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Patients with both psychiatric disorders and substance abuse are linked to significantly increased use of the ED, says this study from Central Arkansas Veterans Healthcare System and University of Arkansas for Medical Sciences, both based in Little Rock, and Baylor College of Medicine and Ben Taub General Hospital, both based in Houston.
Researchers looked at 12,212 patients who were diagnosed with a primary psychiatric disorder in the ED over four years. Patients in this group without a substance abuse disorder had a mean number of 2.8 ED visits, whereas patients in the group with a substance abuse disorder had a mean number of 5.2 ED visits.
The study’s findings suggest that improved detection, referral, and treatment of substance abuse disorders is needed for ED patients with psychiatric disorders, say the researchers. They recommend the following:
Elderly ED patients with two or more risk factors on a triage screening tool are at significantly higher risk for hospitalization, nursing home admission, and subsequent ED use, according to this study from MetroHealth Medical Center, Cleveland Clinic Foundation, and the Benjamin Rose Institute, all based in Cleveland.
The researchers evaluated 650 patients ages 65 or older presenting to two urban EDs with a simple, six-item ED nursing triage risk-screening tool. The tool assessed cognitive impairment, difficulty walking, the number of medications taken, and recent ED use and hospitalization. Patients who were defined as high risk by the screening tool were more likely to require ED use or admission to hospital or nursing home. The risk was highest in the first 30 days after the initial ED visit.
The researchers note the importance of making the screening tool quick and easy to use. They report that the screening tool has been readily accepted by ED nurses at both facilities and is routinely used as a standardized age-appropriate triage assessment tool. The screen takes only one to two minutes to complete.
When ED nurses drew blood through intravenous catheters, this resulted in significantly more red blood cell damage than drawing blood with straight needles, says this study from Johns Hopkins University School of Nursing in Baltimore.
The study surveyed ED nurses and ED clinical technicians over 19 days, and questionnaires were submitted with each blood sample sent to the laboratory for diagnostic testing. A total of 454 surveys were included in the study. The researcher found that 32% of the blood samples had some degree of hemolysis, and 13% were so hemolyzed that the laboratory canceled tests. Blood drawn with straight needles was less likely to result in hemolysis and test cancellation, and using a combination of intravenous catheter and Vacutainer (Becton Dickinson, Franklin Lakes, NJ) caused more hemolysis than using an intravenous catheter with a syringe.
To change ED nursing clinical practice, an ED guideline was revised to encourage staff to draw blood with a syringe through the intravenous catheter, instead of a Vacutainer, and then transfer the blood to a tube via the special needleless connector.
The EDs conducted an audit for 15 consecutive months after the study, and found that average cancellation rates from the laboratory decreased from 13% to 4.8%.