Loading clinical trials...
Loading clinical trials...
Showing 1-20 of 29 trials
NCT07428109
For several decades, hospital emergency departments have been experiencing congestion, sometimes reaching saturation point, where they are no longer able to fulfil their primary mission: to prioritise patients requiring immediate care due to a clinical situation that could be life-threatening or functionally debilitating. The main reason for this situation is a structural mismatch between medical needs, which have increased due to population ageing, and outpatient care supply, which has remained relatively stable in order to contain healthcare expenditure. As a result, a large proportion of people visiting hospital emergency departments are individuals who have been unable to find a solution to their medical needs in the community and have turned to the hospital as a last resort. These are patients seeking urgent, unscheduled care who have been unable to obtain an appointment with their general practitioner or another primary care professional. In times of extreme pressure, as sometimes happens in France during the summer, access to hospital emergency departments is limited to patients who have received prior authorisation to attend. Similarly, new ways of managing these requests for urgent or unscheduled care are being sought in the field of medical regulation. Triage of patients by telephone appears to be an essential step in medical regulation prior to access to hospital emergency departments. Indeed, if solutions are available in the city for patients who do not need to go to the emergency department, this triage will optimise the resources of the healthcare system. However, quickly assessing patients without visual contact (who may be in a state of emotional distress or face a language barrier) is a particularly delicate task. Several triage algorithms are available to assist telephone operators. However, these require structured clinical information that is not easily and quickly accessible during calls. For several years now, artificial intelligence (AI) has emerged as a promising alternative for assisting operators, as it enables the management of large amounts of unstructured data, particularly audio exchanges. AI-based classification models using audio data have shown that they could be useful in medical regulation, particularly in cases of cardiac arrest, stroke or myocardial infarction. However, to our knowledge, previous studies have focused on specific disorders, and their models are not capable of handling the vast range of cases inherent in the classification of general front-line emergency calls. In this context, researchers have developed an AI-based model to identify patients requiring referral to hospital emergency departments among outpatients seeking emergency or unscheduled care through medical call centres. To do so they used telephone calls and medical records from SOS Médecins Grand Paris, a group of approximately 150 general practitioners and emergency doctors who mainly offer same-day home visits in Paris and its neighbouring departments (more than 6.5 million inhabitants). The objective of this study is to evaluate the model's ability to identify patients requiring hospitalization based on (1) new data from SOS Médecins Grand Paris, but also (2) data from Corsica, (3) to compare the model's predictions with those of a physician, and (4) to determine the general conditions for using the predictions in current practice.
NCT07405996
Biological testing is an essential part of general medical practice and plays a role in 60% to 70% of diagnoses. 68.5% of prescriptions are written by general practitioners, and one in seven general medical consultations ends with a prescription for biological testing. The study of patient trajectories is a recent emerging topic in the literature, encompassing general concepts. The angle most often taken is medico-economic and focused on specific chronic conditions such as diabetes, cancer, or cardiovascular disease. To our knowledge, there are a number of referrals to emergency departments by general practitioners for patients with biological abnormalities. However, to our knowledge, no study to date has attempted to quantify these specific referrals.
NCT07225725
Patients diagnosed with head and neck cancer (HNC) after presenting to an emergency department (ED) often face significant delays in diagnosis and treatment. These patients are frequently younger, underinsured, and experience multiple socioeconomic and systems-level barriers to accessing timely cancer care. Delays of more than 30 days have been associated with worse outcomes, including higher recurrence rates and reduced survival. This pilot study will evaluate the feasibility and early impact of a community-based navigation program designed to improve access to timely care for ED-presenting HNC patients. The study embeds trained Community Health Support Specialists (CHSS) from the Engaging Navigators to Reduce Inequities in Cancer Health (ENRICH) program into the ED-to-treatment pathway. After ED discharge, CHSS staff will contact participants by telephone or text message to identify barriers to care-such as transportation, insurance, housing, or communication challenges-and connect them with appropriate community or institutional resources. All participants will receive the CHSS navigation intervention. Outcomes will be compared with a historical cohort of similar ED-presenting HNC patients treated prior to program implementation. The primary outcomes are time from ED discharge to diagnostic biopsy and time from ED discharge to initiation of definitive treatment. Secondary outcomes include feasibility, measured as the proportion of participants who complete CHSS navigation, and exploratory analyses of the types of barriers identified and resolved. Findings from this pilot will generate preliminary data to inform larger studies aimed at improving access, reducing disparities, and accelerating treatment for head and neck cancer patients who first present in the emergency setting.
