Master of Health and Human Services, Youngstown State University, 2014, Department of Health Professions

The current study examined the relationship between job status as well as socioeconomic factors and use of an emergency department (ED) over other sources of care. The study also sought to identify any other confounding variables in this choice of care location such as age, gender, insurance status, or reason for not working. Methods: A secondary analysis of the National Health Interview Survey (NHIS) data was conducted for years 2010-2012 to determine the relationship between job or socioeconomic status and the use of an ED. Binary logistic regression models were performed and many potentially confounding factors were included to determine whether or not the relationship remains despite these other variables. Results: Definite changes in the use of EDs over other sources of care exist between those of differing job status or socioeconomic status. Those making below 150% of the federal poverty level (FPL) are more likely to use an ED (Β= 2.85, p < 0.001) compared to those who earn over 500% of the FPL, and the likelihood of using an ED decreases steadily as the ratio of income to the FPL increases. This change is also seen in education, where the less educated are more likely to use an ED than the more educated. Lastly, those who are working are less likely to use an ED than those who claim to be currently looking for work (Β= 0.00 vs 1.62, p < 0.001) when compared to those who are not working or looking for work. The findings may be used to better identify the despaired population and reduce the burden currently felt on EDs.

Committee: Joseph Lyons Ph.D. (Advisor); Richard Rogers Ph.D. (Committee Member); Joseph Mistovich (Committee Member) Subjects: Health; Health Care; Health Sciences; Public Health

MS, University of Cincinnati, 2012, Medicine: Clinical and Translational Research

Objective: To evaluate for differences in rate of admission and charges between pediatric and general emergency departments for visits by children and young adults with complex chronic conditions Design: Cross-sectional study using data from the 2008 Nationwide Emergency Department Sample Setting: Stratified sample of U.S. hospital-based ED visits Participants: Visits by pediatric-aged patients aged 0-17 years of age and transition-aged patients aged 18-24 years of age with one or more complex chronic conditions Main exposures: Type of ED in which the visit occurred, designated as a pediatric or a general ED Main outcome measures: The three primary outcome measures were: percent of patients admitted from the ED, ED Charges for treat-and-release visits, and total charges (ED + inpatient) for admitted patients. Results: A significantly higher percentage of visits by both pediatric-aged and transition-aged patients to pediatric EDs that had multiple CCCs and technology dependence when compared to visits to general EDs (p<0.0001). When controlling for patient and hospital characteristics, the type of ED was not a significant predictor of admission, ED charges or total charges. Markers of disease severity, presence of multiple CCCs and technology dependence, were predictive of admission and total charges in both pediatric-aged and transition-aged patients. Conclusions: Overall, the results highlight that the influence of type of ED is not significant when controlling for patient and hospital characteristics. This suggests that the increased charges observed at pediatric hospitals in previous studies may be in part due to uncontrolled for differences in disease severity between the individuals cared for at pediatric and general facilities. Our analysis showed that among visits by both pediatric and transition-aged patients, there was a higher percentage of visits by patients with technology dependence and multiple CCCs at pediatric EDs compared to general EDs. Th (open full item for complete abstract)

Committee: Erin Nicole Haynes Ph.D. (Committee Chair); Jackie Grupp-Phelan M.D., M.P.H. (Committee Member); Terri L. Byczkowski Ph.D., M.B.A. (Committee Member) Subjects: Surgery

Doctor of Healthcare Administration (D.H.A.), Franklin University, 2024, Health Programs

This investigation aimed to evaluate the impact of the implementation of the Columbia Suicide Severity Rating Scale tool in the Emergency Department. The setting of the study focused on a non-profit community-based hospital that serves the Hispanic-dominant population in a Suburban area. The utilization of secondary data from 2022 and 2023 was analyzed statistically to evaluate the success of the implementation of the Columbia Suicide Severity Rating Scale tool pre- and post-implementation. The study focused on the impact on risk level assignment, arrival to provider assessment times, and discharge disposition, pre-and post-implementation. The analysis aims to bring awareness and aid in necessary changes to the delivery of care for patients who seek care with suicide ideation or suicide attempts. The statistical analysis utilized a Mann-Whitney U test, Chi-square test, and two sample t-tests to determine the statistical impact pre- and post-implementation of the Columbia Suicide Severity Rating Scale tool. The results showed no statistically significant differences between pre- and post-implementations. Though the outcome shared no statistically significant difference, clinical significance was observed as minor shifts in data were noted. Future studies suggest integrating theoretical themes into the patient's plan of care to accommodate the population being served. The analysis and findings of this study identified vital prospective areas of focus that brought awareness to the psychiatric population, enhance care plans for high-risk patients, and expand on post-discharge education.

