WorldWideScience

Sample records for city emergency department

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

    OpenAIRE

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

    2004-01-01

    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.

    OpenAIRE

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

    1991-01-01

    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.

    OpenAIRE

    Hunt, M T; Glucksman, M E

    1991-01-01

    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.

    OpenAIRE

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

    1996-01-01

    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.

    OpenAIRE

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

    1996-01-01

    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

    DEFF Research Database (Denmark)

    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.

    Science.gov (United States)

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

    2016-04-01

    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.

    Science.gov (United States)

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

    2016-01-01

    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

    Science.gov (United States)

    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.

    2009-01-01

    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

    DEFF Research Database (Denmark)

    Gammelgaard, Britta

    2015-01-01

    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

    Science.gov (United States)

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

    2013-01-01

    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].

    Science.gov (United States)

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

    2016-04-01

    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.

    Directory of Open Access Journals (Sweden)

    Donald R Olson

    2007-08-01

    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

    Directory of Open Access Journals (Sweden)

    Rowe Brian H

    2009-06-01

    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

    International Nuclear Information System (INIS)

    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

    Directory of Open Access Journals (Sweden)

    Abigail Hankin

    2013-08-01

    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

    DEFF Research Database (Denmark)

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

    2012-01-01

    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

    Directory of Open Access Journals (Sweden)

    Kantonen Jarmo

    2012-01-01

    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

    NARCIS (Netherlands)

    Meijer, Albert

    2016-01-01

    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

    OpenAIRE

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

    2011-01-01

    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.

    Science.gov (United States)

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

    2010-03-01

    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

    OpenAIRE

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

    2012-01-01

    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

    DEFF Research Database (Denmark)

    Gammelgaard, Britta; Aastrup, Jesper

    2014-01-01

    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

    Institute of Scientific and Technical Information of China (English)

    Yu-Jang Su; Chia-Jung Liao

    2015-01-01

    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

    DEFF Research Database (Denmark)

    MacKenzie, Colin; Lippert, Freddy

    1999-01-01

    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

    DEFF Research Database (Denmark)

    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.

    Science.gov (United States)

    Leonard, R B; Ricks, R C

    1980-09-01

    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

  8. IZBERBASH CITY IN THE COURSE OF EMERGING

    Directory of Open Access Journals (Sweden)

    Magomed-Ganipa Gamidovich MAGOMEDOV

    2015-05-01

    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

    OpenAIRE

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

    2015-01-01

    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).

    Science.gov (United States)

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

    2005-01-01

    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

    Directory of Open Access Journals (Sweden)

    Neslihan YÜCE

    2012-05-01

    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.

    Science.gov (United States)

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

    2016-07-01

    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

    DEFF Research Database (Denmark)

    Hertzum, Morten

    2011-01-01

    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.

    Science.gov (United States)

    Weiner, Scott G

    2013-03-01

    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

    DEFF Research Database (Denmark)

    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

    DEFF Research Database (Denmark)

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

    2013-01-01

    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.

    Science.gov (United States)

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

    2010-12-01

    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

    OpenAIRE

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

    2011-01-01

    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

    OpenAIRE

    Palmberg, Johanna

    2013-01-01

    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.

    Directory of Open Access Journals (Sweden)

    Aharnish Shah

    2014-07-01

    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.

    Science.gov (United States)

    Welsh, Jeanette

    2015-10-01

    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

    OpenAIRE

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

    2014-01-01

    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

    OpenAIRE

    Hoytema van Konijnenburg, E.M.M.

    2015-01-01

    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...

    Data.gov (United States)

    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

    OpenAIRE

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

    2013-01-01

    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

    NARCIS (Netherlands)

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

    2011-01-01

    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

    NARCIS (Netherlands)

    E.M.M. Hoytema van Konijnenburg

    2015-01-01

    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

    OpenAIRE

    Tsagaratos, Costandinos; Taha, Farook W

    2012-01-01

    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

    Science.gov (United States)

    Persse, David E.; Bradley, Richard N.

    2003-09-01

    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.

    Science.gov (United States)

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

    1982-07-01

    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

    DEFF Research Database (Denmark)

    Hertzum, Morten; Simonsen, Jesper

    2010-01-01

    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

    Directory of Open Access Journals (Sweden)

    Alireza Baratloo

    2015-02-01

    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

    DEFF Research Database (Denmark)

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

    2016-01-01

    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.

    Science.gov (United States)

    Campbell, Samuel G; Sinclair, Douglas E

    2004-07-01

    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

    Data.gov (United States)

    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

    Data.gov (United States)

    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

    OpenAIRE

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

    2010-01-01

    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

    OpenAIRE

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

    2010-01-01

    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...

  19. RETROSPECTIVE EVALUATION POISONING PATIENTS IN EMERGENCY DEPARTMENT

    OpenAIRE

    Onur Yeşil; Haldun Akoğlu; Özge Onur; Özlem Güneysel

    2008-01-01

    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

    OpenAIRE

    Braithwaite Jeffrey; Westbrook Johanna I; Creswick Nerida

    2009-01-01

    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.

    NARCIS (Netherlands)

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

    2012-01-01

    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

    Directory of Open Access Journals (Sweden)

    Marina Mancini

    2014-06-01

    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.

    Science.gov (United States)

    Khalifa, Mohamed; Zabani, Ibrahim

    2016-01-01

    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

    OpenAIRE

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

    2012-01-01

    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

    OpenAIRE

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

    2012-01-01

    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

    OpenAIRE

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

    2009-01-01

    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

    Institute of Scientific and Technical Information of China (English)

    GUAN Youhai; FENG Qimin; JIA Jing

    2006-01-01

    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.

    LENUS (Irish Health Repository)

    Kuan, Samuel C

    2012-02-01

    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

    Directory of Open Access Journals (Sweden)

    John Graneto

    2013-09-01

    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

    OpenAIRE

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

    2011-01-01

    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

    OpenAIRE

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

    2005-01-01

    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

    Directory of Open Access Journals (Sweden)

    John V. Zurlo

    2012-01-01

    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

    Directory of Open Access Journals (Sweden)

    Nickolas Nahm

    2012-09-01

    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.

    Directory of Open Access Journals (Sweden)

    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.

    Science.gov (United States)

    Kaptan, Kubilay

    2014-10-01

    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.

    Science.gov (United States)

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

    2016-06-01

    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.

    OpenAIRE

    Johnson, L. A.; Derlet, R W

    1996-01-01

    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

    Directory of Open Access Journals (Sweden)

    Foley, Mathew

    2011-05-01

    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.

    OpenAIRE

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

    1997-01-01

    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.

    LENUS (Irish Health Repository)

    Hawkes, C

    2012-02-03

    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

    Directory of Open Access Journals (Sweden)

    Alessandra Buja

    2013-12-01

    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

    International Nuclear Information System (INIS)

    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.

    Science.gov (United States)

    Bailey, Benoit; Trottier, Evelyne D

    2016-08-01

    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.

    LENUS (Irish Health Repository)

    O'Connor, Gabrielle

    2012-02-01

    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.

  5. RETROSPECTIVE EVALUATION POISONING PATIENTS IN EMERGENCY DEPARTMENT

    Directory of Open Access Journals (Sweden)

    Onur Yeşil

    2008-01-01

    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

    OpenAIRE

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

    2000-01-01

    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

    Data.gov (United States)

    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

    Directory of Open Access Journals (Sweden)

    Payman Asadi

    2015-02-01

    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

    Directory of Open Access Journals (Sweden)

    Braithwaite Jeffrey

    2009-12-01

    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

    NARCIS (Netherlands)

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

    2010-01-01

    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

    Science.gov (United States)

    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

    2013-01-01

    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

    OpenAIRE

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

    1996-01-01

    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].

    Science.gov (United States)

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

    2015-06-01

    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.

    OpenAIRE

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

    1998-01-01

    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

    OpenAIRE

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

    2013-01-01

    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

    International Nuclear Information System (INIS)

    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.

    Science.gov (United States)

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

    2016-01-01

    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...

    Data.gov (United States)

    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.

    Science.gov (United States)

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

    2016-01-01

    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

    OpenAIRE

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

    2000-01-01

    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.

    OpenAIRE

    Jones, K E; McLauchlan, C A

    1995-01-01

    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

    OpenAIRE

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

    2005-01-01

    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

    OpenAIRE

    Baker, Stephanie J.; Esbenshade, Angie

    2015-01-01

    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.

    OpenAIRE

    Walters, R F

    1987-01-01

    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

    OpenAIRE

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

    2014-01-01

    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

    OpenAIRE

    Johnson LH; Chambers P; Dexheimer JW

    2016-01-01

    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.

    Science.gov (United States)

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

    2015-01-01

    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

    Directory of Open Access Journals (Sweden)

    Ángel Asensio

    2015-06-01

    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.

    Energy Technology Data Exchange (ETDEWEB)

    Cambridge Concord Associates

    2011-02-15

    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

    DEFF Research Database (Denmark)

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

    2010-01-01

    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

    Data.gov (United States)

    U.S. Department of Health & Human Services — MAP:http://tinyurl.com/AsthmaMap 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

    NARCIS (Netherlands)

    Bos, N.

    2013-01-01

    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.

    OpenAIRE

    Heyworth, J

    1988-01-01

    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

    DEFF Research Database (Denmark)

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

    2010-01-01

    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...

  15. MANAGEMENT OF EXTRIMITY FRACTURE IN EMERGENCY DEPARTMENT

    Directory of Open Access Journals (Sweden)

    Putu Sukma Parahita

    2013-09-01

    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

    Directory of Open Access Journals (Sweden)

    Lynn E.J. Gower, DO

    2012-05-01

    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

    OpenAIRE

    Siamidoudaran, Meisam

    2012-01-01

    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

    Directory of Open Access Journals (Sweden)

    Currier, Glenn W.

    2015-01-01

    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

    OpenAIRE

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

    2015-01-01

    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

    OpenAIRE

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

    2015-01-01

    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.

    Science.gov (United States)

    Nelson, Scott C; Hooker, Roderick S

    2016-06-01

    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

    OpenAIRE

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

    2013-01-01

    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.

    Science.gov (United States)

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

    2014-01-01

    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.

    OpenAIRE

    Wood, G D; Leeming, K A

    1995-01-01

    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

    Directory of Open Access Journals (Sweden)

    Metin Ateşçelik

    2014-03-01

    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

    Science.gov (United States)

    Mabingo, Alfdaniels

    2015-01-01

    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

    NARCIS (Netherlands)

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

    2013-01-01

    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

    OpenAIRE

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

    2013-01-01

    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].

    Science.gov (United States)

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

    2015-12-01

    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

    DEFF Research Database (Denmark)

    Sønderskov, Michele L.; Hallas, Peter

    2013-01-01

    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.

    Science.gov (United States)

    Willcock, Simon M

    2008-07-21

    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

    CERN Document Server

    Jabareen, Yosef

    2015-01-01

    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

    OpenAIRE

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

    2007-01-01

    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.

    LENUS (Irish Health Repository)

    Clarke, Heather J

    2012-02-03

    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

    Science.gov (United States)

    Klingner, Jill; Moscovice, Ira

    2012-01-01

    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

    DEFF Research Database (Denmark)

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

    2011-01-01

    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

    Science.gov (United States)

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

    2012-01-01

    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

    Directory of Open Access Journals (Sweden)

    Alim Cokuk

    2013-02-01

    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.

    Science.gov (United States)

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

    2015-03-01

    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

    OpenAIRE

    Helmy, Mona

    2008-01-01

    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

    OpenAIRE

    Portugali, J.; I Benenson; I Omer

    1997-01-01

    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

    Science.gov (United States)

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

    2016-01-01

    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

    Institute of Scientific and Technical Information of China (English)

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

    2016-01-01

    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

    Science.gov (United States)

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

    2015-10-01

    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.

    Science.gov (United States)

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

    2015-08-01

    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?

    Science.gov (United States)

    Proud, Matthew E; Howard, Patricia Kunz

    2016-01-01

    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.

    Science.gov (United States)

    Dumont, V; Rousseau, A

    2002-01-01

    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

    OpenAIRE

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

    2015-01-01

    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.

    OpenAIRE

    Travers, D.; Parham, T.

    1997-01-01

    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’

    OpenAIRE

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

    2011-01-01

    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

    OpenAIRE

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

    2014-01-01

    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

    DEFF Research Database (Denmark)

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

    2011-01-01

    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

    DEFF Research Database (Denmark)

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

    2011-01-01

    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

    OpenAIRE

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

    2016-01-01

    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

    OpenAIRE

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

    2006-01-01

    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.

    OpenAIRE

    Mann, C J

    1996-01-01

    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

    Science.gov (United States)

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

    2015-01-01

    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

    OpenAIRE

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

    2016-01-01

    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.

    Science.gov (United States)

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

    2014-11-01

    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

    Directory of Open Access Journals (Sweden)

    Douglas A. Propp

    2012-09-01

    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.

    Science.gov (United States)

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

    2013-03-01

    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

    Directory of Open Access Journals (Sweden)

    Lotfipour, Shahram

    2013-11-01

    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

    DEFF Research Database (Denmark)

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

    2015-01-01

    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

    Directory of Open Access Journals (Sweden)

    Zornitsa Spasova

    2015-12-01

    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

    Directory of Open Access Journals (Sweden)

    Markham Donna

    2011-12-01

    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.

    Science.gov (United States)

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

    2015-07-01

    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

    OpenAIRE

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

    2015-01-01

    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.

    OpenAIRE

    Moulton, C; Pennycook, A; Crawford, R

    1992-01-01

    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.

    OpenAIRE

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

    1997-01-01

    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.

    LENUS (Irish Health Repository)

    Healy, Sonya

    2012-01-31

    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.

    Science.gov (United States)

    Powley, Denise

    2013-07-01

    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?

    OpenAIRE

    2013-01-01

    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

    OpenAIRE

    Junxi Qian; Shenjing He

    2012-01-01

    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

    Science.gov (United States)

    ... 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

    OpenAIRE

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

    2005-01-01

    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

    Science.gov (United States)

    Shelton, Dominick; Sinclair, Paul

    2016-01-01

    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.

    Science.gov (United States)

    Shelton, Dominick; Sinclair, Paul

    2016-01-01

    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

    Directory of Open Access Journals (Sweden)

    Ghan-Shyam Lohiya

    2015-01-01

    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

    KAUST Repository

    Harrou, Fouzi

    2015-10-21

    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.

    Science.gov (United States)

    Blackmore, C Craig; Castro, Alexandra

    2015-12-01

    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

    Directory of Open Access Journals (Sweden)

    Ohlmeier Martin

    2005-12-01

    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.

    Science.gov (United States)

    McConnell, Donna; McCance, Tanya; Melby, Vidar

    2016-05-01

    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

    Science.gov (United States)

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

    2011-01-01

    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

    Directory of Open Access Journals (Sweden)

    Talley, Brad E

    2011-02-01

    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.

    Science.gov (United States)

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

    2016-03-01

    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

    Institute of Scientific and Technical Information of China (English)

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

    2005-01-01

    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

    OpenAIRE

    Marc Wolfram; Niki Frantzeskaki

    2016-01-01

    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

    Directory of Open Access Journals (Sweden)

    Gerard B Martin

    2013-05-01

    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.

    Science.gov (United States)

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

    2016-09-01

    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

    DEFF Research Database (Denmark)

    Hertzum, Morten

    2012-01-01

    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

    Directory of Open Access Journals (Sweden)

    Debasis Pradhan

    2015-01-01

    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.

    Science.gov (United States)

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

    2007-01-01

    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

    DEFF Research Database (Denmark)

    Laursen, B

    2006-01-01

    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

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-12-12

    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

    Directory of Open Access Journals (Sweden)

    Mustafa Burak Sayhan

    2011-01-01

    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

    DEFF Research Database (Denmark)

    Rosted, Elizabeth Emilie

    2010-01-01

    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

    DEFF Research Database (Denmark)

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

    2012-01-01

    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.

    LENUS (Irish Health Repository)

    Gibbons, Lynda

    2013-09-01

    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

    Directory of Open Access Journals (Sweden)

    Jacob Urkin

    2008-01-01

    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

    Directory of Open Access Journals (Sweden)

    Tamer Durdu

    2013-10-01

    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

    Directory of Open Access Journals (Sweden)

    Morteza Talebi Doluee

    2015-01-01

    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

    Science.gov (United States)

    Latham, Lesley P.; Ackroyd-Stolarz, Stacy

    2014-01-01

    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

    Directory of Open Access Journals (Sweden)

    Courtney M. Smalley

    2014-03-01

    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

    Directory of Open Access Journals (Sweden)

    B. A. Nicks

    2012-01-01

    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'.

    Science.gov (United States)

    Blakemore, Sophie

    2016-06-10

    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.

    OpenAIRE

    Olney, D B

    1988-01-01

    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

    International Nuclear Information System (INIS)

    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

    OpenAIRE

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

    2002-01-01

    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.

    OpenAIRE

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

    1987-01-01

    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.

    Science.gov (United States)

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

    2013-01-01

    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

    Directory of Open Access Journals (Sweden)

    Mieczysław Szyszkowicz

    2016-03-01

    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.

    Science.gov (United States)

    Zalenski, R J; Shamsa, F H

    1998-07-01

    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.

    Science.gov (United States)

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

    2016-07-01

    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

    Directory of Open Access Journals (Sweden)

    Mieczysław Szyszkowicz

    2010-11-01

    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.

    Science.gov (United States)

    Riker, R R; White, B W

    1991-01-01

    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

    Directory of Open Access Journals (Sweden)

    Zohair J Gazzaz

    2012-01-01

    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.

    Science.gov (United States)

    Wyatt, Thomas E; Haug, Eric W

    2012-04-01

    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

    Directory of Open Access Journals (Sweden)

    Gianfranco Cervellin

    2016-05-01

    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.

    Science.gov (United States)

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

    2016-01-01

    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.

    Science.gov (United States)

    Gomez, Carles; Paradells, Josep

    2015-01-01

    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

    Directory of Open Access Journals (Sweden)

    Carles Gomez

    2015-09-01

    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.

    Science.gov (United States)

    Bleetman, A; Kasem, H; Crawford, R

    1996-03-01

    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...

    Science.gov (United States)

    2012-11-07

    ... 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

    Science.gov (United States)

    Howell, Fanon John

    2014-01-01

    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

    OpenAIRE

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

    1998-01-01

    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

    OpenAIRE

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

    2013-01-01

    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

    OpenAIRE

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

    2013-01-01

    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.

    Science.gov (United States)

    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

    2015-08-01

    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.

    NARCIS (Netherlands)

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

    2007-01-01

    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

    Directory of Open Access Journals (Sweden)

    Pankaj B. Patel

    2014-05-01

    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

    Directory of Open Access Journals (Sweden)

    Marc Wolfram

    2016-02-01

    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?

    Science.gov (United States)

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

    2016-01-01

    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.

    Directory of Open Access Journals (Sweden)

    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

    Directory of Open Access Journals (Sweden)

    Thomas E. Terndrup

    2013-03-01

    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.

    Science.gov (United States)

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

    2016-06-01

    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

    OpenAIRE

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

    2015-01-01

    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

    Institute of Scientific and Technical Information of China (English)

    赵双玲; 楼超华; 高尔生

    2000-01-01

    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

    Directory of Open Access Journals (Sweden)

    Delgado Sergio V

    2007-08-01

    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

    Directory of Open Access Journals (Sweden)

    Tara Johnson, MD, MPH

    2016-01-01

    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

    Directory of Open Access Journals (Sweden)

    Fevzi Yilmaz

    2013-10-01

    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

    Directory of Open Access Journals (Sweden)

    Pablo Aguilera, MD

    2016-01-01

    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

    DEFF Research Database (Denmark)

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

    2014-01-01

    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

    DEFF Research Database (Denmark)

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

    2015-01-01

    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.

    NARCIS (Netherlands)

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

    2012-01-01

    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

    OpenAIRE

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

    2013-01-01

    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.

    Science.gov (United States)

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

    2014-01-01

    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

    OpenAIRE

    Farrokhnia Nasim; Göransson Katarina E

    2011-01-01

    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

    OpenAIRE

    de Lacy, Jacqueline

    2011-01-01

    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?

    OpenAIRE

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

    2014-01-01

    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

    OpenAIRE

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

    2011-01-01

    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...

  11. Accreditation of Emergency Department at a Teaching Hospital in Tehran University of Medical Sciences in 2010

    OpenAIRE

    Fereshteh Farzianpour; Roholah Askari; Amin T. Hamedani; Gholamosien Khorshidi; Sanaz Amirifar; Shadi Hosseini

    2011-01-01

    Problem statement: Considering the importance of emergency departments in healthcare system and the high mortality rate of patients referred to these departments, it is crucial to provide quality services in emergency departments. Accreditation is a systematic process for improving quality of care and it enables managers to assess and evaluate the healthcare system. Accreditation of an organization provides an obvious commitment for improving quality of safety, quality of patient care, ensuri...

  12. Emergency care of the elderly in the short-stay ward of the accident and emergency department.

    OpenAIRE

    Harrop, S.N.; Morgan, W J

    1985-01-01

    Review of a consecutive series of the elderly patients who presented unheralded to the Accident and Emergency Department of the Royal Gwent Hospital showed that a relative minority (11%) were difficult to manage because they had no obvious acute medical condition or injury which qualified them for admission by the firms to whom they were first referred. The difficulty was compounded by the shortage of geriatric beds. Judicious use of short-stay ward beds in the accident and emergency departme...

  13. Emergency Department Frequent Utilization for Non-Emergent Presentments: Results from a Regional Urban Trauma Center Study.

    Directory of Open Access Journals (Sweden)

    Joshua G Behr

    Full Text Available First, to test a model of the drivers of frequent emergency department utilization conceptualized as falling within predisposing, enabling, and need dimensions. Second, to extend the model to include social networks and service quality as predictors of frequent utilization. Third, to illustrate the variation in thresholds that define frequent utilization in terms of the number of emergency department encounters by the predictors within the model.Primary data collection over an eight week period within a level-1 trauma urban hospital's emergency department.Representative randomized sample of 1,443 adult patients triaged ESI levels 4-5. Physicians and research staff interviewed patients as they received services. Relationships with the outcome variable, utilization, were tested using logistic regression to establish odds-ratios.70.6 percent of patients have two or more, 48.3 percent have three or more, 25.3 percent have four or more, and 14.9 percent have five or more emergency department visits within 12 months. Factors associated with frequent utilization include gender, race, poor mental health, mental health drugs, prescription drug abuse, social networks, employment, perceptions of service quality, seriousness of condition, persistence of condition, and previous hospital admittance.Interventions targeting associated factors will change global emergency department encounters, although the mutability varies. Policy interventions to address predisposing factors such as substance abuse or access to mental health treatment as well as interventions that speak to enabling factors such as promoting the resiliency of social networks may result in decreased frequency of emergency department utilization.

  14. Transportation Emergency Preparedness Program Plan, U.S. Department of Energy Region 6

    Energy Technology Data Exchange (ETDEWEB)

    Marsha Keister

    2010-04-01

    The United States Department of Energy (DOE) Region 6 Transportation Emergency Preparedness Program Plan (TEPP Plan) operates within the framework of the DOE emergency management system for developing, coordinating, and directing emergency planning, preparedness, and readiness assurance activities for radiological transportation incidents. The DOE Region 6 TEPP Plan is a narrative description of the DOE Transportation Emergency Preparedness Program activities, training and technical assistance provided to states and tribes along DOE's transportation corridors in DOE Region 6.

  15. Recent self-harm and psychological measures in the emergency department

    Directory of Open Access Journals (Sweden)

    Jason R. Randall

    2014-11-01

    Full Text Available The assessment of self-harm risk is a common, difficult, and perplexing task for many physicians, especially those working in emergency departments (ED. Attempts have been made to determine objective methods for assessing patients with suicidal ideation or self-harm though there is still a lack of knowledge about objective assessments of these patients. A study was conducted where 181 suicidal patients were enrolled in two EDs within the city of Edmonton, Canada. Initial interviews were conducted in the ED which collected basic demographics and medical history as well as psychometric measures including the Beck Hopelessness Scale, Barratt Impulsiveness Scale, Brief Symptom Inventory, Drug Abuse Screening Test 10, and CAGE questionnaire. The results of these measures were compared between those who presented to the ED with self-harm and those who presented only with ideation. Those with recent self-harm scored lower on many of the scales and subscales of distress and impulsivity measured compared to those with no recent self-harm. Possible explanations for this difference include differences in psychological traits between the two groups and possible cathartic effects of self-harm. The lower scores obtained by those that present with self-harm may complicate attempts to use psychometric tools to determine future self-harm risk.

  16. Implementation of a Team-based Physician Staffing Model at an Academic Emergency Department

    Directory of Open Access Journals (Sweden)

    Jose V. Nable

    2014-09-01

    Full Text Available Introduction: There is scant literature regarding the optimal resident physician staffing model of academic emergency departments (ED that maximizes learning opportunities. A department of emergency medicine at a large inner-city academic hospital initiated a team-based staffing model. Its pre-interventional staffing model consisted of residents and attending physicians being separately assigned patients, resulting in residents working with two different faculty providers in the same shift. This study aimed to determine if the post-interventional team-based system, in which residents were paired with a single attending on each shift, would result in improved residents’ learning and clinical experiences as manifested by resident evaluations and the number of patients seen. Methods: This retrospective before-and-after study at an academic ED with an annual volume of 52,000 patients examined the mean differences in five-point Likert-scale evaluations completed by residents assessing their ED rotation experiences in both the original and team-based staffing models. The residents were queried on their perceptions of feeling part of the team, decision-making autonomy, clinical experience, amount of supervision, quality of teaching, and overall rotational experience. We also analyzed the number of patients seen per hour by residents. Paired sample t-tests were performed. Residents who were in the program in the year preceding and proceeding the intervention were eligible for inclusion. Results: 34 of 38 eligible residents were included (4 excluded for lack of evaluations in either the pre- or post-intervention period. There was a statistically significant improvement in resident perception of the quality and amount of teaching, 4.03 to 4.27 (mean difference=0.24, p=0.03. There were non-statistically significant trends toward improved mean scores for all other queries. Residents also saw more patients following the initiation of the team-based model

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

    Directory of Open Access Journals (Sweden)

    William K. Mallon

    2011-05-01

    Full Text Available 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.

  18. ANALYSIS OF SUICIDAL POISONING PATIENTS PRESENTED TO EMERGENCY DEPARTMENT

    Directory of Open Access Journals (Sweden)

    Abdulkadir GUNDUZ

    Full Text Available Objective: On this study, it is aimed to evaluate retrospectively cases that are brought to emergency service because of suicidal poisoning. Material and Methods: The files that belong to voluntary self-poisoning cases that came or were brought to Farabi Hospital Emergency Medicine Branch of Karadeniz Technical University (KTU, Faculty of Medicine between the dates of 1 January 2000 and 31 December 2001, were studied. During this period, among 302 poisoning hospitalizations, 207 of them which had sufficient information in their file were accepted in the study. Four criteria of the cases were evaluated; demographic situation, time of incoming, type of medication(s or drug(s used and it was investigated whether there is any significant relation between those. Results: The percentage of voluntary self-poisoning cases among total hospitalizations was found to be 1,64 %. 160 of cases (77,3% were women, 47 of cases(22,7% were men. Average age was 22.7±8.5 among women, 26.7±9.1 among men. % 60,3 of cases came to emergency service between 12:01-24:00. 144 cases (69,7% of voluntary self-poisoned had used their own medications/drugs. Approximately the halves of cases were discovered that they had used more than one type medications/drugs. It was detected that analgesic medications were used at most among these medications/drugs. Conclusion: Voluntary self-poisoning cases are one of continuously met problems in the emergency services. It would be an appropriate approach to emphasize on this subject in emergency medicine trainings. [TAF Prev Med Bull 2004; 3(10.000: 234-242

  19. Geriatric Patients Presenting to the Emergency Department of a Japanese University Hospital

    OpenAIRE

    EZAKI, TAKAHIRO; YAMADA, Tomomi; Yasuda, Mitsuhiro; Setoguchi, Hidekazu; Noda, Eiichiro; Kannna, Tomoo; Shiraishi, Kiminori; Zaitshu, Akinori; Hashizume, Makoto

    2006-01-01

    To evaluate the trend of elderly patients visiting the emergency department of a Japanese University Hospital, out patient-based records were reviewed of the emergency department of Kyushu University Hospital from 2000 to 2004. A total number of 7610 emergency patients visited the department during the five year period. The median(25%, 75%)of age was 32(22, 56). Patients aged 65 years and over accounted for 16% of all attendances. All the patients were classified into 6 groups according to t...

  20. The introduction of the Manchester triage scale to an emergency department in the Republic of Ireland.

    LENUS (Irish Health Repository)

    Cronin, J G

    2012-02-03

    Triage is an integral part of the modern emergency department. The use of a recognised triage system has many advantages for the emergency department including reference to a recognised decision-making structure and support in the form of a professionally accepted and validated system. As part of a programme of internal change the Manchester triage system (MTS) was introduced to an emergency department in the Republic of Ireland. This article outlines the introduction of this method of triage and cites the domestic and international drivers of the change.

  1. Global Emergency Medicine Journal Club: A Social Media Discussion About the Lack of Association Between Press Ganey Scores and Emergency Department Analgesia.

