Sample records for city emergency department

  1. Experience of domestic violence by women attending an inner city accident and emergency department

    Sethi, D; Watts, S.; Zwi, A.; Watson, J; McCarthy, C.


    Objectives: To identify the prevalence of domestic violence (DV) (defined as physical abuse perpetrated by intimate partners) in women attending an inner city accident and emergency department and to elicit women's response about being asked routinely about domestic violence in this setting.

  2. Use of the emergency ambulance service to an inner city accident and emergency department--a comparison of general practitioner and '999' calls.

    Pennycook, A. G.; Makower, R M; Morrison, W G


    Over a 2-week period a prospective study was undertaken of patients brought to an inner city accident and emergency department by the emergency ambulance service. Criteria for assessing the appropriateness of use of the emergency ambulance service are not well defined and at worst entirely subjective. The author's finding that, of patients attending after a '999' call, 49.8% were discharged with no follow-up suggests that many of these journeys represented inappropriate use of the emergency a...

  3. A review of 7 years of complaints in an inner-city accident and emergency department.

    Hunt, M T; Glucksman, M E


    In 7 years between 1982-88, 122 complaints were lodged against the Accident and Emergency department of King's College Hospital. A high percentage mentioned more than one aspect per complaint. Commonest were those regarding attitude (37.7%), missed diagnosis (36.6%), waiting time (32.8%), cursory examination (14.7%) and poor communication (11.5%). These causes of complaint are amenable to improvement. Training in interpersonal skills may reduce complaints of attitude. A high index of suspicio...

  4. The cost of overseas visitors to an inner city accident and emergency department.

    Colville, J.; Burgess, A; Kermani, C; Touquet, R; Fothergill, J


    OBJECTIVE: To estimate, in a metropolitan accident and emergency (A&E) department, the annual cost of treating overseas visitors whose countries of origin do not have reciprocal arrangements with Britain. METHODS: The study was retrospective. A 24 h period (00.01 h to 24.00 h inclusive) on consecutive days in consecutive weeks (that is, Monday in week 1, Tuesday in week 2, etc) was costed over 52 weeks (1.8.92-31.7.93 inclusive) and extrapolated to 365 days. All visitors between those dates w...

  5. An analysis of telephone calls to an inner-city accident and emergency department.

    Crouch, R; Patel, A; Williams, S.; Dale, J


    The general public in the UK often telephone accident and emergency (A&E) departments for medical advice. Such calls are usually dealt with by nursing staff in an informal manner (often with no written record of the call being made). The specific questions addressed in this study are who was calling for advice, when did they call, what were their presenting complaints, and what was the outcome of the call? In addition, the study provided an opportunity to test the implementation of a new syst...

  6. The Emerging City

    Samson, Kristine

    ” – urban furniture that was originally part of an election campaign for the cultural minister of Denmark, will illustrate how both political and artistic signatures become deterritorialized through urban space, time and every day social use. The second example is taken from corporate city development at...... the urban milieu and how other meanings emerge. In the last example, Relocation of beer drinkers on Enghave Square, Copenhagen, I will highlight how a heterogeneous assemblages of architecture, urban design, artistic intervention and every day social life has constructed continuums of intensities over...... a period of time thus establishing an emergent urban space divergent from both the intentions of the planner, architect, artist and user. Through the examples, I suggest that each urban body or design deterritorialize connecting with the city. Broadening up the perspective, I ask whether...

  7. Emergency Department Visits for Homelessness or Inadequate Housing in New York City before and after Hurricane Sandy.

    Doran, Kelly M; McCormack, Ryan P; Johns, Eileen L; Carr, Brendan G; Smith, Silas W; Goldfrank, Lewis R; Lee, David C


    Hurricane Sandy struck New York City on October 29, 2012, causing not only a large amount of physical damage, but also straining people's health and disrupting health care services throughout the city. In prior research, we determined that emergency department (ED) visits from the most vulnerable hurricane evacuation flood zones in New York City increased after Hurricane Sandy for several medical diagnoses, but also for the diagnosis of homelessness. In the current study, we aimed to further explore this increase in ED visits for homelessness after Hurricane Sandy's landfall. We performed an observational before-and-after study using an all-payer claims database of ED visits in New York City to compare the demographic characteristics, insurance status, geographic distribution, and health conditions of ED patients with a primary or secondary ICD-9 diagnosis of homelessness or inadequate housing in the first week after Hurricane Sandy's landfall versus the baseline weekly average in 2012 prior to Hurricane Sandy. We found statistically significant increases in ED visits for diagnosis codes of homelessness or inadequate housing in the week after Hurricane Sandy's landfall. Those accessing the ED for homelessness or inadequate housing were more often elderly and insured by Medicare after versus before the hurricane. Secondary diagnoses among those with a primary ED diagnosis of homelessness or inadequate housing also differed after versus before Hurricane Sandy. These observed differences in the demographic, insurance, and co-existing diagnosis profiles of those with an ED diagnosis of homelessness or inadequate housing before and after Hurricane Sandy suggest that a new population cohort-potentially including those who had lost their homes as a result of storm damage-was accessing the ED for homelessness or other housing issues after the hurricane. Emergency departments may serve important public health and disaster response roles after a hurricane, particularly for

  8. Ambient air pollution and emergency department visits for asthma: a multi-city assessment of effect modification by age.

    Alhanti, Brooke A; Chang, Howard H; Winquist, Andrea; Mulholland, James A; Darrow, Lyndsey A; Sarnat, Stefanie Ebelt


    Previous studies have found strong associations between asthma morbidity and major ambient air pollutants. Relatively little research has been conducted to assess whether age is a factor conferring susceptibility to air pollution-related asthma morbidity. We investigated the short-term relationships between asthma emergency department (ED) visits and ambient ozone (O3), carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2), and fine particulate matter (PM2.5) in Atlanta (1993-2009), Dallas (2006-2009), and St. Louis (2001-2007). City-specific daily time-series analyses were conducted to estimate associations by age group (0-4, 5-18, 19-39, 40-64, and 65+ years). Sub-analyses were performed stratified by race and sex. City-specific rate ratios (RRs) were combined by inverse-variance weighting to provide an overall association for each strata. The overall RRs differed across age groups, with associations for all pollutants consistently strongest for children aged 5-18 years. The patterns of association across age groups remained generally consistent when models were stratified by sex and race, although the strong observed associations among 5-18 year olds appeared to be partially driven by non-white and male patients. Our findings suggest that age is a susceptibility factor for asthma exacerbations in response to air pollution, with school-age children having the highest susceptibility. PMID:26350981

  9. Correlates Intimate Partner Violence among Men and Women in an Inner City Emergency Department

    Walton, Maureen A.; Murray, Regan; Cunningham, Rebecca M.; Chermack, Steve T.; Barry, Kristen L.; Booth, Brenda M.; Ilgen, Mark A.; Wojnar, Marcin; Blow, Frederic C.


    The present study surveyed medical and/or injured patients (men and women) in an inner city ED to examine the rates and correlates of IPV, including substance use patterns. Over a two-year period, participants (n=10,744) self-administered a computerized health survey during their ED visit that included screening items regarding past year history of IPV (including victimization and aggression). Overall, rates of any involvement in past year IPV were 8.7% (7.3% victimization and 4.4% aggression); however, women were more likely than men to report IPV. When examining participants' substance use patterns, participants who reported using both alcohol and cocaine were most likely to report IPV. Predictors of partner aggression and victimization were remarkably similar. This paper provides unique data regarding correlates of past year IPV history among a comprehensive sample of male and female ED patients presenting for medical complaints and/or injury. PMID:20155606

  10. The Emergence of City Logistics

    Gammelgaard, Britta


    Purpose: – Many city logistics projects in Europe have failed. A better understanding of the complex organizational change processes in city logistics projects with many stakeholders may expand city logistics capabilities and thereby help prevent future failures. The purpose of this paper is...... therefore to increase understanding of how city logistics emerge, and secondarily, to investigate whether such processes can be managed at all. Design/methodology/approach: – A paradigm shift in urban planning creates new ways of involving stakeholders in new sustainability measures such as city logistics....... Organizational change theory is applied to capture the social processes leading to emergence of city logistics. The methodology is a qualitative processual analysis of a single longitudinal case. Findings: – The change process took different forms over time. At the time of concluding the analysis, positive...

  11. Alcohol and Drug Use among Patients Presenting to an Inner-city Emergency Department: A Latent Class Analysis

    Blow, Frederic C.; Walton, Maureen A.; Barry, Kristen L.; Murray, Regan L.; Cunningham, Rebecca M.; Massey, Lynn S.; Chermack, Stephen T.; Booth, Brenda M.


    The inner city Emergency Department (ED) provides a window of opportunity for screening for alcohol and other drug misuse and substance use disorders (SUDs), in order to facilitate linkage for individuals who are in need of services targeting such issues. The majority of prior work in this area has focused on alcohol use. This study used latent class analyses to characterize substance use/SUDs among adults presenting to the ED for medical complaints or injuries. Participants (n=14,557; 77% participation; 45% male; 54% African-American) completed a computerized survey assessing demographics, health functioning, and substance use/SUDs. Although injured patients were significantly more likely to use tobacco, alcohol, and marijuana, and were more likely to have an alcohol use disorder, presenting complaint was not related to other drug use/diagnoses. Five latent classes were identified: (1) non users/SUDs (65.9%) (2) binge drinkers (24.3%), (3) marijuana users/SUD (3.5%), (4) cocaine users/SUD (2.9%), and (5) poly-drug users (3.3%). Compared to class 1, participants in the other classes were younger, male, without health insurance, with poor mental health functioning, tobacco users, and had prior substance use treatment. African-Americans were most likely to be in classes 3 or 4 and employed participants were most likely to be in class 2. In comparison to class 1, classes 2 and 3 reported better physical health; class 2 was more likely to present for injury whereas class 5 was more likely to present for a medical complaint. ED-based screening and interventions approaches need to address the co-occurrence of alcohol, illicit drug, and psychoactive prescription drug use. PMID:21514734

  12. [Emergency departments - 2016 update].

    Zimmermann, M; Brokmann, J C; Gräff, I; Kumle, B; Wilke, P; Gries, A


    Acute medical care in hospital emergency departments has experienced rapid development in recent years and gained increasing importance not only from a professional medical point of view but also from an economic and health policy perspective. The present article therefore provides an update on the situation of emergency departments in Germany. Care in emergency departments is provided with an increasing tendency to patients of all ages presenting with varying primary symptoms, complaints, illnesses and injury patterns. In the process, patients reach the emergency department by various routes and structural provision. Cross-sectional communication and cooperation, prioritization and organization of emergency management and especially medical staff qualifications increasingly play a decisive role in this process. The range of necessary knowledge and skills far exceeds the scope of prehospital medical emergency care and the working environment differs substantially. In addition to existing structural and economic problems, the latest developments, as well as future proposals for the design of in-hospital emergency medical care in interdisciplinary emergency departments are described. PMID:26952123

  13. Monitoring the impact of influenza by age: emergency department fever and respiratory complaint surveillance in New York City.

    Donald R Olson


    Full Text Available BACKGROUND: The importance of understanding age when estimating the impact of influenza on hospitalizations and deaths has been well described, yet existing surveillance systems have not made adequate use of age-specific data. Monitoring influenza-related morbidity using electronic health data may provide timely and detailed insight into the age-specific course, impact and epidemiology of seasonal drift and reassortment epidemic viruses. The purpose of this study was to evaluate the use of emergency department (ED chief complaint data for measuring influenza-attributable morbidity by age and by predominant circulating virus. METHODS AND FINDINGS: We analyzed electronically reported ED fever and respiratory chief complaint and viral surveillance data in New York City (NYC during the 2001-2002 through 2005-2006 influenza seasons, and inferred dominant circulating viruses from national surveillance reports. We estimated influenza-attributable impact as observed visits in excess of a model-predicted baseline during influenza periods, and epidemic timing by threshold and cross correlation. We found excess fever and respiratory ED visits occurred predominantly among school-aged children (8.5 excess ED visits per 1,000 children aged 5-17 y with little or no impact on adults during the early-2002 B/Victoria-lineage epidemic; increased fever and respiratory ED visits among children younger than 5 y during respiratory syncytial virus-predominant periods preceding epidemic influenza; and excess ED visits across all ages during the 2003-2004 (9.2 excess visits per 1,000 population and 2004-2005 (5.2 excess visits per 1,000 population A/H3N2 Fujian-lineage epidemics, with the relative impact shifted within and between seasons from younger to older ages. During each influenza epidemic period in the study, ED visits were increased among school-aged children, and each epidemic peaked among school-aged children before other impacted age groups. CONCLUSIONS

  14. Air pollution and emergency department visits for cardiac and respiratory conditions: a multi-city time-series analysis

    Rowe Brian H


    Full Text Available Abstract Background Relatively few studies have been conducted of the association between air pollution and emergency department (ED visits, and most of these have been based on a small number of visits, for a limited number of health conditions and pollutants, and only daily measures of exposure and response. Methods A time-series analysis was conducted on nearly 400,000 ED visits to 14 hospitals in seven Canadian cities during the 1990s and early 2000s. Associations were examined between carbon monoxide (CO, nitrogen dioxide (NO2, ozone (O3, sulfur dioxide (SO2, and particulate matter (PM10 and PM2.5, and visits for angina/myocardial infarction, heart failure, dysrhythmia/conduction disturbance, asthma, chronic obstructive pulmonary disease (COPD, and respiratory infections. Daily and 3-hourly visit counts were modeled as quasi-Poisson and analyses controlled for effects of temporal cycles, weather, day of week and holidays. Results 24-hour average concentrations of CO and NO2 lag 0 days exhibited the most consistent associations with cardiac conditions (2.1% (95% CI, 0.0–4.2% and 2.6% (95% CI, 0.2–5.0% increase in visits for myocardial infarction/angina per 0.7 ppm CO and 18.4 ppb NO2 respectively; 3.8% (95% CI, 0.7–6.9% and 4.7% (95% CI, 1.2–8.4% increase in visits for heart failure. Ozone (lag 2 days was most consistently associated with respiratory visits (3.2% (95% CI, 0.3–6.2%, and 3.7% (95% CI, -0.5–7.9% increases in asthma and COPD visits respectively per 18.4 ppb. Associations tended to be of greater magnitude during the warm season (April – September. In particular, the associations of PM10 and PM2.5with asthma visits were respectively nearly three- and over fourfold larger vs. all year analyses (14.4% increase in visits, 95% CI, 0.2–30.7, per 20.6 μg/m3 PM10 and 7.6% increase in visits, 95% CI, 5.1–10.1, per 8.2 μg/m3 PM2.5. No consistent associations were observed between three hour average pollutant

  15. Fire Department Emergency Response

    In 1995 the SRS Fire Department published the initial Operations Basis Document (OBD). This document was one of the first of its kind in the DOE complex and was widely distributed and reviewed. This plan described a multi-mission Fire Department which provided fire, emergency medical, hazardous material spill, and technical rescue services

  16. Prevalence of Exposure to Risk Factors for Violence among Young Adults Seen in an Inner-City Emergency Department

    Abigail Hankin


    Full Text Available Introduction: To assess the prevalence of risk factors for violent injury among young adults treated at an urban emergency department (ED.Methods: This study is a cross-sectional analysis of data collected as part of a longitudinal study. Enrollment took place in an urban ED in a Level 1 trauma center, June through December 2010. All patients aged 18–24 years were eligible. Patients were excluded if they were incarcerated, critically ill, or unable to read English. Study participants completed a 10-minute multiple-choice questionnaire using previously validated scales: a aggression, b perceived likelihood of violence, c recent violent behavior, d peer behavior, and e community exposure to violence.Results: 403 eligible patients were approached, of whom 365 (90.1% consented to participate. Average age was 21.1 (95% confidence interval: 20.9, 21.3 years, and participants were 57.2% female, 85.7% African American, and 82.2% were educated at the high school level or beyond. Among study participants, rates of high-risk exposure to individual risk factors ranged from 7.4% (recent violent behavior to 24.5% (exposure to community violence, with 32.3% of patients showing high exposure to at least one risk factor. When comparing participants by ethnicity, no significant differences were found between White, African-American, and Hispanic participants. Males and females differed significantly only on 1 of the scales – community violence, (20.4% of males vs. 30.3% of females, p¼0.03. Selfreported hostile/aggressive feelings were independently associated with initial presentation for injury associated complaint after controlling for age, sex, and race (odds ratio 3.48 (1.49-8.13.Conclusion: Over 30% of young adults presenting to an urban ED reported high exposure to risk factors for violent injury. The high prevalence of these risk factors among ED patients highlights the potential benefit of a survey instrument to identify youth who might benefit from

  17. Emergency teams in Danish emergency departments

    Lafrenz, Thomas; Lindberg, Søren Østergaard; La Cour, Jeppe Lerche;


    The use of designated emergency teams for cardiac arrest and trauma patients is widely implemented. However, the use of designated teams in Danish emergency departments (EDs) has not been investigated. Our aim was to investigate the use and staffing of emergency teams in Danish EDs....

  18. Impact of the ABCDE triage in primary care emergency department on the number of patient visits to different parts of the health care system in Espoo City

    Kantonen Jarmo


    Full Text Available Abstract Background Many Finnish emergency departments (ED serve both primary and secondary health care patients and are therefore referred to as combined emergency departments. Primary care doctors are responsible for the initial assessment and treatment. They, thereby, also regulate referral and access to secondary care. Primary health care EDs are easy for the public to access, leading to non-acute patient visits to the emergency department. This has caused increased queues and unnecessary difficulties in providing immediate treatment for urgent patients. The primary aim of this study was to assess whether the flow of patients was changed by implementing the ABCDE-triage system in the EDs of Espoo City, Finland. Methods The numbers of monthly visits to doctors were recorded before and after intervention in Espoo primary care EDs. To study if the implementation of the triage system redirects patients to other health services, the numbers of monthly visits to doctors were also scored in the private health care, the public sector health services of Espoo primary care during office hours and local secondary health care ED (Jorvi hospital. A face-to-face triage system was applied in the primary care EDs as an attempt to provide immediate treatment for the most acute patients. It is based on the letters A (patient sent directly to secondary care, B (to be examined within 10 min, C (to be examined within 1 h, D (to be examined within 2 h and E (no need for immediate treatment for assessing the urgency of patients' treatment needs. The first step was an initial patient assessment by a health care professional (triage nurse. The introduction of this triage system was combined with information to the public on the "correct" use of emergency services. Results After implementation of the ABCDE-triage system the number of patient visits to a primary care doctor decreased by up to 24% (962 visits/month as compared to the three previous years in the EDs

  19. Smart City Governance: A Local Emergent Perspective

    Meijer, Albert


    This chapter presents a local emergent perspective on smart city governance. Smart city governance is about using new technologies to develop innovative governance arrangements. Cities all around the world are struggling to find smart solutions to wicked problems and they hope to learn from successf

  20. Google flu trends: correlation with emergency department influenza rates and crowding metrics

    Trish Perl; Richard Rothman; Darren Mareiniss; Amir Mohareb; Yu-Hsiang Hsieh; Scott Levin; Jesse Pines; Andrea Dugas; Charlotte Gaydos


    City-level Google Flu Trends, a novel Internet-based influenza surveillance tool, shows strong correlation with influenza cases, emergency department influenzalike illness visits, and several emergency department crowding measures, validating its use as an emergency department surveillance tool.

  1. Health information exchange, biosurveillance efforts, and emergency department crowding during the spring 2009 H1N1 outbreak in New York City.

    Shapiro, Jason S; Genes, Nicholas; Kuperman, Gilad; Chason, Kevin; Richardson, Lynne D


    Novel H1N1 influenza spread rapidly around the world in spring 2009. Few places were as widely affected as the New York metropolitan area. Emergency departments (EDs) in the region experienced daily visit increases in 2 distinct temporal peaks, with means of 36.8% and 60.7% over baseline in April and May, respectively, and became, in a sense, the "canary in the coal mine" for the rest of the country as we braced ourselves for resurgent spread in the fall. Biosurveillance efforts by public health agencies can lead to earlier detection, potentially forestalling spread of outbreaks and leading to better situational awareness by frontline medical staff and public health workers as they respond to a crisis, but biosurveillance has traditionally relied on manual reporting by hospital administrators when they are least able: in the midst of a public health crisis. This article explores the use of health information exchange networks, which enable the secure flow of clinical data among otherwise unaffiliated providers across entire regions for the purposes of clinical care, as a tool for automated biosurveillance reporting. Additionally, this article uses a health information exchange to assess H1N1's effect on ED visit rates and discusses preparedness recommendations and lessons learned from the spring 2009 H1N1 experience across 11 geographically distinct EDs in New York City that participate in the health information exchange. PMID:20079955

  2. Hypernatremia in the Emergency Department

    Neslihan YÜCE; ŞAHİN, İdris; Feride Sinem AKGÜN; Süleyman KÖZ; Berber, İlhami; Muzaffer Galip ÖZDEMİR


    INTRODUCTION: To determine the symptoms, clinical characteristics, prevalence and outcome of patients with hypernatremia who presented at the emergency department. MATERIAL and METHODS: We retrospectively studied patients who presented at the emergency department with hypernatremia (Na>148 meq/l) from January 2008 to December 2008. RESULTS: A total of 25.545 cases presented at the Emergency Department and hypernatremia was seen in 86 patients. The prevalence of hypernatremia was 0.34%....

  3. The Emergence of City Logistics

    Gammelgaard, Britta; Aastrup, Jesper


    as a change process where the city is working to change paradigm from a conventional top down regulation to a sustainable mobility paradigm. This long lasting and complex process towards improved organization of goods deliveries in the Copenhagen city center can further be understood as a teleological process...

  4. Hypoglycemia in Emergency Department

    Yu-Jang Su; Chia-Jung Liao


    Objective:To study the epidemiology, etiologies and prognostic factors of hypoglycemia. Methods:A retrospective chart review of hypoglycemic cases from December, 2009 to February, 2012 was conducted to gather the following patient data: age, gender, vital signs at triage, white blood cell count, serum glucose, C-reactive protein, glutamic oxaloacetic transaminase, creatinine, sodium, potassium, past history of liver cirrhosis, uremia, concomitant infection, concomitant cancer/malignancy, length of stay, lack of recent meal, status of acute renal failure and concomitant stroke. A total of 186 cases were enrolled in our study. We analyzed the data using commercial statistics software (SPSS for Windows, version 11.0, SPSS Inc., Chicago, IL). We used the Student's t-test andχ2 test for the statistical analyses, and significance was set at a P value less than 0.05. Results: Hypoglycemia is related to several co-morbidities. In total, 10.2%of the patients had liver cirrhosis and 7.0% had uremia. More than half (55.4%) were bacterial infection during hospitalization. Acute renal failure accounted for 26.3%of the hypoglycemic episodes. In addition to the etiology of infection, the lack of a recent meal accounted for 44.6%hypoglycemic episodes. A total of 2.2%of the cases resulted from an acute cerebrovascular accident. Approximately 8.6%were concomitant with malignancy. Conclusions: When hypoglycemic patients present in the emergency department, physicians should pay attention to the presence of infection, malignancy, liver diseases (liver cirrhosis and biliary tract infection), and acute renal failure.

  5. Emergency Department Management of Trauma

    MacKenzie, Colin; Lippert, Freddy


    Initial assessment and management of severely injured patients may occur in a specialized area of an emergency department or in a specialized area of a trauma center. The time from injury until definitive management is of essence for survival of life-threatening trauma. The initial care delivered...... injured patients after these patients reach a hospital emergency department or a trauma center....

  6. The Emergence of a Modern City

    Steiner, Henriette

    , literature, and visual culture - to do so. The book argues that Copenhagen emerged as a modern city at this time, despite the fact that the Golden Age never witnessed the appearance of the main characteristics of the modernisation of cities associated with industrialisation, such as street lighting, sewer...... when the city began to take on characteristics of ambiguity and alienation in European thinking, while at the same time the city itself retained some pre-modern motifs of a symbolic order. This transformation is set in a larger process of cultural re-orientation, from traditional Baroque culture to...... what might be termed Romantic culture. The book reconsiders the significance of this transformation for the emergent order of the modern European city in the nineteenth century and thus of the very foundation on which our own urban culture rests....

  7. Emergency department radiation accident protocol.

    Leonard, R B; Ricks, R C


    Every emergency department faces the potential problem of handling one or more victims of a radiation accident. While emergency departments near nuclear power plants or isotope production laboratories probably have a detailed protocol for such emergencies, a similar protocol is needed for the emergency department that may have to handle an isolated event, such as a vehicular accident that spills radioactive material and contaminates passengers or bystanders. This communication attempts to answer that need, presenting a step-by-step protocol for decontamination of a radiation victim, the rationale on which each step is based, a list of needed supplies, and a short summary of decorporation procedures that should be started in the emergency department. PMID:7425419


    Magomed-Ganipa Gamidovich MAGOMEDOV


    Full Text Available The paper considered Izberbash city in the course of foundation from scratch, after the (Great Patriotic War. The author has shown the course of building the industrial enterprises, the residential area and the infrastructure of the city in a whole, under the leadership of public authorities. The fact that oil had been struck in this area had contributed to establishment of the city, and it gave a stimulus to advancement of oil industry. At the first stage, the Russianspeaking inhabitants rendered substantial assistance to construction of the city, as well as arrival of newcomers to the republic from various regions of the USSR. The paper also mentioned the part taken by the public authorities in coping with economic and social challenges in the city Izberbash. The paper examined shortcomings and errors made in solving various issues of the emerging city

  9. The associations between daily spring pollen counts, over-the-counter allergy medication sales, and asthma syndrome emergency department visits in New York City, 2002-2012

    Ito, Kazuhiko; Weinberger, Kate R.; Guy S. Robinson; Sheffield, Perry E.; Lall, Ramona; Mathes, Robert; Ross, Zev; Kinney, Patrick L.; Thomas D Matte


    Background Many types of tree pollen trigger seasonal allergic illness, but their population-level impacts on allergy and asthma morbidity are not well established, likely due to the paucity of long records of daily pollen data that allow analysis of multi-day effects. Our objective in this study was therefore to determine the impacts of individual spring tree pollen types on over-the-counter allergy medication sales and asthma emergency department (ED) visits. Methods Nine clinically-relevan...

