Local Anesthetic Systemic Toxicity (LAST): More Common Than You Think.

The number of anesthetic body procedures in the United States is rapidly increasing, with many being performed on an outpatient basis. These procedures are advertised as being safe, and many times the serious complications may not be discussed. Although local anesthetic systemic toxicity is a rare complication, it is associated with an increase in morbidity. The emergency department staff should be aware of the possibility of this rare complication, as well as the variety of resulting symptoms (from minor to severe), potential sequelae, and appropriate management for patients who have undergone an outpatient anesthetic body procedure. Multiple factors contribute to the development of local anesthetic systemic toxicity, resulting in life-threatening effects on the neurologic and cardiovascular systems. Also, the site of administration, along with the local anesthetic agent used, can impact the risk of the development of local anesthetic systemic toxicity. To minimize the risk and ensure the best possible outcome for these patients, emergency department staff must be highly aware of the mechanisms, risk factors, prevention, and management/treatment of local anesthetic systemic toxicity.

Nursing Considerations for Emergency Department Care of the Breastfeeding Dyad.

Although postpartum dyads frequently present to the emergency department, treatment of the lactating parent and breastfeeding child is often driven by medical misconceptions. Incorrect advice about continuation or cessation of breastfeeding for medical reasons can lead to maternal and infant harm. In lactation, demand begets supply; missing a feed can be detrimental to short- and long-term breastfeeding outcomes. The purpose of this Clinical Nurses Forum article is to argue the importance of appropriate care of the breastfeeding dyad in the emergency department setting and to interpret current evidence-based information on lactation for the emergency staff nurse. High-quality care for the breastfeeding dyad requires knowledge of lactation physiology, contraindications for breastfeeding, and safe medications and diagnostic procedures. The well-informed emergency nurse must advocate for evidence-based care of the breastfeeding dyad within the emergency department.

Polish Perspective: The Influence of National Emergency Severity Index Training on Triage Practitioners' Knowledge.

INTRODUCTION: The aim of this study was to assess the impact of the national government initiative Emergency Severity Index version 4.0 validated triage training on triage practitioners' knowledge and accuracy. METHODS: This pre/post intervention study evaluated the knowledge of triage practitioners, who constituted 30% of employees trained by the national program, in 74 emergency departments across Poland in 2020. Statistical analysis was used to evaluate the impact of the triage training. RESULTS: No significant differences in triage knowledge were found based on experience, length of ED service, or previous training. Training resulted in increased accuracy (61.3% vs 81.1%) and decreased overtriage and undertriage. Participants significantly reduced errors and improved Emergency Severity Index guideline-based case evaluations, especially for Emergency Severity Index 1-3 cases, with the most notable improvements observed among those without prior triage experience. The training significantly improved interrater reliability. DISCUSSION: The Emergency Severity Index pilot training demonstrated a significant improvement in the accuracy of triage practitioners. Emergency Severity Index level 4 has been identified as a challenging area to learn, as well as yielding promising results in the acquisition of knowledge across levels 1 and 2, among less experienced practitioners.

Management of Pediatric Convulsive Status Epilepticus From the Perspective of Emergency Nurses: A Cross-sectional, Multicenter Study.

INTRODUCTION: Pediatric convulsive status epilepticus is one of the most common neurologic emergencies and should be managed by health care professionals as soon as possible based on current guidelines. This study aimed to determine the nursing approaches and management of pediatric convulsive status epilepticus from the perspective of emergency nurses in Turkey. METHODS: A cross-sectional, multicenter study was conducted with 162 emergency nurses working in emergency departments in 35 different provinces in Turkey. The data were collected via an online form. Descriptive statistical methods were used in data analysis. RESULTS: Most emergency nurses (72.2%) attempted an intravenous access immediately to administer antiseizure medications during the stabilization phase. Approximately half the emergency nurses stated that rectal diazePAM was frequently administered in the initial therapy phase and intravenous diazePAM was administered in the second therapy phase. The emergency nurses had most difficulties attempting intravenous access, determining status epilepticus types, and calming the parents. DISCUSSION: As health care professionals and important members of the health team, emergency nurses have the responsibility to manage pediatric convulsive status epilepticus in the fastest and the most appropriate way based on current practice guidelines in emergency departments. When intravenous access is not available, nonintravenous benzodiazepines should be considered in the first-line treatment of pediatric convulsive status epilepticus, followed by immediate intravenous access.