NCT06370572
The purpose of this study is to learn if the Pain in Advanced Dementia (PAINAD) scale can improve emergency pain care in persons living with dementia (PLWD). It is hypothesized that a PAINAD electronic health record (EHR) prompt that appears to emergency department (ED) staff will enable them to accurately assess pain levels and lead to better pain treatment for PLWD.
NCT07312019
Drug-related iatrogenesis is a major public health issue, accounting for a significant proportion of adverse events and hospitalizations in emergency departments. Optimizing prescription management in this context is critical to improve both patient safety and physician efficiency This study aims to evaluate the impact of the POSOS AI-driven device on the medical time required for prescription management in polymedicated patients admitted to emergency departments. The main objective is to establish whether the use of POSOS can reduce transcription time compared to standard electronic management.
NCT07004270
In France and around the world, emergency care facilities are facing increasing demand, with rising waiting times. Differentiating care pathways, notably by opening a fast-track unit, helps to improve patient flow and waiting time; which contributes to patient satisfaction. However, a link between patient satisfaction and waiting time is not always found when patients perceive a humanistic approach in care. The implementation of an advanced practice nurse in an emergency department is a way to graduate the offer of care and reduce waiting times before consultation and length of stay for patients with minor degree of severity. In this care context, Advanced Practice Nurses maintain and even improve patient satisfaction. Since July 2024, two Advanced Practice Nurses have integrated Poitiers University Hospital's adult emergency department. Considering the existing and ongoing literature to knowledge, an evaluation of the impact of emergency Advanced Practice Nurses 1 year after their implementation in a French University Hospital would be the first study of its kind. According to the results of previous international studies, the investigators assume that emergency Advanced Practice Nurses activities have a positive impact on the French healthcare system: on the quality of care perceived by patients and on the emergency care pathways of all fast-track patients by maintaining the same level of safety. This study aims to evaluate the impact of emergency Advanced Practice Nurses in a French University Hospital on patient perception of quality of care, safety and patient care pathways in emergency departments. This monocentric cross-sectional observational study is a prospective survey of patient satisfaction and experience with a satisfaction questionnaire; and a retrospective survey on routine care data. The study's main objective is to evaluate the impact of emergency Advanced Practice Nurses in a French University Hospital on patient-perceived quality of care by measuring the overall satisfaction of patients who receive care from Advanced Practice Nurses during their emergency care pathway. Overall patient satisfaction will be measured in a survey conducted with a patient satisfaction and experience questionnaire. The secondary objectives of this study are several: * Assess patients' acceptability of being cared by an emergency Advanced Practice Nurse * Evaluate patient satisfaction with the communication and care relationship with an emergency Advanced Practice Nurse * Evaluate the rate of recommendation of an emergency Advanced Practice Nurse by the patients who receive care from an Advanced Practice Nurse * Evaluate the safety of care pathways including an emergency Advanced Practice Nurse * Evaluate the impact of emergency Advanced Practice Nurses implementation on emergency care pathways for fast-track patients Consistent with each objective and outcome, the study will compare: * groups before and after the implementation of emergency Advanced Practice Nurses * or subgroups in the period after implementation of advanced practice nurses: with and without emergency Advanced Practice Nurses intervention The anonymous patient satisfaction and experience survey will be sent by a link in a verified e-mail during the emergency department visit of patients included in the study, admitted to emergency department between 02/06/2025 and 29/06/2025. Routine care data will be collected from Poitiers hospital medical records for fast-track patients who did not refuse to take part in the study during the following periods: * Before Advanced Practice Nurses' implementation from 05/27/2024 to 06/23/2024 * After Advanced Practice Nurses' implementation from 02/06/2025 to 29/06/2025
NCT07167095
This retrospective observational study investigates factors associated with 90-day mortality among patients with advanced cancer who present to the emergency department (ED). The study will include stage IV solid tumor patients who visited the ED of Etlik City Hospital between December 2022 and March 2025. Demographic, clinical, and laboratory parameters such as performance status, nutritional and inflammatory markers, and biochemical values will be analyzed. The primary objective is to identify prognostic indicators that predict short-term mortality following ED visits. By establishing risk profiles, the study aims to optimize patient triage, guide timely referral to supportive and palliative care services, and improve overall care strategies for advanced cancer patients in acute settings.
