Triage Guidelines for Providers Interfacing with Mental Health Patients Presenting to the Emergency Department

This QI Project was inspired by a concern and belief that a hospital emergency department (ED) can more effectively respond to and manage the mental health patient population by improving its triage process. When a patient in mental health crisis presents to the emergency department (ED) for care, the triage process often results in patients having multiple encounters with various staff asking the same questions over and over. Many times, staff query patients about issues that are considered non-essential. Patients are often frustrated by this repeated questioning and therefore, the ability to develop or maintain a positive therapeutic relationship is compromised. Patients often shut down, become increasingly agitated, are mistrustful, and even walk out of the ED without receiving care. The following initiative focuses on identifying and addressing system level barriers that impede the ability to triage mental health patients seeking care in the ED. At the conclusion of this QI project, practice changes include the reduction of door to doc time, enhanced communication between staff and clarification of assigned roles and duties, and a streamlined workflow process

Transition to adult services for children and young people with palliative care needs : a systematic review

Objective: To evaluate the evidence on the transition process from child to adult services for young people with palliative care needs. Design: Systematic review Setting: Child and adult services and interface between healthcare providers. Patients: Young people aged 13 to 24 years with palliative care conditions in the process of transition. Main outcome measures: Young people and their families’ experiences of transition, the process of transition between services and its impact on continuity of care, and models of good practice. Results: 92 studies included. Papers on transition services were of variable quality when applied to palliative care contexts. Most focused on common life threatening and life limiting conditions. No standardised transition programme identified and most guidelines used to develop transition services were not evidence based. Most studies on transition programmes were predominantly condition-specific (e.g. cystic fibrosis, cancer) services. Cystic fibrosis services offered high quality transition with the most robust empirical evaluation. There were differing condition-dependent viewpoints on when transition should occur but agreement on major principles guiding transition planning and probable barriers. There was evidence of poor continuity between child and adult providers with most originating from within child settings. Conclusions: Palliative care was not, in itself, a useful concept for locating transition-related evidence. It is not possible to evaluate the merits of the various transition models for palliative care contexts, or their effects on continuity of care, as there are no long-term outcome data to measure their effectiveness. Use of validated outcome measures would facilitate research and service development

Comparing Dominant and Non-Dominant Torque and Work Using Biodex 3 Isokinetic Protocol for Knee Flexors and Extensors

INTRODUCTION. There is often a misconception when looking at comparing dominant and non-dominant limbs of any sort. Although there will be a lack of control in non-dominant limbs compared to dominant, the amount of torque and power associated with each limb may be equal; even so, there may be an instance of bilateral deficit, where even though the dominant limb may be used to do work on a specific limb, the non-dominant limb may still receive strength benefits. PURPOSE. The main purpose of this study is to directly relate ability (torque and total work) in both dominant and non-dominate limbs with a focus on knee flexion and extension. METHODS. Participants: Four (N = 4; 4 males, 0 females) volunteers were utilized for this study. The average age of the participants were 24.5 + 1.73 years old, average height was 71.75 + 3.20” (inches or 182.245 centimeters), and average weight was 183.26 + 45.78 pounds (83.3 kilograms). Methodology: Upon arriving to the lab, each participant was measured for height (recorded in inches) and weight (recorded in kilograms), as well as age was recorded (years). Each participant was added into the system when they attempted to perform the protocol. The protocol utilized isokinetic concentric/concentric contractions on the knee for three separate speeds or sets (30/s, 60/s, and 90/s); each set included 5 repetitions. Upon completion of each set (5 repetitions) the participant would be allowed 10 seconds of rest. Following the same protocol, all participants would complete the test using their non-dominate leg. RESULTS. The value and percent difference associated with dominant and non-dominant extension (both torque and work) were rather large. As seen in the percent difference section, the value of each percent difference were at least 7.83% (min) and as high as 27.43% (max). There was also a noticeable percent difference associated with 90/s in flexion for both torque and work between dominant and non-dominant with values at torque = 19.97% and work = 16.23%. DISCUSSION. This study may help provide insight into how dominant and non-dominant limbs may be trained and how they may be equal even without training. This may be untrue due to many variables, but this study has allowed a certain insight into how dominant and non-dominant limbs may be equal in gross motor movements. Results that find non-dominant to dominant differences may be errors due the tester and/or the participant; it may be due to the participant because of situational awareness, they may learn the protocol and movements with one leg and adjust using the other