Comparing quantitative outcomes of synchronous online versus in-person interprofessional symposium.

Healthcare and educational practices changed due to COVID-19. Interprofessional education (IPE) events during the pandemic were canceled or presented through online platforms. Fortunately, IPE using online platforms had been growing during the decade prior to the pandemic. However, few publications document quantitative outcomes of online IPE, and most report qualitative outcomes of student reactions. The purpose of this study was to determine if student outcomes from an online IPE symposium were similar to the positive outcomes from prior in-person IPE symposia. A Community of Inquiry (CoI) model within a synchronous Zoom platform was developed with intentional design supporting cognitive, instructional, and social presence; interprofessional socialisation; and collaboration. Utilising a standardised instrument, student attitudes about healthcare teams were assessed comparing pretest and posttest. Students who participated in the online IPE displayed similar improvements in attitudes towards interprofessional teams at posttest. Hence, this study supports the use of a brief, synchronous, online IPE symposium.

Termination of paroxysmal supraventricular tachycardia by intranasal swab insertion.

Paroxysmal supraventricular tachycardia (SVT) is a common emergency department presentation. Vagal maneuvers are commonly tried to terminate SVT but are often unsuccessful in terminating the dysrhythmia. The use of adenosine, while often successful, is associated with a number of side effects and is often disliked by patients with recurrent episodes of SVT. We report on a 44-year-old woman with a past medical history of SVT who presented to the emergency department (ED) due to a recurrence of her SVT. The patient had no intravenous access and preferred not to receive adenosine. The patient received intranasal stimulation with a nasopharyngeal swab used for COVID-19 testing for 5-10 s. After less than 10 s, the patient converted to a sinus rhythm. She was successfully discharged from the ED after 1 h of observation and no recurrence of her SVT.

Longitudinal outcomes of a brief interprofessional educational experience with or without an interprofessional education course.

Best practices for delivering interprofessional education (IPE) continue to be debated. The objective of this study was to compare the longitudinal effects of two different methods of delivering IPE: a one-day IPE symposium (Symposium Only) vs. a one-day symposium plus a semester-long IPE course (Symposium + IPE). 40 Health Services Administration (HSA) and 57 Occupational Therapy (OT) students participated in this study. Participant attitudes in the Symposium Only group were compared to participant attitudes in the Symposium + IPE group using the Attitudes toward Health Care Teams Scale (ATHCTS). Participants completed the survey prior to the symposium (Time 1), immediately after the symposium (Time 2), and at least 18 months after the symposium (Time 3). A series of one-way repeated measures ANOVAs indicated that students in either the Symposium Only or Symposium +IPE group showed significantly better attitudes toward interprofessional teamwork at Time 2, and that these attitudes were maintained at Time 3. This was true for total ATHCTS, the Physician Centrality subscale, and Quality of Care/Process subscale. While the addition of the semester-long IPE course negatively impacted attitudes toward interprofessional teamwork in the short-term (at Time 2), it had no negative long-term impact at Time 3. Long-term, it appears that adding a semester-long course to a one-day symposium had no impact on attitude toward interprofessional teamwork.

Emergency department evaluation of patients with angiotensin converting enzyme inhibitor associated angioedema.

INTRODUCTION: Angiotensin converting enzyme inhibitor (ACEi) associated angioedema is frequently encountered in the emergency department. Airway management is the primary treatment, but published evidence supporting the decision to intubate patients with this condition is extremely limited. METHOD: We performed a retrospective study of all cases of ACEi associated angioedema encountered in a large, urban, tertiary referral emergency department. We classified demographics, duration of symptoms before presentation, physical exam findings and nasopharyngoscopy findings in patients that did and did not require intubation. RESULTS: We identified a total of 190 separate encounters from 183 unique patients who presented during the 3-year period of the study. Eighteen (9.5%) of these patients required intubation. Patients requiring intubation were more likely to present within 6 h of the onset of angioedema symptoms. Anterior tongue swelling, vocal changes, drooling, and dyspnea were significantly more common in patients requiring intubation. Isolated lip swelling was present in 54% of all patients and was the only finding significantly more common in the group that did not require intubation. CONCLUSIONS: Rapid progression of symptoms within the first 6 h of angioedema onset, anterior tongue swelling, vocal changes, drooling and dyspnea are associated with intubation for ACEi associated angioedema. Isolated lip swelling is significantly more common in patients that do not require intubation. Our data provide risk stratification guidance for providers treating patients with suspected ACEi associated angioedema in the emergency department.

