=38) or a placebo spray (n=34). INTERVENTIONS: Vapocoolant spray or placebo was applied to the IV site and allowed to evaporate prior to cleansing and needle insertion. MAIN OUTCOMES AND MEASURES: The primary outcome was patient perception of pain and anxiety with PIV needle insertion using a 0-10 Likert scale. Secondary outcomes included patient/staff preference for the use of the topical anesthetic for future procedures and staff perception of the procedure and patient anxiety. RESULTS: The patient groups did not vary significantly in previous history of IV placement (p>0.999) nor anxiety pre-procedure (p=0.785). Median scores for patient perception of pain did not vary significantly between vapocoolant (2.0) and placebo populations (2.5), nor did the scores vary significantly for patient-forecasted anxiety regarding the procedure should the same procedure be used again (0.5 for vapocoolant, 0.0 for placebo; p>0.05). Additionally, when asked if they desired the spray for future procedures, nurses and patients responded identically: 89% expressed the desire for vapocoolant, while 74% desired future use of placebo; however, the difference was not significant (p>0.05). Neither placebo nor vapocoolant affected the nurses' ability to obtain IV access (p<0.05). No skin blanching or lesions due to the spray were noted. CONCLUSION: Among adult patients in the Parkland Emergency Department receiving PIV access, no significant differences in pain relief or alleviation of anxiety were found between treatment using a vapocoolant spray or placebo.