Sample records for emergency department nurses

  1. [Emergency department triage: independent nursing intervention?].

    Corujo Fontes, Sergio José


    The branch hospital triage aimed at, as well as exercised by nurses, has evolved to meet their needs to organize and make visible the nurses' duties. However, it is still not properly considered as independent nursing intervention. Evidencing practice triage nurse in hospital as experienced by their protagonists disclosed the possible causes of this paradoxical competence. In a sample of 41 nurses, of the 52 possible with previous experience in hospital triage in the Emergency Department of the Hospital General Dr. José Molina Orosa in Lanzarote, the nurses themselves carried out an opinion survey that group together statements about different aspects of the triaje nurse. In its results, 65.8% of those polled thought the triaje nursing training to be deficient and even though nearly half 48.7%, was considered competent to decide the level of emergency, 46.3% disagreed to take this task part of their duty. It is conclusive that the training received in hospital triage, regulated and sustained, is deficient, that is the main reason why professionals have their doubts to take on an activity they are not familiar with. Triage systems do not record the entire outcome of the nursing work and nursing methodology does not seem to be quite indicative for this task.

  2. Perception of Noise by Emergency Department Nurses

    John Graneto


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

  3. [Competence of triage nurses in hospital emergency departments].

    Martínez-Segura, Estrella; Lleixà-Fortuño, Mar; Salvadó-Usach, Teresa; Solà-Miravete, Elena; Adell-Lleixà, Mireia; Chanovas-Borrás, Manel R; March-Pallarés, Gemma; Mora-López, Gerard


    To identify associations between sociodemographic characteristics variables and competence levels of triage nurses in hospital emergency departments. Descriptive, cross-sectional, multicenter study of triage nurses in hospital emergency departments in the southwestern area of Catalonia (Ebre River territory). We used an instrument for evaluating competencies (the COM_VA questionnaire) and recording sociodemographic variables (age, sex, total work experience, emergency department experience, training in critical patient care and triage) and perceived confidence when performing triage. We then analyzed the association between these variables and competency scores. Competency scores on the COM_VA questionnaire were significantly higher in nurses with training in critical patient care (P=.001) and triage (P=0.002) and in those with longer emergency department experience (P<.0001). Perceived confidence when performing triage increased with competency score (P<.0001) and training in critical patient care (P<.0001) and triage (P=.045). The competence of triage nurses and their perception of confidence when performing triage increases with emergency department experience and training.

  4. Medication errors of nurses in the emergency department.

    Ehsani, Seyyedeh Roghayeh; Cheraghi, Mohammad Ali; Nejati, Amir; Salari, Amir; Esmaeilpoor, Ayeshe Haji; Nejad, Esmaeil Mohammad


    Patient safety is one of the main concepts in the field of healthcare provision and a major component of health services quality. One of the important stages in promotion of the safety level of patients is identification of medication errors and their causes. Medical errors such as medication errors are the most prevalent errors that threaten health and are a global problem. Execution of medication orders is an important part of the treatment and care process and is regarded as the main part of the nurses' performance. The purpose of this study was to explore the medication error reporting rate, error types and their causes among nurses in the emergency department. In this descriptive study, 94 nurses of the emergency department of Imam Khomeini Hospital Complex were selected based on census in 2010-2011. Data collection tool was a researcher-made questionnaire consisting of two parts: demographic information, and types and causes of medication errors. After confirming content-face validity, reliability of the questionnaire was determined to be 0.91 using Cronbach's alpha test. Data analyses were performed by descriptive statistics and inferential statistics. SPSS-16 software was used in this study and P values less than 0.05 were considered significant. The mean age of the nurses was 27.7 ± 3.4 years, and their working experience was 7.3 ± 3.4 years. Of participants 46.8% had committed medication errors in the past year, and the majority (69.04%) had committed the errors only once. Thirty two nurses (72.7%) had not reported medication errors to head nurses or the nursing office. The most prevalent types of medication errors were related to infusion rates (33.3%) and administering two doses of medicine instead of one (23.8%). The most important causes of medication errors were shortage of nurses (47.6%) and lack of sufficient pharmacological information (30.9%). This study showed that the risk of medication errors among nurses is high and medication errors are a

  5. Nurse-patient/visitor communication in the emergency department.

    Pytel, Constance; Fielden, Nina M; Meyer, Kate H; Albert, Nancy


    Patients and visitors need to be encouraged to express their needs and be provided with enough relevant information so that treatment and recovery from illness are optimized. In the emergency department, it is important for nurses to create an environment of trust, respect, and acceptance. Using a survey design, a convenience sample of nurses and patients/visitors described patient/visitor communication needs and determined if needs were met during the ED encounter. Data were analyzed using descriptive statistics. Mantel Haenszel chi(2) tests were used to determine associations between patient-rated importance of nurse communication needs and nursing communication performance. Sixty-four nurses and 123 patients/visitors completed a communication needs survey. More than 80% of patients answered "excellent" or "very good" to 6 of the top 10 important communication needs. Patient and nurse importance differed significantly on only 2 communication needs: calm voice and social status (nurses rated these needs of higher importance than patients; P = .01, P = .006). Patient-ranked importance was positively associated with patient opinion of how well needs were met in 6 of 19 patient/visitor communication needs; that is, not making assumptions about social status (P = .0006), offering reassurance to calm fears (P = .004), and teaching about primary medical concerns/conditions (P = .01). Nurse and patient/visitor perceptions of important communication are similar. Educating nurses about patient/visitor communication needs is the first step in enhancing how well nurses meet those needs.

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

    Rosted, Elizabeth Emilie


    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 geria......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 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...... geriatric patients with nursing intervention and 1 and 6 months follow-up. Included were geriatric patients 70+ years planned to be discharged to their home from ED October 2006-June 2008. Intervention: After detecting the geriatric patients planned to be discharged, the geriatric nurse in the ED did...

  7. Emergency nurse practitioner services in major accident and emergency departments: a United Kingdom postal survey.

    Tye, C C; Ross, F.; Kerry, S. M.


    OBJECTIVE: To establish the current and predicted distribution of formal emergency nurse practitioner services in major accident and emergency departments in the United Kingdom; to determine organisational variations in service provision, with specific reference to funding, role configuration, training, and scope of clinical activity. METHODS: Postal survey of senior nurses of all major accident and emergency departments in the United Kingdom (n = 293) in May/June 1996. RESULTS: There were 27...

  8. Nursing Student Coaches for Emergency Department Super Utilizers.

    Anderson, Della; Patch, Enedina; Oxandale, Brooke; Kincade, Amy; Gamber, Angie; Ohm, Ruth


    The Super Utilizer Project is a collaboration between an integrated health care organization and a baccalaureate school of nursing. The goal is to help the super utilizers access appropriate health care resources through the use of a student coach model. The student coaches provide clients with disease prevention and health promotion education and assistance specific to the clients' unique health care needs. The tenets of the theoretical frameworks of servant leadership, caring theory, and transtheoretical model of behavior change are applied throughout this project. First-year outcomes for the project were encouraging, with the total number of visits for 23 super utilizers to the emergency department decreasing from 710 annually to a projected 510 annually, and second-semester visits for 20 clients decreased from 634 to a projected 462. The students experience complex client care and collaboration with an interdisciplinary team reducing nonemergent emergency department super utilizer visits. [J Nurs Educ. 2017;56(1):27-30.]. Copyright 2017, SLACK Incorporated.

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

    Healy, Sonya


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

  10. Emergency nurses' perceptions of emergency department preparedness for an ebola outbreak: A qualitative descriptive study.

    Pincha Baduge, Mihirika Sds; Moss, Cheryle; Morphet, Julia


    Ebola Virus Disease is highly contagious and has high mortality. In 2014, when the outbreak in West Africa was declared a public health emergency, emergency departments in Australia commenced preparation and vigilance for people presenting with ebola like symptoms, to limit spread of the disease. To examine Australian emergency nurses' perceptions regarding their own and their emergency departments' preparedness to manage an ebola outbreak. A qualitative descriptive design was used to collect and analyse data in one metropolitan emergency department in Victoria, Australia. Four focus groups were conducted with 13 emergency nurses. Data were thematically analysed. Major themes emerged from the data: organisational, personal and future preparedness. Participants' believed that both the organisation and themselves had achieved desirable and appropriate preparedness for ebola in their emergency setting. Participants trusted their organisation to prepare and protect them for ebola. Appropriate policies, procedures, and equipment infrastructure were reportedly in place. Nurses' decisions to care for a patient with ebola were informed by professional commitment, and personal responsibilities. Participants were concerned about transmitting ebola to their families, and suggested that more regular training in personal protective equipment would increase confidence and skill in self-protection. Copyright © 2017 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.

  11. An exploration of emergency nurses' perceptions, attitudes and experience of teamwork in the emergency department.

    Grover, Elise; Porter, Joanne E; Morphet, Julia


    Teamwork may assist with increased levels of efficiency and safety of patient care in the emergency department (ED), with emergency nurses playing an indispensable role in this process. A descriptive, exploratory approach was used, drawing on principles from phenomenology and symbolic interactionism. Convenience, purposive sampling was used in a major metropolitan ED. Semi structured interviews were conducted, audio recorded, and transcribed verbatim. Transcripts were analysed using thematic analysis. Three major themes emerged from the data. The first theme 'when teamwork works' supported the notion that emergency nurses perceived teamwork as a positive and effective construct in four key areas; resuscitation, simulation training, patient outcomes and staff satisfaction. The second theme 'team support' revealed that back up behaviour and leadership were critical elements of team effectiveness within the study setting. The third theme 'no time for teamwork' centred around periods when teamwork practices failed due to various contributing factors including inadequate resources and skill mix. Outcomes of effective teamwork were valued by emergency nurses. Teamwork is about performance, and requires a certain skill set not necessarily naturally possessed among emergency nurses. Building a resilient team inclusive of strong leadership and communication skills is essential to being able to withstand the challenging demands of the ED. Copyright © 2017 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.

  12. Essential documentation elements: quality tool for the emergency department nurse.

    Nielsen, Gayla; Peschel, Laura; Burgess, Ann


    The use of real-time feedback about documentation may improve compliance with best practice standards, provide immediate rewards for high-quality documentation, and present an opportunity to make instantaneous improvements to the documentation. This project was conducted in a large, urban emergency department (ED) to enhance patient safety, improve documentation quality, and increase timeliness of documentation. The PDSA (Plan, Do, Study, Act) model was used to develop a valid and reliable process to enhance the clinical care process. Passive electronic visual cues with real-time feedback to the clinician were developed. Between March 2011 and 2012, a total of 89,521 ED records were reviewed for compliance with 16 documentation elements. Documentation improvements were achieved with seven elements. There was a slight decrease in compliance for four elements, and equivalent levels of compliance in five elements were noted. Staff reported that the program was helpful in providing reminders and that passive cues were more helpful than hard stops. Areas for software refinement were also identified. This process demonstrated that the data collection burden was reduced and sampling error was eliminated. Although additional study is needed, the electronic health record can provide passive visual cues to enhance nursing care, improve regulatory compliance and data collection, and provide immediate feedback to the clinician.

  13. Determining the Optimum Number of Nursing Staff Is Needed in Kerman Shafa Hospital Emergency Department

    S NooriHekmat


    Conclusion: The results indicated that the emergency department of the studied hospital is facing with nurse shortage, particularly at night shift. Solutions to fit the number of nurses with patients in this emergency department can be classified in two areas of demand and supply of emergency services at different hours of day. Since only the early hours of the night shift is faced with large numbers of patients, the rational allocation of overtime to the evening shift nursing staff can be helpful. Furthermore, the hospital can correctly implement the triage nursing so that patient with high priority will serve at the best time.

  14. Nursing home nurses' experiences of resident transfers to the emergency department: no empathy for our work environment difficulties.

    Tsai, Hsiu-Hsin; Tsai, Yun-Fang; Huang, Hsiu-Li


    To explore the experiences of nursing home nurses when they transfer residents from nursing homes to the emergency department in Taiwan. The transfer of residents between nursing homes and emergency departments challenges continuity of care. Understanding nursing home nurses' experiences during these transfers may help to improve residents' continuity of care. However, few empirical data are available on these nurses' transfer experiences worldwide, and none could be found in Asian countries. Qualitative descriptive study. Data were collected from August 2012-June 2013 in audiotaped, individual, in-depth interviews with 25 nurses at five nursing homes in Taiwan. Interview transcripts were analysed by constant comparative analysis. Analysis of interview transcripts revealed that the core theme of nursing home nurses' transfer experience was discontinuity in nursing home to emergency department transitions. This core theme comprised three themes: discontinuity in family involvement, discontinuity in medical resources and expectations, and discontinuity in nurses' professional role. Nursing home nurses need a working environment that is better connected to residents' family members and more immediate and/or easier access to acute care for residents. Communication between nurses and residents' family could be improved by using text messages or social media by mobile phones, which are widely used in Taiwan and worldwide. To improve access to acute care, we suggest developing a real-time telehealth transfer system tailored to the medical culture and policies of each country. This system should facilitate communication among nursing home staff, family members and hospital staff. Our findings on nurses' experiences during transfer of nursing home residents to the emergency department can be used to design more effective transfer policies such as telemedicine systems in Taiwan and other Asian countries or in those with large populations of Chinese immigrants. © 2016 John

  15. Factors that influence the development of compassion fatigue, burnout, and compassion satisfaction in emergency department nurses.

    Hunsaker, Stacie; Chen, Hsiu-Chin; Maughan, Dale; Heaston, Sondra


    The purpose of this study was twofold: (a) to determine the prevalence of compassion satisfaction, compassion fatigue, and burnout in emergency department nurses throughout the United States and (b) to examine which demographic and work-related components affect the development of compassion satisfaction, compassion fatigue, and burnout in this nursing specialty. This was a nonexperimental, descriptive, and predictive study using a self-administered survey. Survey packets including a demographic questionnaire and the Professional Quality of Life Scale version 5 (ProQOL 5) were mailed to 1,000 selected emergency nurses throughout the United States. The ProQOL 5 scale was used to measure the prevalence of compassion satisfaction, compassion fatigue, and burnout among emergency department nurses. Multiple regression using stepwise solution was employed to determine which variables of demographics and work-related characteristics predicted the prevalence of compassion satisfaction, compassion fatigue, and burnout. The α level was set at .05 for statistical significance. The results revealed overall low to average levels of compassion fatigue and burnout and generally average to high levels of compassion satisfaction among this group of emergency department nurses. The low level of manager support was a significant predictor of higher levels of burnout and compassion fatigue among emergency department nurses, while a high level of manager support contributed to a higher level of compassion satisfaction. The results may serve to help distinguish elements in emergency department nurses' work and life that are related to compassion satisfaction and may identify factors associated with higher levels of compassion fatigue and burnout. Improving recognition and awareness of compassion satisfaction, compassion fatigue, and burnout among emergency department nurses may prevent emotional exhaustion and help identify interventions that will help nurses remain empathetic and

  16. Occupational stress and coping strategies among emergency department nurses of China.

    Lu, Dong-Mei; Sun, Ning; Hong, Su; Fan, Yu-ying; Kong, Fan-ying; Li, Qiu-jie


    Emergency department(ED) nurses work in a rapidly changing environment with patients that have wide variety of conditions. Occupational stress in emergency department nurses is a common problem. The purpose of this study was to describe the relationship between coping strategies and occupational stress among ED nurses in China. A correlational, cross-sectional design was adopted. Two questionnaires were given to a random sample of 127 ED nurses registered at the Heilongjiang Nurses' Association. Data were collected from the nurses that worked in the ED of five general hospitals in Harbin China. Occupational stress and coping strategies were measured by two questionnaires. A multiple regression model was applied to analyze the relationship between stress and coping strategies. The stressors of ED nurses mainly come from the ED specialty of nursing (2.97±0.55), workload and time distribution (2.97±0.58). The mean score of positive coping strategies was 2.19±0.35, higher than the norm (1.78±0.52). The mean score of negative coping strategies was 1.20±0.61, lower than the norm (1.59±0.66), both had significant statistical difference (Pprofessional were the influence factors about occupational stress to positive coping styles. Too much documents work, and medical insurance for ED nurses were the influential factors on occupational stress to negative coping styles. This study identified several factors associated with occupational stress in ED nurses. These results could be used to guide nurse managers of ED nurses to reduce work stress. The managers could pay more attention to the ED nurse's coping strategies which can further influence their health state and quality of nursing care. Reducing occupational stress and enhancing coping strategies are vital not only for encouraging nurses but also for the future of nursing development.

  17. ['See and Treat' in the Emergency Department: legal aspects and professional nursing responsibility].

    Radice, Cristiano; Ghinaglia, Monica; Doneda, Renzo; Bollini, Giovanna


    The article aim to analyze the legal aspects of professional responsibility in the autonomous nursing care of a patient with a minor health problem treated in a See and Treat area of the Emergency Department through a literature review and an analyses of the Italian legislation about professional exercise. Recent studies have shown that the treatment of the emergency patients affected by minor health problems in separated areas of the A&E by skilled nurses proved to be effective in reducing time to medical examination and the overall time spent in the Emergency Department. Several studies have shown the positive effects of the Emergency Nurse Practitioner (ENP) in terms of reduction of time to medical examination with an increase in patient satisfaction, maintaining an adequate level of quality in the care of patients with minor health problems. The introduction of a See and Treat area, together with the institution of advanced post-triage protocols, represents a possible answer to the overcrowding of the Emergency Department. The aim is the reduction of waiting times and proper allocation of both material and professional resources. The "See and Treat" nurse represents an expert nurse, with an adequate level of competence, who acts in respect to the clinical protocols shared between physicians and nurses. The Italian legislation is not in contrast with the introduction of the See and Treat nurse, on the contrary it offers opportunities for further professional development.

  18. Geriatric nursing assessment and intervention in an emergency department

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


    : At 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...... 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...

  19. Pain assessment by emergency nurses at triage in the emergency department: A qualitative study.

    Vuille, Marilène; Foerster, Maryline; Foucault, Eliane; Hugli, Olivier


    To investigate the assessment of pain intensity in the specific context of triage. Acute pain affects most patients admitted in emergency departments (ED) but pain relief in this setting remains insufficient. Evaluation of pain and its treatment at the time of patient triage expedites the administration of analgesia, but may be awkward at this time-pressured moment. The assessment of pain intensity by a validated pain scale is a critical initial step, and a patient's self-reporting is widely considered as the key to effective pain management. According to good practice guidelines, clinicians must accept a patient's statement, regardless of their own opinions. A qualitative methodology rooted in interactionist sociology and on the Grounded theory was used to provide an opportunity to uncover complex decision-making processes, such as those involved in assessing pain. A sociologist conducted semi-structured interviews during the 2013-2014 winter months with twelve nurses, trained in the use of an established protocol, focusing on the assessment of pain intensity. The interviews were recorded, fully transcribed and analyzed. The most frequently used pain scale was the Verbal Numerical Rating Scale. Discrepancies between self-assessment and evaluation by a nurse were common. To restore congruence between the two, nurses used various tactics, such as using different definitions of the high-end anchor of the scale, providing additional explanations about the scale, or using abnormal vital signs or the acceptance of morphine as a proof of the validity of severe pain ratings. Nurses cannot easily suspend their own judgment. Their tactics do not express a lack of professionalism, but are consistent with the logic of professional intervention. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

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

    Rosted, Elizabeth Emilie


    the 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...

  1. Patient satisfaction with triage nursing in a rural hospital emergency department.

    Elder, Regina; Neal, Carolyn; Davis, Barbara A; Almes, Elizabeth; Whitledge, Lynn; Littlepage, Nancy


    This study examined what relationships or differences exist between patient and nurse characteristics, satisfaction with triage nurse caring behaviors, general satisfaction with the triage nurse, and intent to return to a rural hospital emergency department (ED). The ED, located at a 401-bed teaching hospital in a small southern city, averages 28,000 visits annually. Samples of ED nurses (N = 11) and ED patients (N = 65) were asked to respond to demographic forms and the Consumer Emergency Care Satisfaction Scale (CECSS) Adapted. Findings indicated that the nurse's acuity rating and the patient's perception of condition had a positive relationship. The patient's perception of condition, patient satisfaction, and caring satisfaction were predictors of intent to return. When patients perceived themselves as seriously ill or injured, they expressed less intent to return to that ED.

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

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


    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.

  3. Physician and Nurse Acceptance of Technicians to Screen for Geriatric Syndromes in the Emergency Department

    Brian F Gage


    Full Text Available Introduction: The objective of this study was to evaluate emergency medicine physician and nurse acceptance of nonnurse, nonphysician screening for geriatric syndromes. Methods: This was a single-center emergency department (ED survey of physicians and nurses after an 8-month project. Geriatric technicians were paid medical student research assistants evaluating consenting ED patients older than 65 years for cognitive dysfunction, fall risk, or functional decline. The primary objective of this anonymous survey was to evaluate ED nurse and physician perceptions about the geriatric screener feasibility and barriers to implementation. In addition, as a secondary objective, respondents reported ongoing geriatric screening efforts independent of the research screeners. Results: The survey was completed by 72% of physicians and 33% of nurses. Most nurses and physicians identified geriatric technicians as beneficial to patients without impeding ED throughput. Fewer than 25% of physicians routinely screen for any geriatric syndromes. Nurses evaluated for fall risk significantly more often than physicians, but no other significant differences were noted in ongoing screening efforts. Conclusion: Dedicated geriatric technicians are perceived by nurses and physicians as beneficial to patients with the potential to improve patient safety and clinical outcomes. Most nurses and physicians are not currently screening for any geriatric syndromes. [West J Emerg Med. 2011;12(4:489–495.

  4. Examination of triage nurse text narratives to identify sports injury cases in emergency department presentations.

    Mitchell, Rebecca; Finch, Caroline; Boufous, Soufiane; Browne, Gary


    Narrative text can be a useful means of identifying injury in routine data collections. An analysis of data from a near real-time emergency department surveillance system (NREDSS) in New South Wales (NSW, Australia) was conducted to determine if sports injuries can be identified from routine narrative text recorded in emergency departments. Around one-third of all emergency department (ED) presentations during 1 September 2003 to 15 February 2007 were identified as injury-related. Narrative text searching of triage nursing assessments using keywords identified between 282 (i.e. football) and 26,944 (i.e. play) potential sports injury presentations depending on the selected sports-related keyword used. Routine narrative text descriptions from triage nurse assessments show promise for the identification of sports injury presentations to EDs. Further work is required regarding in-depth assessment of case detection capabilities and the likelihood of improving the quality of narrative text recorded.

  5. Patient satisfaction, stress and burnout in nursing personnel in emergency departments: A cross-sectional study.

    Ríos-Risquez, M Isabel; García-Izquierdo, Mariano


    of the burnout dimensions, namely emotional exhaustion and cynicism. The length of stay of the patients in the emergency department was negatively related to the frequency of nurses experiencing perceived stress as well as the burnout dimension of cynicism. No significant association was observed between experiences of stress and burnout dimensions by nursing professionals and the satisfaction with care received reported by their patients. These findings could be explained by the professional and organizational characteristics of the unit. Finally, the limitations and implications of the study are discussed, as well as future research questions related to research of the associations between occupational stress, burnout and patient satisfaction. Copyright © 2016 Elsevier Ltd. All rights reserved.

  6. [Nurse-performed FAST ultrasound in the emergency department: a systematic review].

    Storti, Matteo; Musella, Lorenzo; Cianci, Vito


    Focused Assessment with Sonography for Trauma (commonly abbreviated as FAST) is considered for patients with blunt abdominal trauma as the gold standard for accident assessment in site. This method is increasingly used even by not radiologists professionals, as well as by nurses who works in emergency settings. This systematic review is aimed at evaluating the effectiveness of ultrasound FAST performed by nurses in emergencies department. Seven databases of primary and secondary literature as well as three national journals relevant to the field were consulted. The review was conducted between March and August 2011 developing 9 search strings. Articles have been critically reviewed by two authors independently. No restriction on language or time of publication have been used. A total of 4767 documents were displayed, of those only 4 were considered to be reviewed. A total of 1035 FAST ultrasound performed by nurses were included. The results show that the use of ultrasound FAST performed by trained nurses is very effective, with a sensitivity of 84% (95% CI 72.1-92.2) and a specificity of 97.37% (95% CI 92.55-99.10) . Practice execution time was an average of 156 seconds (2.6 minutes), median time of 138 seconds (range = 76 to 357). Just one study specified the training course that nurses were required to attend. To sum up, FAST ultrasound performed by nurses have an important role in emergencies management as well as in triage setting as valid screening tool.

  7. A pilot study on usability analysis of emergency department information system by nurses.

    Kim, M S; Shapiro, J S; Genes, N; Aguilar, M V; Mohrer, D; Baumlin, K; Belden, J L


    Employing new health information technologies while concurrently providing quality patient care and reducing risk is a major challenge in all health care sectors. In this study, we investigated the usability gaps in the Emergency Department Information System (EDIS) as ten nurses differentiated by two experience levels, namely six expert nurses and four novice nurses, completed two lists of nine scenario-based tasks. Standard usability tests using video analysis, including four sets of performance measures, a task completion survey, the system usability scale (SUS), and sub-task analysis were conducted in order to analyze usability gaps between the two nurse groups. A varying degree of usability gaps were observed between the expert and novice nurse groups, as novice nurses completed the tasks both less efficiently, and expressed less satisfaction with the EDIS. The most interesting finding in this study was the result of 'percent task success rate,' the clearest performance measure, with no substantial difference observed between the two nurse groups. Geometric mean values between expert and novice nurse groups for this measure were 60% vs. 62% in scenario 1 and 66% vs. 55% in scenario 2 respectively, while there were some marginal to substantial gaps observed in other performance measures. In addition to performance measures and the SUS, sub-task analysis highlighted navigation pattern differences between users, regardless of experience level. This study will serve as a baseline study for a future comparative usability evaluation of EDIS in other institutions with similar clinical settings.

  8. Exploring the Relationship Among Moral Distress, Coping, and the Practice Environment in Emergency Department Nurses.

    Zavotsky, Kathleen Evanovich; Chan, Garrett K


    Emergency department (ED) nurses practice in environments that are highly charged and unpredictable in nature and can precipitate conflict between the necessary prescribed actions and the individual's sense of what is morally the right thing to do. As a consequence of multiple moral dilemmas, ED staff nurses are at risk for experiencing distress and how they cope with these challenges may impact their practice. To examine moral distress in ED nurses and its relationship to coping in that specialty group. Using survey methods approach. One hundred ninety-eight ED nurses completed a moral distress, coping, and demographic collection instruments. Advanced statistical analysis was completed to look at relationships between the variables. Data analysis did show that moral distress is present in ED nurses (M = 80.19, SD = 53.27), and when separated into age groups, the greater the age, the less the experience of moral distress. A positive relationship between moral distress and some coping mechanisms and the ED environment was also noted. This study's findings suggest that ED nurses experience moral distress and could receive some benefit from utilization of appropriate coping skills. This study also suggests that the environment in which ED nurses practice has a significant impact on the experience of moral distress. Because health care is continuing to evolve, it is critical that issues such as moral distress and coping be studied in ED nurses to help eliminate human suffering.

  9. It Could Never Happen Here: Promoting Violence Prevention Education for Emergency Department Nurses.

    Koller, Lynne H


    HOW TO OBTAIN CONTACT HOURS BY READING THIS ISSUE Instructions: 1.1 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded after you register, pay the registration fee, and complete the evaluation form online at In order to obtain contact hours you must: 1. Read the article, "It Could Never Happen Here: Promoting Violence Prevention Education for Emergency Department Nurses," found on pages 356-360, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website to register for contact hour credit. You will be asked to provide your name, contact information, and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until July 31, 2019. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. OBJECTIVES Suggest strategies targeted for emergency department nurses to prevent or mitigate their exposure

  10. Emergency department nurses' experiences of occupational stress: A qualitative study from a public hospital in Bangkok, Thailand.

    Yuwanich, Nuttapol; Sandmark, Hélène; Akhavan, Sharareh


    Occupational stress has been a health-related issue among nurses for many decades. Emergency department nurses are frequently confronted with occupational stress in their workplace; in particular, they encounter stressful situations and unpredictable events. These encounters could make them feel more stressed than nurses in other departments. Research considering occupational stress from the perspective of Thai emergency department nurses is limited. This study aimed to explore nurses' perceptions of occupational stress in an emergency department. A qualitative approach was used to gain an understanding of nurses' experiences and perceptions regarding stress in their workplace. Semi-structured interviews were used for data collection. Twenty-one emergency department nurses working in a public hospital in Thailand were interviewed, and the data were analyzed using content analysis. The findings comprised three themes: (1) perceived stress, (2) consequences of stress, and (3) stress management. The results of this study can be used by hospital management to help them adopt effective strategies, such as support programs involving co-workers/supervisors, to decrease occupational stress among emergency department nurses. Future research that explores each of the themes found in this study could offer a more comprehensive understanding of nurses' occupational stress in the emergency department.

  11. Measuring emergency department nurses' attitudes towards deliberate self-harm using the Self-Harm Antipathy Scale.

    Conlon, Mary


    The emergency department is an important gateway for the treatment of self-harm patients. Nurses\\' attitudes towards patients who self-harm can be negative and often nurses experience frustration, helplessness, ambivalence and antipathy. Patients are often dissatisfied with the care provided, and meeting with positive or negative attitudes greatly influences whether they seek additional help. A quantitative design was utilised to measure emergency department nurses\\' attitudes towards deliberate self-harm. The \\'Self-Harm Antipathy Scale\\

  12. Nursing Assessment and Intervention to Geriatric Patients Discharged from Emergency Departments

    Rosted, Elizabeth Emilie; Poulsen, Ingrid; Hendriksen, Carsten


    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 geriat......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 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...... geriatric patients with nursing intervention at discharge and 1 and 6 months follow-up. Included were geriatric patients 70+ years discharged to their home October 2006-June 2008. Intervention: After detecting the geriatric patients planned to be discharged, the geriatric nurse in the ED did a brief...

  13. Nursing Assessment and Intervention to Geriatric Patients Discharged From Emergency Department

    Rosted, Elizabeth Emilie; Poulsen, Ingrid; Hendriksen, Carsten

    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 geria......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 geriatric patients have complex and often unresolved caring needs. Objective: To examine the effect of a two-stage nursing assessment and intervention to address the patients uncompensated problems given just after discharge from ED and one and six months after. Method: We conducted a prospective...... nursing assessment comprising a checklist of 10 physical, mental, medical and social items. The focus was on unresolved problems which require medical intervention, new or different home care services, or comprehensive geriatric assessment. Following this the nurses made relevant referrals...

  14. Disruptive Behaviors in an Emergency Department: the Perspective of Physicians and Nurses

    Maddineshat, Maryam; Rosenstein, Alan H; Akaberi, Arash; Tabatabaeichehr, Mahbubeh


    Introduction: Disruptive behaviors cause many problems in the workplace, especially in the emergency department (ED).This study was conducted to assess the physician’s and nurse’s perspective toward disruptive behaviors in the emergency department. Methods: In this cross-sectional study a total of 45 physicians and 110 nurses working in the emergency department of five general hospitals in Bojnurd participated. Data were collected using a translated, changed, and validated questionnaire (25 item). The collected data were analyzed by SPSS ver.13 software. Results: Findings showed that physicians gave more importance to nurse-physician relationships in the ED when compared to nurses’ perspective (90% vs. 70%). In this study, 81% of physicians and 52% of nurses exhibited disruptive behaviors. According to the participants these behaviors could result in adverse outcomes, such as stress (97%), job dissatisfaction and can compromise patient safety (53%), quality of care (72%), and errors (70%). Conclusion: Disruptive behaviors could have a negative effects on relationships and collaboration among medical staffs, and on patients’ quality of care as well. It is essential to provide some practical strategies for prevention of these behaviors. PMID:27752490

  15. Emotional intelligence and stress management in Nursing professionals in a hospital emergency department.

    Nespereira-Campuzano, Tatiana; Vázquez-Campo, Miriam

    To determine stress levels and to identify if there is a relationship between emotional intelligence and work stress in nurses and healthcare assistants of the Emergency Department. Observational, descriptive and cross-sectional study with a quantitative approach. The population were nurses and healthcare assistants of the Emergency Department of the University Hospital of Ourense. The data were collected between January and May 2016. The tool used was a validated, anonymous, and self-administered questionnaire that included the Trait Meta-Mood Scale and Moreno's Brief Burnout Questionnaire. The study was approved by the Clinical Research Ethics Committee of Galicia. Descriptive and association analyses were performed using the SPSS 15.0 statistics program. A total of 60 professionals participated, of whom 36 were qualified nurses and 24 were auxiliary nurses. The response rate was 68.1%. The results showed a deficiency in emotional care, with a score of 22.87, while emotional clarity and reparation of emotions were situated within normal levels, with values of 26.42 and 26.60, respectively. The burnout levels of the sample were medium-high. The mean score in the depersonalisation dimension was 8.05, whereas emotional fatigue obtained a mean of 6.90, with a value of 7.50 for professional fulfilment. Significant positive correlations were found between the employment situation and emotional clarity (r=.276; P=.033), and between the latter and personal fulfilment (r=.277; P=.032), and organisation (r=.316; P=.014). Nurses and healthcare assistants of the Emergency Department showed medium-high average levels of burnout, with depersonalisation being the symptom that reflects the highest values. Emotional Intelligence is related to work stress and, specifically, the understanding of one's own emotional states influences personal fulfilment. Professionals with more job stability show a better capacity to feel and express their feelings. Copyright © 2017 Elsevier Espa

  16. The Role Descriptions of Triage Nurse in Emergency Department: A Delphi Study

    Mohsen Ebrahimi


    Full Text Available Background. Triage nurses play a pivotal role in the emergency department. However some researchers have attempted to expand triage nurse’s role; remarkable discrepancies exist among scholarly communities. The aim was to develop a role description of triage nurse relying on the experts. Methods. A modified Delphi study consisting of 3 rounds was performed from March to October 2014. In the first round, an extensive review of the literature was conducted. Expert selection was conducted through a purposeful sample of 38 emergency medicine experts. Results. Response rates for the second and third rounds were 37% and 58%. Average age of panelists was (38.42±5.94 years. Thirty-nine out of 54 items reached to the final round. Prioritizing had the higher agreement rate and least agreement on triage related interventions. Conclusion. Triage nursing as a relatively new role for nurses needs significant development to be practiced. Comprehensive educational programs and developmental research are required to support diagnostic and therapeutic interventions in triage practice by nurses.

  17. Feasibility of nurses measuring gait speed in older community-dwelling Emergency Department patients.

    Tucker, Paula W; Evans, Dian Dowling; Clevenger, Carolyn K; Ardisson, Michelle; Hwang, Ula

    Gait speed assessment is a rapid, simple and objective measure for predicting risk of unfavorable outcomes which may provide better prognostic and reliable information than existing geriatric ED (Emergency Department) screening tools. This descriptive pilot project was designed to determine feasibility of implementing gait speed screening into routine nursing practice by objectively identifying patients with sub-optimal gait speeds. Participants included community-dwelling adults 65 years and older with plans for discharge following ED treatment. Patients with a gait speed <1.0 m/s were identified as "high-risk" for an adverse event, and referred to the ED social worker for individualized resources prior to discharge. Thirty-five patients were screened and nurse initiated gait speed screens were completed 60% of the time. This project demonstrates ED gait speed screening may be feasible. Implications for practice should consider incorporating gait speed screening into routine nursing assessment to improve provider ED decision-making and disposition planning.

  18. Rationalising Transgression: A Grounded Theory Explaining how Emergency Department Registered Nurses Rationalise Erroneous Behaviour

    Tracy Flenady


    Full Text Available Abstract The aim of this classic grounded theory study was to unearth the main concern of emergency department (ED registered nurses (RN when they perform respiratory rate observations to generate a substantive theory that explicates how the identified problem is resolved. Analysis of data collected from 79 registered nurses revealed that health sector forced compliance in recording observations meant that ED RNs are more than likely to record a respiratory rate without actually counting respirations. This erroneous behaviour provokes varying degrees of emotional discomfort as the nurses’ actions are often incongruent with their professional values and beliefs. The theory Rationalising Transgression explains how nurses continually resolve this issue by compensating, minimalizing, or trivialising to titrate the level of emotional discomfort associated with erroneous behaviour, consequently facilitating the rationalisation of transgression.

  19. An Online Tool for Nurse Triage to Evaluate Risk for Acute Coronary Syndrome at Emergency Department

    Yuwares Sittichanbuncha


    Full Text Available Background. To differentiate acute coronary syndrome (ACS from other causes in patients presenting with chest pain at the emergency department (ED is crucial and can be performed by the nurse triage. We evaluated the effectiveness of the ED nurse triage for ACS of the tertiary care hospital. Methods. We retrospectively enrolled consecutive patients who were identified as ACS at risk patients by the ED nurse triage. Patients were categorized as ACS and non-ACS group by the final diagnosis. Multivariate logistic analysis was used to predict factors associated with ACS. An online model predictive of ACS for the ED nurse triage was constructed. Results. There were 175 patients who met the study criteria. Of those, 28 patients (16.0% were diagnosed with ACS. Patients with diabetes, patients with previous history of CAD, and those who had at least one character of ACS chest pain were independently associated with having ACS by multivariate logistic regression. The adjusted odds ratios (95% confidence interval were 4.220 (1.445, 12.327, 3.333 (1.040, 10.684, and 12.539 (3.876, 40.567, respectively. Conclusions. The effectiveness of the ED nurse triage for ACS was 16%. The online tool is available for the ED triage nurse to evaluate risk of ACS in individuals.

  20. An online tool for nurse triage to evaluate risk for acute coronary syndrome at emergency department.

    Sittichanbuncha, Yuwares; Sanpha-Asa, Patchaya; Thongkrau, Theerayut; Keeratikasikorn, Chaiyapon; Aekphachaisawat, Noppadol; Sawanyawisuth, Kittisak


    Background. To differentiate acute coronary syndrome (ACS) from other causes in patients presenting with chest pain at the emergency department (ED) is crucial and can be performed by the nurse triage. We evaluated the effectiveness of the ED nurse triage for ACS of the tertiary care hospital. Methods. We retrospectively enrolled consecutive patients who were identified as ACS at risk patients by the ED nurse triage. Patients were categorized as ACS and non-ACS group by the final diagnosis. Multivariate logistic analysis was used to predict factors associated with ACS. An online model predictive of ACS for the ED nurse triage was constructed. Results. There were 175 patients who met the study criteria. Of those, 28 patients (16.0%) were diagnosed with ACS. Patients with diabetes, patients with previous history of CAD, and those who had at least one character of ACS chest pain were independently associated with having ACS by multivariate logistic regression. The adjusted odds ratios (95% confidence interval) were 4.220 (1.445, 12.327), 3.333 (1.040, 10.684), and 12.539 (3.876, 40.567), respectively. Conclusions. The effectiveness of the ED nurse triage for ACS was 16%. The online tool is available for the ED triage nurse to evaluate risk of ACS in individuals.

  1. Profile and results of frail patient assessed by advanced practice nursing in an Emergency Department.

    Solé-Casals, Montserrat; Chirveches-Pérez, Emilia; Puigoriol-Juvanteny, Emma; Nubó-Puntí, Núria; Chabrera-Sanz, Carolina; Subirana-Casacuberta, Mireia


    To describe the profile of patients evaluated by Nurse Care Management in an Emergency Department and identify the type of alternative healthcare resource assigned and report the results of clinical practice. Prospective follow-up, on admission to the Emergency Department in an acute hospital and on discharge from the alternative healthcare resource, of patients assessed by Nurse Care Management, from July to December 2015. The patient characteristics, social environment and results of clinical practice were studied. 190 patients were included of whom 13 were readmitted (6.8%). 122 (59.8%) cases from the Emergency Department were referred to to intermediate care facilities, 71 (34.8%) cases for domiciliary care, 10 (4.9%) cases were referred to an acute care hospital and 1 (0.5%) died. Patients referred to intermediate care were more complex, presented geriatric syndromes as their reason for admission and diagnosed with dementia, while those referred to home care presented more respiratory and cardiovascular illnesses (p <0.05). The mean Barthel Index and polypharmacy before emergency admission were higher than at the time of discharge from the alternative healthcare resource (p <0.05). Patients presenting with advanced age, complexity, comorbidity, are referred to intermediate care facilities or domiciliary care, they are admitted to acute care hospitasl and are readmitted less than other patients. After being discharged from the alternative resource, they lose functional capacity and present less polypharmacy. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  2. Developing an e-learning resource for nurse airway assistants in the emergency department.

    Hersey, Peter; McAleer, Sean


    The aims of this project were to determine the required competencies for a nurse in the emergency department assisting with a rapid sequence induction of anaesthesia (RSI), and to produce a relevant e-learning resource. A three-round multidisciplinary Delphi process produced the following competencies: ability to describe the steps and sequence of events of an RSI, familiarity with the equipment used during an RSI, ability to recognise and help manage problems occurring during an RSI, ability to prepare for an RSI, ability to apply cricoid pressure, and understanding the modification of an RSI in special circumstances. An interactive e-learning package was produced and made available online. Twelve emergency department nurses took part in an evaluation of the e-learning package. All either agreed or strongly agreed that they had increased their knowledge and found the learning useful, and 11 out of 12 nurses reported being somewhat or very confident in the role of airway assistant following completion of the learning.

  3. Registered nurses' self-efficacy for assessing and responding to woman abuse in emergency department settings.

    Hollingsworth, Erin; Ford-Gilboe, Marilyn


    Enhanced knowledge regarding the factors that influence and support the self-efficacy of emergency department (ED) registered nurses and their provision of care to women who have experienced abuse is necessary for the promotion of optimal health care. The purpose of this study was to examine the self-efficacy of registered nurses with respect to assessing and responding to woman abuse in the ED. Study hypotheses and research questions were derived from Bandura's theory of self-efficacy. A secondary analysis (N = 158) of data from the Violence against Women: Health Care Provider Survey was completed. Originally, survey questions were not developed to operationalize the concepts outlined by Bandura. However, they were found to be good indicators. Four scales were developed from the item pool, validated through factor analysis and used to operationalize study variables. Positive relationships were found between self-efficacy information available to ED registered nurses and their self-efficacy for assessing and responding to woman abuse (r= .73, p Bandura's theory and demonstrate that the clinical responses of ED registered nurses are complex and must be understood in terms of self-efficacy and the factors that support its development.

  4. Nursing staff experiences and responses to violence and aggression in the emergency department: a grounded theory study

    Ferns, Terence James


    Aims The aims of the study were to explore how emergency department (ED) nursing staff conceptualise the terms that encompass violence and aggression in the clinical area; to explore the formal reporting practices of nursing staff following such experiences and to explore situational factors at play, relating to the development of violent and aggressive incidents in the ED setting. Background Violence and aggression experienced by ED nursing staff is a well recognised, global phen...

  5. Nurses' attitudes towards suicidal behaviour--a comparative study of community mental health nurses and nurses working in an accidents and emergency department.

    Anderson, M


    The purpose of this study was to explore and compare the attitudes towards suicidal behaviour of community mental health nurses (CMHNs) and registered nurses working in an accidents and emergency (A&E) department. The sample consisted of 80 nurses working in the same locality. An instrument was designed using statements from Domino's 'Suicide Opinion Questionnaire' (SOQ) and new statements based on a comprehensive survey of research in this area. The instrument contained four attitudinal categories consisting of; acceptability; morality and mental illness; professional role, work and care; and communication and attention. Results reveal that both groups of nurses held generally positive attitudes towards suicidal behaviour, contrasting with previous studies where more negative attitudes amongst nurses were found. A t-test showed no statistically significant differences between the two groups of nurses in any of the four attitudinal categories. Attitudes were significantly different in accordance with nurses' length of experience and age within both groups. Further research is needed in this area if nurses are to develop their role alongside other professionals working towards the objectives of suicide prevention policies.

  6. Identifying potentially preventable emergency department visits by nursing home residents in the United States

    Burke, Robert E.; Rooks, Sean P.; Levy, Cari; Schwartz, Robert; Ginde, Adit A.


    Objectives To identify and describe potentially preventable emergency department (ED) visits by nursing home (NH) residents in the United States. These visits are important because they are common, frequently lead to hospitalization, and can be associated with significant cost to the patient and the health care system. Design Retrospective analysis of the 2005-2010 National Hospital Ambulatory Care Survey (NHAMCS), comparing ED visits by nursing home residents that did not lead to hospital admission (potentially preventable) to those that led to admission (less likely preventable). Setting Nationally representative sample of United States EDs; Federal hospitals and hospitals with less than six beds were excluded. Participants Older (age ≥65 years) nursing home residents with an ED visit during this time period. Measurements Patient demographics, ED visit information including testing performed, interventions (both procedures and medications) provided, and diagnoses treated. Results Older NH residents accounted for 3,857 of 208,956 ED visits during the time period of interest (1.8%). When weighted to be nationally representative, these represent 13.97 million ED visits, equivalent to 1.8 ED visits annually per NH resident in the United States. More than half of visits (53.5%) did not lead to hospital admission; of those discharged from the ED, 62.8% had normal vital signs on presentation and 18.9% did not have any diagnostic testing prior to ED discharge. Injuries were 1.78 times more likely to be discharged than admitted (44.8% versus 25.3%, respectively, p<0.001), while infections were 2.06 times as likely to be admitted as discharged (22.9% versus 11.1%, respectively). CT scans were performed in 25.4% and 30.1% of older NH residents who were discharged from the ED and admitted to the hospital, respectively, and more than 70% of these were CTs of the head. NH residents received centrally acting, sedating medications prior to ED discharge in 9.4% of visits

  7. A Qualitative Study of Factors Facilitating Clinical Nurse Engagement in Emergency Department Catheter-Associated Urinary Tract Infection Prevention.

    Carter, Eileen J; Pallin, Daniel J; Mandel, Leslie; Sinnette, Corine; Schuur, Jeremiah D


    The aim of this study was to explore the actions of nurse leaders that facilitated clinical nurses' active involvement in emergency department (ED) catheter-associated urinary tract infection (CAUTI) prevention programs. Hospitals face increasing financial pressures to reduce CAUTI. Urinary catheters, often inserted in the ED, expose patients to CAUTI risk. Nurses are the principal champions of ED CAUTI prevention programs. This was a qualitative analysis from a multisite, comparative case study project. A total of 52 interviews and 9 focus groups were analyzed across 6 enrolled EDs. Using a conventional content analysis, members of the research team coded data and developed site summaries to describe themes that had emerged across transcripts. Subsequently, all codes and site summaries were reviewed to identify the actions of nurse leaders that facilitated clinical nurses' engagement in CAUTI prevention efforts. Nurse leaders were the principal champions of CAUTI prevention programs and successfully engaged clinical nurses in CAUTI prevention efforts by (1) reframing urinary catheters as a source of potential patient harm; (2) empowering clinical nurses to identify and address CAUTI improvement opportunities; (3) fostering a culture of teamwork, which facilitated interdisciplinary communication around urinary catheter appropriateness and alternatives; and (4) holding clinical nurses accountable for CAUTI process and outcome measures. The prevention of CAUTI is an important opportunity for nurse leaders to engage clinical nurses in meaningful improvement efforts. Clinical nurses are best positioned to examine urinary catheter insertion workflow and to suggest improvements in avoiding use and improving placement and maintenance. To engage clinical nurses in CAUTI prevention, nurse leaders should focus on how urinary catheters expose patients to potential harm, involve nurses in designing and implementing practice changes, and provide local data to show the impact of

  8. Care of the trauma patient beyond the emergency department: a patient care standard to guide bedside nurses.

    Jaekel, Camilla; Paar, Cheryl; Schiltz, Jenifer; Peterson, Rose


    Injuries sustained from illicit drug use or alcohol intoxication are common in emergency departments. Ongoing assessments of psychosocial issues in trauma patients are imperative, even after the patient leaves the specialized area of the emergency department. Oftentimes, bedside nurses are ill prepared to identify the subtle clues of deeper psychosocial issues in complex patients such as trauma patients. This article focuses on the rationale for the development of a patient care standard to guide the bedside staff nurse in the care of the trauma patient. An example of a multiple trauma diagnosis-related patient care standard is presented.

  9. Screening for Fall Risks in the Emergency Department: A Novel Nursing-Driven Program

    Jill M. Huded


    Full Text Available Introduction: Seniors represent the fasting growing population in the U.S., accounting for 20.3 million visits to emergency departments (EDs annually. The ED visit can provide an opportunity for identifying seniors at high risk of falls. We sought to incorporate the Timed Up & Go Test (TUGT, a commonly used falls screening tool, into the ED encounter to identify seniors at high fall risk and prompt interventions through a geriatric nurse liaison (GNL model. Methods: Patients aged 65 and older presenting to an urban ED were evaluated by a team of ED nurses trained in care coordination and geriatric assessment skills. They performed fall risk screening with the TUGT. Patients with abnormal TUGT results could then be referred to physical therapy (PT, social work or home health as determined by the GNL. Results: Gait assessment with the TUGT was performed on 443 elderly patients between 4/1/13 and 5/31/14. A prior fall was reported in 37% of patients in the previous six months. Of those screened with the TUGT, 368 patients experienced a positive result. Interventions for positive results included ED-based PT (n=63, 17.1%, outpatient PT referrals (n=56, 12.2% and social work consultation (n=162, 44%. Conclusion: The ED visit may provide an opportunity for older adults to be screened for fall risk. Our results show ED nurses can conduct the TUGT, a validated and time efficient screen, and place appropriate referrals based on assessment results. Identifying and intervening on high fall risk patients who visit the ED has the potential to improve the trajectory of functional decline in our elderly population.

  10. An examination of emergency department nurses' attitudes towards deliberate self-harm in an Irish teaching hospital.

    McCarthy, Linda


    The purpose of this study was to examine emergency department (ED) nurses\\' attitudes towards individuals presenting with deliberate self-harm (DSH), including the relationship between attitudes and factors such as age, academic achievements, length of experience, and self-harm education.

  11. Nurses' evaluation of a new formalized triage system in the emergency department - a qualitative study

    Johansen, Mette Brehm; Forberg, Jakob Lundager


    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.......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....

  12. The 'mindless' relationship between nursing homes and emergency departments: what do Bourdieu and Freire have to offer?

    McCloskey, Rose


    The 'mindless' relationship between nursing homes and emergency departments: what do Bourdieu and Freire have to offer? This paper explicates the long-standing and largely unquestioned adversarial relationship between nurses working in the nursing home (NH) and the emergency department (ED). Drawing on the author's own research on resident ED transfers, this paper reports on the conflict and tension that can arise when residents transfer between the two settings. The theoretical concepts of mindlessness, habitus, social capital and oppression are deployed to understand the contextual nature of the social relations that exist between NH and ED practitioners and between practitioners and residents. This theoretical discussion offers the potential to uncover the social relations that give rise to problematic transfers which may lead to alternative and more productive NH to ED transfers. © 2011 Blackwell Publishing Ltd.

  13. Knowledge and awareness of first aid of avulsed tooth among physicians and nurses of hospital emergency department

    Sudeep Sreepad Iyer


    Full Text Available Introduction: Physicians and nurses of emergency department are often the first line of qualified health-care providers attending the patient in person or parent's query over phone reporting immediately following the dental avulsion. Prompt action by them becomes the decisive factor in survival and prognosis of the tooth. Although a few researchers have evaluated knowledge of emergency room physicians, there is scanty of reports concerning nurses who play a climacteric role. Materials and Methods: A 10-item questionnaire regarding clinical situation apropos dental injury and tooth avulsion, inquiring knowledge of physicians and nurses was administered to 150 each of nursing professionals and physicians of the emergency department. Results: With 100% response rate, the data obtained was subjected to statistical analysis. Results showed lack of knowledge and confidence in both groups. About 66.7% (n = 100 nurses and 74.7% (n = 112 considered reimplantation of avulsed tooth. There was overbalanced confusion regarding storage/transport media and handling of avulsed tooth. Conclusion: The findings from the results suggested a definite inadequacy in knowledge, demanding need for appropriate training for delivering treatment with more predictability and better prognosis.

  14. Physicians' and nurses' perceptions of patient safety risks in the emergency department.

    Källberg, Ann-Sofie; Ehrenberg, Anna; Florin, Jan; Östergren, Jan; Göransson, Katarina E


    The emergency department has been described as a high-risk area for errors. It is also known that working conditions such as a high workload and shortage off staff in the healthcare field are common factors that negatively affect patient safety. A limited amount of research has been conducted with regard to patient safety in Swedish emergency departments. Additionally, there is a lack of knowledge about clinicians' perceptions of patient safety risks. Therefore, the purpose of this study was to describe emergency department clinicians' experiences with regard to patient safety risks.

  15. The role of ICT in supporting disruptive innovation: a multi-site qualitative study of nurse practitioners in emergency departments.

    Li, Julie; Westbrook, Johanna; Callen, Joanne; Georgiou, Andrew


    The disruptive potential of the Nurse Practitioner (NP) is evident in their ability to offer services traditionally provided by primary care practitioners and their provision of a health promotion model of care in response to changing health trends. No study has qualitatively investigated the role of the Emergency NP in Australia, nor the impact of Information and Communication Technology (ICT) on this disruptive workforce innovation. This study aimed to investigate ways in which Nurse Practitioners (NP) have incorporated the use of ICT as a mechanism to support their new clinical role within Emergency Departments. A cross-sectional qualitative study was undertaken in the Emergency Departments (EDs) of two large Australian metropolitan public teaching hospitals. Semi-structured, in-depth interviews were conducted with five nurse practitioners, four senior physicians and five senior nurses. Transcribed interviews were analysed using a grounded theory approach to develop themes in relation to the conceptualisation of the ED nurse practitioner role and the influences of ICT upon the role. Member checking of results was achieved by revisiting the sites to clarify findings with participants and further explore emergent themes. The role of the ENP was distinguished from those of Emergency nurses and physicians by two elements: advanced practice and holistic care, respectively. ICT supported the advanced practice dimension of the NP role in two ways: availability and completeness of electronic patient information enhanced timeliness and quality of diagnostic and therapeutic decision-making, expediting patient access to appropriate care. The ubiquity of patient data sourced from a central database supported and improved quality of communication between health professionals within and across sites, with wider diffusion of the Electronic Medical Record holding the potential to further facilitate team-based, holistic care. ICT is a facilitator through which the disruptive

  16. Exploration of Nursing Disputes in Emergency Department%急诊科护理纠纷探析



    Objective:To summarize the causes of nursing dispute in Emergency Department and to provide precautions. Methods:Based on the service attitude and operation skills, this paper analyses the cause of nursing dispute and provides precautions. Results:Nursing quality and relationship between nurse and patient were improved; meanwhile, nursing disputes decreased dramatically. Conclusion:The improvement of nurse theory, morality and professional skill is an effective way to avoid nursing disputes.%目的:对急诊科发生护理纠纷的原因进行总结,整理出护理纠纷的防范措施。方法:从服务态度、操作技能等方面分析护理纠纷发生的原因,针对性的采取防范措施。结果:护理服务水平和质量得到提升,护患关系改善,护理投诉明显下降。结论:完善急诊科护士理论、伦理及操作培训,提高护理人员从业技能,是预防护理纠纷发生的关键。

  17. Emergency department patient satisfaction: customer service training improves patient satisfaction and ratings of physician and nurse skill.

    Mayer, T A; Cates, R J; Mastorovich, M J; Royalty, D L


    Customer service initiatives in healthcare have become a popular way of attempting to improve patient satisfaction. This study investigates the effect of clinically focused customer service training on patient satisfaction in the setting of a 62,000-visit emergency department and level I trauma center. Analysis of patient complaints, patient compliments, and a statistically verified patient-satisfaction survey indicate that (1) all 14 key quality characteristics identified in the survey increased dramatically in the study period; (2) patient complaints decreased by over 70 percent from 2.6 per 1,000 emergency department (ED) visits to 0.6 per 1,000 ED visits following customer service training; and (3) patient compliments increased more than 100 percent from 1.1 per 1,000 ED visits to 2.3 per 1,000 ED visits. The most dramatic improvement in the patient satisfaction survey came in ratings of skill of the emergency physician, likelihood of returning, skill of the emergency department nurse, and overall satisfaction. These results show that clinically focused customer service training improves patient satisfaction and ratings of physician and nurse skill. They also suggest that such training may offer a substantial competitive market advantage, as well as improve the patients' perception of quality and outcome.

  18. Nurse-administered early warning score system can be used for emergency department triage

    Christensen, Dorthea; Jensen, Nanna Martin; Maaløe, Rikke;


    Studies have shown that early warning score systems can identify in-patients at high risk of catastrophic deterioration and this may possibly be used for an emergency department (ED) triage. Bispebjerg Hospital has introduced a multidisciplinary team (MT) in the ED activated by the Bispebjerg Early...

