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Souffront K, P. Nelson B, Lukas M, Reyes Garay H, Gordon L, Matos T, Hanesworth I, Mantel R, Shubeck C, Bernstein C, T. Loo G, Richardson LD. Stage B Heart Failure Is Ubiquitous in Emergency Patients with Asymptomatic Hypertension. West J Emerg Med 2024; 25:160-165. [PMID: 38596912 PMCID: PMC11000548 DOI: 10.5811/westjem.17990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 11/21/2023] [Accepted: 12/19/2023] [Indexed: 04/11/2024] Open
Abstract
Introduction Hypertension is the leading risk factor for morbidity and mortality throughout the world and is pervasive in United States emergency departments (ED). This study documents the point prevalence of subclinical heart disease in emergency patients with asymptomatic hypertension. Method This was a prospective observational study of ED patients with asymptomatic hypertension conducted at two urban academic EDs that belong to an eight-hospital healthcare organization in New York. Adult (≥18 years of age) English- or Spanish-speaking patients who had an initial blood pressure (BP) ≥160/100 millimeters of mercury (mmHg) and second BP ≥140/90 mm Hg, and pending discharge, were invited to participate in the study. We excluded patients with congestive heart failure, renal insufficiency, and atrial fibrillation, or who were pregnant, a prisoner, cognitively unable to provide informed consent, or experiencing symptoms of hypertension. We assessed echocardiographic evidence of subclinical heart disease (left ventricular hypertrophy, and diastolic and systolic dysfunction). Results A total of 53 patients were included in the study; a majority were young (mean 49.5 years old, [SD 14-52]), self-identified as Black or Other (n = 39; 73.5%), and female (n = 30; 56.6%). Mean initial blood pressure was 172/100 mm Hg, and 24 patients (45.3%) self-reported a history of hypertension. Fifty patients completed an echocardiogram. All (100%) had evidence of subclinical heart disease, with 41 (77.4%) displaying left ventricular hypertrophy and 31 (58.5%) diastolic dysfunction. There was a significant relationship between diastolic dysfunction and female gender [x2 (1, n = 53) = 3.98; P = 0.046]; Black or other race [x2 (3, n = 53) = 9.138; P = 0.03] and Hispanic or other ethnicity [x2 (2, n = 53) = 8.03; P = 0.02]. Less than one third of patients demonstrated systolic dysfunction on echocardiogram, and this was more likely to occur in patients with diabetes mellitus [x2 (1, n = 51) = 4.84; P = 0.02]. Conclusion There is a high probability that Black, Hispanic, and female patients with asymptomatic hypertension are on the continuum for developing overt heart failure. Emergency clinicians should provide individualized care that considers their unique health needs, cultural backgrounds, and social determinants of health.
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Affiliation(s)
- Kimberly Souffront
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York
- Center for Nursing Research and Innovation, Mount Sinai Health System, New York
- Ichan School of Medicine at Mount Sinai, Institute for Health Equity Research, New York
| | - Bret P. Nelson
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York
| | - Megan Lukas
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York
| | | | - Lauren Gordon
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York
- Ichan School of Medicine at Mount Sinai, Institute for Health Equity Research, New York
- Icahn School of Medicine at Mount Sinai, Department of Population Health Science and Policy, New York
| | - Thalia Matos
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York
| | - Isabella Hanesworth
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York
| | - Rebecca Mantel
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York
| | - Claire Shubeck
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York
| | - Cassidy Bernstein
- Center for Nursing Research and Innovation, Mount Sinai Health System, New York
| | - George T. Loo
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York
- Icahn School of Medicine at Mount Sinai, Department of Population Health Science and Policy, New York
| | - Lynne D. Richardson
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York
- Ichan School of Medicine at Mount Sinai, Institute for Health Equity Research, New York
- Icahn School of Medicine at Mount Sinai, Department of Population Health Science and Policy, New York
