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401: Clinical Course and Associated Factor of Reexpansion Pulmonary Edema in Non-traumatic Spontaneous Pneumothorax
Research Forum Abstracts 1660 patients presented during the study period with an average ED length of stay, including boarder time, of 8hr 18 minutes, an average door to physician time of 1hr 40 minutes and door to room time of 56minutes. 53 patients LWOT (3.2%), with an average 6pm waiting room census of 6 patients. 131 patients were enrolled under the PDQ methodology. Of these patients the PDQ took primary responsibility for 39 (29.3%), with 92 (71.3%) required complex diagnostic/therapeutic interventions and a room. 36 of 39 primary PDQ patients were discharged, and 3 were observed. The average length of stay for the 39 was 2hrs. Of the 92, 68 (74%) were discharged while 24 (26%)were admitted. For all 131 patients, average door to doctor time was 2 min with an average door to room time of 14 minutes. 0 patients LWOT and the was a 0 patients waiting room census at 6pm Conclusions: Preliminary data suggests that by applying queueing theory to the arrival of patients utilizing PDQ, significant improvements can be made in efficiency, LWOT and door to doctor and room time without physical plant expansion. Additional investigation into application in other ED phases of care or health care delivery outside the ED is warrented.
Results: REPE develops in 25 patients (28.7%) after closed thoracostomy. The pneumothorax size was significantly different between REPE and non-REPE group (85.4⫾42.2% vs 51.9⫾28.9%, p⫽0.001). The incidence rate of REPE is 88% in above 40% of pneumothorax size and 12% in below 40% of it (p⫽0.003). Age, sex, symptom duration, serum BNP level, PaO2, PaCO2, SaO2, and lactate level were not different between REPE and non-REPE group. There was no mortality case and recover in 7 days for all patients. Conclusion: REPE is develops in high proportion (28.7%) after closed thoracostomy (common complication) and has reversible course in 7 days in nontraumatic spontaneous pneumothorax. REPE increases incidence rate when pneumothorax size is more than 40%.
402
BEST “Better Early Stroke Treatment”: Implementation of an Acute Stroke Pathway Improves Emergency Department Throughput
Hoff AM, Yassa AS, Bellolio MF, Gilmore RM, Boie ET, Kashyap R, Enduri S, Vaidyanathan L, Wood HM, Decker WW, Stead LG/Mayo Clinic College of Medicine. Division of Emergency Medicine Research, Rochester, MN
Study Objective: To study whether implementation of an acute stroke care pathway led to faster throughput of patients, given the emphasis of “time is brain” and current overcapacity trends. Methods: A random cohort of 140 and 116 patients respectively were collected before and after implementation of the “Better Early Stroke Treatment” (BEST) pathway in our tertiary care emergency department with over 77,000 visits a year. Sampling was performed using the methodology prescribed by JCAHO. Only patients who were admitted via the ED with an acute ischemic stroke (AIS) were included. The elements of BEST include: - triage to a specialized (critical) area - standardized battery of tests - real time (ED) patient education of warning signs and risk factors - CT Priority Data collected included: 1) Symptom onset to ED presentation 2) Door to CT time 3) ED length of stay (ED LOS) and 4) Area patient triaged Statistical analyses were performed in JMP software, SAS institute, Version 6.0, with analysis of variance, t-test and Pearson Chi-Square test for normally distributed variables and Wilcoxon/Kruskal-Wallis test for non-normally distributed variables. Results: Implementation of a dedicated acute stroke pathway resulted in more efficient ED care, with statistically significant shorter door to CT time. In the overall cohort, patients roomed in the critical area were significantly more likely to have shorter ED LOS times compared to those who went to regular acute care areas (Mean⫾SD, 3:34⫾1:16 vs. 4:26⫾1:37; p⬍0.001).
401
Clinical Course and Associated Factor of Reexpansion Pulmonary Edema in Non-traumatic Spontaneous Pneumothorax
Kim H, Lee IK/Wonju College of Medicine, Wonju, Republic of Korea
Study objective: Reexpansion pulmonary edema (REPE) is a rare, sometimes fatal complication that occurs after the rapid reexpansion of a collapsed lung following drainage and evacuation of pleural disease, such as pneumothoax, hydrothorax, or hemothorax. We performed this study to evaluate clinical course and associated factor of REPE developing in non-traumatic spontaneous pneumothorax. Methods: We conducted a prospective study of 87 patients (male 77, mean age 37 years) who were presented with non-traumatic spontaneous pneumothorax from January 2003 to February 2006. We performed chest CT scan after closed thoracostomy. We divided REPE and non-REPE group and compare with clinical characteristics and associated factor.
