Fluent Essays

Scenario You are the Chief Information Officer (CIO) for a local health system. Your organization held its annual strategic planning session and decided that there needed to be a change in the Emergency Departments (ED) relative to the triage process at one of the facilities. The Chief Executive Officer has suggested a pilot program utilizing telemedicine to supplement its ED services. The use of telemedicine may reduce wait times at the ED and triage non-emergent needs to the appropriate level of care (i.e., urgent care or primary care). It would also allow for more resources to be deployed for ED related services, such as on-call physicians operating remotely. Instructions In your role as CIO, you will need to research the use of telehealth in the ED and its implications for the organization. Draft a memo outlining the readiness of the organization to implement the change strategy. Your memo should include: A SWOT analysis identifying internal and external forces and trends that may impact the change initiative. A discussion of the challenges facing the ED based on research into the utilization practices of the ED in your community or in a community with which you are familiar. Recommendation of the organization’s potential readiness for the change, including any actions that should be taken to increase readiness. Using the attached. Use information from your current facility (or one you are familiar with or can research) to develop a SWOT analysis. Your recommendation should be based on both your SWOT analysis and your research into ED challenges. Rubric:   Comprehensive SWOT analysis identifying internal and external forces and trends that may impact the change initiative.    Clear and thorough discussion of the challenges facing the ED based on research into the utilization practices.    Clear and thorough recommendation of the organization’s potential readiness for the change, including any actions that should be taken to increase readiness.    Memo and SWOT analysis format were very clear and appropriately formatted.Mini Review Maryam Beigom Mobasheri1, Rahim Behtar2, Sanambar Sadighi3 A B S T R A C T According to the studies the rate of emergency departments use among cancer pa- tients exceed those of general population; however, there are differences based on cancer type, initial treatments, socioeconomic status, disease stages, health insurance status and so on. Patients’ symptoms and the severity of complications are varied as well. The emergency departments are actively involved in different stages of cancer management such as primary diagnosis, ongoing treatments and end-of-life period. Cancer patients usually have more serious complications and need more specialized cares at the end of life period, during chemotherapy and surgical treatments. Under- standing the reasons for such visits could be useful in the development of dedicated interventions for preventing unnecessary emergency department visits, which is dis- cussed in this mini-review. Keywords: Cancer emergency, Emergency Department, Acute cancer representa- tions, Emergency cancer management, End-of-life care BCCR 2019; 11(2):103-107 www.bccrjournal.com Received: May 2019 Accepted: June 2019 103 Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran. Medical Emergency Department, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran. Department of Medical Oncology, Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran. Challenges with the Emergency Departments Use among Cancer Patients; a Mini Review 1. 2. 3. *Corresponding Authors: Maryam Beigom Mobasheri Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran. Tel: (+98)21 66581638 Email: [email protected] Challenges with the Emergency Departments Use... 104 www.bccrjournal.comBasic & Clinical Cancer Research, 2019; 11(2): 103-107 INTRODUCTION: The International Agency for Cancer Research (IARC) reported that 18.1 million new cancer cases and 9.6 million cancer deaths happened in 2018 based on the global cancer statistics with focusing on geographic diversity in 20 regions of the world1. The most common cancers in males were the stomach, pros- tate, colorectal, bladder, and lung cancers while breast, colorectal, stomach, thyroid cancers and leukemia were the most common cancers among females1. It reported that about 110,000 cancer cases and nearly 56,000 pa- tients died of cancer in Iran in 20182. Cancer increasingly recognized as a chronic disease rather than a fatal illness. Recently there are substantial achievements, related to the different biomarkers and predictive factors, novel molecular targeted therapeu- tics and improved imaging and surgical techniques. However, there is much work to do for patients to re- ceive ongoing high-quality care with the right special- ized expert oversight in a suitable place at the appro- prORIGINAL RESEARCH Open Access Language diversity and challenges to communication in Indian emergency departments Katherine Douglass1* , Lalit Narayan2, Rebecca Allen3,4, Jay Pandya3,5 and Zohray Talib2,6 Abstract Background: Communication in emergency departments (ED) in India is complicated by the country’s immense language diversity. Prior research has revealed challenges in language and communication as barriers to care. Our objective was to quantify language diversity among clinicians in Indian EDs and