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6 results

  • Characterizing barriers to antibiotic stewardship for skin and soft-tissue infections in the emergency department using a systems engineering framework

  • Michael S. Pulia, Rebecca J. Schwei, Steven P. Hesse, Nicole E. Werner
  • Journal:
    Antimicrobial Stewardship & Healthcare Epidemiology / Volume 2 / Issue 1 / 2022
    Published online by Cambridge University Press:
    07 November 2022, e180
    • Article
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  • Objective:

    Skin and soft-tissue infections (SSTIs) account for 3% of all emergency department (ED) encounters and are frequently associated with inappropriate antibiotic prescribing. We characterized barriers and facilitators to optimal antibiotic use for SSTIs in the ED using a systems engineering framework and matched them with targeted stewardship interventions.

    Design and participants:

    We conducted semistructured interviews with a purposefully selected sample of emergency physicians.

    Methods:

    An interview guide was developed using the Systems Engineering Initiative for Patient Safety (SEIPS) framework. Interviews were recorded, transcribed, and analyzed iteratively until conceptual saturation was achieved. Themes were identified using deductive directed content analysis guided by the SEIPS model.

    Results:

    We conducted 20 interviews with physicians of varying experience and from different practice settings. Identified barriers to optimal antibiotic prescribing for SSTIs included poor access to follow-up (organization), need for definitive diagnostic tools (tools and technology) and fear over adverse outcomes related to missed infections (person). Identified potential interventions included programs to enhance follow-up care; diagnostic aides (eg, rapid MRSA assays for purulent infections and surface thermal imaging for cellulitis); and shared decision-making tools.

    Conclusions:

    Using a systems engineering informed qualitative approach, we successfully characterized barriers and developed targeted antibiotic stewardship interventions for SSTIs managed in the ED work system. The interventions span multiple components of the ED work system and should inform future efforts to improve antibiotic stewardship for SSTIs in this challenging care setting.

  • Chapter 31 - Disaster and terrorism emergency psychiatry

  • from Section 5. - Special populations
  • Edited by Leslie S. Zun
  • Edited in association with Lara G. Chepenik, Mary Nan S. Mallory
  • Book:
    Behavioral Emergencies for the Emergency Physician
    Published online:
    05 April 2013
    Print publication:
    21 March 2013, pp 230-234

  • Summary

    Restraints are used in the healthcare setting primarily in two general situations: violent and/or self-destructive situations when the patient has demonstrated or poses an imminent danger to themselves or another, and disruption of therapy or non-violent, non-self-destructive situations. Chemical restraints are an effective and safe tool in caring for patients when used wisely. This chapter intends to provide an overview of the pharmacology, indications, side effects, and dosages of the three most commonly used medications for chemical sedation: lorazepam, haloperidol, and ketamine. Physical restraint application requires training and the demonstrated competency of involved staff. Alternatives to both chemical and physical restraints should always be explored before their initiation. Seclusion is another form of behavior control used in emergency departments and hospitals, and is simply defined as the confinement of a patient in a closed space for a specific amount of time.

  • Chapter 12 - The patient with post-traumatic stress disorder in the emergency department

  • from Section 3. - Psychiatric illnesses
  • Edited by Leslie S. Zun
  • Edited in association with Lara G. Chepenik, Mary Nan S. Mallory
  • Book:
    Behavioral Emergencies for the Emergency Physician
    Published online:
    05 April 2013
    Print publication:
    21 March 2013, pp 83-87

  • Summary

    Substance use is highly prevalent among patients presenting to emergency departments (EDs). Substance use complicates differential diagnosis of the ED patient, as substance use can mimic a variety of psychiatric syndromes. Chronic drug and/or alcohol use significantly increases the likelihood that a person will use an ED for medical treatment. The drugs of abuse and intoxication include alcohol, opiates, sedative hypnotics, stimulants, hallucinogens and dissociative agents, inhalants, and cannabinoids. Drug intoxication is commonly involved in ED visits, and patients may present with a variety of medical and psychiatric complaints. Drug intoxication complicates clinical presentation and can lead to prolonged ED length-of-stay, deployment of resources, including the use of restraints in severe intoxication syndromes, and creates a challenge for disposition and treatment.