Anne Manton

Data Elements for Emergency Department Systems, Release 1.0 (DEEDS): A Summary Report

See editorial, p 274. Variations in the way that data are entered in emergency department record systems impede the use of ED records for direct patient care and deter their reuse for many other legitimate purposes. To foster more uniform ED data, the Centers for Disease Control and Preventions National Center for Injury Prevention and Control is coordinating a public-private partnership that has developed recommended specifications for many observations, actions, instructions, conclusions, and identifiers that are entered in ED records. The partnerships initial product, Data Elements for Emergency Department Systems, Release 1.0 (DEEDS), is intended for use by individuals and organizations responsible for ED record systems. If the recommended specifications are widely adopted, then problems-such as data incompatibility and high costs of collecting, linking, and using data-can be substantially reduced. The collaborative effort that led to DEEDS, Release 1.0 sets a precedent for future review and revision of the initial recommendations. [DEEDS Writing Committee: Data Elements for Emergency Department Systems, Release 1.0 (DEEDS): A summary report. Ann Emerg Med February 1998;31:264-273.].

The LUNAR project: A description of the population of individuals who seek health care at emergency departments.

INTRODUCTION Although little information exists about the consumers of emergency services and their illness behaviors, such information is essential for decision making by providers, administrators, and policy makers. The purpose of the LUNAR Project was to describe the population of individuals who seek health care at emergency departments. METHODS After they attended a training course, 90 emergency nurses served as site coordinators in 89 emergency departments in 35 states. A standardized protocol was used to collect data retrospectively from 140 randomly selected patient records at each site. The final sample included 12,422 ED patients. RESULTS Overall, 52% of the patient visits were for nonurgent care, 40% were for urgent care, and 8% were for emergent care. Most visits occurred between 10 AM and 8 PM and peaked at 6 PM. Children and younger adults were the largest consumers of services, primarily for nonurgent care. The most frequent reasons for visits were fever, chest pain, and abdominal pain, and the most common discharge diagnoses were middle ear infection, chest pain, and acute upper respiratory infection. DISCUSSION The profile of ED patients showed a need for new types of services to provide nonurgent care and new interventions for preventing illnesses and injuries commonly treated in the emergency department.

Data elements for emergency department systems, release 1.0 (DEEDS): A summary report

Variations in the way that data are entered in ED record systems impede the use of ED records for direct patient care and deter their reuse for many other legitimate purposes. To foster more uniform ED data, the Centers for Disease Control and Preventions (CDC) National Center for Injury Prevention and Control is coordinating a public-private partnership that has developed recommended specifications for many observations, actions, instructions, conclusions, and identifiers that are entered in ED records. The partnerships initial product. Data Elements for Emergency Department Systems, Release 1.0 (DEEDS), is intended for use by individuals and organizations responsible for ED record systems. If the recommended specifications are widely adopted, then problems--such as data incompatibility and high costs of collecting, linking, and using data--can be substantially reduced. The collaborative effort that led to DEEDS, Release 1.0 sets a precedent for future review and revision of the initial recommendations.

In Praise Of

The updated edition of this authoritative, comprehensive, in-depth medical guide features information on more than 1,850 medical topics in language accessible to adult laypersons. Medical updates include information on the new mammogram guidelines, CPR procedures and the status of H1N1 – as well as many drug recalls. In addition to details on managing diseases and conditions, this set contains valuable information on nutrition and wellness. KEy FEatUREs n 108 new entries and more than 500 updated entries n More than 1,850 total entries (500 to 4,000 words) written by medical specialists and reviewed by expert medical advisers n 765 full-color illustrations, photographs and tables n Biographical sidebars give extra information on historic and living figures in the medical sciences n Resources section comprised of books, periodicals, websites and contact information for national health agencies and organizations n Comprehensive subject index and glossary of terms The Gale Encyclopedia of Medicine, 4th Edition covers more than 1,850 topics – including medical conditions, ailments, afflictions and test results – from abdominal ultrasounds to Zoonosis.

Searching the literature: what is known (and not known) about your topic?

n the previous articles in this series (appearing in the November 2012, March 2013, and May 2013 1–3 I issues), we have discussed how evidence can change practice, how to evaluate evidence, and how to develop a clinical question. At this point in the process, you need to find out more about your problem to create workable interventions. For example, who is the best health care professional to perform triage? This is a good question; however, what do you know about this problem and possible solutions that are already in use? Before you can begin to plan to address a clinical problem, you must know what is known and not known about your particular problem. A literature search will familiarize you with the work that has already been done in your area of interest or inquiry. It should be a comprehensive survey of all publications and other information about a specific topic. The search will produce a list of references on the topic of interest.