Characteristics and Trends of Emergency Department Visits in the United States (2010-2014).

BACKGROUND: It is important that policy makers, health administrators, and emergency physicians have up-to-date statistics on the most common diagnoses of patients seen in the emergency department (ED). OBJECTIVES: We sought to describe the changes that occurred in ED visits from 2010 through 2014 and to describe the frequency of different ED diagnoses. METHODS: This is a retrospective analysis of ED visit data from the National Emergency Department Sample from 2010 through 2014. Visits were stratified by age, sex, insurance status, disposition, diagnosis, and diagnostic category. We calculated the total annual ED visits and the ED visit rates by diagnoses and diagnostic categories. RESULTS: Between 2010 and 2014, the number of U.S. ED visits increased from 128.9 million to 137.8 million. The rate of ED Visits per 1000 persons increased from 416.92 (95% confidence interval [CI] 399.47-434.37) in 2010 to 432.51 (95% CI 411.51-453.61) in 2014 (p = 0.0136). ED visits grew twice as quickly (1.7%) as the overall population (0.7%). The most common reason for an ED visit was abdominal pain (11.75% [95% CI 11.61-11.89]). This was followed by mental health problems (4.45% [95% CI 4.19-4.72]). CONCLUSION: The number of ED visits in the United States continues to increase faster than the rate of population growth. Abdominal problems and mental health issues, including substance abuse, were the most common reasons for an ED visit in 2014.

Emergency Physicians' Perception of Barriers and Facilitators for Adopting an Opioid Prescribing Guideline in Ohio: A Qualitative Interview Study.

BACKGROUND: Ohio has the fifth highest rate of prescription opioid overdose deaths in the United States. One strategy implemented to address this concern is a state-wide opioid prescribing guideline in the emergency department (ED). OBJECTIVE: Our aim was to explore emergency physicians' perceptions on barriers and strategies for the Ohio ED opioid prescribing guideline. METHODS: Semi-structured interviews with emergency physicians in Ohio were conducted from October to December 2016. Emergency physicians were recruited through the American College of Emergency Physicians Ohio State Chapter. The interview guide explored issues related to the implementation of the guidelines. Interview data were transcribed and thematically analyzed and coded using a scheme of inductively determined labels. RESULTS: In total, we conducted 20 interviews. Of these, 11 were also the ED medical director at their institution. Main themes we identified were: 1) increased organizational responsibility, 2) improved prescription drug monitoring program (PDMP) integration, 3) concerns regarding patient satisfaction scores, and 4) increased patient involvement. In addition, some physicians wanted the guidelines to contain more clinical information and be worded more strongly against opioid prescribing. Emergency physicians felt patient satisfaction scores were perceived to negatively impact opioid prescribing guidelines, as they may encourage physicians to prescribe opioids. Furthermore, some participants reported that this is compounded if the emergency physicians' income was linked to their patient satisfaction score. CONCLUSIONS: Emergency physicians interviewed generally supported the state-wide opioid prescribing guideline but felt hospitals needed to take additional organizational responsibility for addressing inappropriate opioid prescribing.

Prospective study of the sensitivity of the Wood's lamp for common eye abnormalities.

OBJECTIVE: The Wood's lamp, a handheld instrument that uses long-wave ultraviolet (UV) light with magnification of 2-3 times, is commonly used by non-ophthalmologists for examining patients with eye complaints. The goal of current research was to determine the sensitivity and specificity of the Wood's lamp for common eye abnormalities. STUDY DESIGN: We examined a convenience sample of patients, 18 years of age and older, who presented for eye complaints to an urgent clinic of a large ophthalmology practice. This prospective observational trial was performed from December 2016 until July 2017. An ophthalmologist examined the patient's eyes with a Wood's lamp, followed by examination of the eyes using a slit lamp. The Wood's lamp was compared with the slit lamp, which served as the gold standard. RESULTS: There were 73 patients recruited. The mean age of study subjects (29 female and 44 male) was 49 years. The overall sensitivity of the Wood's lamp was 52% (38/73; 95% CI 40% to 64%). Based on the principal final diagnosis made with the slit lamp, the Wood's lamp only detected 9 of 16 corneal abrasions, 5 of 10 corneal ulcers, 5 of 9 corneal foreign bodies, 0 of 4 cases of non-herpetic keratitis, 1 of 2 cases of herpes keratitis, 1 of 5 rust rings and 18 of 28 other diagnoses. CONCLUSIONS AND RELEVANCE: Examination using the Wood's lamp fails to detect many common eye abnormalities. Our findings support the need for a slit lamp examination of patients with eye complaints whenever possible.