  19. The role of ICT in supporting disruptive innovation: a multi-site qualitative study of nurse practitioners in emergency departments

    Li Julie


    Full Text Available Abstract Background The disruptive potential of the Nurse Practitioner (NP is evident in their ability to offer services traditionally provided by primary care practitioners and their provision of a health promotion model of care in response to changing health trends. No study has qualitatively investigated the role of the Emergency NP in Australia, nor the impact of Information and Communication Technology (ICT on this disruptive workforce innovation. This study aimed to investigate ways in which Nurse Practitioners (NP have incorporated the use of ICT as a mechanism to support their new clinical role within Emergency Departments. Methods A cross-sectional qualitative study was undertaken in the Emergency Departments (EDs of two large Australian metropolitan public teaching hospitals. Semi-structured, in-depth interviews were conducted with five nurse practitioners, four senior physicians and five senior nurses. Transcribed interviews were analysed using a grounded theory approach to develop themes in relation to the conceptualisation of the ED nurse practitioner role and the influences of ICT upon the role. Member checking of results was achieved by revisiting the sites to clarify findings with participants and further explore emergent themes. Results The role of the ENP was distinguished from those of Emergency nurses and physicians by two elements: advanced practice and holistic care, respectively. ICT supported the advanced practice dimension of the NP role in two ways: availability and completeness of electronic patient information enhanced timeliness and quality of diagnostic and therapeutic decision-making, expediting patient access to appropriate care. The ubiquity of patient data sourced from a central database supported and improved quality of communication between health professionals within and across sites, with wider diffusion of the Electronic Medical Record holding the potential to further facilitate team-based, holistic care

  20. Optimal older adult emergency care: introducing multidisciplinary geriatric emergency department guidelines from the American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, and Society for Academic Emergency Medicine.

    Carpenter, Christopher R; Bromley, Marilyn; Caterino, Jeffrey M; Chun, Audrey; Gerson, Lowell W; Greenspan, Jason; Hwang, Ula; John, David P; Lyons, William L; Platts-Mills, Timothy F; Mortensen, Betty; Ragsdale, Luna; Rosenberg, Mark; Wilber, Scott


    In the United States and around the world, effective, efficient, and reliable strategies to provide emergency care to aging adults is challenging crowded emergency departments (EDs) and strained healthcare systems. In response, geriatric emergency medicine clinicians, educators, and researchers collaborated with the American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, and Society for Academic Emergency Medicine to develop guidelines intended to improve ED geriatric care by enhancing expertise, educational, and quality improvement expectations, equipment, policies, and protocols. These Geriatric Emergency Department Guidelines represent the first formal society-led attempt to characterize the essential attributes of the geriatric ED and received formal approval from the boards of directors of each of the four societies in 2013 and 2014. This article is intended to introduce emergency medicine and geriatric healthcare providers to the guidelines while providing recommendations for continued refinement of these proposals through educational dissemination, formal effectiveness evaluations, cost-effectiveness studies, and eventually institutional credentialing. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

  1. Capillary lactate as a tool for the triage nurse among patients with SIRS at emergency department presentation: a preliminary report.

    Manzon, Cyril; Barrot, Loïc; Besch, Guillaume; Barbot, Olivier; Desmettre, Thibaut; Capellier, Gilles; Piton, Gaël


    The triage nurse is involved in the early identification of the most severe patients at emergency department (ED) presentation. However, clinical criteria alone may be insufficient to identify them correctly. Measurement of capillary lactate concentration at ED presentation may help to discriminate these patients. The primary objective of this study was to identify the prognostic value of capillary lactate concentration measured by the triage nurse among patients presenting to the ED. This was a prospective observational study, performed in the ED of a university hospital. At ED presentation, capillary lactate measurement was performed by the triage nurse among patients presenting with a clinical criteria of systemic inflammatory response syndrome (SIRS). Clinical variables usually used to determine severity were collected at presentation. Twenty-eight-day mortality and MEDS score were recorded. One hundred seventy-six patients with clinical SIRS presented to the ED. Median age was 72 years, and 28-day mortality was 16%. Capillary lactate at ED presentation was significantly higher among 28-day non-survivors than among survivors (5.7 mmol.L(-1) [3.2 to 7.4] vs 2.9 mmol.L(-1) [1.9 to 5.2], p = 0.003). A score based on mottling and capillary lactate concentration >3.6 mmol.L(-1) was significantly associated with 28-day mortality (area under curve, AUC = 0.75), independently of the MEDS score (AUC = 0.79) for the prediction of 28-day mortality (AUC global model 0.87). A high capillary lactate concentration measured by the triage nurse among patients presenting to the ED with clinical SIRS is associated with a high risk of death. A score calculated by the triage nurse, based on mottling and capillary lactate concentration, appears to be useful for identifying the most severe patients.

  2. 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.

    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


    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.

  3. Geriatric Nursing Assessment and Intervention in an Emergency Department – a Pilot Study

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


    : At discharge, and at 1 and 6 month 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...... 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 0...

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

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


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

  5. The Adequacy of Nurse Staffing in the Emergency Department When Patient Acuity is a Consideration


    some 40 pieces of patient classification literature, and in 1976 it was likely that the number had tripled (Giovannetti, 1979). Today the literature...generally require a second nurse initially and are detained for observation or admitted. Examples include: acute asthma, COPD ; threatened, incomplete, or

  6. Quality of work life and its association with workplace violence of the nurses in emergency departments.

    Eslamian, Jalil; Akbarpoor, Ali Akbar; Hoseini, Sayed Abbas


    Nurses as the major group of health service providers need to have a satisfactory quality of work life in order to give desirable care to the patients. Workplace violence is one of the most important factors that cause decline in the quality of work life. This study aimed to determine the quality of work life of nurses in selected hospitals of Isfahan University of Medical Sciences and its relationship with workplace violence. This was a descriptive-correlational study. A sample of 186 registered nurses was enrolled in the study using quota sampling method. The research instrument used was a questionnaire consisting of three parts: Demographic information, quality of work life, and workplace violence. Collected data were analyzed using descriptive and inferential statistics by SPSS version 16. The subjects consisted of 26.9% men and 73.1% women, whose mean age was 33.76 (7.13) years. 29.6% were single and 70.4% were married. About 76.9% of the subjects were exposed to verbal violence and 26.9% were exposed to physical violence during past year. Mean score of QNWL was 115.88 (30.98). About 45.7% of the subjects had a low level of quality of work life. There was an inverse correlation between the quality of work and the frequency of exposures to workplace violence. According to the results of this study, it is suggested that the managers and decision makers in health care should plan strategies to reduce violence in the workplace and also develop a program to improve the quality of work life of nurses exposed to workplace violence.

  7. Fire Department Emergency Response

    Blanchard, A. [Westinghouse Savannah River Company, AIKEN, SC (United States); Bell, K.; Kelly, J.; Hudson, J.


    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.

  8. A comparison of adherence to correctly documented triage level of critically ill patients between emergency department and the ambulance service nurses.

    Jönsson, Kenneth; Fridlund, Bengt


    Priority or triage has always occurred in emergency care. Today it is performed by both nurses in emergency departments (EDs) and ambulance services (ASs) to ensure patient safety. Recent studies have shown that nurses are unlikely to change their first impressions and patients suffering from blunt trauma are undertriaged. Our study aimed to compare and evaluate the adherence to correct triage level documentation, between nurses in the ED and the AS, according to current regulations. Of 592 analysed triage records from a university, a central and a district hospital, the adherence was 64% by ED nurses and 43% by AS nurses (pnurses do not adhere to the triage system and do not correctly document the triage level. Internal feedback and control are two approaches to improve the patient outcome, indicating that organisational actions must be taken.

  9. Nursing Assessment and Intervention to Geriatric Patients Discharged from Emergency Departments

    Rosted, Elizabeth Emilie; Poulsen, Ingrid; Hendriksen, Carsten


    relevant referrals to geriatric outpatient clinic, community health centre, primary physician or arrangements with next-of-kin. Findings: 150 geriatric patients participated, mean age 81.7 (70-99). At discharge they had in mean 2 164 (0-9) unresolved problems, after 1 month 0.8 (0-5), and after 6 months 0.......5 (0-4). Before baseline ED visit 85 % of the patients received home care services, 1 and 6 months after discharge it was 96 %. Relevance to clinical practice: Structured nursing assessment and intervention in the ED could be a way of discovering geriatric patients’ unresolved problems and preventing...

  10. 优质护理服务在急诊科的应用效果探究%Application Effect of High Quality Nursing Service in Emergency Department



    Objective To study application effect of high quality nursing service in emergency department .Methods 344 cases patients with emergency treatment were divided into observation group and control group , control group given emergency department routine nursing care , observation group given high quality nursing service .Nursing quality and pa-tient satisfaction were compared .Results Observation group nursing quality , patient satisfaction were significantly high-er than control group .Conclusions High quality nursing service can improve the quality of nursing and patients satisfac -tion.%目的:探讨优质护理服务在急诊科的应用效果。方法选取344例急诊患者为研究对象,采用数字表法随即分为观察组和对照组,对照组实施急诊科常规护理,观察组开展优质护理服务。比较两组护理质量及患者满意度。结果观察组护理质量、患者满意度均明显高于对照组。结论优质护理服务可提升急诊科护理质量,提高患者满意度,值得在临床护理工作中的推广应用。

  11. The emergency department medical director.

    Mayer, T A


    This article has presented an overview of the duties, responsibilities, and management roles of the emergency department Medical Director, a position that can be among the most challenging, stimulating, and exciting in medicine. However, prior to accepting a position as an Emergency Department medical director, one should have a clear understanding of what the job entails. Careful discussions with the hospital administration, medical staff, nursing personnel, and staff emergency physicians should be undertaken to learn the perceptions of these people and expectations of the position. Once the job has been accepted, using the roles, responsibilities, and duties detailed herein may be of benefit--but should always be applied with good judgment, tactful cooperation, and common sense. Finally, it should not be surprising to a medical director to find, as Spinoza did many years ago, that the excellent thing he aspires to are as difficult as they are rare.

  12. Rethinking emergency department visits.

    Resar, Roger K; Griffin, Frances A


    Efforts to date have been unable to reverse the trend of increased emergency department utilization. The Institute for Healthcare Improvement has developed a framework for reducing avoidable emergency department visits on the basis of the formation of local coalitions. These coalitions include interested partners approaching improvement by integrating community resources and nonmedical solutions. Targeted patient populations are identified via homogeneous characteristics. Open-ended interview questions are used to identify possible community and nonmedical solutions to complement medical strategies. This article describes the framework and process of testing. If validated, this approach will have significant policy implications.

  13. The accuracy of nurse performance of the triage process in a tertiary hospital emergency department in Gauteng Province, South Africa.

    Goldstein, L N; Morrow, L M; Sallie, T A; Gathoo, K; Alli, K; Mothopeng, T M M; Samodien, F


    Triage in the emergency department (ED) is necessary to prioritise management according to the severity of a patient's condition.The South African Triage Scale (SATS) is a hospital-based triage tool that has been adopted by numerous EDs countrywide.Many factors can influence the outcome of a patient's triage result, and evaluation of performance is therefore pivotal. To determine how often patients were allocated to the correct triage category and the extent to which they were incorrectly promoted or demoted, and to determine the main reasons for errors in a nurse-led triage system. Triage forms from a tertiary hospital ED in Gauteng Province, South Africa, were collected over a 1-week period and reviewed retrospectively. A total of 1 091 triage forms were reviewed. Triage category allocations were correct 68.3% of the time. Of the incorrect category assignments, 44.4% of patients were promoted and 55.6% demoted. Patients in the green category were most commonly promoted (29.4%) and patients who should have been in orange were most commonly demoted (35.0%). Trauma patients were more likely to be incorrectly promoted and non-trauma patients to be incorrectly demoted. Mistakes were mainly due to discriminator errors (57.8%), followed by numerical miscalculations (21.5%). The leading omitted discriminators were 'abdominal pain', 'chest pain' and 'shortness of breath'. Mis-triaging using the SATS can be attributed to incorrect or lack of discriminator use, numerical miscalculations and other human errors. Quality control and quality assurance measures must target training in these areas to minimise mis-triage in the ED.

  14. The accuracy of nurse performance of the triage process in a tertiary hospital emergency department in Gauteng Province, South Africa

    L N Goldstein


    Full Text Available Background. Triage in the emergency department (ED is necessary to prioritise management according to the severity of a patient’s condition.The South African Triage Scale (SATS is a hospital-based triage tool that has been adopted by numerous EDs countrywide.Many factors can influence the outcome of a patient’s triage result, and evaluation of performance is therefore pivotal. Objectives. To determine how often patients were allocated to the correct triage category and the extent to which they were incorrectly promoted or demoted, and to determine the main reasons for errors in a nurse-led triage system. Methods. Triage forms from a tertiary hospital ED in Gauteng Province, South Africa, were collected over a 1-week period and reviewed retrospectively. Results. A total of 1 091 triage forms were reviewed. Triage category allocations were correct 68.3% of the time. Of the incorrect category assignments, 44.4% of patients were promoted and 55.6% demoted. Patients in the green category were most commonly promoted (29.4% and patients who should have been in orange were most commonly demoted (35.0%. Trauma patients were more likely to be incorrectly promoted and non-trauma patients to be incorrectly demoted. Mistakes were mainly due to discriminator errors (57.8%, followed by numerical miscalculations (21.5%. The leading omitted discriminators were ‘abdominal pain’, ‘chest pain’ and ‘shortness of breath’. Conclusions. Mis-triaging using the SATS can be attributed to incorrect or lack of discriminator use, numerical miscalculations and other human errors. Quality control and quality assurance measures must target training in these areas to minimise mis-triage in the ED.

  15. Qualitative Inquiry into Challenges Experienced by Registered General Nurses in the Emergency Department: A Study of Selected Hospitals in the Volta Region of Ghana

    Adatara, Peter


    Registered General Nurses (RGNs) play crucial roles in emergency departments (EDs). EDs in Ghana are primarily staffed by RGNs who have had no additional formal education in emergency care. Additionally, basic, master's, or doctoral level nursing education programs provide limited content on the complexities of emergency nursing. Nurses in EDs are affected by many challenges such as growing patient population, financial pressures, physical violence, verbal abuse, operational inefficiencies, overcrowding, and work overload. There is a paucity of research on challenges experienced by RGNs in EDs in the Volta Region of Ghana. In this qualitative study, twenty RGNs in EDs from three selected hospitals in the Volta Region of Ghana were interviewed. All recorded interviews were transcribed, reviewed several times by researchers and supervisors, and analyzed using content analysis. Five thematic categories were identified. These thematic categories of challenges were lack of preparation for ED role, verbal abuse from patients relatives, lack of resources in ED, stressful and time consuming nature of ED, and overcrowding in ED. Formal education of RGNs in the advanced role of emergency care, adequate supply of resources, increased hospital management support, and motivations for RGNs working in ED are necessary to improve the practice of emergency care. PMID:27885343

  16. 急诊科新护士焦虑状况的调查分析%Survey in anxiety status of new nurses in emergency department

    许丽春; 林链凤


    目的 调查分析急诊科新护士的焦虑状况,为护理管理提供参考依据.方法 采用Zung焦虑自评量表(self-rating anxiety scale,SAS)及自行设计的问卷,对厦门市2家三甲综合医院的32名急诊科新护士(经过转科来院工作时间不足2年的护士)的焦虑状况及相关因素进行了测评. 结果急诊科新护士的SAS总分均值与常模(中国正常人群)SAS均分比较有显著差异.急诊科新护士中,大专和本科学历SAS均分无显著差异,不同工作年限的急诊科新护士SAS均分有显著差异.结论 急诊科新护士的焦虑情况较严重,建议护理管理者应重视新护士的心理健康和加强培养新护士的心理素质等,缓解急诊科新护士的焦虑心理.%Objective To describe the anxiety status of new nurses in emergency department so as to put forward strategies for nursing management. Methods Thirty-two new nurses (working time less than 2 years) from emergency department of two class Ⅲ- A general hospitals in Xiamen were surveyed by using Zung self-rating anxiety scale (SAS). Results The average of SAS total score showed significant difference from that of the Chinese norm, but no significant difference could be seen in the score of SAS be-tween college and baccalaureate nurses.Nurses with different working length showed significant difference in SAS score. Conclusions Anxiety status of new nurses in emergency department is serious, nursing man-agers should make more efforts to conduct mental health education and improve psychological quality of new nurses in emergency department to relieve their anxiety.

  17. Emergency Nurses Association

    ... TNCC TNCC 1-Day Renewal ENPC CEN Online Review Course ADVANTICE Free CE Emergency Nursing 2017 CNE Application and Approval Process Partner Products Government Relations Public Policy Agenda Federal News EN411 Practice Resources Resource ...

  18. 急诊科实施优质护理服务的体会%Experience of implementing high quality nursing service in emergency department



    目的:探讨优质护理服务在我院急诊科的实施方法及效果。方法:针对急诊科的特点,将“以人为本,以病人为中心”的服务理念融入到对患者的护理服务中。加强对护理人员管理,强化专科知识、急救技能培训,提高护士的业务水平,转变服务理念,改变护理工作模式,明确岗位职责,弹性排班,严格护理人员绩效考核,细化满意度调查。保持绿色通道的畅通、实行急危重症患者“先抢救,后交费”的抢救原则。落实急诊患者无缝隙管理模式以优化就诊、服务流程,优化就诊环境,进行人性化管理等。结果:急诊护理工作质量明显提高,患者及医生对本科室护理工作的满意度也明显提高。结论:在急诊科实施优质护理服务,提高了护理人员工作积极性,提升了护士的整体素质,减少护患纠纷,营造良好的人文服务氛围,构建和谐护患关系,取得了患者满意、医院满意、政府满意、社会满意的良好效果。%Objective: To explore the implementation methods and effect of high quality nursing service in the emergency department of our hospital. Methods: according to the characteristics of emergency department, the concept of “people oriented, patient centric” service was integrated into the care of patients. Moreover, Enhance the management of nursing personnel, strengthen specialty knowledge and training on first aid skills, improve the professional skill of nurses, change the service concept and the nursing work mode, clear responsibilities, keep flexible scheduling and strict performance appraisal of nursing staff, and refine the satisfaction survey.Keep the Easy Access unimpeded, and implement the principle of “rescue first and payment second” for critically ill patients. Implement the seamless management mode of emergency patients to optimize the treatment and service processes, improve the treatment

  19. Nurse Staffing Calculation in the Emergency Department - Performance-Oriented Calculation Based on the Manchester Triage System at the University Hospital Bonn.

    Ingo Gräff

    Full Text Available To date, there are no valid statistics regarding the number of full time staff necessary for nursing care in emergency departments in Europe.Staff requirement calculations were performed using state-of-the art procedures which take both fluctuating patient volume and individual staff shortfall rates into consideration. In a longitudinal observational study, the average nursing staff engagement time per patient was assessed for 503 patients. For this purpose, a full-time staffing calculation was estimated based on the five priority levels of the Manchester Triage System (MTS, taking into account specific workload fluctuations (50th-95th percentiles.Patients classified to the MTS category red (n = 35 required the most engagement time with an average of 97.93 min per patient. On weighted average, for orange MTS category patients (n = 118, nursing staff were required for 85.07 min, for patients in the yellow MTS category (n = 181, 40.95 min, while the two MTS categories with the least acute patients, green (n = 129 and blue (n = 40 required 23.18 min and 14.99 min engagement time per patient, respectively. Individual staff shortfall due to sick days and vacation time was 20.87% of the total working hours. When extrapolating this to 21,899 (2010 emergency patients, 67-123 emergency patients (50-95% percentile per month can be seen by one nurse. The calculated full time staffing requirement depending on the percentiles was 14.8 to 27.1.Performance-oriented staff planning offers an objective instrument for calculation of the full-time nursing staff required in emergency departments.

  20. Factors affecting communication in emergency departments: doctors and nurses' perceptions of communication in a trilingual ED in Hong Kong.

    Pun, Jack K H; Matthiessen, Christian M I M; Murray, Kristen A; Slade, Diana


    This study investigates clinicians' views of clinician-patient and clinician-clinician communication, including key factors that prevent clinicians from achieving successful communication in a large, high-pressured trilingual Emergency Department (ED) in Hong Kong. Researchers interviewed 28 doctors and nurses in the ED. The research employed a qualitative ethnographic approach. The interviews were audio-recorded, transcribed, translated into English and coded using the Nvivo software. The researchers examined issues in both clinician-patient and clinician-clinician communication. Through thematic analyses, they identified the factors that impede communication most significantly, as well as the relationship between these factors. This research highlights the significant communication issues and patterns in Hong Kong EDs. The clinician interviews revealed that communication in EDs is complex, nuanced and fragile. The data revealed three types of communication issues: (1) the experiential parameter (i.e. processes and procedures), (2) the interpersonal parameter (i.e. clinicians' engagements with patients and other clinicians) and (3) contextual factors (i.e. time pressures, etc.). Within each of these areas, the specific problems were the following: compromises in knowledge transfer at key points of transition (e.g. triage, handover), inconsistencies in medical record keeping, serious pressures on clinicians (e.g. poor clinician-patient ratio and long working hours for clinicians) and a lack of focus on interpersonal skills. These communication problems (experiential, interpersonal and contextual) are intertwined, creating a complex yet weak communication structure that compromises patient safety, as well as patient and clinician satisfaction. The researchers argue that hospitals should develop and implement best-practice policies and educational programmes for clinicians that focus on the following: (1) understanding the primary causes of communication problems in

  1. Job burnout and coping strategies of nurses in Emergency Department%急诊科护士职业倦怠调查及应对策略

    王丽容; 肖七秀; 罗慧娟; 尹娜; 欧婵娟


    Objective To investigate occupation burnout of nurses in Emergency Department of the Sixth People's Hos-pital in Huizhou City (“our hospital”for short), in order to put forward the coping strategies. Methods The Maslach job burnout scale was selected. Adopting self reporting form from the "emotional exhaustion", "low personal accomplish-ment", "depersonalization" three aspects to investigate the job burnout of 280 nurses from Emergency and Surgery De-partment, Internal Medicine Department, Pediatrics Department, Obstetrics and Gynecology Department of our hospital, which included 5 items in emotional exhaustion, 11 points below was low, 11-15 points was moderate, above 15 points was high; individual low sense of achievement included 6 items, 18 points below was low, 18-22 points was medium, above 22 points was high;depersonalization contained 5 items, 8 points below was low, 8-12 above was medium, above 12 points was high. The investigation results were recorded and compared between nurses in the Emergency Depart-ment and other departments. Results 56 Emergency Department nurses were investigated, high score of emotional ex-haustion in 25 cases (44.64%);high score of low personal accomplishment in 34 cases (60.71%);high score of deper-sonalization in 32 cases (57.14%). Scores of emotional exhaustion, low personal accomplishment, depersonalization in the Emergency Department nurses were significantly higher than the other departments nurse, the differences were sta-tistically significant (P< 0.05). Conclusion Because of Emergency Department nurses in special working environment and other factors, led to their occupation burnout is significantly higher than other departments nurses. Emergency nursing staffs should take positive attitude to deal with, the hospital leaders should use effective solving measures, elim-inate the occupation burnout of nurses in Emergency Department, to promote of nursing level.%目的:调查广东省惠州市第六人民医院(以

  2. The Clinical Effect of Quality Nursing Service in Emergency Department%优质护理服务在急诊科中的临床效果

    綦甲清; 陈书艳


    Objective To investigate the effect of the application of quality care in the emergency department. Methods Select 160 cases who were treated in emergency patients, which were randomly divided into two groups, the patients in the observation group were given high quality nursing service,the control group were given routine nursing care,compared two groups of patients with nursing effect.Results Patients in the observation group SAS, SDS scores were lower than the control group,and the nursing satisfaction was higher than that of the control group, the differences were statisticaly significant(P<0.05).Conclusion The clinical application effect of high quality nursing service in patients in emergency department were.%目的 探讨优质护理服务在急诊科中的临床效果.方法 选取急诊科收治的160例患者,将其采用随机数字表法分为两组,观察组患者给予优质护理服务,对照组患者给予常规护理服务,比较两组患者的护理效果.结果 观察组患者 SAS、SDS 评分均低于对照组,且护理满意度高于对照组,差异均有统计学意义(均 P<0.05).结论 急诊科患者应用优质护理服务的临床效果明显.

  3. Evaluation of Physicians' and Nurses' Knowledge, Attitudes, and Compliance With Family Presence During Resuscitation in an Emergency Department Setting After an Educational Intervention.

    Ferrara, Gineen; Ramponi, Denise; Cline, Thomas W


    Family presence during resuscitation (FPDR) has been an ongoing topic of discussion in many hospital emergency departments throughout the United States. With the current emphasis promoting patient- and family-centered care, families are now exercising their right to be present at the bedside during resuscitation. With or without a policy, there is continued resistance to allow families to remain with their loved ones during resuscitation. The purpose of this study was to evaluate if an evidence-based educational intervention would increase physicians' and nurses' knowledge, attitudes, and compliance with allowing FPDR. This quasi-experimental study evaluated 30 attending physicians' and 65 registered nurses' knowledge of an existing family presence policy and their attitudes toward family presence post-educational intervention in an emergency department setting. Compliance of family presence was observed for 2 months pre- and post-educational intervention. Results show that most physicians and nurses either were not sure or were not aware that there was an existing written policy. The study demonstrated that nurses agree more than physicians that the option of FPDR is a patient/family right. The results also showed that the educational intervention had no effect on the physicians and nurses attitudes for FPDR, but it did change behaviors. Of the events involving professionals who were exposed to the educational intervention, family members were present 87.5% of the time. In contrast, only 23% of the events involving professionals who did not receive the educational intervention had families present. Ongoing staff education will heighten awareness to FPDR, make the staff more comfortable with families being present, and will presumably continue to increase invitations for FPDR.

  4. Relationships among moral distress, level of practice independence, and intent to leave of nurse practitioners in emergency departments: results from a national survey.

    Trautmann, Jennifer; Epstein, Elizabeth; Rovnyak, Virginia; Snyder, Audrey


    The aims of this research study were to investigate moral distress among emergency department (ED) nurse practitioners (NPs) and examine relationships between moral distress and level of practice independence as well as intent to leave a position. Moral distress has been studied regarding registered nurses and physicians (MDs) but less so in NPs. It is important to explore moral distress in NPs because they tread a unique path between nursing and physician roles. Moral distress may play a significant role in staff nurses' intention to leave practice, and level of practice independence is found to have a relationship with NPs' intention to leave. A convenience sample of ED NPs was obtained from a mailing list of a national nursing specialty organization, the Emergency Nurses Association. Using a correlational design, survey methods assessed moral distress with the Moral Distress Scale-Revised (MDS-R), level of practice independence with the Dempster Practice Behavior Scale, and intent to leave with self-report. Correlational and regression analyses of data were conducted to characterize moral distress among ED NPs and associations between moral distress, level of practice independence, and intent to leave. Results found ED NPs do experience moral distress with poor patient care results from inadequate staff communication and working with incompetent coworkers in their practice. The MDS-R was a significant predictor of intention to leave among respondents. This study is the first of its kind to explore moral distress in ED NPs. Results suggest moral distress influences ED NPs' intent to leave their position. Further studies are needed to explore the findings from this research and to formulate interventions to alleviate moral distress in ED NPs and improve retention in the clinical setting.

  5. Hypoglycemia in Emergency Department

    Yu-Jang Su; Chia-Jung Liao


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

  6. Exploration and Practice of Good Quality Nursing Service in Emergency Department%急诊科优质护理服务的实施及效果

    赖兰静; 张慧; 廖云英; 黄谭招


    目的:探讨急诊科实施优质护理服务的方法与取得的成效。方法针对急诊科特点,开展优质护理服务,转变护理服务理念,改变工作模式和排班方式,加强护患沟通,优化急诊工作流程,开启急诊绿色通道,强化急救技能培训,改善硬件设施,实行弹性排班和责任制整体护理。结果患者的护理满意率、健康教育知晓率、就诊流程满意率、巡视病人满意率、治疗护理满意率、病室管理满意率及陪检率均比较高。结论在急诊科实施优质护理服务,有利于提高护理质量和患者对护理工作的满意度,同时可激发护士的最大潜能。%Objective To investigate the methods and the results of good quality nursing service in emergency department .Methods According to the characteristics of emergency department , carrying out good quality nursing service , changing service concept and the work schedule, optimizing workflow, opening convenient access , mastering the aid skills, improving the hardware facilities , and implementing humane scheduling and overall good care .Results The patients and their families′attitude toward service satisfaction , treatment process satisfaction, health education awareness , infusion district patrol satisfaction , treatment and care satisfaction , management satisfaction and ward accompany detection rate has improved significantly .Conclusion The implementation of good quality nursing service in emergency department will help to improve the quality of care and patients′satisfaction of nursing work , and inspire the greatest potential nurses .

  7. 急诊科护士共情能力培训效果研究%Effects of empathy capacity training in nurses of emergency department

    谢晓梅; 杨大金; 孔悦; 张静; 曾忆恋


    目的 探讨急诊科护士共情能力的培训效果.方法 通过共情理论知识与技能的培训,使用中文版杰弗逊共情量表对21名参加共情能力培训的急诊科护士进行调查.结果 参加共情能力培训后急诊科护士共情能力得分与患者就诊满意度均高于培训前,差异具有统计学意义(P<0.01或P<0.05).结论 通过培训,急诊科护士共情能力的增强和技能的提高能促进护患沟通,促进良好护患关系的建立和发展.%Objective To discuss the effects of empathy capacity training in nurses of emergency department. Methods A total of 21 muses in emergency department were enrolled. Empathy capacity training was implemented and " Chinese version of the Jefferson Scale of Empathy Health Professionals" was employed. Results Nurses'empathy capacity and the score of patients' satisfaction were increased after the training, the differences were statistically significant (P < 0.01 or P < 0.05). Conclusion Through the training,the promotion of empathy capacity and skills can facilitate the communication between nurses and patients, and enhance the development of good nurse - patient relationship.

  8. Emergency teams in Danish emergency departments

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


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

  9. Emergency Department Management of Trauma

    MacKenzie, Colin; Lippert, Freddy


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

  10. Emergency Department Management of Trauma

    MacKenzie, Colin; Lippert, Freddy


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

  11. Virtually Nursing: Emerging Technologies in Nursing Education.

    Foronda, Cynthia L; Alfes, Celeste M; Dev, Parvati; Kleinheksel, A J; Nelson, Douglas A; OʼDonnell, John M; Samosky, Joseph T

    Augmented reality and virtual simulation technologies in nursing education are burgeoning. Preliminary evidence suggests that these innovative pedagogical approaches are effective. The aim of this article is to present 6 newly emerged products and systems that may improve nursing education. Technologies may present opportunities to improve teaching efforts, better engage students, and transform nursing education.

  12. Nonurgent Use of the Emergency Department by Pediatric Patients: A Theory-Guided Approach for Primary and Acute Care Pediatric Nurse Practitioners.

    Ohns, Mary Jean; Oliver-McNeil, Sandra; Nantais-Smith, Leanne M; George, Nancy M


    Providing quality, cost-effective care to children and their families in the appropriate setting is the goal of nurse practitioners in primary and acute care. However, increased utilization of the emergency department (ED) for nonurgent care threatens cost-effective quality care, interrupts continuity of care, and contributes to ED overcrowding. To date, descriptive research has identified demographics of those using the ED for nonurgent care, the chief complaints of children seeking nonurgent care, the cost to the health care system of pediatric nonurgent care, and characteristics of associated primary care settings. Using Donabedian's Model of Quality of Healthcare and a Theory of Dependent Care by Taylor and colleagues, acute and primary care pediatric nurse practitioners can incorporate interventions that will channel care to the appropriate setting and educate caregivers regarding common childhood illnesses and the value of continuity of care. By using a theoretical framework as a guide, this article will help both acute and primary care pediatric nurse practitioners understand why parents seek nonurgent care for their children in the ED and actions they can take to ensure that care is provided in an optimal setting.

  13. Effects of emergency department expansion on emergency department patient flow.

    Mumma, Bryn E; McCue, James Y; Li, Chin-Shang; Holmes, James F


    Emergency department (ED) crowding is an increasing problem associated with adverse patient outcomes. ED expansion is one method advocated to reduce ED crowding. The objective of this analysis was to determine the effect of ED expansion on measures of ED crowding. This was a retrospective study using administrative data from two 11-month periods before and after the expansion of an ED from 33 to 53 adult beds in an academic medical center. ED volume, staffing, and hospital admission and occupancy data were obtained either from the electronic health record (EHR) or from administrative records. The primary outcome was the rate of patients who left without being treated (LWBT), and the secondary outcome was total ED boarding time for admitted patients. A multivariable robust linear regression model was used to determine whether ED expansion was associated with the outcome measures. The mean (±SD) daily adult volume was 128 (±14) patients before expansion and 145 (±17) patients after. The percentage of patients who LWBT was unchanged: 9.0% before expansion versus 8.3% after expansion (difference = 0.6%, 95% confidence interval [CI] = -0.16% to 1.4%). Total ED boarding time increased from 160 to 180 hours/day (difference = 20 hours, 95% CI = 8 to 32 hours). After daily ED volume, low-acuity area volume, daily wait time, daily boarding hours, and nurse staffing were adjusted for, the percentage of patients who LWBT was not independently associated with ED expansion (p = 0.053). After ED admissions, ED intensive care unit (ICU) admissions, elective surgical admissions, hospital occupancy rate, ICU occupancy rate, and number of operational ICU beds were adjusted for, the increase in ED boarding hours was independently associated with the ED expansion (p = 0.005). An increase in ED bed capacity was associated with no significant change in the percentage of patients who LWBT, but had an unintended consequence of an increase in ED boarding hours. ED expansion alone does

  14. Adherence to the guideline ‘Triage in emergency departments’ : A survey of Dutch emergency departments

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


    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. In 2004, a Dutch guideline Triage in emergency departments was developed. Triage is the first step performed by nurses when a pati

  15. Dissection and countermeasure of clinical nursing teaching dilemma emergency department in new period%新时期急诊科临床护理教学困境剖析与对策

    杨瑞; 徐莎莎; 张银玲; 潘梦婷


    Emergency department is an important department of clinical nursing teaching. Nowadays,due to the influence of various adverse factors,the clinical nursing teaching of emergency department is facing many difficulties. This essay mainly analyzed reasons of clinical nursing teaching dilemma emer-gency department and put forward corresponding countermeasures and specific improvement measures,to achieve the aims of enhancing the clinical nursing teaching quality of emergency department and cultivating qualified high - level nursing talents.%急诊科是临床护理教学重要科室。目前,由于各种不利因素影响,急诊科临床护理教学面临许多困难。本文着重分析了急诊科临床护理教学困境的原因,并提出相应的对策与具体改进措施,以达到提高急诊科临床护理教学质量,培养合格高层次护理人才的目的。

  16. 应用团体伦理决策培养急诊科护士的伦理决策能力%To Cultivate the Ethical Decision -making Capacity of Nurses of Emergency Department by Group Ethical Decision- making



    目的 提高急诊科护士的伦理决策能力.方法 通过伦理决策过程,由护理团体对以往在急诊救治中的护理困境作出最佳伦理决策.结果使护士知晓伦理相关的理论,掌握应对护理实践中的护理伦理困惑的方法,提高护理伦理决策能力.结论 通过应用团体伦理决策法,培养和提高急诊科护士的伦理决策能力,有效地减少了护患医疗纠纷.%Objective: To increase the ethical decision - making capacity of nurses of emergency department. Method: Optimal ethical decisions are made by nursing group s discussion of the experience gathered from past ethical predicaments in emergency nursing. Result; Nurses are equipped with relevant ethical theories, measures of coping with possible ethical predicaments in future nursing practice, and increased capacity of nursing ethical decision - making. Conclusion: The ethical decision - making capacity of nurses of emergency department has been cultivated and increased by the approach of group ethical decision - making, resulting in a decrease in medical disputes between nurses and doctors.

  17. Analysis of the Application of Nursing Language in the Communication Between Nurses and Patients in Emergency Department%护理语言美在门急诊护患沟通中的应用分析



    医院服务中的一个重要窗口就是急诊科,因为它能对医院的业务水平和精神文明有直接反映的作用,也代表了医院的形象。门急诊护士与患者的接触比较多,而这些患者在年龄、职业、性别、学历上就有所差异,因此有技巧地通过语言与患者进行沟通,就显得尤为必要。本文探究了护理语言美在门急诊护患沟通中的应用,希望可以帮助读者增加对该领域的认识。%An important window of hospital services is the emergency department,because it can directly reflect the level of the hospital's business and spiritual civilization,and also represents the image of the hospital. There is more contact between emergency nurses and patients,and these patients have differences in age,occupation,gender,education,so it is particularly necessary to communicate with patients through language skils. This paper explores the application of nursing language in the emergency nurse patient communication,hoping to help readers to increase awareness of the field.

  18. Impact of a modified nursing handover model for improving nursing care and documentation in the emergency department: A pre- and post-implementation study.

    Kerr, Debra; Klim, Sharon; Kelly, Anne-Maree; McCann, Terence


    The aim of this study was to evaluate whether implementation of a new nursing handover model led to improved completion of nursing care activities and documentation. A pre- and post-implementation study, using a survey and document audit, was conducted in a hospital ED in Melbourne. A convenience sample of nurses completed the survey at baseline (n = 67) and post-intervention (n = 59), and the audit was completed at both time points. Results showed significant improvements in several processes: handover in front of the patient (P post-intervention). Statistically significant improvements in the completion of two nursing care tasks and three documentation items were identified. The findings suggest that implementation of a new handover model improved completion of nursing care activities and documentation, and transfer of important information to nurses on oncoming shifts.

  19. The impact of nurse-driven targeted HIV screening in 8 emergency departments: study protocol for the DICI-VIH cluster-randomized two-period crossover trial.

    Leblanc, Judith; Rousseau, Alexandra; Hejblum, Gilles; Durand-Zaleski, Isabelle; de Truchis, Pierre; Lert, France; Costagliola, Dominique; Simon, Tabassome; Crémieux, Anne-Claude


    In 2010, to reduce late HIV diagnosis, the French national health agency endorsed non-targeted HIV screening in health care settings. Despite these recommendations, non-targeted screening has not been implemented and only physician-directed diagnostic testing is currently performed. A survey conducted in 2010 in 29 French Emergency Departments (EDs) showed that non-targeted nurse-driven screening was feasible though only a few new HIV diagnoses were identified, predominantly among high-risk groups. A strategy targeting high-risk groups combined with current practice could be shown to be feasible, more efficient and cost-effective than current practice alone. DICI-VIH (acronym for nurse-driven targeted HIV screening) is a multicentre, cluster-randomized, two-period crossover trial. The primary objective is to compare the effectiveness of 2 strategies for diagnosing HIV among adult patients visiting EDs: nurse-driven targeted HIV screening combined with current practice (physician-directed diagnostic testing) versus current practice alone. Main secondary objectives are to compare access to specialist consultation and how early HIV diagnosis occurs in the course of the disease between the 2 groups, and to evaluate the implementation, acceptability and cost-effectiveness of nurse-driven targeted screening. The 2 strategies take place during 2 randomly assigned periods in 8 EDs of metropolitan Paris, where 42 % of France's new HIV patients are diagnosed every year. All patients aged 18 to 64, not presenting secondary to HIV exposure are included. During the intervention period, patients are invited to fill a 7-item questionnaire (country of birth, sexual partners and injection drug use) in order to select individuals who are offered a rapid test. If the rapid test is reactive, a follow-up visit with an infectious disease specialist is scheduled within 72 h. Assuming an 80 % statistical power and a 5 % type 1 error, with 1.04 and 3.38 new diagnoses per 10,000 patients in

  20. Analysis on Reason of Nurses in Emergency Department Experiencing Violence%急诊科护理人员遭受暴力事件原因分析



    Objective: To provide evidence for intervention measures in the prevention of hospital violence by exploring main reasons of nurses in emergency department suffering from violence. Method: We had analyzed different reasons of nurses in emergency department suffering from violence and put forward to corresponding measures. Result: Hospital violence resulted from service quality, communication skills, high cost. Violence mostly happened at 10:00-14:00 am, 21:00-23:00 pm. The ways of violence were threat, abuse, intentional damage to property and physical violence; Nurses would feel wronged, depressed and anxious, suffering from insomnia and didn't want to work. Conclusion: Incidence of workplace violence is related to the following factors: service quality, communication skill, hospital environment and cost.%目的:探讨急诊科护理人员遭受暴力的主要原因,为预防医院暴力制定干预措施提供依据.方法:分析急诊科护士遭受暴力侵袭的各种原因,并提出应对防范措施.结果:暴力事件发生的主要危险因素依次为病人(或家属)的要求未得到满足、就诊时间过长、服务意识不够、沟通能力差、医疗费用过高等.暴力事件多发生在中午10:00~14:00,上半夜21:00~23:00.暴力事件的发生方式从高到低依次为肢体暴力威胁、辱骂、故意损坏财物、肢体暴力.护理人员遭受暴力事件后产生委屈、抑郁、焦虑、失眠、不想继续从事护理工作等情绪.结论:发生工作场所暴力与护士的服务质量、沟通技巧、医院的就诊环境不理想、医疗费用等因素有关.

  1. Application Experience of Performance Assessment in the Nursing Manage-ment in the Department of Emergency%绩效考核在急诊科护理管理中的应用体会



    In the nursing management, performance assessment is one of the most important contents of management, the scientific implementation of performance assessment in the nursing management in the department of emergency contributes to improving the work initiative and creativity of nursing staff and improving the responsibilities of nursing staff when they implement the nursing service, thus ensuring the nursing quality in the department of emergency, in addition, the imple-mentation of performance assessment in the nursing management in the department of emergency is conducive to further standardizing the nursing technical operation and ensuring the standardized and programmatic implementation of various nursing work. The paper comprehensively analyzes the application of performance assessment in the nursing management in the department of nursing on the basis of the performance assessment condition in the nursing management in the depart-ment of emergency in our hospital.%在护理管理中,绩效考核属于管理中非常重要的一项内容,在急诊科护理管理中科学的实施绩效考核,有助于护理人员工作主动性以及创造力的提升,提升护理人员实施护理服务时的责任心,从而能够使急诊科护理质量得到保证。除此之外,在急诊科护理管理中实施绩效考核,有利于使护理技术操作得到进一步规范,保证各项护理工作实施规范化、程序化。该文主要以该院急诊科护理管理中的绩效考核情况为基础,综合分析了绩效考核在急诊科护理管理中的应用。

  2. Hand washing frequency in an emergency department.

    Meengs, M R; Giles, B K; Chisholm, C D; Cordell, W H; Nelson, D R


    Objectives Previous studies, conducted mainly in ICUs, have shown low compliance with hand-washing recommendations, with failure rates approaching 60%. Hand washing in the emergency department has not been studied. We examined the frequency and duration of hand washing in one emergency department and the effects of three variables: level of training, type of patient contact (clean, dirty, or gloved), and years of staff clinical experience. Design Observational. Setting ED of a 1100-bed tertiary referral, central city, private teaching hospital. Participants Emergency nurses, faculty, and resident physicians. Participants were informed that their activities were being monitored but were unaware of the exact nature of the study. Interventions An observer recorded the number of patient contacts and activities for each participant during 3-hour observation periods. Activities were categorized as either clean or dirty according to a scale devised by Fulkerson. The use of gloves was noted and hand-washing technique and duration were recorded. A hand-washing break in technique was defined as failure to wash hands after a patient contact and before proceeding to another patient or activity. Results Eleven faculty, 11 resident physicians, and 13 emergency nurses were observed. Of 409 total contacts, 272 were clean, 46 were dirty, and 91 were gloved. Hand washing occurred after 32.3% of total contacts (SD, 2.31%). Nurses washed after 58.2% of 146 contacts (SD, 4.1%), residents after 18.6% of 129 contacts (SD, 3.4%), and faculty after 17.2% of 134 contacts (SD, 3.3%). Nurses had a significantly higher hand washing frequency than either faculty (p < 0.0001) or resident physicians (p < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

  3. Teamwork improvement in emergency trauma departments

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


    Background: Interprofessional teamwork is considered as the key to improve the quality of patient management in critical settings such as trauma emergency departments, but it is not fully conceptualized in these areas to guide practice. The aim of this article is to explore interprofessional teamwork and its improvement strategies in trauma emergency departments. Materials and Methods: Participants of this qualitative study consisted of 11 nurses and 6 supervisors recruited from the emergency departments of a newly established trauma center using purposive sampling. Data were generated using two focus group and six in-depth individual interviews, and analyzed using qualitative content analysis. Results: Interprofessional teamwork attributes and improvement strategies were emerged in three main themes related to team, context, and goal. These were categorized as the effective presence of team members, role definition in team framework, managerial and physical context, effective patient management, and overcoming competing goals Conclusions: Interprofessional teamwork in trauma emergency departments is explained as interdependence of team, context, and goal; so, it may be improved by strengthening these themes. The findings also provide a basis to evaluate, teach, and do research on teamwork. PMID:24403932

  4. Application of core competencies training of professional nurses in training of nurses at emergency department%专业护士核心能力培训在急诊科护士培训中的实践



    目的 探讨专业核心能力培训在急诊科护士培训中的实践效果.方法 对本科室护士按照核心能力从低到高分为3个层级,围绕急诊专业护士5个核心能力进行分层级培训.评价培训前后护士综合考核及满意度情况.结果 培训后本科室护士专业综合考核成绩优秀率、护士自我评价满意度、急诊科医生及患者对护士护理工作满意度均较培训前明显提高(均P<0.05).结论 采用分层级核心能力培训模式,可以起到优化护理人员能力结构,提高护士专业知识和专业技能,从而提高护理工作质量.%Objective To investigate the effects of core competencies training of professional nurses in the training of the nurses of the emergency department. Methods The nurses of the department were classified into three classes according to their core competencies, followed by training with 5 core competences. Their comprehensive competences were tested before and after training and the degrees of satisfaction were assessed. Result After training, the excellence rate by testing, self-assessment of satisfaction and the physicians' satisfaction with nursing work were all significantly improved (P < 0.05). Conclusion The training model based on nurses' different levels of core competency can optimize the nursing staff's ability, improve the professional knowledge and professional skills of nurses and increase the quality of nursing care.

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

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


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

  6. Evaluation of emergency department performance

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


    Background Evaluation of emergency department (ED) performance remains a difficult task due to the lack of consensus on performance measures that reflects high quality, efficiency, and sustainability. Aim To describe, map, and critically evaluate which performance measures that the published lite...

  7. Hypernatremia in the Emergency Department

    Neslihan YÜCE


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

  8. Critical care in the emergency department.

    O'Connor, Gabrielle


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

  9. Catatonia in the emergency department.

    Jaimes-Albornoz, Walter; Serra-Mestres, Jordi


    Disturbances of the level of awareness are a frequent motive of attendance to emergency departments where the initial assessment and management will determine the direction of their outcome. The syndrome of catatonia must be taken into consideration and although it is normally associated with psychiatric diagnoses, it is also very often found in a great variety of neurological and medical conditions. Due to the clinical complexity of catatonia, there are still difficulties in its correct identification and initial management, something that leads to diagnostic delays and increased morbidity and mortality. In this article, a review of the literature on catatonia is presented with the aim of assisting emergency department doctors (and clinicians assessing patients in emergency situations) in considering this condition in the differential diagnosis of stupor due to its high frequency of association with organic pathology.

  10. Headache in the emergency department.

    Morgenstern, L B; Huber, J C; Luna-Gonzales, H; Saldin, K R; Grotta, J C; Shaw, S G; Knudson, L; Frankowski, R F


    To perform an observational study of the demographics, clinical factors, and therapeutic efficacy in patients presenting to the emergency department with a chief complaint of headache. Acute headache presentations to the emergency department are a therapeutic dilemma for physicians. Patients presenting with nontraumatic headache to the emergency department of Hermann Hospital in Houston, Texas, during a 16-month period were prospectively ascertained by active and passive surveillance. The medical record was abstracted. Demographic and clinical information are presented with descriptive statistics. Relative benefit of individual therapies are compared with odds ratios (95% confidence intervals). Of the 38 730 patients who were prospectively screened, 455 presented with a chief complaint of headache. Seventy-six percent were women, and the mean age was 37 years. Non-Hispanic whites were more likely diagnosed with migraine compared with Hispanics or African Americans (P<.001). Three percent had subarachnoid hemorrhage. Neurologist follow-up was ordered in 10%. The median time in the emergency department was 265 minutes. With the initial treatment, 44% resolved, 47% improved, and 9% had no change; none worsened. In comparison with all other therapies used, there was a trend suggesting the superiority of antiemetics (odds ratio, 2.66; 95% confidence interval, 0.81 to 8.61). Acetaminophen was less helpful (odds ratio, 0.27; 95% confidence interval, 0.10 to 0.70). When comparing specific agents to therapies which could be used at home, antiemetics led to headache resolution most often (odds ratio, 3.18; 95% confidence interval, 1.40 to 7.22); ketorolac showed a similar trend (odds ratio, 2.05; 95% confidence interval, 0.86 to 4.89). Headache in the emergency department is a phenomena of young women who spend a long time waiting and receive many tests. A variety of therapies are used. Antiemetics may be especially useful for headache resolution.

  11. Discussion on nursing strategy on coma patients in emergency department%急诊科昏迷患者的护理对策探讨



    Objective: By summarizing the nursing and rescue experience of emergency patients with coma, to explore the mnsing strategy on coma patients in the emergency department.Methods: 128 emergency patients with coma were divided into control group and observation group according to the admission order.96 cases in the observation group were received the combined nursing method of traditional Chinese and western medicine while 32 cases in the control group were only received the nursing method of western medicine.Results: In the observation group, the incidence rate of hypostatic pneumonia was 8.3% and incidence rate of intestinal obstruction was 3.1%, both of which were significantly lower than those of the control group (21.9%, 12.5%) (P<0.05).For prognosis, 9 cases deteriorated and 8 cases remained in the control group which were significantly less than those of the observation group (17, 18 cases) (P<0.05).In the observation group, there were 47 cases improved and 14 cases recovered, and they were significantly more than those of the control group (11, 4 cases) (P< 0.01).Conclusion: The combined nursing method of traditional Chinese and western medicine on emergency patients with coma can improve the success rate of rescue, decrease complications and reduce mortality.%目的:总结急诊昏迷患者的护理抢救经验,探讨急诊科昏迷患者护理对策.方法:将128例急诊昏迷患者按照接诊顺序分为观察组和对照组,观察组96例采用中西医结合护理方法,对照组32例采用单纯西医护理对策.结果:观察组坠积性肺炎发生率为8.3%、肠梗阻发生率为3.1%,均少于对照组(21.9%、12.5%),两组比较,差异有统计学意义(P<0.05);转归情况,对照组恶化9例、无效8例,均少于观察组(17、18例),两组比较,差异有统计学意义(P<0.05);观察组显效47例、痊愈14例,高于对照组(11、4例),两组比较,差异有高度统计学意义(P<0.01).结论:中西医结合护理方法应

  12. 程序化管理对提高急诊护理质量的效果评价%Effect evaluation of programmed management in nursing management of emergency department



    Objective To investigate the effect of programmed management of nursing quality in nursing management of emergency department.Methods 861 cases of emergency department patients were selected as research subjects and programmed management of nursing quality was implemented.Then 850 cuses of emergency department patients who did not received nursing quality programmed management were chosen as the control The nursing quality before and after the implementation of programmed management of nursing quality were compared.Results After the implementation of the nursing quality programmed management,the admisson time,turnout time,the rate of transfusion errors and the rate of nursepatient disputes were significantly reduced,while the specilist assessment score,rescue success rate and patient satisfaction degree with nursing were significantly increased compared with those before the implementation.Conclusions Application of nursing quality programmed management in nursing management of emergency department can effectively improve the nursing quality and working efficiency.%目的 探讨护理质量程序化管理在急诊护理管理中的应用效果.方法 选择近2年急诊科实施护理质量程序化管理后接诊的861例患者作为研究对象,与实施护理质量程序化管理前的850例患者作对比,观察实施护理质量程序化管理前后的护理质量.结果 实施护理质量程序化管理后护理人员的接诊时间、出车时间、输液差错次数及护患纠纷次数较实施前显著减少;而专科考核得分、抢救成功率及患者对护理工作的满意度较实施前显著提高.结论 在急诊护理管理中应用护理质量程序化管理,可有效提高护理质量及工作效率.

  13. Family needs of critically ill patients in the emergency department.

    Hsiao, Ping-Ru; Redley, Bernice; Hsiao, Ya-Chu; Lin, Chun-Chih; Han, Chin-Yen; Lin, Hung-Ru


    Family members' experience a range of physiological, psychological and emotional impacts when accompanying a critically ill relative in the emergency department. Family needs are influenced by their culture and the context of care, and accurate clinician understanding of these needs is essential for patient- and family-centered care delivery. The aim of this study was to describe the needs of Taiwanese family members accompanying critically ill patients in the emergency department while waiting for an inpatient bed and compare these to the perceptions of emergency nurses. A prospective cross-sectional survey was conducted in a large medical center in Taiwan. Data were collected from 150 family members and 150 emergency nurses who completed a Chinese version of the Critical Care Family Needs Inventory. Family members ranked needs related to 'communication with family members,' as most important, followed by 'family member participation in emergency department care', 'family member support' and 'organizational comfort'; rankings were similar to those of emergency nurses. Compared to nurses, family members reported higher scores for the importance of needs related to 'communication with family members' and 'family members' participation in emergency department care'. Family members place greater importance than emergency nurses on the need for effective communication. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. Emergence of Nordic Nursing Research

    Larsen, Kristian


    This paper reports on a detailed analysis of findings from a larger study of 'Nordic nursing theorists and clinical nurses' reflections on and experience with production and use of research, theory and findings'. The development of nursing science in the Nordic countries goes back to the late 1970s....... With use of a sociological approach the aim was to explore whether nursing science has constituted itself as an autonomous nursing research field in Bourdieu's terms. In-depth interviews were undertaken with a purposive sample of 10 professors drawn from seven universities in the Nordic countries....... The interview agenda explored the participants' research activities and knowledge production. Our conclusion is that one cannot speak of nursing research in the Nordic countries as a fully developed and autonomous field. Yet we see the outlines of an emerging nursing research field with a common doxa. At least...

  15. Study on the Effect of Nursing Safety Management in Emergency Department Nursing%护理安全管理在急诊科护理中的应用效果研究



    目的:分析护理安全管理在急诊科护理中的应用效果。方法将2011年3月~2012年4月安全管理未实施前与2012年5月~2013年6月安全管理实施后不良事件发生率进行比对,并探讨其原因及解决对策。结果临床安全管理未实施前不良事件发生率为46.7%,实施后发生率为6.7%,安全管理实施前后存在鲜明性临床差异(P<0.05)。结论急诊科实施护理安全管理可有效防范护理风险,为患者生命安全提供可靠保障,亦可在提高患者满意率的同时,提高护理人员服务水平。%Objective To analyze the effect of nursing safety management in emergency department nursing. Methods The comparison of the adverse events occurring between March April and May 2012 before the implementation of the security management in 2011 to 2013 years in June, and to investigate the reasons and countermeasures. Results The clinical safety management did not implement the incidence of adverse events was 46.7%, the incidence of the implementation was 6.7%, the safety management before and after the implementation of the clinical differences (P<0.05). Conclusion Emergency department implementation nursing safety management can effectively prevent nursing risk and provide a reliable guarantee for the safety of patients, but also in improving the satisfaction rate of patients at the same time, improve the level of nursing service.

  16. Study on the doctor-nurse coordination in emergency department%急诊急救工作中医护配合问卷调查研究



    目的 调查急诊急救中医护配合现状,为提高急诊急救医护人员配合意识和医疗质量提供依据.方法 采用自制问卷对北京4所三级甲等医院从事急诊急救一线工作的医生、护士进行调查.结果 医生和护士对目前医护关系评价得分处于中上水平(4.28±0.77 vs 3.82±0.87,P<0.05),75.86%的医生认为护士是医生的合作者,24.14%认为护士是医生的助手;8.62%的医生认为与之配合的护士急救知识不足,20.41%的护士认为自身急救理论知识不足.20.69%的医生和12.25%的护士认为护士的急救技能尚不能很好的完成日常急救任务.结论 "并列-互补"型医护关系正在形成,为良好的医护配合打下基础,急救护士应加强护理急救知识和技能的学习,促进医护间的配合.%objective To investigate the situation of coordination between doctor and nurse in emergency medical treatment rescue. Method A self-made questionnaire was conducted to investigate 58 emergency doctors and 49 nurses in four third-level hospital in Beijing. Results 75.6% doctors thought that nurse is doctor's collaborator, 24.14% thought that nurse is doctor's assistant; 8.62% doctors and 20.41% nurses thought that first aid knowledge mastered by nurse is insufficient. Conclusion The insufficient of nursing emergency kowledge may be one of the factors influcing the doctor and nurse coodination, nurse should strengthen the knowledge and skill on emergency medical service to promote the physician and nursing coordination.

