Hany Atallah

Transforming Hospital Emergency Department Workflow and Patient Care

When we encounter an unexpected critical health problem, a hospitals emergency department ED becomes our vital medical resource. Improving an EDs timeliness of care, quality of care, and operational efficiency while reducing avoidable readmissions, is fraught with difficulties, which arise from complexity and uncertainty. In this paper, we describe an ED decision support system that couples machine learning, simulation, and optimization to address these improvement goals. The system allows healthcare administrators to globally optimize workflow, taking into account the uncertainties of incoming patient injuries and diseases and their associated care, thereby significantly reducing patient length of stay. This is achieved without changing physical layout, focusing instead on process consolidation, operations tracking, and staffing. First implemented at Grady Memorial Hospital in Atlanta, Georgia, the system helped reduce length of stay at Grady by roughly 33 percent. By repurposing existing resources, the hospital established a clinical decision unit that resulted in a 28 percent reduction in ED readmissions. Insights gained from the implementation also led to an investment in a walk-in center that eliminated more than 32 percent of the nonurgent-care cases from the ED. As a result of these improvements, the hospital enhanced its financial standing and achieved its target goal of an average ED length of stay of close to seven hours. ED and trauma efficiencies improved throughput by over 16 percent and reduced the number of patients who left without being seen by more than 30 percent. The annual revenue realized plus savings generated are approximately

Tricycle injuries presenting to US emergency departments, 2012-2013

190 million, a large amount relative to the hospitals

Characteristics of United States Emergency Department Visits for Traumatic Amputations in the Elderly Adult from 2010 to 2013

1.5 billion annual economic impact. The underlying model, which we generalized, has been tested and implemented successfully at 10 other EDs and in other hospital units. The system offers significant advantages in that it permits a comprehensive analysis of the entire patient flow from registration to discharge, enables a decision maker to understand the complexities and interdependencies of individual steps in the process sequence, and ultimately allows the users to perform system optimization.

Improving Quality of Emergency Care Through Integration of Mental Health

OBJECTIVE: To investigate the characteristics of tricycle-related injuries in children presenting to US emergency departments (EDs). METHODS: Data regarding tricycle injuries in children younger than 18 years of age were obtained from the National Electronic Injury Surveillance System for calendar years 2012 and 2013. Data included body regions injured, ED disposition, and demographics. RESULTS: There were an estimated 9340 tricycle-related injuries treated in US EDs from 2012 to 2013. The average age was 3 years. Children 2 years of age had the highest frequency of injuries. Boys accounted for 63.6% of all injuries. Children 1 to 2 years of age represented 51.9% of all injuries. Lacerations were the most common type of injury. Internal organ damage was the most common type of injury in 3- and 5-year-olds. Contusions were the most common type of injury in 1- and 7-year-olds. The head was the most commonly injured region of the body and the most common region to endure internal damage. The elbows were the most commonly fractured body part. The upper extremity was more frequently fractured than the lower extremity. Approximately 2.4% of all injured children were admitted to the hospital. CONCLUSIONS: The upper extremity of children, particularly the elbow, was more frequently fractured than the lower extremity. The head was the most common body part to endure internal damage. By elucidating the characteristics of tricycle-related injuries, preventive measures can be implemented to decrease the incidence of tricycle-related injuries and ED visits.

Increase in moped injuries requiring emergency care.

Elderly adults (65 years of age and older) are of particular concern for traumatic amputations due to age‐related changes in vision and coordination, making them more susceptible to injury.

Case Report: Spontaneous Coronary Artery Dissection in a Post Partum 30 Year Old Female

The goal of this study was to better integrate emergency medical and psychiatric care at a large urban public hospital, identify impact on quality improvement metrics, and reduce healthcare cost. A psychiatric fast track service was implemented as a quality improvement initiative. Data on disposition from the emergency department from January 2011 to May 2012 for patients impacted by the pilot were analyzed. 4329 patients from January 2011 to August 2011 (pre-intervention) were compared with 4867 patients from September 2011 to May 2012 (intervention). There was a trend of decline on overall quality metrics of time to triage and time from disposition to discharge. The trend analysis of the psychiatric length of stay and use of restraints showed significant reductions. Integrated emergency care models are evidence-based approach to ensuring that patients with mental health needs receive proper and efficient treatment. Results suggest that this may also improve overall emergency department’s throughput.

Safety and Efficacy of Ureteral Stent Placement at the Bedside Using Local Anesthesia

BACKGROUND There has been a marked increased in moped use over the past few years. In addition, there has been an increase in moped-related injuries presenting to the emergency department (ED). The objective of this study is to characterize moped-related injuries presenting to US EDs and obtain national estimates of moped injury incidence over time. METHODS Data regarding moped injuries were queried from the National Electronic Injury Surveillance System from calendar year 2007 to 2015. Data included diagnosis, body part injured, ED disposition, and patient demographics. RESULTS There were an estimated 114 729 moped-related injuries treated in US EDs from 2007 to 2015 (95% confidence interval, 102 156-127 302). In addition, there was an increase in the number of moped injuries annually (B = 762.1, P < .01). The average number of moped injuries yearly was 12 748. The mean age was 34 years. Patients between ages 19 and 38 years represented 42% of the study population. Men (74%) and whites (55%) accounted for most of the injured population. Most injuries were stabilized in the ED and discharged home (85%). Approximately 9% of injuries were admitted to the hospital, and fractures constituted 59% of all diagnoses admitted to the hospital. Contusions (27%) and fractures (24%) accounted for most diagnoses. The most common body part injured was the head (16%). CONCLUSIONS Moped injuries have increased since 2007 and mopeds are associated with severe injuries. Education and reexamination of current moped laws may decrease the number and severity of moped-related injuries.

Epidemiology of Trauma-Associated Threatened Abortions Presenting to U.S. Emergency Departments From 2013 to 2015 [30C]

Spontaneous coronary artery dissection in post-partum patients is a rare and potentially life-threatening event observed in otherwise healthy, young women. This case discusses a multi - vessel coronary artery dissection in a female 12 days post-partum. This article discusses the phenomenon of spontaneous coronary artery dissection in postpartum patients, emphasizing the important of raising awareness on these unique cases.