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(1 - 9 of 9)
- Title
- Pre and Post Implementation Evaluation of an Emergency Department Severe Sepsis Alert and Practice Protocol.
- Creator
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Williams, Darleen, Andrews, Diane, Sole, Mary Lou, Parrish, Gary, University of Central Florida
- Abstract / Description
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ABSTRACTSevere sepsis kills an estimated 1,400 people worldwide every day. This often fatal infectious process accounts for an estimated 215,000 deaths in the United States (US) annually. The main goal of this project was to evaluate the impact of the Emergency Department Severe Sepsis Alert and Practice Protocol (EDSSAPP) post implementation, on time to first antibiotic administration, length of stay, and mortality in patients admitted via the ORMC ED with severe sepsis.This study evaluated...
Show moreABSTRACTSevere sepsis kills an estimated 1,400 people worldwide every day. This often fatal infectious process accounts for an estimated 215,000 deaths in the United States (US) annually. The main goal of this project was to evaluate the impact of the Emergency Department Severe Sepsis Alert and Practice Protocol (EDSSAPP) post implementation, on time to first antibiotic administration, length of stay, and mortality in patients admitted via the ORMC ED with severe sepsis.This study evaluated the time to first antibiotic administration, total ED and hospital length of stay (LOS) and mortality of severe sepsis patients either with a severe sepsis alert (SSA) activated or no alert activated that were admitted to the hospital through the ED. A retrospective review of the electronic medical record (EMR) was conducted to gather the required data across three time cohorts: base line/time zero (T0), six months prior to the implementation of EDSSAPP; Time one (T1) the first six months following initial EDSSAPP implementation; and Time two (T2), six months following reinstatement of the corporate sepsis committee. The most significant finding of this study was the increased number of Severe Sepsis Alerts activated in time cohort T2 (n=113) compared to T1 (n=19). Another important finding was the decreased mortality in T2 (16.4%) compared to T0 (22.7%) and T1 (33%). Overall, the number of ED patients with severe sepsis who received antibiotics within the EDSSAPP required 60 minutes did not consistently improve across the three time cohorts, T0 (81.8%), T1 (71.7%) and T2 (80.6%).The hospital LOS of stay was increased by almost 1.5 days between those patients with a severe sepsis alert activated in T1 (9.00 days) compared to time T2 (10.48 days). There was no significant decrease in the ED LOS across time cohorts and between groups of patients who had a SSA activated versus no alert activated. However, there was a 1 hour and 28 minute decrease in ED LOS in patients who had a severe sepsis alert activated in T1 compared to T0. In addition, there was a 1 hour and 52 minutes decrease in ED LOS between patients who had a SSA activated compared to those who had no alert activated in T2.While EDSSAPP data does not demonstrate the statistically significant results that was expected, the challenges related to adherence by providers to EDSSAPP is as it is seen in the literature. Increased awareness via consistent communication of on-going audit results to ED personnel will heighten their awareness for severe sepsis and EDSSAPP. Improved collaborative efforts with the interdisciplinary team are needed to refocus everyone's efforts to increase early recognition that is followed by appropriate treatment interventions and documentation is essential. Lastly, the development of a formal process to follow up with individual providers as close to real time as possible following a SSA that includes accountability for care provided and related documentation would also contribute to both awareness and adherence.
Show less - Date Issued
- 2015
- Identifier
- CFE0005739, ucf:50075
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0005739
- Title
- USING SURROGATE MEASURES TO PREDICT PATIENT SATISFACTION IN THE EMERGENCY DEPARTMENT.
- Creator
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Egri, Erica, Malone, Linda, University of Central Florida
- Abstract / Description
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With healthcare organizations struggling to remain competitive and financially stable in a market where minimizing costs is a priority, hospital administrators feel the sense of urgency when it comes to keeping patients satisfied with services in order to expand volume and market share. The Emergency Department is considered the front door of a healthcare organization, and keeping its visitors satisfied in order to guarantee a future visit or a referral to a friend or family member is a must....
