Multisite study of Aggressive Behavior Risk Assessment Tool in emergency departments.

Objective: Violence is a major preventable problem in emergency departments (EDs), and validated screening tools are needed to identify potentially violent patients. We aimed to test the utility of the Aggressive Behavior Risk Assessment Tool (ABRAT) for screening patients in the ED. Methods: A prospective cohort study was conducted among adult and pediatric patients aged ≥10 years visiting 3 emergency departments in Michigan between May 1, 2021, and June 30, 2021. Triage nurses completed the 16-item checklist using electronic health records (EHRs), and the occurrence of violent incidents were collected before ED disposition. A multivariate logistic regression model was applied to select a parsimonious set of items. Results: Among 10,554 patients, 127 had ≥1 violent incidents (1.2%). The regression model resulted in a 7-item ABRAT for EDs, including history of aggression and mental illness and reason for visit, as well as 4 violent behavior indicators. Receiver operating characteristics analysis showed that the area under the curve was 0.91 (95% confidence interval [CI], 0.87-0.95), with a sensitivity of 84.3% (95% CI, 76.5%-89.9%) and specificity of 95.3% (95% CI, 94.8%-95.7%) at the optimal cutoff score of 1. An alternative cutoff score of 4 for identifying patients at high risk for violence had a sensitivity and specificity of 70.1% and 98.9%, respectively. Conclusion: The ABRAT for EDs appears to be a simple yet comprehensive checklist with a high sensitivity and specificity for identifying potentially violent patients in EDs. The availability of such a screening checklist in the EHR may allow rapid identification of high-risk patients and implementation of focused mitigation measures to protect emergency staff and patients.

Nurses' perceived emergency preparedness knowledge: An opportunity for improvement.

OBJECTIVE: This study aimed to provide foundational data supporting the need for nursing education focused on emergency preparedness and response for nursing staff. DESIGN: This study is a cross-sectional, quantitative, descriptive, correlational quality improvement study. SETTING: The study location is a Midwest healthcare system comprised of 14 acute care facilities including pediat-ric and adult level I trauma centers, a burn center, and a fully dedicated pediatric hospital; five long-term care facilities; 230 ambulatory sites; 4,200 employed providers; and a health plan. PARTICIPANTS: A convenience sample of 5,172 currently employed nurses. MAIN OUTCOME MEASURE: The main outcome of this study is the documentation of overall familiarity with emer-gency preparedness and response knowledge among nursing staff. Logistic ordinal regression statistical analysis was completed to determine the significance of individual domains impacting the overall familiarity score. RESULTS: Findings based on the results of the "overall familiarity with response activities related to a large-scale emergency incident" question documented most staff (78.45 percent) have little or no familiarity with their role in dis-aster response. Six domains or focused education areas were identified as having a statistically significant impact (p < 0.0001 - p = 0.0195) on the results of the overall familiarity question. CONCLUSIONS: These study results support the need for more education (academic and/or institutional) related to nursing emergency preparedness and response.

Nurses' perceived emergency preparedness knowledge: An opportunity for improvement.

OBJECTIVE: This study aimed to provide foundational data supporting the need for nursing education focused on emergency preparedness and response for nursing staff. DESIGN: This study is a cross-sectional, quantitative, descriptive, correlational quality improvement study. SETTING: The study location is a Midwest healthcare system comprised of 14 acute care facilities including pediat-ric and adult level I trauma centers, a burn center, and a fully dedicated pediatric hospital; five long-term care facili-ties; 230 ambulatory sites; 4,200 employed providers; and a health plan. PARTICIPANTS: A convenience sample of 5,172 currently employed nurses. MAIN OUTCOME MEASURE: The main outcome of this study is the documentation of overall familiarity with emer-gency preparedness and response knowledge among nursing staff. Logistic ordinal regression statistical analysis was completed to determine the significance of individual domains impacting the overall familiarity score. RESULTS: Findings based on the results of the "overall familiarity with response activities related to a large-scale emergency incident" question documented most staff (78.45 percent) have little or no familiarity with their role in dis-aster response. Six domains or focused education areas were identified as having a statistically significant impact (p < 0.0001 - p = 0.0195) on the results of the overall familiarity question. CONCLUSIONS: These study results support the need for more education (academic and/or institutional) related to nursing emergency preparedness and response.

Understanding the physiological effects of wearing enhanced personal protective equipment while providing patient care.

