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2.
Emerg Med J ; 37(10): 642-643, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32753393

RESUMO

The COVID-19 pandemic has taken the world by storm and overwhelmed healthcare institutions even in developed countries. In response, clinical staff and resources have been redeployed to the areas of greatest need, that is, intensive care units and emergency rooms (ER), to reinforce front-line manpower. We introduce the concept of close air support (CAS) to augment ER operations in an efficient, safe and scalable manner. Teams of five comprising two on-site junior ER physicians would be paired with two CAS doctors, who would be off-site but be in constant communication via teleconferencing to render real-time administrative support. They would be supervised by an ER attending. This reduces direct viral exposure to doctors, conserves precious personal protective equipment and allows ER physicians to focus on patient care. Medical students can also be involved in a safe and supervised manner. After 1 month, the average time to patient disposition was halved. General feedback was also positive. CAS improves efficiency and is safe, scalable and sustainable. It has also empowered a previously untapped group of junior clinicians to support front-line medical operations, while simultaneously protecting them from viral exposure. Institutions can consider adopting our novel approach, with modifications made according to their local context.


Assuntos
Resgate Aéreo/organização & administração , Infecções por Coronavirus/prevenção & controle , Serviços Médicos de Emergência/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Recursos Humanos/organização & administração , Infecções por Coronavirus/epidemiologia , Medicina de Emergência/organização & administração , Feminino , Humanos , Masculino , Inovação Organizacional , Avaliação de Resultados em Cuidados de Saúde , Pandemias/estatística & dados numéricos , Projetos Piloto , Pneumonia Viral/epidemiologia , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Melhoria de Qualidade
5.
Emerg Med Australas ; 32(5): 880-882, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32484307

RESUMO

After successfully avoiding the situations experienced by some countries, Australasian EDs now face a future in which the ongoing threat of COVID-19 is added to the traditional challenges in providing quality emergency care. The contribution of emergency medicine to the national containment strategy adds a new dimension to the demands placed on emergency medicine in Australia and similarly, to the elimination strategy employed in New Zealand. These demands will best be met by a considered, planned and resourced approach that will challenge traditional measures of 'ED efficiency'.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Medicina de Emergência/organização & administração , Planejamento em Saúde/métodos , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Austrália , Infecções por Coronavirus/prevenção & controle , Serviço Hospitalar de Emergência/organização & administração , Feminino , Humanos , Masculino , Determinação de Necessidades de Cuidados de Saúde , Nova Zelândia , Inovação Organizacional , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Medição de Risco
11.
J Nepal Health Res Counc ; 18(1): 142-143, 2020 Apr 20.
Artigo em Inglês | MEDLINE | ID: covidwho-127689

RESUMO

Patan Academy of Health Sciences started preparedness for COVID-19 in response to increasing number of patient in neighboring country. Outbreak preparedness in resource limited setup is challenging. Despite this, preparedness was done in reference to WHO interim guidance utilizing best available resources. During this preparedness, one patient was isolated as suspected COVID-19. This paper presents level of preparedness achieved with the limited resources and the lesson learned while isolating the patient. Keywords: COVID-19; Disaster; hospital preparedness.


Assuntos
Defesa Civil/métodos , Infecções por Coronavirus/epidemiologia , Coronavirus , Planejamento em Desastres , Surtos de Doenças/prevenção & controle , Medicina de Emergência/organização & administração , Pneumonia Viral/epidemiologia , Betacoronavirus , Saúde Global , Hospitais , Humanos , Nepal , Pandemias , Saúde Pública
12.
Emerg Med Clin North Am ; 38(2): 353-361, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32336330

RESUMO

As the number of advanced practice providers has grown in emergency medicine, establishment of guidelines and policies governing their practice has become increasingly important. This article addresses the scope of practice of physician assistants and nurse practitioners working in the emergency department, including the various forms of supervision and the effect on billing, credentialing, and medicolegal considerations in patients' care.


Assuntos
Serviço Hospitalar de Emergência/organização & administração , Profissionais de Enfermagem/organização & administração , Assistentes Médicos/organização & administração , Medicina de Emergência/organização & administração , Humanos , Gestão de Riscos
13.
Emerg Med Clin North Am ; 38(2): 363-382, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32336331

RESUMO

Simulation has been steadily changing the safety culture in the healthcare industry and allowing individual clinicians and interdisciplinary teams to be proactive in the culture of risk reduction and improved patient safety. Literature has demonstrated improved patient outcomes, improved team based skills, systems testing and mitigation of latent safety threats. Simulation may be incorporated into practice via different modalities. The simulation lab is helpful for individual procedures, in situ simulation (ISS) for system testing and teamwork, community outreach ISS for sharing of best practices and content resource experts. Serious medical gaming is developing into a useful training adjunct for the future.