Ultrasound-Guided Radial Artery Puncture by Nurses in Emergency Department: A Randomized Controlled Study.

INTRODUCTION: Radial artery puncture has been performed by palpation as a standard method in many emergency departments and intensive care units. Nurses play an important role in the care of patients in various settings. Ultrasonography can be performed and interpreted not only by physicians but also by nurses. This study aimed to evaluate whether emergency nurses would be more successful in radial artery puncture procedure by using ultrasonography instead of palpation. METHODS: This single-center, prospective, randomized controlled study was conducted in the emergency department. The patients included in the study were randomized into 2 groups as ultrasonography and palpation groups. Data were recorded on the number of interventions, the duration of the procedure in seconds, total time in seconds, whether the puncture was successfully placed, whether there were complications, the types of complications (hematoma, bleeding, and infection), or whether it was necessary to switch to an alternative technique. RESULTS: A total of 72 patients, 36 patients in the ultrasonography group and 36 patients in the palpation group, participated in the study. The success rate at the first attempt was statistically significantly higher in the ultrasonography group. Although hematoma formation among the complications occurred in the entire palpation group, it was observed in 72.2% of the ultrasonography group. Puncture time and total time were statistically significantly lower in the ultrasonography group. DISCUSSION: Our study shows that emergency nurses can use bedside ultrasonography for radial artery puncture successfully.

Universal Suicidality Screening in a Pediatric Emergency Department to Improve Mental Health Safety Risk.

INTRODUCTION: Suicide is the second leading cause of death for youth 12 to 18 years of age. Suicidal ideation can be predictive of suicide attempt, so screening for suicidal ideation by emergency nurses can help identify those at risk and facilitate timely intervention. This study evaluates the use of a universal suicide screening using the Patient Safety Screener 3 and the Columbia Suicide Severity Rating Scale to identify youth ages 12 to 18 years experiencing suicide risk and assess factors predictive of suicide risk level. METHODS: We conducted a retrospective cohort study using data from patients presenting to the emergency department at an acute care hospital that uses a universal screening program for suicide risk. We determined the frequency of positive screens and performed multivariate analyses to identify predictive factors of scoring high on the Columbia Suicide Severity Rating Scale. RESULTS: Notably, 9.1% of patients were experiencing some level of suicide risk; 10% of those with positive scores had no mental health history and were not presenting for a mental health reason. After controlling for other independent variables, insurance status, mental health presentation, and known mental health history were significantly associated with Columbia Suicide Severity Rating Scale score. DISCUSSION: Universal screening for suicide risk in pediatric emergency departments by nurses is critical for all patients older than 12 years, given that we identified patients at risk of suicide who presented for non-mental health reasons. These patients may not have been identified or referred to treatment if they were not screened for suicidality increasing risk of future suicide attempt.

Development and Implementation of a Pediatric Nursing Emergency Behavioral Health Assessment Tool.

INTRODUCTION: The national pediatric mental and behavioral health crisis dramatically increased emergency department mental and behavioral health visits and changed emergency nursing practice. Acuity assessment determines patient severity level and supports appropriate resources and interventions. There are no established nursing tools that assess pediatric mental or behavioral health acuity in the emergency department setting. Our goal was to develop and implement the novel pediatric emergency nurse Emergency Behavioral Health Acuity Assessment Tool. METHODS: This quality-improvement project used the plan, do, study, act model to design/refine the Emergency Behavioral Health Acuity Assessment Tool and a non-experimental descriptive design to assess outcomes. The setting was a 47-bed urban level 1 pediatric trauma center with more than 60,000 annual visits. The team designed the tool using published evidence, emergency nurse feedback, and expert opinion. The tool objectively captured patient acuity and suggested acuity-specific nursing interventions. Project outcomes included acuity, length-of-stay, restraint use, and patient/staff injuries. Analyses included descriptive statistics and correlations. RESULTS: With over 3000 annual mental/behavioral-related visits, the emergency department had an average daily census of 23 mental and behavioral health patients. Implementation occurred in August 2021. The Emergency Behavioral Health Acuity Assessment Tool dashboard provided the number of patients, patient location, and acuity. Length-of-stay did not change; however, patient restraint use and patient/staff injuries declined. Number of restraints positively correlated with moderate acuity levels (r = 0.472, P = 0.036). DISCUSSION: For emergency nurses, the Emergency Behavioral Health Acuity Assessment Tool provided an objective measure of patient acuity. Targeted interventions can improve the care of this population.

