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  1. Article ; Online: Time Cost of Standardized Nursing Screens in the Emergency Department.

    Migdal, Victoria L / Harper, Kaitlin / Haqqani, Nazish / Janiak, Bruce

    The western journal of emergency medicine

    2019  Volume 20, Issue 6, Page(s) 851–854

    Abstract: Introduction: Various policies require that screening questions be asked of all patients who present to the emergency department (ED). No studies have previously examined the potential time costs of standardized screens. Our objective was to analyze the ...

    Abstract Introduction: Various policies require that screening questions be asked of all patients who present to the emergency department (ED). No studies have previously examined the potential time costs of standardized screens. Our objective was to analyze the time nursing spent conducting standardized nursing screens and calculate the corresponding time cost.
    Methods: This was a prospective observational study of ED registered nurses (RN) performing triage assessments on adults presenting to the ED. A study author timed nurses while the RN asked five pre-selected questions from their current triage protocol. The time cost of each question was determined by multiplying the length of time spent asking the question each year by the mean hourly wage of RNs at the study hospital. (T/3,600) × V × S; T = mean time per question (in seconds); V = annual patient volume; S = mean hourly RN wage.
    Results: We observed 200 triage assessments. During the triage assessments, 130 patients (65%) were asked about pneumococcal vaccine status; 161 (80.5%) about tetanus vaccine status; 184 (92%) about medication allergies; 172 (86%) about influenza vaccine; and 73 (36.5%) about recent travel. The mean time spent per question ranged from 4.37-6.26 seconds. The estimated annual time used to ask the five questions in the study ED is 590.73 hours, which equates to $20,675.50 in nursing costs per year.
    Conclusion: There are potential monetary and time costs of standardized screening questions in the ED. The values heavily impact time and cost efficiency in the ED and could be redirected to more pertinent patient care. The required screening questions often have an unclear utility on the care that the patient receives in the ED. Further studies are needed to determine cost effectiveness of required ED screenings.
    MeSH term(s) Clinical Nursing Research ; Cost-Benefit Analysis ; Emergency Service, Hospital/economics ; Emergency Service, Hospital/standards ; Humans ; Mass Screening/nursing ; Prospective Studies ; Surveys and Questionnaires/standards ; Triage/standards ; Vaccination Coverage/statistics & numerical data
    Language English
    Publishing date 2019-10-16
    Publishing country United States
    Document type Journal Article ; Observational Study
    ZDB-ID 2375700-0
    ISSN 1936-9018 ; 1936-900X
    ISSN (online) 1936-9018
    ISSN 1936-900X
    DOI 10.5811/westjem.2019.9.44084
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Time Cost of Standardized Nursing Screens in the Emergency Department

    Victoria L. Migdal / Kaitlin Harper / Nazish Haqqani / Bruce Janiak

    Western Journal of Emergency Medicine, Vol 20, Iss

    2019  Volume 6

    Abstract: Introduction: Various policies require that screening questions be asked of all patients who present to the emergency department (ED). No studies have previously examined the potential time costs of standardized screens. Our objective was to analyze the ... ...

