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VIOLENCE: Top 5 reasons why guns are fired in hospitals

These data were compiled based on reports of firearm discharges in hospitals over a 10-year period ending in December 2016.  During this time, a total of 416 firearm discharges occurred, killing 279 people.  A tendency for larger hospitals to have more frequent firearm discharges was observed.

Top 5 Motives for Firearm Discharge

  • 30 percent (suicide)
  • 15 percent (while violating another law)
  • 10 percent (domestic – family dispute)
  • 10 percent (related to care of patient who is a prisoner)
  •   6 percent (accidental)

Elderly people (over 70 years old) are disproportionately likely to be in this offender group.

Source: Aumack, T., York, T., and Eyestone, K. (2017). Firearm discharges in hospitals: An examination of data from 2006-2016. Journal of Healthcare Protection Management, 33(1), 1-8.  Click here for publisher’s website: http://www.iahss.org/?page=Journal  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

ED: How to onboard and train staff at a new freestanding emergency department in a large city

Lenox Health-Greenwich Village, a division of Lenox Hill Hospital, was the first freestanding emergency department in New York City.  The facility, which opened July 17, 2014, was designed with 24 fully-equipped patient rooms and 2 more rooms with minimal furnishings for the safe care of behavioral health patients.  These rooms are all large enough to accommodate two patients each if needed.  The utilization for the first 6 months was 12,700 patients and by the end of the first year, over 30,000 were treated.  This article describes in some detail the simulation process and topics used to train staff prior to the opening of the new facility.  The video describes the construction projects that were underway to add ambulatory surgery space on the fourth floor, imaging upgrades to the fifth floor, and physician offices on the sixth.


Kerner, R.L., and others. (2016, October). Simulation for operational readiness in a new freestanding emergency department. Simulation in Healthcare, 11(5), 345-356.  Click here for free full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5172849/pdf/sih-11-345.pdf

Here is a video about the facility: https://www.northwell.edu/about/news/video/lenox-health-greenwich-village-what-emergency-care-should-be

Posted by AHA Resource Center (312) 422-2050  rc@aha.org

EMERGENCY DEPARTMENT: Hybrid pediatric inpatient/ED model for lower volume hospitals

Hospitals that do not have enough volume to support 24/7 availability of a pediatric emergency department might consider a hybrid or combination pediatric inpatient/ED unit.  Howard County General Hospital (Columbia, Md.), credited with being the pioneer of this concept nearly 20 years ago, has 6 inpatient beds and 12 emergency beds.  The annual utilization is 18,000 pediatric ED patients.  The recommended minimum volume to make this type of program successful is 10,000 to 12,000 pediatric ED visits per year.

Other hospitals that have established, or are in the process of setting up, a similar unit include Anne Arundel Medical Center (Annapolis, Md.) and Nash General Hospital (Rocky Mount, N.C.).

Why I like this article: It is based on interviews with practitioners and contains pragmatic details about their programs.  Also provided is contact information for each of the interviewees.


Combined pediatric ED/inpatient unit concept catches on with Maryland community hospitals. (2017, January). ED Management, 29(1), 6-11.  Click here https://www.ahcmedia.com/articles/139700-combined-pediatric-edinpatient-unit-concept-catches-on-with-maryland-community-hospitals

See also these hospital websites:

From the Howard County General Hospital website: http://www.hopkinsmedicine.org/howard_county_general_hospital/services/pediatrics/the_childrens_care_center.html

From the Anne Arundel Medical Center website: http://www.aahs.org/peds/er.php

Posted by AHA Resource Center (312) 422-2050 rc@aha.org

EMERGENCY DEPARTMENT: Front door to hospital brings in 65 percent of admissions through the ED (US 2014 data)

These data are from the Emergency Department Benchmarking Alliance (EDBA) which in 2014 included responses from over 1,100 emergency departments in the United States.

The EDBA data survey over the last five years finds that between 65 and 68 percent of hospital inpatients are processed through the ED.  This reflects the role of the ED as the ‘front door’ of the hospital.

