Hyperammonemia following hematopoietic cell transplantation (HCT) has been characterized as idiopathic and is associated with a very high mortality. A causal relationship between Ureaplasma infection and hyperammonemia in immunocompromised lung transplant recipients has recently been described. We document the first case of hyperammonemia following HCT associated with Ureaplasma parvum. The initiation of appropriate antibiotics resulted in rapid resolution of hyperammonemic encephalopathy and eradication of the implicating organism.

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Length of stay (LOS) is an important determinant of patient satisfaction and overall emergency department (ED) operational efficiency. In an effort to reduce length of stay for low-acuity "treated and released" patients, our department created a discharge facilitator team (DFT) composed of an attending physician, physician assistant, and registered nurse. The DFT identified patients who could be rapidly treated and released in the low-acuity treatment Adult Urgent Care Center (AUCC) and provided them rapid treatment and discharge. To assess the efficacy of the DFT, linear regression was used to compare AUCC LOS at times the team was and was not active. Patients seen by the DFT had a LOS that was 35 % shorter than other AUCC patients. There was a 28-min reduction in AUCC LOS during periods where the DFT was active (95% CI 22 to 33 min). We conclude that the establishment of a DFT was associated with a significant reduction in LOS for all low-acuity patients. Other academic medical centers may consider implementing a similar program in order to reduce LOS and improve ED throughput for low acuity patients.

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