Fleet, Richard; Archambault, Patrick; Légaré, France; Chauny, Jean-Marc; Lévesque, Jean-Frédéric; Ouimet, Mathieu; Dupuis, Gilles; Haggerty, Jeannie; Poitras, Julien; Tanguay, Alain; Simard-Racine, Geneviève; Gauthier, Josée
2013-01-01
Emergency departments are important safety nets for people who live in rural areas. Moreover, a serious problem in access to healthcare services has emerged in these regions. The challenges of providing access to quality rural emergency care include recruitment and retention issues, lack of advanced imagery technology, lack of specialist support and the heavy reliance on ambulance transport over great distances. The Quebec Ministry of Health and Social Services published a new version of the Emergency Department Management Guide, a document designed to improve the emergency department management and to humanise emergency department care and services. In particular, the Guide recommends solutions to problems that plague rural emergency departments. Unfortunately, no studies have evaluated the implementation of the proposed recommendations. To develop a comprehensive portrait of all rural emergency departments in Quebec, data will be gathered from databases at the Quebec Ministry of Health and Social Services, the Quebec Trauma Registry and from emergency departments and ambulance services managers. Statistics Canada data will be used to describe populations and rural regions. To evaluate the use of the 2006 Emergency Department Management Guide and the implementation of its various recommendations, an online survey and a phone interview will be administered to emergency department managers. Two online surveys will evaluate quality of work life among physicians and nurses working at rural emergency departments. Quality-of-care indicators will be collected from databases and patient medical files. Data will be analysed using statistical (descriptive and inferential) procedures. This protocol has been approved by the CSSS Alphonse-Desjardins research ethics committee (Project MP-HDL-1213-011). The results will be published in peer-reviewed scientific journals and presented at one or more scientific conferences.
Workloads in Australian emergency departments a descriptive study.
Lyneham, Joy; Cloughessy, Liz; Martin, Valmai
2008-07-01
This study aimed to identify the current workload of clinical nurses, managers and educators in Australian Emergency Departments according to the classification of the department Additionally the relationship of experienced to inexperienced clinical staff was examined. A descriptive research method utilising a survey distributed to 394 Australian Emergency departments with a 21% response rate. Nursing workloads were calculated and a ratio of nurse to patient was established. The ratios included nurse to patient, management and educators to clinical staff. Additionally the percentage of junior to senior clinical staff was also calculated. Across all categories of emergency departments the mean nurse:patient ratios were 1:15 (am shift), 1:7 (pm shift) and 1:4 (night shift). During this period an average of 17.1% of attendances were admitted to hospital. There were 27 staff members for each manager and 23.3 clinical staff for each educator. The percentage of junior staff rostered ranged from 10% to 38%. Emergency nurses cannot work under such pressure as it may compromise the care given to patients and consequently have a negative effect on the nurse personally. However, emergency nurses are dynamically adjusting to the workload. Such conditions as described in this study could give rise to burnout and attrition of experienced emergency nurses as they cannot resolve the conflict between workload and providing quality nursing care.
Department of Energy Emergency Management Functional Requirements Study
International Nuclear Information System (INIS)
1987-05-01
This Study, the Emergency Management Functional Requirements Study (EMFRS), identifies the physical environment, information resources, and equipment required in the DOE Headquarters Emergency Operations Center (EOC) to support the DOE staff in managing an emergency. It is the first step toward converting the present Forrestal EOC into a practical facility that will function well in each of the highly diverse types of emergencies in which the Department could be involved. 2 figs
Tse, Johnson Wai Keung; Hung, Maria Shuk Yu; Pang, Samantha Mei Che
2016-05-01
Provision of end-of-life (EOL) care in the emergency department has improved globally in recent years and has a different scope of interventions than traditional emergency medicine. In 2010, a regional hospital established the first ED EOL service in Hong Kong. The aim of this study was to understand emergency nurses' perceptions regarding the provision of EOL care in the emergency department. A qualitative approach was used with purposive sampling of 16 nurses who had experience in providing EOL care. Semi-structured, face-to-face interviews were conducted from May to October, 2014. All the interviews were transcribed verbatim for content analysis. Four themes were identified: (1) doing good for the dying patients, (2) facilitating family engagement and involvement, (3) enhancing personal growth and professionalism, and (4) expressing ambiguity toward resource deployment. Provision of EOL care in the emergency department can enhance patients' last moment of life, facilitate the grief and bereavement process of families, and enhance the professional development of staff in emergency department. It is substantiated that EOL service in the emergency department enriches EOL care in the health care system. Findings from this study integrated the perspectives on ED EOL services from emergency nurses. The integration of EOL service in other emergency departments locally and worldwide is encouraged. Copyright © 2016 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.
The culture of an emergency department: an ethnographic study.
Person, John; Spiva, Leeanna; Hart, Patricia
2013-10-01
In an environment of change and social interaction, hospital emergency departments create a unique sub-culture within healthcare. Patient-centered care, stressful situations, social gaps within the department, pressure to perform, teamwork, and maintaining a work-life balance were examined as influences that have developed this culture into its current state. The study aim was to examine the culture in an emergency department. The sample consisted of 34 employees working in an emergency department, level II trauma center, located in the Southeastern United States. An ethnographic approach was used to gather data from the perspective of the cultural insider. Data revealed identification of four categories that included cognitive, environmental, linguistic, and social attributes that described the culture. Promoting a culture that values the staff is essential in building an environment that fosters the satisfaction and retention of staff. Findings suggest that efforts be directed at improving workflow and processes. Development and training opportunities are needed to improve relationships to promote safer, more efficient patient care. Removing barriers and improving processes will impact patient safety, efficiency, and cost-effectiveness. Findings show that culture is influenced and created by multiple elements. Copyright © 2012 Elsevier Ltd. All rights reserved.
Emergency Contraception: a survey of Hospital Emergency Departments Staffs
Directory of Open Access Journals (Sweden)
Marco Bo
2011-06-01
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.
Emergency Contraception: a survey of Hospital Emergency Departments Staffs
Directory of Open Access Journals (Sweden)
Marco Bo
2011-03-01
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.
Collaboration and patient safety at an emergency department - a qualitative case study.
Pedersen, Anna Helene Meldgaard; Rasmussen, Kurt; Grytnes, Regine; Nielsen, Kent Jacob
2018-03-19
Purpose The purpose of this paper is to examine how conflicts about collaboration between staff at different departments arose during the establishment of a new emergency department and how these conflicts affected the daily work and ultimately patient safety at the emergency department. Design/methodology/approach This qualitative single case study draws on qualitative semi-structured interviews and participant observation. The theoretical concepts "availability" and "receptiveness" as antecedents for collaboration will be applied in the analysis. Findings Close collaboration between departments was an essential precondition for the functioning of the new emergency department. The study shows how a lack of antecedents for collaboration affected the working relation and communication between employees and departments, which spurred negative feelings and reproduced conflicts. This situation was seen as a potential threat for the safety of the emergency patients. Research limitations/implications This study presents a single case study, at a specific point in time, and should be used as an illustrative example of how contextual and situational factors affect the working environment and through that patient safety. Originality/value Few studies provide an in-depth investigation of what actually takes place when collaboration between professional groups goes wrong and escalates, and how problems in collaboration may affect patient safety.
[The evaluation of academic emergency department design].
Deniz, Turgut; Aydinuraz, Kuzey; Oktay, Cem; Saygun, Meral; Ağalar, Fatih
2007-01-01
In our study which was based upon a questionnaire, the inner and outer architectural designs of emergency services of Emergency Medicine Departments were investigated. In this descriptive study, a standard questionnaire was sent to 26 Emergency Medicine Departments which were operating at that time. In the questionnaire, the internal, external architectural and functional features were questioned. Answers of 22 Emergency Medicine Departments were analysed. Two Emergency Medicine Departments that were not operating at that time were not included in the study. The analysis of the replies revealed that only 59% (n=13) of the Emergency Medicine Departments were designed as an emergency service prior to the construction. The ambulance parking areas were not suitable in 77% of the emergency units while only 54.5% (n=12) had protection against adverse weather conditions. In only 59% (n=13) of the emergency units, a triage unit was present and in only one of the in only one (4.5%), a decontamination room was available. It was understood that only 32% (n=8) of the emergency units were appropriate in enlarging their capacity taking the local risk factors into consideration. There was a toilette for disabled patients in only 18% (n=4) of the units as well. Considering a 12-year of history of the Emergency Medicine in Turkey, the presence of a lecture room is still 68% (n=15) in emergency departments which reflects that academic efforts in this field is emerging in challenging physical conditions. The results of our study revealed that emergency service architecture was neglected in Turkey and medical care given was precluded by the insufficient architecture. The design of emergency services has to be accomplished under guidance of scientific data and rules taking advices of architects who have knowledge and experience on this field.
Prospective pilot study of a tablet computer in an Emergency Department.
Horng, Steven; Goss, Foster R; Chen, Richard S; Nathanson, Larry A
2012-05-01
The recent availability of low-cost tablet computers can facilitate bedside information retrieval by clinicians. To evaluate the effect of physician tablet use in the Emergency Department. Prospective cohort study comparing physician workstation usage with and without a tablet. 55,000 visits/year Level 1 Emergency Department at a tertiary academic teaching hospital. 13 emergency physicians (7 Attendings, 4 EM3s, and 2 EM1s) worked a total of 168 scheduled shifts (130 without and 38 with tablets) during the study period. Physician use of a tablet computer while delivering direct patient care in the Emergency Department. The primary outcome measure was the time spent using the Emergency Department Information System (EDIS) at a computer workstation per shift. The secondary outcome measure was the number of EDIS logins at a computer workstation per shift. Clinician use of a tablet was associated with a 38min (17-59) decrease in time spent per shift using the EDIS at a computer workstation (pcomputer was associated with a reduction in the number of times physicians logged into a computer workstation and a reduction in the amount of time they spent there using the EDIS. The presumed benefit is that decreasing time at a computer workstation increases physician availability at the bedside. However, this association will require further investigation. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
[Oncological emergencies in the emergency department].
Cimpoeşu, Diana; Dumea, Mihaela; Durchi, Simona; Apostoae, F; Olaru, G; Ciolan, Mioara; Popa, O; Corlade-Andrei, Mihaela
2011-01-01
to assess the profile and the characteristic of oncological patients, establishing management in patients with neoplasia presented in the emergency department (ED), the analysis of short-term movements in patients with neoplasia whilst in the ED. we performed a retrospective study on nonrandomized consecutive cases. The lot analysis included 1315 oncological patients admitted in the Emergency Department of the Clinical Emergency Hospital "St. Spiridon" Iaşi, in the period June 1st, 2009 - May 31st, 2010. 23.12% of the patients had high suspicion of neoplasia at the first visit to the ED. 67.07% of patients were in metastatic stage disease located as follows: liver metastasis 37.59%, lung metastasis 18.36%, lymph node metastasis 13, 29%. After processing the data there were found statistically significant correlations between the age of patients and the documented/suspected diagnosis of neoplasia (p = 0.01) in the sense that a neoplasia diagnosis in emergency was more frequent in people of young age. It should be mentioned that other studies rarely mention first diagnosis of neoplasia in emergency department with presence of complications. 1315 oncological patients presented in ED, almost a quarter of which presented high suspicion of neoplasia (still without histopathological confirmation) when in ED (23.12%). Most of them were aged male patients (over 65 years old), with tumors of the digestive system. A significant proportion (almost 60%) of these patients ended up in emergency due to complications and the therapy intended life support and pain management. Some of these patients were directed to further exploring and emergency outpatient therapy while 75% of patients were hospitalized after stabilization. Although we expected that the frequency of complications to be higher in patients previously diagnosed with cancer, data analysis showed no statistically significant differences (p = NS) between the rate of complications in patients previously diagnosed with
Brouns, S.; van der Schuit, K.C.H.; Stassen, P.; Lambooij, S.L.E.; Dieleman, Jeanne P.; Vanderfeesten, I.T.P.; Haak, H.
2017-01-01
Background 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
Bashkin, Osnat; Caspi, Sigalit; Haligoa, Rachel; Mizrahi, Sari; Stalnikowicz, Ruth
2015-01-01
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.
Otegbeye, Mojisola; Scriber, Roslyn; Ducoin, Donna; Glasofer, Amy
2015-01-01
A health system serving Burlington and Camden Counties, New Jersey, sought to improve labor productivity for its emergency departments, with emphasis on optimizing nursing staff schedules. Using historical emergency department visit data and operating constraints, a decision support tool was designed to recommend the number of emergency nurses needed in each hour for each day of the week. The pilot emergency department nurse managers used the decision support tool's recommendations to redeploy nurse hours from weekends into a float pool to support periods of demand spikes on weekdays. Productivity improved significantly, with no unfavorable impact on patient throughput, and patient and staff satisfaction. Today's emergency department manager can leverage the increasing ease of access to the emergency department information system's data repository to successfully design a simple but effective tool to support the alignment of its nursing schedule with demand patterns. Copyright © 2015 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.
Fleet, Richard; Hegg-Deloye, Sandrine; Maltais-Giguère, Julie; Légaré, France; Ouimet, Mathieu; Poitras, Julien; Tanguay, Alain; Archambault, Patrick; Levesque, Jean-Frédéric; Simard-Racine, Geneviève; Dupuis, Gilles
2017-12-07
The Quebec Emergency Department Management Guide (QEDMG) is a unique document with 78 recommendations designed to improve the organization of emergency departments (EDs) in the province of Quebec. However, no study has examined how this guide is perceived or used by rural health care management. We invited all directors of professional services (DPS), directors of nursing services (DNS), head nurses (HN), and emergency department directors (EDD) working in Quebec's rural hospitals to complete an online survey (144 questions). Simple frequency analyses (percentage [%] and 95% confidence interval) were conducted to establish general familiarity and use of the QEDMG, as well as perceived usefulness and implementation of its recommendations. Seventy-three percent (19/26) of Quebec's rural EDs participated in the study. A total of 82% (62/76) of the targeted stakeholders participated. Sixty-one percent of respondents reported being "moderately or a lot" familiar with the QEDMG, whereas 77% reported "almost never or sometimes" refer to this guide. Physician management (DPS, EDD) were more likely than nursing management (DNS and especially HN) to report "not at all" or "little" familiarity on use of the guide. Finally, 98% of the QEDMG recommendations were considered useful. Although the QEDMG is considered a useful guide for rural EDs, it is not optimally known or used in rural EDs, especially by physician management. Stakeholders should consider these findings before implementing the revised versions of the QEDMG.
Pincha Baduge, Mihirika Sds; Moss, Cheryle; Morphet, Julia
2017-05-01
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.
Evaluation of Performance Indexes of Emergency Department
Directory of Open Access Journals (Sweden)
Alireza Baratloo
2015-02-01
Full Text Available Introduction: The importance of evaluating performance indicators in the emergency department, as one of the most important departments of hospital, is obvious to everyone. Therefore, in this study we aimed to appraise the five performance indicators, approved by the ministry of health, in Shohadaye Tajrish hospital, Tehran, Iran. Methods: In a descriptive cross-sectional study based on the profiles of all the patients admitted to the emergency department, performance indicators in the emergency department were evaluated. The study was divided into 2 parts about the establishment of emergency medicine system and training the medical staff: the first 6 months of 1392 and the second. Then these 2 periods were compared using Mann-Whitney U test while P< 0.05 was considered as the level of significance. Results: Of the studied indicators, mean triage time was 6.04 minutes in the first 6 months which was reduced to 1.5 minutes in the second 6 months (p=0.016. In addition, the percentage of patients who moved out of the department in 12 hours was lowered from 97.3% in the first period to 90.4% in the second (p=0.004. While, the percentage of patients who were decided upon in 6 hours (p=0.2, unsuccessful CPR percentage (p=0.34 and patients discharged against medical advice (p=0.42 showed no significant difference. Conclusion: The results of this study showed that the establishment of the emergency medicine system in the emergency department could lead to more efficient triage. Due to the differences made after their establishment including: different pattern of the patients admitted, increased stay of the patients in the department due to their need for prolonged intensive care, a raise in patient referral to the hospital by pre-hospital services and a higher percentage of occupied hospital beds, other indicators have not shown a significant improvement.
Workplace violence against nurses in Indonesian emergency departments.
Noorana Zahra, Anggri; Feng, Jui-Ying
2018-02-01
The objective of this study was to examine the experiences of violent incidents by nurses in Indonesian emergency departments. The World Health Organization's structured questionnaire on workplace violence in the health sector was modified and translated into Bahasa. The study participants were 169 nurses working in emergency departments in six hospitals in Jakarta and Bekasi, Indonesia. The gathered data were analyzed using descriptive and multivariate logistic regression. Ten percent of emergency nurses reported experiencing physical violence, perpetrated mostly by patients, whereas more than half of emergency nurses (54.6%) reported experiencing non-physical violence, with patients' relative as the main perpetrators. A majority of nurses (55.6%) did not have encouragement to report workplace violence, and very few nurses (10.1%) had received any information or training about workplace violence. The findings of this study highlighted the seriousness of violence in Indonesian emergency departments. Support from management, encouragement to report violence, and access to workplace violence training were expected to mitigate and manage violence against nurses in emergency departments. Copyright © 2018 Elsevier España, S.L.U. All rights reserved.
Forecasting the Emergency Department Patients Flow.
Afilal, Mohamed; Yalaoui, Farouk; Dugardin, Frédéric; Amodeo, Lionel; Laplanche, David; Blua, Philippe
2016-07-01
Emergency department (ED) have become the patient's main point of entrance in modern hospitals causing it frequent overcrowding, thus hospital managers are increasingly paying attention to the ED in order to provide better quality service for patients. One of the key elements for a good management strategy is demand forecasting. In this case, forecasting patients flow, which will help decision makers to optimize human (doctors, nurses…) and material(beds, boxs…) resources allocation. The main interest of this research is forecasting daily attendance at an emergency department. The study was conducted on the Emergency Department of Troyes city hospital center, France, in which we propose a new practical ED patients classification that consolidate the CCMU and GEMSA categories into one category and innovative time-series based models to forecast long and short term daily attendance. The models we developed for this case study shows very good performances (up to 91,24 % for the annual Total flow forecast) and robustness to epidemic periods.
Simulation and the emergency department overcrowding problem
Nahhas, A.; Awaldi, A.; Reggelin, T.
2017-01-01
In this paper, a brief review on the emergency department overcrowding problem and its associated solution methodologies is presented. In addition, a case study of an urgent care center is investigated that demonstrates different simulation-based solution strategies to deal with the Emergency Department overcrowding problem. More precisely, a simulation study is conducted to identify critical aspects and propose possible scenarios to configure an urgent care center. Based on statistical data ...
Yuwanich, Nuttapol; Sandmark, Hélène; Akhavan, Sharareh
2015-10-30
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.
Time series modelling and forecasting of emergency department overcrowding.
Kadri, Farid; Harrou, Fouzi; Chaabane, Sondès; Tahon, Christian
2014-09-01
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.
Bobrovitz, Niklas; Lasserson, Daniel S; Briggs, Adam D M
2017-11-02
The four-hour target is a key hospital emergency department performance indicator in England and one that drives the physical and organisational design of the ED. Some studies have identified time of presentation as a key factor affecting waiting times. Few studies have investigated other determinants of breaching the four-hour target. Therefore, our objective was to describe patterns of emergency department breaches of the four-hour wait time target and identify patients at highest risk of breaching. This was a retrospective cohort study of a large type 1 Emergency department at an NHS teaching hospital in Oxford, England. We analysed anonymised individual level patient data for 378,873 emergency department attendances, representing all attendances between April 2008 and April 2013. We examined patient characteristics and emergency department presentation circumstances associated with the highest likelihood of breaching the four-hour wait time target. We used 374,459 complete cases for analysis. In total, 8.3% of all patients breached the four-hour wait time target. The main determinants of patients breaching the four-hour wait time target were hour of arrival to the ED, day of the week, patient age, ED referral source, and the types of investigations patients receive (p target were older, presented at night, presented on Monday, received multiple types of investigation in the emergency department, and were not self-referred (p target including patient age, ED referral source, the types of investigations patients receive, as well as the hour, day, and month of arrival to the ED. Efforts to reduce the number of breaches could explore late-evening/overnight staffing, access to diagnostic tests, rapid discharge facilities, and early assessment and input on diagnostic and management strategies from a senior practitioner.
Screening of the frail patient in the emergency department
DEFF Research Database (Denmark)
Jørgensen, Rasmus; Brabrand, Mikkel
2017-01-01
to detect frailty in patients. ≥. 65. years by their ability to identify the risk of adverse outcomes. Methods: An extensive medical literature search of Embase and PubMed was conducted, to identify studies using frailty screening scales in the emergency department. Data was subsequently extracted...... and evaluated from the results of the included studies. Results: Four studies met the exact inclusion criteria. Four different frailty screening scales: Clinical Frailty Scale, Deficit Accumulation Index, Identification of Seniors At Risk and The Study of Osteoporotic Fracture frailty index used...... emergency department visit. Frailty does however not predict increased risk of 30. day emergency department revisit. Further research highlighting the value of screening for frailty level in elderly emergency department patients is needed. Learning points: Although frail elders in need of further geriatric...
Khan, Yasmin; Sanford, Sarah; Sider, Doug; Moore, Kieran; Garber, Gary; de Villa, Eileen; Schwartz, Brian
2017-04-28
Evidence to inform communication between emergency department clinicians and public health agencies is limited. In the context of diverse, emerging public health incidents, communication is urgent, as emergency department clinicians must implement recommendations to protect themselves and the public. The objectives of this study were to: explore current practices, barriers and facilitators at the local level for communicating public health guidance to emergency department clinicians in emerging public health incidents; and develop a framework that promotes effective communication of public health guidance to clinicians during emerging incidents. A qualitative study was conducted using semi-structured interviews with 26 key informants from emergency departments and public health agencies in Ontario, Canada. Data were analyzed inductively and the analytic approach was guided by concepts of complexity theory. Emergent themes corresponded to challenges and strategies for effective communication of public health guidance. Important challenges related to the coordination of communication across institutions and jurisdictions, and differences in work environments across sectors. Strategies for effective communication were identified as the development of partnerships and collaboration, attention to specific methods of communication used, and the importance of roles and relationship-building prior to an emerging public health incident. Following descriptive analysis, a framework was developed that consists of the following elements: 1) Anticipate; 2) Invest in building relationships and networks; 3) Establish liaison roles and redundancy; 4) Active communication; 5) Consider and respond to the target audience; 6) Leverage networks for coordination; and 7) Acknowledge and address uncertainty. The qualities inherent in local relationships cut across framework elements. This research indicates that relationships are central to effective communication between public health
Jones, Aaron; Schumacher, Connie; Bronskill, Susan E; Campitelli, Michael A; Poss, Jeffrey W; Seow, Hsien; Costa, Andrew P
2018-04-30
The extent to which home care visits contribute to the delay or avoidance of emergency department use is poorly characterized. We examined the association between home care visits and same-day emergency department use among patients receiving publicly funded home care. We conducted a population-based case-crossover study among patients receiving publicly funded home care in the Hamilton-Niagara-Haldimand-Brant region of Ontario between January and December 2015. Within individuals, all days with emergency department visits after 5 pm were selected as cases and matched with control days from the previous week. The cohort was stratified according to whether patients had ongoing home care needs ("long stay") or short-term home care needs ("short stay"). We used conditional logistical regression to estimate the association between receiving a home care visit during the day and visiting the emergency department after 5 pm on the same day. A total of 4429 long-stay patients contributed 5893 emergency department visits, and 2836 short-stay patients contributed 3476 visits. Receiving a home care nursing visit was associated with an increased likelihood of visiting the emergency department after 5 pm on the same day in both long-stay (odds ratio [OR] 1.32, 95% confidence interval [CI] 1.17-1.48) and short-stay patients (OR 1.22, 95% CI 1.07-1.39). Stronger associations were observed for less acute visits to the emergency department. No associations were observed for other types of home care visits. Patients receiving home care were more likely to visit the emergency department during the evening on days they received a nursing visit. The mechanism of the association between home care visits and same-day emergency department use and the extent to which same-day emergency department visits could be prevented or diverted require additional investigation. © 2018 Joule Inc. or its licensors.
Emergency Department Management of Trauma
DEFF Research Database (Denmark)
MacKenzie, Colin; Lippert, Freddy
1999-01-01
Initial assessment and management of severely injured patients may occur in a specialized area of an emergency department or in a specialized area of a trauma center. The time from injury until definitive management is of essence for survival of life-threatening trauma. The initial care delivered...... injured patients after these patients reach a hospital emergency department or a trauma center....
Implementation of Electronic Whiteboards at Two Emergency Departments
DEFF Research Database (Denmark)
Rasmussen, Rasmus; Fleron, Benedicte Frederikke Rex; Hertzum, Morten
2010-01-01
We report from a case study of the implementation of an electronic whiteboard system at two emergency departments at Danish hospitals. The purpose of such whiteboards is to support the clinicians in maintaining an overview of the patients at the department. The electronic whiteboard system...... was designed in collaboration with clinicians from the departments, present more information, and allow some automated updating, as compared to the existing dry-erase whiteboard. Based on observations supported by interviews we describe the implementation of the whiteboard at the two emergency departments...
Priorities for emergency department syncope research
Sun, Benjamin C.; Costantino, Giorgio; Barbic, Franca; Bossi, Ilaria; Casazza, Giovanni; Dipaola, Franca; McDermott, Daniel; Quinn, James; Reed, Matthew; Sheldon, Robert S.; Solbiati, Monica; Thiruganasambandamoorthy, Venkatesh; Krahn, Andrew D.; Beach, Daniel; Bodemer, Nicolai; Brignole, Michele; Casagranda, Ivo; Duca, Piergiorgio; Falavigna, Greta; Ippoliti, Roberto; Montano, Nicola; Olshansky, Brian; Raj, Satish R.; Ruwald, Martin H.; Shen, Win-Kuang; Stiell, Ian; Ungar, Andrea; van Dijk, J. Gert; van Dijk, Nynke; Wieling, Wouter; Furlan, Raffaello
2014-01-01
There is limited evidence to guide the emergency department (ED) evaluation and management of syncope. The First International Workshop on Syncope Risk Stratification in the Emergency Department identified key research questions and methodological standards essential to advancing the science of
Understanding the Experience of Miscarriage in the Emergency Department.
MacWilliams, Kate; Hughes, Jean; Aston, Megan; Field, Simon; Moffatt, Faith Wight
2016-11-01
Up to 20% of pregnancies end in miscarriage, which can be a significant life event for women with psychological implications. Because the only preventative measure for a miscarriage is risk factor modification, the treatment focuses on confirming the miscarriage has occurred and medical management of symptoms. Although women experiencing a miscarriage are frequently directed to seek medical care in emergency departments, the patients are often triaged as nonemergent patients unless they are unstable, which exposes women to potentially prolonged wait times. Research about miscarriages and emergency departments predominantly focus on medical management with little understanding of how emergency care shapes the experience of miscarriage for women. Seeking to describe the experiences of women coming to the emergency department for care while having a miscarriage, interpretive phenomenology-a form of qualitative research-guided this study. Eight women were recruited to participate in semi-structured face-to-face interviews of 60 to 90 minutes in length. Data were analyzed using hermeneutics and thematic analysis. Five themes emerged: "Pregnant/Life: Miscarriage/Death"; "Deciding to go to the emergency department: Something's wrong"; "Not an illness: A different kind of trauma"; "Need for acknowledgement"; and "Leaving the emergency department: What now?". Participants believed their losses were not acknowledged but instead dismissed. These experiences, combined with a perceived lack of discharge education and clarity regarding follow-up, created experiences of marginalization. This study describes the experience of miscarrying in emergency departments and provides insights regarding how nursing and physician care may affect patient perceptions of marginalization. Copyright © 2016 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.
Therapeutic conflicts in emergency department patients with multimorbidity: a cross-sectional study.
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Stefan Markun
Full Text Available Patients with multimorbidity are an increasing concern in healthcare. Clinical practice guidelines, however, do not take into account potential therapeutic conflicts caused by co-occurring medical conditions. This makes therapeutic decisions complex, especially in emergency situations.The aim of this study was to identify and quantify therapeutic conflicts in emergency department patients with multimorbidity.We reviewed electronic records of all patients ≥18 years with two or more concurrent active medical conditions, admitted from the emergency department to the hospital ward of the University Hospital Zurich in January 2009. We cross-tabulated all active diagnoses with treatments recommended by guidelines for each diagnosis. Then, we identified potential therapeutic conflicts and classified them as either major or minor conflicts according to their clinical significance.166 emergency inpatients with multimorbidity were included. The mean number of active diagnoses per patient was 6.6 (SD±3.4. We identified a total of 239 therapeutic conflicts in 49% of the of the study population. In 29% of the study population major therapeutic conflicts, in 41% of the patients minor therapeutic conflicts occurred.Therapeutic conflicts are common among multimorbid patients, with one out of two experiencing minor, and one out of three experiencing major therapeutic conflicts. Clinical practice guidelines need to address frequent therapeutic conflicts in patients with co-morbid medical conditions.
Therapeutic conflicts in emergency department patients with multimorbidity: a cross-sectional study.
Markun, Stefan; Holzer, Barbara M; Rodak, Roksana; Kaplan, Vladimir; Wagner, Claudia C; Battegay, Edouard; Zimmerli, Lukas
2014-01-01
Patients with multimorbidity are an increasing concern in healthcare. Clinical practice guidelines, however, do not take into account potential therapeutic conflicts caused by co-occurring medical conditions. This makes therapeutic decisions complex, especially in emergency situations. The aim of this study was to identify and quantify therapeutic conflicts in emergency department patients with multimorbidity. We reviewed electronic records of all patients ≥18 years with two or more concurrent active medical conditions, admitted from the emergency department to the hospital ward of the University Hospital Zurich in January 2009. We cross-tabulated all active diagnoses with treatments recommended by guidelines for each diagnosis. Then, we identified potential therapeutic conflicts and classified them as either major or minor conflicts according to their clinical significance. 166 emergency inpatients with multimorbidity were included. The mean number of active diagnoses per patient was 6.6 (SD±3.4). We identified a total of 239 therapeutic conflicts in 49% of the of the study population. In 29% of the study population major therapeutic conflicts, in 41% of the patients minor therapeutic conflicts occurred. Therapeutic conflicts are common among multimorbid patients, with one out of two experiencing minor, and one out of three experiencing major therapeutic conflicts. Clinical practice guidelines need to address frequent therapeutic conflicts in patients with co-morbid medical conditions.
Fire Department Emergency Response
International Nuclear Information System (INIS)
Blanchard, A.; Bell, K.; Kelly, J.; Hudson, J.
1997-09-01
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
Directory of Open Access Journals (Sweden)
Li-Chin Chen, MSN
2018-03-01
Full Text Available Purpose: This study aims to gain in-depth understanding of nurses' perspectives of working in an overcrowded emergency. Methods: Symbolic interactionism and Charmaz’s construction of grounded theory were used. Purposive sampling at the start of the study and a further theoretical sampling by snowball technique were used to recruit 40 registered nurses (RN to participate in in-depth, semi-structured interviews between May and November, 2014. Data analysis included analytic techniques of initial, focused and theoretical coding. Results: Study findings showed searching for work role is derived by the themes of Finding the role of positioning in Emergency Department (ED, Recognizing causes of ED overcrowding, and Confined working environment. Nurses' work experience which represents the RNs not gained control over their work, as care actions influenced by the problematic overcrowded circumstance of the ED environment. Conclusion: The findings fill a gap in knowledge about how RNs experience their work role in the context of an overcrowded Emergency Department in Taiwan. Arising from the study result include taking account of nurses' perspectives when planning staff/patient ratios, strategies to reduce waiting time and ensure that clients receive appropriate care. Keywords: crowding, emergency department, grounded theory, nurses
The Profile of Neurology Patients Evaluated in the Emergency Department
Ufuk Emre; Ayşe Semra Demir; Esra Acıman; Nejla Çabuk; Sibel Kıran; Aysun Ünal
2009-01-01
OBJECTIVE: Early, rapid, and multidisciplinary approaches are very important in the diagnosis of neurological disorders in emergency departments. The present study aimed to investigate the features of patients that presented for neurology consultation in the emergency department. METHODS: The present study included 780 patients. Patient demographic features, reasons for emergent treatment and neurological consultation, neurological diagnosis by the neurologist, and laboratory (total blood...
Analysis of emergency department waiting lines
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Urška Močnik
2014-10-01
Full Text Available Background: Steady increase in the numbers of patients seeking medical assistance has recently been observed at the emergency department of the health center under study. This has led to increases in waiting times for patients. The management of the health center has been considering to implement certain measures to remedy this situation. One proposed solution is to add an additional physician to the emergency department. A computer model was constructed to simulate waiting lines and analyze the economic feasibility of employing an additional physician.Aim: This paper analyzes the waiting lines at the emergency department and performs an economic feasibility study to determine whether adding an additional physician to the department would be economically justified.Methods: Data about waiting times at the emergency department were collected to study the situation. For each patient, the arrival time at the waiting room and the starting and ending times of the examination were registered. The data were collected from 13 June 2011 to 25 September 2011. The sample included data on 65 nightly standbys, nine standbys on Saturdays, and 16 standbys on Sundays. Due to incomplete entries, data for nine weekly standbys and six Saturday standbys were excluded from the sample. Based on the data collected, we calculated the waiting and examination times per patient, average number of patients, average waiting time, average examination time, share of active standby teams in total standby time, and number of patients in different time periods. The study involved 1,039 patients. Using a synthesis method, we designed a computer model of waiting lines and economic feasibility. The model was validated using comparative analysis. A what-if analysis was performed using various computer simulations with various scenarios to consider the outcomes of decision alternatives. We applied economic analysis to select the best possible solution.Results: The research results
Patient satisfaction with physiotherapy in the emergency department.
Sheppard, Lorraine A; Anaf, Sophie; Gordon, Jane
2010-10-01
This research aims to explore patient satisfaction with ED physiotherapy within the Australian context by providing a qualitative perspective with in-depth exploration of the factors underlying patients' satisfaction. The physiotherapist was part of the Emergency Department Allied Health Team of social worker and occupational therapist. A qualitative, interpretive, field-based study using face-to-face interviews were carried out post-physiotherapy treatment within the emergency department, followed-up 2-3 weeks later with telephone interviews. Twenty two participants took part in the face-to-face interviews and 15 in the follow-up interviews. Of the 22 participants who took part in the initial interviews 19 were over 65 years of age, with a mean age of 78 years. Within the category 'Physiotherapy in the emergency department' the themes were; expectations, bedside manner, physiotherapy management (i.e. assessment, advice, hands-on, exercise, follow-up/referral) and satisfaction. The physiotherapist at the Australian emergency department appeared to make an impact on patients' experiences in the emergency department through his thorough subjective assessment of the patients' home environment, coping skills and social supports, his assessment of functional mobility, his provision of exercises, advice and hands-on treatment, as well as his involvement in organising follow-up or referral to other services. The physiotherapist's bedside manner shaped patients' perceptions throughout their assessment and treatment, reassuring and comforting patients within the emergency environment. Participants were satisfied with the experience of attending the physiotherapist in the emergency department and commented the blend of skills of the physiotherapists enhanced the service provision and self reported patient outcomes. Copyright © 2009 Elsevier Ltd. All rights reserved.
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Kara H
2013-12-01
Full Text Available Hasan Kara,1 Aysegul Bayir,1 Ahmet Ak,1 Murat Akinci,1 Necmettin Tufekci,1 Selim Degirmenci,1 Melih Azap21Department of Emergency Medicine, Selçuk University, Konya, Turkey; 2Department of Emergency Medicine, Konya Numune Hospital, Konya, TurkeyPurpose: Trauma is a common cause of admission to the hospital emergency department. The purpose of this study was to evaluate the cause of admission, clinical characteristics, and outcomes of patients aged ≥65 years admitted to an emergency department in Turkey because of blunt trauma.Materials and methods: Medical records were retrospectively reviewed for 568 patients (314 women and 254 men aged ≥65 years who were admitted to an emergency department of a tertiary care hospital.Results: Trauma was caused by low-energy fall in 379 patients (67%, traffic accident in 79 patients (14%, high-energy fall in 69 patients (12%, and other causes in 41 patients (7%. The most frequent sites of injury were the lower extremity, thorax, upper extremity, and head. The femur was the most frequent fracture site. After evaluation in the emergency department, 377 patients (66% were hospitalized. There were 31 patients (5% who died. Risk of hospitalization after trauma was significantly associated with trauma to the lower extremity, thorax, and spine; fractures of the femur and rib; and intracranial injury.Conclusion: Emergency department admission after trauma in patients aged $65 years is common after low-energy falls, and most injuries occur to the extremities. It is important to focus on prevention of falls to decrease the frequency of trauma in the elderly.Keywords: fall, femur, fracture, injury
A study on the impact of prioritising emergency department arrivals on the patient waiting time.
Van Bockstal, Ellen; Maenhout, Broos
2018-05-03
In the past decade, the crowding of the emergency department has gained considerable attention of researchers as the number of medical service providers is typically insufficient to fulfil the demand for emergency care. In this paper, we solve the stochastic emergency department workforce planning problem and consider the planning of nurses and physicians simultaneously for a real-life case study in Belgium. We study the patient arrival pattern of the emergency department in depth and consider different patient acuity classes by disaggregating the arrival pattern. We determine the personnel staffing requirements and the design of the shifts based on the patient arrival rates per acuity class such that the resource staffing cost and the weighted patient waiting time are minimised. In order to solve this multi-objective optimisation problem, we construct a Pareto set of optimal solutions via the -constraints method. For a particular staffing composition, the proposed model minimises the patient waiting time subject to upper bounds on the staffing size using the Sample Average Approximation Method. In our computational experiments, we discern the impact of prioritising the emergency department arrivals. Triaging results in lower patient waiting times for higher priority acuity classes and to a higher waiting time for the lowest priority class, which does not require immediate care. Moreover, we perform a sensitivity analysis to verify the impact of the arrival and service pattern characteristics, the prioritisation weights between different acuity classes and the incorporated shift flexibility in the model.
Emergency department crowding in Singapore: Insights from a systems thinking approach.
Schoenenberger, Lukas K; Bayer, Steffen; Ansah, John P; Matchar, David B; Mohanavalli, Rajagopal L; Lam, Sean Sw; Ong, Marcus Eh
2016-01-01
Emergency Department crowding is a serious and international health care problem that seems to be resistant to most well intended but often reductionist policy approaches. In this study, we examine Emergency Department crowding in Singapore from a systems thinking perspective using causal loop diagramming to visualize the systemic structure underlying this complex phenomenon. Furthermore, we evaluate the relative impact of three different policies in reducing Emergency Department crowding in Singapore: introduction of geriatric emergency medicine, expansion of emergency medicine training, and implementation of enhanced primary care. The construction of the qualitative causal loop diagram is based on consultations with Emergency Department experts, direct observation, and a thorough literature review. For the purpose of policy analysis, a novel approach, the path analysis, is applied. The path analysis revealed that both the introduction of geriatric emergency medicine and the expansion of emergency medicine training may be associated with undesirable consequences contributing to Emergency Department crowding. In contrast, enhancing primary care was found to be germane in reducing Emergency Department crowding; in addition, it has apparently no negative side effects, considering the boundary of the model created. Causal loop diagramming was a powerful tool for eliciting the systemic structure of Emergency Department crowding in Singapore. Additionally, the developed model was valuable in testing different policy options.
Shaban, Ramon Z; Holzhauser, Kerri; Gillespie, Kerri; Huckson, Sue; Bennetts, Scott
2012-02-01
It is well established that pain is the most common presenting complaint in Emergency Departments. Despite great improvements in available pain management strategies, patients are left waiting for longer than 60min for pain relief on arrival to the emergency department. The aim of this study was to describe interventions that lead to successful implementation of the National Health and Medical Research Council approved guidelines Acute Pain Management: Scientific Evidence (2nd Edition) that include specific recommendations for best practice pain management. A two-phased, mixed-method, exploratory study of all 52 Australian hospital emergency departments participating in the National Emergency Care Pain Management Initiative incorporating interview and document analysis was undertaken. Interventions used by clinicians to improve pain management included nurse initiated analgesia, intranasal fentanyl for paediatric patients and lignocaine, and facio illiaca block. Education formed a major part of the intervention and the development of a working group of key stakeholders was critical in the successful implementation of change. Staff perceptions of patients' pain level and attitudes toward pain assessment and pain management were identified as barriers. This study highlighted how an effective framework to plan and implement practice change and tailored interventions, including education and training systems and products using the best available evidence, best equipped clinicians to manage pain in the ED. Copyright © 2011 College of Emergency Nursing Australasia Ltd. All rights reserved.
Jung, Hyemin; Do, Young Kyung; Kim, Yoon; Ro, Junsoo
2014-11-01
This study aimed to test our hypothesis that a raise in the emergency fee implemented on March 1, 2013 has increased the proportion of patients with emergent symptoms by discouraging non-urgent emergency department visits. We conducted an analysis of 728 736 patients registered in the National Emergency Department Information System who visited level 1 and level 2 emergency medical institutes in the two-month time period from February 1, 2013, one month before the raise in the emergency fee, to March 31, 2013, one month after the raise. A difference-in-difference method was used to estimate the net effects of a raise in the emergency fee on the probability that an emergency visit is for urgent conditions. The percentage of emergency department visits in urgent or equivalent patients increased by 2.4% points, from 74.2% before to 76.6% after the policy implementation. In a group of patients transferred using public transport or ambulance, who were assumed to be least conscious of cost, the change in the proportion of urgent patients was not statistically significant. On the other hand, the probability that a group of patients directly presenting to the emergency department by private transport, assumed to be most conscious of cost, showed a 2.4% point increase in urgent conditions (pfee implemented on March 1, 2013 increased the proportion of urgent patients in the total emergency visits by reducing emergency department visits by non-urgent patients.
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Anita Sabzghabaei
2014-09-01
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.