- Icahn School of Medicine at Mount Sinai, Department of Artificial Intelligence and Human Health, New York
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Iwama K, Travis A, Nowlin S, Souffront K, Finlayson C, Gorbenko K, Cohen B. Barriers, facilitators, and opportunities for Doctor of Nursing Practice engagement in translational research. Nurs Outlook 2023; 71:102031. [PMID: 37738886 DOI: 10.1016/j.outlook.2023.102031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/26/2023] [Accepted: 08/09/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Little is known about how Doctor of Nursing Practice (DNP) graduates apply translational research competencies in the practice setting. PURPOSE This qualitative descriptive study aimed to explore the barriers, facilitators, and opportunities for engaging in translational research among DNPs in practice. METHODS We conducted semi-structured interviews with 11 DNPs working within an 8-hospital health system from November 2020 through July 2021. DISCUSSION We identified four themes related to barriers (invisibility of the DNP degree and skillset; lack of role clarity and organizational structure for DNPs; lack of time for engagement in translational research; lack of support for engagement in translational research), one theme related to facilitators (encouragement from colleagues and supervisors), and two themes related to opportunities (DNP education promotes recognition of nurse role in translational research; DNPs are interested in role expansion to include translational research). CONCLUSION DNPs have the interest and training to engage in translational research but face structural barriers to doing so.
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Affiliation(s)
- Keiko Iwama
- Mount Sinai Morningside, 1111 Amsterdam Avenue, New York, NY 10025
| | - Arlene Travis
- Mount Sinai Hospital, One Gustave L. Levy Place, New York, NY 10029
| | - Sarah Nowlin
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029
| | - Kimberly Souffront
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029
| | - Catherine Finlayson
- Lienhard School of Nursing, College of Health Professions, Pace University, 861 Bedford Road, Pleasantville, NY 10570
| | - Ksenia Gorbenko
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029
| | - Bevin Cohen
- Department of Geriatric and Palliative Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029.
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Souffront K, Nelson B, Shastry S, Straight M, Gordon L, Narula J, Otobo E, NFN S, Richardson L. 257 Exploring Brain Natriuretic Peptide and Subclinical Heart Disease in Emergency Patients With Asymptomatic Hypertension. Ann Emerg Med 2022. [DOI: 10.1016/j.annemergmed.2022.08.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Squeri B, Gayton M, Huang J, Chavez S, Souffront K. Meeting the Challenges of COVID-19: Evaluation of Nurse-Led Changes to Telephonic Assessment. Home Healthc Now 2022; 40:214-222. [PMID: 35777943 DOI: 10.1097/nhh.0000000000001081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The early months of the COVID-19 pandemic caused suspension of physician home visits at our NYC home-based primary care practice as well as disruptions in community-based services homebound patients rely on. This produced gaps in care for a vulnerable patient population that is considered underserved and medically and socially complex. Telephone triage nurses at Mount Sinai Visiting Doctors Program responded to these gaps in care with targeted enhancements to telephonic patient assessment: creating an encrypted email address to receive photographs, the use of two Epic dot phrases to screen and educate regarding COVID-19, assessment of patients' ability to complete a video visit, the reassessment of goals of care, and the assessment of changes in home care services. We surveyed 15 attending physicians in our practice to evaluate primary care providers' opinions regarding changes in nurse telephone triage and how helpful they were in managing patients at home during the early pandemic. We found enhancements to nurse telephone triage were viewed by physicians as beneficial, valuable, and improved patient care. Physicians found changes improved timeliness of care, could improve self-management, helped avoid transfer to emergency department, and helped manage patient care at home. As the pandemic continues and telehealth becomes more widely used, nurse telephone triage may be adaptable to help care for a variety of patient populations during future public health emergencies.
