Interprofessional simulation-based team-training and self-efficacy in emergency medicine situations.

Teamwork quality has been shown to influence patient safety, and simulation-based team-training (SBTT) is an effective means to increase this quality. However, long-term effects are rarely studied. This study aims to investigate the long-term effects of interprofessional SBTT in emergency medicine in terms of global confidence, self-efficacy in interprofessional communication and in emergency medicine situations. Newly graduated doctors, nurses, auxiliary nurses, and medical and nursing students participated. Four emergency medicine scenarios focused on teamwork according to the A-B-C-D-E-strategy. All participants increased their global confidence from 5.3 (CI 4.9-5.8) before to 6.8 (CI 6.4-7.2; p < .0001) after SBTT. Confidence in interprofessional communication increased from 5.3 (CI 4.9-5.8) to 7.0 (CI 6.6-7.4; p < .0001). Students had the greatest gain. The self-efficacy following the A-B-C-D-E strategy increased from 4.9 (CI 4.4-5.3) to 6.6 (CI 6.2-7.0). Again, students had the steepest increase. Newly graduated doctors achieved a superior increase in global confidence as compared to nurses and auxiliary nurses (p < .0001). Their propensity to recommend SBTT to colleagues was 9.9 (CI 9.8-10.0). The positive effects were sustained over a six-month period, indicating that interprofessional SBTT had a positive impact on competence development, and a potential to contribute to increased team quality in emergency medicine care.

Emergency department sepsis screening tool decreases time to antibiotics in patients with sepsis.

Recent literature has highlighted the importance of early identification and treatment of sepsis; however, limited data exists to help recognize sepsis in the emergency department (ED) through use of a screening tool. The purpose of this study was to evaluate the impact of a sepsis screening tool implemented in an academic medical center ED on compliance with the 3-hour sepsis bundle. This was a retrospective cohort study that included a total of 115 patients, of which 58 were in the pre-tool group and 57 were in the post-tool group. There was no difference in 3-hour bundle compliance between groups (36.2% vs. 47.4%, P = 0.26). There was no difference in the following bundle components: lactate (79.3% vs. 80.7%, P = 0.85), blood cultures (86.2% vs. 96.5%, P = 0.09), blood cultures before administering antibiotics (91.4% vs. 100%, P = 0.57) and adequate fluids administration (44.7% vs. 41.9%, P = 0.820). A significantly higher number of patients received antibiotics within 3 h in the post-tool group (58.6% vs. 89.5%, P < 0.001). Statistically significant secondary outcomes included average time to antibiotics (P = 0.04), administering antibiotics within an hour (P > 0.001), and ICU length of stay (P = 0.03). There was no difference in 30-day mortality, however mortality was numerically lower in the post-tool group (36.2% vs. 26.3%, P = 0.25). Although implementation of an ED sepsis screening tool did not increase 3-hour bundle compliance, it did increase the proportion of patients receiving timely antimicrobial therapy and demonstrated a trend towards decreased mortality.

Celiac Artery Aneurysm: A Rare Cause of Abdominal Pain.

We present the case of a 48-year-old male who presented to the emergency department with left-sided abdominal pain of four-day duration. The pain was described as sharp in nature and was located in the left lower quadrant with radiation to the left shoulder. A computerized tomography (CT) scan of the abdomen and pelvis without contrast showed celiac artery enlargement with adjacent inflammatory stranding. There were other chronic findings secondary to prior surgery. A CT angiogram of the abdomen and pelvis was performed, which showed a 10 x 5 mm saccular pseudoaneurysm at the posterior aspect of the celiac trunk with surrounding inflammatory changes. Endovascular repair was accomplished in the operating room after the placement of the stent graft. Repeat angiogram showed successful exclusion of the aneurysm, with excellent perfusion to the arteries distal to the site of repair. The patient was successfully discharged two days later with outpatient follow-up. Celiac artery aneurysms can present to the emergency department with abdominal pain. The detection of celiac artery aneurysms may be increasing due to increased detection on CT scans. Although rare, this type of visceral artery aneurysm carries a high mortality rate if ruptured. Surgical repair may be either through an endovascular approach or through open surgical repair of the aneurysm preferably with prosthetic grafts.