Show moreWith healthcare organizations struggling to remain competitive and financially stable in a market where minimizing costs is a priority, hospital administrators feel the sense of urgency when it comes to keeping patients satisfied with services in order to expand volume and market share. The Emergency Department is considered the front door of a healthcare organization, and keeping its visitors satisfied in order to guarantee a future visit or a referral to a friend or family member is a must. While patient input on the services received in a healthcare facility is essential to improving quality of care, the costs associated with measuring, collecting and analyzing their feedback are remarkable. This research focuses on developing a linear regression model to predict patient satisfaction in the ED using surrogate measures related to patient's socio-demographic characteristics and visit characteristics. With a model of this kind, healthcare administrators can potentially eliminate survey costs while still being able to determine where the hospital stands in the eyes of the patient. Three modeling approaches were used to develop a multiple regression equation. Modeling approach 1 used monthly patient satisfaction scores as the dependent variable collected by a third-party survey organization. The goal of this model was to predict monthly patient satisfaction scores. Modeling approach 2 used patient satisfaction scores collected by the discharge registrar prior to the patient leaving the ED. The goal of this model was to predict patient satisfaction scores on a patient-by-patient basis. Modeling approach 3 used patient satisfaction scores collected by a third-party survey organization. The goal of this modeling approach was to predict patient satisfaction scores on a patient-by-patient basis. Each modeling approach developed in this study used its own survey tool. Though this study had limitations when it came to developing the models and validating the findings, results are very promising. Analysis shows that predicting average patient satisfaction scores on a monthly basis gives the most accurate results, with socio-demographic characteristics and visit characteristics explaining 96% of variation in monthly average patient satisfaction scores. Other model indicators, such as normality of residuals, predicted error, mean square error, and predicted R-square show that the model fits the data very well and has strong predictive ability. Models that attempted to predict patient satisfaction on a patient-by-patient basis appeared to be ineffective, with very large predicted errors and prediction intervals and low predictive ability.
Show less - Date Issued
- 2007
- Identifier
- CFE0001657, ucf:47241
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0001657
- Title
- THE EFFECTS OF SEPSIS MANAGEMENT PROTOCOLS ON TIME TO ANTIBIOTIC ADMINISTRATION IN THE EMERGENCY DEPARTMENT.
- Creator
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Lorch, Margaret K, Bourgault, Annette, University of Central Florida
- Abstract / Description
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Sepsis is one of the leading causes of death in U.S. hospitals, resulting from organ dysfunction caused by an inappropriate inflammatory reaction to an infection. Timely treatment with empiric antibiotics in the emergency department is crucial to facilitate positive patient outcomes. The Surviving Sepsis Campaign (SSC) recommends initiating empiric antibiotic therapy within one hour of presentation to the emergency department. Some emergency departments have implemented sepsis management...
Show moreSepsis is one of the leading causes of death in U.S. hospitals, resulting from organ dysfunction caused by an inappropriate inflammatory reaction to an infection. Timely treatment with empiric antibiotics in the emergency department is crucial to facilitate positive patient outcomes. The Surviving Sepsis Campaign (SSC) recommends initiating empiric antibiotic therapy within one hour of presentation to the emergency department. Some emergency departments have implemented sepsis management protocols to guide care and ensure timely treatment. The purpose of this study is to determine the effect of a formal sepsis protocol in the emergency department on the time to antibiotic administration. A literature review was conducted using CINAHL, Cochrane Database, Health Source: Nursing/Academic Edition, and MEDLINE. Results from one systematic review, eight quasi-experimental studies, and four quality improvement projects suggested that implementation of a sepsis management protocol in an emergency department may decrease the time to antibiotic administration. ([less than] 10 = spell out) Eleven of the 13 articles reported decreased time to antibiotic administration by as much as 8-193 minutes compared to pre-protocol. One study met the SSC goal of 1 hour and reported a median administration time of 17 minutes. Time to antibiotics was influenced by protocols based on published sepsis guidelines, inclusion of antibiotic guidelines, nurse-initiated treatment, and education for emergency clinicians regarding sepsis management. Emergency departments should implement sepsis protocols adapted to their local institution to decrease time to antibiotic administration and reduce mortality of sepsis patients. Further research on how sepsis protocols affect antibiotic administration time is needed.