"I Just Know if I Keep Going, I'll End Up Hating Nursing." Lived Experiences of Emergency Nurses Three Years Into the Global COVID-19 Pandemic.

INTRODUCTION: As the coronavirus disease 2019 pandemic continues globally, the personal and professional pressure on health care workers continues to accumulate. Literature suggests that as the pandemic evolves, nurses are experiencing increased levels of anxiety, depression, and post-traumatic stress, ultimately leading them to voice intentions to leave the profession, if they have not done so already. METHODS: Informed by an interpretive hermeneutic phenomenological approach, this longitudinal study was designed to capture how the lived experiences of 9 emergency nurses evolved over the coronavirus disease 2019 pandemic, highlighting their feelings, attitudes, and perceptions toward working in the emergency department at this time in history. Interviews were undertaken in June 2022 and were analyzed using a thematic analysis approach. RESULTS: Data analysis resulted in a total of 2 major themes and 8 minor themes. The 2 major themes included "exposed wounds" and "Band-Aid solutions." Levels of burnout increased during the pandemic, with most of the emergency nurse participants dropping their hours, moving roles within the profession, or leaving the profession entirely. Findings elucidate where and how concerns may arise in clinical practice and holistic well-being among emergency nurses, particularly surrounding professional boundaries and protecting work-life balance and professional identity. DISCUSSION: As the world moves to managing coronavirus disease 2019 as a recognized common respiratory illness, providing time and space for emergency nurses to voice their concerns, design their well-being interventions, set professional boundaries, and reconnect with their professional passion may see lower attrition rates and higher levels of professional satisfaction in emergency nurses globally.

Perspective of Emergency Pediatric Nurses Triaging Pediatric Patients in the Emergency Department: A Phenomenographic Study.

INTRODUCTION: Triage, a process to determine illness severity, is implemented by emergency nurses to prioritize treatment and provide care for a maximum number of patients using limited resources. The competency of emergency nurses and a highly reliable triage are crucial for the provision of emergency care. Pediatric patients are different from adult patients in certain aspects, such as growth-phase characteristics, communication ability, and the onset of disease; these aspects often pose challenges during their primary triage. This study explored how emergency nurses triage pediatric patients using the Korean Triage and Acuity Scale. METHODS: Eleven emergency nurses (N = 11) working in the pediatric emergency department of a university hospital in Seoul, South Korea, were recruited using purposive sampling methods. Phenomenography was used to investigate the strategies by which these nurses use the Korean Triage and Acuity Scale to triage pediatric patients. RESULTS: The findings comprised 2 descriptive categories: 6 approaches on how to triage patients (categories of how) and 3 strategies (categories of what) used by pediatric emergency nurses to triage pediatric patients with the Korean Triage and Acuity Scale. DISCUSSION: The experience and proficiency of emergency nurses are essential factors for the effective triage of pediatric patients. Our findings qualitatively elucidate different ways of understanding pediatric triage and indicate the need for pediatric triage education programs.

Evaluation of the factors affecting triage decision-making among emergency department nurses and emergency medical technicians in Iran: a study based on Benner's theory.

INTRODUCTION: Emergency department (ED) nurses and emergency medical technicians (EMTs) find themselves performing triage under time pressure and with limited information. Identifying an effective triage decision-making process can play a significant role in promoting patient safety. Experts are able to make faster and more effective decisions in emergencies than novices. OBJECTIVE: The current study aimed to identify the level of triage decision-making (TDM) and its' predictors in ED nurses and EMTs based on self-reported levels of nursing proficiency in Benner's theory from novice to expert. MATERIALS AND METHODS: Out of 821 ED nurses and EMTs who met the inclusion criteria, 320 ED nurses and 152 EMTs were included in this descriptive-analytical research. Data were collected by a demographic information form and triage decision-making inventory (TDMI) and analyzed by SPSSv.22 software using descriptive statistics, Pearson correlation test, t-test, ANOVA, and multiple linear regression. RESULTS: The total score of TDMI in the ED nurses and EMTs was higher in the expert nurses than in the proficient, competent, advanced beginner and novices. Multiple linear regression analysis showed that self-reported levels of nursing proficiency, age, work experience, marital status and triage training course were predictors of TDM in ED nurses (P < .05), and self-reported levels of nursing proficiency, service location, work experience, and triage training course were predictors of TDM in EMTs (P < .05). CONCLUSION: Understanding the predictors influencing TDM health professionals may facilitate the understanding of their training needs. The training needs of a novice and inexperienced person may be different from those of an expert person, it is recommended that the training methods be based on the experiences and professional levels of nurses so that the training provided is effective and quality. Moreover, to increase the TDM power and reduce TDM errors due to lack of experience, a system is suggested to be established to allow novice nurses in the first year to work with experienced nurses. Also it is suggested that the determining educational and training focus with regards to triage before entering the bedside be done based on predictors.