    Science.gov (United States)

    Westafer, Lauren; Hensley, Justin; Shaikh, Sameed; Lin, Michelle

    2016-01-01

    Annals of Emergency Medicine collaborated with an educational Web site, Academic Life in Emergency Medicine (ALiEM), to host a public discussion featuring the 2014 Annals article on the association between Press Ganey scores and emergency department (ED) analgesia by Schwartz et al. The objective was to curate a 14-day (December 1 through 14, 2014) worldwide academic dialogue among clinicians in regard to preselected questions about the article. Five online facilitators hosted the multimodal discussion on the ALiEM Web site, Twitter, and Google Hangout. Comments across the social media platforms were curated for this report, as framed by the 4 preselected questions. Engagement was tracked through Web analytic tools and analysis of tweets. Blog comments, tweets, and video expert commentary involving the featured article are summarized and reported. The dialogue resulted in 978 page views from 342 cities in 33 countries on the ALiEM Web site, 464,345 Twitter impressions, and 83 views of the video interview with experts. Of the unique 169 identified tweets, discussion (53.3%) and learning points (32.5%) were the most common category of tweets identified. Common themes that arose in the open-access multimedia discussions included Press Ganey data validity and the utility of patient satisfaction in determining pain treatment efficacy. This educational approach using social media technologies demonstrates a free, asynchronous means to engage a worldwide scholarly discourse. PMID:26003003

  2. Infusion of Emerging Technologies and New Teaching Methods into the Mechanical Engineering Curriculum at the City College of New York

    Science.gov (United States)

    Delale, Feridun; Liaw, Benjamin M.; Jiji, Latif M.; Voiculescu, Ioana; Yu, Honghui

    2011-01-01

    From October 2003 to April 2008 a systemic reform of the Mechanical Engineering program at The City College of New York was undertaken with the goal of incorporating emerging technologies (such as nanotechnology, biotechnology, Micro-Electro-Mechanical Systems (MEMS), intelligent systems) and new teaching methodologies (such as project based…

  3. Reversal of Warfarin-Induced Hemorrhage in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Sean O Henderson

    2011-05-01

    Full Text Available Warfarin, an oral vitamin K antagonist, is used to prevent arterial and venous thromboembolism in patients suffering from a multitude of diseases. In 2004, 31 million warfarin prescriptions were dispensed in the United States. Warfarin inhibits the activation of the vitamin K–dependent clotting factors (Factors II, VII, IX, and X and regulatory proteins (proteins C, S, and Z. It is one of the leading drugs implicated in emergency room visits for adverse drug reactions. Annually the frequency of bleeding complications associated with overanticoagulation is 15% to 20%, with fatal bleeds measuring as high as 1% to 3%. The most effective method of warfarin reversal involves the use of Four Factor Prothrombin Complex Concentrate (PCC, which is widely used throughout Europe but is unavailable in the United States. The current therapies available to emergency room physicians in the United States are fresh frozen plasma, recombinant Factor VIIa (rFVIIa, Factor Eight Inhibitory Bypassing Activity, or Three Factor PCC concomitantly administered with vitamin K. We review the advantages and disadvantages of these therapies and recommend Three Factor PCC with small doses of rFVIIa and with vitamin K in life-threatening situations if Four Factor PCC is unavailable. [West J Emerg Med. 2011;12(4:386–392.

  4. Modeling factors influencing the demand for emergency department services in ontario: a comparison of methods

    Directory of Open Access Journals (Sweden)

    Meaney Christopher

    2011-08-01

    Full Text Available Abstract Background Emergency departments are medical treatment facilities, designed to provide episodic care to patients suffering from acute injuries and illnesses as well as patients who are experiencing sporadic flare-ups of underlying chronic medical conditions which require immediate attention. Supply and demand for emergency department services varies across geographic regions and time. Some persons do not rely on the service at all whereas; others use the service on repeated occasions. Issues regarding increased wait times for services and crowding illustrate the need to investigate which factors are associated with increased frequency of emergency department utilization. The evidence from this study can help inform policy makers on the appropriate mix of supply and demand targeted health care policies necessary to ensure that patients receive appropriate health care delivery in an efficient and cost-effective manner. The purpose of this report is to assess those factors resulting in increased demand for emergency department services in Ontario. We assess how utilization rates vary according to the severity of patient presentation in the emergency department. We are specifically interested in the impact that access to primary care physicians has on the demand for emergency department services. Additionally, we wish to investigate these trends using a series of novel regression models for count outcomes which have yet to be employed in the domain of emergency medical research. Methods Data regarding the frequency of emergency department visits for the respondents of Canadian Community Health Survey (CCHS during our study interval (2003-2005 are obtained from the National Ambulatory Care Reporting System (NACRS. Patients' emergency department utilizations were linked with information from the Canadian Community Health Survey (CCHS which provides individual level medical, socio-demographic, psychological and behavioral information for

  5. Overflow and microbiological contamination in surface and groundwaters in La Costa city (Canelones department, Uruguay)

    International Nuclear Information System (INIS)

    In this paper the results of a geological risk study made during 2005 related to overflow and microbiological water contamination at Ciudad de la Costa City (Canelones department) are shown. This city has been showed a great urban growth for the last three decades. New hydrogeological studies looking forward the phreatic level and its bacteriological quality allow to know the level of the risk along 2005´s first semester. The top of the phreatic table in 40% of the studied area is below than 0.50 meter depth. The results of fourteen bacteriologic analyses in groundwater samples show extreme contamination values in faecal colliform, Pseudomona sp. and Aeruginosa content. Both surface drainage and beach water bacteriologic analyses did not show contamination values except those corresponding to Carrasco creek

  6. Overflow and microbiological contamination in surface and groundwaters in La Costa city (Canelones department, Uruguay)

    International Nuclear Information System (INIS)

    In this paper the results of a geological risk study made during 2005 related to overflow and microbiological water contamination at Ciudad de la Costa City (Canelones department) are shown. This city has been showed a great urban growth for the last three decades. New hydrogeological studies looking forward the phreatic level and its bacteriological quality allow to know the level of the risk along 2005 s first semester. The top of the phreatic table in 40% of the studied area is below than 0.50 meter depth. The results of fourteen bacteriologic analyses in groundwater samples show extreme contamination values in faecal colliform, Pseudo mona sp. and Aeruginosa content. Both surface drainage and beach water bacteriologic analyses did not show contamination values except those corresponding to Carrasco creek

  7. Carbon monoxide poisoning: correlation of neurological findings between accident and emergency departments and a hyperbaric unit

    OpenAIRE

    Lynch, R.; Laden, G; Grout, P

    2001-01-01

    Objectives—To investigate and quantify the differences in neurological examination findings in patients acutely poisoned with carbon monoxide, between initial assessment at accident and emergency (A&E) departments and subsequently at a hyperbaric unit.

  8. Referral to the accident and emergency department following the use of community alarms

    OpenAIRE

    Youssef, G.; Underhill, T; Tovey, C

    2000-01-01

    Objectives—To assess the degree of appropriate referral to the accident and emergency (A&E) department following the use of a community alarm where a mobile warden works in conjunction with the community alarm control centre.

  9. Visual Overview, Oral Detail: The Use of an Emergency-Department Whiteboard

    DEFF Research Database (Denmark)

    Hertzum, Morten; Simonsen, Jesper

    2015-01-01

    Whiteboards facilitate coordinative practices by making information publicly accessible and thereby strengthening communication and joint commitment about it. This study investigates how coordination is accomplished in an emergency department through interactions with the whiteboard and with the...

  10. Ultrasound: the triage tool in the emergency department: using ultrasound first.

    Science.gov (United States)

    Nicola, Refky; Dogra, Vikram

    2016-05-01

    Ultrasound in the emergency department has long been recognized as a powerful screening and diagnostic tool for both physicians and radiologists. In the emergency department, since time is of the essence, it becomes a critical tool in triaging patients. Over the years, ultrasound has gained several advantages over other modalities because of its non-ionizing radiation, portability, accessibility, non-invasive method and simpler learning curve. As a result, ultrasound has become one of the most frequently used diagnostic tools in the emergency department by non-radiologists. The value of ultrasound is implemented in every acute ailment in the emergency department such as trauma, acute abdomen, acute pelvic pain, acute scrotal pain, appendicitis in children and acute deep venous thrombosis. Our objective is to discuss the benefit of using ultrasound as the primary modality for each of these diseases. PMID:26568440

  11. Top 10 Tips for Taking an Elderly Parent to the Emergency Department

    Science.gov (United States)

    ... I Waiting So Long? Admission to the Hospital Heroes on Medicine's Front Line Observation Emergency Care Fact ... department with your elderly parent: Tip 1 : Medical History Form: You and your parent's physicians can complete ...

  12. Emergency department management of patients internally contaminated with radioactive material

    International Nuclear Information System (INIS)

    After a radiation emergency that involves the dispersal of radioactive material, patients can become externally and internally contaminated with one or more radionuclides. Internal contamination can lead to the delivery of harmful ionizing radiation doses to various organs and tissues or the whole body. The clinical consequences can range from acute radiation syndrome (ARS) to the long term development of cancer. Estimating the amount of radioactive material absorbed into the body can guide the management of patients. Treatment includes, in addition to supportive care and long term monitoring, certain medical countermeasures like Prussian blue, Calcium DTPA and Zinc DTPA

  13. Lean Manufacturing Improves Emergency Department Throughput and Patient Satisfaction.

    Science.gov (United States)

    Kane, Marlena; Chui, Kristen; Rimicci, Janet; Callagy, Patrice; Hereford, James; Shen, Sam; Norris, Robert; Pickham, David

    2015-09-01

    A multidisciplinary team led by nursing leadership and physicians developed a plan to meet increasing demand and improve the patient experience in the ED without expanding the department's current resources. The approach included Lean tools and engaged frontline staff and physicians. Applying Lean management principles resulted in quicker service, improved patient satisfaction, increased capacity, and reduced resource utilization. Incorporating continuous daily management is necessary for sustainment of continuous improvement activities. PMID:26252725

  14. Occupancy Rates and Emergency Department Work Index Scores Correlate with Leaving Without Being Seen

    OpenAIRE

    Kulstad, Erik B.; Hart, K. Michael; Waghchoure, Simon

    2010-01-01

    Objective: Two crowding metrics are often used to measure emergency department (ED) crowding: the occupancy rate and the emergency department work index (EDWIN) score. To evaluate these metrics for applicability in our community ED, we sought to measure their correlation with the number of patients who left without being seen (LWBS) and determine if either, or both, correlated with our daily LWBS rate. We hypothesized a statistically significant positive correlation between the number of pati...

  15. Bacteremia in nursing home patients. Prevalence among patients presenting to an emergency department.

    OpenAIRE

    Sinclair, D.; Svendsen, A.; Marrie, T

    1998-01-01

    OBJECTIVE: To measure the prevalence of bacteremia and any correlation between signs and symptoms, risk factors, and laboratory data in elderly patients. DESIGN: Prospective analysis. All patients were contacted by the study nurse at 48 hours and 7 days after study entry. SETTING: Adult tertiary care hospital with an emergency department managing 48,000 visits yearly in a metropolitan area of 250,000. PARTICIPANTS: Members of the study population referred to the emergency department for medic...

  16. Family-Witnessed Resuscitation: Perceptions of Nurses and Doctors Working in an Australian Emergency Department

    OpenAIRE

    Angela Bushby; Shane Combs; Rochelle Watkins; Rose Chapman

    2012-01-01

    Inconsistencies abound in the literature regarding staff attitudes and perceptions toward family-witnessed resuscitation. Our study builds on previous research by using a validated tool to investigate emergency department staff perceptions of family-witnessed resuscitation. A cross-sectional survey was distributed to 221 emergency department doctors' and nurses'. We found few differences between doctors and nurses perceptions toward family-witnessed resuscitation. Both nurses and doctors who ...

  17. Head injuries in accident and emergency departments. How different are children from adults?

    OpenAIRE

    Brookes, M; MacMillan, R.; Cully, S; E. Anderson; S. Murray; Mendelow, A D; Jennett, B

    1990-01-01

    STUDY OBJECTIVE--The aim of the study was to examine the differences between child and adult patients attending accident and emergency departments after recent head injuries. DESIGN AND SETTING--A retrospective survey based on existing case records from 23 Scottish accident and emergency departments for 1985 was compared with prospective data from one hospital over 9 months in 1984. PATIENTS--3838 children under 15 and 4775 adults attended hospital with head injuries during the period analyse...

  18. Preparedness of emergency departments in northwest England for managing chemical incidents: a structured interview survey

    OpenAIRE

    Walter Darren; Williams Jane; Challen Kirsty

    2007-01-01

    Abstract Background A number of significant chemical incidents occur in the UK each year and may require Emergency Departments (EDs) to receive and manage contaminated casualties. Previously UK EDs have been found to be under-prepared for this, but since October 2005 acute hospital Trusts have had a statutory responsibility to maintain decontamination capacity. We aimed to evaluate the level of preparedness of Emergency Departments in North West England for managing chemical incidents. Method...

  19. A Simulation-Based Approach for Optimal Nurse Scheduling in an Emergency Department

    OpenAIRE

    Patvivatsiri, Lisa

    2003-01-01

    The purpose of this research is to determine an appropriate nurse staffing strategy for the Intermediate Care Unit (ICU) and the Critical Care Unit (CCU) of the Emergency Department at York Hospital in York, Pennsylvania. This strategy must adhere to certain administrative policies while keeping patient waiting times within allowable limits. Determining the proper number of resources in an emergency department is a difficult problem because while assistance must be provided without delay at a...

  20. The ROSE (Risk Stratification of Syncope in the Emergency Department) Study

    OpenAIRE

    Reed, Matthew J; Newby, David E; Coull, Andrew J.; Prescott, Robin J; Jacques, Keith G; Gray, Alasdair

    2010-01-01

    ObjectivesThe aim of this study was to develop and validate a clinical decision rule (CDR) to predict 1-month serious outcome and all-cause death in patients presenting with syncope to the emergency department.BackgroundSyncope is a common, potentially serious condition accounting for many hospital admissions.MethodsThis was a single center, prospective, observational study of adults presenting to the emergency department with syncope. A CDR was devised from 550 patients in a derivation cohor...

  1. Focused cardiac ultrasound in the emergency department for patients admitted with respiratory symptoms

    DEFF Research Database (Denmark)

    Laursen, C. B.

    2015-01-01

    In patients admitted with respiratory failure, a large proportion is diagnosed incorrectly in the emergency department and an even larger proportion seems to receive inappropriate treatment. Inappropriate initial treatment of these patients in the emergency department is associated with increased...... triage, patients with cardiac arrest, patients with undifferentiated shock, patients with cardiopulmonary instability, patients with respiratory symptoms, trauma patients with suspected cardiac injuries, and assessment of the fluid status before fluid loading. When using focused cardiac ultrasound (US...

  2. Prospective Analysis of Geriatric Patients Admitted to Emergency Department With Trauma

    OpenAIRE

    Aktürk, Abdulkadir; Avci, Akkan; Gülen, Müge; Ay, Mehmet Oğuzhan; İçme, Ferhat; Satar, Salim

    2013-01-01

    Objective: The aim of this study is to reveal the demographic characteristics, causes of trauma, physical examination findings, the presence of fractures and the status of the outcome of the geriatric trauma patients admitted to the emergency department of an educational research hospital. Material and Methods: This study covers all the cases over 65 years who were admitted to emergency department with trauma between September 1 2011-31 August 2012. The demographic characteristics of the pat...

  3. Prospective Analysis of Geriatric Patients Admitted to Emergency Department With Trauma

    OpenAIRE

    Abdulkadir Akturk; Akkan Avci; Muge Gulen; Mehmet Oguzhan Ay; Ferhat Icme; Salim Satar

    2013-01-01

    Objective: The aim of this study is to reveal the demographic characteristics, causes of trauma, physical examination findings, the presence of fractures and the status of the outcome of the geriatric trauma patients admitted to the emergency department of an educational research hospital. Material and Methods: This study covers all the cases over 65 years who were admitted to emergency department with trauma between September 1 2011-31 August 2012. The demographic characteristics of the pati...

  4. Tumultuous Atmosphere (Physical, Mental), the Main Barrier to Emergency Department Inter-Professional Communication

    OpenAIRE

    Varjoshani, Nasrin Jafari; Hosseini, Mohammad Ali; Khankeh, Hamid Reza; Ahmadi, Fazlollah

    2014-01-01

    Background: A highly important factor in enhancing quality of patient care and job satisfaction of health care staff is inter-professional communication. Due to the critical nature of the work environment, the large number of staff and units, and complexity of professional tasks and interventions, inter-professional communication in an emergency department is particularly and exceptionally important. Despite its importance, inter-professional communication in emergency department seems unfavo...

  5. The impact of a standardised intramuscular sedation protocol for acute behavioural disturbance in the emergency department

    OpenAIRE

    Downes Michael A; Calver Leonie A; Page Colin B; Bryant Jenni L; Isbister Geoffrey K

    2010-01-01

    Abstract Background Acute behavioural disturbance (ABD) is an increasing problem in emergency departments. This study aimed to determine the impact of a structured intramuscular (IM) sedation protocol on the duration of ABD in the emergency department. Methods A historical control study was undertaken comparing 58 patients who required physical restraint and parenteral sedation with the structured IM sedation protocol, to 73 historical controls treated predominantly by intravenous sedation, a...

  6. Bedside Washout of a Septic Shoulder in the Emergency Department: A Case Report.

    Science.gov (United States)

    Bunting, Leonard; Kuper, Kenneth

    2016-07-01

    We present a case of successful bedside irrigation of a septic joint in the emergency department. Complicating factors prevented the patient from undergoing operative management. With a simple 2 catheter technique the authors irrigated the patient's septic shoulder at the bedside. The patient's pain and range of motion improved immediately following the technique. The patient had complete recovery without open drainage. With further investigation, definitive management of septic joints could begin in the emergency department. PMID:26875059

  7. Ambient ozone and emergency department visits due to lower respiratory condition

    OpenAIRE

    Termeh Kousha; Brian Rowe

    2014-01-01

    Objectives: Ambient ozone (O3) exposure is associated with a variety of health conditions. The objective of this study was to examine the effect of increased daily concentrations of ozone on emergency department (ED) visits due to lower respiratory diseases (LRD), such as acute or chronic bronchitis, in Edmonton, Canada. Materials and Methods: Data concerning 10 years (1992-2002) were obtained from 5 Edmonton hospital Emergency Departments. Odds ratios (ORs) for ED visits associated with the ...

  8. A Study On Waiting Times Of The Patients Applying An Emergency Department

    OpenAIRE

    YILMAZ, Dr.Metin GENÇ Dr.Mücahit EĞRİ Dr.Erkan

    1999-01-01

    Objective: Waiting t/'mes for examination, laboratory stud/'es and treatment of the patients applied to the emergency departments are important in view of the satisfaction obtained from the service. By th/'s study, it is aimed to get Information about the waiting times of the patients applied to the emergency department of Turgut Özal Medical Center. Material and Methods: In th/'s descriptive study, ali procedures from the entrance to the service of 301 patient...

  9. Efficacy comparison of nebulizator or spacer usage for acute bronchiolitis treatment in emergency department

    OpenAIRE

    SAZ, Eylem Ulaş; MİDYAT, Levent; Duyu, Muhterem; OZANANAR, Yeliz; KARAPINAR, Bülent; ÖZÇETİN, Mustafa

    2009-01-01

    Acute bronchiolitis is one of the most common causes of lower respiratory tract infections in children. Nebulization of inhaled beta-2 agonists in emergency departments is time-consuming. In this study, effects of inhalation of appropriate dose of inhaled salbutamol by nebulization or by spacer are compared. Thirty-five patients between ages of 1-24 months old who were admitted in daytime to Ege University Faculty of Medicine Child Emergency Department for cough and/or wheezing and diagnosed ...

  10. Efficacy of transabdominal ultrasound examination in the diagnosis of early pregnancy complications in an emergency department.

    OpenAIRE

    Wong, T W; Lau, C C; Yeung, A; Lo, L.; Tai, C M

    1998-01-01

    OBJECTIVE: To assess the value of ultrasound in an emergency department in the diagnosis of early pregnancy complications, the efficacy of a study protocol in identifying ectopic pregnancies, and the agreement on ultrasound findings among emergency department staff and gynaecologists. METHODS: All women presenting with early pregnancy complications had a transabdominal ultrasound scan performed by the attending doctor and checked by a senior doctor. The ultrasound findings were classified as ...

  11. Outcome of Patients Underwent Emergency Department Thoracotomy and Its Predictive Factors

    OpenAIRE

    Shahram Paydar; Abdoshahid Moghaninasab; Elham Asiaei; Golnar Sabetian Fard Jahromi; Shahram Bolandparvaz; Hamidreza Abbasi

    2014-01-01

    Introduction: Emergency department thoracotomy (EDT) may serve as the last survival chance for patients who arrive at hospital in extremis. It is considered as an effective tool for improvement of traumatic patients’ outcome. The present study was done with the goal of assessing the outcome of patients who underwent EDT and its predictive factors. Methods: In the present study, medical charts of 50 retrospective and 8 prospective cases underwent emergency department thoracotomy (EDT) were rev...

  12. Factors associated with patient visits to the emergency department for asthma therapy

    OpenAIRE

    AL-Jahdali Hamdan; Anwar Ahmed; AL-Harbi Abdullah; Baharoon Salim; Halwani Rabih; Al Shimemeri Abdulllah; Al-Muhsen Saleh

    2012-01-01

    Abstract Background Acute asthma attacks remain a frequent cause of emergency department (ED) visits and hospital admission. Many factors encourage patients to seek asthma treatment at the emergency department. These factors may be related to the patient himself or to a health system that hinders asthma control. The aim of this study was to identify the main factors that lead to the frequent admission of asthmatic patients to the ED. Methods A cross-sectional survey of all the patients who vi...

  13. Improving Emergency Department Triage Classification with Computerized Clinical Decision Support at a Pediatric Hospital

    Science.gov (United States)

    Kunisch, Joseph Martin

    2012-01-01

    Background: The Emergency Severity Index (ESI) is an emergency department (ED) triage classification system based on estimated patient-specific resource utilization. Rules for a computerized clinical decision support (CDS) system based on a patient's chief complaint were developed and tested using a stochastic model for predicting ESI scores.…

  14. Emergency Department Crowding and Time to Antibiotic Administration in Febrile Infants

    OpenAIRE

    Light, Jennifer K.; Hoelle, Robyn M.; Herndon, Jill Boylston; Hou, Wei; Elie, Marie-Carmelle; Jackman, Kelly; Tyndall, J. Adrian; Carden, Donna Lynne

    2013-01-01

    Introduction: Early antibiotic administration is recommended in newborns presenting with febrile illness to emergency departments (ED) to avert the sequelae of serious bacterial infection. Although ED crowding has been associated with delays in antibiotic administration in a dedicated pediatric ED, the majority of children that receive emergency medical care in the U.S. present to EDs that treat both adult and pediatric emergencies. The purpose of this study was to examine the relationship be...

  15. Characteristics of Patients Who Visit the Emergency Department with Self-Inflicted Injury

    OpenAIRE

    Lee, Choung Ah; Choi, Sang Cheon; Jung, Koo Young; Cho, Soo Hyung; Lim, Ki Young; Pai, Ki Soo; Cho, Joon Pil

    2012-01-01

    During visits to emergency medical facilities, the primary care of and risk identification for individuals who have attempted suicide is considered an important element in suicide prevention. With the ultimate goal of helping to prevent suicide, the aim of the present study was to determine the characteristics of patients with self-inflicted injuries who presented in the emergency department. Patients with self-inflicted injuries who visited 1 of 3 sentinel emergency medical centers from 2007...

  16. Emergence and Epidemiology of Ciguatera in the Coastal Cities of Southern China

    Directory of Open Access Journals (Sweden)

    Thomas Y. K. Chan

    2015-03-01

    Full Text Available In the present review of 23 published case studies, the main objective is to report the emergence and epidemiology of ciguatera in the coastal cities of southern China. There was a sudden surge in ciguatera outbreaks in 2004. Ciguatera mostly occurred in the Guangdong Province. In Shenzhen, the incidence of ciguatera in 2004 was estimated to be over 7.5 per million people. In Foshan and Zhongshan, three large outbreaks each affecting over 100–200 subjects (caused by tiger grouper served at banquets accounted for the much higher incidence of ciguatera in 2004 (>48.7 and >129.9 per million people. Humphead wrasse and areolated coral grouper were the other important ciguatoxic fish. In some subjects, risk factors for increased likelihood of (severe ciguatera were present, namely concomitant alcohol consumption and ingestion of large reef fishes and CTX-rich fish parts. To prevent large outbreaks and severe illness, large apex predators from coral reefs should never be served at banquets and the public should realize the increased risk of severe symptoms due to ingestion of CTX-rich fish parts with alcohol. The systematic collection of accurate details, implementation of risk assessment process and continuing education for the public on prevention are of obvious importance.

  17. Emergence and Epidemiology of Ciguatera in the Coastal Cities of Southern China

    Science.gov (United States)

    Chan, Thomas Y. K.

    2015-01-01

    In the present review of 23 published case studies, the main objective is to report the emergence and epidemiology of ciguatera in the coastal cities of southern China. There was a sudden surge in ciguatera outbreaks in 2004. Ciguatera mostly occurred in the Guangdong Province. In Shenzhen, the incidence of ciguatera in 2004 was estimated to be over 7.5 per million people. In Foshan and Zhongshan, three large outbreaks each affecting over 100–200 subjects (caused by tiger grouper served at banquets) accounted for the much higher incidence of ciguatera in 2004 (>48.7 and >129.9 per million people). Humphead wrasse and areolated coral grouper were the other important ciguatoxic fish. In some subjects, risk factors for increased likelihood of (severe) ciguatera were present, namely concomitant alcohol consumption and ingestion of large reef fishes and CTX-rich fish parts. To prevent large outbreaks and severe illness, large apex predators from coral reefs should never be served at banquets and the public should realize the increased risk of severe symptoms due to ingestion of CTX-rich fish parts with alcohol. The systematic collection of accurate details, implementation of risk assessment process and continuing education for the public on prevention are of obvious importance. PMID:25738329

  18. Does Spanish instruction for emergency medicine resident physicians improve patient satisfaction in the emergency department and adherence to medical recommendations?

    Directory of Open Access Journals (Sweden)

    Stoneking LR

    2016-08-01

    Full Text Available LR Stoneking,1 AL Waterbrook,1 J Garst Orozco,2 D Johnston,1 A Bellafiore,1 C Davies,3 T Nuño,1 J Fatás-Cabeza,4 O Beita,5 V Ng,1 KH Grall,6 W Adamas-Rappaport7 1Department of Emergency Medicine, University of Arizona, Tucson, AZ, 2Department of Emergency Medicine, Sinai Health System, Chicago, IL, 3Department of Emergency Medicine, Maricopa Medical Center, Phoenix, AZ, 4Department of Spanish and Portuguese, University of Arizona, Tucson, AZ, 5Department of Family and Community Medicine, University of Arizona, Tucson, AZ, 6Department of Emergency Medicine, Regions Hospital, St Paul, MN, 7Department of Surgery, University of Arizona, Tucson, AZ, USA Background: After emergency department (ED discharge, Spanish-speaking patients with limited English proficiency are less likely than English-proficient patients to be adherent to medical recommendations and are more likely to be dissatisfied with their visit.Objectives: To determine if integrating a longitudinal medical Spanish and cultural competency curriculum into emergency medicine residency didactics improves patient satisfaction and adherence to medical recommendations in Spanish-speaking patients with limited English proficiency.Methods: Our ED has two Emergency Medicine Residency Programs, University Campus (UC and South Campus (SC. SC program incorporates a medical Spanish and cultural competency curriculum into their didactics. Real-time Spanish surveys were collected at SC ED on patients who self-identified as primarily Spanish-speaking during registration and who were treated by resident physicians from both residency programs. Surveys assessed whether the treating resident physician communicated in the patient’s native Spanish language. Follow-up phone calls assessed patient satisfaction and adherence to discharge instructions.Results: Sixty-three patients self-identified as primarily Spanish-speaking from August 2014 to July 2015 and were initially included in this pilot study

  19. Stages of development and injury: An epidemiological survey of young children presenting to an emergency department

    Directory of Open Access Journals (Sweden)

    Stone David H

    2008-04-01

    Full Text Available Abstract Background The aim of our study was to use a local (Glasgow, west of Scotland version of a Canadian injury surveillance programme (CHIRPP to investigate the relationship between the developmental stage of young (pre-school children, using age as a proxy, and the occurrence (incidence, nature, mechanism and location of injuries presenting to a Scottish hospital emergency department, in an attempt to replicate the findings of a recent study in Kingston, Canada. Methods We used the Glasgow CHIRPP data to perform two types of analyses. First, we calculated injury rates for that part of the hospital catchment area for which reasonably accurate population denominators were available. Second, we examined detailed injury patterns, in terms of the circumstances, mechanisms, location and types of injury. We compared our findings with those of the Kingston researchers. Results A total of 17,793 injury records for children aged up to 7 years were identified over the period 1997–99. For 1997–2001, 6,188 were used to calculate rates in the west of the city only. Average annual age specific rates per 1000 children were highest in both males and females aged 12–35 months. Apart from the higher rates in Glasgow, the pattern of injuries, in terms of breakdown factors, mechanism, location, context, and nature of injury, were similar in Glasgow and Kingston. Conclusion We replicated in Glasgow, UK, the findings of a Canadian study demonstrating a correlation between the pattern of childhood injuries and developmental stage. Future research should take account of the need to enhance statistical power and explore the interaction between age and potential confounding variables such as socio-economic deprivation. Our findings highlight the importance of designing injury prevention interventions that are appropriate for specific stages of development in children.

