Annals of emergency medicine
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Multicenter Study Comparative Study
Assessing hospital disaster preparedness: a comparison of an on-site survey, directly observed drill performance, and video analysis of teamwork.
There is currently no validated method for assessing hospital disaster preparedness. We determine the degree of correlation between the results of 3 methods for assessing hospital disaster preparedness: administration of an on-site survey, drill observation using a structured evaluation tool, and video analysis of team performance in the hospital incident command center. ⋯ The disparate results obtained from the 3 methods suggest that each measures distinct aspects of disaster preparedness, and perhaps no single method adequately characterizes overall hospital preparedness.
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WHAT IS ALREADY KNOWN ON THIS TOPIC: Application of continuous positive airway pressure (CPAP) for patients with acute respiratory distress reduces the need for tracheal intubation and mechanical ventilation. Case series have demonstrated CPAP's feasibility in out-of-hospital settings. ⋯ WHAT THIS STUDY ADDS TO OUR KNOWLEDGE: Within the CPAP group, the rate of intubation was 30% less than the usual care group, and mortality was 20% lower. HOW THIS MIGHT CHANGE CLINICAL PRACTICE: Emergency medical services systems and their medical directors should consider making CPAP available as part of the treatment for out-of-hospital severe respiratory distress patients, particularly in systems with long transport times.
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Multicenter Study
Assessment of the reliability of the Johns Hopkins/Agency for Healthcare Research and Quality hospital disaster drill evaluation tool.
The Joint Commission requires hospitals to implement 2 disaster drills per year to test the response phase of their emergency management plans. Despite this requirement, there is no direct evidence that such drills improve disaster response. Furthermore, there is no generally accepted, validated tool to evaluate hospital performance during disaster drills. We characterize the internal and interrater reliability of a hospital disaster drill performance evaluation tool developed by the Johns Hopkins University Evidence-based Practice Center, under contract from the Agency for Healthcare Research and Quality (AHRQ). ⋯ We found a high degree of internal reliability in the AHRQ instrument's items, suggesting the underlying construct of hospital preparedness is valid. Conversely, we found substantial variability in interrater reliability, suggesting that the instrument needs revision or substantial user training, as well as verification of interrater reliability in a particular setting before use.
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Multicenter Study
Physician clinical impression does not rule out spontaneous bacterial peritonitis in patients undergoing emergency department paracentesis.
We determine whether clinical characteristics and physician assessment are useful in the exclusion of spontaneous bacterial peritonitis in emergency department (ED) patients with ascites requiring paracentesis. ⋯ Clinical characteristics and physician assessment were insufficient in the diagnosis or exclusion of spontaneous bacterial peritonitis in the ED patient undergoing diagnostic or therapeutic paracentesis. This finding supports routine laboratory fluid analysis after ED paracentesis.