scholarly journals Impact of bedside lung ultrasound on physician clinical decision-making in an emergency department in Nepal

2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Darlene R. House ◽  
Yogendra Amatya ◽  
Benjamin Nti ◽  
Frances M. Russell
Keyword(s):  
Decision Making ◽  
Emergency Department ◽  
Clinical Decision Making ◽  
Lung Ultrasound ◽  
Clinical Decision

scholarly journals Can Alveolar-Arterial Difference and Lung Ultrasound Help the Clinical Decision Making in Patients with COVID-19?

Diagnostics ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 761
Author(s):  
Gianmarco Secco ◽  
Francesco Salinaro ◽  
Carlo Bellazzi ◽  
Marco La Salvia ◽  
Marzia Delorenzo ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Lung Ultrasound ◽  
Signs And Symptoms ◽  
Clinical Decision ◽  
Arterial Oxygen ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Lung Dysfunction ◽  
Close Relationship

Background: COVID-19 is an emerging infectious disease, that is heavily challenging health systems worldwide. Admission Arterial Blood Gas (ABG) and Lung Ultrasound (LUS) can be of great help in clinical decision making, especially during the current pandemic and the consequent overcrowding of the Emergency Department (ED). The aim of the study was to demonstrate the capability of alveolar-to-arterial oxygen difference (AaDO2) in predicting the need for subsequent oxygen support and survival in patients with COVID-19 infection, especially in the presence of baseline normal PaO2/FiO2 ratio (P/F) values. Methods: A cohort of 223 swab-confirmed COVID-19 patients underwent clinical evaluation, blood tests, ABG and LUS in the ED. LUS score was derived from 12 ultrasound lung windows. AaDO2 was derived as AaDO2 = ((FiO2) (Atmospheric pressure − H2O pressure) − (PaCO2/R)) − PaO2. Endpoints were subsequent oxygen support need and survival. Results: A close relationship between AaDO2 and P/F and between AaDO2 and LUS score was observed (R2 = 0.88 and R2 = 0.67, respectively; p < 0.001 for both). In the subgroup of patients with P/F between 300 and 400, 94.7% (n = 107) had high AaDO2 values, and 51.4% (n = 55) received oxygen support, with 2 ICU admissions and 10 deaths. According to ROC analysis, AaDO2 > 39.4 had 83.6% sensitivity and 90.5% specificity (AUC 0.936; p < 0.001) in predicting subsequent oxygen support, whereas a LUS score > 6 showed 89.7% sensitivity and 75.0% specificity (AUC 0.896; p < 0.001). Kaplan–Meier curves showed different mortality in the AaDO2 subgroups (p = 0.0025). Conclusions: LUS and AaDO2 are easy and effective tools, which allow bedside risk stratification in patients with COVID-19, especially when P/F values, signs, and symptoms are not indicative of severe lung dysfunction.

scholarly journals Clinical decision making in the emergency department setting using rapid PCR: Results of the CLADE study group

2018 ◽  
Vol 102 ◽  
pp. 42-49 ◽  
Author(s):  
Glen T. Hansen ◽  
Johanna Moore ◽  
Emily Herding ◽  
Tami Gooch ◽  
Diane Hirigoyen ◽  
...  
Keyword(s):  
Decision Making ◽  
Emergency Department ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Study Group ◽  
Rapid Pcr ◽  
Emergency Department Setting

Impact of lung ultrasound on clinical decision making in critically ill patients

2013 ◽  
Vol 40 (1) ◽  
pp. 57-65 ◽  
Author(s):  
Nektaria Xirouchaki ◽  
Eumorfia Kondili ◽  
George Prinianakis ◽  
Polychronis Malliotakis ◽  
Dimitrios Georgopoulos
Keyword(s):  
Decision Making ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Clinical Decision Making ◽  
Lung Ultrasound ◽  
Clinical Decision

scholarly journals Utility and Acceptability of Influenza Surveillance amongst Emergency Providers

2015 ◽  
Vol 7 (1) ◽  
Author(s):  
Andrea F. Dugas ◽  
Howard Burkom ◽  
Anna L. DuVal ◽  
Richard Rothman
Keyword(s):  
Decision Making ◽  
Emergency Department ◽  
Real Time ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Surveillance Data ◽  
Influenza Surveillance ◽  
Additional Information ◽  
Provider Surveys

We provided emergency department providers with a real-time laboratory-based influenza surveillance tool, and evaluated the utility and acceptability of the surveillance information using provider surveys. The majority of emergency department providers found the surveillance data useful and indicated the additional information impacted their clinical decision making regarding influenza testing and treatment.

scholarly journals Recovery from profound acidosis (pH 6.685) in multi-organ dysfunction syndrome

2019 ◽  
pp. 175114371987010
Author(s):  
Eryl A Davies ◽  
Christopher Saleh ◽  
Jonathan Bannard-Smith
Keyword(s):  
Decision Making ◽  
Emergency Department ◽  
Cardiac Arrest ◽  
Critical Care ◽  
Organ Dysfunction ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Circulatory Shock ◽  
Arterial Ph ◽  
Multi Organ Dysfunction Syndrome

Acidosis is a common feature of patients referred to critical care from the emergency department. We present the case of a 49-year-old female with multi-organ dysfunction syndrome (MODS) and an arterial pH of 6.685 on arrival to the emergency department. This case is unique as the patient was in circulatory shock with MODS from rhabdomyolysis on arrival and had not suffered a cardiac arrest. We believe this to be the first reported case of full recovery from such an extreme metabolic disturbance in this context, and discuss the relevance of profound acidosis to early clinical decision-making.

scholarly journals Emotionally evocative patients in the emergency department: a mixed methods investigation of providers’ reported emotions and implications for patient safety