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Gettel CJ, Voils CI, Bristol AA, Richardson LD, Hogan TM, Brody AA, Gladney MN, Suyama J, Ragsdale LC, Binkley CL, Morano CL, Seidenfeld J, Hammouda N, Ko KJ, Hwang U, Hastings SN, Bellolio MF, Biese K, Binkley C, Bott N, Brody A, Carpenter C, Clark S, Dresden MS, Forrester S, Gerson L, Gettel C, Goldberg E, Greenberg A, Hammouda N, Han J, Hastings SN, Hogan T, Hung W, Hwang U, Kayser J, Kennedy M, Ko K, Lesser A, Linton E, Liu S, Malsch A, Matlock D, McFarland F, Melady D, Morano C, Morrow‐Howell N, Nassisi D, Nerbonne L, Nyamu S, Ohuabunwa U, Platts‐Mills T, Ragsdale L, Richardson L, Ringer T, Rosen A, Rosenberg M, Shah M, Skains R, Skees S, Souffront K, Stabler L, Sullivan C, Suyama J, Vargas S, Camille Vaughan E, Voils C, Wei D, Wexler N. Care transitions and social needs: A Geriatric Emergency care Applied Research (GEAR) Network scoping review and consensus statement. Acad Emerg Med 2021; 28:1430-1439. [PMID: 34328674 DOI: 10.1111/acem.14360] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/05/2021] [Accepted: 07/20/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Individual-level social needs have been shown to substantially impact emergency department (ED) care transitions of older adults. The Geriatric Emergency care Applied Research (GEAR) Network aimed to identify care transition interventions, particularly addressing social needs, and prioritize future research questions. METHODS GEAR engaged 49 interdisciplinary stakeholders, derived clinical questions, and conducted searches of electronic databases to identify ED discharge care transition interventions in older adult populations. Informed by the Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences (PRAPARE) framework, data extraction and synthesis of included studies included the degree that intervention components addressed social needs and their association with patient outcomes. GEAR convened a consensus conference to identify topics of highest priority for future care transitions research. RESULTS Our search identified 248 unique articles addressing care transition interventions in older adult populations. Of these, 17 individual care transition intervention studies were included in the current literature synthesis. Overall, common care transition interventions included coordination efforts, comprehensive geriatric assessments, discharge planning, and telephone or in-person follow-up. Fourteen of the 17 care transition intervention studies in older adults specifically addressed at least one social need within the PRAPARE framework, most commonly related to access to food, medicine, or health care. No care transition intervention addressing social needs in older adult populations consistently reduced subsequent health care utilization or other patient-centered outcomes. GEAR stakeholders identified that determining optimal outcome measures for ED-home transition interventions was the highest priority area for future care transitions research. CONCLUSIONS ED care transition intervention studies in older adults frequently address at least one social need component and exhibit variation in the degree of success on a wide array of health care utilization outcomes.
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Affiliation(s)
- Cameron J. Gettel
- Department of Emergency Medicine Yale School of Medicine New Haven Connecticut USA
- National Clinician Scholars Program Department of Internal Medicine Yale School of Medicine New Haven Connecticut USA
| | - Corrine I. Voils
- William S. Middleton Memorial Veterans Hospital Madison Wisconsin USA
- Department of Surgery University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | | | - Lynne D. Richardson
- Department of Emergency Medicine Icahn School of Medicine at Mount Sinai New York New York USA
- Department of Population Health Science & Policy Icahn School of Medicine at Mount Sinai New York New York USA
- Institute for Health Equity Research Icahn School of Medicine at Mount Sinai New York New York USA
| | - Teresita M. Hogan
- Department of Medicine Section of Emergency Medicine The University of Chicago School of Medicine Chicago Illinois USA
| | - Abraham A. Brody
- Hartford Institute for Geriatric Nursing New York University Rory Meyers College of Nursing New York New York USA
| | - Micaela N. Gladney
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham VA Health Care System Durham North Carolina USA