  10. Emergency department overcrowding: the Emergency Department Cardiac Analogy Model (EDCAM).

    Richardson, Sandra K; Ardagh, Michael; Gee, Paul


    Increasing patient numbers, changing demographics and altered patient expectations have all contributed to the current problem with 'overcrowding' in emergency departments (EDs). The problem has reached crisis level in a number of countries, with significant implications for patient safety, quality of care, staff 'burnout' and patient and staff satisfaction. There is no single, clear definition of the cause of overcrowding, nor a simple means of addressing the problem. For some hospitals, the option of ambulance diversion has become a necessity, as overcrowded waiting rooms and 'bed-block' force emergency staff to turn patients away. But what are the options when ambulance diversion is not possible? Christchurch Hospital, New Zealand is a tertiary level facility with an emergency department that sees on average 65,000 patients per year. There are no other EDs to whom patients can be diverted, and so despite admission rates from the ED of up to 48%, other options need to be examined. In order to develop a series of unified responses, which acknowledge the multifactorial nature of the problem, the Emergency Department Cardiac Analogy model of ED flow, was developed. This model highlights the need to intervene at each of three key points, in order to address the issue of overcrowding and its associated problems. PMID:15649683

  11. Hypernatremia in the Emergency Department

    Neslihan YÜCE


    Full Text Available INTRODUCTION: To determine the symptoms, clinical characteristics, prevalence and outcome of patients with hypernatremia who presented at the emergency department. MATERIAL and METHODS: We retrospectively studied patients who presented at the emergency department with hypernatremia (Na>148 meq/l from January 2008 to December 2008. RESULTS: A total of 25.545 cases presented at the Emergency Department and hypernatremia was seen in 86 patients. The prevalence of hypernatremia was 0.34%. The mean age was 69.5±15.2 (20- 96, median age: 75 years and 51 of them (59% were male. Forty percent of the patients died. There were no significant differences according to age, gender and admission Na levels. A comorbid disease were seen 99% of patients. Cerebrovascular disease(CVD, dementia/Alzheimer and hypertension were the most common co-morbid diseases (respectively, 34%, 34%,and 27%. Central neurological system disorders (such as thrombotic or hemorrhagic CVD, Alzheimer, etc. were seen in 72% of the cases. Fifty patients had acute infection at the time of admission. Acute urinary infection, pneumonia and acute CVD were the most common acute illnesses. CONCLUSION: Hypernatremia is usually seen in the geriatric population and associated with a high mortality and morbidity rate and the majority of patients with hypernatremia have a comorbid disease. The prevalence of hypernatremia was 0.34% in our emergency department.

  12. Forecasting the Emergency Department Patients Flow.

    Afilal, Mohamed; Yalaoui, Farouk; Dugardin, Frédéric; Amodeo, Lionel; Laplanche, David; Blua, Philippe


    Emergency department (ED) have become the patient's main point of entrance in modern hospitals causing it frequent overcrowding, thus hospital managers are increasingly paying attention to the ED in order to provide better quality service for patients. One of the key elements for a good management strategy is demand forecasting. In this case, forecasting patients flow, which will help decision makers to optimize human (doctors, nurses…) and material(beds, boxs…) resources allocation. The main interest of this research is forecasting daily attendance at an emergency department. The study was conducted on the Emergency Department of Troyes city hospital center, France, in which we propose a new practical ED patients classification that consolidate the CCMU and GEMSA categories into one category and innovative time-series based models to forecast long and short term daily attendance. The models we developed for this case study shows very good performances (up to 91,24 % for the annual Total flow forecast) and robustness to epidemic periods. PMID:27272135

  13. Electronic Emergency-Department Whiteboards

    Hertzum, Morten


    respondents consider the whiteboard information important to their overview, and they approve of the introduction of electronic whiteboards. With the electronic whiteboards, the ED respondents experience a better overall overview of their work than with dry-erase whiteboards. They also experience......Purpose. Many emergency departments (EDs) are in a process of transitioning from dry-erase to electronic whiteboards. This study investigates differences in ED clinicians’ perception and assessment of their electronic whiteboards across departments and staff groups and at two points in time. Method....... We conducted a survey consisting of a questionnaire administered when electronic whiteboards were introduced and another questionnaire administered when they had been in use for 8-9 months. The survey involved two EDs and, for reasons of comparison, a paediatric department. Results. The ED...

  14. Advertising emergency department wait times.

    Weiner, Scott G


    Advertising emergency department (ED) wait times has become a common practice in the United States. Proponents of this practice state that it is a powerful marketing strategy that can help steer patients to the ED. Opponents worry about the risk to the public health that arises from a patient with an emergent condition self-triaging to a further hospital, problems with inaccuracy and lack of standard definition of the reported time, and directing lower acuity patients to the higher cost ED setting instead to primary care. Three sample cases demonstrating the pitfalls of advertising ED wait times are discussed. Given the lack of rigorous evidence supporting the practice and potential adverse effects to the public health, caution about its use is advised. PMID:23599836

  15. Design Methods in the Emergent City

    Samson, Kristine

    is understood in a broad sense, not as architectural design but as spatial design and artistic interventions in public space. Through the paper I will address how the designer can co-create and reassemble existing urban spaces through design acts. The approach suggests a situated design methodology...... but is based on a theoretical understanding. It is my belief that the designer, by looking into the emergent properties of urban spaces, instead of its physical and cartographical outlines, can see her work as a processual intervention in the city rather than durable object design....

  16. Evaluation of emergency department performance

    Sørup, Christian Michel; Jacobsen, Peter; Forberg, Jakob Lundager


    Background Evaluation of emergency department (ED) performance remains a difficult task due to the lack of consensus on performance measures that reflects high quality, efficiency, and sustainability. Aim To describe, map, and critically evaluate which performance measures that the published...... number of articles addresses this study’s objective (n = 14 of 46 unique hits). Time intervals and patient-related measures were dominant in the identified performance measures in review articles from US, UK, Sweden and Canada. Length of stay (LOS), time between patient arrival to initial clinical...

  17. Cost analysis of emergency department.

    Cremonesi, P; Di Bella, E; Montefiori, M


    This paper is intended to examine both clinical and economic data concerning the activity of an emergency department of an Italian primary Hospital. Real data referring to arrivals, waiting times, service times, severity (according to triage classification) of patients' condition collected along the whole 2009 are matched up with the relevant accounting and economic information concerning the costs faced. A new methodological approach is implemented in order to identify a "standard production cost" and its variability. We believe that this kind of analysis well fits the federalizing process that Italy is experiencing. In fact the federal reform is driving our Country toward a decentralized provision and funding of local public services. The health care services are "fundamental" under the provisions of the law that in turn implies that a standard cost has to be defined for its funding. The standard cost (as it is defined by the law) relies on the concepts of appropriateness and efficiency in the production of the health care service, assuming a standard quality level as target. The identification and measurement of health care costs is therefore a crucial task propaedeutic to health services economic evaluation. Various guidelines with different amount of details have been set up for costing methods which, however, are defined in simplified frameworks and using fictious data. This study is a first attempt to proceed in the direction of a precise definition of the costs inherent to the emergency department activity. PMID:21553561

  18. Emergency Contraception: a survey of Hospital Emergency Departments Staffs

    Marco Bo; Ivo Casagranda; Mario Galzerano; Lorena Charrier; Maria Michela Gianino


    The World Health Organization defines emergency contraception (EC) as a means to prevent unwanted pregnancy. In countries where EC is dispensed behind the counter, emergency departments are a preferred point of care for its prescription and dispensing. In light of this situation and as no studies on emergency contraception in emergency departments in Italy have been conducted to date, this study was designed with a view to analyze the responses of emergency room physicians in relation to thei...

  19. Spontaneous Orders and the Emergence of Economically Powerful Cities

    Palmberg, Johanna


    The importance of cities to economic dynamism and growth cannot be emphasized enough. It is crucial for our understanding of what drives economic growth to understand how cities emerge, develop and prosper. This paper investigates the emergence of cities from a spontaneous order and urban economics perspective. The analysis focus on agglomeration effects, externalities and regional clustering as explanations of cities and regional growth. Factors such as local knowledge and dispersion of know...

  20. Study of patients of road traffic accidents a rriving in emergency department [ED] of V.S hospital at Ahmedabad city, single centre pilot study.

    Aharnish Shah


    Full Text Available Objectives of the study According to the latest world status report on road safety released by WHO, we are now the world leaders in road traffic accident rate & related mortality. Our study intends to find out the epidemiological factors, risk factors, use of safety measures, compliance with traffic laws, presenting injuries & ED intervention required, in patients with road traffic accidents. Materials & methods Our study is a cross sectional observational study in which data was obtained from 150 patients of road traffic accidents arriving at any time to emergency department. Collected data included information about basic details, basic crash characteristics, risk factors, use of safety measures, injuries sustained, ED intervention required & disposition. Results Approximately 77% of the patients belong to 11-50 yr age group. The most common time of RTA is between 6 am to 12 noon [36.67%]. However accidents requiring admission were more during night time [62.74%]. Innocent passengers & pedestrians contributed to 41% of the accident cases. Non compliance with traffic laws & safety measures like driving without license [20%], using mobile phones while driving [10%], not using headlights at night [26%], not using seatbelts [80%], not using helmets [91%], etc were found in a substantial number of cases. Intracranial bleed & skull fractures were significantly (31.2% v/s 0% more in drivers without helmets than those with helmets. ED intervention required in decreasing order were dressing ( 38%, laceration repair (27.33%, splinting (24%, crash intubation (10%, ICD (2.66%. Conclusion: Well equipped secondary & tertiary level trauma centres, specially dedicated to management of trauma patients, with a proper triage plan, are necessary for proper management of trauma patients & better utilisation of resources. Our study shows that an ER physician should be trained in l aceration repair, dressing, splint/slab application, fracture/dislocation reduction

  1. Managing hypopituitarism in emergency departments.

    Welsh, Jeanette


    Healthcare professionals manage patients with a vast range of conditions, but often specialise and acquire expertise in specific disease processes. Emergency and pre-hospital clinicians care for patients with various conditions for short periods of time, so have less opportunity to become familiar with more unusual conditions, yet it is vital that they have some knowledge and understanding of these. Patients with rare conditions can present at emergency departments with common complaints, but the effect of their original diagnosis on the presenting complaint may be overlooked or underestimated. This article uses a case study to describe the experience of one patient who presented with vomiting, but who also had hypopituitarism and therefore required specific management she did not at first receive. The article describes hypopituitarism and the initial management of patients with this condition who become unwell, and discusses how the trust responded to the patient's complaint to improve patient safety and care. It has been written with the full participation and consent of the patient and her husband. PMID:26451942

  2. Knowledge of anaphylaxis among Emergency Department staff

    Ibrahim, Irwani; Chew, Bao Li; Zaw, Wai Wai; Van Bever, Hugo P


    Background Anaphylaxis is an emergency condition that requires immediate, accurate diagnosis and appropriate management. However, little is known about the level of knowledge of doctors and nurses treating these patients in the Emergency Department. Objective To determine the knowledge of doctors and nurses in the Emergency Department on the recent definition and treatment recommendations of anaphylaxis. Methods We surveyed doctors and nurses of all grades in a tertiary Hospital Emergency Dep...

  3. Child maltreatment, parents & the emergency department

    Hoytema van Konijnenburg, E.M.M.


    The research described in this thesis focuses on the evaluation of several methods of screening for child maltreatment at the emergency department, with an emphasis on screening based on parental risk factors (‘child check’). The use of a screening checklist (mandatory in all Dutch emergency departments), a complete physical examination and the child check are discussed. Furthermore, the wellbeing of a family is assessed when a parent visits the emergency department due to intimate partner vi...

  4. Asthma Medication Ratio Predicts Emergency Depart...

    U.S. Department of Health & Human Services — According to findings reported in Asthma Medication Ratio Predicts Emergency Department Visits and Hospitalizations in Children with Asthma, published in Volume 3,...

  5. Teamwork improvement in emergency trauma departments

    Khademian, Zahra; Sharif, Farkhondeh; Tabei, Seyed Ziaadin; Bolandparvaz, Shahram; Abbaszadeh, Abbas; Abbasi, Hamid Reza


    Background: Interprofessional teamwork is considered as the key to improve the quality of patient management in critical settings such as trauma emergency departments, but it is not fully conceptualized in these areas to guide practice. The aim of this article is to explore interprofessional teamwork and its improvement strategies in trauma emergency departments. Materials and Methods: Participants of this qualitative study consisted of 11 nurses and 6 supervisors recruited from the emergency...

  6. Adherence to the guideline 'Triage in emergency departments': a survey of Dutch emergency departments

    Janssen, M.J.; Achterberg, T. van; Adriaansen, M.J.M.; Kampshoff, C.S.; Mintjes-de Groot, J.


    AIMS AND OBJECTIVES: The aim of this study was to evaluate the adherence to the 2004 guideline Triage in emergency departments three years after dissemination in Dutch emergency departments. BACKGROUND: In 2004, a Dutch guideline Triage in emergency departments was developed. Triage is the first ste

  7. Child maltreatment, parents & the emergency department

    E.M.M. Hoytema van Konijnenburg


    The research described in this thesis focuses on the evaluation of several methods of screening for child maltreatment at the emergency department, with an emphasis on screening based on parental risk factors (‘child check’). The use of a screening checklist (mandatory in all Dutch emergency departm

  8. Recognizing Infective Endocarditis in the Emergency Department

    Tsagaratos, Costandinos; Taha, Farook W


    A 52-year-old Caucasian male presented to the emergency department complaining of nontraumatic painful swelling and redness of the distal left fourth finger for 2 days, associated with malaise and subjective fever. The patient denied medical history, drugs, tobacco, or alcohol use. [West J Emerg Med. 2012;13(1):92–93.

  9. City emergency medical services system issues

    Persse, David E.; Bradley, Richard N.


    The City of Houston is continuously improving its preparedness for disasters and terrorism. This preparation requires strong and clear leadership. This includes a designated individual to lead the region"s preparation in the health and medical arena. An effective leader requires an effective command and control center. Real-time information on the situation is imperative.

  10. Cricothyrotomy in the emergency department.

    McGill, J; Clinton, J E; Ruiz, E


    Thirty-eight emergency cricothyrotomies were performed over a 3-year period. This was the first airway control maneuver attempted in 5 patients, 3 of whom had facial and/or neck injury, one apneic with upper airway hemorrhage, and one with aortobronchial fistula. The remaining 33 procedures were performed only after other airway management failed. Five indications were identified among these cases: 1) excessive emesis or hemorrhage (11), 2) possible cervical spine injury with airway compromise (9), 3) technical failure (7), 4) clenched teeth (5), and 5) masseter spasm following succinylcholine administration (1). Fourteen immediate complications occurred in 12 patients (32%). The most frequent was incorrect site of tracheostomy tube placement (5), with 4 of 5 misplaced through the thyrohyoid membrane. Others included execution time greater than 3 minutes (4), unsuccessful tracheostomy tube placement (3), and significant hemorrhage (2). Twelve of the 38 patients were long-term survivors. There was one long-term complication, a longitudinal fracture of the thyroid cartilage during forceful placement of an oversized tube (8 mm inner diameter) through the cricothyroid membrane. This required operative repair and left the patient with severe dysphonia. PMID:7091796

  11. Clinical Overview and Emergency-Department Whiteboards

    Hertzum, Morten; Simonsen, Jesper


    In Denmark emergency departments are newly established and still in a process of devising their procedures and technology support. Electronic whiteboards are a means of supporting clinicians in creating and maintaining the overview necessary to provide quality treatment of patients. The concrete...... meaning of the notion of overview is, however, fussy. To explore the notion of overview and how it might be affected by whiteboards, we conducted a survey at two emergency departments and, for reasons of comparison, a pediatric department. Our results indicate that respondents consider the information on...... their dry-erase whiteboards important to their overview and that they are positive toward the introduction of electronic whiteboards. At the emergency departments, the phy-sicians’ and nurses’ overall perception of their overview correlates with different subcomponents of overview, suggesting...

  12. Evaluation of Performance Indexes of Emergency Department

    Alireza Baratloo


    Full Text Available Introduction: The importance of evaluating performance indicators in the emergency department, as one of the most important departments of hospital, is obvious to everyone. Therefore, in this study we aimed to appraise the five performance indicators, approved by the ministry of health, in Shohadaye Tajrish hospital, Tehran, Iran. Methods: In a descriptive cross-sectional study based on the profiles of all the patients admitted to the emergency department, performance indicators in the emergency department were evaluated. The study was divided into 2 parts about the establishment of emergency medicine system and training the medical staff: the first 6 months of 1392 and the second. Then these 2 periods were compared using Mann-Whitney U test while P< 0.05 was considered as the level of significance. Results: Of the studied indicators, mean triage time was 6.04 minutes in the first 6 months which was reduced to 1.5 minutes in the second 6 months (p=0.016. In addition, the percentage of patients who moved out of the department in 12 hours was lowered from 97.3% in the first period to 90.4% in the second (p=0.004. While, the percentage of patients who were decided upon in 6 hours (p=0.2, unsuccessful CPR percentage (p=0.34 and patients discharged against medical advice (p=0.42 showed no significant difference. Conclusion: The results of this study showed that the establishment of the emergency medicine system in the emergency department could lead to more efficient triage. Due to the differences made after their establishment including: different pattern of the patients admitted, increased stay of the patients in the department due to their need for prolonged intensive care, a raise in patient referral to the hospital by pre-hospital services and a higher percentage of occupied hospital beds, other indicators have not shown a significant improvement.

  13. Prediction of bacteremia in the emergency department

    Pedersen, Marie Kristine Jessen; Mackenhauer, Julie; Hvass, Anne Mette Sondrup Wulff;


    Objective The objective of this study was to validate a previously published clinical decision rule for predicting a positive blood culture in emergency department (ED) patients with suspected infection on the basis of major and minor criteria and a total score (Shapiro et al., J Emerg Med, 2008...... bacteremia’. Data on clinical history, comorbid illnesses, physical observations, and laboratory tests were used to evaluate the application of the clinical decision rule. We report the sensitivity, specificity, and area under the curve. Results Among 1526 patients, 105 (6.9%) patients were classified with...... and is likely to be a useful supplement to clinical judgment....

  14. Strategies for managing a busy emergency department.

    Campbell, Samuel G; Sinclair, Douglas E


    In a time of increased patient loads and emergency department (ED) exit block, the need for strategies to manage patient flow in the ED has become increasingly important. In March 2002 we contacted all 1282 members of the Canadian Association of Emergency Physicians and asked them to delineate strategies for enhancing ED patient flow and ED productivity without increasing stress levels, reducing care standards or compromising patient safety. Thirty physicians responded. Their suggested flow management strategies, which ranged from clinical decision-making to communication to choreography of time, space and personnel, are summarized here. PMID:17382005

  15. HCUP State Emergency Department Databases (SEDD) - Restricted Access File

    U.S. Department of Health & Human Services — The State Emergency Department Databases (SEDD) contain the universe of emergency department visits in participating States. Restricted access data files are...

  16. HCUP Nationwide Emergency Department Database (NEDS) Restricted Access File

    U.S. Department of Health & Human Services — The Nationwide Emergency Department Sample (NEDS) was created to enable analyses of emergency department (ED) utilization patterns and support public health...

  17. Health information technology in US emergency departments

    Pallin, Daniel J.; Sullivan, Ashley F; Kaushal, Rainu; Camargo, Carlos A


    Background Information technology may improve patient safety, and is a focus of health care reform. A minority of emergency departments (EDs) in Massachusetts, and in academic EDs throughout the US, have electronic health records. Aims Assess health information technology adoption in a nationwide sample of EDs. Methods We surveyed 69 US EDs, asking site investigators about the availability of health information technology in 2005–2006. Using multiple linear regression, we compared adoption of...

  18. Human Trafficking in the Emergency Department

    Ahn, Roy; Burke, Thomas; Patel, Ronak B.


    Human trafficking continues to persist, affecting up to 200 million people worldwide. As clinicians in emergency departments commonly encounter victims of intimate partner violence, some of these encounters will be with trafficking victims. These encounters provide a rare opportunity for healthcare providers to intervene and help. This case report of a human trafficking patient from a teaching hospital illustrates the complexity in identifying these victims. Clinicians can better identify pot...


    Onur Yeşil; Haldun Akoğlu; Özge Onur; Özlem Güneysel


    Objectives: Purpose of this study was to determine the clinical properties and demographics of the patients admitting to the emergency department with intoxication.Patient and Methods: A retrospective study was conducted with poisoning patients admitted to our ED 1st of June 2005 and 31st of December 2006. Data regarding the age, sex, reason for the intoxication, and presence of psychiatric evaluation were obtained from the patient files.Results: 147 intoxication was admitted to ED. Mean time...

  20. Understanding communication networks in the emergency department

    Braithwaite Jeffrey; Westbrook Johanna I; Creswick Nerida


    Abstract Background Emergency departments (EDs) are high pressure health care settings involving complex interactions between staff members in providing and organising patient care. Without good communication and cooperation amongst members of the ED team, quality of care is at risk. This study examined the problem-solving, medication advice-seeking and socialising networks of staff working in an Australian hospital ED. Methods A social network survey (Response Rate = 94%) was administered to...

  1. Factors influencing adherence to an emergency department national protocol.

    Ebben, R.H.A.; Vloet, L.C.M.; Groot, J.M. de; Achterberg, T. van


    The objective of this study was to identify factors that influence emergency nurses' adherence to an emergency department national protocol (EDNP). A survey of emergency nurses (n=200) and physicians with medical end responsibility on an emergency department (n=103) was carried out. Emergency nurses

  2. Takotsubo cardiomyopathy: diagnosis in an emergency department

    Marina Mancini


    Full Text Available Takotsubo cardiomyopathy (TC is a reversible cardiomyopathy characterized by transient wall-motion abnormalities of the left ventricle (LV in the absence of significant obstructive coronary disease. In emergency departments the diagnosis remains a challenge because clinical and electrocardiographic presentation of Takotsubo is quite similar to ST-segment elevation myocardial infarction. We conducted a retrospective descriptive study on 1654 patients admitted to our emergency department from 2006 to 2009 who had a left heart catheterization for a suspected acute coronary syndrome and among them we evaluated characteristics on admission of 14 patients with a clinical picture suggestive for a TC. All patients were postmenopausal female. Ten patients (71% had preceding stressful events and four patients (29% did not have identifiable stressors. Thirteen patients (93% presented chest pain and one (7% syncope. ST-segment elevation was present in six patients (43%. One patient (7% presented an episode of ventricular fibrillation. All patients presented increased cardiac Troponin T. Initial LV ejection fraction, evaluated by transthoracic echocardiography was 44±10%. Follow-up LV ejection fraction was 61±10%. Six patients (43% had characteristic apical ballooning and eight patients (57% had hypokinesia or akinesia of the apical or/and midventricular region of the LV without ballooning. Coronary angiography was normal in nine patients (64% and five (36% had stenosis <50%. None had complete obstruction of a coronary. Takotsubo syndrome should be considered as a possible diagnosis in patients admitted in an emergency department with a suspected diagnosis of acute coronary syndrome. Emergency physicians should recognize salient aspects of the medical history at presentation in order to organize appropriate investigations and avoid inappropriate therapies.

  3. Reducing Emergency Department Crowding: Evidence Based Strategies.

    Khalifa, Mohamed; Zabani, Ibrahim


    Emergency department (ED) crowding has become a major barrier to receiving timely care. King Faisal Specialist Hospital & Research Center, Saudi Arabia worked on identifying evidence based strategies for reducing the ED crowding by improving the intake. In addition to a review of literature, qualitative survey methods were used to identify strategies, which were classified into 10 suggested procedures categorized into three types of changes. Physical improvements include using physician cubicles, creating a team triage area and an internal waiting area for less acute patients instead of occupying beds. Technology improvements; include using informatics to update the electronic emergency record with information, using palmar scanning to instantly identify patients and using radio communication devices. Process improvements; include a scribe program to decrease clerical documentation tasks, switching between low flow and high flow processes, placing a physician in triage and using patient segmentation methods. PMID:27350468

  4. Therapy Dogs in the Emergency Department

    Nahm, Nickolas; Lubin, Jill; Lubin, Jeffrey; Bankwitz, Blake K.; Castelaz, McAllister; Chen; Shackson, Joel C.; Aggarwal, Manik N; Totten, Vicken Y.


    Introduction This study examined acceptance by staff and patients of a therapy dog (TD) in the emergency department (ED). Methods Immediately after TD visits to a University Hospital ED, all available ED staff, patients, and their visitors were invited to complete a survey. Results Of 125 “patient” and 105 staff responses, most were favorable. Ninety-three percent of patients and 95% of staff agreed that TDs should visit EDs; 87.8% of patients and 92% of staff approved of TDs for both adult a...

  5. Therapy Dogs in the Emergency Department

    Nahm, Nickolas; Lubin, Jill; Lubin, Jeffrey; Bankwitz, Blake K; Castelaz, McAllister; Chen, Xin; Shackson, Joel C; Aggarwal, Manik N; Totten, Vicken Y.


    Introduction: This study examined acceptance by staff and patients of a therapy dog (TD) in the emergency department (ED). Methods: Immediately after TD visits to a University Hospital ED, all available ED staff, patients, and their visitors were invited to complete a survey. Results: Of 125 ‘‘patient’’ and 105 staff responses, most were favorable. Ninety-three percent of patients and 95% of staff agreed that TDs should visit EDs; 87.8% of patients and 92% of staff approved ...

  6. Molar Pregnancy in the Emergency Department

    Masterson, Lori; Chan, Shu B.; Bluhm, Bryan


    A 15-year-old female presented to the emergency department with complaints of vaginal bleeding. She was pale, anxious, cool and clammy with tachycardic, thready peripheral pulses and hemoglobin of 2.4g/dL. Her abdomen was gravid appearing, approximately early to mid-second trimester in size. Pelvic examination revealed 2 cm open cervical os with spontaneous discharge of blood, clots and a copious amount of champagne-colored grapelike spongy material. After 2L boluses of normal saline and two ...