  20. Tissue donation after death in the accident and emergency department: an opportunity wasted?

    OpenAIRE

    Magrath, H P; Boulstridge, L J

    1999-01-01

    OBJECTIVE: To investigate whether the accident and emergency department (A&E) is a potential source of tissues for donation, from non-heart beating donors (NHBDs). METHODS: A telephone survey of 30 A&E departments was conducted to determine current tissue harvesting practices from NHBDs. The potential number of tissue donors in our own medium sized district general hospital A&E department was estimated. Senior nursing staff were asked to complete a questionnaire to establish their knowledge, ...

  1. Trauma in elderly patients evaluated in a hospital emergency department in Konya, Turkey: a retrospective study

    Directory of Open Access Journals (Sweden)

    Kara H

    2013-12-01

    Full Text Available Hasan Kara,1 Aysegul Bayir,1 Ahmet Ak,1 Murat Akinci,1 Necmettin Tufekci,1 Selim Degirmenci,1 Melih Azap21Department of Emergency Medicine, Selçuk University, Konya, Turkey; 2Department of Emergency Medicine, Konya Numune Hospital, Konya, TurkeyPurpose: Trauma is a common cause of admission to the hospital emergency department. The purpose of this study was to evaluate the cause of admission, clinical characteristics, and outcomes of patients aged ≥65 years admitted to an emergency department in Turkey because of blunt trauma.Materials and methods: Medical records were retrospectively reviewed for 568 patients (314 women and 254 men aged ≥65 years who were admitted to an emergency department of a tertiary care hospital.Results: Trauma was caused by low-energy fall in 379 patients (67%, traffic accident in 79 patients (14%, high-energy fall in 69 patients (12%, and other causes in 41 patients (7%. The most frequent sites of injury were the lower extremity, thorax, upper extremity, and head. The femur was the most frequent fracture site. After evaluation in the emergency department, 377 patients (66% were hospitalized. There were 31 patients (5% who died. Risk of hospitalization after trauma was significantly associated with trauma to the lower extremity, thorax, and spine; fractures of the femur and rib; and intracranial injury.Conclusion: Emergency department admission after trauma in patients aged $65 years is common after low-energy falls, and most injuries occur to the extremities. It is important to focus on prevention of falls to decrease the frequency of trauma in the elderly.Keywords: fall, femur, fracture, injury

  2. Federal enclaves: The community culture of Department of Energy cities Livermore, Los Alamos, Oak Ridge

    Science.gov (United States)

    Moore, Patrick Kerry

    During the Second World War, the United States Government funded the research of nuclear fusion to create the first atomic weapons. To accomplish this task, the Manhattan Engineering District recruited scientists and engineers to remote sites in New Mexico, Tennessee, and Washington. During the five decades of the Cold War, the congressionally created Atomic Energy Commission, and later the Department of Energy (DOE), funded and operated numerous facilities throughout the United States. The mission of the facilities was to design and stockpile atomic weapons and to further the understanding of nuclear energy. This dissertation examines the influences of the United States federal government on three communities associated with these facilities, Los Alamos, New Mexico, Oak Ridge, Tennessee, and Livermore, California. As isolated secret cities, these environments each created complex community structures. This work identifies how, unlike other community settings, the influences of the federal government, both directly and indirectly, created distinctive patterns of behavior within the residents of each city. Examining these behaviors within the framework of the dissertation's chapters provides the necessary context to understand fully the community culture of these Department of Energy cities. This work addresses contemporary community settings in new ways. It approaches the topic broadly by examining five specific areas of community interaction: social, political, business and economic, educational, and ethical. Through the use of oral history methodology and techniques, the researcher captured significant information from respondents. This approach provides valuable insights to the behavior and interaction of the individual populations while revealing important insights all aspects of each town's community culture.

  3. Scenario prediction of emerging coastal city using CA modeling under different environmental conditions: a case study of Lingang New City, China.

    Science.gov (United States)

    Feng, Yongjiu; Liu, Yan

    2016-09-01

    The world's coastal regions are experiencing rapid urbanization coupled with increased risk of ecological damage and storm surge related to global climate and sea level rising. This urban development issue is particularly important in China, where many emerging coastal cities are being developed. Lingang New City, southeast of Shanghai, is an excellent example of a coastal city that is increasingly vulnerable to environmental change. Sustainable urban development requires planning that classifies and allocates coastal lands using objective procedures that incorporate changing environmental conditions. In this paper, we applied cellular automata (CA) modeling based on self-adaptive genetic algorithm (SAGA) to predict future scenarios and explore sustainable urban development options for Lingang. The CA model was calibrated using the 2005 initial status, 2015 final status, and a set of spatial variables. We implemented specific ecological and environmental conditions as spatial constraints for the model and predicted four 2030 scenarios: (a) an urban planning-oriented Plan Scenario; (b) an ecosystem protection-oriented Eco Scenario; (c) a storm surge-affected Storm Scenario; and (d) a scenario incorporating both ecosystem protection and the effects of storm surge, called the Ecostorm Scenario. The Plan Scenario has been taken as the baseline, with the Lingang urban area increasing from 45.8 km(2) in 2015 to 66.8 km(2) in 2030, accounting for 23.9 % of the entire study area. The simulated urban land size of the Plan Scenario in 2030 was taken as the target to accommodate the projected population increase in this city, which was then applied in the remaining three development scenarios. We used CA modeling to reallocate the urban cells to other unconstrained areas in response to changing spatial constraints. Our predictions should be helpful not only in assessing and adjusting the urban planning schemes for Lingang but also for evaluating urban planning in coastal

  4. A Comparison of Medical and Psychobehavioral Emergency Department Visits Made by Adults with Intellectual Disabilities

    Science.gov (United States)

    Lunsky, Yona; Balogh, Rob; Khodaverdian, Alin; Elliott, Deborah; Jaskulski, Christine; Morris, Susan

    2012-01-01

    Study Objective. We describe and contrast medical to psychobehavioral emergency visits made by a cohort of adults with intellectual disabilities. Methods. This was a study of 221 patients with intellectual disabilities who visited the emergency department because of a psychobehavioral or medical emergency. Patient profiles are described and logistic regression was used to assess predictors of psychobehavioral emergencies in this group, including age, residence, psychiatric diagnosis, cognitive level, and life events. Results. Ninety-eight individuals had medical emergencies and 123 individuals presented with psychobehavioral emergencies. The most common medical issue was injury and the most common psychobehavioral issue was aggression. In the multivariate analysis, life events (odds ratio (OR) 0.28; 95% confidence interval (CI) 0.10 to 0.75), psychiatric diagnosis (OR 2.35; 95% CI 1.12 to 4.95), and age group (OR 4.97; 95% CI 1.28 to 19.38) were associated with psychobehavioral emergencies. Psychobehavioral emergencies were more likely to result in admission and caregivers reported lower rates of satisfaction with these visits. Conclusion. Emergency departments would benefit from greater understanding of the different types of presentations made by adults with intellectual disabilities, given the unique presentations and outcomes associated with them. PMID:23056948

  5. Polycentric Puzzles: Emerging Mega-City Regions Seen through the Lens of Advanced Producer Services

    OpenAIRE

    Hoyler, Michael; Kloosterman, Robert Christian; Sokol, Martin

    2008-01-01

    Abstract This paper introduces a special issue of Regional Studies on 'Globalization, City-Regions and Polycentricity in North West Europe'. The issue focuses on the thematic core of the EU-funded project POLYNET: the analysis of economic connections and information flows generated by advanced producer services in eight European polycentric city-regions. The paper first discusses key elements of the current debate on global city-regions and points out some unresolved gaps. A summar...

  6. City Logistics in China – An Empirical Study from An Emerging-Market-Economy Country

    OpenAIRE

    Ma, Yanqiang

    2014-01-01

    City logistics is a young research area. It has undergone over three decades of development since its conception in the last century. It is believed to have the potential to support the realisation of building up sustainable cities. After successful development during the last three decades, China has been seeking a more healthy economic growth model relying on urbanisation and domestic consumption. This is because one billion citizens are expected to be living in Chinese cities by 2030. Logi...

  7. The incidence of injury presentations to emergency departments: what we don't know can hurt us.

    LENUS (Irish Health Repository)

    Meaney, S

    2012-01-01

    The incidence of injury presentations to emergency departments in the Republic of Ireland has not been established. Data were collected relating to all injuries that presented on every eighth day in July-December 2005 to the three hospitals in Cork City. In total, 2,967 injury presentations were recorded. The total, male and female age-adjusted rate of injury presentations was 11,322, 13,933 and 8,550 per 100,000, respectively. The peak male rate was among 15-29 year-olds (26,735 per 100,000), 2.5 times the female rate in the same age range (10,719 per 100,000). The peak female rate was among over 85 year-olds (18,543 per 100,000). Place of injury, activity at time of injury and underlying substance\\/object causing injury were unspecified for 44%, 46% and 43% of recorded injuries. Improving the recording of injury data needs to be prioritised in Irish emergency departments ideally in conjunction with the development of a national injury surveillance system.

  8. The role of information technology in emergency preparedness by local health departments: a literature review.

    Science.gov (United States)

    Nguh, Jonas

    2014-01-01

    Ever since the terrorist attacks of 9/11, the federal government increased funding for emergency preparedness. However, the literature continues to document several areas of weaknesses in public health emergency management by local health departments (LHD). This literature review discusses the role of information technology (IT) for emergency preparedness by LHDs. The focus areas for this review include evaluating the strategic management of IT by LHD, evaluation of the adoption and implementation of IT in emergency management, and assessing LHD's capacity and capability for emergency preparedness. Findings reveal that LHDs face significant challenges in the utilization of IT for emergency preparedness purposes such as weak capacity and capabilities, lack of structured planning and program implementation, and limited resources. Implications from this review include the development of "best practices," increased funding for IT infrastructure, and the establishment of strategic management framework for IT initiatives. PMID:25069026

  9. Geriatric urolithiasis in the emergency department: risk factors for hospitalisation and emergency management patterns of acute urolithiasis

    Directory of Open Access Journals (Sweden)

    Arampatzis Spyridon

    2012-09-01

    Full Text Available Abstract Background Urolithiasis is one of the most common conditions seen in emergency departments (ED worldwide, with an increasing frequency in geriatric patients (>65 years. Given the high costs of emergency medical urolithiasis treatment, the need to optimise management is obvious. We aimed to determine risk factors for hospitalisation and evaluate diagnostic and emergency treatment patterns by ED physicians in geriatric urolithiasis patients to assist in optimising treatment. Methods After receiving ethics committee approval, we examined the records of emergency urolithiasis admissions to our ED between January 2000 and December 2010 to determine risk factors for hospitalisation and to evaluate current diagnostic and emergency treatment patterns in geriatric urolithiasis patients. Results 1,267 consecutive patients at least 20 years of age with confirmed urolithiasis (1,361 ED visits and complete follow-up data were analyzed. Geriatric patients comprised 10% of urolithiasis patients with more than half of them experiencing their first urolithiasis episode at ED admission. Although stone site, side and size did not significantly differ between groups, urinary stone disease was more severe in the elderly. The risk of severe complications correlated with increasing age, female sex and diabetes mellitus. Geriatric patients had a two-fold greater likelihood of being hospitalised. A significantly lower percentage of geriatric patients received combined analgesic therapy for pain management (37% vs. 64%, p =  Conclusion Geriatric patients with urolithiasis have a higher morbidity than younger patients and may be undertreated concerning analgetic and expulsive treatment in ED.

  10. Assessment of Pain Management in Pediatric Emergency Department in Mashhad -Iran

    Directory of Open Access Journals (Sweden)

    Ahmadshah Farhat

    2013-12-01

    Full Text Available Introduction: Pain may be described as a sensation of hurt or strong discomfort and is the body's way of sending message to the brain that an injury has occurred. Pain medicines block these messages or reduce their effect on the brain. Accurate administration of analgesia have a long –lasting effect on children whole experience of medical care and affects parents' and children's future reaction to pediatrics emergency departments. The purpose of this study was to evaluate pain management on children in our emergency department. Materials and Methods: In this study we evaluated the relief of pain and anxiety on 100 children who referred to our pediatric Emergency Department (ED in Imam Reza Hospital- Mashhad .The patients were assessed based on the American Academy of Pediatrics (AAP recommendations about pain.  Results: Patients were gone under IV Line 97%, Intubation 5% and Lumbar Puncture 28%. Training had been provided to 70% participants in the Emergency Department. Nonpharmacologic stress reduction was used in 35% of cases. Family presence was allowed only in 5%. Prehospital pain controlling was began on 20% of patients and continued in ED on 40%. At the time of discharge 40% prescribed analgesics. Sedation and pain prophylaxis was provided for 10% of patients undergoing painful procedures in ED.  Conclusion: According to results, pain management in our Pediatric Emergency Department was inadequate. Physicians and prehospital EMS providers should be justified about the importance of pain relieving and trained how to use all available analgesic and sedative options.

  11. Intentional and unintentional poisoning in Pakistan: a pilot study using the Emergency Departments surveillance project

    Science.gov (United States)

    2015-01-01

    Background Acute poisoning is one of the most common reasons for emergency department visits around the world. In Pakistan, the epidemiological data on poisoning is limited due to an under developed poison information surveillance system. We aim to describe the characteristics associated with intentional and unintentional poisoning in Pakistan presenting to emergency departments. Methods The data was extracted from the Pakistan National Emergency Department Surveillance (Pak-NEDS) which was an active surveillance conducted between November 2010 and March 2011. All patients, regardless of age, who presented with poisoning to any of Pakistan's seven major tertiary care centers' emergency departments, were included. Information about patient demographics, type of poisoning agent, reason for poisoning and outcomes were collected using a standard questionnaire. Results Acute poisoning contributed to 1.2% (n = 233) of patients with intentional and unintentional injuries presenting to EDs of participating centers. Of these, 68% were male, 54% were aged 19 to 44 and 19% were children and adolescents (drug/medicine (27%), alcohol (16.7%) and food/plant (6%). In half of all patients the poisoning was intentional. A total of 11.6% of the patients were admitted and 6.6% died. Conclusion Poisoning causes more morbidity and mortality in young adults in Pakistan compared to other age groups, half of which is intentional. Improving mental health, regulatory control for hazardous chemicals and better access to care through poison information centers and emergency departments will potentially help control the problem. PMID:26691609

  12. Difficult airway equipment in departments of emergency medicine in Ireland: results of a national survey.

    LENUS (Irish Health Repository)

    Walsh, K

    2012-02-03

    BACKGROUND AND OBJECTIVE: Adverse effects associated with difficult airway management can be catastrophic and include death, brain injury and myocardial injury. Closed-malpractice claims have shown prolonged and persistent attempts at endotracheal intubation to be the most common situation leading to disastrous respiratory events. To date, there has been no evaluation of the types of difficult airway equipment currently available in Irish departments of emergency medicine. The objective of this survey was to identify the difficult airway equipment available in Irish departments of emergency medicine. METHODS: Departments of emergency medicine in the Republic of Ireland with at least one dedicated Emergency Medicine consultant were surveyed via telephone. RESULTS: All of the departments contacted held at least one alternative device on site for both ventilation and intubation. The most common alternative ventilation device was the laryngeal mask airway (89%). The most common alternative intubating device was the surgical airway device (100%). CONCLUSIONS: Irish departments of emergency medicine compare well with those in the UK and USA, when surveyed concerning difficult airway equipment. However, we believe that this situation could be further improved by training inexperienced healthcare providers in the use of the laryngeal mask airway and intubating laryngeal mask airway, by placing greater emphasis on the ready availability of capnography and by the increased use of portable difficult airway storage units.

  13. Globalisation, information technology and the emergence of niche transnational cities: the growth of the call centre sector in Dublin

    OpenAIRE

    Breathnach, Proinnsias

    2000-01-01

    The development of information and communications technologies (ICT) has facilitated the emergence of a complex global urban system in which many formerly lower-order cities have been carving out 'niche' specialist functions serving urban fields of transnational dimension. This is illustrated in the case of Dublin, which in recent years has been transcending its traditional role as Ireland's national metropolis through the development of a range of functions servicing mainly European...

  14. Towards smart city education

    OpenAIRE

    Wolff, Annika; Kortuem, Gerd; Cavero, Jose

    2015-01-01

    Sustainability has been an important topic in UK schools for some time, most notably since the Sustainable School Strategy was proposed by the UK Department for Education (DFES) in 2006. However, as smart city technologies emerge and show real promise in contributing to a more sustainable future, it is becoming apparent that new skills for working with the big urban data sets that drive these innovations must be taught to upcoming generations to ensure that they can be active smart city citiz...

  15. Effect of guidelines on management of head injury on record keeping and decision making in accident and emergency departments.

    OpenAIRE

    Thomson, R.; Gray, J; Madhok, R; Mordue, A.; Mendelow, A D

    1994-01-01

    OBJECTIVE--To compare record keeping and decision making in accident and emergency departments before and after distribution of guidelines on head injury management as indices of implementation. DESIGN--Before (1987) and after (1990) study of accident and emergency medical records. SETTING--Two accident and emergency departments in England. PATIENTS--1144 adult patients with head injury in department 1 (533 in 1987, 613 in 1990) and 734 in department 2 (370, 364 respectively). MAIN MEASURES--...

  16. The perceived impact of an emergency department immediate reporting service: An exploratory survey

    International Nuclear Information System (INIS)

    Background: Immediate reporting, commonly referred to as a ‘hot reporting’, has been advocated as a method of effectively supporting clinical decision making. However, its implementation nationally has been limited with poor understanding of its value in practice. Method: A cross sectional attitudinal survey was distributed to emergency department clinicians (medical and nursing staff) and radiographers to explore perceptions of an immediate reporting service in terms of its influence on professional role and autonomy, patient care and service quality. Results: A total of 87 (n = 87/155; 56.1%) completed questionnaires were returned. The findings suggest that significant support for immediate reporting exists. Immediate reporting is believed to improve service quality, reduce clinical errors and provide opportunity for image interpretation skills development. However, responses were not consistent across clinical professions and staff grades. Conclusion: The immediate reporting of emergency department images is perceived to benefit patient, emergency department clinicians and hospital organisation

  17. Development of an Asthma Management System in a Pediatric Emergency Department

    OpenAIRE

    Dexheimer, Judith W; Arnold, Donald H.; Abramo, Thomas J; Aronsky, Dominik

    2009-01-01

    Asthma is the leading chronic childhood disease with exacerbations resulting in urgent and emergency care visits. Guidelines adherence improves patient care but is suboptimal. A computerized guideline system can help improve compliance through automatic initiation and reminders to increase adherence. We designed a computerized management system for asthma care in the pediatric emergency department (ED). The system will be evaluated in two phases. The first phase evaluates a computerized diagn...

  18. Air Pollution and Emergency Department Visits for Suicide Attempts in Vancouver, Canada

    OpenAIRE

    Mieczysław Szyszkowicz; Willey, Jeff B.; Eric Grafstein; Rowe, Brian H; Ian Colman

    2010-01-01

    Background: Comorbidity of depression, heart disease, and migraine has been observed in clinical practice, while ambient air pollution has been identified among different risk factors for these health conditions. Suicide attempts and ideations as the result of depression may be linked to air pollution exposure. Therefore the effects of ambient air pollution on emergency department (ED) visits for suicide attempts were investigated. Methods: Emergency visit data were collected in a hospital in...

  19. Reliability and factor structure of brief emergency department patient satisfaction scale

    OpenAIRE

    Maryam Atari; Saeed Akbari-Zardkhaneh; Mohammad Atari

    2015-01-01

    Patient satisfaction (PS) is an important factor for both patients and healthcare professionals. Psychometrically sound assessment of PS is of absolute importance for quality improvement purposes particularly in private hospitals. One of the PS instruments with high reliability and validity is the Brief Emergency Department Patient Satisfaction Scale (BEPSS). This study aimed to investigate the factor structure of BEPSS in a private hospital. A total of 270 emergency patients from a private h...

  20. Inability of Physicians and Nurses to Predict Patient Satisfaction in the Emergency Department

    OpenAIRE

    DeLaney, Matthew C.; Page, David B.; Kunstadt, Ethan B.; Matt Ragan; Joel Rodgers; Wang, Henry E.

    2015-01-01

    Introduction: Patient satisfaction is a commonly assessed dimension of emergency department (ED) care quality. The ability of ED clinicians to estimate patient satisfaction is unknown. We sought to evaluate the ability of emergency medicine resident physicians and nurses to predict patient-reported satisfaction with physician and nursing care, pain levels, and understanding of discharge instructions.  Methods: We studied a convenience sample of 100 patients tre...

  1. Diagnosis of Intussusception Using Bedside Ultrasound by a Pediatric Resident in the Emergency Department

    OpenAIRE

    Ramsey, Kara Wong; Halm, Brunhild M.

    2014-01-01

    The use of bedside ultrasound in the emergency department has been gaining favor among emergency medicine physicians and can be invaluable in the prompt diagnosis and treatment of acutely ill patients, especially when radiology evaluation is unavailable or delayed. Although pediatric ultrasound examinations are taught in some pediatric residency programs, they are not part of the required pediatric residency curriculum in the United States. This is the first case report of a pediatric residen...

  2. Medical and nursing staff highly value clinical pharmacists in the emergency department

    OpenAIRE

    Fairbanks, Rollin J.; Hildebrand, James M.; Kolstee, Karen E; Schneider, Sandra M.; Shah, Manish N.

    2007-01-01

    Despite the potential impact that emergency pharmacist (EPh) programmes could have on medication safety and quality of care in the emergency department (ED), very few programmes exist. This descriptive survey study aimed to assess staff perceptions of an EPh programme. A random sample of medical and nursing staff in an academic medical centre ED with a dedicated EPh programme received a 26‐item survey (82% return rate). 99% of respondents felt the EPh improves quality of care, 96% feel they a...

  3. Improvement in self-reported confidence in nurses’ professional skills in the emergency department

    OpenAIRE

    Rautava, Veli-Pekka; Palomäki, Erika; Innamaa, Tapio; Perttu, Mika; Lehto, Päivi; Palomäki, Ari

    2013-01-01

    Background The aim of this study was to assess nurses’ self-reported confidence in their professional skills before and after an extensive Emergency Department (ED) reform in Kanta-Häme Central Hospital. Methods Emergency nurses participated in transitional training commencing two years before the establishment of the new organization in 2007. Training was followed by weekly practical educational sessions in the new ED. During this process nurses improved their transition skills, defined hous...

  4. Enhanced Mental Health Interventions in the Emergency Department: Suicide and Suicide Attempt Prevention in the ED

    OpenAIRE

    Hughes, Jennifer L.; Asarnow, Joan R.

    2013-01-01

    Suicide is the third leading cause of death in adolescents, and often youths with suicidal behavior or ideation present to the emergency department (ED) for care. Many suicidal youths do not receive mental health care after discharge from the ED, and interventions are needed to enhance linkage to outpatient intervention. This paper describes the Family Intervention for Suicide Prevention (FISP). Designed for use in emergency settings, the FISP is a family-based cognitive-behavior therapy sess...

  5. Radiology of Fractures in Intoxicated Emergency Department Patients: Locations, Mechanisms, Presentation, and Initial Interpretation Accuracy

    OpenAIRE

    MORITA, Yuka; Nozaki, Taiki; Starkey, Jay; Okajima, Yuka; Ohde, Sachiko; Matsusako, Masaki; Yoshioka, Hiroshi; Saida, Yukihisa; Kurihara, Yasuyuki

    2015-01-01

    Abstract The purpose of this study was to investigate the relationship of alcohol intoxication to time-to-presentation following injury, fracture type, mechanism of injury leading to fracture, and initial diagnostic radiology interpretation performance of emergency physicians versus diagnostic radiologists in patients who present to the emergency department (ED) and are subsequently diagnosed with fracture. Medical records of 1286 patients who presented to the ED and were diagnosed with fract...

  6. Management of critically ill patients receiving noninvasive and invasive mechanical ventilation in the emergency department

    OpenAIRE

    Rose, Louise

    2012-01-01

    Louise RoseLawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, CanadaAbstract: Patients requiring noninvasive and invasive ventilation frequently present to emergency departments, and may remain for prolonged periods due to constrained critical care services. Emergency clinicians often do not receive the same education on management of mechanical ventilation or have similar exposure to these patients as do their critical care colleagues. The aim of this review wa...

  7. A survey on knowledge, attitude, and practice of emergency department practitioners in musculoskeletal injuries

    OpenAIRE

    Levent ALTINEL; Bozan, Eray; YURUMEZ, Yusuf; Demirel, Reha; Yavuz, Yucel

    2004-01-01

    Objectives: A knowledge, attitude, and practice study was conducted in relation to musculoskeletal injuries among emergency department practitioners working in the town of Afyon, Turkey. Methods: Of 40 practitioners working at emergency health services in Afyon, 32 (80%) responded to a 20-item questionnaire that inquired about their knowledge, attitude and practice. A 100-point scoring system was used for the first half of the questionnaire including 10 questions about their knowledge, and...

  8. Pitfalls in Emergency Department Focused Bedside Sonography of First Trimester Pregnancy

    OpenAIRE

    Kerri Layman; Michael Antonis; Jonathan E. Davis

    2013-01-01

    Background. Bedside sonography performed by emergency physicians is frequently utilized for real-time clinical decision-making in the emergency department (ED) setting. This includes the sonographic evaluation of pain or bleeding in the first trimester of pregnancy. The detection of intrauterine pregnancy (IUP) or life-threatening conditions, including ectopic pregnancy, is critical. Objectives. This paper will review several important pearls and avoidable pitfalls of this diagnostic modality...

  9. Stress Myocardial Perfusion Imaging in the Emergency Department - New Techniques for Speed and Diagnostic Accuracy

    OpenAIRE

    Harrison, Sheri D; Harrison, Mark A; Duvall, W. Lane

    2012-01-01

    Emergency room evaluations of patients presenting with chest pain continue to rise, and these evaluations which often include cardiac imaging, are an increasing area of resource utilization in the current health system. Myocardial perfusion imaging from the emergency department remains a vital component of the diagnosis or exclusion of coronary artery disease as the etiology of chest pain. Recent advances in camera technology, and changes to the imaging protocols have allowed MPI to become a ...

  10. Is there any role for resuscitative emergency department thoracotomy in blunt trauma?

    OpenAIRE

    Khorsandi, Maziar; Skouras, Christos; Shah, Rajesh

    2012-01-01

    A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether there is any role for resuscitative emergency department thoracotomy in severe blunt trauma. Emergency thoracotomy is an accepted intervention for patients with penetrating cardiothoracic trauma. However, its role in blunt trauma has been challenged and has been a subject of considerable debate. Altogether, 186 relevant papers were identified, of which 14 represen...

  11. Management of critically ill patients receiving noninvasive and invasive mechanical ventilation in the emergency department

    OpenAIRE

    Rose, Louise

    2012-01-01

    Patients requiring noninvasive and invasive ventilation frequently present to emergency departments, and may remain for prolonged periods due to constrained critical care services. Emergency clinicians often do not receive the same education on management of mechanical ventilation or have similar exposure to these patients as do their critical care colleagues. The aim of this review was to synthesize the evidence on management of patients requiring noninvasive and invasive ventilation in the ...

  12. External Ophthalmomyiasis Presenting to an Emergency Department: Corneal Findings as a Sign of Oestrus ovis

    OpenAIRE

    Gholamhossein, Yaghoubi; Behrouz, Heydari

    2013-01-01

    Purpose This study aims to determine the frequency of opthalmyomyiasis externa and the ocular findings of disease in Southern Khorasan. Methods All patients referred to the emergency department of Valiaser hospital during the year 2011 with external ophthalmomyiasis were enrolled in this study. The diagnosis of external ophthalmomyiasis was made according to clinical findings and the presence of Oestrus ovis larvae. Results There were 18 cases of external ophthalmomyiasis in the emergency dep...

  13. Intimate Partner Violence Among Men Presenting to a University Emergency Department

    OpenAIRE

    Johnson, Cherlin; Gorchynski, Julie

    2004-01-01

    Objective: We sought to investigate the one-year point prevalence for male intimate partner violence (IPV) in men presenting to a university emergency department, to identify types of violence, to examine differences in male IPV rates based on patient demographics, and to identify any differences in prevalence based on types of partnership. Methods: This survey study was conducted from September 2001 until January 2002 at a tertiary, academic, Level I Trauma Center with an emergency departmen...

  14. Correlates of women's cancer screening and contraceptive knowledge among female emergency department patients

    Directory of Open Access Journals (Sweden)

    Bock Beth C

    2007-05-01

    Full Text Available Abstract Background Lack of knowledge regarding preventive health services for women might impede campaigns to expand these services in the emergency department setting. For 18–55-year-old English-speaking women visiting an urban emergency department, we aimed to: (1 Ascertain their knowledge regarding the applicability, purpose, and recommended intervals of three women's cancer screening and three contraceptive methods; and (2 Determine if patient age, race/ethnicity, medical insurance status, and current or recent usage of these methods are associated with greater or lesser knowledge about them. Methods Emergency department-based survey on recent or current usage and knowledge about Pap smears, breast self-examinations, mammograms, condoms, birth control, and emergency contraception. Analyses included calculation of summary statistics and creation of multivariable logistic regression models. Results Of 1,100 patients eligible for the study, 69.9% agreed to participate. Most of the participants were Conclusion Although these female ED patients demonstrated strong knowledge on some women's cancer screening and contraceptive methods, there were several areas of knowledge deficit. Women without private medical insurance and those who have not used a particular cancer screening or contraceptive method demonstrated less knowledge. Reduced knowledge about women's cancer screening and contraceptive methods should be considered during clinical encounters and when instituting or evaluating emergency department-based initiatives that assess the need for these methods.