Bullying: A Pebble in the Pond

Have you ever been bullied in your role as an emergency nurse? If you answered yes, you are not alone. I’ve been bullied too. Due to the fact that bullying is infrequently reported, exact numbers are difficult to obtain. Estimates vary widely from less than 20% to 27% to 46% to 100%. We have to wonder why bullying is so underreported. Could it be that we have normalized bullying behavior? And in normalizing it have we made it acceptable? Think about it. What does the term bullying behavior mean to you? For purposes here, I would describe it as verbal or psychological (rarely physical) actions that are purposely directed toward an individual in an effort to intimidate, humiliate, hurt, demean, or demoralize the person. Bullying is rarely a single action but rather it is a repeated behavior that takes place over time. There are a number of terms used to represent these behaviors. Terms such as horizontal violence and lateral violence suggest the perpetrator is a nurse colleague of equal status, but this is not always the case. It might be a person in a higher position—or it might not even be a nurse. Use of the term harassment indicates a wide range of behaviors that might or might not adequately describe the bullying acts. Calling bullying “workplace incivility” minimizes both the

Behavioral Health in the Spotlight

Prior to the ENA General Assembly meeting in September 2015, ENA members had an opportunity to suggest topics for the practice issues discussion to be held there. It was a surprise to almost no one that care of the behavioral health patient in the emergency department topped the list. At the General Assembly itself, a lively discussion focused on the care of behavioral health patients in the emergency department was facilitated by a group fromtheMassachusetts InstituteofTechnology (MITHackathon). This multifaceted issue requires ongoing attention and dissemination of information. In keeping with the expressed interest of ENA members, it is the purpose of this issue of JEN to shine a spotlight on some of the concerns we as emergency nurses experience related to the care of behavioral health patients. In addition, some of the articles are more nurse-focused and relate to our personal biases, stresses in the emergency setting, the experience of moral distress, and clinical practice information. In a recent study, approximately 40% of nurse-participants responded that they had not had any classes or continuing education regarding care of the behavioral health patient since their prelicensure education. Given that an estimated 1 in every 10 or 12 patients seen in emergency departments are there for behavioral/mental health symptoms, education of emergency care providers is an urgent need.

Emergency Nurses and Code Lavender

Are you familiar with Code Lavender? Although it has existed for a few years and although its core elements are familiar, I have only recently learned of its existence, its meaning, and its application. The name Code Lavender represents 2 seemingly opposite aspects of emergency nursing practice: urgency and calmness. It is recognition of the stress inherent in various crisis conditions and the frequent need for intervention in order to achieve the desired calmness. According to the literature, Code Lavender had its beginning in Hawaii in 2004 primarily for the benefit of patients and families. Soon after, its concepts were adopted by several hospitals as a way to provide support for patients and staff members who were experiencing a traumatic or crisis situation. As the word CODE suggests, a Code Lavender is accomplished by a rapid response team. This rapid response team is not however answering a call related to a physical emergency, but rather a situation of spiritual or emotional trauma that exceeds normal levels. The word LAVENDER is used because studies have shown that the

ED Utilization by Uninsured and Medicaid Patients after Availability of Telephone Triage

It was interesting to read Howells article regarding innovation that decreases low acuity and non-resource patients who present to the emergency department by implementing a telephone triage system (2016). The system described by Howell address issues with patients who are uninsured or underinsured on Medicaid, who present to the ED in lieu of their primary care provider (2016). Howell discusses the advantages of implementing a telephone triage system in order to decrease ED overcrowding by providing advice on other care options to patients with low acuity health conditions. Howell points out several reasons why this is beneficial to the aforementioned patient population, since 31% of primary care physicians in the state of Texas are no longer accepting Medicaid (2016). As a middle manager in faith-based community hospital I have concerns about my role in facilitating this type of innovation. My first concern is where they refer the patients that the telephone triage nurse speaks to. Do they have arrangements or partnerships with community clinics that provide care for the uninsured or underinsured patients? How does this system work for faith-based hospital or hospital systems that make it part of their mission to care for all patients regardless of resource availability? In the case of my organization, Houston Methodist West, we refer our uninsured or underinsured patients that we see to community sponsored organizations such as Christ Clinic of Katy or Spring Branch Clinic. Houston Methodist West is also invested in a partnership with these clinics and others to make it a top priority to ensure that this population of patients in this community has a place to receive quality care. My other question is have the organizations examined any evidence-based processes to decrease overcrowding prior to implementing telephone triage? DeLia and Cantor indicate that overcrowding may often be related to inefficiencies in the flow of patients through different patient care units due to shortage of staffed beds (2009,

IDENTIFYING DOMESTIC VIOLENCE VICTIMS—IT'S OUR JOB

I mportant information about domestic violence, sometimes referred to as domestic abuse, can be found in several articles in this issue of JEN, along with two articles in the previous issue. These articles address the issue of domestic violence from a number of perspectives. Although the term currently favored is “intimate partner violence” (IPV), I prefer to use the older term domestic violence here, because I would like to think more broadly about the violence that occurs in homes and families, not only in the “intimate partner” relationship. Continued efforts by The Joint Commission and various health care organizations to encourage universal screening for domestic violence in the emergency department date back more than 2 decades. The American Medical Association, the American Nurses Association, and other medical and nursing organizations all recommend universal screening for domestic violence. The ENA joint position statement developed with the International Association of Forensic Nurses states, “...nurses routinely screen patients for IPV.” Yet, as noted in the Triage Decisions column in the November 2014 issue of JEN, it has been shown that we emergency care providers are not identifying patients who have been the subjects of such violence in nearly the numbers that are consistently found in domestic violence studies. This is true even though victims of domestic violence are often frequent visitors to