  17. Better communication in the emergency department.

    Burley, Duncan


    The emergency nurse practitioner (ENP) role has evolved since the 1980s, when it was introduced into emergency departments (EDs) in the UK (Tye 1997). Nowadays, ENPs see, treat and refer or discharge patients autonomously. They also document patient histories and are expected to communicate effectively with patients who have complex needs. The role has expanded for several reasons, including the need to reduce doctors' working hours, but mainly to make more flexible use of services. Meanwhile, as ED attendances increase (Thompson et aL 2010), ENPs are placed under increasing pressure and may be forced to spend less time with patients than was expected of them when the ENP role was originally devised. This can affect patient history taking and communication, and may lead to poorer patient outcomes and satisfaction. This article concerns a literature review undertaken by the author to identify and overcome the limitations to effective history taking and communication among ENPs. It also highlights good practice in the management of emergency and urgent-care patients with complex needs. There is little primary research on history taking and communication pressures in emergency care but, after a systematic literature search of the British Nursing Index, CINAHL and Medline databases, the author identified eight research articles on the subject. Three themes emerged from the review: interruptions, overload and barriers. According to the review findings, interruptions occur more often in EDs than in primary care settings, and senior doctors and senior nurses are interrupted more often than other staff. These interruptions can increase information overload, leading to medical errors and adverse clinical outcomes. The main barrier to effective history taking is a failure to understand patients who have poor command of the English language. The author's recommendations for practice include increasing the number of staff and training them in managing pressure, communicating

  18. Electronic Emergency-Department Whiteboards

    Hertzum, Morten


    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...... 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...

  19. 急诊科护士压力源分析及应对措施%Analysis of pressure source of nurses in the emergency department and the countermeasures



    目的分析急诊科护士压力源并提出应对措施。方法采用问卷调查的方式对我院急诊科46名护士现存工作压力源进行调查。结果急诊科护士压力源从高到低依次为工作强度大、护理人员不足、护患矛盾、社会支持不足、职业暴露的危险等。结论通过增加急诊科护理人员编制、掌握良好的沟通技巧、增强护士心理调适能力、加强专科技能训练、人力资源的合理运用、加强职业防护措施,使护士充分释放压力,带着良好的情绪工作,为患者提供优质服务,从而改善护患关系,提高护理工作质量。%Objective Related Factors of the psychological stress of nurses in the emergency department of our hospital and the countermeasures were investigated. Methods Adopting the investigation method of the questionnaire survey was conducted in 46 nurses work pressure sources on the existing emergency department. Results The pressure source of nurses in the emergency department from high to low is the intensity of work,shortage of nursing staff,nurse-patient conflict,lack of social support,occupation exposure risk factors. Conclusion By increasing the emergency department nursing staff,excellent communication skills,enhance nurses psychological adjustment ability,strengthen professional skills training,human resources reasonable use,strengthening occupation protection measures,The nurses fully release the pressure,with a good mood to work,provide the high-quality service for the patients,thereby improving the relationship between nurses and patients,improve the quality of nursing.

  20. Current situation investigation and intervention measures to low back pain of emergency department nurse%急诊科护士腰背痛现状调查及干预措施

    陈建平; 郭月红


    目的:了解急诊科护士腰背痛的基本情况,加强护士腰背痛知识的培训,降低护士腰背痛的发病率。方法自行设计问卷,对急诊科68名护士于培训前后分别进行问卷调查。结果急诊科护士腰背痛发病率高达98.53%,进行护理干预后腰背痛发病率降至63.24%,干预前后比较差异具有统计学意义(P<0.05)。结论采取相应的措施可以明显降低护士腰背痛的发病率。%ObjectiveTo understand the basic situation of low back pain of emergency department nurses, to strengthen the training of nurses' knowledge of low back pain, and reduce the incidence of low back pain in nurses. MethodsQuestionnaire survey was conducted on 68 nurses in emergency department before and after training by self-designed questionnaire. ResultsThe incidence of low back pain in emergency department nurses was 98.53%. After nursing intervention, the incidence of low back pain was reduced to 63.24%. The difference was significant before and after the intervention, with statistical significance(P<0.05).Conclusion Taking appropriate measures can reduce the incidence of low back pain in nurses.

  1. Occupational health hazards of pregnant nurses in emergency department and protective measures%急诊科孕期护士职业健康危害因素与防护对策

    吴晓燕; 吴红敏


    The emergency department is the main place to rescue the critical patients and deal with the emergencies, which is the high-risk department. Due to the complexity and specificity of working environment and service object, the pregnant nurses in emergency department face on the work with the characteristic of fast rhythm and high labor intensity, and are threatened by different occupational health hazards. If the pregnant nurses do not pay attention to personal protection or carry out the undeserved protection, it will cause different occupational injuries. In order to ensure the health of pregnant nurses in emergency department, the authors review and analyze the occupational health hazards that pregnant nurses contact with in emergency department, so as to improve their occupational protection consciousness and reduce the occupational hazards.%急诊科是抢救急危重症患者及处理各种突发事件的主要场所,属于高风险科室.由于工作环境及服务对象的复杂与特殊性,急诊科的孕期护士不得不承担节奏快、任务重、劳动强度大的工作,而且在工作中还会受到多种职业危害的威胁,若不注意个人防护和防护不当,会造成各种不同的职业性损伤.为保障急诊科孕期护士的身体健康,作者对急诊科孕期护士接触的多种职业危害因素进行综述分析,以增强其职业防护意识,减少职业危害的发生.

  2. Advertising Emergency Department Wait Times

    Weiner, Scott G.


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

  3. Advertising emergency department wait times.

    Weiner, Scott G


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

  4. Emergency Department Management of Trauma

    MacKenzie, Colin; Lippert, Freddy


    Initial assessment and management of severely injured patients may occur in a specialized area of an emergency department or in a specialized area of a trauma center. The time from injury until definitive management is of essence for survival of life-threatening trauma. The initial care delivered...... strongly influences patient morbidity and mortality. Prolonged transport times or inadequate prehospital care increases the requirement for early rapid restoration of tissue perfusion and reversal of physiologic disturbances on patient arrival. On the other hand, in urban areas, rapid emergency medical...... services (EMS) response times and advanced prehospital care increase the number of critically injured patients surviving sufficiently long to reach a hospital “in extremis.” Both scenarios provide challenges in the management of traumatized patients. This article addresses the management of severely...

  5. Pediatric Ingestions: Emergency Department Management.

    Tarango Md, Stacy M; Liu Md, Deborah R


    Pediatric ingestions present a common challenge for emergency clinicians. Each year, more than 50,000 children aged less than 5 years present to emergency departments with concern for unintentional medication exposure, and nearly half of all calls to poison centers are for children aged less than 6 years. Ingestion of magnetic objects and button batteries has also become an increasing source of morbidity and mortality. Although fatal pediatric ingestions are rare, the prescription medications most responsible for injury and fatality in children include opioids, sedative/hypnotics, and cardiovascular drugs. Evidence regarding the evaluation and management of common pediatric ingestions is comprised largely of case reports and retrospective studies. This issue provides a review of these studies as well as consensus guidelines addressing the initial resuscitation, diagnosis, and treatment of common pediatric ingestions. Also discussed are current recommendations for decontamination, administration of antidotes for specific toxins, and management of ingested foreign bodies.

  6. The survey analysis of the empathy ability and its influential factors of the emergency department nursing staff%急诊科护理人员共情能力及其影响因素的调查分析



    Objective:To survey the empathy ability status of the emergency department nurses in a Guangzhou Grade-3 Class-A hospital and to analyze dif-ferent population sociological factors influencing the empathy ability. Methods:Adopted the questionnaire survey method to investigate into the empathy ability of 300 frontline clinic nurses on duty of the emergency department in 8 Guangzhou Grade-3 Class-A hospitals. Results:The emergency department nurses got (106.64 ±11.73)scores in the empathy ability. In respect to different genders, ages, nursing ages, marriage status, occupation titles, personnel work natures and home locations, the comparison difference among the nurses′empathy abilities had statistic significance (P0.05),而不同学历的护士共情能力比较差异有统计学意义(P<0.05)。结论:急诊科护士的共情能力相对较好,护士的共情能力受学历因素影响,护理管理者应制定科学的管理计划,制定有针对性的培训计划,提高护士的共情能力,从而提高护理质量。

  7. Discussion on the emergency department nurse training mode%急诊科护士培训模式的探讨



      Objective: Through the theory and operation skills training, to improve the overall quality of the nurses, triage ability and communication skills, establishing a comprehensive high-quality emergency response ability and excellent first aid techniques nursing team. Methods: Since 2008, giving 30 working nurses system, comprehensive and standardized training, to develop a detailed and comprehensive training program and examination system. Results: Business skills of nurses significantly improve and the comprehensive quality enhanced. Conclusion: Emergency nurses must not only have a strong professional skills, agile analytical skills and emergency response capacity, but also have the ability to respond to the emergency situation caused by other special reasons.%  目的:通过理论及操作技能培训,提高护士的整体素质、分诊能力、沟通能力,建立一支综合素质高,应急能力强、急救技术过硬的护理队伍。方法:从2008年起本科对在职30名护士进行了系统、全面、规范化的培训工作,制定详细周全的培训计划和考核制度。结果:护士业务技能显著提高,综合素质增强。结论:急诊护士不仅要具备较强的专业技能,还必须具备敏捷的分析判断能力与应急能力,同时应具备因其他特殊原因造成的紧急情况时的应变能力。

  8. Related Factors and Preventive Measures of Nurse-Patient Disputes in Emergency Department%急诊科护患纠纷的相关因素及预防措施



    Objective Through analize the extant and latant factors of nurse-paitent disputrs in emergency department, to duce its occur ence. Methods In Emergency Department of chengdu University af iliated hospital studies nurse-paitent disputrs records for five years. Conclusion The patients of the hospital to expect too much to the hospital, insuf icient of the skil level and quality of services, nurses working pressure in itself is too large, short of a strong awareness of the law in emergency department nurses is the main reason for the dispute lies. Hospital nurses should be strengthening the moral, technical, legal quality, the promotion of nurse-patient groove,so as to reducetheincidence of disputes.%目的:通过对急诊科护患纠纷现存及潜在因素的分析,以减少急诊科护患纠纷的发生。方法对成都大学附属医院急诊科5年来发生的护患纠纷记录进行回顾研究。结果患者对医院期望过高,护士的技术水平及服务质量不足,护士本身工作压力过大,法律意识不强是急诊科护患纠纷的主要原因所在。医院应通过加强护士道德、技术和法律素质,促进护患沟通,以减少纠纷的发生。

  9. Analysis of Psychological Status of Nurses in Emergency Department and Discussion on Their Coping Style%急诊科护士心理状况分析及其应对方式的探讨



    目的:分析急诊科护士的心理状况,总结有效的应对方式,保证急诊科护士的身心健康。方法从多方面分析影响急诊科护士心理状况的因素,并给予有针对性的应对措施。结果影响急诊科护士心理状况的因素主要有工作性质的不同,护士年龄及家庭原因,得不到医院领导的高度重视,从而影响到急诊科护士的心理健康。经过采取一系列的应对措施,使得护士的身心得到关爱,调动其工作积极性,更提高了护士的心理健康水平。结论急诊科护士从事着特殊的护理工作,身心极易受到影响。所以应从多方面进行干预,合理安排护士的工作和休息时间,为护士提供安全的工作环境,对其进行不定期的业务知识培训,提高自身的素质;同时,还应给予护士更多的情感关怀,真正地理解和关心她们,从而保证护士的身心健康,以为患者提供高效优质的护理服务。%ABSTRACT:Objective To analyze the psychological status of nurses in emergency department, summarize the effective ways of coping, and ensure the physical and mental health of emergency nurses. Methods To analyze the factors that affect the psychological status of emergency department nurses from various aspects, and to give the corresponding measures.Results The factors that affect the psychological status of emergency nurses are different, the age and family reasons of nurses are not highly valued by the leaders of the hospital, thus affecting the psychological health of the emergency department nurses. After taking a series of measures to make the nurses’ physical and psychological care, to mobilize the enthusiasm of the work, but also to improve the level of psychological health of nurses. Conclusion Emergency department nurses are engaged in special nursing work, and the body and mind are extremely easy to be affected. Therefore, we should intervene in many aspects

  10. Blood pressure documentation in the emergency department.

    Daniel, Ana Carolina Queiroz Godoy; Machado, Juliana Pereira; Veiga, Eugenia Velludo


    To analyze the frequency of blood pressure documentation performed by nursing professionals in an emergency department. This is a cross-sectional, observational, descriptive, and analytical study, which included medical records of adult patients admitted to the observation ward of an emergency department, between March and May 2014. Data were obtained through a collection instrument divided into three parts: patient identification, triage data, and blood pressure documentation. For statistical analysis, Pearson's correlation coefficient was used, with a significance level of αvalores obtidos estavam alterados. O tempo médio de admissão até o registro da primeira pressão arterial foi de 2,5 minutos, e de 42 minutos entre as medidas subsequentes. Não foi encontrada correlação entre os valores de pressão arterial sistólica e o intervalo médio de tempo entre os registros da pressão arterial: 0,173 (p=0,031). O presente estudo não encontrou correlação entre frequência de verificação da pressão arterial e os valores de pressão arterial. A frequência do registro da pressão arterial aumentou de acordo com a gravidade do paciente e diminuiu durante seu tempo de permanência no serviço de emergência.

  11. 优质护理服务在急症科感染控制中的作用%The High Quality Nursing Service in the Emergency Department of Infection Control



    Objective To investigate the high quality nursing service in the emergency department of infection control. Methods The patients received emergency treatment in our department were analyzed, according to the time sequence and divided into two groups, the control group to carry out the high quality nursing service, the experimental group was carried out after the analysis of high quality nursing service, the control effect of infection. Results Before the emergency department were enrolled 13425 patients, 741 cases of infection, the infection rate was 5.52%, the infection of the respiratory tract infection in patients with 382 cases, accounting for 2.85%; the development of high quality nursing service, emergency department were enrolled in 11268 cases, infectionoccurred in 252 patients, accounted for 2.24% (P < 0.05). Conclusion The higher rate of infection in emergency department, and the causes of infection is relatively large, the ideal effect of the clinical use of high quality nursing service, can effectively reduce the rate of infection in emergency department, is worthy to be popularized.%目的 探讨优质护理服务在急症科感染控制中的作用.方法 对在我科室接受急症治疗患者资料进行分析,根据活动时间先后顺序分为两组,对照组为优质护理服务开展前,实验组为优质护理服务开展后,分析其感染控制效果.结果活动前急症科室共收纳13 425例患者,患者中741例发生感染,感染发生率为5.52%,感染的患者中382例为呼吸道感染,占2.85%;开展优质护理服务后,急症科共收纳11 268例患者,患者中252例发生感染,占2.24%(P<0.05).结论 急症科感染率较高,且感染的原因也相对较多,临床上采用优质护理服务效果理想,能够有效的降低急症科感染率.

  12. Managing hypopituitarism in emergency departments.

    Welsh, Jeanette


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

  13. Effect Observation of Emergency Department Nursing Intervention in Patients with Hypokalemia%急诊科低钾血症患者的护理干预效果观察



    Objective: To study the clinical ef ects of nursing intervention of the emergency department patients with hypokalemia. Methods: from 2011 January to 2013 September in our hospital 60 cases of emergency department patients with hypokalemia, and divided into observation group and control group, 30 patients in each group. The observation group was treated with nursing intervention on quality, the control group received routine nursing care, analysis and comparison of two groups of patients for nursing satisfaction. Results: Observation of 96.7% nursing satisfaction group, the control group of 83.3% nursing satisfaction, satisfaction in the two groups was significant (P<0.05). Conclusion: the nursing quality of emergency department patients with hypokalemia, not only can ef ectively improve the recovery rate of patients, but also can improve the satisfaction of patients for nursing care, which is worthy to be popularized widely in clinical nursing.%目的:研究分析急诊科低钾血症患者采用护理干预的临床效果。方法选取2011年1月~2013年9月期间在我院接受治疗的60例急诊科低钾血症患者,并将其分为观察组和对照组,每组30例患者。观察组采用优质的护理干预,对照组采用常规护理,分析比较两组患者对护理的满意度情况。结果观察组的护理满意度96.7%,对照组的护理满意度83.3%,两组护理满意度比较差异显著(P<0.05)。结论对于急诊科低钾血症患者采用优质的护理干预,不仅能够有效的提升患者的康复速度,而且还可以提高患者对于护理的满意度,值得临床护理中广泛的应用和推广。

  14. Analysis of the current situation of occupational stress of 76 nurses in the emergency department%急诊科护士76名职业紧张现状分析



    目的:探讨急诊科护士职业紧张现状.方法:采用修订版职业紧张量表(OSI-R)对76名急诊科护士进行调查研究.结果:急诊科护士普遍存在职业紧张现象,不同年龄、学历、职称、工作年限急诊护士的职业紧张情况比较差异有统计学意义(P<0.05,P<0.01).结论:各医疗机构应尽量减少职业紧张危害因素,减轻急诊护士职业紧张反应,以维护其心身健康.%Objective: To discuss the current situation of occupational stress of the nurses in the emergency department. Methods: The revised edition of occupational stress scale ( OSI - R ) was used to conduct a survey on 76 nurses working in the e-mergency department. Results: Most of the nurses in the emergency department have occupational stress, the difference of occupational stress was statistically significant in the nurses at different ages and with different educational background, job title and seniority(P <0. 05, P <0. 01 ). Conclusion: The harmful factors to cause the occupational stress must be minimized so as to ease the nurses tension and maintain their physical and mental health.

  15. Relationship Between Empathy and Well-Being Among Emergency Nurses.

    Bourgault, Patricia; Lavoie, Stephan; Paul-Savoie, Emilie; Grégoire, Maryse; Michaud, Cécile; Gosselin, Emilie; Johnston, Celeste C


    A large number of patients who are in pain upon arriving at the emergency department are still in pain when they are discharged. It is suggested that nurses' personal traits and their level of empathy can explain in part this issue in pain management. The purpose of this study was to better understand the shortfalls in pain management provided by emergency nurses by considering nurses' characteristics. A cross-sectional descriptive correlational design was used for this pilot study. French validated self-administrated questionnaires (sociodemographic characteristics, empathy, psychological distress, and well-being) were presented to 40 emergency nurses. Thirty emergency nurses completed all questionnaires during work hours. Descriptive statistics, group comparisons, and correlation analyses were used for the data analysis. Emergency nurses appear to have low levels of empathy. High levels of psychological distress and low levels of well-being were also observed in our sample. Among these variables, only empathy and well-being appear to be related, because we found higher empathy scores in nurses with higher well-being. The poor mental health we found among emergency nurses is alarming. A clear need exists for supportive interventions for nurses. Finally, well-being was the only variable related to empathy. To our knowledge, this is the first study to report this relationship in nurses. Copyright © 2015 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

  16. Shock in the emergency department

    Holler, Jon Gitz; Henriksen, Daniel Pilsgaard; Mikkelsen, Søren


    BACKGROUND: The knowledge of the frequency and associated mortality of shock in the emergency department (ED) is limited. The aim of this study was to describe the incidence, all-cause mortality and factors associated with death among patients suffering shock in the ED. METHODS: Population......-based cohort study at an University Hospital ED in Denmark from January 1, 2000, to December 31, 2011. All patients aged ≥18 years living in the hospital catchment area with a first time ED presentation with shock (n = 1646) defined as hypotension (systolic blood pressure (SBP) ≤100 mmHg)) and ≥1 organ...... failures. Outcomes were annual incidence per 100,000 person-years at risk (pyar), all-cause mortality at 0-7, and 8-90 days and risk factors associated with death. RESULTS: We identified 1646 of 438,191 (0.4 %) ED patients with shock at arrival. Incidence of shock increased from 53.8 to 80.6 cases per 100...

  17. Improving emergency department patient flow.

    Jarvis, Paul Richard Edwin


    Emergency departments (ED) face significant challenges in delivering high quality and timely patient care on an ever-present background of increasing patient numbers and limited hospital resources. A mismatch between patient demand and the ED's capacity to deliver care often leads to poor patient flow and departmental crowding. These are associated with reduction in the quality of the care delivered and poor patient outcomes. A literature review was performed to identify evidence-based strategies to reduce the amount of time patients spend in the ED in order to improve patient flow and reduce crowding in the ED. The use of doctor triage, rapid assessment, streaming and the co-location of a primary care clinician in the ED have all been shown to improve patient flow. In addition, when used effectively point of care testing has been shown to reduce patient time in the ED. Patient flow and departmental crowding can be improved by implementing new patterns of working and introducing new technologies such as point of care testing in the ED.

  18. Emergency Nurses Association

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  19. Paediatric analgesia in an Emergency Department.

    Hawkes, C


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

  20. Application of SHEL model in safety management of intravenous medication nursing in emergency department%SHEL模式在急诊静脉用药护理安全管理中的应用分析



    目的 评价SHEL模式在急诊静脉用药护理安全管理中的应用效果.方法 对比分析SHEL模式实施前后静脉用药护理安全缺陷、急诊科护士用药安全知识的变化.结果 除皮试阳性结果判断标准外,SHEL模式实施后的其余四个主题的得分均显著优于SHEL模式实施前;SHEL模式实施后静脉用药缺陷率为35.7%,显著低于SHEL模式实施前的60.0%(X2=5.893,P=0.015).结论 SHEL模式能够显著降低急诊科静脉用药缺陷,是一种有效的护理安全管理工作方法.%Objective To assess the effect of the SHEL model in safety management of intravenous medication nursing in emergency department.Methods The changes of intravenous medication errors and knowledge of medication nursing safety in emergency nurses were compared after application of the SHEL model.Results Medication nursing safety knowledge,except judgement of skin test results.was significantly improved after application of the SHEL model The rate of intravenous medication errors was 35.7% after application of the SHEL model,which was decreased significantly as compared with the baseline ( X2 =5.893,P=0.015 ).Conclusions The SHEL model can markedly reduce intravenous medication errors in emergency department and is a management method for nursing safety.

  1. Evolving towards professionalism in emergency nursing in Hong Kong.

    Wong, Eliza Mi-Ling; Lau, Ping Fat


    This paper aims to share with the readers about the experience of emergency nursing development and related roles in Hong Kong. The roles of emergency nurses are evolving and triggered by three major historical milestones. The three milestones consist of: (1) Transition of nursing education from hospital training to nursing degree program at universities in 1990; (2) The re-evolution after the establishment of Hospital Authority in 1993; (3) Hong Kong's return to China in 1997. These milestones have contributed immensely to the development of quality nursing education, nursing professionalism with emphasis on specialty knowledge and skill training in Accident and Emergency departments (AED) in Hong Kong. Since 1991, the emergency nursing role has been expanded and extended. Wound management remains one of the major extending roles for emergency nurses, who confine themselves to manage simple wounds. Nurse initiated tetanus immunization, intravenous access; investigations such as electrocardiogram, blood glucose, and urinalysis are well implemented in all AEDs under the governance of guidelines and protocols. Initial triage analgesic for the minor musculoskeletal injury and fever are also part of the triage care in some AEDs in Hong Kong now. To meet the demand and challenge, innovative role development such as lecturer practitioners and emergency nurse practitioners have been piloted and implemented recently. Besides the normal duty, emergency nurses also participate in the work outside the hospitals such as involvement in emergency medical teams to assist in various rescue missions or volunteer for Flight Nursing (Government Flying Services). However, the nursing shortage is another common problem faced by the Hong Kong health care body. With the help of advanced technology, better pre-graduate and specialty-training programs, Hong Kong health care strives to achieve the highest standards of quality care. Emergency nursing role development in Hong Kong is evolving

  2. Promoting Emergency Nursing Management to Enhance Department Development%促进急救护理管理加强科室持续发展

    张玲; 吴月凤


    急诊医学是一门新兴学科,急诊科的建设和发展直接关系到民众生命的安危.急诊护理也随着医学模式的转变,服务对象、内容、观念的变化,赋予现代急诊护理新的内涵.本文从急救护理的管理、急救护理质量要求、注重以病人为中心、满足患者各方面需要,以及护理人员应具备的素质等方面进行讨论.%With the change of medical mode, service objective, content and idea, the connotation of emergency nursing has been enlarged.In the paper, the management, quality, service idea and service basement were analyzed for the emergency nursing.

  3. Kano模式对提升儿科门急诊护理服务满意度的影响%Effect of Kano model on improving satisfaction of nursing service in outpatient and emergency department of pediatrics

    苏颖; 李素芳; 郑群; 秦尚够; 李绍焕


    Objective To discuss the effect of Kano model on improving satisfaction of nursing service in outpatient and emergency department of pediatrics.Methods Questionnaires about Kano model on the needs of nursing service in outpatient and emergency department were designed,and the attributes of needs were determined.Children' s needs were included in the nursing service process.And the satisfaction of nursing was investigated and compared before and after by a third party.Results There were ten must-be items (M),nine one-dimensional items (O) and six attractive itmes (A) in Kano model analysis of nursing service.After improving nursing process,the satisfaction rate increased from 78.23% to 86.30%,with statistically significant difference (x2 =6.536,P < 0.05).Conclusions Kano model can exactly screen the quality attributes of children's and parents' needs of nursing service,and significantly improve satisfaction in outpatient and emergency department of pediatrics.%目的 探讨Kano模式在提升儿科门急诊护理服务满意度中的作用.方法 自行设计Kano模式门急诊护理服务需求调查问卷,确定儿科门急诊护理服务需求的属性;将患儿需求转化到改进护理服务流程的设计中;委托第三方对流程改进前后的门急诊护理服务满意度进行调查并比较.结果 Kano模式分析中,儿科门急诊护理服务项目必备属性(M)10项、期望属性(0)9项、魅力属性(A)6项;改进护理服务流程后,护理满意度由78.23%提高到86.30%,差异有统计学意义(x2=6.536,P<0.05).结论 Kano模式能准确筛选出患儿及家长对门急诊护理服务需求的质量属性,可以显著提高儿科门急诊护理服务的满意度.

  4. 绩效考评在急诊科护理管理中的应用效果%Application effect of performance appraisal evaluation in nursing management of emergency department



    Objective To analyze the application effect of the performance appraisal evaluation in the nursing management of the emergency department .Methods 50 nursing staffs of the emergency department were selected and implemented the the nurse performance appraisal management system .The work quality of nursing personnel ,pa‐tients satisfaction and the occurrence situation of adverse events were compared before and after implementation of performance appraisal .Results After the implementation of performance appraisal ,the basic nursing score and oper‐ating specifications score were 19 .33 ± 6 .11 and 19 .67 ± 5 .89 respectively ,which were significantly higher than those before implementation .The patients satisfaction to nursing was increased ,and the incidence rates of disputes ,adverse events and complaints were significantly reduced ,the differences were significantly significant (P<0 .05) .Conclusion The performance appraisal evaluation effectively increases the nursing quality and improves the contradiction be‐tween nurses and patients ,which is conducive to conduct the nursing work .%目的:分析绩效考评在急诊科护理管理中的应用效果。方法选取急诊科护理人员50例,对其实行绩效考评的管理制度,比较实行绩效考评前后护理人员的工作质量、患者满意程度以及不良事件的发生情况。结果实行绩效考评后,护理人员的基础护理得分[(19.33±6.11)分]和操作规范得分[(19.67±5.89)分]明显高于实行绩效考评之前,患者对护理的满意度显著升高,纠纷、不良事件、投诉的发生率明显降低,差异均有统计学意义(P<0.05)。结论绩效考评有效地提高了护理质量,改善了护患矛盾,有利于护理工作的进行。

  5. Asthma Medication Ratio Predicts Emergency Depart...

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

  6. Leadership and the emergency department.

    LaSalle, Gar


    Emergency medicine, as the nation's health care system's safety net, is facing ever increasing demands on its resources and infrastructure. Classic and modern theories of leadership, which include broader based models that in corporate team responsibilities, should be studied by anyone wearing the mantle of leadership in emergency medicine, and the Realpolitik of the modern hospital must be accommodated if leadership efforts are to succeed.

  7. Main reason analysis and countermeasures on emergency department nurse-patient communication barriers%急诊科护患沟通障碍主要原因分析与对策



    从急诊科护患沟通具有交流时间短、内容复杂、专业性强、要求高、矛盾多等特点出发,分析其沟通障碍主要有护士和患者及家属两方面的原因,提出解决沟通障碍的对策有三大方面,首先要建立良好的护患沟通基础。良好护患沟通的基础主要有树立以人为本的护理理念、树立积极健康的护士形象及具有丰富的知识和熟练的急救技术等。其次,在工作中要应用护患沟通技巧,包括语言性沟通和非语言性沟通。此外,要创造良好的沟通环境。%From the emergency department nurse-patient communication with communication time short, content complexity, professional and strong, demanding, contradictory and more features, analyzed two reasons its communication barriers are mainly nurses and patients and their families. Put forward the countermeasures to solve the communication obstacles have three aspects, first, to establish a good nurse-patient communication foundation. Good nurse patient communication are mainly set up the nursing of people-oriented philosophy, set up a positive image of nurses and has a wealth of knowledge and skilled first aid technique etc. Secondly, put application of nurse patient communication skills in the work, including language communication and nonverbal communication. In addition, should create a good environment for communication.

  8. Communication Skills Training For Emergency Nurses

    Mehmet Ak, Orhan Cinar, Levent Sutcigil, Emel Dovyap Congologlu, Bikem Haciomeroglu, Hayri Canbaz, Hulya Yaprak, Loni Jay, Kamil Nahit Ozmenler


    Full Text Available Objective: To determine the effects of a communication skills training program on emergency nurses and patient satisfaction.Methods: Sixteen emergency nurses attended a 6-week psychoeducation program that was intended to improve their communication skills. The first 3 sessions of the psychoeducation program consisted of theoretical education on empathy and communication. Other sessions covered awareness, active communication, and empathic skills on a cognitive behavioral basis using discussion, role play, and homework within an interactive group. The effects of the program were assessed using a communication skills scale, empathy scale, and patient satisfaction survey and were reflected by the reduction in the number of undesirable events between nurses and patients in the emergency department.Results: The mean communication skill score (177.8±20 increased to 198.8±15 after training (p=0.001. Empathy score also increased from 25.7±7 to 32.6±6 (p=0.001. The patient satisfaction survey of 429 patients demonstrated increased scores on confidence in the nurses (76.4±11.2 to 84.6±8.3; p=0.01; the nurse's respect, kindness, and thoughtfulness (72.2± 8.1 to 82.1 ± 6,5; p=0.01; individualized attention (71.3± 6.2 to 73.2 ± 9.8; p=0.2; devotion of adequate time to listening (84.6± 9.3 to 89.8 ± 7.6; p=0.03; and counseling and information delivery (71.1± 10.2 to 80.2 ± 9.7; p=0.01. The number of undesirable events and complaints during nurse-patient interactions decreased 66 % from 6 to 2.Conclusion: “Communication Skills Training” can improve emergency nurses' communication and empathy skills with a corresponding increase in patient satisfaction and reduction of the undesirable events and complaints during nurse-patient interactions.

  9. Emergency department response to SARS, Taiwan.

    Chen, Wei-Kung; Wu, Hong-Dar Isaac; Lin, Cheng-Chieh; Cheng, Yi-Chang


    How emergency departments of different levels and types cope with a large-scale contagious infectious disease is unclear. We retrospectively analyzed the response of 100 emergency departments regarding use of personal protective equipment (PPE) and implementation of infection control measures (ICMs) during the severe acute respiratory syndrome outbreak in Taiwan. Emergency department workers in large hospitals were more severely affected by the epidemic. Large hospitals or public hospitals were more likely to use respirators. Small hospitals implemented more restrictive ICMs. Most emergency departments provided PPE (80%) and implemented ICMs (66%) at late stages of the outbreak. Instructions to use PPE or ICMs more frequently originated by emergency department administrators. The difficulty of implementing ICMs was significantly negatively correlated with their effectiveness. Because ability to prepare for and respond to emerging infectious diseases varies among hospitals, grouping infectious patients in a centralized location in an early stage of infection may reduce the extent of epidemics.

  10. Understanding communication networks in the emergency department

    Braithwaite Jeffrey


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

  11. The Popularization and Application in the Emergency Department Nursing Quality Care Services%优质护理服务在急诊科护理中的推广与应用



    目的:在急诊科护理中推广使用优质护理服务,研究分析优质护理服务在其应用中的价值,以提高急诊科护理的质量和患者对护理的满意度。方法:选取本院2012年3月-2014年3月急诊科患者200例作为研究对象。按随机数字表法分为观察组和对照组各100例。两组病患均进行常规护理,观察组在实施常规护理的基础上给予优质护理服务的方式,对两组患者的护理效果进行对比。结果:观察组的临床表现满意率达到98.0%,对照组满意率89.0%,差异有统计学意义(P<0.05)。结论:在急诊科护理工作中,推广使用优质护理方式,不仅可以为患者提供更全面的护理服务,提高护理质量,还有利于患者对护理工作的满意度。采用优质护理方式可有效促进护患之间的和谐关系。%To promote the use of high quality nursing service in the emergency department,research and analysis the value of high quality nursing service in its application,in order to improve the quality of emergency nursing and patients satisfaction.Method:200 cases were selected from our hospital from March 2012 to March 2014, which were randomly divided into observation group and control group,according by random digit table,105 case in each group.They were all treated with routine nursing. While the observation group were given high quality nursing service on the basis of routine nursing.The effect of the nursing care in the two groups were compared.Result:The clinical manifestations satisfaction rate of the observation group reached 98.0%,while the control group patients satisfaction was 89.0%,the difference was statistical significance(P<0.05).Conclusion:In the emergency nursing,promoting the use of high quality nursing way,can provide a more comprehensive nursing services to patients,improve the quality of nursing,so it can also satisfy the patients.Using the high quality nursing way can effectively promote

  12. The present situation and countermeasures of emergency department nurses' happiness index in Dujiangyan area%都江堰地区急诊科护士幸福指数现状及对策

    周玲; 杨桃; 谭思; 骆发冬; 唐阳


    ObjectiveKnowing the present happiness index situation among nurses of emergency department in Dujiangyan district,so as to provide a reference for improving their happiness level.MethodExtract 40 nurses from emergency department of registered medical institutions with sampling method from Dujiangyan city of Sichuan province to take the Multiple Happiness Questionnaire(Multiple Happiness Questionnaire MHQ).Resultshappiness index of nurses from primary emergency department are in the medium level.The dimension level from high to low are friendly relations, self-worth,life vitality,life satisfaction and personality growth,health care,positive emotion,altruistic behavior,negative emotion;Positive correlation between comprehensive sense of happiness and well-being.ConclusionBasic-level hospitals should take appropriate measures to improve the happiness index of their nurses according to the characteristics of the emergency work,further transfer the work initiative,ensure the quality of emergency services and level.%目的:了解都江堰地区急诊科护士幸福指数现状,探讨其改善措施。方法采取偶遇抽样方法抽取四川省都江堰市市级医疗机构40名急诊科注册护士,进行综合幸福问卷调查(multiple happiness questionnaire, MHQ),结果基层急诊科护士幸福指数处于中等水平,各维度水平由高到低依次为友好关系、自我价值、生命活力、生活满意、人格成长、健康关注、正性情感、利他行为、负性情感;幸福指数与综合幸福感呈正相关。结论基层医院应针对急诊科工作特点采取适当措施以提高护士幸福指数,进一步调动其工作积极性,保证急诊服务的质量和水平。

  13. Examination of Migraine Management in Emergency Departments

    Satnam S Nijjar


    Full Text Available BACKGROUND: Despite advances in treatment, patients with migraine have been underdiagnosed and undertreated, specifically in emergency departments. In addition, great variability exists with respect to the diagnosis, management and treatment of migraine patients in emergency departments. In particular, migraine-specific treatments, including serotonin receptor agonists, appear to be rarely used.

  14. Referral patterns in elderly emergency department visits

    Alessandra Buja


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

  15. Nursing Software for Emergency Triage (NSET).

    Mandirola Brieux, H F; Guillen, S; La Rosa, F; Moreno, C; Benitez, S


    Determining the priority of attention in an Emergency Room (ER) has always been a difficult issue. Priority is determined with a simple triage system as people arrive at the hospital. It is important to establish how long they can wait for treatment. In order to obtain the best assessment of patients' conditions, we built a Nursing Software for Emergency Triage (NSET). The objective of this work was to assess the efficacy of the NSET versus the triage process without any software (TWS). Results showed that the NSET we built was a substantial help. With this software, we decreased significantly:1) the length of the triage system process, 2) the waiting time of patients in the waiting room, 3) the number of complaints and 4) the number of patients who walk away. In conclusion, the NSET improves and helps to define more accurately a patient's risk. NSET helps in the emergency department triage.

  16. The Reasons of Emergency Department Patients’ Dissatisfaction

    Farhad Rahmati


    Full Text Available Introduction: Evaluating the reasons of emergency patient dissatisfaction and trying to eliminate them is a step towards increasing the quality of care and profitability. Therefore, this study aimed to evaluate the reasons of patient dissatisfaction in the emergency department of Shohadaye Tajrish Hospital, Tehran, Iran. Methods: The present cross-sectional study was done in the time interval between March 2012 and October 2014. All the patients who had declared their dissatisfaction, whether written, verbal, or by phone, were included. Using a pre-designed checklist, data were gathered regarding characteristics of dissatisfaction including: type, reference, presentation, subject, and outcome and analyzed using SPSS version 21. Significance level was considered as p<0.05. Results: 123 cases of dissatisfaction were detected. In 31 (25.2% cases the patient was right, in 41 (33.3% the hospital was right and 51 (41.5% cases had no outcome. The dissatisfactions were written in 23 (18.7% cases, by phone in 17 (13.8%, and verbal in 83 (67.5%, which showed no significant correlation with the outcome (p=0.277. Only 31 (25.2% cases were declared by the patients themselves which had no correlation with the outcome (p=0.747. However, there was a significant correlation between the type (p=0.025 and subject (p<0.001 of dissatisfaction with the outcome. Conclusion: The results of this study showed that most cases of dissatisfaction were assigned to the surgery group and nursing service. Low quality care and bad behavior of the staff were among the most common causes of patients’ dissatisfaction. In all cases of dissatisfaction regarding the neurosurgery service, internal medicine service, and admission unit, the patients have been right. In contrast, in all cases of triage and laboratory unit, the hospital has been right.

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

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


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

  18. Emergency department triage: an ethical analysis

    Gastmans Chris


    Full Text Available Abstract Background Emergency departments across the globe follow a triage system in order to cope with overcrowding. The intention behind triage is to improve the emergency care and to prioritize cases in terms of clinical urgency. Discussion In emergency department triage, medical care might lead to adverse consequences like delay in providing care, compromise in privacy and confidentiality, poor physician-patient communication, failing to provide the necessary care altogether, or even having to decide whose life to save when not everyone can be saved. These consequences challenge the ethical quality of emergency care. This article provides an ethical analysis of "routine" emergency department triage. The four principles of biomedical ethics - viz. respect for autonomy, beneficence, nonmaleficence and justice provide the starting point and help us to identify the ethical challenges of emergency department triage. However, they do not offer a comprehensive ethical view. To address the ethical issues of emergency department triage from a more comprehensive ethical view, the care ethics perspective offers additional insights. Summary We integrate the results from the analysis using four principles of biomedical ethics into care ethics perspective on triage and propose an integrated clinically and ethically based framework of emergency department triage planning, as seen from a comprehensive ethics perspective that incorporates both the principles-based and care-oriented approach.

  19. Investigation of humanistic caring ability in nurses from emergency department in tertiary comprehensive hospitals in Beijing%急诊护士人文关怀能力现状调查

    刘爱辉; 周文华; 田丽源; 吴丽萍


    目的:调查医院急诊护士人文关怀能力现状,分析不同背景条件下的急诊护士人文关怀能力的差异性,为培养急诊护士关怀能力提供依据。方法:采用便利抽样法,对北京3家三级甲等医院250名急诊护士关怀能力进行问卷调查。结果:调查对象关怀能力总评分及认知维度、勇气维度、耐心维度评分,均低于国际常模最低标准。不同职称急诊护士关怀能力不同,主管护师高于护士和护师(P20年组,分别高于其他工龄组(P40岁组高于其他年龄组(P<0.05)。结论:北京3家三级甲等综合医院急诊护士人文关怀能力低于国际常模。高年资、高职称的急诊护士人文关怀能力较强。%Objective: To describe the status of humanistic caring ability of nurses in the Emergency Department, analyze the differences of the humanistic care ability in emergency nurses under different background, and provide the evidence for the training of nursing care ability. Methods: A convenience sampling method was used to investigate the humanistic caring ability of 250 nurses in 3 tertiary hospitals in Beijing. Results: The scores of the caring ability of the investigated nurses were lower than those of the norm, and the scores of cognitive dimension, courage and patience were also lower than the norm. The care ability of nurses with different titles was different. The scores of nurses in charge were higher than the ordinary nurses, and the difference was statistically signiifcant (P<0.05). The care ability of nurses in different working time groups was different. The scores of those who service more than 20 years were higher than lower working time groups, the difference was statistically significant (P<0.05). Different age groups score different. The care ability of nurses in more than 40 years old group was higher than that in other groups, and the difference was also statistically signiifcant (P<0.05). Conclusion: The

  20. Transdisciplinary care in the emergency department: A qualitative analysis.

    Innes, Kelli; Crawford, Kimberley; Jones, Tamsin; Blight, Renee; Trenham, Catherine; Williams, Allison; Griffiths, D; Morphet, Julia


    In response to increasing demands some emergency departments have introduced transdisciplinary care coordination teams. Such teams comprise staff from multiple disciplines who are trained to perform roles outside their usual scope of practice. This study aimed to critically evaluate the patient, carer and ED staff perceptions of the transdisciplinary model of care in an emergency department in a Melbourne metropolitan hospital. The evaluation of the transdisciplinary team involved interviews with patients and carers who have received the transdisciplinary team services, and focus groups with emergency nursing and transdisciplinary team staff. Analysis of the data revealed that the transdisciplinary model provided an essential service, where staff members were capable of delivering care across all disciplines. The ability to perform comprehensive patient assessments ensured safe discharge, with follow-up services in place. The existence of this team was seen to free up time for the emergency nursing staff, enabling them to see other patients, and improving department efficiency while providing quality care and increasing staff satisfaction. This study identified several important factors which contributed to the success of the transdisciplinary team, which was well integrated into the larger emergency department team. Copyright © 2016 Elsevier Ltd. All rights reserved.

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

    Marco Bo


    Full Text Available 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 their prescribing habits and knowledge about the drug and in relation to frequency and profile of women arriving for care at hospital emergency departments in Piedmont and requesting prescription for the morning-after pill. This cross-sectional survey involved 29 hospital emergency departments in Piedmont where no gynecologists are on active duty. The survey instrument was a 24-item questionnaire. Analysis of responses revealed that in the physicians’ opinion the vast majority of requests came from Italian nationals (97% ranging in age from 18 to 30 years (76%, single and not cohabiting with a partner (60%, and nulliparous (64.0%. Women mostly request EC for first-time and the most common reasons were condom breakage or slippage. Just over half the physicians (52% stated that emergency contraception prescription was not an appropriate part of care provided at an emergency department and 72% stated they felt uneasy about prescribing emergency contraception. The survey also revealed gaps in physician knowledge about the pharmacokinetic and pharmacodynamic properties of emergency contraception pills.

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

    Marco Bo


    Full Text Available 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 their prescribing habits and knowledge about the drug and in relation to frequency and profile of women arriving for care at hospital emergency departments in Piedmont and requesting prescription for the morning-after pill. This cross-sectional survey involved 29 hospital emergency departments in Piedmont where no gynecologists are on active duty. The survey instrument was a 24-item questionnaire. Analysis of responses revealed that in the physicians’ opinion the vast majority of requests came from Italian nationals (97% ranging in age from 18 to 30 years (76%, single and not cohabiting with a partner (60%, and nulliparous (64.0%. Women mostly request EC for first-time and the most common reasons were condom breakage or slippage. Just over half the physicians (52% stated that emergency contraception prescription was not an appropriate part of care provided at an emergency department and 72% stated they felt uneasy about prescribing emergency contraception. The survey also revealed gaps in physician knowledge about the pharmacokinetic and pharmacodynamic properties of emergency contraception pills.

  3. 影响急诊科护理质量管理的相关因素与改革措施%Measures of Nursing Quality Management and Improvement in Emergency Department



    急诊科护理工作质量管理的好坏直接关系到患者的生命,社会大环境影响、劳动强度大、业务能力不足和缺乏社会尊重与理解是影响急诊科护理工作质量的主要原因,本文提出了加强职业道德教育,提高思想素质;加强专业建设,提高业务素质;强化管理手段,,实行科学管理三项改进措施,以提高急诊科护理工作质量.通过两年的实践应用,我院急诊科质量检查达标,服务满意率明显上升.%Emergency department care quality mangement relates to the patient's life. The social environmental impact, labor-intensive, lack of professional ability, lack of social respect and understanding were the main reasons impacting on the quality of care in the emergency department. This article proposes three measures for improvement-to enhance professional ethics education and improve the quality of thinking; strengthen the building of professionals and improve the quality of business; strengthen the management and implement scientific management for improving the nursing quality management in emergency department.

  4. A survey of perfectionism and specialty self-concepts in nurses of emergency department%急诊科护士完美主义与专业自我概念的调查研究



    Objective To investigate the status quo of perfectionism and specialty self-concept in nurses of emergency department and probe into the correlations between them. Method 149 nurses from the emergency department involved in the survey by the Multi-dimension Perfectionism Mental Scale (Chinese version) and the Specialty Self-concept Scale. Result The average scores on the perfectionism and specialty self-concept were (3.24 ± 0.49) and (2.95 ± 0.44), respectively, with a negative correlation between them (P < 0.01). Conclusions The perfectionism and specialty self-concept of the nurses from the emergency departments are active and at mediate level. The nursing administrators may enhance their specialty self-concept by conducting training.%目的 描述急诊科护士完美主义和专业自我概念现状,探讨急诊科护士完美主义与专业自我概念的相关性.方法 对149名急诊科护士运用中文版多维完美主义心理量表和护理专业自我概念量表进行测试.结果 急诊科护士完美主义均分为(3.24±0.49)分,专业自我概念均分为(2.95±0.44)分,急诊科护士完美主义与专业自我概念呈显著性负相关(P<0.01或P<0.05).结论 急诊科护士完美主义、专业自我概念分别是中等水平和积极的.护理管理者可加强对急诊科护士的培训以进一步提高其专业自我概念程度.

  5. Nursing discussion on CT examination of 216 cases of critical patients in emergency department%216例急诊危重症患者CT检查的护理探讨

    卢慧娜; 周瑞卿


    Objective:To explore the nursing methods in the process of CT examination for critical patients in emergency department.Methods:216 cases of critically ill patients were selected.Patients were examined by CT on the basis of taking timely and reasonable care measures.We observed the completion of the inspection,in order to reduce the incidence of accidents.Results:91.20% of patients successfully completed the CT examination,and the image quality was good.4.17% completed the inspection, and the image quality was poor.4.63% failed to complete the inspection.Conclusion:Emergency care of critically ill patients in emergency department is an important part of emergency nursing work and it is very important.%目的:探讨急诊危重症患者行CT检查过程中的护理方法。方法:收治危重症患者216例,在采取及时、合理的护理措施下行 CT 检查,观察检查完成情况,以降低意外事件的发生率。结果:91.20%的患者顺利完成 CT 检查,图像质量好;4.17%完成检查,图像质量较差;4.63%未能完成检查。结论:急诊危重症患者的急诊护理是急诊护理工作的一项重要内容且至关重要。

  6. Rethinking our pressure-packed emergency departments.

    Haugh, Richard


    With overcrowding the single-most difficult issue now confronting emergency departments, innovative hospitals are experimenting with everything from new technology to redeploying staff to redesigning processes and work areas.

  7. Does Faculty Incivility in Nursing Education Affect Emergency Nursing Practice?

    Stokes, Pamela

    Incivility in nursing education is a complicated problem which causes disruptions in the learning process and negatively affects future nursing practice. This mixed method research study described incivility as well as incivility's effects through extensive literature review and application of a modified Incivility in Nursing Education (INE) survey. The INE included six demographic items, four quantitative sections, and five open-ended questions. The survey examined emergency nurses' perceptions of incivility and how the experience affected their personal nursing practice. The INE was initially tested in a 2004 pilot study by Dr. Cynthia Clark. For this research study, modifications were made to examine specifically emergency nurse's perceptions of incivility and the effects on their practice. The population was a group of nurses who were members of the emergency nurses association in a Midwestern state. In the quantitative component of the Incivility in Nursing Education (INE) survey, the Likert scale questions indicated that the majority of the participants reported witnessing or experiencing the uncivil behaviors. In the qualitative section of the INE survey, the participants reported that although they have not seen incivility within their own academic career, they had observed faculty incivility with nursing students when the participants were assigned as preceptors as part of their emergency nursing practice.

  8. Emergency Department Presentations following Tropical Cyclone Yasi

    Peter Aitken; Richard Charles Franklin; Jenine Lawlor; Rob Mitchell; Kerrianne Watt; Jeremy Furyk; Niall Small; Leone Lovegrove; Peter Leggat


    Introduction 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. Methods Data were extracted from the Townsville Hospitals ED information system (EDIS) for three periods in 2009, 2...

  9. OSCE考核在急诊科、ICU护士临床实践技能培训中的应用%Application of OSCE Examination in the Clinical Practice Skill Training in the Department of Emergency and ICU Nurses



    Objective To explore the clinical application of OSCE examination in the clinical practice skill training of in the department of emergency and ICU nurses. Methods 60 cases of on-the-job nursing staff in our hospital were selected and randomly and dynamically divided into two groups with 30 cases in each, and the training time was from April 2015 to April 2016, the control group adopted the traditional teaching method, and the observation group adopted the OSCE exami-nation method. Results There were differences in the nursing evaluation score, case analysis score, specific nursing skill op-eration score, monitoring skill operation score, team rescue cooperation ability score and health education score between the two groups, P<0.05. Conclusion The effect of OSCE examination in the clinical practice skill training of in the department of emergency and ICU nurses is obvious.%目的:探索OSCE考核在急诊科、ICU护士临床实践技能培训中的临床应用。方法选取该院60名在岗护理人员,培训时间均集中在2015年4月-2016年4月期间,并将此次研究对象动态随机分为两组,每组30名护理人员,对照组采用传统教学方式,观察组采用OSCE考核方式。结果观察组和对照组两组护理人员,对比护理评估评分、病例分析评分、专科护理技能操作评分、监护技能操作评分、团队抢救协作能力评分、健康教育评分均存在差异性(P<0.05)。结论 OSCE考核在急诊科、ICU护士临床实践技能培训中效果显著。

  10. Family involvement in emergency department discharge education for older people.

    Palonen, Mira; Kaunonen, Marja; Åstedt-Kurki, Päivi


    To report findings concerning family involvement in emergency department discharge education for older people. The current trend of population ageing in Western countries has caused an increase in emergency department visits. Due to the continuing improvement in the mental and physical status of older people, they are frequently discharged home. Proper discharge education enables older people and their families to better understand how they can cope with the medical issue at home. Given the lack of research, we know relatively little about the significance of family involvement in older people's emergency department discharge education. A descriptive qualitative design was used. Qualitative thematic interviews of seven older patients, five family members and fifteen nurses were conducted. Data were analysed using content analysis. Family involvement in discharge education was seen as turbulent. The experiences were twofold: family involvement was acknowledged, but there was also a feeling that family members were ostracised. Families were seen as a resource for nurses, but as obliged initiators of their own involvement. Our findings suggest that family members are not considered participants in emergency department care. For a family-friendly approach, actions should be taken on both individual and organisational levels. The findings support healthcare providers and organisation leaders in promoting family involvement in discharge education for older people. Families can be encouraged to be involved without feeling responsible for the interaction. © 2016 John Wiley & Sons Ltd.

  11. Child maltreatment, parents & the emergency department

    Hoytema van Konijnenburg, E.M.M.


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

  12. Child maltreatment, parents & the emergency department

    Hoytema van Konijnenburg, E.M.M.


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

  13. Impact of human resource management in emergency department on anxiety of nurses%急诊科人力资源管理对护士焦虑感的影响

    张萍; 刘国伟; 陈志芳; 王丽琼


    Objective To explore the influence of human resources management in emergency department on nurse's anxiety.Methods Self-Rating Anxiety Scale(SAS)was used to investigate 300 nurses in the emergency department in nine secondary level hospitals of Longgang District.Division of human resource management in these hospitals were examined and the correlation between them was statistically analyzed.Results In addition to the three hospitals,nurses anxiety status of the other six hospitals score showed different levels of anxiety,the average scores were above 50,but the hospitals,that the ratio of the three anxiety condition score was less than 50,moderate to severe anxiety were still more than 20.0%,and other six hospitals was up to 66.7%.In the human resource management to achieve excellent and qualified hospital,the anxiety rate was significantly lower than the substandard hospitals.At the same time there was close correlation between the situation of human resource management and nurses anxiety situation.Conclusions Emergency nurses generally have high anxiety,and in hospitals with poor human resource management,career anxiety is even more obvious.That is to say the anxiety of nurses is closely related to emergency department management of human resources.%目的 探讨急诊科人力资源管理对护士焦虑感的影响.方法 以深圳市龙岗区9家二级甲等医院急诊科的300名护士为研究对象,参照焦虑自评量表(SAS)等国内外的研究方法进行问卷调查,评估护士的焦虑现状和急诊科的人力资源管理,对两者相关性进行统计分析.结果 除3家医院外,其他6家医院的护士焦虑状况评分显示均有不同程度的焦虑,平均分均高于50分;即使在3家焦虑状况评分在50分以下的医院里,中重度焦虑的比例仍在20.0%以上,其他6家医院更高,最高达66.7%;同时人力资源管理达到优秀与合格的医院急诊科护士的总体焦虑率明显低于不合格医院,

  14. Skills and educational needs of accident and emergency nurses in Ghana: An initial needs analysis

    Sarah Rominski


    Discussion: Current nurse knowledge and function as well as areas to focus on for future specialty training in emergency nursing have been identified by this needs assessment. The emergency department nurses shared an overwhelming interest in increasing their skill level, learning new methods of patient care and implementing new technologies into their clinical practice.

  15. Clinical Overview and Emergency-Department Whiteboards

    Hertzum, Morten; Simonsen, Jesper


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

  16. 中医院急诊科护士团队效能的调查分析%Survey and Analysis of Nurses' Team Efficacy of Emergency Department in Chinese Medicine Hospital

    谭益冰; 江淑聘


    Objective To know the level of nurses' team efficacy of emergency department in Chinese medicine hospital and explore its affected factors. Methods Cluster sampling was used, and general data questionnaire and team efficiency scale were used. Results 102 subjects were recruited, the total score of team efficacy was 4.34±0.73, belonged to 86.8%level;The differences in several groups, such as age (F = 7.18, P <0.05), working time (F = 2.93, P <0.05) and working department (t = 4.39, P <0.05) were statistically significant. Conclusions Nurses of emergency department in Chinese medicine have good team efficiency, especially in team work efficiency and responsibility. The team efficacy of nurses in middle class and who haven't been fixed up to certain department should be strengthened.%目的:了解中医院急诊科护士团队效能的水平,探讨其影响因素。方法采用整群抽样,使用一般资料调查表及《团队效能量表》对广州市某两家三甲中医院急诊科护士进行调查。结果共调查102人,中医院急诊科护士团队效能总分(4.34±0.73)分,水平为86.8%;不同年龄(F=7.18,P<0.05)、工作时间(F=2.93,P<0.05)及定科情况(t=4.39,P<0.05)组的总分差异具有统计学意义。结论中医院急诊科护士具有良好的团队效能,体现在团队工作效率与责任感;需加强“夹心层”及未定科护士的团队效能。

  17. Emergency Department: Basic Prerequisites for the Upgrade of the NHS

    Georgios Charalambous


    Full Text Available The Emergency Department is an autonomous hospital unit comprised of doctors, nurses and paramedics, who deliver emergency care on a 24-hour basis. It provides an interface between patients and their specialized treatment, as well as a point of contact between primary and tertiary care. The need for medical services has increased disproportionately to the available resources for medical care; a fact that has given rise to difficulties in maintaining the effective function of the Emergency Department. As a result, the provision of high standard services is not ensured. In order to help establish and maintain the effective operation of the Emergency Department, new methods should be established which efficiently utilize existing and up-and-coming information and communication technologies. This will allow for the acceleration of the Department’s operational procedures, more effective treatment of emergency cases, and ultimately assists in maintaining a high level of patient satisfaction. The expansion and development of specific services offered by the ED will also assist in the Department becoming a system of qualitative assessment for primary care. This would lead to a better outcome for emergency cases as a result of fast, spherical and effective treatment.