Committee: Gail Frankle Dr. (Committee Chair); Cynthia Smoak Dr. (Committee Member); Tonia Young-Babb Dr. (Committee Member) Subjects: Health Care; Mental Health

Doctor of Healthcare Administration (D.H.A.), Franklin University, 2024, Health Programs

The United States pediatric population is unique in that the epidemiological trends differ from those seen in the adult population. When discussing the pediatric emergency department (ED), this is typically a setting with high patient flow which requires swift diagnoses and treatment. Ideally, all patients should have equal opportunity to receive their highest possible level of quality healthcare, regardless of social determinants of health (SDOH) such as patient race/ethnic background, preferred spoken language, socioeconomic status, and insurance status. This is essentially the concept of health equity. The goal is to provide responsible and ethical healthcare to patients. If healthcare delivery is disproportionate, this may result in the overcrowding of EDs, delays in patient care, economic burden on the healthcare system, and increased morbidity and mortality. Some scholars have claimed that both individual and systemic biases have resulted in inequitable healthcare delivery. The following research study investigated health equity in the United States pediatric ED via the following question: What government and organizational policy changes can be made to enhance ED pediatric patient equity by utilizing first-hand information from ED physicians? The selected methodology for this research was qualitative and utilized in-depth semi-structured interviews of 15 pediatric ED physicians via Franklin University's Zoom platform. ATLAS.ti software was used to assist in identifying key themes and sub-themes from the code transcriptions.

Committee: David Meckstroth (Committee Chair); Karen Lankisch (Committee Member); John Suozzi (Committee Member) Subjects: Epidemiology; Ethics; Gender Studies; Health; Health Care; Health Care Management; Language; Literacy; Medical Ethics; Medical Imaging; Medicine; Mental Health; Native American Studies; Public Health; Public Health Education

MS, University of Cincinnati, 2024, Medicine: Clinical and Translational Research

Bacteremia is a significant cause of morbidity and mortality in children and young adults with sickle cell disease (SCD), but among those presenting to the Emergency Department (ED) with fever, the absolute risk of, risk factors for, and outcomes of bacteremia are poorly defined. Objective: We sought to obtain contemporary data on the absolute risk of, risk factors for, and outcomes associated with bacteremia in children and young adults with SCD presenting to the Emergency Department (ED) with fever. Design/Setting/Participants: We performed a multi-center retrospective cohort study of individuals with SCD under 22 years of age presenting to EDs within the Pediatric Health Information Systems (PHIS) database from January 2016 to December 2021 with fever (identified by diagnostic codes for fever or the collection of blood cultures and intravenous antibiotic administration). Main Outcomes and Measures: We determined the risk of bacteremia (defined by diagnostic coding) in these children and young adults and used univariate analyses and multivariable regression to determine associations between patient level factors and bacteremia. Results: We analyzed 35,548 encounters from 36 hospitals. The median age of the cohort was 6.2 years and 52.9% were male. Bacteremia was present in 405 encounters (1.1%, 95% CI 1.05%-1.27%). A history of bacteremia, osteomyelitis, stroke, central line associated blood stream infection (CLABSI), central venous catheter, or apheresis were statistically significant in univariate analysis with the diagnosis of bacteremia, while age, gender, HbSC genotype, and race were not. In multivariable analysis, a history of bacteremia (odds ratio [OR] 1.36, 1.01-1.83), CLABSI (OR 6.39, 3.02-13.52) and apheresis (OR 1.77, 1.22-2.55) had higher odds of bacteremia. Conclusions and Relevance: In this large observational cohort, bacteremia in children and young adults with SCD presenting with fever was rare. History of previous (open full item for complete abstract)

Committee: Patrick Ryan Ph.D. (Committee Chair); Luke Smart M.D. (Committee Member); Matthew Lipshaw M.D. (Committee Member); David Schnadower (Committee Member) Subjects: Medicine