Hospital mattress failures-A hidden patient danger.

The objective of the research was to assess the condition of beds and mattresses in 4 US hospitals. In total, 727 beds and mattresses were evaluated, and 523 (72%) had damage: 340 (47%) required mattress cover replacement and 183 (25%) required replacement of the entire mattress.

Erratum: Author Correction: Use of a Launderable Bed Barrier and Antibiotic Stewardship to Decrease Hospital Onset Clostridioides difficile Infections in an Acute Care Hospital: A Retrospective Pre/Post Case Study.

[This corrects the article DOI: 10.36469/001c.11149.].

Outcomes of Hospitalized COVID-19 Patients by Risk Factors: Results from a United States Hospital Claims Database.

BACKGROUND/OBJECTIVE: The primary objective was to quantify the role of the number of Centers of Disease Control and Prevention (CDC) risk factors on in-hospital mortality. The secondary objective was to assess the associated hospital length of stay (LOS), intensive care unit (ICU) bed utilization, and ICU LOS with the number of CDC risk factors. METHODS: A retrospective cohort study consisting of all hospitalizations with a confirmed COVID-19 diagnosis discharged between March 15, 2020 and April 30, 2020 was conducted. Data was obtained from 276 acute care hospitals across the United States. Cohorts were identified based upon the number of the CDC COVID-19 risk factors. Multivariable regression modeling was performed to assess outcomes and utilization. The odds ratio (OR) and incidence rate ratio (IRR) were reported. RESULTS: Compared with patients with no CDC risk factors, patients with risk factors were significantly more likely to die during the hospitalization: One risk factor (OR 2.08, 95% CI, 1.60-2.70; P < 0.001), two risk factors (OR 2.63, 95% CI, 2.00-3.47; P < 0.001), and three or more risk factors (OR 3.49, 95% CI, 2.53-4.80; P < 0.001). The presence of CDC risk factors was associated with increased ICU utilization, longer ICU LOS, and longer hospital LOS compared to those with no risk factors. Patients with hypertension (OR 0.77, 95% CI, 0.70-0.86; P < 0.001) and those administered statins were less likely to die (OR 0.54, 95% CI, 0.49-0.60; P < 0.001). CONCLUSIONS: Quantifying the role of CDC risk factors upon admission may improve risk stratification and identification of patients who may require closer monitoring and more intensive treatment.

Use of a Launderable Bed Barrier and Antibiotic Stewardship to Decrease Hospital Onset Clostridioides difficile Infections in an Acute Care Hospital: A Retrospective Pre-Post Case Study.

BACKGROUND: Hospital-onset Clostridioides difficile infection (HO-CDI) is a major source of morbidity and mortality. The objective of this research was to evaluate the reduction in HO-CDI through the use of a launderable bed barrier (BB) and an antibiotic stewardship program (ASP). METHODS: A retrospective pre-post study was conducted at an acute care hospital in Kentucky. The preintervention period was September 2014 through March 2016. The BB and the ASP were introduced in April 2016, and the post-intervention period for this study ended September 2018. The rate of HO-CDI was calculated from the actual number of HO-CDI divided by the number of patient days each month. The number of defined daily doses of antibiotic therapy was measured each quarter. Hand disinfection compliance, length-of-stay (LOS), case mix index (CMI), and average age of patients were collected to control for confounding in the regression models. RESULTS: There were 34 HO-CDIs and 42 672 patient days in the pre-intervention period and 31 HO-CDIs and 65 882 patient days in the post-intervention period. The average monthly count of HO-CDI was 1.79 (SD 1.51) and 1.03 (SD 0.96) during the pre- and post-periods, respectively. The average monthly rate (per 10 000 patient-days) was 7.94 (SD 6.30) in the pre-intervention period and 4.71 (SD 4.42) during the post-intervention period. The use of antibiotics decreased by 37% (p <0.0001) over the study period. The combination of the BB and the ASP were associated with a 59% (95% CI 36-96%, p 0.034) reduction in HO-CDI. CONCLUSIONS: The use of a launderable BB and the ASP were associated with a statistically and clinically significant reduction in HO-CDI in the acute care hospital setting.

Epidemiology in a health services administration curriculum: what topics are important to practicing healthcare administrators?

