- Email: [email protected]
379 Efficacy of Glucagon for the Relief of Esophageal Obstruction in Adult Emergency Department Patients
Research Forum Abstracts score. For the purposes of this abstract, we analyzed questions relating to pain management, overall quality of medical treatment, discharge process, overall experience, and satisfaction with food in the CDU. For each of these items, we calculated descriptive statistics for each of the survey items. A linear regression of diagnosis on survey response scores was carried out to determine the effect of diagnosis on satisfaction. Results: A total of 226 patients completed the survey and were included in the analysis. The mean age of patients in the CDU was 50.6 years and 57% were female. In an analysis including all respondents, patients gave an average score of 9.3 (SD¼1.4), 9.5 (1.1), 9.2 (1.4), 9.4 (1.1), 7.4 (2.5) for pain management, overall medical treatment, discharge process, overall experience, and quality of food respectively. Most sampled patients were admitted to the CDU for chest pain (43%), followed by syncope/near syncope (8%), abdominal pain (8%), and cellulitis (4%). There was no statistically significant difference among satisfaction scores for any of the survey items based on diagnosis (P>.05). Conclusion: CDUs have the potential for high patient satisfaction scores and therefore could possibly improve overall ED satisfaction scores and reduce the need for inpatient admissions. This study was limited in its sample size, which might have been the reason for not being able to observe any difference by diagnosis group. The next steps include comparing CDU satisfaction scores to ED-only and inpatient satisfaction scores to assess for variation. CDU satisfaction scores could also be analyzed to determine if they vary by length of stay.
379
Efficacy of Glucagon for the Relief of Esophageal Obstruction in Adult Emergency Department Patients
Kleaveland AS, Baumann MR, Rolfe S, Strout TD/Maine Medical Center, Portland, ME
Study Objective: Esophageal food impaction is frequently encountered in the emergency setting and research regarding the efficacy of treatment with glucagon is limited. We sought to determine the effect of glucagon administration on esophageal bolus relief in a cohort of adult emergency department (ED) patients. Methods: Adult patients ( 16 years old) presenting to our academic tertiary care ED with esophageal food bolus were identified through query of our electronic health records system. Data regarding patient characteristics, past medical and surgical history, bolus type and location, pharmacologic and endoscopic treatment, endoscopic findings, the presence of nausea and vomiting, bolus relief, and patient disposition were abstracted by trained reviewers using a standardized data collection tool; inter-rater reliability was established. Chi-square analysis and the independent samples t-test were used to compare glucagon response groups. Results: During the two-year study period, 98 adult patients sought treatment in our ED for 103 esophageal food bolus episodes. The median subject age was 52 years (range 16 - 94) and 60% (n ¼ 62) were male. The vast majority of food boluses were comprised of meat (86%, n ¼ 89) and the distal esophagus was the most frequently documented bolus location (37%, n ¼ 38). Subjects received glucagon in all 103 cases, with bolus passage following glucagon administration reported in 22 cases (21%). Six subjects (6%) were noted to experience spontaneous resolution of their symptoms after vomiting post-glucagon administration while one subject passed a bolus after drinking water. Sixty-seven subjects (65%) underwent subsequent endoscopic treatment, confirming esophageal anatomic abnormality in all 67 (100%) endoscopic cases. Significant differences in age, sex, and history were not noted when glucagon responders and non-responders were compared. Conclusions: In this setting and sample, esophageal food boluses consisted primarily of meat located in the distal esophagus. Glucagon was administered in all cases and was associated with bolus passage approximately 20% of the time. Patients with anatomic esophageal abnormalities confirmed on endoscopy were significantly less likely to respond to glucagon when compared to those with normal anatomy.