Doctor of Philosophy, The Ohio State University, 2024, Educational Studies

Suicide is a growing concern in the United States and around the world. Approximately 50,000 people die by suicide each year and more than 15 million additional people struggle with thoughts of suicide in the U.S. As a result, there are very few people who have not been affected by suicide. Much of the work that has been performed around suicide places a focus on awareness and interventions, which is necessary for understanding the issue and critical in directing people to help. In recent years, the increases in suicide have been met with increases in social awareness. There is one obvious gap, which has been a lack of implemented solutions. Unfortunately, little has been done to provide actual treatment models that have proven effective. This study explored the work conducted at an outpatient treatment center utilizing a novel treatment model specifically developed for individuals actively struggling with thoughts of suicide. This model merges two evidence-based models with over 50 randomized controlled trials between them to bring both access and treatment to the public. The sample included 58 participants with a mean age of 20 years and which was 57% female and 43% male. Importantly, 31% of those in the study had no prior history of mental health diagnosis. The study found that the treatment was effective in reducing suicidality scores in the sample from pre-treatment scores to post-treatment scores, with a very large effect size [t(57) = 8.1, p < .001, d = 1.02]. There were also a significant decreases in scores on hopelessness [t(56) = 9.875, p < .001, d = 1.630], psychological pain [ t(57) = 9.768, p<.001, d = 1.294], stress [t(57) = 9.560, p < .001, d = 1.266], and self-hate [t(57) = 8.118, p < .001, d = 1.075], all with large effect sizes. The treatment and dosage data shows that the participants were able to appropriately address the issue of suicide and achieve resolution in an average of 7.52 sessions over an average of 5.6 weeks, with a 93% succe (open full item for complete abstract)

Committee: Darcy Haag Granello (Advisor); Paul Granello (Committee Member); David Jobes (Committee Member); Kaprea Johnson (Committee Member) Subjects: Behavioral Psychology; Behavioral Sciences; Behaviorial Sciences; Clinical Psychology; Cognitive Psychology; Cognitive Therapy; Counseling Education; Counseling Psychology; Developmental Psychology; Ethics; Experimental Psychology; Health Care; Mental Health; Psychology; Psychotherapy; Public Health; Social Work; Sociology

PhD, University of Cincinnati, 2023, Nursing: Nursing - Doctoral Program

Background: Family presence during resuscitation (FPDR) was first introduced into clinical practice about thirty years ago in Foote Hospital in the U.S. when the chaplain disagreed with the commonly followed practice of excluding the family members from the patient's resuscitation. Since then, several attempts have been made to integrate this care practice into routine patient care. Moreover, several interventions to enhance the perception of FPDR and improve the daily practice of this care practice are developed earlier, including education and policy making. However, nurses' perceptions, attitudes, and behaviors are widely varied regarding the implementation of FPDR in critical and emergency care settings. Cardiopulmonary resuscitation within the hospital is mostly performed in the intensive care unit, cardiac care unit, and emergency department. As a result, critical care and emergency nurses are front-line healthcare providers who influence the practice of FPDR. Therefore, it was essential to understand the perspectives, perceptions, attitudes, and behaviors of critical care and emergency nurses when it comes to the practice of FPDR. Aims: The specific aims of the dissertation were to describe nurses' perceptions and attitudes regarding FPDR and investigate the possible barriers, facilitators, benefits, and risks or challenges associated with practicing FPDR in critical care and emergency settings. Methods: This manuscript-option dissertation was composed of three interrelated projects that collectively address the dissertation's specific aims. The first project was an integrative review to investigate the current evidence on FPDR practice in critical care and emergency settings. The second project was a descriptive qualitative study where 21 registered nurses from critical care units and emergency departments from hospitals across three states in the Midwest U.S. completed interviews about their perceptions, attitudes, benefits, risks, and barriers to p (open full item for complete abstract)

Committee: Carolyn Smith Ph.D. (Committee Chair); Dana Harley Ph.D. M.S.W L.I.S.W. (Committee Member); Gordon Gillespie Ph.D. (Committee Member) Subjects: Health

Doctor of Healthcare Administration (D.H.A.), Franklin University, 2023, Health Programs