| | - Joe Suyama
- Department of Emergency Medicine University of Pittsburgh Pittsburgh Pennsylvania USA
| | - Luna C. Ragsdale
- Department of Surgery Division of Emergency Medicine Duke University School of Medicine Durham North Carolina USA
- Department of Emergency Medicine Durham VA Health Care System Durham North Carolina USA
| | - Christine L. Binkley
- Department of Emergency Medicine University of North Carolina School of Medicine Chapel Hill North Carolina USA
| | - Carmen L. Morano
- School of Social Welfare University at AlbanyState University of New York Albany New York USA
| | - Justine Seidenfeld
- Department of Surgery Division of Emergency Medicine Duke University School of Medicine Durham North Carolina USA
| | - Nada Hammouda
- Department of Emergency Medicine Icahn School of Medicine at Mount Sinai New York New York USA
| | - Kelly J. Ko
- West Health Institute La Jolla California USA
| | - Ula Hwang
- Department of Emergency Medicine Yale School of Medicine New Haven Connecticut USA
- Geriatrics Research, Education, and Clinical Center James J. Peters VAMC Bronx New York USA
| | - Susan N. Hastings
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham VA Health Care System Durham North Carolina USA
- Department of Medicine Duke University School of Medicine Durham NC USA
- Geriatric Research, Education, and Clinical Center Durham VA Health Care System Durham North Carolina USA
- Center for the Study of Human Aging and Development Duke University School of Medicine Durham North Carolina USA
- Department of Population Health Sciences Duke University School of Medicine Durham North Carolina USA
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Hammouda N, Carpenter C, Hung W, Lesser A, Nyamu S, Liu S, Gettel C, Malsch A, Castillo E, Forrester S, Souffront K, Vargas S, Goldberg EM. Moving the needle on fall prevention: A Geriatric Emergency Care Applied Research (GEAR) Network scoping review and consensus statement. Acad Emerg Med 2021; 28:1214-1227. [PMID: 33977589 PMCID: PMC8581064 DOI: 10.1111/acem.14279] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/21/2021] [Accepted: 04/27/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Although falls are common, costly, and often preventable, emergency department (ED)-initiated fall screening and prevention efforts are rare. The Geriatric Emergency Medicine Applied Research Falls core (GEAR-Falls) was created to identify existing research gaps and to prioritize future fall research foci. METHODS GEAR's 49 transdisciplinary stakeholders included patients, geriatricians, ED physicians, epidemiologists, health services researchers, and nursing scientists. We derived relevant clinical fall ED questions and summarized the applicable research evidence, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews. The highest-priority research foci were identified at the GEAR Consensus Conference. RESULTS We identified two clinical questions for our review (1) fall prevention interventions (32 studies) and (2) risk stratification and falls care plan (19 studies). For (1) 21 of 32 (66%) of interventions were a falls risk screening assessment and 15 of 21 (71%) of these were combined with an exercise program or physical therapy. For (2) 11 fall screening tools were identified, but none were feasible and sufficiently accurate for ED patients. For both questions, the most frequently reported study outcome was recurrent falls, but various process and patient/clinician-centered outcomes were used. Outcome ascertainment relied on self-reported falls in 18 of 32 (56%) studies for (1) and nine of 19 (47%) studies for (2). CONCLUSION Harmonizing definitions, research methods, and outcomes is needed for direct comparison of studies. The need to identify ED-appropriate fall risk assessment tools and role of emergency medical services (EMS) personnel persists. Multifactorial interventions, especially involving exercise, are more efficacious in reducing recurrent falls, but more studies are needed to compare appropriate bundle combinations. GEAR prioritizes five research priorities: (1) EMS role in improving fall-related outcomes, (2) identifying optimal ED fall assessment tools, (3) clarifying patient-prioritized fall interventions and outcomes, (4) standardizing uniform fall ascertainment and measured outcomes, and (5) exploring ideal intervention components.