  15. A limited-service rural hospital model: the freestanding emergency department.

    Science.gov (United States)

    Avery, S

    1999-01-01

    A rural hospital that has been downsized to a freestanding emergency department is an important model in that it offers a possible solution to a community's need to have emergency-care services locally available. This model could include other important local services, such as skilled-nursing and outpatient services. This study looks at the financial feasibility of a rural hospital shutting down acute-care services and maintaining emergency services. Expenses were determined, and changes to revenue and expenses were estimated. Reimbursement was assumed static. Medicare cost reports and hospital financial disclosure reports were used in investigating three model categories: an urgent-care clinic with emergency services; a hospital-based emergency department with an outpatient clinic; a hospital-based emergency department with an outpatient clinic and a hospital-based skilled-nursing facility. Even with best-case assumptions regarding continued reimbursement, results show only a small increase in net income and, in two cases, large losses compared with the size of the hospital operations. A subsidy would be required from the community or an affiliated hospital or network for the model to remain financially stable. The regulatory barriers to implementation are noted, as well as the potential problems with the human aspects of implementation--staffing, recruitment and retention, professional education and quality. If the model rural hospital is an affiliate or partner with one or more health care facility, which could assist with financial and staffing needs, it may be feasible. PMID:10511753

  16. Effects of the 2010 World Cup football tournament on emergency department assault attendances in England.

    Science.gov (United States)

    Quigg, Zara; Hughes, Karen; Bellis, Mark A

    2013-06-01

    We explore the impact of the 2010 World Cup, held in South Africa, on levels of assault attendances to 15 emergency departments in England. The majority (70.1%) of assault attendees during the 2010 World Cup was male and aged 18-34 years (52.5%). Assault attendances increased by 37.5% on the days that England played (P 001). Preparation for major sporting events in non-host countries should include violence prevention activity. Emergency department data can be used to identify violence associated with such events and thus inform both the targeting of prevention efforts and assessments of their effectiveness. PMID:22874732

  17. Access to In-Network Emergency Physicians and Emergency Departments Within Federally Qualified Health Plans in 2015

    Directory of Open Access Journals (Sweden)

    Stephen C. Dorner, MSc

    2016-01-01

    Full Text Available Introduction: Under regulations established by the Affordable Care Act, insurance plans must meet minimum standards in order to be sold through the federal Marketplace. These standards to become a qualified health plan (QHP include maintaining a provider network sufficient to assure access to services. However, the complexity of emergency physician (EP employment practices – in which the EPs frequently serve as independent contractors of emergency departments, independently establish insurance contracts, etc... – and regulations governing insurance repayment may hinder the application of network adequacy standards to emergency medicine. As such, we hypothesized the existence of QHPs without in-network access to EPs. The objective is to identify whether there are QHPs without in-network access to EPs using information available through the federal Marketplace and publicly available provider directories. Results: In a national sample of Marketplace plans, we found that one in five provider networks lacks identifiable in-network EPs. QHPs lacking EPs spanned nearly half (44% of the 34 states using the federal Marketplace. Conclusion: Our data suggest that the present regulatory framework governing network adequacy is not generalizable to emergency care, representing a missed opportunity to protect patient access to in-network physicians. These findings and the current regulations governing insurance payment to EPs dis-incentivize the creation of adequate physician networks, incentivize the practice of balance billing, and shift the cost burden to patients.

  18. Preparedness of emergency departments in northwest England for managing chemical incidents: a structured interview survey

    Directory of Open Access Journals (Sweden)

    Walter Darren

    2007-12-01

    Full Text Available Abstract Background A number of significant chemical incidents occur in the UK each year and may require Emergency Departments (EDs to receive and manage contaminated casualties. Previously UK EDs have been found to be under-prepared for this, but since October 2005 acute hospital Trusts have had a statutory responsibility to maintain decontamination capacity. We aimed to evaluate the level of preparedness of Emergency Departments in North West England for managing chemical incidents. Methods A face-to-face semi-structured interview was carried out with the Nurse Manager or a nominated deputy in all 18 Emergency Departments in the Region. Results 16/18 departments had a written chemical incident plan but only 7 had the plan available at interview. All had a designated decontamination area but only 11 felt that they were adequately equipped. 12/18 had a current training programme for chemical incident management and 3 had no staff trained in decontamination. 13/18 could contain contaminated water from casualty decontamination and 6 could provide shelter for casualties before decontamination. Conclusion We have identified major inconsistencies in the preparedness of North West Emergency Departments for managing chemical incidents. Nationally recognized standards on incident planning, facilities, equipment and procedures need to be agreed and implemented with adequate resources. Issues of environmental safety and patient dignity and comfort should also be addressed.

  19. Accreditation of Emergency Department at a Teaching Hospital in Tehran University of Medical Sciences in 2010

    Directory of Open Access Journals (Sweden)

    Fereshteh Farzianpour

    2011-01-01

    Full Text Available Problem statement: Considering the importance of emergency departments in healthcare system and the high mortality rate of patients referred to these departments, it is crucial to provide quality services in emergency departments. Accreditation is a systematic process for improving quality of care and it enables managers to assess and evaluate the healthcare system. Accreditation of an organization provides an obvious commitment for improving quality of safety, quality of patient care, ensuring safety surveillance and continuous activities for reducing dangers which threaten patients and staff. Therefore, given the vital role as well as and the perpetual and indispensable service provided by the emergency departments, it is necessary to re-evaluate the manner of service provision in these departments according to the standards and criteria of accreditation, so that an observance of these criteria will lead to improvement of emergency medicine in Iran. Thus, the present study was undertaken with the purpose of accreditation of emergency department of a teaching hospital of Tehran University of Medical Sciences according to the standards of Iranian Deputy of Health and the JCI. Approach: This is a descriptive-analytic study with a cross-sectional structure. Our study population consisted of 50 individuals of the healthcare staff (physicians and nurses working in morning and evening work shifts of the emergency department in the teaching hospital. Data collection tools consisted of standard questionnaires of the Deputy of Health (9 series and questionnaires developed by authors based on the standards of the Joint Commission International (JCI regarding patient satisfaction with services provided in emergency departments. In order to determine the reliability and validity of the data collection tools, professors and experts reviewed the questionnaire of quality and patient safety in accordance with standards of quality patient safety from the

  20. Children and adolescents in the Psychiatric Emergency Department: a 10-year survey in Copenhagen County

    DEFF Research Database (Denmark)

    Taastrøm, Annette; Klahn, Julie; Staal, Nina;

    2014-01-01

    Background: Knowledge on psychiatric emergencies in children and adolescents is limited. The Psychiatric Emergency Departments (PED) in Copenhagen enable the acute examination of children and adolescents 24 h a day, 7 days a week. However, very little is known about who presents to the PED, and the...... thorough analysis was performed, based on the individual emergency charts. Inter-rater reliability was high. Results: Visits increased nearly threefold during the period. Symptom score for 2003 and 2006 revealed that more than one third of the visitors had suicidal ideation. Depressive and anxiety symptoms...

  1. Emergency department triage: a program assessment using the tools of continuous quality improvement.

    Science.gov (United States)

    Cook, S; Sinclair, D

    1997-01-01

    An assessment was undertaken in the emergency department of a busy tertiary care center to illustrate the role of continuous quality improvement in the evaluation of an emergency triage program that utilizes the emergency medical attendant to provide triage. An evaluation team interviewed triage staff, charge nurses, internal customers, risk management, and the patient representative. A detailed review of staff job descriptions, organization charts, orientation manual, and physical facilities was conducted. A chart audit was completed on 100 triage notes. Direct observation was undertaken on nine occasions. An evaluation of the data gathered was performed using the tools of continuous quality improvement, and resulted in specific recommendations being made to improve the process of care. It was concluded that emergency medical attendants function very well in an emergency medicine triage system and the tools of continuous quality improvement can be applied to a clinical service to improve the quality of care. PMID:9404811

  2. Balancing Tradition and Transcendence in the Implementation of Emergency-Department Electronic Whiteboads

    DEFF Research Database (Denmark)

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

    2010-01-01

    designed in collaboration with clinicians from the departments. Compared to existing dry-erase whiteboards, the electronic whiteboards present more information and allow some automated updating. Based on observations supported by interviews we describe how tradition and transcendence were balanced in the...... implementation of the whiteboards at the two emergency departments. The electronic whiteboards were initially configured to resemble the dry-erase whiteboards and then gradually reconfigured and extended through an improvisational process, along with changes in the clinicians’ work practices....

  3. Goldratt’s Theory Applied to the Problems Associated with an Emergency Department at a Hospital

    Directory of Open Access Journals (Sweden)

    Soumya Nayak

    2012-10-01

    Full Text Available Healthcare costs continue to increase dramatically, while quality remains a significant problem. Reform measures initiated by the government will drive expansion of these costs, further stressing taxpayers and employers, and forcing hospitals to adopt fundamental changes as they try to adjust to increased demands for services and to lessening reimbursements from all payers. This struggle is best seen at the point of entry for many at a hospital: the emergency department (ED. It is at the emergency department that patients’ expectations regarding staff communication with patients, wait times, the triage process, capacity and payment will determine a significant part of a hospital’s revenue. Using Dr. Eliyahu M. Goldratt’s Thinking Process, we will determine what core problem(s are causing a 362-bed regional West Texas hospital emergency department to lose revenue. Evaluation of the current emergency department will determine the Undesirable Effects (UDE. Using that information will lead to the construction of the Current Reality Tree (CRT, which will bring focus to the core problem(s. To break the constraints, which are the core problem(s, an Evaporative Cloud (EC is generated. And, the end result will be to construct a Future Reality Tree (FRT, which will validate the idea(s generated in the EC. It was determined that there are ten major UDE’s that affected this hospital’s emergency department. They were focused around staff communication, wait times, triage process, information management, service provided and bill collections. A conclusion was made that the core problem dealt with triaging patients and utilization of the services provided by the hospital. Since the reimbursement rate is affected by the patient’s satisfaction, the areas to focus on would be: triage, education, communication and retention. Although it may be neither feasible nor desirable to meet all the patient’s expectations, increased focus on those areas may

  4. Benefits of Low Carbon Development Strategies in Emerging Cities of Developing Country: A Case of Kathmandu

    OpenAIRE

    Shakya, Shree Raj

    2016-01-01

    Kathmandu is one of the fastest growing cities in South Asia facing various challenges related to climate change, local pollutants emissions and energy security of supply. This study analysed the greenhouse gas mitigation potential in different economic sectors of the city by using Long-range Energy Planning (LEAP) frame work. It shows that the effect of implementing various low carbon development strategy options can reduce 35.2% of total greenhouse gas emission from energy use as compared t...

  5. Benefits of Low Carbon Development Strategies in Emerging Cities of Developing Country: a Case of Kathmandu

    OpenAIRE

    Shree Raj Shakya

    2016-01-01

    Kathmandu is one of the fastest growing cities in South Asia facing various challenges related to climate change, local pollutants emissions and energy security of supply. This study analysed the greenhouse gas mitigation potential in different economic sectors of the city by using Long-range Energy Planning (LEAP) frame work. It shows that the effect of implementing various low carbon development strategy options can reduce 35.2% of total greenhouse gas emission from energy use as compared t...

  6. Predictors of Violence Following Emergency Department Visit for Cocaine-Related Chest Pain

    Science.gov (United States)

    Walton, Maureen A.; Cunningham, Rebecca; Chermack, Stephen T.; Tripathi, Shanti; Weber, James; Maio, Ronald F.; Booth, Brenda M.

    2009-01-01

    This study examined one-year violence outcomes among non-injured patients treated in the Emergency Department (ED) for cocaine-related chest pain. An urban Level I ED required patients with chest pain (age 60 and younger) provide a urine sample for cocaine testing. Cocaine-positive consenting patients (n=219) were interviewed in the ED; 80% completed follow-up interviews over 12-months (n=174; 59% male, 79% African-American, mean age = 38.8, standard deviation 9.06; range = 19 to 60). Baseline rates of past year violent victimization and perpetration history were: 38% and 30%, respectively. During the12-month follow-up, rates of victimization and perpetration outcomes were 35% and 30%, respectively. Predictors of violence outcomes (either victimization or perpetration) in the year post-ED visit based on characteristics measured at baseline or during the follow-up period (i.e., gender, age, psychological distress, binge drinking days, cocaine use days, marijuana use days, substance abuse/dependence diagnosis, victimization/perpetration history). Victimization during the follow-up was related to younger age, more frequent binge drinking and marijuana use at baseline, and victimization history, and to substance abuse/dependence, more frequent binge drinking, and psychiatric distress at follow-up. Specifically, participants who reported victimization at baseline were approximately 3 times more likely to report victimization at 12-month follow-up. Perpetration during the follow-up was related to younger age and more frequent binge drinking at baseline, and to substance abuse/dependence, more frequent binge drinking, and psychiatric distress at follow-up. Overall, no significant gender differences were observed in violence; however, women were more likely than men to report injury during the most severe partner violence incident. Violence is a common problem among patients presenting to an inner city ED for cocaine-related chest pain, with younger age and frequency of

  7. The emergency department "carousel": an ethnographically-derived model of the dynamics of patient flow.

    Science.gov (United States)

    Nugus, Peter; Forero, Roberto; McCarthy, Sally; McDonnell, Geoff; Travaglia, Joanne; Hilman, Ken; Braithwaite, Jeffrey

    2014-01-01

    Emergency department (ED) overcrowding reduces efficiency and increases the risk of medical error leading to adverse events. Technical solutions and models have done little to redress this. A full year's worth of ethnographic observations of patient flow were undertaken, which involved making hand-written field-notes of the communication and activities of emergency clinicians (doctors and nurses), in two EDs in Sydney, Australia. Observations were complemented by semi-structured interviews. We applied thematic analysis to account for the verbal communication and activity of emergency clinicians in moving patients through the ED. The theoretical model that emerged from the data analysis is the ED "carousel". Emergency clinicians co-construct a moving carousel which we conceptualise visually, and which accounts for the collective agency of ED staff, identified in the findings. The carousel model uniquely integrates diagnosis, treatment and transfer of individual patients with the intellectual labour of leading and coordinating the department. The latter involves managing staff skill mix and the allocation of patients to particular ED sub-departments. The model extends traditional patient flow representations and underlines the importance of valuing ethnographic methods in health services research, in order to foster organisational learning, and generate creative practical and policy alternatives that may, for example, reduce or ameliorate access block and ED overcrowding. PMID:23669027

  8. Emergency Department Use by Nursing Home Residents: Effect of Severity of Cognitive Impairment

    Science.gov (United States)

    Stephens, Caroline E.; Newcomer, Robert; Blegen, Mary; Miller, Bruce; Harrington, Charlene

    2012-01-01

    Purpose: To examine the 1-year prevalence and risk of emergency department (ED) use and ambulatory care-sensitive (ACS) ED use by nursing home (NH) residents with different levels of severity of cognitive impairment (CI). Design and Methods: We used multinomial logistic regression to estimate the effect of CI severity on the odds of any ED visit…

  9. Care of the Older Adult in the Emergency Department: Nurses Views of the Pressing Issues

    Science.gov (United States)

    Boltz, Marie; Parke, Belinda; Shuluk, Joseph; Capezuti, Elizabeth; Galvin, James E.

    2013-01-01

    Purpose: The purpose of the study was to describe nurses' views of the issues to be addressed to improve care of the older adult in the emergency department (ED). Design and Methods: An exploratory content analysis examined the qualitative responses of 527 registered nurses from 49U.S. hospitals who completed the Geriatric Institutional Profile.…

  10. Rural-Urban Disparities in Child Abuse Management Resources in the Emergency Department

    Science.gov (United States)

    Choo, Esther K.; Spiro, David M.; Lowe, Robert A.; Newgard, Craig D.; Hall, Michael Kennedy; McConnell, Kenneth John

    2010-01-01

    Purpose: To characterize differences in child abuse management resources between urban and rural emergency departments (EDs). Methods: We surveyed ED directors and nurse managers at hospitals in Oregon to gain information about available abuse-related resources. Chi-square analysis was used to test differences between urban and rural EDs.…

  11. A prospective validation of the HEART score for chest pain patients at the emergency department

    NARCIS (Netherlands)

    Backus, B. E.; Six, A. J.; Kelder, J. C.; Bosschaert, M. A. R.; Mast, E. G.; Mosterd, A.; Veldkamp, R. F.; Wardeh, A. J.; Tio, R.; Braam, R.; Monnink, S. H. J.; van Tooren, R.; Mast, T. P.; van den Akker, F.; Cramer, M. J. M.; Poldervaart, J. M.; Hoes, A. W.; Doevendans, P. A.

    2013-01-01

    Background: The focus of the diagnostic process in chest pain patients at the emergency department is to identify both low and high risk patients for an acute coronary syndrome (ACS). The HEART score was designed to facilitate this process. This study is a prospective validation of the HEART score.

  12. Identifying Pregnant Women Experiencing Domestic Violence in an Urban Emergency Department

    Science.gov (United States)

    Datner, Elizabeth M.; Wiebe, Douglas J.; Brensinger, Colleen M.; Nelson, Deborah B.

    2007-01-01

    The article describes characteristics of pregnant women presenting to the Emergency Department (ED) who are experiencing current violence and presented a screening tool to identify pregnant women experiencing violence. Women completed an in-person interview regarding violence, sociodemo-graphic factors, health status, and drug use. Fifteen percent…

  13. Emergency department visits and hospitalizations for respiratory disease on the island of Hawaii, 1981 to 1991.

    Science.gov (United States)

    Mannino, D M; Ruben, S; Holschuh, F C; Holschuh, T C; Wilson, M D; Holschuh, T

    1996-03-01

    This study examined trends in and patterns of emergency department visits and hospitalizations for respiratory disease on the island of Hawaii from 1981 to 1991. We found that emergency department visit rates and hospitalization rates for both asthma and COPD for 1987 to 1991 increased in all regions of the island in comparison with such rates for 1981 to 1986. Rates of emergency department visits and hospitalizations for chronic obstructive pulmonary disease or COPD, but not asthma, were significantly higher in the high-exposure Kona side of the island than in the intermittent-exposure Hilo side of the island during 1983 and 1988 to 1990. We also found that during the weeks that winds were from the west, blowing volcanic air pollution toward Hilo, emergency department visits for asthma increased 15%. Some of the results of our study support the hypothesis that volcanic air pollution affects respiratory health on the island of Hawaii, while other results do not. Any future studies should include measurements of air pollutant levels. PMID:8882554

  14. Factors influencing the implementation of the guideline Triage in emergency departments : A qualitative study

    NARCIS (Netherlands)

    Janssen, M.A.P.; Achterberg, Theo van; Adriaansen, Marian; Mintjes, Joke; Schalk, D.M.J.; Kampshoff, C.S.

    2012-01-01

    This is an exploratory study using a qualitative design including: a questionnaire sent to all emergency departments in the Netherlands (n = 108): four focus group interviews, including nurses and ward managers and in-depth interviews with ward managers and doctors. Based on the results, tailored im

  15. Multiple Interventions Improve Analgesic Treatment of Supracondylar Fractures in a Pediatric Emergency Department

    Directory of Open Access Journals (Sweden)

    Robert N Porter

    2015-01-01

    Full Text Available BACKGROUND: Provision of appropriate and timely treatment for pain in the pediatric population has been challenging. Children with painful conditions commonly present to emergency departments (EDs, a setting in which it may be particularly difficult to consistently provide timely analgesic interventions.

  16. Improving Emergency Department Door to Doctor Time and Process Reliability: A Successful Implementation of Lean Methodology.

    Science.gov (United States)

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

    2015-10-01

    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

  17. Is culture associated with patient safety in the emergency department? A study of staff perspectives.

    NARCIS (Netherlands)

    Verbeek-van Noord, I.; Wagner, C.; Dyck, C. van; Twisk, J.W.R.; Bruijne, M.C. de

    2014-01-01

    Objective: To describe the patient safety culture of Dutch emergency departments (EDs), to examine associations between safety culture dimensions and patient safety grades as reported by ED staff and to compare these associations between nurses and physicians. DESIGN: Cross-sectional survey conducte

  18. Assessing Psychosocial Impairment in the Pediatric Emergency Department: Child/Caregiver Concordance

    Science.gov (United States)

    Montano, Zorash; Mahrer, Nicole E.; Nager, Alan L.; Claudius, Ilene; Gold, Jeffrey I.

    2011-01-01

    The objective of this study was to examine the level of agreement between child- and caregiver-reports of the child's psychosocial problems presenting to a Pediatric Emergency Department (PED) using a validated screening tool. This was an anonymous, prospective, cross-sectional, multi-informant (child and caregiver) study assessing cognitive,…

  19. [Psychosocial Characteristics of Adolescents Treated for Alcohol Intoxication in Emergency Departments].

    Science.gov (United States)

    Wartberg, Lutz; Diestelkamp, Silke; Arnaud, Nicolas; Thomasius, Rainer

    2016-09-01

    Psychosocial Characteristics of Adolescents Treated for Alcohol Intoxication in Emergency Departments In Germany, every year a substantial number of adolescents is treated in emergency departments for acute alcohol intoxication. Until now, only few studies have been published investigating psychosocial aspects in this group of adolescents. In the present study 316 adolescents were surveyed in the emergency department regarding their problematic use of alcohol and illicit drugs, their patterns of alcohol consumption, their alcohol-related and mental problems. We reported results for the whole sample. Additionally, the sample was divided in two groups based on the result in an established screening instrument for problematic alcohol use (CRAFFT-d). To compare the two groups we conducted unpaired t tests, chi-square tests and logistic regression analyses. Compared to the other group the adolescents exceeding the cut-off value of the CRAFFT-d reported a statistically significant higher past 30-day binge drinking frequency and number of standard-drinks consumed on a typical drinking occasion, more alcohol-related problems, more frequently a problematic use of illicit drugs and more mental problems (regarding antisocial behavior, anger control problems and self-esteem). Antisocial behavior was the most important factor for the affiliation to one of the two groups. The application of the screening instrument for problematic alcohol use (CRAFFT-d) in the emergency department seems to be a promising approach to identify adolescents with a general higher psychosocial burden. PMID:27595810

  20. Dermatobia hominis in the accident and emergency department: "I've got you under my skin".

    Science.gov (United States)

    MacNamara, A; Durham, S

    1997-05-01

    An unusual form of larval infestation from South America is presented which, in view of increasing tourism to South america's tropical areas, may present to any accident and emergency department. Infestation with Dermatobia hominis is reviewed in terms of clinical recognition and life cycle. Techniques of removal are described. PMID:9193989

  1. Mechanical ventilation in emergency departments: Non invasive or invasive mechanical ventilation. Where is the answer?

    OpenAIRE

    Esquinas Rodriguez Antonio M; Cosentini Roberto; Papadakos Peter J

    2012-01-01

    The Emergency Department length of stay for patients requiring mechanical ventilation paper in this issue is very illustrative of many variables that still confound the way we treat patients that may not require endotracheal intubation (ETI) but may benefit from non-invasive mechanical ventilation (NIV) [1].

  2. Child Maltreatment and Repeat Presentations to the Emergency Department for Suicide-Related Behaviors

    Science.gov (United States)

    Rhodes, Anne E.; Boyle, Michael H.; Bethell, Jennifer; Wekerle, Christine; Tonmyr, Lil; Goodman, Deborah; Leslie, Bruce; Lam, Kelvin; Manion, Ian

    2013-01-01

    Objectives: To identify factors associated with repeat emergency department (ED) presentations for suicide-related behaviors (SRB)--hereafter referred to as repetition--among children/youth to aid secondary prevention initiatives. To compare rates of repetition in children/youth with substantiated maltreatment requiring removal from their parental…

  3. Additional value of procalcitonin for diagnosis of infection in patients with fever at the emergency department

    NARCIS (Netherlands)

    M.D. de Kruif; M. Limper; H. Gerritsen; C.A. Spek; D.P.M. Brandjes; H. ten Cate; P.M. Bossuyt; P.H. Reitsma; E.C.M. van Gorp

    2010-01-01

    Objective: First, to determine whether procalcitonin (PCT) significanty adds diagnostic value in terms of sensitivity and specificity to a common set of markers of infection, including C-reactive protein (CRP), at the Emergency Department. Second, to create a simple scoring rule implementing PCT val

  4. Global Emergency Medicine Journal Club: A Social Media Discussion About the Lack of Association Between Press Ganey Scores and Emergency Department Analgesia

    OpenAIRE

    Westafer, L; Hensley, J.; Shaikh, S; Lin, M.

    2016-01-01

    © 2015 American College of Emergency Physicians. Annals of Emergency Medicine collaborated with an educational Web site, Academic Life in Emergency Medicine (ALiEM), to host a public discussion featuring the 2014 Annals article on the association between Press Ganey scores and emergency department (ED) analgesia by Schwartz etal. The objective was to curate a 14-day (December 1 through 14, 2014) worldwide academic dialogue among clinicians in regard to preselected questions about the article....

  5. A Simple Clinical Score “TOPRS” to Predict Outcome in Pediatric Emergency Department in a Teaching Hospital in India

    OpenAIRE

    Ravinder Kumar Soni; Bains, Harmesh S.

    2012-01-01

    Objective: To develop a simple clinical scoring system for severity of illness to help prioritize care and predict outcome in emergency department.Methods: Prospective hospital based observational study. Out of a total of 874 children who attended emergency department in one year, 777 were included in the study. Data was collected at the time of admission in emergency department. The baseline information like age, gender, etc and variables of ‘toprs’ score viz temperature, oxygen saturation, ...

  6. Complicated bronchiolitis: another use for your bedside ultrasound in the emergency department.

    Science.gov (United States)

    Soto, Fernando; Soltero, Roxana; Rovira, Helen

    2009-01-01

    Diaphragmatic eventration or diaphragmatic herniations are congenital defect that involve abnormal development of the diaphragm and stretching of the muscular fibers leading to protrusion of abdominal organs into the thoracic cavity. Left sided defects will lead to stomach contents into the chest cavity while, right sided defects will have bowel or liver in the thoracic cavity. Infants with Congenital diaphragmatic hernia often present with respiratory distress that can be life-threatening unless treated appropriately. Bedside ultrasound in the Emergency Department, performed by the Emergency Physician can be a very useful tool in diagnosing conditions such as this one. We present a case of diaphragmatic eventration in a two month old male sent to Emergency Department (ED) by his primary care physician due to a severe case of bronchiolitis. PMID:20120987

  7. Consumer satisfaction with nursing care in a rural community hospital emergency department.

    Science.gov (United States)

    Clark, C A; Pokorny, M E; Brown, S T

    1996-01-01

    The article describes a study undertaken to assess patient satisfaction with nursing care in a rural hospital emergency department with respect to psychological safety, discharge teaching, information giving, and technical competence. This descriptive research utilized Davis' Consumer Emergency Care Satisfaction Scale to determine the degree to which 52 patients perceived overall satisfaction with nursing care. Findings indicated that patients were satisfied with nursing care. No statistically significant effect of gender or education level on consumer satisfaction or on any subscale was detected, but African American consumers were less satisfied with discharge teaching, which may suggest that discharge teaching should reflect the cultural diversity of consumers presenting to the emergency department. Nursing staff may need to spend more time with rural African American consumers. Staff may need to be inserviced to meet the cultural and educational needs of African Americans. PMID:8562989

  8. The economic role of the Emergency Department in the health care continuum: applying Michael Porter's five forces model to Emergency Medicine.

    Science.gov (United States)

    Pines, Jesse M

    2006-05-01

    Emergency Medicine plays a vital role in the health care continuum in the United States. Michael Porters' five forces model of industry analysis provides an insight into the economics of emergency care by showing how the forces of supplier power, buyer power, threat of substitution, barriers to entry, and internal rivalry affect Emergency Medicine. Illustrating these relationships provides a view into the complexities of the emergency care industry and offers opportunities for Emergency Departments, groups of physicians, and the individual emergency physician to maximize the relationship with other market players. PMID:16740464

  9. A Prevalence and Management Study of Acute Pain in Children Attending Emergency Departments by Ambulance.

    Science.gov (United States)

    Murphy, Adrian; McCoy, Siobhan; O'Reilly, Kay; Fogarty, Eoin; Dietz, Jason; Crispino, Gloria; Wakai, Abel; O'Sullivan, Ronan

    2016-01-01

    Pain is the most common symptom in the emergency setting and remains one of the most challenging problems for emergency care providers, particularly in the pediatric population. The primary objective of this study was to determine the prevalence of acute pain in children attending emergency departments (EDs) in Ireland by ambulance. In addition, this study sought to describe the prehospital and initial ED management of pain in this population, with specific reference to etiology of pain, frequency of pain assessment, pain severity, and pharmacological analgesic interventions. A prospective cross-sectional study was undertaken over a 12-month period of all pediatric patients transported by emergency ambulance to four tertiary referral hospitals in Ireland. All children (management of acute pain in children transferred by ambulance to the ED in Ireland is currently poor, with documentary evidence of only 26% receiving prehospital analgesic agents. PMID:26024309

  10. Psychiatric and Medical Management of Marijuana Intoxication in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Bui, Quan M.