The mental, emotional, and physiological health of healthcare professionals deteriorated during the COVID-19 pandemic and professionals reported experiencing symptoms of depression, anxiety, and posttraumatic stress. The researcher conducted a quantitative research study that focused on measuring burnout in nursing professionals working in an emergency department (ED) and intensive care unit (ICU) post COVID-19 pandemic. A casual comparable study using a cross-sectional survey design was used to gather the research data. Furthermore, the Maslach Burnout Scale has been described as the gold standard for measuring burnout and was used to collect current data. The research was aimed at determining which group of nursing professionals were at higher risk for experiencing burnout and if stress management techniques were associated with burnout levels. The goal of this study was to identify the current state of nursing professionals' mental health years after the onset of COVID-19. In addition, evaluate burnout differences amongst the nursing groups. The study also identified associations between nursing professional's burnout and their participation in stress management techniques. The researcher believed the study would make known that nurses working in the ED experienced higher levels of burnout than nurses working in the ICU. This study aimed to provide current and relevant information regarding nurse's burnout to healthcare organizations and leaders with hopes of producing a plan for creating a healthier work lifestyle for professionals.

Committee: Gail Frankle (Committee Chair); Scott McDoniel (Committee Member); Jesse Florang (Committee Member) Subjects: Health Care; Nursing

BS, Kent State University, 2023, College of Nursing

Education regarding opioid prescriptions upon discharge from the Emergency Department (ED) is essential to ensuring the safe use of opioid analgesics. ED nurses are on the front lines fighting the opioid epidemic, and effective discharge education is one of the primary tools used to reach individuals that are receiving opioid prescriptions either for the first time or after a long history of exposure. Current literature explores nurse perceptions of pain management in the ED as well as effective education techniques; however, it does not address the factors that influence an ED nurse regarding discharge education about opioid analgesics. The purpose of this study is to identify these factors. Interviews were conducted with 12 ED nurses from three hospitals in northeastern Ohio (one urban, one suburban, and one critical access hospital). The data was analyzed and coded, and three overarching factors that influence discharge education in the ED were identified: patient characteristics, nursing factors, and professional resources. Patient characteristics can be broken into demographics, the presence of family or a caregiver at discharge, a patient's history of exposure, and a patient's access to health resources. Nursing factors include personal experiences with opioid prescriptions or addiction and alternatives to opioids for pain management. Examples of professional resources are patient NARx scores, discharge materials, the amount of time allotted for discharge, the physician writing the prescription, and recent changes in prescribing practice. All these factors influence discharge education by increasing or decreasing the amount of time spent on discharge, as well as the amount of detail that is included in discharge education. Keywords: Opioid; Emergency Department; Discharge Education; Nursing

Committee: Tracy Dodson (Advisor); Amy Miracle (Committee Member); Cassandra Storlie (Committee Member); Pamela Stephenson (Committee Member) Subjects: Demographics; Education; Health Care; Health Education; Medicine; Nursing; Pharmaceuticals; Teaching

Doctor of Nursing Practice Degree Program in Population Health Leadership DNP, Xavier University, 2023, Nursing

Sepsis is a global issue impacting the lives of our most vulnerable populations. However, evidence-based treatment guidelines are available making sepsis treatable and, if identified early, can be nonfatal. Understanding and recognizing the signs of sepsis is important to survival, especially in rural areas where access to higher levels of care may take time. Training nursing staff to properly care for sepsis patients presenting to the emergency room is necessary for good patient outcomes. This can be difficult when the incidence of sepsis may be low among the local population. The use of in-situ simulation offers a training modality that allows nurses to experience the realness of caring for a septic patient but doing so in a safe environment where actual patients cannot be harmed. The purpose of this Doctor of Nursing Practice (DNP) project was to assess if the use of in-situ simulated sepsis training with emergency department nurses could increase adherence to sepsis treatment bundles, resulting in improved patient outcomes.

