Ashley Diane Tapia

Scopus Publications

Implementation of the Acute Care Clinic Easy Scheduling System at the Brooke Army Medical Center
Ashley D Tapia, Giselle Tapia, Bradley L Snyder, Natasha L Bebo, Eric J Chin, Steven G Schauer
Military Medicine, 2023
Introduction Emergency departments (EDs) have continued to struggle with overcrowding, causing delays in patient care and increasing stress on the medical staff and resources. This was further illustrated during the recent coronavirus disease 2019 pandemic, where we saw large unpredictable surges to the ED as hospitals tried to meet the medical needs of patients while trying to minimize the spread of coronavirus disease. A previous study from the Department of Emergency at the Brooke Army Medical Center (BAMC) found that nearly half of the patients presenting to the ED could have been managed in a primary care setting. We sought to pilot an alternate appointment scheduling system, Acute Care Clinic Easy Scheduling System, to allow patients to see and book available appointments while waiting in the ED waiting room. Materials and Methods Our appointment display system was created through collaboration with the BAMC Information Management Division. A Tableau data interface connects to the Composite Health Care System to view available primary appointments across the San Antonio Military Health Care System. These are displayed in real-time on multiple TV screens outside the ED and in the ED waiting room. Patients were provided signage that provides a way to call or use a World Wide Web–based interface to immediately schedule the open appointments within the next 48 hours. Patients voluntarily opted to use this system and may opt to leave the ED if another appointment became available within an acceptable time frame to them. Results This section is not applicable to this article. Conclusions Expansion of the Acute Care Clinic Easy Scheduling System within the Military Health Care System may (1) help reduce ED crowding, (2) improve access to care through a live-tracking system that patients can review and select from, and (3) reduce the number of unfilled primary care appointments. The system in place in the BAMC ED serves as a template for other MTFs to use.
A Retrospective Review of Emergency Department Visits That May Be Appropriate for Management in Non-Emergency Settings
Ashley D Tapia, Jeffrey T Howard, Natasha L Bebo, James A Pfaff, Eric J Chin, Wesley A Trueblood, Michael D April, Brit J Long, Adrianna N Long, William G Fernandez, Steven G Schauer
Military Medicine, 2022
Background Emergency departments (EDs) continue to struggle with overcrowding, increasing wait times, and a surge in patients with non-urgent conditions. Patients frequently choose the ED for non-emergent medical issues or injuries that could readily be handled in a primary care setting. We analyzed encounters in the ED at the Brooke Army Medical Center—the largest hospital in the Department of Defense—to determine the percentage of visits that could potentially be managed in a lower cost, appointment-based setting. Materials and Methods We conducted a retrospective chart review of patients within our electronic medical record system from September 2019 to August 2020, which represented equidistance from the start of the COVID-19 pandemic, resulting in a shift in ED used based on previously published data. Our study also compared the number of ED visits pre-covid vs. post-covid. We defined visits to be primary care eligible if they were discharged home and received no computed tomography imaging, ultrasound, magnetic resonance imaging, intravenous medications, or intramuscular-controlled substances. Results During the 12 month period, we queried data on 75,205 patient charts. We categorized 56.7% (n = 42,647) of visits as primary care eligible within our chart review. Most primary-care-eligible visits were ESI level 4 (59.2%). The largest proportion of primary-care-eligible patients (28.3%) was seen in our fast-track area followed by our pediatric pod (21.9%). The total number of ED visits decreased from 7,477 pre-covid to 5,057 post-covid visits. However, the proportion of patient visits that qualified as primary care eligible was generally consistent. Conclusions Over half of all ED visits in our dataset could be primary care eligible. Our findings suggest that our patient population may benefit from other on-demand and appointment-based healthcare delivery to decompress the ED.
A mixed methods end-user assessment to determine the ideal supraglottic airway device for inclusion into the medic's aid bag
Steven G. Schauer, Ashley D. Tapia, Ian L. Hudson, Erika A. Jeschke, Jessica Mendez, Mireya A. Escandon, Nguvan Uhaa, Michael D. April, Robert A. De Lorenzo
Journal of Trauma and Acute Care Surgery, 2022
What's the best airway for medics to carry in their aid bag? We sought to answer that question. Data converged around the i-gel and the BaskaMask. BACKGROUND Many advancements in supraglottic airway technology have occurred since the start of the Global War on Terrorism. While the Tactical Combat Casualty Care guidelines previously recommend the i-gel device, this is based on little data and minimal end-user input. OBJECTIVE We sought to use a mixed methods approach to investigate the properties of an ideal device for inclusion into the medic's aid bag. METHODS We performed prospective, serial qualitative studies to uncover and articulate themes relative to airway device usability with 68W-combat medics. 68W are trained roughly to the level of a civilian advanced emergency medical technician with a heavier focus on trauma care. Physicians with airway expertise demonstrated the use of each device and provided formal training on all the presented devices. We then administered performed focus groups to solicit end-user feedback along with survey data. RESULTS We enrolled 250 medics during the study. The preponderance of medics were of the rank E4 (28%) and E5 (44%). Only 35% reported ever placing a supraglottic airway in a real human. When reporting on usability, the i-gel had the highest median score, ease of manipulation, grip comfort and ease of insertion while also scoring the best in regard to requiring minimal training. The other compared devices had no clear highest score. Qualitative data saturated around a strong preference for the BaskaMask and/or the i-gel airway device, with the least favorite being the AirQ and the LMA Fastrach airway devises. There was a strong qualitative alignment in how both the BaskaMask and i-gel provided ease of use and simplicity of training. CONCLUSION There were strong qualitative preferences for two specific airway devices: Baska Mask and i-gel. However, many medics commented on their previous experience with the i-gel compared with the other devices, which may have biased them toward the i-gel. The overall data suggest that medics would prefer a device engineered with features from several devices. LEVEL OF EVIDENCE Therapeutic/care management; Level V.
STAT vs. CAT: A pilot comparison after a video demonstration
Brandon M. Carius, Ashley D. Tapia, Nguvan Uhaa, Sarah A. Johnson, Camaren M. Cuenca, Ryann S. Lauby, Steven G. Schauer
American Journal of Emergency Medicine, 2021