Irish medical journal
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Irish medical journal · Mar 2014
Use of lean principals to improve flow of patients with fractured neck of femur--the HOPE study.
We describe the implementation of a care pathway for patients with fractured neck of femur (NOF) using Lean and Six Sigma principles. After introduction of the Lean pathway, 32 patients out a total of 86 (37%) with fractured NOF were admitted to the Trauma Ward within 4 hours of presentation to the hospital; prior to implementation this was 16 patients out of a total of 59 (27%). ⋯ An additional 52 patients (12%) received surgery within 24 hours of admission, resulting in 1 night length of stay reduction. Lean methodology proved an effective method to guide change resulting in an improved journey for the patient and significant workflow gains.
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Irish medical journal · Mar 2014
Electronic discharge summaries--are they being done and do they have the required information?
A retrospective audit was conducted to evaluate the completeness of the available electronic discharge summaries. Forty-five randomly selected patients had their respective electronic discharge summaries reviewed including criteria such as length of stay; discharge summary availability; documentation of discharge medications; medication changes; medical co-morbidities and follow-up arrangements. ⋯ The readmission rate was found to be high when compared to published numbers with a quarter of the discharged patients being readmitted within 28 days. The recommendations resulting from this audit include the need for improved education on the requirements of the electronic dischange summary, appropriate documentation and possible implementation of out-of-hour discharge summary availability.
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Irish medical journal · Feb 2014
Comparative StudyImpact of new UK paracetamol overdose guidelines on patients presenting to the emergency department.
Paracetamol is involved in a large proportion of overdoses that present to the Emergency Department (ED), either as lone or mixed overdoses. Non-treatment of toxic levels can lead to fulminant liver failure. This study is to determine the impact the new UK treatment guidelines will have on patients presenting with paracetamol overdose. ⋯ A total of 523 patients were identified, 95 (18%) of whom had detectable paracetamol levels. 74 patients from the 95 were evaluated. 18 (24%) patients were treated with N-acetylcysteine as per the then paracetamol overdose guidelines. Using the new guidelines would have resulted in 3 more patients being admitted. Our study shows that most patients who present following paracetamol overdose do not require treatment with N-acetylcysteine and suggests that the introduction of the new UK treatment guidelines is likely to result in only a small increase in the number of patients requiring treatment.
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Irish medical journal · Oct 2013
The addition of ondansetron to a oral rehydration protocol for children with acute gastroenteritis.
This study describes the introduction of Ondansetron to an established waiting room Oral Rehydration Therapy (ORT) for Emergency Department (ED) children with acute gastroenteritis, and evaluates its impact on intravenous fluid administration and admissions. Children who failed initial ORT while waiting further medical assessment received Ondansetron and ORT reattempted. Data collected over a six week period in 2009 was compared to a similar period in 2008 when children received ORT without an anti-emetic. ⋯ Rates of IVF administration reduced by 19% [88/215 (40.9%) in 2008, 51/234 (21.7%) in 2009, p < 0.0001] with a 1.6% reduction in admission rates [31/215 (14.41%) vs 30/234(12.82%) p=0.62]. Thirty four patients received Ondansetron, 79% were successfully rehydrated orally. The addition of Ondansetron to our established ORT programme has successfully reduced rates of IVF administration and admissions in children with gastroenteritis.