Committee: Miranda Knapp PhD., DNP, APRN,AGCNS-BC, CNE, ENP-C (Committee Chair); Lisa Schauseil DNP, MSN, M.Ed.,PMHNP-BS, FNP-BC (Advisor) Subjects: Health; Health Care; Health Care Management; Health Education; Health Sciences; Inservice Training; Nursing; Public Health

DNP, Otterbein University, 2024, Nursing

Angioedema (AE) is a potentially life-threatening medical condition that occurs with a higher frequency than medical providers may expect, with the emergency department (ED) serving as the usual first point of medical contact for patients. Any hesitation in recognizing AE or inconsideration of the disease process in differential diagnoses may lead to a dangerous delay of care. Due to the potential rapid progression of airway obstruction in AE, inexperienced providers should not attempt intubation, instead deferring to providers experienced in alternative airway techniques (i.e., anesthesia providers). The primary goal of this project is to develop an evidencebased practice guideline for AE to facilitate a quality improvement project for guideline implementation. The proposed guideline offers medication choices for AE patients, steps for providers to follow when presented with an AE case, and suggests intubation and emergency surgical airway techniques. Project implementation involves retrospective and prospective chart reviews, in person staff training, and the creation of an angioedema cart containing all necessary medications and intubation supplies suggested in the guideline. The project also supplies an infographic algorithm for quick use, with separate task lists for ED and anesthesia providers. If implemented, the full proposed timeline for training and data gathering would be one year, with the outcomes of patient mortality, hypoxic brain injury, cardiac arrest, and airway placement metrics to be assessed via chart review pre and post guideline implementation. The project emphasizes the importance of successfully managing AE and the guideline hopes to serve as a quick resource to providers dealing with emergent AE airway issues.

Committee: Amy Bishop DNP, AGCNS, (Committee Member); Chai Sribanditmongkol RN, IBCLC, CNS, (Committee Member); Brian Garrett DNP, CRNA (Advisor) Subjects: Medicine; Nursing

Doctor of Healthcare Administration (D.H.A.), Franklin University, 2023, Health Programs

The Crisis Intervention Team (CIT) program is a partnership of law enforcement agencies, the behavioral healthcare system, emergency departments (EDs), advocacy groups, and other stakeholders in a geographic region. People in the community who experience a crisis related to a behavioral health (BH) condition often encounter police officers, and the CIT program offers guidance on the safe handling of those situations that ideally ends with a connection to treatment. In the United States, crisis BH resources are often unavailable, and it is common for officers to resolve the situation by initiating an ED visit, which is not associated with positive health outcomes for the patient. The aim of this study is to test the implications of Structural Functional Theory (SFT) in one CIT program. SFT suggests that imbalanced systems lead to the inappropriate reliance on other systems. The analysis of crisis events may provide insight into potential BH system improvements that align with the goals of the CIT program. One research question aims to find predictors of each disposition option available to LE officers in the CIT program. Findings in this study are drawn from the quantitative analysis of 594 CIT encounters over a 3-year period. The results of the multinomial logistic regression models indicate that adolescents and young adults experience suicide-related crises more often than other types of crises, and the most likely outcome is an ED visit. Findings suggest that the local system could benefit from improvements in BH resources, especially in crisis situations.

Committee: Gail Frankle (Committee Chair); Jesse Florang (Committee Member); Dail Fields (Committee Member) Subjects: Health Care Management

DNP, Walsh University, 2022, Nursing

Persons undergoing cancer-directed therapy may experience side effects that require medical care. Often the care is provided in the emergency department (ED) resulting in unnecessary admission to the hospital. Rapid Access Care Clinics (RACC) have been developed as alternative care settings to manage the specialized needs of patients with cancer. Although the benefit of RACC is that they are staffed with providers specializing in oncology care, little is known about the use of RACC or the effectiveness of RACC in preventing hospital admissions. The purposes of this research study were to (a) assess utilization of the Rapid Access Cancer Clinic versus the Emergency Department for solid tumor cancer patients, and (b) examine the association between location of care (RACC versus ED) and same-day hospital admissions, demographic characteristics, socioeconomic status, and clinical characteristics. This study was a descriptive, correlational design using retrospective chart review methods. The sample included 788 patients with solid tumor cancers that utilized the RACC or ED from May 1, 2020, through May 31, 2022. The study found a statistically significant association between the location of care (RACC versus ED) and same day hospital admissions. Additionally, there was a significant association between the location of care and race, marital status, insurance status, type of cancer, stage of cancer, and current treatment modality.