  18. Evaluation of Performance Indexes of Emergency Department

    Alireza Baratloo


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

  19. 输液流程再造提高门急诊护理质量的效果观察%Effect of Transfusion Process Reengineering in Improving the Nursing Quality for Outpatient and Emergency Department

    荚恒娅; 张玲


    目的 探讨便捷、高效、安全、合理的门急诊输液流程,以提高门急诊护理质量.方法 方便性抽样选择第二军医大学长海医院急诊科2010年1月流程再造前门急诊输液患者500例和2011年4月流程再造后门急诊输液患者500例,以及门急诊输液室护理人员25名,对实施流程再造前后患者就诊至输液各环节的等候时间、患者对输液过程满意度、护理人员各项操作所用时间及护理人员满意度进行对比分析.结果 流程再造后所测得患者各环节等候时间及护理人员各项操作所用时间均低于流程再造前,患者及护理人员各项满意度均高于流程再造前,差异均有统计学意义(P<0.05或P<0.01).结论 再造后的输液流程更符合便捷、高效、安全、合理的标准,有效提高了门急诊输液室的护理质量,值得在临床中推广应用.%Objective To investigate a convenient, highly effective, safe and advisable transfusion process in clinic and emergency for better nursing quality of outpatient and emergency departments. Methods U-sing convenience sampling method, 500 transfusion outpatients before the reengineering in January 2010, 500 after the reengineering in April 2011 and 25 nurses in the transfusion room of emergency department of Changhai Hospital of Second military Medical University were selected to undertake contrastive analysis on the waiting time from doctor's visiting to taking transfusion for the outpatients, the satisfaction degree of the patients to the convenience, safety and nursing service, time of completing the procedure, and the satisfaction degree of the nursing staffs to individual prevention, safety and time-and-labor-saving. Results The waiting time and the time for completing the procedure after the reengineering were both shorter than the time before it. The satisfaction degrees of patients and the nursing staffs after the engineering were also all higher than those before it. The

  20. Implementing evidence-based practices in an emergency department

    Kirk, Jeanette W.; Nilsen, Per


    department influence nurses' use of a research-based clinical guideline and a nutrition screening routine. METHODS: Ethnographic fieldwork was carried out over three months. The first author followed nurses, medical secretaries and doctors in the emergency department. Data were also collected by means...... and screening routines provided a flow stop. Four associated contradictions were identified: insufficient time to implement guidelines; guilty conscience due to perceived nonadherence to evidence-based practices; newcomers having different priorities; and conflicting views of what constituted being...... a professional. CONCLUSION: We found that research-supported guidelines and screening routines were not used if they were perceived to stop the patient flow, suggesting that the practice was not fully evidence based....

  1. [Behavior theory and skill of outpatient department nursing administration].

    Xu, Y L; Li, Z X; Liu, X


    51 nurses in the out patient department (OPD) were surveied by Eysenck Personality Questionaire and Cattle 16 Personality Factors. Some nurses' jobs were changed and the psychological principles were applied to improve the nurses' mental health by the manager according to the result. The management in the out patient department was more effective after behavior theory was adopted.

  2. The nursing department's view towards moroccan patients.

    Sánchez-Ojeda, María Angustias; Alemany Arrebola, Inmaculada; Gallardo Vigil, Miguel Ángel


    To determine the Melilla Hospital Nursing Department's attitude towards Moroccan patients. Descriptive ex post facto study. A questionnaire has been handed over to staff, on the Immigration Attitude Scale for Nursing. In general, nurses exhibit negative attitudes towards Moroccan patients, such as: the increase in crime is caused by the arrival of immigrants, those who commit offenses must be expelled from Spain, they take advantage of the Spanish health system and too many resources are devoted to immigration. The worst-rated immigrants are the Moroccans, considering that they do not pay much attention to their personal hygiene and do not adapt to their host countries. It is necessary to work with the nursing staff to change these attitudes. Future degree students must be trained in cultural skills and the care of immigrants will improve with a greater commitment towards cultural differences. Conocer la actitud de enfermería del Hospital de Melilla hacia los pacientes marroquíes. Estudio ex post facto descriptivo. Se ha pasado un cuestionario de Escala de Actitud ante la Inmigración para Enfermería. En general las enfermeras presentan actitudes negativas ante los pacientes marroquíes, como: el aumento de la delincuencia es provocado por la llegada de inmigrantes, los que delinquen deben ser expulsados de España, se aprovechan del sistema sanitario y se dedican demasiados recursos para la inmigración. Los inmigrantes peores valorados son los marroquíes, considerando que son pocos cuidadosos con su higiene personal y no se adaptan a los países de acogida. Es necesario trabajar con el personal de enfermería para que cambien estas actitudes. Las futuras promociones de Grado deben estar formadas en competencias culturales y mejorarán los cuidados a los inmigrantes como un mayor compromiso con la diferencia cultural.

  3. Assigning treatment rooms at the Emergency Department

    van de Vrugt, Noëlle Maria; Boucherie, Richardus J.


    Increasing efficiency at the Emergency Department (ED) reduces overcrowding. At the ED in typical Dutch Hospitals treatment rooms are mostly shared by two residents of different specialties: a Surgeon and an Internist. Each resident uses multiple rooms in parallel; while one patient awaits test resu

  4. Emergency department crowding: Factors influencing flow

    van der Linden, M.C.


    This thesis focuses on emergency department (ED) crowding. In the first part (ED crowding in the Netherlands) the current state of EDs regarding patients’ length of stay and ED managers’ experiences of crowding are described. Part two (input factors) contains three studies which describe the case lo

  5. Accidental oxygen disconnection in the emergency department

    Hill Guyon


    Full Text Available Accidental oxygen disconnection during rapid sequence intubation (RSI in the emergency department is a potentially catastrophic yet avoidable event. We report three cases of inadvertent oxygen disconnection during RSI, which resulted in significant oxygen desaturation. This error can potentially be prevented by thorough preparation, focusing on teamwork training, ensuring an ergonomic environment, and by making simple modifications to existing equipment.

  6. Assigning treatment rooms at the Emergency Department

    Vrugt, van de Maartje; Boucherie, Richard J.


    Increasing efficiency at the Emergency Department (ED) reduces overcrowding. At the ED in typical Dutch Hospitals treatment rooms are mostly shared by two residents of different specialties: a Surgeon and an Internist. Each resident uses multiple rooms in parallel; while one patient awaits test resu

  7. 急诊科护士主观幸福感及影响因素研究%Study of subjective well-being of nurses in emergency department and its influence factor

    王丽娜; 景晓娜; 延丽华; 张丽; 程三放


    Objective To analyze subjective well-being of nurses in emergency department, discuss its influence fac-tors. Methods 217 cases of nurses in Department of Emergency, the Second Affiliated Hospital of Xi'an Jiaotong Uni-versity were selected as respondents. Campbell happiness index scale was used for subjective well-being evaluation. The influence of gender, age, educational background, working time and job title on subjective well-being was analyzed. SPSS 19.0 statistical software was used for data statistics and analysis. Results Single factor analysis results showed that subjective well-being scores of nurses with different gender, age, educational background, working time and job ti-tle had statistically significant (P< 0.05). Multi-factor Logistic analysis showed that age (OR=1.424, P< 0.05), gender (OR=1.354, P<0.05), educational background (OR=1.299, P< 0.05), working time (OR=1.301, P< 0.05) and job title (OR=1.227, P< 0.05) were the influence factors of nurse subjective well-being. Conclusion Subjective well-being of nurses has affected by multiple factors. Corresponding measure should be adopted to improve the nurse subjective well-being.%目的:分析急诊科护士主观幸福感特征,探讨影响主观幸福感的相关因素。方法选择西安交通大学第二附属医院急诊科护士217名为调查对象,采用Compbell幸福感指数量表评价其主观幸福感。分析性别、年龄、学历、工作时间和工作职称对主观幸福感的影响。使用SPSS 19.0统计学软件进行数据统计及分析。结果单因素分析结果显示,不同年龄、性别、学历、工作时间以及工作职称的护士主观幸福感得分差异有统计学意义(P<0.05)。多因素 Logistic 分析发现,年龄(OR=1.424,P <0.05)、性别(OR=1.354,P <0.05)、学历(OR=1.299,P <0.05)、工作时间(OR=1.301,P<0.05)以及工作职称(OR=1.227,P<0.05)均是护士主观幸福感的影响因素。结论护士

  8. Developments in emergency nursing education in Ghana.

    Bell, Sue Anne; Bam, Victoria; Acheampong, Emmanuel


    Providing effective emergency nursing is challenging in low- to middle-income countries because of limited resources and an inadequate infrastructure. The role of the emergency nurse is growing throughout sub-Saharan Africa and this will help decrease the burden of acute illness and trauma on both the people and the economies in the area. However, there is a gap in education for emergency nurses in this part of the world which needs to be addressed. This article describes an emergency nursing degree programme in Ghana which was developed in collaboration with a university in the United States and one in Ghana. It also outlines the development and content of the programme and discusses its success and challenges.

  9. 急诊科护理人员手部细菌培养监测分析%Bacteriological surveillance for hand hygiene of nursing staffs in department of emergency

    梅申聪; 丁亚君; 唐芳; 朱长太


    目的 调查急诊科护理人员手部细菌携带情况及细菌种类,监测其洗手效果,评估其执行手卫生的意义.方法 对急诊科共20 名护理人员进行手部细菌培养检测,分别在洗手前及洗手后进行采样.细菌鉴定及药敏主要由VITEK 仪器完成.结果 洗手前手部中位菌落数为2 CFU/cm2,四分位距(interquartile range,IQR)为1-3.75 CFU/cm2.洗手后中位菌落数为0 CFU/cm2,IQR 为0-0 CFU/cm2.同洗手前比较,洗手后菌落计数减少有统计学意义(P<0.05).细菌鉴定及药敏结果显示:菌种分布较为广泛,以葡萄球菌属及肠杆菌科等条件致病菌为主;检出多重耐药菌3 株.结论 急诊科护理人员操作中手部存在一定程度细菌污染,而正确洗手及提高护理人员手卫生依从性,可有效清除细菌,有利于预防医院感染的发生.%Objective To investigate the situation of bacteria carrying and classification on the hands of nursing staffs in the department of emergency, monitor the effect of hand -washing, and evaluate the significance of hand hygiene. Methods 20 nurses in the department of emergency were selected, and the samplings for the hands were conducted and cultivated in operation (before hand-washing) and after hand-washing , respectively. Bacterial identification and antimicrobial susceptibility testing were performed mainly by the VITEK instrument. Results The median colony number before hand-washing was 2 CFU (colony forming unit)/cm2 and the interquartile range (IQR) was 1-3.75 CFU/cm2. While after hand-washing, the median and IQR colony numbers were 0 CFU/cm2 and. 0-0 CFU/cm2, respectively. There was a statistically significant reduction before hand-washing in colony count compared to that after hand-washing (P<0.05). The identification and susceptibility results showed that the distribution of bacteria species were widely, but mainly belonged to Staphylococcus and Enterobacteriaceae opportunistic pathogen. Three multidrug

  10. Nursing Service Innovation: a case study examining emergency nurse practitioner service sustainability.

    Fox, Amanda; Gardner, Glenn; Osborne, Sonya


    This research aimed to explore factors that influence sustainability of health service innovation, specifically emergency nurse practitioner service. Planning for cost effective provision of healthcare services is a concern globally. Reform initiatives are implemented often incorporating expanding scope of practice for health professionals and innovative service delivery models. Introducing new models is costly in both human and financial resources and therefore understanding factors influencing sustainability is imperative to viable service provision. This research used case study methodology (Yin, 2014). Data were collected during 2014 from emergency nurse practitioners, emergency department multidisciplinary team members and documents related to nurse practitioner services. Collection methods included telephone and semi-structured interviews, survey and document analysis. Pattern matching techniques were used to compare findings with study propositions. In this study, emergency nurse practitioner services did not meet factors that support health service sustainability. Multidisciplinary team members were confident that emergency nurse practitioner services were safe and helped to meet population health needs. Organizational support for integration of nurse practitioner services was marginal and led to poor understanding of service capability and underuse. This research provides evidence informing sustainability of nursing service models but more importantly raises questions about this little explored field. The findings highlight poor organizational support, excessive restrictions and underuse of the service. This is in direct contrast to contemporary expanding practice reform initiatives. Organizational support for integration is imperative to future service sustainability. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  11. Emergency Nurses as Second Victims of Error: A Qualitative Study.

    Ajri-Khameslou, Mehdi; Abbaszadeh, Abbas; Borhani, Fariba

    There are many nurses who are victims of errors in the hospital environment. It is quite essential to perceive the outcome of mistakes in nurses' profession. The aim of this scientific study was to interpret the causes that place nurses in danger of errors in emergency departments and also the consequences resulting from confronting the errors in the job environment. This research was designed to pursue a qualitative approach following content analysis. Through the purposeful sampling, 18 emergency nurses were selected to participate in this study. In-depth semi-structured interviews were used for data collection. Participants were selected by purposive sampling. Data collection continued until saturation was reached. The results of data analysis were presented in three different categories: the psychological reactions to error, learning from errors, and avoiding reactions. The current study revealed that errors could create positive and negative impacts on the emergency nurses' attitude. Confronting the errors through learning from the mistakes can result in the improvement of patients' safety whereas the negative outcomes can provoke destructive effects on nurses' career. Nurses are considered as victims of errors; therefore, they need support and protection to enhance their career.

  12. Emergency Department Management Of Acute Infective Endocarditis.

    Schauer, Steven G; Pfaff, James A; Cuenca, Peter John


    Infective endocarditis has a high rate of mortality, and most patients suspected of having the disease will require hospital admission. This review examines the literature as it pertains specifically to emergency clinicians who must maintain vigilance for risk factors and obtain a thorough history, including use of intravenous drugs, in order to guide the workup and treatment. Properly obtained cultures are critical during the evaluation, as they direct the course of antibiotic therapy. Although transthoracic echocardiography is widely available in United States emergency departments, it is not sensitive or specific enough to rule out a diagnosis of infective endocarditis. In high-risk patients, transesophageal echocardiography should be considered.

  13. Procedures and Collaborative Information Seeking: A Study of Emergency Departments

    Hertzum, Morten; Reddy, Madhu


    Information seeking is a central and inherently collaborative activity in the emergency department (ED) which is the common entry point to hospitals for nearly all acute patients. In this paper, we investigate how ED clinicians’ collabo-rative information seeking (CIS) is shaped by the procedures...... that the clinicians follow in the ED. Based on observations in two Danish EDs, we identify four pro-cedures prominent to how CIS is accomplished: the triage procedure, the timeouts, the coordinating nurse, and the recurrent opportunities for information seeking at the whiteboard. We then discuss how CIS activities...

  14. Procedures and Collaborative Information Seeking: A Study of Emergency Departments

    Hertzum, Morten; Reddy, Madhu


    Information seeking is a central and inherently collaborative activity in the emergency department (ED) which is the common entry point to hospitals for nearly all acute patients. In this paper, we investigate how ED clinicians’ collabo-rative information seeking (CIS) is shaped by the procedures...... that the clinicians follow in the ED. Based on observations in two Danish EDs, we identify four pro-cedures prominent to how CIS is accomplished: the triage procedure, the timeouts, the coordinating nurse, and the recurrent opportunities for information seeking at the whiteboard. We then discuss how CIS activities...

  15. 护理人员分层管理对急诊科护理质量的作用探讨%Study on Effect of Layer Management of Nursing Staff on the Nursing Qual-ity in the Department of Emergency

    李颖; 李晓英; 安晓红


    Objective To study the important significance of layer management of nursing staff to the improvement of nurs-ing quality in the process of emergency nursing. Methods The layer management of nursing staff had been formally imple-mented since July 2013 in the department of emergency in our hospital, the nursing situation in the department of emergen-cy from January 2014 to January 2015 was collected, and compared after 1-year implementation of layer management, 25 cases of on-the-job female nursing staff in the department of emergency aged from 25 to 47 (33.62±6.49)years old on average) treated in our hospital from January 2014 to January 2015 were selected as the research objects, in terms of professional ti-tle, 3 cases were nurses-in-charge, 17 cases were nurses, and 5 cases were primary nurses; in terms of academic level, 15 cases were undergraduates, 6 cases graduated from junior colleges, and 4 cases graduated from the technical secondary school, in this research, the incidence rate of errors, satisfactory degrees of patients and physicians in the department of e-mergency before and after the implementation of layer management needed to be compared, and the self-made satisfactory degree score table method was adopted for assessment in the course of evaluating the satisfactory degree, and the full mark was 10 marks. Results After the implementation of layer management in the department of emergency, the incidence rate of errors, satisfactory degrees of patients and physicians in the department of emergency were obviously improved, and all dif-ferences had statistical significance after the comparison of statistical methods, P<0.05. Conclusion The implementation of layer management means of nursing staff in the department of emergency can obviously improve the nursing quality in the department of emergency, which is of important significance to the normal treatment of patients and physical recovery, and it is of extremely high application value.%目的:探

  16. Enhanced monitoring of abnormal emergency department demands

    Harrou, Fouzi


    This paper presents a statistical technique for detecting signs of abnormal situation generated by the influx of patients at emergency department (ED). The monitoring strategy developed was able to provide early alert mechanisms in the event of abnormal situations caused by abnormal patient arrivals to the ED. More specifically, This work proposed the application of autoregressive moving average (ARMA) models combined with the generalized likelihood ratio (GLR) test for anomaly-detection. ARMA was used as the modelling framework of the ARMA-based GLR anomaly-detection methodology. The GLR test was applied to the uncorrelated residuals obtained from the ARMA model to detect anomalies when the data did not fit the reference ARMA model. The ARMA-based GLR hypothesis testing scheme was successfully applied to the practical data collected from the database of the pediatric emergency department (PED) at Lille regional hospital center, France. © 2015 IEEE.

  17. Approach to dizziness in the emergency department

    Jung, Ileok; Kim, Ji-Soo


    Acute dizziness/vertigo is among the most common causes for visiting the emergency department. The traditional approach to dizziness starts with categorizing dizziness into four types: vertigo, presyncope, disequilibrium, and nonspecific dizziness. However, a recently proposed approach begins with classifying dizziness/vertigo as acute prolonged spontaneous dizziness/vertigo, recurrent spontaneous dizziness/vertigo, recurrent positional vertigo, or chronic persistent dizziness and imbalance. ...

  18. Computed radiography in an emergency department setting

    Andriole, Katherine P.; Gould, Robert G.; Arenson, Ronald L.


    Evaluation of radiologist and non-radiologist physician acceptance of computed radiography (CR) as an alternative to film-based radiography in an emergency department (ED) is performed. All emergency department radiographs are performed using photostimulable phosphor plates and rad by a computed radiography laser reader placed in the former emergency department darkroom. Soft copy images are simultaneously transmitted to high- and medium-resolution dual-monitor display stations located in radiology and ED reading rooms respectively. The on-call radiologist is automatically paged by the Radiology Information System (RIS) upon exam completion, to read the new ED imaging study. Patient demographic information including relevant clinical history is conveyed to the radiologist via the RIS. A 'wet read' preliminary radiology report is immediately transmitted back to the ED. Radiology and ED physicians are surveyed to ascertain preferences for CR or traditional screen-film, based on system implementation, image viewing and clinical impact issues. Preliminary results indicate a preference for filmless CR among the ED physicians if digital reliability and speed issues are met. This preference appears to be independent of physician level of experience. Inexperienced radiologists-in-training appear to have less comfort with softcopy reading for primary diagnosis. However, additional training in softcopy reading techniques can improve confidences. Image quality issues are most important tot he radiologist, while speed and reliability are the major issues for ED physicians. Reasons for CR preference include immediate access to images on display stations, near-zero exam retake rates, and improved response time and communication between radiology and the emergency department clinician.

  19. Forecasting the Emergency Department Patients Flow.

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


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

  20. Effect of workplace violence on psychological health in nurse of emergency department%医院工作场所暴力对急诊科护士心理健康的影响

    丘宇茹; 王吉文; 吴惠文


    Objective To investigate the effect of workplace violence on psychological health in nurse of emergency department.Methods 96 nurses of emergency department from 6 third-grade class-A hospitals in Guangzhou who had experienced workplace violence since the last six months were investigated by means of SCL-90 and self-designed questionnaire according to WHO' definition of workplace violence.Results 42.16% of workplace violence happened between late night and early dawn.The incidence of psychological violence was 72.55%.The patients and their family were the main troublemakers.The risk factors of violence were:needs not met,dissatisfaction of service,heavy drinking,in sequence.On account of workplace violence,the average score of somatization,compulsion,depression,anxiety,hostility,fear and mental disease was significantly higher than the Chinese norm (t =4.676,3.745,2.892,8.236,2.796,8.012,5.177,23.801;P < 0.01 or P < 0.05 ).Conclusions Workplace violence severely affects psychological health of nurse in emergency department and should be prevented and controlled by effective measures.%目的 探讨医院工作场所暴力对急诊科护士心理健康的影响.方法 根据世界卫生组织( WHO)发布的工作场所暴力定义设计调查表及应用症状自评量表(SCL-90),对广州市6所三级甲等综合医院96名急诊科护士在半年内遭受过工作场所暴力后进行问卷调查.结果 急诊科护士遭受工作场所暴力事件42.16%发生在深夜凌晨,心理暴力发生率为72.55%,患者和患者家属是主要肇事者,暴力事件的危险因素依次为患者或家属的要求未得到满足、对服务不满意、肇事者酗酒.遭受工作场所暴力后,急诊科护士在躯体化、强迫症状、抑郁、焦虑、敌对、恐怖、精神病性等方面的因子得分均高于国内常模,差异有统计学意义(t分别为4.676,3.745,2.892,8.236,2.796,8.012,5.177,23.801;P <0.05或P<0.01).结论 工作场所暴力

  1. 微量泵在急诊科的临床应用以及护理体会%Clinical Application and Nursing of Micro Pump in the Emergency Department



    Objective To evaluate the clinical application of micro pump in the emergency department and the problems of critical y il patients in clinical nursing work to find ef ective solutions to ensure drug safety and ef icacy.Methods A retrospective hospital emergency department in June 2013 June 2014 120 patients we specifications,lack of knowledge,responsibility is not enough.Results The cause of nursing staf is not familiar with micro pump using the operating specifications of the main reasons for the problem of micro pump in clinical use, lack of knowledge, lack of responsibility. Conclusion For clinical use micro-pump problems,the development of micro-pumps use practices,rescue ef iciency,reduce the incidence of adverse events.%目的:探讨微量泵在急诊科危重患者的临床应用以及在临床护理工作中的问题,找出有效的解决措施,确保用药有效性和安全性。方法回顾我院急诊科2013年6月~2014年6月收治的120例患者应用微量泵的临床护理资料。结果导致微量泵在临床使用中出现问题主要原因是护理人员对微量泵使用操作规范不熟悉,缺乏相关知识,责任心不够。结论针对微量泵临床使用中的问题,制定微量泵使用操作规范,对护理人员加强专业培训,掌握微量泵使用操作流程、适应症及相关药物知识等,可以提高抢救效率,减少不良事件的发生。

  2. QC活动结合护理查房在急诊科提高病人满意度的作用%An Investigation into the Effect of QC Activities Combined with Nursing Round on Patients'Satisfaction in Emergency Department

    廖明霞; 谢秀飞


    Objective:To investigate the effect of QC activities combined with nursing round on patients' satisfaction in emergency department.Methods:Establish QC group and carry out problem-based nursing round ,make the nurses in emergency department proficient in first-aid procedures ,the application of first-aid instrument,the training of first-aid skills,the mastery of healthy knowledge and the skills to communi-cate with patients through nursing round .Results:QC activities and the application of nursing round in the cultivation for nurse in emergency department improved the professional skill level ,nursing quality and service level of the nurses ,and it has improve patients'satisfaction with nursing from 65.8%(before QC ac-tivities)to 94.1%(after QC activities).Conclusion:To cultivate nurses with QC activities combined with nurs-ing round can improve he professional skill level ,nursing quality and service level of the nurses,and it is also an effective way to improve patients'satisfaction with nursing work.%目的::探讨QC活动结合护理查房在急诊科提高病人对护理工作满意度的作用。方法:组建QC活动小组,实施以问题为基础的护理查房,应用护理查房的方法培训急科护士对急救流程熟练、急救仪器使用,急救技能的训练,健康知识宣教的掌握及与病人沟通的技巧。结果:QC活动结合护理查房,应用护理查房的方法培训急诊科护士,提高了急诊科护士专业技术水平,护理质量和服务水平,使病人对急诊护理工作的满意度由 QC活动前的65.8%提高到开展 QC活动后的94.1%。结论:QC活动结合护理查房对护士进行的培训,提高急诊科护士急救技术水平、护理质量及服务水平,提高病人对急诊科护理工作满意度是一种行之有效的方法。

  3. Takotsubo cardiomyopathy: diagnosis in an emergency department

    Marina Mancini


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

  4. Emergency Department Overcrowding and Ambulance Turnaround Time.

    Lee, Yu Jin; Shin, Sang Do; Lee, Eui Jung; Cho, Jin Seong; Cha, Won Chul


    The aims of this study were to describe overcrowding in regional emergency departments in Seoul, Korea and evaluate the effect of crowdedness on ambulance turnaround time. This study was conducted between January 2010 and December 2010. Patients who were transported by 119-responding ambulances to 28 emergency centers within Seoul were eligible for enrollment. Overcrowding was defined as the average occupancy rate, which was equal to the average number of patients staying in an emergency department (ED) for 4 hours divided by the number of beds in the ED. After selecting groups for final analysis, multi-level regression modeling (MLM) was performed with random-effects for EDs, to evaluate associations between occupancy rate and turnaround time. Between January 2010 and December 2010, 163,659 patients transported to 28 EDs were enrolled. The median occupancy rate was 0.42 (range: 0.10-1.94; interquartile range (IQR): 0.20-0.76). Overcrowded EDs were more likely to have older patients, those with normal mentality, and non-trauma patients. Overcrowded EDs were more likely to have longer turnaround intervals and traveling distances. The MLM analysis showed that an increase of 1% in occupancy rate was associated with 0.02-minute decrease in turnaround interval (95% CI: 0.01 to 0.03). In subgroup analyses limited to EDs with occupancy rates over 100%, we also observed a 0.03 minute decrease in turnaround interval per 1% increase in occupancy rate (95% CI: 0.01 to 0.05). In this study, we found wide variation in emergency department crowding in a metropolitan Korean city. Our data indicate that ED overcrowding is negatively associated with turnaround interval with very small practical significance.

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

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

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

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

  7. A moment in time: emergency nurses and the Canterbury earthquakes.

    Richardson, S; Ardagh, M; Grainger, P; Robinson, V


    To outline the impact of the Canterbury, New Zealand (NZ) earthquakes on Christchurch Hospital, and the experiences of emergency nurses during this time. NZ has experienced earthquakes and aftershocks centred in the Canterbury region of the South Island. The location of these, around and within the major city of Christchurch, was unexpected and associated with previously unknown fault lines. While the highest magnitude quake occurred in September 2010, registering 7.1 on the Richter scale, it was the magnitude 6.3 event on 22 February 2011 which was associated with the greatest injury burden and loss of life. Staff working in the only emergency department in the city were faced with an external emergency while also being directly affected as part of the disaster. SOURCES OF EVIDENCE: This paper developed following interviews with nurses who worked during this period, and draws on literature related to healthcare responses to earthquakes and natural disasters. The establishment of an injury database allowed for an accurate picture to emerge of the injury burden, and each of the authors was present and worked in a clinical capacity during the earthquake. Nurses played a significant role in the response to the earthquakes and its aftermath. However, little is known regarding the impact of this, either in personal or professional terms. This paper presents an overview of the earthquakes and experiences of nurses working during this time, identifying a range of issues that will benefit from further exploration and research. It seeks to provide a sense of the experiences and the potential meanings that were derived from being part of this 'moment in time'. Examples of innovations in practice emerged during the earthquake response and a number of recommendations for nursing practice are identified. © 2013 The Authors. International Nursing Review © 2013 International Council of Nurses.

  8. Human Trafficking in the Emergency Department

    Ahn, Roy


    Full Text Available 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 potential trafficking cases by increasing their awareness of this phenomenon, using qualified interpreters, isolating potential victims by providing privacy and using simple clear reassuring statements ensuring security. A multidisciplinary approach can then be mobilized to help these patients. [West J Emerg Med. 2010;11(5; 402-404.

  9. Hepatorenal Syndrome in the Emergency Department: A Case Report

    Win Jim Tan


    Full Text Available Background: Hepatorenal syndrome is a condition where there is functional renal failure in a background of liver disease. It is relatively common in patients with liver cirrhosis and is associated with a high mortality rate if untreated. Results: This is a case report of an 88-year-old Chinese man presenting from a community hospital with a new onset of abdominal distension on a background of cryptogenic liver cirrhosis diagnosed on computed tomography scan. Clinical history and physical findings were consistent with that of fluid overload. Investigations performed indicated acute kidney injury together with liver failure secondary to liver cirrhosis. The patient was diagnosed with hepatorenal syndrome in accordance with the criteria established by the International Ascites Club and managed with an infusion of vasopressin and albumin in the emergency department. He was subsequently admitted to the general ward (gastrology, where he was managed for hepatorenal syndrome, improved clinically and was discharged to the nursing home. Conclusion: Hepatorenal syndrome can be managed effectively with albumin and vasopressin, and such treatment can be started as early as in the emergency department. Acute care physicians should not be hesitant in diagnosing and treating hepatorenal syndrome as early as in the emergency department for appropriate patients.

  10. Human Trafficking in the Emergency Department

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


    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 potential trafficking cases by increasing their awareness of this phenomenon, using qualified interpreters, isolating potential victims by providing privacy and using simple clear reassuring statements ensuring security. A multidisciplinary approach can then be mobilized to help these patients. PMID:21293753

  11. Frequent users of the pediatric emergency department.

    Seguin, Jade; Osmanlliu, Esli; Zhang, Xun; Clavel, Virginie; Eisman, Harley; Rodrigues, Robert; Oskoui, Maryam


    Emergency department (ED) crowding is associated with increased morbidity and mortality. Its etiology is multifactorial, and frequent ED use (defined as more or equal to five visits per year) is a major contributor to high patient volumes. Our primary objective is to characterize the frequent user population. Our secondary objective is to examine risk factors for frequent emergency use. We conducted a retrospective cohort study of pediatric emergency department (PED) visits at the Montreal Children's Hospital using the Système Informatique Urgence (SIURGE), electronic medical record database. We analysed the relation between patient's characteristics and the number of PED visits over a 1-year period following the index visit. Patients totalling 52,088 accounted for 94,155 visits. Of those, 2,474 (4.7%) patients had five and more recurrent visits and accounted for 16.6% (15,612 visits) of the total PED visits. Lower level of acuity at index visit (odds ratio [OR] 0.85) was associated with a lower number of recurrent visits. Lower socioeconomic status (social deprivation index OR 1.09, material deprivation index OR 1.08) was associated with a higher number of recurrent visits. Asthma (OR 1.57); infectious ear, nose, and sinus disorders (OR 1.33); and other respiratory disorders (OR 1.56) were independently associated with a higher incidence of a recurrent visit within the year following the first visit. Our study is the first Canadian study to assess risk factors of frequent pediatric emergency use. The identified risk factors and diagnoses highlight the need for future evidence-based, targeted innovative research evaluating strategies to minimize ED crowding, to improve health outcomes and to improve patient satisfaction.

  12. Do emergency nurses have enough emotional intelligence?

    Codier, Estelle; Codier, David


    A significant body of research suggests there is a correlation between measured emotional intelligence (EI) abilities and performance in nursing. The four critical elements of EI, namely the abilities to identify emotions correctly in self and others, using emotions to support reasoning, understanding emotions and managing emotions, apply to emergency care settings and are important for safe patient care, teamwork, retention and burnout prevention. This article describes 'emotional labour' and the importance of EI abilities for emergency nurses, and suggests that such abilities should be considered core competencies for the profession.

  13. International perspectives on emergency department crowding.

    Pines, Jesse M; Hilton, Joshua A; Weber, Ellen J; Alkemade, Annechien J; Al Shabanah, Hasan; Anderson, Philip D; Bernhard, Michael; Bertini, Alessio; Gries, André; Ferrandiz, Santiago; Kumar, Vijaya Arun; Harjola, Veli-Pekka; Hogan, Barbara; Madsen, Bo; Mason, Suzanne; Ohlén, Gunnar; Rainer, Timothy; Rathlev, Niels; Revue, Eric; Richardson, Drew; Sattarian, Mehdi; Schull, Michael J


    The maturation of emergency medicine (EM) as a specialty has coincided with dramatic increases in emergency department (ED) visit rates, both in the United States and around the world. ED crowding has become a public health problem where periodic supply and demand mismatches in ED and hospital resources cause long waiting times and delays in critical treatments. ED crowding has been associated with several negative clinical outcomes, including higher complication rates and mortality. This article describes emergency care systems and the extent of crowding across 15 countries outside of the United States: Australia, Canada, Denmark, Finland, France, Germany, Hong Kong, India, Iran, Italy, The Netherlands, Saudi Arabia, Catalonia (Spain), Sweden, and the United Kingdom. The authors are local emergency care leaders with knowledge of emergency care in their particular countries. Where available, data are provided about visit patterns in each country; however, for many of these countries, no national data are available on ED visits rates or crowding. For most of the countries included, there is both objective evidence of increases in ED visit rates and ED crowding and also subjective assessments of trends toward higher crowding in the ED. ED crowding appears to be worsening in many countries despite the presence of universal health coverage. Scandinavian countries with robust systems to manage acute care outside the ED do not report crowding is a major problem. The main cause for crowding identified by many authors is the boarding of admitted patients, similar to the United States. Many hospitals in these countries have implemented operational interventions to mitigate crowding in the ED, and some countries have imposed strict limits on ED length of stay (LOS), while others have no clear plan to mitigate crowding. An understanding of the causes and potential solutions implemented in these countries can provide a lens into how to mitigate ED crowding in the United States

  14. Treating pain in the emergency department.

    Kuan, Samuel C


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

  15. Physician Assistants Contribution to Emergency Department Productivity

    Christopher Brook, MD


    Full Text Available Introduction: The objective of this report is to determine physician assistant (PA productivity in anacademic emergency department (ED and to determine whether shift length or department censusimpact productivity.Methods: A retrospective chart review was conducted at a tertiary ED during June and July of 2007.Productivity was calculated as the mean number of patients seen each hour. Analysis of variance wasused to compare the productivity of different length shifts, and linear regression analysis was used toassess the relationship between productivity and department volume.Results: One hundred sixty PA shifts were included. Shifts ranged from 4 to 13 hours. Meanproductivity was 1.16 patients per hour (95% confidence interval [CI] ¼ 1.12–1.20. Physicianassistants generated a mean of 2.35 relative value units (RVU per hour (95% CI¼1.98–2.72. Therewas no difference in productivity on different shift lengths (P¼0.73. There was no correlation betweendepartmental census and productivity, with an R2 (statistical term for the coefficient of determination of0.01.Conclusion: In the ED, PAs saw 1.16 patients and generated 2.35 RVUs per hour. The length of theshift did not affect productivity. Productivity did not fluctuate significantly with changing departmentalvolume.

  16. Irish Emergency Nurses’ Attitudes towards Role Expansion in, and Barriers to, Nurse Prescribing

    Clancy, Michele


    Aim This study set out to explore Irish emergency nurses’ attitudes towards nurse prescribing and also to elicit their attitudes towards potential barriers to nurse prescribing. Method A quantitative descriptive survey was used to answer the research question, a questionnaire was administered to a systematic random sample of Emergency Department nurses. This consisted of a 31 item Likert-type attitudinal scale, previously developed for a similar study. Background Traditionally,...

  17. Recognition and management of seizures in children in emergency departments.

    Caplan, Edward; Dey, Indranil; Scammell, Andrea; Burnage, Katy; Paul, Siba Prosad


    Seizure is defined as 'a sudden surge of electrical activity in the brain, which usually affects how a person appears or acts for a short time'. Children who have experienced seizures commonly present to emergency departments (EDs), and detailed history taking will usually help differentiate between epileptic and non-epileptic events. ED nurses are often the first health professionals to manage children with seizures, and this is best done by following the ABCDE approach. Treatment involves termination of seizures with anticonvulsants, and children may need other symptomatic management. Seizures in children can be an extremely distressing experience for parents, who should be supported and kept informed by experienced ED nurses. Nurses also play a vital role in educating parents on correct administration of anticonvulsants and safety advice. This article discusses the aetiology, clinical presentation, diagnosis and management of children with seizures, with particular emphasis on epilepsy. It includes two reflective case studies to highlight the challenges faced by healthcare professionals managing children who present with convulsions.

  18. Homelessness and housing crises among individuals accessing services within a Canadian emergency department.

    Forchuk, C; Reiss, J P; Mitchell, B; Ewen, S; Meier, A


    Studies have indicated that individuals who are homeless access hospital emergency departments more frequently and may have different needs than individuals who are housed. Successful interventions have been developed and tested to reduce discharge to homelessness for psychiatric inpatients but have not been similarly tested for discharge from emergency departments. This study was developed to provide baseline data on this issue to inform future emergency department interventions. Findings from the current study suggest that discharge from emergency departments to homelessness happens frequently in London, Canada. Participants are unlikely to spontaneously disclose their housing/homelessness issue when first entering the emergency department, which may result in services that do not adequately meet their complex needs. Screening for housing issues is necessary within emergency departments and psychiatric crisis teams as housing issues may be a reason for accessing care or contribute to the presenting condition. Nurses are in an ideal position to evaluate housing needs among emergency department patients. Services outside of the emergency department are also needed to address housing issues, particularly outside of regular office hours. Individuals who have mental health issues and are homeless or in housing crisis have been found to access emergency departments more frequently than individuals with stable housing. While emergency departments primarily focus on medical issues, homeless individuals may require psychosocial support as well. This study examined issues around housing crises and emergency department use for individuals with mental illness in Canada. Collecting baseline data about these issues is important to inform subsequent interventions. Administrative data from a hospital emergency department and psychiatric crisis service were collected, and five individuals accessing the emergency department for psychiatric reasons were interviewed. Results

  19. Therapy Dogs in the Emergency Department

    Nickolas Nahm


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

  20. Incidental Rickets in the Emergency Department Setting

    John V. Zurlo


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

  1. Optimizing emergency department front-end operations.

    Wiler, Jennifer L; Gentle, Christopher; Halfpenny, James M; Heins, Alan; Mehrotra, Abhi; Mikhail, Michael G; Fite, Diana


    As administrators evaluate potential approaches to improve cost, quality, and throughput efficiencies in the emergency department (ED), "front-end" operations become an important area of focus. Interventions such as immediate bedding, bedside registration, advanced triage (triage-based care) protocols, physician/practitioner at triage, dedicated "fast track" service line, tracking systems and whiteboards, wireless communication devices, kiosk self check-in, and personal health record technology ("smart cards") have been offered as potential solutions to streamline the front-end processing of ED patients, which becomes crucial during periods of full capacity, crowding, and surges. Although each of these operational improvement strategies has been described in the lay literature, various reports exist in the academic literature about their effect on front-end operations. In this report, we present a review of the current body of academic literature, with the goal of identifying select high-impact front-end operational improvement solutions.

  2. Etiology of Shock in the Emergency Department

    Holler, Jon Gitz; Jensen, Helene Kildegaard; Henriksen, Daniel Pilsgaard


    INTRODUCTION: The knowledge of the etiology and associated mortality of undifferentiated shock in the emergency department (ED) is limited. We aimed to describe the etiology based proportions and incidence rates (IR) of shock, as well as the associated mortality in the ED. METHODS: Population......-based cohort study at an University Hospital ED in Denmark from January 1, 2000, to December 31, 2011. Patients aged ≥18 years living in the ED-catchment area (N = 225,000) with a first time ED presentation with shock (n = 1,646) defined as hypotension (systolic blood pressure ≤100 mmHg)) and ≥1 organ failures...... were included. Discharge diagnoses defined the etiology and were grouped as; distributive septic shock (SS), distributive non-septic shock (NS)), cardiogenic shock (CS), hypovolemic shock (HS), obstructive shock (OS) and other conditions (OC). Outcomes were etiology-based characteristics, annual IR per...

  3. Medication errors recovered by emergency department pharmacists.

    Rothschild, Jeffrey M; Churchill, William; Erickson, Abbie; Munz, Kristin; Schuur, Jeremiah D; Salzberg, Claudia A; Lewinski, Daniel; Shane, Rita; Aazami, Roshanak; Patka, John; Jaggers, Rondell; Steffenhagen, Aaron; Rough, Steve; Bates, David W


    We assess the impact of emergency department (ED) pharmacists on reducing potentially harmful medication errors. We conducted this observational study in 4 academic EDs. Trained pharmacy residents observed a convenience sample of ED pharmacists' activities. The primary outcome was medication errors recovered by pharmacists, including errors intercepted before reaching the patient (near miss or potential adverse drug event), caught after reaching the patient but before causing harm (mitigated adverse drug event), or caught after some harm but before further or worsening harm (ameliorated adverse drug event). Pairs of physician and pharmacist reviewers confirmed recovered medication errors and assessed their potential for harm. Observers were unblinded and clinical outcomes were not evaluated. We conducted 226 observation sessions spanning 787 hours and observed pharmacists reviewing 17,320 medications ordered or administered to 6,471 patients. We identified 504 recovered medication errors, or 7.8 per 100 patients and 2.9 per 100 medications. Most of the recovered medication errors were intercepted potential adverse drug events (90.3%), with fewer mitigated adverse drug events (3.9%) and ameliorated adverse drug events (0.2%). The potential severities of the recovered errors were most often serious (47.8%) or significant (36.2%). The most common medication classes associated with recovered medication errors were antimicrobial agents (32.1%), central nervous system agents (16.2%), and anticoagulant and thrombolytic agents (14.1%). The most common error types were dosing errors, drug omission, and wrong frequency errors. ED pharmacists can identify and prevent potentially harmful medication errors. Controlled trials are necessary to determine the net costs and benefits of ED pharmacist staffing on safety, quality, and costs, especially important considerations for smaller EDs and pharmacy departments. Copyright (c) 2009 American College of Emergency Physicians

  4. Emergency Department Presentations following Tropical Cyclone Yasi.

    Peter Aitken

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

  5. Preparing a nursing department for downshifting.

    Davidhizar, R


    1. Downshifting is a movement away from intense job attention and a focus toward the family. Many individuals in all parts of America are shifting their focus away from materialism and financial prosperity, and toward a simpler lifestyle and homelier values. This increasing focus on family--rather than career--can also be seen in nursing. 2. Motivation to downshift because of decreasing interest in career is less likely when the employee is a nurse. However, rising emphasis on the hazards of latchkey children and the need for quality parenting have increased nurses' concerns about the effect of being out of the home for extended periods. 3. With today's nursing shortage, personnel policies must be responsive to the priorities of the prospective job applicant. To be desirable, an employer must appear responsive to personal needs. The national trend to make positions more compatible with home responsibilities must be incorporated in personnel strategies if nurses are to remain in nursing positions and be satisfied.

  6. Perceptions of Emergency Department Crowding in Pennsylvania

    Pines, Jesse M


    Full Text Available Introduction: The state of emergency department (ED crowding in Pennsylvania has not previously been reported.Methods: We assessed perceptions of ED crowding by surveying medical directors/chairs from Pennsylvania EDs in the spring of 2008.Results: A total of 106 completed the questionnaire (68% response rate. A total of 83% (86/104 agreed that ED crowding was a problem; 26% (27/105 reported that at least half of admitted patients boarded for more than 4 hours. Ninety-eight percent (102/104 agreed that patient satisfaction suffers during crowding and 79% (84/106 stated that quality suffers. Sixty-five percent (68/105 reported that crowding had worsened during the past 2 years. Several hospital interventions were used to alleviate crowding: expediting discharges, 81% (86/106; prioritizing ED patients for inpatient beds, 79% (84/ 106; and ambulance diversion, 55% (57/105. Almost all respondents who had improved ED operations reported that it had reduced crowding.Conclusion: ED crowding is a common problem in Pennsylvania and is worsening in the majority of hospitals, despite the implementation of a variety of interventions. [West J EmergMed. 2013;14(1:1–10.

  7. National study of emergency department observation services.

    Wiler, Jennifer L; Ross, Michael A; Ginde, Adit A


    The objective was to describe patient and facility characteristics of emergency department (ED) observation services in the United States. The authors analyzed the 2007 National Hospital Ambulatory Medical Care Survey (NHAMCS). Characteristics of EDs with observation units (OUs) were compared to those without, and patients with a disposition of ED observation were compared to those with a "short-stay" (observational analysis. An estimated 1,746 U.S. EDs (36%) reported having OUs, of which 56% are administratively managed by ED staff. Fifty-two percent of hospitals with ED-managed OUs are in an urban location, and 89% report ED boarding, compared to 29 and 65% of those that do not have an OU. The admission rate is 38% at those with ED-managed OUs and 15% at those without OUs. Of the 15.1% of all ED patients who are kept in the hospital following an ED visit, one-quarter are kept for either a short-stay admission (1.8%) or an ED observation admission (2.1%). Most (82%) ED observation patients were discharged from the ED. ED observation patients were similar to short-stay admission patients in terms of age (median = 52 years for both, interquartile range = 36 to 70 years), self-pay (12% vs. 10%), ambulance arrival (37% vs. 36%), urgent/emergent triage acuity (77% vs. 74%), use of ≥1 ED medication (64% vs.76%), and the most common primary chief complaints and primary diagnoses. Over one-third of U.S. EDs have an OU. Short-stay admission patients have similar characteristics as ED observation patients and may represent an opportunity for the growth of OUs. © 2011 by the Society for Academic Emergency Medicine.

  8. Establishment and implementation of competency-based training model for nursing interns in emergency department%急诊科护理专业实习生能力本位培训模式的建立与实施

    杨洁; 贾春玲; 王秋; 孙红; 郭金玉


    Nursing interns who were educated in nursing college for 2 to 4 years will take the clinical position after the internship stage. Knowledge, techniques and competences obtained in school need to apply into the practice, and competency-based education provided us an idea for interns' training in emergency department. Based on literature review and group discussion, the article described our competency-based training model from three aspects, the competence orientation, training model design and supervision and reflection. According to this model, the clinical teachers have the evidence to teach the students and the students have the contents to learn. As a result, the interns improved their clinical practice ability, involved in the clinical work by stimulating their own competences, promoted their competency development, and the realized the improvment of teaching and learning.%护理专业实习生(护生)在校经过2~4年的校内教育,即将走上临床岗位,需要将获取的知识转化到应用过程中,能力本位教育为急诊科护生的培训提供了思路。本研究从能力定位、培训模式设置和监督反馈三个方面介绍了我科为护生设计的能力培训模式。在临床实践过程中,实现了临床带教老师在带教过程中有据可依,护生有内容可学,提高了护生在急诊科的临床实践能力,同时激发了护生调动和发挥自身所具备的能力参与临床工作,促进了其能力的发展,实现了教学相长。

  9. Redundancy in the accident and emergency department.

    Durcan, T


    Whilst this article was being written, the Government announced that the pay of nurses will be based on productivity. The Trade Unions have announced that they have made a claim to the independent pay review body for a payment of 10% as a pay award, but the RCN indicated that up to 50,000 nursing jobs have been lost between 1992 and 1993. This gives an indication that the future is not so bright for nurses. Under this cloud of uncertainty nurses may deduce that there is a clear message that their job is no longer a job for life. Market forces, contracts, targets and flexibility are the jargon of today's care. Nursing is under threat and attack.

  10. The job engagement and its influencing factors of nursing staffs working in the emergency department of Level-Ⅱ Class-A general hospitals%二级甲等综合医院急诊科护理人员工作投入现状及其影响因素研究



    Objective: To explore the level of job engagement of nursing staffs in emergency department, and the relevance between the demographic characteristic of nursing staffs and job engagement, in order to supply some reference for nursing administrators. Method: 281 nursing staffs were investigated with the Utrecht Work Engagement Scale, and the data were analyzed with the descriptive analysis and the multiple linear regression. Result: The average score of job engagement for nursing staffs in emergency department was 68.46, the length of service was enrolled in the multiple linear regression equation, in which the job engagement appearing as the dependent variable and the demographic characteristic as the independent variable. The coefficient of determination was 0.036.Conclusion: The job engagement of nursing staffs in the emergency department is in the intermediate level. The length of service has a certain degree influence on the job engagement.%目的:了解急诊护理人员工作投入水平及人口学特征与其相关性,为护理管理者提供参考.方法:采用工作投入量表对281名急诊护理人员进行调查,采用描述性分析及多元线性回归分析对结果进行统计.结果:急诊护理人员工作投入水平总体平均得分为68.46分,工龄进入了以工作投入为因变量、人口学特征为自变量的多元线性回归分析方程,决定系数为0.036.结论:急诊护理人员工作投入水平处于中等,工龄对其工作投入有一定程度的影响.

  11. Diagnosing Achilles tendon injuries in the emergency department.

    Gibbons, Lynda


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

  12. The Financial Impact of Emergency Department Crowding

    Foley, Mathew


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

  13. A Staffing Tool to Improve Efficiency at a Nursing Department

    M.A. Louly


    Full Text Available The paper suggests a staffing tool to improve efficiency at a nursing department of a local hospital. The managers consider they are understaffed and try to overwhelm the staffing deficit problem through overtime, rather than hiring additional nurses. The estimates indicate that the shortage at the hospital level corresponds to 300 full time equivalent (FTE nurses. However, the huge amount of allocated budget for overtime becomes a concern since the deficit is not accurately estimated. Indeed, the suggested staffing tool shows that some nursing units are unnecessarily overstaffed. Moreover, the current study reveals that the real deficit is of only 215 FTE resulting in a potential saving of 28%.

  14. Ethnic Disparities in Emergency Severity Index Scores among U.S. Veteran's Affairs Emergency Department Patients.

    Jacob M Vigil

    Full Text Available The goal of these analyses was to determine whether there were systematic differences in Emergency Severity Index (ESI scores, which are intended to determine priority of treatment and anticipate resource needs, across categories of race and ethnicity, after accounting for patient-presenting vital signs and examiner characteristics, and whether these differences varied among male and female Veterans Affairs (VA ED patients.We used a large national database of electronic medical records of ED patients from twenty-two U.S. Department of Veterans Affairs ED stations to determine whether ESI assignments differ systematically by race or ethnicity. Multi-level, random effects linear modeling was used to control for demographic characteristics and patient's vital signs (heart rate, respiratory rate, and pain level, as well as age, gender, and experience of triage nurses. The dataset included 129,991 VA patients presenting for emergency care between 2008 and 2012 (91% males; 61% non-Hispanic White, 28% Black, 7% Hispanic, 2% Asian, <1% American Indian/Alaska Native, 1% mixed ethnicity and 774 nurses for a total of 359,642 patient/examiner encounters. Approximately 13% of the variance in ESI scores was due to patient characteristics and 21% was due to the nurse characteristics. After controlling for characteristics of nurses and patients, Black patients were assigned less urgent ESI scores than White patients, and this effect was more prominent for Black males compared with Black females. A similar interaction was found for Hispanic males. It remains unclear how these results may generalize to EDs and patient populations outside of the U.S. VA Health Care system.The findings suggest the possibility that subgroups of VA patients receive different ESI ratings in triage, which may have cascading, downstream consequences for patient treatment quality, satisfaction with care, and trust in the health equity of emergency care.

  15. Seeking Status: The Process of Becoming and Remaining an Emergency Nurse.

    Winters, Nancy


    Understanding the process of becoming and remaining an emergency nurse is of great value in emergency nursing research and for nursing administration. If hospitals want to retain qualified emergency nurses, they must learn the process that nurses use when they choose to continue working within an emergency department. Research focusing on this process may inhibit turnover and simultaneously address the ED nursing shortage. The objectives of this study were to explore this process and highlight the strategies that nurses use throughout this process. Using Grounded Theory methods, data were collected through semi-structured, open-ended interviews until data saturation occurred. The ages of the 7 participants ranged from 29 to 56 years, with ED nursing experience ranging from 1 to 17 years and nursing experience from 2 to 18 years. Five phases emerged from data analysis using constant comparative analysis of 183 pages of transcripts, through coding, categorizing, and conceptualizing of phrases. These phases, each with subcategories, explained a process identified as Seeking Status. The 5 phases were "joining the troops," "working in the trenches," "passing muster," "earning stripes," and "looking ahead." Passing muster emerged as the core category-that is, the one that best explained the process and connected the other conceptual categories in this process. Processes and strategies to retain qualified emergency nurses are urgently needed. The findings from this study address only a broad understanding of ED and nursing roles. This study highlighted several possible avenues to advance nursing science in this area. For example, for nurses "working in the trenches," it is important to undertake further research to determine factors that might help them adjust. Copyright © 2015 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

  16. Forensic experience of Saudi nurses; an emerging need for forensic qualifications.

    Alsaif, Dalia M; Alfaraidy, Maram; Alsowayigh, Kholoud; Alhusain, Awal; Almadani, Osama M


    Forensic nursing was recognized as a nursing subspecialty after the perceived need for forensic nurses to bring about their nursing duties while at the same time helping legal authorities to deliver justice. With the increased rate of cases that are presenting to the forensic centers in Saudi Arabia, there was a need for the presence of nurses to work side by side to physicians. This study was aimed at determining the forensic qualifications of nurses working in emergency departments in the area of Dammam and their knowledge about principles of forensic nursing. A self-administered questionnaire was distributed to registered nurses who are working in Emergency departments of secondary hospitals in the area of Dammam. Questions included knowledge, awareness and attitude toward forensic nursing. A total of 96 participants responded to the questionnaire with females representing 78% (n: 75). Diploma was the highest earned nursing degree in 95% (n: 91) of participants. Only 33% (n: 32) were aware of the term forensic nursing and the majority of the respondents gave invalid or didn't know the answers to knowledge questions. A total of 77% (n: 74) agreed that they are not adequately trained for handling forensic cases. Saudi nurses need forensic education. The presence of qualified forensic nurses would help delivering optimal forensic services and would assist in bringing justice.

  17. Management of Demented Patients in Emergency Department

    Lavinia Valeriani


    Full Text Available The hospitalization of the elderly with acute illness is one of the most discussed in the organization of health services, it is not yet clear whether the hospital is really the best response to the needs of the elderly, especially those with cognitive impairment. Despite evidence of possible adverse effects of hospitalization (immobilization, acute confusional state resulting in sedation, risk of falls, intestinal sub-ileus, there has been an increasing use of the hospital, particularly to specialist services. Regardless of the benefits from the shelter (instrumental diagnosis and prompt treatment of acute somatic disease, in people with dementia it needs to identify the characteristics of the person (cognitive impairment, functional status, somatic comorbidity, social and familial status, the personal needs and, therefore, diagnostic and therapeutic targets which must be assumed for that sick person during hospitalization. To this end, it is fundamental the role of assessment and diagnostic orientation that takes place in the Department of Emergency and Acceptance (DEA, which mainly receives patients at the hospital. Even before the hospital recovery it is therefore essential to check how many elderly patients with cognitive impairment that belong to the DEA, and what are their needs.

  18. Factors Associated With Emergency Department Visits

    Parul Agarwal


    Full Text Available Objective: The objective of this study was to examine the association of patient- and county-level factors with the emergency department (ED visits among adult fee-for-service (FFS Medicaid beneficiaries residing in Maryland, Ohio, and West Virginia. Methods: A cross-sectional design using retrospective observational data was implemented. Patient-level data were obtained from 2010 Medicaid Analytic eXtract files. Information on county-level health-care resources was obtained from the Area Health Resource file and County Health Rankings file. Results: In adjusted analyses, the following patient-level factors were associated with higher number of ED visits: African Americans (incidence rate ratios [IRR] = 1.47, Hispanics (IRR = 1.63, polypharmacy (IRR = 1.89, and tobacco use (IRR = 2.23. Patients with complex chronic illness had a higher number of ED visits (IRR = 3.33. The county-level factors associated with ED visits were unemployment rate (IRR = 0.94 and number of urgent care clinics (IRR = 0.96. Conclusion: Patients with complex healthcare needs had a higher number of ED visits as compared to those without complex healthcare needs. The study results provide important baseline context for future policy analysis studies around Medicaid expansion options.

  19. Use of Emergency Department by Elderly Patients

    Orhan Akpinar


    Full Text Available Aim: Using of EDs by the geriatric population is being increased in parallel to increase of our geriatric population. Objective of this study was to demonstrate what can be done for the EDs to be more effectively benefited by evaluating clinical and demographic data of the patients over 65 years old who presented to an emergency department. Material and Method: Recordings of the patients who presented to Isparta Public Hospital, ED in 2011 were retrospectively screened. All the data were evaluated through SPSS 17.0 software. Results: Of total 114,522 patients who presented to our ED during the study, 14,645 (12.7% were geriatrics. Mean age was found as 74,6 ± 6 years. The most common cause of presentation was found as cardiologic problems as 3,120 (21.3%, followed by respiratory system problems as 2,040 (13.9%, gastrointestinal problems as 1,875 (12.8%, neurological problems as 1,512 (10.3% and musculo-skeletal system problems as 1,230 (8.4% patients. While 71% of these patients were treated in basis of outpatients, 1,877 patients (12.8% were hospitalized and 9 patients were lost in the ED. Discussion: Some regional differences may be seen in the follow-up of geriatric patients. We recommend that, each hospital should arrange its ED services considering its patient profile.