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Affiliation(s)
- Nada Hammouda
- Department of Emergency Medicine, Mount Sinai School of Medicine, New York City, NY
| | | | - William Hung
- Department of Geriatrics and Palliative Care, Mount Sinai School of Medicine, New York City, NY
| | | | - Sylviah Nyamu
- Department of Emergency Medicine, Mount Sinai Hospital, New York City, NY
| | - Shan Liu
- Department of Emergency Medicine, Harvard School of Medicine, Boston, MA
| | - Cameron Gettel
- National Clinician Scholars Program, Yale School of Medicine, New Haven, CT
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | | | - Edward Castillo
- Department of Emergency Medicine, University of California San Diego, San Diego, CA
| | - Savannah Forrester
- Department of Emergency Medicine, Queen’s University, Kingston, Ontario, CA
| | - Kimberly Souffront
- Department of Emergency Medicine, Mount Sinai School of Medicine, New York City, NY
| | - Samuel Vargas
- Department of Emergency Medicine, Mount Sinai Hospital, New York City, NY
| | - Elizabeth M. Goldberg
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI
- Department of Emergency Medicine, The Warren Alpert Medical School of Brown University, Providence, RI
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Nowlin S, Rampertaap K, Lulgjuraj D, Goldwire T, Cohen B, Souffront K. Willing But Not Quite Ready: Nurses' Knowledge, Attitudes, and Practices of Research in an Academic Healthcare System. J Nurs Adm 2021; 51:495-499. [PMID: 34550103 DOI: 10.1097/nna.0000000000001053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe nurses' research knowledge, attitudes, and practices within an academic hospital system. BACKGROUND Hospitals are investing in research resources to meet Magnet® goals and advance the science of nursing, but nurses' specific needs for support are not well characterized and may vary by setting. METHODS We conducted an anonymous online survey of RNs at an academic hospital system in 2019-2020 using the validated Nurses' Knowledge, Attitudes, and Practices of Research Survey. RESULTS Respondents (N = 99) indicated high willingness to engage in research-related tasks but low or moderate knowledge of and ability to perform them. Knowledge, attitudes, and practices of research increased with level of education, although gaps between willingness to engage versus knowledge and ability persisted even among doctorally prepared nurses. CONCLUSIONS Research support for clinical nurses should leverage enthusiasm for research and focus on developing and applying specific practical skills, even among nurses with advanced degrees.
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Affiliation(s)
- Sarah Nowlin
- Author Affiliations: Nurse Scientist (Dr Nowlin), Senior Project Director (Ms Rampertaap), Research Program Coordinator (Ms Goldwire), Director (Dr Cohen), Associate Director (Dr Souffront), Center for Nursing Research and Innovation, The Mount Sinai Hospital, New York; Doctoral Student (Ms Lulgjuraj), Lienhard School of Nursing, Pace University, Pleasantville, New York
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Linton E, Souffront K, Gordon L, Loo GT, Genes N, Glassberg J. System Level Informatics to Improve Triage Practices for Sickle Cell Disease Vaso-Occlusive Crisis: A Cluster Randomized Controlled Trial. J Emerg Nurs 2021; 47:742-751.e1. [PMID: 34301422 PMCID: PMC9924131 DOI: 10.1016/j.jen.2021.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 04/28/2021] [Accepted: 05/21/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND National Heart Lung and Blood Institute guidelines for the treatment of vaso-occlusive crisis among people with sickle cell disease in the emergency department recommend assigning an emergency severity index of 2 at triage. However, patients with sickle cell disease often do not receive guideline-concordant care at triage. To address this gap, a decision support tool was developed, in the form of a text banner on the triage page in the electronic health record system, visible to triage nurses. METHODS A prospective quality improvement initiative was designed where the emergency severity index clinical decision support tool was deployed to a stratified random sample of emergency department triage nurses to receive the banner (n = 24) or not to receive the banner (n = 27), reminding them to assign the patient to emergency severity index category 2. The acceptability of the emergency severity index clinical decision support tool was evaluated with the Ottawa Acceptability of Decision Rules Instrument. Descriptive and bivariate (chi-square test) statistics were used to characterize the study's primary outcome, proportion of visits assigned an emergency severity index of 2 or higher. A generalized linear mixed model with clustering at the level of the triage nurse was performed to test the association between the banner intervention and triage practices. RESULTS A total of 384 ED visits were included for analysis. Before study initiation, the percentage of sickle cell disease patients' visits with the proper emergency severity index assignment at triage was 37.04%. After initiation, the proportion of sickle cell disease patients' visits with an emergency severity index of 2 or higher triaged by nurses in the intervention group was markedly higher in the intervention group than in the control group (64.95% vs 35.05%; χ2 = 8.79, P ≤ .003). Accounting for clustering by nurse, the odds ratio for proper triage emergency severity index assignment was 3.22 (95% confidence interval 1.17-8.85; P ≤ .02) for the intervention versus control. Surveyed triage nurses reported the emergency severity index clinical decision support tool to be moderately acceptable (nurses' mean Ottawa Acceptability of Decision Rules Instrument scores ranged from 4.13 to 4.90 on the 6-point scale; n = 11). There were no differences in ED experience outcomes including time to first analgesic or length of stay between the control and intervention groups. CONCLUSION Substantial improvements in triage guideline concordance were achieved and sustained without direct nursing education.