380
A Triage-Based Algorithm to Decrease Median Time to Pain Management for Long Bone Fractures
Figure #1. Median Time to Pain Management for Long Bone Fracture. 2% points from a hospital’s CMS reimbursement. One of the newest metrics relating to the ED is “OP-21: Median Time to Pain Management for Long Bone Fracture.” The bar for this metric is currently set at a median time of 47 minutes. During the initial reporting period for OP-21, our institution was not meeting this metric. Therefore our objective was to evaluate the effectiveness of a triage-based “Long Bone Fracture Algorithm” (LBFA) to decrease “Median Time to Pain Management for Long Bone Fracture” (TTPM). Methods: At our 80,000-visit community hospital ED, we conducted a before and after study from January 2013 to March 2014. The before cohort extended for the first eight months of the trial and provided baseline data detailing our TTPM. During a one-month washout period in September 2013, a LBFA was created by a multidisciplinary team of ED physician, administrative and nursing personnel. Three key elements of the LBFA include 1) assigning patients in this cohort as priority 2, thereby alerting staff to mobilize the patient into the ED within ten minutes of arrival, 2) dreating a “just in time” TTPM tool that stayed with the patient and would include a place to document ED arrival time as well as provide space to document the final time a patient should receive pain control in order to meet the metric, and 3) educating the triage and minor care staff to document whether the patient received pain medications at home prior to arrival or if they declined pain medications upon initial exam or triage. The after cohort consisted of the following six months to track our process with the LBFA. Our primary outcome measure was TTPM as compared between both cohorts. Data was analyzed using descriptive statistics and a Mann-Whitey U test was to assess for statistical significance. Results: A total of 116 consecutive cases were evaluated in the before cohort over an eight-month period. The median TTPM was 56.50 minutes during that time with 77 (66.4%) of cases not meeting the metric. After a one-month implementation period, a total of 85 consecutive cases comprised the after cohort over the following six months. The median TTPM was 47 minutes with 42 (49.4%) of the cases not meeting the metric. The difference between both cohorts was 9.5 minutes [95% CI of 8.22 minutes] and a P¼.0110. A graphical breakdown of the before cohort and the after cohorts broken down by month is illustrated in Figure 1 which illustrates a continued improvement in the metric throughout the after cohort. Conclusion: A triage-based long bone fracture algorithm can decrease median time to pain management for long bone fracture in a community hospital setting.
381
Characteristics of Patients Requiring Automatic Implantable Cardioverter Defibrillator or Permanent Pacemaker Implantation During the Hospital Stay in Patients Without Evidence of Ventricular Tachycardia on Presentation to the Emergency Department
Bastani A, Weintraub CH, Milewski AM, Rocchini A, Thurston K, Kumar V, Anderson W/ Troy Beaumont Hospital, Troy, MI
Garg N, Hoang N, Wong C, Ali Z, Patel R, Suarez AE/New York Hospital Queens, Flushing, NY
Study Objectives: The Centers for Medicare and Medicaid Services (CMS) is the dominant force in the determination of how emergency departments (EDs) and emergency physicians are reimbursed. One avenue in which CMS exerts its influence is through the Outpatient Prospective Payment System (OPPS). The OPPS is a set of outpatient and ED metrics that hospitals must report regarding the quality of care provided. The hospitals score across these metrics may result in a reduction of up to
Background: Ventricular tachycardia (VT)/V fib is the most feared complication of many cardiac and pulmonary diseases. Automatic implantable cardioverter defibrillator or permanent pacemaker (AICD/PPM) placement is recommended for patients with LVEF <45% in several clinical trials. Given the changing health care and narrowing guidelines for telemetry use, our study aims to identify the characteristics of patients presenting to emergency department (ED) without
S136 Annals of Emergency Medicine
Volume 64, no. 4s : October 2014
379
Efficacy of Glucagon for the Relief of Esophageal Obstruction in Adult Emergency Department Patients
Kleaveland AS, Baumann MR, Rolfe S, Strout TD/Maine Medical Center, Portland, ME
Study Objective: Esophageal food impaction is frequently encountered in the emergency setting and research regarding the efficacy of treatment with glucagon is limited. We sought to determine the effect of glucagon administration on esophageal bolus relief in a cohort of adult emergency department (ED) patients. Methods: Adult patients ( 16 years old) presenting to our academic tertiary care ED with esophageal food bolus were identified through query of our electronic health records system. Data regarding patient characteristics, past medical and surgical history, bolus type and location, pharmacologic and endoscopic treatment, endoscopic findings, the presence of nausea and vomiting, bolus relief, and patient disposition were abstracted by trained reviewers using a standardized data collection tool; inter-rater reliability was established. Chi-square analysis and the independent samples t-test were used to compare glucagon response groups. Results: During the two-year study period, 98 adult patients sought treatment in our ED for 103 esophageal food bolus episodes. The median subject age was 52 years (range 16 - 94) and 60% (n ¼ 62) were male. The vast majority of food boluses were comprised of meat (86%, n ¼ 89) and the distal esophagus was the most frequently documented bolus location (37%, n ¼ 38). Subjects received glucagon in all 103 cases, with bolus passage following glucagon administration reported in 22 cases (21%). Six subjects (6%) were noted to experience spontaneous resolution of their symptoms after vomiting post-glucagon administration while one subject passed a bolus after drinking water. Sixty-seven subjects (65%) underwent subsequent endoscopic treatment, confirming esophageal anatomic abnormality in all 67 (100%) endoscopic cases. Significant differences in age, sex, and history were not noted when glucagon responders and non-responders were compared. Conclusions: In this setting and sample, esophageal food boluses consisted primarily of meat located in the distal esophagus. Glucagon was administered in all cases and was associated with bolus passage approximately 20% of the time. Patients with anatomic esophageal abnormalities confirmed on endoscopy were significantly less likely to respond to glucagon when compared to those with normal anatomy.