Evaluation of Head Trauma Cases in the Emergency Department
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Alim Cokuk
2013-02-01
Full Text Available Aim: In this study, we aimed to determine the epidemiological characteristics, morbidity and mortality rates of patients admitted to the emergency department with head trauma. Material and Methods: In this study, ambulatory and hospitalized patients over the age of 18 brought to the Emergency Department because of head trauma between 01.12.2009 - 31.12.2010 were analyzed retrospectively. Patient data were recorded to standard data entry form. SPSS 17.0 package program was used for statistical analysis of data. The statistical significance level of all tests was p <0.05. Results: 5200 patients were included in this study. The average age of the patients was 39.97 ± 16.66 years. 4682'si patients (90 % were discharged from the emergency department. The most common reason for admission to the emergency department was falls (41.81 % in the discharged patients. 518 (10 % patients were hospitalized. Gender of these patients was 110 female (21:24% and 408 male (78.76%. 256 patients (48.35% were injured as a result of a traffic accident. 201(38.8% of the cerebral CT were reported as normal and 89 (17.2% of the cerebral CT were reported as traumatic subarachnoid hemorrhage (SAH in hospitalized patients. The fracture of lumbar spine (12 % was detected as an additional pathological disease in patients. 75 patients hospitalized because of head trauma (14.5% had died (1.44 % of all patients. Cervical spine fracture was the most common (14 patients, 18.68 % additional pathology in patients who died. Thoracic trauma was detected as the second most common (13 patients, 17.33 % additional pathology. Conclusion: Most of the patients admitted to the emergency department with head injury had a minor trauma. Patients can be discharged from the emergency department after a thorough physical examination and simple medical intervention. Most of the head injury patients admitted to hospital were male. The most common reason of the patients with head injury admitted to
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Botti Primo
2011-03-01
Full Text Available Abstract Background Delayed neuropsychological sequelae (DNS commonly occur after recovery from acute carbon monoxide (CO poisoning. The preventive role and the indications for hyperbaric oxygen therapy in the acute setting are still controversial. Early identification of patients at risk in the Emergency Department might permit an improvement in quality of care. We conducted a retrospective study to identify predictive risk factors for DNS development in the Emergency Department. Methods We retrospectively considered all CO-poisoned patients admitted to the Emergency Department of Careggi University General Hospital (Florence, Italy from 1992 to 2007. Patients were invited to participate in three follow-up visits at one, six and twelve months from hospital discharge. Clinical and biohumoral data were collected; univariate and multivariate analysis were performed to identify predictive risk factors for DNS. Results Three hundred forty seven patients were admitted to the Emergency Department for acute CO poisoning from 1992 to 2007; 141/347 patients participated in the follow-up visit at one month from hospital discharge. Thirty four/141 patients were diagnosed with DNS (24.1%. Five/34 patients previously diagnosed as having DNS presented to the follow-up visit at six months, reporting a complete recovery. The following variables (collected before or upon Emergency Department admission were associated to DNS development at one month from hospital discharge in the univariate analysis: CO exposure duration >6 hours, a Glasgow Coma Scale (GCS score Conclusions Our study identified several potential predictive risk factors for DNS. Treatment algorithms based on an appropriate risk-stratification of patients in the Emergency Department might reduce DNS incidence; however, more studies are needed. Adequate follow-up after hospital discharge, aimed at correct recognition of DNS, is also important.
Yuwanich, Nuttapol
2017-01-01
Working at an emergency department has some characteristics, which may generate stress. In this thesis, the stressors for emergency nurses were evaluated and an instrument was developed for measuring their impact. In order to gain a deeper understanding regarding the occupational stress among emergency nurses, a descriptive qualitative design with semi-structured interviews were used in two studies (I, II), one at a private and the other at a public hospital in Thailand. Three main categories...
National Research Council Canada - National Science Library
Wingert, Tracy
1998-01-01
Once considered reserved for life-threatening disease or illness, emergency departments in the United States are now described as the primary care clinic and the social work department for many Americans (Grumback, Keane & Bindman, 1993...
Lloyd-Rees, Johanna
2016-01-01
The Emergency Nurse Practitioner (ENP) role has become established over the last two decades within emergency care. This role has developed to meet the rising demands of healthcare, combat the continuing medical workforce shortfall and address targets around healthcare delivery within emergency care. The ENP role has been widely evaluated in terms of patient satisfaction, safety and outcome. To date there is no published literature exploring what drives senior nurses to undertake this role which involves additional clinical responsibility and educational preparation for no increase in pay. This research seeks to explore how Emergency Nurse Practitioners view their role within the Emergency Department and Emergency Care Team. A qualitative approach was utilised in order to gain greater in-depth understanding of ENPs' perspectives. A purposive sample of eight ENPs was chosen and semi-structured interviews were digitally recorded. The transcribed interviews were subjected to thematic analysis to look for any recurrent themes. Following analysis of the data, four main themes emerged with a total of eight sub themes. The findings suggested that whilst the role had been accepted amongst doctors within the ED, there was still a lack of understanding of the role outside the ED and conflict still existed amongst junior nurses. ENPs were motivated to undertake the role in order to gain greater job satisfaction. The findings also highlighted the concerns regarding financial remuneration for the role, lack of standardisation of the role and educational preparation. The study concludes that education has a key role in the development and acceptance of the role and that ENPs are disappointed with the lack of financial remuneration for the role. Copyright © 2015 Elsevier Ltd. All rights reserved.
Joseph, Christine L M; Lu, Mei; Stokes-Bruzzelli, Stephanie; Johnson, Dayna A; Duffy, Elizabeth; Demers, Michele; Zhang, Talan; Ownby, Dennis R; Zoratti, Edward; Mahajan, Prashant
2016-01-01
The emergency department could represent a means of identifying patients with asthma who could benefit from asthma interventions. To assess the initiation of a Web-based tailored asthma intervention in the emergency department of 2 urban tertiary care hospitals. In addition to awareness strategies for emergency department staff (eg, attending nursing huddles, division meetings, etc), recruitment experiences are described for 2 strategies: (1) recruitment during an emergency department visit for acute asthma and (2) recruitment from patient listings (mail or telephone). Patient enrollment was defined as baseline completion, randomization, and completion of the first of 4 online sessions. Of 499 eligible patients 13 to 19 years old visiting the emergency department for asthma during the study period, 313 (63%) were contacted in the emergency department (n = 65) or by mail or telephone (n = 350). Of these, 121 (38.6%) were randomized. Mean age of the study sample was 15.4 years and 88.4% were African American. Refusal rates for emergency department recruitment and mail or telephone were 18.5% (12 of 65) and 16.6% (58 of 350), respectively. On average, emergency department enrollment took 44 to 67 minutes, including downtime. When surveyed, emergency department providers were more positive about awareness activities and emergency department recruitment than were research staff. Emergency department recruitment was feasible but labor intensive. Refusal rates were similar for the 2 strategies. Targeting patients with acute asthma in the emergency department is one way of connecting with youth at risk of future acute events. Copyright © 2016 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
Blood pressure documentation in the emergency department
Daniel, Ana Carolina Queiroz Godoy; Machado, Juliana Pereira; Veiga, Eugenia Velludo
2017-01-01
ABSTRACT Objective To analyze the frequency of blood pressure documentation performed by nursing professionals in an emergency department. Methods 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 α<0.05. Results One hundred fifty-seven records and 430 blood pressure measurements were analyzed with an average of three measurements per patient. Of these measures, 46.5% were abnormal. The mean time from admission to documentation of the first blood pressure measurement was 2.5 minutes, with 42 minutes between subsequent measures. There is no correlation between the systolic blood pressure values and the mean time interval between blood pressure documentations: 0.173 (p=0.031). Conclusion The present study found no correlation between frequency of blood pressure documentation and blood pressure values. The frequency of blood pressure documentation increased according to the severity of the patient and decreased during the length of stay in the emergency department. PMID:28444085
DEFF Research Database (Denmark)
Strøm, Camilla; Mollerup, Talie Khadem; Kromberg, Laurits Schou
2017-01-01
Medicine Department (IMD). METHODS: Observational study evaluating adverse events during hospitalisation in non-emergent, age-matched, internal medicine patients ≥75 years, acutely admitted to either the SSU or the IMD at Holbaek Hospital, Denmark, from January to August, 2014. Medical records were......, unplanned readmission, and nosocomial infection. CONCLUSIONS: Adverse events of hospitalisation were significantly less common in older patients acutely admitted to an Emergency Department Short-stay Unit as compared to admission to an Internal Medicine Department.......BACKGROUND: Older patients are at particular risk of experiencing adverse events during hospitalisation. OBJECTIVE: To compare the frequencies and types of adverse events during hospitalisation in older persons acutely admitted to either an Emergency Department Short-stay Unit (SSU) or an Internal...
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,...
Clinical Aspects and Emergent Management of Snake Bites Presented to Emergency Department
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Bedriye Sonmez
2014-03-01
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.
Emergency Department Management of Delirium in the Elderly
Lynn E.J. Gower, DO; Medley O’Keefe Gatewood, MD; Christopher S. Kang, MD
2012-01-01
An increasing number of elderly patients are presenting to the emergency department. Numerous studies have observed that emergency physicians often fail to identify and diagnose delirium in the elderly. These studies also suggest that even when emergency physicians recognized delirium, they still may not have fully appreciated the import of the diagnosis. Delirium is not a normal manifestation of aging and, often, is the only sign of a serious underlying medical condition. This article will r...
Pincha Baduge, Mihirika Surangi De Silva
2017-01-01
Introduction: Ebola Virus Disease (EVD) is a highly contagious disease with a high mortality rate. The 2014 outbreak in West Africa grew uncontrollably, and on the 8th August 2014, the World Health Organization (WHO) declared the outbreak as a public health emergency of international concern. Emergency Departments (ED) in Australian health services commenced preparation and vigilance for people presenting with EVD like symptoms, so that any spread of the disease could be prevented. Researc...
Emergency Department Management of Trauma
DEFF Research Database (Denmark)
MacKenzie, Colin; Lippert, Freddy
1999-01-01
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......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....
Procedures and Collaborative Information Seeking: A Study of Emergency Departments
DEFF Research Database (Denmark)
Hertzum, Morten; Reddy, Madhu
2015-01-01
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...
Emergency Department Care in the Postpartum Period: California Births, 2009-2011.
Batra, Priya; Fridman, Moshe; Leng, Mei; Gregory, Kimberly D
2017-11-01
To use population data to identify patient characteristics associated with a postpartum maternal emergency department visit within 90 days of discharge after birth. This retrospective cross-sectional study analyzed linked maternal discharge and emergency department data for all live California births from 2009 to 2011. The primary outcome was at least one emergency department visit within 90 days of hospital discharge after birth. Secondary outcomes included three or more visits within 90 days ("high utilization") and inpatient readmission. Independent variables included demographics (age, race or ethnicity, payer, income) and clinical characteristics (length of stay, antepartum complications, mode of delivery, and severe maternal morbidity at delivery). Multilevel logistic regression identified variables associated study outcomes; we validated the predictive model with a split-sample approach and receiver operating characteristic curve analysis. Of 1,071,232 deliveries included, 88,674 women (8.3%) visited the emergency department at least once in the 90 days after delivery discharge. Emergency department use was significantly associated with Medicaid insurance (adjusted odds ratio [OR] 2.15, 95% CI 2.08-2.21), age younger than 20 years (adjusted OR 2.08, 95% CI 1.98-2.19), severe maternal morbidity at delivery (adjusted OR 1.58, 95% CI 1.49-1.71), antepartum complications (adjusted OR 1.46, 95% CI 1.42-1.50), and cesarean delivery (adjusted OR 1.40, 95% CI 1.37-1.44). Approximately one fifth of visits occurred within 4 days of discharge, and more than half were within 3 weeks. High utilizers comprised 0.5% of the entire sample (5,171 women) and only 1.2% of women presenting for emergency department care were readmitted. Receiver operating curve model analysis using the validation sample supported predictive accuracy for postpartum emergency department use (area under the curve=0.95). One in 12 California women visited the emergency department in the first 90 days
Amini, Afshin; Dindoost, Payam; Moghimi, Mehrdad; Kariman, Hamid; Shahrami, Ali; Dolatabadi, Ali Arhami; Ali-Mohammadi, Hossein; Alavai-Moghaddam, Mostafa; Derakhshanfar, Hojjat; Hatamabadi, HamidReza; Heidari, Kamran; Alamdari, Shahram; Meibodi, Mohammad Kalantar; Shojaee, Majid; Foroozanfar, Mohammad Mehdi; Hashemi, Behrooz; Sabzeghaba, Anita; Kabir, Ali
2012-02-01
To assess the deficiencies and potential areas through a medical audit of the emergency departments, in six general hospitals affiliated to Shahid Beheshti University of Medical Sciences at Tehran, Iran, after preparing specific wards-based international standards. A checklist was completed for all hospitals which met our eligibility criteria mainly observation and interviews with head nurses and managers of the emergency medicine unit of the hospitals before (2003) and after (2008) the establishment of emergency departments there. Domains studied included staffing, education and continuing professional development (CPD), facility (design), equipment, ancillary services, medical records, manuals and references, research, administration, pre-hospital care, information systems, disaster planning, bench-marking and hospital accreditation. Education and CPD (p = 0.042), design and facility (p = 0.027), equipment (p = 0.028), and disaster (p = 0.026) had significantly improved after the establishment of emergency departments. Nearly all domains showed a positive change though it was non-significant in a few. In terms of observation, better improvement was seen in disaster, security, design, and research. According to the score for each domain compared to what it was in the earlier phase, better improvement was observed in hospital accreditation, information systems, security, disaster planning, and research. Security, disaster planning, research, design and facility had improved in hospitals that wave studied, while equipment, records, ancillary services, administration and bench-marking had the lowest improvement even after the establishment of emergency department, and, hence, needed specific attention.
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...
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...
Air pollution and emergency department visits for conjunctivitis: A case-crossover study
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Mieczysław Szyszkowicz
2016-06-01
Full Text Available Objectives: The purpose of this study was to examine the associations between emergency department (ED visits for conjunctivitis and ambient air pollution levels in urban regions across the province of Ontario, Canada. Material and Methods: Information from the National Ambulatory Care Reporting System was used to create time-series records, for the period of April 2004 to December 2011, on emergency department visits of patients suffering from conjunctivitis. A total of 77 439 emergency department visits for conjunctivitis were analyzed. A time-stratified case-crossover design was applied, completed with meta-analysis in order to pool inter-city results. Odds ratio (OR for an emergency department visit was calculated in different population strata per one-unit increase (one interquartile range – IQR increase in a pollutant’s daily level while controlling for the impacts of temperature and relative humidity. Results: Statistically significant positive results were observed in the female population sample, for nitrogen dioxide (NO2 exposure lagged 5–8 days, with the highest result for the 7-day lag (OR = 1.035, 95% CI: 1.018–1.052 and for fine particulate matter with a median aerodynamic diameter of less than 2.5 μm (PM2.5, for lags 6 and 7 days, with the highest result for lag 7 (OR = 1.017, 95% CI: 1.003–1.031. In the male population sample, statistically significant positive results were observed for NO2 at lag 5 days (OR = 1.024, 95% CI: 1.004–1.045 and for ozone (O3, at lags 0–3 and 7 days, with the highest result for lag 0 (OR = 1.038, 95% CI: 1.012–1.056. Also for males, statistically significant results were observed in the case of PM2.5 exposure lagged by 5 days (OR = 1.003, 95% CI: 1.000–1.038 and sulfur dioxide (SO2 exposure lagged by 1 and 2 days (OR = 1.016, 95% CI: 1.000–1.031 and OR = 1.018, 95% CI: 1.002–1.033. Conclusions: The findings of this study suggest that there are associations between levels of air
Evaluation of emergency department nursing services and patient satisfaction of services.
Mollaoğlu, Mukadder; Çelik, Pelin
2016-10-01
To identify nursing services and assess patient satisfaction in patients who present to the emergency department. Emergency nursing care is a significant determinant of patient satisfaction. Patient satisfaction is often regarded as a reliable indicator of the quality of services provided in the emergency department. This is a descriptive study. Eighty-four patients who presented to the university emergency department were included in the study. The study data were collected by the Patient Information Form and the Satisfaction Level Form. Emergency nursing services, including history taking, assessing vital signs, preparing the patient for an emergency intervention, oxygen therapy, drug delivery and blood-serum infusion were shown to be more commonly provided compared with other services such as counselling the patients and the relatives about their care or delivering educational and psychosocial services. However, 78·6% of the patients were satisfied with their nursing services. The highest satisfaction rates were observed in the following sub-dimensions of the Satisfaction Level Form: availability of the nurse (82·1%), behaviour of the nurse towards the patient (78·6%) and the frequency of nursing rounds (77·4%). The most common practices performed by nurses in the emergency department were physical nursing services. Patient satisfaction was mostly associated with the availability of nurses when they were needed. Our results suggest that in addition to the physical care, patients should also receive education and psychosocial care in the emergency department. We believe that this study will contribute to the awareness and understanding of principles and concepts of emergency nursing, extend the limits of nursing knowledge and abilities, and improve and maintain the quality of clinical nursing education and practice to train specialist nurses with high levels of understanding in ethical, intellectual, administrative, investigative and professional issues.
Ahanhanzo, Yolaine Glèlè; Kpozehouen, Alphonse; Sopoh, Ghislain; Sossa-Jérôme, Charles; Ouedraogo, Laurent; Wilmet-Dramaix, Michèle
2016-01-01
The management of health information is a key pillar in both emergencies reception and handling facilities, given the strategic position and the potential of these facilities within hospitals, and in the monitoring of public health and epidemiology. With the technological revolution, computerization made the information systems evolve in emergency departments, especially in developed countries, with improved performance in terms of care quality, productivity and patient satisfaction. This study analyses the situation of Benin in this field, through the case of the Academic Clinic of Emergency Department of the National University Teaching Hospital of Cotonou, the national reference hospital. The study is cross-sectional and evaluative. Collection techniques are literature review and structured interviews. The components rated are resources, indicators, data sources, data management and the use-dissemination of the information through a model adapted from Health Metrics Network framework. We used quantitative and qualitative analysis. The absence of a regulatory framework restricts the operation of the system in all components and accounts for the lack and inadequacy of the dedicated resources. Dedication of more resources for this system for crucial needs such as computerization requires sensitization and greater awareness of the administrative authorities about the fact that an effective health information management system is of prime importance in this type of facility.
Effects of Systematic Screening and Detection of Child Abuse in Emergency Departments
Louwers, Eveline C. F. M.; Korfage, Ida J.; Affourtit, Marjo J.; Scheewe, Dop J. H.; van de Merwe, Marjolijn H.; Vooijs-Moulaert, Anne-Françoise S. R.; van den Elzen, Annette P. M.; Jongejan, Mieke H. T. M.; Ruige, Madelon; Manaï, Badies H. A. N.; Looman, Caspar W. N.; Bosschaart, Adriaan N.; Teeuw, Arianne H.; Moll, Henriëtte A.; de Koning, Harry J.
2012-01-01
OBJECTIVE: Although systematic screening for child abuse of children presenting at emergency departments might increase the detection rate, studies to support this are scarce. This study investigates whether introducing screening, and training of emergency department nurses, increases the detection
Sport and active recreation injuries in Australia: evidence from emergency department presentations
Finch, C.; Valuri, G.; Ozanne-Smith, J.
1998-01-01
OBJECTIVE: Despite the rise in specialist clinical services for the management of sports and active recreation injury, many patients attend hospital emergency departments for treatment. The purpose of this study was to describe sports injury cases presented to selected hospital emergency departments around Australia for the period 1989-1993. METHODS: Routinely collected emergency department injury presentation data from the Australian National Injury Surveillance Unit were examined. Dat...
The Profile of Neurology Patients Evaluated in the Emergency Department
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Ufuk Emre
2009-09-01
Full Text Available OBJECTIVE: Early, rapid, and multidisciplinary approaches are very important in the diagnosis of neurological disorders in emergency departments. The present study aimed to investigate the features of patients that presented for neurology consultation in the emergency department. METHODS: The present study included 780 patients. Patient demographic features, reasons for emergent treatment and neurological consultation, neurological diagnosis by the neurologist, and laboratory (total blood count, serum glucose level, urea, creatine, erythrocyte sedimentation rate, and D-dimer levels and imaging findings were retrospectively evaluated based on patient charts. RESULTS: Impaired consciousness was the most frequent reason for neurological consultation (19.7%. Among these patients, ischemic stroke was diagnosed in 27.9%, hypoxic encephalopathy in 18.2%, cerebral hemorrhage in 9.1%, and 11% had no neurological diagnosis. Other common reasons for neurological consultation were vertigo, headache, seizure, and stroke. Clinical findings were related to other systemic causes in 43.7% of the study group. Focal neurological findings were present, especially in patients that presented with ischemic and hemorrhagic stroke, epilepsy, and hypoxic encephalopathy. CONCLUSION: In emergency departments, metabolic causes should be ruled out in patients with impaired consciousness and the absence of focal neurological signs. Intracranial structural disorders must be evaluated when focal neurological signs are present. Cautiously prepared algorithms and neurological examination training will help improve the accuracy of emergency department diagnoses
Cheong, Chang Heon; Lee, Seonhye
2018-03-13
The prevention of airborne infections in emergency departments is a very important issue. This study investigated the effects of architectural features on airborne pathogen dispersion in emergency departments by using a CFD (computational fluid dynamics) simulation tool. The study included three architectural features as the major variables: increased ventilation rate, inlet and outlet diffuser positions, and partitions between beds. The most effective method for preventing pathogen dispersion and reducing the pathogen concentration was found to be increasing the ventilation rate. Installing partitions between the beds and changing the ventilation system's inlet and outlet diffuser positions contributed only minimally to reducing the concentration of airborne pathogens.
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
2017-02-01
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.
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Kamphuis Helen CM
2008-11-01
Full Text Available Abstract Background Accident and emergency (A&E departments and general practitioner (GP posts are often used inappropriately, leading to overcrowding. In the Netherlands, increasingly more integrated emergency posts (IEPs are being created, integrating the care provided by GP posts and A&E departments, in order to improve the provision of the emergency care. Methods This explorative study compares the efficiency and patient and employee satisfaction in IEPs with those in two GP posts and two A&E departments. To this end, information was retrieved from hospital and GP patient records for the first quarter of the year before and of the year after the creation of IEPs. Patients and employees were sent a questionnaire to measure their satisfaction. Lastly, groups of hospital doctors, GPs, GP assistants, and nurses were interviewed. Results After the creation of IEPs, there was a shift of more than fifteen percent from secondary care to primary care for emergency consultations and waiting/consultation times were shortened by more than ten percent. Compared with the control settings, patients were more satisfied about telephone contact with an IEP, but professionals working at the IEP were less satisfied with several aspects of their work. Conclusion IEPs could be a promising innovation to organize emergency care more efficiently; however, it might take time to convince professionals of the possible advantages. Studies involving more IEPs and longer follow-up times are needed to determine whether such integration should be stimulated.
Kool, Rudolf B; Homberg, Daniel J; Kamphuis, Helen C M
2008-11-04
Accident and emergency (A&E) departments and general practitioner (GP) posts are often used inappropriately, leading to overcrowding. In the Netherlands, increasingly more integrated emergency posts (IEPs) are being created, integrating the care provided by GP posts and A&E departments, in order to improve the provision of the emergency care. This explorative study compares the efficiency and patient and employee satisfaction in IEPs with those in two GP posts and two A&E departments. To this end, information was retrieved from hospital and GP patient records for the first quarter of the year before and of the year after the creation of IEPs. Patients and employees were sent a questionnaire to measure their satisfaction. Lastly, groups of hospital doctors, GPs, GP assistants, and nurses were interviewed. After the creation of IEPs, there was a shift of more than fifteen percent from secondary care to primary care for emergency consultations and waiting/consultation times were shortened by more than ten percent. Compared with the control settings, patients were more satisfied about telephone contact with an IEP, but professionals working at the IEP were less satisfied with several aspects of their work. IEPs could be a promising innovation to organize emergency care more efficiently; however, it might take time to convince professionals of the possible advantages. Studies involving more IEPs and longer follow-up times are needed to determine whether such integration should be stimulated.
Child maltreatment, parents & the emergency department
Hoytema van Konijnenburg, E.M.M.
2015-01-01
The research described in this thesis focuses on the evaluation of several methods of screening for child maltreatment at the emergency department, with an emphasis on screening based on parental risk factors (‘child check’). The use of a screening checklist (mandatory in all Dutch emergency
Eick, Christian; Rizas, Konstantinos D; Meyer-Zürn, Christine S; Groga-Bada, Patrick; Hamm, Wolfgang; Kreth, Florian; Overkamp, Dietrich; Weyrich, Peter; Gawaz, Meinrad; Bauer, Axel
2015-05-01
To evaluate heart rate deceleration capacity, an electrocardiogram-based marker of autonomic nervous system activity, as risk predictor in a medical emergency department and to test its incremental predictive value to the modified early warning score. Prospective cohort study. Medical emergency department of a large university hospital. Five thousand seven hundred thirty consecutive patients of either sex in sinus rhythm, who were admitted to the medical emergency department of the University of Tübingen, Germany, between November 2010 and March 2012. None. Deceleration capacity of heart rate was calculated within the first minutes after emergency department admission. The modified early warning score was assessed from respiratory rate, heart rate, systolic blood pressure, body temperature, and level of consciousness as previously described. Primary endpoint was intrahospital mortality; secondary endpoints included transfer to the ICU as well as 30-day and 180-day mortality. One hundred forty-two patients (2.5%) reached the primary endpoint. Deceleration capacity was highly significantly lower in nonsurvivors than survivors (2.9 ± 2.1 ms vs 5.6 ± 2.9 ms; p model yielded an area under the receiver-operator characteristic curve of 0.706 (0.667-0.750). Implementing deceleration capacity into the modified early warning score model led to a highly significant increase of the area under the receiver-operator characteristic curve to 0.804 (0.770-0.835; p capacity was also a highly significant predictor of 30-day and 180-day mortality as well as transfer to the ICU. Deceleration capacity is a strong and independent predictor of short-term mortality among patients admitted to a medical emergency department.
FAST scanning in the developing world emergency department ...
African Journals Online (AJOL)
FAST scanning in the developing world emergency department. ZA Smith, N Postma, D Wood. Abstract. Objectives. To assess the utility of an existing ultrasound machine for the purposes of focused assessment sonography in trauma (FAST) scanning in a developing world emergency department (ED). Design. Prospective ...
Physician Assistants and Nurse Practitioners in Rural Washington Emergency Departments.
Nelson, Scott C; Hooker, Roderick S
2016-06-01
One role of physician assistants (PAs) and nurse practitioners (NPs) is to meet the growing demand for access to rural health care. Critical Access Hospitals, those with less than 25 beds, are usually located in rural communities, often providing continuity of care that clinics cannot deliver. Because little is known about staffing in these small hospital emergency departments, an exploratory study was undertaken using a mixed-methods approach. In Washington State, 18 of the 39 Critical Access Hospitals staff their emergency departments with PAs and NPs. Utilization data were collected through structured interviews by phone or in person on site. Most PAs and NPs lived within the community and staffing tended to be either 24 hours in-house or short notice if they lived or worked nearby. Emergency department visits ranged from 200 to 25,000 per year. All sites were designated level V or IV trauma centers and often managed cardiac events, significant injuries and, in some larger settings, obstetrics. In most instances, PAs were the sole providers in the emergency departments, albeit with physician backup and emergency medical technician support if a surge of emergency cases arose. Two-thirds of the PAs had graduated within the last 5 years. Most preferred the autonomy of the emergency department role and all expressed job satisfaction. Geographically, the more remote a Washington State Critical Access Hospital is, the more likely it will be staffed by PAs/NPs. The diverse utilization of semiautonomous PAs and NPs and their rise in rural hospital employment is a new workforce observation that requires broader investigation.
Emergency department discharge prescription interventions by emergency medicine pharmacists.
Cesarz, Joseph L; Steffenhagen, Aaron L; Svenson, James; Hamedani, Azita G
2013-02-01
We determine the rate and details of interventions associated with emergency medicine pharmacist review of discharge prescriptions for patients discharged from the emergency department (ED). Additionally, we evaluate care providers' satisfaction with such services provided by emergency medicine pharmacists. This was a prospective observational study in the ED of an academic medical center that serves both adult and pediatric patients. Details of emergency medicine pharmacist interventions on discharge prescriptions were compiled with a standardized form. Interventions were categorized as error prevention or optimization of therapy. The staff of the ED was surveyed related to the influence and satisfaction of this new emergency medicine pharmacist-provided service. The 674 discharge prescriptions reviewed by emergency medicine pharmacists during the study period included 602 (89.3%) for adult patients and 72 (10.7%) for pediatric patients. Emergency medicine pharmacists intervened on 68 prescriptions, resulting in an intervention rate of 10.1% (95% confidence interval [CI] 8.0% to 12.7%). The intervention rate was 8.5% (95% CI 6.4% to 11.1%) for adult prescriptions and 23.6% for pediatric prescriptions (95% CI 14.7% to 35.3%) (difference 15.1%; 95% CI 5.1% to 25.2%). There were a similar number of interventions categorized as error prevention and optimization of medication therapy, 37 (54%) and 31 (46%), respectively. More than 95% of survey respondents believed that the new pharmacist services improved patient safety, optimized medication regimens, and improved patient satisfaction. Emergency medicine pharmacist review of discharge prescriptions for discharged ED patients has the potential to significantly improve patient care associated with suboptimal prescriptions and is highly valued by ED care providers. Copyright © 2012. Published by Mosby, Inc.
Pun, Jack Kh; Chan, Engle Angela; Murray, Kristen A; Slade, Diana; Matthiessen, Christian Mim
2017-11-01
consultation. The findings reveal that the quality of communication in this Hong Kong emergency department is compromised by specific factors inherent in the linguistic complexity of Hong Kong emergency departments. These factors include the constant translation of medical information, inadequate documentation of medical information and significant professional and cultural pressures. Each of these issues increases the likelihood that healthcare communication will be difficult, incomplete or incorrect. This research provides empirical evidence for, and justifies the development of, an effective framework to enable clinicians to overcome communication challenges. The findings of this study may shed light on the unique conditions faced by clinicians, particularly in relation to communication, in the complex trilingual healthcare context of an emergency department similar to those in Hong Kong, and provide potential policy solutions for barriers to improve communication in such settings. © 2016 John Wiley & Sons Ltd.
Chen, Li-Chin; Lin, Chun-Chih; Han, Chin-Yen; Hsieh, Chun-Lan; Wu, Chiung-Jung Jo; Liang, Hwey-Fang
2018-03-01
This study aims to gain in-depth understanding of nurses' perspectives of working in an overcrowded emergency. Symbolic interactionism and Charmaz's construction of grounded theory were used. Purposive sampling at the start of the study and a further theoretical sampling by snowball technique were used to recruit 40 registered nurses (RN) to participate in in-depth, semi-structured interviews between May and November, 2014. Data analysis included analytic techniques of initial, focused and theoretical coding. Study findings showed searching for work role is derived by the themes of Finding the role of positioning in Emergency Department (ED), Recognizing causes of ED overcrowding, and Confined working environment. Nurses' work experience which represents the RNs not gained control over their work, as care actions influenced by the problematic overcrowded circumstance of the ED environment. The findings fill a gap in knowledge about how RNs experience their work role in the context of an overcrowded Emergency Department in Taiwan. Arising from the study result include taking account of nurses' perspectives when planning staff/patient ratios, strategies to reduce waiting time and ensure that clients receive appropriate care. Copyright © 2018. Published by Elsevier B.V.
Emergency Department Management of Delirium in the Elderly
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Lynn E.J. Gower, DO
2012-05-01
Full Text Available An increasing number of elderly patients are presenting to the emergency department. Numerousstudies have observed that emergency physicians often fail to identify and diagnose delirium in theelderly. These studies also suggest that even when emergency physicians recognized delirium, theystill may not have fully appreciated the import of the diagnosis. Delirium is not a normal manifestation ofaging and, often, is the only sign of a serious underlying medical condition. This article will review thesignificance, definition, and principal features of delirium so that emergency physicians may betterappreciate, recognize, evaluate, and manage delirium in the elderly.
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Steffie H A Brouns
Full Text Available 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, p<0.001, and a peak in both mEDWIN (0.30-0.33 and ED crowding (52.9-63.4% was found between 13:00-18:00 h. A comparison of the mEDWIN with the occupancy 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.
Reliability and validity of emergency department triage systems
van der Wulp, I.
2010-01-01
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
Violence against emergency department employees and the attitude of employees towards violence.
Çıkrıklar, H Í; Yürümez, Y; Güngör, B; Aşkın, R; Yücel, M; Baydemir, C
2016-10-01
This study was conducted to evaluate the occurrence of violent incidents in the workplace among the various professional groups working in the emergency department. We characterised the types of violence encountered by different occupation groups and the attitude of individuals working in different capacities. This cross-sectional study included 323 people representing various professional groups working in two distinct emergency departments in Turkey. The participants were asked to complete questionnaires prepared in advance by the researchers. The data were analysed using the Statistical Package for the Social Sciences (Windows version 15.0). A total of 323 subjects including 189 (58.5%) men and 134 (41.5%) women participated in the study. Their mean (± standard deviation) age was 31.5 ± 6.5 years and 32.0 ± 6.9 years, respectively. In all, 74.0% of participants had been subjected to verbal or physical violence at any point since starting employment in a medical profession. Moreover, 50.2% of participants stated that they had been subjected to violence for more than 5 times. Among those who reported being subjected to violence, 42.7% had formally reported the incident(s). Besides, 74.3% of participants did not enjoy their profession, did not want to work in the emergency department, or would prefer employment in a non-health care field after being subjected to violence. According to the study participants, the most common cause of violence was the attitude of patients or their family members (28.7%). In addition, 79.6% (n=257) of participants stated that they did not have adequate safety protection in their working area. According to the study participants, there is a need for legal regulations to effectively deter violence and increased safety measures designed to reduce the incidence of violence in the emergency department. Violence against employees in the emergency department is a widespread problem. This situation has a strong negative effect on employee
Violence toward health care workers in emergency departments in Denizli, Turkey.
Boz, Bora; Acar, Kemalettin; Ergin, Ahmet; Erdur, Bulent; Kurtulus, Ayse; Turkcuer, Ibrahim; Ergin, Nesrin
2006-01-01
This study sought to determine the frequency and types of violence that occurred during the previous year against health care workers in emergency departments in Denizli, Turkey, and to discern the views of workers on the prevention of such aggressive behavior. This study was conducted from March 1 to April 15, 2003, and included a group of 79 health care workers from the emergency departments of 3 hospitals in Denizli, namely, the Hospital of Pamukkale University Medical Faculty, the City Hospital of Denizli, and the Hospital of the Social Insurance Foundation. Data were collected from a self-administered questionnaire. In all, 88.6% of participants had been subjected to or had witnessed verbal violence, and 49.4% of them had been subjected to or had witnessed physical violence during the previous year. The most frequent reason (31.4%) for violence was abuse of alcohol and drugs by perpetrators. The second most frequent reason (24.7%) was the long waiting times typical of emergency departments. The most common type of violence was loud shouting; swearing, threatening, and hitting were the next most frequent violent behaviors. In all, 36.1% of subjects who had experienced violence reported that they developed psychological problems after the incident. Most participants commented on the insufficiency of currently available security systems within emergency departments and on the need for further training about violence. All health care personnel within emergency departments should be aware of the risk of violence and should be prepared for unpredictable conditions and events; in addition, security systems should be updated so that violence within emergency departments can be prevented.
Conflicts between managed care organizations and emergency departments in California.
Johnson, L A; Derlet, R W
1996-01-01
To control costs, managed care organizations have begun to restrict the use of hospital emergency departments by their enrollees. They are doing this by educating enrollees, providing better access to 24-hour urgent care, denying preauthorizations for care for some patients who do present to emergency departments, and retrospectively denying payment for certain patients who use emergency services. Changing traditional use of emergency departments has resulted in conflicts between managed care...
Love, Jennifer S; Karp, David; Delgado, M Kit; Margolis, Gregg; Wiebe, Douglas J; Carr, Brendan G
2016-08-01
Boarding admitted patients decreases emergency department (ED) capacity to accommodate daily patient surge. Boarding in regional hospitals may decrease the ability to meet community needs during a public health emergency. This study examined differences in regional patient boarding times across the United States and in regions at risk for public health emergencies. A retrospective cross-sectional analysis was performed by using 2012 ED visit data from the American Hospital Association (AHA) database and 2012 hospital ED boarding data from the Centers for Medicare and Medicaid Services Hospital Compare database. Hospitals were grouped into hospital referral regions (HRRs). The primary outcome was mean ED boarding time per HRR. Spatial hot spot analysis examined boarding time spatial clustering. A total of 3317 of 4671 (71%) hospitals were included in the study cohort. A total of 45 high-boarding-time HRRs clustered along the East/West coasts and 67 low-boarding-time HRRs clustered in the Midwest/Northern Plains regions. A total of 86% of HRRs at risk for a terrorist event had high boarding times and 36% of HRRs with frequent natural disasters had high boarding times. Urban, coastal areas have the longest boarding times and are clustered with other high-boarding-time HRRs. Longer boarding times suggest a heightened level of vulnerability and a need to enhance surge capacity because these regions have difficulty meeting daily emergency care demands and are at increased risk for disasters. (Disaster Med Public Health Preparedness. 2016;10:576-582).
Evaluation of Pediatric Forensic Cases in Emergency Department: A Retrospective Study
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Tanzer Korkmaz
2014-12-01
Full Text Available Aim: Our aim was to evaluate the properties of pediatric forensic cases and to discuss the precautions in order to prevent the occurrence of these forensic events. Methods: The patient files and forensic reports of pediatric (age 0-18 years forensic cases, who were referred to the emergency department in our hospital between January 01, 2009 and December 31, 2011 were retrospectively investigated. Results: A total of 421 forensic pediatric cases with a median age of 9.9±5.5 years were included in the study. Off the cases, 61% (n=257 were male and 47.3% were in 5-14 age group. The type of the events were traffic accident (50.4%, fall (18.3%, stab injuries (10.9%, intoxication (5.9%, pounding (5.0% and other incidents (9.5%. There were nine cases of suicide attempt (all of them were above 14 years of age and four cases of physical abuse (three of them were under 15 years of age. After the observation period, 79.8% of the cases were discharged from the emergency department, whilst 20.2% of cases were hospitalized in one of the clinics. Conclusion: Because most of the cases were traffic accident, this situation show us that these injuries are preventable. Prevention and intervention strategies should be developed for providing a safe environment for children.
Demographic, Seasonal, and Geographic Differences in Emergency Department Visits for Epistaxis.
Chaaban, Mohamad R; Zhang, Dong; Resto, Vicente; Goodwin, James S
2017-01-01
Objective To determine the demographics and seasonal and geographic variation of epistaxis in the United States. Study Design Retrospective cohort analysis based on data from Medicare claims. Setting Emergency department visits. Subjects and Methods We used a 5% sample of Medicare data from January 2012 to December 2012. Our cohort included patients with an incident diagnosis of epistaxis during a visit to the emergency department, excluding those with a diagnosis in the prior 12 months. Demographics included age, sex, race, and ethnicity. We compared the rate of emergency department visits for epistaxis by geographic division and individual states. Results In the 5% sample of Medicare data, 4120 emergency department visits for incident epistaxis were identified in 2012. Our results showed an increase in the emergency department visits for epistaxis with age. Compared with patients 85 years old were 1.36 (95% confidence interval [95% CI], 1.23-1.50), 2.37 (95% CI, 2.14-2.62), and 3.24 (95% CI, 2.91-3.62) more likely to present with epistaxis, respectively. Men were 1.24 (95% CI, 1.17-1.32) times more likely to present with epistaxis than women. Blacks were 1.23 (95% CI, 1.10-1.36) times more likely to present with epistaxis when compared with non-Hispanic whites. Epistaxis emergency department visits were 40% lower in the summer months versus winter. The seasonal variation was more pronounced in the northern versus southern United States. Conclusion Emergency department visits for epistaxis increase with age and appear to be seasonal, with a more pronounced variation in the northern versus southern United States.
Emergency Department and Older Adult Motor Vehicle Collisions
Directory of Open Access Journals (Sweden)
Lotfipour, Shahram
2013-11-01
Full Text Available In 2009, the Center for Disease Control and Prevention reported there were 33 million licensed drivers 65 years and older in the U.S. This represents a 23 percent increase from 1999, number that is predicted to double by 2030. Although, motor vehicle collisions (MVC-related to emergency department (ED visits for older adults are lower per capita than for younger adults, the older-adults MVCs require more resources, such as additional diagnostic imaging and increased odds of admission. Addressing the specific needs of older-adults could lead to better outcomes yet not enough research currently exists. It is important to continue training emergency physicians to treat the increasing older-patient population, but its also imperative we increase our injury prevention and screening methodology. We review research findings from the article: Emergency Department Visits by Older Adults for Motor Vehicle Collisions: A Five-year national study, with commentary on current recommendation and policies for the growing older-adult driving population. [West J Emerg Med.2013;14(6:582–584.
Khan, Nadeem; Pérez-Núñez, Ricardo; Shamim, Nudrat; Khan, Uzma; Naseer, Naureen; Feroze, Asher; Razzak, Junaid; Hyder, Adnan A
2015-01-01
Acute poisoning is one of the most common reasons for emergency department visits around the world. In Pakistan, the epidemiological data on poisoning is limited due to an under developed poison information surveillance system. We aim to describe the characteristics associated with intentional and unintentional poisoning in Pakistan presenting to emergency departments. The data was extracted from the Pakistan National Emergency Department Surveillance (Pak-NEDS) which was an active surveillance conducted between November 2010 and March 2011. All patients, regardless of age, who presented with poisoning to any of Pakistan's seven major tertiary care centers' emergency departments, were included. Information about patient demographics, type of poisoning agent, reason for poisoning and outcomes were collected using a standard questionnaire. Acute poisoning contributed to 1.2% (n = 233) of patients with intentional and unintentional injuries presenting to EDs of participating centers. Of these, 68% were male, 54% were aged 19 to 44 and 19% were children and adolescents (<18 years). Types of poisoning included chemical/gas (43.8%), drug/medicine (27%), alcohol (16.7%) and food/plant (6%). In half of all patients the poisoning was intentional. A total of 11.6% of the patients were admitted and 6.6% died. Poisoning causes more morbidity and mortality in young adults in Pakistan compared to other age groups, half of which is intentional. Improving mental health, regulatory control for hazardous chemicals and better access to care through poison information centers and emergency departments will potentially help control the problem.
Advertising Emergency Department Wait Times
Weiner, Scott G
2013-01-01
Advertising emergency department (ED) wait times has become a common practice in the United States. Proponents of this practice state that it is a powerful marketing strategy that can help steer patients to the ED. Opponents worry about the risk to the public health that arises from a patient with an emergent condition self-triaging to a further hospital, problems with inaccuracy and lack of standard definition of the reported time, and directing lower acuity patients to the higher cost ED se...
Olive, Philippa
2017-08-01
To explore the naming, or classification, of physical assaults by a partner as 'intimate partner violence' during emergency department consultations. Research continues to evidence instances when intimate partner physical violence is 'missed' or unacknowledged during emergency department consultations. Theoretically, this research was approached through complexity theory and the sociology of diagnosis. Research design was an applied, descriptive and explanatory, multiple-method approach that combined qualitative semistructured interviews with service-users (n = 8) and emergency department practitioners (n = 9), and qualitative and quantitative document analysis of emergency department health records (n = 28). This study found that multiple classifications of intimate partner violence were mobilised during emergency department consultations and that these different versions of intimate partner violence held different diagnostic categories, processes and consequences. The construction of different versions of intimate partner violence in emergency department consultations could explain variance in people's experiences and outcomes of consultations. The research found that the classificatory threshold for 'intimate partner violence' was too high. Strengthening systems of diagnosis (identification and intervention) so that all incidents of partner violence are named as 'intimate partner violence' would reduce the incidence of missed cases and afford earlier specialist intervention to reduce violence and limit its harms. This research found that identification of and response to intimate partner violence, even in contexts of severe physical violence, was contingent. By lowering the classificatory threshold so that all incidents of partner violence are named as 'intimate partner violence', practitioners could make a significant contribution to reducing missed intimate partner violence during consultations and improving health outcomes for this population. This
Situational Factors Associated With Burnout Among Emergency Department Nurses.