  20. Occupational burns treated in emergency departments.

    Reichard, Audrey A; Konda, Srinivas; Jackson, Larry L


    Despite reported declines, occupational burn injuries remain a workplace safety concern. More severe burns may result in costly medical treatment and long-term physical and psychological consequences. We used the National Electronic Injury Surveillance System-Occupational Supplement to produce national estimates of burns treated in emergency departments (EDs). We analyzed data trends from 1999 to 2008 and provided detailed descriptions of 2008 data. From 1999 to 2008 there were 1,132,000 (95% CI: ±192,300) nonfatal occupational burns treated in EDs. Burn numbers and rates declined approximately 40% over the 10 years. In 2008, men and younger workers 15-24 years old had the highest rates. Scalds and thermal burns accounted for more than 60% of burns. Accommodation and food service, manufacturing, and construction industries had the largest number of burns. Despite declining burn rates, emphasis is needed on reducing burn hazards to young food service workers and using job specific hazard analyses to prevent burns. © 2015 Wiley Periodicals, Inc.

  1. Geriatric Homelessness: Association with Emergency Department Utilization

    Hategan, Ana; Tisi, Daniel; Abdurrahman, Mariam; Bourgeois, James A.


    Background Homeless adults frequently use emergency departments (EDs), yet previous studies investigating ED utilization by the older segment received little attention. This study sought to characterize older homeless adults who utilized local urban EDs. Methods ED encounters at three hospitals in Hamilton (Ont.) were analyzed, and demographic and clinical characteristics of the older homeless (age > 50) vs. younger counterparts (age ≤ 50) were compared during a 24-month period. Results Of all adults, 1,330 were homeless, of whom 66% were above age 50. Older homeless adults sought less acute care within 30 days from an index visit compared with their younger counterparts. Non-acute illnesses constituted only 18% of triaged cases. Older homeless women with access to a primary care physician (PCP) were 3.3 times more likely to return to ED within 30 days, whereas older homeless men (irrespective of PCP access) were less likely to return to ED. Conclusions Despite high homeless patient acuity, a lesser number of ED visits with increasing age remains concerning because of previously reported high morbidity and mortality rates. Access to primary care may not be enough to reduce ED utilization. Further research is needed to evaluate acute care interventions and their effectiveness in ED, and to identify homeless patients requiring more targeted services. PMID:28050223

  2. Forecasting emergency department visits using internet data.

    Ekström, Andreas; Kurland, Lisa; Farrokhnia, Nasim; Castrén, Maaret; Nordberg, Martin


    Using Internet data to forecast emergency department (ED) visits might enable a model that reflects behavioral trends and thereby be a valid tool for health care providers with which to allocate resources and prevent crowding. The aim of this study is to investigate whether Web site visits to a regional medical Web site, the Stockholm Health Care Guide, a proxy for the general public's concern of their health, could be used to predict the ED attendance for the coming day. In a retrospective, observational, cross-sectional study, a model for forecasting the daily number of ED visits was derived and validated. The model was derived through regression analysis, using visits to the Stockholm Health Care Guide Web site between 6 pm and midnight and day of the week as independent variables. Web site visits were measured with Google Analytics. The number of visits to the ED within the region was retrieved from the Stockholm County Council administrative database. All types of ED visits (including adult, pediatric, and gynecologic) were included. The period of August 13, 2011, to August 12, 2012, was used as a training set for the model. The hourly variation of visits was analyzed for both Web site and the ED visits to determine the interval of hours to be used for the prediction. The model was validated with mean absolute percentage error for August 13, 2012, to October 31, 2012. The correlation between the number of Web site visits between 6 pm and midnight and ED visits the coming day was significant (r=0.77; Pforecasting results for ED visits were achieved for the entire county, with a mean absolute percentage error of 4.8%. The result for the individual hospitals ranged between mean absolute percentage error 5.2% and 13.1%. Web site visits may be used in this fashion to predict attendance to the ED. The model works both for the entire region and for individual hospitals. The possibility of using Internet data to predict ED visits is promising. Copyright © 2014

  3. The Influence of Emerging Nursing Strategy and Policy Leaders: An Interview With Dr Suzanne Miyamoto.

    Miyamoto, Suzanne; Adams, Jeffrey M


    This department highlights emerging nursing leaders who have demonstrated great potential in advancing innovation and patient care leadership in practice, policy, research, education, and theory. This interview profiles Suzanne Miyamoto, PhD, RN, Senior Director of Government Affairs and Health Policy at the American Association of Colleges of Nursing.

  4. Measuring social contacts in the emergency department.

    Douglas W Lowery-North

    Full Text Available BACKGROUND: Infectious individuals in an emergency department (ED bring substantial risks of cross infection. Data about the complex social and spatial structure of interpersonal contacts in the ED will aid construction of biologically plausible transmission risk models that can guide cross infection control. METHODS AND FINDINGS: We sought to determine the number and duration of contacts among patients and staff in a large, busy ED. This prospective study was conducted between 1 July 2009 and 30 June 2010. Two 12-hour shifts per week were randomly selected for study. The study was conducted in the ED of an urban hospital. There were 81 shifts in the planned random sample of 104 (78% with usable contact data, during which there were 9183 patient encounters. Of these, 6062 (66% were approached to participate, of which 4732 (78% agreed. Over the course of the year, 88 staff members participated (84%. A radiofrequency identification (RFID system was installed and the ED divided into 89 distinct zones structured so copresence of two individuals in any zone implied a very high probability of contact <1 meter apart in space. During study observation periods, patients and staff were given RFID tags to wear. Contact events were recorded. These were further broken down with respect to the nature of the contacts, i.e., patient with patient, patient with staff, and staff with staff. 293,171 contact events were recorded, with a median of 22 contact events and 9 contacts with distinct individuals per participant per shift. Staff-staff interactions were more numerous and longer than patient-patient or patient-staff interactions. CONCLUSIONS: We used RFID to quantify contacts between patients and staff in a busy ED. These results are useful for studies of the spread of infections. By understanding contact patterns most important in potential transmission, more effective prevention strategies may be implemented.

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

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


    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.…

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

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


    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

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

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


    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.…

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

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


    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

  9. Inter-Rater Agreement of Emergency Nurses and Physicians in Emergency Severity Index (ESI Triage

    Mehrdad Esmailian


    Full Text Available Introduction: Triage is one of the most important systems in patients prioritizing at the time of arrival to hospital. Based on the severity of the injury and the need for treatment, this system manages patients in the least time which could lead to rotation of patients with high reliability and safety. Currently, the most accepted method for triage is emergency severity index (ESI system, considered as five-level triage method, too. This method were implemented in Al Zahra Hospital of Isfahan by trained nurses since March to May 2010. This study was aimed to evaluate the accuracy of emergency nursing triage using ESI. Methods: This prospective cross sectional study was carried out on 601 patients referred to Al-Zahra hospital of Isfahan through May 2010. The patients’ triage level were determined by physicians and nurses separately and the results compared. To define the level of agreement between two groups (inter-rater agreement, the kappa index was evaluated. To specify the association between the time interval of initial triage and patient final status, Chi-Square test was applied using SPSS 18 statistical software. Results: There was no significant difference between results of nurses and physicians triage (P<0/0001. The agreement level (kappa index between two groups was 94% (95% CI: 0.931-0.957. Of 601 patients, 44.1% ones were hospitalized at the emergency department, 52.6% discharged and 3.3% died. The average of time interval between nursing triage and physician visit was 9.55 minutes at the level one triage, 21.64 minutes at level two, 26.03 minutes at level three, 26.93 minutes at level four, and 11.70 minutes at level five. Conclusion: It seems that there is an acceptable inter-rater agreement between emergency nurses and physicians regarding patients’ triage in terms of ESI system.

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

    Brehm Johansen, Mette; Forberg, Jakob Lundager


    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...

  11. Work-Practice Changes Associated with an Electronic Emergency-Department Whiteboard

    Hertzum, Morten; Simonsen, Jesper


    , existing work practices, and the clinicians’ experience. Another change in the work practices is distributed access to whiteboard information from the computers in patient rooms. A decrease in the mental workload of the coordinating nurse was envisaged but has not emerged. Achieving more changes appears......Electronic whiteboards are introduced at emergency departments (EDs) to improve work practices. This study investigates whether the time physicians and nurses at an ED spend in patient rooms versus at the control desk increases after the introduction of an electronic whiteboard. After using...... this whiteboard for four months nurses, but not physicians, spend more of their time with the patients. With the electronic whiteboard, nurses spend 28% of their time in patient rooms and physicians 20%. Importantly, the changes facilitated by the electronic whiteboard are also dependent on implementation issues...

  12. Defining dignity in end-of-life care in the emergency department.

    Fernández-Sola, Cayetano; Cortés, María Mar Díaz; Hernández-Padilla, José Manuel; Torres, Cayetano José Aranda; Terrón, José María Muñoz; Granero-Molina, José


    Respecting dignity is having a profound effect on the clinical relationship and the care framework for terminally ill patients in palliative care units, hospices and their own homes, with particular consequences for the emergency department. However, dignity is a vague and multifaceted concept that is difficult to measure. The aim of this study is to define the attributes of dignity in end-of-life care in the emergency department, based on the opinions of physicians and nurses. A hermeneutic phenomenological approach utilising Gadamer's philosophical underpinnings guided the study. Participants and research context: This research was conducted in Spain in 2013-2014. Participants included 10 physicians and 16 nurses with experience working in the emergency department. Two focus groups and 12 in-depth interviews were carried out. Ethical considerations: The study was approved by the Research Centre Ethical Committee (Andalusian Health Service, Spain). The results point to the person's inherent value, socio-environmental conditions and conscious actions/attitudes as attributes of dignity when caring for a dying patient in the emergency department. Dying with dignity is a basic objective in end-of-life care and is an ambiguous but relevant concept for physicians and nurses. In line with our theoretical framework, our results highlight care environment, professional actions and socio-family context as attributes of dignity. Quality care in the emergency department includes paying attention to the dignity of people in the process of death. The dignity in the care of a dying person in the emergency department is defined by acknowledging the inherent value in each person, socio-environmental conditions and social and individual acceptance of death. Addressing these questions has significant repercussions for health professionals, especially nurses.

  13. Debrief in Emergency Departments to Improve Compassion Fatigue and Promote Resiliency.

    Schmidt, Madeline; Haglund, Kristin

    The purpose of this case study was to describe compassion fatigue using one nurse's experience as an example and to present the process of Personal Reflective Debrief as an intervention to prevent compassion fatigue in emergency department (ED) nurses. Debriefing after adverse outcomes using a structured model has been used in health care as a nonthreatening and relatively low-cost way to discuss unanticipated outcomes, identify opportunities for improvement, and heal as a group. There are many methods of debrief tailored to specific timing around events, specific populations of health care workers, and amount of time for debriefing. Debrief with personal and group reflection will help develop insights that nurses may need to understand their own emotions and experiences, as well as to develop knowledge that can be used in subsequent situations. Regular engagement in a proactive scheduled Personal Reflective Debrief has been identified as a method of promoting resiliency in an environment where the realities of emergency nursing make compassion fatigue an imminent concern. Nurses working in the ED normally experience some level of stress because of high acuity patients and high patient volume; yet, repeated exposure puts them at risk for developing compassion fatigue. The Personal Reflective Debrief is one way emergency nurses can alleviate some of this caring-related stress and thereby become more resilient. Increasing nurses' resilience to workplace stress can counter compassion fatigue. The key is to provide planned, proactive resources to positively improve resiliency.

  14. Knowledge assessment and preparation for the certified emergency nurses examination.

    Carlson, Kathleen


    With the current emphasis on credentialing in nursing, many nurses have committed to taking the CEN examination. The following questions have been developed to assist in emergency nursing knowledge assessment and in preparation for the CEN examination. Questions, rationale for the correct answers, and references are provided here for your self-evaluation. ENA has developed educational materials that can be used as further resources for CEN preparation: Emergency Nursing Core Curriculum and CEN Review Manual.

  15. 北京市三级甲等医院急诊科护士配置现状的横断面研究%Present situation of nurses allocation in emergency department in Beijing tertiary hospitals-a cross-sectional study

    翟玉翠; 任昊芹; 王莹; 郭凯; 陈冬梅


    目的:调查北京市三级甲等医院急诊科护士配置现状,为人力资源优化配置提供参考依据。方法采用分层抽样法,选取19家北京市三级甲等医院为受试单位,对急诊科设置、急诊护士基线数据、急诊护士配置状况、离职护士和原因等内容进行横断面调查。结果年急诊量>10万人次的医院占84.21%,实际急诊科护士数与医院总床位数之比为(3.97~10.40)∶100,急诊科各区域床护比依次为:ICU区(0.6±0.3)∶1、抢救区(0.7±0.3)∶1、留观区(1.9±0.7)∶1、输液区(15.7±14.6)∶1和分诊区(49.0±21.0)∶1;急诊科护士人员构成中男护士占总护士数的7.50%,35岁以下护士占总护士数的79.30%,临床工作年限3年以下占26.12%、各层级职称护士比例,初级职称、中级职称、高级职称比例为1∶0.15∶0.01;护士离职危险因素包括工作负荷、人身威胁,保护因素包括福利待遇、职业归属感(P100 thousand/year accounted for 84.21%. The ratio of the number of nurses in emergency and the total hospital beds was (3.97-10.40) ∶100, while the ratios of the number of nurses and beds in emergency department were:intensive care unit (ICU):(0.6±0.3), rescue area:(0.7±0.3)∶1, observation area:(1.9±0.7)∶1, infusion area:(15.7±14.6)∶1 and triage area:(49.0±21.0)∶1. Male nurses accounted for 7.50% of the total number of the nurses, nurses under 35 years old accounted for 79. 30% and nurses with working time below 3 years accounted for 26.12%. The ratio of the primary, secondary and senior nurse was 1∶0.15∶0.01. The risk factors of nurses′quit were working load and personal threats, and the protection factors included the low welfare benefits and lack of professional sense of belonging (P<0.05). Conclusions As a result of overload in emergency department, the nursing human resource is in shortage, and the ratio of nurses and beds is higher than the standard ratio. The current main

  16. Investigation on Workplace Violence of Nurses in Emergency Department of Comprehensive Hospital%综合性医院急诊科护士遭受工作场所暴力的调查

    潘菲; 韩学美


    Objective To explore the workplace violence of emergency nurses and the influencing factors so as to provide evidence for the intervention measures. Methods From September 2009 to September 2010, 168 emergency nurses from 4 military Grade-Ⅲ Class-A hospitals were investigated with a questionnaire on the general status and workplace violence. Results Of the 166 validate questionnaires. 149 (89.8%) emergency nurses had been subjected to workplace violence. No significant difference was observed on the incidence of workplace violence in emergency nurses with different age, working experience, education background and professional titles(P>0. 05). The incidences of workplace violence from high to low were listed as follows: language hurt (86. 1%), somatic conflict (32. 5%), specific threats (20. 5%) and sexual violence(3. 0%) . The major causes for workplace violence were listed as follows: too long waiting time (67. 1%) ,unsatisfied request of patients(64. 8%) ,the risk of accident , drunk or drug abuse(58. 4%) and high medical costs(53. 4%). A series of outcomes of workplace violence were listed as follows: grievances (75. 8%),anger(66. 4%) and insecurity(47. 6% ) . Conclusion Workplace violence is common on emergency nurses which may cause serious psychological damage. The administrators should take effective measures to prevent and control workplace violence.%目的 探讨综合性医院急诊科护士遭受工作场所暴力的现状及其原因,为采取干预措施提供依据.方法 2009年9月至2010年9月采用便利抽样的方法选择北京市4所三级甲等综合性医院的168名急诊科护士作为调查对象,调查内容包括一般资料和护士遭受工作场所暴力的情况.结果 在166份有效问卷中,有149名(89 8%)护士遭受过工作场所暴力.不同年龄、工作时间、学历和职称的护士遭受工作场所暴力的发生率差异无统计学意义(P>0.05);急诊科护士遭受工作场所暴力

  17. Applicability of the modified Emergency Department Work Index (mEDWIN) at a Dutch emergency department.

    Brouns, Steffie H A; van der Schuit, Klara C H; Stassen, Patricia M; Lambooij, Suze L E; Dieleman, Jeanne; Vanderfeesten, Irene T P; Haak, Harm R


    Emergency department (ED) crowding leads to prolonged emergency department length of stay (ED-LOS) and adverse patient outcomes. No uniform definition of ED crowding exists. Several scores have been developed to quantify ED crowding; the best known is the Emergency Department Work Index (EDWIN). Research on the EDWIN is often applied to limited settings and conducted over a short period of time. To explore whether the EDWIN as a measure can track occupancy at a Dutch ED over the course of one year and to identify fluctuations in ED occupancy per hour, day, and month. Secondary objective is to investigate the discriminatory value of the EDWIN in detecting crowding, as compared with the occupancy rate and prolonged ED-LOS. A retrospective cohort study of all ED visits during the period from September 2010 to August 2011 was performed in one hospital in the Netherlands. The EDWIN incorporates the number of patients per triage level, physicians, treatment beds and admitted patients to quantify ED crowding. The EDWIN was adjusted to emergency care in the Netherlands: modified EDWIN (mEDWIN). ED crowding was defined as the 75th percentile of mEDWIN per hour, which was ≥0.28. In total, 28,220 ED visits were included in the analysis. The median mEDWIN per hour was 0.15 (Interquartile range (IQR) 0.05-0.28); median mEDWIN per patient was 0.25 (IQR 0.15-0.39). The EDWIN was higher on Wednesday (0.16) than on other days (0.14-0.16, poccupancy rate revealed an area under the curve (AUC) of 0.86 (95%CI 0.85-0.87). The AUC of mEDWIN compared with a prolonged ED-LOS (≥4 hours) was 0.50 (95%CI 0.40-0.60). The mEDWIN was applicable at a Dutch ED. The mEDWIN was able to identify fluctuations in ED occupancy. In addition, the mEDWIN had high discriminatory power for identification of a busy ED, when compared with the occupancy rate.

  18. Investigation analysis of hierarchical configuration of nursing human re-sources in department of emergency and current status of work%急诊科护理人力资源分层配置和工作现状调查分析

    陈妮; 黄冶; 毛世芳


    Objective To investigate the hierarchical configuration of nursing human resources in department and of e-mergency current status of work. Methods By cluster sampling,from July to August in 2014,frequencies of direct nurs-ing and indirect nursing in all nursing staff in different hierarchies of department of emergency from 4 comprehensive hospitals in grade three in our city was investigated by questionnaire. Results In direct nursing,nurses in different edu-cation,title and years of experience displayed statistical difference in escort for examinations,sanitary disposal,pre-triage and pre-hospital care (P<0.05).In indirect nursing,nurses in different years of experience and title displayed statistical differences in clinical teaching,nursing quality control,nursing scientific research (P<0.01).Nurses with a lower back-ground education,lower title and few years of experience had higher frequencies in implementation of escort for exami-nations,sanitary disposal and pre-hospital care,while nurses with many years of experience and senior professional post had higher frequencies of pre-triage,clinical teaching,nursing quality control and nursing scientific research.The abili-ties of nurses in different hierarchies of emergency department were not the same.However,in practical work,except sev-eral items like escort for examinations,sanitary disposal,pre-triage,pre-hospital care,nursing education,nursing quality control and nursing scientific research,etc.the rest work contents were basically the same. Conclusion Human resources in emergency department should be scientifically and reasonably allocated in hierarchy in order to ensure the quality of emergency nursing and improve patient’s satisfaction in emergency treatment.%目的:了解急诊科护理人力资源分层配置和工作现状。方法采取整群抽样,于2014年7~8月对本市4家三级综合医院急诊科各层级护理人员工作内容中实施直接护理和间接护理的频次进行问卷调

  19. A subtle mimicker in emergency department

    Angelis, Maria Vittoria De; Giacomo, Roberta Di; Muzio, Antonio Di; Onofrj, Marco; Bonanni, Laura


    Abstract Background: Movement disorder emergencies include any movement disorder which develops over hours to days, in which failure to appropriately diagnose and manage can result in patient morbidity or mortality. Movement disorder emergencies include acute dystonia: sustained or intermittent muscle contractions causing abnormal, often repetitive, movements. Acute dystonia is a serious challenge for emergency room doctors and neurologists, because of the high probability of misdiagnosis, due to the presence of several mimickers including partial seizures, meningitis, localized tetanus, serum electrolyte level abnormalities, strychnine poisoning, angioedema, malingering, catatonia, and conversion. Methods: We describe 2 examples, accompanied by videos, of acute drug-induced oro-mandibular dystonia, both subsequent to occasional haloperidol intake. Results: Management and treatment of this movement disorder are often difficult: neuroleptics withdrawal, treatment with benzodiazepines, and anticholinergics are recommended. Conclusion: Alternative treatment options are also discussed. PMID:27741141

  20. Southern Hospitality: How We Changed the NPO Practice in the Emergency Department.

    Denton, Traci D


    In the Vanderbilt Medical Center adult emergency department, the practice has been to keep patients on "nothing by mouth" (NPO) status throughout their assessment, diagnostic, and treatment phases. As a result, most patients have NPO status for a period of several hours to days. The consequences are patient discomfort, hunger, thirst, dehydration, interruptions in routine medication schedules, poor glucose control, and compromised acid/base balance. The purpose of this project was to modify the NPO practice in the adult emergency department. A survey of nursing staff perceptions demonstrated both staff and patient dissatisfaction with the NPO practice. Responses to postdischarge satisfaction surveys demonstrated that patients experienced some discomfort because of hunger or thirst. A search of the literature revealed that the American Society of Anesthesiologists (ASA) adopted guidelines in 1999 that patients should fast 6 hours from solids and 2 hours from liquids preoperatively. These guidelines were implemented in the adult emergency department using the Standard Rollout Process. Physician order sets for the emergency department and the ED chest pain unit were modified to reflect the ASA guidelines. After implementation of the ASA guidelines, a follow-up survey of nursing staff showed increased staff and patient satisfaction. After implementation, the patient satisfaction survey demonstrated an increase in patients who reported "no discomfort" because of hunger or thirst. No adverse outcomes or delays were reported in relation to the change in NPO standards. This change in practice resulted in improved satisfaction for patents and staff. The ASA guidelines have been in existence for more than a decade. They are evidence based. The role of the nurse is to advocate for the patient. Nurses need to be proactive in determining the timing of procedures and asking physicians to give diet orders that are in accordance with the ASA guidelines. Copyright © 2015 Emergency

  1. The birth of an emergency department

    S. Inglis*


    But most of all, it will highlight the passion and commitment by ED staff at Edendale Hospital to build a comprehensive ED, efficient and excellent and one where staff have evolved from confused ’casualty’ cooks to EM doctors providing quality, comprehensive emergency care.

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

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

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

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

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

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


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

  5. Knowledge, behaviors of nurses and midwives with emergency contraception

    Nülüfer Erbil


    Full Text Available Aim: The using of emergency contraception may play important role for preventing unplanned pregnancies and induced abortion. The aim of this study was to determine the knowledge and behaviors of nurses and midwives with emergency contraception. Material and Methods: Sample of this descriptive and cross-sectional study were voluntary 89 nurses and 100 midwives. The data of study were collected using face-to-face interwiev methods via questionnarie. This study was made 1st-15th February, 2005.Results: It was determined that 46.6% of nurses and midwives heard emergency contraception. Of the nurses and midwives who completed the sample 74.1% reported that they did not know about what used for emergency contraception and 77.2% of them did not know about beginning time to emergency contraception. It was found that rate of using the emergency contraception among nurses and midwives was 4.2%. Half of nurses and midwives who used emergency contraception reported that emergency contraception prevented their pregnancy. It was found that occupation (p=0.000 and institution (p=0.000 of participants effected hearing of emergency contraception by nurses and midwives the differences were significant. Conclusion: Knowledge and behaviors of nurses and midwives with emergency contraception are not adequate. The education should prepare to health care providers for the presenting of knowledge and behavior about this subject. Advance researches into knowledge, attitude and behaviors of health professionals are advised.

  6. Danish emergency nurses' attitudes towards self-harm - a cross-sectional study

    Perbøll, Penille Wimmer; Hammer, N. M.; Østergaard, Birte


    %. Results show that the emergency nurses generally held positive attitudes toward patients with acetaminophen poisoning. Nurses with longer ED experience held more positive attitudes, and women scored significantly higher than men on the whole scale. Only 19% of the respondents had received education......AIM: The aim of this study was to examine Danish emergency nurses' attitudes toward people hospitalized after an acetaminophen poisoning. Furthermore, the study examined the relationship between attitudes and factors such as age, gender, and education on self-harm. METHODS: A cross-sectional design...... was applied. Nurses from seven emergency departments (EDs) in a region in Denmark were asked to complete the Danish version of Attitudes towards Deliberate Self-Harm Questionnaire (ADSHQ). RESULTS: Of the 254 eligible nurses working in the ED, 122 returned the questionnaires, leaving the response rate at 48...

  7. [Systematization of nursing care in urgency and emergency services: feasibility of implementation].

    Maria, Monica Antonio; Quadros, Fátima Alice Aguiar; Grassi, Maria de Fátima Oliveira


    This study analyzes the feasibility of implementing the Nursing Care Systematization in an emergency and urgency hospital department. This is a field study, descriptive, qualitative structured according to the content analysis described by Bardin (2009). It was performed in a hospital specialized in emergency care. The sample consisted of eight practical nurses, five nurses and two assistants, all of them with experience of at least six months in the emergency room. The difficulties referred to the implementation of the NCS are: complexity in their steps; disinterest of the institution; theoretical unpreparedness of nursing, its devaluation by other professionals, inadequate sizing of employees and inadequacy of the hospital physical structure. In this context, it was note that the nurse loses representation in the health team and the application of SAE turns out to be often underestimated.

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

    Janssen, Maaike A P; van Achterberg, Theo; Adriaansen, Marian J M; Kampshoff, Caroline S; Schalk, Donna M J; Mintjes-de Groot, Joke


    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. Guideline dissemination is no guarantee for guideline implementation. In 2004 the guideline Triage in Emergency Departments was disseminated in Dutch hospitals. Guideline revision was scheduled in 2008. Prior to the revision, factors which influenced the implementation of the guideline [2004] were studied to be addressed at the implementation of the revised guideline. 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 implementation strategies and activities were suggested which target the identified influencing factors. Various factors at individual, social context and organisational level were identified as influencing the implementation of the 2004 version of the guideline, namely: level of knowledge; insight and skills; work preferences; motivation and/or commitment; support; informed doctors; preliminary work and arrangements for implementation; description of tasks and responsibilities; workload and resources. Ward managers, nurses and doctors mentioned similar as well as different factors. Consequently, tailored implementation strategies and activities related to education, maintenance of change, motivation and consensus-building, information, organisation and facilitation were suggested. Nurses, ward managers and doctors broadly indicated similar influencing factors, although the importance of these factors differed for the different groups. For nurses, resistance and lack of resources are most important, ward managers mentioned culture and doctors

  9. The emergency department occupancy rate: a simple measure of emergency department crowding?

    McCarthy, Melissa L; Aronsky, Dominik; Jones, Ian D; Miner, James R; Band, Roger A; Baren, Jill M; Desmond, Jeffrey S; Baumlin, Kevin M; Ding, Ru; Shesser, Robert


    We examine the validity of the emergency department (ED) occupancy rate as a measure of crowding by comparing it to the Emergency Department Work Index Score (EDWIN), a previously validated scale. A multicenter validation study was conducted according to ED visit data from 6 academic EDs for a 3-month period in 2005. Hourly ED occupancy rate (ie, total number of patients in ED divided by total number of licensed beds) and EDWIN scores were calculated. The correlation between the scales was determined and their validity evaluated by their ability to discriminate between hours when 1 or more patients left without being seen and hours when the ED was on ambulance diversion, using area under the curve (AUC) statistics estimated from the bootstrap method. We calculated the ED occupancy rate and EDWIN for 2,208 consecutive hours at each of the 6 EDs. The overall correlation between the 2 scales was 0.58 (95% confidence interval [CI] 0.56 to 0.60). The ED occupancy rate (AUC=0.73; 95% CI 0.65 to 0.80) and the EDWIN (AUC=0.65; 95% CI 0.58 to 0.72) did not differ significantly in correctly identifying hours when patients left without being seen. The ED occupancy rate (AUC=0.78; 95% CI 0.75 to 0.80) and the EDWIN (AUC=0.70; 95% CI 0.59 to 0.81) performed similarly for ED diversion hours. The ED occupancy rate and the EDWIN classified leaving without being seen and ambulance diversion hours with moderate accuracy. Although the ED occupancy rate is not ideal, its simplicity makes real-time assessment of crowding feasible for more EDs nationwide.

  10. Emergency department usage by uninsured patients in Galveston County, Texas.

    Baillargeon, Jacques; Paar, David; Giordano, Thomas P; Zachariah, Brian; Rudkin, Laura L; Wu, Z Helen; Raimer, Ben G


    The number of uninsured Texas residents who rely on the medical emergency department as their primary health care provider continues to increase. Unfortunately, little information about the characteristics of this group of emergency department users is available. Using an administrative billing database, we conducted a descriptive study to examine the demographic and clinical features of 17,110 consecutive patients without medical insurance who presented to the emergency department of the University of Texas Medical Branch in Galveston over a 12-month period. We also analyzed the risk of multiple emergency department visits or hospitalization according to demographic characteristics. Twenty percent of the study population made two or more emergency department visits during the study period; 19% of the population was admitted to the hospital via the emergency department. The risk of multiple emergency department visits was significantly elevated among African Americans and increased in a stepwise fashion according to age. The risk of being hospitalized was significantly reduced among females, African Americans, and Hispanics. There was an age-related monotonic increase in the risk of hospitalization. Abdominal pain, cellulitis, and spinal disorders were the most common primary diagnoses in patients who made multiple emergency department visits. Hospitalization occurred most frequently in patients with a primary diagnosis of chest pain, nonischemic heart disease, or an affective disorder. Additional studies of emergency department usage by uninsured patients from other regions of Texas are warranted. Such data may prove helpful in developing effective community-based alternatives to the emergency department for this growing segment of our population. Local policymakers who are responsible for the development of safety net programs throughout the state should find this information particularly useful.

  11. Posttraumatic stress symptomatology among emergency department workers following workplace aggression.

    Gillespie, Gordon Lee; Bresler, Scott; Gates, Donna M; Succop, Paul


    Workplace aggression has the potential to adversely affect the psychological health of emergency department (ED) workers. The purpose of this study was to compare posttraumatic stress symptomatology based on verbal and verbal plus physical aggression. A descriptive cross-sectional design was used with a convenience sample (n = 208) of ED workers who completed a three-component survey. Descriptive statistics were computed to compare traumatic stress scores based on type of aggression. Two-way analysis of variance statistics were computed to determine if scores differed on the demographic variables. Fewer than half of the ED workers reported traumatic stress symptomatology; however, workplace aggression has the potential to adversely affect the mental health of ED workers. Occupational health nurses can establish or maintain a nurturing and protective environment open to discussing the personal thoughts, feelings, and behaviors of ED workers related to their experiences of workplace aggression. This open and more positive work environment may aid in reducing the negative impact of posttraumatic stress symptoms among those ED workers who have been victimized.

  12. Analysis on post-traumatic stress disorder and its relative factors of emergency department nurses after suffering from workplace violence%广州市急诊护士遭受工作场所暴力后应激障碍发生状况及相关因素分析

    余婷; 胡爱玲; 温瑞娟; 张艳君; 林秋萍; 王弈升


    Objective To describe the general condition of workplace violence against emergency department nurses in five hospitals of Guangzhou;to investigate the status of the post-traumatic stress disorder in the emergency department nurses after suffering from workplace violence;to analyze the relative factors of post-traumatic stress disorder.Methods 143 emergency department nurses from 5 hospitals in Guangzhou were investigated by general information questionnaire,workplace violence questionnaire,PCLC and SSRS.The investigation data were analyzed.Results 86.7% of emergency department nurses suffered from workplace violence during the past 1 year;the most popular style was non-physical violence.The emergency department nurses suffered from negative emotional experience,such as grievance,chagrin,low work passion,not focused spirit.The scores of PCL-C of emergency department nurses who had suffered from workplace violence were obviously higher than those who hadn't.21.8% of the emergency department nurses who suffered from workplace violence in the past one year had certain degree of the signs of PTSD,12.1% had obvious signs of PTSD.The influencing factors of PTSD:degree of hurt,objective support and availability of social support.Conclusions The situation of workplace violence which the emergency department nurses were faced with was more and more grave.The emergency department nurses who had suffered from workplace violence were in different degree of PTSD.The more social supports the nurses get,the better mental health status they will possess.%目的 描述广州市5家三甲医院急诊科工作场所暴力发生的概况;调查急诊护士遭受工作场所暴力后应激障碍发生的情况;分析急诊护士遭受工作场所暴力后发生应激障碍的相关因素.方法 采用自行设计的一般资料调查问卷、工作场所暴力问卷、创伤后应激障碍评定量表平民版(PCLC)以及社会支持评定量表(SSRS)对广州市5

  13. Requesting wrist radiographs in emergency department triage: developing a training program and diagnostic algorithm.

    Streppa, Joanna; Schneidman, Valerie; Biron, Alain D


    Crowding is extremely problematic in Canada, as the emergency department (ED) utilization is considerably higher than in any other country. Consequently, an increase has been noted in waiting times for patients who present with injuries of lesser acuity such as wrist injuries. Wrist fractures are the most common broken bone in patients younger than 65 years. Many nurses employed within EDs are requesting wrist radiographs for patients who present with wrist complaints as a norm within their working practice. Significant potential advantages can ensue if EDs adopt a triage nurse-requested radiographic protocol; patients can benefit from a significant time-saving of 36% in ED length of stay (M. Lindley-Jones & B. J Finlayson, 2000)— when nurses initiated radiographs in triage. In addition, the literature suggests that increased rates of patient and staff satisfaction may be achieved, without compromising quality of radiographic request or quality of service (W. Parris,S. McCarthy, A. M. Kelly, & S. Richardson, 1997). Studies have shown that nurses are capable of requesting appropriate radiographs on the basis of a preset protocol. As there are no standardized set of rules for assessing patients, presenting with suspected wrist fractures, a training program as well as a diagnostic algorithm was developed to prepare emergency nurses to appropriately request wrist radiographs. The triage nurse-specific training program includes the following topics: wrist anatomy and physiology, commonly occurring wrist injuries, mechanisms of injury, physical assessment techniques, and types of radiographic images required. The triage nurse algorithm includes the clinical decision-making process. Providing triage nurses with up-to-date evidence-based educational material not only allowed triage nurses to independently assess and request wrist radiographs for patients with potential wrist fractures but also strengthening the link between competent nursing care and better patient

  14. The application and effect of the stratified management modes based on the responsibility of the leader of nursing teamwork in the department of emergency%组长负责制分层管理模式在急诊护理管理中的应用效果评价

    廖全全; 邹红梅; 王从华; 廖月红


    目的 利用现有人力资源,建立组长负责制分层管理模式,减少护理缺陷,减少护理纠纷,提高急诊护理质量.方法 制订考核标准,将护士分层使用和分层管理,实施组长负责制层级管理模式,通过考核,将结果进行分析、反馈.结果 实施前后护理质量、患者对护士的满意度、医生对护士的满意度、相关科室对急诊护理工作的满意度经χ2检验,差异明显.护理缺陷由2005年的5次,减少到2007年的1次;护理纠纷由2005年的5宗,减少到2007年的0宗;急救物品完好率由98%提高到100%.结论 组长负责制分层管理模式,保证急诊护理各时段、各环节护理质量均得到落实,减少了护理缺陷,减少了护理纠纷,提高了患者满意度,提高了护理质量,值得临床急诊科借鉴.%Objective Through utilizing the existing human resources and establishing stratified management modes based on the responsibility of the leader of nursing teamwork to reduce nursing de-fects and nursing disputes, and improve the quality of emergency care. Methods Nurses in the depart-ment of emergency were stratified, and the stratified management modes based on the responsibility of the leader of nursing teamwork was implemented. Then the results underwent analysis and feedback through assessment. Results Quality of care, the satisfaction degree of patients, doctors and the relevant depart-ments before and after the implementation had statistical significance by χ2 test. The cases of nursing de-fects reduced from 5 in 2005 to 1 in 2007 and nursing disputes reduced from 5 in 2005 to 0 in 2007.The intact rate of first aid materials increased from 98% in 2005 to 100% in 2007. Conclusions The strati-fied management modes can ensure that the quality of emergency care implemented in every hour and link, and can reduce the nursing defects and disputes, increase patient satisfaction degree and improve quality of care. So the stratified management modes are worthy

  15. Emergency nurses' current practices and understanding of family presence during CPR.

    Madden, Eilis


    PURPOSE: To examine emergency nurses\\' current practices and understanding of family presence during CPR in the emergency department, Cork University Hospital, Republic of Ireland. METHOD: A quantitative descriptive design was used in the study. A questionnaire developed by ENA was distributed to emergency nurses working in a level I trauma emergency department at Cork University Hospital. The total sample number was 90, including all emergency nurses with at least 6 months\\' emergency nursing experience. RESULTS: Emergency nurses often took families to the bedside during resuscitation efforts (58.9%) or would do so if the opportunity arose (17.8%). A high percentage (74.4%) of respondents would prefer a written policy allowing the option of family presence during CPR. The most significant barrier to family witnessed resuscitation (FWR) was conflicts occurring within the emergency team. The most significant facilitator to FWR was a greater understanding of health care professionals on the benefits of FWR to patients and families, indicating the need for educational development. CONCLUSION: The findings of the study and previously published studies indicate the need for development of written polices and guidelines on the practice to meet the needs of patients, families, and staff by providing consistent, safe, and caring practices for all involved in the resuscitation process. Recommendations of the study include the development of a written policy and an educational programme on the safe implementation and practices of FWR.

  16. Perceived incivility during emergency department phone consultations.

    Shetty, Amith L; Vaghasiya, Milan; Boddy, Rachel; Byth, Karen; Unwin, Danielle


    Perceived incivility during ED medical phone consultations is poorly researched. We aimed to determine frequency and factors influencing perceived incivility during ED phone consultations. We conducted a prospective self-reported survey of 40 consecutive phone consultations for 21 ED volunteer doctors. Consultations were classified based on the aim of consultation and deemed as 'positive', 'neutral' or 'negative' based on the perceptions of the consulting doctor. Training levels, time bands and specialty data were collected for both consulting and consulted parties. Fifty-seven of 714 included consultations (7.98%, 95% CI 6.2-10.2%) were reported as negative by ED medical staff. Factors associated with significant incidence of negative grading of consultation involved requests for investigations (19.3% vs 5.3%, P  4 (9.1% vs 3.8%, P incivility during ED phone consultations. Perceived incivility occurs infrequently during ED phone consultations. ED female medical staff are at an increased risk of perceived incivility during phone consultations with non-ED medical professionals. Health organisations should actively pursue programmes to investigate the occurrence of incivility during healthcare consultations and implement programmes to mitigate the risk of developing a negative workplace culture. © 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  17. Perspectives of patients with acute abdominal pain in an emergency department observation unit and a surgical assessment unit

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


    AIMS AND OBJECTIVES: To investigate the patient perspective when admitted with acute abdominal pain to an emergency department observation unit compared with the perspective when admitted to a surgical assessment unit. BACKGROUND: An increase in emergency department observation units has led...... to more short-term admissions and has changed the patient journey from admission to specialised wards staffed by specialist nurses to stays in units staffed by emergency nurses. DESIGN: A comparative field study. METHODS: The study included 21 patients. Participant observation and qualitative interviews...... were performed, and the analyses were phenomenological-hermeneutic. RESULTS: Emergency department observation unit patients had extensive interaction with health professionals, which could create distrust. Surgical assessment unit patients experienced lack of interaction with nurses, also creating...

  18. Emergency nurses' decisions regarding frequency and nature of vital sign assessment.

    Lambe, Katherine; Currey, Judy; Considine, Julie


    To explore the factors emergency nurses use to inform their decisions regarding frequency and nature of vital sign assessment. Research related to clinical deterioration and vital sign assessment in the emergency department is in its infancy. Studies to date have explored the frequency of vital sign assessment in the emergency department; however, there are no published studies that have examined factors that emergency nurses use to inform their decisions regarding frequency and nature of ongoing vital sign assessment. A prospective exploratory design was used. Data were collected using a survey consisting of eight patient vignettes. The study was conducted in one emergency department in metropolitan Melbourne. Participants were emergency nurses permanently employed at the study site. A 96% response rate was achieved (n = 47/49). The most common frequency of patient reassessment nominated by participants was 15 or 30 minutely, with an equal number of participants choosing these frequency intervals. Abnormality in initial vital sign parameters was the most common factor identified for choosing either a 15- or 30-minute assessment interval. Frequency of assessment decisions was influenced by years of emergency nursing experience in one vignette and level of postgraduate qualification in three vignettes. Heart rate, respiratory rate and blood pressure were all nominated by over 80% of participants as vital signs that participants considered important for reassessment. The frequency and nature of vital signs selected varied according to vignette content. There were significant negative correlations between assessment of conscious state and years of nursing experience and assessment of respiratory rate and years of emergency nursing experience. Level of postgraduate qualification did not influence selection of parameters for reassessment. Emergency nurses are tailoring vital sign assessment to patients' clinical status, and nurses are integrating known vital sign data

  19. The Culture of General Palliative Nursing Care in Medical Departments

    Bergenholtz, Heidi; Jarlbæk, Lene; Hølge-Hazelton, Bibi


    and the nurses' reflections on GPNC: (1) GPNC provided in a treatment setting, (2) transition to loving care and the licence to perform palliative care (PC) and (3) potential for team improvement. Conclusions: GPNC as a culture in medical departments seemed to be embedded in a setting not suited for dying...... patients. Palliative care was still practised according to the transition model of care, sharply dividing curative from palliative care, and was inappropriately conducted in a fragmented and individual-based way. The term ‘loving care’ was used as a ‘gate-opener’ to provide palliative care for the dying......Background: In many countries, approximately half of the population dies in hospital, making general palliative nursing care (GPNC) a core nursing task. GPNC in the hospital setting is described as challenging, however little is known about its actual practice. Aim: To explore the GPNC culture...

  20. Organizational factors affecting length of stay in the emergency department: initial observational study.

    Bashkin, Osnat; Caspi, Sigalit; Haligoa, Rachel; Mizrahi, Sari; Stalnikowicz, Ruth


    Length of stay (LOS) is considered a key measure of emergency department throughput, and from the perspective of the patient, it is perceived as a measure of healthcare service quality. Prolonged LOS can be caused by various internal and external factors. This study examined LOS in the emergency department and explored the main factors that influence LOS and cause delay in patient care. Observations of 105 patients were performed over a 3-month period at the emergency room of a community urban hospital. Observers monitored patients from the moment of entrance to the department until discharge or admission to another hospital ward. Analysis revealed a general average total emergency department LOS of 438 min. Significant differences in average LOS were found between admitted patients (Mean = 544 min, SD = 323 min) and discharged patients (Mean = 291 min, SD = 286 min). In addition, nurse and physician change of shifts and admissions to hospital wards were found to be significant factors associated with LOS. Using an Ishikawa causal diagram, we explored various latent organizational factors that may prolong this time. The study identified several factors that are associated with high average emergency department LOS. High LOS may lead to increases in expenditures and may have implications for patient safety, whereas certain organizational changes, communication improvement, and time management may have a positive effect on it. Interdisciplinary methods can be used to explore factors causing prolonged emergency department LOS and contribute to a better understanding of them.


    Putu Sukma Parahita


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

  2. Analysis on Reasons of Outpatient and Emergency Department Nursing Tangle in Grass-roots Hospital%基层医院门急诊科护理纠纷的原因分析

    张宇燕; 冯科壬


    分析引起护理纠纷的各种隐患因素,通过制定加强护士队伍建设,合理配置护理人力资源,对护理人员进行相关培训,进行相关法律、法规知识教育,减轻护士心理压力以及加强护患沟通等一系列管理措施,达到有效地促进护理安全,防范护理纠纷,全面提高护理质量的目的 .%An analysis on different hidden trouble factors leading to nursing tangle, through nursing construction strengthening, nursing human resources rational allocation, related law and regulations knowledge training, nurses psychological pressure lightening and nurse- patient communication, it achieves nursing safety improvement effective, nursing tangle prevention and nursing quality improvement comprehensive.

  3. Time series modelling and forecasting of emergency department overcrowding.

    Kadri, Farid; Harrou, Fouzi; Chaabane, Sondès; Tahon, Christian


    Efficient management of patient flow (demand) in emergency departments (EDs) has become an urgent issue for many hospital administrations. Today, more and more attention is being paid to hospital management systems to optimally manage patient flow and to improve management strategies, efficiency and safety in such establishments. To this end, EDs require significant human and material resources, but unfortunately these are limited. Within such a framework, the ability to accurately forecast demand in emergency departments has considerable implications for hospitals to improve resource allocation and strategic planning. The aim of this study was to develop models for forecasting daily attendances at the hospital emergency department in Lille, France. The study demonstrates how time-series analysis can be used to forecast, at least in the short term, demand for emergency services in a hospital emergency department. The forecasts were based on daily patient attendances at the paediatric emergency department in Lille regional hospital centre, France, from January 2012 to December 2012. An autoregressive integrated moving average (ARIMA) method was applied separately to each of the two GEMSA categories and total patient attendances. Time-series analysis was shown to provide a useful, readily available tool for forecasting emergency department demand.

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

    Kirk, Jeanette W.; Sivertsen, Ditte M.; Petersen, Janne;


    Domains Framework guided data collection and analysis. Content analysis was performed whereby new themes and themes already existing within each domain were described. Results: Six predominant domains were identified: (1) professional role and identity; (2) beliefs about consequences; (3) goals; (4......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...... 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 Theoretical...

  5. Emergency department response to the deliberate release of biological agents.

    Ollerton, J E


    Bioterrorism is the use of biological agents outside the arena of war. Its purpose is to disrupt civilian life. This article investigates the role of the emergency department in the event of an act of bioterrorism.

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

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


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

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

    Kirk, Jeanette W.; Sivertsen, Ditte M.; Petersen, Janne


    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...... that different cultures exist in the same local context and influence the perception of barriers and facilitators differently. These cultures must be identified and addressed when implementation is planned....

  8. Primary amebic meningoencephalitis diagnosed in the emergency department.

    McCool, J A; Spudis, E V; McLean, W; White, J; Visvesvara, G S


    Reported is a case of primary amebic meningoencephalitis diagnosed in the emergency department. The patient, a previously healthy teenager, developed Naegleria meningoencephalitis after swimming in a freshwater public pool. The Naegleria caused acute fulminating infection culminating in the death of the patient 36 hours after admission. Results of a spinal tap, together with the history of swimming in warm fresh water, led to the emergency department diagnosis.

  9. Analysis of Heat Illness using Michigan Emergency Department Syndromic Surveillance

    Mamou, Fatema*; Henderson, Tiffany


    Objective The purpose of this work was to conduct an enhanced analysis of heat illness during a heat wave using Michigan?s Emergency Department Syndromic Surveillance System (MSSS) that could be provided to Public Health and Preparedness Stakeholders for situational awareness. Introduction The MSSS, described elsewhere (1), has been in use since 2003 and records Emergency Department (ED) chief complaint data along with the patient?s age, gender and zip code in real time. There were 85/139 hos...

  10. Web-based learning for continuing nursing education of emergency unit staff.

    Paavilainen, Eija; Salminen-Tuomaala, Mari


    The authors describe a Web-based continuing education course focusing on patient counseling in an emergency department. Course materials were developed based on data collected from the department's patients and their family members and on earlier findings on counseling. Web-based education is an appropriate method for continuing education in a specific hospital department. This puts special demands for nurse managers in arranging, designing, and implementing the education together with educators.

  11. Keep it clean: a visual approach to reinforce hand hygiene compliance in the emergency department.

    Wiles, Lynn L; Roberts, Chris; Schmidt, Kim


    Although hand hygiene strategies significantly reduce health care-associated infections, multiple studies have documented that hand hygiene is the most overlooked and poorly performed infection control intervention. Emergency nurses and technicians (n = 95) in a 41-bed emergency department in eastern Virginia completed pretests and posttests, an education module, and two experiential learning activities reinforcing hand hygiene and infection control protocols. Posttest scores were significantly higher than pretest scores (t (108) = -6.928, P = .048). Hand hygiene compliance rates improved at the conclusion of the project and 3 months after the study (F (2, 15) = 9.89, P = .002). Interfaces with staff as they completed the interactive exercise, as well as anecdotal notes collected during the study, identified key times when compliance suffered and offered opportunities to further improve hand hygiene and, ultimately, patient safety. Copyright © 2015 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

  12. A systematic review of triage-related interventions to improve patient flow in emergency departments

    Asplund Kjell


    Full Text Available Abstract Background Overcrowding in emergency departments is a worldwide problem. A systematic literature review was undertaken to scientifically explore which interventions improve patient flow in emergency departments. Methods A systematic literature search for flow processes in emergency departments was followed by assessment of relevance and methodological quality of each individual study fulfilling the inclusion criteria. Studies were excluded if they did not present data on waiting time, length of stay, patients leaving the emergency department without being seen or other flow parameters based on a nonselected material of patients. Only studies with a control group, either in a randomized controlled trial or in an observational study with historical controls, were included. For each intervention, the level of scientific evidence was rated according to the GRADE system, launched by a WHO-supported working group. Results The interventions were grouped into streaming, fast track, team triage, point-of-care testing (performing laboratory analysis in the emergency department, and nurse-requested x-ray. Thirty-three studies, including over 800,000 patients in total, were included. Scientific evidence on the effect of fast track on waiting time, length of stay, and left without being seen was moderately strong. The effect of team triage on left without being seen was relatively strong, but the evidence for all other interventions was limited or insufficient. Conclusions Introducing fast track for patients with less severe symptoms results in shorter waiting time, shorter length of stay, and fewer patients leaving without being seen. Team triage, with a physician in the team, will probably result in shorter waiting time and shorter length of stay and most likely in fewer patients leaving without being seen. There is only limited scientific evidence that streaming of patients into different tracks, performing laboratory analysis in the emergency

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

    Sønderskov, Michele L.; Hallas, Peter


    We aimed to investigate whether there was an unmet need for paediatric procedural pain management and/or sedation in Danish emergency departments (EDs). Cross-sectional survey of the 21 emergency hospitals in Denmark. Physical restraint during painful procedures was used by 80% (n=12...

  14. Emergency department radiology: reality or luxury? An international comparison.

    Kool, D.R.; Blickman, J.G.


    Changes in society and developments within emergency care affect imaging in the emergency department. It is clear that radiologists have to be pro-active to even survive. High quality service is the goal, and if we are to add value to the diagnostic (and therapeutic) chain of healthcare, sub-special

  15. Prevalence of victims of violence admitted to an emergency department

    Hofner, M; Python, N; Martin, E; Gervasoni, J; Graz, B; Yersin, B


    Objective: To collect data on the consultation frequency and demographic profile of victims of violence attending an emergency department (ED) in Switzerland. Methods: We undertook screening of all admitted adult patients (>16 years) in the ED of the CHUV, Lausanne, Switzerland, over a 1 month period, using a modified version of the Partner Violence Screen questionnaire. Exclusionary criteria were: life threatening injury (National Advisory Committee on Aeronautics score ⩾4), or inability to understand or speak French, to give oral informed consent, or to be questioned without a family member or accompanying person being present. Data were collected on history of physical and/or psychological violence during the previous 12 months, the type of violence experienced by the patient, and if violence was the reason for the current consultation. Sociodemographic data were obtained from the registration documents. Results: The final sample consisted of 1602 patients (participation rate of 77.2%), with a refusal rate of 1.1%. Violence during the past 12 months was reported by 11.4% of patients. Of the total sample, 25% stated that violence was the reason for the current consultation; of these, 95% of patients were confirmed as victims of violence by the ED physicians. Patients reporting violence were more likely to be young and separated from their partner. Men were more likely to be victims of public violence and women more commonly victims of domestic violence. Conclusions: Based on this monthly prevalence rate, we estimate that over 3000 adults affected by violence consult our ED per annum. This underlines the importance of the problem and the need to address it. Health services organisations should establish measures to improve quality of care for victims. Guidelines and educational programmes for nurses and physicians should be developed in order to enhance providers' skills and basic knowledge of all types of violence, how to recognise and interact appropriately

  16. The role of Victorian emergency nurses in the collection and preservation of forensic evidence: a review of the literature.

    McGillivray, Bree


    Emergency Departments (ED) are providing care for increasing numbers of patients who present as a result of criminal or interpersonal violence and patients may be victims, suspects or perpetrators. As a result, the role of emergency nurses in the recognition, collection and preservation of forensic evidence is increasing. There is little published literature about the role and responsibilities of emergency nurses regarding the collection and preservation of evidence in the state of Victoria and this is complicated by a lack of department and organisation policy and the need for more specific educational preparation of emergency nurses in this area. While it is well accepted that the primary focus of nursing care will always be the physical and emotional care of the patient, the increasing importance of the role of emergency nurses in the recognition and collection of forensic evidence in Victoria is now being recognized and the need for education of emergency nurses in this area understood. This paper reviews the literature related to the recognition, collection and preservation, of forensic materials in EDs by emergency nurses in the state of Victoria and discusses the role of emergency nurses in Victoria in caring for patients who present as victims of violence and in whom the collection and preservation of forensic evidence is required.

  17. Challenging the dominant logic of Emergency Departments: guidelines from chaos theory.

    Chinnis, A; White, K R


    Chaos is order without predictability (1 ). Any unfortunate patient who has recently made a trek to an Emergency Department (ED) or even better, has watched the immensely popular TV show, ER, knows that the visit can be a frustrating and a time consuming experience. The waits are so protracted that one can observe all cycles of birth, death, love, and romance in the waiting room. The process is tedious for the patient who must tell one's tale to a triage nurse, a registration clerk, the primary nurse, the nursing care partner, and finally the emergency physician. Then, the patient must face more delays while being pushed, ineffectively, in a horizontal fashion, through vertical functional silos of care, such as laboratory and radiology. The mind-set or dominant logic of this system of ED patient flow assumes that waits are acceptable and unavoidable, and that the function of the ED is to care for only the truly emergent patient. This dominant logic, coupled with the market constraints of population-based versus case-based payment mechanisms, has led to a declining trend in ED visits for the first time in 20 years (2). In order to improve the quality of ED care as well as to increase acceptability for patient and payer, the dominant logic must be challenged. An understanding of chaos theory and perception of the Emergency Department as a complex adaptive system foster methods for challenging the dominant logic.

  18. Emergency department visits during an Olympic gold medal television broadcast

    Donald A Redelmeier; Vermeulen, Marian J


    Background Practice pattern variations are often attributed to physician decision-making with no accounting for patient preferences. Objective To test whether a mass media television broadcast unrelated to health was associated with changes in the rate and characteristics of visits for acute emergency care. Design Time-series analysis of emergency department visits for any reason. Subjects Population-based sample of all patients seeking emergency care in Ontario, Canada. Measures The broadcas...

  19. Facial emotion recognition ability: psychiatry nurses versus nurses from other departments.

    Gultekin, Gozde; Kincir, Zeliha; Kurt, Merve; Catal, Yasir; Acil, Asli; Aydin, Aybike; Özcan, Mualla; Delikkaya, Busra N; Kacar, Selma; Emul, Murat


    Facial emotion recognition is a basic element in non-verbal communication. Although some researchers have shown that recognizing facial expressions may be important in the interaction between doctors and patients, there are no studies concerning facial emotion recognition in nurses. Here, we aimed to investigate facial emotion recognition ability in nurses and compare the abilities between nurses from psychiatry and other departments. In this cross-sectional study, sixty seven nurses were divided into two groups according to their departments: psychiatry (n=31); and, other departments (n=36). A Facial Emotion Recognition Test, constructed from a set of photographs from Ekman and Friesen's book "Pictures of Facial Affect", was administered to all participants. In whole group, the highest mean accuracy rate of recognizing facial emotion was the happy (99.14%) while the lowest accurately recognized facial expression was fear (47.71%). There were no significant differences between two groups among mean accuracy rates in recognizing happy, sad, fear, angry, surprised facial emotion expressions (for all, p>0.05). The ability of recognizing disgusted and neutral facial emotions tended to be better in other nurses than psychiatry nurses (p=0.052 and p=0.053, respectively) Conclusion: This study was the first that revealed indifference in the ability of FER between psychiatry nurses and non-psychiatry nurses. In medical education curricula throughout the world, no specific training program is scheduled for recognizing emotional cues of patients. We considered that improving the ability of recognizing facial emotion expression in medical stuff might be beneficial in reducing inappropriate patient-medical stuff interaction.

  20. On the Management of Emergency Nurses%浅谈急诊护士管理



    The emergency nurses are the main force in hospital emergency departments, their work status is always determines the hospital service quality. To strengthen the emergency nurse management, is the basic conditions to protect the hospital emergency department smoothly, ef ectively carried out the work, is an important step to guarantee the hospital emergency medical care security.%急诊护士是医院急诊部门的主力军,她们的工作状态一直决定着医院服务质量的高低。加强对急诊护士的管理,是保障医院急诊科顺利、有效展开工作的基本条件,是保障医院医疗急诊安全的重要步骤。

  1. Care management in nursing within emergency care units

    Roberta Juliane Tono de Oliveira


    Full Text Available Objective.Understand the conditions involved in the management of nursing care in emergency care units. Methodology. Qualitative research using the methodological framework of the Grounded Theory. Data collection occurred from September 2011 to June 2012 through semi-structured interviews with 20 participants of the two emergency care units in the city of Florianopolis, Brazil. Results. Hindering factors to care management are: lack of experience and knowledge of professionals in emergency services; inadequate number of professionals; work overload of emergency care units in the urgent care network; difficulty in implementing nursing care systematization, and need for team meetings. Facilitating factors are: teamwork; importance of professionals; and confidence of the nursing technicians in the presence of the nurse. Conclusion. Whereas the hindering factors in care management are related to the organizational aspects of the emergency care units in the urgency care network, the facilitating ones include specific aspects of teamwork.