NCT07111624
Fenice has proposed a new indicator to measure the level of crowding in the ER. The aim of this study is to evaluate, in a national multicenter context, the degree of agreement between the Fenice indicator and the perception of crowding of the ER operators and to compare this agreement with that between NEDOCS and the perception of the operators.
NCT06681376
Introduction: The aging of the population is a global phenomenon, with projections indicating a significant increase in the proportion of individuals aged 65 years and older by 2050. This demographic shift requires adapting emergency department (ED) services to meet the specific demands of older patients, who often present with multiple comorbidities and face challenges such as sensory and cognitive difficulties. EDs, traditionally designed for acute illness and injury management, may not be adequately equipped to meet the unique needs of this vulnerable population. This can result in suboptimal patient experiences, prolonged ED stays, increased hospitalizations, and poorer outcomes. Methods: This study protocol outlines a before-and-after study to evaluate the impact of implementing a comfort menu and cart on the experience and outcomes of older patients treated in the ED. The study will be conducted in the ED of Hospital Sírio-Libanês (HSL), a tertiary private hospital in São Paulo, Brazil. Patients aged 65 and older who presented to the ED will be eligible for inclusion. Participants will be recruited in two phases: pre-intervention and post-implementation of the comfort menu and cart. Data will be collected through patient and staff interviews, chart reviews, and a 30-day follow-up interview. Patient experience, staff experience, length of hospital stays, hospital costs, ED readmissions, falls, delirium incidence, quality of life, functional status, cognitive performance, and mortality will be assessed. Ethics and dissemination: Ethical approval for this study has been granted by the Institutional Review Board of HSL. All participants, or their legal representatives for those with cognitive impairment, will provide written informed consent before any study procedures are initiated. The consent process has been designed keeping the study hypothesis blind by not revealing the outcomes that will be measured after the comfort cart intervention. The results will be shared with the academic community through peer-reviewed publications and presentations at relevant conferences to inform future clinical practice and research. Expected Results: A positive impact of implementing the comfort menu and cart in the ED is expected on patient-centered outcomes. Improvements in the experience of older patients and medical and multidisciplinary staff are anticipated, and improvements in other exploratory outcomes, such as length of hospital stay, hospital costs, readmissions, falls, delirium incidence, quality of life, functionality, and cognitive performance, will be explored.
NCT07021118
Mild TBI is one of the main causes of admission to the Emergency Department (ED). Brain computed tomography (CT) is one of the most widely used diagnostic tools to assess the presence of intracranial lesions. However, in Western countries, 85-95% of CT scans performed in the ED for mild TBI are negative. It is therefore conceivable that a significant number of CTs could be avoided by a more careful use of this exam. On the other hand, excessive use of CT exposes patients to unnecessary radiation, increases healthcare costs and slows down the management of patients in the ED. This study aims to analyze the variability in the use of CT in mild TBI in Italian EDs, validate the scores designed to help the physician decide when to use it and develop a model that predicts the medium-term outcome of patients with mild head trauma.
NCT06219486
Emergency departments (ED) internationally are treating an increasing number of patients. Most require hospital services but some could be better cared for on alternative pathways. D-dimer has some unique properties. It is non-specific and is elevated in many acute condi- tions; but conversely remains normal in the absence of significant disease. Previous studies have shown that having a normal D-dimer on arrival to the emergency department is associated with a very low risk of 30-day all-cause mortality. The investigators propose a multicenter randomized controlled trial using D-dimer to identify patients at low risk and test if providing this information will change time to discharge disposition by the treating physician.
NCT06345352
The aim of this study is to develop, study and validate a rigorous and sustainable method for assessing the clinical appropriateness of the decision taken in the Emergency Department to admit or not to admit patients.
NCT06668636
The goal of this clinical trial is to examine the effectiveness and implementation of the Emergency Department Patient-Activated Transition to Care at Home (ED-PATCH) tool, which is used by patients to manage information during their visit to the emergency department. The main aims of the trial are: * To study whether ED-PATCH works well in Canadian emergency department settings * To understand the context and strategies impacting the implementation of ED-PATCH in Canadian emergency department settings ED-PATCH is an electronic tool accessed using a smartphone or tablet that patients and caregivers can use to create their own summary of what happened during their visit to the emergency department. Using a questionnaire format, the tool prompts users to enter information about their symptoms, tests and procedures done during the visit, diagnosis, medications given, and their plans after leaving the emergency department. A healthcare provider checks that the information is correct before the summary is locked and emailed to the patient. Researchers will compare data collected before ED-PATCH is launched and after it is launched to learn if the tool reduces return visits to the emergency department and other outcomes such as participants' stress, memory and understanding of their visit, health status, and care experiences.