better understand issues related to clinician-clinician and clinician-patient communication. Methodology: A cross-sectional survey of ED clinicians was conducted. Survey participants were recruited in- person and through email at six partner sites in India. ANOVA and binary logistic regression were used for subgroup analysis. Semi-structured interviews were conducted with ED clinicians. Interview data was analyzed using the rapid assessment process to determine predominant themes. Results: 106 clinicians completed the survey. On average, clinicians spoke 3.75 languages. Seventy-one percent used a non-English language to speak to fellow clinicians most of the time, and 53\% reported at least one critical incident over the last year where poor communication played a part. Interviews revealed challenges including low health literacy, high patient volume, and workplace hierarchy. Conclusions: This study is the first to document the impact of language diversity and communication barriers in Indian EDs. The results highlight the need for effective strategies to improve communication between the multiple languages spoken by clinicians and patients. Keywords: Emergency Care, Communication, Language, India Background In the emergency setting, communication is essential to provide efficient and effective patient care, especially given the context of high acuity, limited availability of patient history, and high patient volumes. Prior studies indicate that communication challenges in the Emer- gency Department (ED) can have a negative impact on quality and safety of care and the patient’s subjective ex- perience [1]. An Australian emergency communication study cited that the main cause of critical incidents in their hospital system, namely adverse events that re- sulted in patient harm, was poor and inadequate com- munication between clinicians and patients [2]. Good communication is the foundation of great clinical care in the emergency department. Physician communication is positively correlated with patient adherence to treat- ment. One meta-analysis indicated that there was a 19\% increased risk of non-adherence with patients of physi- cians who communicated poorly [3]. Additionally, good clinician-patient communication in the emergency de- partment during life-threatening cardiac events has been © The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharingRESEARCH ARTICLE The challenge of involving old patients with polypharmacy in their medication during hospitalization in a medical emergency department: An ethnographic study Pia Keinicke FabriciusID 1,2*, Ove Andersen1,2,3, Karina Dahl Steffensen4,5,6, Jeanette Wassar KirkID 1,7 1 Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Copenhagen, Denmark, 2 Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark, 3 Emergency Department, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark, 4 Department of Oncology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark, 5 Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark, 6 Center for Shared Decision Making, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark, 7 Department of Public Health, Nursing, Aarhus University, Aarhus C, Denmark * [email protected] Abstract Background More than 70\% of patients admitted to emergency departments (EDs) in Denmark are older patients with multimorbidity and polypharmacy vulnerable to adverse events and poor out- comes. Research suggests that patient involvement and shared decision-making (SDM) could optimize the treatment of older patients with polypharmacy. The patients become more aware of potential outcomes and, therefore, often tend to choose less medication. However, implementing SDM in clinical practice is challenging if it does not fit into existing workflows and healthcare systems. Aim The aim was to explore the determinants of patient involvement in decisions made in the ED about the patient’s medication. Methods The design was a qualitative ethnographic study. We observed forty-eight multidisciplinary healthcare professionals in two medical EDs focusing on medication processes and patient involvement in medication. Based on field notes, we developed a semi-structured interview guide. We conducted 20 semi-structured interviews with healthcare professionals to elabo- rate on the findings. Data were analyzed with thematic analyses. Findings We found five themes (determinants) which affected patient involvement in decisions about medicine in the ED: 1) blurred roles among multidisciplinary healthcare professionals, 2) PLOS ONE PLOS ONE | https://doi.org/10.1371/journal.pone.0261525 December 30, 2021 1 / 20 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 OPEN ACCESS Citation: Fabricius PK, Andersen O, Steffensen KD, Kirk JW (2021) The challenge of involving old patients with polypharmacy in their medication during hospitalization in a medical emergency department: An ethnographic study. PLoS ONE 16(12): e0261525. https://doi.org/10.1371/journal. pone.0261525 Editor: Adam Todd, Newcastle University, UNITED KINGDOM Received: April 12, 2021 Accepted: December 3, 2021 Published: December 30, 2021 Peer Review History: PLOS recognizes the benefits of tMedical Science Pulse 2019 (13) 1© Copyright by PMWSZ w Opolue-ISSN 2544-1620 This is an open access article distributed under the terms of the Creative Commons license