  7. A GIS-based Earthquake and Tsunami Emergency Command System for Seaside Cities

    GUAN Youhai; FENG Qimin; JIA Jing


    In this paper the geographical information system (GIS) is applied to earthquake and tsunami emergency work and an earthquake and tsunami emergency command system (ETECS) for seaside cities is developed which is composed of a basic database and six subsystems. By employing this system, the responsible municipal departments can make rapid prediction before the occurrence of earthquake or tsunami, make commanding decisions concerning the disaster-fight during the disastrous event, and make rapid estimates of the casualties and economic losses. So that the government could conduct relief work in time and planning for future disaster reduction and prevention.

  8. Treating pain in the emergency department.

    Kuan, Samuel C


    The objective of this audit was to evaluate the impact of brief educational intervention on prompt recognition and treatment of pain in the emergency department. The audit was performed on all patients in the emergency department with pain presenting over a 24-h period on three occasions: preintervention, 1-week postintervention and at 4 months. In 151 patients, pain severity scores were mild (24%), moderate (42%), severe (16%) and unknown (18%). Pain score documentation at triage improved from 72 to 94% during the audit (P = 0.01). There was no significant difference in the number of patients treated within 20 min for severe pain (P = 0.076) and within 60 min for moderate pain (P = 0.796) between audits. The likelihood of receiving analgesia within 20 min increased with the patients\\' pain category (relative risk: 1.8 95% confidence interval: 1.4-2.3). Documentation of pain assessment and the use of pain scores at triage improved after a brief educational intervention but there was no measurable impact on treatment times.

  9. Perception of Noise by Emergency Department Nurses

    John Graneto


    Full Text Available Introduction: Noise in the emergency department (ED may be perceived to be high by both patients and nurses alike. This increased noise level is hypothesized to be responsible for communication interference and subsequent disruption of complex procedures and decision-making. The objective of this study is to quantify ambient noise level in an ED while obtaining coincident subjective surveys from nurses in the assessment of actual versus perceived noise.Methods: Data collected from surveys of ED nurses on each of 3 different dates revealed that sound levels within the selected ED were consistently at or below 70 decibels (dB of sound as measured by a sound level meter. This level of sound is of the same decibel of normal conversation at a 3-5 foot distance. Nurses surveyed overwhelmingly rated noise as “low” or “not loud” irrespective of a variance (though predominantly within a 10 dB range in actual sound decibel measurements.Results: Years of experience of work within emergency departments proved the most consistent predictor of nurses’ opinions on the frequency with which noise levels within the ED were louder than they should be, with more experienced nurses all ranking noise levels as “frequently” or “always” louder than they should be.Conclusion: Individual variance existed in how nurses felt that noise level affected work function. ED nurses��� perception of noise is perceived to be low and generally not interfering with their cognitive function. [West J Emerg Med. 2013;14(5:547–550.

  10. Characterizing emergency departments to improve understanding of emergency care systems

    Steptoe, Anne P; Corel, Blanka; Sullivan, Ashley F; Camargo, Carlos A.


    International emergency medicine aims to understand different systems of emergency care across the globe. To date, however, international emergency medicine lacks common descriptors that can encompass the wide variety of emergency care systems in different countries. The frequent use of general, system-wide indicators (e.g. the status of emergency medicine as a medical specialty or the presence of emergency medicine training programs) does not account for the diverse methods that contribute t...

  11. Pilot study of a paediatric emergency department oral rehydration protocol

    Boyd, R.; Busuttil, M; Stuart, P


    Objective: To ascertain if the use of a paediatric oral rehydration protocol in the emergency department changed rates of admission, total time spent in hospital, total time spent in the emergency department, or number of unscheduled returns to the emergency department.

  12. Incidental Rickets in the Emergency Department Setting

    John V. Zurlo


    Full Text Available Vitamin D deficiency rickets is a childhood osteomalacia, with impaired skeletal development and potentially skeletal deformities. The radiographic findings of rickets are many but include widening, fraying, and cupping of the metaphysis. Developmental delay and related complications of seizure and tetany have also been reported. This medical entity is often thought of as a classic medical disease of the past. However, it persists, and the recognition of rickets is on the rise. The reemergence of rickets correlates with the increase in the number of children exclusively breastfed and with the frequent use of sun block in the pediatric population. We present two cases of rickets, diagnosed through a visit to the Emergency Department made for unrelated symptoms. These two cases illustrate the importance of diagnosing rickets as an “incidental” finding. With early detection, dietary supplementation can be initiated potentially sparing the patient symptomatic disease.

  13. Therapy Dogs in the Emergency Department

    Nickolas Nahm


    Full Text Available Introduction: This study examined acceptance by staff and patients of a therapy dog (TD in the emergency department (ED.Methods: Immediately after TD visits to a University Hospital ED, all available ED staff, patients, and their visitors were invited to complete a survey.Results: Of 125 ‘‘patient’’ and 105 staff responses, most were favorable. Ninety-three percent of patients and 95% of staff agreed that TDs should visit EDs; 87.8% of patients and 92% of staff approved of TDs for both adult and pediatric patients. Fewer than 5% of either patients or staff were afraid of the TDs. Fewer than 10% of patients and staff thought the TDs posed a sanitary risk or interfered with staff work.Conclusion: Both patients and staff approve of TDs in an ED. The benefits of animal-assisted therapy should be further explored in the ED setting.

  14. Emergency Department Presentations following Tropical Cyclone Yasi.

    Peter Aitken

    Full Text Available Emergency departments see an increase in cases during cyclones. The aim of this study is to describe patient presentations to the Emergency Department (ED of a tertiary level hospital (Townsville following a tropical cyclone (Yasi. Specific areas of focus include changes in: patient demographics (age and gender, triage categories, and classification of diseases.Data were extracted from the Townsville Hospitals ED information system (EDIS for three periods in 2009, 2010 and 2011 to coincide with formation of Cyclone Yasi (31 January 2011 to six days after Yasi crossed the coast line (8 February 2012. The analysis explored the changes in ICD10-AM 4-character classification and presented at the Chapter level.There was a marked increase in the number of patients attending the ED during Yasi, particularly those aged over 65 years with a maximum daily attendance of 372 patients on 4 Feb 2011. The most marked increases were in: Triage categories--4 and 5; and ICD categories--diseases of the skin and subcutaneous tissue (L00-L99, and factors influencing health care status (Z00-Z99. The most common diagnostic presentation across all years was injury (S00-T98.There was an increase in presentations to the ED of TTH, which peaked in the first 24-48 hours following the cyclone and returned to normal over a five-day period. The changes in presentations were mostly an amplification of normal attendance patterns with some altered areas of activity. Injury patterns are similar to overseas experience.

  15. An organizational metamodel for hospital emergency departments.

    Kaptan, Kubilay


    I introduce an organizational model describing the response of the hospital emergency department. The hybrid simulation/analytical model (called a "metamodel") can estimate a hospital's capacity and dynamic response in real time and incorporate the influence of damage to structural and nonstructural components on the organizational ones. The waiting time is the main parameter of response and is used to evaluate the disaster resilience of health care facilities. Waiting time behavior is described by using a double exponential function and its parameters are calibrated based on simulated data. The metamodel covers a large range of hospital configurations and takes into account hospital resources in terms of staff and infrastructures, operational efficiency, and the possible existence of an emergency plan; maximum capacity; and behavior both in saturated and overcapacitated conditions. The sensitivity of the model to different arrival rates, hospital configurations, and capacities and the technical and organizational policies applied during and before a disaster were investigated. This model becomes an important tool in the decision process either for the engineering profession or for policy makers. PMID:25397658

  16. Public Health, Hypertension, and the Emergency Department.

    Brody, Aaron; Janke, Alex; Sharma, Vineet; Levy, Phillip


    Hypertension (HTN) is the most common cardiovascular disease worldwide and is associated with severe long-term morbidity when not treated appropriately. Despite this, blood pressure (BP) control remains suboptimal, particularly among underserved populations and those who rely on emergency departments (EDs) as a source of primary care. ED providers encounter patients with severely elevated BP daily, and yet adherence to minimal standards of BP reassessment and referral to outpatient medical care, as recommended by the American College of Emergency Physicians, is limited. Barriers such as provider knowledge deficits, resource constraints, and negative attitudes towards patients who utilize EDs for nonurgent complaints are compounded by perceptions of HTN as a condition that can only be addressed in a primary care setting to contribute to this. Efforts to reduce this gap must go beyond government mandates to address systemic issues including access to care and payment models to encourage health promotion. Additionally, individual physician behavior can be shifted through targeted education, financial incentives, and the accumulation of high-quality evidence to encourage more proactive approaches to the management of uncontrolled HTN in the ED. PMID:27165429

  17. Conflicts between managed care organizations and emergency departments in California.

    Johnson, L. A.; Derlet, R W


    To control costs, managed care organizations have begun to restrict the use of hospital emergency departments by their enrollees. They are doing this by educating enrollees, providing better access to 24-hour urgent care, denying preauthorizations for care for some patients who do present to emergency departments, and retrospectively denying payment for certain patients who use emergency services. Changing traditional use of emergency departments has resulted in conflicts between managed care...

  18. The Financial Impact of Emergency Department Crowding

    Foley, Mathew


    Full Text Available Objective: The economic benefits of reducing emergency department (ED crowding are potentially substantial as they may decrease hospital length of stay. Hospital administrators and public officials may therefore be motivated to implement crowding protocols. We sought to identify a potential cost of ED crowding by evaluating the contribution of excess ED length of stay (LOS to overall hospital length of stay. Methods: We performed a retrospective review of administrative data of adult patients from two urban hospitals (one county and one university in Brooklyn, New York from 2006-2007. Data was provided by each facility. Extrapolating from prior research (Krochmal and Riley, 2005, we determined the increase in total hospital LOS due to extended ED lengths of stay, and applied cost and charge analyses for the two separate facilities. Results: We determined that 6,205 (5.0% admitted adult patients from the county facility and 3,017 (3.4% patients from the university facility were held in the ED greater than one day over a one-year period. From prior research, it has been estimated that each of these patient’s total hospital length of stay was increased on average by 11.7% (0.61 days at the county facility, and 0.71 days at the university facility. The increased charges over one year at the county facility due to the extended ED LOS was therefore approximately $9.8 million, while the increased costs at the university facility were approximately $3.9 million. Conclusion: Based on extrapolations from Krochmal and Riley applied to two New York urban hospitals, the county hospital could potentially save $9.8 million in charges and the university hospital $3.9 million in costs per year if they eliminate ED boarding of adult admitted patients by improving movement to the inpatient setting. [West J Emerg Med. 2011;12(2:192-197.

  19. Organ donation in the accident and emergency department: a study of relatives' views.

    Wellesley, A.; Glucksman, E.; Crouch, R


    OBJECTIVE: To determine whether recently bereaved people would object to being asked about organ donation immediately after the death of their relative. METHODS: A telephone interview of 78 recently bereaved relatives of people who had died in an inner city accident and emergency (A&E) department; 68 (87%) agreed to participate in the study and were sent a questionnaire. Outcome measures were views on being asked about organ donation in the A&E department immediately after the death of a rela...

  20. Paediatric analgesia in an Emergency Department.

    Hawkes, C


    Timely management of pain in paediatric patients in the Emergency Department (ED) is a well-accepted performance indicator. We describe an audit of the provision of analgesia for children in an Irish ED and the introduction of a nurse-initiated analgesia protocol in an effort to improve performance. 95 children aged 1-16 presenting consecutively to the ED were included and time from triage to analgesia, and the rate of analgesia provision, were recorded. The results were circulated and a nurse initiated analgesia protocol was introduced. An audit including 145 patients followed this. 55.6% of patients with major fractures received analgesia after a median time of 54 minutes, which improved to 61.1% (p = 0.735) after 7 minutes (p = 0.004). Pain score documentation was very poor throughout, improving only slightly from 0% to 19.3%. No child had a documented pain score, which slightly improved to 19.3%. We recommend other Irish EDs to audit their provision of analgesia for children.

  1. Referral patterns in elderly emergency department visits

    Alessandra Buja


    Full Text Available OBJECTIVE: To assess elderly individuals' demand for emergency department (ED care, in terms of the characteristics, processes, outcomes, costs by referral pattern. DATA SOURCE: All ED visits involving patients aged 65 and older, extracted from the 2010 dataset of an Local Health Agency, in North-Eastern Italy (no. = 18 648. STUDY DESIGN: Retrospective cohort study. PRINCIPAL FINDINGS: Patients were referred by primary care professionals (PCPs in 43.1% of cases, 1.4% came from nursing homes (NH, and 55.5% were self-referred (SR. The SR group had a higher adjusted odds ratio (aOR for non-urgent conditions (1.98 CI 1.85-2.12, but a lower aOR for conditions amenable to ambulatory care (0.53 CI 0.48-0.59, and a lower consumption of resources. The SR group tend to occur more frequently out of hours, and to coincide with a shorter stay at the ED, lower observation unit activation rates, lower hospitalization rates and a lower consumption of services than other two groups. The average costs for all procedures were lower for the SR patients (mean = 106.04 € ± SD 84.90 € than for those referred by PCPs (mean = 138.14 € ± SD 101.17 € or NH (mean = 143.48 € ± SD 95.28 €. CONCLUSION: Elderly patients coming in ED have different characteristics, outcomes and recourses consume by referral pattern.

  2. CT utilization: the emergency department perspective

    CT scan utilization in the pediatric emergency department (ED) has dramatically increased in recent years. This likely reflects the improved diagnostic capability of CT, as well as its wider availability. However, the utility of CT is tempered by the high radiation exposure to patients as well as cost. In this review we will consider the magnitude of changes in CT use in the pediatric ED, and we will examine some of the driving forces behind these increases. In addition, we will consider strategies to limit growth in CT scan utilization or even result in reductions in CT use in the future. These strategies include better physician and patient education, application of existing clinical decision rules to reduce CT utilization and development of new rules, technical alterations in CT protocols to reduce per-exam exposures, use of alternative imaging modalities such as US and MRI that do not expose patients to ionizing radiation, and expanded use of clinical observation in place of immediate diagnostic imaging. Reform of liability laws might alleviate another driving force behind high CT utilization rates. Protocols must be designed to maximize patient safety by limiting radiation exposures while preserving rapid and accurate diagnosis of time-sensitive conditions. (orig.)

  3. Managing Pediatric Pain in the Emergency Department.

    Bailey, Benoit; Trottier, Evelyne D


    Far more attention is now given to pain management in children in the emergency department (ED). When a child arrives, pain must be recognized and evaluated using a pain scale that is appropriate to the child's development and regularly assessed to determine whether the pain intervention was effective. At triage, both analgesics and non-pharmacological strategies, such as distraction, immobilization, and dressing should be started. For mild pain, oral ibuprofen can be administered if the child has not received it at home, whereas ibuprofen and paracetamol are suitable for moderate pain. For patients who still require pain relief, oral opioids could be considered; however, many EDs have now replaced this with intranasal fentanyl, which allows faster onset of pain relief and can be administered on arrival pending either intravenous access or definitive care. Intravenous opioids are often required for severe pain, and paracetamol or ibuprofen can still be considered for their likely opioid-sparing effects. Specific treatment should be used for patients with migraine. In children requiring intravenous access or venipuncture, non-pharmacological and pharmacological strategies to decrease pain and anxiety associated with needle punctures are mandatory. These strategies can also be used for laceration repairs and other painful procedures. Despite the gaps in knowledge, pain should be treated with the most up-to-date evidence in children seen in EDs. PMID:27260499

  4. Critical care in the emergency department.

    O'Connor, Gabrielle


    BACKGROUND: The volume and duration of stay of the critically ill in the emergency department (ED) is increasing and is affected by factors including case-mix, overcrowding, lack of available and staffed intensive care beds and an ageing population. The purpose of this study was to describe the clinical activity associated with these high-acuity patients and to quantify resource utilization by this patient group. METHODS: The study was a retrospective review of ED notes from all patients referred directly to the intensive care team over a 6-month period from April to September 2004. We applied a workload measurement tool, Therapeutic Intervention Scoring System (TISS)-28, which has been validated as a surrogate marker of nursing resource input in the intensive care setting. A nurse is considered capable of delivering nursing activities equal to 46 TISS-28 points in each 8-h shift. RESULTS: The median score from our 69 patients was 19 points per patient. Applying TISS-28 methodology, we estimated that 3 h 13 min nursing time would be spent on a single critically ill ED patient, with a TISS score of 19. This is an indicator of the high levels of personnel resources required for these patients in the ED. ED-validated models to quantify nursing and medical staff resources used across the spectrum of ED care is needed, so that staffing resources can be planned and allocated to match service demands.


    Onur Yeşil


    Full Text Available Objectives: Purpose of this study was to determine the clinical properties and demographics of the patients admitting to the emergency department with intoxication.Patient and Methods: A retrospective study was conducted with poisoning patients admitted to our ED 1st of June 2005 and 31st of December 2006. Data regarding the age, sex, reason for the intoxication, and presence of psychiatric evaluation were obtained from the patient files.Results: 147 intoxication was admitted to ED. Mean time spent before admission to ED after exposure was 7,61 hours. 78 cases admitted at daytime, 69 cases at night. Agent exposed was drugs at 72 of cases whereas 63 was food and 12 was alcohol. 102 cases were treated in ED and 45 cases admitted to hospital. Psychiatric evaluation was performed on 65 patients.Conclusions: Demographics of the patients admitting to our ED resemble with the findings of other studies reported from Turkey. Intoxication seems to be the problem of young woman and drugs are the most frequent agents. Drug intoxicated cases are younger, report faster to ED and all of them were intended suicide. All of these intentional cases were admitted to a hospital and psychiatric evaluation has been made.

  6. Survey of directors of emergency departments in California on overcrowding

    Richards, John R.; Navarro, Misty L; Derlet, Robert W.


    Objective To survey the directors of emergency departments in California on their opinions of the extent and factors associated with overcrowding in emergency departments. Methods Surveys were mailed to a random sample of emergency department directors. Questions included estimated magnitude, frequency, causes, and effects of overcrowding. Results Of 160 directors surveyed, 113 (71%) responded, and 109 (96%) reported overcrowding as a problem. All (n = 21) university or county hospital direct...

  7. Asthma Emergency Department Visit Rates by County in 2012

    U.S. Department of Health & Human Services — This dataset contains counts and rates (per 10,000 residents) of asthma (ICD9-CM, 493.0-493.9) emergency department visits among California residents by County and...

  8. Discharge against Medical Advice in Emergency Department

    Payman Asadi


    Full Text Available Introduction: Discharge against medical advice (AMA is the patient voluntarily leaving the hospital against the physician’s advice, which might indicate a problem in the hospital or the quality of care in it. This study aimed to evaluate the frequency and reasons of AMA in the emergency department (ED. Methods: The present cross-sectional study evaluated the reasons of AMA in the ED of Poursina Hospital, Rasht, Iran. The studied population included all the discharged AMA patients from April 2012 to March 2013. Demographic data and data regarding insurance status, insurance provider, number of hospitalization days, admission shift (morning, evening, night, type of disease or reason for referral (multiple trauma, surgery, orthopedics, neurosurgery, neurology, probable readmission in the next 15 days, and reasons for discharge AMA were gathered using a pre-designed checklist. Data were analyzed using SPSS version 20 and chi square test. p < 0.05 was considered significant. Results: 3367 patients were admitted to ED over the course of the study, 1060 (31.4% of which were discharged AMA (62.92% male. Most discharged AMA patients were married and 20-30 years old. Most had neurological problems and surgery, and were referred in the evening or night shifts. 62.17% of the patients were insured by Ta’min Ejtema’i insurance company. The reasons for discharge AMA was patient related in 1009 (95.19% cases, medical staff related in 35 cases (3.3%, and hospitalization related in 16 (1.51% cases. Readmission in the next 15 days was seen in 9.06% of those who were discharged AMA. Conclusion: Based on the results of the present study, most cases of discharge AMA were patient related. Increasing the knowledge of the patients regarding probable consequences, designing outpatient management programs for these patients and improving the quality of medical services can help decrease discharge AMA cases.

  9. Understanding communication networks in the emergency department

    Braithwaite Jeffrey


    Full Text Available Abstract Background Emergency departments (EDs are high pressure health care settings involving complex interactions between staff members in providing and organising patient care. Without good communication and cooperation amongst members of the ED team, quality of care is at risk. This study examined the problem-solving, medication advice-seeking and socialising networks of staff working in an Australian hospital ED. Methods A social network survey (Response Rate = 94% was administered to all ED staff (n = 109 including doctors, nurses, allied health professionals, administrative staff and ward assistants. Analysis of the network characteristics was carried out by applying measures of density (the extent participants are concentrated, connectedness (how related they are, isolates (how segregated, degree centrality (who has most connections measured in two ways, in-degree, the number of ties directed to an individual and out-degree, the number of ties directed from an individual, betweenness centrality (who is important or powerful, degree of separation (how many ties lie between people and reciprocity (how bi-directional are interactions. Results In all three networks, individuals were more closely connected to colleagues from within their respective professional groups. The problem-solving network was the most densely connected network, followed by the medication advice network, and the loosely connected socialising network. ED staff relied on each other for help to solve work-related problems, but some senior doctors, some junior doctors and a senior nurse were important sources of medication advice for their ED colleagues. Conclusions Network analyses provide useful ways to assess social structures in clinical settings by allowing us to understand how ED staff relate within their social and professional structures. This can provide insights of potential benefit to ED staff, their leaders, policymakers and researchers.

  10. Screening for child abuse at emergency departments : a systematic review

    Louwers, Eveline C. F. M.; Affourtit, Marjo J.; Moll, Henriette A.; de Koning, Harry J.; Korfage, Ida J.


    Introduction Child abuse is a serious problem worldwide and can be difficult to detect. Although children who experience the consequences of abuse will probably be treated at an emergency department, detection rates of child abuse at emergency departments remain low. Objective To identify effective

  11. Portrait of rural emergency departments in Quebec and utilisation of the Quebec Emergency Department Management Guide: a study protocol

    Fleet, Richard; Archambault, Patrick; Légaré, France; Chauny, Jean-Marc; Lévesque, Jean-Frédéric; Ouimet, Mathieu; Dupuis, Gilles; Haggerty, Jeannie; Poitras, Julien; Tanguay, Alain; Simard-Racine, Geneviève; Gauthier, Josée


    Introduction Emergency departments are important safety nets for people who live in rural areas. Moreover, a serious problem in access to healthcare services has emerged in these regions. The challenges of providing access to quality rural emergency care include recruitment and retention issues, lack of advanced imagery technology, lack of specialist support and the heavy reliance on ambulance transport over great distances. The Quebec Ministry of Health and Social Services published a new version of the Emergency Department Management Guide, a document designed to improve the emergency department management and to humanise emergency department care and services. In particular, the Guide recommends solutions to problems that plague rural emergency departments. Unfortunately, no studies have evaluated the implementation of the proposed recommendations. Methods and analysis To develop a comprehensive portrait of all rural emergency departments in Quebec, data will be gathered from databases at the Quebec Ministry of Health and Social Services, the Quebec Trauma Registry and from emergency departments and ambulance services managers. Statistics Canada data will be used to describe populations and rural regions. To evaluate the use of the 2006 Emergency Department Management Guide and the implementation of its various recommendations, an online survey and a phone interview will be administered to emergency department managers. Two online surveys will evaluate quality of work life among physicians and nurses working at rural emergency departments. Quality-of-care indicators will be collected from databases and patient medical files. Data will be analysed using statistical (descriptive and inferential) procedures. Ethics and dissemination This protocol has been approved by the CSSS Alphonse–Desjardins research ethics committee (Project MP-HDL-1213-011). The results will be published in peer-reviewed scientific journals and presented at one or more scientific

  12. Emergency thoracotomy for thoracic trauma in the accident and emergency department: indications and outcome

    Jahangiri, Marjan; Youhana, Aprim; Hyde, Jonathan; Lewis, Terence; Griffin, Steven; Wood, Alan; Magee, Patrick


    To assess the efficacy of emergency thoracotomy performed for thoracic trauma in the accident and emergency department, a retrospective analysis of patients who underwent this procedure and were brought to hospital by the Helicopter Emergency Medical Service was carried out. Between 1991 and 1994, 16 patients had emergency thoracotomy performed in the accident department. Twelve patients had sustained blunt trauma and four patients had sustained penetrating injuries. Three patients first asse...

  13. [Position paper for a reform of medical emergency care in German emergency departments].

    Riessen, R; Gries, A; Seekamp, A; Dodt, C; Kumle, B; Busch, H-J


    The hospital emergency departments play a central role for the in- and outpatient care of patients with medical emergencies in Germany. In this position paper we point out some general financial and organizational problems of German emergency departments and urge for a higher significance of emergency care in the German health system as an element of public services. The corresponding reform proposals include a change in hospital financing towards a more budget-based system for the emergency departments, an improved structural planning for regional and transregional emergency care, an intensified cooperation with the emergency services of the ambulatory care physicians, a better organizational representation of emergency care within the hospitals and an advancement of emergency medicine in postgraduate medical education. PMID:26024948

  14. Admissions and transfers from a rural emergency department.

    De Freitas, T. L.; Spooner, G. R.; Szafran, O.


    OBJECTIVE: To examine the characteristics of patients transferred from a rural hospital emergency department, to compare them with patients admitted on an emergency basis, and to use this information to help plan physician education. DESIGN: Descriptive study using records for the period January 1, 1991, to June 30, 1992. SETTING: The emergency department at Bonnyville Health Centre, an acute care rural hospital located 240 km northeast of Edmonton, serving a catchment population of approxima...

  15. Management of Pneumothorax in Emergency Medicine Departments: Multicenter Trial

    Ince, Abdulkadir; Ozucelik, Dogac Niyazi; Avci, Akkan; Nizam, Ozgur; Dogan, Halil; Topal, Mehmet Ali


    Background: Pneumothorax is common and life-threatening clinical condition which may require emergency treatment in Emergency Medicine Departments. Objectives: We aimed to reveal the epidemiological analysis of the patients admitted to the Emergency Department with pneumothorax. Material and Methods: This case-control and multi-center study was conducted in the patients treated with the diagnosis of pneumothorax between 01.01.2010-31.12.2010. Patient data were collected from hospital automati...