NCT04550169
The State of Wisconsin is now expanding its investment in care coordination models as an effort to reduce inappropriate hospital emergency department (ED) use, improve health outcomes, and reduce Medicaid expenditures. This effort begins with a pilot program to support emergency department care coordination in hospitals and health systems that apply and are selected to participate in the pilot program. The Wisconsin Medicaid program seeks to understand whether this program achieves its intended goals and, specifically, whether the Medicaid payment for such care coordination services produces the intended program outcomes. Hospitals will select members that will receive care coordination services. In a quasi-experimental approach, the study team will compare members that do vs. do not receive the services will be used examine the effects of care coordination and referrals on total ED visits, primary-care treatable ED visits, non-emergent ED visits, and health care costs, as well as the specific effects of referring patients to providers who offer low-cost and after-hours care. To assess the importance of targeting, study team will conduct stratified analyses of vulnerable groups such as people with disabilities and individuals with specific clinical needs.
NCT06703931
The goal of this prospective, comparative, multi-centre interventional clinical investigation, is to evaluate the performance of the Thermodiag® medical device, compared with reference methods, for continuous measurement of core temperature in critical care patients. The main question it aims to answer is to develop non-invasive alternatives to the current methods of measuring core body, to reduce health risks, and overcome various other limitations (as infection, bleeding, thrombosis and local reactions).
NCT06338111
This study aims to identify the prognostic role of procalcitonin (PCT), soluble Triggering Receptor Expressed on Myeloid Cells-1 (sTREM-1), the soluble form of the urokinase plasminogen activator receptor (suPAR), highly sensitive C-reactive protein (hs-CRP), Interleukin-6 (IL-6), and azurocidin 1 (AZU1) in 28-day mortality for patients with sepsis in Emergency Department.
NCT04235738
This study examines the prevalence and incidence of older ER users with cognitive impairment (i.e., dementia and/or delirium) using the ER2 item temporal disorientation in older ED users who are participants of the ER2 cohort study database.
NCT05580016
Soluble Urokinase Plasminogen Activation Receptor (SUPAR) is a validated biomarker with applications in the study of inflammation and infection. Elevated levels of SUPAR have recently been linked to a higher mortality in patients suffering from undifferentiated sepsis, pneumonia, and more recently, COVID-19 infection. Large randomized controlled trials have been conducted on patients admitted to the emergency department (ER), regardless of the reason for admittance. These studies have stratified risk based on three cutoffs at initial measurement: * Low risk : \< 3 ng/mL * Intermediate risk : entre 3 et 6 ng/mL * High risk : \> 6 ng/mL Low levels of SUPAR are associated with low risk of mortality in the short and long term in patients presenting to the ED, no matter the reason for admittance. Risk stratification could be an added decision-making tool for clinicians to comfort hospital discharge. To the best of our knowledge, there is no available data on the added value of SUPAR for predicting mortality in abdominal sepsis and abdominal pain. Abdominal pain is responsible for 10 to 30 % of ER admissions. Consequently, abdominal pain is then responsible for roughly 10 % of admissions into medical and surgical wards. Mortality varies depending on patient factors. Mortality is usually stratified on age. In patients under 50 years of age, it is near 8%, but it reaches 19 % in patients over 50. Diagnostic accuracy also decreases drastically with age, reaching approximately 30 % patients over 75. Taking this into account, integrating a measure of SUPAR levels into the current standard of care could stratify the risk of complications in patients admitted to the ER with abdominal pain.
NCT05978154
The goal of this observational study is to evaluate whether thigh muscle mass and muscle wasting are associated with mortality in patients who visit the emergency department. The main questions it aims to answer are: * Is thigh muscle mass associated with mortality in patient who visit the emergency department? * Does muscle wasting exist during staying in the emergency department? * Is muscle wasting associated with mortality in patient who visit the emergency department? Participants will be evaluated for serial thigh muscle mass using point-of-care ultrasound at the emergency department.
NCT05357365
This study aims to understand the epidemiological characteristics, related factors , and current status of occupational diseases and damage that occur in emergency medical workers (doctors and nurses). A number of surveys were conducted on about 100 emergency medical workers for about a year with occupational factors, physical health, and mental health.