There is no published empirical research into what topics should be covered in a managerial epidemiology course for graduate students in health services administration (HSA). The goal of the research described here was to identify epidemiologic topics seen as important to healthcare executives. A survey was conducted of a convenience sample of alumni the Graduate program in Health Services Administration of Xavier University in Cincinnati Ohio. Alumni were asked to rank 68 epidemiologic topics on a likert-type scale: 1 = Not important; 2 = Slightly Important; 3 = Important; 4 = Very Important; 5 = Not applicable. Demographic characteristics were collected including: age of respondents, gender, years since graduation, and current position. All responses of important (3) and very important (4) were grouped together. Topics were then ranked based on the percent of respondents who answered the question and ranked the topic as a 3 or 4. A total of 858 surveys were mailed to alumni, and 177 completed surveys were returned for a 21% response rate. Respondents were 64% male, and there were similar number of graduates from all age groups and from year of graduation. The largest groups of respondents were CEOs and Managers. Clinical guidelines, Quality and Satisfaction, and Benchmarking ranked highest for number or respondents ranking the topic as important or very important. The majority of graduates indicated that almost all epidemiologic topics are important or very important. Topics dealing with quality were ranked highest by the graduates.

Statewide cross-sectional survey of emergency departments' adoption and implementation of the Ohio opioid prescribing guidelines and opioid prescribing practices.

STUDY OBJECTIVE: To evaluate the implementation of the Ohio Emergency and Acute Care Facility Opioids and Other Controlled Substances Prescribing Guidelines and their perceived impact on local policies and practice. METHODS: The study design was a cross-sectional survey of emergency department (ED) medical directors, or appropriate person identified by the hospital, perception of the impact of the Ohio ED Opioid Prescribing Guidelines on their departments practice. All hospitals with an ED in Ohio were contacted throughout October and November 2016. Distribution followed Dillman's Tailored Design Method, augmented with telephone recruitment. Hospital chief executive officers were contacted when necessary to encourage ED participation. Descriptive statistics were used to assess the impact of opioid prescribing policies on prescribing practices. RESULTS: A 92% response rate was obtained (150/163 EDs). In total, 112 (75%) of the respondents stated that their ED has an opioid prescribing policy, is adopting one or is implementing prescribing guidelines without a specific policy. Of these 112 EDs, 81 (72%) based their policy on the Ohio ED Opioid Prescribing Guidelines. The majority of respondents strongly agreed/agreed that the prescribing guidelines have increased the use of the prescription drug monitoring programme (86%) and have reduced inappropriate opioid prescribing (71%). CONCLUSION: This study showed that the Ohio ED Opioid Prescribing Guidelines have been widely disseminated and that the majority of EDs in Ohio are using them to develop local policies. The majority of respondents believed that the Ohio opioid prescribing guidelines reduced inappropriate opioid prescribing. However, prescribing practices still varied greatly between EDs.

Ambulance transports from a state prison: a unique service staffed by prisoners.

OBJECTIVE: To describe an emergency medical service (EMS) staffed by convicted felons and to determine the nature of emergencies at a state penitentiary. METHODS: We retrospectively reviewed runs performed by the prison EMS for 2003. For each run, we recorded emergency run or a non-emergency transport, location of the patient, whether or not the run was staffed with a nurse or physician, and whether or not an automated external defibrillator (AED) was used. We also determined the cost of operating the service. RESULTS: During 2003, the prison EMS had a total call volume of 477 transports. The AED was used 8 times with one patient surviving to hospital admission neurologically intact. There were 357 emergency runs and 120 nonemergency transports. The majority of emergency transports, 305 (85%), were for medical complaints. The actual cost of operating the service for 2003 was $35,421. There were no attempted escapes or injured providers. This study shows that the majority of emergency transports in our prison were for medical conditions. CONCLUSION: The use of state prisoners as EMS providers results in substantial cost savings and most transports were for medical emergencies.

Reasons prehospital personnel do not administer aspirin to all patients complaining of chest pain.

