- Email: [email protected]
428 Prevalence of Homelessness and Housing Insecurity in an Urban Emergency Department
Research Forum Abstracts students and residents (p¼0.005). They felt more confident that they could explain to another person how to meditate (p¼0.0001) and be mindful (p¼0.0001); more confident in their own ability to meditate (p¼0.0001) and be mindful (p¼0.0001); meditated more often (p¼0.0001) and practiced mindfulness more often (p¼0.0001); and were more likely to recommend meditation (p¼0.002) and mindfulness (p¼0.0001) to another person. More importantly, however, many of these changes remained significantly sustained even up to six months later. Six months following their participation, the students still felt more confident that they could explain to another person how to meditate (p¼0.0001) and be mindful (p¼0.0001); more confident in their own ability to meditate (p¼0.006) and be mindful (p¼0.002); meditated more often (p¼0.013) and practiced mindfulness more often (p¼0.016); and were more likely to recommend meditation (p¼0.007) and mindfulness (p¼0.008) to another person when compared to prior to their participation in the curriculum. Conclusions: Although the sample size was small, our pilot curriculum had a significantly sustained behavioral impact on our students. In the future, this intervention could easily be adapted for any four-week rotation during medical school to reduce burnout and increase physician wellness.
427
Music in Emergent Settings: A Randomized Controlled Trial
Tyndall J, Kerrigan M, Baker Chowdhury MA, Elie M-C, Gul S, Balakrishnan MP, Sonke J/University of Florida, Gainesville, FL
Study Objectives: To investigate the impact of live preferential music (LPM) on patients receiving care in a level 1 trauma center and academic emergency department and to determine if LPM can affect the need for and utilization of pain medication among emergency department patients Methods: From May to October 2015, a total of 855 subjects were enrolled in a double blind randomized controlled trial (423-control, 432-intervention) and were consented, enrolled, and randomly assigned to either an intervention group who listened to LPM or a control group who did not receive LPM. Both intervention and control groups included patients or their care surrogates. All participants were aged 18 years or older. Music interventions were administered by trained UF Health Arts in Medicine Musicians in Residence. Interventions were conducted on alternating days over a 20-week period. Musicians delivered interventions in pairs and all were either guitarists or vocalists with a very broad repertoire of musical styles. Outcome measures included changes in vital signs including systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), oxygen saturation (OS), and respiratory rate (RR). Patient satisfaction, Morphine equivalence, and length of stay were also considered as secondary outcomes. Vital sign measurements were recorded at four time points (baseline, 2 hours, 4 hours, and 6 hours after the intervention) on the same day of observation. Data analysis incorporated several methods, including two-tailed t-tests, one way and repeated measure analysis of variance (ANOVA), Tukey multiple comparisons, and Kruskal Wallis non-parametric testing, utilizing a 5% error rate. Results: Among the control participants, 55.32% were female and 44.68% were male. Of the intervention participants, 56.71% were female and 43.29% were male. The mean SBP and DBP at baseline was 135.36 mmHg (SD25.07), 78.50 mmHg (SD16.60) for the control group and 139.12 mmHg (SD26.87), 78.86 mmHg (SD16.89) for the intervention group. Among the all intervention patients, a significant reduction of 9.03 mmHg in SBP (N(c)¼623, N(i) ¼194) and 5.86 mmHg in DBP (N(c) ¼623, N(i)¼194) was observed after two hours of intervention. For hypertensive patients (where presenting BP was clinically defined as stage 1 or above, N¼77), there was a steep reduction of 19.70 mmHg (p<0.001) in SBP after two hours of intervention. Both SBP and DBP continued to decline significantly four and six hours post intervention. Similar to SBP and DBP, there was a 7.24 bpm (p<0.03) decline in HR among the intervention patients. A 32.8% average reduction in administration of morphine equivalents was found among intervention patients. We also observed a non-significant reduction in OS and RR. Conclusions: Our findings indicate that LPM has the potential to reduce SBP, DBP, and HR within two hours of the initial intervention, may have a long-term effect on reduction in these indicators up to 6 hours post LPM exposure, and may reduce the need for analgesia in the emergency department environment.