Show less - Date Issued
- 2018
- Identifier
- CFH2000341, ucf:45734
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFH2000341
- Title
- IDENTIFYING DRUG-SEEKING BEHAVIORS IN THE EMERGENCY DEPARTMENT.
- Creator
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Bush-Burman, Randi, Talbert, Steven, University of Central Florida
- Abstract / Description
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Pain is the leading cause of Emergency Department (ED) visits making it one of the primary concerns of the emergency medical field. The experience of pain is subjective and unique to every individual making it difficult to effectively manage. As a result, the subjective nature of pain is also commonly associated with drug-seekers often claiming to have pain simply to receive narcotics to support their addiction. There have been numerous studies completed to determine how to effectively...
Show morePain is the leading cause of Emergency Department (ED) visits making it one of the primary concerns of the emergency medical field. The experience of pain is subjective and unique to every individual making it difficult to effectively manage. As a result, the subjective nature of pain is also commonly associated with drug-seekers often claiming to have pain simply to receive narcotics to support their addiction. There have been numerous studies completed to determine how to effectively recognize drug-seeking. This integrative literature review will identify the common behaviors that have been seen as indicators of drug-seeking in the ED. The evidence collected from articles published between 2001 and 2011 examined the use of assessment tools, drug screening, and prescription monitoring programs for distinguishing drug-seekers. The evidence did not identify a specific evaluation tool used to recognize drug-seekers; however, the research did suggested that using these techniques can help to identify drug-seeking behavior allowing emergency medical staff to effectively manage pain in the ED.
Show less - Date Issued
- 2011
- Identifier
- CFH0004070, ucf:44802
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFH0004070
- Title
- AN EXPLORATORY INQUIRY AND CREATION OF EMERGENCY ROOM DISCHARGE EDUCATION MATERIALS.
- Creator
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Catalano, Ivory, Heglund, Stephen, University of Central Florida
- Abstract / Description
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Background Each Emergency Room (ER) across the USA provides every patient with paperwork upon discharge, which commonly includes information about the patient�s diagnosis. This information will briefly describe the condition, provide information on treatment outside the ER, and possibly more, depending on the document and source. These documents are not made by hospital staff, but are generally purchased from outside providers who mass market such documents as resources for hospitals to use...
Show moreBackground Each Emergency Room (ER) across the USA provides every patient with paperwork upon discharge, which commonly includes information about the patient�s diagnosis. This information will briefly describe the condition, provide information on treatment outside the ER, and possibly more, depending on the document and source. These documents are not made by hospital staff, but are generally purchased from outside providers who mass market such documents as resources for hospitals to use to educate patients. One issue with these documents lies in their mass usage, which is not necessarily designed to target the general population�s reading and educational levels. Purpose The purpose of this research was to investigate currently used discharge education materials and evaluate them for their readability and content. From this investigation, recommendations were made and adjustments to the documents were applied in order to increase understanding for the general population. Results The documents ranged in Flesch-Kincaid grade level rankings from 7.8 to 3.6, and with Flesch Reading Ease scores of 54.7 to 85.3. The entirety of the standard documents were ranked at a minimum of 7th grade equivalents, and are, at the hardest rank, ranked at a 54.7 by the Reading Ease score. In comparison, the �easy to read� documents were ranked all below 5th grade level, and at the hardest rank, ranked at a 69.0 with the Flesch Reading Ease calculation. At a minimum, all documents included condition information and home care guidelines. The major obvious difference between the documents considered �easy to read� and the standard documents are that those considered easy to read typically had sections found on the standard document removed, and have the same overall content as the standard version remaining, only in a simpler vocabulary. Conclusions In order to provide the best educational materials to the general public, it would be in the best interest of companies manufacturing these documents to produce only one version, which would be at a level around the 6th grade or below. A document slightly below the 6th grade level would be more ideal, as the simpler the document is, the more patients it will be accessible for overall, accounting for those who are below the national standards. It is not truly necessary to separate the documents into two forms, and it helps to prevent confusion or offense by doing so.