  16. Department of Energy Emergency Management Functional Requirements Study

    This Study, the Emergency Management Functional Requirements Study (EMFRS), identifies the physical environment, information resources, and equipment required in the DOE Headquarters Emergency Operations Center (EOC) to support the DOE staff in managing an emergency. It is the first step toward converting the present Forrestal EOC into a practical facility that will function well in each of the highly diverse types of emergencies in which the Department could be involved. 2 figs

  17. The San Bernardino, California, Terror Attack: Two Emergency Departments' Response.

    Lee, Carol; Walters, Elizabeth; Borger, Rodney; Clem, Kathleen; Fenati, Gregory; Kiemeney, Michael; Seng, Sakona; Yuen, Ho-Wang; Neeki, Michael; Smith, Dustin


    On December 2, 2015, a terror attack in the city of San Bernardino, California killed 14 Americans and injured 22 in the deadliest attack on U.S. soil since September 11, 2001. Although emergency personnel and law enforcement officials frequently deal with multi-casualty incidents (MCIs), what occurred that day required an unprecedented response. Most of the severely injured victims were transported to either Loma Linda University Medical Center (LLUMC) or Arrowhead Regional Medical Center (ARMC). These two hospitals operate two designated trauma centers in the region and played crucial roles during the massive response that followed this attack. In an effort to shed a light on our response to others, we provide an account of how these two teaching hospitals prepared for and coordinated the medical care of these victims. In general, both centers were able to quickly mobilize large number of staff and resources. Prior disaster drills proved to be invaluable. Both centers witnessed excellent teamwork and coordination involving first responders, law enforcement, administration, and medical personnel from multiple specialty services. Those of us working that day felt safe and protected. Although we did identify areas we could have improved upon, including patchy communication and crowd-control, they were minor in nature and did not affect patient care. MCIs pose major challenges to emergency departments and trauma centers across the country. Responding to such incidents requires an ever-evolving approach as no two incidents will present exactly alike. It is our hope that this article will foster discussion and lead to improvements in management of future MCIs. PMID:26823922

  18. Emergency Department Utilization in the Texas Medicaid...

    U.S. Department of Health & Human Services — There were 44,246 individuals enrolled in TexKat in 2005. Roughly 13 percent of these enrollees had at least one ED visit during the sample period, with one quarter...

  19. Asthma-related emergency department use: current perspectives.

    Johnson, Laurie H; Chambers, Patricia; Dexheimer, Judith W


    Asthma is one of the most common chronic pediatric diseases. Patients with asthma often present to the emergency department for treatment for acute exacerbations. These patients may not have a primary care physician or primary care home, and thus are seeking care in the emergency department. Asthma care in the emergency department is multifaceted to treat asthma patients appropriately and provide quality care. National and international guidelines exist to help drive clinical care. Electronic and paper-based tools exist for both physicians and patients to help improve emergency, home, and preventive care. Treatment of patients with asthma should include the acute exacerbation, long-term management of controller medications, and controlling triggers in the home environment. We will address the current state of asthma research in emergency medicine in the US, and discuss some of the resources being used to help provide a medical home and improve care for patients who suffer from acute asthma exacerbations. PMID:27471415

  20. Pain in young children attending an accident and emergency department

    McCarthy, C.; Hewitt, S; Choonara, I.


    Objectives—To assess pain in young children presenting to an accident and emergency (A&E) department. To evaluate the use of the toddler-preschooler postoperative pain scale (TPPPS) and the use of analgesia in these children.

  1. Unusual presentation of tuberculosis to the accident and emergency department.

    Jones, K E; McLauchlan, C A


    A patient with localized, reactive tendinitis secondary to tuberculosis presented to the accident and emergency (A&E) department. Tendinitis is a relatively common complaint, and it is important to consider uncommon systemic causes, including tuberculosis.

  2. Observational study of suspected maltreatment in Italian paediatric emergency departments

    Palazzi, S; G. De Girolamo; Liverani, T; on, b


    Aims: To evaluate how often children seen in paediatric accident & emergency (A&E) departments were suspected of abuse or neglect, and to explore some of the correlates of suspected child maltreatment.

  3. Partnering Effectively With Inpatient Leaders for Improved Emergency Department Throughput

    Baker, Stephanie J.; Esbenshade, Angie


    The boarding of patients is a root cause of overcrowding in a majority of emergency departments (EDs) nationwide. It reduces capacity to treat ED patients, decreases bed utilization, and compromises quality, safety, and the patient experience. Because of its systemic nature, it can only be effectively addressed through attention and commitment by all stakeholders. Once emergency departments have addressed throughput challenges they can solve on their own, they are ready to focus on proactive ...

  4. Diphtheria presenting in the accident and emergency department.

    Walters, R F


    A case of diphtheria encountered in the accident and emergency department is described. In addition, 38 cases of diphtheria have been analysed, and demonstrate that, although now rare in this country, the disease still exists and its clinical features remain unchanged. It presents almost as often in the accident and emergency department as it does to the general practitioner and remains overwhelmingly a disease of children. Diphtheria is still a notifiable disease. The diagnosis must be made ...

  5. Management of Patients with Renal Colic in Emergency Department

    Mehmet Oguzhan Ay; Akkan Avci; Selen Acehan; Muge Gulen; Ferhat Icme; Ahmet Sebe


    Renal colic is a common emergent urological problem seen in emergency departments, which often occurs due to kidney stone disease and characterized by severe pain. Renal colic is described by the patients as the most painful and debilitating experience of their life. The main purpose of emergency treatment is to control pain effectively, and resolve urinary obstruction without causing loss of renal function. In this compilation, studies regarding the management of patients with renal colic in...

  6. Asthma-related emergency department use: current perspectives

    Johnson LH; Chambers P; Dexheimer JW


    Laurie H Johnson,1 Patricia Chambers,1 Judith W Dexheimer1,2 1Division of Emergency Medicine, 2Division of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA Abstract: Asthma is one of the most common chronic pediatric diseases. Patients with asthma often present to the emergency department for treatment for acute exacerbations. These patients may not have a primary care physician or primary care home, and thus are seeking care in the emergency de...

  7. Managing Emergency Situations in the Smart City: The Smart Signal.

    Asensio, Ángel; Blanco, Teresa; Blasco, Rubén; Marco, Álvaro; Casas, Roberto


    In a city there are numerous items, many of them unnoticed but essential; this is the case of the signals. Signals are considered objects with reduced technological interest, but in this paper we prove that making them smart and integrating in the IoT (Internet of Things) could be a relevant contribution to the Smart City. This paper presents the concept of Smart Signal, as a device conscious of its context, with communication skills, able to offer the best message to the user, and as a ubiquitous element that contributes with information to the city. We present the design considerations and a real implementation and validation of the system in one of the most challenging environments that may exist in a city: a tunnel. The main advantages of the Smart Signal are the improvement of the actual functionality of the signal providing new interaction capabilities with users and a new sensory mechanism of the Smart City. PMID:26094626

  8. Managing Emergency Situations in the Smart City: The Smart Signal

    Ángel Asensio


    Full Text Available In a city there are numerous items, many of them unnoticed but essential; this is the case of the signals. Signals are considered objects with reduced technological interest, but in this paper we prove that making them smart and integrating in the IoT (Internet of Things could be a relevant contribution to the Smart City. This paper presents the concept of Smart Signal, as a device conscious of its context, with communication skills, able to offer the best message to the user, and as a ubiquitous element that contributes with information to the city. We present the design considerations and a real implementation and validation of the system in one of the most challenging environments that may exist in a city: a tunnel. The main advantages of the Smart Signal are the improvement of the actual functionality of the signal providing new interaction capabilities with users and a new sensory mechanism of the Smart City.

  9. U.S. Department of Energy clean cities five-year strategic plan.

    Cambridge Concord Associates


    Clean Cities is a government-industry partnership sponsored by the U.S. Department of Energy's (DOE) Vehicle Technologies Program, which is part of the Office of Energy Efficiency and Renewable Energy. Working with its network of about 100 local coalitions and more than 6,500 stakeholders across the country, Clean Cities delivers on its mission to reduce petroleum consumption in on-road transportation. In its work to reduce petroleum use, Clean Cities focuses on a portfolio of technologies that includes electric drive, propane, natural gas, renewable natural gas/biomethane, ethanol/E85, biodiesel/B20 and higher-level blends, fuel economy, and idle reduction. Over the past 17 years, Clean Cities coalitions have displaced more than 2.4 billion gallons of petroleum; they are on track to displace 2.5 billion gallons of gasoline per year by 2020. This Clean Cities Strategic Plan lays out an aggressive five-year agenda to help DOE Clean Cities and its network of coalitions and stakeholders accelerate the deployment of alternative fuel and advanced technology vehicles, while also expanding the supporting infrastructure to reduce petroleum use. Today, Clean Cities has a far larger opportunity to make an impact than at any time in its history because of its unprecedented $300 million allocation for community-based deployment projects from the American Recovery and Reinvestment Act (ARRA) (see box below). Moreover, the Clean Cities annual budget has risen to $25 million for FY2010 and $35 million has been requested for FY2011. Designed as a living document, this strategic plan is grounded in the understanding that priorities will change annually as evolving technical, political, economic, business, and social considerations are woven into project decisions and funding allocations. The plan does not intend to lock Clean Cities into pathways that cannot change. Instead, with technology deployment at its core, the plan serves as a guide for decision-making at both the

  10. Implementation of Electronic Whiteboards at Two Emergency Departments

    Rasmussen, Rasmus; Fleron, Benedicte Frederikke Rex; Hertzum, Morten; Simonsen, Jesper


    designed in collaboration with clinicians from the departments, present more information, and allow some automated updating, as compared to the existing dry-erase whiteboard. Based on observations supported by interviews we describe the implementation of the whiteboard at the two emergency departments, the...... improvisational process following the implementation, and the use and reconfiguration of the system and work practices by the clinicians....

  11. Asthma Emergency Department Visit Rates by ZIP Code

    U.S. Department of Health & Human Services — MAP: This dataset contains counts and rates (per 10,000) of asthma (ICD9-CM, 493.0-493.9) emergency department visits among California...

  12. Measuring patients' experiences in the Accident and Emergency department

    Bos, N.


    Two questionnaires were used to measure patients’ experiences in the Accident and Emergency department (A&E). First, the English A&E department questionnaire used in the English National Survey Programme, and after translation in Dutch used in the Netherlands. The second questionnaire concerned the

  13. Hepatitis B vaccination in United Kingdom accident and emergency departments.

    Heyworth, J


    Hepatitis B vaccination is not widespread amongst staff in accident and emergency departments in the United Kingdom. The results of a survey of departments training senior registrars reveal that unfounded fears concerning the safety of the vaccine are responsible for the low uptake. The need for vaccination, cost, medicolegal aspects and future developments are discussed.

  14. Current use of intraosseous infusion in Danish emergency departments

    Molin, Rune; Hallas, Peter; Brabrand, Mikkel;


    BACKGROUND: Intraosseous infusion (IOI) is recommended when intravenous access cannot be readily established in both pediatric and adult resuscitation. We evaluated the current use of IOI in Danish emergency departments (EDs). METHODS: An online questionnaire was e-mailed to the Heads of Department...


    Putu Sukma Parahita


    Full Text Available Normal 0 false false false EN-US X-NONE X-NONE Fracture injuries in the extremities are accounted for 40% of the incidence of fractures in the United States and causes high morbidity (physical suffering, lost time, and mental stress. High-energy fractures of the lower limbs can also cause life threatening condition like major vascular injury, crush syndrome, and compartment syndrome. Initial treatment in the emergency room is essential to save lives and to save the fractured extremities. Primary survey (securing the airway, breathing and circulation and the secondary survey will be able to quickly and accurately identify dangerous early complication of fractures, such as major arterial injury, crush syndrome and compartment syndrome. /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin-top:0in; mso-para-margin-right:0in; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0in; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;}

  16. Emergency Department Management of Delirium in the Elderly

    Lynn E.J. Gower, DO


    Full Text Available An increasing number of elderly patients are presenting to the emergency department. Numerousstudies have observed that emergency physicians often fail to identify and diagnose delirium in theelderly. These studies also suggest that even when emergency physicians recognized delirium, theystill may not have fully appreciated the import of the diagnosis. Delirium is not a normal manifestation ofaging and, often, is the only sign of a serious underlying medical condition. This article will review thesignificance, definition, and principal features of delirium so that emergency physicians may betterappreciate, recognize, evaluate, and manage delirium in the elderly.

  17. Emergency Service Location Study for Kyrenia City in Cyprus

    Siamidoudaran, Meisam


    ABSTRACT: Considering the attractiveness of one of the cities in Cyprus, known as Kyrenia, among tourists due to its historical buildings and touristic environment, it is crucial to protect the area from fire. Therefore, the aim of this study is to identify suitable locations for a fire station which has been achieved through applying the Quantum Geographic Information Systems (QGIS) software and Python Programming Language. In this thesis, a detailed study was conducted for the city of K...

  18. Screening for Sexual Orientation in Psychiatric Emergency Departments

    Currier, Glenn W.


    Full Text Available Introduction: Our goal was to explore whether emergency department (ED patients would disclose their sexual orientation in a research evaluation and to examine demographic and clinical characteristics of patients by self-identified sexual orientation. Methods: Participants (n=177 presented for psychiatric treatment at three urban EDs in New York City, Rochester, NY, and Philadelphia, PA. Participants were interviewed in the context of a larger study of a standardized suicide risk assessment. We assessed participants’ willingness to answer questions regarding sexual orientation along three dimensions: a self-description of sexual orientation, a self-description of sexual attraction, and the gender of any prior sexual partners. Results: No participants (0/177 refused to respond to the categorical question about sexual orientation, 168/177 (94.9% agreed to provide information about prior sexual partners, and 100/109 (91.7% provided information about current sexual attraction toward either gender. Of all 177 participants, 154 (87.0% self-identified as heterosexual, 11 (6.2% as bisexual, 10 (5.6% as gay or lesbian, and 2 (1.1% indicated they were not sure. As compared with heterosexual patients, lesbian, gay and bisexual (LGB patients were significantly younger and more likely to be non-white, but did not differ significantly in terms of education, income, employment, or religious affiliation or participation. Further, LGB participants did not differ from self-identified heterosexual participants for lifetime suicide attempt rate or lifetime history of any mood, substance-related, psychotic spectrum, or other Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV Axis I disorder. Of self-identified heterosexual participants 5.6% (5/89 reported sexual attraction as other than ‘only opposite sex,’ and 10.3% (15/142 of sexually active ‘heterosexual’ participants reported previous same-gender sexual partners. Conclusion

  19. Managing Emergency Situations in the Smart City: The Smart Signal

    Ángel Asensio; Teresa Blanco; Rubén Blasco; Álvaro Marco; Roberto Casas


    In a city there are numerous items, many of them unnoticed but essential; this is the case of the signals. Signals are considered objects with reduced technological interest, but in this paper we prove that making them smart and integrating in the IoT (Internet of Things) could be a relevant contribution to the Smart City. This paper presents the concept of Smart Signal, as a device conscious of its context, with communication skills, able to offer the best message to the user, and as a ubiqu...

  20. GlideScope video laryngoscopy versus direct laryngoscopy in the emergency department: a propensity score-matched analysis

    Choi, Hyuk Joong; Kim, Young-Min; Oh, Young Min; Kang, Hyung Goo; Yim, Hyun Woo; Jeong, Seung Hee


    Objective To evaluate whether the use of a GlideScope video laryngoscope (GVL) improves first-attempt intubation success compared with the Macintosh laryngoscope (MAC) in the emergency department (ED). Design A propensity score-matched analysis of data from a prospective multicentre ED airway registry—the Korean Emergency Airway Management Registry (KEAMR). Setting 4 academic EDs located in a metropolitan city and a province in South Korea. Participants A total of 4041 adult patients without ...

  1. Physician Assistants and Nurse Practitioners in Rural Washington Emergency Departments.

    Nelson, Scott C; Hooker, Roderick S


    One role of physician assistants (PAs) and nurse practitioners (NPs) is to meet the growing demand for access to rural health care. Critical Access Hospitals, those with less than 25 beds, are usually located in rural communities, often providing continuity of care that clinics cannot deliver. Because little is known about staffing in these small hospital emergency departments, an exploratory study was undertaken using a mixed-methods approach. In Washington State, 18 of the 39 Critical Access Hospitals staff their emergency departments with PAs and NPs. Utilization data were collected through structured interviews by phone or in person on site. Most PAs and NPs lived within the community and staffing tended to be either 24 hours in-house or short notice if they lived or worked nearby. Emergency department visits ranged from 200 to 25,000 per year. All sites were designated level V or IV trauma centers and often managed cardiac events, significant injuries and, in some larger settings, obstetrics. In most instances, PAs were the sole providers in the emergency departments, albeit with physician backup and emergency medical technician support if a surge of emergency cases arose. Two-thirds of the PAs had graduated within the last 5 years. Most preferred the autonomy of the emergency department role and all expressed job satisfaction. Geographically, the more remote a Washington State Critical Access Hospital is, the more likely it will be staffed by PAs/NPs. The diverse utilization of semiautonomous PAs and NPs and their rise in rural hospital employment is a new workforce observation that requires broader investigation. PMID:27183500

  2. Assessment and Management of Bullied Children in the Emergency Department

    Waseem, Muhammad; Ryan, Mary; Foster, Carla Boutin; Peterson, Janey


    Bullying is an important public health issue in the United States. Up to 30% of children report exposure to such victimization. Not only does it hurt bully victim, but it also negatively impacts the bully, other children, parents, school staff, and health care providers. Because bullying often presents with accompanying serious emotional and behavioral symptoms, there has been an increase in psychiatric referrals to emergency departments. Emergency physicians may be the first responders in th...

  3. Donation after cardiac death and the emergency department: ethical issues.

    Simon, Jeremy R; Schears, Raquel M; Padela, Aasim I


    Organ donation after cardiac death (DCD) is increasingly considered as an option to address the shortage of organs available for transplantation, both in the United States and worldwide. The procedures for DCD differ from procedures for donation after brain death and are likely less familiar to emergency physicians (EPs), even as this process is increasingly involving emergency departments (EDs). This article explores the ED operational and ethical issues surrounding this procedure. PMID:24552527

  4. Oral and maxillofacial surgery in accident and emergency departments.

    Wood, G D; Leeming, K A


    Patients with oral and facial injuries presenting as emergencies to the accident and emergency (A&E) unit at Arrowe Park Hospital have been used to compare the treatment method of direct referral to oral and maxillofacial surgery with that of the routine A&E procedure. A quicker and more effective treatment was administered by direct referral of patients to oral and maxillofacial surgery and an argument for such specialist staff to be based in A&E departments is advanced.

  5. Evaluation of Patients Applied to Emergency Department with Penetrating Trauma

    Metin Ateşçelik


    Full Text Available Aim: We aimed in this study to present the data of patients applied to our emergency department with penetrating trauma. Material and method: Cases that applied to Fırat University Emergency Department with penetrating trauma were prospectively evaluated. The age, gender, time of the trauma, type of trauma, time after trauma, mode of arrival to the emergency room, vital signs, type and area of trauma, injury severity score, Glasgow Coma Scale, duration of stay in the emergency department, consultations, the department the patient stay, duration of hospitalization and results were recorded. Results: We evaluated 593 patients applied to our emergency department with penetrating trauma. 477 (80,4% of them were male, and the mean age was 26,43±16,49 yr. The people with the ages between 17-44 years were the most commonly injured group and males were more commonly affected than women. The most common cause of the injury was stab wounds (49,3%. The most common time of exposure to injury was between 13:00-16:59 hours. The most common part of the body exposed to injury were upper extremities (44,5%. Most of the cases were discharged from emergency department as cured (68,8%. The hospitalization ratio was 28,5%, and the mortality rate was 1,3%. Conclusion: The most common group exposed to penetrating trauma were young adult males. We believe that this study is important because of its contribution to the epidemiologic data of penetrating traumas in our country.

  6. Integrating Emerging Technologies in Teaching Ugandan Traditional Dances in K-12 Schools in New York City

    Mabingo, Alfdaniels


    Schools in New York City have made attempts to embrace and support the strand of "making connections", which is laid out in the New York City Department of Dance blueprint for teaching and learning in dance for grades PreK-12. Accordingly, some schools have integrated Ugandan traditional dances into the dance curriculum, and dance…

  7. Knowledge Locations in Cities: Emergence and Development Dynamics

    L.M. da Costa Monteiro de Carvalho (Luís)


    textabstractThis thesis studies the development of knowledge locations: area-based initiatives aimed at agglomerating knowledge-intensive activities in a designated area or city district (e.g. technology parks, creative “factories”). It relates the reinvigorated interest (and qualitative change) in

  8. Ten Years of Frequent Users in an Urban Emergency Department

    Martin, Gerard B; Stephanie A Stokes-Buzzelli; Jennifer M Peltzer-Jones; Lonni R Schultz


    Introduction:The purpose of this study was to determine if differences could be detected in the presentation patterns and admission rates among frequent emergency department users (FEDU) of an urban emergency department over a 10-year period.Methods: This was an IRB approved, retrospective review of all patients who presented to the ED 5 or more times for 3 distinct time periods: “year 0” 11/98-10/99, “year 5” 11/03–10/04, and “year 10” 11/08–10/9. FEDU were grouped into those with 5–9, 10–14...

  9. [Hospitality for elderly patients in the emergency department].

    Boulet, Marie-Claude; Dami, Fabrice; Hugli, Olivier; Renard, Delphine; Foucault, Eliane; Carron, Pierre-Nicolas


    Demographic evolution results in a growing use of emergency department by elderly patients. They require special care to avoid any further degradation of cognitive and functional abilities already compromised by the disease or injury that led them to hospital in the first place. Through a clinical case, we list the risks related to the care of these particular patients in the emergency department. Early recognition of those risks and careful management of these patients' specific needs can significantly contribute to reduce lengths of stay, an important outcome from both the individual patient's and society's perspective. PMID:26790241

  10. The use of 'brutacaine' in Danish emergency departments

    Sønderskov, Michele L.; Hallas, Peter


    We aimed to investigate whether there was an unmet need for paediatric procedural pain management and/or sedation in Danish emergency departments (EDs). Cross-sectional survey of the 21 emergency hospitals in Denmark. Physical restraint during painful procedures was used by 80% (n=12) of the...... departments and procedural sedation in children was used in 33% (n=5) of the EDs. A total of 73% (n=11) of the participants reported that they believed that there was a need for better pain management and/or sedation of children in their ED. There is an unmet need for paediatric procedural pain management in...

  11. Getting back into the emergency department: diversifying general practice while relieving emergency medicine workforce shortages.

    Willcock, Simon M


    New medical graduates expect to work in an environment that allows scope for flexibility and change across a career in medicine. Recruitment to general practice is adversely affected by its perceived limited scope of practice. Training in procedural and hospital skills is not difficult to access for general practice trainees, but complex and inconsistent credentialling criteria and protectionist attitudes among some specialist colleges mean that many skilled general practitioners are unable to utilise the full range of their skills in clinical practice. The discipline of emergency medicine is also experiencing difficulty in recruiting trainees. The employment of skilled GPs in emergency departments (including metropolitan departments) could improve vocational satisfaction for GPs and emergency physicians, and possibly also improve patient outcomes and flow through the emergency department. PMID:18637784

  12. The risk city cities countering climate change : emerging planning theories and practices around the world

    Jabareen, Yosef


    Contemporary cities face phenomenal risks, and they face particularly high levels of mounting social and environmental risks, including social polarization, urban conflicts, riots, terror, and climate change threats. This book suggests that climate change and its resulting uncertainties challenge the concepts, procedures, and scope of conventional approaches to planning, creating a need to rethink and revise current planning methods. Therefore, this book suggests a paradigm shift in our thinking, interrogation, and planning of our cities. Based on the contemporary conditions of risk at cities

  13. The Farm, the City and the Emergence of Social Security

    Caucutt, Elizabeth; Cooley, Thomas F; Guner, Nezih


    During the period from 1880 to 1950 publicly managed retirement security programs became an important part of the social fabric in most advanced economies. In this paper we study the social, demographic and economic origins of social security. We describe a model economy in which demographics, technology, and social security are linked together. We study an economy with two locations (sectors), the farm (agricultural) and the city (industrial). The decision to migrate from rural to urban loca...

  14. The impact of a temporary ice-rink on an emergency department service.

    Clarke, Heather J


    BACKGROUND: A temporary ice-rink opened close to Cork city for 6 weeks from 30 November 2003. During this time, a number of patients presented to the local emergency departments with ice-skating-related injuries. We documented these injuries. METHODS: All patients presenting to emergency departments in Cork city with ice-skating-related complaints were included. Information on age and sex, mechanism of injury, diagnosis, follow-up\\/disposition and ambulance service utilization was recorded. RESULTS: One hundred and twenty-five ice-rink-related attendances were reported at Cork emergency departments, representing 1.25% of total attendances. One hundred and twenty-three patients presented with skating-related injuries and two with medical complaints occurring at the ice-rink: 70.8% were female patients and 29.2% were male patients. In the 4-14-year age group, however, 48.5% were girls and 51.5% were boys. Most injuries were directly due to falls; 5.6% were due to skate blades. The commonest site of injury was the upper limb. Fractures and dislocations accounted for 53.9% of injuries, with 20.5% of these requiring orthopaedic admission. Lacerations and digital injuries accounted for 7.1%, with 11% of these required admission for surgery. One minor head injury was reported. 38.1% had soft tissue injuries. Fifteen patients were transported by ambulance. These attendances represented a minimum overall cost of 77,510 euro to the local health service. CONCLUSIONS: A temporary ice-rink had a significant impact on local emergency departments. Currently, there is no specific legislation in Ireland relating to public health and safety in ice-rinks. We recommend consultation with local public bodies before opening such facilities, and appropriate regulation.

  15. Development and Testing of Emergency Department Patient Transfer Communication Measures

    Klingner, Jill; Moscovice, Ira


    Purpose: Communication problems are a major contributing factor to adverse events in hospitals. The contextual environment in small rural hospitals increases the importance of emergency department (ED) patient transfer communication quality. This study addresses the communication problems through the development and testing of ED quality…

  16. Low compliance with a validated system for emergency department triage

    Christensen, Dorthea; Jensen, Nanna Martin; Maaløe, Rikke; Rudolph, Søren Steemann; Belhage, Bo; Perrild, Hans Jørgen Duckert


    Bispebjerg Hospital has introduced a triage system at the Emergency Department (ED) based on "primary criteria" and a physiological scoring system named the Bispebjerg Early Warning Score (BEWS). A BEWS is calculated on the basis of five vital signs which are accessible bedside. Patients who have a...

