INTRODUCTION:Emergency department visits can vary greatly in level of acuity and range of intervention required. High-acuity patients require rapid intervention using life-saving measures. In these moments, it is essential for medical teams to be well prepared. The literature suggests that assigned roles in a resuscitation are essential to outcomes. METHODS:This process improvement work was conducted in a pediatric emergency department in the western United States. This department sees an average of roughly 99 patients per day. Role designation, role clarity, and an understanding of role specifics during resuscitation and/or critical care events in this emergency department were lacking. Double-sided badge cards were created, notating each role name on the front of the badges and listing each respective role's responsibilities on the back. A pre- and post-intervention observation study was performed to measure team members understanding of roles and the assigning of roles. RESULTS:Resuscitation roles used and clearly defined increased from 17% to 76% (P = .000). Team members also noted that the responsibilities assigned to each role had a knowledge increase from 60% to 100% (P = .000). DISCUSSION:Having clearly defined roles and associated responsibilities during in-hospital resuscitation events is an essential component to ensure effective patient care. Having roles that are clearly defined and understood by team members promotes positive communication, confidence in skill, and situational crowd control.
INTRODUCTION:Emergency departments are high-stress clinical environments where health care workers are exposed to unpredictable patient acuity, trauma, workplace violence, and rapid decision making. Animal-assisted interventions have demonstrated benefits for patients, with emerging evidence suggesting potential value for reducing health care worker stress and improving emotional well-being. However, objective physiological outcomes and emergency department-specific data remain limited. METHODS:This descriptive, interventional study examined the association between therapy dog visits and perceived and physiological stress among emergency department health care workers. Patient- and nonpatient-facing staff completed measures of salivary cortisol, perceived stress, and blood pressure immediately before and after dog interactions. Participants also provided qualitative descriptions of their feelings pre- and postintervention. RESULTS:A total of 76 staff members participated, accounting for 100 therapy dog interactions. Overall, pre- to postintervention changes in salivary cortisol were not statistically significant. Perceived stress decreased significantly for all participants (P < .001), and mean arterial pressure decreased at the α = 0.10 level. Qualitative findings revealed a shift from negative emotional states (stressed and overwhelmed) before dog visits to more positive emotions (calmer, happier, and reenergized) afterward. DISCUSSION:Results of this study suggest that therapy dog visits were associated with lower perceived stress and were well received by staff. Pet therapy may be considered as 1 component of broader organizational strategies to support health care workers in high-stress clinical environments. Therapy dog programs may represent a feasible, low-cost approach for promoting a supportive healing environment.
INTRODUCTION:Vehicle extrication is a critical prehospital phase for patients trapped in motor vehicle collisions. Historically driven by rigid technical protocols, recent evidence suggests a shift toward clinically oriented, multidisciplinary decision-making. This scoping review aims to synthesize current evidence on extrication frameworks and their impact on clinical care. METHODS:A scoping review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Major databases were searched for studies describing decision-making frameworks, algorithms, or clinical pathways for the extrication of trapped trauma patients. RESULTS:Eleven key studies and frameworks were identified. Findings suggest an emerging transition from routine spinal immobilization to selective Spinal Motion Restriction. Biomechanical studies included in the review reported lower spinal movement during guided self-extrication in selected stable scenarios, although this evidence is mainly derived from experimental or simulation-based settings. Contemporary frameworks emphasize the roles of physiological and anatomical assessment, multidisciplinary coordination, and shared decision-making between clinical and technical rescue teams. Emerging themes include mitigating hypothermia risk and managing psychological sequelae following entrapment. DISCUSSION:Extrication is evolving into a dynamic clinical intervention. Transitioning to evidence-based pathways requires integrating clinical triage, selective spinal motion restriction, and thermal protection. For emergency nurses, this implies a leadership role in field triage and patient advocacy, ensuring that technical procedures do not compromise clinical outcomes. Implementing patient-centered extrication frameworks may contribute to reducing scene times and secondary morbidity, although further prospective validation is required. Future research should focus on prospectively validating these algorithms in real-world trauma settings to confirm their impact on long-term survival.
INTRODUCTION:Emergency department crowding contributes to adverse patient outcomes and resource strain. Home Hospital, which delivers hospital-level care in a patient's home, can reduce inpatient volume while maintaining quality and safety. Although Home Hospital programs offer a viable solution to these systemic pressures, a recognized gap exists between program availability and actual use by emergency department providers. METHODS:This quality improvement project used 3 sequential Plan-Do-Study-Act cycles: (1) a self-paced online learning module on eligibility and referral workflow; (2) point-of-care visual aids at provider workstations; and (3) integration of standardized referral guidance into the emergency department provider manual for sustainability, along with referral data sharing and a QR code link for feedback. The primary outcomes included the proportion of Home Hospital referrals originating in the emergency department and provider confidence with eligibility and referral steps, measured pre- and postintervention using the Home Hospital Clinician Perception Survey and electronic medical record data. RESULTS:During the 3 months before the intervention, 5 of 259 referrals (1.9%) originated in the emergency department. Following the intervention, emergency department--initiated referrals increased significantly to 47 of 266 (17.7%; P < .001), with an odds ratio of 10.9. Provider confidence in identifying eligible patients increased from 41% to 94%, and confidence in completing the referral process increased from 41% to 84%. Provider engagement was high; participation rates reached 94% for the online module and 82% for the visual aids. DISCUSSION:Embedding a low-cost, multi-component strategy into existing workflows was associated with an increase in emergency department--initiated Home Hospital referrals and an increase in provider confidence. This approach is scalable and supports timely, patient-centered alternatives to hospital admission.