Committee: Janeen Kotsch (Committee Co-Chair); Shelly Amato-Curan (Committee Chair) Subjects: Nursing

MS, University of Cincinnati, 2022, Medicine: Clinical and Translational Research

Objective: To compare clinical features and outcomes of blood culture positive vs. culture negative sepsis. Design: A single- center retrospective cohort study. Setting: The pediatric emergency department (PED) at a tertiary pediatric care center. Patients: All children < 18 years of age treated for sepsis in a single PED. Interventions: None. Measurements and Main Results: We analyzed 1307 patients treated for sepsis during from January 1, 2017 to March 31, 2021, of which 117 (9.0%) had positive blood cultures. Of children with culture-positive sepsis, 62 (53.0%) had organ dysfunction compared to 514 (43.2%) with culture-negative sepsis (odds ratio (OR) = 1.54, 95% confidence interval 1.01-2.17, adjusted for age, race, high-risk medical condition, and time to antibiotics). Children with culture-positive sepsis had a larger base deficit (-4 vs -1; p < 0.01), and higher procalcitonin (3.84 vs. 0.56 ng/mL; p < 0.01). Conclusions: Children meeting treatment-based sepsis criteria with positive blood culture have higher rates of organ dysfunction than children who are culture-negative, although our 9% rate of blood culture positivity is lower than previously cited pediatric intensive care unit (PICU) literature. Early laboratory values associated with blood culture positivity may help physicians appropriately identify children at higher risk of organ dysfunction and guide treatment to mitigate morbidity.

Committee: Scott Langevin Ph.D. (Committee Member); Yin Zhang M.S. (Committee Member); Paria Wilson M.D. (Committee Member); Michelle Eckerle M.D. (Committee Member) Subjects: Surgery

Master of Science, The Ohio State University, 2021, Mechanical Engineering

Poor outcomes for patients with trauma result from many non-linear dependent risk factors, including patient demographics, injury characteristics, medical care provided, and characteristics of medical facilities; yet traditional approaches attempted to capture these relationships using rigid regression models. We hypothesized that neural networks and gradient-boosted trees could deeply understand a trauma patient's condition and accurately identify individuals at high risk for mortality or admission to an intensive care unit without relying on restrictive regression model criteria. Deidentified patient visit data were obtained from the years 2007-2014 of the National Trauma Data Bank and 2007-2015 of the National Hospital Ambulatory Medical Care Survey. All patient visits occurred in U.S. hospitals, with only a small minority of the more than 2 million encounters resulting in mortality or admission to an intensive care unit. We designed, trained, and evaluated different models' performance on patients with complete data and those with missing features independently. The models were evaluated on their sensitivity, specificity, positive and negative predictive value, and Matthews Correlation Coefficient. When working with complete data only, gradient-boosted tree methods and neural networks perform similarly and models developed in recent papers, with a slightly more favorable Matthews Correlation Coefficient with the neural net. However, the tree-based methods had much stronger performance characteristics once incomplete data was introduced, as they did not require any form of imputation in order to process the data. While testing for confounding factors, we discovered that excluding fall-related injuries boosted performance for adult trauma patients; however, it reduced performance for children. The models described here demonstrate similar performance to contemporary machine intelligence models without requiring restrictive regression model criteria or extensive (open full item for complete abstract)

Committee: Satyanarayana Seetharaman (Committee Member); Herman Shen (Advisor) Subjects: Mechanical Engineering

Doctor of Nursing Practice, Mount St. Joseph University , 2021, Department of Nursing

Quality metrics prove to be an essential part of healthcare and hospital reimbursement. Emergency departments have specific metrics to meet, standards of care to maintain, as well as patient satisfaction scores. Inefficiency in throughput during the triage phase can lead to lengthy stays, delays in care, poor patient outcomes, and ultimately, patient dissatisfaction. The goal of this evidence-based practice quality improvement (EBP-QI) project is to improve care by creating a solution that will help the throughput of the patient presenting to the emergency department (ED) with complaints of chest pain by implementing an ED Triage chest pain protocol. This EBP-QI project will enable the ED to utilize nurse-driven protocols in the triage area to promote quality standards and achieve metrics that will improve the delivery of care to patients presenting with complaints of chest pain. The Donabedian model and Lewin's Change Theory were used to focus on quality care and implement change in clinical practice with the goal of overall improvement in door-to-door time, door-to-EKG time, door-to-lab time, door-to-imaging time, and patient satisfaction scores. This EBP-QI project used an educational learning management system coupled with hands on simulation training to 25 ED nurses. The project lead compared pre-and post-intervention metrics of door-to-door time, door-to-EKG time, door-to-lab time, door-to-imaging time, and patient satisfaction scores for improvements in data. The results of pre-post implementation data found that door-to-door time decreased from an average 253.9 minutes to 161.2 minutes for an average decrease of 92.7 minutes, door-to-EKG time decreased from an average of 13.9 minutes to 8.75 minutes for an average decrease of 5.15 minutes, door-to-lab time decreased from an average of 22.7 to 21.225 minutes for an average decrease of 1.475 minutes, door-to-imaging time decreased from an average of 32.06 minutes to an average of 24.65 minutes for an average d (open full item for complete abstract)