  17. Aftercare, Emergency Department Visits, and Readmission in Adolescents

    Carlisle, Corine E.; Mamdani, Muhammad; Schachar, Russell; To, Teresa


    Objective: U.S. and Canadian data demonstrate decreasing inpatient days, increasing nonurgent emergency department (ED) visits, and short supply of child psychiatrists. Our study aims to determine whether aftercare reduces ED visits and/or readmission in adolescents with first psychiatric hospitalization. Method: We conducted a population-based…

  18. Evaluation of Head Trauma Cases in the Emergency Department

    Alim Cokuk


    Full Text Available Aim: In this study, we aimed to determine the epidemiological characteristics, morbidity and mortality rates of patients admitted to the emergency department with head trauma. Material and Methods: In this study, ambulatory and hospitalized patients over the age of 18 brought to the Emergency Department because of head trauma between 01.12.2009 - 31.12.2010 were analyzed retrospectively. Patient data were recorded to standard data entry form. SPSS 17.0 package program was used for statistical analysis of data. The statistical significance level of all tests was p <0.05. Results: 5200 patients were included in this study. The average age of the patients was 39.97 ± 16.66 years. 4682'si patients (90 % were discharged from the emergency department. The most common reason for admission to the emergency department was falls (41.81 % in the discharged patients. 518 (10 % patients were hospitalized. Gender of these patients was 110 female (21:24% and 408 male (78.76%. 256 patients (48.35% were injured as a result of a traffic accident. 201(38.8% of the cerebral CT were reported as normal and 89 (17.2% of the cerebral CT were reported as traumatic subarachnoid hemorrhage (SAH in hospitalized patients. The fracture of lumbar spine (12 % was detected as an additional pathological disease in patients. 75 patients hospitalized because of head trauma (14.5% had died (1.44 % of all patients. Cervical spine fracture was the most common (14 patients, 18.68 % additional pathology in patients who died. Thoracic trauma was detected as the second most common (13 patients, 17.33 % additional pathology. Conclusion: Most of the patients admitted to the emergency department with head injury had a minor trauma. Patients can be discharged from the emergency department after a thorough physical examination and simple medical intervention. Most of the head injury patients admitted to hospital were male. The most common reason of the patients with head injury admitted to

  19. Ambient ozone concentration and emergency department visits for panic attacks.

    Cho, Jaelim; Choi, Yoon Jung; Sohn, Jungwoo; Suh, Mina; Cho, Seong-Kyung; Ha, Kyoung Hwa; Kim, Changsoo; Shin, Dong Chun


    The effect of ambient air pollution on panic disorder in the general population has not yet been thoroughly elucidated, although the occurrence of panic disorder in workers exposed to organic solvents has been reported previously. We investigated the association of ambient air pollution with the risk of panic attack-related emergency department visits. Using health insurance claims, we collected data from emergency department visits for panic attacks in Seoul, Republic of Korea (2005-2009). Daily air pollutant concentrations were obtained using automatic monitoring system data. We conducted a time-series study using a generalized additive model with Poisson distribution, which included spline variables (date of visit, daily mean temperature, and relative humidity) and parametric variables (daily mean air pollutant concentration, national holiday, and day of the week). In addition to single lag models (lag1 to lag3), cumulative lag models (lag0-1 to lag0-3) were constructed using moving-average concentrations on the days leading up to the visit. The risk was expressed as relative risk (RR) per one standard deviation of each air pollutant and its 95% confidence interval (95% CI). A total of 2320 emergency department visits for panic attacks were observed during the study period. The adjusted RR of panic attack-related emergency department visits was 1.051 (95% CI, 1.014-1.090) for same-day exposure to ozone. In cumulative models, adjusted RRs were 1.068 (1.029-1.107) in lag0-2 and 1.074 (1.035-1.114) in lag0-3. The ambient ozone concentration was significantly associated with emergency department visits for panic attacks. PMID:25669697

  20. Urban branding strategies and the emerging Arab cityscape : the image of the Gulf city

    Helmy, Mona


    Since 1970, oil has given the Arab Gulf cities the opportunity to break regional and international records in urban development and economic growth, experiencing dramatic changes in the political, economic and socio-cultural domains, and especially in architecture and urbanism. The development of oil urbanization was shaped by the different practices of "Urban Branding" and city marketing processes. More important, "Urban branding" presents the duality of the emerging cityscape, in which the ...

  1. Spatial cognitive dissonance and sociospatial emergence in a self-organizing city

    Portugali, J.; I Benenson; I Omer


    By conceiving the city as a self-organizing system, we highlight and examine three interrelated phenomena of residential sociospatial segregation in a city: the gap which exists between intentions, preferences, and motives, on the one hand, and actual spatial behavior, on the other; the existence and role of local regions of instability within an otherwise stable urban system; and the conjunction between these two phenomena and the processes related to the emergence of new sociospatial entiti...

  2. Google Flu Trends Spatial Variability Validated Against Emergency Department Influenza-Related Visits

    Jalalpour, Mehdi; Levin, Scott; Washington, Raynard E; Pines, Jesse M; Rothman, Richard E; Dugas, Andrea Freyer


    Background Influenza is a deadly and costly public health problem. Variations in its seasonal patterns cause dangerous surges in emergency department (ED) patient volume. Google Flu Trends (GFT) can provide faster influenza surveillance information than traditional CDC methods, potentially leading to improved public health preparedness. GFT has been found to correlate well with reported influenza and to improve influenza prediction models. However, previous validation studies have focused on isolated clinical locations. Objective The purpose of the study was to measure GFT surveillance effectiveness by correlating GFT with influenza-related ED visits in 19 US cities across seven influenza seasons, and to explore which city characteristics lead to better or worse GFT effectiveness. Methods Using Healthcare Cost and Utilization Project data, we collected weekly counts of ED visits for all patients with diagnosis (International Statistical Classification of Diseases 9) codes for influenza-related visits from 2005-2011 in 19 different US cities. We measured the correlation between weekly volume of GFT searches and influenza-related ED visits (ie, GFT ED surveillance effectiveness) per city. We evaluated the relationship between 15 publically available city indicators (11 sociodemographic, two health care utilization, and two climate) and GFT surveillance effectiveness using univariate linear regression. Results Correlation between city-level GFT and influenza-related ED visits had a median of .84, ranging from .67 to .93 across 19 cities. Temporal variability was observed, with median correlation ranging from .78 in 2009 to .94 in 2005. City indicators significantly associated (P<.10) with improved GFT surveillance include higher proportion of female population, higher proportion with Medicare coverage, higher ED visits per capita, and lower socioeconomic status. Conclusions GFT is strongly correlated with ED influenza-related visits at the city level, but unexplained

  3. Carotid artery blowout producing massive hematemesis in the emergency department

    Harrison K Borno; Richard J Menendez; John C Chaloupka; Michael T Dalley; David A Farcy


    Carotid blowout syndrome (CBS) is a rare and fatal complication which arises from patients who have been treated for head and neck cancer. The incidence of CBS is rare and not commonly seen by emergency physicians. We review a case of a 68-year-old woman with a history of laryngectomy and chemo-radiation therapy presenting with massive oral bleeding and hypotension. Her course and treatments are highlighted, literature referring to CBS are described and we reintroduce the approach of managing such a patient in the emergency department.

  4. Temporal patterns of emergency calls of a metropolitan city in China

    Wang, Wenjun; Yuan, Ning; Pan, Lin; Jiao, Pengfei; Dai, Weidi; Xue, Guixiang; Liu, Dong


    Quantitative understanding of human communication behavior, one of the fundamental human activities, is of great value in many practical problems, ranging from urban planning to emergency management. Most of the recent studies have focused on human communication under normal situations. Here, we study the temporal patterns of emergency calls, which is a special kind of human communication activity under emergency circumstances, by analyzing a dataset of emergency call records that collected from a metropolitan city in China during a five year period. We find that most individuals rarely make emergency calls. The distribution of inter-call durations decays as double power law along with an exponential tail. We also discover that, comparing with the normal communication activities, the activity of calling the emergency number shows more significant characteristics of burstiness and memory. We further demonstrate that the behavior of calling the emergency number when people encounter extreme events could be explained by an event-driven memory process.

  5. Clustering Emergency Department patients - an assessment of group normality.

    Schmidt, Thomas; Hallam, John; Lassen, Annmarie; Wiil, Uffe Kock


    This paper presents an investigation into clustering of vital signs from Emergency Department patients with an intention of uncovering distinct thresholds for groups of patients. Emergency Department clinicians have to deal with an enormous spectrum of symptoms and diseases. The variety in patients is a cause for false alarms which greatly burden clinicians. Better targeted alarm thresholds may mitigate the risk of alarm fatigue. The study is based on vital signs from a prospective cohort study at a Danish Hospital coupled with health registry data, and utilizes k-means clustering and novel evaluation metrics for cluster assessment. All combinations of 5 key vital signs are clustered in a range from 2..20. We evaluate the clustering of respiration and arterial peripheral oxygen saturation for k=7. The study fails to identify distinct groups, but does uncover relevant traits and contribute with an evaluation strategy for further studies. PMID:26737861

  6. Why Do Patients Return to the Emergency Department?

    Proud, Matthew E; Howard, Patricia Kunz


    Review of recent evidence with translation to practice for the advanced practice nurse (APN) role is presented using a case study module for "Return Visits to the Emergency Department: The Patient Perspective." This qualitative inquiry performed 60 semistructured interviews of patients who returned to the emergency department within 9 days of their primary visit for the same complaint. Patients most often returned because of concerns that their initial visit did not adequately address their complaint, and they needed assurance from providers that their clinical condition was not a serious health concern. Patients also expressed a lack of contact with a provider between the 2 visits either to answer questions or to address ongoing concerns. This study highlights the important role of the APN in providing quality care, reassurance, and communication related to follow-up care. PMID:27139129

  7. Medical information system in hospital emergency departments' organizational perspectives.

    Dumont, V; Rousseau, A


    The study reported in this article examines the implementation of the same software in 3 emergency departments from different Belgian hospitals. It was experienced and perceived very differently as a failure or a success by the units' staff. The software integrates different functionalities, which can be chosen and customized by some members of the units themselves. We will look at the three processes of implementation to find out different plausible explanation for their 'failure or success'. Our approach is developed through the qualitative methodology of case studies. The translation theory is presented as a renewal way of thinking the perceived 'successful or failed' implementation of a new information system and a guide for new project in emergency department. PMID:15058415

  8. Modeling and analysis of triage nurse ordering in emergency departments

    Ghanes, Karim; Jouini, Oualid; Wargon, Mathias; Jemai, Zied


    International audience Emergency departments are facing a worldwide problem that affects their performance, namely Overcrowding. Triage Nurse Ordering appears to be a promising approach in addition to be cost effective. This paper proposes a process-based triage nurse ordering model and assesses its efficiency on the ED performance through simulation while considering the length of stay as the key indicator. The study examines the impact of triage nurse ability, system load and triage time...

  9. Improving information access with an emergency department system.

    Travers, D.; Parham, T.


    An emergency department (ED) clinical system was developed by in-house personnel, with ED physician, nursing, registration and clerical staff input. The utilization of existing hardware and customization of the hospital's mainframe hospital information system (HIS) facilitated the implementation of a cost-effective system that meets the information access needs of a busy, state-of-the-art academic ED. The transition to automation of the ED was facilitated through the use of a comprehensive tr...

  10. Load Balancing at Emergency Departments using ‘Crowdinforming’

    Friesen, Marcia R.; Strome, Trevor; Mukhi, Shamir; McLoed, Robert


    Background: Emergency Department (ED) overcrowding is an important healthcare issue facing increasing public and regulatory scrutiny in Canada and around the world. Many approaches to alleviate excessive waiting times and lengths of stay have been studied. In theory, optimal ED patient flow may be assisted via balancing patient loads between EDs (in essence spreading patients more evenly throughout this system). This investigation utilizes simulation to explore “Crowdinforming” as a basis for...

  11. Emergency Department Use among HIV-Infected Released Jail Detainees

    Boyd, Andrew T.; Song, Dahye L.; Meyer, Jaimie P.; Altice, Frederick L.


    Release from short-term jail detention is highly destabilizing, associated with relapse to substance use, recidivism, and disrupted health care continuity. Little is known about emergency department (ED) use, potentially a surrogate for medical, psychiatric, or social instability, by people living with HIV/AIDS (PLWHA) leaving jails. All ED visits were reviewed from medical records for a cohort of 109 PLHWA in the year following release from county jail in Connecticut, between January 1, 2008...

  12. The use of triage in Danish Emergency Departments

    Østergaard Lindberg, Søren; la Cour, Jeppe Lerche; Folkestad, Lars;


    The emergency departments (EDs) handle approximately 1,000,000 contacts annually. Danish health care is undergoing reorganization that involves the creation of fewer and larger EDs to handle these contacts. There is therefore a need to prioritize the use of resources to optimize treatment. We thus...... wanted to investigate if Danish EDs are using triage systems and, if so, which systems they are using....

  13. The use of triage in Danish emergency departments

    Lindberg, Søren Østergaard; Lerche la Cour, Jeppe; Folkestad, Lars;


    The emergency departments (EDs) handle approximately 1,000,000 contacts annually. Danish health care is undergoing reorganization that involves the creation of fewer and larger EDs to handle these contacts. There is therefore a need to prioritize the use of resources to optimize treatment. We thus...... wanted to investigate if Danish EDs are using triage systems and, if so, which systems they are using....

  14. Environment, Self-Situation Awareness and Performance in Emergency Department

    Herlina A.Hamzah; M.Alimin Maidin; Indrianty Sudirman; Pasinringi, Syahrir A


    The aim of this research was to analyzing correlation among physical environment and human environment to self-situation awareness and performance both directly and indirectly for medical staff in Emergency Department The research method used was a multi-stage analysis. Descriptive data analyzed by using SPSS program version 16, then correlation data among variables analyzed by using Covariance Based Structural Equation Modelling (VBSEM) AMOS technique to get fit model with actual research d...

  15. Timeliness of Emergency Department Diagnoses for Syndromic Surveillance

    Travers, Debbie; Barnett, Clifton; Ising, Amy; Waller, Anna


    Emergency Department (ED) data are key components of syndromic surveillance systems. While diagnosis data are widely available in electronic form from EDs and often used as a source of clinical data for syndromic surveillance, our previous survey of North Carolina EDs found that the data were not available in a timely manner for early detection. The purpose of this study was to measure the time of availability of participating EDs’ diagnosis data in a state-based syndromic surveillance system...

  16. Use of an accident and emergency department by hospital staff.

    Mann, C J


    OBJECTIVE: To assess the number of attendances by hospital staff at an accident and emergency (A&E) department, and reasons for their attendance. METHODS: A&E attendances by hospital staff were studied for a 12 month period. Comparison was made with attendances by non-hospital staff in full or part time employment. Differences between the observed and expected numbers of attendances were analysed using chi 2 analysis. RESULTS: 560 staff attendances were recorded out of 78,103 total attendance...

  17. Improving Emergency Department Door to Doctor Time and Process Reliability

    El Sayed, Mazen J.; El-Eid, Ghada R.; Saliba, Miriam; Jabbour, Rima; Hitti, Eveline A.


    Abstract The aim of this study is to determine the effectiveness of using lean management methods on improving emergency department door to doctor times at a tertiary care hospital. We performed a before and after study at an academic urban emergency department with 49,000 annual visits after implementing a series of lean driven interventions over a 20 month period. The primary outcome was mean door to doctor time and the secondary outcome was length of stay of both admitted and discharged patients. A convenience sample from the preintervention phase (February 2012) was compared to another from the postintervention phase (mid-October to mid-November 2013). Individual control charts were used to assess process stability. Postintervention there was a statistically significant decrease in the mean door to doctor time measure (40.0 minutes ± 53.44 vs 25.3 minutes ± 15.93 P < 0.001). The postintervention process was more statistically in control with a drop in the upper control limits from 148.8 to 72.9 minutes. Length of stay of both admitted and discharged patients dropped from 2.6 to 2.0 hours and 9.0 to 5.5 hours, respectively. All other variables including emergency department visit daily volumes, hospital occupancy, and left without being seen rates were comparable. Using lean change management techniques can be effective in reducing door to doctor time in the Emergency Department and improving process reliability. PMID:26496278

  18. Emergency Department of a Rural Hospital in Ecuador

    Tara Johnson, MD, MPH; David Gaus, MD, MPH/TM; Diego Herrera, MD


    Introduction: There is a paucity of data studying patients and complaints presenting to emergency departments (EDs) in low- and middle-income countries. The town of Pedro Vicente Maldonado (PVM) is located in the northwestern highlands of Ecuador. Hospital PVM (HPVM) is a rural teaching hospital providing family medicine residency training. These physicians provide around-the-clock acute medical care in HPVM’s ED. This study provides a first look at a functioning ED in rural Latin America by ...

  19. Using LEAN to improve a segment of emergency department flow.

    Vose, Courtney; Reichard, Christine; Pool, Susan; Snyder, Megan; Burmeister, David


    Emergency department (ED) overcrowding is an organizational concern. This article describes how Toyota LEAN methods were used as a performance improvement framework to address ED overcrowding. This initiative also impacted "bolus of patients" or "batching" concerns, which occur when inpatient units receive an influx of patients from EDs and other areas at the same time. In addition to decreased incidence of overcrowding, the organization realized increased interprofessional collaboration. PMID:25340919

  20. Successful Introduction of an Emergency Department Electronic Heal th Record

    Douglas A. Propp


    Full Text Available Our emergency department had always relied on a paper-based infrastructure. Our goal was to convert to a paperless, efficient, easily accessible, technologically advanced system to support optimal care. We outline our sequential successful transformation, and describe the resistance, costs, incentives and benefits of the change. Critical factors contributing to the significant change included physician leadership, training and the rate of the endorsed change. We outline various tactics, tools, challenges and unintended benefits and problems.

  1. Assessment and management of bullied children in the emergency department.

    Waseem, Muhammad; Ryan, Mary; Foster, Carla Boutin; Peterson, Janey


    Bullying is an important public health issue in the United States. Up to 30% of children report exposure to such victimization. Not only does it hurt bully victim, but it also negatively impacts the bully, other children, parents, school staff, and health care providers. Because bullying often presents with accompanying serious emotional and behavioral symptoms, there has been an increase in psychiatric referrals to emergency departments. Emergency physicians may be the first responders in the health care system for bullying episodes. Victims of bullying may present with nonspecific symptoms and be reluctant to disclose being victimized, contributing to the underdiagnosis and underreporting of bully victimization. Emergency physicians therefore need to have heightened awareness of physical and psychosocial symptoms related to bullying. They should rapidly screen for bullying, assess for injuries and acute psychiatric issues that require immediate attention, and provide appropriate referrals such as psychiatry and social services. This review defines bullying, examines its presentations and epidemiology, and provides recommendations for the assessment and evaluation of victims of bullying in the emergency department. PMID:23462401

  2. Emergency Department and Older Adult Motor Vehicle Collisions

    Lotfipour, Shahram


    Full Text Available In 2009, the Center for Disease Control and Prevention reported there were 33 million licensed drivers 65 years and older in the U.S. This represents a 23 percent increase from 1999, number that is predicted to double by 2030. Although, motor vehicle collisions (MVC-related to emergency department (ED visits for older adults are lower per capita than for younger adults, the older-adults MVCs require more resources, such as additional diagnostic imaging and increased odds of admission. Addressing the specific needs of older-adults could lead to better outcomes yet not enough research currently exists. It is important to continue training emergency physicians to treat the increasing older-patient population, but its also imperative we increase our injury prevention and screening methodology. We review research findings from the article: Emergency Department Visits by Older Adults for Motor Vehicle Collisions: A Five-year national study, with commentary on current recommendation and policies for the growing older-adult driving population. [West J Emerg Med.2013;14(6:582–584.

  3. Emergency team calls for critically ill non-trauma patients in the emergency department

    Jensen, Søren Marker; Do, Hien Quoc; Rasmussen, Søren W.;


    BACKGROUND: Handling critically ill patients is a complex task for Emergency Department (ED) personnel. Initial treatment is of major importance and requires adequately experienced ED doctors to initiate and decide for the right medical or surgical treatment. Our aim was, with regard to clinical...... presentation, management and mortality to describe adult non-trauma patients that upon ED arrival elicited emergency team calls. METHODS: An observational study of adult patients (≥ 18 years) admitted to a regional ED with conditions that elicited acute team activation and additional emergency team...... consultation calls for non-ED specialist physicians. Emergency team calls were two-tiered with 'orange' and 'red' calls. Additionally, intensive care unit (ICU) admission charts were reviewed to identify the total number of adult non-trauma and non-cardiac arrest patients admitted to the ICU from the ED during...

  4. Seasonal variations of schizophrenic patients in emergency departments in Sofia, Bulgaria

    Zornitsa Spasova


    Full Text Available Aim: The purpose of this study was to reveal the seasonal distribution of emergency department visits of schizophrenic patients in Sofia, Bulgaria. Methods: We collected daily data for visits of patients with schizophrenia, schizotypal and delusional disorders in the emergency center of the regional dispenser for mental disorders in the city of Sofia for the period 1998-2003. The total number of emergency visits was 5723 (mean daily visits: 5.04±2.4. T-test was used to compare the monthly and seasonal distribution of visits. Results: The season with the highest levels of emergency visits was summer, and the lowest levels were observed in winter (P<0.0001. Spring and autumn had intermediate values close to the mean value, and significantly differentiated from winter values. The month with the highest admission rates was September, followed by May and the three summer’s months. The lowest levels were observed in December, October and January, with statistically significant differences observed between the values of all the three months. Differences between July values compared with December and October values were significant, but not with January values. Conclusion: The study showed significant seasonal and monthly differences in emergency schizophrenics’ visits. The data confirm the outcome of similar studies conducted in countries with temperate climate in the Northern Hemisphere. These results could prove useful for psychiatrists, public health specialists, and governmental authorities dealing with team planning and prevention programs in the field of psychiatry.

  5. Characteristics of frequent emergency department presenters to an Australian emergency medicine network

    Markham Donna


    Full Text Available Abstract Background To describe the characteristics of emergency department (ED patients defined as frequent presenters (FP presenting to an Australian emergency department network and compare these with a cohort of non-frequent presenters (NFP. Method A retrospective chart review utilising an electronic emergency medicine patient medical record database was performed on patients presenting to Southern Health EDs from March 2009 to March 2010. Non-frequent presenters were defined as patients presenting less than 5 times and frequent presenters as presenting 8 or more times in the study period. Characteristics of both groups were described and compared. Results During the 12-month study period there were 540 FP patients with 4549 admissions and 73,089 NFP patients with 100,943 admissions. FP patients were slightly older with a significant increase in frequency of patients between the ages of 70 to 79 years and they were more likely to be divorced or separated than NFP patients. Frequent presenters to the emergency department were more likely to utilise the ambulance service to arrive at the hospital, or in the custody of police than NFP patients. FPs were more likely to be admitted to hospital, more likely to have an admission to a mental health bed than NFP patients and more likely to self-discharge from the emergency department while waiting for care. Conclusions There are major implications for the utilisation of limited ED resources by frequent presenters. By further understanding the characteristics of FP we may be able to address the specific health care needs of this population in more efficient and cost effective ways. Further research analysing the effectiveness of targeted multidisciplinary interventions aiming to reduce the frequency of ED attendances may be warranted.

  6. Experience of morning reports in the emergency department.

    Sabbagh, C; Chaddad, M; El Rassy, E


    Morning report in the emergency medicine departments is an emerging teaching modality in the medicine curriculum. Our institution, Hotel-Dieu de France hospital, a multidisciplinary tertiary care university hospital affiliated to the Saint Joseph University of Medical Sciences, is the only hospital in Middle East to hold morning reports in the emergency department (ED). We evaluate the usefulness of the morning report as a pedagogic tool as it assesses the content, quality of the discussions, professionalism, leadership, participation and duration of the morning report. The particularity of this paper is that it takes into consideration the interns' input often under-recognised in the studies. An anonymous questionnaire was diffused to the residents and interns that rotated in the ED during the previous year. It consisted of seven multiple-choice questions to evaluate the quality of the presentations, targeted discussions, ethics and professionalism, evidence-based medicine, clinical reasoning, relation of cases to discussions and implication of the ED physician. Overall, of the 63 patients who answered the survey, 65.1% were satisfied by the content. The majority considered the quality of the discussions acceptable and the leadership and participation satisfactory, professionalism was judged poor. Both residents and interns were satisfied of the teaching point of the morning reports. The only fail back observed was professionalism and pathophysiological discussions that require to be added to the sessions, whereas clinical management, teaching points, leadership and time management were completely satisfactory. PMID:26134698

  7. Emergency Medicine in Zanzibar: the Effect of System Changes in the Emergency Department

    Thomassen, Oyvind; Mann, Clifford; Mbwana, Juma Salum; Brattebo, Guttorm


    Background Mnazi Mmoja Hospital is a tertiary hospital in Zanzibar serving a population of 1.2 million. The emergency department was overcrowded and understaffed and the hospital management initiated a quality improvement project. The aim of this article is to describe the approach, methods and main results of this quality improvement process. Methods The Plan-Do-Study-Act (PDSA) method was used in a five-circle process. In addition, a consensus-based approach was performed to identify areas ...

  8. Intracardiac therapy following emergency thoracotomy in the accident and emergency department: an experimental model.

    Moulton, C; Pennycook, A; Crawford, R


    For a select group of patients with penetrating chest trauma, immediate thoracotomy in the accident and emergency department offers the only chance of survival. Foley catheters have been used to achieve haemostasis in cardiac wounds but are not widely used for intracardiac fluid and drug administration during resuscitation. In an anatomical model designed to assess this procedure an average flow rate of 275 ml min-1 was achieved. The equipment required is readily available and easily assembled.

  9. Administration of medicines by emergency nurse practitioners according to protocols in an accident and emergency department.

    Marshall, J.; Edwards, C.; Lambert, M.


    OBJECTIVE: To present the legal and professional issues related to nurse administration of drugs according to protocols, and describe the implementation and initial audit findings of such a scheme. SETTING: Accident and emergency (A&E) department of a district general hospital. METHODS: Analysis of legal and professional opinion. Protocols acceptable to the medical, nursing, and pharmacy professions were developed across a wide range of drugs appropriate for administration by accident and eme...

