Overcoming stagnant flow: A scoping review of vertical movement in the emergency department.

OBJECTIVES: Improving emergency department (ED) patient flow has plagued many hospitals worldwide. "Vertical" flow improves throughput by maximizing use of chairs and waiting areas instead of beds. This process, however, is inconsistently described in the literature. The objective of this study was to collate existing evidence of successful vertical care programs. METHOD: A scoping review was conducted within several databases utilizing key search terms to capture relevant traditional and gray literature. All articles were uploaded into Covidence (n = 1000). After duplicates were removed, remaining abstracts were initially screened by two reviewers (n = 731). Records identified by at least one reviewer subsequently underwent a two-reviewer full-text screening for inclusion (n = 46). This process yielded 36 articles. Finally, each record underwent data extraction by two independent study members and any inconsistencies were resolved by a third study member. Extracted data included 21 predetermined variables. Descriptive statistics were used to summarize results. RESULTS: Of the 36 included articles, most were published from the United States (91.7%), after 2014 (55.6%), and as a peer-reviewed article or abstract/conference proceeding (86.1%). While every article discussed some aspect of vertical flow, most (77.8%) were observational studies. Only half of the studies reported details of staffing and/or physical resources. A variety of challenges and success strategies were described, with several themes identified. Positive outcomes were reported by most articles (86%), although measurement of outcomes varied with the two most common being length of stay (69.4%) and arrival-to-provider time (55.6%). CONCLUSIONS: The findings of this scoping review provide the first summative report of existing literature on vertical flow processes within the ED setting. Despite different measurable outcomes and varied processes, most articles support the use of vertical flow to improve throughput.

From Obscurity To Spotlight: Staphylococcus lugdunensis-Induced Infective Endocarditis, a Profound Case Unraveling.

Infective endocarditis (IE) represents a grave infection characterized by endocardial inflammation and valve impairment due to diverse pathogens. Staphylococcus lugdunensis, a coagulase-negative organism, has garnered increasing recognition as a significant etiological agent of IE. This bacterium is renowned for its aggressive tissue infections encompassing bone and joint, bloodstream, and IE sites. Particularly noteworthy is the rapid devastation and abscess formation it induces on heart valves, resulting in elevated mortality rates. The pathogen's affinity for von Willebrand factor facilitates its attachment to cardiac valves and blood vessels, thereby exacerbating its virulence. This abstract provides a comprehensive overview of S. lugdunensis-triggered IE. We present a compelling case involving a 66-year-old female afflicted by IE attributed to this microorganism, illuminating the clinical manifestations and challenges linked to the ailment. Moreover, we scrutinize previously reported instances of S. lugdunensis-related IE spanning from 1993 to 2022, accentuating the escalating importance of this pathogen in disease causality. The deleterious consequences of S. lugdunensis-induced IE emanate from its distinctive clinical attributes, necessitating tailored diagnostic strategies and treatment considerations. Given the gravity and swift progression of the infection, healthcare professionals play a pivotal role in administering timely and efficacious management for afflicted patients. Further research is imperative to enhance diagnostic modalities and explore therapeutic approaches aimed at effectively combating this formidable and life-threatening infection.

Drug-Induced Thrombocytopenia: A Case Involving Vancomycin.

Drug-induced thrombocytopenia (DIT) is a rare adverse effect that occurs when administering various medications. The medications associated with this possible adverse effect include heparin, penicillin, furosemide, vancomycin, non-steroidal anti-inflammatory drugs, ranitidine, and many others. DIT causes a rapid decrease in platelet counts after drug administration and typically resolves once the offending agent has been discontinued. The induced thrombocytopenia increases the bleeding risk and possibility of adverse effects throughout a hospital course. In this case report, we look at the presenting symptoms and treatment course of an interesting case of DIT that occurred following the administration of vancomycin.

COVID-19 With an Initial Presentation of Intraperitoneal Hemorrhage Secondary to Spontaneous Splenic Rupture.

The WHO declared coronavirus disease 2019 (COVID-19) a global pandemic in early 2020. As the pandemic has continued to evolve over a period of several months, many cases of unusual presentations are now emerging, which pose a greater challenge for physicians in terms of quickly identifying COVID-19 patients based on initial signs and symptoms. In this report, we present one such unusual presentation in a patient with sudden intraperitoneal hemorrhage and spontaneous splenic rupture with COVID-19 as the likely etiology and contributing factor. The patient was a 75-year-old Caucasian woman who presented to the emergency department (ED) with complaints of severe left-sided abdominal pain for several days without any preceding trauma. A CT of the abdomen/pelvis revealed a large amount of fluid in the abdomen, which raised suspicion of bleeding. An exploratory laparotomy revealed splenic rupture with hemoperitoneum, and the patient subsequently underwent an emergent splenectomy. The patient's COVID-19 antigen test returned positive during the surgery and was subsequently confirmed with a polymerase chain reaction (PCR) test. COVID-19 has been found to result primarily in respiratory symptoms through its ability to invade endothelial cells via angiotensin-converting enzyme 2 affinity. It is speculated that this mechanism may cause a predisposition to micro-thromboses, which can eventually lead to manifestations such as large lymphoid organ thrombosis. Based on this case presentation and the evolving literature on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), spontaneous splenic rupture is an emergent differential diagnosis that should be considered in COVID-19 patients presenting with gastrointestinal complaints such as abdominal pain and nausea.