Show less - Date Issued
- 2016
- Identifier
- CFH2000016, ucf:45585
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFH2000016
- Title
- REDUCING NON-URGENT UTILIZATION OF THE EMERGENCY DEPARTMENT BY SELF-PAY PATIENTS: ANALYSIS OF THE IMPACT OF A COMMUNITY-WIDE PROVIDER NETWORK.
- Creator
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van Caulil, Karen, Liberman, Aaron, University of Central Florida
- Abstract / Description
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The purpose of this study was to determine whether a coordinated and comprehensive system of care for the uninsured changed the behavior of the uninsured by decreasing non-urgent utilization of the emergency departments within a large, urban county. The literature on emergency department trends and interventions designed to decrease "inappropriate" or non-urgent use of the emergency departments was reviewed and links to relevant theoretical concepts were identified. Utilization data from six...
Show moreThe purpose of this study was to determine whether a coordinated and comprehensive system of care for the uninsured changed the behavior of the uninsured by decreasing non-urgent utilization of the emergency departments within a large, urban county. The literature on emergency department trends and interventions designed to decrease "inappropriate" or non-urgent use of the emergency departments was reviewed and links to relevant theoretical concepts were identified. Utilization data from six emergency departments and six federally qualified health centers were evaluated. Secondary data over a three-year time period were abstracted from patient and organizational records at the hospitals and federally qualified health centers. The utilization data from the emergency departments and health centers were compared. The analysis revealed a significant change in the number of non-urgent visits by self-pay patients at the emergency departments when the health centers expanded. A 32.2 percent decrease in utilization of the emergency departments by self-pay patients was found. Non-parametric tests demonstrated significant differences in the population seen at the emergency departments and the clinics over the three-year study period. Regression analysis demonstrated a statistically significant decrease in non-urgent, self-pay visits at the emergency departments as a result of the increase in self-pay visits at the federally qualified health centers. Further analysis includes forecasting the impact of future federally qualified health centers on emergency department utilization. Recommendations for future research include evaluation of the increased numbers of non-urgent transports from the local emergency medical system by self-pay patients as well as the design of a pilot study to look at the effectiveness of transporting these patients to the federally qualified health centers for care instead of to the local emergency departments.
Show less - Date Issued
- 2005
- Identifier
- CFE0000436, ucf:46393
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0000436
- Title
- Stressors Experienced by Emergency Department Registered Nurses at the Bedside: A Phenomenological Study.
- Creator
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Heglund, Stephen, Wink, Diane, Andrews, Diane, Leuner, Jean, Malvey, Donna, Chase, Susan, University of Central Florida
- Abstract / Description
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The Emergency Department (ED) as a workplace for the Registered Nurse (RN) is a stressful environment. Reasons are thought to include interactions with other members of the interdisciplinary team as well as the situations associated with the environment of the ED such as trauma, death, sadness, joy and the general unpredictability of each moment. Studies have documented general health care workplace stress and its influence on staff, but a very limited number of studies have concentrated on...
Show moreThe Emergency Department (ED) as a workplace for the Registered Nurse (RN) is a stressful environment. Reasons are thought to include interactions with other members of the interdisciplinary team as well as the situations associated with the environment of the ED such as trauma, death, sadness, joy and the general unpredictability of each moment. Studies have documented general health care workplace stress and its influence on staff, but a very limited number of studies have concentrated on the ED. No widely published studies have identified stressors from the perspective of the ED RN.This dissertation is an interpretive phenomenological study that seeks to understand the experience of being an ED RN through the exploration of the perceptions of stress as lived by individuals who practice their art and science in this unique setting. Materials for evaluation and thematic identification were obtained through personal interviews of practicing nurses. The stories told by the participants communicated what each individual found to be negatively stressful as well as what each found to be positively stressful.Conclusions based on the findings of this work suggest a need for the ED RN to be able to depend on the presence of several factors in order to be able to function with as little distress as possible. The optimal ED environment for the RN is posited to be supportive of the individual goals of the RN, provide adequate resources and foster a communicative interdisciplinary environment. Recommendations are made to improve resource management and interdisciplinary relations.