380
A Triage-Based Algorithm to Decrease Median Time to Pain Management for Long Bone Fractures
Figure #1. Median Time to Pain Management for Long Bone Fracture. 2% points from a hospital’s CMS reimbursement. One of the newest metrics relating to the ED is “OP-21: Median Time to Pain Management for Long Bone Fracture.” The bar for this metric is currently set at a median time of 47 minutes. During the initial reporting period for OP-21, our institution was not meeting this metric. Therefore our objective was to evaluate the effectiveness of a triage-based “Long Bone Fracture Algorithm” (LBFA) to decrease “Median Time to Pain Management for Long Bone Fracture” (TTPM). Methods: At our 80,000-visit community hospital ED, we conducted a before and after study from January 2013 to March 2014. The before cohort extended for the first eight months of the trial and provided baseline data detailing our TTPM. During a one-month washout period in September 2013, a LBFA was created by a multidisciplinary team of ED physician, administrative and nursing personnel. Three key elements of the LBFA include 1) assigning patients in this cohort as priority 2, thereby alerting staff to mobilize the patient into the ED within ten minutes of arrival, 2) dreating a “just in time” TTPM tool that stayed with the patient and would include a place to document ED arrival time as well as provide space to document the final time a patient should receive pain control in order to meet the metric, and 3) educating the triage and minor care staff to document whether the patient received pain medications at home prior to arrival or if they declined pain medications upon initial exam or triage. The after cohort consisted of the following six months to track our process with the LBFA. Our primary outcome measure was TTPM as compared between both cohorts. Data was analyzed using descriptive statistics and a Mann-Whitey U test was to assess for statistical significance. Results: A total of 116 consecutive cases were evaluated in the before cohort over an eight-month period. The median TTPM was 56.50 minutes during that time with 77 (66.4%) of cases not meeting the metric. After a one-month implementation period, a total of 85 consecutive cases comprised the after cohort over the following six months. The median TTPM was 47 minutes with 42 (49.4%) of the cases not meeting the metric. The difference between both cohorts was 9.5 minutes [95% CI of 8.22 minutes] and a P¼.0110. A graphical breakdown of the before cohort and the after cohorts broken down by month is illustrated in Figure 1 which illustrates a continued improvement in the metric throughout the after cohort. Conclusion: A triage-based long bone fracture algorithm can decrease median time to pain management for long bone fracture in a community hospital setting.
381
Characteristics of Patients Requiring Automatic Implantable Cardioverter Defibrillator or Permanent Pacemaker Implantation During the Hospital Stay in Patients Without Evidence of Ventricular Tachycardia on Presentation to the Emergency Department
Bastani A, Weintraub CH, Milewski AM, Rocchini A, Thurston K, Kumar V, Anderson W/ Troy Beaumont Hospital, Troy, MI
Garg N, Hoang N, Wong C, Ali Z, Patel R, Suarez AE/New York Hospital Queens, Flushing, NY
Study Objectives: The Centers for Medicare and Medicaid Services (CMS) is the dominant force in the determination of how emergency departments (EDs) and emergency physicians are reimbursed. One avenue in which CMS exerts its influence is through the Outpatient Prospective Payment System (OPPS). The OPPS is a set of outpatient and ED metrics that hospitals must report regarding the quality of care provided. The hospitals score across these metrics may result in a reduction of up to
Background: Ventricular tachycardia (VT)/V fib is the most feared complication of many cardiac and pulmonary diseases. Automatic implantable cardioverter defibrillator or permanent pacemaker (AICD/PPM) placement is recommended for patients with LVEF <45% in several clinical trials. Given the changing health care and narrowing guidelines for telemetry use, our study aims to identify the characteristics of patients presenting to emergency department (ED) without
S136 Annals of Emergency Medicine
Volume 64, no. 4s : October 2014