Committee: Donna Glankler Dr. (Committee Chair) Subjects: Nursing

PhD, University of Cincinnati, 2020, Medicine: Epidemiology (Environmental Health)

The association between opioid prescribing and opioid use disorder (OUD) is complex, not well characterized, and yet the need to treat pain remains high. This is particularly true for emergency departments (EDs), that have 136.9 million visits annually (43% for pain) and prescribe opioids to 17% of discharged patients. My objectives were to use clinically obtained data in electronic medical records (EMRs) and apply modern machine learning techniques to 1) evaluate the effect of an ED opioid prescription on diagnosis of OUD and 2) develop a predictive model to identify those at risk for OUD in an ED patient population. Objective 1 Case-control study of adult (=18 years), non-cancer, discharged ED patients without pre-existing OUD. Each patient's first ED visit (10/2014-9/2019) was identified and designated as “index”. Propensity score (PS) weights were calculated using machine learning to simulate random treatment assignment. OUD was defined as diagnosis of an opioid use disorder or unintentional opioid overdose. A Cox proportional hazards model was used to estimate the PS weighted, adjusted hazard ratio (aHR) of OUD (adjusted for: age, sex, race, history of non-opioid substance use disorder and mental health condition), in patients prescribed an opioid at index compared to those who were not, and then stratified by other medical exposures to evaluate modifying effects. Objective 2 Develop and test an OUD predictive model in adult emergency department (ED) patients (1/2013-10/2019). Medications and diagnostic codes were used to construct two machine learning models (random forest and LASSO regression). Potential predictors included: age, race, sex, insurance type, number of opioid prescriptions, and 161 diagnostic codes (ICD-10 code categories, excluding OUD outcome codes and categories occurring in < 1% of patients). Only medications and diagnoses that occurred prior to first OUD diagnosis or last ED visit in the system (for those without an OUD diagnosis) we (open full item for complete abstract)

Committee: Jane Khoury Ph.D. (Committee Chair); Scott Langevin Ph.D. (Committee Member); Michael Lyons M.D. (Committee Member) Subjects: Epidemiology

MS, University of Cincinnati, 2020, Medicine: Clinical and Translational Research

Objectives: The objective was to examine the relationship between illness severity and healthcare resource utilization in tobacco smoke-exposed children compared with unexposed children who presented to a pediatric emergency department (PED). Methods: We performed a retrospective, cross-sectional study using data from two studies conducted at Cincinnati Children's Hospital Medical Center. Adjusted logistic regression models were built to assess these relationships between 380 tobacco smoke-exposed children and 1,140 unexposed children. Results: Children who received a supplemental oxygen source (adjusted odds ratio [aOR]=3.21, 95% confidence interval [CI]=2.44-4.21) and baby booger grabber (BBG) suctioning (aOR=4.76, 95%CI=4.18-5.42) were significantly more likely to be in the tobacco smoke exposure (TSE) group. Children with the following tests performed were at increased likelihood of being tobacco smoke-exposed: infectious diagnostic testing (aOR=3.04, 95%CI=2.87-3.22) including influenza (aOR=4.04, 95%CI=3.22-5.06), strep (aOR=2.34, 95%CI=2.21-2.49), monospot (aOR=8.61, 95%CI=6.89-10.75), and blood culture tests (aOR=14.78, 95%CI=11.26-19.41); laboratory testing including renal profile and/or complete blood count (aOR=10.20, 95%CI=8.60-12.09); and radiologic testing (aOR=6.49, 95%CI=5.89-7.15) including chest x-ray (aOR=5.02, 95%CI=4.54-5.55) and lateral airway x-ray (aOR=24.01, 95%CI=17.67-32.64). Children who received the following medications during their PED visit were also more likely to be in the TSE group: steroids (aOR=0.66, 95%CI=7.54-9.32), albuterol (aOR=4.69, 95%CI=4.23-5.19), ipratropium (aOR=6.03, 95%CI=5.10-7.13), and IV fluids (aOR=60.46, 95%CI=43.68-83.69). Children who were prescribed oral antibiotics (aOR=1.21, 95%CI=1.14-1.29), ophthalmic antibiotics (aOR=1.49, 95%CI=1.29-1.73), and albuterol and steroids combined (aOR=3.07, 95%CI=2.73-3.45) were more likely to be in the TSE group. Children who were admitted to the hospital were 13.58 time (open full item for complete abstract)