    Abstract Introduction: Various policies require that screening questions be asked of all patients who present to the emergency department (ED). No studies have previously examined the potential time costs of standardized screens. Our objective was to analyze the time nursing spent conducting standardized nursing screens and calculate the corresponding time cost. Methods: This was a prospective observational study of ED registered nurses (RN) performing triage assessments on adults presenting to the ED. A study author timed nurses while the RN asked five pre-selected questions from their current triage protocol. The time cost of each question was determined by multiplying the length of time spent asking the question each year by the mean hourly wage of RNs at the study hospital. (T/3,600) × V × S; T = mean time per question (in seconds); V = annual patient volume; S = mean hourly RN wage. Results: We observed 200 triage assessments. During the triage assessments, 130 patients (65%) were asked about pneumococcal vaccine status; 161 (80.5%) about tetanus vaccine status; 184 (92%) about medication allergies; 172 (86%) about influenza vaccine; and 73 (36.5%) about recent travel. The mean time spent per question ranged from 4.37–6.26 seconds. The estimated annual time used to ask the five questions in the study ED is 590.73 hours, which equates to $20,675.50 in nursing costs per year. Conclusion: There are potential monetary and time costs of standardized screening questions in the ED. The values heavily impact time and cost efficiency in the ED and could be redirected to more pertinent patient care. The required screening questions often have an unclear utility on the care that the patient receives in the ED. Further studies are needed to determine cost effectiveness of required ED screenings.
    Keywords Medicine ; R ; Medical emergencies. Critical care. Intensive care. First aid ; RC86-88.9
    Subject code 330
    Language English
    Publishing date 2019-10-01T00:00:00Z
    Publisher eScholarship Publishing, University of California
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Risk-benefit analysis of lumbar puncture to evaluate for nontraumatic subarachnoid hemorrhage in adult ED patients.

    Migdal, Victoria L / Wu, W Kelly / Long, Drew / McNaughton, Candace D / Ward, Michael J / Self, Wesley H

    The American journal of emergency medicine

    2015  Volume 33, Issue 11, Page(s) 1597–1601

    Abstract: Objective: The objective of the study is to compare the risks and benefits of lumbar puncture (LP) to evaluate for subarachnoid hemorrhage (SAH) after a normal head computed tomographic (CT) scan.: Methods: This was an observational study of adult ... ...

    Abstract Objective: The objective of the study is to compare the risks and benefits of lumbar puncture (LP) to evaluate for subarachnoid hemorrhage (SAH) after a normal head computed tomographic (CT) scan.
    Methods: This was an observational study of adult emergency department patients at a single hospital who presented with headache and underwent LP after a normal head CT to evaluate for SAH. Lumbar puncture results classified as indicating a SAH included xanthochromia in cerebrospinal fluid (CSF) or red blood cells in the final tube of CSF with an aneurysm or arteriovenous malformation on cerebral angiography. An LP-related complication was defined as hospitalization or a return visit due to symptoms attributed to the LP. Proportions of the study patients who had SAH diagnosed by LP and who experienced an LP-related complication were compared.
    Results: The study included 302 patients, including 2 (0.66%) who were diagnosed with SAH based on LP (number needed to diagnose, 151); both of these patients had a known intracranial aneurysm. Eighteen (5.96%) patients experienced an LP-related complication (P < .01 compared with number with SAH diagnosed; number needed to harm, 17). Complications included 12 patients with low-pressure headaches, 4 with pain at the LP site, and 2 with contaminated CSF cultures.
    Conclusion: The yield of LP for diagnosing SAH in adults with nontraumatic headache after a normal head CT was very low. The severity of LP-related complications was low, but complications were more common than SAH diagnoses. Lumbar puncture may not be advisable after a normal head CT to evaluate for SAH, particularly in patients with low-risk clinical features for SAH.
    MeSH term(s) Adolescent ; Adult ; Aged ; Aged, 80 and over ; Emergency Service, Hospital ; Female ; Headache/etiology ; Hospitalization/statistics & numerical data ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Risk Assessment ; Spinal Puncture/adverse effects ; Subarachnoid Hemorrhage/complications ; Subarachnoid Hemorrhage/diagnosis ; Tomography, X-Ray Computed ; Young Adult
    Language English
    Publishing date 2015-11
    Publishing country United States
    Document type Journal Article ; Observational Study ; Research Support, N.I.H., Extramural
    ZDB-ID 605890-5
    ISSN 1532-8171 ; 0735-6757
    ISSN (online) 1532-8171
    ISSN 0735-6757
    DOI 10.1016/j.ajem.2015.06.048
    Database MEDical Literature Analysis and Retrieval System OnLINE

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