The American journal of emergency medicine
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80 % of Americans wish to die somewhere other than a hospital, and hospice is an essential resource for providing such care. The emergency department (ED) is an important location for identifying patients with end-of-life care needs and providing access to hospice. The objective of this study was to analyze a quality improvement (QI) program designed to increase the number of patients referred directly to hospice from the ED, without the need for an observation stay and without access to in-hospital hospice. ⋯ In this largest study to date on direct ED-to-hospice discharges, a QI program focused on workflow optimization, education, and EMR modification was insufficient to significantly impact ED-to-hospice discharges. Future efforts to increase hospice transitions from the ED should investigate methods to improve patient identification, the impact of in-hospital hospice programs, and coordination with hospital and community teams to support home-based care for those desiring to remain there.
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To determine the predictive value of brain natriuretic peptide (BNP) levels for 30-day mortality after return of spontaneous circulation (ROSC) in patients with cardiac arrest (CA) of presumed cardiac etiology. ⋯ BNP level was a predictive factor for 30-day mortality after ROSC in patients with CA of presumed cardiac etiology who regained ROSC. The nomogram model included BNP may provide a reference for predicting 30-day mortality.
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According to the guidelines of the American Heart Association and American College of Emergency Physicians, respectively, there is no indication for immediate lowering of asymptomatic hypertension in the Emergency Department (ED), and no requirement for routine diagnostic testing in these patients. Despite this, asymptomatic hypertension represents a recurring source of referrals for ED evaluation from other healthcare settings, or from patient self-referral, with significant practice variation in the evaluation and treatment of this complaint. ⋯ Our findings redemonstrate that patients presenting to the ED with asymptomatic hypertension are at low risk for short-term complications of hypertension, and that diagnostic testing is low yield in this population. While we were able to achieve reductions in unnecessary testing, further work is needed to educate clinicians and improve adherence to evidence based principles when caring for these patients.
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Opioid overdoses have increased at a concerning rate in recent years. Middle-aged individuals have been reported as an age group of high concern for opioid overdoses. The purpose of this study was to assess trends in opioid overdose 911 dispatches between Q1 2018 and Q3 2023 among different age groups. It was hypothesized that the steepest increase in dispatches would be among middle-aged individuals. ⋯ Middle-aged individuals experienced significant increases in opioid-related 911 dispatches between Q1 2018 and Q2 2021, and had the steepest increase compared to the other age groups. Conversely, younger-aged individuals have experienced a recent decrease in dispatches. These findings support previous indications that middle-aged individuals are at significant risk for opioid overdose. Additional research is necessary to identify geographic and demographic factors that may affect these trends.