  2. Asthma-related emergency department use: current perspectives

    Johnson LH


    Full Text Available 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 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. Keywords: asthma, pediatric, emergency department

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

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


    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.

  4. Safety and efficiency of emergency department assessment of chest discomfort

    Christenson, Jim; Innes, Grant; McKnight, Douglas; Boychuk, Barb; Grafstein, Eric; Thompson, Christopher R.; Rosenberg, Frances; Anis, Aslam H.; Gin, Ken; Tilley, Jessica; Wong, Hubert; Singer, Joel


    Background Most Canadian emergency departments use an unstructured, individualized approach to patients with chest pain, without data to support the safety and efficiency of this practice. We sought to determine the proportions of patients with chest discomfort in emergency departments who either had acute coronary syndrome (ACS) and were inappropriately discharged from the emergency department or did not have ACS and were held for investigation. Methods Consecutive consenting patients aged 25 years or older presenting with chest discomfort to 2 urban tertiary care emergency departments between June 2000 and April 2001 were prospectively enrolled unless they had a terminal illness, an obvious traumatic cause, a radiographically identifiable cause, severe communication problems or no fixed address in British Columbia or they would not be available for follow-up by telephone. At 30 days we assigned predefined explicit outcome diagnoses: definite ACS (acute myocardial infarction [AMI] or definite unstable angina) or no ACS. Results Of 1819 patients, 241 (13.2%) were assigned a 30-day diagnosis of AMI and 157 (8.6%), definite unstable angina. Of these 398 patients, 21 (5.3%) were discharged from the emergency department without a diagnosis of ACS and without plans for further investigation. The clinical sensitivity for detecting ACS was 94.7% (95% confidence interval [CI] 92.5%– 96.9%) and the specificity 73.8% (95% CI 71.5%– 76.0%). Of the patients without ACS or an adverse event, 71.1% were admitted to hospital or held in the emergency department for more than 3 hours. Interpretation The current individualized approach to evaluation and disposition of patients with chest discomfort in 2 Canadian tertiary care emergency departments misses 5.3% of cases of ACS while consuming considerable health care resources for patients without coronary disease. Opportunities exist to improve both safety and efficiency. PMID:15184334

  5. Managing the advanced cancer patient in the Australian emergency department environment : Findings from a national survey of emergency department clinicians

    T.J. Weiland (Tracey); Lane, H. (Heather); G.A. Jelinek; C.H.L. Marck (Claudia); Weil, J. (Jennifer); M. Boughey (Mark); Philip, J. (Jennifer)


    textabstractBackground: Delivery of care to people with advanced cancer in the emergency department (ED) is complicated by competing service demands, workloads and physical design constraints. We explored emergency clinicians’ attitudes to the ED environment when caring for patients who present with

  6. Emergency Department Management of Delirium in the Elderly

    Lynn E.J. Gower, DO


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

  7. Factors influencing satisfaction with emergency department medical service: Patients' and their companions' perspectives.

    Son, Heesook; Yom, Young-Hee


    To examine the individual determinants that influence satisfaction with medical services at the emergency department and to compare the factors that influence satisfaction for the patients, compared with their companions. Using data from the 2009 Korea Health Panel Survey, Andersen's behavioral model was used to examine the factors that affect satisfaction with service. A logistic regression analysis was conducted with the data. Patients who were older, female, and employed were more satisfied with the service, as were patients who visited more frequently and those who had non-surgical treatment. Companions who had less education, were accompanying non-Medicaid-holders, and spent a longer time in the emergency department were less likely to be satisfied. This was in contrast to those who spent a shorter amount of time in the emergency department and who visited due to illness, rather than injury; these companions were more satisfied with the service. When all the factors were analyzed simultaneously, they differed significantly between the two groups of patients and companions. Different factors contributed to the satisfaction with the services for the patients and their companions. In order to increase the satisfaction levels and improve the quality of care in emergency departments, it is necessary to consider more specific approaches that reflect the different perspectives of the visitors to the emergency department. © 2016 Japan Academy of Nursing Science.

  8. Perspectives of Emergency Department Staff on Triage Practice

    Özlem Bilir


    Full Text Available Objective: The aim of this study was to evaluate pre-training perspectives of the staff, who were scheduled to undertake triage in hospitals of Ministry of Health, working in collaboration with university hospitals on the triage system. Materials and Methods: This study included 33 workers who volunteered to participate. A questionnaire consisting of 19 questions on demographic characteristics and perspective on triage system was prepared. Results: Of the sample group, 75.8% were female and the average age was 28.94±6.11 years. All participants in the study considered that emergency department was overused by the society. When the percentage of patients who were admitted to the emergency department for causes complying with the emergency criteria was questioned, 54.5% stated that 10% or less of the admissions were actual emergency cases. Triage practice was suggested by 54.5% of the participants to reduce crowding in emergency departments. Conclusion: Triage practice which allows correct identification of patients who need the most urgent intervention in emergency departments is important in terms of both giving the right care to the right patients and quality of service provided by healthcare workers. Community-based education as well as training of workers on this subject is a necessity.

  9. Keeping experience at the bedside: the emergency consultant nurse role.

    Currie, Jane

    The consultant nurse concept has not yet been transferred to the military setting. The motivation for developing the role in the NHS was to improve the quality of patient care by strengthening professional leadership and extending the clinical career ladder. The consultant nurse may be defined as an expert in their clinical field, possessing expert leadership and visionary skills. The role is based on four domains: expert practice, professional leadership, education and research. Typically, the emergency consultant nurse spends 50% of their time working clinically, thereby providing senior clinical expertise and adding value to the clinical role. In a military context the consultant nurse role could be perceived as the coming together of the senior command and administrative role and the clinical role. The military has the opportunity to develop a senior clinical emergency nurse role encompassing elements of the civilian consultant nurse model, which may strengthen leadership, provide a central resource of expertise and raise the profile of military nursing. This has the added potential to provide inspiration for junior nurses and retain experienced emergency nurses in the clinical arena.

  10. Comparison Between Emergency Department and Inpatient Nurses’ Perceptions of Boarding of Admitted Patients

    Bryce C. Pulliam


    Full Text Available Introduction: The boarding of admitted patients in the emergency department (ED is a major causeof crowding and access block. One solution is boarding admitted patients in inpatient ward (Whallways. This study queried and compared ED and W nurses’ opinions toward ED and W boarding.It also assessed their preferred boarding location if they were patients.Methods: A survey administered to a convenience sample of ED and W nurses was performedin a 631-bed academic medical center (30,000 admissions/year with a 68-bed ED (70,000 visits/year. We identified nurses as ED or W, and if W, whether they had previously worked in the ED. Thenurses were asked if there were any circumstances where admitted patients should be boarded inED or W hallways. They were also asked their preferred location if they were admitted as a patient.Six clinical scenarios were then presented, and the nurses’ opinions on boarding based on eachscenario were queried.Results: Ninety nurses completed the survey, with a response rate of 60%; 35 (39% were currentED nurses (cED, 40 (44% had previously worked in the ED (pED. For all nurses surveyed 46(52% believed admitted patients should board in the ED. Overall, 52 (58% were opposed to Wboarding, with 20% of cED versus 83% of current W (cW nurses (P < 0.0001, and 28% of pEDversus 85% of nurses never having worked in the ED (nED were opposed (P < 0.001. If admittedas patients themselves, 43 (54% of all nurses preferred W boarding, with 82% of cED versus33% of cW nurses (P < 0.0001 and 74% of pED versus 34% nED nurses (P = 0.0007. The mostcommonly cited reasons for opposition to hallway boarding were lack of monitoring and patientprivacy. For the 6 clinical scenarios, significant differences in opinion regarding W boarding existedin all but 2 cases: a patient with stable chronic obstructive pulmonary disease but requiring oxygen,and an intubated, unstable sepsis patient.Conclusion: Inpatient nurses and those who have never worked in

  11. Impact of emergency department transitions of care on thrombolytic use in acute ischemic stroke.

    Madej-Fermo, Olga P; Staff, Ilene; Fortunato, Gil; Abbott, Lincoln; McCullough, Louise D


    In-hospital mortality is higher for certain medical conditions based on the time of presentation to the emergency department. The primary goal of this study was to determine whether patients with acute ischemic stroke who arrived to the emergency department during a nursing shift change had similar rates of thrombolytic use and functional outcomes compared with patients presenting during nonshift change hours. A retrospective review of patients with acute ischemic stroke presenting to the emergency department of a primary stroke center from 2005 through 2010. The time to notify the stroke team, perform a head CT scan, and to start intravenous or intra-arterial thrombolysis was assessed. Thrombolysis rates, mortality rate, discharge disposition, change in the National Institutes of Health Stroke Scale, and change in modified Barthel Index at 3 and 12 months were assessed. Of 3133 patients with acute ischemic stroke, 917 met criteria for inclusion. Arrival during nursing shift change, weekends, and July through September had no impact on process times, thrombolysis rates, and functional outcomes. Arrival at night did result in longer time to intra-arterial but not to intravenous thrombolysis, higher mortality rate, and smaller gain in functional status as measured by the modified Barthel Index at 3 months. The degree of emergency department "busyness" also did not influence tissue-type plasminogen activator treatment times. Presentation during a nursing shift change, a time of transition of care, did not delay thrombolytic use in eligible patients with acute ischemic stroke. Presentation with acute ischemic stroke at night did result in delays of care for patients undergoing interventional therapies.

  12. 二级甲等医院急诊科护理人员工作投入与组织承诺相关性研究%Study on the relationship between job engagement and organization commitment of nursing staffs in emergency departments in 2A -level hospital

    孟宪东; 李继平


    Objective To analyze the relationship between job engagement and organization commitment of nursing staffs in emergency departments in 2A -level hospitals.Methods A total of 281 emergency nursing staffs from 46 2A -level hospitals were recriuted in the study.The nurses were investigated with general information questionnaire, Utrecht Work Engagement Scale (UWES) and Three- Component Conceptualization of Organization Commitment (3 -OC).Multiple linear regression and confirmatory factor analysis were adopted to analyze the data.Results The coefficients of determination of job engagement to affective commitment and normative commitment were 0.466 and 0.364 respectively.The correlation between job engagement and organization commitment of nursing staff of emergency departments in 2A - level hospitals was significant ( r =0.645 ).Conclusion There is a positive correlation between job engagement and organization commitment.The level of organization commitment can be effected by the level of job engagement.%目的 探索二级甲等医院急诊科护理人员工作投入与组织承诺的关系.方法 抽取成都市46所二级甲等医院的281名急诊科护理人员,采用护理人员一般资料问卷、Utrecht工作投入量表和三因素组织承诺量表对其进行调查,采用多元线性回归分析及验证性因子分析方法进行分析.结果 二级甲等医院急诊科护理人员工作投入总体水平对组织承诺中情感承诺和规范承诺的总体决定系数分别为0.466和0.364.工作投入总体水平与其组织承诺总体水平的相关系数为0.645.结论 二级甲等医院急诊科护理人员工作投入与组织承诺呈正相关,工作投入程度影响组织承诺水平.

  13. Strategic emergency department design: An approach to capacity planning in healthcare provision in overcrowded emergency rooms.

    Exadaktylos, Aristomenis K; Evangelopoulos, Dimitrios S; Wullschleger, Marcel; Bürki, Leo; Zimmermann, Heinz


    Healthcare professionals and the public have increasing concerns about the ability of emergency departments to meet current demands. Increased demand for emergency services, mainly caused by a growing number of minor and moderate injuries has reached crisis proportions, especially in the United Kingdom. Numerous efforts have been made to explore the complex causes because it is becoming more and more important to provide adequate healthcare within tight budgets. Optimisation of patient pathways in the emergency department is therefore an important factor.This paper explores the possibilities offered by dynamic simulation tools to improve patient pathways using the emergency department of a busy university teaching hospital in Switzerland as an example.

  14. Patient Ethnicity Affects Triage Assessments and Patient Prioritization in U.S. Department of Veterans Affairs Emergency Departments.

    Vigil, Jacob M; Coulombe, Patrick; Alcock, Joe; Kruger, Eric; Stith, Sarah S; Strenth, Chance; Parshall, Mark; Cichowski, Sara B


    Ethnic minority patients receive lower priority triage assignments in Veteran's Affairs (VA) emergency departments (EDs) compared to White patients, but it is currently unknown whether this disparity arises from generalized biases across the triage assessment process or from differences in how objective and/or subjective institution-level or person-level information is incorporated into the triage assessment process, thus contributing to disparate treatment.The VA database of electronic medical records of patients who presented to the VA ED from 2008 to 2012 was used to measure patient ethnicity, self-reported pain intensity (PI) levels, heart rate (HR), respiratory rate (RR), and nurse-provided triage assignment, the Emergency Severity Index (ESI) score. Multilevel, random effects linear modeling was used to control for demographic and clinical characteristics of patients as well as age, gender, and experience of triage nurses.A total of 359,642 patient/provider encounters between 129,991 VA patients and 774 nurses were included in the study. Patients were 61% non-Hispanic White [NHW], 28% African-American, 7% Hispanic, 2% Asian-American, nurses and patients, African-American, Hispanic, and mixed-ethnicity patients reported higher average PI scores but lower HRs and RRs than NHW patients. NHW patients received higher priority ESI ratings with lower PI when compared against African-American patients. NHW patients with low to moderate HRs also received higher priority ESI scoring than African-American, Hispanic, Asian-American, and Mixed-ethnicity patients; however, when HR was high NHWs received lower priority ESI ratings than each of the minority groups (except for African-Americans).This study provides evidence for systemic differences in how patients' vital signs are applied for determining ESI scores for different ethnic groups. Additional prospective research will be needed to determine how this specific person-level mechanism affects healthcare quality and

  15. [Vertigo in the Emergency Department: new bedside tests].

    Tamás, T László; Garai, Tibor; Tompos, Tamás; Szirmai, Ágnes


    According to international statistics, the first examination of 25% of patients with vertigo is carried out in Emergency Departments. The most important task of the examining physician is to diagnose life threatening pathologic processes. One of the most difficult otoneurological diagnostic challange in Emergency Departments is to differentiate between dangerous posterior scale stroke presenting with isolated vertigo and the benign vestibular neuritis.These two disorders can be safely differentiated using fast, non-invasive, evidence based bedside tests which have been introduced in the past few years. 35% of stroke cases mimicking vestibular neuritis (pseudoneuritis) are misdiagnosed at the Emergency Department, and 40% of these cases develop complications. During the first 48 hours, sensitivity for stroke of the new test that is based on the malfunction of the oculomotor system is better than the diffusion-weighted cranial magnetic resonance imaging. Using special test glasses each component of the new test can be made objective and repeatable.

  16. Patient satisfaction with nursing care in an emergency service

    Patrícia Fátima Levandovski; Maria Alice Dias da Silva Lima; Aline Marques Acosta


    To analyze patient satisfaction with nursing care received at a hospital emergency service. Methodology. This is a quantitative, descriptive, cross-sectional study. The sample was composed by 250 patients over 18 years old who used an emergency service in the south region of Brazil. Data were collected using an identification form and the Patient Satisfaction Instrument. Results. Results point to a good level of satisfaction of patients with the nursing care received, with the greatest mean f...

  17. Factors Influencing Emergency Nurses' Burnout During an Outbreak of Middle East Respiratory Syndrome Coronavirus in Korea.

    Kim, Ji Soo; Choi, Jeong Sil


    Emergency department (ED) nurses suffer from persistent stress after experiencing the traumatic event of exposure to Middle East respiratory syndrome coronavirus (MERS-CoV), which can subsequently lead to burnout. This study aimed to assess ED nurses' burnout level during an outbreak of MERS-CoV and to identify influencing factors in order to provide basic information for lowering and preventing the level of burnout. Study participants were ED nurses working in eight hospitals designated for treating MERS-CoV-infected patients in Korea. We performed multiple regression analysis to explore the factors influencing burnout. The ED nurses' burnout was affected by job stress (β=0.59, pburnout. ED nurses taking care of MERS-CoV-infected patients should be aware that burnout is higher for nurses in their divisions than nurses in other hospital departments and that job stress is the biggest influential factor of burnout. To be ready for the outbreak of emerging contagious diseases such as MERS-CoV, efforts and preparations should be made to reduce burnout. Job stress should be managed and resolved. Working conditions for mitigating job stress and systematic stress management programs should be provided, and hospital resources for the treatment of MERS-CoV need to be reinforced. Moreover, promoting support from family and friends is required. Copyright © 2016. Published by Elsevier B.V.

  18. A solution to the shortage of nursing faculty: awareness and understanding of the leadership style of the nursing department head.

    Byrne, Daria M; Martin, Barbara N


    The purpose of this research was to determine if there was a relationship between the leadership style of the nursing department head and the level of professional satisfaction and organizational commitment by nursing faculty members. The survey instrument was designed to measure the department heads' leadership style as perceived by the nursing faculty and assess the nursing faculty members' level of professional satisfaction and organizational commitment. Five schools of nursing in 2 Midwestern states, with a total of 52 full-time baccalaureate nursing faculty, were the focus of the inquiry. Findings support statistically significant relationships between the 3 variables of department head leadership, organizational commitment, and professional satisfaction. Implications for leadership style exhibited by the nursing department head are discussed.

  19. Emergency medical service, nursing, and physician providers' perspectives on delirium identification and management.

    LaMantia, Michael A; Messina, Frank C; Jhanji, Shola; Nazir, Arif; Maina, Mungai; McGuire, Siobhan; Hobgood, Cherri D; Miller, Douglas K


    Purpose of the study The study objective was to understand providers' perceptions regarding identifying and treating older adults with delirium, a common complication of acute illness in persons with dementia, in the pre-hospital and emergency department environments. Design and methods The authors conducted structured focus group interviews with separate groups of emergency medical services staff, emergency nurses, and emergency physicians. Recordings of each session were transcribed, coded, and analyzed for themes with representative supporting quotations identified. Results Providers shared that the busy emergency department environment was the largest challenge to delirium recognition and treatment. When describing delirium, participants frequently detailed hyperactive features of delirium, rather than hypoactive features. Participants shared that they employed no clear diagnostic strategy for identifying the condition and that they used heterogeneous approaches to treat the condition. To improve care for older adults with delirium, emergency nurses identified the need for more training around the management of the condition. Emergency medical services providers identified the need for more support in managing agitated patients when in transport to the hospital and more guidance from emergency physicians on what information to collect from the patient's home environment. Emergency physicians felt that delirium care would be improved if they could have baseline mental status data on their patients and if they had access to a simple, accurate diagnostic tool for the condition. Implications Emergency medical services providers, emergency nurses, and emergency physicians frequently encounter delirious patients, but do not employ clear diagnostic strategies for identifying the condition and have varying levels of comfort in managing the condition. Clear steps should be taken to improve delirium care in the emergency department including the development of mechanisms

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

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


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

  1. A generic method for evaluating crowding in the emergency department

    Eiset, Andreas Halgreen; Erlandsen, Mogens; Møllekær, Anders Brøns;


    Background Crowding in the emergency department (ED) has been studied intensively using complicated non-generic methods that may prove difficult to implement in a clinical setting. This study sought to develop a generic method to describe and analyse crowding from measurements readily available......, a ‘carry over’ effect was shown between shifts and days. Conclusions The presented method offers an easy and generic way to get detailed insight into the dynamics of crowding in an ED. Keywords Crowding, Emergency department, ED, Generic, Method, Model, Queue, Patient flow...

  2. Asthma-related emergency department use: current perspectives


    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 emergenc...

  3. Effectiveness of fever education in a pediatric emergency department.

    Baker, Mark D; Monroe, Kathy W; King, William D; Sorrentino, Annalise; Glaeser, Peter W


    This study was designed to assess the impact of a brief educational video shown to parents during an emergency department visit for minor febrile illnesses. We hypothesized that a video about home management of fever would reduce medically unnecessary return emergency department visits for future febrile episodes. A convenience sample of 280 caregivers presenting to one urban pediatric emergency department was enrolled in this prospective, randomized cohort study. All the caregivers presented with a child aged 3 to 36 months with complaint of fever and were independently triaged as nonemergent. A pretest and posttest were administered to assess baseline knowledge and attitudes about fever. One hundred forty subjects were randomized to view either an 11-minute video about home management of fever or a control video about child safety. Subjects were tracked prospectively, and all return visits for fever complaints were independently reviewed by 3 pediatric emergency physicians to determine medical necessity. There were no differences between the fever video and the control groups in baseline demographics (eg, demographically comparable). The fever video group had a significant improvement in several measures relating to knowledge and attitudes about childhood fever. There was no statistical difference between the intervention and control groups in subsequent return visits or in the determination of medical necessity. A brief standardized video about home management of fever improved caregiver knowledge of fever but did not decrease emergency department use or increase medical necessity for subsequent febrile episodes.

  4. Strategies for reducing medication errors in the emergency department

    Weant KA


    Full Text Available Kyle A Weant,1 Abby M Bailey,2 Stephanie N Baker2 1North Carolina Public Health Preparedness and Response, North Carolina Department of Health and Human Services, Raleigh, NC, 2University of Kentucky HealthCare, Department of Pharmacy Services, Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY, USA Abstract: Medication errors are an all-too-common occurrence in emergency departments across the nation. This is largely secondary to a multitude of factors that create an almost ideal environment for medication errors to thrive. To limit and mitigate these errors, it is necessary to have a thorough knowledge of the medication-use process in the emergency department and develop strategies targeted at each individual step. Some of these strategies include medication-error analysis, computerized provider-order entry systems, automated dispensing cabinets, bar-coding systems, medication reconciliation, standardizing medication-use processes, education, and emergency-medicine clinical pharmacists. Special consideration also needs to be given to the development of strategies for the pediatric population, as they can be at an elevated risk of harm. Regardless of the strategies implemented, the prevention of medication errors begins and ends with the development of a culture that promotes the reporting of medication errors, and a systematic, nonpunitive approach to their elimination. Keywords: emergency medicine, pharmacy, medication errors, pharmacists, pediatrics

  5. Quality improvement of medical and nursing service during "H7N9 bird influenza epidemic" in emergency department%“H7N9禽流感”流行期的急诊医护服务品质改进

    王玲敏; 王芳; 刘川


    Objective To explore the quality improvement methods of medical and nursing service during "H7N9 bird influenza epidemic" in emergency department.Methods The methods included implementing "H7N9 bird influenza epidemic" prevention and control system,establishing "H7N9 bird influenza epidemic " prevention cycle,strengthening the management of nursing key links,strengthening the knowledge of "H7N9 bird influenza epidemic "and improving the medical service.Results There is to achieve zero cross infection of patients,zero infection of medical personnel during "H7N9 bird influenza epidemic" in emergency department.Conclusion Implemention the quality improvement methods of medical and nursing service during " H7N9 bird influenza epidemic" in emergency department can effectively prevent cross infection between hospital medical staffs and patients.%目的 探讨医院急诊科在预防“H7N9禽流感”中的一系列医护服务品质改进的有效措施.方法 通过落实“H7N9禽流感”防范管理制度,成立“H7N9禽流感”防范应急圈,加强护理重点环节管理,加强“H7N9禽流感”知识宣教和改进医疗服务形式等措施改进服务品质.结果 急诊科应对“H7N9禽流感”疫情期间,实现医院内患者零交叉感染,医护人员零感染.结论 “H7N9禽流感”流行期实施急诊医护服务品质改进,能有效防止院内医护患交叉感染.

  6. Improving emergency department flow through Rapid Medical Evaluation unit.

    Chartier, Lucas; Josephson, Timothy; Bates, Kathy; Kuipers, Meredith


    The Toronto Western Hospital is an academic hospital in Toronto, Canada, with an annual Emergency Department (ED) volume of 64,000 patients. Despite increases in patient volumes of almost six percent per annum over the last decade, there have been no commensurate increases in resources, infrastructure, and staffing. This has led to substantial increase in patient wait times, most specifically for those patients with lower acuity presentations. Despite requiring only minimal care, these patients contribute disproportionately to ED congestion, which can adversely impact resource utilization and quality of care for all patients. We undertook a retrospective evaluation of a quality improvement initiative aimed at improving wait times experienced by patients with lower acuity presentations. A rapid improvement event was organized by frontline workers to rapidly overhaul processes of care, leading to the creation of the Rapid Medical Evaluation (RME) unit - a new pathway of care for patients with lower acuity presentations. The RME unit was designed by re-purposing existing resources and re-assigning one physician and one nurse towards the specific care of these patients. We evaluated the performance of the RME unit through measurement of physician initial assessment (PIA) times and total length of stay (LOS) times for multiple groups of patients assigned to various ED care pathways, during three periods lasting three months each. Weekly measurements of mean and 90th percentile of PIA and LOS times showed special cause variation in all targeted patient groups. Of note, the patients seen in the RME unit saw their median PIA and LOS times decrease from 98min to 70min and from 165min to 130min, respectively, from baseline. Despite ever-growing numbers of patient visits, wait times for all patients with lower acuity presentations remained low, and wait times of patients with higher acuity presentations assigned to other ED care pathways were not adversely affected. By

  7. Eventos adversos com medicação em Serviços de Emergência: condutas profissionais e sentimentos vivenciados por enfermeiros Eventos adversos con medicaciones en Servicios de Urgencia: conductas profesionales y sentimientos vividos por los enfermeros Medication adverse events in Emergency Department: nurse's professional conduct and personal feelings

    Audry Elizabeth dos Santos


    graduado, mientras que los sentimientos se relacionaran com la idad y vivencia anterior com este tipo de evento.The study had as objectives to verify the professional conduct and feelings of nurses from Emergency Department when they are faced with an adverse event related to medication therapy and to verify its associations with such factors as age, time of completion of college degree, time of experience in the field and previous history with this type of event. The sample was composed of 116 nurses working in various general hospitals in the municipality of Sao Paulo who answered a questionnaire about a fictitious situation related with a medication error. The results revealed the following conducts in order of priority: communicate the physician (69,8%, intensify patient care (55,1% and make proper annotations in the patient's chart. The most prevailing affective manifestation was to worry (79,3%, followed by impotence and rage (22,4% each and insecurity (22,4%. The variable analysis showed a relationship between the professional conduct and the time of completion of college degree, while the feelings were related to age and previous experience with this type of event.

  8. [Medical short stay unit for geriatric patients in the emergency department: clinical and healthcare benefits].

    Pareja, Teresa; Hornillos, Mercedes; Rodríguez, Miriam; Martínez, Javier; Madrigal, María; Mauleón, Coro; Alvarez, Bárbara


    To evaluate the impact of comprehensive geriatric assessment and management of high-risk elders in a medical short stay unit located in the emergency department of a general hospital. We performed a descriptive, prospective study of patients admitted to the medical short stay unit for geriatric patients of the emergency department in 2006. A total of 749 patients were evaluated, with a mean (standard deviation) stay in the unit of 37 (16) h. The mean age was 86 (7) years; 57% were women, and 50% had moderate-severe physical impairment and dementia. Thirty-five percent lived in a nursing home. The most frequent reason for admission was exacerbation of chronic cardiopulmonary disease. Multiple geriatric syndromes were identified. The most frequent were immobility, pressure sores and behavioral disorders related to dementia. Seventy percent of the patients were discharged to home after being stabilized and were followed-up by the geriatric clinic and day hospital (39%), the home care medical team (11%), or the nursing home or primary care physician (20%). During the month after discharge, 17% were readmitted and 7.7% died, especially patients with more advanced age or functional impairment. After the unit was opened, admissions to the acute geriatric unit fell by 18.2%. Medical short stay units for geriatric patients in emergency departments may be useful for geriatric assessment and treatment of exacerbations of chronic diseases. These units can help to reduce the number of admissions and optimize the care provided in other ambulatory and domiciliary geriatric settings.

  9. Prognostic value of infrared thermography in an emergency department

    Holm, Jesper K; Kellett, John G; Jensen, Nadia H


    OBJECTIVE: In this study, we aimed to investigate the prognostic potential of infrared thermography in a population of medical patients admitted to the emergency department. Central-to-peripheral temperature gradients were analyzed for association with 30-day mortality. METHODS: This prospective...

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

    Klingner, Jill; Moscovice, Ira


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

  11. Models of emergency departments for reducing patient waiting times.

    Laskowski, Marek; McLeod, Robert D; Friesen, Marcia R; Podaima, Blake W; Alfa, Attahiru S


    In this paper, we apply both agent-based models and queuing models to investigate patient access and patient flow through emergency departments. The objective of this work is to gain insights into the comparative contributions and limitations of these complementary techniques, in their ability to contribute empirical input into healthcare policy and practice guidelines. The models were developed independently, with a view to compare their suitability to emergency department simulation. The current models implement relatively simple general scenarios, and rely on a combination of simulated and real data to simulate patient flow in a single emergency department or in multiple interacting emergency departments. In addition, several concepts from telecommunications engineering are translated into this modeling context. The framework of multiple-priority queue systems and the genetic programming paradigm of evolutionary machine learning are applied as a means of forecasting patient wait times and as a means of evolving healthcare policy, respectively. The models' utility lies in their ability to provide qualitative insights into the relative sensitivities and impacts of model input parameters, to illuminate scenarios worthy of more complex investigation, and to iteratively validate the models as they continue to be refined and extended. The paper discusses future efforts to refine, extend, and validate the models with more data and real data relative to physical (spatial-topographical) and social inputs (staffing, patient care models, etc.). Real data obtained through proximity location and tracking system technologies is one example discussed.

  12. Reliability and validity of emergency department triage systems

    van der Wulp, I.


    Reliability and validity of triage systems is important because this can affect patient safety. In this thesis, these aspects of two emergency department (ED) triage systems were studied as well as methodological aspects in these types of studies. The consistency, reproducibility, and criterion vali

  13. Five easy equations for patient flow through an emergency department

    Madsen, Thomas Lill; Kofoed-Enevoldsen, Allan


    Queue models are effective tools for framing management decisions and Danish hospitals could benefit from awareness of such models. Currently, as emergency departments (ED) are under reorganization, we deem it timely to empirically investigate the applicability of the standard "M/M/1" queue model...

  14. Rate, characteristics, and factors associated with high emergency department utilization

    M.C. van der Linden (M. Christien); C.L. van den Brand (Crispijn); N. van der Linden (Naomi); A.H. Rambach (Anna H.J.H.); C. Brumsen (Caro)


    textabstractBackground: Patients with high emergency department (ED) utilization account for a disproportionate number of ED visits. The existing research on high ED utilization has raised doubts about the homogeneity of the frequent ED user. Attention to differences among the subgroups of frequent

  15. Emergency department crowding in The Netherlands: managers’ experiences

    C. van der Linden (Christien); R. Reijnen (Resi); R. Derlet (Robert); N. van der Linden (Naomi); R. Lindeboom (Robert); C. Lucas (Cees); J. Richards (John)


    markdownabstract__Abstract__ __Background__ In The Netherlands, the state of emergency department (ED) crowding is unknown. Anecdotal evidence suggests that current ED patients experience a longer length of stay (LOS) compared to some years ago, which is indicative of ED crowding. However, no multi

  16. Injury patterns in children with frequent emergency department visits

    Laursen, B


    OBJECTIVES: To compare injury patterns in children with many and few emergency department (ED) visits in order to reveal the causes for the frequent visits. METHODS: Three cohorts of Danish children (total 579 721 children) were followed for three years when their ages were 0-2, 6-8, and 12...

  17. Predictors of Emergency Department Utilization Among Children in Vulnerable Families.

    Flood, Colin; Sheehan, Karen; Crandall, Marie


    Preventable visits to the emergency department (ED) are estimated to represent as much as 56% of overall annual ED utilization and contribute to the high cost of health care in the United States. There are more than 25 million annual pediatric ED visits.

  18. Imaging strategies for acute chest pain in the emergency department

    A. Dedic (Admir); T.S.S. Genders (Tessa); K. Nieman (Koen); M.G.M. Hunink (Myriam)


    textabstractOBJECTIVE. Echocardiography, radionuclide myocardial perfusion imaging (MPI), and coronary CT angiography (CTA) are the three main imaging techniques used in the emergency department for the diagnosis of acute coronary syndrome (ACS). The purpose of this article is to quantitatively

  19. Evaluation of Head Trauma Cases in the Emergency Department

    Alim Cokuk


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

  20. Nurses’ experiences and understanding of workplace violence in a trauma and emergency department in South Africa

    Maureen Kennedy


    Full Text Available Violence in South African society has reached epidemic levels and has permeated the walls of the workplace. The aim of the study was to gain a deeper understanding of how nurses experience and understand workplace violence perpetrated by patients, and to make recommendations to reduce this type of violence. A qualitative, exploratory and descriptive study was conducted to explore the experiences and coping mechanisms of nurses regarding workplace violence. The purposive sample comprised eight nurses working in the Trauma and Emergency Department in the Western Cape, South Africa. Thematic analysis was done of the semi-structured interviews. Four main themes and 10 categories were identified. Nurses are experiencing physical threats, verbal abuse and psychological and imminent violence on a regular basis. They tend to ‘normalise’ abusive patient behaviour because of the perception that workplace abuse ‘comes with the territory’, which resulted in under-reporting. However, perpetrators received compromised care by being avoided, ignored or given only minimal nursing care. Coping mechanisms ranged from using colleagues as sounding boards, helping out with duties, taking a smoke break and using friends and family to get it ‘off their chest’. The tolerance of non-physical violence and the absence of policies to deal with the violence, contribute to under-reporting.

  1. An emerging role: the nurse content curator.

    Brooks, Beth A


    A new phenomenon, the inverted or "flipped" classroom, assumes that students are no longer acquiring knowledge exclusively through textbooks or lectures. Instead, they are seeking out the vast amount of free information available to them online (the very essence of open source) to supplement learning gleaned in textbooks and lectures. With so much open-source content available to nursing faculty, it benefits the faculty to use readily available, technologically advanced content. The nurse content curator supports nursing faculty in its use of such content. Even more importantly, the highly paid, time-strapped faculty is not spending an inordinate amount of effort surfing for and evaluating content. The nurse content curator does that work, while the faculty uses its time more effectively to help students vet the truth, make meaning of the content, and learn to problem-solve. Brooks.

  2. Nursing and climate change: An emerging connection.

    Adlong, William; Dietsch, Elaine


    Awareness of the importance of climate change to public health has been growing. Calls for health professionals, including nurses, to take action to prepare for, and mitigate, climate change have been coming from a number of credible sources. This paper will assist nurses to recognise the health consequences of climate change, to generate and disseminate knowledge about these health consequences, to be active in mitigating emissions locally and within their organisations and to advocate and have input into policy processes. It is valuable for nurses to understand the health co-benefits of emission mitigation and the current health costs of fossil fuels. As advocates for evidence-based public health initiatives, nurses have a role to play in communicating to the public and to policy makers accurate information, including about the health costs of fossil fuel policies and the affordability of renewable energy technologies.

  3. Associations between workplace violence and intent to leave among nurses in emergency department:the mediating role of burnout%职业倦怠在急诊科护士的工作场所暴力与离职意愿关系中的中介作用

    包满珍; 吴丹; 汪苗; 陶莉; 张淼; 汪娜娜; 唐友玲


    Objective To examine the mediating role of burnout in the relation between workplace violence and intent to leave using a sample of nurses in emergency departments.Methods A cross-sectional study was conducted among 199 randomly selected nurses in emergency departments from eight first-rate of level three hospitals in Anhui province.Descriptive statistics,Spearman rank correlation analysis,and structural equation model were used to examine the mediating role of burnout in the relation between workplace violence and intent to leave.Results Among nurses in emergency department,workplace violence had a positive correlation with emotional exhaustion,depersonalization,and intent to leave (all P < 0.05).The burnout (emotional exhaustion and depersonalization) also had a positive correlation with intent to leave (all P < 0.05).Path analyses demonstrated that emotional exhaustion (t =6.21,95% CI:0.021-0.059) and depersonalization (t =5.39,95% CI:0.019-0.056) mediated the relationship between workplace violence and intent to leave.Conclusions Both workplace violence and burnout are related to intent to leave among nurses in emergency department.Furthermore,emotional exhaustion and depersonalization mediate the relationship between workplace violence and intent to leave.%目的 探索职业倦怠在急诊科护士的工作场所暴力与离职意愿关系中的中介作用.方法 从安徽省8所三级甲等医院急诊科随机选择199名在职在岗护士接受本次横断面调查,数据采用描述性统计、Spearman 相关分析,使用结构方程模型验证职业倦怠在急诊科护士的工作场所暴力与离职意愿关系中的中介作用.结果 急诊科护士职业场所暴力与职业倦怠中情感衰竭、去人格化以及离职倾向呈正相关(均有P <0.05),职业倦怠中情感衰竭以及去人格化与离职倾向之间呈正相关(均有P<0.05).路径分析显示,职业场所暴力通过情感衰竭和去人格化对离职倾

  4. Evolving prehospital, emergency department, and "inpatient" management models for geriatric emergencies.

    Carpenter, Christopher R; Platts-Mills, Timothy F


    Alternative management methods are essential to ensure high-quality and efficient emergency care for the growing number of geriatric adults worldwide. Protocols to support early condition-specific treatment of older adults with acute severe illness and injury are needed. Improved emergency department care for older adults will require providers to address the influence of other factors on the patient's health. This article describes recent and ongoing efforts to enhance the quality of emergency care for older adults using alternative management approaches spanning the spectrum from prehospital care, through the emergency department, and into evolving inpatient or outpatient processes of care.

  5. 广州市三甲医院急诊科护理人员共情能力与工作环境相关性研究%A study on the correlation between empathy ability of nursing staff and working environment in the emergency department of the hospitals at the level of grade Ⅲclass A in Guangzhou city



    目的:探讨广州市三级甲等医院急诊科护士共情能力及护士工作环境感知的现状,分析不同人口社会学因素对护士共情能力的影响,探讨护士工作环境与护士共情能力的相关性。方法:采用非实验设计的描述性研究方法,对广州市8家三甲医院急诊科300名在岗临床一线护士进行问卷调查,采用 SPSS19.0软件对所收集资料进行统计分析。结果:广州市三级甲等医院急诊科护士不同学历、不同人事情况的护士共情能力差异有统计学意义(P ﹤0.05);护士工作环境感知各维度得分及总分均与护理人员共情能力呈正相关(P ﹤0.05),进一步多元线性回归分析,得出护士共情能力与医护关系、患者信息交流、团队合作、冲突处理方式有线性回归关系,呈正相关(P ﹤0.05)。结论:广州市三级甲等医院急诊科护士的共情能力及工作环境感知在中等水平,护士的共情能力受多种因素影响;护理管理者应制定管理计划,采取有针对性的、有效的培训措施,增强护士的共情能力,促进护患沟通,建立良好护患关系,提高护理质量。%Objective:To study the correlation between empathy ability of nursing staff and working environment in the emergency de-partment of the hospitals at the level of grade Ⅲclass A in Guangzhou city through the investigation on the perception of the nursing staff. Methods:A questionnaire survey was conducted on 300 on - the - job clinical nurses in the emergency department of 8 hospitals at the lev-el of grade Ⅲclass A in Guangzhou city and the collected data were statistically processed and analyzed by using SPSS19. 0 software. Re-sults:There was statistically significant difference in the comparison of empathy ability between the nurses with different educational back-ground and different employment forms(P ﹤ 0. 05);the score of each dimension of the nurse

  6. To Investigate the Application and Effect of Nursing Risk Prevention of Routine Nursing Mode in The Department of Obstetrics and Gynecology Emergency Measures%预防妇产科护理风险中常规护理模式加应急措施的应用及效果探讨



    目的:探究妇产科护理风险中常规护理模式加急措施的应用和效果。方法选取140例在我院进行治疗的妇产科患者,并随机分成观察组和对照组两组,给予对照组常规的护理服务,观察组则在常规护理的基础上加入应急措施。结果观察组的并发症、护理失误发生率、患者满意度和住院费用等明显优于对照组,差异明显具有统计学意义(P<0.05)。讨论对妇产科患者实施常规护理模式联合应急措施可以有效减少并发症的发生,缩短住院时间,节省住院费用。%Objective To explore the application and effect of the vice of obstetric nursing risks in conventional nursing mode of urgent measures. Methods Select 140 cases of Obstetrics and gynecology patients treated in our hospital, and randomly divided into observation group and control group two groups, the control group given routine nursing service, the observation group was added to the emergency measures on the basis of routine nursing. Results In the observation group, the incidence rate of complications of nursing errors, patient satisfaction and the cost of hospitalization was significantly better than the control group, the difference was statistical y significance (P<0.05). Discussion The implementation of routine nursing mode combined with emergency measures on obstetrics and gynecology patients can effectively reduce the occurrence of complications, shorten the time of hospitalization,cost.

  7. Use of mobile devices in the emergency department: A scoping review.

    Dexheimer, Judith W; Borycki, Elizabeth M


    Electronic health records are increasingly used in regional health authorities, healthcare systems, hospitals, and clinics throughout North America. The emergency department provides care for urgent and critically ill patients. Over the past several years, emergency departments have become more computerized. Tablet computers and Smartphones are increasingly common in daily use. As part of the computerization trend, we have seen the introduction of handheld computers, tablets, and Smartphones into practice as a way of providing health professionals (e.g. physicians, nurses) with access to patient information and decision support in the emergency department. In this article, we present a scoping review and outline the current state of the research using mobile devices in the emergency departments. Our findings suggest that there is very little research evidence that supports the use of these mobile devices, and more research is needed to better understand and optimize the use of mobile devices. Given the prevalence of handheld devices, it is inevitable that more decision support, charting, and other activities will be performed on these devices. These developments have the potential to improve the quality and timeliness of care but should be thoroughly evaluated.

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

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


    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. Copyright © 2013 Elsevier Ltd. All rights reserved.

  9. Emergency Preparedness Education for Nurses: Core Competency Familiarity Measured Utilizing an Adapted Emergency Preparedness Information Questionnaire.

    Georgino, Madeline M; Kress, Terri; Alexander, Sheila; Beach, Michael


    The purpose of this project was to measure trauma nurse improvement in familiarity with emergency preparedness and disaster response core competencies as originally defined by the Emergency Preparedness Information Questionnaire after a focused educational program. An adapted version of the Emergency Preparedness Information Questionnaire was utilized to measure familiarity of nurses with core competencies pertinent to first responder capabilities. This project utilized a pre- and postsurvey descriptive design and integrated education sessions into the preexisting, mandatory "Trauma Nurse Course" at large, level I trauma center. A total of 63 nurses completed the intervention during May and September 2014 sessions. Overall, all 8 competencies demonstrated significant (P < .001; 98% confidence interval) improvements in familiarity. In conclusion, this pilot quality improvement project demonstrated a unique approach to educating nurses to be more ready and comfortable when treating victims of a disaster.

  10. Improvement on first-aid and nursing flow model in emergency department for patients with acute infarct of cardiac muscle%急诊科急性心肌梗死抢救护理流程模式的改进

    石丹琴; 马晓华; 林真珠; 赵俐玫; 张立民; 钟立光


    目的 为了提高急诊科急性心肌梗死抢救护理成功率.方法 对50例急性心肌梗死患者,采取在现有条件下,改进配合医生最便捷、有效抢救护理流程模式,缩短收住院时间.结果 50例患者经急诊科初步急救,病情稳定护送综合ICU或心内科住院部,成功率94%,与改进前50例比较,成功率提高10%(P<0.05),收住院时间由传统平均每人次15.5 min,下降到平均每人次6 min(P<0.01).结论 探索急诊科急性心肌梗死抢救护理流程模式,改进能有效配合医生提高抢救成功率;明显缩短收住院时间,为时间就是生命的抢救中争取了更宝贵的时间,提高满意度.%Objective To increase the success rate of first-aid and nursing of patients with acute infarct of cardiac muscle in emergency departments.Methods A total of 50 patients with acute infarct of cardiac muscle were taken,for seeking for the most convenient,effective flow model for first-aid and nursing under current conditions,which has a smooth cooperation with doctors,and shortens the time of patients staying in hosptal.Results The 50 patients were primarily first-aided in emergency department,and shew a stable status of disease,and were sent to the complex ICU or the cardiacology department in the in-patient section with care.The success rate was 94%.Compared with 50 patients in the past,the success rate was increased by 10% (P<0.05).The time for staying in hospital was reduced to 6 rain for a patient at a time in average,from the tradiational average time for a patient at a time of 15.5 rain.Conclusions This exploration in nursing model for first-aid and nursing of patients with acute infarct of cardiac muscle in emergency departments provides an improvement which can closely match with doctors,and increase the success rate of first aid.It clearly shortens the in-hospital time for patients.The model gives valuable time for the first-aid process which shows time is life,and increases the

  11. The New Mexico School Nurse and Emergency Medical Services Emergency Preparedness Course: Program Description and Evaluation

    Elgie, Robert; Sapien, Robert E.; Fullerton-Gleason, Lynne


    Illness and injuries are common among students and school staff. Therefore, school nurses must be prepared. In this study, a 16-hour scenario-based emergency preparedness course for school nurses was evaluated for its effectiveness. Effectiveness was measured by (a) traditional methods (written exams and confidence surveys) and (b) skills and…

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

    Harrison K. Borno


    Full Text Available 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.

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

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


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

  14. An integration of Emergency Department Information and Ambulance Systems.

    Al-Harbi, Nada; El-Masri, Samir; Saddik, Basema


    In this paper we propose an Emergency Department Information System that will be integrated with the ambulance system to improve the communication, enhance the quality of provided emergency services and facilitate information sharing. The proposed system utilizes new advanced technologies such as mobile web services that overcome the problems of interoperability between different systems, HL7 and GPS. The system is unique in that it allows ambulance officers to locate the nearest specialized hospital and allows access to the patient's electronic health record as well as providing the hospital with required information to prepare for the incoming patient.

  15. Medical Identity Theft in the Emergency Department: Awareness is Crucial

    Michelino Mancini


    Full Text Available Medical Identity theft in the emergency department (ED can harm numerous individuals, and many frontline healthcare providers are unaware of this growing concern. The two cases described began as typical ED encounters until red flags were discovered upon validating the patient’s identity. Educating all healthcare personnel within and outside the ED regarding the subtle signs of medical identity theft and implementing institutional policies to identify these criminals will discourage further fraudulent behavior. [West J Emerg Med. 2014;15(7:–0.

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

    Christensen, Dorthea; Jensen, Nanna Martin; Maaløe, Rikke;


    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 "primary criterion" or a BEWS ≥ 5 are presumed to be critically ill or severely injured and should be received by a multidisciplinary team, termed the Emergency Call (EC) and Trauma Call (TC), respectively. The aim of this study was to examine compliance with this triage system at Bispebjerg Hospital....

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

    Christensen, Dorthea; Jensen, Nanna Martin; Maaløe, Rikke;


    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 "primary criterion" or a BEWS = 5 are presumed to be critically ill or severely injured and should be received by a multidisciplinary team, termed the Emergency Call (EC) and Trauma Call (TC), respectively. The aim of this study was to examine compliance with this triage system at Bispebjerg Hospital....

  18. Usability evaluation of an emergency department information system prototype designed using cognitive systems engineering techniques.

    Clark, Lindsey N; Benda, Natalie C; Hegde, Sudeep; McGeorge, Nicolette M; Guarrera-Schick, Theresa K; Hettinger, A Zachary; LaVergne, David T; Perry, Shawna J; Wears, Robert L; Fairbanks, Rollin J; Bisantz, Ann M


    This article presents an evaluation of novel display concepts for an emergency department information system (EDIS) designed using cognitive systems engineering methods. EDISs assist emergency medicine staff with tracking patient care and ED resource allocation. Participants performed patient planning and orientation tasks using the EDIS displays and rated the display's ability to support various cognitive performance objectives along with the usability, usefulness, and predicted frequency of use for 18 system components. Mean ratings were positive for cognitive performance support objectives, usability, usefulness, and frequency of use, demonstrating the successful application of design methods to create useful and usable EDIS concepts that provide cognitive support for emergency medicine staff. Nurse and provider roles had significantly different perceptions of the usability and usefulness of certain EDIS components, suggesting that they have different information needs while working.

  19. [Opinion survey on information, communication and treatment in an Emergency Department].

    García-García, A; Arévalo-Velasco, A; García-Iglesias, M A; Sánchez-Barba, M; Delgado-Vicente, M A; Bajo-Bajo, A; Diego-Robledo, F


    To gather specific details about the information, communication, and treatment as regards users of hospital emergency services using a telephone survey, in order to implement improvement measures, if necessary. A prospective study was conducted in two emergency departments in Salamanca. A total of 400 patients were included in the study (mean age 56.4±20.5years, 58.4% women). A telephone survey was performed with 19 items, of which 12 required responses on a Likert-type scale, with scores of 1 (very bad) to 5 (very good). The remainder of the questions allowed to answer "yes" or "no". The treatment received by the professionals in general was evaluated positively by 86% of the patients; with 92% reporting they were respectful, 87% were treated by doctors and 71% received treatment from nurses. More than one-quarter (27.5%) did not recall receiving information from blue point staff (personnel specially trained to provide information. Statistical significance (P=.045) was found in relation to the kindness and respect shown by nurses. Most patients that were admitted to the observation area of the emergency department were not informed about the visiting hours (P=.003). Perception of care received by patients is good, while in relation to information and communication it is evidently improvable, and could be assessed using the survey that is proposed in order to detect and use the weaknesses in these aspects of health care as implementation initiatives. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.

  20. Structural elements of critical thinking of nurses in emergency care

    Maria da Graça Oliveira Crossetti

    Full Text Available The objective of this study was to analyze the structural elements of critical thinking (CT of nurses in the clinical decision-making process. This exploratory, qualitative study was conducted with 20 emergency care nurses in three hospitals in southern Brazil. Data were collected from April to June 2009, and a validated clinical case was applied from which nurses listed health problems, prescribed care and listed the structural elements of CT. Content analysis resulted in categories used to determine priority structural elements of CT, namely theoretical foundations and practical relationship to clinical decision making; technical and scientific knowledge and clinical experience, thought processes and clinical decision making: clinical reasoning and basis for clinical judgments of nurses: patient assessment and ethics. It was concluded that thinking critically is a skill that enables implementation of a secure and effective nursing care process.

  1. Epidemiology of Emergency Medical Services (EMS) Utilization in Four Indian Emergency Departments.

    Wijesekera, Olindi; Reed, Amanda; Chastain, Parker S; Biggs, Shauna; Clark, Elizabeth G; Kole, Tamorish; Chakrapani, Anoop T; Ashish, Nandy; Rajhans, Prasad; Breaud, Alan H; Jacquet, Gabrielle A


    Introduction Without a universal Emergency Medical Services (EMS) system in India, data on the epidemiology of patients who utilize EMS are limited. This retrospective chart review aimed to quantify and describe the burden of disease and patient demographics of patients who arrived by EMS to four Indian emergency departments (EDs) in order to inform a national EMS curriculum.

  2. Emergency department patient characteristics: Potential impact on emergency medicine residency programs in the Netherlands.

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


    OBJECTIVES: We set out to study emergency department patient characteristics at a busy level-2 trauma center, to gain insight into the practise of emergency medicine, which is not yet recognized as a specialty in the Netherlands. METHODS: From May 27 to July 4 2001, the following data were recorded

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

    Hertzum, Morten; Simonsen, Jesper


    and with the coordinating nurse, who is the main keeper of the whiteboard. On the basis of observations, we find that coordination is accomplished through a highly intertwined process of technologically mediated visual overview combined with orally communicated details. The oral details serve to clarify and elaborate......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...... instrumental and communicative coordination are central to the coordinative function of the whiteboard. We discuss this and other implications for design....

  4. Epigenetics: An Emerging Framework for Advanced Practice Psychiatric Nursing.

    DeSocio, Janiece E


    The aims of this paper are to synthesize and report research findings from neuroscience and epigenetics that contribute to an emerging explanatory framework for advanced practice psychiatric nursing. Discoveries in neuroscience and epigenetics reveal synergistic mechanisms that support the integration of psychotherapy, psychopharmacology, and psychoeducation in practice. Advanced practice psychiatric nurses will benefit from an expanded knowledge base in neuroscience and epigenetics that informs and explains the scientific rationale for our integrated practice. © 2015 Wiley Periodicals, Inc.

  5. Emergency mental health nursing for self-harming refugees and asylum seekers.

    Procter, Nicholas G


    This article describes the structure and function of emergency mental health nursing practice for self-harming refugees and asylum seekers on Temporary Protection Visas. Emergency nurses working in accident and emergency departments or as part of crisis intervention teams will see self-harming refugees and asylum seekers at the very point of their distress. This clinical paper is intended to support nurses in their practice should they encounter an adult asylum seeker needing emergency mental health care. Practical strategies are highlighted to help mental health nurses assess, care, and comfort refugees and asylum seekers in this predicament. Mental health nurses should, where possible, work closely with asylum seekers, their support workers, and accredited interpreters and translators to ensure the appropriate use of language when dealing with mental and emotional health issues without further isolating the asylum seeker from appropriate services. To help strengthen continuity and integration of mental health supports for refugees and asylum seekers, well-resourced care must be experienced as coherent and connected. A coherent, interdisciplinary and team-orientated approach will synthesize different viewpoints to shape clinical practice and create workable solutions in local situations.

  6. Hyponatremia in older adults presenting to the emergency department.

    Nelson, Joan M; Robinson, Marylou V


    Hyponatremia is a common disorder seen in the emergency department and is more prevalent in older adults than in other adult populations (Miller, 2009). Though often discovered by accident, through routine bloodwork, even mild hyponatremia has been shown to have potentially dangerous consequences for older adults, increasing their risks for falls, altered mental status, osteoporosis and fractures, and gastrointestinal disturbances (Soiza and Talbot, 2011). Optimal management of older adults with hyponatremia in the ED involves not only treatment of serum sodium levels and the immediate consequence of the disorder, but exploration and reversal of the causes of the hyponatremia to avoid recurrence. This case study illustrates the clinical presentation, complications and management of hyponatremia in the setting of the emergency department.

  7. A "Patch" to the NYU Emergency Department Visit Algorithm.

    Johnston, Kenton J; Allen, Lindsay; Melanson, Taylor A; Pitts, Stephen R


    To document erosion in the New York University Emergency Department (ED) visit algorithm's capability to classify ED visits and to provide a "patch" to the algorithm. The Nationwide Emergency Department Sample. We used bivariate models to assess whether the percentage of visits unclassifiable by the algorithm increased due to annual changes to ICD-9 diagnosis codes. We updated the algorithm with ICD-9 and ICD-10 codes added since 2001. The percentage of unclassifiable visits increased from 11.2 percent in 2006 to 15.5 percent in 2012 (p < .01), because of new diagnosis codes. Our update improves the classification rate by 43 percent in 2012 (p < .01). Our patch significantly improves the precision and usefulness of the most commonly used ED visit classification system in health services research. © Health Research and Educational Trust.

  8. Conflict management style, supportive work environments and the experience of work stress in emergency nurses.

    Johansen, Mary L; Cadmus, Edna


    To examine the conflict management style that emergency department (ED) nurses use to resolve conflict and to determine whether their style of managing conflict and a supportive work environment affects their experience of work stress. Conflict is a common stressor that is encountered as nurses strive to achieve patient satisfaction goals while delivering quality care. How a nurse perceives support may impact work stress levels and how they deal with conflict. A correlational design examined the relationship between supportive work environment, and conflict management style and work stress in a sample of 222 ED nurses using the expanded nurse work stress scale; the survey of perceived organisational support; and the Rahim organisational conflict inventory-II. Twenty seven percent of nurses reported elevated levels of work stress. A supportive work environment and avoidant conflict management style were significant predictors of work stress. Findings suggest that ED nurses' perception of a supportive work environment and their approach to resolving conflict may be related to their experience of work stress. Providing opportunities for ED nurses in skills training in constructive conflict resolution may help to reduce work stress and to improve the quality of patient care. © 2015 John Wiley & Sons Ltd.

  9. Geographic information system data from ambulances applied in the emergency department: effects on patient reception

    Raaber, Nikolaj; Pedersen, Iben Duvald; Riddervold, Ingunn Skogstad;


    BACKGROUND: Emergency departments (ED) recognize crowding and handover from prehospital to in-hospital settings to be major challenges. Prehospital Geographical Information Systems (GIS) may be a promising tool to address such issues. In this study, the use of prehospital GIS data was implemented...... was displayed in the ED. Data included real-time estimated time of arrival, distance to ED, dispatch criteria, patient data and ambulance contact information. Data was used by coordinating nurses for time activation of TT and MET involved in the initial treatment of severely-injured or critically-ill patients....... DISCUSSION: The contradiction of measured median wait time and nurses perceived improved timing of team activation may result from having both RT- ETA and supplemental patient information not only for seriously-injured or critically-ill patients received by the TT and MET, but for all patients transported...