S126 Annals of Emergency Medicine
Conclusion: Implementation of an acute stroke pathway can enhance ED throughput, which in disease states such as acute stroke can be of paramount importance. Triage of stroke to the higher acuity areas also helps to shorten door to CT time.
Volume , . : September
Results: REPE develops in 25 patients (28.7%) after closed thoracostomy. The pneumothorax size was significantly different between REPE and non-REPE group (85.4⫾42.2% vs 51.9⫾28.9%, p⫽0.001). The incidence rate of REPE is 88% in above 40% of pneumothorax size and 12% in below 40% of it (p⫽0.003). Age, sex, symptom duration, serum BNP level, PaO2, PaCO2, SaO2, and lactate level were not different between REPE and non-REPE group. There was no mortality case and recover in 7 days for all patients. Conclusion: REPE is develops in high proportion (28.7%) after closed thoracostomy (common complication) and has reversible course in 7 days in nontraumatic spontaneous pneumothorax. REPE increases incidence rate when pneumothorax size is more than 40%.
402
BEST “Better Early Stroke Treatment”: Implementation of an Acute Stroke Pathway Improves Emergency Department Throughput
Hoff AM, Yassa AS, Bellolio MF, Gilmore RM, Boie ET, Kashyap R, Enduri S, Vaidyanathan L, Wood HM, Decker WW, Stead LG/Mayo Clinic College of Medicine. Division of Emergency Medicine Research, Rochester, MN
Study Objective: To study whether implementation of an acute stroke care pathway led to faster throughput of patients, given the emphasis of “time is brain” and current overcapacity trends. Methods: A random cohort of 140 and 116 patients respectively were collected before and after implementation of the “Better Early Stroke Treatment” (BEST) pathway in our tertiary care emergency department with over 77,000 visits a year. Sampling was performed using the methodology prescribed by JCAHO. Only patients who were admitted via the ED with an acute ischemic stroke (AIS) were included. The elements of BEST include: - triage to a specialized (critical) area - standardized battery of tests - real time (ED) patient education of warning signs and risk factors - CT Priority Data collected included: 1) Symptom onset to ED presentation 2) Door to CT time 3) ED length of stay (ED LOS) and 4) Area patient triaged Statistical analyses were performed in JMP software, SAS institute, Version 6.0, with analysis of variance, t-test and Pearson Chi-Square test for normally distributed variables and Wilcoxon/Kruskal-Wallis test for non-normally distributed variables. Results: Implementation of a dedicated acute stroke pathway resulted in more efficient ED care, with statistically significant shorter door to CT time. In the overall cohort, patients roomed in the critical area were significantly more likely to have shorter ED LOS times compared to those who went to regular acute care areas (Mean⫾SD, 3:34⫾1:16 vs. 4:26⫾1:37; p⬍0.001).
401
Clinical Course and Associated Factor of Reexpansion Pulmonary Edema in Non-traumatic Spontaneous Pneumothorax
Kim H, Lee IK/Wonju College of Medicine, Wonju, Republic of Korea
Study objective: Reexpansion pulmonary edema (REPE) is a rare, sometimes fatal complication that occurs after the rapid reexpansion of a collapsed lung following drainage and evacuation of pleural disease, such as pneumothoax, hydrothorax, or hemothorax. We performed this study to evaluate clinical course and associated factor of REPE developing in non-traumatic spontaneous pneumothorax. Methods: We conducted a prospective study of 87 patients (male 77, mean age 37 years) who were presented with non-traumatic spontaneous pneumothorax from January 2003 to February 2006. We performed chest CT scan after closed thoracostomy. We divided REPE and non-REPE group and compare with clinical characteristics and associated factor.
S126 Annals of Emergency Medicine
Conclusion: Implementation of an acute stroke pathway can enhance ED throughput, which in disease states such as acute stroke can be of paramount importance. Triage of stroke to the higher acuity areas also helps to shorten door to CT time.
Volume , . : September