    2015-05-01

    Full Text Available We use a case report to describe the acute psychiatric and medical management of marijuana intoxication in the emergency setting. A 34-year-old woman presented with erratic, disruptive behavior and psychotic symptoms after recreational ingestion of edible cannabis. She was also found to have mild hypokalemia and QT interval prolongation. Psychiatric management of cannabis psychosis involves symptomatic treatment and maintenance of safety during detoxification. Acute medical complications of marijuana use are primarily cardiovascular and respiratory in nature; electrolyte and electrocardiogram monitoring is indicated. This patient’s psychosis, hypokalemia and prolonged QTc interval resolved over two days with supportive treatment and minimal intervention in the emergency department. Patients with cannabis psychosis are at risk for further psychotic sequelae. Emergency providers may reduce this risk through appropriate diagnosis, acute treatment, and referral for outpatient care. [West J Emerg Med. 2015;16(3:414–417.

  11. Rates of TBI-related Emergency Department Visits, Hospitalizations, and Deaths — United States, 2001–2010

    Data.gov (United States)

    U.S. Department of Health & Human Services — In general, total combined rates for traumatic brain injury (TBI)-related emergency department (ED) visits, hospitalizations and deaths have increased over the past...

  12. The Image of the City of İstanbul as an Emerging Destination in Turkey's Tourism

    OpenAIRE

    ÜNER, M. Mithat; Evren GÜÇER; TAŞÇI, Aslı

    2006-01-01

    The study that is substantiated by the support of Ministry of Culture and Tourism, is aimed to determine the image in the foreigners view of the city of Istanbul that is by following Antajya being in the position of the most important tourism destination of Turkey and also in the future years it will be expected to make strong its current position in the country tourism. In the content of the study, after discussing the position and the importance of the city of Istanbul in the Turkey's touri...

  13. Factors predicting early outcome in patients admitted at emergency department with severe head trauma

    Institute of Scientific and Technical Information of China (English)

    Rejeb Belfekih Imen; Chakroun Olfa; Chtara Kamilia; Boujelbene Meriam; Ksibi Hichem; Chaari Adel; Bahloul Mabrouk; Rekik Noureddine

    2015-01-01

    Objective:To determine predictive factors of early mortality among severe traumatic brain injury in emergency department. Methods: This study is based on a retrospective analysis of 198 admitted in emergency depatment with severe head injury (Glasgow coma scale score≤8) of an university hospital (Sfax, Tunisia). Basic demographic, clinical, biological and radiological data were recorded on admission and during emergency department stay. Results: Forty two patients were died. Univariate analysis showed that the presence of shock, cardiac arrest, bilateral mydriasis, high value of injury severity score and low value of Glasgow coma scale were associated with mortality. Moreover, meningeal hemorrhage, cerebral and subdural haematoma were associated with poorer outcome. Multivariate analysis showed that factors associated with a poor prognosis were cardiac arrest cerebral and the presence of cerebral haematoma. Conclusions: Improving pre-hospital care and ovoid futile resuscitation to given priority in resource allocation and urgent CT scan of the head to look for operable mass lesions as early detection should improve the prognosis of severe head injury at emergency department.

  14. Have Maryland local health departments effectively put in place the information technology relevant to emergency preparedness?

    Science.gov (United States)

    Nguh, Jonas

    2013-01-01

    Ever since the terrorist attacks of 9/11, the federal government has increased funding for emergency preparedness. However, the literature continues to document several areas of weaknesses in public health emergency management by local health departments (LHD). This lack of preparedness affects the entire public. The purpose of this study was to determine whether or not Maryland LHDs have effectively put in place the information technology (IT) that is relevant for emergency preparedness. Base Firm-wide IT Infrastructure Services and the Feeny/Willcocks Framework for Core IS Capabilities are the two conceptual frameworks used in this study. This qualitative study used the survey method and the data were analyzed through content analysis. The results revealed that utilization, practice, and performance of IT by Maryland LHDs are not efficient or effective. Recommendations included the development of "best practices," increased funding for IT infrastructure and the establishment of strategic management framework for IT initiatives. Implications for positive social change include the development of recommendations to enhance emergency preparedness practice, and advancement of knowledge so as to facilitate the functions, and duties of health departments in emergency preparedness operations. PMID:24187746

  15. The diagnosis of sepsis using POCT in the Emergency Department – Medical and legal implications

    Directory of Open Access Journals (Sweden)

    Bogdan C. Teușdea

    2015-04-01

    Full Text Available Sepsis, severe sepsis and septic shock are some of the most serious affections which threaten the lives of the patients who come to the Emergency Department and which require fast treatment because the more severe the sepsis was, the higher the mortality, up to 50% higher in severe sepsis. That is why, at present, the 2013 Guides of Surviving Sepsis Campaign recommend that the potential source of infection should be confirmed as soon as possible, in the first 6 hours since the patient arrived in the Emergency Unit if possible, moreover the large spectrum antibiotics therapy must be administered in one hour after the severe sepsis or the septic shock were identified. That is why the identification of these patients at risk is very important and this identification can only be made using POCT type devices. This type of devices has the capacity to make precise determinations, in a short time (15-17 minutes, using minimum quantities of integral blood, without using test tubes, sepsis biomarkers and other additional material. The possibility to fast diagnose sepsis, offers the doctors from the Emergency Department, the capacity to fast initiate an antibiotic treatment, to hospitalize the patient and at the same time, it gives them the certainty that they did not miss the sepsis diagnosis, thus avoiding the situation of malpractice. A preliminary study, regarding the sepsis biomarkers, which took place in the Emergency Unit of University Central Emergency Military Hospital, is also presented within this article.

  16. Using Queuing Theory and Simulation Modelling to Reduce Waiting Times in An Iranian Emergency Department

    Directory of Open Access Journals (Sweden)

    Hourvash Akbari Haghighinejad

    2016-01-01

    Full Text Available Background: Hospital emergencies have an essential role in health care systems. In the last decade, developed countries have paid great attention to overcrowding crisis in emergency departments. Simulation analysis of complex models for which conditions will change over time is much more effective than analytical solutions and emergency department (ED is one of the most complex models for analysis. This study aimed to determine the number of patients who are waiting and waiting time in emergency department services in an Iranian hospital ED and to propose scenarios to reduce its queue and waiting time. Methods: This is a cross-sectional study in which simulation software (Arena, version 14 was used. The input information was extracted from the hospital database as well as through sampling. The objective was to evaluate the response variables of waiting time, number waiting and utilization of each server and test the three scenarios to improve them. Results: Running the models for 30 days revealed that a total of 4088 patients left the ED after being served and 1238 patients waited in the queue for admission in the ED bed area at end of the run (actually these patients received services out of their defined capacity. The first scenario result in the number of beds had to be increased from 81 to179 in order that the number waiting of the “bed area” server become almost zero. The second scenario which attempted to limit hospitalization time in the ED bed area to the third quartile of the serving time distribution could decrease the numberwaiting to 586 patients. Conclusion: Doubling the bed capacity in the emergency department and consequently other resources and capacity appropriately can solve the problem. This includes bed capacity requirement for both critically ill and less critically ill patients. Classification of ED internal sections based on severity of illness instead of medical specialty is another solution.

  17. Using Queuing Theory and Simulation Modelling to Reduce Waiting Times in An Iranian Emergency Department

    Science.gov (United States)

    Haghighinejad, Hourvash Akbari; Kharazmi, Erfan; Hatam, Nahid; Yousefi, Sedigheh; Hesami, Seyed Ali; Danaei, Mina; Askarian, Mehrdad

    2016-01-01

    Background: Hospital emergencies have an essential role in health care systems. In the last decade, developed countries have paid great attention to overcrowding crisis in emergency departments. Simulation analysis of complex models for which conditions will change over time is much more effective than analytical solutions and emergency department (ED) is one of the most complex models for analysis. This study aimed to determine the number of patients who are waiting and waiting time in emergency department services in an Iranian hospital ED and to propose scenarios to reduce its queue and waiting time. Methods: This is a cross-sectional study in which simulation software (Arena, version 14) was used. The input information was extracted from the hospital database as well as through sampling. The objective was to evaluate the response variables of waiting time, number waiting and utilization of each server and test the three scenarios to improve them. Results: Running the models for 30 days revealed that a total of 4088 patients left the ED after being served and 1238 patients waited in the queue for admission in the ED bed area at end of the run (actually these patients received services out of their defined capacity). The first scenario result in the number of beds had to be increased from 81 to179 in order that the number waiting of the “bed area” server become almost zero. The second scenario which attempted to limit hospitalization time in the ED bed area to the third quartile of the serving time distribution could decrease the number waiting to 586 patients. Conclusion: Doubling the bed capacity in the emergency department and consequently other resources and capacity appropriately can solve the problem. This includes bed capacity requirement for both critically ill and less critically ill patients. Classification of ED internal sections based on severity of illness instead of medical specialty is another solution. PMID:26793727

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

    Directory of Open Access Journals (Sweden)

    Farrokhnia Nasim

    2011-12-01

    Full Text Available 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 In 2009 and 2010 the Swedish Council on Health Technology Assessment sent out a questionnaire to the ED managers in all (74 Swedish hospital emergency departments. The questionnaire comprised questions about triage and interventions to improve patient flows. Results Nearly all (97% EDs in Sweden employed a triage scale in 2010, which was an increase from 2009 (73%. Further, the Medical Emergency Triage and Treatment System was the triage scale most commonly implemented across the country. The implementation of flow-related interventions was not as common, but more than half (59% of the EDs have implemented or plan to implement nurse requested X-ray. Conclusions There has been an increase in the use of triage scales in Swedish EDs during the last few years, with acceleration for the past two years. Most EDs have come to use the Medical Emergency Triage and Treatment System, which also indicates regional co-operation. The implementation of different interventions for improved patient flows in EDs most likely is explained by the problem of crowding. Generally, more studies are needed to investigate the economical aspects of these interventions.

  19. Study on emergency system of contemporary city power grid construction layout%当代城市建设电网应急体系布局研究

    Institute of Scientific and Technical Information of China (English)

    李建军

    2015-01-01

    in recent years, the city grid emergencies occur frequently, the serious influence to the city economic and social development, the need for a comprehensive strengthening the construction of emergency response system. Emergency capacity evaluation is an important method for the construction of the emergency response system and improve the effective inspection and guidance. This paper analyzes the characteristics of city power grid emergency defines the related concept of city power grid emergency capability assessment, analysis of emergency capability assessment, the status quo at home and abroad and puts forward some ideas of city power grid emergency capability assessment, combining the ideas of perfecting the city power grid emergency capability assessment system and establish the system of evaluation index.%近年来城市电网突发事件频发,对城市经济社会发展造成严重影响,需要全面加强应急体系建设。应急能力评估是对应急体系建设和完善进行有效检验和指导的重要手段。本文分析了城市电网突发事件的特点明确了城市电网应急能力评估的相关概念,分析了应急能力,评估国内外现状提出了城市电网应急能力评估思路,结合该思路完善了城市电网应急能力评估体系并且建立评估指标体系。

  20. Effectiveness of interventions targeting frequent users of emergency departments: a systematic review

    OpenAIRE

    Althaus F.

    2012-01-01

    L'article publié de le cadre de cette thèse est intitulé "Effectiveness of interventions targeting frequent users of emergency departments: A systematic review." Il a été publié par les "Annals of Emergency Medicine (AEM)" en juillet 2011. Le titre en français pourrait être: "Efficacité des interventions ciblant les utilisateurs fréquents des services d'urgence: Une revue systématique." Le titre du journal américain pourrait être: "Annales de Médecine d'Urgence". Il s'agit du journal du "Coll...

  1. Advanced Concepts and Controversies in Emergency Department Pain Management.

    Science.gov (United States)

    Motov, Sergey M; Nelson, Lewis S

    2016-06-01

    Pain is the most common complaint for which patients come to the emergency department (ED). Emergency physicians are responsible for pain relief in a timely, efficient, and safe manner in the ED. The improvement in our understanding of the neurobiology of pain has balanced the utilization of nonopioid and opioid analgesia, and simultaneously has led to more rational and safer opioid prescribing practices. This article reviews advances in pain management in the ED for patients with acute and chronic pain as well as describes several newer strategies and controversies. PMID:27208710

  2. Diagnostic value of end tidal capnography in patients with hyperglycemia in the emergency department

    OpenAIRE

    Bou Chebl, Ralphe; Madden, Bryan; Belsky, Justin; Harmouche, Elie; Yessayan, Lenar

    2016-01-01

    Background Diabetic Ketoacidosis (DKA) is a potentially life-threatening emergency that requires prompt diagnosis and treatment. In paediatric populations an end tidal capnography value greater than 36 mmHg was found to be 100 % sensitive in ruling out DKA. Methods A cross sectional observational study of adults ≥ 17 years of age presenting to the emergency department between January 2014 and May 2014 with glucose > 550 mg/dL. In all patients, nasal capnography and venous blood gas analysis w...

  3. Violence and aggression in the emergency department: factors impinging on nursing research.

    Science.gov (United States)

    Ferns, Terry; Stacey, Chrissie; Cork, Alison

    2006-01-01

    This paper examines issues involved in the debate regarding the role of research in nursing. The authors take the example of violence and aggression in the emergency field to discuss methodological, philosophical, professional, logistical, power differentials and leadership theory that influence and explain the process of conducting research surrounding violence and aggression experienced by nurses working in emergency departments. The paper examines the importance of research and discusses practical issues that impinge or frustrate clinical nursing staff who wish to conduct original research. PMID:16209925

  4. Prospective Analysis of Geriatric Patients Admitted to Emergency Department With Trauma

    Directory of Open Access Journals (Sweden)

    Abdulkadir Akturk

    2013-08-01

    Full Text Available Objective: The aim of this study is to reveal the demographic characteristics, causes of trauma, physical examination findings, the presence of fractures and the status of the outcome of the geriatric trauma patients admitted to the emergency department of an educational research hospital. Material and Methods: This study covers all the cases over 65 years who were admitted to emergency department with trauma between September 1 2011-31 August 2012. The demographic characteristics of the patients such as, age, gender, date of application and as well as the causes of trauma, physical examination findings and outcome situation in the emergency department were evaluated. The study was performed prospectively. SPSS V.20 was used for statistical analysis of the data obtained. Results: Total 175 patients were included to the study, 74 were male (42.28% and 101 were female (57.72%. The mean age of male patients were 75.01 ± 6.557 while the mean age of female patients were 76.10 ± 7.353. The most common cause of trauma in both gender was falls. This rate was 91.1% in female and 8.9% in male patients. 40.6% of the female patients and 27% of the male patients were admitted to the hospital before because of any trauma. The most common form of trauma according to exposed body localization in both gender was extremity traumas. It was seen in 51.5% of the females and 56.8% of the males. 30 female patients (29.7% and 13 male patients (17.6% had fracture in limbs. 78.3% of all patients were discharged from the emergency department and 21.7% of the patients were hospitalised. None of the patients were died in emergency department and none of the patients were referred to another institution from the emergency department. Total 38 patients were hospitalised, 32 of them were discharged, 2 of them were referred to another institution, and 4 of them were died. 26 of 38 hospitalised patients had undergone surgery while 20 of them were orthopedic surgeries

  5. A cluster randomised trial to assess the impact of clinical pathways on AMI management in rural Australian emergency departments

    Directory of Open Access Journals (Sweden)

    Snow Pamela C

    2009-05-01

    Full Text Available Abstract Background People living in rural Australia are more likely to die in hospital following an acute myocardial infarction than those living in major cities. While several factors, including time taken to access hospital care, contribute to this risk, it is also partially attributable to the lower uptake of evidence-based guidelines for the administration of thrombolytic drugs in rural emergency departments where up to one-third of eligible patients do not receive this life-saving intervention. Clinical pathways have the potential to link evidence to practice by integrating guidelines into local systems, but their impact has been hampered by variable implementation strategies and sub-optimal research designs. The purpose of this study is to determine the impact of a five-step clinical pathways implementation process on the timely and efficient administration of thrombolytic drugs for acute myocardial infarctions managed in rural Australian emergency departments. Methods/Design The design is a two-arm, cluster-randomised trial with rural hospital emergency departments that treat and do not routinely transfer acute myocardial infarction patients. Six rural hospitals in the state of Victoria will participate, with three in the intervention group and three in the control group. Intervention hospitals will participate in a five-step clinical pathway implementation process: engagement of clinicians, pathway development according to local resources and systems, reminders, education, and audit and feedback. Hospitals in the control group will each receive a hard copy of Australian national guidelines for chest pain and acute myocardial infarction management. Each group will include 90 cases to give a power of 80% at 5% significance level for the two primary outcome measures: proportion of those eligible for thrombolysis receiving the drug and time to delivery of thrombolytic drug. Discussion Improved compliance with thrombolytic guidelines via

  6. Telephone advice in the accident and emergency department: a survey of current practice.

    OpenAIRE

    Evans, R J; McCabe, M; Allen, H.; Rainer, T; Richmond, P. W.

    1993-01-01

    The objective of this study was to assess the standard of advice given by telephone by accident and emergency (A&E) departments following patients' enquiries. In order to do this patient enquiries were simulated and a telephone questionnaire was carried out. The study was carried out in 18 major and 16 minor A&E departments in Wales. Results achieved were that overall, correct telephone advice was given to 72 of 97 simulated patients (74%). Sixty calls were dealt with by the nursing staff (62...

  7. Audit of telephone advice in a paediatric accident and emergency department.

    OpenAIRE

    Molyneux, E; Jones, N.; Aldom, G; Molyneux, B

    1994-01-01

    This paper audits the telephone requests for advice to a paediatric accident and emergency (A&E) Department over a 4-week period. All calls were answered by senior nurses. Most calls were received in the early evenings when the A&E department was busy. Parents were the most frequent callers and the majority of calls were for children under 5 years of age. The problems presented were wide ranging but advice over the telephone meant that many unnecessary visits to hospital were prevented. The p...

  8. Use of anti-D in an accident and emergency department.

    OpenAIRE

    Huggon, A M; Watson, D P

    1993-01-01

    A retrospective study was made of the use of anti-D in an accident and emergency (A&E) department in 1 month. Patients who are discharged home with a diagnosis of threatened miscarriage should have their blood group determined and anti-D should be given to those who are rhesus negative. We found that only 8/29 patients discharged from the department had their blood group determined and none of the rhesus negative patients was given anti-D. We have introduced a practical method of reminding me...

  9. Implementation of a clinical pathway for emergency department out-patient management of deep vein thrombosis.

    LENUS (Irish Health Repository)

    Kidney, R

    2010-09-01

    There is good evidence demonstrating that outpatient management of deep venous thrombosis (DVT) is feasible and safe. However, few emergency departments in Ireland have implemented care pathways for outpatient management of DVT. The aim of this study was to examine the safety and efficacy of implementing an Emergency Department (ED)- care pathway for outpatient management of patients with DVT. A retrospective observational study of this care pathway introduced at our institution was performed. The primary outcome measure was the number of hospital admissions avoided by using the care pathway. Two hundred and eighty-four patients presenting to the ED with suspected lower limb DVT, were managed using the care pathway over a 6 month period. Forty-nine patients (17%) had a DVT diagnosed. Thirty-nine patients (81%) were suitable for outpatient DVT management. Ten patients (19%) were admitted to hospital. At 3 months there were no reported cases of the following complications: missed DVT, pulmonary embolism or death.

  10. Game theoretic analysis of congestion, safety and security networks, air traffic and emergency departments

    CERN Document Server

    Zhuang, Jun

    2015-01-01

    Maximizing reader insights into the roles of intelligent agents in networks, air traffic and emergency departments, this volume focuses on congestion in systems where safety and security are at stake, devoting special attention to applying game theoretic analysis of congestion to: protocols in wired and wireless networks; power generation, air transportation and emergency department overcrowding. Reviewing exhaustively the key recent research into the interactions between game theory, excessive crowding, and safety and security elements, this book establishes a new research angle by illustrating linkages between the different research approaches and serves to lay the foundations for subsequent analysis. Congestion (excessive crowding) is defined in this work as all kinds of flows; e.g., road/sea/air traffic, people, data, information, water, electricity, and organisms. Analyzing systems where congestion occurs – which may be in parallel, series, interlinked, or interdependent, with flows one way or both way...

  11. Barriers and facilitators for implementing a new screening tool in an emergency department

    DEFF Research Database (Denmark)

    Wassar Kirk, Jeanette; Sivertsen, Ditte M; Petersen, Janne;

    2016-01-01

    AIM: The aim was to identify the factors that were perceived as most important as facilitators or barriers to the introduction and intended use of a new tool in the emergency department among nurses and a geriatric team. BACKGROUND: A high incidence of functional decline after hospitalisation for...... to identify patients at particularly high risk of functional decline and readmission was developed. DESIGN: Qualitative study based on semistructured interviews with nurses and a geriatric team in the emergency department and semistructured single interviews with their managers. METHODS: The......; (4) knowledge; (5) optimism and (6) environmental context and resources. The content analysis identified three themes, each containing two subthemes. The themes were professional role and identity, beliefs about consequences and preconditions for a successful implementation. CONCLUSIONS: Two...

  12. E-FAST:A propos of hemopericardium in the Emergency Department

    Institute of Scientific and Technical Information of China (English)

    Alejandro Cardozo; Federico Puerta; Libardo Valencia

    2016-01-01

    The extended-focused assessment with sonography in trauma is still recognized as a technique approach to patients whose trauma involves the chest and the abdomen, with the aim of ruling out conditions as pneumothorax, hemothorax, pericardial effusion/cardiac tamponade, and intraperitoneal free fluid. Although CT is the gold standard test, the inconvenience of moving unstable patients and the amount of time it takes to carry it out, makes it not always possible in the Emergency Department, which positions the ultrasound as an ideal tool in the evaluation of patients with trauma in the Emergency Department. In this case report, we presented the case of a patient who complains of multiple stab wounds, and the extended-focused assessment with sonography in trauma confirmed the diagnostic impressions.

  13. Emergency department syndromic surveillance providing early warning of seasonal respiratory activity in England.

    Science.gov (United States)

    Hughes, H E; Morbey, R; Hughes, T C; Locker, T E; Pebody, R; Green, H K; Ellis, J; Smith, G E; Elliot, A J

    2016-04-01

    Seasonal respiratory infections place an increased burden on health services annually. We used a sentinel emergency department syndromic surveillance system to understand the factors driving respiratory attendances at emergency departments (EDs) in England. Trends in different respiratory indicators were observed to peak at different points during winter, with further variation observed in the distribution of attendances by age. Multiple linear regression analysis revealed acute respiratory infection and bronchitis/bronchiolitis ED attendances in patients aged 1-4 years were particularly sensitive indicators for increasing respiratory syncytial virus activity. Using near real-time surveillance of respiratory ED attendances may provide early warning of increased winter pressures in EDs, particularly driven by seasonal pathogens. This surveillance may provide additional intelligence about different categories of attendance, highlighting pressures in particular age groups, thereby aiding planning and preparation to respond to acute changes in EDs, and thus the health service in general. PMID:26415918

  14. MOSAIIC : City-Level Agent-Based Traffic Simulation Adapted to Emergency Situations

    OpenAIRE

    Czura, Guillaume; Taillandier, Patrick; Tranouez, Pierrick; Daudé, Éric

    2015-01-01

    International audience In this paper, we present MOSAIIC, an agent-based model to simulate the road traffic of a city in the context of a catastrophic event. Whether natural (cyclone, earthquake, flood) or human (industrial accident) in origin, catastrophic situations modify both infrastructures (buildings, road networks) and human behaviors, which can have a huge impact on human safety. Because the heterogeneities of human behaviors, of land- uses and of network topology have a great impa...

  15. Web-Based Predictive Analytics to Improve Patient Flow in the Emergency Department

    Science.gov (United States)

    Buckler, David L.

    2012-01-01

    The Emergency Department (ED) simulation project was established to demonstrate how requirements-driven analysis and process simulation can help improve the quality of patient care for the Veterans Health Administration's (VHA) Veterans Affairs Medical Centers (VAMC). This project developed a web-based simulation prototype of patient flow in EDs, validated the performance of the simulation against operational data, and documented IT requirements for the ED simulation.

  16. Report of an audit of nurse triage in an accident and emergency department.

    OpenAIRE

    Wong, T W; Tseng, G; Lee, L W

    1994-01-01

    The nurse triage process in an accident and emergency (A&E) department was audited as part of the nursing quality assurance programme. It was found that in most cases documentation was adequate and guidelines had been adhered to. Triage decisions were accurate in most cases using the discharge diagnosis as a bench-mark. Waiting time improvements were also seen. Triage audit was a useful tool in the continuous quality improvement effort.

  17. The Impact on Emergency Department Visits for Respiratory Illness During the Southern California Wildfires

    OpenAIRE

    Dohrenwend, Paul B; Le, Minh V; Bush, Jeffrey A; Thomas, Cyril F

    2013-01-01

    Introduction: In 2007 wildfires ravaged Southern California resulting in the largest evacuation due to a wildfire in American history. We report how these wildfires affected emergency department (ED) visits for respiratory illness. Methods: We extracted data from a Kaiser Permanente database for a single metropolitan community ED. We compared the number of visits due to respiratory illness at t ime intervals of 2 weeks before and during the time when the fires were burn...

  18. Unrecognized Hypoxia and Respiratory Depression in Emergency Department Patients Sedated for Psychomotor Agitation: A Pilot Study

    OpenAIRE

    Deitch, Kenneth; Rowden, Adam; Damiron, Kathia; Lares, Claudia; Oqroshidze, Nino; Aguilera, Elizabeth

    2014-01-01

    Introduction: The incidence of respiratory depression in patients who are chemically sedated in the emergency department (ED) is not well understood. As the drugs used for chemical restraint are respiratory depressants, improving respiratory monitoring practice in the ED may be warranted. The objective of this study is to describe the incidence of respiratory depression in patients chemically sedated for violent behavior and psychomotor agitation in the ED. Methods: Adult patients wh...

  19. Unrecognized Hypoxia and Respiratory Depression in Emergency Department Patients Sedated For Psychomotor Agitation: Pilot Study

    OpenAIRE

    Deitch, Kenneth; Rowden, Adam; Damiron, Kathia; Lares, Claudia; Oqroshidze, Nino; Aguilera, Elizabeth

    2014-01-01

    Introduction The incidence of respiratory depression in patients who are chemically sedated in the emergency department (ED) is not well understood. As the drugs used for chemical restraint are respiratory depressants, improving respiratory monitoring practice in the ED may be warranted. The objective of this study is to describe the incidence of respiratory depression in patients chemically sedated for violent behavior and psychomotor agitation in the ED. Methods Adult patients who met eligi...

  20. Eliminating Amylase Testing from the Evaluation of Pancreatitis in the Emergency Department

    OpenAIRE

    Volz, Kathryn A.; McGillicuddy, Daniel C.; Gary L Horowitz; Wolfe, Richard E.; Joyce, Nina; Sanchez, Leon D.

    2010-01-01

    Background: Alterations in serum biomarkers have been used to evaluate for pancreatitis in the emergency department (ED). Studies have shown lipase to be as sensitive and more specific than amylase in diagnosing pancreatitis and that amylase plus lipase does not improve accuracy over lipase alone. Objective: To determine effects of interventions to decrease ordering of amylase in the evaluation of pancreatitis. Methods: We conducted a pre- and post-cohort study. The number o...

  1. Pediatric gastroenteritis in the emergency department: Practice evaluation in Belgium, France, The Netherlands and Switzerland

    OpenAIRE

    Pelc, Isidore; Redant, Sébastien; Julliand, Sébastien; Llor, X.; Lorrot, Mathie; Oostenbrink, Rianne; Gajdos, Vincent; Angoulvant, François

    2014-01-01

    textabstractBackground: Based on European recommendations of ESPGHAN/ESPID from 2008, first line therapy for dehydration caused by acute gastroenteritis (AGE) is oral rehydration solution (ORS). In case of oral route failure, nasogastric tube enteral rehydration is as efficient as intra-venous rehydration and seems to lead to fewer adverse events. The primary objective was to describe rehydration strategies used in cases of AGE in pediatric emergency departments (PEDs) in Belgium, France, The...

  2. Estimating the cost of Emergency Department presentations in NSW. CHERE Working Paper 2014/01

    OpenAIRE

    Rebecca Reeve; Marion Haas

    2013-01-01

    This brief methods paper explains how to use the NSW Government Health Costs of Care Standards to estimate the cost of presentations to emergency departments (ED) in NSW. We begin with a discussion of the allocation of presentations according to visit type, triage category and mode of separation to urgency disposition group (UDG) class for the purpose of allocating cost weights and how to apply these weights to estimate the cost per presentation. The discussion is then extended to incorporate...

  3. The first aid management of epistaxis by accident and emergency department staff.

    OpenAIRE

    McGarry, G W; Moulton, C

    1993-01-01

    Most nose bleeds can be controlled by compressing the ala nasi, thus applying direct pressure over Little's area. The ability to demonstrate the correct position for this manoeuvre was assessed in 115 members of the staff of the accident and emergency (A&E) department of a major teaching hospital. Overall, the correct response rate was only 33% and even trained medical and nursing staff achieved less than a 50% success rate. Increased awareness of this simple and effective technique is recomm...

  4. The use of music therapy in reducing anxiety on patients attending accident and emergency department

    OpenAIRE

    So, Wing-hong; 蘇永康

    2013-01-01

    In Hong Kong, there has about 70% patients who attend Accident and Emergency Department (AED) is categorized as semi- or non-urgent cases. The medical conditions with the relative longer waiting time provoke the anxiety level. Furthermore the anxiety is worsen by the noisy waiting environment. These phenomena not only affect the psychological but also the physiological changes of patients. Therefore, there is a need to develop an evidence-based intervention that can effectively reduce the anx...