The Loneliness of Aging.

Isolation and loneliness have become buzz words when discussing older adults during the coronavirus disease pandemic; yet, these are age-old problems. Both have been studied extensively, yet there currently is no rapid or succinct tool that can be used in the emergency department to screen for either, or a consensus of evidence-based ways to correct these issues. This is of concern because both loneliness and social isolation have been linked to poor health. Poor health, in turn, can lead to worse isolation and loneliness. These health problems may lead to the older adult seeking care in the emergency department where screening and initial treatment could be initiated. Suggestions for questions that emergency nurses can ask to identify an older adult who is lonely or suffers from social isolation, as well as steps to consider when encountering the older adult with complaints of loneliness and/or social isolation, are provided, with the realization that these are only the first steps of many that would need to be taken. The purpose of this article is to bring forward updated information that discusses loneliness and social isolation in older adults, a timely priority during the coronavirus disease pandemic and often listed as a factor in older adult deaths. A review of relevant screening tools for use in the emergency department are provided.

Use of the Donabedian Model as a Framework for COVID-19 Response at a Hospital in Suburban Westchester County, New York: A Facility-Level Case Report.

The purpose of this facility-level case report was to describe our facility's leadership process of applying the Donabedian model to structure an early response to the coronavirus disease pandemic relative to emergency care. Using the Donabedian model as a guide, both structure and process changes were implemented to maintain high-quality clinical outcomes as well as ED staff safety and engagement. Rapid changes to the model of care, both architecturally and through the expansion of universal precautions through personal protective equipment, created the foundation for what was to follow. Clinical, service quality, and staff safety outcomes were evaluated to demonstrate that the collaborative changes that follow a known process improvement model can be used to address the coronavirus disease pandemic. Further study is needed to compare the outcomes of this facility-level case study with those of others to evaluate the success of the measures outlined.

Pain assessment and interventions by nurses in the emergency department: A national survey.

AIM: The aim of this study was to examine the knowledge, perceptions and factors influencing pain assessment and management practices among Australian emergency nurses. BACKGROUND: Pain is the most commonly reported symptom in patients presenting to the emergency department, with over half rating their pain as moderate-to-severe. Patients unable to communicate, such as critically ill intubated patients, are at greater risk of inadequate pain management. DESIGN: This cross-sectional exploratory study used survey methodology to explore knowledge, perceptions and factors influencing pain management practices among Australian emergency nurses. METHODS: Australian emergency nurses were invited to complete an online survey comprising 91 items. The response rate was 450 of 1,488 (30.2%). STROBE guidelines were used in reporting this study. RESULTS: Variations in level of acute pain management knowledge, especially in older, cognitively impaired or mechanically ventilated patients were identified. Poor interprofessional communication, workload and staffing negatively impacted on nurses' intention to administer analgesia. For intubated patients, validated observation pain assessment instruments were rarely used, although respondents recognised the importance of pain management in critically ill patients. CONCLUSIONS: Emergency nurses recognise the importance of pain relief. The ability to nurse-initiate analgesia, education and training in pain management education is variable. Little education is provided on assessing and managing acute pain in elderly, cognitively impaired or mechanically ventilated patients. Use of validated pain assessment instruments to assess pain in critically ill patients is poor. RELEVANCE TO CLINICAL PRACTICE: While pain management is the responsibility of all healthcare professionals, in the emergency department, it is a core role of emergency nursing. This study highlights the variation in ability to nurse-initiate analgesia, level of acute pain knowledge, education and training, and use of validated pain assessment instruments to guide pain management in critically ill intubated patients.

Transcultural Health Practices of Emergency Nurses Working With Indigenous Peoples: A Descriptive Study.