  10. Automated electronic medical record sepsis detection in the emergency department

    Su Q. Nguyen; Edwin Mwakalindile; Booth, James S.; Vicki Hogan; Jordan Morgan; Prickett, Charles T; Donnelly, John P; Wang, Henry E.


    Background. While often first treated in the emergency department (ED), identification of sepsis is difficult. Electronic medical record (EMR) clinical decision tools offer a novel strategy for identifying patients with sepsis. The objective of this study was to test the accuracy of an EMR-based, automated sepsis identification system. Methods. We tested an EMR-based sepsis identification tool at a major academic, urban ED with 64,000 annual visits. The EMR system collected vital sign and lab...

  11. Simulation for Operational Readiness in a New Freestanding Emergency Department

    Kerner, Robert L.; Gallo, Kathleen; Cassara,Michael; D'Angelo, John.; Egan, Anthony; Simmons, John Galbraith


    Summary Statement Simulation in multiple contexts over the course of a 10-week period served as a core learning strategy to orient experienced clinicians before opening a large new urban freestanding emergency department. To ensure technical and procedural skills of all team members, who would provide care without on-site recourse to specialty backup, we designed a comprehensive interprofessional curriculum to verify and regularize a wide range of competencies and best practices for all clini...

  12. [Care for the dying patient in emergency departments].

    Iglesias, M L; Lafuente, A


    The aim of this article is to provide professionals in the hospital emergency departments with sufficient tools to face, according to the organisation and possibilities of each hospital, the admission of patients in the final days of life. It is primordial to provide a professional, technical and human environment based on concepts, attitudes and skills that make it possible to deal with the demands of comfort and the emotional and psycho-social requirements generated by these situations.

  13. Hand hygiene and aseptic technique in the emergency department.

    Al-Damouk, M; Pudney, E; Bleetman, A


    Hand hygiene and simple aseptic measures before invasive procedures are effective in reducing rates of healthcare-associated infection. The perceived urgency of a clinical situation in the emergency department, however, may influence medical staff's compliance with good practice in infection control. The aims of this prospective, single-blinded, observational study were twofold. First, to assess doctors' compliance with good practice in hand hygiene between patient episodes and asepsis during invasive procedures in the emergency department. Second, to assess the effect of clinical urgency on compliance with good practice in hand hygiene and asepsis during invasive procedures. Good practice standards for asepsis in invasive procedures and hand hygiene between patient episodes were compiled from a literature search. Doctors' compliance with these standards was observed in two emergency departments (UK and New Zealand). Observed clinical cases were classified as immediate, urgent and non-urgent based on the triage system. There was poor compliance with good practice guidelines for asepsis in invasive procedures in both centres. Staff achieved high compliance with the guidelines in only 27% of cases in the UK and 58% of cases in New Zealand. Clinical urgency did not appear to adversely affect compliance with aseptic good practice. Hand hygiene between patient consultations was very low at 14% in the UK and 12% in New Zealand. Asepsis and hand hygiene was poor in both the UK and New Zealand emergency departments. There may be a need for some compromise in standards of asepsis in very sick patients due to the urgency of the clinical situation. Compliance in all situations especially non-urgent procedures needs to be improved.

  14. Emergency Department Use among Adults with Autism Spectrum Disorders (ASD)

    Vohra, Rini; Madhavan, Suresh; Sambamoorthi, Usha


    A cross-sectional analyses using Nationwide Emergency Department Sample (2006-2011) was conducted to examine the trends, type of ED visits, and mean total ED charges for adults aged 22-64 years with and without ASD (matched 1:3). Around 0.4% ED visits (n = 25,527) were associated with any ASD and rates of such visits more than doubled from 2006 to…

  15. Analysis of factors that determine hospitalization of emergency department patients

    Katarzyna Szwamel


    Full Text Available Background. Optimization of health care financing under current standards of treatment can be achieved by determining the factors that affect the number of hospital admissions at emergency departments (ED, and their significance. Objectives . Identification of factors determining hospitalizations at emergency department. Material and methods . The study involved 150 emergency department patients in Kedzierzyn-Kozle. An original questionnaire, the Health Behaviors Inventory, and a modified version of the Camberwell Assessment of Need Short Appraisal Schedule (CANSAS were used. Results. At greatest risk of hospitalization are those patients who: take more than 4 drugs (OR 12.17, 95% CI 2.97–73.67; are being treated for chronic diseases (OR 5.37, 95% CI 2.56–11.62; are above 44.5 years of age (OR 3.14, 95% CI 1.54–6.51; are being treated at an outpatient specialist clinic (OR 3.87, 95% CI 1.85–8.32; have a BMI above 27.1 (OR 2.84, 95% CI 1.39–5.88; have at most average material status (OR 0.42, 95% CI 0.20–0.87; have symptoms of severity greater than 5 (OR 2.23, 95% CI 1.11–4.55; and have a low index of unsatisfied needs (a Camberwell index lower than 0.825: OR 0.36, 95% CI 0.17–0.72. Conclusions . Any program to prevent hospitalization should be based on the measurement of health behavior, should focus on promoting knowledge of chronic diseases and the means of preventing them, and should involve patient education on the purpose of emergency departments. It is necessary to strive for increase responsiveness of healthcare to patients’ needs and to support the area of primary-care-oriented services in the field of ‘small surgery’.

  16. Real-time demand forecasting in the emergency department.

    Jones, Spencer S


    Shifts in the supply of and demand for emergency department (ED) services have led to ED overcrowding and make the efficient allocation of ED resources increasingly important. Reliable means of modeling and forecasting the demand for resources are critical to any ED resource planning strategy. Vector Autoregression (VAR) is a flexible multivariate time-series forecasting methodology that is well suited to modeling demand for resources in the ED.

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

    Douglas A. Propp


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

  18. Medical identity theft in the emergency department: awareness is crucial.

    Mancini, Michelino


    Medical identity theft in the emergency department (ED) can harm numerous individuals, and many frontline healthcare providers are unaware of this growing concern. The two cases described began as typical ED encounters until red flags were discovered upon validating the patient's identity. Educating all healthcare personnel within and outside the ED regarding the subtle signs of medical identity theft and implementing institutional policies to identify these criminals will discourage further fraudulent behavior.

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

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


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

  20. A National Survey of Emergency Department Triage in Sweden

    Göransson, Katarina; Ehrenberg, Anna; Ehnfors, Margareta


    The aim of this study was to identify the organisation of and knowledge about triage work in Swedish emergency departments (ED) as a first step to understanding what is necessary for decision support in ED triage systems in Sweden. A national survey using telephone interviews for data collection was used. Results showed great variety in how work regarding ED triage is organised and performed. The variety occurs in several areas including education, personnel performing triage, facilities available and scales used. PMID:14728356


    Freitas, Ana Cristina; Moreira, Ana Raquel; Tomé, Soraia; Cardoso, Raquel


    Introduction: Hospital emergency department (ED) utilization by non-urgent situations is common and leads to worse care, patients and professionals dissatisfaction and increasing costs.Objective: To determine the reasons and adequacy for the use of a hospital pediatric ED. Methods: Descriptive, cross-sectional study between October 10 and December 31 2013 at an hospital pediatric ED, through analysis of questionnaires completed by child caretakers and with clinical data provided by the doctor...

  2. Automated electronic medical record sepsis detection in the emergency department

    Nguyen, Su Q.; Edwin Mwakalindile; Booth, James S.; Vicki Hogan; Jordan Morgan; Prickett, Charles T; Donnelly, John P.; Wang, Henry E.


    Background. While often first treated in the emergency department (ED), identification of sepsis is difficult. Electronic medical record (EMR) clinical decision tools offer a novel strategy for identifying patients with sepsis. The objective of this study was to test the accuracy of an EMR-based, automated sepsis identification system. Methods. We tested an EMR-based sepsis identification tool at a major academic, urban ED with 64,000 annual visits. The EMR system collected vital sign and lab...

  3. Automated electronic medical record sepsis detection in the Emergency Department

    Nguyen, Su; Mwakalindile, Edwin; Booth, James S.; Hogan, Vicki; Morgan, Jordan; Prickett, Charles T; Donnelly, John P.; Wang, Henry E.


    Background: While often first treated in the Emergency Department (ED), identification of sepsis is difficult. Electronic medical record (EMR) clinical decision tools offer a novel strategy for identifying patients with sepsis. The objective of this study was to test the accuracy of an EMR-based, automated sepsis identification system. Methods : We tested an EMR-based sepsis identification tool at a major academic, urban ED with 64,000 annual visits. The EMR system collected vital sign and la...

  4. Tumor lysis syndrome in the emergency department: challenges and solutions

    Ñamendys-Silva SA


    Full Text Available Silvio A Ñamendys-Silva,1,2 Juan M Arredondo-Armenta,1 Erika P Plata-Menchaca,2 Humberto Guevara-García,1 Francisco J García-Guillén,1 Eduardo Rivero-Sigarroa,2 Angel Herrera-Gómez,1 1Department of Critical Care Medicine, Instituto Nacional de Cancerología, 2Department of Critical Care Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico Abstract: Tumor lysis syndrome (TLS is the most common oncologic emergency. It is caused by rapid tumor cell destruction and the resulting nucleic acid degradation during or days after initiation of cytotoxic therapy. Also, a spontaneous form exists. The metabolic abnormalities associated with this syndrome include hyperkalemia, hyperphosphatemia, hypocalcemia, hyperuricemia, and acute kidney injury. These abnormalities can lead to life-threatening complications, such as heart rhythm abnormalities and neurologic manifestations. The emergency management of overt TLS involves proper fluid resuscitation with crystalloids in order to improve the intravascular volume and the urinary output and to increase the renal excretion of potassium, phosphorus, and uric acid. With this therapeutic strategy, prevention of calcium phosphate and uric acid crystal deposition within renal tubules is achieved. Other measures in the management of overt TLS are prescription of hypouricemic agents, renal replacement therapy, and correction of electrolyte imbalances. Hyperkalemia should be treated quickly and aggressively as its presence is the most hazardous acute complication that can cause sudden death from cardiac arrhythmias. Treatment of hypocalcemia is reserved for patients with electrocardiographic changes or symptoms of neuromuscular irritability. In patients who are refractory to medical management of electrolyte abnormalities or with severe cardiac and neurologic manifestations, early dialysis is recommended.Keywords: tumor lysis syndrome, emergency department, emergency

  5. Emergency Department and Older Adult Motor Vehicle Collisions

    Lotfipour, Shahram


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

  6. Management of angioedema without urticaria in the emergency department.

    Pedrosa, Maria; Prieto-García, Alicia; Sala-Cunill, Anna


    Angioedema refers to a localized, transient swelling of the deep skin layers or the upper respiratory or gastrointestinal mucosa. It develops as a result of mainly two different vasoactive peptides, histamine or bradykinin. Pathophysiology, as well as treatment, is different in each case; nevertheless, the resulting signs and symptoms may be similar and difficult to distinguish. Angioedema may occur at any location. When the affected area involves the upper respiratory tract, both forms of angioedema can lead to an imminent upper airway obstruction and a life-threatening emergency. Emergency physicians must have a basic understanding of the pathophysiology underlying this process. Angioedema evaluation in the emergency department (ED) should aim to distinguish between histamine- and bradykinin-induced angioedema, in order to provide appropriate treatment to patients. However, diagnostic methods are not available at the ED setting, neither to confirm one mechanism or the other, nor to identify a cause. For this reason, the management of angioedema should rely on clinical data depending on the particular features of the episode and the patient in each case. The history-taking should be addressed to identify a possible etiology or triggering agent, recording complete information for an ulterior diagnostic study in the outpatient clinic. It is mandatory quickly to recognize and treat a potential life-threatening upper airway obstruction or anaphylaxis. This review focuses on the underlying mechanisms and management of histamine- and bradykinin-induced angioedema at the emergency department and provides an update on the currently available treatments.

  7. Interprofessional education in a student-led emergency department: A realist evaluation.

    Ericson, Anne; Löfgren, Susanne; Bolinder, Gunilla; Reeves, Scott; Kitto, Simon; Masiello, Italo


    This article reports a realist evaluation undertaken to identify factors that facilitated or hindered the successful implementation of interprofessional clinical training for undergraduate students in an emergency department. A realist evaluation provides a framework for understanding how the context and underlying mechanisms affect the outcome patterns of an intervention. The researchers gathered both qualitative and quantitative data from internal documents, semi-structured interviews, observations, and questionnaires to study what worked, for whom, and under what circumstances in this specific interprofessional setting. The study participants were medical, nursing, and physiotherapy students, their supervisors, and two members of the emergency department's management staff. The data analysis indicated that the emergency ward provided an excellent environment for interprofessional education (IPE), as attested by the students, supervisors, and the clinical managers. An essential prerequisite is that the students have obtained adequate skills to work independently. Exemplary conditions for IPE to work well in an emergency department demand the continuity of effective and encouraging supervision throughout the training period and supervisors who are knowledgeable about developing a team.

  8. Strategic emergency department design: An approach to capacity planning in healthcare provision in overcrowded emergency rooms

    Bürki Leo


    Full Text Available Abstract Healthcare professionals and the public have increasing concerns about the ability of emergency departments to meet current demands. Increased demand for emergency services, mainly caused by a growing number of minor and moderate injuries has reached crisis proportions, especially in the United Kingdom. Numerous efforts have been made to explore the complex causes because it is becoming more and more important to provide adequate healthcare within tight budgets. Optimisation of patient pathways in the emergency department is therefore an important factor. This paper explores the possibilities offered by dynamic simulation tools to improve patient pathways using the emergency department of a busy university teaching hospital in Switzerland as an example.

  9. Consequences of peritonism in an emergency department setting

    Bjørsum-Meyer, Thomas; Schmidt, Thomas A.


    Background: In patients who were referred to the emergency department (ED) with abdominal pain, it is crucial to determine the presence of peritonism to allow for appropriate handling and subsequent referral to stationary departments. We aimed to assess the incidence of perceived peritonism...... on the patients with abdominal pain. Following a physical examination, the patients with abdominal pain were divided into those who had clinical signs of peritonism and those who did not. Results: Among the 1,270 patients admitted to the ED, 10% had abdominal pain. In addition, 41% of these patients were found...... to have signs indicative of peritonism, and 90% were admitted to the Department of Surgery (DS). Also, 24% of those patients with signs of peritonism and admission to the DS underwent surgical intervention in terms of laparotomy/laparoscopy. Five of the patients without peritonism underwent surgery...

  10. Levels of empathy in undergraduate emergency health, nursing, and midwifery students: a longitudinal study

    Williams B


    Full Text Available Brett Williams,1 Ted Brown,2 Malcolm Boyle,1 Lisa McKenna,3 Claire Palermo,4 Jamie Etherington1 1Department of Community Emergency Health and Paramedic Practice, 2Department of Occupational Therapy, 3School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University–Peninsula Campus, Frankston, 4Department of Nutrition and Dietetics, Faculty of Medicine, Nursing and Health Sciences, Monash University–Berwick Campus, Berwick, Vic, Australia Purpose: This research examines the extent and nature of empathy among emergency health (paramedic, nursing, and midwifery students at one Australian university and investigates the longitudinal changes in empathy levels across the course of study. Methods: First-, second-, and third-year students at Monash University completed the Jefferson Scale of Empathy–Health Professional (JSE-HP in 2008, 2009, and 2010, and the resulting mean empathy scores were analyzed by course, year of course, year of study, age, and sex. Results: Midwifery students were found to have higher empathy levels than nursing and emergency health students. Second- and third-year students scored higher than their counterparts in the first year. Empathy levels dipped in 2009 and rose in 2010. Students aged 26–30 years and 31–35 years recorded higher scores than their younger colleagues, and female students were found to be more empathic than their male counterparts. Conclusion: The finding that empathy levels are relatively stable over the term of study contributes to the understanding of how empathy evolves over the course of study and offers insights into the importance of incorporating and promoting empathy in health care curricula. Keywords: empathy, nursing, paramedics, midwifery, undergraduates

  11. Perception of radiation dose and potential risks of computed tomography in emergency department medical personnel

    Lee, Jin Hee; Kim, Kyuseok; Lee, Kyoung Ho; Kim, Kwang Pyo; Kim, Yu Jin; Park, Chanjong; Kang, Changwoo; Lee, Soo Hoon; Jeong, Jin Hee; Rhee, Joong Eui


    Objective Use of computed tomography (CT) continues to increase, but the relatively high radiation doses associated with CT have raised health concerns such as future risk of cancer. We investigated the level of awareness regarding radiation doses and possible risks associated with CT in medical personnel (MP). Methods This study was conducted from April to May 2012 and included physicians and nurses who worked in the emergency department of 17 training hospitals. The questionnaire included measurement of the effect of CT or radiography on health using a 10-point numerical rating scale, estimation of the radiation dose of one abdominal CT scan compared with one chest radiograph, and perception of the increased lifetime risk of cancer associated with CT. Results A total of 354 MP participated in this study: 142 nurses, 87 interns, 86 residents, and 39 specialists. Interns were less aware of the effects of CT or radiography on health than other physicians or nurses (mean±SD of 4.8±2.7, 5.9±2.7, 6.1±2.7, and 6.0±2.2 for interns, residents, specialists, and nurses, respectively; P<0.05). There was a significant difference in knowledge about the relative radiation dose of one abdominal CT scan compared with one chest radiograph between physicians and nurses (48.6% vs. 28.9% for physicians vs. nurses, P<0.05). MP perceived an increased risk of cancer from radiation associated with CT. Conclusion MP perceive the risk of radiation associated with CT, but their level of knowledge seems to be insufficient.

  12. CSI: New @ York: development of forensic evidence collection guidelines for the emergency department.

    Eisert, Peter J; Eldredge, Kelli; Hartlaub, Tami; Huggins, Emily; Keirn, Geneva; O'brien, Patti; Rozzi, Heather V; Pugh, Linda C; March, Karen S


    Emergency department (ED) nurses care for victims of trauma almost daily. Although preservation of evidence is crucial, the ED is chaotic when a trauma patient arrives and staff members must do everything possible to save the patient's life. However, an integral responsibility of the staff nurse is collection and preservation of forensic evidence. This article provides insight into the process undertaken by a multidisciplinary team to develop a set of evidence-based guidelines for forensic evidence collection. The team compiled evidence from more than 20 articles and consultations with law enforcement officials and forensic experts. This information was used to develop a set of guidelines for forensic evidence collection in the ED or operating room. Staff educational needs presented some challenges. Training was designed to specifically address the roles of three major groups of staff: patient representatives and emergency and trauma nurses. Educational topics included evidence recognition, handling of clothing, gross/trace evidence, documentation, packaging of evidence, and use of the "chain-of-evidence" form. Practice modifications included development of a new "chain-of-evidence" form, a forensic cart in the operating room, and use of a collapsible plastic box for collection of clothing in the ED.

  13. Factors influencing length of stay in the Emergency Department in a Private Hospital in North Jakarta

    Irwan Juss


    Full Text Available Length of stay (LOS is a key measure of Emergency Department (ED throughput and a marker of quality objectives. Time studies that assess ED services may help to clarify the causes of prolonged ED service to patients. The objective of this study was to analyse factors influencing LOS in the ED of Private Hospital X. This study was conducted at the ED of Private Hospital X in North Jakarta. One hundred and seventy one adult patients were admitted via the over a period of three weeks in March 2008. Data recorded included characteristics of patients, service time of nurses, service time of physicians, and overall ED LOS. Anova and independent t-test were performed to determine factors associated with ED LOS. Elderly patients, patients in emergency status, patients with letters of referral, electrocardiogram (ECG training for physicians and advance cardiac life support (ACLS training for nurses were significantly associated with duration of service in the ED. Mean ED LOS was 50 ± 20.7 minutes. Patient category and characteristics of physicians and nurses are important independent variables that influence the ED’s duration of service. Future research is necessary to determine how these and other factors can be incorporated into a model for predicting ED LOS.

  14. Critical realism in nursing: an emerging approach.

    Schiller, Catharine J


    Critical realism, a philosophical framework originally developed by Roy Bhaskar in the 1970s, represents a relatively new approach to research generally and to nursing research in particular. This article explores the ontological and epistemological tenets of critical realism and examines the application of critical realist principles to nursing research and practice through a review of the literature. It is evident that few published nursing research studies have, as of yet, utilized critical realism as their paradigm of choice. Both the strengths and limitations of the presentation and use of critical realism in these studies are discussed in this article. Given the varying degrees of success of the authors in explicating critical realism as a philosophical framework, the value of critical realism to the research study, and the ways in which usage of the critical realist framework influenced development of the study and interpretation of findings, it is evident that the quality of future publications espousing the use of critical realism must continue to be strengthened significantly.

  15. Hypoglycemic treatment of diabetic patients in the Emergency Department

    Carmen Caballero Requejo


    Full Text Available Objectives: To analyze if the hypoglycemic therapy prescribed in the Emergency Department adapts to the consensus recommendations available, as well as to assess its clinical impact. Methods: A descriptive observational study, which included patients awaiting hospital admission, who were in the Observation Ward of the Emergency Department and had been previously diagnosed with diabetes mellitus, and were receiving treatment with hypoglycemic drugs at home. The management of antidiabetic treatment and its clinical impact were assessed. Results: 78 patients were included. At admission to the Emergency Department, treatment was modified for 91% of patients, and omitted for 9%. The most prescribed treatment was sliding scale insulin (68%. The treatments prescribed coincided in a 16.7% with the recommendations by the Spanish Society of Emergency Medicine. After intervention by the Pharmacist, the omission descended to 1.3%, and the adaptation to the recommendations increased to 20.5%. Comparing patients whose treatment coincided with the recommendations and those who did not, the clinical impact was respectively: mean glycemia at 24 hours: 138.3 } 49.5 mg/dL versus 182.7 } 97.1 mg/dL (p = 0.688; mean rescues with insulin lispro: } 1.6 versus 1.5 } 1.8 (p = 0.293; mean units of insulin lispro administered: 4.6 } 12.7 IU versus 6.6 } 11.3 IU (p = 0.155. Conclusions: We found antidiabetic prescriptions to have a low adaptation to consensus recommendations. These results are in line with other studies, showing an abuse of sliding scale regimen as single hypoglycemic treatment

  16. Journey to a safe environment: fall prevention in an emergency department at a level I trauma center.

    Alexander, Danette; Kinsley, Terry L; Waszinski, Christine


    Predicting which patients will fall is a challenging task, especially in the often unpredictable setting of an emergency department of a Level I Trauma Center. Unfortunately, there is a great potential for falls to occur in this environment. Fall risk assessment tools used in inpatient settings do not adequately capture the risk factors of patients presenting to the emergency department. The ability to accurately identify patients at risk for falling at the point of entry is the first step toward preventing patient harm. Once patients are identified as at risk for a fall, the next challenge is to be sure that they do not fall. We created the KINDER1 Fall Risk Assessment Tool for use in the emergency department. This instrument was specifically designed for the rapid identification of patients at risk for a fall as well as the re-evaluation of patients for fall risk throughout their stay in the emergency department. Once we had an appropriate assessment tool, our next challenge was for staff to consistently apply fall prevention interventions. Performing a mini-root cause analysis on each fall showed trends and in turn led to the design and implementation of specific fall prevention interventions to motivate the nursing staff to focus on fall prevention that the ED nursing leadership used to select change strategies. With improved identification of fall risk patients and consistent application of innovative prevention strategies, we were able to show a trend toward reduction of falls and fall-related injuries in our emergency department.

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

    Fereshteh Farzianpour


    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

  18. [Epidemiological characteristics in suicidal adolescents seen in the Emergency Department].

    Margarit Soler, Adriana; Martínez Sanchez, Lídia; Martínez Monseny, Antonio; Trenchs Sainz de la Maza, Victoria; Picouto González, María Dolores; Villar Cabeza, Francisco; Luaces Cubells, Carles


    Suicide attempt in adolescents is a major global health problem. In order to prevent them, the risks factors need to be identified. The present study evaluates the clinical and epidemiological aspects of adolescent patients after attempted suicide, who were seen in an emergency department. Description of retrospective study of patients younger than 18 years who visited emergency department unit after a suicide attempt, during the period from 2008 to 2012. A total of 241 patients were included, of whom 203 were female. The median age of the patients was 15.6 years. Psiquiatric history was present in 65.1% of the patients. The most frequent suicide mechanism was drug overdose (94.2%). Attempted suicide ideation was more common in males and in patients with previous attempts, and were also more related to sequels. Moreover, patients with an overdose were associated with psychiatric history and clinical toxicity. Patients with any of the following characteristics; male, psychiatric history, a history of previous suicide attempts and/or clinical toxicity at the time of the visit in the emergency center, were more associated suicidal ideation before the attempt. Therefore, they had greater severity and risk repeating the attempt. They require a careful psychiatric evaluation and close monitoring. Copyright © 2015 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

  19. Coarse particles and respiratory emergency department visits in California.

    Malig, Brian J; Green, Shelley; Basu, Rupa; Broadwin, Rachel


    Although respiratory disease has been strongly connected to fine particulate air pollution (particulate matter effects of coarse particles (particulate matter from 2.5 to 10 μm in diameter), possibly because of the greater spatial heterogeneity of coarse particles. In this study, we evaluated the relationship between coarse particles and respiratory emergency department visits, including common subdiagnoses, from 2005 to 2008 in 35 California counties. A time-stratified case-crossover design was used to help control for time-invariant confounders and seasonal influences, and the study population was limited to those residing within 20 km of pollution monitors to mitigate the influence of spatial heterogeneity. Significant associations between respiratory emergency department visits and coarse particle levels were observed. Asthma visits showed associations (for 2-day lag, excess risk per 10 μg/m³ = 3.3%, 95% confidence interval: 2.0, 4.6) that were robust to adjustment by other common air pollutants (particles acute respiratory infection visits were not associated, although some suggestion of a relationship with chronic obstructive pulmonary disease visits was present. Our results indicate that coarse particle exposure may trigger asthma exacerbations requiring emergency care, and reducing exposures among asthmatic persons may provide benefits.

  20. Smartphones and Medical Applications in the Emergency Department Daily Practice.

    Jahanshir, Amirhosein; Karimialavijeh, Ehsan; Sheikh, Hojjat; Vahedi, Motahar; Momeni, Mehdi


    Medical applications help physicians to make more rapid and evidence based decisions that may provide better patient care. This study aimed to determine the extent to which smart phones and medical applications are integrated in the emergency department daily practice. In a cross sectional study, a modified standard questionnaire (Payne et al.) consisting of demographic data and information regarding quality and quantity of smartphone and medical app utilization was sent to emergency-medicine residents and interns twice (two weeks apart), in January 2015. The questionnaire was put online using open access "Web-form Module" and the address of the web page was e-mailed along with a cover letter explaining the survey. Finally, responses were analyzed using descriptive statistics and SPSS 22 software. 65 cases participated (response rate 86%). The mean age of interns and residents were 25.03 ± 1.13 and 30.27 ± 4.68 years, respectively (p UpToDate, respectively. 38 (61.3%) of the respondents were using their apps more than once a day and mostly for drug information. English (83.9%), Persian (12.9%), and other languages (3.2%) were preferred languages for designing a medical software among the participants, respectively. The findings of present study showed that smartphones are very popular among Iranian interns and residents in emergency department and a substantial number of them own a smartphone and are using medical apps regularly in their clinical practice.

  1. Chloramphenicol and acute esophagitis in the emergency department

    Chad T Andicochea


    Full Text Available Even with its broad spectrum and low cost, concern over chloramphenicol′s adverse effects limited its use in the United States during the 1980s. Reports from United Kingdom and China in the 1990s demonstrated a low incidence of blood dyscrasias with the topical preparation of chloramphenicol, and showed continued good efficacy and low cost. Today, topical chloramphenicol is being used by some groups within otolaryngology and ophthalmology in the United States. As a result, emergency physicians are once again considering chloramphenicol-induced side effects in patients presenting to the emergency department. To date, there have been no published reports associating chest pain, dyspnea with chloramphenicol use, and there has only been one report of fungal esophagitis associated with topical chloramphenicol. We present a 31-year-old woman, 4 months status post tympanoplasty with a modified radical canal wall down mastoidectomy due to a cholesteatoma involving the epitympanum who had a residual tympanic membrane defect. She presented to the emergency department with chest "burning", with no other symptoms shortly after starting treatment with an insufflated combination antibiotic containing chloramphenicol. After ruling out cardiopulmonary or vascular etiology, she was treated successfully with a gastrointestinal cocktail cocktail for presumed esophagitis secondary to newly prescribed chloramphenicol.

  2. Identifying ethical issues of the Department of the Army civilian and Army Nurse Corps certified registered nurse anesthetists.

    Jenkins, Constance L; Elliott, Aaron R; Harris, Janet R


    The purposes of this study were to identify the ethical issues Department of the Army civilian and Army Nurse Corps certified registered nurse anesthetists (CRNAs) encountered in their anesthesia practice and how disturbed they were by these issues. This descriptive study used a secondary data analysis of a cross-sectional survey of Army Nurse Corps officers and Department of the Army civilian registered nurses (N = 5,293). The CRNA subset (n = 97) was obtained from questionnaires that indicated a primary practice setting as anesthesia. The most frequently occurring ethical issue identified was conflict in the nurse-physician relationship, whereas the most disturbing issue was working with incompetent/impaired colleagues. Unresolved ethical conflicts can negatively influence the nurses' morale, leading to avoidance of the issue and contributing to burnout. Identifying the ethical issues and disturbance level experienced by CRNAs should contribute to the development of an ethics education program that addresses issues encountered in CRNA practice.

  3. Hospitalization and emergency department visits among seniors receiving homecare: a pilot study

    Abernathy Tom


    Full Text Available Abstract Background Despite the recent growth in home health services, data on clinical outcomes and acute health care utilization among older adults receiving homecare services are sparse. Obtaining such data is particularly relevant in Ontario where an increasing number of frail seniors receiving homecare are awaiting placement in long-term care facilities. In order to determine the feasibility of a large-scale study, we conducted a pilot study to assess utilization of acute health care services among seniors receiving homecare to determine associated clinical outcomes. Methods This prospective cohort study followed forty-seven seniors admitted to homecare by two homecare agencies in Hamilton, Ontario over a 12-month period. Demographic information and medical history were collected at baseline, and patients were followed until either termination of homecare services, death, or end of study. The primary outcome was hospitalization. Secondary outcomes included emergency department visits that did not result in hospitalization and death. Rates of hospitalization and emergency department visits without admission were calculated, and univariate analyses were performed to test for potential risk factors. Survival curves for accumulative rates of hospitalization and emergency department visits were created. Results 312 seniors were eligible for the study, of which 123 (39% agreed to participate initially. After communicating with the research nurse, of the 123 who agreed to participate initially, 47 (38% were enrolled in the study. Eleven seniors were hospitalized during 3,660 days of follow-up for a rate of 3.0 incident hospitalizations per 1,000 homecare-days. Eleven seniors had emergency department visits that did not result in hospitalization, for a rate of 3.3 incident emergency department visits per 1,000 homecare-days. There were no factors significantly associated with hospitalization or emergency department visits when adjustment was made

  4. The relationship between psychosocial job stress and burnout in emergency departments: an exploratory study.

    García-Izquierdo, Mariano; Ríos-Rísquez, María Isabel


    The purpose of this study was to examine the relationship and predictive power of various psychosocial job stressors for the 3 dimensions of burnout in emergency departments. This study was structured as a cross-sectional design, with a questionnaire as the tool. The data were gathered using an anonymous questionnaire in 3 hospitals in Spain. The sample consisted of 191 emergency departments. Burnout was evaluated by the Maslach Burnout Inventory and the job stressors by the Nursing Stress Scale. The Burnout Model in this study consisted of 3 dimensions: emotional exhaustion, cynicism, and reduced professional efficacy. The model that predicted the emotional exhaustion dimension was formed by 2 variables: Excessive workload and lack of emotional support. These 2 variables explained 19.4% of variance in emotional exhaustion. Cynicism had 4 predictors that explained 25.8% of variance: Interpersonal conflicts, lack of social support, excessive workload, and type of contract. Finally, variability in reduced professional efficacy was predicted by 3 variables: Interpersonal conflicts, lack of social support, and the type of shift worked, which explained 10.4% of variance. From the point of view of nurse leaders, organizational interventions, and the management of human resources, this analysis of the principal causes of burnout is particularly useful to select, prioritize, and implement preventive measures that will improve the quality of care offered to patients and the well-being of personnel. Copyright © 2012 Elsevier Inc. All rights reserved.

  5. Emergency preparedness curriculum in nursing schools in the United States.

    Weiner, Elizabeth; Irwin, Margaret; Trangenstein, Patricia; Gordon, Jeffry


    With concern about bioterrorism and inadequacies in responding to mass casualty events, health care professionals have been placed in the category of first responders. The International Nursing Coalition for Mass Casualty Education (INCMCE) was established to plan strategically to address the educational needs of the nation's nurses. This study sought to determine the types and levels of disaster preparedness curricula being delivered or in development in nursing programs at all levels. INCMCE surveyed 2,013 deans or directors of nursing schools as to curricula for emergency preparedness prior to September 11, 2001, and during the two following academic years. Initial requests were sent via email and the US postal service. Respondents were invited to answer the online survey so data could be directly entered into a database for purposes of data analysis. Responses were received from 348 schools of nursing. Curriculum plans, followed by competency lists, were selected as most helpful for teaching content in disaster preparedness. The survey results validated the general assumption that nursing programs provide limited curricula in this area. The mean number of hours of disaster preparedness content provided, approximately four hours, did not change significantly over three academic years. The study also showed that 75 percent of respondents thought that nurse faculty were inadequately prepared in the area of disaster management. The study established a baseline for future curricular growth.

  6. The relationship between emergency department volume and patient complexity.

    Hahn, Barry; Zuckerman, Batya; Durakovic, Milazim; Demissie, Seleshi


    Forecasting emergency department (ED) visits is a well-studied topic. The importance of understanding the complexity of patients along with the days and times of varying patient volumes is critical for planning medical and ancillary staffing. Though multiple studies stratify their results based on severity of disease, severity was determined by triage status. The goal of this study was to utilize a novel method to evaluate the correlation between daily emergency department patient complexity, based on Current Procedure Terminology (CPT) code, and day of the week. This was a retrospective study of subjects presenting to the ED between January 1, 2010 and December 31, 2015. We identified the correlation between subjects with each CPT code who were evaluated on a specific day of the week and evaluated the day before, the day of and the day after a legal holiday. During the study period 312,550 (48%) male and 336,348 (52%) female subjects were identified. No correlation between daily ED patient complexity, based on CPT code, and day of the week (p=0.75) or any legal holidays were identified. Individual significant differences were noted among day of the week and particular CPT code as well as legal holiday and particular CPT code with no appreciable trend or pattern. There was no correlation between daily ED patient complexity based on CPT code and day of the week or daily ED patient acuity and legal holiday. In light of these data, emergency department staffing and resource allocation patterns may need to be revisited. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Tenecteplase to treat pulmonary embolism in the emergency department.

    Kline, Jeffrey A; Hernandez-Nino, Jackeline; Jones, Alan E


    Tenecteplase, a mutant form of alteplase, possesses pharmacological properties that might favor its use for emergent fibrinolysis of acute pulmonary embolism. Contemporaneous search of the World's literature reveals 14 humans with acute pulmonary embolism treated with tenecteplase. Here, we summarize those cases and report the presentation features, dosing details and outcomes of eight additional patients with acute pulmonary embolism treated with tenecteplase in an academic emergency department. None of our eight patients had a significant hemorrhagic event after tenecteplase, and the outcomes of all eight appear to be acceptable. Taken together, we submit that the present case report and prior case reports are sufficient to comprise a phase I study of the safety and efficacy of tenecteplase to treat acute pulmonary embolism.

  8. Acute Hemolysis in the Emergency Department: Think about Clostridium perfringens!

    Roustit Cécilia


    Full Text Available Clostridium perfringens (CP gives several clinical settings, from an asymptomatic to a massive intravascular hemolysis. We report a case of fatal intravascular hemolysis due to CP septicemia having a hepatic supposed starting point in the emergency department. Like in many cases, the diagnosis was made when patient had already gone into shock and died. The CP septicemia often complicated the course of the digestive or genital pathologies. The alpha toxin can damage the structural integrity of the red cell membrane by means of a phospholipase activity. Nevertheless, a massive intravascular hemolysis arises only rarely in this septicemia, only from 7 to 15% of the cases. The emergency physician has to think about this complication in case of hemoglobinuria and/or signs of hemolysis associated with a septic syndrome. An immediate antibiotic treatment adapted as well as the symptomatic treatment of the spread intravascular coagulation could improve the survival of these patients.

  9. Elevated Intracranial Pressure Diagnosis with Emergency Department Bedside Ocular Ultrasound

    D. Amin


    Full Text Available Bedside sonographic measurement of optic nerve sheath diameter can aid in the diagnosis of elevated intracranial pressure in the emergency department. This case report describes a 21-year-old female presenting with 4 months of mild headache and 2 weeks of recurrent, transient binocular vision loss. Though limited by patient discomfort, fundoscopic examination suggested the presence of blurred optic disc margins. Bedside ocular ultrasound (BOUS revealed wide optic nerve sheath diameters and bulging optic discs bilaterally. Lumbar puncture demonstrated a cerebrospinal fluid (CSF opening pressure of 54 cm H2O supporting the suspected diagnosis of idiopathic intracranial hypertension. Accurate fundoscopy can be vital to the appropriate diagnosis and treatment of patients with suspected elevated intracranial pressure, but it is often technically difficult or poorly tolerated by the photophobic patient. BOUS is a quick and easily learned tool to supplement the emergency physician’s fundoscopic examination and help identify patients with elevated intracranial pressure.

  10. Administration Medication Errors in Emergency Department in Level III Hospital

    Silvia González Gómez


    Full Text Available • Objective: To determine the prevalence of medication errors associated with the administration in the emergency room of University Hospital Marques de Valdecilla. • Introduction: Adverse events related to health care, are increasingly common, it is estimated that between 44000 and 98000 people served in U.S. hospitals die from adverse events related to health care. In 7000 these deaths are caused by medication errors. In Spain the studies speak of similar figures. The emergency services are excluded usually in these studies because of its particular characteristics, but also are well known that these are characteristics (speed of decision-making, not having systems in unit dose dispensing ... what is expected that mistakes can be produced in larger numbers in emergency services in the areas of Spain hospitalization. • Method: This is a descriptive study in which cross-examine a sample of 627 administrations made in different areas of attention of the Emergency Department Valdecilla Hospital, in different time slots, months of the year and days a week. Between the months of January and December 2009.• Results: Have detected 119 errors in 627 observations, the most common error is log.• Conclusions: We have found a lower incidence of error 2.7%, comparing with other work (10%. While most of the studies reviewed speak of medication errors in general, including prescription, transcription, and administration.

  11. Communication in Hong Kong Accident and Emergency Departments

    Eloise Chandler


    Full Text Available In this article, we report findings from the first qualitatively driven study of patient–clinician communication in Hong Kong Accident and Emergency Departments (AEDs. In light of the Hong Kong Hospital Authority’s policy emphasis on patient-centered care and communication in the public hospitals it oversees, we analyze clinicians’ perceptions of the role and relevance of patient-centered communication strategies in emergency care. Although aware of the importance of effective communication in emergency care, participants discussed how this was frequently jeopardized by chronic understaffing, patient loads, and time pressures. This was raised in relation to the absence of spoken interdisciplinary handovers, the tendency to downgrade interpersonal communication with patients, and the decline in staff attendance at communication training courses. Participants’ frequent descriptions of patient-centered communication as dispensable from, and time-burdensome in, AEDs highlight a discrepancy between the stated Hong Kong Hospital Authority policy of patient-centered care and the reality of contemporary Hong Kong emergency practice.

  12. Emergency nurses' perceptions of critical incidents and stress debriefing.

    Burns, C; Harm, N J


    This is a descriptive study of questionnaire responses of 682 members of three state ENAs, with supporting interview data from 26 of those participants. The objective was to determine (1) the types of clinical events perceived as critical and (2) the usefulness of critical incident stress debriefings for emergency nurses. Questionnaires asking emergency nurses to rate clinical incidents as critical and to respond to questions about their experiences with debriefings were sent to members of three state ENAs. Structured interviews about personal experiences with critical incidents and debriefings were conducted with 26 respondents. Emergency nurses responding to the questionnaire viewed the death of a child and the death of a coworker as the most critical of the possible events. The majority of interviewees saw an incident related to the death of a child as the most critical in their careers. Of the questionnaire respondents, 32% had participated in debriefings; 88% of those found them helpful in reducing critical incident stress. The findings suggest that managers should be alerted to the possibility of acute stress responses when emergency nurses experience a child's death. Education regarding stress and debriefings may be helpful to ED personnel.

  13. [The nurse within emergency medical-psychological units].

    Darbon, Rémy; Dalphin, Catherine; Prieto, Nathalie; Cheucle, Éric


    The growing recognition of post-traumatic stress disorders and the need to intervene early justifies the creation of emergency medical-psychological units. The nurse has a major role to play within these teams. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

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

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


    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.

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

    Farrokhnia Nasim


    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.

  16. Process Improvements to Reform Patient Flow in the Emergency Department.

    Whatley, Shawn D; Leung, Alexander K; Duic, Marko


    Emergency departments (ED) function to diagnose, stabilize, manage and dispose patients as efficiently as possible. Although problems may be suspected at triage, ED physician input is required at each step of the patient journey through the ED, from diagnosis to disposition. If we want timely diagnosis, appropriate treatment and great outcomes, then ED processes should connect patients and physicians as quickly as possible. This article discusses the key concepts of ED patient flow, value and efficiency. Based on these fundamentals, it describes the significant impact of ED process improvements implemented on measures of ED efficiency at a large community ED in Ontario, Canada.

  17. Emergency department management of the sexual assault victim.

    Kobernick, M E; Seifert, S; Sanders, A B


    The optimal management of the sexual assault victim involves a multidisciplinary effort on the part of all legal, police, medical, and support personnel who interface in the emergency department. History, general physical examination, and pelvic examination are performed methodically, keeping in mind that the primary goal is to tend to the patient's medical needs. The gathering of evidence proceeds simultaneously with the physical examination. Evidence to be obtained and techniques are reviewed. Treatment entails attention to physical injuries, potential venereal disease and pregnancy, and psychiatric intervention. Management of the male rape victim or child victim of sexual abuse requires special attention to the peculiarities of those problems.

  18. Marketing and public relations in the emergency department.

    Mayer, T A; Tilson, W; Hemingway, J


    This article outlines the elements of successful ED marketing, as well as providing definitions for terms used within the marketing process. In today's competition and rapidly changing environment, marketing and public relations are tools that every ED Medical Director may want to consider. Because the marketing process requires a great deal of time and effort, as well as a high degree of intellectual honesty, it should never be entered into without a strong commitment. However, marketing the ED can be among the most productive, stimulating, and gratifying experiences for the ED Medical Director, the emergency department physicians, and all ED service personnel.

  19. Quality and Safety Implications of Emergency Department Information Systems

    Farley, Heather L.; Baumlin, Kevin M.; Hamedani, Azita G.; Cheung, Dickson S.; Edwards, Michael R.; Fuller, Drew C.; Genes, Nicholas; Griffey, Richard T.; Kelly, John J.; McClay, James C.; Nielson, Jeff; Phelan, Michael P.; Shapiro, Jason S.; Stone-Griffith, Suzanne; Pines, Jesse M.


    The Health Information Technology for Economic and Clinical Health Act of 2009 and the Centers for Medicare & Medicaid Services “meaningful use” incentive programs, in tandem with the boundless additional requirements for detailed reporting of quality metrics, have galvanized hospital efforts to implement hospital-based electronic health records. As such, emergency department information systems (EDISs) are an important and unique component of most hospitals’ electronic health records. System functionality varies greatly and affects physician decisionmaking, clinician workflow, communication, and, ultimately, the overall quality of care and patient safety. This article is a joint effort by members of the Quality Improvement and Patient Safety Section and the Informatics Section of the American College of Emergency Physicians. The aim of this effort is to examine the benefits and potential threats to quality and patient safety that could result from the choice of a particular EDIS, its implementation and optimization, and the hospital’s or physician group’s approach to continuous improvement of the EDIS. Specifically, we explored the following areas of potential EDIS safety concerns: communication failure, wrong order–wrong patient errors, poor data display, and alert fatigue. Case studies are presented that illustrate the potential harm that could befall patients from an inferior EDIS product or suboptimal execution of such a product in the clinical environment. The authors have developed 7 recommendations to improve patient safety with respect to the deployment of EDISs. These include ensuring that emergency providers actively participate in selection of the EDIS product, in the design of processes related to EDIS implementation and optimization, and in the monitoring of the system’s ongoing success or failure. Our recommendations apply to emergency departments using any type of EDIS: custom-developed systems, best-of-breed vendor systems, or

  20. Complexities of emergency communication: clinicians' perceptions of communication challenges in a trilingual emergency department.

    Pun, Jack Kh; Chan, Engle Angela; Murray, Kristen A; Slade, Diana; Matthiessen, Christian Mim


    To understand the challenges that clinicians face in communicating with patients and other clinicians within a Hong Kong trilingual emergency department. Effective communication has long been recognised as fundamental to the delivery of quality health care, especially in high-risk and time-constrained environments such as emergency departments. The issue of effective communication is particularly relevant in Hong Kong emergency departments, due to the high volume of patients and the linguistic complexity of this healthcare context. In Hong Kong, emergency department clinicians are native speakers of Chinese, but have received their medical training in English. The clinicians read and record virtually all of their medical documentation in English, yet they communicate verbally with patients in Cantonese and Mandarin. In addition, communication between clinicians occurs in spoken Cantonese, mixed with medical English. Thus, medical information is translated numerous times within one patient journey. This complex linguistic environment creates the potential for miscommunication. A mixed-methods design consisting of a quantitative survey with a sequential qualitative interview. Data were collected in a survey from a purposive sample of 58 clinicians and analysed through descriptive statistics. Eighteen of the clinicians were then invited to take part in semi-structured interviews, the data from which were then subjected to a manifest content analysis. Nearly half of the clinicians surveyed believed that medical information may be omitted or altered through repeated translation in a trilingual emergency department. Eighty-three per cent of clinicians stated that there are communication problems at triage. Over 40% said that they have difficulties in documenting medical information. Around 50% believed that long work hours reduced their ability to communicate effectively with patients. In addition, 34% admitted that they rarely or never listen to patients during a

  1. Critical challenges in establishing emergency physician driven emergency departments – A Durban experience

    R. Maharaj*


    The Western Cape experience has demonstrated the utility of an Emergency Physician led Emergency Department in improving the outcome of acute illness and trauma, which are strongly dependent on the early recognition of severity and the need for early intervention. We believe that a similar mind-set needs to be developed to service the increasing needs of the urban and peri-urban population served by eThekwini hospitals.

  2. The value of the pre-hospital learning environment as part of the emergency nursing programme

    Sonett van Wyk


    Conclusion: The research findings support the value and continuation of utilising the pre-hospital clinical learning environment for placing post-basic emergency nursing students when enrolled in the emergency nursing programme.

  3. Perceptions of Emergency Department Physicians Toward Collaborative Practice With Nurse Practitioners in an Emergency Department Setting


    University of the Health Sciences. Approval for the research was granted prior to the data collection phase (see Appendix D). Ethical considerations were an...years of medical school is spent in Chemistry and Embryology . I have spent the last 12 years completely dedicated to my career and a physician

  4. Building an automated SOAP classifier for emergency department reports.

    Mowery, Danielle; Wiebe, Janyce; Visweswaran, Shyam; Harkema, Henk; Chapman, Wendy W


    Information extraction applications that extract structured event and entity information from unstructured text can leverage knowledge of clinical report structure to improve performance. The Subjective, Objective, Assessment, Plan (SOAP) framework, used to structure progress notes to facilitate problem-specific, clinical decision making by physicians, is one example of a well-known, canonical structure in the medical domain. Although its applicability to structuring data is understood, its contribution to information extraction tasks has not yet been determined. The first step to evaluating the SOAP framework's usefulness for clinical information extraction is to apply the model to clinical narratives and develop an automated SOAP classifier that classifies sentences from clinical reports. In this quantitative study, we applied the SOAP framework to sentences from emergency department reports, and trained and evaluated SOAP classifiers built with various linguistic features. We found the SOAP framework can be applied manually to emergency department reports with high agreement (Cohen's kappa coefficients over 0.70). Using a variety of features, we found classifiers for each SOAP class can be created with moderate to outstanding performance with F(1) scores of 93.9 (subjective), 94.5 (objective), 75.7 (assessment), and 77.0 (plan). We look forward to expanding the framework and applying the SOAP classification to clinical information extraction tasks.

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

    Harrou, Fouzi


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

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

    Ghan-Shyam Lohiya


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

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

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


    BACKGROUND: Handling critically ill patients is a complex task for Emergency Department (ED) personnel. Initial treatment is of major importance and requires adequately experienced ED doctors to initiate and decide for the right medical or surgical treatment. Our aim was, with regard to clinical...... presentation, management and mortality to describe adult non-trauma patients that upon ED arrival elicited emergency team calls. METHODS: An observational study of adult patients (≥ 18 years) admitted to a regional ED with conditions that elicited acute team activation and additional emergency team.......004). Additionally, 115 adult patients were admitted to the ICU directly from the ED without eliciting an emergency team call during the study period. These patients mainly comprised patients who were intoxicated, were unconscious or had respiratory failure. CONCLUSION: The majority of emergency team call patients...

  8. Emergency department transfers and transfer relationships in United States hospitals.

    Kindermann, Dana R; Mutter, Ryan L; Houchens, Robert L; Barrett, Marguerite L; Pines, Jesse M


    The objective was to describe transfers out of hospital-based emergency departments (EDs) in the United States and to identify different characteristics of sending and receiving hospitals, travel distance during transfer, disposition on arrival to the second hospital, and median number of transfer partners among sending hospitals. Emergency department records were linked at transferring hospitals to ED and inpatient records at receiving hospitals in nine U.S. states using the 2010 Healthcare Cost and Utilization Project (HCUP) State Emergency Department Databases and State Inpatient Databases, the American Hospital Association Annual Survey, and the Trauma Information Exchange Program. Using the Clinical Classification Software (CCS) to categorize conditions, the 50 disease categories with the highest transfer rates were studied, and these were then placed into nine clinical groups. Records were included where both sending and receiving records were available; these data were tabulated to describe ED transfer patterns, hospital-to-hospital distances, final patient disposition, and number of transfer partners. A total of 97,021 ED transfer encounters were included in the analysis from the 50 highest transfer rate disease categories. Among these, transfer rates ranged from 1% to 13%. Circulatory conditions made up about half of all transfers. Receiving hospitals were more likely to be nonprofit, teaching, trauma, and urban and have more beds with greater specialty coverage and more advanced diagnostic and therapeutic resources. The median transfer distance was 23 miles, with 25% traveling more than 40 to 50 miles. About 8% of transferred encounters were discharged from the second ED, but that varied from 0.6% to 53% across the 50 conditions. Sending hospitals had a median of seven transfer partners across all conditions and between one and four per clinical group. Among high-transfer conditions in U.S. EDs, patients are often transferred great distances, more

  9. Perception of nurses regarding risk classification in emergency care units

    Carmen Lúcia Mottin Duro


    Full Text Available This study aimed to assess nurses’ perception regarding the risk classification in emergency care units. It is a descriptive study that used a qualitative approach and that was conducted with 55 nurses from emergency care units in the south of Brazil. Data were collected between July and October, 2011, through open questions, answered in writing. The data collected were submitted to the thematic analysis technique. Results indicate that the risk classification contributes to the organization of the service flow provided to patients, intervening in severe cases and preventing sequelae. Difficulties were described, such as: inadequate physical installations, overcrowding, disagreement in the definition of priorities among doctors and nurses and lack of articulation between the emergency care network and basic health care. It is highlighted the need to improve the physical structure, the quantity of human resources and the implementation of public policies to overcome these challenges.

  10. Kaizen: a method of process improvement in the emergency department.

    Jacobson, Gregory H; McCoin, Nicole Streiff; Lescallette, Richard; Russ, Stephan; Slovis, Corey M


    Recent position statements from health care organizations have placed a strong emphasis on continuous quality improvement (CQI). CQI finds many of its roots in kaizen, which emphasizes small, low-cost, low-risk improvements. Based on the successful Kaizen Programs at organizations such as Toyota, the authors thought the emergency department (ED) would be an ideal environment to benefit from such a program. The authors sought to create a CQI program using a suggestion-based model that did not require a large time commitment, was easy to implement, and had the potential to empower all physicians in the department. It would not take the place of other improvement efforts, but instead augment them. The hypothesis was that such a program would foster sustainable engagement of emergency physicians in system improvement efforts and lead to a continuous stream of low-cost implementable system improvement interventions. A CQI program was created for the physician staff of the Department of Emergency Medicine at Vanderbilt University Medical Center, focusing on a suggestion-based model using kaizen philosophy. Lectures teaching kaizen philosophy were presented. Over the past 4 years, a methodology was developed utilizing a Web-based application, the Kaizen Tracker, which aids in the submission and implementation of suggestions that are called kaizen initiatives (KIs). The characteristics of the KIs submitted, details regarding resident and faculty participation, and the effectiveness of the Kaizen Tracker were retrospectively reviewed. There were 169, 105, and 101 KIs placed in the postimplementation calendar years 2006, 2007, and 2008, respectively. Seventy-six percent of KIs submitted thus far have identified a "process problem." Fifty-three percent of KIs submitted have led to operational changes within the ED. Ninety-three percent of the resident physicians entered at least one KI, and 73% of these residents submitted more than one KI. Sixty-nine percent of the

  11. Interprofessional communication supporting clinical handover in emergency departments: An observation study.

    Redley, Bernice; Botti, Mari; Wood, Beverley; Bucknall, Tracey


    Poor interprofessional communication poses a risk to patient safety at change-of-shift in emergency departments (EDs). The purpose of this study was to identify and describe patterns and processes of interprofessional communication impacting quality of ED change-of-shift handovers. Observation of 66 change-of-shift handovers at two acute hospital EDs in Victoria, Australia. Focus groups with 34 nurse participants complemented the observations. Qualitative data analysis involved content and thematic methods. Four structural components of ED handover processes emerged represented by (ABCD): (1) Antecedents; (2) Behaviours and interactions; (3) Content; and (4) Delegation of ongoing care. Infrequent and ad hoc interprofessional communication and discipline-specific handover content and processes emerged as specific risks to patient safety at change-of-shift handovers. Three themes related to risky and effective practices to support interprofessional communications across the four stages of ED handovers emerged: 1) standard processes and practices, 2) teamwork and interactions and 3) communication activities and practices. Unreliable interprofessional communication can impact the quality of change-of-shift handovers in EDs and poses risk to patient safety. Structured reflective analysis of existing practices can identify opportunities for standardisation, enhanced team practices and effective communication across four stages of the handover process to support clinicians to enhance local handover practices. Future research should test and refine models to support analysis of practice, and identify and test strategies to enhance ED interprofessional communication to support clinical handovers. Copyright © 2017 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.

  12. An Audit of Emergency Department Accreditation Based on Joint Commission International Standards (JCI

    Behrooz Hashemi


    Full Text Available Introduction: Despite thousands of years from creation of medical knowledge, it not much passes from founding the health care systems. Accreditation is an effective mechanism for performance evaluation, quality enhancement, and the safety of health care systems. This study was conducted to assess the results of emergency department (ED accreditation in Shohadaye Tajrish Hospital, Tehran, Iran, 2013 in terms of domesticated standards of joint commission international (JCI standards. Methods: This is a cohort study with a four months follow up which was conducted in the ED of Shohadaye Tajrish hospital in December 2013. The standard evaluation check list of Iran hospitals (based on JCI standards included 24 heading and 337 subheading was used for this purpose. The effective possible causes of weak spots were found and their solutions considered. After correction, assessment of accreditation were repeated again. Finally, the achieved results of two periods were analyzed using SPSS version 20. Results: Quality improvement, admission in department and patient assessment, competency and capability test for staffs, collection and analysis of data, training of patients, and facilities had the score of below 50%. The mean of total score for accreditation in ED in the first period was 60.4±30.15 percent and in the second period 68.9±22.9 (p=0.005. Strategic plans, head of department, head nurse, resident physician, responsible nurse for the shift, and personnel file achieved the score of 100%. Of total headings below 50% in the first period just in two cases, collection and analysis of data with growth of 40% as well as competency and capability test for staffs with growth of 17%, were reached to more than 50%. Conclusion: Based on findings of the present study, the ED of Shohadaye Tajrish hospital reached the score of below 50% in six heading of quality improvement, admission in department and patient assessment, competency and capability test for

  13. Clinical Aspects and Emergent Management of Snake Bites Presented to Emergency Department

    Bedriye Sonmez


    Full Text Available Aim: Evaluating the epidemiologic characteristics and management of snake bites presenting to emergency departments. Material and Method: In this retrospective study 74 cases of snakebites admitted to Emergency Department of Diyarbakir Training and Research Hospital between 2008 and 2009 were retrospectively evaluated. Results: Fourty-six (62.2% of patients were male and 28 (37.8% were female. Mean age of the study population was 34.85±19.17 (min 7- max 80 years. Most of the snakebites occurred between 18.00 to 06.00 hours and at home (73%. 79.7% of snake bites occurred to upper extremities. %93 of cases had intravenous administration of antivenin (one dose. Neither none of the patients needed recurrent administration. Discussion: Snake bites are still a major public health problem especially in rural areas. Particularly emergency care physicians should be adequately capable and sophisticated in multidisciplinary management of snake bites.