  10. Stress in emergency departments: experiences of nurses and doctors.

    Healy, Sonya


    The effects of stressful incidents on emergency department (ED) staff can be profound. Witnessing aggression, violence or the death of patients, or participating in resuscitation, can be emotionally and physically demanding. Despite the frequency of these events, ED staff do not become immune to the stress they cause, and are often ill prepared and under supported to cope with them. This article reports on a study of nurses\\' and doctors\\' attitudes to, and experiences of, workplace stress in three EDs in Ireland, and offers some suggestions on how stress among ED staff can be reduced.

  11. Reducing violence and aggression in the emergency department.

    Powley, Denise


    Emergency department (ED) staff, particularly nursing students and inexperienced nurses, are at risk of violence and aggression from patients. However, by reflecting on violent incidents, nurses can gain new knowledge, improve their practice and prepare themselves for similar incidents. This article refers to the Gibbs reflective cycle to analyse a violent incident involving a patient with mental health and alcohol-dependence problems that occurred in the author's ED. It also identifies strategies for nurses to pre-empt and defuse violent situations. PMID:23901870

  12. Is Geriatric Care Associated with Less Emergency Department Use?


    This study found that community-dwelling individuals and nursing home residents treated by a geriatrician were less likely to use the emergency department (ED) than individuals treated by other providers. Compared with those with no geriatric care, the predicted probability of ED use in one month was 11.3 percent lower for community-dwelling individuals who had one or more office, home, or nursing home visits to a geriatrician in the previous six-month period. Results for nursing home residen...

  13. Rethinking social power and the right to the city amidst China’s emerging urbanism

    Junxi Qian; Shenjing He


    In this paper we engage with a theoretical reflection on the concept of the right to the city amidst China’s emerging urbanism. In particular, we conceptualize the right to the city as embedded within the complex geometries of power relations throughout the production process of China’s urban modernity; and in this sense assert the right to urban life is inevitably entangled with a social project of altering dominant power structures. We suggest that the rights of three social groups—namely s...

  14. Emergency Department Visits by Persons Aged 65 and Over: United States, 2009-2010

    ... Order from the National Technical Information Service NCHS Emergency Department Visits by Persons Aged 65 and Over: ... 2009–2010, a total of 19.6 million emergency department (ED) visits in the United States were ...

  15. Suicide Assessment in Hospital Emergency Departments: Implications for Patient Satisfaction and Compliance

    Mitchell, Ann M; Garand, Linda; Dean, Diane; Panzak, George; Taylor, Melissa


    Suicide is a complex, multidimensional event with a host of contributing factors. Suicidal emergencies are among other behavioral and psychiatric emergencies that provide the basis for emergency department visits. Therefore, emergency departments are ideal clinical environments for the assessment of suicidal patients. A case example from an emergency department visit is provided as a basis of discussion as we describe subpopulations at high risk for suicide and review critical assessment para...

  16. Availability of ambulance patient care reports in the emergency department

    Shelton, Dominick; Sinclair, Paul


    Clinical handovers of patient care among healthcare professionals is vulnerable to the loss of important clinical information. A verbal report is typically provided by paramedics and documented by emergency department (ED) triage nurses. Paramedics subsequently complete a patient care report which is submitted electronically. This emergency medical system (EMS) patient care report often contains details of paramedic assessment and management that is not all captured in the nursing triage note. EMS patient care reports are often unavailable for review by emergency physicians and nurses. Two processes occur in the distribution of EMS patient care reports. The first is an external process to the ED that is influenced by the prehospital emergency medical system and results in the report being faxed to the ED. The second process is internal to the ED that requires clerical staff to distribute the fax report to accompany patient charts. A baseline audit measured the percentage of EMS patient care reports that were available to emergency physicians at the time of initial patient assessments and showed a wide variation in the availability of EMS reports. Also measured were the time intervals from patient transfer from EMS to ED stretcher until the EMS report was received by fax (external process measure) and the time from receiving the EMS fax report until distribution to patient chart (internal process measure). These baseline measures showed a wide variation in the time it takes to receive the EMS reports by fax and to distribute reports. Improvement strategies consisted of: 1. Educating ED clerical staff about the importance of EMS reports 2. Implementing a new process to minimize ED clerical staff handling of EMS reports for nonactive ED patients 3. Elimination of the automatic retrieval of old hospital charts and their distribution for ED patients 4. Introduction of an electronic dashboard for patients arriving by ambulance to facilitate more efficient distribution of

  17. Availability of ambulance patient care reports in the emergency department.

    Shelton, Dominick; Sinclair, Paul


    Clinical handovers of patient care among healthcare professionals is vulnerable to the loss of important clinical information. A verbal report is typically provided by paramedics and documented by emergency department (ED) triage nurses. Paramedics subsequently complete a patient care report which is submitted electronically. This emergency medical system (EMS) patient care report often contains details of paramedic assessment and management that is not all captured in the nursing triage note. EMS patient care reports are often unavailable for review by emergency physicians and nurses. Two processes occur in the distribution of EMS patient care reports. The first is an external process to the ED that is influenced by the prehospital emergency medical system and results in the report being faxed to the ED. The second process is internal to the ED that requires clerical staff to distribute the fax report to accompany patient charts. A baseline audit measured the percentage of EMS patient care reports that were available to emergency physicians at the time of initial patient assessments and showed a wide variation in the availability of EMS reports. Also measured were the time intervals from patient transfer from EMS to ED stretcher until the EMS report was received by fax (external process measure) and the time from receiving the EMS fax report until distribution to patient chart (internal process measure). These baseline measures showed a wide variation in the time it takes to receive the EMS reports by fax and to distribute reports. Improvement strategies consisted of: 1. Educating ED clerical staff about the importance of EMS reports 2. Implementing a new process to minimize ED clerical staff handling of EMS reports for nonactive ED patients 3. Elimination of the automatic retrieval of old hospital charts and their distribution for ED patients 4. Introduction of an electronic dashboard for patients arriving by ambulance to facilitate more efficient distribution of

  18. Scombrotoxinism: Protracted Illness following Misdiagnosis in the Emergency Department

    Ghan-Shyam Lohiya


    Full Text Available Background. Scombrotoxinism is an acute toxin-induced illness caused primarily by bacterial synthesis of histamine in decomposed fish. Case Report. Immediately after taking 2-3 bites of cooked salmon, a clerical worker developed oral burning, urticaria, and asthma. In the emergency department, she was diagnosed with “allergies”; scombrotoxinism was never considered. She then developed wide-ranging symptoms (e.g., chronic fatigue, asthma, anxiety, multiple chemical sensitivity, and paresthesiae and saw many specialists (in pulmonology, otorhinolaryngology, allergy, toxicology, neurology, psychology, and immunology. During the next 500+ days, she had extensive testing (allergy screens, brain MRI, electroencephalogram, electromyogram, nerve conduction velocity, heavy metal screen, and blood chemistry with essentially normal results. She filed a workers’ compensation claim since this injury occurred following a business meal. She was evaluated by a Qualified Medical Evaluator (GL on day 504, who diagnosed scombrotoxinism. Comment. Scombrotoxinism should be considered in all patients presenting to the emergency department with “oral burning” or allergy symptoms following “fish consumption.” Initial attention to such history would have led to a correct diagnosis and averted this patient’s extended illness. Specialist referrals and tests should be ordered only if clinically indicated and not for diagnostic fishing expedition. Meticulous history is crucial in resolving clinical dilemmas.

  19. Early detection of abnormal patient arrivals at hospital emergency department

    Harrou, Fouzi


    Overcrowding is one of the most crucial issues confronting emergency departments (EDs) throughout the world. Efficient management of patient flows for ED services has become an urgent issue for most hospital administrations. Handling and detection of abnormal situations is a key challenge in EDs. Thus, the early detection of abnormal patient arrivals at EDs plays an important role from the point of view of improving management of the inspected EDs. It allows the EDs mangers to prepare for high levels of care activities, to optimize the internal resources and to predict enough hospitalization capacity in downstream care services. This study reports the development of statistical method for enhancing detection of abnormal daily patient arrivals at the ED, which able to provide early alert mechanisms in the event of abnormal situations. The autoregressive moving average (ARMA)-based exponentially weighted moving average (EWMA) anomaly detection scheme proposed was successfully applied to the practical data collected from the database of the pediatric emergency department (PED) at Lille regional hospital center, France.

  20. Improving the Quality of Imaging in the Emergency Department.

    Blackmore, C Craig; Castro, Alexandra


    Imaging is critical for the care of emergency department (ED) patients. However, much of the imaging performed for acute care today is overutilization, creating substantial cost without significant benefit. Further, the value of imaging is not easily defined, as imaging only affects outcomes indirectly, through interaction with treatment. Improving the quality, including appropriateness, of emergency imaging requires understanding of how imaging contributes to patient care. The six-tier efficacy hierarchy of Fryback and Thornbury enables understanding of the value of imaging on multiple levels, ranging from technical efficacy to medical decision-making and higher-level patient and societal outcomes. The imaging efficacy hierarchy also allows definition of imaging quality through the Institute of Medicine (IOM)'s quality domains of safety, effectiveness, patient-centeredness, timeliness, efficiency, and equitability and provides a foundation for quality improvement. In this article, the authors elucidate the Fryback and Thornbury framework to define the value of imaging in the ED and to relate emergency imaging to the IOM quality domains. PMID:26568040

  1. Psychiatric patients turnaround times in the emergency department

    Ohlmeier Martin


    Full Text Available Abstract Background To analyze the turnaround times of psychiatric patients within the Emergency Department (ED from registration to discharge or hospitalization in a University Hospital in 2002. Methods Data from a one-year period of psychiatric admissions to the emergency service at a University Hospital were monitored and analyzed focused on turnaround times within the ED. Information on patients variables such as age, sex, diagnosis, consultations and diagnostic procedures were extracted from the patients' charts. Results From 34.058 patients seen in the ED in 2002, 2632 patients were examined by psychiatrists on duty. Mean turnaround time in the ED was 123 (SD 97 minutes (median 95. Patients to be hospitalized on a psychiatric ward stayed shorter within the ED, patients who later were admitted to another faculty, were treated longer in the ED. Patients with cognitive or substance related disorders stayed longer in the ED than patients with other psychiatric diagnoses. The number of diagnostic procedures and consultations increased the treatment time significantly. Conclusion As the number of patients within the examined ED increases every year, the relevant variables responsible for longer or complicated treatments were assessed in order to appropriately change routine procedures without loss of medical standards. Using this basic data, comparisons with the following years and other hospitals will help to define where the benchmark of turnaround times for psychiatric emergency services might be.

  2. Exploring person-centredness in emergency departments: A literature review.

    McConnell, Donna; McCance, Tanya; Melby, Vidar


    Person-centred approaches to care delivery have been increasingly promoted in international policy and strategy, but despite this there is evidence of failings within healthcare systems that negatively impact on the care experience for patients and staff. This paper explores the international literature on person-centredness within emergency departments (EDs). The Person-centred Practice Framework was used as the underpinning theoretical framework. This theory contends that staff must possess certain attributes to manage the care environment appropriately to deliver effective care processes in order to achieve effective person-centred outcomes for patients and staff. An initial search of the literature identified no relevant papers that discussed person-centredness as a concept within EDs. A further search using terms drawn from a definition of person-centredness revealed literature that reflected components of person-centredness. Themes that emerged included medical-technical intervention, a culture of worthiness, managing the patient journey, nurse/doctor relationships, patients' and relatives' experience of care, and ED as a stressful environment. The themes can be mapped onto the Person-centred Practice Framework, suggesting that components of person-centred practice have emerged from studies in a fragmented fashion, without consideration of person-centredness as a whole within an ED context. PMID:26546388

  3. Length of Stay of Pediatric Mental Health Emergency Department Visits in the United States

    Case, Sarah D.; Case, Brady G.; Olfson, Mark; Linakis, James G.; Laska, Eugene M.


    Objective: To compare pediatric mental health emergency department visits to other pediatric emergency department visits, focusing on length of stay. Method: We analyzed data from the National Hospital Ambulatory Medical Care Survey, a nationally representative sample of US emergency department visits from 2001 to 2008, for patients aged less than…

  4. Variable Access to Immediate Bedside Ultrasound in the Emergency Department

    Talley, Brad E


    Full Text Available Objective: Use of bedside emergency department (ED ultrasound has become increasingly important for the clinical practice of emergency medicine (EM. We sought to evaluate differences in the availability of immediate bedside ultrasound based on basic ED characteristics and physician staffing.Methods: We surveyed ED directors in all 351 EDs in Colorado, Georgia, Massachusetts, and Oregon between January and April 2009. We assessed access to bedside ED ultrasound by the question: “Is bedside ultrasound available immediately in the ED?” ED characteristics included location, visit volume, admission rate, percent uninsured, total emergency physician full-time equivalents and proportion of EM board-certified (BC or EM board-eligible (BE physicians. Data analysis used chi-square tests and multivariable logistical regression to compare differences in access to bedside ED ultrasound by ED characteristics and staffing.Results: We received complete responses from 298 (85% EDs. Immediate access to bedside ultrasound was available in 175 (59% EDs. ED characteristics associated with access to bedside ultrasound were: location (39% for rural vs. 71% for urban, P20%] rates, P<0.001; and EM BC/BE physicians (26% for EDs with a low percentage [0-20%] vs.74% for EDs with a high percentage [≥80%], P<0.001.Conclusion: U.S. EDs differ significantly in their access to immediate bedside ultrasound. Smaller, rural EDs and those staffed by fewer EM BC/BE physicians more frequently lacked access to immediate bedside ultrasound in the ED. [West J Emerg Med. 2011;12(1:96-99.

  5. Intelligent Emergency Department: Validation of Sociometers to Study Workload.

    Yu, Denny; Blocker, Renaldo C; Sir, Mustafa Y; Hallbeck, M Susan; Hellmich, Thomas R; Cohen, Tara; Nestler, David M; Pasupathy, Kalyan S


    Sociometers are wearable sensors that continuously measure body movements, interactions, and speech. The purpose of this study is to test sociometers in a smart environment in a live clinical setting, to assess their reliability in capturing and quantifying data. The long-term goal of this work is to create an intelligent emergency department that captures real-time human interactions using sociometers to sense current system dynamics, predict future state, and continuously learn to enable the highest levels of emergency care delivery. Ten actors wore the devices during five simulated scenarios in the emergency care wards at a large non-profit medical institution. For each scenario, actors recited prewritten or structured dialogue while independent variables, e.g., distance, angle, obstructions, speech behavior, were independently controlled. Data streams from the sociometers were compared to gold standard video and audio data captured by two ward and hallway cameras. Sociometers distinguished body movement differences in mean angular velocity between individuals sitting, standing, walking intermittently, and walking continuously. Face-to-face (F2F) interactions were not detected when individuals were offset by 30°, 60°, and 180° angles. Under ideal F2F conditions, interactions were detected 50 % of the time (4/8 actor pairs). Proximity between individuals was detected for 13/15 actor pairs. Devices underestimated the mean duration of speech by 30-44 s, but were effective at distinguishing the dominant speaker. The results inform engineers to refine sociometers and provide health system researchers a tool for quantifying the dynamics and behaviors in complex and unpredictable healthcare environments such as emergency care. PMID:26645317

  6. Data Mining and Visualization of Grid-Based City Emergency System

    XUE Jingsheng; SUN Jizhou; LIU Muxing; ZHANG Xu; HE Hong


    A cluster analyzing algorithm based on grids is introduced in this paper,which is applied to data mining in the city emergency system. In the previous applications, data mining was based on the method of analyzing points and lines, which was not efficient enough in dealing with the geographic information in units of police areas. The proposed algorithm maps an event set stored as a point set to a grid unit set, utilizes the cluster algorithm based on grids to find out all the clusters, and shows the results in the method of visualization. The algorithm performs well when dealing with high dimensional data sets and immense data. It is suitable for the data mining based on geogra-phic information system and is supportive to decision-makings in the city emergency system.

  7. Cities and Systemic Change for Sustainability: Prevailing Epistemologies and an Emerging Research Agenda

    Marc Wolfram; Niki Frantzeskaki


    Cities are key for sustainability and the radical systemic changes required to enable equitable human development within planetary boundaries. Their particular role in this regard has become the subject of an emerging and highly interdisciplinary scientific debate. Drawing on a qualitative literature review, this paper identifies and scrutinizes the principal fields involved, asking for their respective normative orientation, interdisciplinary constitution, theories and methods used, and empi...

  8. Two Years of Frequent Users in an Urban Emergency Department

    Gerard B Martin


    Full Text Available Introduction:The purpose of this study was to determine if differences could be detected in the presentation patterns and admission rates among frequent emergency department users (FEDU of an urban emergency department over a 10-year period.Methods: This was an IRB approved, retrospective review of all patients who presented to the ED 5 or more times for 3 distinct time periods: “year 0” 11/98-10/99, “year 5” 11/03–10/04, and “year 10” 11/08–10/9. FEDU were grouped into those with 5–9, 10–14, 15–19, and ≥ 20 visits per year. Variables analyzed included number of visits, disposition, and insurance status. We performed comparisons using Kolmogorov-Smirnov and chi-square tests. A P < 0.05 was considered significant.Results: We found a a 66% increase in FEDU patients over the decade studied, with a significant increase in both the number of FEDU in each visit frequency category over the 3 time periods (P < 0.0001, as well as the total number of visits by each group of FEDU (P < 0.0001. The proportion of FEDU visits for the 5–9 group resulting in admission increased from 25.9% to 29% from year 0 to year 10 (P < 0.001, but not for the other visit groups. In comparing admission rates between FEDU groups, the admission rate for the 5–9 group was significantly higher than the ≥ 20 group for the year 5 time period (P < 0.001 and the year 10 time period (P < 0.001 and showed a similar trend, but not significant, at year 0 (P = 0.052. The overall hospital admission rate for emergency patients over the same time span remained stable at 22-24%. The overall proportion of uninsured FEDU was stable over the decade studied, while the uninsured rate for the overall ED population for the same time periods increased.Conclusion: The results demonstrate the FEDU population is not a homogeneous group of patients. Increased attention to differences among FEDU groups is necessary in order to plan more effective interventions. [West J Emerg

  9. Resilience skills as emergent phenomena: A study of emergency departments in Brazil and the United States.

    Wachs, Priscila; Saurin, Tarcisio Abreu; Righi, Angela Weber; Wears, Robert Lewis


    Although the use of resilience skills (RSs) by emergency department (ED) front-line staff is ubiquitous, the nature and origin of these skills tend to be taken for granted. This study investigates the research question "where do RSs come from"? Case studies in two EDs were undertaken in order to answer the research question: one in Brazil and the other in the United States. The case studies adopted the same data collection and analysis procedures, involving interviews, questionnaires, observations, and analysis of documents. A model for describing RSs as emergent phenomena is proposed. The model indicates that RSs arise from interactions between: work constraints, hidden curriculum, gaps in standardized operating procedures, organizational support for resilience, and RSs themselves. An instantiation of the model is illustrated by a critical event identified from the American ED. The model allows the identification of leverage points for influencing the development of RSs, instead of leaving their evolution purely to chance. PMID:26972019

  10. The Distributed Use of Electronic Emergency-Department Whiteboards

    Hertzum, Morten


    At emergency departments (EDs), electronic whiteboards are introduced to provide a better overview and to support clinicians in spending more time with patients. Often, the main difference between electronic and dry-erase whiteboards is that electronic whiteboards provide distributed access...... and when they do it is to prepare for seeing and to document having seen a patient, rather than in patient rooms with the patients. Important reasons for the limited distributed use among physicians and nurses appear to be a frequent need and practice of visiting the physical information hub of the ED....... The information hub features a permanent wall-mounted display of the electronic whiteboard and this display, rather than distributed access, is preferred by physicians and nurses....

  11. Difficult airway management from Emergency Department till Intensive Care Unit

    Debasis Pradhan


    Full Text Available We report a case of "can ventilate but can′t intubate" situation which was successfully managed in the Emergency Department and Intensive Care Unit by the use of ProSeal laryngeal mask airway and Frova Intubating Introducer as bridging rescue devices. Use of appropriate technique while strictly following the difficult airway algorithm is the mainstay of airway management in unanticipated difficult airway situations. Although the multiple airway devices were used but each step took not more than 2 min and "don′t struggle, skip to the next step principle" was followed. With the availability of many advanced airway management tools, the intensivists should have a training and experience along with preparedness in order to perform such lifesaving airway managements.

  12. Temporary transvenous pacemaker placement in the Emergency Department.

    Harrigan, Richard A; Chan, Theodore C; Moonblatt, Steven; Vilke, Gary M; Ufberg, Jacob W


    Emergency Department placement of a temporary transvenous cardiac pacemaker offers potential life-saving benefits, as the device can definitively control heart rate, ensure effective myocardial contractility, and provide adequate cardiac output in select circumstances. The procedure begins with establishment of central venous access, usually by a right internal jugular or left subclavian vein approach, although the femoral vein is an acceptable alternative, especially in patients who are more likely to bleed should vascular access become complicated. The indications for the procedure, as well as the equipment needed, are reviewed. Both blind and ECG-guided techniques of insertion are described. Methods of verification of pacemaker placement and function are discussed, as are the early complications of the procedure. PMID:17239740

  13. Injury patterns in children with frequent emergency department visits

    Laursen, B


    OBJECTIVES: To compare injury patterns in children with many and few emergency department (ED) visits in order to reveal the causes for the frequent visits. METHODS: Three cohorts of Danish children (total 579 721 children) were followed for three years when their ages were 0-2, 6-8, and 12-14....... RESULTS: Children with frequent visits had a different injury pattern with 0-46% more superficial injuries and 25-82% more dislocations, sprains, and strains. There was 20-30% fewer fractures and 12% fewer falls from a higher level. 15-51% fewer were admitted. CONCLUSIONS: Children with many ED visits had...... years. Information on all ED visits was obtained from the Danish National Patient Registry. Injury type, place of accident, injury mechanism, admission, and distance to ED were compared between children with frequent ED visits (five or more during the three years) and children with only one visit...

  14. Analysis of a US Department of Energy Emergent Technologies Cohort

    Strader, Cliff; Ellis, Elizabeth; Barrie, Martin D; Tankersley, William; Wallace, Phil


    As a major user of engineered nanoparticles, the U.S. Department of Energy (DOE) uses various methods to monitor the health of emergent technologies workers (ETW) who handle or could potentially be exposed to unbound engineered nanoparticles (UNP). Using data from DOE’s Illness and Injury Surveillance Program (IISP), Oak Ridge Associated Universities (ORAU) created a registry of ETWs. IISP currently tracks 125,000 workers at 14 DOE facilities. Workers in IISP, who were classified as ETWs, were placed in a separate database using Microsoft Access. Using SAS (Version 9.2; Cary, NC), the health status of this cohort was analyzed by a variety of different variables such as age, gender, occupation, years of employment, number of years classified as an ETW, and site.

  15. Skull Base Osteomyelitis in the Emergency Department: A Case Report

    Mustafa Burak Sayhan


    Full Text Available Skull base osteomyelitis (SBO is a rare clinical presentation and usually occurs as a complication of trauma or sinusitis. A 5-year-old child presented to the emergency department with a three-week history of fever associated with drowsiness and left parietal headache, and a week's history of swelling on the left frontoparietal soft tissue. He had suffered a penetrating scalp injury four month ago. On physical examination, there was a tender swelling with purulent stream on the lateral half of his scalp. His vital signs are within normal limits. Plain X-ray of the skull showed a lytic lesion on the left frontoparietal bone. A cranial computed tomography (CT scan demonstrated a large subgaleal abscess at the left frontoparietal region. SBO possesses a high morbidity and mortality; therefore, prompt diagnosis and appropriate treatment are mandatory to prevent further complications and to reduce morbidity and mortality significantly.

  16. Structured nursing intervention to geriatric patients discharged from Emergency Department

    Rosted, Elizabeth Emilie


    geriatric patients have complex and often unresolved caring needs. Objective: To investigate a structured nursing intervention’s impact on geriatric patients’ unresolved problems and their use of help from the community health centre. Method: We conducted a prospective descriptive study of selected...... nurse made relevant referrals to geriatric outpatient clinic, community health centre, primary physician or arrangements with next-of-kin. Results: 150 geriatric patients participated, mean age 81.7 (70-99). At discharge they had in mean 2 (0-9) unresolved problems, after 1 month 0.8 (0-5), and after 6......Background: Geriatric patients recently discharged from hospital are at risk of unplanned readmissions and admission to nursing home. When discharged directly from Emergency Department (ED) the risk increases, as time pressure often requires focus on the presenting problem, although 80 % of...

  17. Geriatric nursing assessment and intervention in an emergency department

    Rosted, Elizabeth Emilie; Wagner, Lis; Hendriksen, Carsten;


    assessment, the nurse made relevant referrals to the geriatric outpatient clinic, community health centre, general practitioner or made arrangements with next of kin. Results. One hundred and fifty people participated, mean age was 81.7. At discharge, they had a mean of 1.9 unresolved problems, after 1 month......To describe and test a model for structured nursing assessment and intervention to older people discharged from emergency department (ED). Background. Older people recently discharged from hospital are at high risk of readmission. This risk may increase when they are discharged straight home from...... discharge, and at 1 and 6 months follow-up, a brief standardised nursing assessment (ISAR 2) developed by McCusker et al. was carried out. The focus was on unresolved problems that required medical or nursing intervention, new or different home care services or comprehensive geriatric assessment. After...

  18. Diagnosing Achilles tendon injuries in the emergency department.

    Gibbons, Lynda


    Achilles tendon (AT) injury is an overuse injury often seen in professional and recreational athletes. It tends to affect men, particularly those in their thirties and forties, more than women, and is typically seen in people who are intermittently active. To ensure AT ruptures are identified and treated effectively, early intervention in emergency departments (EDs) is crucial. This article discusses how advanced nurse practitioners can use their comprehensive problem-solving, clinical decision-making and clinical judgement skills to manage patients who present with suspected AT injury. It also describes the anatomy of tendon rupture, the aetiology and mechanism of injuries, and the importance of assessment and diagnostic tools, therapeutic techniques and management strategies. Finally, it considers the psychological effect this injury can have on patients, while in the ED and after discharge. A case study is included as an example of ED management.