Rozo, Jose Andres; Olson, DaiWai M; Thu, Hlaing Sue; Stutzman, Sonja E
2017-06-01
Emergency departments are high-stress environments for patients and clinicians. As part of the clinical team, nurses experience this stress daily and are subject to high levels of burnout, which has been shown to lead to hypertension, depression, and anxiety. Presence of these diseases may also contribute to burnout, creating a cycle of stress and illness. This prospective qualitative study used a phenomenological approach to better understand factors associated with burnout among emergency department nurses. Burnout manifests itself in multiple modes, can affect nurses' decisions to leave the profession, and must be addressed to mitigate the phenomenon.
Emergency Department Crowding: Factors Influencing Flow
Arkun, Alp; Briggs, William M; Patel, Sweha; Datillo, Paris A; Bove, Joseph; Birkhahn, Robert H
2010-01-01
Background: The objective of this study was to evaluate those factors, both intrinsic and extrinsic to the emergency department (ED) that influence two specific components of throughput: “door-to-doctor” time and dwell time. Methods: We used a prospective observational study design to determine the variables that played a significant role in determining ED flow. All adult patients seen or waiting to be seen in the ED were observed at 8pm (Monday-Friday) during a three-month period. V...
Implementing evidence-based practices in an emergency department
DEFF Research Database (Denmark)
Kirk, Jeanette W.; Nilsen, Per
2016-01-01
of semi-structured interviews. An activity system analysis, as described in the Cultural Historical Activity Theory, was conducted to identify various contradictions that could exist between different parts of the activity system. RESULTS: The main contradiction identified was that guidelines......BACKGROUND: An emergency department is typically a place of high activity where practitioners care for unanticipated presentations, which yields a flow culture so that actions that secure available beds are prioritised by the practitioners. OBJECTIVES: How does the flow culture in an emergency...... 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...
Wait Time for Treatment in Hospital Emergency Departments: 2009
... Medical Care Survey: 2003 emergency department summary. Advance data from vital and health statistics; no 358. Hyattsville, MD: National Center for Health Statistics. 2005. Burt CW, McCaig LF, Valverde RH. Analysis of ambulance diversions in U.S. emergency departments. Ann ...
Redley, Bernice; Botti, Mari; Wood, Beverley; Bucknall, Tracey
2017-08-01
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.
Multidisciplinary evaluation of an emergency department nurse navigator role: A mixed methods study.
Jessup, Melanie; Fulbrook, Paul; Kinnear, Frances B
2017-09-20
To utilise multidisciplinary staff feedback to assess their perceptions of a novel emergency department nurse navigator role and to understand the impact of the role on the department. Prolonged emergency department stays impact patients, staff and quality of care, and are linked to increased morbidity and mortality. One innovative strategy to facilitate patient flow is the navigator: a nurse supporting staff in care delivery to enhance efficient, timely movement of patients through the department. However, there is a lack of rigorous research into this emerging role. Sequential exploratory mixed methods. A supernumerary emergency department nurse navigator was implemented week-off-week-on, seven days a week for 20 weeks. Diaries, focus groups, and an online survey (24-item Navigator Role Evaluation tool) were used to collect and synthesise data from the perspectives of multidisciplinary departmental staff. Thematic content analysis of cumulative qualitative data drawn from the navigators' diaries, focus groups and survey revealed iterative processes of the navigators growing into the role and staff incorporating the role into departmental flow, manifested as: Reception of the role and relationships with staff; Defining the role; and Assimilation of the role. Statistical analysis of survey data revealed overall staff satisfaction with the role. Physicians, nurses and others assessed it similarly. However, only 44% felt the role was an overall success, less than half (44%) considered it necessary, and just over a third (38%) thought it positively impacted inter-professional relationships. Investigation of individual items revealed several areas of uncertainty about the role. Within-group differences between nursing grades were noted, junior nurses rating the role significantly higher than more senior nurses. Staff input yielded invaluable insider feedback for ensuing modification and optimal instigation of the navigator role, rendering a sense of departmental
Nurse-Physician Teamwork in the Emergency Department
Ajeigbe, David Oladipo
2012-01-01
Background: Teamwork gained momentum in the 1980s. Research studies in the military and aviation demonstrated that teamwork is essential to safety. There were limited studies dealing with the practice of teamwork between nurses and physicians in the Emergence Departments (EDs). Aims: Descriptive aim of the study was to examine differences between staff in the Interventional and Control Groups on perception of staff teamwork. The exploratory aim was to examine staff perception of job satisfac...
Assessment of Pain Management in Pediatric Emergency Department in Mashhad -Iran
Directory of Open Access Journals (Sweden)
Ahmadshah Farhat
2013-12-01
Full Text Available Introduction: Pain may be described as a sensation of hurt or strong discomfort and is the body's way of sending message to the brain that an injury has occurred. Pain medicines block these messages or reduce their effect on the brain. Accurate administration of analgesia have a long –lasting effect on children whole experience of medical care and affects parents' and children's future reaction to pediatrics emergency departments. The purpose of this study was to evaluate pain management on children in our emergency department. Materials and Methods: In this study we evaluated the relief of pain and anxiety on 100 children who referred to our pediatric Emergency Department (ED in Imam Reza Hospital- Mashhad .The patients were assessed based on the American Academy of Pediatrics (AAP recommendations about pain. Results: Patients were gone under IV Line 97%, Intubation 5% and Lumbar Puncture 28%. Training had been provided to 70% participants in the Emergency Department. Nonpharmacologic stress reduction was used in 35% of cases. Family presence was allowed only in 5%. Prehospital pain controlling was began on 20% of patients and continued in ED on 40%. At the time of discharge 40% prescribed analgesics. Sedation and pain prophylaxis was provided for 10% of patients undergoing painful procedures in ED. Conclusion: According to results, pain management in our Pediatric Emergency Department was inadequate. Physicians and prehospital EMS providers should be justified about the importance of pain relieving and trained how to use all available analgesic and sedative options.
Carrico, Ruth; Goss, Linda
2005-01-01
Electronic syndromic surveillance may have value in detecting emerging pathogens or a biological weapons release. Hospitals that have an agile process to evaluate chief complaints of patients seeking emergency care may be able to more quickly identify subtle changes in the community's health. An easily adaptable prototype system was developed to monitor emergency department patient visits during the Kentucky Derby Festival in Louisville, Kentucky, from April 16-May 14, 2002. Use of the system was continued during the same festival periods in 2003 and 2004. Twelve area hospitals in Louisville, Kentucky, participated in a prospective analysis of the chief symptoms of patients who sought care in the emergency department during the Kentucky Derby Festival during 2002. Six hospitals were classified as computer record groups (CRG) and used their existing computerized record capabilities. The other 6 hospitals used a personal digital assistant (PDA) with customized software (PDA group). Data were evaluated by the health department epidemiologist using SaTScan, a modified version of a cancer cluster detection program, to look for clusters of cases above baseline over time and by Zip code. All 12 hospitals were able to collect and provide data elements during the study period. The 6 CRG hospitals were able to perform daily data transmission; however, 3 CRG hospitals were unable to interpret their data because it was transmitted in pure text format. In contrast, data from all 6 PDA group hospitals were interpretable. Real-time data analysis was compared with post-event data, and it was found that the real-time evaluation correctly identified no unusual disease activity during the study period. The 12 hospitals participating in this study demonstrated that community-wide surveillance using computerized data was possible and that the 6 study hospitals using a PDA could quickly interpret emergency department patients' chief complaints. The emergency department chief complaints
Langabeer, James R; Gonzalez, Michael; Alqusairi, Diaa; Champagne-Langabeer, Tiffany; Jackson, Adria; Mikhail, Jennifer; Persse, David
2016-11-01
Emergency medical services (EMS) agencies transport a significant majority of patients with low acuity and non-emergent conditions to local emergency departments (ED), affecting the entire emergency care system's capacity and performance. Opportunities exist for alternative models that integrate technology, telehealth, and more appropriately aligned patient navigation. While a limited number of programs have evolved recently, no empirical evidence exists for their efficacy. This research describes the development and comparative effectiveness of one large urban program. The Houston Fire Department initiated the Emergency Telehealth and Navigation (ETHAN) program in 2014. ETHAN combines telehealth, social services, and alternative transportation to navigate primary care-related patients away from the ED where possible. Using a case-control study design, we describe the program and compare differences in effectiveness measures relative to the control group. During the first 12 months, 5,570 patients participated in the telehealth-enabled program, which were compared against the same size control group. We found a 56% absolute reduction in ambulance transports to the ED with the intervention compared to the control group (18% vs. 74%, P models are effective at reducing unnecessary ED ambulance transports and increasing EMS unit productivity. This provides support for broader EMS mobile integrated health programs in other regions.
Alcohol-related presentations to emergency departments in Ireland: a descriptive prevalence study
LENUS (Irish Health Repository)
McNicholl, Brian
2018-05-24
To determine the prevalence of alcohol-related presentations in all 29 emergency departments (EDs) in Ireland and compare with non-alcohol-related presentations in order to identify opportunities for improvements in the quality of patient care and related data collection.
Shock in the emergency department
DEFF Research Database (Denmark)
Holler, Jon Gitz; Henriksen, Daniel Pilsgaard; Mikkelsen, Søren
2016-01-01
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...... 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...
DEMİRCAN, Ahmet; KELEŞ, Ayfer; GÜRBÜZ, Neslihan; BİLDİK, Fikret
2008-01-01
Aims: Clinical forensic medicine deals with cases involving both the legal and medical aspects of patient care, such as motor vehicle trauma or poisoning. In this study, we aimed to draw attention to the forensic issues by retrospective investigation of 13823 emergency cases and to share our experiences on this topic. Materials and Methods: This retrospective study was conducted in a university Emergency Department (ED) in Ankara, Turkey. The data were collected from official hospital polic...
Advanced nursing interventions and length of stay in the emergency department.
Stauber, Mary A
2013-05-01
Over the past 15 years, emergency departments have become overcrowded, with prolonged wait times and an extended length of stay (LOS). These factors cause delay in treatment, which reduces quality of care and increases the potential for adverse events. One suggestion to decrease LOS in the emergency department is to implement advanced nursing interventions (ANIs) at triage. The study purpose was to determine whether there was a difference in ED LOS between patients presenting with a chief complaint of abdominal pain who received ANIs at triage and patients who did not receive ANIs at triage. A retrospective chart review was performed to determine the ED LOS (mean time in department and mean time in room [TIR]). The convenience sample included ED patients who presented to a large Midwestern academic medical center's emergency department with a chief complaint of abdominal pain and Emergency Severity Index level 3. Independent-samples t tests were used to determine whether there was any statistical difference in LOS between the two groups. Cohen's d statistic was used to determine effect size. Implementation of ANIs at triage for patients with low-acuity abdominal pain resulted in an increased time in department and a decreased TIR with a medium effect size. A reduction in TIR optimizes bed availability in the emergency department. Low-acuity patients spend less time occupying an ED bed, which preserves limited bed space for the sickest patients. Results of diagnostic tests are often available by the time the patient is placed in a room, facilitating early medical decision making and decreasing treatment time. Copyright © 2013 Emergency Nurses Association. Published by Mosby, Inc. All rights reserved.
Raising the bar of care for older people in Ontario emergency departments.
Flynn, Doris Splinter; Jennings, Jane; Moghabghab, Rola; Nancekivell, Tracy; Tsang, Clara; Cleland, Michelle; Shipman-Vokner, Karen
2010-09-01
To describe the role of geriatric emergency management nurses as a catalyst for culture change in emergency department processes with the goal to improve care and outcomes of older people. The changing context and literature has called for a culture change within emergency department care to integrate principles of older people care into care delivery. There is a paucity of reports describing how geriatric emergency care models bring about a broader change in culture within the entire emergency department. The Ontario Ministry of Health and Long-term Care in Canada established a programme to place geriatric emergency management nurses into emergency departments with the goal to improve delivery of care through development of unique, site-appropriate solutions. Geriatric emergency management nurses incorporate capacity building into their role to develop and strengthen the skills, instincts, abilities, process and resources of the emergency department. Care processes focus on areas of staffing, mobilization, comfort, medication, hygiene, nutrition/hydration, cognition, environment, equipment and stimulation. Multi-modal educational strategies and advocacy promote appropriate person-centred care. Improved communication among care providers at key patient transition points remains a priority system-level improvement. Geriatric emergency management nurses work collaboratively with the emergency department team to facilitate change in the way that emergency department care is provided to the older person experiencing health emergencies. Known strategies that have been effective in improving outcomes for older people within the hospital and residential care setting can be generalized into emergency department care. Further research into the effectiveness of these strategies in this environment is recommended. © 2010 Blackwell Publishing Ltd.
Aftercare, Emergency Department Visits, and Readmission in Adolescents
Carlisle, Corine E.; Mamdani, Muhammad; Schachar, Russell; To, Teresa
2012-01-01
Objective: U.S. and Canadian data demonstrate decreasing inpatient days, increasing nonurgent emergency department (ED) visits, and short supply of child psychiatrists. Our study aims to determine whether aftercare reduces ED visits and/or readmission in adolescents with first psychiatric hospitalization. Method: We conducted a population-based…
Directory of Open Access Journals (Sweden)
Kotsikoris Ioannis
2011-11-01
Full Text Available Abstract Background The structure of health care in Greece is receiving increased attention to improve its cost-effectiveness. We sought to examine the epidemiological characteristics of patients presenting to the vascular emergency department of a Greek tertiary care hospital during a 2-year period. We studied all patients presenting to the emergency department of vascular surgery at Red Cross Hospital, Athens, Greece between 1st January 2009 and 31st December 2010. Results Overall, 2452 (49.4% out of 4961 patients suffered from pathologies that should have been treated in primary health care. Only 2509 (50.6% needed vascular surgical intervention. Conclusions The emergency department of vascular surgery in a Greek tertiary care hospital has to treat a remarkably high percentage of patients suitable for the primary health care level. These results suggest that an improvement in the structure of health care is needed in Greece.
Emergency department visual urinalysis versus laboratory urinalysis.
Worrall, James C
2009-11-01
The primary objective of this study was to compare the results of nurse-performed urinalysis (NPU) interpreted visually in the emergency department (ED) with laboratory performed urinalysis (LPU) interpreted by reflectance photometry. This was a prospective observational study based on a convenience sample from my emergency practice. Emergency nurses, who were unaware of the study, performed usual dipstick analysis before sending the same urine sample to the laboratory for testing. Of 140 urinalyses performed during the study period, 124 were suitable for analysis. When compared with the reference standard LPU, the NPU had an overall sensitivity of 100% (95% confidence interval [CI] 95%-100%) and a specificity of 49% (95% CI 33%-65%) for the presence of any 1 of blood, leukocyte esterase, nitrites, protein, glucose or ketones in the urine. Of 20 falsely positive NPUs, 18 were a result of the nurse recording 1 or more components as "trace" positive. Although NPU does not yield identical results to LPU, a negative LPU is expected when the initial NPU in the ED is negative.
[Causes of 72-hour return visits to hospital emergency departments].
Jiménez-Puente, Alberto; Del Río-Mata, José; Arjona-Huertas, José Luis; Mora-Ordóñez, Begoña; Nieto-de Haro, Lourdes; Lara-Blanquer, Antonio; Martínez-Reina, Alfonso; Martínez Del Campo, Miguel
2015-10-01
The return-visit rate has been suggested as a measure of emergency department quality of care. We aimed to identify the reasons for emergency revisits and the percentage of returns related to problems with quality of care in the previous visit. Cross-sectional observational study of clinical records for a random sample of unscheduled returns within 72 hours of discharge from the emergency departments of 3 hospitals attending a population of nearly 3 million in the Spanish province of Malaga. The records were reviewed by 2 data collectors, who assigned a reason for revisits according to a standardized classification. A sample of 1075 emergency revisits were reviewed; 895 met the inclusion criteria. The most common reasons for revisits were the persistence or progression of disease (48.8%), an unrelated new problem (9.3%), and referral from a hospital that did not have the required specialized service (8.6%). Reasons attributable to the patient accounted for 14.5% of the revisits; 15.2% were attributable to health care staff errors, 9.2% to system organization, and 61.1% to the disease process. Most emergency department revisits are related to the progression of the disease that led to the first visit. Only a small percentage can be linked to diagnostic or treatment errors in the previous visit.
Thallium myocardial scanning in the emergency department evaluation of chest pain
International Nuclear Information System (INIS)
Mace, S.E.
1989-01-01
Chest pain is a common complaint of patients seen in the emergency department. The causes are legion, and range from the non-life threatening to the potentially catastrophic. Thallium heart scanning was done prospectively in 20 patients with a ''classic'' history for myocardial infarction (eight patients) or atypical chest pain and/or associated symptoms plus an abnormal ECG (12 patients) to discern a subset of patients from whom thallium scintography may be indicated in the emergency department. Although further investigation is needed, our preliminary study suggests that myocardial scanning with thallium can be a safe, fairly rapid, and useful objective parameter in the emergency department detection of suspected myocardial infarction, and in differential diagnosis of chest pain when other data such as the history, physical examination, ECG, or enzymes are inconclusive
Muntlin Athlin, Asa; von Thiele Schwarz, Ulrica; Farrohknia, Nasim
2013-11-01
Long waiting times for emergency care are claimed to be caused by overcrowded emergency departments and non-effective working routines. Teamwork has been suggested as a promising solution to these issues. The aim of the present study was to investigate the effects of teamwork in a Swedish emergency department on lead times and patient flow. The study was set in an emergency department of a university hospital where teamwork, a multi-professional team responsible for the whole care process for a group of patients, was introduced. The study has a longitudinal non-randomized intervention study design. Data were collected for five two-week periods during a period of 1.5 years. The first part of the data collection used an ABAB design whereby standard procedure (A) was altered weekly with teamwork (B). Then, three follow-ups were conducted. At last follow-up, teamwork was permanently implemented. The outcome measures were: number of patients handled within teamwork time, time to physician, total visit time and number of patients handled within the 4-hour target. A total of 1,838 patient visits were studied. The effect on lead times was only evident at the last follow-up. Findings showed that the number of patients handled within teamwork time was almost equal between the different study periods. At the last follow-up, the median time to physician was significantly decreased by 11 minutes (p = 0.0005) compared to the control phase and the total visit time was significantly shorter at last follow-up compared to control phase (p = Teamwork seems to contribute to the quality improvement of emergency care in terms of small but significant decreases in lead times. However, although efficient work processes such as teamwork are necessary to ensure safe patient care, it is likely not sufficient for bringing about larger decreases in lead times or for meeting the 4-hour target in the emergency department.
Emergency department management of shoulder dystocia.
Del Portal, Daniel A; Horn, Amanda E; Vilke, Gary M; Chan, Theodore C; Ufberg, Jacob W
2014-03-01
Precipitous obstetric deliveries can occur outside of the labor and delivery suite, often in the emergency department (ED). Shoulder dystocia is an obstetric emergency with significant risk of adverse outcome. To review multiple techniques for managing a shoulder dystocia in the ED. We review various techniques and approaches for achieving delivery in the setting of shoulder dystocia. These include common maneuvers, controversial interventions, and interventions of last resort. Emergency physicians should be familiar with multiple techniques for managing a shoulder dystocia to reduce the chances of fetal and maternal morbidity and mortality. Copyright © 2014 Elsevier Inc. All rights reserved.
Míguez Navarro, Concepción; Oikonomopoulou, Niki; Lorente Romero, Jorge; Vázquez López, Paula
2017-07-24
The objective of this study was to describe the current practice regarding the preparation of the sedation-analgesia (SA) procedures performed in the paediatric emergency centres in Spain. A multicentre, observational and prospective analytical study was carried out on the SA procedures that were performed on children under 18 years-old in 18 paediatric emergency departments between February 2015 and January 2016. A total of 658 SA procedures were registered in 18 hospitals of Spain, most of them to children older than 24 months. The type of the procedure was: simple analgesia in 57 (8.6%), sedation in 44 (6.7%), SA for a not very painful procedure in 275 (41.8%), and SA for a very painful procedure in 282 (42.9%). Informed consent was requested in 98.6% of the cases. The written form was more frequently preferred in the group of patients that received SA for a very painful procedure (76.6%) in comparison to a painful procedure or to simple analgesia (62.9% and 54.4%, respectively, P<.001). The staff that most frequently performed the SA procedures were the paediatricians of the emergency departments (64.3%), followed by Paediatrics Residents (30.7%). The most frequent reasons for the SA were traumatological (35.9%) and surgical (28.4%). Fasting was observed in 81% of the cases. More than two-thirds (67.3%, n=480) children were monitored, the majority (95.8%) of them using pulse oximetry. The pharmacological strategy used was the administration of one drug in 443 (67.3%) of the cases, mostly nitrous oxide, and a combination of drugs in 215 (32.7%), especially midazolam/ketamine (46.9%). The majority of the SA procedures analysed in this study have been carried out correctly and prepared in accordance with the current guidelines. Copyright © 2017. Publicado por Elsevier España, S.L.U.
Hughes, Elizabeth; Terry, David; Huynh, Chi; Petridis, Konstantinos; Aiello, Matthew; Mazard, Louis; Ubhi, Hirminder; Terry, Alex; Wilson, Keith; Sinclair, Anthony
2017-01-01
Background There are concerns about maintaining appropriate clinical staffing levels in Emergency Departments. Pharmacists may be one possible solution. Objective To determine if Emergency Department attendees could be clinically managed by pharmacists with or without advanced clinical practice training. Setting Prospective 49 site cross-sectional observational study of patients attending Emergency Departments in England. Method Pharmacist data collectors identified patient attendance at thei...
Workload and casemix in Cape Town emergency departments.
Wallis, Lee A; Twomey, Michele
2007-12-01
Little is known about the nature of patients presenting to emergency departments (EDs) in South Africa. This study aimed to provide evidence on ED usage in Cape Town by studying patients at four community health centre (CHC) EDs, with details of the severity of their presentation and their disposal. A total of 16,392 patients presented in this 8-week prospective observational study, and 15,681 were included in the descriptive data analysis. One-quarter were children. There were clear and predictable peaks in attendance after 1600 hr and at weekends, with a steady stream of patients presenting overnight. Case severity was evenly distributed between emergency, urgent and routine care. Nearly 10% of patients were referred on to a higher level of care. The data from this study present a model for staffing and resource allocation. It has implications for the provision of emergency care in CHC EDs.
DEFF Research Database (Denmark)
Rasmussen, Rasmus; Fleron, Benedicte; Hertzum, Morten
2010-01-01
We report from a case study of the implementation of an electronic whiteboard system at two emergency departments at Danish hospitals. The purpose of the whiteboards is to support the clinicians in maintaining an overview of the patients at the departments. The electronic whiteboard system...... in the implementation of the whiteboards at the two emergency departments. The electronic whiteboards were initially configured to resemble the dry-erase whiteboards and then gradually reconfigured and extended through an improvisational process, along with changes in the clinicians’ work practices....
Directory of Open Access Journals (Sweden)
Michal Hemmo-Lotem
2006-01-01
Full Text Available Animal bite/sting injuries are a known source of morbidity with a significantly higher incidence among children who are most often bitten in the face, head, and neck. The objective of this study was to provide a better understanding of bite/sting injuries treated at the pediatric emergency department in order to guide preventive efforts.The sociodemographic, epidemiological, and clinical data on all bite/sting injuries treated in one representative pediatric emergency department in Israel over a 1-year period were retrieved and analyzed. Two hundred of the 9,309 pediatric trauma cases treated in the emergency department were bite/sting injuries (2.1%. Non-Jewish patients were under-represented in this subgroup. The majority of patients were males (61.5%. Age distribution from 0–12 years was fairly even, except for an unexplained peak at 8 years. Dogs inflicted 56%, cats 11%, and hornets 9.5% of the injuries. Limbs were affected in 64% and the head and neck in 27%. Specialists, mostly plastic surgeons, were consulted in 42 cases (21%. The incidence rate for hospitalization (7% was similar to that seen in other types of injuries. Children with scorpion or hornet stings and young age were more likely to be hospitalized. Preventive and educational aspects are discussed.
Quality of work life of rural emergency department nurses and physicians: a pilot study
Bragard, Isabelle; Fleet, Richard; Etienne, Anne-Marie; Archambault, Patrick; L?gar?, France; Chauny, Jean-Marc; L?vesque, Jean-Fr?d?ric; Ouimet, Mathieu; Poitras, Julien; Dupuis, Gilles
2015-01-01
Background Information about recruitment and retention factors and quality of work life (QWL) in rural emergency departments (EDs) is limited. A pilot study was used to determine the feasibility of a large-scale study of these variables in Quebec EDs. Methods Two EDs, approximately 10,000 and 30,000 patients per year respectively, were selected as convenience samples. An online survey containing the Quality of Work Life Systemic Inventory (QWLSI; 34 items) and the Recruitment and Retention Fa...
Prospective Analysis of Geriatric Patients Admitted to Emergency Department With Trauma
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Abdulkadir Akturk
2013-08-01
Full Text Available Objective: The aim of this study is to reveal the demographic characteristics, causes of trauma, physical examination findings, the presence of fractures and the status of the outcome of the geriatric trauma patients admitted to the emergency department of an educational research hospital. Material and Methods: This study covers all the cases over 65 years who were admitted to emergency department with trauma between September 1 2011-31 August 2012. The demographic characteristics of the patients such as, age, gender, date of application and as well as the causes of trauma, physical examination findings and outcome situation in the emergency department were evaluated. The study was performed prospectively. SPSS V.20 was used for statistical analysis of the data obtained. Results: Total 175 patients were included to the study, 74 were male (42.28% and 101 were female (57.72%. The mean age of male patients were 75.01 ± 6.557 while the mean age of female patients were 76.10 ± 7.353. The most common cause of trauma in both gender was falls. This rate was 91.1% in female and 8.9% in male patients. 40.6% of the female patients and 27% of the male patients were admitted to the hospital before because of any trauma. The most common form of trauma according to exposed body localization in both gender was extremity traumas. It was seen in 51.5% of the females and 56.8% of the males. 30 female patients (29.7% and 13 male patients (17.6% had fracture in limbs. 78.3% of all patients were discharged from the emergency department and 21.7% of the patients were hospitalised. None of the patients were died in emergency department and none of the patients were referred to another institution from the emergency department. Total 38 patients were hospitalised, 32 of them were discharged, 2 of them were referred to another institution, and 4 of them were died. 26 of 38 hospitalised patients had undergone surgery while 20 of them were orthopedic surgeries
Forsberg, Helena Hvitfeldt; Muntlin Athlin, Åsa; von Thiele Schwarz, Ulrica
2015-04-01
The aim was to understand how multitasking is experienced by registered nurses and how it relates to their everyday practice in the emergency department. Interviews with open-ended questions were conducted with registered nurses (n = 9) working in one of two included emergency departments in Sweden. Data were analyzed using Schilling's structured model for qualitative content analysis. Three core concepts related to multitasking emerged from the interviews: 'multitasking - an attractive prerequisite for ED care'; 'multitasking implies efficiency' and 'multitasking is not stressful'. From these core concepts an additional theme emerged: '… and does not cause errors – at least for me', related to patient safety. This study shows how the patient load and the unreflected multitasking that follows relate to nurses' perceived efficiency and job satisfaction. It also shows that the relationship between multitasking and errors is perceived to be mediated by whom the actor is, and his or her level of experience. Findings from this study add value to the discourse on multitasking and the emergency department context, as few studies go beyond examining the quantitative aspect of interruptions and multitasking and how it is experienced by the staff in their everyday practice. Copyright © 2014 Elsevier Ltd. All rights reserved.
Differential diagnosis of vertigo and dizziness in the emergency department.
Ozono, Yoshiyuki; Kitahara, Tadashi; Fukushima, Munehisa; Michiba, Takahiro; Imai, Ryusuke; Tomiyama, Youichirou; Nishiike, Suetaka; Inohara, Hidenori; Morita, Hisaki
2014-02-01
To establish a system of differential diagnosis for vertigo/dizziness at the Emergency Department (ED), careful history-taking of complications and examinations of nystagmus should be helpful and therefore prepared by ED staff. Vertigo/dizziness could come from various kinds of organs for equilibrium, sometimes resulting in an emergency due to the central origin. In the present study, we checked patients' background data at the ED in advance of a definitive diagnosis at the Department of Otolaryngology and examined the significance of the correlation between the data and the diagnosis. We studied a series of 120 patients with vertigo/dizziness, who visited the Departments of Emergency and Otolaryngology between April 2011 and March 2012. At the ED, we first checked patients' backgrounds and carried out neurologic and neuro-otologic examinations. At the Department of Otolaryngology, we finally diagnosed all the patients according to the criteria and classified the origins of vertigo/dizziness into central and non-central diseases. The ratio of patients with disease of central origin was 12.5% and that for non-central origin was 87.5%. The risk factors for cerebrovascular disease such as hypertension, heart disease, and diabetes were also the risk factors for central vertigo/dizziness by the chi-squared test. To predict a central origin for vertigo/dizziness, only gaze nystagmus was the significant factor by multivariate regression analysis.
Prognostic value of infrared thermography in an emergency department
DEFF Research Database (Denmark)
Holm, Jesper K; Kellett, John G; Jensen, Nadia H
2018-01-01
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...... as a marker for central temperature and the three others as markers for peripheral temperatures, resulting in three gradients per patient. Thirty-day follow-up was performed and 30-day mortality was reported. RESULTS: One hundred and ninety-eight patients were included and the number of events was nine...... observational study included 198 medical patients admitted to the Emergency Department, at Odense University Hospital. A standardized thermal picture was taken and temperatures of the inner canthus, the earlobe, the nose tip, and the tip of the third finger were reported. The inner canthus was chosen...
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Alaaddin Yorulmaz
2017-12-01
Full Text Available Introduction: In this study, we aimed to retrospectively analyze the demographic and epidemiologic features, clinical course, laboratory results and prognoses of the patients admitted to the department of pediatric emergency due to poisoning. Methods: This trial enrolled a total of 430 patients aged 1 month to 18 years. The medical data of the patients were reviewed retrospectively according to patient's medical record. Demographic data such as age, sex, time of occurrence, time of patient presentation to the emergency department, time to first medical intervention after taking the drug, cause of poisoning, received active substances, ways of taking, number of active substances received, and symptoms at admission to the hospital were analyzed. Results: The study population consisted of 0.74% of all patients who were admitted to the department of pediatric emergency. 243 (56.5% patients were female and 187 (43.5% were male. The age of the patients ranged from 4 months to 220 months (72.89±66.38. One hundred-thirteen (26.3% of our patients were referred to our hospital in the summer, 111 (25.8% in the spring, 110 (25.6% in the autumn and 96 (22.3% in the winter. Eighteen patients were admitted to our emergency department with poisoning in 2014, 193 in 2015, 178 in 2016 and 41 in 2017. 12.3% of our patients were referred to our emergency department between hours 00:00 and 08:00, 35.1% between 08:00 and 16:00 and 52.6% between 16:00 and 24:00. Ninety-six of the patients were admitted to our emergency department due to suicidal poisoning and 334 due to accidental poisoning. Nausea was present at the time of presentation in 142 (33.02% of our patients, vomiting in 122 (28.37% and dizziness in 102 (23.72%. Conclusion: We believe that determination of the epidemiological features of the poisonings in our country by large scale studies and public consciousness will contribute significantly to the prevention of childhood poisoning.
Jafari Varjoshani, Nasrin; Hosseini, Mohammad Ali; Khankeh, Hamid Reza; Ahmadi, Fazlollah
2014-08-22
A highly important factor in enhancing quality of patient care and job satisfaction of health care staff is inter-professional communication. Due to the critical nature of the work environment, the large number of staff and units, and complexity of professional tasks and interventions, inter-professional communication in an emergency department is particularly and exceptionally important. Despite its importance, inter-professional communication in emergency department seems unfavorable. Thus, this study was designed to explain barriers to inter-professional communication in an emergency department. This was a qualitative study with content analysis approach, based on interviews conducted with 26 participants selected purposively, with diversity of occupation, position, age, gender, history, and place of work. Interviews were in-depth and semi-structured, and data were analyzed using the inductive content analysis approach. In total, 251 initial codes were extracted from 30 interviews (some of the participants re-interviewed) and in the reducing trend of final results, 5 categories were extracted including overcrowded emergency, stressful emergency environment, not discerning emergency conditions, ineffective management, and inefficient communication channels. Tumultuous atmosphere (physical, mental) was the common theme between categories, and was decided to be the main barrier to effective inter-professional communication. Tumultuous atmosphere (physical-mental) was found to be the most important barrier to inter-professional communication. This study provided a better understanding of these barriers in emergency department, often neglected in most studies. It is held that by reducing environmental turmoil (physical-mental), inter-professional communication can be improved, thereby improving patient care outcomes and personnel job satisfaction.
The role of teamwork and communication in the emergency department: a systematic review.
Kilner, Emily; Sheppard, Lorraine A
2010-07-01
The aim of this study was to develop a systematic review using international research to describe the role of teamwork and communication in the emergency department, and its relevance to physiotherapy practice in the emergency department. Searches were conducted of CINAHL, Academic Search Premier, Scopus, Cochrane, PEDro, Medline, Embase, Amed and PubMed. Selection criteria included full-text English language research papers related to teamwork and/or communication based directly in the emergency department, involvement of any profession in the emergency department, publication in peer-reviewed journals, and related to adult emergency services. Studies were appraised using a validated critical appraisal tool. Fourteen eligible studies, all of mid-range quality, were identified. They demonstrated high levels of staff satisfaction with teamwork training interventions and positive staff attitudes towards the importance of teamwork and communication. There is moderate evidence that the introduction of multidisciplinary teams to the ED may be successful in reducing access block, and physiotherapists may play a role in this. The need for teamwork and communication in the ED is paramount, and their roles are closely linked, with the common significant purposes of improving patient safety, reducing clinical errors, and reducing waiting times. 2009 Elsevier Ltd. All rights reserved.
[Vertigo in the Emergency Department: new bedside tests].
Tamás, T László; Garai, Tibor; Tompos, Tamás; Szirmai, Ágnes
2016-03-13
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.
Exadaktylos, Aristomenis K; Evangelopoulos, Dimitrios S; Wullschleger, Marcel; Bürki, Leo; Zimmermann, Heinz
2008-11-17
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.
Langabeer, James R.; Gonzalez, Michael; Alqusairi, Diaa; Champagne-Langabeer, Tiffany; Jackson, Adria; Mikhail, Jennifer; Persse, David
2016-01-01
Introduction Emergency medical services (EMS) agencies transport a significant majority of patients with low acuity and non-emergent conditions to local emergency departments (ED), affecting the entire emergency care system’s capacity and performance. Opportunities exist for alternative models that integrate technology, telehealth, and more appropriately aligned patient navigation. While a limited number of programs have evolved recently, no empirical evidence exists for their efficacy. T...
Elliot, A J; Hughes, H E; Hughes, T C; Locker, T E; Brown, R; Sarran, C; Clewlow, Y; Murray, V; Bone, A; Catchpole, M; McCloskey, B; Smith, G E
2014-08-01
This study illustrates the potential of using emergency department attendance data, routinely accessed as part of a national syndromic surveillance system, to monitor the impact of thunderstorm asthma. The Emergency Department Syndromic Surveillance System (EDSSS) routinely monitors anonymised attendance data on a daily basis across a sentinel network of 35 emergency departments. Attendance data for asthma, wheeze and difficulty breathing are analysed on a daily basis. A statistically significant spike in asthma attendances in two EDSSS emergency departments in London was detected on 23 July 2013, coinciding with a series of large violent thunderstorms across southern England. There was also an increase in the reported severity of these attendances. This preliminary report illustrates the potential of the EDSSS to monitor the impact of thunderstorms on emergency department asthma attendances. Further work will focus on how this system can be used to quantify the impact on emergency departments, thus potentially improving resource planning and also adding to the thunderstorm asthma evidence-base. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Managing hypopituitarism in emergency departments.
Welsh, Jeanette
2015-10-01
Healthcare professionals manage patients with a vast range of conditions, but often specialise and acquire expertise in specific disease processes. Emergency and pre-hospital clinicians care for patients with various conditions for short periods of time, so have less opportunity to become familiar with more unusual conditions, yet it is vital that they have some knowledge and understanding of these. Patients with rare conditions can present at emergency departments with common complaints, but the effect of their original diagnosis on the presenting complaint may be overlooked or underestimated. This article uses a case study to describe the experience of one patient who presented with vomiting, but who also had hypopituitarism and therefore required specific management she did not at first receive. The article describes hypopituitarism and the initial management of patients with this condition who become unwell, and discusses how the trust responded to the patient's complaint to improve patient safety and care. It has been written with the full participation and consent of the patient and her husband.
Glass injuries seen in the emergency department of a South African district hospital
Nzaumvila, Doudou; Govender, Indiran; Kramer, Efraim B.
2015-01-01
BACKGROUND: The emergency department of Embhuleni Hospital frequently manages patients with glass-related injuries. This study assessed these injuries and the glass that caused them in more detail. AIM: The objectives of our study included determining the type of glass causing these injuries and describing the circumstances associated with different types of glass injuries. SETTING: The emergency department of Embhuleni Hospital in Elukwatini, Mpumalanga province, South Africa. METHODS: This ...
Clinical Overview and Emergency-Department Whiteboards
DEFF Research Database (Denmark)
Hertzum, Morten; Simonsen, Jesper
2010-01-01
In Denmark emergency departments are newly established and still in a process of devising their procedures and technology support. Electronic whiteboards are a means of supporting clinicians in creating and maintaining the overview necessary to provide quality treatment of patients. The concrete ...
Opportunities to preserve forensic evidence in emergency departments.
Peel, Matthew
2016-11-10
Victims of violence often seek assistance from emergency departments, so emergency nurses are ideally placed to identify them, and other 'forensic' patients, and protect the evidence that could support any ensuing legal process. Emergency nurses who are trained to identify, collect and preserve forensic evidence can support the identification, elimination and prosecution of suspects. This article gives an overview of forensic evidence, and explains how emergency nurses can preserve and collect samples effectively.
Physicians' and nurses' perceptions of patient safety risks in the emergency department.
Källberg, Ann-Sofie; Ehrenberg, Anna; Florin, Jan; Östergren, Jan; Göransson, Katarina E
2017-07-01
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. Semi-structured interviews were conducted with 10 physicians and 10 registered nurses from two emergency departments. Interviews were analysed by inductive content analysis. The experiences reflect the complexities involved in the daily operation of a professional practice, and the perception of risks due to a high workload, lack of control, communication and organizational failures. The results reflect a complex system in which high workload was perceived as a risk for patient safety and that, in a combination with other risks, was thought to further jeopardize patient safety. Emergency department staff should be involved in the development of patient safety procedures in order to increase knowledge regarding risk factors as well as identify strategies which can facilitate the maintenance of patient safety during periods in which the workload is high. Copyright © 2017 Elsevier Ltd. All rights reserved.
[Hospitality for elderly patients in the emergency department].
Boulet, Marie-Claude; Dami, Fabrice; Hugli, Olivier; Renard, Delphine; Foucault, Eliane; Carron, Pierre-Nicolas
2015-12-09
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.
Advertising Emergency Department Wait Times
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Scott G. Weiner
2013-03-01
Full Text Available Advertising emergency department (ED wait times has become a common practice in the UnitedStates. Proponents of this practice state that it is a powerful marketing strategy that can help steerpatients to the ED. Opponents worry about the risk to the public health that arises from a patient withan emergent condition self-triaging to a further hospital, problems with inaccuracy and lack of standarddefinition of the reported time, and directing lower acuity patients to the higher cost ED setting insteadto primary care. Three sample cases demonstrating the pitfalls of advertising ED wait times arediscussed. Given the lack of rigorous evidence supporting the practice and potential adverse effects tothe public health, caution about its use is advised
Workplace violence in the emergency department in the Kingdom of Saudi Arabia
ALSHEHRI, WALEED MOHAMMED A.
2017-01-01
This study explored workplace violence among emergency department nurses and doctors in public hospitals in Saudi Arabia for the first time. Workplace violence is prevalent among nurses and doctors and it has physical, psychological and emotional impact. There is a lack of safety measures, precautions and management support for victims. Most staff feel vulnerable to violence in the next 12 months of employment. The findings will inform Emergency Department managements and the Ministry of H...
Verbal and physical violence in emergency departments: a survey of nurses in Istanbul, Turkey.
Pinar, Rukiye; Ucmak, Firdevs
2011-02-01
The aim of this study was to determine the perceived verbal and physical violence and related factors experienced by nurses in emergency settings. Studies on violence in emergency departments indicate an increasing frequency of these incidents. However, little is known about the violence experienced by the Turkish nurses working in emergency departments. Survey. The study population included 255 nurses. Data were collected using a questionnaire. Verbal violence was reported with a frequency of 91.4%. Of the nurses, 74.9% had been exposed to physical violence in at least several episodes during the previous 12 months. Patients' relatives were the main perpetrators, followed by patients, most of whom were male. After experiencing violence, most of the nurses reported that, they had felt fear and only 3% described that they took sick leave, while 80% did not report the incidences of violence they experienced. The nurses described that, after a violent incident, they sought support mainly from their colleagues in emergency departments rather than from the administration. Over half of the nurses (65%) felt safe 'none of the time' in emergency departments, and 89.8% of them described that patients and patient relatives may potentially exhibit violent behaviours towards the staff when they are first admitted to emergency department, while 73.7% believed that the staffing pattern and physical environment of their emergency departments were not adequate to prevent violence. Most of the nurses (83.5%) stated that they should be provided with the training that will help them prevent and manage violence as part of their in-service education, whereas 82.7% of them had not received any such training. The findings have implications for occupational health and safety from both employer and employee perspective. © 2010 Blackwell Publishing Ltd.
LQAS usefulness in an emergency department.
de la Orden, Susana Granado; Rodríguez-Rieiro, Cristina; Sánchez-Gómez, Amaya; García, Ana Chacón; Hernández-Fernández, Tomás; Revilla, Angel Abad; Escribano, Dolores Vigil; Pérez, Paz Rodríguez
2008-01-01
This paper aims to explore lot quality assurance sampling (LQAS) applicability and usefulness in the evaluation of quality indicators in a hospital emergency department (ED) and to determine the degree of compliance with quality standards according to this sampling method. Descriptive observational research in the Hospital General Universitario Gregorio Marañón (HGUGM) emergency department (ED). Patients older than 15 years, diagnosed with dyspnoea, chest pain, urinary tract colic or bronchial asthma attending the HGUGM ED from December 2005 to May 2006, and patients admitted during 2005 with exacerbation of chronic obstructive pulmonary disease or acute meningitis were included in the study. Sample sizes were calculated using LQAS. Different quality indicators, one for each process, were selected. The upper (acceptable quality level (AQL)) and lower thresholds (rejectable quality level (RQL)) were established considering risk alpha = 5 per cent and beta = 20 per cent, and the minimum number of observations required was calculated. It was impossible to reach the necessary sample size for bronchial asthma and urinary tract colic patients. For chest pain, acute exacerbation of chronic obstructive pulmonary disease, and acute meningitis, quality problems were detected. The lot was accepted only for the dyspnoea indicator. The usefulness of LQAS to detect quality problems in the management of health processes in one hospital's ED. The LQAS could complement traditional sampling methods.
Managing patients with oncologic complications in the emergency department [digest].