  5. Does increased medication use among seniors increase risk of hospitalization and emergency department visits?

    OpenAIRE

    Sara Allin; David Rudoler; Audrey Laporte

    2015-01-01

    Objective: to examine the extent of the health risks of consuming multiple medications among the older population. Data sources/study setting: Secondary data from the period 2004-2006. The study setting was the province of Ontario, Canada, and the sample consisted of individuals aged 65 years or older who responded to a national health survey. Study design: We estimated a system of equations for inpatient and emergency department (ED) services to test the marginal effect of medication use on ...

  6. Use of a management plan for treating asthma in an emergency department.

    OpenAIRE

    Town, I; Kwong, T; Holst, P.; Beasley, R

    1990-01-01

    A standardised management protocol has been developed for the assessment and treatment of adults with acute asthma attending an emergency department. The management protocol consists of an assessment sheet for recording essential features of the history and examination findings and a flow diagram with guidelines for initial management that were based on spirometric recordings. The protocol was introduced at Wellington Hospital in 1986. The effect of this intervention was assessed by analysing...

  7. Factors associated with hospital admissions and repeat emergency department visits for adults with asthma

    OpenAIRE

    Adams, R; B. Smith; Ruffin, R

    2000-01-01

    BACKGROUND—A small proportion of patients with asthma account for a disproportionate number of acute health service events. To identify whether factors other than severity and low socioeconomic status were associated with this disproportionate use, a prospective study was undertaken to examine management and psychosocial factors associated with increased risk for admission to hospital with asthma and repeat visits to the emergency department over a 12month period.
METHODS...

  8. Automated examination notification of Emergency Department images in a picture archiving and communication system

    OpenAIRE

    Andriole, Katherine P.; Avrin, David E.; Weber, Ellen; Luth, David M.; Bazzill, Todd M.

    2001-01-01

    This study compares the timeliness of radiology interpretation of Emergency Department (ED) imaging examinations in a picture archiving and communication system (PACS) before and after implementation of an automated paging system for notification of image availability. An alphanumeric pager for each radiology subspecialty (chest, pediatrics, bone, neuroradiology, and body) was used to alert the responsible radiologist that an ED imaging examination is available to be viewed on the PACS. The p...

  9. Seizure visits in US emergency departments: epidemiology and potential disparities in care

    OpenAIRE

    Pallin, Daniel J.; Goldstein, Joshua N; Moussally, Jon S.; Pelletier, Andrea J.; Green, Alexander R; Camargo, Carlos A.

    2008-01-01

    Introduction While epilepsy is a well-characterized disease, the majority of emergency department (ED) visits for “seizure” involve patients without known epilepsy. The epidemiology of seizure presentations and national patterns of management are unclear. The aim of this investigation was to characterize ED visits for seizure in a large representative US sample and investigate any potential impact of race or ethnicity on management. Methods Seizure visits from the National Hospital Ambulatory...

  10. Measuring the relationship between interruptions, multitasking and prescribing errors in an emergency department: a study protocol

    OpenAIRE

    Raban, Magdalena Z; Scott R Walter; Douglas, Heather E.; Strumpman, Dana; Mackenzie, John; Westbrook, Johanna I

    2015-01-01

    Introduction Interruptions and multitasking are frequent in clinical settings, and have been shown in the cognitive psychology literature to affect performance, increasing the risk of error. However, comparatively less is known about their impact on errors in clinical work. This study will assess the relationship between prescribing errors, interruptions and multitasking in an emergency department (ED) using direct observations and chart review. Methods and analysis The study will be conducte...

  11. Epidemiology of Mental Health Attendances at Emergency Departments: Systematic Review and Meta-Analysis

    OpenAIRE

    Barratt, H. S.; Rojas-Garcia, A.; Clarke, K.; Moore, A; Whittington, C.; Stockton, S.; J. Thomas; Pilling, S.; Raine, R

    2016-01-01

    Background: The characteristics of Emergency Department (ED) attendances due to mental or behavioural health disorders need to be described to enable appropriate development of services. We aimed to describe the epidemiology of mental health-related ED attendances within health care systems free at the point of access, including clinical reason for presentation, previous service use, and patient sociodemographic characteristics. / Method: Systematic review and meta-analysis of observational s...

  12. Associations between perceived discrimination and health status among frequent Emergency Department users

    OpenAIRE

    Baggio S.; Iglesias K.; Hugli O.; Burnand B.; Ruggeri O.; Wasserfallen J.B.; Moschetti K.; Staeger P.; Alary S.; Canepa Allen M.; Daeppen J.B.; Bodenmann P.

    2016-01-01

    Objective : Frequent Emergency Department (ED) users are vulnerable individuals and discrimination is usually associated with increased vulnerability. The aim of this study was to investigate frequent ED users' perceptions of discrimination and to test whether they were associated with increased vulnerability. Methods : In total, 250 adult frequent ED users were interviewed in Lausanne University Hospital. From a previously published questionnaire, we assessed 15 dichotomous sources of per...

  13. University researchers collaborate with Virginia Department of Emergency Management to develop statewide hazard mitigation plan

    OpenAIRE

    Fay, Patrick

    2009-01-01

    Floods, wild fires, hurricanes, and tornadoes are just a few examples of natural phenomena that cost the state millions of dollars in property and infrastructure damage. National, state, and local agencies are working with Virginia's Department of Emergency Management (VDEM) and researchers at the Virginia Tech Center for Geospatial Information Technology (CGIT) to develop part of a revised statewide plan for communities to identify these risks, vulnerabilities, and estimate potential losses.

  14. Association between Intimate Partner Violence and Health Behaviors of Female Emergency Department Patients

    OpenAIRE

    Anitha Elizabeth Mathew; Brittany Marsh; L. Shakiyla Smith; Debra Houry

    2012-01-01

    Introduction: We assessed the correlation between intimate partner violence (IPV) and health behaviors, including seat belt use, smoke alarm in home, handgun access, body mass index, diet, and exercise. We hypothesized that IPV victims would be less likely to have healthy behaviors as compared to women with similar demographics. Methods: All adult female patients who presented to 3 Atlanta-area emergency department waiting rooms on weekdays from 11AM to 7PM were asked to participate ...

  15. The Nature and Occurrence of Registration Errors in the Emergency Department

    OpenAIRE

    Hakimzada, A. Forogh; Green, Robert A.; Sayan, Osman R.; Zhang, Jiajie; Patel, Vimla L.

    2007-01-01

    Research into the nature and occurrence of medical errors has shown that these often result from a combination of factors that lead to the breakdown of workflow. Nowhere is this more critical than in the emergency department (ED), where the focus of clinical decision is on the timely evaluation and stabilization of patients. This paper reports on the nature of errors and their implications for patient safety in an adult ED, using methods of ethnographic observation, interviews, and think-alou...

  16. Reducing Preventable Emergency Department Utilization and Costs by Using Community Health Workers as Patient Navigators

    OpenAIRE

    Enard, Kimberly R.; Ganelin, Deborah M.

    2013-01-01

    Primary care–related emergency department (PCR-ED) utilization, including for conditions that are preventable or treatable with appropriate primary care, is associated with decreased efficiency of and increased costs to the health system. Many PCR-ED users experience actual or perceived problems accessing appropriate, ongoing sources of medical care. Patient navigation, an intervention used most often in the cancer care continuum, may help to address these barriers among medically underserved...

  17. A Retrospective Analysis of the Burn Injury Patients Records in the Emergency Department, an Epidemiologic Study

    OpenAIRE

    Nilgün Aksoy; Senay Arli; Ozlem Yigit

    2014-01-01

    Introduction: Burns can be very destructive, and severely endanger the health and lives of humans. It maybe cause disability and even psychological trauma in individuals. . Such an event can also lead to economic burden on victim’s families and society. The aim of our study is to evaluate epidemiology and outcome of burn patients referring to emergency department. Methods: This is a cross-sectional study was conducted by evaluation of patients’ files and forensic reports of burned patients’ r...

  18. The effects of Ramadan fasting on the number of renal colic visits to the emergency department

    OpenAIRE

    Cevik, Yunsur; Corbacioglu, Seref Kerem; Cikrikci, Gulsah; Oncul, Veysel; Emektar, Emine

    2016-01-01

    Objective: The effects of fluid and diet restriction strictly during the long hours in Ramadan on the number of colic visits and biochemical factors of stone formation are controversial in the literature. The aim of this study was to assess the effects of Ramadan fasting on the number of renal colic visits and laboratory results of patients with renal colic. Methods: This was a prospective observational study, which was conducted with patients who were admitted to our emergency department wit...

  19. Therapeutic Approaches for Renal Colic in the Emergency Department: A Review Article

    OpenAIRE

    Golzari, Samad EJ; Soleimanpour, Hassan; Rahmani, Farzad; Zamani Mehr, Nahid; Safari, Saeid; Heshmat, Yaghoub; Ebrahimi Bakhtavar, Hanieh

    2014-01-01

    Context: Renal colic is frequently described as the worst pain ever experienced, and management of this intense pain is necessary. The object of our review was to discuss different approaches of pain control for patients with acute renal colic in the emergency department. Evidence Acquisition: Studies that discussed the treatment of renal colic pain were included in this review. We collected articles from reputable internet databases. Results: Our study showed that some new treatment approach...

  20. Effectiveness of intravenous lidocaine versus intravenous morphine for patients with renal colic in the emergency department

    OpenAIRE

    Soleimanpour Hassan; Hassanzadeh Kamaleddin; Vaezi Hassan; EJ Golzari Samad; Esfanjani Robab; Soleimanpour Maryam

    2012-01-01

    Abstract Background Despite the fact that numerous medications have been introduced to treat renal colic, none has been proven to relieve the pain rapidly and thoroughly. In this study, we aimed at comparing the effects of intravenous lidocaine versus intravenous morphine in patients suffering from renal colic. Methods In a prospective randomized double-blind clinical trial performed in the emergency department of Imam Reza educational hospital of Tabriz, Iran, we studied 240 patients, 18–65 ...

  1. Effects of Full-Moon Definition on Psychiatric Emergency Department Presentations

    OpenAIRE

    Parmar, Varinder S.; Talikowska-Szymczak, Ewa; Downs, Emily; Szymczak, Peter; Meiklejohn, Erin; Groll, Dianne

    2014-01-01

    Objectives. The lunar cycle is believed to be related to psychiatric episodes and emergency department (ED) admissions. This belief is held by both mental health professionals and the general population. Previous studies analyzing the lunar effect have yielded inconsistent results. Methods. ED records from two tertiary care hospitals were used to assess the impact of three different definitions of the full-moon period, commonly found in the literature. The full-moon definitions used in this s...

  2. Pubic Hair Grooming Injuries Presenting to U.S. Emergency Departments

    OpenAIRE

    Glass, AS; Bagga, HS; Tasian, GE; Fisher, PB; McCulloch, CE; Blaschko, SD; McAninch, JW; Breyer, BN

    2012-01-01

    Objective: To describe the demographics and mechanism of genitourinary (GU) injuries related to pubic hair grooming in patients who present to U.S. emergency departments (EDs). Materials and Methods: The National Electronic Injury Surveillance System contains prospectively collected data from patients who present to EDs with consumer product-related injuries. The National Electronic Injury Surveillance System is a stratified probability sample, validated to provide national estimates of all p...

  3. Is culture associated with patient safety in the emergency department? A study of staff perspectives.

    OpenAIRE

    Verbeek-van Noord, I.; Wagner, C.; Van Dyck, C.; Twisk, J.W.R.; de Bruijne, M.C.

    2014-01-01

    Objective: To describe the patient safety culture of Dutch emergency departments (EDs), to examine associations between safety culture dimensions and patient safety grades as reported by ED staff and to compare these associations between nurses and physicians. DESIGN: Cross-sectional survey conducted in 2007. Setting: Thirty-three non-academic EDs in the Netherlands. Participants: Four hundred and eighty nurses, 159 physicians and 91 other professionals. Main outcome measure: Self-reported le...

  4. Bench-to-bedside review: Outcome predictions for critically ill patients in the emergency department

    OpenAIRE

    Hargrove, Jenny; Nguyen, H Bryant

    2005-01-01

    The escalating number of emergency department (ED) visits, length of stay, and hospital overcrowding have been associated with an increasing number of critically ill patients cared for in the ED. Existing physiologic scoring systems have traditionally been used for outcome prediction, clinical research, quality of care analysis, and benchmarking in the intensive care unit (ICU) environment. However, there is limited experience with scoring systems in the ED, while early and aggressive interve...

  5. The Effects of the Work Environment on Nurse Burnout in Emergency Department

    OpenAIRE

    Ayda KEBAPÇI; AKYOLCU, Neriman

    2011-01-01

    Objectives: This study examines the relationship between burnout and work environment among nurses working in emergency departments (ED) in Istanbul. Methods: The subjects were ED nurses who met the research criteria (n=132). Data were collected by questionnaire to determine the demographic characteristics of the subjects as well as their emotions and opinions about their Professional life. Nurses’ burnout was measured by the Maslach Burnout Inventory and nurses’ work environment was determin...

  6. Effects of Particulate Air Pollution on Emergency Department Visits for Headache as Chief Complaint

    OpenAIRE

    Selahattin KIYAN; Murat ERSEL; Uluer, Hatice; Ozsarac, Murat; Aslihan YURUKTUMEN; Eylem ERSAN

    2009-01-01

    Objective: Particulate air pollution is a mixture of solid, liquid, or solid and liquid particles suspended in the air. There have been abundant studies on the short-term effects of air pollution on health, with emphasis on mortality and hospital admissions. Here we propose to assess the relationship between ambient air pollution, and monthly emergency department (ED) visits for headache. In the present study, the objective was to examine the relationship between monthly ED visits for headach...

  7. “Sickle Cell Disease in the Emergency Department: Atypical Complications and Management”

    OpenAIRE

    Brandow, Amanda M.; Liem, Robert

    2011-01-01

    Sickle cell disease is the most common inherited blood disorder in the United States. This disorder of hemoglobin structure leads to a chronic hemolytic anemia and complex chronic disease manifested by sudden, severe, and life-threatening complications. These acute complications can occur in any organ system beginning in early childhood and lasting throughout life. The intermittent nature and acuity of these complications lend the emergency department to be an important site of care. The hall...

  8. Comparison of Canadian versus United States Emergency Department Visits for Chronic Obstructive Pulmonary Disease Exacerbation

    OpenAIRE

    Rowe, Brian H; Rita K Cydulka; Chu-Lin Tsai; Sunday Clark; Douglas Sinclair; Camargo, Carlos A.

    2008-01-01

    INTRODUCTION: Despite the frequency of emergency department (ED) visits for chronic obstructive pulmonary disease (COPD) exacerbation, little is known about practice variation in EDs.OBJECTIVES: To examine the differences between Canadian and United States (US) COPD patients, and the ED management they receive.METHODS: A prospective multicentre cohort study was conducted involving 29 EDs in the US and Canada. Using a standard protocol, consecutive ED patients with COPD exacerbations were inte...

  9. Neuroleptic Malignant Syndrome: A Rare Cause of Fever 1 in the Emergency Department

    OpenAIRE

    Hayriye Gonullu

    2013-01-01

       Neuroleptic malignant syndrome (NMS) is a rare and life threatening complication of antipsychotic therapy. It presents with fever, altered mental status, autonomic instability and muscle rigidity. Differential diagnosis consist many conditions. NMS is a diagnosis of exclusion. NMS is in the differential diagnosis of patients presenting with fever to emergency department, where careful history and previous medication use is essential for diagnosing and treating this phenomenon.

  10. Neuroleptic Malignant Syndrome: A Rare Cause of Fever 1 in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Hayriye Gonullu

    2013-10-01

    Full Text Available    Neuroleptic malignant syndrome (NMS is a rare and life threatening complication of antipsychotic therapy. It presents with fever, altered mental status, autonomic instability and muscle rigidity. Differential diagnosis consist many conditions. NMS is a diagnosis of exclusion. NMS is in the differential diagnosis of patients presenting with fever to emergency department, where careful history and previous medication use is essential for diagnosing and treating this phenomenon.

  11. Expired CO2 Measurement in Intubated or Spontaneously Breathing Patients from the Emergency Department

    OpenAIRE

    Verschuren, Franck; Kabayadondo, Maidei Gugu; Thys, Frédéric

    2011-01-01

    Carbon dioxide (CO2) along with oxygen (O2) share the role of being the most important gases in the human body. The measuring of expired CO2 at the mouth has solicited growing clinical interest among physicians in the emergency department for various indications: (1) surveillance et monitoring of the intubated patient; (2) verification of the correct positioning of an endotracheal tube; (3) monitoring of a patient in cardiac arrest; (4) achieving normocapnia in intubated head trauma patients;...

  12. Predictive Value of Capnography for Suspected Diabetic Ketoacidosis in the Emergency Department

    OpenAIRE

    Soleimanpour, Hassan; Taghizadieh, Ali; Niafar, Mitra; Rahmani, Farzad; Golzari, Samad EJ; Mehdizadeh Esfanjani, Robab

    2013-01-01

    Introduction: Metabolic acidosis confirmed by arterial blood gas (ABG) analysis is one of the diagnostic criteria for diabetic ketoacidosis (DKA). Given the direct relationship between end-tidal carbon dioxide (ETco2), arterial carbon dioxide (PaCO2) and metabolic acidosis, measuring ETco2 may serve as a surrogate for ABG in the assessment of possible DKA. The current study focuses on the predictive value of capnography in diagnosing DKA in patients referring to the emergency department (ED) ...

  13. Impact of Mental Health and Substance Use Disorders on Emergency Department Visit Outcomes for HIV Patients

    OpenAIRE

    Brian Y. Choi, MD, MPH; Diana M. DiNitto, PhD; C. Nathan Marti, PhD; Namkee G. Choi, PhD

    2016-01-01

    Introduction: A disproportionate number of individuals with human immunodeficiency virus (HIV) have mental health and substance-use disorders (MHSUDs), and MHSUDs are significantly associated with their emergency department (ED) visits. With an increasing share of older adults among HIV patients, this study investigated the associations of MHSUDs with ED outcomes of HIV patients in four age groups: 21-34, 35-49, 50-64, and 65+ years. Methods: We used the 2012 Nationwide ...

  14. Epidemiology of the Systemic Inflammatory Response Syndrome (SIRS) in the Emergency Department

    OpenAIRE

    Horeczko, Timothy; Green, Jeffrey P.; Panacek, Edward A

    2014-01-01

    Introduction: Consensus guidelines recommend sepsis screening for adults with systemic inflammatory response syndrome (SIRS), but the epidemiology of SIRS among adult emergency department (ED) patients is poorly understood. Recent emphasis on cost-effective, outcomes-based healthcare prompts the evaluation of the performance of large-scale efforts such as sepsis screening. We studied a nationally representative sample to clarify the epidemiology of SIRS in the ED and subsequent category of il...

  15. Analgesia and Addiction in Emergency Department Patients with Acute Pain Exacerbations

    OpenAIRE

    Gorchynski, Julie; Kelly, Kevin

    2005-01-01

    Introduction: There is ongoing controversy regarding the appropriate use of narcotic analgesia for patients presenting frequently to the emergency department (ED) with subjective acute exacerbations of pain. "Are we treating pain or enabling addiction?” Objectives: To determine whether the presence o f specific factors could be used to identify adults complaining of acute exacerbations of pain for suspected drug addiction, to estimate the percentage of drug addicted patients, to asse...

  16. Resilience-based design of a hospital Emergency Department considering human behavior

    OpenAIRE

    Piqué Saboya, Marta

    2013-01-01

    The paper presents a hospital testbed which aims to help the earthquake engineering community moving another step toward th e realization and implementation of resilience(based design strategie s for health care facilities. An organizational model describing the response of the Hospital Emergency Department (ED) has been implemented using a discre te events simulation model (DES). The waiting time is the main response parame ter used to evaluate the resilie...

  17. Quality indicators for the assessment and management of pain in the emergency department: A systematic review

    OpenAIRE

    Stang, Antonia S.; Hartling, Lisa; Fera, Cassandra; Johnson, David; Ali, Samina

    2014-01-01

    BACKGROUND: Evidence indicates that pain is undertreated in the emergency department (ED). The first step in improving the pain experience for ED patients is to accurately and systematically assess the actual care being provided. Identifying gaps in the assessment and treatment of pain and improving patient outcomes requires relevant, evidence-based performance measures. OBJECTIVE: To systematically review the literature and identify quality indicators specific to the assessment and managemen...

  18. Notification of infectious diseases by junior doctors in accident and emergency departments.

    OpenAIRE

    Spedding, R L; Jenkins, M G; O'Reilly, S A

    1998-01-01

    OBJECTIVE: To assess the knowledge about notifiable infectious diseases by accident and emergency (A&E) senior house officers. METHODS: A telephone questionnaire of senior house officers was carried out over a one week period at the end of their six month attachment in A&E departments in Northern Ireland. RESULTS: 81 (91%) of the senior house officers participated in the study; 23 (29%) realised that the doctor diagnosing the notifiable disease had a statutory duty to notify that disease; nin...

  19. Analysis of the Korean Emergency Department Syndromic Surveillance System: Mass Type Acute Diarrheal Syndrome

    OpenAIRE

    Ahn, Shin; Lee, Jae Ho; KIM, WON; Lim, Kyung Soo

    2010-01-01

    Objectives This study was designed to compare the data from the emergency department syndromic surveillance system of Korea in detection and reporting of acute diarrheal syndrome (mass type) with the data from the Korea Food and Drug Administration. And to offer fundamental materials for making improvements in current surveillance system was our purpose. Methods A study was conducted by reviewing the number of cases reported as acute diarrheal syndrome (mass type) from the Korean Center for D...

  20. Evaluation of the Xpert Flu Rapid PCR Assay in High-Risk Emergency Department Patients

    Science.gov (United States)

    Valsamakis, Alexandra; Gaydos, Charlotte A.; Forman, Michael; Hardick, Justin; Kidambi, Pranav; Amin, Sharmeen; Gupta, Alisha; Rothman, Richard E.

    2014-01-01

    We prospectively evaluated the performance of Cepheid's GeneXpert Xpert Flu assay in a target population of 281 adults presenting to the emergency department with an acute respiratory illness who met Centers for Disease Control and Prevention (CDC) criteria for recommended antiviral treatment. Compared with the Prodesse ProFlu+ assay, Xpert Flu had an overall sensitivity of 95.3% and specificity of 99.2%. PMID:25253792

  1. Self Inflicted Injuries among Children in United States - estimates from a nationwide emergency department sample.

    Directory of Open Access Journals (Sweden)

    Naseem Sulyman

    Full Text Available OBJECTIVE: The objectives of the current study are to provide nationally representative estimates of hospital based emergency department visits (ED attributed to self inflicted injuries and attempted suicides among children in United States; and to identify potential methods of such intentional self inflicted injuries and attempted suicides. METHODS: The Nationwide Emergency Department Sample (year 2007 was used. All ED visits occurring among children (aged ≤18 years with an External Cause of Injury for any of self inflicted injuries were selected. Outcomes examined include hospital ED charges and hospitalization charges. All estimates were projected to national levels. RESULTS: 77,420 visits to hospital based emergency departments were attributed to self inflicted injuries among children (26,045 males and 51,370 females. The average age of the ED visits was 15.7 years. 134 patients died in ED's (106 males and 28 females and 93 died in hospitals following in-patient admission (75 males and 18 females. A greater proportion of male ED visits were discharged routinely as opposed to female ED visits (51.1% versus 44%. A greater proportion of male ED visits also died in the emergency departments compared to female visits (0.4% versus 0.05%. 17,965 ED visits necessitated admission into same hospital. The mean charge for each ED visit was $1,874. Self inflicted injuries by poisoning were the most frequently reported sources accounting for close to 70% of all ED visits. CONCLUSIONS: Females comprise a greater proportion of ED visits attributed to self inflicted injuries. 227 children died either in the ED's or in hospitals. The current study results highlight the burden associated with such injuries among children.

  2. Headache in Pregnancy: An Approach to Emergency Department Evaluation and Management

    OpenAIRE

    Schoen, Jessica C.; Campbell, Ronna L.; Sadosty, Annie T.

    2015-01-01

    Headache is a common presenting complaint in the emergency department. The differential diagnosis is broad and includes benign primary causes as well as ominous secondary causes. The diagnosis and management of headache in the pregnant patient presents several challenges. There are important unique considerations regarding the differential diagnosis, imaging options, and medical management. Physiologic changes induced by pregnancy increase the risk of cerebral venous thrombosis, dissection, a...

  3. Molar Pregnancy with False Negative β-hCG Urine in the Emergency Department

    OpenAIRE

    Hunter, Christopher L.; Ladde, Jay

    2011-01-01

    This case describes an atypical presentation of molar pregnancy in an emergency department patient with abdominal pain and vaginal bleeding. The patient demonstrated clinical features of hydatidiform mole, including acute discharge of a large, grape-like vesicular mass, despite multiple negative urine pregnancy tests. These false-negative qualitative human chorionic gonadotropin assays were likely caused by the “high-dose hook effect” and may have delayed proper care of the patient, who displ...

  4. The diagnosis of ectopic pregnancy in an accident and emergency department.

    OpenAIRE

    Clancy, M J; Illingworth, R N

    1989-01-01

    The correct diagnosis was initially suspected in 32 (53%) of 60 patients with ectopic pregnancy who attended an accident and emergency department. Incorrect diagnoses were made because ectopic pregnancy was not considered or because relevant symptoms and signs were missed or misinterpreted. Three patients had been 'sterilized'. Twenty-four patients (40%) had abdominal pain or vaginal bleeding for more than 1 week before attending. Fever and leucocytosis were wrongly attributed to pelvic infec...

  5. A case of Tailgut Cyst presented to the emergency department due to urinary retention

    OpenAIRE

    ERYİĞİT, Umut; ÇEBİ, Nilay; Karaca, Yunus; KEHA KURT, Nurbanu; GÜNDÜZ, Abdülkadir

    2015-01-01

    Tailgut cysts are infrequent tumors in the presacral area and most presacral tumors in the literature are single-case, these tumors constitute 1/40.000 of applications to hospital. A 27-year-old male presented to the emergency department with urinary and fecal retention. Abdominal pain and swelling had persisted for a week. At physical examination the abdomen was swollen and distended. Rectal examination revealed a mass exerting external pressure on the inferior wall of the anal canal. Comput...

  6. Experience of being a low priority patient during waiting time at an emergency department

    Directory of Open Access Journals (Sweden)

    Adolfsson A

    2012-01-01

    Full Text Available Ingrid Dahlen1,2, Lars Westin1, Annsofie Adolfsson11School of Life Sciences, University of Skövde, Skövde, Sweden; 2Emergency Department, Skaraborg Hospital, Skövde, SwedenBackground: Work in the emergency department is characterized by fast and efficient medical efforts to save lives, but can also involve a long waiting time for patients. Patients are given a priority rating upon their arrival in the clinic based on the seriousness of their problem, and nursing care for lower priority patients is given a lower prioritization. Regardless of their medical prioritization, all patients have a right to expect good nursing care while they are waiting. The purpose of this study was to illustrate the experience of the low prioritized patient during their waiting time in the emergency department.Methods: A phenomenological hermeneutic research method was used to analyze an interview transcript. Data collection consisted of narrative interviews. The interviewees were 14 patients who had waited more than three hours for surgical, orthopedic, or other medical care.Results: The findings resulted in four different themes, ie, being dependent on care, being exposed, being vulnerable, and being secure. Lower priority patients are not paid as much attention by nursing staff. Patients reported feeling powerless, insulted, and humiliated when their care was delayed without their understanding what was happening to them. Not understanding results in exposure that violates self-esteem.Conclusion: The goal of the health care provider must be to minimize and prevent suffering, prevent feelings of vulnerability, and to create conditions for optimal patient well being.Keywords: emergency department, patients, waiting times, nursing staff

  7. Pain, distress, and anticipated recovery for older versus younger emergency department patients after motor vehicle collision

    OpenAIRE

    Pereira, Gregory F; McLean, Samuel A.; Tkacik, Thomas J; Swor, Robert A; Jones, Jeffrey S.; Lee, David C; Peak, David A.; Domeier, Robert M.; Rathlev, Niels K.; Hendry, Phyllis L.; Platts-Mills, Timothy F.

    2014-01-01

    Background Motor vehicle collisions (MVCs) are the second most common injury mechanism resulting in emergency department (ED) visits by older adults. MVCs result in substantial pain and psychological distress among younger individuals, but little is known about the occurrence of these symptoms in older individuals. We describe the frequency of and characteristics associated with pain, distress, and anticipated time for physical and emotional recovery for older adults presenting to the ED afte...

  8. The Intersecting Roles of Violence, Gender, and Substance Use in the Emergency Department: A Research Agenda

    OpenAIRE

    Choo, Esther K.; Benz, Madeline; Rybarczyk, Megan; Broderick, Kerry; Linden, Judith; Boudreaux, Edwin L.; Ranney, Megan L.

    2014-01-01

    The relationship between gender, violence, and substance use in the emergency department (ED) is complex. This paper examines the role of gender in the intersection of substance use and three types of violence: peer violence, intimate partner violence, and firearm violence. Current approaches to treatment of substance abuse and violence are similar across both genders; however, as patterns of violence and substance abuse differ by gender, interventions may be more effective if they are design...

  9. Validation of ICD-9 Codes for Stable Miscarriage in the Emergency Department

    OpenAIRE

    Quinley, Kelly E.; Falck, Ailsa; Kallan, Michael J.; Datner, Elizabeth M.; Carr, Brendan G.; Schreiber, Courtney A.