  19. Referral Criteria from Community Clinics to Pediatric Emergency Departments

    Jacob Urkin


    Full Text Available Referral of patients to a pediatric emergency department (PED should be medically justified and the need for referral well communicated. The objectives of this paper were (1 to create a list of criteria for referral from the community to the PED, (2 to describe how community physicians categorize their need for referral, and (3 to determine agreement between the physician's referral letter and the selected criteria. We present a descriptive study of referrals to the PED of Soroka University Medical Center, Beer-Sheva, Israel, during February to April 2003. A list of 22 criteria for referral was created, using the Delphi method for reaching consensus. One or more criteria could be selected from this list for each referral, by the referring community physicians and, independently, based on the physicians' referral letters, by two consultants, and compared. There were 140 referrals included in the study. A total of 262 criteria for referral were selected by the referring community physicians. The criteria most frequently selected were: “Need for same-day consultation/laboratory/imaging result not available in the community” (32.1%, “Suspected life- or organ-threatening infection” (16.4%, and “Need for hospitalization” (15.7%. Rates of agreement regarding criteria for referral between the referring physicians and the two consultants, and a senior community pediatrician and a senior PED pediatrician, were 57.9 and 48.6%, respectively. We conclude that the standard referral letter does not convey in full the level of need for referral to the PED. A list of criteria for referral could augment efficient utilization of emergency department services and improve communication between community physicians and the PED.

  20. Analysis of Trauma Cases Admitted to the Emergency Department

    Tamer Durdu


    Full Text Available Aim: Trauma is a serious problem affecting especially the young population in the world. In our study, we aimed to investigate to the clinical and demographic characteristics of trauma cases admitted to our emergency department. Material and Method: The research data were collected from 1267 patients who applied to the Ankara Numune Training and Research Hospital Emergency Service with trauma. The patients’ demographic data, vital sign and symptoms at the application time, the trauma mechanism, requested consultations, and the patients’ discharge or hospitalization procedure were recorded on the forms. Results: The average age of the patients was determined as 35.3±15.4. Male ratio of the patients was 75.4%. The most frequently trauma type was resulted from motorized vehicle accident (55.8%. While the mechanism of blunt trauma was significantly at a high rate (83.1%, the most frequently exposed anatomical region was upper extremities (44.8%. Discussion: Trauma affects young adult males more frequently.

  1. Pain management in emergency department: intravenous morphine vs. intravenous acetaminophen

    Morteza Talebi Doluee


    Full Text Available Pain is the most common complaint in emergency department and there are several methods for its control. Among them, pharmaceutical methods are the most effective. Although intravenous morphine has been the most common choice for several years, it has some adverse effects. There are many researches about intravenous acetaminophen as an analgesic agent and it appears that it has good analgesic effects for various types of pain. We searched some electronic resources for clinical trials comparing analgesic effects of intravenous acetaminophen vs. intravenous morphine for acute pain treatment in emergency setting.In two clinical trials, the analgesic effect of intravenous acetaminophen has been compared with intravenous morphine for renal colic. The results revealed no significant difference between analgesic effects of two medications. Another clinical trial revealed that intravenous acetaminophen has acceptable analgesic effects on the post-cesarean section pain when combined with other analgesic medications. One study revealed that administration of intravenous acetaminophen compared to placebo before hysterectomy decreased consumption of morphine via patient-controlled analgesia pump and decreased the side effects. Similarly, another study revealed that the infusion of intravenous acetaminophen vs. placebo after orthopedic surgery decreased the consumption of morphine after the surgery. A clinical trial revealed intravenous acetaminophen provided a level of analgesia comparable to intravenous morphine in isolated limb trauma, while causing less side effects than morphine.It appears that intravenous acetaminophen has good analgesic effects for visceral, traumatic and postoperative pains compare with intravenous morphine.

  2. Emergency Department Utilization by Older Adults: a Descriptive Study

    Latham, Lesley P.; Ackroyd-Stolarz, Stacy


    Background Emergency Departments (EDs) are playing an increasingly important role in the care of older adults. Characterizing ED usage will facilitate the planning for care delivery more suited to the complex health needs of this population. Methods In this retrospective cross-sectional study, administrative and clinical data were extracted from four study sites. Visits for patients aged 65 years or older were characterized using standard descriptive statistics. Results We analyzed 34,454 ED visits by older adults, accounting for 21.8% of the total ED visits for our study time period. Overall, 74.2% of patient visits were triaged as urgent or emergent. Almost half (49.8%) of visits involved diagnostic imaging, 62.1% involved lab work, and 30.8% involved consultation with hospital services. The most common ED diagnoses were symptom- or injury-related (25.0%, 17.1%. respectively). Length of stay increased with age group (Mann-Whitney U; p < .0001), as did the proportion of visits involving diagnostic testing and consultation (χ2; p < .0001). Approximately 20% of older adults in our study population were admitted to hospital following their ED visit. Conclusions Older adults have distinct patterns of ED use. ED resource use intensity increases with age. These patterns may be used to target future interventions involving alternative care for older adults. PMID:25452824

  3. Impact of a Teaching Service on Emergency Department Throughput

    Courtney M. Smalley


    Full Text Available Introduction: There are 161 emergency medicine residency programs in the United States, many of which have medical students rotating through the emergency department (ED. Medical students are typically supervised by senior residents or attendings while working a regular shift. Many believe that having students see and present patients prolongs length of stay (LOS, as care can be delayed. Our institution implemented a unique method of educating medical students while in the ED with the creation of a teaching service, whose primary goal is education in the setting of clinical care. The objective of this study was to explore the effect of the teaching service on efficiency by describing LOS and number of patients seen on shifts with and without a teaching service. Methods: This was a retrospective chart review performed over a 12-month period of visits to an urban academic ED. We collected data on all patients placed in a room between 14:00 and 19:59, as these were the hours that the teaching shift worked in the department. We categorized shifts as 1 a teaching service with students (TWS; 2 a teaching service without students (TWOS; and 3 no teaching service (NTS. LOS and median number of patients seen on days with a teaching service, both with and without students (TWS and TWOS, was compared to LOS on days without a teaching service (NTS.Results: The median LOS on shifts with a dedicated teaching service without students (TWOS was 206 minutes, while the median LOS on shifts with a teaching service with students (TWS was 220 minutes. In comparison, the median LOS on shifts when no teaching service was present (NTS was 202.5 minutes. The median number of patients seen on shifts with the teaching service with students (TWS was 44, identical to the number seen on shifts when the teaching service was present without students (TWOS. When the teaching service was absent (NTS, the median number of patients seen was 40. Conclusion: A teaching service in

  4. The Impact of Psychiatric Patient Boarding in Emergency Departments

    B. A. Nicks


    Full Text Available Objectives. Studies have demonstrated the adverse effects of emergency department (ED boarding. This study examines the impact of resource utilization, throughput, and financial impact for psychiatric patients awaiting inpatient placement. Methods. The authors retrospectively studied all psychiatric and non-psychiatric adult admissions in an Academic Medical Center ED (>68,000 adult visits from January 2007-2008. The main outcomes were ED length of stay (LOS and associated reimbursement. Results. 1,438 patients were consulted to psychiatry with 505 (35.1% requiring inpatient psychiatric care management. The mean psychiatric patient age was 42.5 years (SD 13.1 years, with 2.7 times more women than men. ED LOS was significantly longer for psychiatric admissions (1089 min, CI (1039–1140 versus 340 min, CI (304–375; <0.001 when compared to non-psychiatric admissions. The financial impact of psychiatric boarding accounted for a direct loss of ($1,198 compared to non-psychiatric admissions. Factoring the loss of bed turnover for waiting patients and opportunity cost due to loss of those patients, psychiatric patient boarding cost the department $2,264 per patient. Conclusions. Psychiatric patients awaiting inpatient placement remain in the ED 3.2 times longer than non-psychiatric patients, preventing 2.2 bed turnovers (additional patients per psychiatric patient, and decreasing financial revenue.

  5. Make emergency department 'a hub for other services'.

    Blakemore, Sophie


    A LANDMARK event to debate the problems facing emergency care services was hosted by the RCN's Emergency Care Association (ECA) and the Royal College of Emergency Medicine (RCEM) last month. PMID:27286012

  6. Patterns of presentation of abused children to the accident and emergency department.

    Olney, D B


    A search of accident and emergency department records showed that 61% of 85 children registered as being physically or sexually abused by the Department of Community Paediatrics at St James's University Hospital, Leeds, England, were found to have visited the accident and emergency department an average of 2.9 times before the diagnosis was made. Fifty-two per cent of the attendances were because of problems other than injuries. Staff of accident and emergency departments should be aware that...

  7. Air pollution and emergency department visits for asthma among Ohi Medicaid recipients, 1991-1996

    We examined the effects of nitrogen dioxide (NO2), ozone (O3) particulate matter of 10), and sulfur dioxide (SO2) on asthmatics ages 5-34 years enrolled in Medicaid i Cincinnati, Cleveland, and Columbus, OH (N=5416). Our study period was fo the summer months, June-August, from July 1, 1991 to June 30, 1996. W preformed Poisson regression analyses for the number of daily emergency department (ED) visits for asthma in each city and on the aggregate dat controlling for time trends and minimum temperature. We found a 12% increase likelihood of an asthma ED visit per 50 μg/m3 increase in PM10 i Cleveland [95% confidence interval (CI)=0-27%] and a 35% increase per 5 μg/m3 increase in SO2 in Cincinnati (95% CI=9-21%). When data wer analyzed for all three cities combined, the risk of an ED visit increased fo all pollutant increases and specifically by 12% (95% CI=1-23%) per 5 μg/m3 increase in SO2. Attributable risk estimates show a five time greater impact on Cleveland over Cincinnati or Columbus. Between 1991 an 1996, air pollutants in Cincinnati, Cleveland, and Columbus increased E visits for asthmatics enrolled in Medicaid

  8. Rapid sequence induction in the emergency department: a strategy for failure

    Carley, S; Gwinnutt, C.; Butler, J.; Sammy, I; Driscoll, P


    Background: Rapid sequence induction (RSI) is increasingly used by emergency physicians in the emergency department. A feared complication of the technique is the inability to intubate and subsequently ventilate the patient. Current drills based on anaesthetic practice may be unsuitable for use in the emergency department.

  9. Operation of a support service team in the emergency department of a general hospital.

    Condra, M; Groll, L; Walker, D M; Abrams, M O; Sims, P.


    We describe the development and operation of an emergency support service team in the Emergency Department of the Kingston General Hospital, Kingston, Ont. The team, composed of professionals from other departments of the hospital, provides emotional and practical support to family members or survivors in medical emergencies. We discuss the roles of the team members and their procedures for dealing with distress and grief.

  10. Successful implementation of strategies to transform Emergency Department transfusion practice.

    Reed, Matthew J; Kelly, Sarah-Louise; Beckwith, Hannah; Innes, Catherine J; Manson, Lynn


    Blood component transfusion is an important and lifesaving Emergency Department (ED) procedure. It is not however risk-free and careful consideration of its clinical benefit for each individual patient is therefore essential. In 2008, we audited the patterns of blood component usage in 2007 within our ED. This work revealed that whilst 3209 units of blood component were ordered only 39.5% were transfused, and 9.5% were unaccounted for. This was the first and only published detailed look at ED blood transfusion practices. We had to address our poor traceability (i.e. unaccounted for units), our high blood usage, and our ordering of units which were then not transfused as this can lead to wastage. Firstly, better links between the ED and the Scottish National Blood Transfusion Service (SNBTS) were established. A set of improvement measures were then implemented including better ED medical and nursing staff education, monthly traceability reports sent to the ED clinical management teams, the introduction of an ED transfusion guideline, moving our blood fridge into the resuscitation room, having a named ED transfusion consultant and ED transfusion link nurse, ED consultant representation on the Hospital Transfusion Group and finally increasing awareness of ED emergency transfusion with a rotational thromboelastometry (ROTEM) research programme. In 2012, we re-audited our practice looking at our blood component usage in 2011. There was a 64% reduction in blood component ordering (3209 vs. 1034 units), a 39% reduction in blood component transfusion (1131 vs. 687 units), a 68% increase in the proportion of ordered units that were transfused and a 96% reduction in unaccounted units (289 vs. 9 units) between 2007 and 2011. In attempting to cost the savings resulting from our changes we showed that SNBTS spent £306,437 less in 2011 compared to 2007 on handling and issuing ED transfusion requests. Our improvements are immediately generalizable across the UK and the potential

  11. Air pollution and emergency department visits for conjunctivitis: A case-crossover study

    Mieczysław Szyszkowicz


    Full Text Available Objectives: The purpose of this study was to examine the associations between emergency department (ED visits for conjunctivitis and ambient air pollution levels in urban regions across the province of Ontario, Canada. Material and Methods: Information from the National Ambulatory Care Reporting System was used to create time-series records, for the period of April 2004 to December 2011, on emergency department visits of patients suffering from conjunctivitis. A total of 77 439 emergency department visits for conjunctivitis were analyzed. A time-stratified case-crossover design was applied, completed with meta-analysis in order to pool inter-city results. Odds ratio (OR for an emergency department visit was calculated in different population strata per one-unit increase (one interquartile range – IQR increase in a pollutant’s daily level while controlling for the impacts of temperature and relative humidity. Results: Statistically significant positive results were observed in the female population sample, for nitrogen dioxide (NO2 exposure lagged 5–8 days, with the highest result for the 7-day lag (OR = 1.035, 95% CI: 1.018–1.052 and for fine particulate matter with a median aerodynamic diameter of less than 2.5 μm (PM2.5, for lags 6 and 7 days, with the highest result for lag 7 (OR = 1.017, 95% CI: 1.003–1.031. In the male population sample, statistically significant positive results were observed for NO2 at lag 5 days (OR = 1.024, 95% CI: 1.004–1.045 and for ozone (O3, at lags 0–3 and 7 days, with the highest result for lag 0 (OR = 1.038, 95% CI: 1.012–1.056. Also for males, statistically significant results were observed in the case of PM2.5 exposure lagged by 5 days (OR = 1.003, 95% CI: 1.000–1.038 and sulfur dioxide (SO2 exposure lagged by 1 and 2 days (OR = 1.016, 95% CI: 1.000–1.031 and OR = 1.018, 95% CI: 1.002–1.033. Conclusions: The findings of this study suggest that there are associations between levels of air

  12. Diagnostic testing of the emergency department patient with chest pain.

    Zalenski, R J; Shamsa, F H


    In evaluating patients with nondiagnostic initial clinical or electrocardiogram (ECG) findings for acute cardiac ischemia, continuous 12-lead ECG monitoring increases the detection of diagnostic ECG findings, including ST-segment elevation, in patients awaiting hospital admission. Rest scanning with technitium-99m sestamibi is able to risk stratify low-moderate risk patients into lower and higher risk groups for cardiac events. Caveats include the reduced sensitivity of scanning of patients who are pain free and the need for follow-up exercise scans for patients free of perfusion defects at rest. Cardiac markers, particularly the troponins, show great promise for the detection of a larger part of the spectrum of acute coronary syndromes in the emergency department, including patients with minimal myocardial damage and higher risk for short-term death and nonfatal acute myocardial infarction. Accelerated diagnostic protocols using serial testing with cardiac markers, ECGs and then provocative testing over a 14-hour period, are feasible, safe, and cost-effective. PMID:10091020

  13. Antibiotic-associated diarrhoea in emergency department observation unit patients.

    Haran, J P; Wu, G; Bucci, V; Fischer, A; Keang, L; Boyer, E W; Hibberd, P L


    Clostridium difficile diarrhoea is an urgent threat to patients, but little is known about the role of antibiotic administration that starts in emergency department observation units (EDOUs). We studied risk factors for antibiotic-associated diarrhoea (AAD) and C. difficile infection (CDI) in EDOU patients. This prospective cohort study enrolled adult patients discharged after EDOU antibiotic treatment between January 2013 and 2014. We obtained medical histories, EDOU treatment and occurrence of AAD and CDI over 28 days after discharge. We enrolled and followed 275 patients treated with antibiotics in the EDOU. We found that 52 (18·6%) developed AAD and four (1·5%) had CDI. Patients treated with vancomycin [relative risk (RR) 0·52, 95% confidence interval (CI) 0·3-0·9] were less likely to develop AAD. History of developing diarrhoea with antibiotics (RR 3·11, 95% CI 1·92-5·03) and currently failing antibiotics (RR 1·90, 95% CI 1·14-3·16) were also predictors of AAD. Patients with CDI were likely to be treated with clindamycin. In conclusion, AAD occurred in almost 20% of EDOU patients with risk factors including a previous history of diarrhoea with antibiotics and prior antibiotic therapy, while the risk of AAD was lower in patients receiving treatment regimens utilizing intravenous vancomycin. PMID:27324463

  14. Ambient Ozone and Emergency Department Visits for Cellulitis

    Mieczysław Szyszkowicz


    Full Text Available Objectives were to assess and estimate an association between exposure to ground-level ozone and emergency department (ED visits for cellulitis. All ED visits for cellulitis in Edmonton, Canada, in the period April 1992–March 2002 (N = 69,547 were examined. Case-crossover design was applied to estimate odds ratio (OR, and 95% confidence interval per one interquartile range (IQR increase in ozone concentration (IQR = 14.0 ppb. Delay of ED visit relating to exposure was probed using 0- to 5-day exposure lags. For all patients in the all months (January–December and lags 0 to 2 days, OR = 1.05 (1.02, 1.07. For male patients during the cold months (October-March: OR = 1.05 (1.02, 1.09 for lags 0 and 2 and OR = 1.06 (1.02, 1.10 for lag 3. For female patients in the warm months (April-September: OR = 1.12 (1.06, 1.18 for lags 1 and 2. Cellulitis developing on uncovered (more exposed skin was analyzed separately, observed effects being stronger. Cellulitis may be associated with exposure to ambient ground level ozone; the exposure may facilitate cellulitis infection and aggravate acute symptoms.

  15. Organ and tissue donation from the emergency department.

    Riker, R R; White, B W


    Despite mandatory request legislation, the lack of available donor organs and tissues continues to limit transplant efforts. The potential contribution from emergency department (ED) patients remains undefined. We reviewed the charts of patients dying in our ED for organs and tissues potentially suitable for transplantation, age, cause of death, and physician documentation of donation inquiry. Of 155 charts reviewed, potential donors were identified for corneas (99), bones (61), heart valves (42), and kidneys (3). Of the 155 charts, 130 (84%) made no mention of donation, and of 37 charts containing a donor request form, 34 (92%) were incorrectly filled out or left blank. Four charts (2.6%) mentioned donation in the narrative section, two (1.3%) documented discussion with family, and one patient was referred to our Organ Procurement Organization, with recovery of one kidney and heart valves. We conclude that physicians rarely document consideration of donation for patients dying in the ED; the number of potential donors far exceeds the number referred or recovered. Future efforts should focus on methods to increase recognition and referral of organ and tissue donors from the ED. PMID:1787284

  16. Audit of an urban paediatric emergency department visits

    Zohair J Gazzaz


    Full Text Available Background: This study aimed to highlight the health seeking behavior of children in an Emergency Department (ED. Materials and Methods: Retrospective files review of ED was done for the month of July, 2008. Data about the children ≤12 years of age was gathered. Results: In one month period a total 21000 patients visited our ED, out of them 6120 (29% were children. Males, Saudis and children of (1-6 years were more frequent, i.e., 3540 (57.8%, 5760 (94.1% and 3180 (52%, respectively. Majority of patients visited in shift "2", i.e., 15:30 hours to 23:30 hours. Among the patients "diseases of respiratory system" were found more frequent 4170 (68.1% and main diagnosis was "acute upper respiratory tract infection" 3300 (53.9%. Non-urgent cases were 2020 (33% while 244 (4% were admitted. Conclusion: Young children as well as non-urgent cases were predominant. Evening shift was the busiest one.

  17. Modified emergency department thoracotomy for postablation cardiac tamponade.

    Wyatt, Thomas E; Haug, Eric W


    Cardiac dysrhythmias are a common problem in the United States. Radiofrequency ablation is being used more frequently as a treatment for these diagnoses. Although rare, serious complications such as cardiac tamponade have been reported as a result of ablation procedures. Traditionally, emergency department (ED) thoracotomy has been reserved for cases of traumatic arrest only. We report a case of a successful modified ED thoracotomy in a patient with postablation cardiac tamponade and subsequent obstructive shock who failed intravenous fluid resuscitation, pressor administration, and multiple attempts at pericardiocentesis. In this case, a modified approach was used to incise the pericardium. Although this was associated with large blood loss, we believed that using the traditional method of completely removing the pericardium would have resulted in uncontrolled hemorrhage. Instead, our method led to successful resuscitation of the patient until definitive care was available. A smaller pericardial incision than is traditionally used during ED thoracotomy deserves further consideration and research to determine whether and when it may be most useful as a temporizing treatment of cardiac tamponade when other methods have failed. PMID:22104519

  18. Defensive medicine in the emergency department. The clinicians’ perspective

    Gianfranco Cervellin


    Full Text Available The overuse of medical services is regarded as a growing problem in Western countries, accounting for up to 30% of all delivered care, and carrying a higher risk of morbidity and mortality. One of the leading drivers toward medical overuse is the so-called defensive medicine, which is commonly defined as ordering of tests, procedures, and visits, or, at variance, avoidance of high-risk patients or procedures, aimed to reduce exposure to malpractice liability. Defensive medicine may increase the amount of care provided to the patients (i.e., additional tests or therapies, change care or setting of care (i.e., patients referred to another specialist or another healthcare facility, or impair the optimal care (i.e., refusing risky patients. Some studies seem to confirm a large utilization of defensive medicine in the emergency departments. This article tries to analyze some key points capable to pave the way to a consistent reduction of defensive medicine, thus defining a hierarchical list of priorities, keeping the patient’s health always at the center of the matter.

  19. Presentations to Emergency Departments for COPD: A Time Series Analysis.

    Rosychuk, Rhonda J; Youngson, Erik; Rowe, Brian H


    Background. Chronic obstructive pulmonary disease (COPD) is a common respiratory condition characterized by progressive dyspnea and acute exacerbations which may result in emergency department (ED) presentations. This study examines monthly rates of presentations to EDs in one Canadian province. Methods. Presentations for COPD made by individuals aged ≥55 years during April 1999 to March 2011 were extracted from provincial databases. Data included age, sex, and health zone of residence (North, Central, South, and urban). Crude rates were calculated. Seasonal autoregressive integrated moving average (SARIMA) time series models were developed. Results. ED presentations for COPD totalled 188,824 and the monthly rate of presentation remained relatively stable (from 197.7 to 232.6 per 100,000). Males and seniors (≥65 years) comprised 52.2% and 73.7% of presentations, respectively. The ARIMA(1,0, 0) × (1,0, 1)12 model was appropriate for the overall rate of presentations and for each sex and seniors. Zone specific models showed relatively stable or decreasing rates; the North zone had an increasing trend. Conclusions. ED presentation rates for COPD have been relatively stable in Alberta during the past decade. However, their increases in northern regions deserve further exploration. The SARIMA models quantified the temporal patterns and can help planning future health care service needs. PMID:27445514

  20. Urban Automation Networks: Current and Emerging Solutions for Sensed Data Collection and Actuation in Smart Cities.

    Gomez, Carles; Paradells, Josep


    Urban Automation Networks (UANs) are being deployed worldwide in order to enable Smart City applications. Given the crucial role of UANs, as well as their diversity, it is critically important to assess their properties and trade-offs. This article introduces the requirements and challenges for UANs, characterizes the main current and emerging UAN paradigms, provides guidelines for their design and/or choice, and comparatively examines their performance in terms of a variety of parameters including coverage, power consumption, latency, standardization status and economic cost. PMID:26378534

  1. Urban Automation Networks: Current and Emerging Solutions for Sensed Data Collection and Actuation in Smart Cities

    Carles Gomez


    Full Text Available Urban Automation Networks (UANs are being deployed worldwide in order to enable Smart City applications. Given the crucial role of UANs, as well as their diversity, it is critically important to assess their properties and trade-offs. This article introduces the requirements and challenges for UANs, characterizes the main current and emerging UAN paradigms, provides guidelines for their design and/or choice, and comparatively examines their performance in terms of a variety of parameters including coverage, power consumption, latency, standardization status and economic cost.

  2. Review of emergency thoracotomy for chest injuries in patients attending a UK Accident and Emergency department.

    Bleetman, A; Kasem, H; Crawford, R


    Over a two and a half year period, 25 patients presenting to the Glasgow Royal Infirmary underwent emergency thoracotomy for suspected severe chest injuries. Eighteen (72 per cent) were performed in the Accident and Emergency (A&E) department and seven (28 per cent) in a fully equipped operating theatre after resuscitation. There were 23 men and 2 women. Twenty-three (92 per cent) had been stabbed, one (4 per cent) had been shot and one (4 per cent) had sustained a blunt injury in a road traffic accident. Eight (32 per cent) patients survived. All survivors had been stabbed and seven were well enough to undergo thoracotomy in theatre. Only one (5.6 per cent) of the patients operated upon in the A&E department survived to discharge, although three (16.8 per cent) survived the initial procedure. Three of four patients survived, in whom the diagnosis of cardiac tamponade was initially missed. Thirteen (76.5 per cent) of the 17 who did not survive had no vital signs on admission. Outcomes may be improved if appropriately trained hospital staff are immediately available and prehospital delays are minimized so that patients arrive sooner with signs of life still present. Ambulance paramedic interventions have little to offer these patients and may worsen the prognosis if they result in delayed transport to hospital. The emphasis placed on diagnosis and treatment of cardiac tamponade in Advanced Trauma Life Support programmes is appropriate and all staff involved in these cases should undergo this type of training. PMID:8730388

  3. 77 FR 66824 - City of Holyoke Gas and Electric Department; Notice of Application Accepted for Filing...


    ... increase the project's installed capacity by 600 kilowatts, and increase the maximum hydraulic capacity by... Application: Amendment of License. b. Project No.: 2004-287. c. Date Filed: August 31, 2012. d. Applicant: City of Holyoke Gas and Electric Department. e. Name of Project: Holyoke Project. f. Location: On...