Wacker, David; McCurdy, Michael T; Nusbaum, Jeffrey; Gupta, Nachi
2018-01-22
As the prevalence of cancer continues to increase in the general population and improvements in cancer treatment prolong survival, the incidence of patients presenting to the emergency department with oncologic complications will, similarly, continue to rise. This issue reviews 3 of the more common presentations of oncology patients to the emergency department: metastatic spinal cord compression, tumor lysis syndrome, and febrile neutropenia. Signs and symptoms of these conditions can be varied and nonspecific, and may be related to the malignancy itself or to an adverse effect of the cancer treatment. Timely evidence-based decisions in the emergency department regarding diagnostic testing, medications, and arrangement of disposition and oncology follow-up can significantly improve a cancer patient's quality of life. [Points & Pearls is a digest of Emergency Medicine Practice.].
Identifying Patients at Risk of Deterioration in the Joint Emergency Department
DEFF Research Database (Denmark)
Schmidt, Thomas; Wiil, Uffe Kock
2015-01-01
at the case through the lenses of common information spaces. In particular, we apply Bossen’s seven-parameter framework to discover new dimensions of how Emergency Departments and individual clinicians identify and respond to unforeseen events, and how they handle the associated cognitive challenges. We......In recent years, Danish hospitals have merged their emergency facilities into Joint Emergency Departments. This poses new collaborative challenges across traditionally separated specialized departments, which now have to collaborate in a shared environment. Despite established protocols and patient...
Alavi, Nazanin; Reshetukha, Taras; Prost, Eric; Antoniak, Kristen; Patel, Charmy; Sajid, Saad; Groll, Dianne
2017-07-01
Increasing numbers of adolescents are visiting emergency departments with suicidal ideation. This study examines the relationship between bullying and suicidal ideation in emergency department settings. A chart review was conducted for all patients under 18 years of age presenting with a mental health complaint to the emergency departments at Kingston General or Hotel Dieu Hospitals in Kingston, Canada, between January 2011 and January 2015. Factors such as age, gender, history of abuse, history of bullying, type and time of bullying, and diagnoses were documented. 77% of the adolescents had experienced bullying, while 68.9% had suicide ideation at presentation. While controlling for age, gender, grade, psychiatric diagnosis, and abuse, a history of bullying was the most significant predictor of suicidal ideation. Individuals in this study who reported cyber bullying were 11.5 times more likely to have suicidal ideation documented on presentation, while individuals reporting verbal bullying were 8.4 times more likely. The prevalence of bullying in adolescent patients presenting to emergency departments is high. The relationship found between suicidal ideation and bullying demonstrates that clinicians should ask questions about bullying as a risk factor for suicide ideation during the assessment of children and adolescents.
Paavilainen, Eija; Salminen-Tuomaala, Mari; Kurikka, Sirpa; Paussu, Paula
2009-08-01
To describe patients' experiences of counselling, defined as information giving and advice by nursing staff, in the emergency department. A particular focus was on the waiting period and on the importance of family participation in counselling. Counselling is a widely studied topic in nursing. Too little is known about counselling in emergency departments and especially about participation of family members and suitability of counselling for the patient's life situation. Descriptive quantitative study. Data were collected by questionnaires from patients (n = 107) visiting a hospital emergency department. The data were subjected to statistical analysis. Forty-two per cent of patients arrived at the emergency department with a family member: spouse or cohabiting partner, mother, father or daughter. Patients were fairly satisfied with the counselling. The presence of a family member was important to the majority of patients (75%). About half of the patients wanted information concerning their illness, condition and treatment to be given to their family members. Those visiting the department with a family member were more satisfied with counselling and felt that it promoted their participation in care. It is to encourage patients' family members to participate in counselling situations in emergency departments. However, the type of information passed on to family members should be carefully discussed and prepared. Patients' family members seem to be important partners in counselling situations. The presence of family members supports patients in the emergency department during the waiting period and helps them orientate in their situation. When family members are present, issues which patients wish to discuss should be carefully planned. Family presence should be encouraged in emergency departments.
Directory of Open Access Journals (Sweden)
Meaney Christopher
2011-08-01
Full Text Available Abstract Background Emergency departments are medical treatment facilities, designed to provide episodic care to patients suffering from acute injuries and illnesses as well as patients who are experiencing sporadic flare-ups of underlying chronic medical conditions which require immediate attention. Supply and demand for emergency department services varies across geographic regions and time. Some persons do not rely on the service at all whereas; others use the service on repeated occasions. Issues regarding increased wait times for services and crowding illustrate the need to investigate which factors are associated with increased frequency of emergency department utilization. The evidence from this study can help inform policy makers on the appropriate mix of supply and demand targeted health care policies necessary to ensure that patients receive appropriate health care delivery in an efficient and cost-effective manner. The purpose of this report is to assess those factors resulting in increased demand for emergency department services in Ontario. We assess how utilization rates vary according to the severity of patient presentation in the emergency department. We are specifically interested in the impact that access to primary care physicians has on the demand for emergency department services. Additionally, we wish to investigate these trends using a series of novel regression models for count outcomes which have yet to be employed in the domain of emergency medical research. Methods Data regarding the frequency of emergency department visits for the respondents of Canadian Community Health Survey (CCHS during our study interval (2003-2005 are obtained from the National Ambulatory Care Reporting System (NACRS. Patients' emergency department utilizations were linked with information from the Canadian Community Health Survey (CCHS which provides individual level medical, socio-demographic, psychological and behavioral information for
Moineddin, Rahim; Meaney, Christopher; Agha, Mohammad; Zagorski, Brandon; Glazier, Richard Henry
2011-08-19
Emergency departments are medical treatment facilities, designed to provide episodic care to patients suffering from acute injuries and illnesses as well as patients who are experiencing sporadic flare-ups of underlying chronic medical conditions which require immediate attention. Supply and demand for emergency department services varies across geographic regions and time. Some persons do not rely on the service at all whereas; others use the service on repeated occasions. Issues regarding increased wait times for services and crowding illustrate the need to investigate which factors are associated with increased frequency of emergency department utilization. The evidence from this study can help inform policy makers on the appropriate mix of supply and demand targeted health care policies necessary to ensure that patients receive appropriate health care delivery in an efficient and cost-effective manner. The purpose of this report is to assess those factors resulting in increased demand for emergency department services in Ontario. We assess how utilization rates vary according to the severity of patient presentation in the emergency department. We are specifically interested in the impact that access to primary care physicians has on the demand for emergency department services. Additionally, we wish to investigate these trends using a series of novel regression models for count outcomes which have yet to be employed in the domain of emergency medical research. Data regarding the frequency of emergency department visits for the respondents of Canadian Community Health Survey (CCHS) during our study interval (2003-2005) are obtained from the National Ambulatory Care Reporting System (NACRS). Patients' emergency department utilizations were linked with information from the Canadian Community Health Survey (CCHS) which provides individual level medical, socio-demographic, psychological and behavioral information for investigating predictors of increased emergency
Sport and active recreation injuries in Australia: evidence from emergency department presentations.
Finch, C; Valuri, G; Ozanne-Smith, J
1998-09-01
Despite the rise in specialist clinical services for the management of sports and active recreation injury, many patients attend hospital emergency departments for treatment. The purpose of this study was to describe sports injury cases presented to selected hospital emergency departments around Australia for the period 1989-1993. Routinely collected emergency department injury presentation data from the Australian National Injury Surveillance Unit were examined. Data on 98,040 sports and active recreation emergency department presentations were analysed. Sports and active recreation activities were ranked according to frequency of presentation. Relative proportions of injury type and body region injured were determined. Data are presented separately for children (15 years of age). Among the 10 activities that most commonly led to a sports or active recreation injury presentation for all ages were cycling, Australian football, basketball, soccer, cricket, netball, and rugby. For children, injuries were also commonly associated with roller skating/blading, skateboarding, and trampolining. Hockey, martial arts, and dancing injuries were frequent in adults. Most sporting injuries occurred during organised competition or practice whereas the active recreation injuries occurred in a variety of settings. Fractures, strains, and sprains, particularly to the lower and upper extremities, were common types of injury. The rich, but nevertheless limited, information available about sports and active recreation injuries from data collected in emergency departments indicates that these activities are a common context for injury at the community level in Australia.
Sport and active recreation injuries in Australia: evidence from emergency department presentations
Finch, C.; Valuri, G.; Ozanne-Smith, J.
1998-01-01
OBJECTIVE: Despite the rise in specialist clinical services for the management of sports and active recreation injury, many patients attend hospital emergency departments for treatment. The purpose of this study was to describe sports injury cases presented to selected hospital emergency departments around Australia for the period 1989-1993. METHODS: Routinely collected emergency department injury presentation data from the Australian National Injury Surveillance Unit were examined. Data on 98,040 sports and active recreation emergency department presentations were analysed. Sports and active recreation activities were ranked according to frequency of presentation. Relative proportions of injury type and body region injured were determined. Data are presented separately for children (15 years of age). RESULTS: Among the 10 activities that most commonly led to a sports or active recreation injury presentation for all ages were cycling, Australian football, basketball, soccer, cricket, netball, and rugby. For children, injuries were also commonly associated with roller skating/blading, skateboarding, and trampolining. Hockey, martial arts, and dancing injuries were frequent in adults. Most sporting injuries occurred during organised competition or practice whereas the active recreation injuries occurred in a variety of settings. Fractures, strains, and sprains, particularly to the lower and upper extremities, were common types of injury. CONCLUSION: The rich, but nevertheless limited, information available about sports and active recreation injuries from data collected in emergency departments indicates that these activities are a common context for injury at the community level in Australia. PMID:9773170
Kuhmmer, Regina; Lima, Karine Margarites; Ribeiro, Rodrigo Antonini; Hammes, Luciano Serpa; Bastos, Gisele Alsina Nader; Cotta de Souza, Maria Claudia Schardosim; Polanczyk, Carisi Anne; Soares Rollin, Guilherme Alcides Flores; Caon, Suhelen; Guterres, Cátia Moreira; Araújo Leite, Leni Everson; Delabary, Tássia Scholante; Falavigna, Maicon
2015-02-25
Patient education on pharmacological therapy may increase medication adherence and decrease hospitalizations. Our aim is to evaluate the effectiveness of pharmaceutical care at emergency department discharge in patients with hypertension and/or diabetes. This is a randomized controlled trial. Participants will be recruited from a public emergency department at Restinga district in Porto Alegre, southern Brazil. A total of 380 patients will be randomly assigned into 2 groups at the moment of emergency department discharge after receiving medical orientations: an intervention group, consisting of a structured individual counseling session by a pharmacist in addition to written orientations, or a control group, consisting only of written information about the disease. Outcomes will be assessed in an ambulatory visit 2 months after the randomization. The primary outcome is the proportion of patients with high medication adherence assessed using the Morisky-Green Test and the Brief Medication Questionnaire. The secondary outcomes are reduction of blood pressure, glycated hemoglobin, fasting plasma glucose, quality of life and number of visits to the emergency department. Pharmaceutical care interventions have shown to be feasible and effective in increasing medication adherence in both hospital outpatient and community pharmacy settings. However, there have been no previous assessments of the effectiveness of pharmacy care interventions initiated in patients discharged from emergency departments. Our hypothesis is that pharmaceutical counseling is also effective in this population. ClinicalTrials.gov registration number: NCT01978925 (11 November 2013) and Brazilian Registry of Clinical Trials U1111-1149-8922 (5 November 2013).
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James Robert Langabeer
2016-11-01
Full Text Available Introduction Emergency medical services (EMS agencies transport a significant majority of patients with low acuity and non-emergent conditions to local emergency departments (ED, affecting the entire emergency care system’s capacity and performance. Opportunities exist for alternative models that integrate technology, telehealth, and more appropriately aligned patient navigation. While a limited number of programs have evolved recently, no empirical evidence exists for their efficacy. This research describes the development and comparative effectiveness of one large urban program. Methods The Houston Fire Department initiated the Emergency Telehealth and Navigation (ETHAN program in 2014. ETHAN combines telehealth, social services, and alternative transportation to navigate primary care-related patients away from the ED where possible. Using a case-control study design, we describe the program and compare differences in effectiveness measures relative to the control group. Results During the first 12 months, 5,570 patients participated in the telehealth-enabled program, which were compared against the same size control group. We found a 56% absolute reduction in ambulance transports to the ED with the intervention compared to the control group (18% vs. 74%, P<.001. EMS productivity (median time from EMS notification to unit back in service was 44 minutes faster for the ETHAN group (39 vs. 83 minutes, median. There were no statistically significant differences in mortality or patient satisfaction. Conclusion We found that mobile technology-driven delivery models are effective at reducing unnecessary ED ambulance transports and increasing EMS unit productivity. This provides support for broader EMS mobile integrated health programs in other regions.
Advertising emergency department wait times.
Weiner, Scott G
2013-03-01
Advertising emergency department (ED) wait times has become a common practice in the United States. Proponents of this practice state that it is a powerful marketing strategy that can help steer patients to the ED. Opponents worry about the risk to the public health that arises from a patient with an emergent condition self-triaging to a further hospital, problems with inaccuracy and lack of standard definition of the reported time, and directing lower acuity patients to the higher cost ED setting instead to primary care. Three sample cases demonstrating the pitfalls of advertising ED wait times are discussed. Given the lack of rigorous evidence supporting the practice and potential adverse effects to the public health, caution about its use is advised.
Advertising Emergency Department Wait Times
Weiner, Scott G.
2013-01-01
Advertising emergency department (ED) wait times has become a common practice in the United States. Proponents of this practice state that it is a powerful marketing strategy that can help steer patients to the ED. Opponents worry about the risk to the public health that arises from a patient with an emergent condition self-triaging to a further hospital, problems with inaccuracy and lack of standard definition of the reported time, and directing lower acuity patients to the higher cost ED setting instead to primary care. Three sample cases demonstrating the pitfalls of advertising ED wait times are discussed. Given the lack of rigorous evidence supporting the practice and potential adverse effects to the public health, caution about its use is advised. PMID:23599836
Lee, David C; Carr, Brendan G; Smith, Tony E; Tran, Van C; Polsky, Daniel; Branas, Charles C
2015-12-01
Emergency visits are rising nationally, whereas the number of emergency departments is shrinking. However, volume has not increased uniformly at all emergency departments. It is unclear what factors account for this variability in emergency volume growth rates. The objective of this study was to test the association of hospital and population characteristics and the effect of hospital closures with increases in emergency department volume. The study team analyzed emergency department volume at New York State hospitals from 2004 to 2010 using data from cost reports and administrative databases. Multivariate regression was used to evaluate characteristics associated with emergency volume growth. Spatial analytics and distances between hospitals were used in calculating the predicted impact of hospital closures on emergency department use. Among the 192 New York hospitals open from 2004 to 2010, the mean annual increase in emergency department visits was 2.7%, but the range was wide (-5.5% to 11.3%). Emergency volume increased nearly twice as fast at tertiary referral centers (4.8%) and nonurban hospitals (3.7% versus urban at 2.1%) after adjusting for other characteristics. The effect of hospital closures also strongly predicted variation in growth. Emergency volume is increasing faster at specific hospitals: tertiary referral centers, nonurban hospitals, and those near hospital closures. This study provides an understanding of how emergency volume varies among hospitals and predicts the effect of hospital closures in a statewide region. Understanding the impact of these factors on emergency department use is essential to ensure that these populations have access to critical emergency services.
He, Siran; Lunnen, Jeffrey C; Zia, Nukhba; Khan, Uzma; Shamim, Khusro; Hyder, Adnan A
2015-01-01
Drowning is a heavy burden on the health systems of many countries, including Pakistan. To date, no effective large-scale surveillance has been in place to estimate rates of drowning and near-drowning in Pakistan. The Pakistan National Emergency Department Surveillance (Pak-NEDS) study aimed to fill this gap. Patients who presented with a complaint of "near-drowning" were analyzed to explore patterns of true near-drowning (unintentional) and intentional injuries that led to the "near-drowning" complaint. Bivariate analysis was done to establish patterns among patients treated in emergency departments, including socio-demographic information, injury-related information, accompanying injuries, and emergency department resource utilization. A total of 133 patients (0.2% of all injury patients) with "near-drowning" as presenting complaints were recorded by the Pak-NEDS system. True near-drowning (50.0%) and intentional injuries that led to "near-drowning" complaints (50.0%) differed in nature of injuries. The highest proportion of true near-drowning incidents occurred among patients aged between 25-44 years (47.5%), and among males (77.5%). True near-drowning patients usually had other accompanying complaints, such as lower limb injury (40.0%). Very few patients were transported by ambulance (5.0%), and triage was done for 15% of patients. Eleven (27.5%) true near-drowning patients received cardiopulmonary resuscitation. There was major under-reporting of drowning and near-drowning cases in the surveillance study. The etiology of near-drowning cases should be further studied. Patients who experienced non-fatal drownings were more commonly sent for medical care due to other accompanying conditions, rather than near-drowning event itself. There is also need for recognizing true near-drowning incidents. The results of this study provide information on data source selection, site location, emergency care standardization, and multi-sector collaboration for future drowning
Emergency Department Staff Beliefs About Self-Harm: A Thematic Framework Analysis.
Koning, Kate Louise; McNaught, Angela; Tuffin, Keith
2017-11-03
To explore the beliefs and attitudes of emergency department staff about self-harm behaviour. Existing studies looking at views regarding self-harm rely solely on the information provided by medical and nursing staff using a questionnaire format. No studies currently consider ancillary staff members' beliefs about self-harm, even though they also work with these patients. A thematic framework analysis of interview transcripts was carried out. Individual semi-structured interviews were conducted from December 2015 to February 2016. Fifteen medical, nursing, and ancillary staff members from a large, tertiary emergency department participated. There were 5 major themes identified-causes of self-harm are multifactorial; beliefs about self-harm can change over time; emergency departments should only focus on the physical; self-harm occurs on a spectrum; and the system has failed. The results suggest participants felt ill-prepared and lacking in appropriate training to help patients that self-harm, and furthermore they have little faith in the mental health system. Staff beliefs and attitudes may change over time with exposure to patients who self-harm, possibly becoming more positive in response to a greater understanding of why the self-harm behaviour is occurring.
García-Izquierdo, Mariano; Ríos-Rísquez, María Isabel
2012-01-01
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.
Tang, Patrick H P; Worster, Andrew; Srigley, Jocelyn A; Main, Cheryl L
2011-07-01
The objective of this study was to determine the prevalence of Staphylococcus-contaminated stethoscopes belonging to emergency department (ED) staff and to identify the proportion of these that were Staphylococcus aureus or methicillin-resistant Staphylococcus aureus (MRSA). We conducted a prospective observational cohort study of bacterial cultures from 100 ED staff members' stethoscopes at three EDs. Study participants were asked to complete a questionnaire. Fifty-four specimens grew coagulase-negative staphylococci and one grew methicillin-susceptible S. aureus. No MRSA was cultured. Only 8% of participants, all of whom were nurses, reported cleaning their stethoscope before or after each patient assessment. Alcohol-based wipes were most commonly used to clean stethoscopes. A lack of time, being too busy, and forgetfulness were the most frequently reported reasons for not cleaning the stethoscope in the ED. This study indicates that although stethoscope contamination rates in these EDs are high, the prevalence of S. aureus or MRSA on stethoscopes is low.
Boudjemai, Y; Mbida, P; Potinet-Pagliaroli, V; Géffard, F; Leboucher, G; Brazier, J-L; Allenet, B; Charpiat, B
2013-07-01
Paracetamol is the most widely used analgesic and antipyretic drug. In France, little is known concerning patients' knowledge and beliefs about paracetamol. To determine how much outpatients attending an emergency department know about paracetamol. A semi-structured questionnaire was applied to patients consulting for non-severe medical or traumatic conditions. Thirty-three (45%) of 73 participating patients knew that paracetamol was the active ingredient of the medication they used to reduce pain and/or fever. Three patients thought 2g was the maximum recommended single dose; 25% thought that a delay between two doses ≤ 3 hours was recommended and 15% thought the maximum daily dose was > 4 g. While 8% cited liver toxicity as a side effect, 38% did not believe an excessive dose could be fatal. Two patients correctly answered all questions and five gave no correct answer. Outpatients attending an emergency department (ED) have poor knowledge about paracetamol. This situation is disturbing and our results may serve as an eye opener to healthcare professionals. They emphasize the need for research programs with the following objectives: a) to determine the actual content of the message delivered by healthcare professionals; b) to study conditions under which this message is issued; c) to analyze how patients understand key messages and what their behavioral response is. In ED patients, the level of knowledge about paracetamol is insufficient to ensure its safe use in ambulatory care. Further studies are needed to determine the causes and to permit better patient education. Copyright © 2013 Elsevier Masson SAS. All rights reserved.
Emergency department management of priapism [digest].
Podolej, Gregory S; Babcock, Christine; Kim, Jeremy
2017-01-22
Priapism is a genitourinary emergency that demands a thorough, time-sensitive evaluation. There are 3 types of priapism: ischemic, nonischemic, and recurrent ischemic priapism; ischemic priapism accounts for 95% of cases. Ischemic priapism must be treated within 4 to 6 hours to minimize morbidity, including impotence. The diagnosis of ischemic priapism relies heavily on the history and physical examination and may be facilitated by penile blood gas analysis and penile ultrasound. This issue reviews current evidence regarding emergency department treatment of ischemic priapism using a stepwise approach that begins with aspiration of cavernosal blood, cold saline irrigation, and penile injection with sympathomimetic agents. Evidence-based management and appropriate urologic follow-up of nonischemic and recurrent ischemic priapism maximizes patient outcomes and resource utilization. [Points & Pearls is a digest of Emergency Medicine Practice].
Alcohol-related Injuries at an Emergency Department in Eastern Taiwan
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Yin-Ming Li
2006-01-01
Conclusion: Injuries were alcohol related in one out of seven patients this study from an emergency department in eastern Taiwan. Ongoing epidemiologic monitoring of the prevalence and nature of alcohol abuse among patients visiting the ED are urgently needed.
Incidence and Cost of Ankle Sprains in United States Emergency Departments
Shah, Shweta; Thomas, Abbey C.; Noone, Joshua M.; Blanchette, Christopher M.; Wikstrom, Erik A.
2016-01-01
Background: Ankle sprains represent a common injury in emergency departments, but little is known about common complications, procedures, and charges associated with ankle sprains in emergency departments. Hypothesis: There will be a higher incidence of ankle sprains among younger populations (≤25 years old) and in female patients. Complications and procedures will differ between ankle sprain types. Lateral ankle sprains will have lower health care charges relative to medial and high ankle sprains. Study Design: Descriptive epidemiological study. Level of Evidence: Level 3. Methods: A cross-sectional study of the 2010 Nationwide Emergency Department Sample was conducted. Outcomes such as charges, complications, and procedures were compared using propensity score matching between lateral and medial as well as lateral and high ankle sprains. Results: The sample contained 225,114 ankle sprains. Female patients sustained more lateral ankle sprains (57%). After propensity score adjustment, lateral sprains incurred greater charges than medial ankle sprains (median [interquartile range], $1008 [$702-$1408] vs $914 [$741-$1108]; P sprain of the foot (2.96% vs 0.70%, P ankle sprain events. Among procedures, medial ankle sprains were more likely to include diagnostic radiology (97.91% vs 83.62%, P ankle sprains (0.87% vs 2.79%, P ankle sprains than lateral ankle sprains (24 [6.06%] vs 1 [0.25%], P Ankle sprain emergency department visits account for significant health care charges in the United States. Age- and sex-related differences persist among the types of ankle sprains. Clinical Relevance: The health care charges associated with ankle sprains indicate the need for additional preventive measures. There are age- and sex-related differences in the prevalence of ankle sprains that suggest these demographics may be risk factors for ankle sprains. PMID:27474161
Using a balanced scorecard to improve the performance of an emergency department.
Huang, Shu-Hsin; Chen, Ping-Ling; Yang, Ming-Chin; Chang, Wen-Yin; Lee, Haw-Jenn
2004-01-01
The performance of the emergency department significantly improved after implementing the balanced scorecard including hours of continuing education attended by the staff, staff job satisfaction, the rate of incomplete laboratory tests within 30 minutes, the average monthly inappropriate return rate, and hospital profit. The results can assist administrators plan for the future. Although this was a pilot program for implementing a balanced scorecard in an emergency department, the indicators used in this study may also be reasonable for a hospital that has limited resources.
Haghighinejad, Hourvash Akbari; Kharazmi, Erfan; Hatam, Nahid; Yousefi, Sedigheh; Hesami, Seyed Ali; Danaei, Mina; Askarian, Mehrdad
2016-01-01
Background: Hospital emergencies have an essential role in health care systems. In the last decade, developed countries have paid great attention to overcrowding crisis in emergency departments. Simulation analysis of complex models for which conditions will change over time is much more effective than analytical solutions and emergency department (ED) is one of the most complex models for analysis. This study aimed to determine the number of patients who are waiting and waiting time in emerg...
Treating pain in the emergency department.
LENUS (Irish Health Repository)
Kuan, Samuel C
2012-02-01
The objective of this audit was to evaluate the impact of brief educational intervention on prompt recognition and treatment of pain in the emergency department. The audit was performed on all patients in the emergency department with pain presenting over a 24-h period on three occasions: preintervention, 1-week postintervention and at 4 months. In 151 patients, pain severity scores were mild (24%), moderate (42%), severe (16%) and unknown (18%). Pain score documentation at triage improved from 72 to 94% during the audit (P = 0.01). There was no significant difference in the number of patients treated within 20 min for severe pain (P = 0.076) and within 60 min for moderate pain (P = 0.796) between audits. The likelihood of receiving analgesia within 20 min increased with the patients\\' pain category (relative risk: 1.8 95% confidence interval: 1.4-2.3). Documentation of pain assessment and the use of pain scores at triage improved after a brief educational intervention but there was no measurable impact on treatment times.
Effects of emergency department expansion on emergency department patient flow.
Mumma, Bryn E; McCue, James Y; Li, Chin-Shang; Holmes, James F
2014-05-01
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
Long, Elizabeth; Dowdell, Elizabeth B
2017-12-15
Human trafficking is estimated to surpass the drug trade as the leading illegal industry in the world. According to a recent study, over 87.8% of trafficking survivors came into contact with a healthcare professional while they were enslaved and were not identified as a victim of human trafficking. The aims of this study are to understand the perceptions of emergency nurses about human trafficking, victims of violence, and prostitution. A qualitative, descriptive study using a semi-structured interview approach was done with ten registered nurses in a large, urban Emergency Department in the northeastern U.S. Interviews were recorded and transcribed; thematic analysis was performed. Six themes emerged from the interviews including, "human trafficking exists in the patient population" yet no nurse has screened or treated a victim; human trafficking victims are perceived to be "young, female, and foreign born"; all of the emergency nurses reported having worked with or screened a victim of violence; victims of violence were viewed as patients who present as "sad and grieving"; prostitutes are seen as "hard and tough"; and emergency nurses did not have education on human trafficking victims' needs or resources. Emergency nurses should be more aware about victims of human trafficking. The media portrayal of human trafficking victims had influenced the nurses' perceptions of this population. Victims of violence are perceived to be very different from prostitutes, but there is a desire for education about violence as well as information about specific resources open to victims. Copyright © 2017 Elsevier Inc. All rights reserved.
The National Trauma Data Bank story for emergency department thoracotomy: How old is too old?
Gil, Lindsay A; Anstadt, Michael J; Kothari, Anai N; Javorski, Michael J; Gonzalez, Richard P; Luchette, Fred A
2018-03-01
The fastest growing segment of the American population is the elderly (>65 years). This change in demographics also is being seen in trauma centers. Emergency department thoracotomy is utilized in an attempt to restore circulation for patients arriving in extremis. The purpose of this study was to investigate the relationship between clinical variables, particularly age, and outcomes for injured patients receiving an emergency department thoracotomy. Using the National Trauma Data Bank for years 2008-2012, observations with International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes for exploratory thoracotomy were identified. Emergency department thoracotomy was defined as any observation that occurred at a time to thoracotomy less than the total time spent in the emergency department thoracotomy, and within 15 minutes of arrival. Mechanisms of injury, demographic data, and injuries were analyzed for predictors of survival and mortality rates. Mortality rates were determined for each decade and year of life. There were 11,380 observations for thoracotomy identified. Of these, 2,519 were emergency department thoracotomy, with the majority (n= 2,026, 80% observations) performed for penetrating wounds. Mortality rates ranged from 80% to 100% for each decade of life. Mortality was 100% for patients >57 years old with either penetrating or blunt mechanisms of injury. Emergency department thoracotomy offered no survival benefit for patients older than 57 years of age. These data suggest that emergency department thoracotomy performed in elderly patients may be futile. Copyright © 2017 Elsevier Inc. All rights reserved.
Disruptive Behaviors in an Emergency Department: the Perspective of Physicians and Nurses
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Maryam Maddineshat
2016-09-01
Full Text Available 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.
Water tubing-related injuries treated in US emergency departments, 1991-2009.
Heinsimer, Kevin R; Nelson, Nicolas G; Roberts, Kristin J; McKenzie, Lara B
2013-02-01
The objective was to describe the patterns and mechanisms of water tubing-related injuries treated in U.S. emergency departments. The National Electronic Injury Surveillance System was used to examine cases of water tubing-related injuries. Sample weights were used to calculate national estimates of water tubing-related injuries. Analyses were conducted in 2010. From 1991-2009 an estimated 69,471 injuries were treated in US emergency departments for water tubing-related injuries. The annual number of cases increased 250% over the 19-year study period (P tubing-related injuries differ for children and adults. Research is needed to determine how best to reduce these injuries.
Chiu, Chih-Wen; Lee, Tsung-Chieh; Hsu, Po-Chi; Chen, Chia-Yun; Chang, Shun-Chang; Chiang, John Y; Lo, Lun-Chien
2015-06-09
Dizziness and vertigo account for roughly 4% of chief symptoms in the emergency department (ED). Pharmacological therapy is often applied for these symptoms, such as vestibular suppressants, anti-emetics and benzodiazepines. However, every medication is accompanied with unavoidable side-effects. There are several research articles providing evidence of acupuncture treating dizziness and vertigo but few studies of acupuncture as an emergent intervention in ED. We performed a pilot cohort study to evaluate the efficacy and safety of acupuncture in treating patients with dizziness and vertigo in ED. A total of 60 participants, recruited in ED, were divided into acupuncture and control group. Life-threatening conditions or central nervous system disorders were excluded to ensure participants' safety. The clinical effect of treating dizziness and vertigo was evaluated by performing statistical analyses on data collected from questionnaires of Dizziness Handicap Inventory (DHI), Visual Analog Scale (VAS) of dizziness and vertigo, and heart rate variability (HRV). The variation of VAS demonstrated a significant decrease (p-value: 0.001 and p-value: 0.037) between two groups after two different durations: 30 mins and 7 days. The variation of DHI showed no significant difference after 7 days. HRV revealed a significant increase in high frequency (HF) in the acupuncture group. No adverse event was reported in this study. Acupuncture demonstrates a significant immediate effect in reducing discomforts and VAS of both dizziness and vertigo. This study provides clinical evidence on the efficacy and safety of acupuncture to treat dizziness and vertigo in the emergency department. ClinicalTrials.gov ID: NCT02358239 . Registered 5 February 2015.
An Emergency Department Intervention to Increase Parent-Child Tobacco Communication: A Pilot Study
Mahabee-Gittens, E. Melinda; Huang, Bin; Slap, Gail B.; Gordon, Judith S.
2008-01-01
We conducted a randomized trial of parents and their 9- to 16-year-old children to pilot test an emergency department (ED)-based intervention designed to increase parent-child tobacco communication. Intervention group (IG) parents received verbal/written instructions on how to relay anti-tobacco messages to their children; control group (CG)…
ABC estimation of unit costs for emergency department services.
Holmes, R L; Schroeder, R E
1996-04-01
Rapid evolution of the health care industry forces managers to make cost-effective decisions. Typical hospital cost accounting systems do not provide emergency department managers with the information needed, but emergency department settings are so complex and dynamic as to make the more accurate activity-based costing (ABC) system prohibitively expensive. Through judicious use of the available traditional cost accounting information and simple computer spreadsheets. managers may approximate the decision-guiding information that would result from the much more costly and time-consuming implementation of ABC.
Taylor, David McD; Wolfe, Rory; Cameron, Peter A
2002-03-01
Emergency department patient complaints are often justified and may lead to apology, remedial action or compensation. The aim of the present study was to analyse emergency department patient complaints in order to identify procedures or practices that require change and to make recommendations for intervention strategies aimed at decreasing complaint rates. We undertook a retrospective analysis of patient complaints from 36 Victorian emergency departments during a 61 month period. Data were obtained from the Health Complaint Information Program (Health Services Commissioner). In all, 2,419 emergency department patients complained about a total of 3,418 separate issues (15.4% of all issues from all hospital departments). Of these, 1,157 complaints (47.80%) were received by telephone and 829 (34.3%) were received by letter; 1,526 (63.1 %) complaints were made by a person other than the patient. Highest complaint rates were received from patients who were female, born in non-English-speaking countries and very young or very old. One thousand one hundred and forty-one issues (33.4%) related to patient treatment, including inadequate treatment (329 issues) and inadequate diagnosis (249 issues); 1079 (31.6%) issues related to communication, including poor staff attitude, discourtesy and rudeness (444 issues); 407 (11.9%) issues related to delay in treatment. Overall, 2516 issues (73.6%) were resolved satisfactorily, usually by explanation or apology. Only 59 issues (1.7%) resulted in a procedure or policy change. Remedial action was taken in 109 issues (3.2%) and compensation was paid to eight patients. Communication remains a significant factor in emergency department patient dissatisfaction. While patient complaints have resulted in major changes to policy and procedure, research and intervention strategies into communication problems are indicated. In the short term, focused staff training is recommended.
Cooke, M. W.; Allan, T. F.; Wilson, S.
1999-01-01
AIM: To determine whether there were any changes in attendance at accident and emergency departments that could be related to international football matches (Euro96 tournament). METHOD: Fourteen accident and emergency departments (seven adjacent to and seven distant from a Euro96 venue) provided their daily attendance figures for a nine week period: three weeks before, during, and after the tournament. The relation between daily attendance rates and Euro96 football matches was assessed ...
Molar Pregnancy in the Emergency Department
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Masterson, Lori
2009-11-01
Full Text Available A 15-year-old female presented to the emergency department with complaints of vaginal bleeding. She was pale, anxious, cool and clammy with tachycardic, thready peripheral pulses and hemoglobin of 2.4g/dL. Her abdomen was gravid appearing, approximately early to mid-second trimester in size. Pelvic examination revealed 2 cm open cervical os with spontaneous discharge of blood, clots and a copious amount of champagne-colored grapelike spongy material. After 2L boluses of normal saline and two units of crossmatched blood, patient was transported to the operating room. Surgical pathology confirmed a complete hydatidiform mole.[West J Emerg Med. 2009;10(4:295-296.
Agudo Villa, Teresa; Álvarez-Rodríguez, Esther; Caurel Sastre, Zaida; Martín Martínez, Alfonso; Merinero Palomares, Raúl; Alvarez Rodríguez, Virginia; Portero Sánchez, Isabel
2015-06-01
To analyze the risk profile of patients with diabetes who seek care from hospital emergency departments and emergency department involvement in preventing cardiovascular complications in these patients. Cross-sectional analysis of case series from 2 Spanish hospital emergency departments. We included all patients with a history or final diagnosis of diabetes mellitus who were treated in the emergency department between November 1, 2010, and June 30, 2011. Each patient's cardiovascular risk profile was analyzed. The main outcome was the appropriate of prescribed treatment to prevent cardiovascular complications according to the 2012 guidelines of the American Diabetes Association on the patient's discharge from emergency care. A total of 298 patients were included; 275 (92%) had type II diabetes. Ninety percent of the series (269 patients) had at least 1 cardiovascular risk factor and 147 (49%) had prior target organ damage; target organ damage was newly diagnosed in 41 (14%). Fifty-eight percent (172 patients) were discharged home from the emergency department. Although 215 patients (72%) were not adhering to at least 1 previously prescribed preventive treatment and 30 (10%) were not adhering to any prescribed treatment, drug prescriptions were modified only in 1.1% to 3.3% of patients and no follow-up was recommended in 42 cases (24%). Although diabetic patients treated in emergency departments are at high risk for cardiovascular complications, their visit is not used to optimize preventive treatment for these complications or ensure appropriate follow-up.
Models of emergency departments for reducing patient waiting times.
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Marek Laskowski
Full Text Available 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.
Patterns of 'at-home' alcohol-related injury presentations to emergency departments.
Bunker, Naomi; Woods, Cindy; Conway, Jane; Barker, Ruth; Usher, Kim
2017-01-01
This study aimed to establish the scale of alcohol-related injuries originating in the home. Despite recent media and public attention on alcohol-related injuries occurring at licensed venues, many occur in other locations including the home. A retrospective observational study. Emergency department surveillance data sourced from the Queensland Injury Surveillance Unit were interrogated for alcohol-related emergency department presentations from 2003-2012 (n = 12,296). Descriptive analysis was undertaken to assess alcohol involvement in injury, and analysis of variance was used to determine the differences among group means and their associated presentations. The relationship between demographic variables and injury location was assessed using p value of domestic violence by spouse or partner (n = 510), 59·5% occurred 'at home'. This is the first study to investigate alcohol-related injuries occurring at home. The home accounts for a greater proportion of injuries than the frequently assessed licensed premises location. Further research is required to validate these findings in a wider setting. A public health campaign is required to minimise harm associated with alcohol-related injuries in the home, and nurses are positioned to inform health policy makers around this issue. Furthermore, emergency department nurses are in a unique position to provide brief interventions around safe alcohol consumption and injury prevention. © 2016 John Wiley & Sons Ltd.
[Loyal frequent users of hospital emergency departments: the FIDUR project].
Fernández Alonso, Cesáreo; Romero Pareja, Rodolfo; Rivas García, Aristides; Jiménez Gallego, Rosa; Majo Carbajo, Yolanda; Aguilar Mulet, Juan Mariano
2016-02-01
To describe the characteristics of frequent users of hospital emergency departments and analyze whether characteristics varied in relation to how revisits were distributed over the course of the year studied. Retrospective study of patients over the age of 14 years who were treated in a hospital emergency department at least 10 times in 2013. Patients were identified in 17 public hospitals in the Spanish autonomous community of Madrid. Data related to the first and successive visits were gathered and analyzed by quarter year. We included 2340 patients with a mean (SD) age of 54 (21) years. A total of 1361 (58.%) were women, 1160 (50%) had no concomitant diseases, 1366 (58.2%) were substance abusers, and 25 (1.1%) were homeless. During the first visit, 2038 (87.1%) complained of a recent health problem, and 289 (12.4%) were admitted. Sixty (2.6%) patients concentrated their revisits in a single quarters 335 (14.3%) in 2 quarters, 914 (39.1%) in 3, and 1005 (42.9%) in 4. Patients whose revisits were distributed over more quarters were older (> 65 years), had more concomitant conditions, were on more medications (P women (P = .012) and more likely to have a specific diagnosis (P loyally comes to the same emergency department over the course of a year. Patients whose revisits are dispersed over a longer period have more complex problems and use more resources during their initial visit.
The Integration of Palliative Care into the Emergency Department
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Nursah BASOL
2015-06-01
Full Text Available SUMMARY: Palliative care (PC is a new and developing area. It aims to provide the best possible quality of life for patients with life-limiting diseases. It does not primarily include life-extending therapies, but rather tries to help patients spend the rest of their lives in the best way. PC patients often are admitted to emergency departments during the course of a disease. The approach and management of PC include differences with emergency medicine. Thus, there are some problems while providing PC in the ED. With this article, the definition, main features, benefits, and problems of providing PC are presented, with the primary aim of emphasizing the importance of PC integration into the ED. Key words: Emergency department, integration, palliative care, training
Current use of intraosseous infusion in Danish emergency departments
DEFF Research Database (Denmark)
Molin, Rune; Hallas, Peter; Brabrand, Mikkel
2010-01-01
BACKGROUND: Intraosseous infusion (IOI) is recommended when intravenous access cannot be readily established in both pediatric and adult resuscitation. We evaluated the current use of IOI in Danish emergency departments (EDs). METHODS: An online questionnaire was e-mailed to the Heads of Department...
Yu, Amy Y X; Quan, Hude; McRae, Andrew; Wagner, Gabrielle O; Hill, Michael D; Coutts, Shelagh B
2017-09-18
Validation of administrative data case definitions is key for accurate passive surveillance of disease. Transient ischemic attack (TIA) is a condition primarily managed in the emergency department. However, prior validation studies have focused on data after inpatient hospitalization. We aimed to determine the validity of the Canadian 10th International Classification of Diseases (ICD-10-CA) codes for TIA in the national ambulatory administrative database. We performed a diagnostic accuracy study of four ICD-10-CA case definition algorithms for TIA in the emergency department setting. The study population was obtained from two ongoing studies on the diagnosis of TIA and minor stroke versus stroke mimic using serum biomarkers and neuroimaging. Two reference standards were used 1) the emergency department clinical diagnosis determined by chart abstractors and 2) the 90-day final diagnosis, both obtained by stroke neurologists, to calculate the sensitivity, specificity, positive and negative predictive values (PPV and NPV) of the ICD-10-CA algorithms for TIA. Among 417 patients, emergency department adjudication showed 163 (39.1%) TIA, 155 (37.2%) ischemic strokes, and 99 (23.7%) stroke mimics. The most restrictive algorithm, defined as a TIA code in the main position had the lowest sensitivity (36.8%), but highest specificity (92.5%) and PPV (76.0%). The most inclusive algorithm, defined as a TIA code in any position with and without query prefix had the highest sensitivity (63.8%), but lowest specificity (81.5%) and PPV (68.9%). Sensitivity, specificity, PPV, and NPV were overall lower when using the 90-day diagnosis as reference standard. Emergency department administrative data reflect diagnosis of suspected TIA with high specificity, but underestimate the burden of disease. Future studies are necessary to understand the reasons for the low to moderate sensitivity.
Enhanced monitoring of abnormal emergency department demands
Harrou, Fouzi
2016-06-13
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.
Designing a clinical dashboard to fill information gaps in the emergency department.
Swartz, Jordan L; Cimino, James J; Fred, Matthew R; Green, Robert A; Vawdrey, David K
2014-01-01
Data fragmentation within electronic health records causes gaps in the information readily available to clinicians. We investigated the information needs of emergency medicine clinicians in order to design an electronic dashboard to fill information gaps in the emergency department. An online survey was distributed to all emergency medicine physicians at a large, urban academic medical center. The survey response rate was 48% (52/109). The clinical information items reported to be most helpful while caring for patients in the emergency department were vital signs, electrocardiogram (ECG) reports, previous discharge summaries, and previous lab results. Brief structured interviews were also conducted with 18 clinicians during their shifts in the emergency department. From the interviews, three themes emerged: 1) difficulty accessing vital signs, 2) difficulty accessing point-of-care tests, and 3) difficulty comparing the current ECG with the previous ECG. An emergency medicine clinical dashboard was developed to address these difficulties.
The perception of the patient safety climate by professionals of the emergency department.