attribution-nonCommercial-Sharea like 4.0 International (CC bY-nC-Sa 4.0). license available: https://creativecommons.org/licenses/ by-nc-sa/4.0/ original papers DoI: 10.5604/01.3001.0013.0312 AbSTR ACT background: Population aging is one of the most important social policy and public health challenges for the state. Increased proportions of older people is accompanied with increased negative attitudes manifested toward them, as represented by ageism, the discrimination against the elderly, contributing to their exclusion from public life. Aim of the study: To study the prevalence and characteristics of ageism manifestations in healthcare institu- tions in the city of Grodno (belarus) and to consider measures to minimize it. Material and methods: 250 random urban respondents from Grodno age 60 or more not undergoing treated in healthcare institutions were anonymously questioned. Data analysis was performed using different statis- tical methods. Results: The majority of respondents rated geriatric, social and medical care in the country as functioning at a high level. The share of elderly people who felt age discrimination was 70 (28.0\%) and was independent from the gender and age of the respondents. Clinical departments were mentioned by 24 (34.3\%) of respondents as places where manifestations of ageism were seen, particularly in emergency rooms – 14 (20.0\%) and family doc- tor offices– 17 (24.3\%). In 35 (50\%) of cases, the family doctor explained the symptoms of the disease by the onset of old age, which can be regarded as a manifestation of ageism. Conclusions: Training in the field of geriatrics is very important for medical professionals. failure to take meas- ures to ensure a holistic (integrated) approach in the treatment and care of elderly must be considered discrim- inatory. Particular measures should be taken to develop all types of care for the elderly, increasing the level of patient satisfaction with medical services and reducing the frequency of gerontological ageism manifestations. KEyWORDS: healthcare sector, discrimination, ageism PoPulaTIon aGInG IS one of The MoST IMPoRTanT ChallenGeS faCInG SoCIal PolICY anD PublIC healTh andrei Shpakou1,3 a–C,e,f • ORCID: 0000-0003-4340-5211 aliaksandr Shpakau1,3 a,D,e,f • ORCID: 0000-0001-5260-6547 aleh Kuzniatsou2,3 D–f • ORCID: 0000-0002-1348-8688 1 Department of Sport Medicine and Rehabilitation Yanka Kupala State university of Grodno, Grodno, belarus 2 Department of Clinical laboratory Diagnostics and Immunology, Grodno State Medical university, belarus 3 university of Medical Science in bialystok, Poland A – study design, b – data collection, C – statistical analysis, D – interpretation of data, E – manuscript preparation, F – literature review, G – sourcing of funding background The aginRESEARCH Open Access Does Case Management Provide Support for Staff Facing Frequent Users of Emergency Departments? A Comparative Mixed-Method Evaluation of ED Staff Perception Michael von Allmen1*, Véronique S. Grazioli1, Miriam Kasztura1, Oriane Chastonay1, Joanna C. Moullin2, Olivier Hugli3, Jean-Bernard Daeppen4 and Patrick Bodenmann1 Abstract Objective: Frequent users of emergency departments (FUED) account for a disproportionate number of emergency department (ED) visits and contribute to a wide range of challenges for ED staff. While several research has documented that case management (CM) tailored to FUED leads to a reduction in ED visits and a better quality of life (QoL) among FUED, whether there is added value for ED staff remains to be explored. This study aimed to compare, among staff in two academic EDs in Switzerland (one with and one without CM), the FUED-related knowledge, perceptions of the extent of the FUED issue, FUED-related work challenges and FUEDs’ legitimacy to use ED. Method: Mixed methods were employed. First, ED physicians and nurses (N = 253) of the two EDs completed an online survey assessing their knowledge and perceptions of FUEDs. Results between healthcare providers working in an ED with CM to those working in an ED without CM were compared using independent two-sided T-tests. Next, a sample of participants (n = 16) took part in a qualitative assessment via one-to-one interviews (n = 6) or focus groups (n = 10). Results: Both quantitative and qualitative results documented that the FUED-related knowledge, the extent FUED were perceived as an issue and perceived FUEDs’ legitimacy to use ED were not different between groups. The level of perceived FUED-related challenges was also similar between groups. Quantitative results showed that nurses with CM experienced more challenges related to FUED. Qualitative exploration revealed that lack of psychiatric staff within the emergency team and lack of communication between ED staff and CM team were some of the explanations behind these counterintuitive findings. © The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the articles Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the articles Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication RESEARCH ARTICLE Open Access Interdisciplinary clinical debriefing in the emergency department: an observational study of learning topics and outcomes Andrew Coggins* , Aaron De Los Santos, Ramez Zaklama and Margaret Murphy Abstract Background: Defined as a ‘guided reflective learning conversation’, ‘debriefing’ is