Browsing by Author "Alexander, Andreia"

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    A novel emergency medical services protocol to improve treatment time for large vessel occlusion strokes
    (PLOS, 2022-02-25) Glober , Nancy; Supples , Michael; Persaud, Sarah; Kim , David; Liao , Mark; Glidden , Michele; O'Donnell , Dan; Tainter , Christopher; Boustani , Malaz; Alexander, Andreia; Emergency Medicine, School of Medicine
    In many systems, patients with large vessel occlusion (LVO) strokes experience delays in transport to thrombectomy-capable centers. This pilot study examined use of a novel emergency medical services (EMS) protocol to expedite transfer of patients with LVOs to a comprehensive stroke center (CSC). From October 1, 2020 to February 22, 2021, Indianapolis EMS piloted a protocol, in which paramedics, after transporting a patient with a possible stroke remained at the patient's bedside until released by the emergency department or neurology physician. In patients with possible LVO, EMS providers remained at the bedside until the clinical assessment and CT angiography (CTA) were complete. If indicated, the paramedics at bedside transferred the patient, via the same ambulance, to a nearby thrombectomy-capable CSC with which an automatic transfer agreement had been arranged. This five-month mixed methods study included case-control assessment of use of the protocol, number of transfers, safety during transport, and time saved in transfer compared to emergent transfers via conventional interfacility transfer agencies. In qualitative analysis EMS providers, and ED physicians and neurologists at both sending and receiving institutions, completed e-mail surveys on the process, and offered suggestions for process improvement. Responses were coded with an inductive content analysis approach. The protocol was used 42 times during the study period; four patients were found to have LVOs and were transferred to the CSC. There were no adverse events. Median time from decision-to-transfer to arrival at the CSC was 27.5 minutes (IQR 24.5-29.0), compared to 314.5 minutes (IQR 204.0-459.3) for acute non-stroke transfers during the same period. Major themes of provider impressions included: incomplete awareness of the protocol, smooth process, challenges when a stroke alert was activated after EMS left the hospital, greater involvement of EMS in patient care, and comments on communication and efficiency. This pilot study demonstrated the feasibility, safety, and efficiency of a novel approach to expedite endovascular therapy for patients with LVOs.
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    The Case of Ty Jackson: An Interactive Module on LGBT Health Employing Introspective Techniques and Video-Based Case Discussion
    (Association of American Medical Colleges, 2019-06-04) Gavzy, Samuel J.; Berenson, Marc G.; Decker, Jilyan; Domogauer, Jason; Alexander, Andreia; Pulaski, Matthew; Soto-Greene, Maria; Sánchez, Nelson; Sánchez, John Paul; Emergency Medicine, School of Medicine
    Introduction: The Institute of Medicine's 2011 report on lesbian, gay, bisexual, and transgender (LGBT) health and the legalization of same-sex marriage are just two of the numerous milestones that have hastened medical schools' efforts to prepare trainees to address the needs of LGBT community members. Early awareness of sexual diversity through self- and peer introspection and video-based education can help trainees build a foundation towards providing affirming care to LGBT patients. Methods: The Kern model was used to develop, implement, and evaluate an interactive multimodal workshop to provide first-year medical students with a formative introduction to LGBT health. Learning objectives focused on comprehending the spectrum of human sexuality, health issues for LGBT patients, and better practices for promoting affirming care. The module consisted of a PowerPoint presentation, sexuality survey, videos of provider-patient encounters, and community-based resources. Results: The workshop was implemented among 178 first-year medical students in September 2018, with 93% completing the pre-/postworkshop evaluations. Comparison of evaluations showed an increase in confidence in addressing each of the three learning objectives. Over 85% rated the PowerPoint and videos as very good or excellent. Discussion: This workshop was effective in helping first-year medical students appreciate the spectrum of sexual diversity, health issues facing LGBT individuals, and better practices to promote affirming care. The real-time sexuality survey helped trainees appreciate sexual diversity through self-reflection and near-peer sharing. The videos and accompanying discussion provided real-life encounters, along with common pitfalls in and pearls for communicating with LGBT patients.
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    Perceived impact of physician-in-triage on resident education
    (Elsevier, 2018) Ullo, Michael; Alexander, Andreia; Sugalski, Gregory; Emergency Medicine, School of Medicine
    Emergency department (ED) overcrowding is a problem that has deleterious consequences for both patients and providers. Complications from such a burden on the ED include prolonged wait times, patient dissatisfaction, decreased productivity, and increased patient mortality [1,2]. The physician-in-triage (PIT) model has become increasingly popular in ED settings with results suggestive of a positive impact on ED throughput [3-6]. Our ED implemented a novel PIT, termed the Rapid Assessment Team (RAT), exclusively for patients arriving via emergency medical services (EMS).