PURPOSE: There is a lack of information regarding the physiological effects of healthcare workers performing patient care while wearing enhanced personal protective equipment (PPE). This study aimed to provide foundational data necessary to maintain the health and safety of healthcare workers while performing tasks wearing enhanced PPE related to patient care in a biocontainment unit. DESIGN AND METHOD: This study is a descriptive study evaluating the physiological effects of conducting patient care while wearing enhanced PPE. Participant vital signs (blood pressure, body temperature, and oxygen saturation) were monitored pre-donning, throughout the transport, and post-doffing. RESULTS: There is no statistically significant difference in the physiological measurements of any of the participants. The results consisted of: blood pressure (systolic p = 0.0659; diastolic p = 0.94345); oxygen saturation (p = 0.6233); and orally derived body temperature (p = 0.1093). Physical balance was subjectively measured by both the participant and the trained observer during the donning and doffing process. Results show no visible difference in balance between the donning period and the doffing period. CONCLUSION: This study demonstrated there were no physiological changes to the healthcare workers in this study performing patient care activities during patient transport and in a biocontainment unit while wearing the provided enhanced PPE. However, limitations of this study include: (1) it was conducted at one location within the Midwest; (2) with a small number of participants; and (3) only the enhanced ensemble of PPE was worn during testing. Therefore, the results may not be generalizable to other locations or levels of PPE. CLINICAL RELEVANCE: This study will help to guide assessment standards for healthcare workers providing care while wearing enhanced level PPE.

Rebooting healthcare information technology downtime management.

Healthcare, like many other industries, has become reliant on technology to manage daily operations. Often, technology downtimes are managed within the information technology departments to ensure the technical staff can return the hardware or software to the end users as quickly as possible. However, if managed strictly through IT departments, such incidents lack critical communication components and an understanding of the impact on end users. This paper argues that such technological incidents need to be managed not just rapidly but also in conjunction with the emergency preparedness department. It presents the example of a healthcare system from the US Midwest where the IT department has worked closely with the emergency preparedness department to design a major incident management system that closely resembles the hospital incident command structure. The development and implementation of this process has improved several metrics, including time to declare (declaration of an incident) and mean time to restore (returning the technology back to the end users). This paper will describe how this collaboration between information technology and emergency preparedness has improved the impact on healthcare operations, and will highlight the metrics used to monitor success.

A systematic approach to very important person preparedness for a trauma center.

Hospitals across the United States are more involved in disaster/rapid response planning than ever. This collaboration is often driven by continuing federal and state preparedness and all-hazards planning efforts that provide cooperative agreement and/or grant support. These efforts currently include programs administered by the US assistant secretary for preparedness and response, the US Centers for Disease Control and Prevention, the US Department of Defense, and the US Department of Homeland Security. Beyond legislated support or mandates, key emergency management regulations governing hospital-specific disaster planning and response activities are required of hospitals by The Joint Commission, the largest national hospital accrediting body. Despite this ongoing, heightened awareness and inclusion of health care in local and regional emergency response planning, there is 1 partnership to yet strengthen: the relationship between community trauma centers and US Secret Service staff responsible for White House travel and health care contingency plans. One Michigan hospital system designed a program that has made preevent communications and preparedness for rapid very important person response with the Secret Service as important as other local all-hazards planning; the evolution of this partnership is the focus of this article.

How can hospitals be better prepared? A case study of an exercise design program and its effect on a real-life event.

Hospitals continue to strive to meet exercise requirements of The Joint Commission and simultaneously identify organization-specific components of a successful exercise design program. The authors suggest that using a department-level focus during this process improves education, exercise design and outcome, and contributed to the success of a real life disaster response.

Hospital-based special needs patient decontamination: lessons from the shower.

OBJECTIVES: A hospital-based decontamination team tested whether it could (1) perform effective technical decontamination while maintaining safety of staff and patients; (2) safely accommodate unique needs in the showers, including guide dogs and motorized wheelchairs; (3) identify needs of special needs populations by patient type, including blindness, hearing loss, and cognitive learning disabilities; (4) outline effective use of federal preparedness funds to support planning and execution of tabletop and mock victim drills; and (5) demonstrate the ability of a community hospital to act as a catalyst for community-wide disaster response improvements. DESIGN: A series of five disaster exercises were used to test hypotheses and to generate quality improvement results. SETTING: Fixed emergency department decontamination facilities. PATIENTS/PARTICIPANTS: A total of 39 hospital-based decontamination team members, 40 other drill staff and 35 mock victims were included. MAIN OUTCOME MEASURES: Three priority decontamination operations changes resulted from each of the five completed drills. RESULTS: Formulated prioritized list of decontamination team procedural changes to improve patient safety and technical decontamination and to generate a table of best practices to share. CONCLUSIONS: With enhanced training, disaster drills participation of community response agencies and special needs patients, community hospitals can improve safety while accommodating unique patient needs.