INTRODUCTION: Aspirin is administered to patients with acute coronary syndromes (ACSs), but prehospital providers do not administer aspirin to all patients with chest pain that could be secondary to an ACS. OBJECTIVE: To identify reasons prehospital providers fail to administer aspirin to all patients complaining of chest pain. METHODS: A convenience sample of prehospital providers was surveyed as they transported patients with a chief complaint of chest pain to the emergency department. The providers were asked if they had given aspirin, nitroglycerin, or oxygen, or if they utilized a monitor. If the medications had not been administered, the paramedic was asked about the reason. The patient's age and previous cardiac history also was recorded. RESULTS: A total of 52 patients with chest pain who were transported were identified over eight weeks, and all of the providers agreed to participate in the study. Only 13 of the patients (25%) received aspirin. Reasons given for not administering aspirin to the other 39 patients included: (1) chest pain was not felt to be cardiac in 13 patients (33%); (2) 10 patients already had taken aspirin that day (26%); (3) the medical provider was a basic-level emergency medical technician (EMT)-Basic and could not administer aspirin to six patients (15%); (4) pain subsided prior to arrival of emergency medical services (EMS) in these three patients; and (5) other reasons were provided for the remaining seven patients. CONCLUSIONS: The most common reason that paramedics did not administer aspirin was the paramedic's belief that the chest pain was not of a cardiac nature. Another common reason for not giving aspirin was the inability of EMT-Basic providers to administer aspirin.

Percutaneous transtracheal ventilation: resuscitation bags do not provide adequate ventilation.

INTRODUCTION: Percutaneous, transtracheal jet ventilation (PTJV) is an effective way to ventilate both adults and children. However, some authors suggest that a resuscitation bag can be utilized to ventilate through a cannula placed into the trachea. HYPOTHESIS: Percutaneous transtracheal ventilation (PTV) through a 14-gauge catheter is ineffective when attempted using a resuscitation bag. METHODS: Eight insufflation methods were studied. A 14-gauge intravenous catheter was attached to an adult resuscitation bag, a pediatric resuscitation bag, wall-source (wall) oxygen, portable-tank oxygen with a regulator, and a jet ventilator (JV) at two flow rates. The resuscitation bags were connected to the 14-gauge catheter using a 7 mm adult endotracheal tube adaptor connected to a 3 cc syringe barrel. The wall and tank oxygen were connected to the 14-gauge catheter using a three-way stopcock. The wall oxygen was tested with the regulator set at 15 liters per minute (LPM) and with the regulator wide open. The tank was tested with the regulator set at 15 and 25 LPM. The JV was connected directly to the 14-gauge catheter using JV tubing supplied by the manufacturer. Flow was measured using an Ohmeda 5420 Volume Monitor. A total of 30 measurements were taken, each during four seconds of insufflation, and the results averaged (milliliters (ml) per second (sec)) for each device. RESULTS: Flow rates obtained using both resuscitation bags, tank oxygen, and regulated wall oxygen were extremely low (adult 215 +/- 20 ml/sec; pediatric 195 +/- 19 ml/sec; tank 358 +/- 13 ml/sec; wall at 15 l/min 346 +/- 20 ml/sec). Flow rates of 1,394 +/- 13 ml were obtained using wall oxygen with the regulator wide open. Using the JV with the regulator set at 50 pounds per square inch (psi), a flow rate of 1,759 +/- 40 was obtained. These were the only two methods that produced flow rates high enough to provide an adequate tidal volume to an adult. CONCLUSIONS: Resuscitation bags should not be used to ventilate adult patients through a 14-gauge, transtracheal catheter. Jet ventilation is needed when percutaneous transtracheal ventilation is attempted. If jet ventilation is attempted using oxygen supply tubing, it must be connected to an unregulated oxygen source of at least 50 psi.

Decreasing Clostridium difficile health care-associated infections through use of a launderable mattress cover.

BACKGROUND: The annual incidence of Clostridium difficile infection (CDI) in the United States is estimated to be 330,000 cases. We evaluated the impact of using a launderable mattress and bed deck cover on the incidence of hospital-onset CDI in 2 long-term acute care hospitals (LTACHs). METHODS: Two LTACHs began using a launderable mattress and bed deck cover on beds starting in May 2013. One facility had 74 beds, and the other had 30 beds. Covers were changed after every patient. The covers were laundered using hot water, detergent, and chlorine. Rates for CDIs were compared using Poisson regression between the 16 months before use of the launderable cover and the 14 months after the cover started being used. RESULTS: At hospital A, the use of bedcovers reduced the rate of infection by 47.8% (95% confidence interval [CI], 47.1-48.6), controlling for the rate of handwashing compliance and length of stay in days. At hospital B, the use of bedcovers reduced the rate of infection by 50% (95% CI, 47.5-52.7), controlling for the rate of handwashing compliance and length of stay in days. CONCLUSION: The use of a launderable cover for mattresses and bed decks of hospital beds was associated with a decreased rate of health care-associated CDI in 2 LTACHs.