The Impact of Coronavirus Disease 2019 on US Emergency Departments

Physical Restraint Use in the Pediatric Emergency Department

ABSTRACT

Children and adolescents can present to the emergency department with acute agitation and aggression due to various physical and/or mental health conditions. With acute agitation/aggression, these patients may present a risk of injury to themselves, their caregivers, or emergency department providers/staff. It is imperative for providers to understand how to safely care for these children. When initial deescalating interventions fail or an underlying etiology for the behavior change cannot be found, the use of physical restraints may be required. Without proper training or preparation, physical restraints can lead to significant morbidity and mortality. Given these potential risks, strict guidelines have been set out by the Center for Medicare and Medicaid Services and the Joint Commission regarding the use of physical restraints in the pediatric population. This article will review approaches to the acutely agitated/aggressive patient, the appropriate use of physical restraints, and recommended assessment/documentation of restraints in the acutely agitated/aggressive pediatric patient.

Changes in the Prevalence of Infection in Pregnant Women during the COVID-19 Lockdown

BACKGROUND

During the outbreak of SARS-CoV-2, strict mitigation measures and national lockdowns were implemented. Our objective was to investigate to what extent the prevalence of some infections in pregnancy was altered during different periods of the COVID-19 pandemic.

METHODS

This was a single centre retrospective cohort study conducted in the Netherlands on data collected from electronic patient files of pregnant women from January 2017 to February 2021. We identified three time periods with different strictness of mitigation measures: the first and second lockdown were relatively strict; the inter-lockdown period was less strict. The prevalence of the different infections (Group B Streptococcus (GBS)-carriage, urinary tract infections and Cytomegalovirus infection) during the lockdown was compared to the same time periods in previous years (2017-2019).

RESULTS

In the first lockdown, there was a significant decrease in GBS-carriage (19.5% in 2017-2019 vs. 9.1% in 2020; p = 0.02). In the period following the first lockdown and during the second, no differences in prevalence were found. There was a trend towards an increase in positive Cytomegalovirus IgM during the inter-lockdown period (4.9% in 2017-2019 vs. 12.8% in 2020; p = 0.09), but this did not reach statistical significance. The number of positive urine cultures did not significantly change during the study period.

CONCLUSIONS

During the first lockdown there was a reduction in GBS-carriage; further studies are warranted to look into the reason why.

Contemporary Practices for Medical Evaluation of the Psychiatric Patient in the Emergency Department

Although emergency department (ED) visits for patients with mental illness are frequent, medical evaluation (i.e., "medical screening") of patients presenting with psychiatric complaints is inconsistent. This may largely be related to differing goals for medical screening, which often vary according to specialty. Although emergency physicians typically focus on stabilization of life-threatening diseases, psychiatrists tend to believe that care in the ED is more comprehensive, which often places the two fields at odds. The authors discuss the concept of medical screening, review the literature on this topic, and offer a clinically oriented update to the 2017 American Association for Emergency Psychiatry consensus guidelines on medical evaluation of the adult psychiatric patient in the ED.

Feasibility of Peer-Delivered Suicide Safety Planning in the Emergency Department: Results From a Pilot Trial

OBJECTIVE

The emergency department (ED) is an important site for suicide prevention efforts, and safety planning has been identified as a best practice for suicide prevention among ED patients at increased suicide risk. However, few ED clinicians are prepared to assess suicide risk or guide patients in the creation of safety plans. This study was a pilot randomized controlled trial of the feasibility, acceptability, and preliminary effects of safety planning by individuals with lived experience of suicide attempt or of severe suicidal ideation but without medical training (i.e., peers) in the ED.

METHODS

Patients at risk for suicide in a general ED were randomly assigned to receive peer-delivered or mental health provider–delivered safety planning. Intervention feasibility measures included ED length of stay, safety plan completeness, and safety plan quality. Acceptability measures included patient satisfaction. Preliminary effects were assessed as number of ED returns within the 3 months after the ED visit.

RESULTS

Data from 31 participants were available for analysis. Compared with participants with provider-delivered safety planning, participants with peer-delivered safety planning had similar ED lengths of stay, higher safety plan completeness, and higher safety plan quality. Acceptability of the safety planning process was similar for the two groups. Compared with participants receiving provider-delivered safety planning, participants receiving peer-delivered planning had significantly fewer ED visits during the subsequent 3 months than during the 3 months preceding the ED visit.

CONCLUSIONS

Peer-delivered safety planning is feasible and acceptable and may result in fewer return ED visits. These findings provide preliminary support for peer-delivered safety planning in the ED.