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Increased Emergency Department Boarding Times2012 MarijaDjokovicAbstractProlonged boarding times (increased wait times for admitted patients) in the emergencydepartment result in an increase in morbidity and mortality in critically ill adult patients admittedto the ICU. Overcrowding in the emergency department (ED), medication errors, and a delay intransfer to the ICU are the leading reasons for an increase in morbidity and mortality. Thisproject focuses on a comprehensive assessment of a Las Vegas emergency department. The

assessment will determine if the issues cited in the literature of: 1) overcrowding, 2) medicationerrors, and 3) delay in transfer are a current problem in the Las Vegas emergency department andbased on the assessment data and evidence-based plan will be developed.

Common infection control practices in the emergency department:A literature review2014Eileen J. Carter et alAbstract:Background: Health care-associated infections (HAIs) are a major health concern, despite being largelyavoidable. The emergency department (ED) is an essential component of the health care system andsubject to workflow challenges, which may hinder ED personnel adherence to guideline-based infectionprevention practices.Methods: The purpose of this review was to examine published literature regarding adherence ratesamong ED personnel to selected infection control practices, including hand hygiene (HH) and aseptictechnique during the placement of central venous catheters and urinary catheters. We also reviewedstudies reporting rates of ED equipment contamination. PubMed was searched for studies that includedadherence rates among ED personnel to HH during routine patient care, aseptic technique during theplacement of central venous catheters and urinary catheters, and rates of equipment contamination.Results: In total, 853 studies was screened, and 589 abstracts were reviewed. The full texts of 36 paperswere examined, and 23 articles were identified as meeting inclusion criteria. Eight studies used variousscales to measure HH compliance, which ranged from 7.7% to 89.7%. Seven articles examined centralvenous catheters inserted in the ED or by emergency medicine residents. Detail of aseptic techniquepractices during urinary catheterization was lacking. Four papers described equipment contamination inthe ED.Conclusion: Standardized methods and definitions of compliance monitoring are needed to compareresults across settings.

Explanation:

As stated in this study, to be able to lessen the population of patients in the emergency room, an advance nursing intervention should be given at the time the patient got to the triage. It can also help alleviate the complaint of the patients and vacate the beds that patients with a critical case will need.

ADVANCED NURSING INTERVENTIONS AND LENGTHOF STAY IN THE EMERGENCY DEPARTMENT2013Mary A. Stauber et alAbstractIntroduction: Over the past 15 years, emergency departmentshave become overcrowded, with prolonged wait times and anextended length of stay (LOS). These factors cause delay intreatment, which reduces quality of care and increases thepotential for adverse events. One suggestion to decrease LOS inthe emergency department is to implement advanced nursinginterventions (ANIs) at triage. The study purpose was todetermine whether there was a difference in ED LOS betweenpatients presenting with a chief complaint of abdominal painwho received ANIs at triage and patients who did not receiveANIs at triage.Methods: A retrospective chart review was performed todetermine the ED LOS (mean time in department and mean timein room [TIR]). The convenience sample included ED patients whopresented to a large Midwestern academic medical center’semergency department with a chief complaint of abdominal painand Emergency Severity Index level 3. Independent-samples ttests were used to determine whether there was any statisticaldifference in LOS between the two groups. Cohen’s d statisticwas used to determine effect size.Results: Implementation of ANIs at triage for patients with lowacuityabdominal pain resulted in an increased time in departmentand a decreased TIR with a medium effect size.Conclusion: A reduction in TIR optimizes bed availability in theemergency department. Low-acuity patients spend less timeoccupying an ED bed, which preserves limited bed space for thesickest patients. Results of diagnostic tests are often available bythe time the patient is placed in a room, facilitatinHealthcare workers and health care-associatedinfections: knowledge, attitudes, and behavior inemergency departments in Italy2010Cristiana Parmeggiani et alAbstract:

Background: This survey assessed knowledge, attitudes, and compliance regarding standard precautions abouthealth care-associated infections (HAIs) and the associated determinants among healthcare workers (HCWs) inemergency departments in Italy.Methods: An anonymous questionnaire, self-administered by all HCWs in eight randomly selected non-academicacute general public hospitals, comprised questions on demographic and occupational characteristics; knowledgeabout the risks of acquiring and/or transmitting HAIs from/to a patient and standard precautions; attitudes towardguidelines and risk perceived of acquiring a HAI; practice of standard precautions; and sources of information.Results: HCWs who know the risk of acquiring Hepatitis C (HCV) and Human Immunodeficiency Virus (HIV) from apatient were in practice from less years, worked fewer hours per week, knew that a HCW can transmit HCV andHIV to a patient, knew that HCV and HIV infections can be serious, and have received information from educationalcourses and scientific journals. Those who know that gloves, mask, protective eyewear, and hands hygiene afterremoving gloves are control measures were nurses, provided care to fewer patients, knew that HCWs’ hands arevehicle for transmission of nosocomial pathogens, did not know that a HCW can transmit HCV and HIV to apatient, and have received information from educational courses and scientific journals. Being a nurse, knowingthat HCWs’ hands are vehicle for transmission of nosocomial pathogens, obtaining information from educationalcourses and scientific journals, and needing information were associated with a higher perceived risk of acquiring aHAI. HCWs who often or always used gloves and performed hands hygiene measures after removing gloves werenurses, provided care to fewer patients, and knew that hands hygiene after removing gloves was a controlmeasure.Conclusions: HCWs have high knowledge, positive attitudes, but low compliance concerning standard precautions.Nurses had higher knowledge, perceived risk, and appropriate HAIs’ control measures than physicians and HCWsanswered correctly and used appropriately control measures if have received information from educational coursesand scientific journals.

The Effect of Emergency DepartmentCrowding on Patient Outcomes

2011Kimberly D. Johnson et alAbstractThe purpose of this review was to summarize the findings of published reports that investigatedquality-related outcomes and emergency department (ED) crowding. Of 276 data-based articles, 23reported associations between patient outcomes and crowding. These articles were grouped into3 categories: delay in treatment, decreased satisfaction, and increased mortality. Although thesestudies suggest that crowding results in poor outcomes, it is possible that other factors such asnursing care contribute to these adverse outcomes. Nursing care has been shown to contribute toboth positive and negative patient outcomes in other settings. Building an understanding of how EDcrowding affects the practice of the emergency nurse is essential to examining how nursing care,surveillance, and communication impact outcomes of emergency patients. Investigation into nursesensitivequality indicators in the ED has potential to develop strategies that deliver high quality ofcare, regardless of crowded conditions.

Emergency Department Triage Scales and TheirComponents: A Systematic Review of theScientific Evidence2011NasimFarrohknia et alAbstractEmergency department (ED) triage is used to identify patients’ level of urgency and treat them based on theirtriage level. The global advancement of triage scales in the past two decades has generated considerable researchon the validity and reliability of these scales. This systematic review aims to investigate the scientific evidence forpublished ED triage scales. The following questions are addressed:1. Does assessment of individual vital signs or chief complaints affect mortality during the hospital stay or within30 days after arrival at the ED?2. What is the level of agreement between clinicians’ triage decisions compared to each other or to a goldstandard for each scale (reliability)?3. How valid is each triage scale in predicting hospitalization and hospital mortality?A systematic search of the international literature published from 1966 through March 31, 2009 explored the British

Nursing Index, Business Source Premier, CINAHL, Cochrane Library, EMBASE, and PubMed. Inclusion was limited tocontrolled studies of adult patients (≥15 years) visiting EDs for somatic reasons. Outcome variables were death inED or hospital and need for hospitalization (validity). Methodological quality and clinical relevance of each studywere rated as high, medium, or low. The results from the studies that met the inclusion criteria and qualitystandards were synthesized applying the internationally developed GRADE system. Each conclusion was thenassessed as having strong, moderately strong, limited, or insufficient scientific evidence. If studies were notavailable, this was also noted.We found ED triage scales to be supported, at best, by limited and often insufficient evidence.The ability of the individual vital signs included in the different scales to predict outcome is seldom, if at all,studied in the ED setting. The scientific evidence to assess interrater agreement (reliability) was limited for onetriage scale and insufficient or lacking for all other scales. Two of the scales yielded limited scientific evidence, andone scale yielded insufficient evidence, on which to assess the risk of early death or hospitalization in patientsassigned to the two lowest triage levels on a 5-level scale (validity).