2020 ◽  
Vol 29 (10) ◽  
pp. 1.3-2 ◽  
Author(s):  
Linda M Isbell ◽  
Julia Tager ◽  
Kendall Beals ◽  
Guanyu Liu
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Emergency Department ◽  
Patient Safety ◽  
Qualitative Data ◽  
Clinical Decision Making ◽  
Quality Care ◽  
Clinical Decision ◽  
Safety Risks ◽  
Recent Patient

BackgroundEmergency department (ED) physicians and nurses frequently interact with emotionally evocative patients, which can impact clinical decision-making and behaviour. This study introduces well-established methods from social psychology to investigate ED providers’ reported emotional experiences and engagement in their own recent patient encounters, as well as perceived effects of emotion on patient care.MethodsNinety-four experienced ED providers (50 physicians and 44 nurses) vividly recalled and wrote about three recent patient encounters (qualitative data): one that elicited anger/frustration/irritation (angry encounter), one that elicited happiness/satisfaction/appreciation (positive encounter), and one with a patient with a mental health condition (mental health encounter). Providers rated their emotions and engagement in each encounter (quantitative data), and reported their perception of whether and how their emotions impacted their clinical decision-making and behaviour (qualitative data).ResultsProviders generated 282 encounter descriptions. Emotions reported in angry and mental health encounters were remarkably similar, highly negative, and associated with reports of low provider engagement compared with positive encounters. Providers reported their emotions influenced their clinical decision-making and behaviour most frequently in angry encounters, followed by mental health and then positive encounters. Emotions in angry and mental health encounters were associated with increased perceptions of patient safety risks; emotions in positive encounters were associated with perceptions of higher quality care.ConclusionsPositive and negative emotions can influence clinical decision-making and impact patient safety. Findings underscore the need for (1) education and training initiatives to promote awareness of emotional influences and to consider strategies for managing these influences, and (2) a comprehensive research agenda to facilitate discovery of evidence-based interventions to mitigate emotion-induced patient safety risks. The current work lays the foundation for testing novel interventions.

scholarly journals FUTURES: Forecasting the Unexpected Transfer to Upgraded Resources in Sepsis

2019 ◽  
Vol 8 (1) ◽  
pp. 187-191
Author(s):  
Alexa Profozich ◽  
Trevor Sytsma ◽  
Ryan Arnold ◽  
Kristen Miller ◽  
Muge Capan
Keyword(s):  
Decision Making ◽  
Emergency Department ◽  
Clinical Decision Making ◽  
Point Of Care ◽  
Initial Point ◽  
Clinical Decision ◽  
Sepsis Management ◽  
Insight Into

Sepsis is one of the most deadly and costly diseases. The Emergency Department (ED) is the initial point of care for most patients who become hospitalized due to sepsis. Quantifying the accuracy of ED clinician forecasting regarding patients’ clinical trajectories and outcomes can provide insight into clinical decision making and inform sepsis management.

scholarly journals Perceptions of critical and emergency department nurses regarding changes in their professional role

2018 ◽  
Vol 51 (0) ◽  
Author(s):  
Maria NK Karanikola ◽  
Margarita Giannakopoulou ◽  
Meropi Mpouzika ◽  
Christiana Nicolaou ◽  
George Tsiaousis ◽  
...  
Keyword(s):  
Decision Making ◽  
Emergency Department ◽  
Clinical Decision Making ◽  
Clinical Skills ◽  
Preliminary Investigation ◽  
Clinical Decision ◽  
Professional Role ◽  
Professional Autonomy ◽  
Emergency Department Nurses ◽  
Participation In Decision Making

ABSTRACT Objective Preliminary investigation of the way Greek critical and emergency department nurses conceptualize changes in their professional role. Method A qualitative focus-group methodology was applied. Following purposeful sampling and informed consent of participants. Results Participated eight individuals. The need for enhancement of nurses’ participation in decision-making in order for an actual change in their professional role to be achieved was the central theme of participants’ narratives. Perceived advancements in professional role performance regarded: evidence-based practice; technology; education, knowledge; clinical skills; research; heightened nurse-physician collaboration. Perceived reasons why these advancements failed to enhance nurses’ professional role were lack of meritocracy; competitive relationships; lack of support among nurses; insufficient managerial support; budget limitations. Conclusion Despite advancements in clinical practice, participants did not deem that their professional role was enhanced significantly, as participation in decision-making and control over practice remain limited. Interventions targeted to enhance nurses’ participation in clinical decision-making, and overall professional autonomy are recommended.

scholarly journals Clinical Informatics during the COVID-19 Pandemic: Lessons Learned and Implications for Emergency Department and Inpatient Operations

2020 ◽  
Author(s):  
Hanson Hsu ◽  
Peter W Greenwald ◽  
Matthew R Laghezza ◽  
Peter Steel ◽  
Richard Trepp ◽  
...  
Keyword(s):  
Decision Making ◽  
Emergency Department ◽  
Medical Care ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Lessons Learned ◽  
Clinical Informatics ◽  
Security And Privacy ◽  
Care Pathways ◽  
Provider Education

Abstract In response to a pandemic, hospital leaders can use clinical informatics to aid clinical decision-making, virtualizing medical care, coordinating communication, and defining workflow and compliance. Clinical informatics procedures need to be implemented nimbly, with governance measures in place to properly oversee and guide novel patient care pathways, diagnostic and treatment workflows, and provider education and communication. The authors’ experience recommends: (1) creating flexible ordersets that adapt to evolving guidelines that meet needs across specialties (2) enhancing and supporting inherent telemedicine capability (3) electronically enabling novel workflows quickly and suspending non-critical administrative or billing functions in the EHR and (4) using communication platforms based on tiered urgency that do not compromise security and privacy.

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