most often undertaken in small groups following healthcare simulation training. Clinical debriefing (CD) following experiences in the working environment has the potential to enhance learning and improve performance. Methods: Prior to the study, a literature review was completed resulting in a standardised approach to CD that was used for training faculty. A pilot study of CD (n = 10) was then performed to derive a list of discussion topics and optimise the faculty training. The resulting debriefing approach was based on the “S.T.O.P.” structure (Summarise the case; Things that went well; Opportunities for improvement; Points of action). A debriefing aid, with suggested scripting, was provided. A subsequent observational study assessed CD within 1-h of clinical events. ‘Significantly distressing’ or ‘violent’ events were excluded. Data was collected on participant characteristics, discussion topics, and team recommendations. Study forms were non-identifiable. Subsequent analysis was performed by two investigators using content analysis of the debriefing forms (n = 71). Discussion topics (learning points) were coded using a modified version of the Promoting Excellence and Reflective Learning in Simulation (PEARLS) framework. One month after completion of the study, ED management staff were surveyed for reports of “harm” as the result of CD. Results: During the study period, 71 CDs were recorded with a total of 506 participants. Mean debriefing length was 10.93 min (SD 5.6). Mean attendance was 7.13 (SD 3.3) participants. CD topics discussed were divided into ‘plus’ (well-done) and ‘delta’ (need to improve) groupings. 232 plus domains were recorded of which 195 (84.1\%) aligned with the PEARLS debriefing framework, suggesting simulation debriefing skills may be translatable to a clinical setting. Topics discussed outside the PEARLS framework included family issues, patient outcome and environmental factors. CD reports led to preventative interventions for equipment problems and to changes in existing protocols. There were no recorded incidents of participant harm resulting from CD. Conclusions: Topics discussed in CD predominantly aligned to those commonly observed in simulation-based medical education. Collective recommendations from CD can be used as evidence for improving existing protocols and models of care. Keywords: Debriefing, Professional education, Training programs, Quality improvement © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give CLINICAL RESEARCH REPORT Supplementary material is available with the full text of this article at AJHP online. Address correspondence to Dr. O’Neal ([email protected]). © American Society of Health-System Pharmacists 2019. All rights reserved. For permissions, please e-mail: journals. [email protected] DOI 10.1093/ajhp/zxz193 Fredrick O’Neal, Pharm.D., BCPS, Clinical Services Group, HCA Healthcare Nashville, and University of Tennessee College of Pharmacy, Nashville, TN. Joan Kramer, Pharm.D., BCPS, Clinical Services Group, HCA Healthcare Nashville, Nashville,TN. Mandelin Cooper, Pharm.D., BCPS, Clinical Services Group, HCA Healthcare Nashville, Nashville, TN. Edward Septimus, M.D., Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. Sanya Sharma, M.P.H., Clinical Services Group, HCA Healthcare Nashville, Nashville, TN. L. Hayley Burgess, Pharm.D., BCPP, Clinical Services Group, HCA Healthcare Nashville, Nashville, TN. Purpose. To assess antibiotic selection, administration, and prescribing practices in emergency departments across a large hospital system using evidence-based practices and susceptibility patterns. Methods. This retrospective data review was conducted using health system–level electronic data compiled from 145 emergency departments (EDs) across the United States. Data were examined for national general- izability, most common diagnoses of infectious origin seen in nonadmitted patients in the ED, most commonly administered antibiotics in the ED, and geographically defined areas’ unique patterns of antibiotic resistance and susceptibility. Results. More than 627,000 unique patient encounters and 780,000 anti- biotic administrations were assessed for trends in patient demographics, antibiotics administered for a diagnosis of infectious origin, and correspond- ing susceptibility patterns. Results indicated that practices in the EDs of this health system aligned with evidence-based practices for streptococcal phar- yngitis, otitis media, cellulitis, and uncomplicated urinary tract infections. Conclusion. These results provide a representative sample of the cur- rent state of practices within many EDs across the United States for nonadmitted patients. A similar data reconstruction can be completed by other health systems to assess their prescribing practices in the ED to improve and elevate care for patients visiting the emergency room and treated as outpatients. Keywords: antibiotic use, antimicrobial, emergency department, health system, pharmacist, stewardship Am J Health-Syst Pharm. 2019; 76:1753-1761 Overuse and misuse of antibiotics have caused a surge in antibiotic- resistant bacteria.1–5 The Centers for Disease Control and Prevention and World Health Organization have made efforts to develop updates, action plans, and initiatives with the intention of com- batting the growing antibiotic resistance crisis.6,7 The