195 Screening Electrocardiograms in Cocaine-Positive Chest-Pain-Free Psychiatric Patients Requiring Medical Clearance

Abstract

curriculum was developed for nurses. SBML is an educational model that engages learners in simulated scenarios and involves deliberate practice until a predetermined standard is achieved. The SBML curriculum consisted of a pre-training skills assessment, watching a recorded lecture and demonstrational video, deliberate practice on a simulator with expert feedback, and a post-training skills assessment. Nurses then completed 5 successful proctored insertions on patients before becoming independent. There was no formal USGIV training for physicians. We extracted data from the electronic medical record on all ED visits where IV access was attempted from January 2015 -December 2017. Patient visits were categorized as standard of care (SOC) patients or DIVA patients. We defined SOC patients as those who received an IV in 2 attempts, while DIVA patients received an IV in 3 attempts or required an USGIV. We measured clinical outcomes including time to IV placement, time to lab results, time to IV pain medication, and ED length of stay (LOS) between SOC patient and DIVA patients. We also compared these outcomes as well as the number of insertion attempts between MD and RN for visits where an USGIV was inserted.Results: Over the study period, 148,559 ED visits were included. DIVA occurred in 8.9% of patient visits. DIVA resulted in significant delays when compared to SOC patients, including increased time to IV placement (120.9 versus 65.8 min; p<0.01), increased time to laboratory results (118.2 versus 81.1 min, p<0.01), increased time to IV pain medication (192.7 versus 171.3 min, P<0.01), and increased ED LOS (489.8 versus 423.3 min, p<0.01). Of the DIVA patients, 5,862 received an USGIV, 3,683 were RNinitiated, and 2,179 were MD-initiated. RN-initiated USGIVs when compare to MDinitiated USGIVs resulted in fewer insertion attempt (2.2 versus 3.1, p<0.01), faster time to IV placement (131.9 versus 179.0 min, P<0.01), and faster time to laboratory results (127.7 versus 159.1, P< 0.01). RN-initiated USGIV did not show a statistically significant change in IV pain medication (197.4 versus 206.1) or LOS (494.0 versus 506.6).Conclusions: To our knowledge, this is the largest study exploring how DIVA affects care deliver and delays in the ED. Our study shows that DIVA is a prevalent condition, and leads to delays in IV access, time to diagnostic and therapeutic interventions, and increased LOS. While USGIV is known to be effective in obtaining access in DIVA patients, our study also shows that training RNs using SBML to perform USGIV improves patient care.