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Affiliation(s)
- Elizabeth Linton
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Kimberly Souffront
- Department of Emergency Medicine; Mount Sinai Department of Nursing Center for Nursing Research & Innovation, Icahn School of Medicine at Mount Sinai Hospital, New York, NY
| | - Lauren Gordon
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai Hospital, New York, NY
| | - George T. Loo
- Department of Emergency Medicine; Population Health Science and Policy, Ichan School of Medicine at Mount Sinai, New York, NY
| | - Nicholas Genes
- Department of Emergency Medicine; Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai Hospital, New York, NY
| | - Jeffrey Glassberg
- For correspondence, write: Jeffrey Glassberg, MD, MA; , Twitter: @DRGlassberg
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Schrading WA, Trent SA, Paxton JH, Rodriguez RM, Swanson MB, Mohr NM, Talan DA, Bahamon M, Carlson JN, Chisolm‐Straker M, Driver B, Faine B, Galbraith J, Giordano PA, Haran JP, Higgins A, Hinson J, House S, Idris AH, Kean E, Krebs E, Kurz MC, Lee L, Liang SY, Lim SC, Moran G, Nandi U, Pathmarajah K, Perez Y, Rothman R, Shuck J, Slev P, Smithline HA, Souffront K, Steele M, St. Romain M, Stubbs A, Tiao J, Torres JR, Uribe L, Venkat A, Volturo G, Wallace K, Weber KD. Vaccination rates and acceptance of SARS-CoV-2 vaccination among U.S. emergency department health care personnel. Acad Emerg Med 2021; 28:455-458. [PMID: 33608937 PMCID: PMC8013804 DOI: 10.1111/acem.14236] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 02/16/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Walter A. Schrading
- Department of Emergency Medicine University of Alabama at Birmingham Birmingham Alabama USA
| | - Stacy A. Trent
- Department of Emergency Medicine Denver Health Medical Center Denver Colorado USA
- Department of Emergency Medicine University of Colorado School of Medicine Aurora Colorado USA
| | - James H. Paxton
- Department of Emergency Medicine Wayne State University Detroit Michigan USA
| | - Robert M. Rodriguez
- Department of Emergency Medicine University of California, San Francisco San Francisco California USA
| | - Morgan B. Swanson
- Department of Emergency Medicine University of Iowa Carver College of Medicine Iowa City Iowa USA
| | - Nicholas M. Mohr
- Department of Emergency Medicine University of Iowa Carver College of Medicine Iowa City Iowa USA
| | - David A. Talan
- Department of Emergency Medicine University of Iowa Carver College of Medicine Iowa City Iowa USA
- Olive View–UCLA Education and Research Institute Los Angeles California USA
- Department of Emergency Medicine University of California‐Los Angeles Los Angeles California USA
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Linton EA, Goodin DA, Hankins JS, Kanter J, Preiss L, Simon J, Souffront K, Tanabe P, Gibson R, Hsu LL, King A, Richardsona LD, Glassberg JA. A Survey-Based Needs Assessment of Barriers to Optimal Sickle Cell Disease Care in the Emergency Department. Ann Emerg Med 2020; 76:S64-S72. [PMID: 32928465 DOI: 10.1016/j.annemergmed.2020.08.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE Guided by an implementation science framework, this needs assessment identifies institutional-, provider-, and patient-level barriers to care of sickle cell disease (SCD) in the emergency department (ED) to inform future interventions conducted by the multicenter Sickle Cell Disease Implementation Consortium. METHODS The consortium developed and implemented a validated needs assessment survey administered to a cross-sectional convenience sample of patients with SCD and ED providers caring for them. In total, 516 adolescents and adults with SCD and 243 ED providers from 7 and 5 regions of the United States, respectively, responded to the ED care delivery for SCD survey. RESULTS Survey results demonstrated that 84.5% of respondents with SCD have an outpatient provider who treats many patients with SCD. In the ED, 54.3% reported not receiving care fast enough and 46.0% believed physicians did not care about them and believed similarly of nurses (34.9%). Consequently, 48.6% of respondents were "never" or "sometimes" satisfied with their ED care. Of surveyed ED providers, 75.1% were unaware of the National Heart, Lung, and Blood Institute recommendations for vaso-occlusive crises, yet 98.1% were confident in their knowledge about caring for patients with SCD. ED providers identified the following factors as barriers to care administration: opioid epidemic (62.1%), patient behavior (60.9%), crowding (58.0%), concern about addiction (47.3%), and implicit bias (37.0%). CONCLUSION The results underscore that many patients with SCD are dissatisfied with their ED care and highlight challenges to optimal care on the practice, provider, and patient levels. Exploring these differences may facilitate improvements in ED care.
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Affiliation(s)
- Elizabeth A Linton
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Dania A Goodin
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Jane S Hankins
- Department of Hematology, St Jude Children's Research Hospital, Memphis, TN
| | - Julie Kanter
- Division of Hematology and Oncology, University of Alabama at Birmingham School of Medicine, Birmingham, AL
| | | | - Jena Simon
- Department of Nursing, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kimberly Souffront
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Center for Nursing Research and Innovation, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Robert Gibson
- Department of Emergency Medicine, Medical College of Georgia, Augusta, GA
| | - Lewis L Hsu
- Division of Pediatric Hematology-Oncology, University of Illinois, Chicago, IL
| | - Allison King
- Department of Pediatric Hematology and Oncology, Washington University in St. Louis, St. Louis, MO
| | - Lynne D Richardsona
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jeffrey A Glassberg
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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Glassberg J, Linton E, Souffront K, Genes N, Gordon L. 359 Piloting a System-Level Informatics Intervention to Improve Emergency Department Care of Sickle Cell Disease Vaso-Occlusive Crises. Ann Emerg Med 2019. [DOI: 10.1016/j.annemergmed.2019.08.320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Souffront K, Richardson L. 260EMF Electronic Health Record Innovations to Improve Referral for Asymptomatic Hypertension in the Emergency Department. Ann Emerg Med 2017. [DOI: 10.1016/j.annemergmed.2017.07.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
Persistently elevated blood pressure ([BP]; hypertension [HTN]) occurs at higher rates in the emergency department ([ED]; 44%) than in the general population (27%) and disproportionately affects black patients and older adults. The American College of Emergency Physicians recommends referral to primary care for HTN confirmation and management when patients are asymptomatic and their BP is persistently elevated (). However, adherence to this clinical policy is suboptimal. The purpose of this study was to examine the prevalence of asymptomatic HTN, rates of BP reassessment and referral, and factors associated with it among adult patients who visit the ED and who were discharged a decade after this policy was disseminated. A retrospective chart analysis of adults with an initial BP of 140/90 mmHg or greater and who were discharged was included in the sampling frame. Appropriate bivariate analysis, followed by multivariate regression, was conducted. There were 2,367 patients who met inclusion criteria, of which 1,184 patients had asymptomatic HTN. A greater proportion of the sample was male (51.3%), Black (43.2%; p < 0.000), middle aged (μ = 50.2 ± 16), and covered by Medicaid (39.8%). Mean initial BP was 170/88 mmHg. A large proportion of patients with asymptomatic HTN (94.2%) had no previously diagnosed cardiovascular disease (CVD). The BP reassessment rate was 49% (μ = 158/88), and these patients were more likely to have no previously diagnosed CVDs (p = 0.02). Only 4.6% (n = 28) of patients with asymptomatic HTN were referred, and these patients were more likely to have no previously diagnosed CVDs (p = 0.000) and be middle-aged (p = 0.008). Adherence to follow-up was 100%.
