Prevalence of life-threatening arrhythmias in ED patients transported to the radiology suite while monitored by telemetry

Decreasing non-value-added nursing time transporting stable patients from the emergency department

In the emergency department (ED), one non-value-added task is transporting stable patients to telemetry units. This process improvement intervention introduces a decision tree to determine which patients are stable enough to be safely transported nonmonitored, thus more efficiently using valuable nursing time. A decision tree was utilized to determine which patients would be transported nonmonitored. A data collection instrument was completed at the time of each nonmonitored transport of a patient, and data were collected over a 4-month period. A total of 280 patients met the criteria to be transported nonmonitored from the ED to the inpatient unit during the data collection period, saving an average of 20.7 hr per month. With appropriate use of the decision tree, clinical staff successfully determined the need for monitored transport of patients admitted to non-intensive care unit telemetry units from the ED. There were no adverse patient events.

Pediatric cardiac emergencies: Children are not small adults

Compared with adults, cardiac emergencies are infrequent in children and clinical presentation is often quite variable. In adults, cardiac emergencies are most commonly related to complications of coronary artery disease; however, in pediatric cases, the coronaries are only rarely the underlying problem. Pediatric cardiac emergencies comprise a range of pathology including but not limited to undiagnosed congenital heart disease in the infant; complications of palliated congenital heart disease in children; arrhythmias related to underlying cardiac pathology in the teenager and acquired heart disease. The emergency room physician and pediatric intensivist will usually be the first and second lines of care for pediatric cardiac emergencies and thus it is imperative that they have knowledge of the diverse presentations of cardiac disease in order to increase the likelihood of delivering early appropriate therapy and referral. The objective of this review is to outline cardiac emergencies in the pediatric population and contrast the presentation with adults.