IntroductionTo analyze the correlation between the many different emergency department (ED) treatment metric intervals and determine if the metrics directly impacted by the physician correlate to the “door to room” interval in an ED (interval determined by ED bed availability). Our null hypothesis was that the cause of the variation in delay to receiving a room was multifactorial and does not correlate to any one metric interval.MethodsWe collected daily interval averages from the ED information system, Meditech©. Patient flow metrics were collected on a 24-hour basis. We analyzed the relationship between the time intervals that make up an ED visit and the “arrival to room” interval using simple correlation (Pearson Correlation coefficients). Summary statistics of industry standard metrics were also done by dividing the intervals into 2 groups, based on the average ED length of stay (LOS) from the National Hospital Ambulatory Medical Care Survey: 2008 Emergency Department Summary.ResultsSimple correlation analysis showed that the doctor-to-discharge time interval had no correlation to the interval of “door to room (waiting room time)”, correlation coefficient (CC) (CC=0.000, p=0.96). “Room to doctor” had a low correlation to “door to room” CC=0.143, while “decision to admitted patients departing the ED time” had a moderate correlation of 0.29 (p <0.001). “New arrivals” (daily patient census) had a strong correlation to longer “door to room” times, 0.657, p<0.001. The “door to discharge” times had a very strong correlation CC=0.804 (p<0.001), to the extended “door to room” time.ConclusionPhysician-dependent intervals had minimal correlation to the variation in arrival to room time. The “door to room” interval was a significant component to the variation in “door to discharge” i.e. LOS. The hospital-influenced “admit decision to hospital bed” i.e. hospital inpatient capacity, interval had a correlation to delayed “door to room” time. The other major factor affecting department bed availability was the “total patients per day.” The correlation to the increasing “door to room” time also reflects the effect of availability of ED resources (beds) on the patient evaluation time. The time that it took for a patient to receive a room appeared more dependent on the system resources, for example, beds in the ED, as well as in the hospital, than on the physician.

Objectives:To assess the timeliness of thrombolytic therapy in the ED for selected patients with acute myocardial infarction (AMI) following continuous quality improvement (CQI) interventions. Methods:A retrospective, historical comparison study was performed of triage-to-thrombolytic time intervals for AM1 patients using chart review for data collection. Patients treated after implementation of the CQI process vs a historical control group were compared. The patients with AM1 who had received thrombolytics during the oneyear period prior to the CQI interventions and who had documentation of time intervals served as the control group. The patients treated during a four-month period, beginning about one and a half years following introduction of the CQI interventions, served as the intervention group. Interventions included: a triage protocol, CQI review, and staff feedback.Results: The mean triage-to-thrombolytic interval was longer for the control group (72 ? 25 vs 40.0 & 22 min; p < 0.OOOl). The mean triage-to-ECG interval also was longer for the control group (16.5 2 8.9 vs 8.5 & 7.5 min; p < 0.0001). Most (79%) of the study group received thrombolytic therapy within 60 minutes, and 39% within 30 minutes, whereas 39% of the control group received thrombolytic therapy within 60 minutes, and 3% within 30 minutes. Conclusion:The implementation of CQI techniques, including 100% chart review, intensive systems analysis, and staff feedback, had a positive effect on the timeliness of thrombolytic therapy for the ED patients who had AMI. As a result, most (79%) of the patients received therapy within the 60-minute time window recommended currently by the American Heart Association.

Objective: To determine whether the frequency of unintentional needlesticks can be reduced by replacing conventional IV catheters with self-capping ones. Methods:Retrospective cohort, historically controlled study, conducted in an emergency medical services advanced life support (ALS) service. The ALS service annually transports 12,000 patients, for whom IV therapy is attempted in about 65% of cases. The needlestick rate per 1,000 patients receiving attempts at IV access was examined during the 2 10-month periods, before and after introduction of a self-capping IV catheter.Results: For the 2 periods, the percentage of patients for whom IV access was attempted remained constant at 65%. The success rate for IV access was statistically unchanged from 88% to 90% (p > 0.5, power = 0.995). During the period prior to use of the new datheter, 44 injuries were reported overall. Of these, 15 were due to unintentional needlesticks, 1 1 associated with contaminated needles. Following the system-wide introduction of the new catheter, only 1 of 31 reported injuries was due to needlestick (uncontaminated). The extrapolated annual incidence of contaminated needlesticks decreased from 169 (95% CI; 85, 253) to 0 (95% CI; 0, 46) per 100,000 IV attempts. The extrapolated incidence for all needlesticks decreased from 231 (95% CI; 132, 330) to 15 (95% CI; 0, 40) per 100,000 IV attempts. The absolute number of needlesticks and the proportion of injuries due to needlesticks decreased significantly (p < 0.005). Conclusion:The use of IV catheters with self-capping needles was associated with a significant reduction in the absolute number of inadvertent needlesticks as well as the proportion of injuries due to needlesticks among ALS providers. The use of self-capping IV catheters was feasible and did not appear to be a deterrent to initiating IV therapy in the out-of-hospital environment.Key words: emergency medical services systems; EMS; infectious disease; hepatitis; HIV, needlestick; universal precautions.Acad. Emerg. Med. 1996; 3:668-674. cluding HIV, hepatitis B virus (HBV), hepatitis c virus (HCV), and cytomegalovirus, can be transmitted by in-

Background Data for hospital antibiograms are typically compiled from all patients, regardless of disposition, demographics and other comorbidities. Objective We hypothesized that the sensitivity patterns for urinary pathogens would differ significantly from the hospital antibiogram in patients that were discharged from the emergency department (ED). Methods We evaluated a retrospective cohort of all adult patients with positive urine cultures treated in the 2016 calendar year at an inner-city academic ED. Positive urine cultures defined by our institution’s microbiology department. Investigators conducted a structured review of an electronic medical record (EMR) to collect demographic, historical and microbiology records. We utilized a one-sample test of proportion to compare the sensitivity of each organism for discharged patients to the hospital published antibiogram. Alpha set at 0.05. Results During the study period, 414 patients were discharged from the ED and found to have positive urine cultures; 20% age > 60 years old, 85% female, 79% Hispanic, 33% diabetic. The most common organisms was E. coli (78%). E. coli was sensitive to Trimethoprim-Sulfamethoxazole for 59% vs. 58% in our antibiogram ( p = 0.77), Ciprofloxacin 81% vs. 69% ( p < 0. 001), Nitrofurantoin 96% vs 95%; ( p = 0.25). K. pneumoniae was sensitive to Trimethoprim-Sulfamethoxazole 87% vs. 80% in our antibiogram ( p = 0.26), Ciprofloxacin 100% vs. 92% ( p = 0.077), Nitrofurantoin 86% vs 41% ( p < 0.001). Conclusions For our predominantly Hispanic study group with a high prevalence of diabetes, we found that our hospital antibiogram had relatively good value in guiding antibiotic therapy though for some organism/antibiotic combinations sensitivities were higher than expected.