  14. Improving the Treatment and Assessment of Moderate and Severe Pain in a Pediatric Emergency Department

    Roger Chafe


    Full Text Available Background. The Janeway Children’s Hospital previously enacted a number of measures to improve pain management for patients in its emergency department (ED. While improvements were demonstrated, rates for the timely assessment and treatment of pain remain below standards of care. Objectives. The study objectives are to investigate the impact of the previous attempts to improve the treatment of pain and to explore ways to further improve pain management in the ED. Methods. Key informant interviews and a focus group were conducted with nurses, physicians, and parents whose children were identified as having severe pain. Results. Interviews were conducted with 31 parents or children, 9 physicians, and 8 nurses. The focus group was attended by 15 nurses. Previous initiatives were viewed as improvements. Continued barriers include difficulties in accurately capturing the level of pain, issues in treating pain for specific types of patients, and inadequacy in addressing patients in severe pain. Conclusion. Changes in pain treatment protocols can result in positive impacts but are likely insufficient on their own to achieve desired standards of care. Consistent measurement and engagement with staff can identify additional opportunities for improving pain management within an ED setting.

  15. Development and evaluation of an inpatient [correction of impatient] holistic nursing care services department.

    Newshan, Gayle


    This paper describes the development and evaluation of a holistic nursing department at a 261-bed conventional, community hospital. Through the holistic nursing department, a nurse visits hospitalized inpatients. The visit might include complementary and alternative modalities (CAM) therapies, such as relaxation techniques, therapeutic touch, aromatherapy, and therapeutic suggestion. Evaluation of visits occurred through a retrospective chart review and patient satisfaction surveys. Main outcome measures were patient satisfaction, physiological changes, and pre- and post-distress scores. Discomfort and distress was decreased and patient satisfaction high when CAM therapies were used in conjunction with traditional inpatient medical and nursing care.

  16. Establishing an educational programme for nurses to supply emergency hormonal contraception (combined method) to protocol.

    Brittain, D


    This paper gives an account of an innovative educational programme developed by the Department of Midwifery Studies at the University of Central Lancashire (UCLAN) in 1995. The North West Regional Health Authority (NWRHA) approached the Department of Midwifery Studies to develop an educational programme for family planning nurses to supply the combined method of emergency hormonal contraception (EHC) under protocol when a doctor was not present. The purpose was to increase the availability and accessibility of EHC for young people in the North West region. The 3-day programme was designed to complement previous ENB 901/900 training, and also to provide the nurses with the specific skills and knowledge required to undertake this new role. One hundred and thirty-nine nurses from the North West area attended the programme between 1995-1998. Students were assessed both theoretically and clinically. Extending the role of family planning nurses to supply EHC gives purchasers and providers of sexual health care the potential to offer a wider range of accessible services. The recently published interim Crown Report1 on the supply and administration of medicines under group protocols states that protocols should specify clear arrangements for professional responsibility and accountability. Appropriate training is essential to ensure that the extended role of the nurse in family planning is fully understood.

  17. Frequency of medication errors in an emergency department of a large teaching hospital in southern Iran

    Vazin A


    Full Text Available Afsaneh Vazin,1 Zahra Zamani,1 Nahid Hatam2 1Department of Clinical Pharmacy, Faculty of Pharmacy, 2School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran Abstract: This study was conducted with the purpose of determining the frequency of medication errors (MEs occurring in tertiary care emergency department (ED of a large academic hospital in Iran. The incidence of MEs was determined through the disguised direct observation method conducted by a trained observer. A total of 1,031 medication doses administered to 202 patients admitted to the tertiary care ED were observed over a course of 54 6-hour shifts. Following collection of the data and analysis of the errors with the assistance of a clinical pharmacist, frequency of errors in the different stages was reported and analyzed in SPSS-21 software. For the 202 patients and the 1,031 medication doses evaluated in the present study, 707 (68.5% MEs were recorded in total. In other words, 3.5 errors per patient and almost 0.69 errors per medication are reported to have occurred, with the highest frequency of errors pertaining to cardiovascular (27.2% and antimicrobial (23.6% medications. The highest rate of errors occurred during the administration phase of the medication use process with a share of 37.6%, followed by errors of prescription and transcription with a share of 21.1% and 10% of errors, respectively. Omission (7.6% and wrong time error (4.4% were the most frequent administration errors. The less-experienced nurses (P=0.04, higher patient-to-nurse ratio (P=0.017, and the morning shifts (P=0.035 were positively related to administration errors. Administration errors marked the highest share of MEs occurring in the different medication use processes. Increasing the number of nurses and employing the more experienced of them in EDs can help reduce nursing errors. Addressing the shortcomings with further research should result in reduction

  18. A case management intervention targeted to reduce healthcare consumption for frequent Emergency Department visitors: results from an adaptive randomized trial


    Background A small group of frequent visitors to Emergency Departments accounts for a disproportionally large fraction of healthcare consumption including unplanned hospitalizations and overall healthcare costs. In response, several case and disease management programs aimed at reducing healthcare consumption in this group have been tested; however, results vary widely. Objectives To investigate whether a telephone-based, nurse-led case management intervention can reduce healthcare consumptio...

  19. Perception of the nursing staff about the nurse’s role in the emergency service

    Mayckel da Silva Barreto


    Full Text Available Objective: to know the perception of the nursing staff about the nurse's role in emergency service. Methods: descriptive study of a qualitative approach. 30 nursing professionals participated and were active in a unit of Emergency. The data were subjected to Content Analysis, thematic modality. Results: the interviewees highlighted as nurses functions, the development of management activities; the leadership and supervision of nursing staff; and the care provided to seriously ill patients. From the perspective of nursing technicians, management activities receive great attention from nurses, rather than direct patient care. However, for nurses, managerial functions and leadership and supervision of staff converge for quality care. Conclusion: the importance of care work of nurses in emergency situations is perceived both by nursing technicians and by nurses. However, perceptions of their role as a manager still show up conflicting.

  20. Staff perspectives of violence in the emergency department: Appeals for consequences, collaboration, and consistency.

    Renker, Paula; Scribner, Shellie A; Huff, Pam


    Violence committed by patients and their families and visitors against Emergency Department staff in the United States is common and detrimental to staff well being, morale, and care practices. Hospitals losses occur due to decreased staff retention, prestige, and patient and visitor satisfaction. The purpose of the baseline survey reported here was to identify and describe staff experiences, concerns, and perceptions related to violence and abuse perpetrated by patients, family, and non-family visitors in a Level 1 emergency department. The survey sample was composed of 41 registered nurses and 10 paramedics. The majority of the participants (84%, n= 41) were female and worked full time (82%, n= 41) on the 7P-7A (49%, n= 25) shift. The cross-sectional mixed-method descriptive design used a survey to measure violence experiences and interviews with key informants. Specific analytical methods included descriptive and inferential statistics and ethnography. The findings are summarized by a model that portrays 1) Contributing factors to the development of violence in the ED, 2) maladaptive reactions to workplace violence of Cynicism, Concern for focus on customer service, and Conflict, and 3) three themes that, depending on their presence or absence, serve as barriers or facilitators to violence: Consistency, Consequences and Collaboration. Interventions developed to minimize violence in the ED must focus on modifiable risk factors and address what is in the department's control including staff education in recognizing escalating anxious or aggressive behavior, policy development and implementation, and environmental changes.

  1. Perception of the nursing staff about the nurse’s role in the emergency service

    Mayckel da Silva Barreto; Elen Ferraz Teston; Jamilly Grava Miranda; Guilherme de Oliveira Arruda; Elizabeth Amancio de Souza da Silva Valsecchi; Sonia Silva Marcon


    Objective: to know the perception of the nursing staff about the nurse's role in emergency service. Methods: descriptive study of a qualitative approach. 30 nursing professionals participated and were active in a unit of Emergency. The data were subjected to Content Analysis, thematic modality. Results: the interviewees highlighted as nurses functions, the development of management activities; the leadership and supervision of nursing staff; and the care provided to seriously ill patients. Fr...

  2. Transient Global Amnesia: Emergency Department Evaluation And Management.

    Faust, Jeremy Samuel; Nemes, Andreea


    Transient global amnesia is a clinically distinct syndrome characterized by the acute inability to form new memories. It can last up to 24 hours. The diagnosis is dependent on eliminating other more serious etiologies including toxic ingestions, acute strokes, complex partial seizures, and central nervous system infections. Transient global amnesia confers no known long-term risks; however, when abnormal signs or symptoms are present, they take precedence and guide the formulation of a differential diagnosis and investigation. In witnessed transient global amnesia with classic features, a minimalist approach is reasonable, avoiding overtesting, inappropriate medication, and medical interventions in favor of observation, ensuring patient safety, and reassuring patients and their families. This review provides a detailed framework for distinguishing transient global amnesia from its dangerous mimics and managing its course in the emergency department.

  3. Predicting asthma-related emergency department visits using big data.

    Ram, Sudha; Zhang, Wenli; Williams, Max; Pengetnze, Yolande


    Asthma is one of the most prevalent and costly chronic conditions in the United States, which cannot be cured. However, accurate and timely surveillance data could allow for timely and targeted interventions at the community or individual level. Current national asthma disease surveillance systems can have data availability lags of up to two weeks. Rapid progress has been made in gathering nontraditional, digital information to perform disease surveillance. We introduce a novel method of using multiple data sources for predicting the number of asthma-related emergency department (ED) visits in a specific area. Twitter data, Google search interests, and environmental sensor data were collected for this purpose. Our preliminary findings show that our model can predict the number of asthma ED visits based on near-real-time environmental and social media data with approximately 70% precision. The results can be helpful for public health surveillance, ED preparedness, and targeted patient interventions.

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

    Pradhan, Debasis; Bhattacharyya, Prithwis


    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.

  5. Cycling Injuries Presenting to an Irish Emergency Department

    J Foley, J


    There is little published data on cycling injuries in Ireland and the present study aims to describe the cycling related injuries presenting to the emergency department (ED), of a tertiary urban university hospital. This is a retrospective review of cycling-related injuries presenting to the ED of St. Vincent’s University Hospital (SVUH) from 1st of January to 31st of December 2014. There were 534 cycling related injuries presenting to the ED during the study period. Just over 71% of the patients were male, and 14.8% of patients presented following a collision with a motor vehicle. Forty patients required admission to hospital following their injury with 6 of these patients spending time in the intensive care unit. Cycling is now a very popular means of transport and exercise activity in Ireland and using hospital based data, it is possible that EDs may provide a vector for guiding injury prevention strategies in the future

  6. Management of oral and genital herpes in the emergency department.

    Mell, Howard K


    The epidemiology of oral and genital herpes has dramatically changed over the past decade. Herpes simplex virus-1, traditionally associated with oral herpes, is now implicated in an increasing percentage of genital herpes cases. The possibility of "autoinoculation" (or self-infection) of anatomic sites other than that of the primary infection has been recognized. New methods of suppression therapy are being examined. These changes have led to a revision in the recommendations by the Centers for Disease Control and Prevention (CDC). This review discusses herpes infections of the oral and genital mucosa and the suggested approach to the infected patient who presents in the emergency department. Specific attention is given to the CDC's 2006 guidelines for the treatment of sexually transmitted diseases.

  7. Integrated simulation and data envelopment analysis models in emergency department

    Aminuddin, Wan Malissa Wan Mohd; Ismail, Wan Rosmanira


    This study aims to determine the best resource allocation and to increase the efficiency service of an emergency department in a public hospital in Kuala Lumpur. We integrate Discrete Event Simulation (DES) and three models of Data Envelopment Analysis (DEA); Input-oriented CCR model, Input-oriented BCC model and Super-Efficiency model to fulfill such objective. Based on the comparison of results taken from the DEA models, the combination of DES, Input-oriented BCC model and Super-Efficiency BCC model is seen to be the best resource allocation technique to be used for enhancing the hospital efficiency. The combination has reduced patients waiting time while improving the average utilization rate of hospital resources compared to the current situation.

  8. Child abuse diagnosis and the emergency department chart.

    Johnson, C F; Apolo, J; Joseph, J A; Corbitt, T


    Failure to uncover and report nonaccidental injury may have serious consequences for the child and the physician. To determine if the information recorded in the emergency department record was adequate to eliminate the possibility of nonaccidental injury, the charts of 333 children under five years of age were reviewed. No charts contained all the information deemed necessary; in 12.6% a diagnosis of nonaccidental injury could not be eliminated. In three cases, the injury was inconsistent with the history. Missing historical information included where the injury occurred, the presence of witnesses, notation of previous injuries, and old chart review. Information regarding size, color, and age of the injury was incomplete. A complete examination was recorded 22.3% of the time. The private-pay category charts and those recorded by staff were most complete. Remedial actions, guided by periodic chart reviews, are suggested.

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

    Mustafa Burak Sayhan


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

  10. Emergency Department Observation Units and the Older Patient

    Moseley, Mark G.; Hawley, Miles P.; Caterino, Jeffrey M.


    Synopsis An increasing number of emergency departments (EDs) are providing extended care and monitoring of patients in ED observation units (EDOUs). EDOUs can be particularly useful for older adults both as an alternative to hospitalization in appropriately selected patients and as a means to risk-stratify older adults with unclear presentations. They can also provide a period of therapeutic intervention and reassessment for older patients in whom the appropriateness and safety of immediate outpatient care is unclear. They offer the opportunity for more comprehensive evaluation of many characteristics of particular importance to the care of older adults which cannot be accomplished during a short ED stay. The manuscript first discusses the general characteristics of EDOUs. Next, it reviews appropriate entry and exclusion criteria for older adults in EDOU including specific focus on several of the most common observation unit protocols, focusing on their relevance to older adults. Finally, it briefly discusses regulatory implications of observation status for patients with Medicare. PMID:23177601

  11. Process-Improvement Cost Model for the Emergency Department.

    Dyas, Sheila R; Greenfield, Eric; Messimer, Sherri; Thotakura, Swati; Gholston, Sampson; Doughty, Tracy; Hays, Mary; Ivey, Richard; Spalding, Joseph; Phillips, Robin


    The objective of this report is to present a simplified, activity-based costing approach for hospital emergency departments (EDs) to use with Lean Six Sigma cost-benefit analyses. The cost model complexity is reduced by removing diagnostic and condition-specific costs, thereby revealing the underlying process activities' cost inefficiencies. Examples are provided for evaluating the cost savings from reducing discharge delays and the cost impact of keeping patients in the ED (boarding) after the decision to admit has been made. The process-improvement cost model provides a needed tool in selecting, prioritizing, and validating Lean process-improvement projects in the ED and other areas of patient care that involve multiple dissimilar diagnoses.

  12. Early death after discharge from emergency departments: analysis of national US insurance claims data.

    Obermeyer, Ziad; Cohn, Brent; Wilson, Michael; Jena, Anupam B; Cutler, David M


     To measure incidence of early death after discharge from emergency departments, and explore potential sources of variation in risk by measurable aspects of hospitals and patients.  Retrospective cohort study.  Claims data from the US Medicare program, covering visits to an emergency department, 2007-12.  Nationally representative 20% sample of Medicare fee for service beneficiaries. As the focus was on generally healthy people living in the community, patients in nursing facilities, aged ≥90, receiving palliative or hospice care, or with a diagnosis of a life limiting illnesses, either during emergency department visits (for example, myocardial infarction) or in the year before (for example, malignancy) were excluded.  Death within seven days after discharge from the emergency department, excluding patients transferred or admitted as inpatients.  Among discharged patients, 0.12% (12 375/10 093 678, in the 20% sample over 2007-12) died within seven days, or 10 093 per year nationally. Mean age at death was 69. Leading causes of death on death certificates were atherosclerotic heart disease (13.6%), myocardial infarction (10.3%), and chronic obstructive pulmonary disease (9.6%). Some 2.3% died of narcotic overdose, largely after visits for musculoskeletal problems. Hospitals in the lowest fifth of rates of inpatient admission from the emergency department had the highest rates of early death (0.27%)-3.4 times higher than hospitals in the highest fifth (0.08%)-despite the fact that hospitals with low admission rates served healthier populations, as measured by overall seven day mortality among all comers to the emergency department. Small increases in admission rate were linked to large decreases in risk. In multivariate analysis, emergency departments that saw higher volumes of patients (odds ratio 0.84, 95% confidence interval 0.81 to 0.86) and those with higher charges for visits (0.75, 0.74 to 0.77) had significantly fewer deaths. Certain

  13. The Effect of Emergency Department Overcrowding on Efficiency of Emergency Medicine Residents’ Education

    Anita Sabzghabaei


    Full Text Available Introduction: Creating a calm and stress-free environment affects education significantly. The effects of the emergency department overcrowding (EDO on the training of emergency medicine residents (EMR is a highly debated subject. Therefore, this study aimed to evaluate the effect of EDO on efficiency of EMR’s education. Methods: In this cross-sectional study, the effects of overcrowding on EMR’s education in the resuscitation room and acute care unit. Data collection was done using a questionnaire, which was filled out by the second year EMRs.  The crowding level was calculated based on the national emergency department overcrowding scale (NEDOCS. The relationship between the two studied variables was evaluated using independent sample t-test and SPSS 21 statistical software. Results: 130 questionnaires were filled out during 61 shifts. 47 (77.05% shifts were overcrowded. The attend’s ability to teach was not affected by overcrowding in the resuscitation room (p=0.008. The similar results were seen regarding the attend’s training ability in the acute care unit. Conclusion: It seems that the emergency department overcrowding has no effect on the quality of education to the EMRs.

  14. Analysis of Adult Trauma Patients Admitted to Emergency Department

    Sema Puskulluoglu


    Full Text Available Purpose: Trauma is one of the most common reason of admissions to emergency departments. In this study, it was aimed to determine the demographic characteristics, etiology, morbidity and mortality rates and prognosis of adult trauma patients admitted to our emergency department (ED. Materials and Methods: Patients over the age of 18 years, who admitted to ED between 01 March 2011 and 31 August 2011 were included in this retrospective study. Patient examination cards, hospitalization files and records entered with ICD 10 codes to hospital automation system were analyzed. Patients with inaccessible data were excluded from the study. Results: During the study period, total number of 110495 patients admitted to ED, and 13585 (12,29% of them admitted with trauma. Simple extremity injuries (38,28% and falls (31,7% were most common etiological factors. Glasgow coma scales of 99,71% of the patients were between 13 and 15. Of the patients with trauma, 9,6% had a Computed Tomography (CT scan, and 84,5% of CT scans were evaluated as normal, and cranial CT was the most requested one. Only 6% of the patients were hospitalized, and 0,9% of the trauma patients died. Falls from height in females and traffic accidents in males were the leading causes of death. Conclusion: Most of the patients with simple traumas admitted to ED can be discharged from the hospital with a complete history and careful examination. The rate of unnecessary medical tests, loss of time and waste money should be reduced, and the time and labor allocated to severe patients can be increased by this way. [Cukurova Med J 2015; 40(3.000: 569-579

  15. Etiological characterization of acute poisonings in the emergency department

    Khlifi Malek


    Full Text Available Introduction: An investigation of emergency department (ED poisonings was conducted to characterize poisoning demographics and evaluate correlations with select co-morbidities. Methods: The study population evaluated consisted of 649 poisoning cases admitted between 2004 and 2007 to an inner-city, level 1 emergency department. Results: Ethnicity, age, and gender had a substantial impact on the population distribution as poisoning cases were predominantly African Americans (79.9% between 36 and 45 years old with a 1:3 male to female ratio. Intentional illicit drug overdose was the most prevalent cause of poisoning, heroin being the most frequent substance found in 35.4% ( n = 230 of cases, followed by cocaine overdose at 31.7% ( n = 206, concomitant heroin and cocaine overdose at 4.3% ( n = 28, multiple drug poisoning at 5.5% ( n = 36, and antidepressant/antipsychotic poisoning at 6% ( n = 39. Significant correlations were found between heroin poisoning and asthma (F = 20.29, DF = 1, P = 0.0001, cocaine poisoning and hypertension (F = 33.34, DF = 1, P = 0.0001, and cocaine poisoning and cardiovascular disease (F = 35.34, DF = 1, P = 0.0001. A change in the pattern of illicit drug use from injection to inhalation was detected and the resulting increase of inhalation and insufflation of illicit substances may partially explain the correlation found between heroin use and asthma. Conclusions: These results provide supporting evidence that deliberate poisoning with illicit drugs remains a serious healthcare issue that significantly aggravates co-morbidities and raises treatment costs by increasing both the rate of hospitalization and hospital length of stay.

  16. Application of lean manufacturing techniques in the Emergency Department.

    Dickson, Eric W; Singh, Sabi; Cheung, Dickson S; Wyatt, Christopher C; Nugent, Andrew S


    "Lean" is a set of principles and techniques that drive organizations to continually add value to the product they deliver by enhancing process steps that are necessary, relevant, and valuable while eliminating those that fail to add value. Lean has been used in manufacturing for decades and has been associated with enhanced product quality and overall corporate success. To evaluate whether the adoption of Lean principles by an Emergency Department (ED) improves the value of emergency care delivered. Beginning in December 2005, we implemented a variety of Lean techniques in an effort to enhance patient and staff satisfaction. The implementation followed a six-step process of Lean education, ED observation, patient flow analysis, process redesign, new process testing, and full implementation. Process redesign focused on generating improvement ideas from frontline workers across all departmental units. Value-based and operational outcome measures, including patient satisfaction, expense per patient, ED length of stay (LOS), and patient volume were compared for calendar year 2005 (pre-Lean) and periodically after 2006 (post-Lean). Patient visits increased by 9.23% in 2006. Despite this increase, LOS decreased slightly and patient satisfaction increased significantly without raising the inflation adjusted cost per patient. Lean improved the value of the care we delivered to our patients. Generating and instituting ideas from our frontline providers have been the key to the success of our Lean program. Although Lean represents a fundamental change in the way we think of delivering care, the specific process changes we employed tended to be simple, small procedure modifications specific to our unique people, process, and place. We, therefore, believe that institutions or departments aspiring to adopt Lean should focus on the core principles of Lean rather than on emulating specific process changes made at other institutions.

  17. Referral Criteria from Community Clinics to Pediatric Emergency Departments

    Jacob Urkin


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

  18. Decreasing Time to Pain Relief for Emergency Department Patients with Extremity Fractures

    Heilman, James A.; Tanski, Mary; Burns, Beech; Lin, Amber; Ma, John


    Significant delays occur in providing adequate pain relief for patients who present to the emergency department (ED) with extremity fractures. The median time to pain medication administration for patients presenting to our ED with extremity fractures was 72.5 minutes. We used a multidisciplinary approach to implement three improvement cycles with the goal of reducing the median time to pain medication by 15% over an eight month time period. First, we redesigned nursing triage and treatment processes. Second, we improved nursing documentation standardization to ensure accurate tracking of patients who declined pain medication. Third, through consensus building within our physician group, we implemented a department-wide standard of care to provide early pain relief for extremity fractures. Median time to pain medication for patients with an extremity fracture reduced significantly between the pre-and post-intervention periods (p=0.009). The average monthly median time to medication was 72.5 minutes (95% CI: 57.1 to 88.0) before the intervention (Jan 2013-Oct 2014) and 49.8 minutes (95% CI: 42.7 to 56.9) after the intervention (November 2014 to June 2016). In other words, monthly median time was 31% faster (22.7 minute difference) in the post intervention period. Implementing three key interventions reduced the time to pain medication for patients with extremity injuries. Since June 2016 the reductions in median time to medication have continued to improve. PMID:28090328

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

    Markham Donna


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

  20. Screening adolescents in the emergency department for weapon carriage.

    Cunningham, Rebecca M; Resko, Stella M; Harrison, Stephanie Roahen; Zimmerman, Marc; Stanley, Rachel; Chermack, Stephen T; Walton, Maureen A


    The objective was to describe the prevalence and correlates of past-year weapon involvement among adolescents seeking care in an inner-city emergency department (ED). This cross-sectional study administered a computerized survey to all eligible adolescents (age 14-18 years), 7 days a week, who were seeking care over an 18-month period at an inner-city Level 1 ED. Validated measures were administered, including measures of demographics, sexual activity, substance use, injury, violent behavior, weapon carriage, and/or weapon use. Zero-inflated Poisson (ZIP) regression models were used to identify correlates of the occurrence and past-year frequency of these weapons variables. Adolescents (n = 2069, 86% response rate) completed the computerized survey. Fifty-five percent were female; 56.5% were African American. In the past year, 20% of adolescents reported knife or razor carriage, 7% reported gun carriage, and 6% pulled a knife or gun on someone. Although gun carriage was more frequent among males, females were as likely to carry a knife or pull a weapon in the past year. One-fifth of all adolescents seeking care in this inner-city ED have carried a weapon. Understanding weapon carriage among teens seeking ED care is a critical first step to future ED-based injury prevention initiatives. (c) 2010 by the Society for Academic Emergency Medicine.

  1. Emergency Department Physician Internet Use during Clinical Encounters

    Chisholm, Robin; Finnell, John T.


    Objective: This study explored the Internet log files from emergency department workstations to determine search patterns, compared them to discharge diagnoses, and the emergency medicine curriculum as a way to quantify physician search behaviors. Methods: The log files from the computers from January 2006 to March 2010 were mapped to the EM curriculum and compared to discharge diagnoses to explore search terms and website usage by physicians and students. Results: Physicians in the ED averaged 1.35 searches per patient encounter using and 83.9% of the time. The most common searches were for drug information (23.1%) by all provider types. The majority of the websites utilized were in the third tier evidence level for evidence-based medicine (EBM). Conclusion: We have shown a need for a readily accessible drug knowledge base within the EMR for decision support as well as easier access to first and second tier EBM evidence. PMID:23304394

  2. Security Implications of Physical Design Attributes in the Emergency Department.

    Pati, Debajyoti; Pati, Sipra; Harvey, Thomas E


    Security, a subset of safety, is equally important in the efficient delivery of patient care. The emergency department (ED) is susceptible to violence creating concerns for the safety and security of patients, staff, and visitors and for the safe and efficient delivery of care. Although there is an implicit and growing recognition of the role of the physical environment, interventions typically have been at the microlevel. The objective of this study was to identify physical design attributes that potentially influence safety and efficiency of ED operations. An exploratory, qualitative research design was adopted to examine the efficiency and safety correlates of ED physical design attributes. The study comprised a multimeasure approach involving multidisciplinary gaming, semistructured interviews, and touring interviews of frontline staff in four EDs at three hospital systems across three states. Five macro physical design attributes (issues that need to be addressed at the design stage and expensive to rectify once built) emerged from the data as factors substantially associated with security issues. They are design issues pertaining to (a) the entry zone, (b) traffic management, (c) patient room clustering, (d) centralization versus decentralization, and (e) provisions for special populations. Data from this study suggest that ED security concerns are generally associated with three sources: (a) gang-related violence, (b) dissatisfied patients, and (c) behavioral health patients. Study data show that physical design has an important role in addressing the above-mentioned concerns. Implications for ED design are outlined in the article. © The Author(s) 2016.

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

    Morteza Talebi Doluee


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

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

    Logue EP


    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

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

    Rose L


    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

  6. The effect of tropical cyclones (typhoons) on emergency department visits.

    Lin, Chien-Hao; Hou, Sen-Kuang; Shih, Frank Fuh-Yuan; Su, Syi


    Case reports have indicated that a tropical cyclone may increase Emergency Department (ED) visits significantly. To examine emergency health care demands across a series of tropical cyclones, and to build a predictive model to analyze a cyclone's potential effect. This was an observational non-concurrent prospective study performed in Taiwan. Twenty hospitals were included. The number of daily ED visits in each hospital was our primary end point, and data were retrieved from the database provided by the National Health Insurance Research Database. Our study examined the period from 2000 to 2008. A total of 22 tropical cyclones (typhoons) that had passed over eastern Taiwan and covered the area under study were included. Multiple linear regression time-series models were employed to estimate the effects of "days since typhoon landfall" and various characteristics of the typhoons on the end point of daily ED visits to each hospital. The final multiple linear regression time-series model showed that the number of daily ED visits increased in areas where a strong typhoon had landed directly, with the increase being evident during the first 2 days since landfall. Our model also indicated that the three most important variables to predict a change in the pattern of daily ED visits were intensity of typhoon, simultaneous heavy rain, and direct landfall. During tropical cyclones, emergency services were under increased demand in selected time periods and areas. Health care authorities should collect information to build local models to optimize their resources allocation in preparation. Crown Copyright © 2013. Published by Elsevier Inc. All rights reserved.

  7. Patients who leave the emergency department against medical advice

    Lee, Choung Ah; Cho, Joon Pil; Choi, Sang Cheon; Kim, Hyuk Hoon; Park, Ju Ok


    Objective Discharge against medical advice (DAMA) from the emergency department (ED) accounts for 0.1% to 2.7% of all ED discharges. DAMA carries a risk of increased mortality and readmissions. Our aim was to investigate the general characteristics of DAMA patients and the differences between them and non-DAMA patients. Methods We reviewed data collected by the National Emergency Medical Center between 2010 and 2011. Subjects were categorized into 2 groups, namely, the DAMA group and the non-DAMA group. We compared these groups with respect to age, gender, trauma or non-trauma status, type of hospital, health insurance, level of consciousness on admission, and diagnosis. Results Of 8,000,529 patients, 222,389 (2.78%) left against medical advice. The risk factors for DAMA across all age groups were as follows: no medical insurance (odds ratio [OR], 1.993), initial response to voice (OR, 2.753) or pain (OR, 2.101), trauma admission (OR, 1.126), admission to a local emergency medical center (OR, 1.215), and increased age. A high risk of DAMA was observed among patients with immune, endocrine, psychiatric, neurological, circulatory diseases, and external causes of morbidity and mortality. Conclusion Although DAMA cases account for only a small percentage of hospital discharges, they are important because DAMA patients have high readmission and mortality rates. It is therefore important to understand the general characteristics and predictors of DAMA in order to improve patient outcome and minimize the economic burden on the healthcare system.

  8. Medical clearance of the psychiatric patient in the emergency department.

    Janiak, Bruce D; Atteberry, Suzanne


    As part of the emergency department (ED) evaluation of patients with psychiatric complaints, emergency physicians are often asked to perform screening laboratory tests prior to admitting psychiatric patients, the value of which is questionable. To determine if routine screening laboratory studies performed in the ED on patients with a psychiatric chief complaint would alter ED medical clearance (evaluation, management or disposition) of such patients. In this retrospective chart review, the patient charts were reviewed for triage notes, history and physical examination, laboratory study results, and patient disposition. The study investigators subjectively determined if any of the laboratory abnormalities identified after admission would have changed ED management or disposition of the patient had they been identified in the ED. Subjects were 519 consecutive adult patients (18 years of age and older) admitted to the Medical College of Georgia's inpatient psychiatric ward through the ED. There were 502 patients who met inclusion criteria, and 50 of them had completely normal laboratory studies. Laboratory studies were performed in the ED for 148 patients. The most common abnormalities identified were positive urine drug screen (n = 221), anemia (n = 136), and hyperglycemia (n = 139). There was one case (0.19%) identified in which an abnormal laboratory value would have changed ED management or disposition of the patient had it been found during the patient's ED visit. Patients presenting to the ED with a psychiatric chief complaint can be medically cleared for admission to a psychiatric facility by qualified emergency physicians using an appropriate history and physical examination. There is no need for routine medical screening laboratory tests. Copyright © 2012 Elsevier Inc. All rights reserved.

  9. Clinical relevance of pharmacist intervention in an emergency department.

    Pérez-Moreno, Maria Antonia; Rodríguez-Camacho, Juan Manuel; Calderón-Hernanz, Beatriz; Comas-Díaz, Bernardino; Tarradas-Torras, Jordi


    To evaluate the clinical relevance of pharmacist intervention on patient care in emergencies, to determine the severity of detected errors. Second, to analyse the most frequent types of interventions and type of drugs involved and to evaluate the clinical pharmacist's activity. A 6-month observational prospective study of pharmacist intervention in the Emergency Department (ED) at a 400-bed hospital in Spain was performed to record interventions carried out by the clinical pharmacists. We determined whether the intervention occurred in the process of medication reconciliation or another activity, and whether the drug involved belonged to the High-Alert Medications Institute for Safe Medication Practices (ISMP) list. To evaluate the severity of the errors detected and clinical relevance of the pharmacist intervention, a modified assessment scale of Overhage and Lukes was used. Relationship between clinical relevance of pharmacist intervention and the severity of medication errors was assessed using ORs and Spearman's correlation coefficient. During the observation period, pharmacists reviewed the pharmacotherapy history and medication orders of 2984 patients. A total of 991 interventions were recorded in 557 patients; 67.2% of the errors were detected during medication reconciliation. Medication errors were considered severe in 57.2% of cases and 64.9% of pharmacist intervention were considered relevant. About 10.9% of the drugs involved are in the High-Alert Medications ISMP list. The severity of the medication error and the clinical significance of the pharmacist intervention were correlated (Spearman's ρ=0.728/pclinical pharmacists identified and intervened on a high number of severe medication errors. This suggests that emergency services will benefit from pharmacist-provided drug therapy services. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  10. The Impact of Psychiatric Patient Boarding in Emergency Departments

    B. A. Nicks


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

  11. Does Limiting Oral Contrast Decrease Emergency Department Length of Stay?

    Erik Barton


    Full Text Available Introduction: The purpose of this study was to examine the impact on emergency department (EDlength of stay (LOS of a new protocol for intravenous (IV-contrast only abdominal/pelvic computedtomography (ABCT compared to historical controls.Methods: This was a retrospective case-controlled study performed at a single academic medicalcenter. Patients ≥ 18 undergoing ABCT imaging for non-traumatic abdominal pain were included inthe study. We compared ED LOS between historical controls undergoing ABCT imaging with PO/IVcontrast and study patients undergoing an IV-contrast-only protocol. Imaging indications were thesame for both groups and included patients with clinical suspicion for appendicitis, diverticulitis, smallbowel obstruction, or perforation. We identified all patients from the hospital’s electronic storehouse(imaging code, ordering department, imaging times, and we abstracted ED LOS and dispositionfrom electronic medical records.Results: Two hundred and eleven patients who underwent PO/IV ABCT prep were compared to 184patients undergoing IV-contrast only ABCT prep. ED LOS was shorter for patients imaged with theIV-contrast only protocol (4:35 hrs vs. 6:39 hrs, p < 0.0001.Conclusion: Implementation of an IV-contrast only ABCT prep for select ED patients presentingfor evaluation of acute abdominal pain significantly decreased ED LOS.

  12. Relationship between musculoskeletal disorders, job demands, and burnout among emergency nurses.

    Sorour, Amany Sobhy; El-Maksoud, Mona M Abd


    Musculoskeletal disorders (MSDs) represent one of the most common occupational problems in nursing. MSDs can negatively impact one's quality of life. The aim of the study was to investigate the relationship between MSDs, job demands, and burnout among emergency nurses. The researchers hypothesized that increased job demands were associated with more MSDs and consequently higher levels of burnout. The study was conducted on a convenience sample of 58 nurses working in the emergency departments of Zagazig University Hospital and Al-Ahrar, Hospital Egypt from October to December 2010, using a cross-sectional analytic design. Data were collected using a self-administered questionnaire that included the Standardized Nordic Questionnaire, the Job Content Questionnaire, and the Maslach Burnout Inventory. The results revealed that 32.8% of the nurses were overweight and 17.2% were obese. The most common sites of pain were the neck (67.2%), shoulder (65.5%), and lower back (63.8%). Lower back pain was the most common site affected (72.4%) with a mean 5.1 on a scale ranging from 0 to 13. A positive correlation existed between the scores of job demand and burnout (r = 0.340, p burnout whereas the job demand score was the independent predictor of the number of MSDs. This study documents an increased prevalence of MSDs among emergency nurses, as predicted by increased job demand and associated with a higher level of burnout. Hence, it is important for hospital and nursing administrators to address the factors contributing to job stress and burnout, with emphasis on job satisfaction and work organization to alleviate the burden of psychosocial factors in this setting.

  13. The Quality of Patients’ Files Documentation in Emergency Department; a Cross Sectional Study

    Mehrdad Esmailian


    Full Text Available Introduction: Emergency departments as one of the most important wards of hospitals, provide the emergency therapeutic care to decrease the mortality and disability rates among patients. The management and evaluation of emergency activities are possible through timely, accurate, and complete registration of information, based on standard rules. Thus, the aim of this research was detecting the observance rate of documentation standards in the emergency department of Al-Zahra Hospital, Isfahan, to find patients’ files documentation failures and eliminate them. Methods: I This was a cross sectional study performed in the emergency department of Al-Zahra Hospital, Isfahan, 2009. For data gathering, a checklist included 23 questions in two parts was used. The first and second parts had 9 and 14 questions to detect observance rate of patients’ characteristics documentation and nurse reports documentation, respectively. Based on Likert scale, the answer of each option includes blank (score 1, illegible (score 2, incomplete (score 3, and complete (score 4. Therefore, the minimum and maximum reachable scores were determined 9-36 in the documentation of patients’ characteristics and 14-56 in the nurse reports. Data was analyzed using SPSS 8 and Chi-squared test and Fisher’s exact test were applied to compare qualitative data. Student’s t-test was used to compare quantitative information, too. P<0.05 was considered as significant. Results: 300 documents were studied in this research. The average of reached score in the quality assessment of patients record completion was 24.66±17 (15-34, (the maximum reachable score was 36. The total score of emergency patients records was 61.8±4.8 (45-74 from total of 92 reachable scores. The average of total reached score for nurse reports was 37.2±3.7 (28-46, (with the maximum reachable score of 56. No significant difference was seen in the accuracy of patients’ documentation according to referring

  14. 75 FR 32855 - Safety Zone; Pierce County, WA, Department of Emergency Management, Regional Water Exercise


    ... Management, Regional Water Exercise AGENCY: Coast Guard, DHS. ACTION: Temporary final rule. SUMMARY: The Pierce County, Washington, Department of Emergency Management is sponsoring a Regional Water Rescue... County, Washington, Department of Emergency Management is sponsoring a Regional Water Rescue Exercise...

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

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


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

  16. How Can an Emergency Department Assist Patients and Caregivers at the End of Life?

    ... Be Prepared Share this! Home » Be Prepared How Can An Emergency Department Assist Patients And Caregivers At ... your family. 5 ways that the Emergency Department can help 1. Assist in the recognition and understanding ...

  17. Patient and provider attitudes toward commercial television film crews in the emergency department.

    Rodriguez, R M; Dresden, G M; Young, J C


    One of the most successful reality-based television shows is The Learning Channel's "Trauma-Life in the ER," in which patients are filmed prior to being consented and camera crews are intimately intertwined in resuscitations. To assess provider and patient attitudes regarding privacy and satisfaction during filming. This was a prospective survey of patients and providers working in an urban, county teaching emergency department (ED). Scores of visual analog scales (VASs) for satisfaction, privacy, and willingness to return to the ED were accessed. Eighty patients, 39 physicians and 39 nurses, were interviewed. On a 10-cm VAS where 0 = no invasion of patient privacy and 10 = extreme privacy invasion, the mean (+/-SD) rating by physicians was 5.4 (+/-2.6), by nurses was 4.9 (+/-3.1), and by patients was 2.3 (+/-3.2). There was no significant difference between physician and nurse ratings (p = 0.69), but patients rated invasion of privacy significantly lower (p < 0.0001). Filmed patients rated significantly higher invasion of privacy (3.8 +/- 4.1) than patients not filmed or those unsure whether they had been filmed (1.6 +/- 2.5); p < 0.01). On a 10-cm VAS where -5 = extreme decrease in satisfaction and 5 = extreme increase in satisfaction, the mean rating by physicians was -0.25 (+/-1.6), by nurses was -0.32 (+/-1.3), and by patients was 0.02 (+/-1.4). There was no statistical difference between the satisfaction levels of providers and patients (p = 0.19). Providers rated invasion of patient privacy higher than patients rated their own invasion of privacy. Patients who were filmed rated invasion of privacy higher than patients who were not filmed. Filming had no significant effect on the satisfaction of providers or patients.

  18. Urine Collection in the Emergency Department: What Really Happens in There?

    Harrison Alter


    Full Text Available Introduction: In women with suspected urinary tract infection (UTI, a non-contaminated voidedspecimen is considered important for valid urinalysis and culture results. We assess whethermidstream parted-labia catch (MSPC instructions were provided by nurses, understood, andperformed correctly, according to the patient.Methods: We conducted a cross-sectional survey of English- and Spanish-speaking female patientssubmitting voided urine samples for urinalysis for suspected UTI. The survey was conducted in apublic teaching hospital emergency department (ED from June to December 2010, beginning 2months after development and dissemination of a nursing MSPC instructions protocol. Researchassistants administered the survey within 2 hours of urine collection. Nurses were unaware of thestudy purpose.Results: Of 129 patients approached, 74 (57% consented and were included in the analysis.Median age was 35; 44% were Latino. Regarding instructions from nurses, patients reported thefollowing: 45 (61%; 95% CI 50-72% received any instructions; of whom 37 (82%; 95% CI 71-93%understood them completely. Sixteen (36%; 95% CI 22-51% were instructed to collect midstream;and 7 (16%; 95% CI 6-29% to part the labia. Regardless of receiving or understanding instructions,33 (45%; 95% CI 33-57% reported actually collecting midstream, and 11 (15%, 95% CI 8-25%parting the labia.Conclusion: In this ED, instructions for MSPC urine collection frequently were not given, despite anursing protocol, and patients rarely performed the essential steps. An evidence-based approachto urine testing in the ED that considers urine collection technique, is needed.

  19. Nothing changes, nobody cares: understanding the experience of emergency nurses physically or verbally assaulted while providing care.

    Wolf, Lisa A; Delao, Altair M; Perhats, Cydne


    Workplace violence has been recognized as a violent crime that requires targeted responses from employers, law enforcement, and the community. According to data from the Bureau of Labor Statistics, the most common source of nonfatal injuries and illnesses requiring days away from work in the health care and social assistance industry was assault on the health care worker. What is not well understood are the precursors and sequelae of violence perpetrated against emergency nurses and other health care workers by patients and visitors. The purpose of this study was to better understand the experience of emergency nurses who have been physically or verbally assaulted while providing patient care in US emergency departments. The study was conducted using a qualitative descriptive exploratory design. The sample consisted of 46 written narratives submitted by e-mail by emergency nurses describing the experience of violence while providing care at work. Narrative analysis and constant comparison were used to identify emerging themes in the narratives. "Environmental," "personal," and "cue recognition" were identified as the themes. Overall, nurses believed that violence was endemic to their workplace and that both limited recognition of cues indicating a high-risk person or environment and a culture of acceptance of violence were barriers to mitigation. These findings are consistent with the extant literature but with an added contribution of clearly identifying an underlying cultural acceptance of violence in the emergency department, as well as a distinct lack of cue recognition, in this sample of emergency nurses. Copyright © 2014 Emergency Nurses Association. Published by Mosby, Inc. All rights reserved.

  20. Are we prepared for a growing population? Morbid obesity and its implications in Irish emergency departments.


    Two percent of the Irish population is morbidly obese with this figure expected to rise significantly. This survey aimed to establish the present logistical capacity of Irish emergency departments (EDs) to adequately cater for the bariatric patients. A telephone survey was carried out of 37 health service executive EDs over a 5-day period in October 2008. Questions were posed to the departmental lead nurse regarding facilities (Supplemental digital content 1). No ED had adequate facilities. Two of 37 units questioned had on-site hoists designed to lift patients of more than 170 kg. Four departments had rapid access to mattresses within the hospital and three of these four had access to beds and trolleys for weighing patients. Two percent of the Irish population is morbidly obese with this figure expected to rise significantly to more than 150 kg. One department had access to commodes, chairs, wheelchairs and trolleys from inpatient services. All departments had extra-wide blood pressure cuffs and 12 had a difficult airways trolley. Necessary infrastructure and equipment for bariatric patients is deficient in the majority of Irish EDs.

  1. Nursing home nurses' perceptions of emergency transfers from nursing homes to hospital: A review of qualitative studies using systematic methods.

    O'Neill, Barbara; Parkinson, Lynne; Dwyer, Trudy; Reid-Searl, Kerry


    The aim is to describe nursing home nurses' perceptions around emergency transfers to hospital. Transfers are costly and traumatic for residents, and efforts are underway to avoid hospitalization. Nurses play a key role in transfers, yet their views are underreported. A systematic review of qualitative studies was undertaken, guided by Joanna Briggs Institute methods. From seven reviewed studies, it was clear nursing home nurses are challenged by the complexity of the transfer process and understand their need for appropriate clinical knowledge, skills and resources. Communication is important, yet nurses often use persuasive and targeted communication. Ambiguity, strained relationships and negative perceptions of residents' experiences around hospitalization contribute to conflict and uncertainty. Nurses are more confident when there is a plan. Transferring a resident is a complex process and special skills, knowledge and resources are required, but may be lacking. Efforts to formalize the transfer process and improve communication and collaboration amongst all stakeholders is needed and would be well received. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Impact of an ABCDE team triage process combined with public guidance on the division of work in an emergency department.

    Kantonen, Jarmo; Lloyd, Robert; Mattila, Juho; Kauppila, Timo; Menezes, Ricardo


    To study the effects of applying an emergency department (ED) triage system, combined with extensive publicity in local media about the "right" use of emergency services, on the division of work between ED nurses and general practitioners (GPs). An observational and quasi-experimental study based on before-after comparisons. Implementation of the ABCDE triage system in a Finnish combined ED where secondary care is adjacent, and in a traditional primary care ED where secondary care is located elsewhere. GPs and nurses from two different primary care EDs. Numbers of monthly visits to different professional groups before and after intervention in the studied primary care EDs and numbers of monthly visits to doctors in the local secondary care ED. The beginning of the triage process increased temporarily the number of independent consultations and patient record entries by ED nurses in both types of studied primary care EDs and reduced the number of patient visits to a doctor compared with previous years but had no effect on doctor visits in the adjacent secondary care ED. No further decrease in the number of nurse or GP visits was observed by inhibiting the entrance of non-urgent patients. The ABCDE triage system combined with public guidance may reduce non-urgent patient visits to doctors in different kinds of primary care EDs without increasing visits in the secondary care ED. However, the additional work to implement the ABCDE system is mainly directed to nurses, which may pose a challenge for staffing.

  3. Analysis of Emergency Triage Safety Management in Emergency Department%急诊分诊安全管理在急诊的应用分析



    Objective To discuss and analyze the effects of emergency triage safety management in emergency nursing.Methods 500 patients admitted to emergency department from May 2013 to May 2014 were selected as the control group while 500 patients admitted from June 2014 to June 2015 were selected as the treatment group. Triage safety management was not conducted in the control group but in the treatment group. Compared the nursing quality score and patient's satisfaction on nursing between two groups.Results Nursing quality score for treatment group was (96.2±1.4) while it was 81.3±2.5 for control group. The difference was of statistically significant difference(P<0.05). Patient's satisfaction rate on nursing for treatment group and control group was 95.4% and 74% respectively with significant difference (P<0.05).Conclusion The application of emergency triage safety management in emergency nursing is conductive to improving nursing quality and nursing satisfaction.%目的探讨分析在急诊护理中应用急诊分诊安全管理模式的效果。方法选择本院急诊科2013年5月至2014年5月收治的500例病患作为对照组观察对象,再以急诊科2014年6月至2015年6月收治的500例病患作为试验组。对照组未实施分诊安全管理,试验组实施分诊安全管理,比较两组护理质量评分与患者护理满意度。结果试验组的护理质量评分是(96.2±1.4)分,较对照组的(81.3±2.5)分高,差异具有统计学意义(P<0.05);试验组患者的护理满意度为95.4%,对照组为74%,两组比较,试验组更高(P<0.05)。结论将急诊分诊安全管理模式应用于急诊护理中,对护理质量及护理满意度的提高均有促进作用。

  4. Assessment and Management of Work-Related Stress in Hospital Emergency Departments in Italy.

    d'Ettorre, Gabriele; Greco, Maria Rita


    Recent changes in the organization of the healthcare system, triggered by the current economic crisis in Italy, require interventions aimed at minimizing the impact of work-related stress (WRS) on healthcare workers' health status and well-being. Emergency department (ED) personnel appear to be particularly vulnerable to WRS as a consequence of specific occupational risk factors. The aim of this retrospective observational study was to analyze the level of WRS after improvement interventions implemented by the management staff of the ED and focused on work context factors. The assessment of WRS showed that nurses and physicians of the ED are exposed to a medium level of risk; the improvement interventions aimed at reducing WRS were focused on: (1) function and organizational culture; (2) role within the occupational organization; and (3) relationships at work policy. These interventions were found to be significantly effective in reducing the risk of WRS.

  5. Whiteboard Icons to Support the Blood-Test Process in an Emergency Department

    Torkilsheyggi, Arnvør Martinsdottir á; Hertzum, Morten; From, Gustav


    The competent treatment of emergency department (ED) patients requires an effective and efficient process for handling laboratory tests such as blood tests. This study investigates how ED clinicians go about the process, from ordering blood tests to acknowledging their results and, specifically......, assesses the use of whiteboard icons to support this process. On the basis of observation and interviews we find that the blood-test process is intertwined with multiple other temporal patterns in ED work. The whiteboard icons, which indicate four temporally distinct steps in the blood-test process......, support the nurses in maintaining the flow of patients through the ED and the physicians in assessing test results at timeouts. The main results of this study are, however, that the blood-test process is temporally and collaboratively complex, that the whiteboard icons pass by most of this complexity...

  6. A simulation-based training program improves emergency department staff communication.

    Sweeney, Lynn A; Warren, Otis; Gardner, Liz; Rojek, Adam; Lindquist, David G


    The objectives of this study were to evaluate the effectiveness of Project CLEAR!, a novel simulation-based training program designed to instill Crew Resource Management (CRM) as the communication standard and to create a service-focused environment in the emergency department (ED) by standardizing the patient encounter. A survey-based study compared physicians' and nurses' perceptions of the quality of communication before and after the training program. Surveys were developed to measure ED staff perceptions of the quality of communication between staff members and with patients. Pretraining and posttraining survey results were compared. After the training program, survey scores improved significantly on questions that asked participants to rate the overall communication between staff members and between staff and patients. A simulation-based training program focusing on CRM and standardizing the patient encounter improves communication in the ED, both between staff members and between staff members and patients.

  7. Psychological impact of verbal abuse and violence by patients on nurses working in psychiatric departments



    Abstract  The aim of this study was to assess the psychological impact of verbal abuse or violence by patients on nurses working in psychiatry departments and to identify factors related to their impact...

  8. Revised National Estimates of Emergency Department Visits for Sepsis in the United States.

    Wang, Henry E; Jones, Allison R; Donnelly, John P


    The emergency department is an important venue for initial sepsis recognition and care. We sought to determine contemporary estimates of the epidemiology of U.S. emergency department visits for sepsis. Analysis of data from the National Hospital Ambulatory Medical Care Survey. U.S. emergency department visits, 2009-2011. Adult (age, ≥ 18 yr) emergency department sepsis patients. We defined serious infection as an emergency department diagnosis of a serious infection or a triage temperature greater than 38°C or less than 36°C. We defined three emergency department sepsis classifications: 1) original emergency department sepsis-serious infection plus emergency department diagnosis of organ dysfunction, endotracheal intubation, or systolic blood pressure less than or equal to 90 mm Hg or explicit sepsis emergency department diagnoses; 2) quick Sequential Organ Failure Assessment emergency department sepsis-serious infection plus presence of at least two "quick" Sequential Organ Failure Assessment criteria (Glasgow Coma Scale ≤ 14, respiratory rate ≥ 22 breaths/min, or systolic blood pressure ≤ 100 mm Hg); and 3) revised emergency department sepsis-original or quick Sequential Organ Failure Assessment emergency department sepsis. None. We used survey design and weighting variables to produce national estimates of annual adult emergency department visits using updated sepsis classifications. Over 2009-2011, there were 103,257,516 annual adult emergency department visits. The estimated number of emergency department sepsis visits were as follows: 1) original emergency department sepsis 665,319 (0.64%; 95% CI, 0.57-0.73); 2) quick Sequential Organ Failure Assessment emergency department sepsis 318,832 (0.31%; 95% CI, 0.26-0.37); and 3) revised emergency department sepsis 847,868 (0.82%; 95% CI, 0.74-0.91). Sepsis continues to present a major burden to U.S. emergency departments, affecting up to nearly 850,000 emergency department visits annually. Updated

  9. PAT (2009)—Revisions to the Paddington Alcohol Test for Early Identification of Alcohol Misuse and Brief Advice to Reduce Emergency Department Re-attendance

    Touquet, Robin; Brown, Adrian


    The Paddington Alcohol Test (PAT) has evolved over 15 years as a clinical tool to facilitate emergency physicians and nurses giving brief advice and the offer of an appointment for brief intervention by an alcohol nurse specialist. Previous work has shown that unscheduled emergency department re-attendance is reduced by ‘making the connection’ between alcohol misuse and resultant problems necessitating emergency care. The revised ‘PAT (2009)’ now includes education on clinical signs of alcohol misuse and advice on when to request a blood alcohol concentration. PMID:19329654

  10. PAT (2009)--revisions to the Paddington Alcohol Test for early identification of alcohol misuse and brief advice to reduce emergency department re-attendance.

    Touquet, Robin; Brown, Adrian


    The Paddington Alcohol Test (PAT) has evolved over 15 years as a clinical tool to facilitate emergency physicians and nurses giving brief advice and the offer of an appointment for brief intervention by an alcohol nurse specialist. Previous work has shown that unscheduled emergency department re-attendance is reduced by 'making the connection' between alcohol misuse and resultant problems necessitating emergency care. The revised 'PAT (2009)' now includes education on clinical signs of alcohol misuse and advice on when to request a blood alcohol concentration.

  11. Emergency Department Patients' Perceptions of Radiation From Medical Imaging.

    Repplinger, Michael D; Li, Annabel J; Svenson, James E; Ehlenbach, William J; Westergaard, Ryan P; Reeder, Scott B; Jacobs, Elizabeth A


    To evaluate emergency department patients' knowledge of radiation exposure and subsequent risks from computed tomography (CT) and magnetic resonance imaging (MRI) scans. This is a cross-sectional survey study of adult, English-speaking patients from June to August 2011 at 2 emergency departments--1 academic and 1 community-based--in the upper Midwest. The survey consisted of 2 sets of 3 questions evaluating patients' knowledge of radiation exposure from medical imaging and subsequent radiation-induced malignancies and was based on a previously published survey. The question sets paralleled each other, but one pertained to CT and the other to MRI. Questions in the survey ascertained patients' understanding of (1) the relative amount of radiation exposed from CT/MRI compared with a single chest x-ray; (2) the relative amount of radiation exposed from CT/MRI compared with a nuclear power plant accident; and (3) the possibility of radiation-induced malignancies from CT/MRl. Sociodemographic data also were gathered. The primary outcome measure was the proportion of correct answers to each survey question. Multiple logistic regression then was used to examine the relationship between the percentage correct for each question and sociodemographic variables, using odds ratios with 95% confidence intervals. P-values less than 0.05 were considered statistically significant. There were 500 participants in this study, 315 from the academic center and 185 from the community hospital. Overall, 14.1% (95% CI, 11.0%-17.2%) of participants understood the relative radiation exposure of a CT scan compared with a chest x-ray, while 22.8% (95% CI, 18.9%-26.7%) of respondents understood the lack of ionizing radiation use with MRI. At the same time, 25.6% (95% CI, 21.8%- 29.4%) believed that there was an increased risk of developing cancer from repeated abdominal CTs, while 55.6% (95% CI, 51.1%-60.1%) believed this to be true of abdominal MRI. Higher educational level and identification

  12. Evaluation of gunshot wounds in the emergency department.

    Karaca, Mehmet Ali; Kartal, Nil Deniz; Erbil, Bülent; Öztürk, Elif; Kunt, Mehmet Mahir; Şahin, Tevfik Tolga; Özmen, Mehmet Mahir


    This study aimed to evaluate injury patterns of patients admitted to the emergency department with gunshot wounds, results of imaging studies, treatment modalities, outcomes, mortality ratios, and complications. A retrospective descriptive study was carried out including a total number of one hundred and forty-two patients admitted to Hacettepe University Emergency Department with gunshot injuries between January 1, 1999 and December 31, 2013. The Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), Injury Severity Score (ISS), and the Trauma and Injury Severity Score (TRISS) probability of survival for penetrating trauma were calculated for all patients. Among the one hundred and forty-two patients in the study, one hundred and twenty-eight (90.1%) were male. Mean age was 36 years. On admission, the average GCS score was 13, mean RTS was 6.64, median ISS was 5 and