the study. We included English and Spanish speaking providers. The survey questions were as follows:Did your provider greet you and introduce himself/herself upon entering the room?Did your provider communicate with you about your child's treatment plan and any delays in care?Is there any staff member you wish to recognize for providing excellent care? How well are we doing with your child's pain control? (5-point Likert scale and option of "does not apply.") Do you have any specific comments and feedback about the care we are providing for your child?Results: A total of 1261 surveys were completed. Of these, 891/1261 (70.6%) were treated in the main ED site, and 370/1261 (29.4%) in the satellite ED. 80/1261 (6.3%) of the participants had limited English proficiency. Mean length of stay was 343 minutes (SD¼138 min). In univariable analysis, a positive patient experience was associated with all 5 survey elements. Multivariable analysis revealed that for the 187/1261 (14.8%) patients who had reported pain, the adequacy of pain control was the single factor independently associated with a positive ED experience ]. For all participants, regardless of whether pain was reported, staff recognition, )], communication of care plan, ] and improvement feedback [OR 0.16 (0.08-0.31)] were associated with a positive patient experience, while provider greeting and introduction was not associated with a positive patient experience.Conclusion: Pediatric patient caregivers were more likely to report a positive ED visit if pain was addressed, when providers communicated the plan of care, and when the caregiver was given the opportunity to provide real-time feedback about their ED visit.

Background The emergency department (ED) lies between the inpatient and outpatient worlds. Varying rates of antimicrobial resistance along with the volume of patients presenting to the ED with potential urinary tract infections make empiric antibiotic selection difficult but vital. However, simply referring to the guidelines may neither optimize therapy nor mitigate resistance. Methods This was a retrospective cohort study comparing antimicrobial sensitivities of women from home, diagnosed with uncomplicated cystitis and discharged home, versus sensitivities of an institution-wide antibiogram between September 1, 2016, and February 28, 2017. The primary outcome was determining whether there was a difference between Escherichia coli sensitivities in nonpregnant women older than 14 years, from home, being discharged home and diagnosed with uncomplicated cystitis versus an institution-specific antibiogram. Results Over the study period, 258 patients were evaluated for uncomplicated cystitis with 128 patients included in the final analysis as the retrospective cohort after 130 patients were excluded. Statistically significant differences between the retrospective cohort and institution-wide antibiogram were 80.5% versus 57% (P < 0.001) for amoxicillin/clavulanic acid, 85.9% versus 75% (P = 0.007) for cefazolin, 94.5% versus 86% (P = 0.008) for ceftriaxone, 96.1% versus 87% (P = 0.003) for cefepime, 97.5% versus 66% (P < 0.001) for levofloxacin, and 99.2% versus 95% (P = 0.032) for nitrofurantoin, respectively. Conclusions Our study shows differences between an ED-specific antibiogram and institution-wide antibiogram. Many common and guideline-recommended antimicrobials used to treat acute uncomplicated cystitis may not be appropriate. Compiling ED-specific antibiograms at all institutions may help to optimally guide therapy.

Introduction: Emergency department (ED) overcrowding is a nationally recognized problem and multiple strategies have been proposed and implemented with varying levels of success. It has caused patients to present to the ED but leave without being seen (LWBS). These patients suffer delayed diagnosis, delayed treatment, and ultimately increased morbidity and mortality. In efforts to decrease the number of patients who leave without being seen, one proposed solution is to place a provider in triage to evaluate these patients at the initial point of contact. Methods: A retrospective chart review was conducted on patient's presenting to the Emergency Department from October through January for the years 2013 through 2017. A list of all patient dispositions for each study month was analyzed and compared for the 4 consecutive years with the implementation of an Advanced Practice Provider (APP) in triage. Results: A total of 2162 patients dispositioned as LWBS during the entire study period of October 2013 through January 2017 were enrolled in the analysis. After implementation of a provider in triage, there was a 39% overall decrease (95% CI 0.005) in patients who left the ED before completion of treatment. There was a 69% reduction (95% CI 0.005) in patients who left before seeing the provider in triage. After seeing the provider, we saw an 83% reduction (95% CI<0.001) in LWBS. Overall, our initial LWBS rate was found to be 5%, and after implementation of a provider in triage that rate decreased to 1%. Discussion: The addition of a provider in triage decreased our LWBS rate from 5% to 1%. The addition of a provider in triage also helped identify sick patients in the waiting room and helped facilitate more rapid assessment of ED patients on arrival.

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