View clinical trials related to Emergency Department.
Filter by:The aim of this study is to develop, study and validate a rigorous and sustainable method for assessing the clinical appropriateness of the decision taken in the Emergency Department to admit or not to admit patients.
This study aims to identify the prognostic role of procalcitonin (PCT), soluble Triggering Receptor Expressed on Myeloid Cells-1 (sTREM-1), the soluble form of the urokinase plasminogen activator receptor (suPAR), highly sensitive C-reactive protein (hs-CRP), Interleukin-6 (IL-6), and azurocidin 1 (AZU1) in 28-day mortality for patients with sepsis in Emergency Department.
The goal of this clinical is to compare treatment outcomes between continuous nebulization and intermittent therapy in the management of acute exacerbation of asthma in the emergency department(ED). Participants will random assign to either continuous or intermittent nebulization. In the continuous group, patients receive budesonide, fenoterol, ipratropium bromide, and normal saline continuously for an hour. In the intermittent group, the same medications are administer every 20 minutes for an hour. Measurements include symptom severity, respiratory rate, oxygen saturation, and pulmonary function tests. Primary endpoints are ED stay length, hospital admission, and ED revisit within 48 hours post-discharge. Adverse events are documented.
Emergency departments (ED) internationally are treating an increasing number of patients. Most require hospital services but some could be better cared for on alternative pathways. D-dimer has some unique properties. It is non-specific and is elevated in many acute condi- tions; but conversely remains normal in the absence of significant disease. Previous studies have shown that having a normal D-dimer on arrival to the emergency department is associated with a very low risk of 30-day all-cause mortality. The investigators propose a multicenter randomized controlled trial using D-dimer to identify patients at low risk and test if providing this information will change time to discharge disposition by the treating physician.
Soluble Urokinase Plasminogen Activation Receptor (SUPAR) is a validated biomarker with applications in the study of inflammation and infection. Elevated levels of SUPAR have recently been linked to a higher mortality in patients suffering from undifferentiated sepsis, pneumonia, and more recently, COVID-19 infection. Large randomized controlled trials have been conducted on patients admitted to the emergency department (ER), regardless of the reason for admittance. These studies have stratified risk based on three cutoffs at initial measurement: - Low risk : < 3 ng/mL - Intermediate risk : entre 3 et 6 ng/mL - High risk : > 6 ng/mL Low levels of SUPAR are associated with low risk of mortality in the short and long term in patients presenting to the ED, no matter the reason for admittance. Risk stratification could be an added decision-making tool for clinicians to comfort hospital discharge. To the best of our knowledge, there is no available data on the added value of SUPAR for predicting mortality in abdominal sepsis and abdominal pain. Abdominal pain is responsible for 10 to 30 % of ER admissions. Consequently, abdominal pain is then responsible for roughly 10 % of admissions into medical and surgical wards. Mortality varies depending on patient factors. Mortality is usually stratified on age. In patients under 50 years of age, it is near 8%, but it reaches 19 % in patients over 50. Diagnostic accuracy also decreases drastically with age, reaching approximately 30 % patients over 75. Taking this into account, integrating a measure of SUPAR levels into the current standard of care could stratify the risk of complications in patients admitted to the ER with abdominal pain.
Overcrowding in emergency departments (ED) is a major concern worldwide. Recent reports show that Canada has among the longest ED waiting times and limited access to care has been associated with poorer outcomes for many patients. Patients suffering from musculoskeletal disorders (MSKD) represent at least 25% of all ED visits and this number is expected to increase with the aging population. New collaborative models of care have been emerging in various settings, such as EDs, and physiotherapists (PT) have been identified as expert clinicians to care for patients with MSKD. These advanced practice physiotherapy (APP) models of care often allow for a more extended scope of practice for PTs in which they have direct access to patients without a physician referral, triage patients and sometimes prescribe medical imaging or medication. ED APP has emerged as a promising new ED model of care, but evidence of the efficacy and safety of such models is still limited. Only a few RCTs have been conducted and no studies have assessed the efficacy or cost-utility of physiotherapy models of care for patients with MSKD in Canadian EDs. Evaluation of the benefits of such models is highly context-dependent and systematic evaluation of these models is warranted to support further implementation in Canada. The aim of this multicenter stepped-wedge cluster RCT and cost analysis is to compare the effectiveness of a direct access APP model of care compared to usual physician ED care for persons presenting to an ED with a MSKD, in terms of pain, function, health care resources utilization and costs. Evidence-based development of new APP models of care in EDs could help improve access and quality of care for Canadians, thus relieving some of the pressure on our healthcare system by providing new innovative pathways of access to care for these patients.
The increase in emergency room visits is partly related to the growing increase in unscheduled care, paradoxically associated with a decrease in the outpatient supply in the city. The "avoidable" passing rate is estimated at 43% in the last major DREES survey on hospital emergencies. Emergency services have been facing this challenge for years, but there is an urgent need to rethink its organizational model with the liberal system to meet this growing demand. Reorientation from the reception of emergencies is one of the avenues envisaged to face this challenge. It offers a different course from that of emergencies, provided that there are care structures equipped and adapted to unscheduled care. The Hospital in Saint-Denis is particularly faced with these challenges given a particular social ecosystem. Methodology : This single-center prospective observational study includes all adult patients sorted 4 and 5 by the reception organizing nurse, present during the survey. The reorientation is one of the solutions proposed in the context of reorganizing access to care throughout the territory, appearing as one of the major public health issues in the coming years, it is appropriate to ask the question on a local scale. particularly exposed to the problem of unscheduled care, if patients are eligible for reorientation The non-medical factors identified as limiting the reorientation are: the absence of social cover, the language barrier, the patients referred by the samu or the fire brigade or a doctor, the patients who came by ambulance (because considered in theory as in the impossibility to move or having already been the subject of a "regulation") Each 4 or 5 redirected patient is included and completes a questionnaire allowing the collection of information relating to their care pathways. Primary endpoint : Determine the proportion of patients not eligible for reorientation on non-medical criteria via a questionnaire, and identify the distribution of factors complicating reorientation Secondary endpoints : Identify the needs of patients re-orientated towards city medicine via the analysis of their passage to the emergency room, the reasons for their recourse to the emergency room (reasons, means and modes of arrival) their knowledge of the health system, and their relationship to general medicine
The purpose of this research study is to develop and test an artificial intelligence intervention for emergency department (ED) discharge care transitions experienced by caregivers of older adults with cognitive impairment.
This is a single-site, randomized, controlled trial. Investigators will evaluate feasibility of the Emergency Department Healthcare Education Assessment and Response for Teen Relationships (ED-HEART) intervention among adolescents age 14-19 years receiving care in the Children's Mercy emergency department.
In this study investigators want to examine if heart rate variability at hospital entry predicts prognosis in participants with severe disease.