Rigobello, Mayara Carvalho Godinho; Carvalho, Rhanna Emanuela Fontenele Lima de; Guerreiro, Juliana Magalhães; Motta, Ana Paula Gobbo; Atila, Elizabeth; Gimenes, Fernanda Raphael Escobar
2017-07-01
The aim of this study was to assess the patient safety climate from the perspective of healthcare professionals working in the emergency department of a hospital in Brazil. Emergency departments are complex and dynamic environments. They are prone to adverse events that compromise the quality of care provided and reveal the importance of patient safety culture and climate. This was a quantitative, descriptive, cross-sectional study. The Safety Attitudes Questionnaire (SAQ) - Short Form 2006 was used for data collection, validated and adapted into Portuguese. The study sample consisted of 125 participants. Most of the participants were female (57.6%) and had worked in emergency department for more than 10years (56.8%). Sixty-two participants (49.6%) were nursing professionals. The participants demonstrated satisfaction with their jobs and dissatisfaction with the actions of management with regard to safety issues. Participants' perceptions about the patient safety climate were found to be negative. Knowledge of professionals' perceptions of patient safety climate in the context of emergency care helps with assessments of the safety culture, contributes to improvement of health care, reduces adverse events, and can focus efforts to improve the quality of care provided to patients. Copyright © 2017 Elsevier Ltd. All rights reserved.
Wait times in the emergency department for patients with mental illness
Atzema, Clare L.; Schull, Michael J.; Kurdyak, Paul; Menezes, Natasja M.; Wilton, Andrew S.; Vermuelen, Marian J.; Austin, Peter C.
2012-01-01
Background: It has been suggested that patients with mental illness wait longer for care than other patients in the emergency department. We determined wait times for patients with and without mental health diagnoses during crowded and noncrowded periods in the emergency department. Methods: We conducted a population-based retrospective cohort analysis of adults seen in 155 emergency departments in Ontario between April 2007 and March 2009. We compared wait times and triage scores for patients with mental illness to those for all other patients who presented to the emergency department during the study period. Results: The patients with mental illness (n = 51 381) received higher priority triage scores than other patients, regardless of crowding. The time to assessment by a physician was longer overall for patients with mental illness than for other patients (median 82, interquartile range [IQR] 41–147 min v. median 75 [IQR 36–140] min; p < 0.001). The median time from the decision to admit the patient to hospital to ward transfer was markedly shorter for patients with mental illness than for other patients (median 74 [IQR 15–215] min v. median 152 [IQR 45–605] min; p < 0.001). After adjustment for other variables, patients with mental illness waited 10 minutes longer to see a physician compared with other patients during noncrowded periods (95% confidence interval [CI] 8 to 11), but they waited significantly less time than other patients as crowding increased (mild crowding: −14 [95% CI −12 to −15] min; moderate crowding: −38 [95% CI −35 to −42] min; severe crowding: −48 [95% CI −39 to −56] min; p < 0.001). Interpretation: Patients with mental illness were triaged appropriately in Ontario’s emergency departments. These patients waited less time than other patients to see a physician under crowded conditions and only slightly longer under noncrowded conditions. PMID:23148052
Recent Suicidal Ideation among Patients in an Inner City Emergency Department
Ilgen, Mark A.; Walton, Maureen A.; Cunningham, Rebecca M.; Barry, Kristen L.; Chermack, Steve T.; De Chavez, Peter; Blow, Frederic C.
2009-01-01
The rates and associated features of suicidal ideation among 5,641 patients seeking routine, nonsuicide related care in an inner-city emergency department were examined. Approximately 8% of patients seeking routine care in the emergency department reported some form of suicidal ideation within the past 2 weeks. Suicidal ideation was common in…
Risk for Repeat Emergency Department Visits for Violent Injuries in Youth Firearm Victims
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Hyun Ja Lim
2009-01-01
Full Text Available Objective To identify significant risk factors associated with repeat emergency department (ED. Visits for violent injuries in youth firearm victims. Methods The study subjects of this retrospective cohort study were firearm victims aged 18 and younger presenting to a Pediatric Emergency Department/Trauma Center at Children's Hospital of Wisconsin between 1990 and 1995. The primary outcome was subsequent Emergency Department visits (REDV at any emergency department in Milwaukee for a violent injury. Results A total of 495 subjects were eligible for the present study in the pediatric firearm victim's ED visit database. Eighty-five percent (n = 420 were males and 82% were African-Americans. Mean age was 15 years old (s.d = ±3.6. A majority of them had a single-parent family. Eighty-eight subjects (17.8% had a prior history of ED visit due to violence. During the study time, 201 subjects had at least one REDV. In the multivariable model, a subject without a social worker consulting at the hospital were more likely to have REDV compared to subjects with a social worker consulting (O.R = 1.749; p-value = 0.047, controlling for guardian and disposition. Subjects disposed to detention center or police custody were more likely to have REDV compared to subjects disposed to home or a hospital (O.R = 5.351; p-value = 0.003. Conclusion Our analysis indicates that individuals with guardians, those who did not receive social worker intervention on their initial visit, and those discharged in police custody were associated with increased repeat ED visits due to a violent injury.
The transmission and interpretation of emergency department radiographs.
James, J J; Grabowski, W; Mangelsdorff, A D
1982-08-01
Twenty-five radiographic studies representative of the spectrum of trauma cases that might present to an emergency department were selected from actual cases presenting at Brooke Army Medical Center (BAMC) in San Antonio, Texas. The studies were then transmitted from a local television studio via satellite back to BAMC and three other Army hospitals. A panel of 29 physicians (11 radiologists, 7 emergency physicians, and 11 others from various specialty areas) viewed the images on commercial grade television sets and attempted to make a diagnosis. The diagnostic accuracy of the radiologists (86%) was significantly better than that of the other two groups (77% each). However, given the overall expense of a teleradiology network, this difference in accuracy - especially when translated into clinically significant errors - might not justify the establishment of such a network in terms of cost-effectiveness.
The legal and ethical implications of social media in the emergency department.
Lyons, Rachel; Reinisch, Courtney
2013-01-01
Social media is a growing and popular means of communication. It is understandable that health care providers may not share identifying information on patients through these sources. Challenges arise when patients and family members wish to record the care provided in the emergency department. The health care provider may be faced with an ethical and possibly legal dilemma when social media is present in the emergency department. This article seeks to discuss the legal and ethical principles surrounding social media in the emergency department.
[Antidotes: use guidelines and minimun stock in an emergency department].
García-Martín, A; Torres Santos-Olmos, R
2012-01-01
To develop a guide for antidotes and other medications used to counteract poisoning, and define the stock in an emergency department, as a safety priority for the part-time pharmacist assigned to the unit. A search of specialist databases and web portals of the Spanish Society of Toxicology and the British National Poisons Information Service, as well as toxicology databases, TOXICONET, information from other hospitals, tertiary sources, Micromedex and Medline. The Guide contains 42 active ingredients and is accessible to the Pharmacy and Emergency departments in electronic format. A minimum emergency stock was agreed based on the daily treatment of a 100 kg patient. This information, including updated expiry dates, is available at the emergency department antidote stock facilities and in electronic format. On a monthly basis, the pharmacist reviews the need to replace any drugs, due to their expiry date or lack of use. The lack of evidence from high quality antidote studies, the variability due to the difficulties of updating sources and some geographical differences in their use means that decision-making can be difficult. It would be useful to have minimum quantity recommendations from societies of toxicology, regulatory agencies and organisations such as the Joint Commission on the Accreditation of Healthcare Organisations. It would also be useful to have a suprahospital risk assessment to optimise management and ensure the availability of antidotes which are expensive, have a limited shelf life, or of which demand is difficult to forecast. Copyright © 2011 SEFH. Published by Elsevier Espana. All rights reserved.
Emergency department waiting room stress: can music or aromatherapy improve anxiety scores?
Holm, Lydia; Fitzmaurice, Laura
2008-12-01
The aim of this study was to determine the effect of music alone, aromatherapy alone, and music in addition to aromatherapy on anxiety levels of adults accompanying children to a pediatricemergency department waiting area. The study was conducted over 28 consecutive days, assigned to 1 of 4 groups: no intervention, music, aromatherapy, and both music and aromatherapy. Adults accompanying children to the emergency department of an urban pediatric tertiary care referral center were given a survey including a Spielberger state anxiety inventory with additional questions about whether they noticed an aroma or music and if so their response to it. The music was classic ingenre with a tempo of 60 to 70 beats per minute. The aromatherapyused the essential oil Neroli dispersed using 2 aromatherapydiffusers placed in strategic airflow ends of the emergency department. The 1104 surveys were completed. There was a statistically significant decrease in anxietylevel on those days when music was playing (36.3 vs. 39.2; P = 0.017). There was no difference in anxiety levels on those days when aromatherapy was present compared with the nonaromatherapy days (37.3 vs. 38.0; P = 0.347). Music is an easy and useful way to decrease the anxiety of visitors in an emergency department waiting area. Although no difference was detected for the aromatherapy group, this could be because of environmental conditions or imprecise application of the aromatherapy; further study is needed to either prove or disprove its effectiveness in this setting.
Aguilar de la Red, Yurena; Manrique Martín, Gema; Guerrero Marquez, Gloria; González Herrero, Concepción; Vázquez López, Paula; Míguez Navarro, Concepción
2018-02-01
An inadequate pain management is common in the emergency department. Our objective was to analyze pain management among children with an orofacial infection or trauma in the emergency department and to assess compliance and satisfaction with analgesia prescribed at discharge. Cross-sectional, observational and analytical study in children attending the emergency department for an orofacial infection or trauma over 2 months. Pain management in the emergency department, analgesia prescribed at home and, following a call to parents, treatment provided and its adequacy to control pain were registered. In total, 252patients (mean age: 4.5 years, SD: 3.89) were included. Pain assessment was recorded at the triage for 8.7%, and in the medical report, for 3.6%. Analgesia was administered to 41.3% in the emergency room. At discharge, no analgesia was prescribed to 13.9%; scheduled analgesia, to 25.4%; and as needed, to 60.3%. Pediatricians prescribed scheduled analgesia more frequently than surgeons (34.4% versus 16.5%, p Pain assessment and management was scarce in the emergency department. The most common prescription was as needed, contrary to what is recommended in the guidelines. Analgesic control worked better for trauma injuries than for infections. Sociedad Argentina de Pediatría
Emergency department radiology: reality or luxury? An international comparison.
Kool, D.R.; Blickman, J.G.
2010-01-01
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,
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Mansur Kürsad Erkuran
2013-12-01
Full Text Available INTRODUCTION: The patients applying to a emergency service may stay longer than necessary for diagnosis, monitoring and treatment. This can be due to the inadequacy of the treatment performed in emergency department or to the absence of the required unit in the hospital. In this study, we analyzed the waiting period of the patients who have not been hospitalized. METHODS: The patients applying to Bolu İzzet Baysal Public Hospital Emergency Unit between 24.11.2009 and 25.08.2011 have been studied regarding their application date, the season, and their waiting period in the emergency unit. The data have been analyzed using the statistics software Package for the Social Sciences (SPSS, Inc., Chicago, IL, version 17.0 for Windows. The chi-square χ2 test has been used for the determination of the percentage distribution and significance and p<0,05 has been considered significant. RESULTS: 4215 patients applying to Bolu İzzet Baysal Public Hospital Emergency Unit between 24.11.2009 and 25.08.2011 and monitored without hospitalization have been studied. The patients mainly presented during spring (p<0.05. The application occurred more often between 20.00 PM – 23.59 PM (p<0.005. The mean duration of the accept-standby of the patients in emergency unit was 09±12 (minimum 0 minute, maximum 130 minutes. The patients waited 0,26 ±70 minutes in emergency unit examination (minimum 0 minute, maximum 1292 minutes. The total waiting time in emergency unit was 52 ±100 minutes (minimum 10, maximum 1435 minutes. DISCUSSION AND CONCLUSION: In this study, we observed that the duration of the hospitalization in emergency unit is longer than the ideal duration.
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Bock Beth C
2007-05-01
Full Text Available Abstract Background Lack of knowledge regarding preventive health services for women might impede campaigns to expand these services in the emergency department setting. For 18–55-year-old English-speaking women visiting an urban emergency department, we aimed to: (1 Ascertain their knowledge regarding the applicability, purpose, and recommended intervals of three women's cancer screening and three contraceptive methods; and (2 Determine if patient age, race/ethnicity, medical insurance status, and current or recent usage of these methods are associated with greater or lesser knowledge about them. Methods Emergency department-based survey on recent or current usage and knowledge about Pap smears, breast self-examinations, mammograms, condoms, birth control, and emergency contraception. Analyses included calculation of summary statistics and creation of multivariable logistic regression models. Results Of 1,100 patients eligible for the study, 69.9% agreed to participate. Most of the participants were Conclusion Although these female ED patients demonstrated strong knowledge on some women's cancer screening and contraceptive methods, there were several areas of knowledge deficit. Women without private medical insurance and those who have not used a particular cancer screening or contraceptive method demonstrated less knowledge. Reduced knowledge about women's cancer screening and contraceptive methods should be considered during clinical encounters and when instituting or evaluating emergency department-based initiatives that assess the need for these methods.
Tinker, Sarah C; Moe, Christine L; Klein, Mitchel; Flanders, W Dana; Uber, Jim; Amirtharajah, Appiah; Singer, Philip; Tolbert, Paige E
2010-01-01
The extent to which drinking water turbidity measurements indicate the risk of gastrointestinal illness is not well understood. Despite major advances in drinking water treatment and delivery, infectious disease can still be transmitted through drinking water in the United States, and it is important to have reliable indicators of microbial water quality to inform public health decisions. The objective of our study was to assess the relationship between gastrointestinal illness, quantified through emergency department visits, and drinking water quality, quantified as raw water and filtered water turbidity measured at the treatment plant. We examined the relationship between turbidity levels of raw and filtered surface water measured at eight major drinking water treatment plants in the metropolitan area of Atlanta, Georgia, and over 240,000 emergency department visits for gastrointestinal illness during 1993-2004 among the population served by these plants. We fit Poisson time-series statistical regression models that included turbidity in a 21-day distributed lag and that controlled for meteorological factors and long-term time trends. For filtered water turbidity, the results were consistent with no association with emergency department visits for gastrointestinal illness. We observed a modest association between raw water turbidity and emergency department visits for gastrointestinal illness. Our results suggest that source water quality may contribute modestly to endemic gastrointestinal illness in the study area. The association between turbidity and emergency department visits for gastrointestinal illness was only observed when raw water turbidity was considered; filtered water turbidity may not serve as a reliable indicator of modest pathogen risk at all treatment plants.
Emergency department operations and management education in emergency medicine training
Institute of Scientific and Technical Information of China (English)
Bret A Nicks; Darrell Nelson
2012-01-01
BACKGROUND:This study was undertaken to examine the current level of operations and management education within US-based Emergency Medicine Residency programs.METHODS:Residency program directors at all US-based Emergency Medicine Residency programs were anonymously surveyed via a web-based instrument.Participants indicated their levels of residency education dedicated to documentation,billing/coding,core measure/quality indicator compliance,and operations management.Data were analyzed using descriptive statistics for the ordinal data/Likert scales.RESULTS:One hundred and six(106)program directors completed the study instrument of one hundred and fifty-six(156)programs(70%).Of these,82.6%indicated emergency department(ED)operations and management education within the training curriculum.Dedicated documentation training was noted in all but 1 program(99%).Program educational offerings also included billing/coding(83%),core measure/quality indicators(78%)and operations management training(71%).In all areas,the most common means of educating came through didactic sessions and direct attending feedback or 69%-94%and 72%-98%respectively.Residency leadership was most confident with resident understanding of quality documentation(80%)and less so with core measures(72%),billing/coding/RVUs(58%),and operations management tools(23%).CONCLUSIONS:While most EM residency programs integrate basic operational education related to documentation and billing/coding,a smaller number provide focused education on the dayto-day management and operations of the ED.Residency leadership perceives graduating resident understanding of operational management tools to be limited.All respondents value further resident curriculum development of ED operations and management.
Stolz, Lori A; Muruganandan, Krithika M; Bisanzo, Mark C; Sebikali, Mugisha J; Dreifuss, Bradley A; Hammerstedt, Heather S; Nelson, Sara W; Nayabale, Irene; Adhikari, Srikar; Shah, Sachita P
2015-08-01
To describe the outcomes and curriculum components of an educational programme to train non-physician clinicians working in a rural, Ugandan emergency department in the use of POC ultrasound. The use of point-of-care ultrasound was taught to emergency care providers through lectures, bedsides teaching and hands-on practical sessions. Lectures were tailored to care providers' knowledge base and available therapeutic means. Every ultrasound examination performed by these providers was recorded over 4.5 years. Findings of these examinations were categorised as positive, negative, indeterminate or procedural. Other radiologic studies ordered over this same time period were also recorded. A total of 22,639 patients were evaluated in the emergency department by emergency care providers, and 2185 point-of-care ultrasound examinations were performed on 1886 patients. Most commonly used were the focused assessment with sonography in trauma examination (53.3%) and echocardiography (16.4%). Point-of-care ultrasound studies were performed more frequently than radiology department-performed studies. Positive findings were documented in 46% of all examinations. We describe a novel curriculum for point-of-care ultrasound education of non-physician emergency practitioners in a resource-limited setting. These non-physician clinicians integrated ultrasound into clinical practice and utilised this imaging modality more frequently than traditional radiology department imaging with a large proportion of positive findings. © 2015 John Wiley & Sons Ltd.
Epidemiological characteristics of pediatric epistaxis presenting to the emergency department.
Shay, Sophie; Shapiro, Nina L; Bhattacharyya, Neil
2017-12-01
Investigate the epidemiological characteristics of pediatric epistaxis in the emergency department setting. Cross-sectional study using national databases. Children (age epistaxis were extracted from the State Emergency Department Databases for New York, Florida, Iowa, and California for the calendar year 2010. Associated diagnoses, procedures, encounter characteristics, and demographic data were examined. There were 18,745 cases of pediatric epistaxis (mean age 7.54 years, 57.4% male). Overall, 6.9% of patients underwent procedures to control epistaxis, of which 93.5% had simple anterior epistaxis control. The distribution of pediatric epistaxis was highest in spring and summer months (p epistaxis presentations (38.8%, p epistaxis control procedure performed (p epistaxis control procedure (p epistaxis control procedure compared to those of minority backgrounds (p epistaxis are uninvolved cases that do not require procedural intervention. The overrepresentation of low socioeconomic status patients may suggest an overutilization of emergency services for minor cases of epistaxis, and perhaps a lack of access to primary care providers. This is the first study to evaluate racial and socioeconomic factors in relationship to pediatric epistaxis. Further investigation is needed to better elucidate these potential disparities. Copyright © 2017 Elsevier B.V. All rights reserved.
Surveillance of construction worker injuries through an urban emergency department.
Hunting, K L; Nessel-Stephens, L; Sanford, S M; Shesser, R; Welch, L S
1994-03-01
To learn more about the causes of nonfatal construction worker injuries, and to identify injury cases for further work-site investigations or prevention programs, an emergency department-based surveillance program was established. Construction workers with work-related injuries or illnesses were identified by reviewing the medical records of all patients treated at the George Washington University Emergency Department between November 1, 1990 and November 31, 1992. Information regarding the worker, the injury, and the injury circumstances were abstracted from medical records. Information was obtained on 592 injured construction workers from numerous trades. Lacerations were the most commonly treated injuries among these workers, followed by strains and sprains, contusions, and eye injuries. Injuries were most commonly caused by sharp objects (n = 155, 26%), falls (n = 106, 18%), and falling objects (n = 70, 12%). Thirty-five percent of injuries were to the hands, wrists, or fingers. Among the twenty-eight injuries severe enough to require hospital admission, eighteen (64%) were caused by falls. Laborers and Hispanic workers were overrepresented among these severe cases. Emergency Department records were a useful surveillance tool for the initial identification and description of work-related injuries. Although E codes were not that useful for formulating prevention strategies, detailed review of injury circumstances from Emergency Department records was valuable and has helped to establish priorities for prevention activities.
Human Trafficking in the Emergency Department
Patel, Ronak B; Ahn, Roy; Burke, Thomas F
2010-01-01
Human trafficking continues to persist, affecting up to 200 million people worldwide. As clinicians in emergency departments commonly encounter victims of intimate partner violence, some of these encounters will be with trafficking victims. These encounters provide a rare opportunity for healthcare providers to intervene and help. This case report of a human trafficking patient from a teaching hospital illustrates the complexity in identifying these victims. Clinicians can better identify pot...
Improving communication between emergency department staff.
Moore, Kate
2014-05-01
During redevelopment of the emergency department at the Royal Sussex County Hospital, Brighton, it was deemed vital that its internal communication system should be as effective as possible. An audit of staff perceptions of the existing communication system and a relevant literature review were undertaken, therefore, to inform a proposal for the development of a new online system. This article describes the development and implementation of the system.
Héguy, Léa; Garneau, Michelle; Goldberg, Mark S; Raphoz, Marie; Guay, Frédéric; Valois, Marie-France
2008-02-01
Asthma among children is a major public health problem worldwide. There are increasing number of studies suggesting a possible association between allergenic pollen and exacerbations of asthma. In the context of global climate change, a number of future climate and air pollution scenarios predict increases in concentrations of pollen, an extension of the pollen season, and an increase in the allergenicity of pollen. The goal of the present study is to evaluate the short-term effects of exposure to grass and weed pollen on emergency department visits and readmissions for asthma among children aged 0-9 years living in Montreal between April and October, 1994-2004. Time-series analyses were carried out using parametric log-linear overdispersed Poisson models that were adjusted for temporal variations, daily weather conditions (temperature, atmospheric pressure), and gaseous air pollutants (ozone and nitrogen dioxide). We have found positive associations between emergency department visits and concentrations of grass pollen 3 days after exposure. The effect of grass pollen was higher on emergency department readmissions as compared to initial visits. Weak negative associations were found between weed pollen (including ragweed pollen) and emergency department visits 2 days after exposure. The data indicate that among children, emergency department visits increased with increasing concentrations of grass pollen.
State Emergency Department Opioid Guidelines: Current Status.
Broida, Robert I; Gronowski, Tanner; Kalnow, Andrew F; Little, Andrew G; Lloyd, Christopher M
2017-04-01
The purpose of this study was to evaluate and categorize current state-sponsored opioid guidelines for the practice of emergency medicine (EM). We conducted a comprehensive search of EM-specific opioid prescribing guidelines and/or policies in each state to determine current state involvement in EM opioid prescribing, as well as to evaluate some of the specifics of each guideline or policy. The search was conducted using an online query and a follow-up email request to each state chapter of ACEP. We found that 17 states had emergency department-specific guidelines. We further organized the guidelines into four categories: limiting prescriptions for opioids with 67 total recommendations; preventing/diverting abuse with 56 total recommendations; addiction-related guidelines with 29 total recommendations; and a community resources section with 24 total recommendations. Our results showed that current state guidelines focus on providers limiting opioid pain prescriptions and vetting patients for possible abuse/diversion. This study highlights the 17 states that have addressed opioid prescribing guidelines and categorizes their efforts to date. It is hoped that this study will provide the basis for similar efforts in other states.
Patient experience in the emergency department: inconsistencies in the ethic and duty of care.
Moss, Cheryle; Nelson, Katherine; Connor, Margaret; Wensley, Cynthia; McKinlay, Eileen; Boulton, Amohia
2015-01-01
To understand how people who present on multiple occasions to the emergency department experience their health professionals' moral comportment (ethic of care and duty of care); and to understand the consequences of this for 'people who present on multiple occasions' ongoing choices in care. People (n = 34) with chronic illness who had multiple presentations were interviewed about the role that emergency departments played within their lives and health-illness journey. Unprompted, all participants shared views about the appropriateness or inappropriateness of the care they received from the health professionals in the emergency departments they had attended. These responses raised the imperative for specific analysis of the data regarding the need for and experience of an ethic of care. Qualitative description of interview data (stage 3 of a multimethod study). The methods included further analysis of existing interviews, exploration of relevant literature, use of Tronto's ethic of care as a theoretical framework for analysis, thematic analysis of people who present on multiple occasions' texts and explication of health professionals' moral positions in relation to present on multiple occasions' experiences. Four moral comportment positions attributed by the people who present on multiple occasions to the health professionals in emergency department were identified: 'sustained and enmeshed ethic and duty of care', 'consistent duty of care', 'interrupted or mixed duty and ethic of care', and 'care in breach of both the ethic and duty of care'. People who present on multiple occasions are an important group of consumers who attend the emergency department. Tronto's phases/moral elements in an ethic of care are useful as a framework for coding qualitative texts. Investigation into the bases, outcomes and contextual circumstances that stimulate the different modes of moral comportment is needed. Findings carry implications for emergency department care of people who
Directory of Open Access Journals (Sweden)
Mura P
2017-12-01
Full Text Available Paolo Mura,1 Elisabetta Serra,1 Franco Marinangeli,2 Sebastiano Patti,3 Mario Musu,1 Ilenia Piras,3 Maria Valeria Massidda,1 Giorgio Pia,3 Maurizio Evangelista,4 Gabriele Finco1 1Department of Medical Sciences “M. Aresu”, University of Cagliari, Cagliari, Italy; 2Department of Anesthesiology, Intensive Care and Pain Medicine, University of L’Aquila, L’Aquila, Italy; 3Department of Emergency Medicine, Santissima Trinità Hospital, Cagliari, Italy; 4Department of Anesthesiology and Pain Medicine, Cattolica University, Rome, Italy Aim: Pain represents the most frequent cause for patient admission to emergency departments (EDs. Oligoanalgesia is a common problem in this field. The aims of this study were to assess prevalence and intensity of pain in patients who visited a second-level urban ED and to evaluate the efficacy of pharmacological treatment administered subsequent to variations in pain intensity. Methods: A 4-week prospective observational study was carried out on 2,838 patients who visited a second-level urban ED. Pain intensity was evaluated using the Numeric Rating Scale at the moment of triage. The efficacy of prescribed analgesic therapy was evaluated at 30 and 60 minutes, and at discharge. Data concerning pain intensity were classified as absent, slight, mild, or severe. Pain was evaluated in relation to the prescribed therapy. Results: Pain prevalence was 70.7%. Traumatic events were the primary cause in most cases (40.44%, followed by pain linked to urologic problems (13.52%, abdominal pain (13.39%, and nontraumatic musculoskeletal pain (7.10%. Only 32.46% of patients were given pharmacological therapy. Of these, 76% reported severe pain, 19% moderate, and 5% slight, and 66% received nonsteroidal anti-inflammatory drugs or paracetamol, 4% opioids, and 30% other therapies. A difference of at least 2 points on the Numerical Rating Scale was observed in 84% of patients on reevaluation following initial analgesic therapy
Pharmaceutical advertising in emergency departments.
Marco, Catherine A
2004-04-01
Promotion of prescription drugs represents a growing source of pharmaceutical marketing expenditures. This study was undertaken to identify the frequency of items containing pharmaceutical advertising in clinical emergency departments (EDs). In this observational study, emergency physician on-site investigators quantified a variety of items containing pharmaceutical advertising present at specified representative times and days, in clinical EDs. Measurements were obtained by 65 on-site investigators, representing 22 states. Most EDs in this study were community EDs (87% community and 14% university or university affiliate), and most were in urban settings (50% urban, 38% suburban, and 13% rural). Investigators measured 42 items per ED (mean = 42; median = 31; interquartile range of 14-55) containing pharmaceutical advertising in the clinical area. The most commonly observed items included pens (mean 15 per ED; median 10), product brochures (mean 5; median 3), stethoscope labels (mean 4; median 2), drug samples (mean 3; median 0), books (mean 3.4), mugs (mean 2.4), and published literature (mean 3.1). EDs with a policy restricting pharmaceutical representatives in the ED had significantly fewer items containing pharmaceutical advertising (median 7.5; 95% CI = 0 to 27) than EDs without such a policy (median 35; 95% CI = 27 to 47, p = 0.005, nonparametric Wilcoxon two-sample test). There were no differences in quantities of pharmaceutical advertising for EDs in community compared with university settings (p = 0.5), rural compared with urban settings (p = 0.3), or annual ED volumes (p = 0.9). Numerous items containing pharmaceutical advertising are frequently observed in EDs. Policies restricting pharmaceutical representatives in the ED are associated with reduced pharmaceutical advertising.
Bernhard, Michael; Pietsch, Christian; Gries, André
2009-06-01
The essential tasks of a department of interdisciplinary emergency medicine are the initial triage and assessment of vital function as well as the subsequent organization und initiation of emergency treatment. A previously defined set of diagnostic and therapeutic measures is carried out before the patient is allocated to an in-hospital clinical service and is admitted to a ward. Moreover, diagnosis and treatment for outpatients are performed. "Time" is a critical factor to be considered for all organizational and structural aspects of a department of interdisciplinary emergency medicine.
Mathews, Kusum S; Durst, Matthew S; Vargas-Torres, Carmen; Olson, Ashley D; Mazumdar, Madhu; Richardson, Lynne D
2018-05-01
ICU admission delays can negatively affect patient outcomes, but emergency department volume and boarding times may also affect these decisions and associated patient outcomes. We sought to investigate the effect of emergency department and ICU capacity strain on ICU admission decisions and to examine the effect of emergency department boarding time of critically ill patients on in-hospital mortality. A retrospective cohort study. Single academic tertiary care hospital. Adult critically ill emergency department patients for whom a consult for medical ICU admission was requested, over a 21-month period. None. Patient data, including severity of illness (Mortality Probability Model III on Admission), outcomes of mortality and persistent organ dysfunction, and hourly census reports for the emergency department, for all ICUs and all adult wards were compiled. A total of 854 emergency department requests for ICU admission were logged, with 455 (53.3%) as "accept" and 399 (46.7%) as "deny" cases, with median emergency department boarding times 4.2 hours (interquartile range, 2.8-6.3 hr) and 11.7 hours (3.2-20.3 hr) and similar rates of persistent organ dysfunction and/or death 41.5% and 44.6%, respectively. Those accepted were younger (mean ± SD, 61 ± 17 vs 65 ± 18 yr) and more severely ill (median Mortality Probability Model III on Admission score, 15.3% [7.0-29.5%] vs 13.4% [6.3-25.2%]) than those denied admission. In the multivariable model, a full medical ICU was the only hospital-level factor significantly associated with a lower probability of ICU acceptance (odds ratio, 0.55 [95% CI, 0.37-0.81]). Using propensity score analysis to account for imbalances in baseline characteristics between those accepted or denied for ICU admission, longer emergency department boarding time after consult was associated with higher odds of mortality and persistent organ dysfunction (odds ratio, 1.77 [1.07-2.95]/log10 hour increase). ICU admission decisions for
Use of mobile devices in the emergency department: A scoping review.
Dexheimer, Judith W; Borycki, Elizabeth M
2015-12-01
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. © The Author(s) 2014.
Morales Erazo, Alexander; Cardona Arango, Doris
The main aim of this study was to identify the variables related to early mortality in the elderly at the time of admission to the emergency department. Using probability sampling, the study included patients 60 years old or older of both genders who were admitted for observation to the emergency department of the University Hospital of Nariño, ¿Colombia? in 2015. Using a questionnaire designed for this study, some multidimensional features that affect the health of the elderly were collected (demographic, clinical, psychological, functional, and social variables). The patients were then followed-up for 30 days in order to determine the mortality rate during this time. Univariate and multivariate logistic regressions and survival analysis were performed. Data were collected from 246 patients, with a mean age of 75.27 years and the majority female. The 30-day mortality rate was 15%. The variables most associated with death were: being female, temperature problems, initial diagnosis of neoplasia, and unable to walk independently in the emergency department. It is possible to determine the multidimensional factors present in the older patient admitted to an emergency department that could affect their 30-day mortality prognosis. and which should be intervened. Copyright © 2017 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.
[Psychoactive drugs use and related visits of adolescents to the emergency department].
Arias Constantí, Vanessa; Sanz Marcos, Nuria; Trenchs Sainz de La Maza, Victoria; Curcoy Barcenilla, Ana I; Matalí Costa, Josep; Luaces Cubells, Carles
2010-05-08
To describe psychoactive substances (PS)-related visits of adolescents to the emergency department and to explore possible differential features in patients according to the kind of PS consumed. Observational and analytic study. PS-related visits of adolescents to the emergency department during 30 months were studied. Patients were divided in two groups: those with alcohol intoxication only (Group_1) and those with other PS (Group_2) and they were compared. 333 consults were included, corresponding to 321 patients. Their mean age was 16,1 years (SD:1,1 years). Two hundred sixty-two(78,7%) were alcohol-related visits, and 110(33%) were related with another PS consumption. Of the 262 alcohol-related visits, 223 were only related with alcohol(Group_1), while the other 110 visits made up Group_2. Group_2 was composed of more males, more adolescents placed in Institutional Care and more adolescents with psychiatric records than Group_1. Likewise, distribution of Group_2 visits was less predictable than distribution of Group_1. PS consumption is a frequent major complaint in an Emergency Department. There are more poly-intoxications in males with psycho-social problems. In those cases, consumption seems to happen regardless of the time in the day or the day of the week.
Galloway, R; Sherren, P B
2010-12-01
The use of therapeutic hypothermia after cardiac arrest is a well-practised treatment modality in the intensive care unit (ICU). However, recent evidence points to advantages in starting the cooling process as soon as possible after the return of spontaneous circulation (ROSC). There are no data on implementation of this treatment in the emergency department. A telephone survey was conducted of the 233 emergency departments in the UK. The most senior available clinician was asked if, in cases where they have a patient with a ROSC after an out-of-hospital cardiac arrest, would therapeutic hypothermia be started in the emergency department. Of the 233 hospitals called, 230 responded, of which 35% would start cooling in the emergency department. Of this 35%, over half (56%) said the decision to start cooling was made by the emergency physician before consultation with the ICU. Also, of the 35% who would begin cooling in the emergency department, 55% would cool only for ventricular fibrillation/ventricular tachycardia, 66% would monitor temperature centrally, and 14% would use specialised cooling equipment. There is often a delay in getting patients to ICU from the emergency department, and thus the decision not to start cooling in the emergency department may impact significantly on patient outcome. The dissemination of these data may persuade emergency physicians that starting treatment in the emergency department is an appropriate and justifiable decision that is becoming a more accepted practice throughout the UK.
Hinsliff-Smith, Kathryn; McGarry, Julie
2017-12-01
To identify, review and critically evaluate published empirical studies concerned with the prevalence, management and support for survivors of domestic violence and abuse who present at emergency department. Domestic violence and abuse is a global phenomenon with a wealth of studies that explore the different aspects of the issue including the economic, social and health effects on survivors and on society as a whole. Emergency department is widely recognised as one healthcare facility where domestic violence and abuse survivors will often disclose domestic violence and abuse. In the UK, National Institute of Clinical Excellence produced guidelines in 2014 requiring all sectors of health care and those they work alongside to recognise support and manage survivors of domestic violence and abuse. Whilst there is an increasing body of research on domestic violence and abuse, limited synthesised work has been conducted in the context of domestic violence and abuse within emergency department. This review encompasses empirical studies conducted in emergency department for screening interventions, management and support for domestic violence and abuse patients including prevalence. This review included studies that included emergency department staff, emergency department service users and domestic violence and abuse survivors. A systematic approach across five electronic bibliographic databases found 35 studies meeting the inclusion criteria published between 2000-2015. From the 35 studies, four descriptive overarching themes were identified (i) prevalence of domestic violence and abuse in emergency department, (ii) use of domestic violence and abuse screening tools and emergency department interventions, (iii) current obstacles for staff working in emergency department and (iv) emergency department users and survivor perspectives. Having knowledgeable and supportive emergency department staff can have a positive benefit for the longer-term health of the domestic
April, Michael D; Arana, Allyson; Pallin, Daniel J; Schauer, Steven G; Fantegrossi, Andrea; Fernandez, Jessie; Maddry, Joseph K; Summers, Shane M; Antonacci, Mark A; Brown, Calvin A
2018-05-07
Although both succinylcholine and rocuronium are used to facilitate emergency department (ED) rapid sequence intubation, the difference in intubation success rate between them is unknown. We compare first-pass intubation success between ED rapid sequence intubation facilitated by succinylcholine versus rocuronium. We analyzed prospectively collected data from the National Emergency Airway Registry, a multicenter registry collecting data on all intubations performed in 22 EDs. We included intubations of patients older than 14 years who received succinylcholine or rocuronium during 2016. We compared the first-pass intubation success between patients receiving succinylcholine and those receiving rocuronium. We also compared the incidence of adverse events (cardiac arrest, dental trauma, direct airway injury, dysrhythmias, epistaxis, esophageal intubation, hypotension, hypoxia, iatrogenic bleeding, laryngoscope failure, laryngospasm, lip laceration, main-stem bronchus intubation, malignant hyperthermia, medication error, pharyngeal laceration, pneumothorax, endotracheal tube cuff failure, and vomiting). We conducted subgroup analyses stratified by paralytic weight-based dose. There were 2,275 rapid sequence intubations facilitated by succinylcholine and 1,800 by rocuronium. Patients receiving succinylcholine were younger and more likely to undergo intubation with video laryngoscopy and by more experienced providers. First-pass intubation success rate was 87.0% with succinylcholine versus 87.5% with rocuronium (adjusted odds ratio 0.9; 95% confidence interval 0.6 to 1.3). The incidence of any adverse event was also comparable between these agents: 14.7% for succinylcholine versus 14.8% for rocuronium (adjusted odds ratio 1.1; 95% confidence interval 0.9 to 1.3). We observed similar results when they were stratified by paralytic weight-based dose. In this large observational series, we did not detect an association between paralytic choice and first-pass rapid sequence
Good Interdepartmental Relationships: The Foundations of a Solid Emergency Department
Directory of Open Access Journals (Sweden)
Frank J. Edwards
2018-02-01
Full Text Available “No man is an island” said the English poet, John Donne, and nowhere can that statement be better appreciated than in a modern emergency department (ED. As emergency physicians, we work in the setting of a close knit team involving nurses, technicians, consultants, clerks, security guards and many more. On a macroscopic level as well, the ED itself needs productive relationships with every other department in the hospital. Back when the ED was staffed by physicians-in-training, general practitioners and moonlighting specialists, the care of patients was jealously divided between the long-entrenched traditional specialties. Anesthesiologists handled difficult airways; Surgeons took care of trauma; Radiologists did the ultrasounds and read all the films, and so forth. Emergency medicine—a specialty that encompassed parts of many disciplines—was initially met with skepticism and resistance from the traditional fields. I have been in practice long enough to remember when anesthesiologists fought against emergency physicians doing RSI and how they tried to stop us from using propofol or ketamine for procedural sedation. Orthopedists wanted to be consulted before we reduced a shoulder. Surgeons got angry if you gave morphine to a belly pain patient. In the early 1990’s at the University of Rochester, my colleague, Dr. Steve White, had to sneak into the ED with his own portable ultrasound device (with its postage stamp sized screen, because to have done so openly would have brought down the wrath of radiologists who believed that ultrasonography belonged to their department alone. These turf battles are mostly a thing of the past, thanks to clinical studies conducted by our specialty that proved what we can and should do. But challenges regarding interdepartmental relationships still remain. In the following discussion we will look at current friction points between the ED and other departments, including radiology, anesthesia, surgery
Preanalytic Factors Associated With Hemolysis in Emergency Department Blood Samples.
Phelan, Michael P; Reineks, Edmunds Z; Schold, Jesse D; Hustey, Frederic M; Chamberlin, Janelle; Procop, Gary W
2018-02-01
- Hemolysis of emergency department blood samples is a common occurrence and has a negative impact on health care delivery. - To determine the effect of preanalytic factors (straight stick, intravenous [IV] line, needle gauge, location of blood draw, syringe versus vacuum tube use, tourniquet time) on hemolysis in emergency department blood samples. - A single 65 000-visit emergency department's electronic health record was queried for emergency department potassium results and blood draw technique for all samples obtained in calendar year 2014, resulting in 54 531 potassium results. Hemolyzed potassium was measured by hemolysis index. Comparisons of hemolysis by sampling technique were conducted by χ 2 tests. - Overall hemolysis was 10.0% (5439 of 54 531). Hemolysis among samples obtained from straight stick was significantly less than among those obtained with IV line (5.4% [33 of 615] versus 10.2% [4821 of 47 266], P < .001). For IV-placed blood draws, antecubital location had a statistically significant lower overall hemolysis compared with other locations: 7.4% (2117 of 28 786) versus 14.6% (2622 of 17 960) ( P < .001). For blood drawn with a syringe compared with vacuum, hemolysis was 13.0% (92 of 705) and 11.0% (1820 of 16 590), respectively ( P = .09, not significant). For large-gauge IV blood draws versus smaller-gauge IV lines, a lower hemolysis was also observed (9.3% [3882 of 41 571] versus 16.7% [939 of 5633]) ( P < .001). For IV-drawn blood with tourniquet time less than 60 seconds, hemolysis was 10.3% (1362 of 13 162) versus 13.9% for more than 60 seconds (532 of 3832), P < .001. - This study confirmed previous findings that straight stick and antecubital location are significantly associated with reduced hemolysis and indicated that shorter tourniquet time and larger gauge for IV draws were significantly associated with lower hemolysis.
Hu, Yi-Chun; Chen, Jih-Chang; Chiu, Hsiao-Ting; Shen, Hsi-Che; Chang, Wen-Yin
2010-06-01
(1) To understand nurses' subjective perceptions of the current nursing workforce in their emergency departments, (2) to examine the relationship between nurses' workforce perceptions and its impact on the managerial outcomes and (3) to analyse the correlation between nurses' characteristics and the scores on workforce perception. While the association between workforce perceptions and nurse outcomes is well-documented, few studies have examined how emergency department nurses perceive current workforce and related outcomes. A cross-sectional questionnaire survey. A self-reported workforce perception questionnaire was used to survey 538 registered nurses in the emergency departments of 19 hospitals in northern Taiwan, during May to October 2006. Data were analysed using descriptive statistics, chi-square test, independent t-test, Pearson correlation and one-way anova. The mean score of workforce perception was 6.28 points (total = 10 points). Both overtime (p = 0.02) and number of callbacks on days off (p = 0.01) were significantly correlated to current nursing workforce and hospital level. Older nurses tended to have more emergency department experience (r = 0.37; p = 0.01) and those with more emergency department experience tended to have vacation accumulation (r = 0.09; p = 0.04), overtime (r = 0.10; p = 0.03) and better perception of their emergency department's current workforce (r = 0.09; p = 0.05). Although nurses' perceptions were found to be only moderate, overtime and number of callbacks on days off are potential problems that should be addressed by nursing leaders to benefit future emergency nurses. The findings can help drive strategies to ensure adequate staffing, to stabilise the nursing workforce and to prevent nurses from burnout factors such as working long hours, unpredictable schedules and a stressful work environment that may impact both the quality of emergency care and the quality of the nurses' work environment.
Emergency Department Utilization and Self-Reported Symptoms in Community-Dwelling Older Adults
Sawyer, Patricia; Kennedy, Richard; Williams, Courtney; Brown, Cynthia J.