INTRODUCTION: For decades, health inequalities have persisted among Indigenous peoples. As the Indigenous population is growing in the cities, health care delivery in urban areas can be challenging. Emergency nurses are often the first contact in the health system, and they play a key role in the patient's experience. This study aims to describe the transcultural health practices of Canadian emergency nurses working with Indigenous peoples. METHODS: A descriptive study was conducted among 30 emergency nurses. RESULTS: Approximately 90% of the nurses who participated in the study had not received specific training about Indigenous health. The most common type of culturally appropriate nursing care was clinical examination (mean = 7.22), and sexuality care was the least frequent (mean = 5.47). The nurses were less confident in their ability to interview Indigenous peoples about the importance of home remedies and folk medicine (mean = 5.38). DISCUSSION: In summary, emergency nurses had more confidence in their ability to provide technical care than in their knowledge regarding the cultural aspects of providing care. As Indigenous populations face challenges regarding access to health care, specific interventions should be implemented to support better-quality cultural care from emergency nurses.

Emergency Nursing Care of Patients With Novel Coronavirus Disease 2019.

Novel coronavirus disease 2019 is the disease caused by the novel coronavirus originally from Wuhan, China. Its pathophysiology is poorly understood, but it is known to be contagious and deadly. Multiple symptoms and complications from the disease have been described, with the most common complaints being respiratory. Nursing care of patients with novel coronavirus disease 2019 is largely supportive, but it should include a strong focus on mitigating the spread of infection to staff, other patients, and the community.

Facility-Level Case Report of Nursing Care Processes for Patients With Suspected 2019 Novel Coronavirus Disease in Shanghai, China.

INTRODUCTION: Coronavirus disease emerged in Wuhan, China, on December 31, 2019, and spread rapidly worldwide. Few studies have described the nursing care provided to patients in isolation between suspicion of having the disease and a confirmed diagnosis. The purpose of this study was to describe the treatment of, and nursing care processes for, patients suspected, but not yet confirmed, of having coronavirus disease at 1 facility in Shanghai, China. METHODS: For this retrospective facility case review and patient health record study, data were collected on all patients with suspected coronavirus disease who were treated between January 22, 2020, and February 29, 2020, at 1 hospital. The facility's nursing care processes were described in detail. RESULTS: A total of 119 patients were suspected of having coronavirus disease on the basis of the screening criteria. Nine (7.6%) patients had confirmed coronavirus disease and were transferred to a higher level of care. The remaining 110 (92.4%) were treated and discharged. No cross-infection between patients and hospital staff or other patients was detected. The patients' symptoms included fever (n = 98, 82.4%), cough (n = 79, 66.4%), dizziness (n = 28, 23.5%), headache (n = 26, 21.8%), fatigue (n = 26, 21.8%), myalgia (n = 16, 13.4%), rhinorrhea (n = 6, 5.0%), diarrhea (n = 5, 4.2%), severe nasal congestion (n = 4, 3.4%), and dyspnea (n = 1, 0.8%). DISCUSSION: Coronavirus disease is very contagious. Nurses need to understand the symptoms and treatment of the disease as well as nursing procedures, and learn how to cut off transmission routes, control transmission sources, and use protective equipment correctly to prevent transmission of the disease within the hospital.

Preparedness of Our Emergency Department During the Coronavirus Disease Outbreak from the Nurses' Perspectives: A Qualitative Research Study.

INTRODUCTION: This study explores the preparedness of our emergency department during the COVID-19 outbreak from the nurses' perspectives, providing a reference and basis for our emergency department's response to public health emergencies. METHODS: Using qualitative research methods, semistructured interviews were conducted with 12 emergency nurses who met the inclusion criteria, and Colaizzi analysis was used for data analysis, summary, and induction. RESULTS: A cluster of 4 themes that involved preparedness of the emergency department during the COVID-19 outbreak was extracted: organizational preparedness, personal preparedness, patient and family preparedness, and deficiencies and challenges. DISCUSSION: Organizations, individuals, patients, and family members were actively prepared to respond to novel coronavirus pneumonia outbreak in the emergency department. The emergency nurses said that the trusted organization guaranteed personal preparedness, and the active cooperation from patients and families was a motivator for personal preparedness. In addition, our study showed that there were deficiencies in both multidisciplinary collaboration efforts and efforts to rapidly diagnose and treat patients with fever in critical condition.

Assessing the Impact of ED Triage Directives on Febrile Oncology Patient Wait Times.

