Advanced emergency nursing journal
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Patients who present to the emergency department want definitive care by a health care provider who can perform an initial assessment, initiate treatment, and implement a disposition plan. The traditional "nurse triage" model often creates barriers to the process of rapidly evaluating patients. ⋯ One such approach is a rapid team triage system that provides a patient-centered process. This article describes the implementation of a rapid team triage model in an urban community hospital.
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Comparative Study
The impact of ED boarding time, severity of illness, and discharge destination on outcomes of critically ill ED patients.
This aim of this study was to determine the association between emergency department (ED) boarding time, severity of illness, and outcomes for critically ill patients. This was a prospective cohort study of ED patients who met criteria for admission to the intensive care unit (ICU). ⋯ Factors associated with increased mortality included patients who spent 6 hr or longer in the ED, had a fever, were admitted in the evening or night, or were indirect ICU admissions. Length of time spent in the ED prior to transfer to inpatient care is one of several factors associated with increased mortality in critical care patients who were intubated in the ED.
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Recognizing the adverse impact that trauma has on a patient's overall well-being and hemodynamic stability is key to successful management and improved outcomes for this patient population. It is well established that trauma is accompanied by deadly pathophysiological sequelae, referred to as the "trauma triad." This triad is characterized by hypothermia, acidosis, and coagulopathy. This triad is cyclic and, moreover, each element of the triad builds upon one another to exacerbate the next. Hence, evidence demonstrates that it is important to recognize the cycle and intervene early to reduce or prevent negative outcomes.
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Review
Body surface mapping improves diagnosis of acute myocardial infarction in the emergency department.
Traditionally, the diagnosis of acute myocardial infarction (AMI) in emergency departments is done through an assessment of history and presenting symptoms, 12-lead electrocardiogram (ECG), and cardiac biomarkers. The 12-lead ECG is not highly sensitive for detecting ECG changes, and some infarctions may be missed. Failure to identify patients in the early stages of AMI can result in failure to provide beneficial therapies. ⋯ Body surface mapping has greater sensitivity in detecting AMI in the inferoposterior portions of the left ventricle and the right ventricle. Portable hardware and user-friendly software coupled with an easily applied disposable torso vest containing the electrodes produce a 12-lead ECG, 80-lead ECG, and color contour torso or flat map showing ECG changes. Recent studies support the use of 80-lead body surface mapping for detecting AMI in the emergency department.
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Hospital emergency departments (EDs) throughout the United States are faced with overwhelming challenges due to the high demand for services, an increasing number of visits, overuse and misuse of services, and escalating healthcare costs. The result of this situation is that EDs are overcrowded, patients are experiencing long wait times, ambulances are being diverted, admitted patients are being boarded, and patients in need of emergency medical care are leaving without treatment. The purpose of this article is to present a quality improvement initiative designed and implemented to improve patient flow through an ED by redesigning the triage process to increase the efficiency and timeliness of initial patient contact with a licensed medical provider, increasing patient satisfaction, and decreasing the number of patients who leave without being seen. ⋯ The results of this initiative have proven to be positive in goal attainment. The time from patient arrival to initial contact with a licensed medical provider has decreased from 75 to 25 min. The percentage of patients who leave without being seen has decreased from 3.6% to 0.9%.