2016-01-01
Background The rise in emergency department (ED) utilization among older adults is a nursing concern, because emergency nurses are uniquely positioned to positively impact the care of older adults. Symptoms have been associated with ED utilization, however, it remains unclear if symptoms are the primary reason for ED utilization. Purpose Describe the self-reported symptoms of community-dwelling older adults prior to accessing the emergency department. Examine the differences in self-reported symptoms among those who utilized the emergency department, and those who did not. Procedures A prospective longitudinal design was used. The sample included 403 community-dwelling older adults 75 years and older. Baseline in-home interviews were conducted followed by monthly telephone interviews over 15 months. Main Findings Commonly reported symptoms at baseline included pain, feeling tired, and having shortness of breath. In univariate analysis, pain, shortness of breath, fair/poor well-being, and feeling tired were significantly correlated with ED utilization. In multivariable models, problems with balance, and fair/poor well-being were significantly associated with ED utilization. Conclusions Several symptoms were common among this cohort of older adults. However, there were no significant differences in the types of symptoms reported by older adults who utilized the emergency department compared to those who did not use the emergency department. Based on these findings, symptoms among community-dwelling older adults may not be the primary reason for ED utilization. PMID:28131350
Verbeek-van Noord, I.; Wagner, C.; Dyck, C. van; Twisk, J.W.R.; Bruijne, M.C. de
2014-01-01
Objective: To describe the patient safety culture of Dutch emergency departments (EDs), to examine associations between safety culture dimensions and patient safety grades as reported by ED staff and to compare these associations between nurses and physicians. DESIGN: Cross-sectional survey
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Stoneking LR
2016-08-01
Full Text Available LR Stoneking,1 AL Waterbrook,1 J Garst Orozco,2 D Johnston,1 A Bellafiore,1 C Davies,3 T Nuño,1 J Fatás-Cabeza,4 O Beita,5 V Ng,1 KH Grall,6 W Adamas-Rappaport7 1Department of Emergency Medicine, University of Arizona, Tucson, AZ, 2Department of Emergency Medicine, Sinai Health System, Chicago, IL, 3Department of Emergency Medicine, Maricopa Medical Center, Phoenix, AZ, 4Department of Spanish and Portuguese, University of Arizona, Tucson, AZ, 5Department of Family and Community Medicine, University of Arizona, Tucson, AZ, 6Department of Emergency Medicine, Regions Hospital, St Paul, MN, 7Department of Surgery, University of Arizona, Tucson, AZ, USA Background: After emergency department (ED discharge, Spanish-speaking patients with limited English proficiency are less likely than English-proficient patients to be adherent to medical recommendations and are more likely to be dissatisfied with their visit.Objectives: To determine if integrating a longitudinal medical Spanish and cultural competency curriculum into emergency medicine residency didactics improves patient satisfaction and adherence to medical recommendations in Spanish-speaking patients with limited English proficiency.Methods: Our ED has two Emergency Medicine Residency Programs, University Campus (UC and South Campus (SC. SC program incorporates a medical Spanish and cultural competency curriculum into their didactics. Real-time Spanish surveys were collected at SC ED on patients who self-identified as primarily Spanish-speaking during registration and who were treated by resident physicians from both residency programs. Surveys assessed whether the treating resident physician communicated in the patient’s native Spanish language. Follow-up phone calls assessed patient satisfaction and adherence to discharge instructions.Results: Sixty-three patients self-identified as primarily Spanish-speaking from August 2014 to July 2015 and were initially included in this pilot study
Clinical and financial implications of emergency department visits for synthetic marijuana.
Rowley, Eric; Benson, David; Tiffee, Aaron; Hockensmith, Adam; Zeng, Henry; Jones, Glenn N; Musso, Mandi W
2017-10-01
Many users believe that synthetic cannabinoids offer a safe and legal means of getting high. However, spikes in emergency department visits have been associated with use of synthetic cannabinoids. The purpose of the current study was to document emergency department visits from three large hospitals in one metropolitan area over a two month period. This was a retrospective chart review examining 218 patients presenting to three inner city emergency departments between March and April 2014. Data collected included demographic information, information regarding ED diagnosis and treatment, signs and symptoms, ancillary testing, ED disposition, and cost of the medical treatment. The majority of patients (75.7%) were discharged after ED workup, but 12.4% were admitted for medical treatment and 11.5% were admitted for psychiatric treatment. Ten patients (4.6%) were admitted to the ICU. Symptoms experienced most frequently include: hypertension, tachycardia, agitation, drowsiness, nausea, and confusion. Cluster analysis revealed four symptom clusters of individuals presenting after using synthetic cannabinoids: 1) confusion, hostility, agitation, 2) nausea, vomiting, abdominal pain, 3) drowsiness, and 4) the absence of these symptoms. This study has three important findings. First, significant ED resources are being used to treat individuals presenting due to effects of synthetic cannabis. Second, synthetic cannabis is not a benign substance. Third, while the hostile and agitated user is generally presented in the media, this study finds significant heterogeneity in presentation. Further research is needed to fully understand the implications of synthetic cannabinoid use. Copyright © 2017 Elsevier Inc. All rights reserved.
Kirk, Jeanette W; Sivertsen, Ditte M; Petersen, Janne; Nilsen, Per; Petersen, Helle V
2016-10-01
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. A high incidence of functional decline after hospitalisation for acute medical illness has been shown in the oldest patients and those who are physically frail. In Denmark, more than 35% of older medical patients acutely admitted to the emergency department are readmitted within 90 days after discharge. A new screening tool for use in the emergency department aiming to identify patients at particularly high risk of functional decline and readmission was developed. Qualitative study based on semistructured interviews with nurses and a geriatric team in the emergency department and semistructured single interviews with their managers. The Theoretical Domains Framework guided data collection and analysis. Content analysis was performed whereby new themes and themes already existing within each domain were described. Six predominant domains were identified: (1) professional role and identity; (2) beliefs about consequences; (3) goals; (4) knowledge; (5) optimism and (6) environmental context and resources. The content analysis identified three themes, each containing two subthemes. The themes were professional role and identity, beliefs about consequences and preconditions for a successful implementation. Two different cultures were identified in the emergency department. These cultures applied to different professional roles and identity, different actions and sense making and identified how barriers and facilitators linked to the new screening tool were perceived. The results show 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. © 2016 The Authors. Journal of Clinical Nursing Published by John
Yang, Zhi; Yang, Runxiang; Kwak, Min Ji; Qdaisat, Aiham; Lin, Junzhong; Begley, Charles E; Reyes-Gibby, Cielito C; Yeung, Sai-Ching Jim
2018-01-01
Although cancer patients (CPs) are increasingly likely to visit emergency department (ED), no population-based study has compared the characteristics of CPs and non-cancer patients (NCPs) who visit the ED and examined factors associated with hospitalization via the ED. In this study, we (1) compared characteristics and diagnoses between CPs and NCPs who visited the ED in a cancer center or general hospital; (2) compared characteristics and diagnoses between CPs and NCPs who were hospitalized via the ED in a cancer center or general hospital; and (3) investigated important factors associated with such hospitalization. We analyzed patient characteristic and diagnosis [based on International Classification of Diseases-9 (ICD-9) codes] data from the ED of a comprehensive cancer center (MDACC), 24 general EDs in Harris County, Texas (HCED), and the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 1/1/2007-12/31/2009. Approximately 3.4 million ED visits were analyzed: 47,245, 3,248,973, and 104,566 visits for MDACC, HCED, and NHAMCS, respectively, of which 44,143 (93.4%), 44,583 (1.4%), and 632 (0.6%) were CP visits. CPs were older than NCPs and stayed longer in EDs. Lung, gastrointestinal (excluding colorectal), and genitourinary (excluding prostate) cancers were the three most common diagnoses related to ED visits at general EDs. CPs visiting MDACC were more likely than CPs visiting HCED to be privately insured. CPs were more likely than NCPs to be hospitalized. Pneumonia and influenza, fluid and electrolyte disorders, and fever were important predictive factors for CP hospitalization; coronary artery disease, cerebrovascular disease, and heart failure were important factors for NCP hospitalization. CPs consumed more ED resources than NCPs and had a higher hospitalization rate. Given the differences in characteristics and diagnoses between CPs and NCPs, ED physicians must pay special attention to CPs and be familiar with their unique set of oncologic
Nickolas, Thomas L; Schmidt-Ott, Kai M; Canetta, Pietro; Forster, Catherine; Singer, Eugenia; Sise, Meghan; Elger, Antje; Maarouf, Omar; Sola-Del Valle, David Antonio; O'Rourke, Matthew; Sherman, Evan; Lee, Peter; Geara, Abdallah; Imus, Philip; Guddati, Achuta; Polland, Allison; Rahman, Wasiq; Elitok, Saban; Malik, Nasir; Giglio, James; El-Sayegh, Suzanne; Devarajan, Prasad; Hebbar, Sudarshan; Saggi, Subodh J; Hahn, Barry; Kettritz, Ralph; Luft, Friedrich C; Barasch, Jonathan
2012-01-17
This study aimed to determine the diagnostic and prognostic value of urinary biomarkers of intrinsic acute kidney injury (AKI) when patients were triaged in the emergency department. Intrinsic AKI is associated with nephron injury and results in poor clinical outcomes. Several urinary biomarkers have been proposed to detect and measure intrinsic AKI. In a multicenter prospective cohort study, 5 urinary biomarkers (urinary neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, urinary liver-type fatty acid binding protein, urinary interleukin-18, and cystatin C) were measured in 1,635 unselected emergency department patients at the time of hospital admission. We determined whether the biomarkers diagnosed intrinsic AKI and predicted adverse outcomes during hospitalization. All biomarkers were elevated in intrinsic AKI, but urinary neutrophil gelatinase-associated lipocalin was most useful (81% specificity, 68% sensitivity at a 104-ng/ml cutoff) and predictive of the severity and duration of AKI. Intrinsic AKI was strongly associated with adverse in-hospital outcomes. Urinary neutrophil gelatinase-associated lipocalin and urinary kidney injury molecule 1 predicted a composite outcome of dialysis initiation or death during hospitalization, and both improved the net risk classification compared with conventional assessments. These biomarkers also identified a substantial subpopulation with low serum creatinine at hospital admission, but who were at risk of adverse events. Urinary biomarkers of nephron damage enable prospective diagnostic and prognostic stratification in the emergency department. Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Evaluation of response capacity to patient attention demand in an Emergency Department
Bruballa Vilas, Eva
2017-01-01
The progressive growth of aging, increased life expectancy and a greater number of chronic diseases contribute significantly to the growing demand of emergency medical care, and thus, on saturation of Emergency Departments. This is one of the most important current problems in healthcare systems worldwide. This work proposes an analytical model to calculate the theoretical throughput of a particular sanitary staff configuration in a Hospital Emergency Department, which is, the number of patie...
Violence toward health workers in Bahrain Defense Force Royal Medical Services’ emergency department
Directory of Open Access Journals (Sweden)
Rafeea F
2017-11-01
Full Text Available Faisal Rafeea,1 Ahmed Al Ansari,2–4 Ehab M Abbas,1 Khalifa Elmusharaf,5 Mohamed S Abu Zeid1 1Emergency Department, Bahrain Defense Force Hospital, Riffa, Bahrain; 2Training and Education Department, Bahrain Defense Force Hospital, Riffa, Bahrain; 3Department of General Surgery, College of Medicine and Medical Science, Arabian Gulf University, Manama, Bahrain; 4Medical Education Department, Royal College of Surgeons in Ireland - Medical University of Bahrain, Busaiteen, Bahrain; 5Graduate Entry Medical School, University of Limerick, Ireland Background: Employees working in emergency departments (EDs in hospital settings are disproportionately affected by workplace violence as compared to those working in other departments. Such violence results in minor or major injury to these workers. In other cases, it leads to physical disability, reduced job performance, and eventually a nonconducive working environment for these workers. Materials and methods: A cross-sectional exploratory questionnaire was used to collect data used for the examination of the incidents of violence in the workplace. This study was carried out at the ED of the Bahrain Defense Force (BDF Hospital. Participants for the study were drawn from nurses, support staff, and emergency physicians. Both male and female workers were surveyed.Results: The study included responses from 100 staff in the ED of the BDF Hospital in Bahrain (doctors, nurses, and support personnel. The most experienced type of violence in the workers in the past 12 months in this study was verbal abuse, which was experienced by 78% of the participants, which was followed by physical abuse (11% and then sexual abuse (3%. Many cases of violence against ED workers occurred during night shifts (53%, while physical abuse was reported to occur during all the shifts; 40% of the staff in the ED of the hospital were not aware of the policies against workplace violence, and 26% of the staff considered leaving their jobs
The Emergency Department: Challenges and Opportunities for Suicide Prevention.
Asarnow, Joan Rosenbaum; Babeva, Kalina; Horstmann, Elizabeth
2017-10-01
Emergency departments (EDs) can offer life-saving suicide prevention care. This article focuses on the ED and emergency services as service delivery sites for suicide prevention. Characteristics of EDs, models of emergency care, ED screening and brief intervention models, and practice guidelines and parameters are reviewed. A care process model for youths at risk for suicide and self-harm is presented, with guidance for clinicians based on the scientific evidence. Strengthening emergency infrastructure and integrating effective suicide prevention strategies derived from scientific research are critical for advancing suicide prevention objectives. Copyright © 2017 Elsevier Inc. All rights reserved.
Emergency department radiology: Reality or luxury? An international comparison
International Nuclear Information System (INIS)
Kool, D.R.; Blickman, J.G.
2010-01-01
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-specialization is the key, and, although specifically patient-oriented and not organ-based, emergency and trauma imaging is well suited for that. The development of emergency radiology in Europe and the United States is compared with emphasis on how different healthcare systems and medical cultures affect the utilization of Acute Care imaging.
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
2013-10-01
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 enterprise systems
Evaluating Emergency Department Asthma Management Practices in Florida Hospitals.
Nowakowski, Alexandra C H; Carretta, Henry J; Dudley, Julie K; Forrest, Jamie R; Folsom, Abbey N
2016-01-01
To assess gaps in emergency department (ED) asthma management at Florida hospitals. Survey instrument with open- and closed-ended questions. Topics included availability of specific asthma management modalities, compliance with national guidelines, employment of specialized asthma care personnel, and efforts toward performance improvement. Emergency departments at 10 large hospitals in the state of Florida. Clinical care providers and health administrators from participating hospitals. Compliance with national asthma care guideline standards, provision of specific recommended treatment modalities and resources, employment of specialized asthma care personnel, and engagement in performance improvement efforts. Our results suggest inconsistency among sampled Florida hospitals' adherence to national standards for treatment of asthma in EDs. Several hospitals were refining their emergency care protocols to incorporate guideline recommendations. Despite a lack of formal ED protocols in some hospitals, adherence to national guidelines for emergency care nonetheless remained robust for patient education and medication prescribing, but it was weaker for formal care planning and medical follow-up. Identified deficiencies in emergency asthma care present a number of opportunities for strategic mitigation of identified gaps. We conclude with suggestions to help Florida hospitals achieve success with ED asthma care reform. Team-based learning activities may offer an optimal strategy for sharing and implementing best practices.
Hunsaker, Stacie; Chen, Hsiu-Chin; Maughan, Dale; Heaston, Sondra
2015-03-01
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
Back, Jonathan; Ross, Alastair J; Duncan, Myanna D; Jaye, Peter; Henderson, Katherine; Anderson, Janet E
2017-01-01
Study objective: Escalation policies are used by emergency departments when responding to an increase in demand (e.g., a sudden inflow of patients) or a reduction in capacity (e.g., a lack of beds to admit patients). The policies aim to maintain the ability to deliver patient care, without compromising safety, by modifying ‘normal’ processes. The study objective was to examine escalation policies in theory and practice. \\ud Methods: This was a mixed-method study, involving: i) a conceptual an...
Anderson, Linda; FitzGerald, Mary; Luck, Lauretta
2010-09-01
To critique the evidence that underpins interventions intended to minimise workplace violence directed against emergency department nurses, to inform researchers and policy makers regarding the design, development, implementation and evaluation of emergency nursing anti-violence and counter-violence interventions. Workplace violence perpetrated against emergency department nurses is at least continuing and at worst increasing. Occupational violence has detrimental effects on job satisfaction, retention and recruitment, and the quality and cost of patient care. An integrated literature review. Searches of the Cochrane Library, CINAHL, MEDLINE and the Joanna Briggs Institute between 1986-May 2007. Included articles were appraised and then synthesised into a narrative summary. Ten primary research studies were included. Interventions were classified as environmental, practices and policies, or skills. While each study has useful information regarding the implementation of interventions, there is no strong evidence for their efficacy. The weight of effort is still directed towards defining the phenomenon rather than addressing solutions. Studies that assessed the efficacy of a single intervention failed to take account of context; and participatory context-driven studies failed to provide generalisable evidence. Concerted multi-site and multi-disciplinary, action-oriented research studies are urgently needed to provide an evidence base for the prevention and mitigation of violence perpetrated against emergency department nurses. The investigation of interventions rather than repeatedly redefining the problem and directing resources into debating semantics or differentiating 'degrees' of violence and aggression is recommended. This review unambiguously identifies the gap in research-based interventions. © 2010 Blackwell Publishing Ltd.
Improving handoffs in the emergency department.
Cheung, Dickson S; Kelly, John J; Beach, Christopher; Berkeley, Ross P; Bitterman, Robert A; Broida, Robert I; Dalsey, William C; Farley, Heather L; Fuller, Drew C; Garvey, David J; Klauer, Kevin M; McCullough, Lynne B; Patterson, Emily S; Pham, Julius C; Phelan, Michael P; Pines, Jesse M; Schenkel, Stephen M; Tomolo, Anne; Turbiak, Thomas W; Vozenilek, John A; Wears, Robert L; White, Marjorie L
2010-02-01
Patient handoffs at shift change are a ubiquitous and potentially hazardous process in emergency care. As crowding and lengthy evaluations become the standard for an increasing proportion of emergency departments (EDs), the number of patients handed off will likely increase. It is critical now more than ever before to ensure that handoffs supply valid and useful shared understandings between providers at transitions of care. The purpose of this article is to provide the most up-to-date evidence and collective thinking about the process and safety of handoffs between physicians in the ED. It offers perspectives from other disciplines, provides a conceptual framework for handoffs, and categorizes models of existing practices. Legal and risk management issues are also addressed. A proposal for the development of handoff quality measures is outlined. Practical strategies are suggested to improve ED handoffs. Finally, a research agenda is proposed to provide a roadmap to future work that may increase knowledge in this area. Copyright (c) 2009 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.
[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
2016-07-01
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.
Directory of Open Access Journals (Sweden)
Amélie Perrin
2017-09-01
Full Text Available Background: Each year, around one out of two nursing home (NH residents are hospitalized in France, and about half to the emergency department (ED. These transfers are frequently inappropriate. This paper describes the protocol of the FINE study. The first aim of this study is to identify the factors associated with inappropriate transfers to ED. Methods/design: FINE is a case-control observational study. Sixteen hospitals participate. Inclusion period lasts 7 days per season in each center for a total period of inclusion of one year. All the NH residents admitted in ED during these periods are included. Data are collected in 4 times: before transfer in the NH, at the ED, in hospital wards in case of patient's hospitalization and at the patient's return to NH. The appropriateness of ED transfers (i.e. case versus control NH residents is determined by a multidisciplinary team of experts. Results: Our primary objective is to determine the factors predisposing NH residents to inappropriate transfer to ED. Our secondary objectives are to assess the cost of the transfers to ED; study the evolution of NH residents' functional status and the psychotropic and inappropriate drugs prescription between before and after the transfer; calculate the prevalence of potentially avoidable transfers to ED; and identify the factors predisposing NH residents to potentially avoidable transfer to ED. Discussion: A better understanding of the determinant factors of inappropriate transfers to ED of NH residents may lead to proposals of recommendations of better practice in NH and would allow implementing quality improvement programs in the health organization. Keywords: Inappropriate transfer, Nursing home resident, Emergency department transfer, Potentially avoidable transfer, Appropriateness of transfer, Inappropriate hospitalization
United States Department of Energy radiological emergency response programme - a national capability
International Nuclear Information System (INIS)
Gordon-Hagerty, L.E.
1993-01-01
In order to respond to a radiological emergency, the United States Department of Energy (USDOE) maintains seven emergency response assets and capabilities in support of a radiological emergency of any proportion within the continental United States and abroad. The seven emergency response assets and capabilities include: Accident Response Group; Aerial Measuring Systems; Atmospheric Release Advisory Capability; Federal Radiological Monitoring and Assessment Center; Nuclear Emergency Search Team; Radiation Emergency Assistance Center/Training Site; and Radiological Assistance Program. Presently, USDOE maintains the most comprehensive national radiological emergency response assets in the United States, capable of dealing with any type of emergency involving nuclear materials. In all, the Department's assets are available to support any type of accident/incident involving radioactive materials in coordination with other United States Federal agencies, as well as state and local governments, as required. (author)
Low compliance with a validated system for emergency department triage
DEFF Research Database (Denmark)
Christensen, Dorthea; Jensen, Nanna Martin; Maaløe, Rikke
2011-01-01
Bispebjerg Hospital has introduced a triage system at the Emergency Department (ED) based on "primary criteria" and a physiological scoring system named the Bispebjerg Early Warning Score (BEWS). A BEWS is calculated on the basis of five vital signs which are accessible bedside. Patients who have...... a "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....
Discharge from an emergency department observation unit and a surgical assessment unit
DEFF Research Database (Denmark)
Schultz, Helen; Qvist, Niels; Backer Mogensen, Christian
2014-01-01
To investigate the experiences of patients with acute abdominal pain at discharge from an emergency department observation unit compared with discharge from a surgical assessment unit.......To investigate the experiences of patients with acute abdominal pain at discharge from an emergency department observation unit compared with discharge from a surgical assessment unit....
Wright-Brown, Salena; Sekula, Kathleen; Gillespie, Gordon; Zoucha, Rick
A successful career as an emergency department registered nurse (RN) requires the ability to respond quickly to a wide variety of potentially life-threatening illnesses and injuries. The unpredictable nature of this work can evoke emotional and physical stress on the RN beyond that which might be experienced by nurses who work in more stable, controlled, and predictable environments. Emergency healthcare is predicated on unexpected illness or injury leading to unscheduled episodic work. Additional stress is placed on the RN by the potential for violence that occurs in emergency departments. This mixed method pilot study describes the experiences of RNs who have been injured by violence while working in an emergency department. The study included an assessment of the job satisfaction of RNs in the emergency department based on Porter's Need Satisfaction Scale. This scale addresses need fulfillment in five categories: security, social, esteem, autonomy, and self-actualization. The self-actualization subscale measures satisfaction with personal growth, worthwhile accomplishments, and self-fulfillment. During the second strand of the study, phenomenological informed interviews were held with RNs who had been injured while on duty in an emergency department. The findings indicate that the largest reported gaps between the current state and the desired state were found in the area of security and self-actualization. RNs in the emergency department who answered the survey indicated that they desired a safe, secure worksite where they could achieve personal growth, worthwhile accomplishments, and self-fulfillment; but they were not satisfied with their current status in these areas.
Level of Agitation of Psychiatric Patients Presenting to an Emergency Department
Zun, Leslie S.; Downey, La Vonne A.
2008-01-01
Objectives: The primary purpose of this study was to determine the level of agitation that psychiatric patients exhibit upon arrival to the emergency department. The secondary purpose was to determine whether the level of agitation changed over time depending upon whether the patient was restrained or unrestrained.
Li, Yu-Fang; Chao, Minston; Shih, Chih-Ting
2017-10-10
Studies that examined the negative impact of violence in emergency departments on nurses' leave and avoidance behavior are well-documented. However, few studies provided an integrated model of how and when violence influences their leave and avoidance behavior. The study adopted Affective Events Theory to propose and examine a model of violent events, negative emotions, and (leave and avoidance) behaviors on nurses in emergency departments and further analyzed whether the model is salient to nurses' occupational burnout, nursing experience, and nursing rank. The sample included 123 emergency department nurses at a teaching hospital in northern, Taiwan. All participants had experienced violent incidents within the preceding 6 months. Moderated mediation analysis suggested that nurses experienced one of two emotional processes following violent incidents: "violence-negative feelings toward work-intention to resign" or "violence-negative emotion and physical symptoms-avoidance tendencies." Moreover, nurses with high burnout levels expressed weaker intention to resign after violent incidents, while nurses with more experience and higher rank were less likely to avoid violence after violent incidents. Emergency nurses do not simply elect to escape but may engage in avoidance behavior. This study revealed that how violent incidents affect nurses' resignation or avoidance behaviors depends on how they feel. Occupational burnout and nurses' attributes affected their behavior. Copyright © 2017 Elsevier Ltd. All rights reserved.
Community emergency department utilization following a natural disaster (the Goderich Tornado).
Appavoo, Samuel D; Khemlin, Alexander; Appavoo, Donna M; Flynn, Candi J
2016-01-01
On 21 August 2011 an F3 tornado hit the Canadian town of Goderich, Ontario, leaving 40 people injured and one dead. Specific medium-term changes in utilization of health care following a disaster have not been analyzed in medical literature. Documenting the emergency department utilization through this subacute period would be helpful to enable institutions and healthcare practitioners to be better prepared for future events. A medical chart review was conducted at the Alexandra Marine and General Hospital in Goderich. All emergency department visits made during the 30 days after the Tornado in 2011 (intervention group), 30 days prior to the tornado in 2011 (primary control group), and during the similar calendar period of 30 days after the tornado in 2010 (seasonal control group) were reviewed. Medical diagnoses of all patients who presented at the emergency department were collected and compared. Fewer people presented to the emergency department following the tornado than during the control periods, and those who did were significantly older than those who presented in the control periods (pptornado in a rural Ontario community. This information serves to inform the medical community and other hospitals how to increase their level of preparedness should a comparable disaster occur again in the future.
Impact on Quality of Life in Dermatology Patients Attending an Emergency Department.
Alegre-Sánchez, A; de Perosanz-Lobo, D; Pascual-Sánchez, A; Pindado-Ortega, C; Fonda-Pascual, P; Moreno-Arrones, Ó M; Jaén-Olasolo, P
2017-12-01
Dermatological complaints have been estimated to represent up to 5-10% of all the visits to emergency departments. The main objective of our study was to determine how affected is the Health related Quality of Life (HRQL) in a series of patients attending an emergency department due to skin symptoms. A prospective study during one month (July 2016) was conducted in a hospital with full-time on-call dermatologists. The Short-Form SF-12v2 Health Survey and the Dermatology Life Quality Index (DLQI) were offered to all the patients over 18 years old attending the emergency department with cutaneous complaints. Clinical and epidemiological characteristics were also collected. In total 108 patients completed the study. Mean age found was 45.1±16.1 years. Mean DLQI score found was 10.56±6.12. Fifty-three patients (49%) had a score of 11 or higher in the DLQI questionnaire. Most affected subscales were "Symptoms and Feelings" in DLQI scale and "Overall Health" and "Vitality" for the SF-12. A very significant difference (p<0.0001) was found between women's (12.4±5.7) and men's (7.5±5.6) DLQI mean score (mean difference of 4.9; 95% confidence interval of the difference: 2.7-7.1). Patients visiting emergency units with cutaneous complaints seem to feel a moderate-large impact on their quality of life which is mainly related to the symptoms and feelings that they are experiencing. This impact is significantly higher among women. Copyright © 2017 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.
Griffith, Brent; Vallee, Phyllis; Krupp, Seth; Jung, Melissa; Slezak, Michelle; Nagarwala, Jumana; Loeckner, C Patrick; Schultz, Lonni R; Jain, Rajan
2014-02-01
The aim of this study was to determine the effect of a clinical education initiative on the appropriate utilization of screening cervical spine CT in the emergency department. The purpose was to assess if clinical education can produce stricter adherence to the ACR Appropriateness Criteria and improve the utilization of screening CT examinations in the emergency department. Institutional review board approval was obtained for this HIPAA-compliant study. All adult patients presenting to a level 1 trauma center with blunt trauma prompting screening cervical spine CT were eligible. For each study, the requesting clinician completed a survey selecting all clinical indications. CT examinations were evaluated by a board-certified radiologist blinded to survey data. Results were compared with retrospective and prospective studies performed before the institution of the education initiative. Of the 388 cervical spine CT examinations performed, 12 (3.1%) were positive for acute cervical spine injury, compared to only 1.0% before the clinical education program (phase 2). Of the 376 examinations without injury, 13% met all 5 National Emergency X-Radiography Utilization Study criteria for nonimaging (down from 16.1% in phase 2), and 15 (4%) required no imaging when both National Emergency X-Radiography Utilization Study and abbreviated Canadian cervical spine rule criteria were applied. Implementation of a clinical education initiative resulted in improved adherence to ACR Appropriateness Criteria and improved clinical effectiveness of the studies by increasing fracture detection rate. Initiatives such as these could potentially influence imaging overutilization without burdening emergency department clinicians with excessive roadblocks to image ordering. Copyright © 2014 American College of Radiology. Published by Elsevier Inc. All rights reserved.
Failure Mode and Effect Analysis in Increasing the Revenue of Emergency Department
Directory of Open Access Journals (Sweden)
Farhad Rahmati
2015-02-01
Full Text Available Introduction: Successful performance of emergency department(ED is one of the important indications of increasing the satisfaction among referees. The insurance of such successful performance is fiscal discipline and avoiding from non-beneficial activities in this department. Therefore, the increasing revenue of emergency department is one of the interested goals of hospital management system. According to above-mentioned, the researchers assessed problems lead to loss the revenue of ED and eliminate them by using failure mode and effects analysis (FMEA.Methods: This was the prospective cohort study performed during 18 months, set in 6 phases. In the first phase, the failures were determined and some solutions suggested to eliminate them. During 2-5 phases, based on the prioritizing the problems, solutions were performed. In the sixth phase, final assessment of the study was done. Finally, the feedback of system’s revenue was evaluated and data analyzed using repeated measure ANOVA.Results: Lack of recording the consuming instrument and attribution of separate codes for emergency services of hospitalized patients were the most important failures that lead to decrease the revenue of ED. Such elimination caused to 75.9% increase in revenue within a month (df = 1.6; F = 84.0; p<0.0001. Totally, 18 months following the eliminating of failures caused to 328.2% increase in the revenue of ED (df = 15.9; F = 215; p<0.0001.Conclusion: The findings of the present study shows that failure mode and effect analysis, can be used as a safe and effected method to reduce the expenses of ED and increase its revenue.
Ngo, Stephanie; Shahsahebi, Mohammad; Schreiber, Sean; Johnson, Fred; Silberberg, Mina
2017-11-09
This study evaluated the correlation of an emergency department embedded care coordinator with access to community and medical records in decreasing hospital and emergency department use in patients with behavioral health issues. This retrospective cohort study presents a 6-month pre-post analysis on patients seen by the care coordinator (n=524). Looking at all-cause healthcare utilization, care coordination was associated with a significant median decrease of one emergency department visit per patient (p management of behavioral health patients.
Gillespie, Gordon Lee; Pekar, Bunnany; Byczkowski, Terri L; Fisher, Bonnie S
2017-03-04
Workplace violence committed by patients and visitors has high propensity to occur against emergency department employees. This article reports the association of worker, workplace, and community/environmental factors with violence risks. A cross-sectional research design was used with 280 employees from six emergency departments in the Midwest United States. Respondents completed the Survey of Violence Experienced by Staff and a 10-item demographic questionnaire. Data were analyzed using frequencies, percentages, Chi-square tests, and adjusted relative risks with 95% confidence intervals. Over 80% of respondents experienced at least one type of workplace violence with their current employer and approximately 40% experienced all three types. Risks for workplace violence were significantly higher for registered nurses and hospital-based emergency departments. Workplace violence can impact all employees in the emergency department regardless of worker, workplace, and community/environmental factors.
DEFF Research Database (Denmark)
Plesner, Louis Lind; Iversen, Anne Kristine Servais; Langkjær, Sandra
2015-01-01
the Danish Emergency Proces Triage (DEPT) which categorizes patients as green (not urgent), yellow (urgent), orange (emergent) or red (rescusitation). Presenting complaints, admission diagnoses, comorbidities, length of stay, and 'events' during admission (any of 20 predefined definitive treatments......BACKGROUND: Patient crowding in emergency departments (ED) is a common challenge and associated with worsened outcome for the patients. Previous studies on biomarkers in the ED setting has focused on identification of high risk patients, and and the ability to use biomarkers to identify low...
Nurses' attitudes towards the reporting of violence in the emergency department.
Hogarth, Kathryn M; Beattie, Jill; Morphet, Julia
2016-05-01
The incidence of workplace violence against nurses in emergency departments is underreported. Thus, the true nature and frequency of violent incidents remains unknown. It is therefore difficult to address the problem. To identify the attitudes, barriers and enablers of emergency nurses to the reporting of workplace violence. Using a phenomenological approach, two focus groups were conducted at a tertiary emergency department. The data were audio-recorded, transcribed verbatim and analysed using thematic analysis. Violent incidents in this emergency department were underreported. Nurses accepted violence as part of their normal working day, and therefore were less likely to report it. Violent incidents were not defined as 'violence' if no physical injury was sustained, therefore it was not reported. Nurses were also motivated to report formally in order to protect themselves from any possible future complaints made by perpetrators. The current formal reporting system was a major barrier to reporting because it was difficult and time consuming to use. Nurses reported violence using methods other than the designated reporting system. While emergency nurses do report violence, they do not use the formal reporting system. When they did use the formal reporting system they were motivated to do so in order to protect themselves. As a consequence of underreporting, the nature and extent of workplace violence remains unknown. Copyright © 2015 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.
[Reasons for attending emergency departments. People speak out].
Pasarín, M Isabel; Fernández de Sanmamed, M José; Calafell, Joana; Borrell, Carme; Rodríguez, Dolors; Campasol, Salvador; Torné, Elvira; Torras, M Glòria; Guarga, Alex; Plasència, Antoni
2006-01-01
To ascertain why people attend hospital emergency departments (ED) for low complexity health problems. A phenomenological, interactionist, qualitative study was performed. A theoretical sample that selected one urban and one rural area from Catalonia (Spain) was designed. In each setting, persons (n = 36) who had used the ED or a primary care emergency service 1 month before the beginning of the study were chosen. Data were obtained through 8 focus groups. An interpretative content analysis was performed, and emergent categories were constructed through research triangulation. Five categories emerged: symptoms, whether or not self-diagnosis was involved, perception of needs, awareness of the health services available, and the overall context of the person. Symptoms generated feelings of failing health and thus initiated care seeking. Self-diagnosis determined perceived need and the type of care sought. People contrasted their self-perception of need with their own opinion about the health services available. The decision to go to one or other service was made as a result of this contrast, but the individual's family, work, and social situations also played a part. Informants were more familiar with the service provided by the ED than with that provided by primary care. Time consumption also figured heavily in decision making. The presence or absence of self-diagnosis is a determining factor in attendance at EDs. Other factors that influence demand are the level of awareness of the health services available, previous experiences, and the life situation of the individual.
Violence in the Emergency Department.
Stowell, Keith R; Hughes, Nolan P; Rozel, John S
2016-12-01
Violence is common in the emergency department (ED). The ED setting has numerous environmental risk factors for violence, including poor staffing, lack of privacy, overcrowding, and ready availability of nonsecured equipment that can be used as weapons. Strategies can be taken to mitigate the risk of violence toward health care workers, including staff training, changes to the ED layout, appropriate use of security, and policy-level changes. Health care providers in the ED should be familiar with local case law and standards related to the duty to warn third parties when a violent threat is made by a patient. Copyright © 2016 Elsevier Inc. All rights reserved.
Psychiatric service users' experiences of emergency departments
DEFF Research Database (Denmark)
Carstensen, Kathrine; Lou, Stina; Jensen, Lotte Groth
2017-01-01
Background: There is increased clinical and political attention towards integrating general and psychiatric emergency departments (ED). However, research into psychiatric service users’ experiences regarding general EDs is limited. Aim: To identify and summarize current, qualitative evidence rega...... the discomfort. Overall, the results of this review speak in favour of integrated EDs where service users’ needs are more likely to be recognized and accommodated....
Emergency Department Presentations following Tropical Cyclone Yasi.
Directory of Open Access Journals (Sweden)
Peter Aitken
Full Text Available Emergency departments see an increase in cases during cyclones. The aim of this study is to describe patient presentations to the Emergency Department (ED of a tertiary level hospital (Townsville following a tropical cyclone (Yasi. Specific areas of focus include changes in: patient demographics (age and gender, triage categories, and classification of diseases.Data were extracted from the Townsville Hospitals ED information system (EDIS for three periods in 2009, 2010 and 2011 to coincide with formation of Cyclone Yasi (31 January 2011 to six days after Yasi crossed the coast line (8 February 2012. The analysis explored the changes in ICD10-AM 4-character classification and presented at the Chapter level.There was a marked increase in the number of patients attending the ED during Yasi, particularly those aged over 65 years with a maximum daily attendance of 372 patients on 4 Feb 2011. The most marked increases were in: Triage categories--4 and 5; and ICD categories--diseases of the skin and subcutaneous tissue (L00-L99, and factors influencing health care status (Z00-Z99. The most common diagnostic presentation across all years was injury (S00-T98.There was an increase in presentations to the ED of TTH, which peaked in the first 24-48 hours following the cyclone and returned to normal over a five-day period. The changes in presentations were mostly an amplification of normal attendance patterns with some altered areas of activity. Injury patterns are similar to overseas experience.
Modeling Hourly Resident Productivity in the Emergency Department.
Joseph, Joshua W; Henning, Daniel J; Strouse, Connie S; Chiu, David T; Nathanson, Larry A; Sanchez, Leon D
2017-08-01
Resident productivity, defined as new patients per hour, carries important implications for emergency department operations. In high-volume academic centers, essential staffing decisions can be made on the assumption that residents see patients at a static rate. However, it is unclear whether this model mirrors reality; previous studies have not rigorously examined whether productivity changes over time. We examine residents' productivity across shifts to determine whether it remained consistent. This was a retrospective cohort study conducted in an urban academic hospital with a 3-year emergency medicine training program in which residents acquire patients ad libitum throughout their shift. Time stamps of all patient encounters were automatically logged. A linear mixed model was constructed to predict productivity per shift hour. A total of 14,364 8- and 9-hour shifts were worked by 75 residents between July 1, 2010, and June 20, 2015. This comprised 6,127 (42.7%) postgraduate year (PGY) 1 shifts, 7,236 (50.4%) PGY-2 shifts, and 998 (6.9%) PGY-3 nonsupervisory shifts (Table 1). Overall, residents treated a mean of 10.1 patients per shift (SD 3.2), with most patients at Emergency Severity Index level 3 or more acute (93.8%). In the initial hour, residents treated a mean of 2.14 patients (SD 1.2), and every subsequent hour was associated with a significant decrease, with the largest in the second, third, and final hours. Emergency medicine resident productivity during a single shift follows a reliable pattern that decreases significantly hourly, a pattern preserved across PGY years and types of shifts. This suggests that resident productivity is a dynamic process, which should be considered in staffing decisions and studied further. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
Directory of Open Access Journals (Sweden)
Meghan L. Botes
2016-06-01
Full Text Available Background: Families are not prepared for traumatic injuries of loved ones. Emergency nurses have the important role of caring for patients and families in this time of crisis. Family needs in the critical care setting have been explored using the Critical Care Family Needs Inventory (CCFNI, however little is known about family needs in the emergency department. Objectives: This study sought to determine the needs of family members accompanying injured patients into the emergency department, and if these needs were met. Methods: A quantitative, descriptive, study was conducted in a level 1 trauma facility in Johannesburg, South Africa. The population included families of patients admitted to the emergency department, sampling 100 participants. The instrument, based on the CCFNI, was validated in a pilot study in Melbourne, Australia and re-evaluated using the Cronbach Alpha validity test to ensure internal consistency. Five themes were explored: ‘meaning’, ‘proximity’, ‘communication’, ‘comfort’ and ‘support’ and data were analysed using descriptive statistics. Responses to open-ended questions were analysed using content analysis. Permission from the Human Research Ethics Committee was granted and participants were ensured confidentiality and the option for counselling if required. Results: Themes ranked highly important were ‘meaning’ and ‘communication’. Satisfaction was highest for ‘meaning’. Low satisfaction levels for ‘communication’ were found. Issues regarding prolonged time spent in the emergency department and discrimination were raised. Conclusion: These findings have a negative impact on the family’s satisfaction with care and it is recommended that the nurse’s role in family care be further explored and emphasised. Keywords: Family needs, emergency department, emergency nurses
Why patients self-refer to the Emergency Department: A qualitative interview study.
Kraaijvanger, Nicole; Rijpsma, Douwe; Willink, Lisa; Lucassen, Peter; van Leeuwen, Henk; Edwards, Michael
2017-06-01
There have been multiple studies investigating reasons for patients to self-refer to the Emergency Department (ED). The majority made use of questionnaires and excluded patients with urgent conditions. The goal of this qualitative study is to explore what motives patients have to self-refer to an ED, also including patients in urgent triage categories. In a large teaching hospital in the Netherlands, a qualitative interview study focusing on reasons for self-referring to the ED was performed. Self-referred patients were included until no new reasons for attending the ED were found. Exclusion criteria were as follows: not mentally able to be interviewed or not speaking Dutch. Patients who were in need of urgent care were treated first, before being asked to participate. Interviews followed a predefined topic guide. Practicing cyclic analysis, the interview topic guide was modified during the inclusion period. Interviews were recorded on an audio recorder, transcribed verbatim, and anonymized. Two investigators independently coded the information and combined the codes into meaningful clusters. Subsequently, these were categorized into themes to build a framework of reasons for self-referral to the ED. Characteristic quotes were used to illustrate the acquired theoretical framework. Thirty self-referred patients were interviewed. Most of the participants were male (63%), with a mean age of 46 years. Two main themes emerged from the interviews that are pertinent to the patients' decisions to attend the ED: (1) health concerns and (2) practical issues. This study found that there are 2 clearly distinctive reasons for self-referral to the ED: health concerns or practical motives. Self-referral because of practical motives is probably most suitable for strategies that aim to reduce inappropriate ED visits. © 2016 John Wiley & Sons, Ltd.
小山, 真; Koyama, Shin
2001-01-01
The author would like to celebrate the start of the Department of emergency and critical care medicine and the Emergency unit of the Niigata University Hospital. The author also wishes to express his opinion, which is mentioned below, on preparing the Department and the Emergency unit for their future activity. 1 . The stuff members of the Department are expected to instruct undergraduate students in the knowledge and technique of Triage and the first aid in emergency exactly. 2 . The Emergen...
McManus, Moira C; Cramer, Robert J; Boshier, Maureen; Akpinar-Elci, Muge; Van Lunen, Bonnie
2018-01-13
Emergency department (ED) utilization has increased due to factors such as admissions for mental health conditions, including suicide and self-harm. We investigate direct and moderating influences on non-emergent ED utilization through the Behavioral Model of Health Services Use. Through logistic regression, we examined correlates of ED use via 2014 New York State Department of Health Statewide Planning and Research Cooperative System outpatient data. Consistent with the primary hypothesis, mental health admissions were associated with emergent use across models, with only a slight decrease in effect size in rural living locations. Concerning moderating effects, Spanish/Hispanic origin was associated with increased likelihood for emergent ED use in the rural living location model, and non-emergent ED use for the no non-emergent source model. 'Other' ethnic origin increased the likelihood of emergent ED use for rural living location and no non-emergent source models. The findings reveal 'need', including mental health admissions, as the largest driver for ED use. This may be due to mental healthcare access, or patients with mental health emergencies being transported via first responders to the ED, as in the case of suicide, self-harm, manic episodes or psychotic episodes. Further educating ED staff on this patient population through gatekeeper training may ensure patients receive the best treatment and aid in driving access to mental healthcare delivery changes.