Assuntos
Medicina de Emergência , Simulação de Paciente , Gestão de Riscos , Medicina de Emergência/educação , Medicina de Emergência/métodos , Medicina de Emergência/organização & administração , Humanos , Gestão de Riscos/métodos , Gestão de Riscos/organização & administração
14.
J Nepal Health Res Counc ; 18(1): 142-143, 2020 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-32335611

RESUMO

Patan Academy of Health Sciences started preparedness for COVID-19 in response to increasing number of patient in neighboring country. Outbreak preparedness in resource limited setup is challenging. Despite this, preparedness was done in reference to WHO interim guidance utilizing best available resources. During this preparedness, one patient was isolated as suspected COVID-19. This paper presents level of preparedness achieved with the limited resources and the lesson learned while isolating the patient. Keywords: COVID-19; Disaster; hospital preparedness.


Assuntos
Defesa Civil/métodos , Infecções por Coronavirus/epidemiologia , Coronavirus , Planejamento em Desastres , Surtos de Doenças/prevenção & controle , Medicina de Emergência/organização & administração , Pneumonia Viral/epidemiologia , Betacoronavirus , Saúde Global , Hospitais , Humanos , Nepal , Pandemias , Saúde Pública
18.
Acad Emerg Med ; 27(4): 317-332, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32037678

RESUMO

The goal of the 2019 Society for Academic Emergency Medicine Consensus Conference was to explore the current cultural and systemic issues in emergency medicine that impact the individual well-being of every emergency physician and to make recommendations for future study. Burnout is epidemic in emergency medicine. Physician wellness is required to enhance patient clinical outcomes as well as to ensure professional satisfaction and longevity. For conference preparation, a consensus steering committee was created, and a decision was made to use the groundbreaking model of the National Academy of Medicine's "Factors Affecting Clinician Well-Being and Resilience" to further identify areas of needed study. On May 14, 2019, the Wellness Consensus Conference was attended by over 50 faculty physicians from across the United States. These attendees discussed key concepts and prior research presented by content experts. Groups of participants engaged in crowdsourcing techniques to consolidate ideas derived from those discussions. These consensus concepts were recorded and are presented within this article. A repetitive theme noted at the conference was the overwhelming effect of the system and organization factors on individual physician well-being. The concept of ongoing assessment of professional fulfillment over the life span of the emergency physician was felt to be crucial in guiding wellness and resilience interventions in a timely manner. Examining ways to enable physicians to flourish rather than experience burnout are strong future directions for study.


Assuntos
Esgotamento Profissional/prevenção & controle , Medicina de Emergência/organização & administração , Esgotamento Profissional/psicologia , Humanos , Médicos/psicologia , Resiliência Psicológica , Estados Unidos
20.
BMC Med Inform Decis Mak ; 20(1): 13, 2020 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-31992301

RESUMO

BACKGROUND: The emergency department is a critical juncture in the trajectory of care of patients with serious, life-limiting illness. Implementation of a clinical decision support (CDS) tool automates identification of older adults who may benefit from palliative care instead of relying upon providers to identify such patients, thus improving quality of care by assisting providers with adhering to guidelines. The Primary Palliative Care for Emergency Medicine (PRIM-ER) study aims to optimize the use of the electronic health record by creating a CDS tool to identify high risk patients most likely to benefit from primary palliative care and provide point-of-care clinical recommendations. METHODS: A clinical decision support tool entitled Emergency Department Supportive Care Clinical Decision Support (Support-ED) was developed as part of an institutionally-sponsored value based medicine initiative at the Ronald O. Perelman Department of Emergency Medicine at NYU Langone Health. A multidisciplinary approach was used to develop Support-ED including: a scoping review of ED palliative care screening tools; launch of a workgroup to identify patient screening criteria and appropriate referral services; initial design and usability testing via the standard System Usability Scale questionnaire, education of the ED workforce on the Support-ED background, purpose and use, and; creation of a dashboard for monitoring and feedback. RESULTS: The scoping review identified the Palliative Care and Rapid Emergency Screening (P-CaRES) survey as a validated instrument in which to adapt and apply for the creation of the CDS tool. The multidisciplinary workshops identified two primary objectives of the CDS: to identify patients with indicators of serious life limiting illness, and to assist with referrals to services such as palliative care or social work. Additionally, the iterative design process yielded three specific patient scenarios that trigger a clinical alert to fire, including: 1) when an advance care planning document was present, 2) when a patient had a previous disposition to hospice, and 3) when historical and/or current clinical data points identify a serious life-limiting illness without an advance care planning document present. Monitoring and feedback indicated a need for several modifications to improve CDS functionality. CONCLUSIONS: CDS can be an effective tool in the implementation of primary palliative care quality improvement best practices. Health systems should thoughtfully consider tailoring their CDSs in order to adapt to their unique workflows and environments. The findings of this research can assist health systems in effectively integrating a primary palliative care CDS system seamlessly into their processes of care. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03424109. Registered 6 February 2018, Grant Number: AT009844-01.


Assuntos
Sistemas de Apoio a Decisões Clínicas/instrumentação , Medicina de Emergência/organização & administração , Cuidados Paliativos , Encaminhamento e Consulta , Design de Software , Fluxo de Trabalho , Serviço Hospitalar de Emergência/organização & administração , Humanos , New York , Qualidade da Assistência à Saúde
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