INTRODUCTION: Fever during chemotherapy is a common and potentially severe complication being increasingly evaluated in emergency departments to minimize morbidity and mortality. Streamlining triage of these patients may improve health outcomes and wait times in the health care system. METHODS: A retrospective chart review of febrile patients undergoing chemotherapy was conducted at a local emergency department to assess the impact of nurse-initiated protocols on wait times. RESULTS: We identified 315 patients undergoing current chemotherapy presenting with fever. Of these, 140 (44%) and 87 (28%) were initiated on the sepsis and febrile neutropenia nurse-initiated protocols, respectively. In total, 197 (63%) were admitted. The febrile neutropenia protocol had a shorter wait time from triage to disposition than the sepsis protocol (403 minutes [SD = 23] vs 329 minutes [SD = 19], t = 1.71, P = 0.01). Furthermore, the febrile neutropenia protocol demonstrated shorter times from both triage to lab results reported, in addition to the physician initial assessment in the admitted patient subgroup. DISCUSSION: Decreased wait times from triage associated with the use of a febrile neutropenia protocol could be accounted for by a lower number of lab results required through this protocol in addition to shorter physician assessment times in the admitted population. This study shows that nurse-initiated protocols may influence door-to-antibiotic time for patients undergoing chemotherapy. By having a targeted protocol for the cancer population, health care centers may be able to demonstrate decreased health care expenditure and increased resource availability. Furthermore, as the current population of patients undergoing chemotherapy is at a high risk for neutropenia, prompt management is crucial to minimize mortality.

Code Critical: Improving Care Delivery for Critically Ill Patients in the Emergency Department.

PROBLEM: Although certain critically ill patients in emergency departments-such as those experiencing trauma, stroke, and myocardial infarction-often receive care through coordinated team responses, resource allocation and care delivery can vary widely for other high-acuity patients. The absence of a well-defined response process for these patients may result in delays in care, suboptimal outcomes, and staff dissatisfaction. The purpose of this quality improvement project was to develop, implement, and evaluate an ED-specific alert team response for critically ill medical adult and pediatric patients not meeting criteria for other medical alerts. METHODS: Lean (Lean Enterprise Institute, Boston, MA) principles and processes were used to develop, implement, and evaluate an ED-specific response team and process for critically ill medical patients. Approximately 300 emergency nurses, providers, technicians, unit secretaries/nursing assistants, and ancillary team members were trained on the code critical process. Turnaround and throughput data was collected during the first 12 weeks of code critical activations (n = 153) and compared with historical controls (n = 168). RESULTS: After implementing the code critical process, the door-to-provider time decreased by 62%, door to laboratory draw by 76%, door-to-diagnostic imaging by 46%, and door-to-admission by 19%. A year later, data comparison demonstrated sustained improvement in all measures. DISCUSSION: Emergency nurses and providers see the value of coordinated team response in the delivery of patient care. Team responses to critical medical alerts can improve care delivery substantially and sustainably.

Can You Catch It? Lessons Learned and Modification of ED Triage Symptom- and Travel-Screening Strategy.

INTRODUCTION: Efficient identification and isolation of patients with communicable diseases limits exposure to health care workers, other patients, and visitors. In August 2014, our team developed and implemented an algorithm to triage suspected cases of Ebola virus disease in a midwestern United States emergency department and outpatient clinics based on patient travel history and symptoms. Here, we present the lessons learned and modifications to update the tool. METHODS: Two strategies were developed and utilized to properly identify, isolate, and inform on patients with suspected highly hazardous communicable diseases: 1) a robust electronic symptom and travel screen with decision support tools in the electronic medical record, and 2) the availability of workflow protocols for Ebola virus disease, Middle East Respiratory Syndrome (MERS), and coronavirus 2019 (COVID-19) once a person under investigation is identified. After action reports provided opportunities to modify the algorithm and improve the identification and isolation processes. RESULTS: Since our screening and travel electronic medical record inception 5 years ago, modifications changed iteratively to further enhance the screening process. Since 2018, staff have identified 5 patients at risk for MERS; in all cases, identification occurred during the check-in process. Exposure investigations in the emergency department decreased significantly after algorithm implementation in January 2019, from 30 in 2018 to 0 in 2019. DISCUSSION: Although highly hazardous communicable diseases like Ebola virus disease and MERS are of concern due to their mortality rates and limited treatment options, these same concepts may be applied to the early identification and isolation of patients suspected of having more common communicable diseases like measles and influenza, emphasizing the importance of protocol-based screening in the healthcare environment.