Merchant, Roland C; Gee, Erin M; Bock, Beth C; Becker, Bruce M; Clark, Melissa A
2008-11-01
We sought to determine the extent to which adult female emergency department participants viewed two women's cancer screening and two contraceptive measures negatively. The study also explored the relationship between having a negative opinion about these measures and participant demography, lack of knowledge, and lack of usage of these measures. Few women expressed negative opinions about these measures. Lack of knowledge about and lack of use of these measures were associated with having negative opinions on these cancer screening and contraceptive measures. Having any negative opinion about one cancer screening or contraceptive measure was associated with a higher risk of having any negative opinion on another measure. The results suggest that influencing opinion and knowledge about these measures might impact the success of emergency department-based cancer screening and contraceptive health programs. Editors' Strategic Implications: Emergency departments (and primary care settings) provide key opportunities for prevention. Replication is needed, but the authors present important data on knowledge, attitudes, and characteristics that might influence women's receptivity to consent to and engage in behaviors consistent with prevention, screening, and health promotion.
Quality of work life of rural emergency department nurses and physicians: a pilot study.
Bragard, Isabelle; Fleet, Richard; Etienne, Anne-Marie; Archambault, Patrick; Légaré, France; Chauny, Jean-Marc; Lévesque, Jean-Frédéric; Ouimet, Mathieu; Poitras, Julien; Dupuis, Gilles
2015-04-01
Information about recruitment and retention factors and quality of work life (QWL) in rural emergency departments (EDs) is limited. A pilot study was used to determine the feasibility of a large-scale study of these variables in Quebec EDs. Two EDs, approximately 10,000 and 30,000 patients per year respectively, were selected as convenience samples. An online survey containing the Quality of Work Life Systemic Inventory (QWLSI; 34 items) and the Recruitment and Retention Factors Questionnaire (39 items) was sent to ED nurses and physicians of these two EDs. Descriptive statistics of percentage, mean and standard deviation and correlations were used to analyse the data. Forty out of 64 eligible workers (62%) gave their consent to participate, but only 20 had completed both questionnaires. Participants' mean age was 42 years (SD = 11.6). The average participants satisfaction with their access to continuing education was low (Mean = 1.6, SD = 0.8). However, their satisfaction with technical resources (Mean = 2.4, SD = 0.7), pre-hospital and inter-hospital transfer services (Mean = 2.5, SD = 0.6), relationships with colleagues (Mean = 2.7, SD = 0.6) and managers (Mean = 2.2, SD = 0.7), work-life balance (Mean = 2.4, SD = 0.6) and emergency patient access to other departments (Mean = 3.7, SD = 0.6) was in the average. The impact of several aspects of the rural environment (e.g. tranquility) on quality of life was also in the average (Mean = 2.5, SD = 0.7). QWL was in the average, excepted subscale 'support offered to employee' for which the QWL was lower. Data collection was difficult and the larger study will require strategies to improve recruitment such as a paper alternative. The study showed globally good recruitment and retention factors and QWL for these ED nurses and physicians. These results will help hospital administrations better plan initiatives aimed at improving retention and QWL.
Tinker, Sarah C.; Moe, Christine L.; Klein, Mitchel; Flanders, W. Dana; Uber, Jim; Amirtharajah, Appiah; Singer, Philip; Tolbert, Paige E.
2013-01-01
Background The extent to which drinking water turbidity measurements indicate the risk of gastrointestinal illness is not well-understood. Despite major advances in drinking water treatment and delivery, infectious disease can still be transmitted through drinking water in the U.S., and it is important to have reliable indicators of microbial water quality to inform public health decisions. The objective of our study was to assess the relationship between gastrointestinal illness, quantified through emergency department visits, and drinking water quality, quantified as raw water and filtered water turbidity measured at the treatment plant. Methods We examined the relationship between turbidity levels of raw and filtered surface water measured at eight major drinking water treatment plants in the metropolitan area of Atlanta, Georgia, and over 240 000 emergency department visits for gastrointestinal illness during 1993–2004 among the population served by these plants. We fit Poisson time-series statistical regression models that included turbidity in a 21-day distributed lag and that controlled for meteorological factors and long-term time trends. Results For filtered water turbidity, the results were consistent with no association with emergency department visits for gastrointestinal illness. We observed a modest association between raw water turbidity and emergency department visits for gastrointestinal illness. This association was not observed for all treatment plants in plant-specific analyses. Conclusions Our results suggest that source water quality may contribute modestly to endemic gastrointestinal illness in the study area. The association between turbidity and emergency department visits for gastrointestinal illness was only observed when raw water turbidity was considered; filtered water turbidity may not serve as a reliable indicator of modest pathogen risk at all treatment plants. PMID:18941478
Demand and capacity planning in the emergency department: how to do it.
Higginson, I; Whyatt, J; Silvester, K
2011-02-01
Unless emergency departments have adequate capacity to meet demand, they will fail to meet clinical and performance standards and will be operating in the 'coping zone'. This carries risks both for staff and patients. As part of a quality improvement programme, the authors undertook an in-depth analysis of demand and capacity for an emergency department in the UK. The paper describes this rigorous approach to capacity planning, which draws on techniques from other industries. Proper capacity planning is vital, but is often poorly done. Planning using aggregated data will lead to inadequate capacity. Understanding demand, and particularly the variation in that demand, is critical to success. Analysis of emergency department demand and capacity is the first step towards effective workforce planning and process redesign.
Patients in prehospital transport to the emergency department
DEFF Research Database (Denmark)
Bech, Camilla Louise Nørgaard; Brabrand, Mikkel; Mikkelsen, Søren
2018-01-01
BACKGROUND: Ambulance transfer is the first contact with the healthcare system for many patients in emergency conditions.We aimed to identify prognostic risk factors accessible in the prehospital phase that indicate an increased risk of 7-day mortality. PATIENTS AND METHODS: We included patients ...... aged 18 years or older, transferred by ambulance to the emergency department at Odense University Hospital, from 1 April 2012 to 30 September 2014. We carried out multivariate logistic regressions, adjusted for age and sex, to describe the relationship between vital sign values recorded...
2011-09-28
... 1974; Department of Homeland Security Federal Emergency Management Agency--012 Suspicious Activity... establish a new system of records titled, ``Department of Homeland Security/Federal Emergency Management... Department of Homeland Security/Federal Emergency Management Agency to collect, maintain, and retrieve...
Rutkow, Lainie; Paul, Amy; Taylor, Holly A; Barnett, Daniel J
Local health departments play a key role in emergency preparedness and respond to a wide range of threats including infectious diseases such as seasonal influenza, tuberculosis, H1N1, Ebola virus disease, and Zika virus disease. To successfully respond to an infectious disease outbreak, local health departments depend upon the participation of their workforce; yet, studies indicate that sizable numbers of workers would not participate in such a response. The reasons why local health department workers participate, or fail to participate, in infectious disease responses are not well understood. To understand why local health department workers are willing, or not willing, to report to work during an infectious disease response. From April 2015 to January 2016, we conducted 28 semistructured interviews with local health department directors, preparedness staff, and nonpreparedness staff. Interviews were conducted with individuals throughout the United States. We interviewed 28 individuals across 3 groups: local health department directors (n = 8), preparedness staff (n = 10), and nonpreparedness staff (n = 10). Individuals' descriptions of why local health department workers are willing, or not willing, to report to work during an infectious disease response. Factors that facilitate willingness to respond to an infectious disease emergency included availability of vaccines and personal protective equipment; flexible work schedule and childcare arrangements; information sharing via local health department trainings; and perceived commitments to one's job and community. Factors that hinder willingness to respond to an infectious disease emergency included potential disease exposure for oneself and one's family; logistical considerations for care of children, the elderly, and pets; and perceptions about one's role during an infectious disease response. Our findings highlight opportunities for local health departments to revisit their internal policies and engage in
Pain management: association with patient satisfaction among emergency department patients.
Bhakta, Hemangini C; Marco, Catherine A
2014-04-01
Patient satisfaction with emergency care is associated with timeliness of care, empathy, technical competence, and information delivery. Previous studies have demonstrated inconsistent findings regarding the association between pain management and patient satisfaction. This study was undertaken to determine the association between pain management and patient satisfaction among Emergency Department (ED) patients presenting with acute painful conditions. In this survey study, a standardized interview was conducted at the Emergency Department at the University of Toledo Medical Center in May-July 2011. Participants were asked to answer 18 questions pertaining to patient satisfaction. Additional data collected included demographic information, pain scores, and clinical management. Among 328 eligible participants, 289 (88%) participated. The mean triage pain score on the verbal numeric rating scale was 8.2 and the mean discharge score was 6.0. The majority of patients (52%) experienced a reduction in pain of 2 or more points. Participants received one pain medication dose (44%), two medication doses (14%), three medication doses (5%), or four medication doses (2%). Reduction in pain scores of 2 or more points was associated with a higher number of medications administered. Reduction in pain scores was associated with higher satisfaction as scored on questions of patient perceptions of adequate assessment and response to pain, and treatment of pain. There was a significant association between patient satisfaction and a reduction in pain of 2 or more points and number of medications administered. Effective pain management is associated with improved patient satisfaction among ED patients with painful conditions. Copyright © 2014 Elsevier Inc. All rights reserved.
Chloramphenicol and acute esophagitis in the emergency department
Directory of Open Access Journals (Sweden)
Chad T Andicochea
2015-01-01
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.
Lin, Blossom Yen-Ju; Wan, Thomas T H; Hsu, Chung-Ping Cliff; Hung, Feng-Ru; Juan, Chi-Wen; Lin, Cheng-Chieh
2012-05-01
Given the limited studies on emergency care management, this study aimed to explore the relationships of emergency department (ED) culture values to certain dimensions of ED physicians' and nurses' work satisfaction and intent to leave. Four hundred and forty-two emergency medical professionals completed the employee satisfaction questionnaire across 119 hospital-based EDs, which had culture value evaluations filed, were used as unit of analysis in this study. Adjusting the personal and employment backgrounds, and the surrounded EDs' unit characteristics and environmental factors, multiple regression analyses revealed that clan and market cultures were related to emergency physicians' work satisfaction and intent to leave. On the other hand, adhocracy, market and hierarchical cultures were related to emergency nurses' work satisfaction. There do exist different patterns among various culture types on various work satisfaction dimensions and intent to leave of emergency physicians and nurses. The findings could offer hospital and ED leaders insights for changes or for building a better atmosphere to enhance the work life of emergency physicians and nurses.
Harel, Ziv; Wald, Ron; McArthur, Eric; Chertow, Glenn M; Harel, Shai; Gruneir, Andrea; Fischer, Hadas D; Garg, Amit X; Perl, Jeffrey; Nash, Danielle M; Silver, Samuel; Bell, Chaim M
2015-12-01
Clinical outcomes after a hospital discharge are poorly defined for patients receiving maintenance in-center (outpatient) hemodialysis. To describe the proportion and characteristics of these patients who are rehospitalized, visit an emergency department, or die within 30 days after discharge from an acute hospitalization, we conducted a population-based study of all adult patients receiving maintenance in-center hemodialysis who were discharged between January 1, 2003, and December 31, 2011, from 157 acute care hospitals in Ontario, Canada. For patients with more than one hospitalization, we randomly selected a single hospitalization as the index hospitalization. Of the 11,177 patients included in the final cohort, 1926 (17%) were rehospitalized, 2971 (27%) were treated in the emergency department, and 840 (7.5%) died within 30 days of discharge. Complications of type 2 diabetes mellitus were the most common reason for rehospitalization, whereas heart failure was the most common reason for an emergency department visit. In multivariable analysis using a cause-specific Cox proportional hazards model, the following characteristics were associated with 30-day rehospitalization: older age, the number of hospital admissions in the preceding 6 months, the number of emergency department visits in the preceding 6 months, higher Charlson comorbidity index score, and the receipt of mechanical ventilation during the index hospitalization. Thus, a large proportion of patients receiving maintenance in-center hemodialysis will be readmitted or visit an emergency room within 30 days of an acute hospitalization. A focus on improving care transitions from the inpatient setting to the outpatient dialysis unit may improve outcomes and reduce healthcare costs. Copyright © 2015 by the American Society of Nephrology.
Adult Status Epilepticus: A Review of the Prehospital and Emergency Department Management
Billington, Michael; Kandalaft, Osama R.; Aisiku, Imoigele P.
2016-01-01
Seizures are a common presentation in the prehospital and emergency department setting and status epilepticus represents an emergency neurologic condition. The classification and various types of seizures are numerous. The objectives of this narrative literature review focuses on adult patients with a presentation of status epilepticus in the prehospital and emergency department setting. In summary, benzodiazepines remain the primary first line therapeutic agent in the management of status epilepticus, however, there are new agents that may be appropriate for the management of status epilepticus as second- and third-line pharmacological agents. PMID:27563928
Clinical features of emergency department patients with depression ...
African Journals Online (AJOL)
Clinical features of emergency department patients with depression who had attempted to commit suicide by poisoning. ... MDD patients. Conclusion: In poisoning patients with MDD, physicians in the ED must consider that they have a higher tendency to show suicidal behavior and to have ingested multiple types of drugs.
Fernández-Sola, Cayetano; Granero-Molina, José; Díaz-Cortés, María Del Mar; Jiménez-López, Francisca Rosa; Roman-López, Pablo; Saez-Molina, Encarnación; Aranda-Torres, Cayetano José; Muñoz-Terrón, José María; García-Caro, María Paz; Hernández-Padilla, José Manuel
2018-06-01
To explore and understand the experiences of terminally ill patients and their relatives regarding dignity during end-of-life care in the emergency department. The respect given to the concept of dignity is significantly modifying the clinical relationship and the care framework involving the end-of-life patient in palliative care units, critical care units, hospices and their own homes. This situation is applicable to in-hospital emergency departments, where there is a lack of research which takes the experiences of end-of-life patients and their relatives into account. A phenomenological qualitative study. The protocol was approved in December 2016 and will be carried out from December 2016-December 2020. The Gadamer's philosophical underpinnings will be used in the design and development of the study. The data collection will include participant observation techniques in the emergency department, in-depth interviews with terminally ill patients and focus groups with their relatives. For the data analysis, the field notes and verbatim transcriptions will be read and codified using ATLAS.ti software to search for emerging themes. Emerging themes that contribute to comprehending the phenomenon of dignity in end-of-life care in the emergency department are expected to be found. This study's results could have important implications in the implementation of new interventions in emergency departments. These interventions would be focused on improving: the social acceptance of death, environmental conditions, promotion of autonomy and accompaniment and assumption (takeover) of dignified actions and attitudes (respect for human rights). © 2018 John Wiley & Sons Ltd.
Assessing the physical service setting: a look at emergency departments.
Steinke, Claudia
2015-01-01
To determine the attributes of the physical setting that are important for developing a positive service climate within emergency departments and to validate a measure for assessing physical service design. The design of the physical setting is an important and contributing factor for creating a service climate in organizations. Service climate is defined as employee perceptions of the practices, procedures, and behaviors that get rewarded, supported, and expected with regard to customer service and customer service quality. There has been research conducted which identifies antecedents within organization that promotes a positive service climate which in turn creates service-oriented behaviors by employees toward clients. The antecedent of the physical setting and its impact on perceptions of service climate has been less commonly explored. Using the concept of the physical service setting (which may be defined as aspects of the physical, built environment that facilitate the delivery of quality service), attributes of the physical setting and their relationship with service climate were explored by means of a quantitative paper survey distributed to emergency nurses (n = 180) throughout a province in Canada. The results highlight the validity and reliability of six scales measuring the physical setting and its relation to service. Respondents gave low ratings to the physical setting of their departments, in addition to low ratings of service climate. Respondents feel that the design of the physical setting in the emergency departments where they work is not conducive to providing quality service to clients. Certain attributes of the physical setting were found to be significant in influencing perceptions of service climate, hence service quality, within the emergency department setting. © The Author(s) 2015.
Evaluation and management of acute abdominal pain in the emergency department
Directory of Open Access Journals (Sweden)
Macaluso CR
2012-09-01
Full Text Available Christopher R Macaluso, Robert M McNamaraDepartment of Emergency Medicine, Temple University School of Medicine, Philadelphia, PA, USAAbstract: Evaluation of the emergency department patient with acute abdominal pain is sometimes difficult. Various factors can obscure the presentation, delaying or preventing the correct diagnosis, with subsequent adverse patient outcomes. Clinicians must consider multiple diagnoses, especially those life-threatening conditions that require timely intervention to limit morbidity and mortality. This article will review general information on abdominal pain and discuss the clinical approach by review of the history and the physical examination. Additionally, this article will discuss the approach to unstable patients with abdominal pain.Keywords: acute abdomen, emergency medicine, peritonitis
[Managing the discharge of diabetic patients from the emergency department: a consensus paper].
Cuervo Pinto, Rafael; Álvarez-Rodríguez, Esther; González Pérez de Villar, Noemí; Artola-Menéndez, Sara; Girbés Borrás, Juan; Mata-Cases, Manel; Galindo Rubio, Mercedes; Puig Larrosa, Juan; Muñoz Albert, Ricardo; Díaz Pérez, José Ángel
2017-10-01
Eighty to 90% of patients attended in emergency departments are discharged to home. Emergency department physicians are therefore responsible for specifying how these patients are treated afterwards. An estimated 30% to 40% of emergency patients have diabetes mellitus that was often decompensated or poorly controlled prior to the emergency. It is therefore necessary to establish antidiabetic treatment protocols that contribute to adequate metabolic control for these patients in the interest of improving the short-term prognosis after discharge. The protocols should also maintain continuity of outpatient care from other specialists and contribute to improving the long-term prognosis. This consensus paper presents the consensus of experts from 3 medical associations whose members are directly involved with treating patients with diabetes. The aim of the paper is to facilitate the assessment of antidiabetic treatment when the patient is discharged from the emergency department and referred to outpatient care teams.
Hayakawa, Itaru; Miyama, Sahoko; Inoue, Nobuaki; Sakakibara, Hiroshi; Hataya, Hiroshi; Terakawa, Toshiro
2016-09-01
Pediatric convulsive status epilepticus with fever is common in the emergency setting but leads to severe neurological sequelae in some patients. To explore the epidemiology of convulsive status epilepticus with fever, a retrospective cohort covering all convulsive status epilepticus cases with fever seen in the emergency department of a tertiary care children's hospital were consecutively collected. Of the 381 consecutive cases gathered, 81.6% were due to prolonged febrile seizure, 6.6% to encephalopathy/encephalitis, 0.8% to meningitis, and 7.6% to epilepsy. In addition, seizures were significantly longer in encephalopathy/encephalitis cases than in prolonged febrile seizure cases (log rank test, P status epilepticus with fever in the emergency setting, and will help optimize the management of pediatric patients presenting to the emergency department with convulsive status epilepticus with fever. © The Author(s) 2016.
How Can an Emergency Department Assist Patients and Caregivers at the End of Life?
... And Caregivers At The End Of Life? How Can An Emergency Department Assist Patients And Caregivers At ... your family. Five ways that the Emergency Department can help 1. Assist in the recognition and understanding ...
Assessment and Management of Bullied Children in the Emergency Department
Waseem, Muhammad; Ryan, Mary; Foster, Carla Boutin; Peterson, Janey
2015-01-01
Bullying is an important public health issue in the United States. Up to 30% of children report exposure to such victimization. Not only does it hurt bully victim, but it also negatively impacts the bully, other children, parents, school staff, and health care providers. Because bullying often presents with accompanying serious emotional and behavioral symptoms, there has been an increase in psychiatric referrals to emergency departments. Emergency physicians may be the first responders in the health care system for bullying episodes. Victims of bullying may present with nonspecific symptoms and be reluctant to disclose being victimized, contributing to the underdiagnosis and underreporting of bully victimization. Emergency physicians therefore need to have heightened awareness of physical and psychosocial symptoms related to bullying. They should rapidly screen for bullying, assess for injuries and acute psychiatric issues that require immediate attention, and provide appropriate referrals such as psychiatry and social services. This review defines bullying, examines its presentations and epidemiology, and provides recommendations for the assessment and evaluation of victims of bullying in the emergency department. PMID:23462401
Early detection of abnormal patient arrivals at hospital emergency department
Harrou, Fouzi; Sun, Ying; Kadri, Farid; Chaabane, Sondes; Tahon, Christian
2015-01-01
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.
Early detection of abnormal patient arrivals at hospital emergency department
Harrou, Fouzi
2015-10-21
Overcrowding is one of the most crucial issues confronting emergency departments (EDs) throughout the world. Efficient management of patient flows for ED services has become an urgent issue for most hospital administrations. Handling and detection of abnormal situations is a key challenge in EDs. Thus, the early detection of abnormal patient arrivals at EDs plays an important role from the point of view of improving management of the inspected EDs. It allows the EDs mangers to prepare for high levels of care activities, to optimize the internal resources and to predict enough hospitalization capacity in downstream care services. This study reports the development of statistical method for enhancing detection of abnormal daily patient arrivals at the ED, which able to provide early alert mechanisms in the event of abnormal situations. The autoregressive moving average (ARMA)-based exponentially weighted moving average (EWMA) anomaly detection scheme proposed was successfully applied to the practical data collected from the database of the pediatric emergency department (PED) at Lille regional hospital center, France.
Violence in the emergency department: a survey of health care workers.
Fernandes, C M; Bouthillette, F; Raboud, J M; Bullock, L; Moore, C F; Christenson, J M; Grafstein, E; Rae, S; Ouellet, L; Gillrie, C; Way, M
1999-11-16
Violence in the workplace is an ill-defined and underreported concern for health care workers. The objectives of this study were to examine perceived levels of violence in the emergency department, to obtain health care workers' definitions of violence, to determine the effect of violence on health care workers and to determine coping mechanisms and potential preventive strategies. A retrospective written survey of all 163 emergency department employees working in 1996 at an urban inner-city tertiary care centre in Vancouver. The survey elicited demographic information, personal definition of violence, severity of violence, degree of stress as a result of violence and estimate of the number of encounters with violence in the workplace in 1996. The authors examined the effects of violence on job performance and job satisfaction, and reviewed coping and potential preventive strategies. Of the 163 staff, 106 (65%) completed the survey. A total of 68% (70/103) reported an increased frequency of violence over time, and 60% (64/106) reported an increased severity. Most of the respondents felt that violence included witnessing verbal abuse (76%) and witnessing physical threats or assaults (86%). Sixty respondents (57%) were physically assaulted in 1996. Overall, 51 respondents (48%) reported impaired job performance for the rest of the shift or the rest of the week after an incident of violence. Seventy-seven respondents (73%) were afraid of patients as a result of violence, almost half (49%) hid their identities from patients, and 78 (74%) had reduced job satisfaction. Over one-fourth of the respondents (27/101) took days off because of violence. Of the 18 respondents no longer working in the emergency department, 12 (67%) reported that they had left the job at least partly owing to violence. Twenty-four-hour security and a workshop on violence prevention strategies were felt to be the most useful potential interventions. Physical exercise, sleep and the company of
Grover, Elise; Porter, Joanne E; Morphet, Julia
2017-05-01
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.
Level of agitation of psychiatric patients presenting to an emergency department.
Zun, Leslie S; Downey, La Vonne A
2008-01-01
The primary purpose of this study was to determine the level of agitation that psychiatric patients exhibit upon arrival to the emergency department. The secondary purpose was to determine whether the level of agitation changed over time depending upon whether the patient was restrained or unrestrained. An observational study enrolling a convenience sample of 100 patients presenting with a psychiatric complaint was planned, in order to obtain 50 chemically and/or physically restrained and 50 unrestrained patients. The study was performed in summer 2004 in a community, inner-city, level 1 emergency department with 45,000 visits per year. The level of patient agitation was measured using the Agitated Behavior Scale (ABS) and the Richmond Agitation-Sedation Scale (RASS) upon arrival and every 30 minutes over a 3-hour period. The inclusion criteria allowed entry of any patient who presented to the emergency department with a psychiatric complaint thought to be unrelated to physical illness. Patients who were restrained for nonbehavioral reasons or were medically unstable were excluded. 101 patients were enrolled in the study. Of that total, 53 patients were not restrained, 47 patients were restrained, and 1 had incomplete data. There were no differences in gender, race, or age between the 2 groups. Upon arrival, 2 of the 47 restrained patients were rated severely agitated on the ABS, and 13 of 47 restrained patients were rated combative on the RASS. There was a statistical difference (p = .01) between the groups on both scales from time 0 to time 90 minutes. Scores on the agitation scales decreased over time in both groups. One patient in the unrestrained group became unarousable during treatment. This study demonstrated that patients who were restrained were more agitated than those who were not, and that agitation levels in both groups decreased over time. Some restrained patients did not meet combativeness or severe agitation criteria, suggesting either that use of
Geriatric Nursing Assessment and Intervention in an Emergency Department – a Pilot Study
DEFF Research Database (Denmark)
Rosted, Elizabeth Emilie; Wagner, Lis; Henriksen, Carsten
2012-01-01
Aim To describe and test a model for structured nursing assessment and intervention to older people discharged from Emergency Department (ED). Background Older people recently discharged from hospital are at high risk of readmission. This risk may increase when they are discharged straight home...... and intervenes at discharge from ED, and at follow-up. However a randomized controlled test should be carried out to confirm this. Relevance to clinical practice Nursing assessment and intervention should be implemented in the ED to reduce older peoples’ unrevealed problems....
Howell, Stuart C; Wills, Rachael A; Johnston, Trisha C
2014-02-01
The aim of the present study was to assess the suitability of emergency department (ED) discharge diagnosis for identifying patient cohorts included in the definitions of key performance indicators (KPIs) that are used to evaluate ED performance. Hospital inpatient episodes of care with a principal diagnosis that corresponded to an ED-defined KPI were extracted from the Queensland Hospital Admitted Patient Data Collection (QHAPDC) for the year 2010-2011. The data were then linked to the corresponding ED patient record and the diagnoses applied in the two settings were compared. The asthma and injury cohorts produced favourable results with respect to matching the QHAPDC principal diagnosis with the ED discharge diagnosis. The results were generally modest when the QHAPDC principal diagnosis was upper respiratory tract infection, poisoning and toxic effects or a mental health diagnosis, and were quite poor for influenza. There is substantial variation in the capture of patient cohorts using discharge diagnosis as recorded on Queensland Hospital Emergency Department data. WHAT IS KNOWN ABOUT THE TOPIC? There are several existing KPIs that are defined according to the diagnosis recorded on ED data collections. However, there have been concerns over the quality of ED diagnosis in Queensland and other jurisdictions, and the value of these data in identifying patient cohorts for the purpose of assessing ED performance remains uncertain. WHAT DOES THIS PAPER ADD? This paper identifies diagnosis codes that are suitable for use in capturing the patient cohorts that are used to evaluate ED performance, as well as those codes that may be of limited value. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? The limitations of diagnosis codes within ED data should be understood by those seeking to use these data items for healthcare planning and management or for research into healthcare quality and outcomes.
Zafar, Waleed
2015-04-01
Emergency departments (ED) are often stressful environments posing unique ethical challenges-issues that primarily raise moral rather than clinical concerns-in patient care. Despite this, there are very few reports of what emergency physicians find ethically challenging in their everyday work. Emergency medicine (EM) is a relatively young but rapidly growing specialty that is gaining acceptance worldwide. The aim of this study was to explore the perspectives of EM residents and physicians regarding the common ethical challenges they face during patient care in one of only two academic EM departments in Pakistan. These challenges could then be addressed in residents' training and departmental practice guidelines. A qualitative research design was employed and in-depth interviews were conducted with ED physicians. Participants were encouraged to think of specific examples from their work, to highlight the particular ethical concerns raised and to describe in detail the process by which those concerns were addressed or left unresolved. Transcripts were analysed using grounded theory methods. Thirteen participants were interviewed and they described four key challenges: how to provide highest quality care with limited resources; how to be truthful to patients; what to do when it is not possible to provide or continue treatment to patients; and when (and when not) to offer life-sustaining treatments. Participants' accounts provided important insights into how physicians tried to resolve these challenges in the 'local moral world' of an ED in Pakistan. The study highlights the need for developing systematic and contextually appropriate mechanisms for resolving common ethical challenges in the EDs and for training residents in moral problem solving. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Wiler, Jennifer L; Welch, Shari; Pines, Jesse; Schuur, Jeremiah; Jouriles, Nick; Stone-Griffith, Suzanne
2015-05-01
The objective was to review and update key definitions and metrics for emergency department (ED) performance and operations. Forty-five emergency medicine leaders convened for the Third Performance Measures and Benchmarking Summit held in Las Vegas, February 21-22, 2014. Prior to arrival, attendees were assigned to workgroups to review, revise, and update the definitions and vocabulary being used to communicate about ED performance and operations. They were provided with the prior definitions of those consensus summits that were published in 2006 and 2010. Other published definitions from key stakeholders in emergency medicine and health care were also reviewed and circulated. At the summit, key terminology and metrics were discussed and debated. Workgroups communicated online, via teleconference, and finally in a face-to-face meeting to reach consensus regarding their recommendations. Recommendations were then posted and open to a 30-day comment period. Participants then reanalyzed the recommendations, and modifications were made based on consensus. A comprehensive dictionary of ED terminology related to ED performance and operation was developed. This article includes definitions of operating characteristics and internal and external factors relevant to the stratification and categorization of EDs. Time stamps, time intervals, and measures of utilization were defined. Definitions of processes and staffing measures are also presented. Definitions were harmonized with performance measures put forth by the Centers for Medicare and Medicaid Services (CMS) for consistency. Standardized definitions are necessary to improve the comparability of EDs nationally for operations research and practice. More importantly, clear precise definitions describing ED operations are needed for incentive-based pay-for-performance models like those developed by CMS. This document provides a common language for front-line practitioners, managers, health policymakers, and researchers.
Directory of Open Access Journals (Sweden)
M. Yousefi
Full Text Available This study presents an agent-based simulation modeling in an emergency department. In a traditional approach, a supervisor (or a manager allocates the resources (receptionist, nurses, doctors, etc. to different sections based on personal experience or by using decision-support tools. In this study, each staff agent took part in the process of allocating resources based on their observation in their respective sections, which gave the system the advantage of utilizing all the available human resources during the workday by being allocated to a different section. In this simulation, unlike previous studies, all staff agents took part in the decision-making process to re-allocate the resources in the emergency department. The simulation modeled the behavior of patients, receptionists, triage nurses, emergency room nurses and doctors. Patients were able to decide whether to stay in the system or leave the department at any stage of treatment. In order to evaluate the performance of this approach, 6 different scenarios were introduced. In each scenario, various key performance indicators were investigated before and after applying the group decision-making. The outputs of each simulation were number of deaths, number of patients who leave the emergency department without being attended, length of stay, waiting time and total number of discharged patients from the emergency department. Applying the self-organizing approach in the simulation showed an average of 12.7 and 14.4% decrease in total waiting time and number of patients who left without being seen, respectively. The results showed an average increase of 11.5% in total number of discharged patients from emergency department.
Studying protocol-based pain management in the emergency department
Directory of Open Access Journals (Sweden)
Akkamahadevi Patil
2017-01-01
Full Text Available Background: Majority of the patients presenting to emergency department (ED have pain. ED oligoanalgesia remains a challenge. Aims: This study aims to study the effect of implementing a protocol-based pain management in the ED on (1 time to analgesia and (2 adequacy of analgesia obtained. Settings and Design: Cross-sectional study in the ED. Methods: Patients aged 18–65 years of age with pain of numeric rating scale (NRS ≥4 were included. A series of 100 patients presenting before introduction of the protocol-based pain management were grouped “pre-protocol,” and managed as per existing practice. Following this, a protocol for management of all patients presenting to ED with pain was implemented. Another series of 100 were grouped as “post-protocol” and managed as per the new pain management protocol. The data of patients from both the groups were collected and analyzed. Statistical Analysis Used: Descriptive statistical tests such as percentage, mean and standard deviation and inferential statistical tests such as Pearson coefficient, Student's t-test were applied. Differences were interpreted as significant when P < 0.05. Results: Mean time to administer analgesic was significantly lesser in the postprotocol group (preprotocol 20.30 min vs. postprotocol 13.05 min; P < 0.001. There was significant difference in the pain relief achieved (change in NRS between the two groups, with greater pain relief achieved in the postprotocol group (preprotocol group 4.6800 vs. postprotocol group 5.3600; P < 0.001. Patients' rating of pain relief (assessed on E5 scale was significantly higher in the postprotocol group (preprotocol 3.91 vs. postprotocol 4.27; P = 0.001. Patients' satisfaction (North American Spine Society scale with the overall treatment was also compared and found to be significantly higher in postprotocol group (mean: preprotocol 1.59 vs. postprotocol 1.39; P = 0.008. Conclusion: Protocol-based pain management provided timely and
The Impact of High-Profile Sexual Abuse Cases in the Media on a Pediatric Emergency Department.
Flannery, Dustin D; Stephens, Clare L; Thompson, Amy D
2016-01-01
High-profile media cases of sexual abuse may encourage disclosures of abuse from victims of unrelated assaults and also influence parental concerns, leading to increased emergency department visits. In the region of the study authors' institution, there are two recent high-profile sexual abuse cases with media coverage: Earl Bradley, a Delaware pediatrician, and Jerry Sandusky, a Pennsylvania college football coach. This is a retrospective cohort study of children evaluated for sexual abuse at a pediatric emergency department. Patients were classified as either presenting during a media period or non-media period. The media periods were one-month periods immediately following breaking news reports, when the cases were highly publicized in the media. The non-media periods were the 12-month periods directly preceding the first reports. The median number of emergency department visits per month during a non-media period was 9 visits (interquartile range 6-10). There were 11 visits in the month following the Sandusky case and 13 visits following the Bradley case. There was no statistical difference in number of emergency department visits for sexual abuse between the periods (p = .09). These finding have implications regarding use of resources in pediatric EDs after high-profile sexual abuse cases.
Therapy Dogs in the Emergency Department
Directory of Open Access Journals (Sweden)
Nickolas Nahm
2012-09-01
Full Text Available Introduction: This study examined acceptance by staff and patients of a therapy dog (TD in the emergency department (ED.Methods: Immediately after TD visits to a University Hospital ED, all available ED staff, patients, and their visitors were invited to complete a survey.Results: Of 125 ‘‘patient’’ and 105 staff responses, most were favorable. Ninety-three percent of patients and 95% of staff agreed that TDs should visit EDs; 87.8% of patients and 92% of staff approved of TDs for both adult and pediatric patients. Fewer than 5% of either patients or staff were afraid of the TDs. Fewer than 10% of patients and staff thought the TDs posed a sanitary risk or interfered with staff work.Conclusion: Both patients and staff approve of TDs in an ED. The benefits of animal-assisted therapy should be further explored in the ED setting.
LENUS (Irish Health Repository)
O'Connell, Sarah
2016-01-01
Studies suggest 2 per 1000 people in Dublin are living with HIV, the level above which universal screening is advised. We aimed to assess the feasibility and acceptability of a universal opt-out HIV, Hepatitis B and Hepatitis C testing programme for Emergency Department patients and to describe the incidence and prevalence of blood-borne viruses in this population.
Hughes, Elizabeth; Terry, David; Huynh, Chi; Petridis, Konstantinos; Aiello, Matthew; Mazard, Louis; Ubhi, Hirminder; Terry, Alex; Wilson, Keith; Sinclair, Anthony
2017-08-01
Background There are concerns about maintaining appropriate clinical staffing levels in Emergency Departments. Pharmacists may be one possible solution. Objective To determine if Emergency Department attendees could be clinically managed by pharmacists with or without advanced clinical practice training. Setting Prospective 49 site cross-sectional observational study of patients attending Emergency Departments in England. Method Pharmacist data collectors identified patient attendance at their Emergency Department, recorded anonymized details of 400 cases and categorized each into one of four possible options: cases which could be managed by a community pharmacist; could be managed by a hospital pharmacist independent prescriber; could be managed by a hospital pharmacist independent prescriber with additional clinical training; or medical team only (unsuitable for pharmacists to manage). Impact indices sensitive to both workload and proportion of pharmacist manageable cases were calculated for each clinical group. Main outcome measure Proportion of cases which could be managed by a pharmacist. Results 18,613 cases were observed from 49 sites. 726 (3.9%) of cases were judged suitable for clinical management by community pharmacists, 719 (3.9%) by pharmacist prescribers, 5202 (27.9%) by pharmacist prescribers with further training, and 11,966 (64.3%) for medical team only. Impact Indices of the most frequent clinical groupings were general medicine (13.18) and orthopaedics (9.69). Conclusion The proportion of Emergency Department cases that could potentially be managed by a pharmacist was 36%. Greatest potential for pharmacist management was in general medicine and orthopaedics (usually minor trauma). Findings support the case for extending the clinical role of pharmacists.
Emergency team calls for critically ill non-trauma patients in the emergency department
DEFF Research Database (Denmark)
Jensen, Søren Marker; Do, Hien Quoc; Rasmussen, Søren W.
2015-01-01
BACKGROUND: Handling critically ill patients is a complex task for Emergency Department (ED) personnel. Initial treatment is of major importance and requires adequately experienced ED doctors to initiate and decide for the right medical or surgical treatment. Our aim was, with regard to clinical...... the study period. RESULTS: A total of 109 emergency team calls were triggered (79 orange and 30 red), comprising 66 (60.6 %) men and 43 women, with a median age of 64 years. Patients presented with: 4 Airway, 27 Breathing, 41 Circulation, 31 Disability, 2 Exposure and 4 Other problems. Overall, 58/109 (53.......2 %) patients were admitted to the ICU, while 20/109 (18.3 %) patients were deemed ineligible for ICU admission. 30-day mortality was 34/109 (31.2 %), and circulatory problems were the most frequent cause of death (61.8 %, p = 0.02). Patients who died were significantly older than those who survived (p = 0...
Son, Youn-Jung; Kim, Bo Hwan
2017-12-01
Anemia is a frequent comorbidity in patients with heart failure. However, the incidence of anemia in patients with heart failure varies widely, and there is limited evidence on the association between anemia and rehospitalization and on the health consequences of anemia in patients with heart failure. We aimed to identify the prevalence of anemia and its influence on hospital readmissions and emergency department visits in outpatients with heart failure. This cross-sectional study included 284 patients with heart failure diagnosed at outpatient cardiology clinics at a tertiary care university hospital in Cheonan, South Korea. We obtained socio-demographic and clinical information, including frequency of readmissions and emergency department visits, using face-to-face interviews and medical record reviews. The prevalence of anemia, defined based on World Health Organization guidelines, was 39.1% among patients with heart failure. Anemia was significantly more prevalent among patients with one or more re-admissions or emergency department visits compared with patients with no history of hospital re-admissions or emergency department visits (42.7% vs. 13.9% ( p = 0.001) and 55.1% vs. 34% ( p = 0.002) respectively). Anemia increased the risk of hospital readmission (odds ratio =8.04, 95% confidence interval, 2.19-29.54) and emergency department visit (odds ratio=2.37, 95% confidence interval, 1.22-4.60) in patients with heart failure. It is imperative that patients with heart failure presenting with anemia undergo appropriate nursing assessment and intervention. Future prospective studies targeting interventions to improve anemia are required to determine whether anemia influences readmission rates and emergency department visits.
Profile of frequent attenders to a Dublin inner city emergency department
LENUS (Irish Health Repository)
Ramasubbu, B
2016-04-01
A retrospective review of the demographics, co-morbidities and substance misuse of the 20 most frequent presenters to the Mater Misericordiae University Hospital emergency department during 2014 was carried out in an attempt to better understand the epidemiology of their presentations. Eighty-five percent were male and 15% female (p<0.001). The average age was 40.6 years with a median 38.5 years. All were unemployed and 7 (35%) had no fixed abode. Thirteen patients (65%) lived an average of 4.5 kilometres from the ED. In this study the presence of a mental illness, homelessness, alcohol or drug misuse were associated with significantly higher attendance rates (p=0.001, p<0.001, p<0.05, p<0.001 respectively). Early identification of these patients and targeting them for effective case-based community-led treatment strategies could improve their quality of life, decrease their cost of care and ultimately lead to more effective utilisation of our already overburdened emergency departments.
2011-04-28
...-AA00 Safety Zone; Pierce County Department of Emergency Management Regional Water Exercise, East... the Regional Water Rescue Exercise. Basis and Purpose The Pierce County, Washington, Department of... to read as follows: Sec. 165.T13-0251 Safety Zone; Pierce County Department of Emergency Management...
Hospital-Level Factors Associated with Pediatric Emergency Department Return Visits.
Pittsenbarger, Zachary; Thurm, Cary; Neuman, Mark; Spencer, Sandra; Simon, Harold; Gosdin, Craig; Shah, Samir; McClead, Richard; Stack, Anne; Alpern, Elizabeth
2017-07-01
Return visits (RVs) and RVs with admission (RVAs) are commonly used emergency department quality measures. Visit- and patient-level factors, including several social determinants of health, have been associated with RV rates, but hospital-specific factors have not been studied. To identify what hospital-level factors correspond with high RV and RVA rates. Multicenter mixed-methods study of hospital characteristics associated with RV and RVA rates. Pediatric Health Information System with survey of emergency department directors. Adjusted return rates were calculated with generalized linear mixed-effects models. Hospitals were categorized by adjusted RV and RVA rates for analysis. Twenty-four hospitals accounted for 1,456,377 patient visits with an overall adjusted RV rate of 3.7% and RVA rate of 0.7%. Hospitals with the highest RV rates served populations that were more likely to have government insurance and lower median household incomes and less likely to carry commercial insurance. Hospitals in the highest RV rate outlier group had lower pediatric emergency medicine specialist staffing, calculated as full-time equivalents per 10,000 patient visits: median (interquartile range) of 1.9 (1.5-2.1) versus 2.9 (2.2-3.6). There were no differences in hospital population characteristics or staffing by RVA groups. RV rates were associated with population social determinants of health and inversely related to staffing. Hospital-level variation may indicate population-level economic factors outside the control of the hospital and unrelated to quality of care. © 2017 Society of Hospital Medicine
Comparative emergency department resource utilisation across age groups.
Burkett, Ellen; Martin-Khan, Melinda G; Gray, Leonard C
2017-12-11
Objectives The aim of the present study was to assess comparative emergency department (ED) resource utilisation across age groups. Methods A retrospective analysis of data collected in the National Non-admitted Patient Emergency Department Care Database was undertaken to assess comparative ED resource utilisation across six age groups (0-14, 15-35, 36-64, 65-74, 75-84 and ≥85 years) with previously used surrogate markers of ED resource utilisation. Results Older people had significantly higher resource utilisation for their individual ED episodes of care than younger people, with the effect increasing with advancing age. Conclusion With ED care of older people demonstrated to be more resource intensive than care for younger people, the projected increase in older person presentations anticipated with population aging will have a magnified effect on ED services. These predicted changes in demand for ED care will only be able to be optimally managed if Australian health policy, ED funding instruments and ED models of care are adjusted to take into account the specific care and resource needs of older people. What is known about the topic? Current Australian ED funding models do not adjust for patient age. Several regional studies have suggested higher resource utilisation of ED patients aged ≥65 years. Anticipated rapid population aging mandates that contribution of age to ED visit resource utilisation be further explored. What does this paper add? The present study of national Australian ED presentations compared ED resource utilisation across age groups using surrogate markers of ED cost. Older people were found to have significantly higher resource utilisation in the ED, with the effect increasing further with advancing age. What are the implications for practitioners? The higher resource utilisation of older people in the ED warrants a review of current ED funding models to ensure that they will continue to meet the needs of an aging population.