Volume 70, no. 4s : October 2017
428
Prevalence of Homelessness and Housing Insecurity in an Urban Emergency Department
Jackson TS, Moran T, Lin J, Salhi BA/Emory University, Atlanta, GA; Emory University, Atlanta, GA
Study Objectives: Homelessness is a substantial problem in the United States. Currently, the US Department of Housing and Urban Development estimates that over 560,000 people experience homelessness on any given night, and up to 1.5 million individuals experience homelessness over the course of a year. Homeless persons pose special challenges for the emergency provider. Prevalence of homelessness in the ED is primarily estimated from the ED component of the NHAMCS database, which estimates that homeless persons account for 0.5% of ED visits nationally. We hypothesized that this measure may underestimate the prevalence of homelessness and housing insecurity among ED patients as housing status is under-discussed in the acute care setting. The goal of this study is to determine the prevalence of homelessness and housing insecurity among ED patients in an urban safety net Atlanta hospital. Methods: A cross-sectional survey of a convenience sample of patients presenting to the ED over a 3-month span was performed. A team of trained research assistants administered a structured survey instrument. Patients were surveyed in all areas of the ED and at all times of the day. Patients were 18 years old, English-speaking, not incarcerated, and able to provide informed consent. Results: 923 ED patients (55.1% Male; Median Age ¼ 44) completed the survey. The racial makeup of the sample was as follows: 71.3% Black, 16.7% White, 6.5% Hispanic, 1.6% Asian and 4% self-identified as “other.” Most patients had at least a High school education (42.1% high school/GED; 41.5% at least some college; 16.4% did not High school and were unemployed (47.9% unemployed; 19.4% part-time; 32.7% full-time). 51.5% of surveyed ED patients reported some measure of housing insecurity in the past 12 months: moved in with others to save money (19.9%); lived with others but didn’t pay rent (30.2%); skipped mortgage or rent payment (12%); experienced eviction (8%); lived in a hotel or motel (21.2%); lived in a place not meant for human habitation (8.2%); slept in a shelter (14.2%); slept on the street (12.5%). 42% of homeless or housing-insecure women reported that they were also caring for children. Conclusions: The rate of housing-insecure patients at our hospital is substantially greater than the national estimates. While this may be a result of selection bias in our safety-net setting, our results suggest that homelessness and housing insecurity may be under-recognized among ED patients. Given the welldocumented association between homelessness, poor health and repeat ED visits our study may have far reaching implications in recognizing and treating these patients in the ED. More research is needed on homelessness and its implications for ED Patients.
429
Assessment of Access to Firearms in Suicidal Patients in the Emergency Department
Naganathan S, Koscso MK, Mueller K/Washington University School of Medicine and Barnes-Jewish Hospital, Saint Louis, MO; Washington University School of Medicine, Saint Louis, MO
Study Objectives: Suicide is the 10th leading cause of death in the United States. Suicidal ideation (SI) is a common chief complaint of patients presenting to the emergency department (ED). Nearly half of suicide deaths in the United States in 2014 were due to firearms. Despite these numbers, provider documentation on access to lethal means is lacking. Our primary objective was to quantify documentation of access to firearms in patients who presented to the ED with a chief complaint of SI. Methods: We performed a retrospective chart review of consecutive patients who presented to the ED with a chief complaint or diagnosis of SI during July 2014. This study was performed at an urban, academic ED. Charts were queried from the electronic medical record. Primary outcomes assessed included whether the ED physician team documented: 1) patient access to firearms, 2) access to firearms in the home, and 3) assessment of storage methods. Assessment and documentation by psychiatry, when consulted, was compared to that of emergency physicians. Secondary outcomes included demographics, preexisting psychiatric diagnoses, substance use, disposition at time of visit, and disposition upon return visit for SI within 30 days.
Annals of Emergency Medicine S167
427
Music in Emergent Settings: A Randomized Controlled Trial
Tyndall J, Kerrigan M, Baker Chowdhury MA, Elie M-C, Gul S, Balakrishnan MP, Sonke J/University of Florida, Gainesville, FL
Study Objectives: To investigate the impact of live preferential music (LPM) on patients receiving care in a level 1 trauma center and academic emergency department and to determine if LPM can affect the need for and utilization of pain medication among emergency department patients Methods: From May to October 2015, a total of 855 subjects were enrolled in a double blind randomized controlled trial (423-control, 432-intervention) and were consented, enrolled, and randomly assigned to either an intervention group who listened to LPM or a control group who did not receive LPM. Both intervention and control groups included patients or their care surrogates. All participants were aged 18 years or older. Music interventions were administered by trained UF Health Arts in Medicine Musicians in Residence. Interventions were conducted on alternating days over a 20-week period. Musicians delivered interventions in pairs and all were either guitarists or vocalists with a very broad repertoire of musical styles. Outcome measures included changes in vital signs including systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), oxygen saturation (OS), and respiratory rate (RR). Patient satisfaction, Morphine equivalence, and length of stay were also considered as secondary outcomes. Vital sign measurements were recorded at four time points (baseline, 2 hours, 4 hours, and 6 hours after the intervention) on the same day of observation. Data analysis incorporated several methods, including two-tailed t-tests, one way and repeated measure analysis of variance (ANOVA), Tukey multiple comparisons, and Kruskal Wallis non-parametric testing, utilizing a 5% error rate. Results: Among the control participants, 55.32% were female and 44.68% were male. Of the intervention participants, 56.71% were female and 43.29% were male. The mean SBP and DBP at baseline was 135.36 mmHg (SD25.07), 78.50 mmHg (SD16.60) for the control group and 139.12 mmHg (SD26.87), 78.86 mmHg (SD16.89) for the intervention group. Among the all intervention patients, a significant reduction of 9.03 mmHg in SBP (N(c)¼623, N(i) ¼194) and 5.86 mmHg in DBP (N(c) ¼623, N(i)¼194) was observed after two hours of intervention. For hypertensive patients (where presenting BP was clinically defined as stage 1 or above, N¼77), there was a steep reduction of 19.70 mmHg (p<0.001) in SBP after two hours of intervention. Both SBP and DBP continued to decline significantly four and six hours post intervention. Similar to SBP and DBP, there was a 7.24 bpm (p<0.03) decline in HR among the intervention patients. A 32.8% average reduction in administration of morphine equivalents was found among intervention patients. We also observed a non-significant reduction in OS and RR. Conclusions: Our findings indicate that LPM has the potential to reduce SBP, DBP, and HR within two hours of the initial intervention, may have a long-term effect on reduction in these indicators up to 6 hours post LPM exposure, and may reduce the need for analgesia in the emergency department environment.