Show less - Date Issued
- 2012
- Identifier
- CFE0004384, ucf:49408
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0004384
- Title
- FACTORS CONTRIBUTING TO THE NEGATIVE AND UNHEALTHY PSYCHOLOGICAL CONDITIONS IN THE ED RN.
- Creator
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Nieves, Ariana M, Heglund, Stephen, Dever, Kimberly, University of Central Florida
- Abstract / Description
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The emergency department is a stressful environment. Emergency department registered nurses (ED RNs) are at an increased risk of development of negative and unhealthy psychological conditions due to their frequent exposure to stress and traumatic events. These conditions include post-traumatic stress disorder, compassion fatigue, and burnout syndrome, which are already known to be common in the emergency department registered nurse population. It is important to understand the factors that...
Show moreThe emergency department is a stressful environment. Emergency department registered nurses (ED RNs) are at an increased risk of development of negative and unhealthy psychological conditions due to their frequent exposure to stress and traumatic events. These conditions include post-traumatic stress disorder, compassion fatigue, and burnout syndrome, which are already known to be common in the emergency department registered nurse population. It is important to understand the factors that influence the development of these psychological conditions in order to provide better education to nurses regarding prevention of the development of these psychological conditions. This literature review aimed to identify articles that examined the factors associated with post-traumatic stress disorder, compassion fatigue, and burnout syndrome. Databases searched included but were not limited to CINAHL, MEDLINE, and PsycINFO. The determinants discussed in this paper include personality traits, social support, coping style, workplace violence, work environment, internal perceptions held by the nurse, and external perceptions held by the patient. Limited research exists regarding the factors influencing the development of compassion fatigue in the ED RN.
Show less - Date Issued
- 2019
- Identifier
- CFH2000462, ucf:45745
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFH2000462
- Title
- BARRIERS AFFECTING COMPLIANCE WITH THE IMPLEMENTATION OF EARLY GOAL DIRECTED THERAPY IN THE EMERGENCY DEPARTMENT.
- Creator
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Castro, Ivan, Blackwell, Christopher, University of Central Florida
- Abstract / Description
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Early Goal Directed Therapy (EGDT) has been thoroughly researched and clinically supported to be effective at lowering morbidity and mortality associated with severe sepsis and septic shock. Due to the strengths of its efficacy, it has been integrated as an essential component of the Surviving Sepsis Campaign. However, very few studies have explored the barriers that affect compliance of the protocol in actual practice. The purpose of this study was to synthesize current research findings...
Show moreEarly Goal Directed Therapy (EGDT) has been thoroughly researched and clinically supported to be effective at lowering morbidity and mortality associated with severe sepsis and septic shock. Due to the strengths of its efficacy, it has been integrated as an essential component of the Surviving Sepsis Campaign. However, very few studies have explored the barriers that affect compliance of the protocol in actual practice. The purpose of this study was to synthesize current research findings regarding nursing barriers associated with EGDT. This research was limited to studies performed in the United States between 2003-2012, with patients at least 18 years old, and with data obtained from studies conducted within emergency departments (EDs) only. These findings may serve to help increase the compliance rate with the protocol among nurses in the ED. Findings indicated that compliance rates were mostly affected by two major barriers: 1) Lack of knowledge regarding the presentation and management of sepsis and septic shock, and 2)Lack of resources in the ED to perform the protocol to its full potential. Limitations of the review noted were that most research studies used were in major academic hospitals which limited the generalizability of the findings to other hospital settings. Nursing education should emphasize early recognition and aggressive treatment of sepsis. Future research should focus on addressing the most efficient ways to educate nurses on sepsis presentation and management and the ways these can be implemented in practice.
Show less - Date Issued
- 2013
- Identifier
- CFH0004420, ucf:45095
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFH0004420