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Affiliation(s)
- Kimberly Souffront
- Assistant Professor, Mount Sinai Icahn School of Medicine, Department of Emergency Medicine, 212-824-8095
| | - Christina Gestal
- Research Coordinator, Mount Sinai Icahn School of Medicine, Department of Emergency Medicine
| | | | - Lynne Richardson
- Professor of Emergency Medicine, Mount Sinai Icahn School of Medicine, Department of Emergency Medicine
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14
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Brody A, Twiner M, Kumar A, Goldberg E, McNaughton C, Souffront K, Millis S, Levy PD. Survey of Emergency Physician Approaches to Management of Asymptomatic Hypertension. J Clin Hypertens (Greenwich) 2016; 19:265-269. [PMID: 27677856 DOI: 10.1111/jch.12921] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 07/27/2016] [Accepted: 08/02/2016] [Indexed: 11/27/2022]
Abstract
Uncontrolled hypertension (HTN) is commonly encountered in emergency medicine practice, but the optimal approach to management has not been delineated. The objective of this study was to define emergency physician (EP) approaches to management of asymptomatic HTN in various clinical scenarios and assess adherence to the American College of Emergency Physician clinical policies, utilizing an online survey of EPs. A total of 1200 surveys were distributed by e-mail with completion by 199 participants. The variables associated with a decision to prescribe oral antihypertensive medications were a history of HTN and referral from primary care. Acute blood pressure (BP) reduction using intravenous antihypertensive medications was also more likely with the latter and BP >180/120 mm Hg. Logistic regression revealed association of EP female sex, fewer years in practice, and a high-volume practice setting with guideline-concordant therapy. Wide variability exists in EP approaches to patients with asymptomatic HTN. Treatment decisions were impacted by patient history of chronic HTN, referral from primary care providers, and magnitude of BP elevation.
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15
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Souffront K, Chyun D, Kovner C. Barriers to referral for elevated blood pressure in the emergency department and differences between provider type. J Clin Hypertens (Greenwich) 2015; 17:207-14. [PMID: 25582763 PMCID: PMC4432468 DOI: 10.1111/jch.12468] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 11/11/2014] [Accepted: 11/13/2014] [Indexed: 11/30/2022]
Abstract
A multidisciplinary sample of emergency department providers across the United States (n=450) were surveyed to identify barriers to referral for elevated blood pressure (BP) in the emergency department and differences between provider type. Registered nurses reported less knowledge of stage I hypertension (P=.043) and prehypertension (P<.01); were less aware of definitions for hypertension (P<.001); reported more difficulty in caring for patients who are asymptomatic (P=.007); required financial compensation to refer (P=.048); and perceived that BP referrals are influenced by the medical director (P<.001). Medical doctors reported more skills to refer (P=.008) and time as a barrier (P=.038). Physician assistants were more likely to report patients are not aware of health benefits (P=.035), doubted their concern for their BP (P=.023), and felt emotionally uncomfortable when referring (P=.025). Despite these differences, there was no significant difference between provider type and referral rates.
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Affiliation(s)
- Kimberly Souffront
- Mount Sinai Medical CenterNew YorkNY
- New York University College of NursingNew YorkNY
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