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Dlott CC, Metcalfe T, Khunte A, Jain S, Bahel A, Hsiang WR, Donnelley CA, Kayani J, Wiznia DH. Evaluating musculoskeletal urgent care center triage and transfer of emergency conditions for emergency surgical assessment and intervention. Medicine (Baltimore) 2022; 101:e32519. [PMID: 36595864 PMCID: PMC9794202 DOI: 10.1097/md.0000000000032519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Musculoskeletal urgent care centers (MUCCs) are an alternative to emergency departments (EDs) for patients to seek care for low acuity orthopedic injuries such as ankle sprains or joint pain, but are not equipped to manage orthopedic emergencies that require a higher level of care provided in the ED. This study aims to evaluate telephone and online triage practices as well as ED transfer procedures for MUCCs for patients presenting with an orthopedic condition requiring urgent surgical intervention. We called 595 MUCCs using a standardized script presenting as a critical patient with symptoms of lower extremity compartment syndrome. We compared direct ED referral frequency and triage frequency for MUCCs for patients insured by either Medicaid or by private insurance. We found that patients presenting with an apparent compartment syndrome were directly referred to the ED by < 1 in 5 MUCCs. Additionally, < 5% of patients were asked additional triage questions that would increase clinician suspicion for compartment syndrome and allow MUCCs to appropriately direct patients to the ED. MUCCs provide limited telephone and online triage for patients, which may result in delays of care for life or limb threatening injuries that require ED resources such as sedation, reductions, and emergency surgery. However, when MUCCs did conduct triage, it significantly increased the likelihood that patients were appropriately referred to the ED. Level of Evidence: Level II, prognostic study.
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Affiliation(s)
- Chloe C. Dlott
- Yale University School of Medicine, Department of Orthopaedics & Rehabilitation, New Haven, CT, United States
- * Correspondence: Chloe C. Dlott, Yale University School of Medicine, Department of Orthopaedics & Rehabilitation, 800 Howard Avenue, New Haven, CT 06519, United States (e-mail: )
| | - Tanner Metcalfe
- Yale University School of Medicine, Department of Orthopaedics & Rehabilitation, New Haven, CT, United States
| | - Akshay Khunte
- Yale University School of Medicine, Department of Orthopaedics & Rehabilitation, New Haven, CT, United States
| | - Sanjana Jain
- Yale University School of Medicine, Department of Orthopaedics & Rehabilitation, New Haven, CT, United States
| | - Anchal Bahel
- Yale University School of Medicine, Department of Orthopaedics & Rehabilitation, New Haven, CT, United States
| | - Walter R. Hsiang
- University of California San Francisco, Department of Urology, San Francisco, CA, United States
| | - Claire A. Donnelley
- Yale University School of Medicine, Department of Orthopaedics & Rehabilitation, New Haven, CT, United States
| | - Jehanzeb Kayani
- Yale University School of Medicine, Department of Orthopaedics & Rehabilitation, New Haven, CT, United States
| | - Daniel H. Wiznia
- Yale University School of Medicine, Department of Orthopaedics & Rehabilitation, New Haven, CT, United States
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Cowell N, Kalnow A. Upper Extremity Hematoma: An Atypical Case of Compartment Syndrome. Cureus 2021; 13:e12453. [PMID: 33552771 PMCID: PMC7853728 DOI: 10.7759/cureus.12453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Compartment syndrome is a potentially life- or limb-threatening condition that carries high morbidity if not promptly diagnosed and treated. This case is an atypical presentation demonstrating why a high index of suspicion, prompt surgical consultation, and intervention is required if compartment syndrome is suspected.
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Affiliation(s)
- Nicholas Cowell
- Emergency Medicine, OhioHealth Doctors Hospital, Columbus, USA
| | - Andrew Kalnow
- Emergency Medicine, OhioHealth Doctors Hospital, Columbus, USA.,Emergency Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, USA
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Abstract
The objective of this educational article is to explain in non-technical terms how the engineering considerations in the design of prophylactic dressings for pressure ulcer (PU, also known as pressure injury) prevention eventually determine the associated clinical and cost-benefit outcomes. The article specifically describes a bioengineering algorithm for quantitative evaluation of the biomechanical efficacy of different prophylactic dressing designs, which is exemplified for two fundamentally different dressing technologies, one based on superabsorbent cellulose core versus the conventional silicone-foam dressing design. A set of three biomechanical indices is described and employed for the above comparative evaluation, namely, the protective efficacy index, the protective endurance and the prophylactic trade-off design parameter. It is demonstrated that the dressing with the superabsorbent cellulose core is at least as good as silicone-foams but, importantly, provides a good balance between its protective performance in its ‘new’ condition, as opposed to its ‘used’ condition, i.e., after being exposed to moisture. Most notably, we show that preventative dressings are never equal in their performances; the underlying structure and the dressing ingredients together determine the extent of the delivered tissue protection and its durability.
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Affiliation(s)
- Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University Tel Aviv 6997801, Israel
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