    2015-01-01

    Introduction: International Classification of Disease, Ninth Revision (ICD-9) diagnosis codes have not been validated for identifying cases of missed abortion where a pregnancy is no longer viable but the cervical os remains closed. Our goal was to assess whether ICD-9 code “632” for missed abortion has high sensitivity and positive predictive value (PPV) in identifying patients in the emergency department (ED) with cases of stable early pregnancy failure (EPF). Methods:...

  10. Validation of ICD-9 Codes for Stable Miscarriage in the Emergency Department

    OpenAIRE

    Quinley, Kelly E.; Falck, Ailsa; Kallan, Michael J.; Datner, Elizabeth M.; Carr, Brendan G.; Schreiber, Courtney A.

    2015-01-01

    Introduction International Classification of Disease, Ninth Revision (ICD-9) diagnosis codes have not been validated for identifying cases of missed abortion where a pregnancy is no longer viable but the cervical os remains closed. Our goal was to assess whether ICD-9 code “632” for missed abortion has high sensitivity and positive predictive value (PPV) in identifying patients in the emergency department (ED) with cases of stable early pregnancy failure (EPF). Methods We studied females ages...

  11. Emergency department thoracotomy for the critically injured patient: Objectives, indications, and outcomes

    OpenAIRE

    Moore Ernest E; Cothren C Clay

    2006-01-01

    Abstract In the past three decades there has been a significant clinical shift in the performance of emergency department thoracotomy (EDT), from a nearly obligatory procedure before declaring any trauma patient to select patients undergoing EDT. The value of EDT in resuscitation of the patient in profound shock but not yet dead is unquestionable. Its indiscriminate use, however, renders it a low-yield and high-cost procedure. Overall analysis of the available literature indicates that the su...

  12. Goldratt’s Theory Applied to the Problems Associated with an Emergency Department at a Hospital

    OpenAIRE

    Soumya Nayak; Lloyd J. Taylor

    2012-01-01

    Healthcare costs continue to increase dramatically, while quality remains a significant problem. Reform measures initiated by the government will drive expansion of these costs, further stressing taxpayers and employers, and forcing hospitals to adopt fundamental changes as they try to adjust to increased demands for services and to lessening reimbursements from all payers. This struggle is best seen at the point of entry for many at a hospital: the emergency department (ED). It is at the eme...

  13. Factors associated with rejection of renal transplant patients in the Emergency Department

    OpenAIRE

    Erkan GOKSU; Ozlem YIGIT; Oktay ERAY; Ayse GOZLUKAYA; Cenker EKEN

    2010-01-01

    Objective: Renal transplantation is the most effective treatment for the end-stage kidney disease. Increased number of renal transplant patients lead to a rise in the acute presentations of these patients to emergency departments (EDs) in recent years. The most important problem for these patients is ‘rejection’. We aimed to determine the factors to predict a possible rejection in patients with kidney transplantation in our study. Methods: This retrospective case control study was conducted i...

  14. Missed Opportunities: Refusal to Confirm Reactive Rapid HIV Tests in the Emergency Department

    OpenAIRE

    Collins, Jamie E.; Reichmann, William M.; Donnell-Fink, Laurel A.; Ganguli, Ishani; Losina, Elena; Katz, Jeffrey Neil; Arbelaez, Christian; Walensky, Rochelle P.

    2013-01-01

    Background HIV infection remains a major US public health concern. While HIV-infected individuals now benefit from earlier diagnosis and improved treatment options, progress is tempered by large numbers of newly diagnosed patients who are lost to follow-up prior to disease confirmation and linkage to care. Methodology In the randomized, controlled USHER trial, we offered rapid HIV tests to patients presenting to a Boston, MA emergency department. Separate written informed consent was required...

  15. Transjugular Intrahepatic Portosystemic Shunt (TIPS) Migration to the Heart Diagnosed by Emergency Department Ultrasound

    OpenAIRE

    Wendler, Carlan; Shoenberger, Jan Marie; Mailhot, Thomas; Perera, Phillips

    2012-01-01

    A 57-year-old man presented to our emergency department with altered mental status. He had a past medical history significant for cirrhosis and previous placement of a transjugular intrahepatic portosystemic shunt (TIPS). On cardiac auscultation, a new heart murmur and an unexpected degree of cardiac ectopy were noted. On the 12-lead electrocardiogram, the patient was noted to have multiple premature atrial contractions, corroborating the irregular heart rhythm on physicalexam. A focused beds...

  16. Clinical pharmacist evaluation of medication inappropriateness in the emergency department of a teaching hospital in Malta

    OpenAIRE

    West LM; Cordina M; Cunningham S

    2012-01-01

    Appropriate prescribing remains an important priority in all medical areas of practice. Objective The objective of this study was to apply a Medication Appropriateness Index (MAI) to identify issues of inappropriate prescribing amongst patients admitted from the Emergency Department (ED). Methods This study was carried out at Malta's general hospital on 125 patients following a two-week pilot period on 10 patients. Patients aged 18 years and over and on medication therapy were included. Medic...

  17. A framework for implementation, education, research and clinical use of ultrasound in emergency departments by the Danish Society for Emergency Medicine

    OpenAIRE

    Laursen, Christian B; Nielsen, Klaus; Riishede, Minna; Tiwald, Gerhard; Møllekær, Anders; Aagaard, Rasmus; Posth, Stefan; Weile, Jesper

    2014-01-01

    The first Danish Society for Emergency Medicine (DASEM) recommendations for the use of clinical ultrasound in emergency departments has been made. The recommendations describes what DASEM believes as being current best practice for training, certification, maintenance of acquired competencies, quality assurance, collaboration and research in the field of clinical US used in an ED.

  18. The use of a new design irrigator for the emergency treatment of chemical eye injuries in an accident and emergency department.

    OpenAIRE

    Watts, M T; Mulira, A

    1989-01-01

    The introduction of a hand-held drench hose into a district general hospital accident and emergency department, for the emergency irrigation of chemically injured eyes is reported. The hose is described, together with the technique of irrigation. The advantages that a high-flow, low pressure system affords over conventional irrigation methods are discussed. The system appears to offer a simple, immediately available, effective tool for emergency eye care, which is suitable for use by a variet...

  19. An emergency department intervention to protect an overlooked group of children at risk of significant harm.

    LENUS (Irish Health Repository)

    Kaye, P

    2012-02-01

    BACKGROUND: Parental psychiatric disorder, especially depression, personality disorder and deliberate self-harm, is known to put children at greater risk of mental illness, neglect or physical, emotional and sexual abuse. Without a reliable procedure to identify children of parents presenting with these mental health problems, children at high risk of significant harm can be easily overlooked. Although deliberate self-harm constitutes a significant proportion of emergency presentations, there are no guidelines which address the emergency physician\\'s role in identifying and assessing risk to children of these patients. METHODS: A robust system was jointly developed with the local social services child protection team to identify and risk-stratify children of parents with mental illness. This allows us to intervene when we identify children at immediate risk of harm and to ensure that social services are aware of potential risk to all children in this group. The referral process was audited repeatedly to refine the agreed protocol. RESULTS: The proportion of patients asked by the emergency department personnel about dependent children increased and the quality of information received by the social services child protection team improved. CONCLUSIONS: All emergency departments should acknowledge the inadequacy of information available to them regarding patients\\' children and consider a policy of referral to social services for all children of parents with mental health presentations. This process can only be developed through close liaison within the multidisciplinary child protection team.

  20. Calcium Disorders in the Emergency Department: Independent Risk Factors for Mortality.

    Directory of Open Access Journals (Sweden)

    Thomas C Sauter

    Full Text Available Calcium disorders are common in both intensive care units and in patients with chronic kidney disease and are associated with increased morbidity and mortality. It is unknown whether calcium abnormalities in unselected emergency department admissions have an impact on in-hospital mortality.This cross-sectional analysis included all admissions to the Emergency Department at the Inselspital Bern, Switzerland from 2010 to 2011. For hyper- and hypocalcaemic patients with a Mann-Whitney U-test, the differences between subgroups divided by age, length of hospital stay, creatinine, sodium, chloride, phosphate, potassium and magnesium were compared. Associations between calcium disorders and 28-day in-hospital mortality were assessed using the Cox proportional hazard regression model.8,270 patients with calcium measurements were included in our study. Overall 264 (3.2% patients died. 150 patients (6.13% with hypocalcaemia and 7 patients with hypercalcaemia (6.19% died, in contrast to 104 normocalcaemic patients (1.82%. In univariate analysis, calcium serum levels were associated with sex, mortality and pre-existing diuretic therapy (all p<0.05. In multivariate Cox regression analysis, hypocalcaemia and hypercalcaemia were independent risk factors for mortality (HR 2.00 and HR 1.88, respectively; both p<0.01.Both hypocalcaemia and hypercalcaemia are associated with increased 28-day in-hospital mortality in unselected emergency department admissions.

  1. Cardiopulmonary resuscitation decisions in the emergency department: An ethnography of tacit knowledge in practice.

    Science.gov (United States)

    Brummell, Stephen P; Seymour, Jane; Higginbottom, Gina

    2016-05-01

    Despite media images to the contrary, cardiopulmonary resuscitation in emergency departments is often unsuccessful. The purpose of this ethnographic study was to explore how health care professionals working in two emergency departments in the UK, make decisions to commence, continue or stop resuscitation. Data collection involved participant observation of resuscitation attempts and in-depth interviews with nurses, medical staff and paramedics who had taken part in the attempts. Detailed case examples were constructed for comparative analysis. Findings show that emergency department staff use experience and acquired tacit knowledge to construct a typology of cardiac arrest categories that help them navigate decision making. Categorisation is based on 'less is more' heuristics which combine explicit and tacit knowledge to facilitate rapid decisions. Staff then work as a team to rapidly assimilate and interpret information drawn from observations of the patient's body and from technical, biomedical monitoring data. The meaning of technical data is negotiated during staff interaction. This analysis was informed by a theory of 'bodily' and 'technical' trajectory alignment that was first developed from an ethnography of death and dying in intensive care units. The categorisation of cardiac arrest situations and trajectory alignment are the means by which staff achieve consensus decisions and determine the point at which an attempt should be withdrawn. This enables them to construct an acceptable death in highly challenging circumstances. PMID:27017090

  2. [Fatigue and stress sensitivity of physicians after 16 hours on duty at the emergency department].

    Science.gov (United States)

    Frey, R; Klösch, G; Reinfried, L; Decker, K; Saletu, B; Laggner, A N

    2001-04-17

    In addition to their 40-hour working week (Mon-Fri, 8 a.m.-4 p.m.) residents at the emergency department of the General Hospital of Vienna have to do approximately six 24-hour duties. The reasons for conducting the present field study were physicians' complaints about tiring night duties. 11 residents (4 women, 7 men; aged between 28 and 43 years, x = 33.5 +/- 4.9 years; working at the emergency department for 4-50 months, x = 31 +/- 20 months) were tested on an ordinary working day at 9 a.m. and midnight. Self-rating concerning sleep duration, perception of stress and workload on the days of the investigations were found to be representative of other prolonged duties. Subjects reported a usual nocturnal sleep duration of only 6-7 hours. Stress was regarded as moderate by most of the volunteers. Blood pressure and pulse rates did not show diurnal changes. Generally, residents felt significantly (p working at the emergency department for a longer period experienced a more pronounced impairment. Further studies are required in order to objectify a nocturnal decrease in vigilance (by means of computer-assisted EEG) and to evaluate potential performance deficits (by means of psychometric tests). PMID:11383386

  3. Image and Imaging an Emergency Department: Expense and Benefit of Different Quality Assessment Methods

    Directory of Open Access Journals (Sweden)

    Carmen Andrea Pfortmueller

    2013-01-01

    Full Text Available Introduction. In this era of high-tech medicine, it is becoming increasingly important to assess patient satisfaction. There are several methods to do so, but these differ greatly in terms of cost, time, and labour and external validity. The aim of this study is to describe and compare the structure and implementation of different methods to assess the satisfaction of patients in an emergency department. Methods. The structure and implementation of the different methods to assess patient satisfaction were evaluated on the basis of a 90-minute standardised interview. Results. We identified a total of six different methods in six different hospitals. The average number of patients assessed was 5012, with a range from 230 (M5 to 20 000 patients (M2. In four methods (M1, M3, M5, and M6, the questionnaire was composed by a specialised external institute. In two methods, the questionnaire was created by the hospital itself (M2, M4.The median response rate was 58.4% (range 9–97.8%. With a reminder, the response rate increased by 60% (M3. Conclusion. The ideal method to assess patient satisfaction in the emergency department setting is to use a patient-based, in-emergency department-based assessment of patient satisfaction, planned and guided by expert personnel.

  4. Coordinating a Team Response to Behavioral Emergencies in the Emergency Department: A Simulation-Enhanced Interprofessional Curriculum

    Directory of Open Access Journals (Sweden)

    Ambrose H. Wong

    2015-10-01

    Full Text Available Introduction: While treating potentially violent patients in the emergency department (ED, both patients and staff may be subject to unintentional injury. Emergency healthcare providers are at the greatest risk of experiencing physical and verbal assault from patients. Preliminary studies have shown that a teambased approach with targeted staff training has significant positive outcomes in mitigating violence in healthcare settings. Staff attitudes toward patient aggression have also been linked to workplace safety, but current literature suggests that providers experience fear and anxiety while caring for potentially violent patients. The objectives of the study were (1 to develop an interprofessional curriculum focusing on improving teamwork and staff attitudes toward patient violence using simulation-enhanced education for ED staff, and (2 to assess attitudes towards patient aggression both at pre- and post-curriculum implementation stages using a survey-based study design. Methods: Formal roles and responsibilities for each member of the care team, including positioning during restraint placement, were predefined in conjunction with ED leadership. Emergency medicine residents, nurses and hospital police officers were assigned to interprofessional teams. The curriculum started with an introductory lecture discussing de-escalation techniques and restraint placement as well as core tenets of interprofessional collaboration. Next, we conducted two simulation scenarios using standardized participants (SPs and structured debriefing. The study consisted of a survey-based design comparing pre- and post-intervention responses via a paired Student t-test to assess changes in staff attitudes. We used the validated Management of Aggression and Violence Attitude Scale (MAVAS consisting of 30 Likert-scale questions grouped into four themed constructs. Results: One hundred sixty-two ED staff members completed the course with >95% staff participation

  5. Procalcitonin and C-reactive protein cannot differentiate bacterial or viral infection in COPD exacerbation requiring emergency department visits

    Directory of Open Access Journals (Sweden)

    Chang CH

    2015-04-01

    Full Text Available Chih-Hao Chang,1 Kuo-Chien Tsao,2,3 Han-Chung Hu,1,4 Chung-Chi Huang,1,4 Kuo-Chin Kao,1,4 Ning-Hung Chen,1,4 Cheng-Ta Yang,1,4 Ying-Huang Tsai,4,5 Meng-Jer Hsieh4,51Department of Pulmonary and Critical Care Medicine, Linkou Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chang-Gung University College of Medicine, Taoyuan, Taiwan; 2Department of Laboratory Medicine, Linkou Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation; 3Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan; 4Department of Respiratory Therapy, Chang-Gung University, Taoyuan, Taiwan; 5Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Puzi City, TaiwanBackground: Viral and bacterial infections are the most common causes of chronic obstructive pulmonary disease (COPD exacerbations. Whether serum inflammatory markers can differentiate bacterial from virus infection in patients with COPD exacerbation requiring emergency department (ED visits remains controversial.Methods: Viral culture and polymerase chain reaction (PCR were used to identify the viruses in the oropharynx of patients with COPD exacerbations. The bacteria were identified by the semiquantitative culture of the expectorated sputum. The peripheral blood white blood cell (WBC counts, serum C-reactive protein (CRP, procalcitonin (PCT, and clinical symptoms were compared among patients with different types of infections.Results: Viruses were isolated from 16 (22.2% of the 72 patients enrolled. The most commonly identified viruses were parainfluenza type 3, influenza A, and rhinovirus. A total of 30 (41.7% patients had positive bacterial cultures, with the most commonly found bacteria being Haemophilus influenzae and Haemophilus parainfluenzae. Five patients (6.9% had both positive sputum cultures and virus identification. The WBC, CRP, and PCT levels of the bacteria-positive and bacteria

  6. 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

    Directory of Open Access Journals (Sweden)

    Gabriel Uche Pascal Iloh

    2013-01-01

    Full Text Available 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, Umuahia, Nigeria using data from medical records, patients′ case notes, ED admission registers, and nurses′ report books. The data collected included age, sex, place of the incidence, time of the incidence, time of presentation to the hospital, anatomic sites, and etiology of the injury. Results : The age ranged from 14 years to 80 years with mean age of 47 ± 8.1 years. There were 95 males and 22 females with a male to female ratio of 4.3:1. The three most common causes were armed robbery (31.6%, kidnapping (21.3%, and police brutality (17.9%. The incident predominantly affected the middle age group (57.3%, occurred mostly during the day time (72.6%, affecting mainly the lower limbs (65.8% and majority (84.6% of the victims presented 1 hour after the injury. None of the victims received prehospital care. Conclusion: There was variability in the epidemiology of GSIs with kidnapping and police brutality emerging among preeminent contributors and downward trend of armed robbery-related GSIs. The incident occurred predominantly during the day time and most victims presented late to the ED. Interventional strategies including the responsible security apparatus system are advocated.

  7. Risk Factors of Discharged Against Medical Advice among Adolescents Self-inflicted Injury and Attempted Suicide in the Korean Emergency Department.

    Science.gov (United States)

    Jung, Jin Hee; Kim, Do Kyun; Jung, Jae Yun; Lee, Jin Hee; Kwak, Young Ho

    2015-10-01

    Suicide is a leading cause of death among Korean adolescents. Many suicide attempting adolescents often are discharged against medical advice in the emergency department. The aim of the present study was to determine the risk factors for discharge against medical advice (DAMA) after self-inflicted injury or attempted suicide in the emergency department. We extracted data on adolescents (10-19 yr old) from the national emergency department information system; we used data from 2007 and 2011. A total of 6,394 adolescents visited EDs after self-inflicted injury or attempted suicide. Among these patients, the median age was 17 yr (Interquatile range, 15-18 yr), 83.2% were between 15-19 yr of age, and 63.3% were female. Poisoning was the most common method of attempted suicide, while hanging and fall were the most common methods of fatality. The rate of DAMA from the ED was 22.8%. Independent risk factors for DAMA included female gender (odds ratio [OR], 1.49), older age adolescents (OR, 1.96), residence in a metropolitan/large city area (OR, 1.49), and discharge at night (OR, 1.38). These risk factors should be considered in establishing management and counseling plans for patients discharged against medical advice by community services and EDs. PMID:26425044

  8. Developing an effective 2-D urban flood inundation model for city emergency management based on cellular automata

    Directory of Open Access Journals (Sweden)

    L. Liu

    2014-09-01

    Full Text Available Flash floods have occurred frequently and severely in the urban areas of South China. An effective process-oriented urban flood inundation model becomes an urgent demand for urban storm water and emergency management. This study develops an effective and flexible cellular automaton (CA model to simulate storm water runoff and the flood inundation process during extreme storm events. The process of infiltration, inlets discharge and flow dynamic can be simulated only with little pre-processing on commonly available basic urban geographic data. In this model, a set of gravitational diverging rules are implemented in a cellular automation (CA model to govern the water flow in a 3 x 3 cell template of a raster layer. The model is calibrated by one storm event and validated by another in a small urban catchment in Guangzhou of Southern China. The depth of accumulated water at the catchment outlet is interpreted from street monitoring sensors and verified by on-site survey. A good level of agreement between the simulated process and the reality is reached for both storm events. The model reproduces the changing extent and depth of flooded areas at the catchment outlet with an accuracy of 4 cm in water depth. Comparisons with a physically-based 2-D model (FloodMap results show that the model have the capability of simulating flow dynamics. The high computational efficiency of CA model can satisfy the demand of city emergency management. The encouraging results of the simulations demonstrate that the CA-based approach is capable of effectively representing the key processes associated with a storm event and reproducing the process of water accumulation at the catchment outlet for making process-considered city emergency management decisions.

  9. Occupational chemical burns: a 2-year experience in the emergency department

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    Touzopoulos P

    2011-10-01

    Full Text Available Panagiotis Touzopoulos1, Paul Zarogoulidis2, Alexandros Mitrakas1, Michael Karanikas1, Panagiotis Milothridis1, Dimitrios Matthaios1, Ioannis Kouroumichakis3, Stella Proikaki3, Paschalis Pavlioglou3, Nikolaos Katsikogiannis4, Theodoros C Constantinidis511st University Surgical Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, 2Pulmonary Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, 32nd Internal Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, 4Surgical Department (NHS, University General Hospital of Alexandroupolis, 5Medical School, Laboratory of Hygiene and Environmental Protection, Democritus University of Thrace, Regional Laboratory of Public Health (Eastern Macedonia-Thrace, GreeceAbstract: Chemical burn injuries are a result of exposure to acid, alkali, or organic compounds. In this retrospective study, a total of 21 patients suffering occupational chemical burns, came to the emergency room at the University General Hospital of Alexandroupolis, from 2008 to 2010; 76.2% were workers, 19% were farmers, and 4.8% were desk officers. The majority of burns were due to exposure to acid (61.9%. Upper extremities were the most frequently injured area followed by the lower extremities and thorax. None of the patients needed further hospital care, but in the follow-up, four of the patients suffered keloid. Proper surgical treatment at the emergency room decreases the length of hospital stay for patients who suffer chemically induced burns.Keywords: chemical burns, surgical treatment, labor accidents

  10. Oral ondansetron administration in emergency departments to children with gastroenteritis: an economic analysis.

    Directory of Open Access Journals (Sweden)

    Stephen B Freedman

    2010-10-01

    Full Text Available BACKGROUND: The use of antiemetics for children with vomiting is one of the most controversial decisions in the treatment of gastroenteritis in developed countries. Ondansetron, a selective serotonin receptor antagonist, has been found to be effective in improving the success of oral rehydration therapy. However, North American and European clinical practice guidelines continue to recommend against its use, stating that evidence of cost savings would be required to support ondansetron administration. Thus, an economic analysis of the emergency department administration of ondansetron was conducted. The primary objective was to conduct a cost analysis of the routine administration of ondansetron in both the United States and Canada. METHODS AND FINDINGS: A cost analysis evaluated oral ondansetron administration to children presenting to emergency departments with vomiting and dehydration secondary to gastroenteritis from a societal and health care payer's perspective in both the US and Canada. A decision tree was developed that incorporated the frequency of vomiting, intravenous insertion, hospitalization, and emergency department revisits. Estimates of the monetary costs associated with ondansetron use, intravenous rehydration, and hospitalization were derived from administrative databases or emergency department use. The economic burden in children administered ondansetron plus oral rehydration therapy was compared to those not administered ondansetron employing deterministic and probabilistic simulations. We estimated the costs or savings to society and health care payers associated with the routine administration of ondansetron. Sensitivity analyses considered variations in costs, treatment effects, and exchange rates. In the US the administration of ondansetron to eligible children would prevent approximately 29,246 intravenous insertions and 7,220 hospitalizations annually. At the current average wholesale price, its routine administration

  11. Characteristics of patients and families who make early return visits to the pediatric emergency department

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    Logue EP

    2013-06-01

    Full Text Available Erin Patricia Logue,1 Samina Ali,2,3 Judith Spiers,4 Amanda S Newton,2,3 Janice A Lander4 1 Alberta Health Services, 2Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 3Women and Children’s Health Research Institute, 4Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada Objectives: The primary objective of this study was to identify reasons why parents make early return visits, within 72 hours of discharge from a tertiary care pediatric emergency department (PED. A secondary objective was to investigate associated demographic and diagnostic variables. Methods: A survey was conducted with a convenience sample of parents of children returning to the PED within 72 hours of discharge. A chart review was also completed for consented survey participants. Recruitment occurred from September 2005 to August 2006 at the Stollery Children's Hospital, Edmonton, Alberta, Canada. Results: A total of 264 parents were approached to participate. Overall, 231 surveys were returned and 212 (92% charts were reviewed. The overall rate of early return during the study period was 5.4%. More than half of parents stated that they returned because their child's condition worsened and many parents (66.7% reported feeling stressed. Patients were typically under 6 years of age (67.4%, and most frequently diagnosed with infectious diseases (38.0%. Patients triaged with the Canadian Emergency Department Triage and Acuity Scale (CTAS as CTAS 2 (emergent for initial visits were more likely to be admitted on return, regardless of age (P < 0.001. Conclusion: Variables associated with early returns included young age, diagnosis, triage acuity, and parental stress. Future variable definition should include a deeper exploration of modifiable factors such as parental stress and patient education. These next steps may help direct interventions and resources to address needs in this group and possibly pre-empt the need to return

  12. Management of critically ill patients receiving noninvasive and invasive mechanical ventilation in the emergency department

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    Rose L

    2012-03-01

    Full Text Available Louise RoseLawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, CanadaAbstract: Patients requiring noninvasive and invasive ventilation frequently present to emergency departments, and may remain for prolonged periods due to constrained critical care services. Emergency clinicians often do not receive the same education on management of mechanical ventilation or have similar exposure to these patients as do their critical care colleagues. The aim of this review was to synthesize the evidence on management of patients requiring noninvasive and invasive ventilation in the emergency department including indications, clinical applications, monitoring priorities, and potential complications. Noninvasive ventilation is recommended for patients with acute exacerbation of chronic obstructive pulmonary disease or cardiogenic pulmonary edema. Less evidence supports its use in asthma and other causes of acute respiratory failure. Use of noninvasive ventilation in the prehospital setting is relatively new, and some evidence suggests benefit. Monitoring priorities for noninvasive ventilation include response to treatment, respiratory and hemodynamic stability, noninvasive ventilation tolerance, detection of noninvasive ventilation failure, and identification of air leaks around the interface. Application of injurious ventilation increases patient morbidity and mortality. Lung-protective ventilation with low tidal volumes based on determination of predicted body weight and control of plateau pressure has been shown to reduce mortality in patients with acute respiratory distress syndrome, and some evidence exists to suggest this strategy should be used in patients without lung injury. Monitoring of the invasively ventilated patient should focus on assessing response to mechanical ventilation and other interventions, and avoiding complications, such as ventilator-associated pneumonia. Several key aspects of management of noninvasive

  13. Supervision and feedback for junior medical staff in Australian emergency departments: findings from the emergency medicine capacity assessment study

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    Weiland Tracey J

    2010-11-01

    Full Text Available Abstract Background Clinical supervision and feedback are important for the development of competency in junior doctors. This study aimed to determine the adequacy of supervision of junior medical staff in Australian emergency departments (EDs and perceived feedback provided. Methods Semi-structured telephone surveys sought quantitative and qualitative data from ED Directors, Directors of Emergency Medicine Training, registrars and interns in 37 representative Australian hospitals; quantitative data were analysed with SPSS 15.0 and qualitative data subjected to content analysis identifying themes. Results Thirty six of 37 hospitals took part. Of 233 potential interviewees, 95 (40.1% granted interviews including 100% (36/36 of ED Directors, and 96.2% (25/26 of eligible DEMTs, 24% (19/81 of advanced trainee/registrars, and 17% (15/90 of interns. Most participants (61% felt the ED was adequately supervised in general and (64.2% that medical staff were adequately supervised. Consultants and registrars were felt to provide most intern supervision, but this varied depending on shift times, with registrars more likely to provide supervision on night shift and at weekends. Senior ED medical staff (64% and junior staff (79% agreed that interns received adequate clinical supervision. Qualitative analysis revealed that good processes were in place to ensure adequate supervision, but that service demands, particularly related to access block and overcrowding, had detrimental effects on both supervision and feedback. Conclusions Consultants appear to provide the majority of supervision of junior medical staff in Australian EDs. Supervision and feedback are generally felt to be adequate, but are threatened by service demands, particularly related to access block and ED overcrowding.

  14. Benefits of Low Carbon Development Strategies in Emerging Cities of Developing Country: a Case of Kathmandu

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    Shree Raj Shakya

    2016-06-01

    Full Text Available Kathmandu is one of the fastest growing cities in South Asia facing various challenges related to climate change, local pollutants emissions and energy security of supply. This study analysed the greenhouse gas mitigation potential in different economic sectors of the city by using Long-range Energy Planning (LEAP frame work. It shows that the effect of implementing various low carbon development strategy options can reduce 35.2% of total greenhouse gas emission from energy use as compared to the base case scenario in 2030. This indicates the need for exploring the possibility of utilizing the global climate funds and adopting voluntary mechanisms for greenhouse gas mitigation. The estimated demand side technology investment cost of low carbon measures for different sectors ranges from less than US$ 1/tonne CO2e for residential sector to US$ 99/tonne CO2e for transport sector. The low carbon options also results co-benefits in terms of significant reduction in emission of local pollutants and improvement of energy security. As Government of Nepal has envisioned following low carbon economic development path on the long run, there is the need of establishment of regulatory framework, institutional framework and development of clear action plans for realizing the implementation of low carbon development strategy measures in the country.

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

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    Farhad Rahmati

    2015-02-01

    Full Text Available 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 eliminate them by using failure mode and effects analysis (FMEA.Methods: This was the prospective cohort study performed during 18 months, set in 6 phases. In the first phase, the failures were determined and some solutions suggested to eliminate them. During 2-5 phases, based on the prioritizing the problems, solutions were performed. In the sixth phase, final assessment of the study was done. Finally, the feedback of system’s revenue was evaluated and data analyzed using repeated measure ANOVA.Results: Lack of recording the consuming instrument and attribution of separate codes for emergency services of hospitalized patients were the most important failures that lead to decrease the revenue of ED. Such elimination caused to 75.9% increase in revenue within a month (df = 1.6; F = 84.0; p<0.0001.  Totally, 18 months following the eliminating of failures caused to 328.2% increase in the revenue of ED (df = 15.9; F = 215; p<0.0001.Conclusion: The findings of the present study shows that failure mode and effect analysis, can be used as a safe and effected method to reduce the expenses of ED and increase its revenue.