Percent of Patients Processed Through the ED

  • 58 percent (2004)
  • 61 percent (2005)
  • 61 percent (2006)
  • 62 percent (2007)
  • 64 percent (2008)
  • 65 percent (2009)
  • 66 percent (2010)
  • 67 percent (2011)
  • 68 percent (2012)
  • 68 percent (2013)
  • 65 percent (2014)

Source: Augustine, J.J. (2016, Apr. 13). National surveys on emergency department trends bring future improvements into focus. ACEP Now.  Click here:  http://www.acepnow.com/article/national-surveys-emergency-department-trends-bring-future-improvements-focus/?singlepage=1  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

EMERGENCY DEPARTMENT: What is a warm handoff?

Reading Hospital (West Reading, PA) implemented a program in early 2016 referred to as a “warm handoff” intended to help patients who present in the emergency department with heroin or other opioid addiction.  The idea is to first care for whatever caused the patient to come to the ED and then connect the patient with a substance abuse treatment program.  If the patient is interested in accepting the warm handoff, the ED staff makes a connection to appropriate mental health staff.

The hospital website indicates that the Reading Hospital is one of the busiest EDs in Pennsylvania, with over 107,000 ED visits per year.  The warm handoff program is currently operating at about one patient every two days … so 182 warm handoff patients per year, by my calculation.  Or, 182 patients/107,000 visits = 170 warm handoff patients/100,000 ED visits, again by my calculation.


Sandel, K. (2016, May 18). What is the ‘warm hand-off’ and how can it help Pennsylvania’s opioid abuse crisis? Pennsylvania Medical Society Quality and Value Blog. https://www.pamedsoc.org/tools-you-can-use/topics/quality-and-value-blog/BlogMay1816

Warm handoffs connect substance abuse patients to vital services. (2016, Oct.). ED Management, 28(10), 118-119. Click here for publisher website: https://www.ahcmedia.com/articles/138640  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

New CDC Data on Emergency Department Use

The National Center for Health Statistics has just released updated numbers on emergency department use in the U.S. and the five most populous states Here are some key findings:

  • The national ED visit rate in 2012 was 42 visits per 100 persons.
  • The national percentage of ED visits resulting in an admission to the same hospital was 11%.
  • Nationwide, 63% of all ED visits were made by adults aged 18-64; children accounted for 21% of visits and the elderly 65 and over for 16%.
  • Private insurance was the expected primary source of payment for 29% of ED visits, and Medicaid or CHIP accounted for 25%.

Data is also available for California, Florida, Illinois, New York, and Texas.

Source: Hing E and Rui P. Emergency department use in the country’s five most populous states and the total United States, 2012. NCHS [National Center for Health Statistics] Data Brief, no. 252, June 2016.  https://www.cdc.gov/nchs/data/databriefs/db252.pdf

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

STROKE: Kaiser Permanente studies door-to-needle time

According to the American Stroke Association website, ischemic stroke – in which a clot blocks a blood vessel – is by far the most common type of stroke, occurring in just under 90 percent of cases.  If the stroke patient reaches care quickly enough, a good standard treatment is the administration of tissue plasminogen activator (tPA), but the key to improved outcomes is getting the drug administered quickly.

This was a study of 11,630 patients age 18 and over with ischemic stroke who arrived in the 14 emergency departments in the Kaiser Permanente Southern California health system from 2009 to 2013.  Interestingly, a relatively small percentage of these patients were treated with tPA – under 3 percent in 2009 and a little over 6 percent in 2013.  (The authors suggest that the reason that there was a low percentage of tPA administration was because patients were ineligible because they had not made it to the hospital in time for this therapy to be effective, or for other clinical reasons.)

During the 5 years of the study, Kaiser clinicians were able to shave time off of their door-to-imaging time – 46 minutes in the most recent year.  Likewise, they were able to decrease their door-to-needle time to 67 minutes in the most recent year.


American Stroke Association. (2016).  Click here: www.strokeassociation.org

Sauser-Zachrison, K., and others. (2016, Spring). Emergency care of patients with acute ischemic stroke in the Kaiser Permanente Southern California integrated health system. Permanente Journal, 20(2), 10-13. Click here: http://www.thepermanentejournal.org/files/Spring2016/KaiserPermanenteSouthernCalifornia.pdf Posed by AHA Resource Center (312) 422.2050, rc@aha.org