  4. Entropic Management: Restructuring District Office Culture in the New York City Department of Education

    Howell, Fanon John


    Although a growing body of literature is produced on reform of urban school districts, few studies examine shifts in the culture of managers resulting from reorganization in these bureaucracies. This article engages an analysis of central office managerial culture in the New York City Department of Education during a culminating moment of district…

  5. Sport and active recreation injuries in Australia: evidence from emergency department presentations

    Finch, C; Valuri, G; Ozanne-Smith, J


    OBJECTIVE: Despite the rise in specialist clinical services for the management of sports and active recreation injury, many patients attend hospital emergency departments for treatment. The purpose of this study was to describe sports injury cases presented to selected hospital emergency departments around Australia for the period 1989-1993. METHODS: Routinely collected emergency department injury presentation data from the Australian National Injury Surveillance Unit were examined. Dat...

  6. Methodology for developing quality indicators for the care of older people in the Emergency Department

    Martin-Khan, Melinda; Burkett, Ellen; Schnitker, Linda; Jones, Richard N.; Gray, Leonard C


    Background: Compared with younger people, older people have a higher risk of adverse health outcomes when presenting to emergency departments. As the population ages, older people will make up an increasing proportion of the emergency department population. Therefore it is timely that consideration be given to the quality of care received by older persons in emergency departments, and to consideration of those older people with special needs. Particular attention will be focused on important ...

  7. Methodology for developing quality indicators for the care of older people in the Emergency Department

    Martin-Khan, Melinda; Burkett, Ellen; Schnitker, Linda; Jones, Richard N.; Gray, Leonard C


    Background Compared with younger people, older people have a higher risk of adverse health outcomes when presenting to emergency departments. As the population ages, older people will make up an increasing proportion of the emergency department population. Therefore it is timely that consideration be given to the quality of care received by older persons in emergency departments, and to consideration of those older people with special needs. Particular attention will be focused on important g...

  8. Emergency department management of syncope: need for standardization and improved risk stratification.

    Thiruganasambandamoorthy, Venkatesh; Taljaard, Monica; Stiell, Ian G; Sivilotti, Marco L A; Murray, Heather; Vaidyanathan, Aparna; Rowe, Brian H; Calder, Lisa A; Lang, Eddy; McRae, Andrew; Sheldon, Robert; Wells, George A


    Variations in emergency department (ED) syncope management have not been well studied. The goals of this study were to assess variations in management, and emergency physicians' risk perception and disposition decision making. We conducted a prospective study of adults with syncope in six EDs in four cities over 32 months. We collected patient characteristics, ED management, disposition, physicians' prediction probabilities at index presentation and followed patients for 30 days for serious outcomes: death, myocardial infarction (MI), arrhythmia, structural heart disease, pulmonary embolism, significant hemorrhage, or procedural interventions. We used descriptive statistics, ROC curves, and regression analyses. We enrolled 3662 patients: mean age 54.3 years, and 12.9 % were hospitalized. Follow-up data were available for 3365 patients (91.9 %) and 345 patients (10.3 %) suffered serious outcomes: 120 (3.6 %) after ED disposition including 48 patients outside the hospital. After accounting for differences in patient case mix, the rates of ED investigations and disposition were significantly different (p decision making, and serious outcomes after ED disposition. A valid risk-stratification tool might help standardize ED management and improve disposition decision making. PMID:25918108

  9. Validation of the Emergency Severity Index (ESI) in self-referred patients in a European emergency department.

    Elshove-Bolk, J.; Mencl, F.; Rijswijck, B.T. van; Simons, M.P.; Vugt, A.B. van


    OBJECTIVE: To validate the Emergency Severity Index (ESI) triage algorithm in predicting resource consumption and disposition by self-referred patients in a European emergency department. METHODS: This was a prospective, observational cohort study using a convenience sample of self-referred emergenc

  10. Informed Consent Documentation for Lumbar Puncture in the Emergency Department

    Pankaj B. Patel


    Full Text Available Introduction: Informed consent is a required process for procedures performed in the emergency department (ED, though it is not clear how often or adequately it is obtained by emergency physicians. Incomplete performance and documentation of informed consent can lead to patient complaints, medico-legal risk, and inadequate education for the patient/guardian about the procedure. We undertook this study to quantify the incidence of informed consent documentation in the ED setting for lumbar puncture (LP and to compare rates between pediatric (<18 years and adult patients. Methods: In this retrospective cohort study, we reviewed the ED electronic health records (EHR for all patients who underwent successful LPs in three EDs between April 2010 and June 2012. Specific elements of informed consent documentation were reviewed. These elements included the presence of general ED and LP-specific consent forms, signatures of patient/guardian, witness, and physician, documentation of purpose, risks, benefits, alternatives, and explanation of the LP. We also reviewed the use of educational material about the LP and LP-specific discharge information. Results: Our cohort included 937 patients; 179 (19.1% were pediatric. A signed general ED consent form was present in the EHR for 809 (86% patients. A consent form for the LP was present for 524 (56% patients, with signatures from 519 (99% patients/guardians, 327 (62% witnesses, and 349 (67% physicians. Documentation rates in the EHR were as follows: purpose (698; 74%, risks (742; 79%, benefits (605; 65%, alternatives (635; 68%, and explanation for the LP (57; 6%. Educational material about the LP was not documented as having been given to any of the patients and LP-specific discharge information was documented as given to 21 (2% patients. No significant differences were observed in the documentation of informed consent elements between pediatric and adult patients. Conclusion: General ED consent was obtained in

  11. Cities and Systemic Change for Sustainability: Prevailing Epistemologies and an Emerging Research Agenda

    Marc Wolfram


    Full Text Available Cities are key for sustainability and the radical systemic changes required to enable equitable human development within planetary boundaries. Their particular role in this regard has become the subject of an emerging and highly interdisciplinary scientific debate. Drawing on a qualitative literature review, this paper identifies and scrutinizes the principal fields involved, asking for their respective normative orientation, interdisciplinary constitution, theories and methods used, and empirical basis to provide orientations for future research. It recognizes four salient research epistemologies, each focusing on a distinct combination of drivers of change: (A transforming urban metabolisms and political ecologies; (B configuring urban innovation systems for green economies; (C building adaptive urban communities and ecosystems; and (D empowering urban grassroots niches and social innovation. The findings suggest that future research directed at cities and systemic change towards sustainability should (1 explore interrelations between the above epistemologies, using relational geography and governance theory as boundary areas; (2 conceive of cities as places shaped by and shaping interactions between multiple socio-technical and social-ecological systems; (3 focus on agency across systems and drivers of change, and develop corresponding approaches for intervention and experimentation; and (4 rebalance the empirical basis and methods employed, strengthening transdisciplinarity in particular.

  12. Paediatric femur fractures at the emergency department: accidental or not?

    Hoytema van Konijnenburg, Eva M M; Vrolijk-Bosschaart, Thekla F; Bakx, Roel; Van Rijn, Rick R


    Only a small proportion of all paediatric fractures is caused by child abuse or neglect, especially in highly prevalent long bone fractures. It can be difficult to differentiate abusive fractures from non-abusive fractures. This article focuses on femoral fractures in young children. Based on three cases, this article presents a forensic evidence-based approach to differentiate between accidental and non-accidental causes of femoral fractures. We describe three cases of young children who were presented to the emergency department because of a suspected femur fracture. Although in all cases, the fracture had a similar location and appearance, the clinical history and developmental stage of the child led to three different conclusions. In the first two cases, an accidental mechanism was a plausible conclusion, although in the second case, neglect of parental supervision was the cause for concern. In the third case, a non-accidental injury was diagnosed and appropriate legal prosecution followed. Any doctor treating children should always be aware of the possibility of child abuse and neglect in children with injuries, especially in young and non-mobile children presenting with an unknown trauma mechanism. If a suspicion of child abuse or neglect arises, a thorough diagnostic work-up should be performed, including a full skeletal survey according to the guidelines of the Royal College of Radiologists and the Royal College of Paediatrics and Child Health. In order to make a good assessment, the radiologist reviewing the skeletal survey needs access to all relevant clinical and social information. PMID:26642309

  13. Adverse events related to emergency department care: a systematic review.

    Antonia S Stang

    Full Text Available OBJECTIVE: To systematically review the literature regarding the prevalence, preventability, severity and types of adverse events (AE in the Emergency Department (ED. METHODS: We systematically searched major bibliographic databases, relevant journals and conference proceedings, and completed reference reviews of primary articles. Observational studies (cohort and case-control, quasi-experimental (e.g. before/after studies and randomized controlled trials, were considered for inclusion if they examined a broad demographic group reflecting a significant proportion of ED patients and described the proportion of AE. Studies conducted outside of the ED setting, those examining only a subpopulation of patients (e.g. a specific entrance complaint or receiving a specific intervention, or examining only adverse drug events, were excluded. Two independent reviewers assessed study eligibility, completed data extraction, and assessed study quality with the Newcastle Ottawa Scale. RESULTS: Our search identified 11,624 citations. Ten articles, representing eight observational studies, were included. Methodological quality was low to moderate with weaknesses in study group comparability, follow-up, and outcome ascertainment and reporting. There was substantial variation in the proportion of patients with AE related to ED care, ranging from 0.16% (n = 9308 to 6.0% (n = 399. Similarly, the reported preventability of AE ranged from 36% (n = 250 to 71% (n = 24. The most common types of events were related to management (3 studies, diagnosis (2 studies and medication (2 studies. CONCLUSIONS: The variability in findings and lack of high quality studies on AE in the high risk ED setting highlights the need for research in this area. Further studies with rigorous, standardized outcome assessment and reporting are required.

  14. Multimedia Education Increases Elder Knowledge of Emergency Department Care

    Thomas E. Terndrup


    Full Text Available Introduction: Elders who utilize the emergency department (ED may have little prospectiveknowledge of appropriate expectations during an ED encounter. Improving elder orientation toED expectations is important for satisfaction and health education. The purpose of this study wasto evaluate a multi-media education intervention as a method for informing independently livingelders about ED care. The program delivered messages categorically as, the number of tests,providers, decisions and disposition decision making.Methods: Interventional trial of representative elders over 59 years of age comparing pre andpost multimedia program exposure. A brief (0.3 hour video that chronicled the key events after ahypothetical 911 call for chest pain was shown. The video used a clinical narrator, 15 ED healthcare providers, and 2 professional actors for the patient and spouse. Pre- and post-video testsresults were obtained with audience response technology (ART assessed learning using a 4point Likert scale.Results: Valid data from 142 participants were analyzed pre to post rankings (Wilcoxon signedranktests. The following four learning objectives showed significant improvements: number oftests expected [median differences on a 4-point Likert scale with 95% confidence intervals: 0.50(0.00, 1.00]; number of providers expected 1.0 (1.00, 1.50; communications 1.0 (1.00, 1.50;and pre-hospital medical treatment 0.50 (0.00, 1.00. Elders (96% judged the intervention asimproving their ability to cope with an ED encounter.Conclusion: A short video with graphic side-bar information is an effective educational strategy toimprove elder understanding of expectations during a hypothetical ED encounter following calling911.

  15. Naloxone Administration in US Emergency Departments, 2000-2011.

    Frank, Joseph W; Levy, Cari; Calcaterra, Susan L; Hoppe, Jason A; Binswanger, Ingrid A


    Rates of opioid overdose and opioid-related emergency department (ED) visits have increased dramatically. Naloxone is an effective antidote to potentially fatal opioid overdose, but little is known about naloxone administration in ED settings. We examined trends and correlates of naloxone administration in ED visits nationally from 2000 to 2011. Using data from the National Hospital Ambulatory Medical Care Survey, we examined ED visits involving (1) the administration of naloxone or (2) a diagnosis of opioid overdose, abuse, or dependence. We assessed patient characteristics in these visits, including concomitant administration of prescription opioid medications. We used logistic regression to identify correlates of naloxone administration. From 2000 to 2011, naloxone was administered in an estimated 1.7 million adult ED visits nationally; 19 % of these visits recorded a diagnosis of opioid overdose, abuse, or dependence. An estimated 2.9 million adult ED visits were related to opioid overdose, abuse, or dependence; 11 % of these visits involved naloxone administration. In multivariable logistic regression models, patient age, race, and insurance and non-rural facility location were independently associated with naloxone administration. An opioid medication was provided in 14 % of visits involving naloxone administration. Naloxone was administered in a minority of ED visits related to opioid overdose, abuse, or dependence. Among all ED visits involving naloxone administration, prescription opioids were also provided in one in seven visits. Further work should explore the provider decision-making in the management of opioid overdose in ED settings and examine patient outcomes following these visits. PMID:26621354

  16. Failure Mode and Effect Analysis in Increasing the Revenue of Emergency Department

    Farhad Rahmati; Ali Shahrami; Alireza Baratloo; Behrooz Hashemi; Nastaran Sadat Mahdavi; Saeed Safari; Hamidreza Hatamabadi


    Introduction: Successful performance of emergency department(ED) is one of the important indications of increasing the satisfaction among referees. The insurance of such successful performance is fiscal discipline and avoiding from non-beneficial activities in this department. Therefore, the increasing revenue of emergency department is one of the interested goals of hospital management system. According to above-mentioned, the researchers assessed problems lead to loss the revenue of ED and ...

  17. Analysis on the Emergency Contraception Knowledge Level and Its Influencing Factors among Abortion Patients in Shanghai City

    赵双玲; 楼超华; 高尔生


    Objective To evaluate the knowledge level of emergency contraception, explore the determinants of the knowledge level among women seeking abortion and give suggestions on how to improve the quality of emergency contraception service.Method A total of 606 women requiring abortion at three MCHs in Shanghai City were interviewed face to face with structured questionnaire.Results 63. 7% of unwanted pregnancy could use EC to prevent. Subjects got their knowledge on EC mainly from books~newspapers~magazines and relatives/friends/parents. The proportion of the awareness of EC was 28. 5%. Most subjects were aware of hormonal EC pill, but only 14. 9% of them knew that the pill should be taken within 72 hours after the intercourse. Among the subjects who were aware of EC, the average score of the knowledge was lower than half of the full marks. The lower the subject's educational level was, the less likely they were aware of EC and the lower score of the knowledge of EC they had. The score of the knowledge of EC was higher among subjects who learned of EC mainly from family planning publicity.Conclusion It is urgent to popularize EC in order to reduce unwanted pregnancy and induced abortion. The information, including EC can be used in which situations, it's advantages and disadvantages as well as indication, should be given to women in an appropriate way and using plain language. The departments of family planning should play a leading role in improving women's knowledge of EC.

  18. Failure of psychiatric referrals from the pediatric emergency department

    Delgado Sergio V


    Full Text Available Abstract Background Recognition of mental illness in the pediatric emergency department (PED followed by brief, problem oriented interventions may improve health-care seeking behavior and quality of life. The objective of this study was to compare the frequency of mental health follow up after an enhanced referral compared to a simple referral in children presenting to the PED with unrecognized mental health problems. Methods A prospective randomized control trial comparing an enhanced referral vs. simple referral in 56 families of children who were screened for mental health symptoms was performed in a large tertiary care PED. Children presenting to the PED with stable medical problems were approached every fourth evening for enrollment. After consent/assent was obtained, children were screened for a mental health problem using both child and parent reports of the DISC Predictive Scales. Those meeting cutoffs for a mental health problem by either parent or child report were randomized to 1 simple referral (phone number for mental health evaluation by study psychiatrist or 2 enhanced referral (short informational interview, appointment made for child, reminder 2 days before and day of interview for an evaluation by study psychiatrist. Data analysis included descriptive statistics and Chi-Square test to calculate the proportion of children with mental health problems who completed mental health follow-up with and without the enhanced referral. Results A total of 69 families were enrolled. Overall 56 (81% children screened positive for a mental health problem as reported by either the child (self report or mother (maternal report of child mental health problem. Of these, 33 children were randomized into the enhanced referral arm and 23 into the simple referral arm. Overall, only 6 families with children screening positive for a mental health problem completed the psychiatric follow up evaluation, 2 in the enhanced referral arm and 4 in the simple

  19. Emergency Department of a Rural Hospital in Ecuador

    Tara Johnson, MD, MPH


    Full Text Available Introduction: There is a paucity of data studying patients and complaints presenting to emergency departments (EDs in low- and middle-income countries. The town of Pedro Vicente Maldonado (PVM is located in the northwestern highlands of Ecuador. Hospital PVM (HPVM is a rural teaching hospital providing family medicine residency training. These physicians provide around-the-clock acute medical care in HPVM’s ED. This study provides a first look at a functioning ED in rural Latin America by reviewing one year of ED visits to HPVM. Methods: All ED visits between April 14, 2013, and April 13, 2014, were included and analyzed, totaling 1,239 patient visits. Data were collected from their electronic medical record and exported into a de-identified Excel® database where it was sorted and categorized. Variables included age, gender, mode of arrival, insurance type, month and day of the week of the service, chief complaint, laboratory and imaging requests, and disposition. We performed descriptive statistics, and where possible, comparisons using Student’s T or chi-square, as appropriate. Results: Of the 1239 total ED visits, 48% were males and 52% females; 93% of the visits were ambulatory, and 7% came by ambulance. Sixty-three percent of the patients had social security insurance. The top three chief complaints were abdominal pain (25.5%, fever (15.1% and trauma (10.8%. Healthcare providers requested labs on 71.3% of patients and imaging on 43.2%. The most frequently requested imaging studies were chest radiograph (14.9%, upper extremity radiograph (9.4%, and electrocardiogram (9.0%. There was no seasonal or day-of-week variability to number of ED patients. The chief complaint of human or animal bite made it more likely the patient would be admitted, and the chief complaint of traumatic injury made it more likely the patient would be transferred. Conclusion: Analysis of patients presenting to a rural ED in Ecuador contributes to the global study

  20. Evaluation of Cases with Rabies Risk Presenting to Emergency Department

    Fevzi Yilmaz


    Full Text Available Aim: All around the world 10-12 million people/year receive rabies prophylaxis. Rabies is an acute fatal central nervous system viral enfection. The virus can infect all warm-blooded animals and almost in all cases the enfection results with fatal encephalitis. The aim of this study is to determine the demographic characteristics of cases with rabies risk exposures and behind this to emphasise the significance of cooperation between the institutions to perform effective and accurate treatment. Material and Method: This study was performed with retrospective analysis of 1429 cases who attended to Emergency Department of Diyarbakir Goverment Hospital between January 2007-2010 for animal bites and exposures with the risk of rabies. Statistical analysis of data was performed SPSS V16 pocket programme. Data were defined as frequency and %. For statistical analysis Chi-Square and Fischer exact test was used. A value of P<0.05 was accepted statistically significant. Results: A total of 1055 (73.8% were male, 374 (26.2% were female and the mean age was 21.75 ± 16.9 (6 months-87 years. The major group in children was 6-11 years old and 651 (% 45.5 of the cases attended to hospital were under 18 years old. The vast majority (39.3% in adults were between 19-49 years. In our study 808 (56.5% of the cases  were bitten, 597 (41.8% of the cases  were scrabbled by the animal and 24 (1.7%of them  had indirect contact with the animal Both of them were taken into prophylactic vaccination programme (p<0.05. The vast majority of animal bites were dog (67%  and cat (28%. 3 doses of Human diploid cell vaccine-HDCV were administered to 1001 (70% of the patients and 5 doses to 428 (30% of patients. Human rabies immune globulin-HRIG were administered to 475 (33,3% of the patients in addition to vaccine. Discussion:  In our region rabies risk exposure is an important public health problem. Public oriented education should be given about attending to health care

  1. Medication Overdoses at a Public Emergency Department in Santiago, Chile

    Pablo Aguilera, MD


    Full Text Available Introduction: While a nationwide poison control registry exists in Chile, reporting to the center is sporadic and happens at the discretion of the treating physician or by patients’ self-report. Moreover, individual hospitals do not monitor accidental or intentional poisoning in a systematic manner. The goal of this study was to identify all cases of intentional medication overdose (MO that occurred over two years at a large public hospital in Santiago, Chile, and examine its epidemiologic profile. Methods: This study is a retrospective, explicit chart review conducted at Hospital Sótero del Rio from July 2008 until June 2010. We included all cases of identified intentional MO. Alcohol and recreational drugs were included only when they were ingested with other medications. Results: We identified 1,557 cases of intentional MO and analyzed a total of 1,197 cases, corresponding to 0.51% of all emergency department (ED presentations between July 2008 and June 2010. The median patient age was 25 years. The majority was female (67.6%. Two peaks were identified, corresponding to the spring of each year sampled. The rate of hospital admission was 22.2%. Benzodiazepines, selective serotonin reuptake inhibitors, and tricyclic antidepressants (TCA were the causative agents most commonly found, comprising 1,044 (87.2% of all analyzed cases. Acetaminophen was involved in 81 (6.8% cases. More than one active substance was involved in 35% of cases. In 7.3% there was ethanol co-ingestion and in 1.0% co-ingestion of some other recreational drug (primarily cocaine. Of 1,557 cases, six (0.39% patients died. TCA were involved in two of these deaths. Conclusion: Similar to other developed and developing nations, intentional MO accounts for a significant number of ED presentations in Chile. Chile is unique in the region, however, in that its spectrum of intentional overdoses includes an excess burden of tricyclic antidepressant and benzodiazepine overdoses, a

  2. Discharge from an emergency department observation unit and a surgical assessment unit

    Schultz, Helen; Qvist, Niels; Backer Mogensen, Christian;


    To investigate the experiences of patients with acute abdominal pain at discharge from an emergency department observation unit compared with discharge from a surgical assessment unit.......To investigate the experiences of patients with acute abdominal pain at discharge from an emergency department observation unit compared with discharge from a surgical assessment unit....

  3. Systolic blood pressure and short-term mortality in the emergency department and prehospital setting

    Kristensen, Anders Kasper Bruun; Holler, Jon Gitz; Mikkelsen, Søren;


    retrospective, hospital-based cohort study was performed at Odense University Hospital which included all adult patients in the emergency department between 1995 and 2011, all patients transported to the emergency department in ambulances in the period 2012-2013, and all patients serviced by the physician...

  4. Factors influencing the implementation of the guideline triage in emergency departments: a qualitative study.

    Janssen, M.A.M.; Achterberg, T. van; Adriaansen, M.J.M.; Kampshoff, C.S.; Schalk, D.M.; Mintjes-de Groot, A.J.


    AIMS AND OBJECTIVES: The objectives are: (1) to identify factors that influence the implementation of the guideline Triage in emergency departments [2004] in emergency departments in the Netherlands, and (2) to develop tailored implementation strategies for implementation of this guideline. BACKGROU

  5. The emerging trend in the epidemiology of gunshot injuries in the emergency department of a Nigerian tertiary hospital in a State without formal prehospital emergency medical services

    Gabriel Uche Pascal Iloh; Abali Chuku; John Nnaemeka Ofoedu; Ogbonna Hyginus Ugwele; James Onyedikachi Onyekwere; Agwu Nkwa Amadi


    Background : Gunshot injuries (GSIs) though a rarity in Nigeria before the Nigerian civil war have now become rampant with variable epidemiology. It is emerging as a common cause of trauma-related emergency hospitalizations. Aim: The study was aimed at reviewing the epidemiology of gunshot injuries in the emergency department (ED) of a Nigerian tertiary hospital over a 5-year period. Materials and Methods: This was a retrospective study of GSIs seen at the ED of Federal Medical Centre, Umuahi...

  6. Designing a clinical dashboard to fill information gaps in the emergency department.

    Swartz, Jordan L; Cimino, James J; Fred, Matthew R; Green, Robert A; Vawdrey, David K


    Data fragmentation within electronic health records causes gaps in the information readily available to clinicians. We investigated the information needs of emergency medicine clinicians in order to design an electronic dashboard to fill information gaps in the emergency department. An online survey was distributed to all emergency medicine physicians at a large, urban academic medical center. The survey response rate was 48% (52/109). The clinical information items reported to be most helpful while caring for patients in the emergency department were vital signs, electrocardiogram (ECG) reports, previous discharge summaries, and previous lab results. Brief structured interviews were also conducted with 18 clinicians during their shifts in the emergency department. From the interviews, three themes emerged: 1) difficulty accessing vital signs, 2) difficulty accessing point-of-care tests, and 3) difficulty comparing the current ECG with the previous ECG. An emergency medicine clinical dashboard was developed to address these difficulties. PMID:25954420

  7. Swedish emergency department triage and interventions for improved patient flows: a national update

    Farrokhnia Nasim; Göransson Katarina E


    Abstract Background In Scandinavia, emergency department triage and patient flow processes, are under development. In Sweden, the triage development has resulted in two new triage scales, the Adaptive Process Triage and the Medical Emergency Triage and Treatment System. Both these scales have logistic components, aiming to improve patient flows. The aim of this study was to report the development and current status of emergency department triage and patient flow processes in Sweden. Methods I...

  8. Improving the Assessment and Triage of Patients with Mental Illness attending the Emergency Department

    de Lacy, Jacqueline


    Since the amalgamation of mental institutions with acute hospitals there has been an increase in presentations of patients with mental illness to the Emergency Department. The first point of contact for the patient attending the Emergency Department is typically triage. It is the point where emergency care begins with the nurse assessing the patient and assigning a triage category that best suits the patient’s clinical need. Traditionally triage had its origins in assessing patients presentin...

  9. What do we really know about infants who attend Accident and Emergency departments?

    Heys, M; Kwong, H-M; Reed, J.; Blair, M


    Aims: Accident and Emergency attendances continue to rise. Infants are disproportionately represented. This study examines the clinical reasons infants attend UK Accident and Emergency departments. Methods: A retrospective review of 6,667 infants aged less than one year attending Accident and Emergency at two district general hospitals in London from 1st April 2009 to 30th March 2010. All infants had been assigned to a diagnostic category by the medical coding department according to Natio...

  10. Tattoos and Piercing: A Review for the Emergency Department Physician

    Urdang, Michael; Mallek, Jennifer T; Mallon, William K.


    Tattoos and piercings are increasingly part of everyday life for large sections of the population, and more emergency physicians are seeing these body modifications (BM) adorn their patients. In this review we elucidate the most common forms of these BMs, we describe how they may affect both the physical and psychological health of the patient undergoing treatment, and also try to educate around any potential pitfalls in treating associated complications. [West J Emerg Med. 2011;12(4):393–398...