Volume 70, no. 4s : October 2017
428
Prevalence of Homelessness and Housing Insecurity in an Urban Emergency Department
Jackson TS, Moran T, Lin J, Salhi BA/Emory University, Atlanta, GA; Emory University, Atlanta, GA
Study Objectives: Homelessness is a substantial problem in the United States. Currently, the US Department of Housing and Urban Development estimates that over 560,000 people experience homelessness on any given night, and up to 1.5 million individuals experience homelessness over the course of a year. Homeless persons pose special challenges for the emergency provider. Prevalence of homelessness in the ED is primarily estimated from the ED component of the NHAMCS database, which estimates that homeless persons account for 0.5% of ED visits nationally. We hypothesized that this measure may underestimate the prevalence of homelessness and housing insecurity among ED patients as housing status is under-discussed in the acute care setting. The goal of this study is to determine the prevalence of homelessness and housing insecurity among ED patients in an urban safety net Atlanta hospital. Methods: A cross-sectional survey of a convenience sample of patients presenting to the ED over a 3-month span was performed. A team of trained research assistants administered a structured survey instrument. Patients were surveyed in all areas of the ED and at all times of the day. Patients were 18 years old, English-speaking, not incarcerated, and able to provide informed consent. Results: 923 ED patients (55.1% Male; Median Age ¼ 44) completed the survey. The racial makeup of the sample was as follows: 71.3% Black, 16.7% White, 6.5% Hispanic, 1.6% Asian and 4% self-identified as “other.” Most patients had at least a High school education (42.1% high school/GED; 41.5% at least some college; 16.4% did not High school and were unemployed (47.9% unemployed; 19.4% part-time; 32.7% full-time). 51.5% of surveyed ED patients reported some measure of housing insecurity in the past 12 months: moved in with others to save money (19.9%); lived with others but didn’t pay rent (30.2%); skipped mortgage or rent payment (12%); experienced eviction (8%); lived in a hotel or motel (21.2%); lived in a place not meant for human habitation (8.2%); slept in a shelter (14.2%); slept on the street (12.5%). 42% of homeless or housing-insecure women reported that they were also caring for children. Conclusions: The rate of housing-insecure patients at our hospital is substantially greater than the national estimates. While this may be a result of selection bias in our safety-net setting, our results suggest that homelessness and housing insecurity may be under-recognized among ED patients. Given the welldocumented association between homelessness, poor health and repeat ED visits our study may have far reaching implications in recognizing and treating these patients in the ED. More research is needed on homelessness and its implications for ED Patients.
429
Assessment of Access to Firearms in Suicidal Patients in the Emergency Department
Naganathan S, Koscso MK, Mueller K/Washington University School of Medicine and Barnes-Jewish Hospital, Saint Louis, MO; Washington University School of Medicine, Saint Louis, MO
Study Objectives: Suicide is the 10th leading cause of death in the United States. Suicidal ideation (SI) is a common chief complaint of patients presenting to the emergency department (ED). Nearly half of suicide deaths in the United States in 2014 were due to firearms. Despite these numbers, provider documentation on access to lethal means is lacking. Our primary objective was to quantify documentation of access to firearms in patients who presented to the ED with a chief complaint of SI. Methods: We performed a retrospective chart review of consecutive patients who presented to the ED with a chief complaint or diagnosis of SI during July 2014. This study was performed at an urban, academic ED. Charts were queried from the electronic medical record. Primary outcomes assessed included whether the ED physician team documented: 1) patient access to firearms, 2) access to firearms in the home, and 3) assessment of storage methods. Assessment and documentation by psychiatry, when consulted, was compared to that of emergency physicians. Secondary outcomes included demographics, preexisting psychiatric diagnoses, substance use, disposition at time of visit, and disposition upon return visit for SI within 30 days.
Annals of Emergency Medicine S167