INTRODUCTION:Patients with non-English language preference and English-speaking patients may have different critical care outcomes. It is important to examine how both patient groups compare in critical care admissions via the emergency department because patients with non-English language preference can be frequent users of emergency department services. The objective of this study was to examine the association between non-English language preference status and intensive care unit admissions via the emergency department. METHODS:This study included hospitalized patients between January 1, 2018, and December 31, 2022, at a large multi-specialty health care organization in the United States Midwest. We used propensity score matching to ensure that patients with non-English language preference and English-speaking patients were comparable across observed characteristics. This study examined the probability of intensive care unit admissions from the emergency department as the primary outcome using logistic regression and examined intensive care unit and hospital length of stay as secondary outcomes using negative binomial models for patients with non-English language preference and English-speaking patients. RESULTS:Patients with non-English language preference had 99% higher odds of being admitted to the intensive care unit via the emergency department compared with similar English-speaking patients (odds ratio = 1.986; 95% CI, 1.627-2.424; P < .001). There were no statistically significant differences between the 2 groups in intensive care unit length of stay and hospital length of stay among the patients who were admitted to the intensive care unit via the emergency department directly. CONCLUSION:There were differences in how patients with non-English language preference were admitted to the intensive care unit via the emergency department. The results from this study can be used to inform initiatives aimed at improving access to care for patients with non-English language preference.
INTRODUCTION:Research has demonstrated that night shift nursing and ancillary hospital staff face challenges ranging from sleep disorders to increased medication errors. Night shift work in the emergency department can pose unique wellness barriers worth exploring, given the patient population and the demanding, high-risk setting. METHODS:This qualitative descriptive study was conducted via online focus groups in the emergency department of a 355-bed teaching hospital. A total of 18 night-shift staff from clinical and nonclinical roles participated. A reflexive thematic analysis framework was used for coding and theme development. Data saturation was achieved by conducting additional focus groups, and credibility was ensured through reflexive journaling, member checking, deep immersion in the data, and triangulation across separate focus group meetings. RESULTS:Seven themes emerged: "Sleep as a balancing act," "Night shift workers want a life, too," "Night shift work impacts health," "Impaired professional effectiveness," "Fewer hands make for heavy work, which makes for fewer hands," "Organizational structures and schedules burden night shift," and "Shift vs shift (night shift problems)." The individual barriers were described as influencing and exacerbating one another. DISCUSSION:Participants identified both personal and work barriers as important to their wellness. Consistent with previous research, sleep, health, and social concerns were priorities. In the current study, participants also identified impaired professional effectiveness as both a measure of and a barrier to their wellness. Understanding these challenges and their impact on staff could inform interventions to improve the quality of life on the night shift.
INTRODUCTION:Despite rising overdose mortality nationwide, racial and ethnic disparities in naloxone access persist. This study examined whether these disparities remained after adjusting for demographic and clinical risk factors, including an electronic health record-based Clinical Decision Support alert, within an emergency department setting. METHODS:A retrospective cross-sectional study of 10,313 emergency department encounters was conducted over a 2-year period. Multivariable logistic regression was used to assess the association between race or ethnicity and naloxone distribution during the emergency department encounter. The model adjusted for age, illness severity, nursing-documented intravenous drug use risk, and daily morphine milligram equivalents. RESULTS:Documented intravenous drug use risk emerged as the strongest predictor, with patients with this risk having significantly higher odds of naloxone distribution (odds ratio, 1.84; 95% confidence interval [CI], 1.67-2.03). Clinical Decision Support alert activation was also associated with increased odds of distribution (odds ratio, 1.14; 95% CI, 1.04-1.25), indicating that the alert contributed modestly when activated. Minor racial and ethnic differences were observed. Black/African American patients had higher odds of naloxone distribution compared with white patients (odds ratio, 1.08; 95% CI, 0.90-1.30). In contrast, increasing age (odds ratio, 0.99; 95% CI, 0.99-0.99) and higher Emergency Severity Index scores (odds ratio, 0.82; 95% CI, 0.77-0.88) were associated with reduced odds of naloxone distribution. DISCUSSION:Integrated Clinical Decision Support may promote more consistent naloxone distribution, though this study could not determine whether the observed patterns reflected equitable access or other clinical and contextual influences. Strengthening early medication reconciliation and embedding reliable risk indicators into triage workflows may improve the reliability of Clinical Decision Support reliability.
Introduction Arterial blood gas analysis is a fundamental diagnostic procedure for evaluating respiratory function, yet patients frequently perceive it as 1 of the most painful techniques. Although major scientific societies and clinical practice guidelines recommend the subcutaneous infiltration of local anesthesia before puncture, its implementation remains limited. This study aimed to explore the prevalence of local anesthetic use before arterial puncture and nurses’ attitudes around the use of preprocedure local anesthetic across 3 hospital units. Methods A descriptive cross-sectional study was conducted between January and May 2023. Nurses providing direct patient care in respiratory outpatient clinics, respiratory inpatient wards, and the emergency department were invited to participate. Data were collected through an anonymous self-administered questionnaire including sociodemographic and occupational variables, as well as attitudes and perceptions regarding arterial puncture. Descriptive statistics and nonparametric tests were performed using R version 3.6.3. Results The sample comprised 102 professionals, predominantly female, with a median age of 36 years. Only 5.9% reported routinely using local anesthesia, and 11.8% considered its use necessary. The main reasons for nonuse were the belief that it provided no real benefit and the lack of routine implementation in their unit. Significant associations were observed between clinical unit, previous training, and anesthetic use, with outpatient clinics showing the highest adherence. Discussion The findings reveal a persistent gap between evidence-based recommendations and current practice. These results underscore the need for institutional measures, standardized protocols, and specific training to integrate pain management as an essential component of quality, person-centered care.