  16. Does Spanish instruction for emergency medicine resident physicians improve patient satisfaction in the emergency department and adherence to medical recommendations?

    Science.gov (United States)

    Stoneking, LR; Waterbrook, AL; Garst Orozco, J; Johnston, D; Bellafiore, A; Davies, C; Nuño, T; Fatás-Cabeza, J; Beita, O; Ng, V; Grall, KH; Adamas-Rappaport, W

    2016-01-01

    Background After emergency department (ED) discharge, Spanish-speaking patients with limited English proficiency are less likely than English-proficient patients to be adherent to medical recommendations and are more likely to be dissatisfied with their visit. Objectives To determine if integrating a longitudinal medical Spanish and cultural competency curriculum into emergency medicine residency didactics improves patient satisfaction and adherence to medical recommendations in Spanish-speaking patients with limited English proficiency. Methods Our ED has two Emergency Medicine Residency Programs, University Campus (UC) and South Campus (SC). SC program incorporates a medical Spanish and cultural competency curriculum into their didactics. Real-time Spanish surveys were collected at SC ED on patients who self-identified as primarily Spanish-speaking during registration and who were treated by resident physicians from both residency programs. Surveys assessed whether the treating resident physician communicated in the patient’s native Spanish language. Follow-up phone calls assessed patient satisfaction and adherence to discharge instructions. Results Sixty-three patients self-identified as primarily Spanish-speaking from August 2014 to July 2015 and were initially included in this pilot study. Complete outcome data were available for 55 patients. Overall, resident physicians spoke Spanish 58% of the time. SC resident physicians spoke Spanish with 66% of the patients versus 45% for UC resident physicians. Patients rated resident physician Spanish ability as very good in 13% of encounters – 17% for SC versus 5% for UC. Patient satisfaction with their ED visit was rated as very good in 35% of encounters – 40% for SC resident physicians versus 25% for UC resident physicians. Of the 13 patients for whom Spanish was the language used during the medical encounter who followed medical recommendations, ten (77%) of these encounters were with SC resident physicians

  17. Effectiveness Of Bureaucracy In The Implementation Of Free Education System In The Department Of Education Makassar City

    OpenAIRE

    Muhammad Sawir; Rakhmat; Suryadi Lambali; Syahribulan

    2015-01-01

    Abstract This study aims to explain the effectiveness of the bureaucracy in organizing a free education system in Makassar City Department of Education. Deductive approach qualitative research through case studies. Data collected through observation interviews and documentation. Data were analyzed through data reduction techniques presentation of data conclusions and verification. The effectiveness of the bureaucracy can be seen with the achievement of goals and objectives. Goals to be achiev...

  18. Stress Myocardial Perfusion Imaging in the Emergency Department - New Techniques for Speed and Diagnostic Accuracy

    Science.gov (United States)

    Harrison, Sheri D; Harrison, Mark A; Duvall, W Lane

    2012-01-01

    Emergency room evaluations of patients presenting with chest pain continue to rise, and these evaluations which often include cardiac imaging, are an increasing area of resource utilization in the current health system. Myocardial perfusion imaging from the emergency department remains a vital component of the diagnosis or exclusion of coronary artery disease as the etiology of chest pain. Recent advances in camera technology, and changes to the imaging protocols have allowed MPI to become a more efficient way of providing this diagnostic information. Compared with conventional SPECT, new high-efficiency CZT cameras provide a 3-5 fold increase in photon sensitivity, 1.65-fold improvement in energy resolution and a 1.7-2.5-fold increase in spatial resolution. With stress-only imaging, rest images are eliminated if stress images are normal, as they provide no additional prognostic or diagnostic value and cancelling the rest images would shorten the length of the test which is of particular importance to the ED population. The rapid but accurate triage of patients in an ED CPU is essential to their care, and stress-only imaging and new CZT cameras allow for shorter test time, lower radiation doses and lower costs while demonstrating good clinical outcomes. These changes to nuclear stress testing can allow for faster throughput of patients through the emergency department while providing a safe and efficient evaluation of chest pain. PMID:22708910

  19. Stress myocardial perfusion imaging in the emergency department--new techniques for speed and diagnostic accuracy.

    Science.gov (United States)

    Harrison, Sheri D; Harrison, Mark A; Duvall, W Lane

    2012-05-01

    Emergency room evaluations of patients presenting with chest pain continue to rise, and these evaluations which often include cardiac imaging, are an increasing area of resource utilization in the current health system. Myocardial perfusion imaging from the emergency department remains a vital component of the diagnosis or exclusion of coronary artery disease as the etiology of chest pain. Recent advances in camera technology, and changes to the imaging protocols have allowed MPI to become a more efficient way of providing this diagnostic information. Compared with conventional SPECT, new high-efficiency CZT cameras provide a 3-5 fold increase in photon sensitivity, 1.65-fold improvement in energy resolution and a 1.7-2.5-fold increase in spatial resolution. With stress-only imaging, rest images are eliminated if stress images are normal, as they provide no additional prognostic or diagnostic value and cancelling the rest images would shorten the length of the test which is of particular importance to the ED population. The rapid but accurate triage of patients in an ED CPU is essential to their care, and stress-only imaging and new CZT cameras allow for shorter test time, lower radiation doses and lower costs while demonstrating good clinical outcomes. These changes to nuclear stress testing can allow for faster throughput of patients through the emergency department while providing a safe and efficient evaluation of chest pain. PMID:22708910

  20. Seasonal ARMA-based SPC charts for anomaly detection: Application to emergency department systems

    KAUST Repository

    Kadri, Farid

    2015-10-22

    Monitoring complex production systems is primordial to ensure management, reliability and safety as well as maintaining the desired product quality. Early detection of emergent abnormal behaviour in monitored systems allows pre-emptive action to prevent more serious consequences, to improve system operations and to reduce manufacturing and/or service costs. This study reports the design of a new methodology for the detection of abnormal situations based on the integration of time-series analysis models and statistical process control (SPC) tools for the joint development of a monitoring system to help supervising of the behaviour of emergency department services (EDs). The monitoring system developed is able to provide early alerts in the event of abnormal situations. The seasonal autoregressive moving average (SARMA)-based exponentially weighted moving average (EWMA) anomaly detection scheme proposed was successfully applied to the practical data collected from the database of the paediatric emergency department (PED) at Lille regional hospital centre, France. The method developed utilizes SARMA as a modelling framework and EWMA for anomaly detection. The EWMA control chart is applied to the uncorrelated residuals obtained from the SARMA model. The detection results of the EWMA chart are compared with two other commonly applied residual-based tests: a Shewhart individuals chart and a Cumulative Sum (CUSUM) control chart.

  1. Improved Principal Component Analysis for Anomaly Detection: Application to an Emergency Department

    KAUST Repository

    Harrou, Fouzi

    2015-07-03

    Monitoring of production systems, such as those in hospitals, is primordial for ensuring the best management and maintenance desired product quality. Detection of emergent abnormalities allows preemptive actions that can prevent more serious consequences. Principal component analysis (PCA)-based anomaly-detection approach has been used successfully for monitoring systems with highly correlated variables. However, conventional PCA-based detection indices, such as the Hotelling’s T2T2 and the Q statistics, are ill suited to detect small abnormalities because they use only information from the most recent observations. Other multivariate statistical metrics, such as the multivariate cumulative sum (MCUSUM) control scheme, are more suitable for detection small anomalies. In this paper, a generic anomaly detection scheme based on PCA is proposed to monitor demands to an emergency department. In such a framework, the MCUSUM control chart is applied to the uncorrelated residuals obtained from the PCA model. The proposed PCA-based MCUSUM anomaly detection strategy is successfully applied to the practical data collected from the database of the pediatric emergency department in the Lille Regional Hospital Centre, France. The detection results evidence that the proposed method is more effective than the conventional PCA-based anomaly-detection methods.

  2. Emerging Societal Involvement in City Management : the case of Cape Town

    Directory of Open Access Journals (Sweden)

    Neil Dewar

    1999-02-01

    Full Text Available Since the advent of full participatory democracy in South Africa in April 1994, a fundamental revision of the norms, values and practices of urban management has occurred. A central feature of this is expressed commitment to greater transparency and public participation in decision-making and project execution. Manegerial practice has moved from being essentially technocratic and control-oriented to more pluralistic and development-oriented. The previously disenfranchised and largely impoverished sectors of the community have moved from exclusion and confrontation toward greater involvement and empowerment. This has not been without problems however. The current status of community participation in Cape Town is reviewed and explored against a theoretical model. The conclusion drawn is that, political impediments notwithstanding, a considerable energy and momentum has been generated at local level in civil society towards the goal of improvement in social and living environments in the city.

  3. Users' experiences of an emergency department patient admission predictive tool: A qualitative evaluation.

    Science.gov (United States)

    Jessup, Melanie; Crilly, Julia; Boyle, Justin; Wallis, Marianne; Lind, James; Green, David; Fitzgerald, Gerard

    2016-09-01

    Emergency department overcrowding is an increasing issue impacting patients, staff and quality of care, resulting in poor patient and system outcomes. In order to facilitate better management of emergency department resources, a patient admission predictive tool was developed and implemented. Evaluation of the tool's accuracy and efficacy was complemented with a qualitative component that explicated the experiences of users and its impact upon their management strategies, and is the focus of this article. Semi-structured interviews were conducted with 15 pertinent users, including bed managers, after-hours managers, specialty department heads, nurse unit managers and hospital executives. Analysis realised dynamics of accuracy, facilitating communication and enabling group decision-making Users generally welcomed the enhanced potential to predict and plan following the incorporation of the patient admission predictive tool into their daily and weekly decision-making processes. They offered astute feedback with regard to their responses when faced with issues of capacity and communication. Participants reported an growing confidence in making informed decisions in a cultural context that is continually moving from reactive to proactive. This information will inform further patient admission predictive tool development specifically and implementation processes generally. PMID:25916833

  4. Complex Controls on Groundwater Quality in Growing Mid-sized Cities: A Case Study Focused on Nitrate and Emerging Contaminants

    Science.gov (United States)

    Ohr, C. A.; Godsey, S.; Welhan, J. A.; Larson, D. M.; Lohse, K. A.; Finney, B.; Derryberry, D.

    2015-12-01

    Many regions rely on quality groundwater to support urban growth. Groundwater quality often responds in a complex manner to stressors such as land use change, climate change, or policy decisions. Urban growth patterns in mid-sized cities, especially ones that are growing urban centers in water-limited regions in the western US, control and are controlled by water availability and its quality. We present a case study from southeastern Idaho where urban growth over the past 20 years has included significant ex-urban expansion of houses that rely on septic systems rather than city sewer lines for their wastewater treatment. Septic systems are designed to mitigate some contaminants, but not others. In particular, nitrates and emerging contaminants, such as pharmaceuticals, are not removed by most septic systems. Thus, even well-maintained septic systems at sufficiently high densities can impact down gradient water quality. Here we present patterns of nitrate concentrations over the period from 1985-2015 from the Lower Portneuf River Valley in southeastern Idaho. Concentrations vary from 0.03 to 27.09 nitrate-nitrogen mg/L, with average values increasing significantly over the 30 year time period from 3.15 +/- 0.065 to 3.57 +/- 0.43 mg/L. We examine temporal changes in locations of nitrate hotspots, and present pilot data on emerging contaminants of concern. Initial results suggest that high nitrate levels are generally associated with higher septic densities, but that this pattern is influenced by legacy agricultural uses and strongly controlled by underlying aquifer properties. Future work will include more detailed hydrological modeling to predict changes in hotspot locations under potential climate change scenarios.

  5. Consensus statement on advancing research in emergency department operations and its impact on patient care.

    Science.gov (United States)

    Yiadom, Maame Yaa A B; Ward, Michael J; Chang, Anna Marie; Pines, Jesse M; Jouriles, Nick; Yealy, Donald M

    2015-06-01

    The consensus conference on "Advancing Research in Emergency Department (ED) Operations and Its Impact on Patient Care," hosted by The ED Operations Study Group (EDOSG), convened to craft a framework for future investigations in this important but understudied area. The EDOSG is a research consortium dedicated to promoting evidence-based clinical practice in emergency medicine. The consensus process format was a modified version of the NIH Model for Consensus Conference Development. Recommendations provide an action plan for how to improve ED operations study design, create a facilitating research environment, identify data measures of value for process and outcomes research, and disseminate new knowledge in this area. Specifically, we call for eight key initiatives: 1) the development of universal measures for ED patient care processes; 2) attention to patient outcomes, in addition to process efficiency and best practice compliance; 3) the promotion of multisite clinical operations studies to create more generalizable knowledge; 4) encouraging the use of mixed methods to understand the social community and human behavior factors that influence ED operations; 5) the creation of robust ED operations research registries to drive stronger evidence-based research; 6) prioritizing key clinical questions with the input of patients, clinicians, medical leadership, emergency medicine organizations, payers, and other government stakeholders; 7) more consistently defining the functional components of the ED care system, including observation units, fast tracks, waiting rooms, laboratories, and radiology subunits; and 8) maximizing multidisciplinary knowledge dissemination via emergency medicine, public health, general medicine, operations research, and nontraditional publications. PMID:26014365

  6. Emergency Department Crowding and Time to Antibiotic Administration in Febrile Infants

    Directory of Open Access Journals (Sweden)

    Jennifer K Light

    2013-09-01

    Full Text Available Introduction: Early antibiotic administration is recommended in newborns presenting with febrile illness to emergency departments (ED to avert the sequelae of serious bacterial infection. Although ED crowding has been associated with delays in antibiotic administration in a dedicated pediatric ED, the majority of children that receive emergency medical care in the U.S. present to EDs that treat both adult and pediatric emergencies. The purpose of this study was to examine the relationship between time to antibiotic administration in febrile newborns and crowding in a general ED serving both an adult and pediatric population.Methods: We conducted a retrospective chart review of 159 newborns presenting to a general ED between 2005 and 2011 and analyzed the association between time to antibiotic administration and ED occupancy rate at the time of, prior to, and following infant presentation to the ED.Results: We observed delayed and variable time to antibiotic administration and found no association between time to antibiotic administration and occupancy rate prior to, at the time of, or following infant presentation (P > 0.05. ED time to antibiotic administration was not associated with hospital length of stay, and there was no inpatient mortality.Conclusion: Delayed and highly variable time to antibiotic treatment in febrile newborns was common but unrelated to ED crowding in the general ED study site. Guidelines for time to antibiotic administration in this population may reduce variability in ED practice patterns. [West J Emerg Med. 2013;14(5:518-524.

  7. Attitudes of patients and physicians regarding physician dress and demeanor in the emergency department.

    Science.gov (United States)

    Colt, H G; Solot, J A

    1989-02-01

    To compare the opinions of patients and physicians regarding physician dress and demeanor in the emergency department, we conducted a cross-sectional survey of 190 ED patients and 129 medical specialists, family practitioners, surgeons, and emergency physicians in a community hospital. Seventy-three percent of physicians and 43% of patients thought that physical appearance influenced patient opinion of medical care. Forty-nine percent of patients believed emergency physicians should wear white coats, but only 18% disliked scrub suits. Patients were more tolerant of casual dress than were physicians. Both groups disliked excessive jewelry, prominent ruffles or ribbons, long fingernails, blue jeans, and sandals. Opinions and practices of emergency physicians were similar to those of other medical specialists. Most physicians (96%) addressed patients by surname or title, but 43% of patients preferred being called by their first names. The age, gender, income, and education of patients did not influence how they wished to be addressed. Larger studies are needed to assess the influence of age, sex, race, and depth of feeling regarding first-name address and physician attire in the ED. PMID:2783838

  8. Underground Water Consumption and Public Health risks, in Metropolitan Suburbs in an Emerging City, Accra, Ghana

    OpenAIRE

    Kwaku D. Kessey; Afia N. Nyarko

    2015-01-01

    Purpose: Urbanisation has become a common development phenomenon in emerging countries, as urban population growth rate is high in those countries. Consequently, demand for urban utilities, especially fresh water, exceeds supply. To address the challenge of inadequate fresh water supply in homes, for household use, many property owners extract underground water in residential areas, by drilling wells. They drink, cook, bath and do their laundry from that source of water. Although that practic...

  9. Work-related psychosocial hazards among emergency medical responders (EMRS) in Mansoura city

    OpenAIRE

    Eman Omar Khashaba; Mona Abdel Fattah El-Sherif; Adel Al-Wehedy Ibrahim; Mostafa Ahmed Neatmatallah

    2014-01-01

    Purpose: This research was done to assess levels of psychosocial stress and related hazards [(burnout, depression, and posttraumatic stress disorder (PTSD)] among emergency medical responders (EMRs). Materials and Methods: A comparative cross-sectional study was conducted upon (140) EMRs and a comparative group composed of (140) nonemergency workers. The groups studied were subjected to semistructured questionnaire including demographic data, survey for job stressors, Maslach burn out invento...

  10. Ethical issues in the response to Ebola virus disease in United States emergency departments: a position paper of the American College of Emergency Physicians, the Emergency Nurses Association, and the Society for Academic Emergency Medicine.

    Science.gov (United States)

    Venkat, Arvind; Asher, Shellie L; Wolf, Lisa; Geiderman, Joel M; Marco, Catherine A; McGreevy, Jolion; Derse, Arthur R; Otten, Edward J; Jesus, John E; Kreitzer, Natalie P; Escalante, Monica; Levine, Adam C

    2015-05-01

    The 2014 outbreak of Ebola virus disease (EVD) in West Africa has presented a significant public health crisis to the international health community and challenged U.S. emergency departments (EDs) to prepare for patients with a disease of exceeding rarity in developed nations. With the presentation of patients with Ebola to U.S. acute care facilities, ethical questions have been raised in both the press and medical literature as to how U.S. EDs, emergency physicians (EPs), emergency nurses, and other stakeholders in the health care system should approach the current epidemic and its potential for spread in the domestic environment. To address these concerns, the American College of Emergency Physicians, the Emergency Nurses Association, and the Society for Academic Emergency Medicine developed this joint position paper to provide guidance to U.S. EPs, emergency nurses, and other stakeholders in the health care system on how to approach the ethical dilemmas posed by the outbreak of EVD. This paper will address areas of immediate and potential ethical concern to U.S. EDs in how they approach preparation for and management of potential patients with EVD. PMID:25903144

  11. The HIV-Infected Adult Patient In The Emergency Department, The Changing Landscape Of Disease.

    Science.gov (United States)

    Gutteridge, David L; Egan, Daniel J

    2016-02-01

    The care of the HIV-infected patient in the emergency department has changed since the development of highly active antiretroviral therapy. This therapy has resulted in longer life expectancies and increased quality of life for HIV-infected patients, and in cases of treatment compliance and success, virtual elimination of AIDS-associated opportunistic infections. As a result, the emergency clinician is now more often confronted with adverse events related to medication and the diseases associated with aging and chronic disease. This issue focuses on the differences in evaluation of HIV patients on long-term therapy and patients with medication noncompliance and low CD4 counts, as well as recognition of life-threatening and rare opportunistic infections. Disease processes related to the effect of longstanding HIV infection, even with good control, on many organ systems are addressed. PMID:26760316

  12. Achieve Sustainable Hospital Excellence Through 5-S in an Emergency Department in Hong Kong

    Directory of Open Access Journals (Sweden)

    Tsoi Vincent F. K.

    2014-11-01

    Full Text Available 5-S is the first step towards TQM. Over the last century, the Japanese have formalised the technique and named it as 5-S Practice. Since 1993, Sam Ho has improved and defined its terms in English/Chinese and developed the world's first 5-S Audit Checklist. In the article, an emergency department of a Hong Kong hospital was examined against 5-S 50-point Checklist for the improvement of their quality assurance systems towards its accreditation process with Australian standards. The findings evidently reveal that the impact of 5-S on hospital quality assurance in the unit are positive. Riding on the above scenario, the research aim is to identify whether the 5-S practice is a suitable and effective tool for healthcare quality assurance in an emergency setting which is led towards its accreditation process set by other mechanisms.

  13. Creutzfeldt-Jakob disease: an emergency department presentation of a rare disease.

    Science.gov (United States)

    Prince, Louise A; Mann, Deborah; Reilly, Tracey

    2006-07-01

    Creutzfeldt-Jakob Disease (CJD) is one of a group of neurodegenerative disorders causing spongiform encephalopathies. CJD is the most common human transmissible spongiform encephalopathy, or prion disease, but has an annual incidence of only 0.4-1.8 cases per million population worldwide. The prognosis for this disease is very poor and there is currently no cure. Patients typically present with non-specific neurological or psychiatric complaints and often have multiple physician visits before diagnosis, which requires histological examination of brain tissue. This patient had serial presentations to our Emergency Department, with progressive symptoms and multiple laboratory and radiological tests as well as consults, but her diagnosis remained unclear until her disease rapidly progressed and a brain biopsy was performed. With increasing concerns about prion diseases such as bovine spongiform encephalopathy (BSE)-or mad cow disease-and CJD, awareness of the symptoms and diagnostic challenges associated with these diseases will be helpful to emergency physicians. PMID:16798153

  14. Impacts of social networking sites on patient care in the emergency department.

    Science.gov (United States)

    Bennett, Anne; Pourmand, Ali; Shokoohi, Hamid; Shesser, Robert; Sanchez, Jesus; Joyce, Joseph

    2014-01-01

    The use of Facebook is ubiquitous among both patients and physicians. Often Facebook intrudes into medical practice, thereby highlighting its potential to be either a positive or negative factor in a patient's medical care. Despite being a "hot topic" in the medical literature, very few real world examples exist of physicians actually using information obtained from Facebook to reach a diagnosis or otherwise affect patient care. We present a case involving a 13-year-old girl who posted photographs and captions on Facebook demonstrating suicidal ideation. The patient's parents were alerted to the girl's statements in her Facebook profile and brought her to the emergency department. The girl's statements and photographs, as reported by her parents, were used by an emergency physician to make a diagnosis of suicidal risk and to disposition of the patient to an inpatient psychiatric ward. We discuss the potential diagnostic utility of information posted on Facebook and briefly discuss the ethical questions surrounding this situation. PMID:24160899

  15. Nurses’ Evaluation of a New Formalized Triage System in the Emergency Department

    DEFF Research Database (Denmark)

    Brehm Johansen, Mette; Forberg, Jakob Lundager

    2011-01-01

    Introduction: Formalized triage in the emergency department (ED) is not widely used in Denmark; this study explores the effects of introducing a five-level process triage system in a Danish ED. Material and methods: Semi-structured qualitative interviews were conducted with 15 emergency nurses. The...... interviews were preceded by observations of the work of the ED nurses in which focus was on the triage process. Results: Formalized triage was experienced to improve the overview of patients and resources at the ED, and the nurses described that they felt more assured when prioritizing between patients....... Communication and coordination were also improved by the triage system. But more time spent on documentation and re-evaluation may cause the nurses to feel professionally inadequate if adequate resources are not provided. Furthermore, the triage system has reduced the focus on the humanistic and psychosocial...

  16. Transjugular Intrahepatic Portosystemic Shunt (TIPS) Migration to the Heart Diagnosed by Emergency Department Ultrasound.

    Science.gov (United States)

    Wendler, Carlan; Shoenberger, Jan Marie; Mailhot, Thomas; Perera, Phillips

    2012-12-01

    A 57-year-old man presented to our emergency department with altered mental status. He had a past medical history significant for cirrhosis and previous placement of a transjugular intrahepatic portosystemic shunt (TIPS). On cardiac auscultation, a new heart murmur and an unexpected degree of cardiac ectopy were noted. On the 12-lead electrocardiogram, the patient was noted to have multiple premature atrial contractions, corroborating the irregular heart rhythm on physical exam. A focused bedside emergency ultrasound of the heart was then performed. This exam revealed an apparent foreign body in the right atrium. It appeared as if the patient's TIPS had migrated from the heart into the right atrium. This case, as well as the literature describing this unusual complication of TIPS placement, is reviewed in this case report. PMID:23358693

  17. Transjugular Intrahepatic Portosystemic Shunt (TIPS Migration to the Heart Diagnosed by Emergency Department Ultrasound

    Directory of Open Access Journals (Sweden)

    Carlan Wendler

    2012-12-01

    Full Text Available A 57-year-old man presented to our emergency department with altered mental status. He had a past medical history significant for cirrhosis and previous placement of a transjugular intrahepatic portosystemic shunt (TIPS. On cardiac auscultation, a new heart murmur and an unexpected degree of cardiac ectopy were noted. On the 12-lead electrocardiogram, the patient was noted to have multiple premature atrial contractions, corroborating the irregular heart rhythm on physical exam. A focused bedside emergency ultrasound of the heart was then performed. This exam revealed an apparent foreign body in the right atrium. It appeared as if the patient’s TIPS had migrated from the heart into the right atrium. This case, as well as the literature describing thisunusual complication of TIPS placement, is reviewed in this case report

  18. Causes of poisoning in patients evaluated in a hospital emergency department in Konya, Turkey

    International Nuclear Information System (INIS)

    Objectives: To evaluate demographic and clinical characteristics of patients with poisoning at a community hospital. Methods: The retrospective study comprised records of patients who were admitted to the emergency department of Konya Numune Hospital, Turkey, because of poisoning between January 1, 2009, and December 31, 2011. Data was evaluated for age, gender, educational status, occupation, arrival time, mechanism of intoxication , body temperature, pulse, respiratory rate, Glasgow Coma Scale score, treatment applied, duration of hospital stay, duration of follow-up, test results, final diagnosis, clinical disposition, and outcome. Agents causing the poisoning were also determined. Results: Records of 1036 patients were evaluated. Of them, 764(74%) were female and 272(26%) were male. The predominant age range was 15-24 years in 617(60%) patients. The median time from substance exposure to admission to the emergency department was 2 hours. The most common cause of poisoning was attempted suicide in 955 (92%) patients and drug intoxication was the agent involved in 932 (90%). In the 15-24 year age range, there were 469(76%) female patients. Of the total female population in the study, 716(94%) attempted suicide. The median hospital stay was 24 hours. There were 908(88%) patients who were advised to seek further evaluation at the psychiatry clinic, and 9 (0.9%) patients were admitted to the psychiatry inpatient units after medical treatment. In patients who were hospitalized and followed up, 1 (0.1%) died because of multiple drug poisoning. Conclusion: Most admissions to the emergency department for poisoning related to young women had used drugs during a suicide attempt. (author)

  19. Abdominal ultrasound referred by the Emergency department – Can sonographer findings help guide timely patient management?

    International Nuclear Information System (INIS)

    Objective: To compare sonographer findings with radiologists' reports regarding the level of agreement, ability to answer the clinical question, and the use of hedging (descriptive words that do not commit to a definitive diagnosis) in abdominal ultrasound cases referred by the Emergency department. Other criteria compared included caveats of image quality and requests for further investigations. Methods: Abdominal ultrasound examinations referred by the Emergency department at a large regional tertiary hospital were retrospectively reviewed and sonographer findings compared with radiologists' reports. A consultant Intensivist scored all examinations into one of four categories according to the level of diagnostic agreement between the sonographer and associated radiologists. The same rater also identified where hedging terminology was used, whether the clinical question posed was answered and when further requests for investigations (including imaging) were made. The proportion of scores between sonographers and radiologists for each outcome variable were analysed using Fisher Exact tests. Results: Eighty-six cases were identified for this study. Of those, 73 (84.9%) were in complete agreement. In 12 cases (14.0%) a minor discrepancy was reported and only one case (1.1%) was scored as moderately discrepant between sonographers findings and radiologists' reports. There were no significant differences in the use of hedging, ability to answer the clinical question, requests for further investigations or interpretation of image quality. Conclusion: Sonographer findings for cases of abdominal ultrasound referred by the Emergency department have a high level of agreement with radiologists' reports and could form the basis for acute patient care when radiologists' reports are unavailable

  20. Simulation modelling of a patient surge in an emergency department under disaster conditions

    Directory of Open Access Journals (Sweden)

    Muhammet Gul

    2015-10-01

    Full Text Available The efficiency of emergency departments (EDs in handling patient surges during disaster times using the available resources is very important. Many EDs require additional resources to overcome the bottlenecks in emergency systems. The assumption is that EDs consider the option of temporary staff dispatching, among other options, in order to respond to an increased demand or even the hiring temporarily non-hospital medical staff. Discrete event simulation (DES, a well-known simulation method and based on the idea of process modeling, is used for establishing ED operations and management related models. In this study, a DES model is developed to investigate and analyze an ED under normal conditions and an ED in a disaster scenario which takes into consideration an increased influx of disaster victims-patients. This will allow early preparedness of emergency departments in terms of physical and human resources. The studied ED is located in an earthquake zone in Istanbul. The report on Istanbul’s disaster preparedness presented by the Japan International Cooperation Agency (JICA and Istanbul Metropolitan Municipality (IMM, asserts that the district where the ED is located is estimated to have the highest injury rate. Based on real case study information, the study aims to suggest a model on pre-planning of ED resources for disasters. The results indicate that in times of a possible disaster, when the percentage of red patient arrivals exceeds 20% of total patient arrivals, the number of red area nurses and the available space for red area patients will be insufficient for the department to operate effectively. A methodological improvement presented a different distribution function that was tested for service time of the treatment areas. The conclusion is that the Weibull distribution function used in service process of injection room fits the model better than the Gamma distribution function.