A Quantification of the Impact of Awaiting Results of a Urinalysis upon Emergency Department Length of Stay.

BACKGROUND: Despite the popular conception that ordering a urinalysis causes a significant increase in emergency department (ED) length of stay (LOS), there is little research on its actual impact. OBJECTIVES: This study investigated the quantitative impact of obtaining the results of a urinalysis, compared with the quantitative impact of obtaining the results of any laboratory testing of blood ("blood testing"), upon ED LOS in the National Hospital Ambulatory Medical Care Survey-Emergency Department (NHAMCS-ED) dataset. METHODS: The NHAMCS-ED dataset was queried from 2006-2015, comparing LOS in visits where urinalysis was ordered, blood testing was ordered, both were ordered, or neither. RESULTS: There were 1,232,279,000 ED visits with LOS data found in the study period. Urinalysis was performed in 24.2% of visits, blood testing in 36.7%, both in 18.2%, and none in 57.4%. Median LOS was 153 min. No blood or urine testing had a median LOS of 109, urinalysis only 161 min, blood testing only 221 min, and both, 250 min. CONCLUSION: Urinalysis does increase LOS, but blood testing increases it more, with additive effects when both are ordered.

Emergency Physicians Who Produce Higher Relative Value Units Per Hour Spend Similar Amounts of Time at Patient Bedsides as Their Colleagues.

BACKGROUND: Emergency physicians (EPs) are expected to deliver quality care while maintaining high levels of efficiency and productivity as measured by the relative value unit (RVU). OBJECTIVES: We sought to determine whether academic EPs with higher RVUs spend less time at the bedside than their colleagues. METHODS: This was a prospective, observational, cohort study. A 13-item task list was generated, pilot-tested, and placed onto a computerized tablet. RESULTS: There was no difference among EPs in terms of time spent at bedside, 26.7% of total time, 17.31 min (95% confidence interval [CI] 14.43-20.19), p = 0.052; resident interaction 13.1%, 8.46 min (95% CI 4.68-12.25), p = 0.959; charting, 11.1%, 7.17 min (95% CI .746-5.65), p = 0.055; information search, 10.5%, 6.80 min (95% CI 0.84-8.52), p = 0.320; walking, 9.0%, 5.86 min (95% CI 5.17-6.54), p = 0.112; consultant interaction, 8.2%, 5.28 min (95% CI 3.18-7.40), p = 0.404; writing orders, 6.5%, 4.19 min (95% CI 3.22-5.15), p = 0.109; nursing interaction, 5.6%, 3.65 min (95% CI 2.54-4.76), p = 0.260; other, 5.2%, 3.65 min (95% CI 1.76-5.02), p = 0.785; medical student interaction, 4.2%, 2.75 min (95% CI 0.53-4.97), p = 0.102; physician assistant interaction, 2.8%, 1.79 min (95% CI 1.08-2.50), p = 0.959; clerical interaction, 1.7%, 1.13 min (95% CI .69-1.57), p = 0.335; and electrocardiogram interpretation, 0.7%, 0.45 min (95% CI .32-.58), p = 0.793. CONCLUSIONS: Despite differences in RVU-based productivity data, academic EPs spend similar amounts of time involved in the daily tasks of taking care of patients, underscoring that direct physician-patient interaction is one practice parameter that is not compromised among these EPs.

A single ventilator for multiple simulated patients to meet disaster surge.

OBJECTIVES: To determine if a ventilator available in an emergency department could quickly be modified to provide ventilation for four adults simultaneously. METHODS: Using lung simulators, readily available plastic tubing, and ventilators (840 Series Ventilator; Puritan-Bennett), human lung simulators were added in parallel until the ventilator was ventilating the equivalent of four adults. Data collected included peak pressure, positive end-expiratory pressure, total tidal volume, and total minute ventilation. Any obvious asymmetry in the delivery of gas to the lung simulators was also documented. The ventilator was run for almost 12 consecutive hours (5.5 hours of pressure control and more than six hours of volume control). RESULTS: Using readily available plastic tubing set up to minimize dead space volume, the four lung simulators were easily ventilated for 12 hours using one ventilator. In pressure control (set at 25 mm H2O), the mean tidal volume was 1,884 mL (approximately 471 mL/lung simulator) with an average minute ventilation of 30.2 L/min (or 7.5 L/min/lung simulator). In volume control (set at 2 L), the mean peak pressure was 28 cm H2O and the minute ventilation was 32.5 L/min total (8.1 L/min/lung simulator). CONCLUSIONS: A single ventilator may be quickly modified to ventilate four simulated adults for a limited time. The volumes delivered in this simulation should be able to sustain four 70-kg individuals. While further study is necessary, this pilot study suggests significant potential for the expanded use of a single ventilator during cases of disaster surge involving multiple casualties with respiratory failure.