Committee: Patrick Ryan Ph.D. (Committee Chair); Roman Jandarov Ph.D. (Committee Member); Melinda Mahabee-Gittens Ph.D. (Committee Member) Subjects: Environmental Health

Master of Science in Biological Sciences, Youngstown State University, 2019, Department of Biological Sciences and Chemistry

The present investigation looked at the effect of patient expectations on patient satisfaction. Researchers approached walk-in patients at St. Joseph's Warren Hospital meeting the inclusion criteria and asked them to participate in the study. Upon receipt of consent, the participant was randomized into one of two groups: control or experimental. If the participant was randomized into the experimental group, they received a pre-visit expectation survey and the post-visit satisfaction survey. If the participant was randomized into the control group, they only received the post-visit satisfaction survey. The pre-visit expectation survey evaluated self-triage and self-assessment of necessary diagnostics or treatments during their visit. The post-visit satisfaction survey used a 10-point Likert scale to assess the patients' satisfaction with their overall experience, doctor, perceived length of stay, and level to which their expectations were met. There were 230 participants included in the study, 117 in the control group and 113 in the experimental group. Of the 113 participants in the experimental group, over half could accurately self-triage. Patients predicted their need for blood tests, x-rays, and CAT scans with overwhelming accuracy. The need for admission to the hospital was over-estimated. Medications while in the Emergency Department (ED) and new prescriptions were both under-estimated factors. The study revealed that there is not a statistically significant difference in satisfaction scores between the control and experimental groups for overall satisfaction, doctor, perceived length of stay, and level to which their expectations were met. A 2-tailed Pearson correlation was used to assess the potential relationship between meeting patient expectations and overall satisfaction scores. The results show that there is a positive correlation between the two factors (r=0.680, where the correlation is considered significant at less than 0.01).

Committee: Jill Tall PhD (Advisor); Kelly Colwell EdD (Committee Member); Matthew Lindberg PhD (Committee Member) Subjects: Biomedical Research; Health Care

Master of Science in Biological Sciences, Youngstown State University, 2019, Department of Biological Sciences and Chemistry

A medical encounter's quality can be measured both objectively and subjectively. Subjective measures provide insight to the patient's experience. This experience can have many influential factors including patient perceptions and patient expectations. Hospitals are now required to publically report quarterly satisfaction rating or face decreased reimbursement (CMS, 2017). For emergency departments (EDs), that operate under time constraints with a diversity of medical and trauma presentations, building rapport and creating satisfied patients can be a challenge. The introduction of a pre-visit expectation questionnaire to allow patients to provide a reason for why they have arrived to the ED, their perceived medical severity, and what they believe is medically appropriate, may help physicians better understand their patients' needs and lead to decreased length of stay. Half of the included survey participants were randomized into the control group (n = 117) that received only the post-visit satisfaction, and the second half was randomized into the experimental group (n = 113) that received both the post-visit satisfaction survey and pre-visit expectation questionnaire. A one-way ANOVA analysis found no significant difference between the control and experimental groups (p = .952) and no statistically significant relationship for the within groups of actual length of stay and estimated (perceived) length of stay (p = .455). Due to the findings the control group and experimental group were pooled together for further analysis (n = 230). A Pearson correlation tested for the relationship between the study participants level of satisfaction with their provider and accuracy of perceived length of stay, calculated by subtracting the reported estimated length of stay from the actual length of stay (r = -.135, p = .043). As the level of satisfaction decreased with the provider the perception of length of stay was inversely effected. This implicated that the level of (open full item for complete abstract)

Committee: Jill Tall PhD (Advisor); Matthew Lindberg PhD (Committee Member); Kelly Colwell EdD (Committee Member) Subjects: Biology; Biomedical Research; Health Care; Medicine