Emergency department (ED) providers serve as the primary point-of-contact for many survivors of sexual assault, but are often untrained on their unique treatment needs. Sexual assault nurse examiners (SANE) are therefore an important resource for training other ED providers. The objective of this project was to create a SANE-led educational intervention addressing this training gap. We achieved this objective by 1) conducting a needs-assessment of ED providers' selfreported knowledge of and comfort with sexual assault patient care at an urban academic adult ED, and 2) using these results to create and implement a SANE-led educational intervention to improve emergency medicine (EM) residents' ability to provide sexual assault patient care. From the needs-assessment survey, ED providers reported confidence in medical management but not in providing trauma-informed care, conducting forensic exams, or understanding hospital policies or state laws. Less than half of respondents felt confident in their ability to avoid re-traumatizing sexual assault patients and only 29% felt comfortable conducting a forensic exam. Based on these results, a SANE-led educational intervention was developed for EM residents, consisting of a didactic lecture, two standardized patient cases, and a forensic pelvic exam simulation. Pre-and post-intervention surveys demonstrated an increase in respondents' ability to avoid retraumatizing patients, comfort with conducting forensic exams, and understanding of laws and
Purpose
Opioid overdose education and naloxone distribution (OEND) for use by laypersons has been shown to be safe and effective, but implementation in the emergency department (ED) setting is challenging. Recent literature has shown a discouragingly low rate of obtainment of naloxone that is prescribed in the ED setting. We conducted a study to evaluate the feasibility of point-of-care (POC) distribution of naloxone in an ED, hypothesizing a rate of obtainment higher than prescription fill rates reported in previous studies.
Summary
A multidisciplinary team of experts, including pharmacists, physicians, nurses, and case management professionals used an iterative process to develop a protocol for POC OEND in the ED. The protocol includes 5 steps: (1) patient screening, (2) order placement in the electronic health record (EHR), (3) a patient training video, (4) dispensing of naloxone kit, and (5) written discharge instructions. The naloxone kits were assembled, labeled to meet requirements for a prescription, and stored in an automated dispensing cabinet. Two pharmacists, 30 attending physicians, 65 resident physicians, and 108 nurses were trained. In 8 months, 134 orders for take-home naloxone were entered and 117 naloxone kits were dispensed, resulting in an obtainment rate of 87.3%. The indication for take-home naloxone kit was heroin use for 61 patients (92.4%).
Conclusion
POC naloxone distribution is feasible and yielded a rate of obtainment significantly higher than previous studies in which naloxone was prescribed. POC distribution can be replicated at other hospitals with low rates of obtainment.
Appropriate use of consultation can improve patient outcomes, but inappropriate use may cause harm. Factors affecting the variability of inpatient consultation are poorly understood. We aimed to describe physician-, patient-, and admission-level factors influencing the variability of inpatient consultations on general medicine services. We conducted a retrospective study of patients hospitalized from 2011 to 2016 and enrolled in the University of Chicago Hospitalist Project, which included 6,153 admissions of 4,772 patients under 69 attendings. Consultation use varied widely; a 5.7-fold difference existed between the lowest (mean, 0.613) and highest (mean, 3.47) quartiles of use (P <.01). In mixed-effect Poisson regression, consultations decreased over time, with 45% fewer consultations for admissions in 2015 than in 2011 (P <.01). Patients on nonteaching hospitalist teams received 9% more consultations than did those on teaching services (P =.02). Significant variability exists in inpatient consultation use. Further understanding may help to identify groups at high-risk for underuse/overuse and aid in the development of interventions to improve high-value care.
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