Mikkola, Riitta; Huhtala, Heini; Paavilainen, Eija
2017-10-01
To describe fear, the threats causing fear and the occurrence of fear among emergency department nursing staff and physicians. The emergency department is a challenging workplace where the staff is often confronted by factors that cause fear. A cross-sectional study. A survey was conducted in 16 hospitals (n = 544). Nurses, practical nurses, orderlies and physicians from those hospitals participated in the survey. The survey questionnaire was based on the analysis of interviews of 30 nurses from one university hospital and one central hospital. The results of the interviews were analysed using the inductive content analysis method. The analysis of the survey was performed using statistical methods, such as frequencies, cross-tabulation and principal component analysis. The results showed that nearly all of the emergency department personnel had experienced work-related fear. Generally, the fear had been momentary. According to the survey results, fear was most often caused by medication errors, the resuscitation of a child, a catastrophic accident, urgent or violent situations or patients armed with weapons. Threats that caused fear included insecurity, danger in the work environment, threat of loss of one's health and threat of the consequences of one's mistakes and actions. The staff of emergency departments often encountered factors or situations that caused fear. The main threats causing fear that were raised by the respondents were insecurity and danger in the work environment. The data obtained from this study can be utilised in identifying and describing work-related fear and threats of fear among emergency department nursing staff and physicians. Based on the information herein, it will be possible to develop methods to prevent situations that cause fear in emergency departments. © 2016 John Wiley & Sons Ltd.
Abdellah, Rasha Farouk; Salama, Khaled Morsy
2017-01-01
Emergency department is one of the high-risk areas, where violence against health care workers (HCWs) is a prevalent and serious problem. Violence has negative effects on HCWs, and therefore on the quality of care provided in emergency department. This study aimed to determine the prevalence, types, sources and risk factors of violence reported by HCWs in emergency department. A cross-sectional study was conducted using a standardized questionnaire developed by the WHO. One hundred thirty four questionnaires were included in this study (94.4% response rate). WPV was reported by 59.7% of HCWs. Verbal violence was the most reported (58.2%), compared to physical violence (15.7%). The most reported reasons for violence were waiting time and that patient and family expectations not being met. Only 29.5% of HCWs who experienced verbal violence and 23.8% of who experienced physical violence reported it to hospital authority. About 75% of HCW thought that work place violence could be prevented, and about 60% said that no action was taken against the attacker by hospital authority. Violence against HCWs in emergency department is a significant issue that cannot be ignored. There are multiple reasons. The key point in dealing with the problem is to treat its specific causes.
Ketamine as a first-line treatment for severely agitated emergency department patients.
Riddell, Jeff; Tran, Alexander; Bengiamin, Rimon; Hendey, Gregory W; Armenian, Patil
2017-07-01
Emergency physicians often need to control agitated patients who present a danger to themselves and hospital personnel. Commonly used medications have limitations. Our primary objective was to compare the time to a defined reduction in agitation scores for ketamine versus benzodiazepines and haloperidol, alone or in combination. Our secondary objectives were to compare rates of medication redosing, vital sign changes, and adverse events in the different treatment groups. We conducted a single-center, prospective, observational study examining agitation levels in acutely agitated emergency department patients between the ages of 18 and 65 who required sedation medication for acute agitation. Providers measured agitation levels on a previously validated 6-point sedation scale at 0-, 5-, 10-, and 15-min after receiving sedation. We also assessed the incidence of adverse events, repeat or rescue medication dosing, and changes in vital signs. 106 patients were enrolled and 98 met eligibility criteria. There was no significant difference between groups in initial agitation scores. Based on agitation scores, more patients in the ketamine group were no longer agitated than the other medication groups at 5-, 10-, and 15-min after receiving medication. Patients receiving ketamine had similar rates of redosing, changes in vital signs, and adverse events to the other groups. In highly agitated and violent emergency department patients, significantly fewer patients receiving ketamine as a first line sedating agent were agitated at 5-, 10-, and 15-min. Ketamine appears to be faster at controlling agitation than standard emergency department medications. Copyright © 2017 Elsevier Inc. All rights reserved.
Faulkner, Debbie; Law, Julia
2015-11-01
Increasing demands are being placed on emergency departments in Australia and there is a view that older Australians are more likely than other age groups to attend for non-urgent conditions. The objective of this paper is to compare and contrast administrative data with the views of hospital staff and older people with regard to their presentation at two emergency departments in metropolitan Adelaide and how this aligns with the Australian Institute of Health and Welfare definition of 'potentially avoidable general practitioner-type presentations'. The study used three sources of data from two emergency departments: hospital data for the financial year 2010-11 for patients aged 65 years and over and identified as triage category four or five; three focus groups with medical, nursing and allied staff from these two hospitals; and interviews with 58 older people who presented at the two emergency departments over a two-week period. The hospital administrative data provided a very limited insight into why older people attended the emergency department, other than the medical diagnosis. Professional staff identified individual determinants, societal determinants and the health services system as explanations. Older people attended the emergency department for a range of reasons that may not necessarily reflect the opinions of health professionals. For many older people the emergency department was an appropriate place to attend considering their condition, though some presentations could be circumvented with appropriate and increased services in the community. However, as many older people suffer comorbidities, careful consideration needs to be given as to the best possible practices to achieve this.
Chew, K S; Mohd Hashairi, F; Jusoh, A F; Aziz, A A; Nik Hisamuddin, N A R; Siti Asma, H
2013-08-01
Although a vital test, blood culture is often plagued with the problem of contamination and false results, especially in a chaotic emergency department setting. The objectives of this pilot study is to find out the level of understanding among healthcare staffs in emergency department, Hospital Universiti Sains Malaysia (HUSM) regarding good blood culture sampling practice. All healthcare staffs in emergency department, HUSM who consented to this study were given a set of selfadministered anonymous questionnaire to fill. More than half (53.1%) of the 64 participants are emergency medicine residents. Majority of them (75%) have been working in the emergency medicine, HUSM for more than 2 years. More than half of them were able to answer correctly the amount of blood volume needed for culture in adult and pediatric patients. When asked what are the factors required to improve the true yield as well as to reduce the risk of culture contamination, the four commonest answers given were observing proper aseptic technique during blood sampling, donning sterile glove, proper hand scrubbing as well as ensuring the sterility of the equipments. This study suggests that there is a lack of proper knowledge of good blood culture sampling practice among our healthcare staffs in emergency department.
Pediatric wound care and management in the emergency department [digest].
Sanders, Jennifer E; Pade, Kathryn H
2017-10-23
Traumatic wounds and lacerations are common pediatric presenting complaints to emergency departments. Although there is a large body of literature on wound care, many emergency clinicians base management of wounds on theories and techniques that have been passed down over time. Therefore, controversial, conflicting, and unfounded recommendations are prevalent. This issue reviews evidence-based recommendations for wound care and management, including wound cleansing and irrigation, anxiolysis/sedation techniques, closure methods, and post-repair wound care. [Points & Pearls is a digest of Pediatric Emergency Medicine Practice].
Effectiveness of a multimodal hand hygiene improvement strategy in the emergency department
Arntz, P.R.; Hopman, J.; Nillesen, M.; Yalcin, E.; Bleeker-Rovers, C.P.; Voss, A.; Edwards, M.J.; Wei, A.T.W.
2016-01-01
BACKGROUND: Hand hygiene (HH) is essential in preventing nosocomial infection. The emergency department (ED) is an open portal of entry for pathogens into the hospital system, hence the important sentinel function of the ED personnel. The main objective of this study was to assess the effect of a
The Integration of Palliative Care into the Emergency Department
BASOL, Nursah
2015-01-01
SUMMARY: Palliative care (PC) is a new and developing area. It aims to provide the best possible quality of life for patients with life-limiting diseases. It does not primarily include life-extending therapies, but rather tries to help patients spend the rest of their lives in the best way. PC patients often are admitted to emergency departments during the course of a disease. The approach and management of PC include differences with emergency medicine. Thus, there are some problems while pr...
Vezyridis, Paraskevas; Samoutis, Alexis; Mavrikiou, Petroula M
2015-05-01
To identify perceived prevalence, characteristics, precipitating factors and suggestions for improving workplace violence in all nine public emergency departments in the Cyprus Republic. Workplace violence is a common phenomenon in emergency departments, but little is known about this phenomenon in Cyprus. A retrospective cross-sectional survey. Two hundred and twenty of 365 emergency nurses (85·7%) and doctors (14·3%) participated in this study, of which 62% were female. Data were collected via a Greek language version of the Violent Incident Form. Additional questions examined perceived frequencies, encouragement for reporting, satisfaction with actions taken and suggestions for improvement. Descriptive analysis, chi-square tests and multiple logistic regression analyses were used to describe and associate characteristics with workplace prevalence. During the previous 12 months, the vast majority of nurses and doctors (76·2%) were exposed to verbal abuse (88·8%), mainly by relatives or friends of the patient (59·1%). Relatively inexperienced clinicians were at greater risk. Waiting time was identified as the most significant organisational factor. Alcohol intoxication, substance abuse and mental illness were individual factors for workplace violence. Severe underreporting (72·2%) and a belief that workplace violence is part of the work (74·1%) were also identified. Workplace violence was highly correlated with several factors, including a lack of encouragement for reporting, a feeling in advance that a violent incident was about to happen and having to handle the incident personally. Suggestions for improvement included more security measures (26·7%) and public education about the proper use of emergency services (15·2%). Verbal abuse is common in Cypriot emergency departments, but clinicians are increasingly worried about physical assaults. Training, security policies, encouragement of reporting and support for staff after a violent incident are needed
Waseem, Muhammad; Boutin-Foster, Carla; Robbins, Laura; Gonzalez, Rita; Vargas, Steven; Peterson, Janey C
2014-11-01
The problem of bullying is an increasing public health threat encountered by emergency physicians especially in inner city emergency departments (EDs). Bullying may result in emotional disturbances and psychological trauma in children. Many children sent to the ED because of behavioral misconduct require immediate stabilization and treatment. The emergency physician performs an initial assessment and stabilization. Emergency departments are increasingly on the frontline of the bullying problem. Our objective was to explore children's perspective of bullying and their views of potential solutions. A qualitative study was conducted in a cohort of 50 children (age, 8-17 years), who were referred to the ED from school because of their behavioral misconduct. An interview survey tool about bullying was administered. It focused on what bullying meant to them and what advice they have for a child who is bullied. They were also asked what advice they would have for adults who try to help. We used grounded theory to analyze the data. Similar concepts were grouped, and the categories with similar properties and dimensions were defined. Common themes were then identified. We interviewed 50 children, of whom 27 were boys and 23 were girls. Their mean (SD) age was 12.5 (2.12) years (range, 8-17 years). Bullying was identified by children as including physical, verbal, and emotional actions. Several themes emerged. First, a power imbalance between a bully and victim may render an individual vulnerable to bullying. Being different and weak also increases the risk of being bullied. Second, bullying is wrong, and the bully should be punished. Third, children should learn how to handle bullying situations and develop resilience against bullying. Finally, adults need to be more proactive to prevent or stop bullying. Our results provide insights into the perceptions of children regarding bullying. We have garnered a better understanding of what these children feel adults should do to
Paganini, Matteo; Borrelli, Francesco; Cattani, Jonathan; Ragazzoni, Luca; Djalali, Ahmadreza; Carenzo, Luca; Della Corte, Francesco; Burkle, Frederick M Jr; Ingrassia, Pier Luigi
2016-08-15
Since the 1990s, Italian hospitals are required to comply with emergency disaster plans known as Emergency Plan for Massive Influx of Casualties. While various studies reveal that hospitals overall suffer from an insufficient preparedness level, the aim of this study was to better determine the preparedness level of Emergency Departments of Italian hospitals by assessing the knowledge-base of emergency physicians regarding basic disaster planning and procedures. A prospective observational study utilized a convenience sample of Italian Emergency Departments identified from the Italian Ministry of Health website. Anonymous telephone interviews were conducted of medical consultants in charge at the time in the respective Emergency Departments, and were structured in 3 parts: (1) general data and demographics, (2) the current disaster plan and (3) protocols and actions of the disaster plan. Eighty-five Emergency Departments met inclusion criteria, and 69 (81 %) agreed to undergo the interview. Only 45 % of participants declared to know what an Emergency Plan for Massive Influx of Casualties is, 41 % believed to know who has the authority to activate the plan, 38 % knew who is in charge of intra-hospital operations. In Part 3 physicians revealed a worrisome inconsistency in critical content knowledge of their answers. Results demonstrate a poor knowledge-base of basic hospital disaster planning concepts by Italian Emergency Department physicians-on-duty. These findings should alert authorities to enhance staff disaster preparedness education, training and follow-up to ensure that these plans are known to all who have responsibility for disaster risk reduction and management capacity.
Emergency department visits during an Olympic gold medal television broadcast.
Redelmeier, Donald A; Vermeulen, Marian J
2011-01-01
Practice pattern variations are often attributed to physician decision-making with no accounting for patient preferences. 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. Time-series analysis of emergency department visits for any reason. Population-based sample of all patients seeking emergency care in Ontario, Canada. The broadcast day was defined as the Olympic men's gold medal ice hockey game final. The control days were defined as the 6 Sundays before and after the broadcast day. A total of 99 447 visits occurred over the 7 Sundays, of which 13 990 occurred on the broadcast day. Comparing the broadcast day with control days, we found no significant difference in the hourly rate of visits before the broadcast (544 vs 537, p = 0.41) or after the broadcast (647 vs 639, p = 0.55). In contrast, we observed a significant reduction in hourly rate of visits during the broadcast (647 vs 783, p television broadcasts can influence patient preferences and thereby lead to a decrease in emergency department visits.
Williams, Cylie M; Haines, Terry P
2014-01-23
Many women are warned against the dangers of wearing high heel footwear however there is limited empirical evidence demonstrating an association between wearing high heel with injury. Gait laboratory testing has found a higher heel height placed the foot in a position that increases the risk of ankle sprain. Women have also been surveyed about wearing high heels and approximately half of those reported inconvenience and pain after wearing a high heel shoe. This study aims to explore emergency department presentations of injuries and the estimated costs that have been directly attributed to wearing high heeled footwear within Victoria, Australia during 2006-2010. The Victorian Emergency Minimum Dataset (VEMD) was searched for all injuries attributed to wearing high heel footwear presenting to emergency departments in Victoria Australia, between the years of 2006-2010. The VEMD produced a report detailing sex, age at presentation, month of presentation, time of day of presentation, day of presentation, location that injury occurred and type of injury for presentation. Monash Health in Victoria Australia, provided emergency department estimates for injury types to calculate an estimated cost of an acute injury related to wearing high heel footwear. There were 240 injuries presenting to Victorian emergency departments directly attributed to wearing high heeled footwear. The majority of people injured were women (n = 236) and all were less than 55 years of age. More injuries presented on a Sunday (n = 83) and more in the 8 am-12 pm time bracket (n = 64). There were also more injuries presenting in the months of November, December and January (n = 80). The most commonly injured body part was the ankle (n = 123). The emergency department estimate of the cost of these injuries over this time-frame was almost $72,000 (mean of $316.72 per presentation). People who wear high heel footwear on weekends appear to be at higher risk for injury that leads to
Stress in emergency departments: experiences of nurses and doctors.
LENUS (Irish Health Repository)
Healy, Sonya
2012-01-31
The effects of stressful incidents on emergency department (ED) staff can be profound. Witnessing aggression, violence or the death of patients, or participating in resuscitation, can be emotionally and physically demanding. Despite the frequency of these events, ED staff do not become immune to the stress they cause, and are often ill prepared and under supported to cope with them. This article reports on a study of nurses\\' and doctors\\' attitudes to, and experiences of, workplace stress in three EDs in Ireland, and offers some suggestions on how stress among ED staff can be reduced.
Botes, Meghan L; Langley, Gayle
2016-06-24
Families are not prepared for traumatic injuries of loved ones. Emergency nurses have the important role of caring for patients and families in this time of crisis. Family needs in the critical care setting have been explored using the Critical Care Family Needs Inventory (CCFNI), however little is known about family needs in the emergency department. This study sought to determine the needs of family members accompanying injured patients into the emergency department, and if these needs were met. A quantitative, descriptive, study was conducted in a level 1 trauma facility in Johannesburg, South Africa. The population included families of patients admitted to the emergency department, sampling 100 participants. The instrument, based on the CCFNI, was validated in a pilot study in Melbourne, Australia and re-evaluated using the Cronbach Alpha validity test to ensure internal consistency.Five themes were explored: 'meaning', 'proximity', 'communication', 'comfort' and 'support' and data were analysed using descriptive statistics. Responses to open-ended questions were analysed using content analysis. Permission from the Human Research Ethics Committee was granted and participants were ensured confidentiality and the option for counselling if required. Themes ranked highly important were 'meaning' and 'communication'. Satisfaction was highest for 'meaning'. Low satisfaction levels for 'communication' were found. Issues regarding prolonged time spent in the emergency department and discrimination were raised. These findings have a negative impact on the family's satisfaction with care and it is recommended that the nurse's role in family care be further explored and emphasised.
[Quality management in emergency departments: Lack of uniform standards for fact-based controlling].
Ries, M; Christ, M
2015-11-01
The general high occupancy of emergency departments during the winter months of 2014/2015 outlined deficits in health politics. Whether on the regional, province, or federal level, verifiable and accepted figures to enable in depth analysis and fact-based controlling of emergency care systems are lacking. As the first step, reasons for the current situation are outlined in order to developed concrete recommendations for individual hospitals. This work is based on a selective literature search with focus on quality management, ratio driven management, and process management within emergency departments as well as personal experience with implementation of a key ratio system in a German maximum care hospital. The insufficient integration of emergencies into the DRG systematic, the role as gatekeeper between inpatient and outpatient care sector, the decentralized organization of emergency departments in many hospitals, and the inconsistent representation within the medical societies can be mentioned as reasons for the lack of key ratio systems. In addition to the important role within treatment procedures, emergency departments also have an immense economic importance. Consequently, the management of individual hospitals should promote implementation of key ratio systems to enable controlling of emergency care processes. Thereby the perspectives finance, employees, processes as well as partners and patients should be equally considered. Within the process perspective, milestones could be used to enable detailed controlling of treatment procedures. An implementation of key ratio systems without IT support is not feasible; thus, existing digital data should be used and future data analysis should already be considered during implementation of new IT systems.
Hitti, Eveline A; El-Eid, Ghada R; Tamim, Hani; Saleh, Rana; Saliba, Miriam; Naffaa, Lena
2017-09-05
Emergency Department overcrowding has become a global problem and a growing safety and quality concern. Radiology and laboratory turnaround time, ED boarding and increased ED visits are some of the factors that contribute to ED overcrowding. Lean methods have been used in the ED to address multiple flow challenges from improving door-to-doctor time to reducing length of stay. The objective of this study is to determine the effectiveness of using Lean management methods on improving Emergency Department transportation times for plain radiography. We performed a before and after study at an academic urban Emergency Department with 49,000 annual visits after implementing a Lean driven intervention. The primary outcome was mean radiology transportation turnaround time (TAT). Secondary outcomes included overall study turnaround time from order processing to preliminary report time as well as ED length of stay. All ED patients undergoing plain radiography 6 months pre-intervention were compared to all ED patients undergoing plain radiography 6 months post-intervention after a 1 month washout period. Post intervention there was a statistically significant decrease in the mean transportation TAT (mean ± SD: 9.87 min ± 15.05 versus 22.89 min ± 22.05, respectively, p-value <0.0001). In addition, it was found that 71.6% of patients in the post-intervention had transportation TAT ≤ 10 min, as compared to 32.3% in the pre-intervention period, p-value <0.0001, with narrower interquartile ranges in the post-intervention period. Similarly, the "study processing to preliminary report time" and the length of stay were lower in the post-intervention as compared to the pre-intervention, (52.50 min ± 35.43 versus 54.04 min ± 34.72, p-value = 0.02 and 3.65 h ± 5.17 versus 4.57 h ± 10.43, p < 0.0001, respectively), in spite of an increase in the time it took to elease a preliminary report in the post-intervention period. Using Lean change management
van Ierland, Yvette; Elshout, Gijs; Moll, Henritte A.; Nijman, Ruud G.; Vergouwe, Yvonne; van der Lei, Johan; Berger, Marjolein Y.; Oostenbrink, Rianne
Background The diagnostic value of alarm features of serious infections in low prevalence settings is unclear. Aim To explore to what extent alarm features play a role in referral to the emergency department (ED) by GPs who face a febrile child during out-of-hours care. Design and setting
DEFF Research Database (Denmark)
Sørup, Christian Michel; Jacobsen, Peter
2013-01-01
Patient satisfaction determinants in emergency departments (EDs) have for decades been heavily investigated. Despite great focus, a lack of consensus about which parameters are deemed most important remains. This study proposes an integrated framework for ED patient satisfaction, testing four key...
Iskra, María P; Ramón, José M; Martínez-Serrano, Andrés; Serra, Carmen; Goday, Albert; Trillo, Lourdes; Lanzarini, Enrique; Pera, Manuel; Grande, Luis
2018-04-01
Hospital readmission is used as a measure of quality healthcare. The aim of this study was to determine the incidence, causes, and risk factors related to emergency consultations and readmissions within 30 and 90 days in patients undergoing laparoscopic gastric bypass and laparoscopic sleeve gastrectomy. Retrospective study of 429 patients operated on from January 2004 to July 2015 from a prospectively maintained database and electronic medical records. Demographic data, type of intervention, postoperative complications, length of hospital stay and records of emergency visits and readmissions were analyzed. Within the first 90 days postoperative, a total of 117 (27%) patients consulted the Emergency Department and 24 (6%) were readmitted. The most common reasons for emergency consultation were noninfectious problems related to the surgical wound (n=40, 34%) and abdominal pain (n=28, 24%), which was also the first cause of readmission (n=9, 37%). Postoperative complications, reintervention, associated surgery in the same operation and depression were risk factors for emergency consultation within the first 90 days of the postoperative period. Despite the high number of patients who visit the Emergency Department in the first 90 days of the postoperative period, few require readmission and none surgical reoperation. It is important to know the reasons for emergency consultation to establish preventive measures and improve the quality of care. Copyright © 2018 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.
Antidote use in a pediatric emergency department
Martínez Sánchez, L; Almario Hernández, AF; Escuredo Argullós, L; Mação, P; Trenchs Sainz de la Maza, V; Luaces Cubells, C
2014-01-01
INTRODUCTION: Poisoning is an infrequent cause of consultation in a pediatric emergency department (PED), but it can be potentially serious. Pediatricians should know how to use the available antidotes properly. OBJECTIVES: To analyze the use of antidotes in a PED and to assess the suitability of their indications. MATERIALS AND METHODS: A retrospective review of antidote use in a PED between January 2008 and June 2012. Inclusion criteria were age younger than 18 years and cons...
Directory of Open Access Journals (Sweden)
Li Julie
2012-04-01
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
Li, Julie; Westbrook, Johanna; Callen, Joanne; Georgiou, Andrew
2012-04-02
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
Karam, Marlène; Tricas, Sandra Maria; Darras, Elisabeth; Macq, Jean
2016-01-01
Introduction: The use of emergency department (ED) services has known a significant rise in the past decade. Organizational factors, such as the models of after-hours primary medical care services, and the shortage of general practitioners (GPs) could explain this phenomena. But also demographic and societal elements combined with the problem of patient’s ‘inappropriate visits to the ED. In order to ensure continuity of care for patients, collaboration between GPs and EDs becomes increasingly...
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Filleul Laurent
2009-02-01
Full Text Available Abstract Background The health impacts of heat waves are serious and have prompted the development of heat wave response plans. Even when they are efficient, these plans are developed to limit the health effects of heat waves. This study was designed to determine relevant indicators related to health effects of heat waves and to evaluate the ability of a syndromic surveillance system to monitor variations in the activity of emergency departments over time. The study uses data collected during the summer 2006 when a new heat wave occurred in France. Methods Data recorded from 49 emergency departments since July 2004, were transmitted daily via the Internet to the French Institute for Public Health Surveillance. Items collected on patients included diagnosis (ICD10 codes, outcome, and age. Statistical t-tests were used to compare, for several health conditions, the daily averages of patients within different age groups and periods (whether 'on alert' or 'off alert'. Results A limited number of adverse health conditions occurred more frequently during hot period: dehydration, hyperthermia, malaise, hyponatremia, renal colic, and renal failure. Over all health conditions, the total number of patients per day remained equal between the 'on alert' and 'off alert' periods (4,557.7/day vs. 4,511.2/day, but the number of elderly patients increased significantly during the 'on alert' period relative to the 'off alert' period (476.7/day vs. 446.2/day p Conclusion Our results show the interest to monitor specific indicators during hot periods and to focus surveillance efforts on the elderly. Syndromic surveillance allowed the collection of data in real time and the subsequent optimization of the response by public health agencies. This method of surveillance should therefore be considered as an essential part of efforts to prevent the health effects of heat waves.
Zhang, Yue; Yan, Chenyang; Kan, Haidong; Cao, Junshan; Peng, Li; Xu, Jianming; Wang, Weibing
2014-11-25
Many studies have examined the association between ambient temperature and mortality. However, less evidence is available on the temperature effects on gender- and age-specific emergency department visits, especially in developing countries. In this study, we examined the short-term effects of daily ambient temperature on emergency department visits (ED visits) in Shanghai. Daily ED visits and daily ambient temperatures between January 2006 and December 2011 were analyzed. After controlling for secular and seasonal trends, weather, air pollution and other confounding factors, a Poisson generalized additive model (GAM) was used to examine the associations between ambient temperature and gender- and age-specific ED visits. A moving average lag model was used to evaluate the lag effects of temperature on ED visits. Low temperature was associated with an overall 2.76% (95% confidence interval (CI): 1.73 to 3.80) increase in ED visits per 1°C decrease in temperature at Lag1 day, 2.03% (95% CI: 1.04 to 3.03) and 2.45% (95% CI: 1.40 to 3.52) for males and females. High temperature resulted in an overall 1.78% (95% CI: 1.05 to 2.51) increase in ED visits per 1°C increase in temperature on the same day, 1.81% (95% CI: 1.08 to 2.54) among males and 1.75% (95% CI: 1.03 to 2.49) among females. The cold effect appeared to be more acute among younger people aged effects were consistent on individuals aged ≥65 years. In contrast, the effects of high temperature were relatively consistent over all age groups. These findings suggest a significant association between ambient temperature and ED visits in Shanghai. Both cold and hot temperatures increased the relative risk of ED visits. This knowledge has the potential to advance prevention efforts targeting weather-sensitive conditions.
Residents' Experiences of Abuse and Harassment in Emergency Departments.
Sadrabad, Akram Zolfaghari; Bidarizerehpoosh, Farahnaz; Farahmand Rad, Reza; Kariman, Hamid; Hatamabadi, Hamidreza; Alimohammadi, Hossein
2016-04-21
The widespread epidemic of emerging abuse in Emergency Departments (ED) toward residents generates negative effects on the residents' health and welfare. The purpose of this study was to determine and highlight the high prevalence of abuse and harassment toward Emergency residents. In 2011, a multi-institutional, cross-sectional study was conducted at seven Emergency Residencies of central hospitals in Iran. Residents were asked about their age, marital status, postgraduate year (PGY) levels, and work experiences before residency. Prevalence of abuse in four categories was evaluated: verbal abuse; verbal and physical threat; physical assault and sexual harassment; and by whom. The data were analyzed by SPSS version 17.0 (SPSS, Inc., Chicago, IL, USA). Two hundred fifteen of the 296 residents (73%) completed the survey. The prevalence of any type of abuse experienced was 89%; 43% of residents experienced verbal and physical threats, 10% physical assault, and 31% sexual harassment. Verbal abuse and verbal and physical threats without the use of weapons were higher in men in comparison with women (pmen to encounter sexual harassment (31% vs. 7%, psexual harassment categories, sexual jokes (51%) were the most prevalent between residents. Junior residents (PGY-1) were more likely to experience abuse than senior residents (PGY-2 and PGY-3; pharassment during residency in ED are highly prevalent. Educational programs and effective preventive measures against this mistreatment are urgently required. © The Author(s) 2016.
A Rare Case in the Emergency Department: Holmes-Adie Syndrome
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Sahin COLAK
2015-03-01
Full Text Available SUMMARY: Holmes-Adie syndrome (HAS is a rare syndrome characterized by tonic pupil and the absence of deep tendon reflexes. HAS was first described in 1931 and is usually idiopathic, with incidences reported to be 4-7 per 100,000. Although tonic pupil is usually unilateral, it can also be bilateral. Enlarged and irregular pupil is usually noticed by the patient. Light reflex is weak or unresponsive. Another characteristic of HAS is the absence of deep tendon reflexes, and unilateral involvement is more common. This case report emphasizes that HAS should be considered in the differential diagnosis of patients presenting to the emergency department with anisocoria, and the dilute pilocarpine test can be used in diagnosis. Key words: Emergency department, Holmes-Adie syndrome, pilocarpine
Mollen, Cynthia J; Miller, Melissa K; Hayes, Katie L; Wittink, Marsha N; Barg, Frances K
2013-11-01
The objective was to identify adolescent preferences for emergency department (ED)-based education about emergency contraception. This was a cross-sectional computerized survey, using adaptive conjoint analysis (ACA). Patients were eligible if they were females ages 14 through 19 years old and were seeking care in one of two urban EDs. Patients were excluded if they were too ill to participate in the survey or if they were non-English speaking. Participants completed a computerized survey that used ACA, a technique that can be used to assess patients' relative preferences for services. ACA uses the individual's answers to update and refine questions through trade-off comparisons, so that each respondent answers a customized set of questions. The survey assessed preferences for the following attributes of emergency contraception education: who should deliver the education, if anyone (e.g., nurse, doctor); how the education should be delivered (e.g., by a person or via video); how often the education should be offered if patients were to frequent the ED (e.g., every time or only when asking for it); length (e.g., 5 minutes, 10 minutes); and chief complaint that would trigger the education (e.g., headache or stomach pain). A total of 223 patients were enrolled (37.2% at Hospital 1 and 62.8% at Hospital 2). The mean (±SD) age of the participants was 16.1 (±1.3) years. Just over half (55%) reported a history of sexual activity; 8% reported a history of pregnancy. Overall, the participants preferred education that was delivered by a person, specifically a doctor or nurse. They preferred a slightly longer education session and preferred education directed at patients seeking care in the ED for complaints potentially related to sexual activity. Adolescents have specific preferences for how education about emergency contraception would best serve their needs. This information can inform clinicians as they work to improve adolescents' knowledge about pregnancy prevention
Schimanski, Karen; Jull, Andrew; Mitchell, Nancy; McLay, Jessica
2014-12-01
Forearm blood pressures have been suggested as an alternative site to measure blood pressures when the upper arm is unavailable. However there is little evidence utilising clinical populations to support this substitution. To determine agreement between blood pressures measured in the left upper arm and forearm using a singular oscillometric non-invasive device in adult Emergency Department patients. The secondary objective was to explore the relationship of blood pressure differences with age, sex, ethnicity, smoking history and obesity. Single centre comparison study. Adult Emergency Department, Tertiary Trauma Centre. Forty-four participants who met inclusion/exclusion criteria selected sequentially from the Emergency Department arrival board. A random assignment of order of measurement for left upper arm and forearm blood pressures was utilised. Participants were eligible if they were aged 18 years or older, had been assigned an Australasian Triage Scale code of 2, 3, 4, or 5, were able to consent, and able to have blood pressures measured on their left arm whilst lying at a 45° angle. The Bland-Altman method of statistical analysis was used, with the level of agreement for clinical acceptability for the systolic, diastolic and mean arterial pressure defined as ±10 mmHg. The forearm measure overestimated systolic (mean difference 2.2 mmHg, 95% limits of agreement ±19 mmHg), diastolic (mean difference 3.4 mmHg, 95% limits of agreement ±14.4 mmHg), and mean arterial pressures (mean difference 4.1 mmHg, 95% limits of agreement ±13.7 mmHg). The systolic measure was not significantly different from zero. Evidence of better agreement was found with upper arm/forearm systolic measures below 140 mmHg compared to systolic measures above 140 mmHg using the Levene's test (p=0.002, F-statistic=11.09). Blood pressure disparity was not associated with participant characteristics. Forearm measures cannot routinely replace upper arm measures for blood pressure measurement
Consequences of peritonism in an emergency department setting
DEFF Research Database (Denmark)
Bjørsum-Meyer, Thomas; Schmidt, Thomas A.
2013-01-01
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...
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K Asish
2016-01-01
Full Text Available Background and Aims: Tertiary care teaching hospitals remain referral centres for victims of trauma and mass casualty. Often specialists from various disciplines manage these crowded casualty areas. These age old casualty areas are being replaced, throughout the country by Emergency Medicine Departments (EMDs, presumed to be better planned to confront a crisis. We aimed to gather basic data contributive in setting up of an EMD at a tertiary care teaching hospital from the lessons learned from functioning existent systems. Methods: This is primarily a questionnaire-based descriptive study at tertiary care referral centres across the country, which was purposively selected.The study models included one from a hospital without designated EMD and the other four from hospitals with established EMDs. Direct observation and focus group meetings with experienced informants at these hospitals contributed to the data. In the absence of a validated hospital preparedness assessment scale, comparison was done with regard to quantitative, qualitative and corroborative parameters using descriptive analysis. Results: The EMDs at best practice models were headed by specialist in Emergency Medicine assisted by organised staff, had protocols for managing mass casualty incident (MCI, separate trauma teams, ergonomic use of infrastructure and public education programmes. In this regard, these hospitals seemed well organised to manage MCIs and disasters. Conclusion: The observation may provide a preliminary data useful in setting up an EMD. In the absence of published Indian literature, this may facilitate further research in this direction. Anaesthesiologists, presently an approved Faculty in Emergency Medicine training can provide creative input with regard to its initial organisation and functioning, thus widening our horizons in a country where there is a severe dearth of trained emergency physicians.
Job satisfaction among emergency department staff.
Suárez, M; Asenjo, M; Sánchez, M
2017-02-01
To compare job satisfaction among nurses, physicians and administrative staff in an emergency department (ED). To analyse the relationship of job satisfaction with demographic and professional characteristics of these personnel. We performed a descriptive, cross-sectional study in an ED in Barcelona (Spain). Job satisfaction was evaluated by means of the Font-Roja questionnaire. Multivariate analysis determined relationship between the overall job satisfaction and the variables collected. Fifty-two nurses, 22 physicians and 30 administrative staff were included. Administrative staff were significantly more satisfied than physicians and nurses: 3.42±0.32 vs. 2.87±0.42 and 3.06±0.36, respectively. Multivariate analysis showed the following variables to be associated with job satisfaction: rotation among the different ED acuity levels (OR: 2.34; 95%CI: 0.93-5.89) and being an administrative staff (OR: 0.27; 95%CI: 0.09-0.80). Nurses and physicians reported greater stress and work pressure than administrative staff and described a worse physical working environment. Interpersonal relationships obtained the highest score among the three groups of professionals. Job satisfaction of nurses and physicians in an ED is lower than that of administrative staff with the former perceiving greater stress and work pressure. Conversely, interpersonal relationships are identified as strength. Being nurse or physician and not rotating among the different ED acuity levels increase dissatisfaction. Copyright © 2016 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.
Delgado Vicente, Miriam; Lecaroz Agara, Mª Concepción; Barrios Andrés, José Luis; Canut Blasco, Andrés
2017-02-01
To assess process-of-care indicators and outcomes in acute pyelonephritis (APN) in a general hospital emergency department, and compare them between uncomplicaed and complicated APN. Retrospective study of consecutive patients discharged with a diagnosis of APN. We studied health processof- care indicators (percentage admitted, avoidable hospitalization, appropriate initial antibiotic therapy, urine and blood cultures) and outcomes (hospital length of stay [LOS], discharge from the emergency department, revisits, mortality, yields of microbiological tests ordered). A total of 529 cases (59% of them complicated) were included. Patients with uncomplicated APN were significantly younger on average (mean, 39 years) than patients with complicated APN (56 years). Escherichia coli was the most common pathogen identified, although the percentage of E coli infection was lower in patients with complicated APN (78%) than in patients with uncomplicated APN (95%). The rates of admission and orders for urine and blood cultures were significantly higher and hospital LOS was longer in the group with complicated APN. Moreover, these patients had even longer stays if the initial antibiotic therapy was inappropriate. Significantly more patients with uncomplicated APN were discharged from the emergency department. Sixty-one percent of patients with uncomplicated APN were admitted; 9% of these cases were considered avoidable hospitalizations. Complicated APN is diagnosed more often in older patients, and E coli infection causes a smaller proportion of these cases. Hospital LOS is longer in complicated APN and more urine and blood cultures are ordered. Patients with uncomplicated APN are more often discharged from the emergency department, although the number of avoidable hospitalizations seems high based on the rate found in this study.
Rainer, T H; Sollich, P; Piotrowski, T; Coolen, A C C; Cheng, B; Graham, C A
2012-12-01
Healthcare systems are under pressure to efficiently and safely reduce acute care admissions to hospital. There is a need to develop a standardised system for assessing emergency department performance which takes into account case-mix variation. The objective of this study was to derive and validate a standardised tool for assessing variations in medical admissions through emergency departments in Hong Kong. Retrospective study of patients attending emergency departments of 14 acute hospitals in Hong Kong. Data were retrieved from a centralised administrative database. Of 2,531,225 patients who attended emergency departments between 1 January 2001 and 31 December 2003, 780,444 (30.8%) were admitted to medical wards. A model derived from 2001 data shows well-calibrated admission probabilities, with an area under the receiver operating characteristic curve for probability of admission of 90.3 (95% CI ±0.11). The areas under the receiver operating characteristic curves for 2002 and 2003 validation sets were 89.9 (95% CI ±0.11) and 89.0 (95% CI ±0.12), respectively. With an averaged benchmark, reductions in medical admissions of up to 19% could be achieved, while under the most optimistic assumption, reductions of up 36% could be achieved. A tool for benchmarking hospital medical admissions and minimising case-mix variation has been derived and validated in Hong Kong, but it requires further validation in other healthcare systems given the wide variations in admission thresholds internationally. This may be used as one potential method to evaluate the performance of emergency departments against a common standard.
Cost of a roller skating rink to the local accident and emergency department.
Nayeem, N; Shires, S E; Porter, J E
1990-01-01
A 14 month retrospective study was undertaken to determine the cost implications of the opening of a roller skating rink to the local hospital accident and emergency department (A and E). A total of 398 patients attended following injury at the roller skating rink, of whom 384 were included in the study. The estimated cost of their injuries was determined by the hospital accounts department. The average cost per patient attending the A and E department following roller skating injury was about 100 pounds. The total cost to the A and E department of all injuries sustained at the rink over this period was 38,412 pounds. The cost implications of opening a roller skating rink for the A and E department are considerable. If proposals for self-budgeting are applied, A and E departments will have to seek additional funding if such leisure facilities are opened in their vicinity. PMID:2097020
Emergency Department Crowding: Factors Influencing Flow
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Arkun, Alp
2010-02-01
Full Text Available Background: The objective of this study was to evaluate those factors, both intrinsic and extrinsic to the emergency department (ED that influence two specific components of throughput: “door-to-doctor” time and dwell time.Methods: We used a prospective observational study design to determine the variables that played a significant role in determining ED flow. All adult patients seen or waiting to be seen in the ED were observed at 8pm (Monday-Friday during a three-month period. Variables measured included daily ED volume, patient acuity, staffing, ED occupancy, daily admissions, ED boarder volume, hospital volume, and intensive care unit volume. Both log-rank tests and time-to-wait (survival proportional-hazard regression models were fitted to determine which variables were most significant in predicting “door-to-doctor” and dwell times, with full account of the censoring for some patients.Results: We captured 1,543 patients during our study period, representing 27% of total daily volume. The ED operated at an average of 85% capacity (61-102% with an average of 27% boarding. Median “door-to-doctor” time was 1.8 hours, with the biggest influence being triage category, day of the week, and ED occupancy. Median dwell time was 5.5 hours with similar variable influences.Conclusion: The largest contributors to decreased patient flow through the ED at our institution were triage category, ED occupancy, and day of the week. Although the statistically significant factors influencing patient throughput at our institution involve problems with inflow, an increase in ED occupancy could be due to substantial outflow obstruction and may indicate the necessity for increased capacity both within the ED and hospital. [West J Emerg Med. 2010; 11(1:10-15
Hsieh, Hsiu-Fen; Chen, Yao-Mei; Wang, Hsiu-Hung; Chang, Shu-Chen; Ma, Shu-Ching
2016-09-01
This correlation study examined the relationship among recently workplace violence, depressive tendency, social support, and resilience of victimised nurses, and we also tried to identify protective factors and potential targets for preventive interventions for these nurses. Workplace violence in hospitals negatively affects occupational health and safety of medical professionals, especially for emergency department nurses. A cross-sectional, correlation research design was applied. Hierarchical regression was used to examine data which were collected from June 2013 to December 2013 from emergency departments in Taiwan. One hundred and eighty nurses were recruited from two hospitals. Structured interviews and questionnaires were applied to collect data, including the Social Support Scale, the Resilience Scale and the Center for Epidemiologic Studies Depression. A total of 159 (88·33%) nurses had suffered from physical or verbal violence by patients or their family. Resilience and peer support were significantly higher in the group without depressive tendency. Components of resilience of personal strength, social competence, structure style and religious beliefs were significant factors which accounted for 46·0% of variance in depressive tendency. Three of the five components of resilience: personal strength, social competence and structured style were found to have profounder effects against depressive tendency than peer support. Hospital managers should establish a safer working environment for emergency department nurses and reinforce their resilience against depression when they encounter workplace violence. This study showed that three of the five components of resilience: personal strength, social competence and structured style are protective factors against depressive tendency in victimised nurses. Improving these three components with coping and problem-solving skills by healthcare manager would be effective measures for enhancing their resilience in
Identifying Local Hotspots of Pediatric Chronic Diseases Using Emergency Department Surveillance
Lee, David C.; Yi, Stella S.; Fong, Hiu-Fai; Athens, Jessica K.; Ravenell, Joseph E.; Sevick, Mary Ann; Wall, Stephen P.; Elbel, Brian
2016-01-01
Objective To use novel geographic methods and large-scale claims data to identify the local distribution of pediatric chronic diseases in New York City. Methods Using a 2009 all-payer emergency claims database, we identified the proportion of unique children aged 0 to 17 with diagnosis codes for specific medical and psychiatric conditions. As a proof of concept, we compared these prevalence estimates to traditional health surveys and registry data using the most geographically granular data available. In addition, we used home addresses to map local variation in pediatric disease burden. Results We identified 549,547 New York City children who visited an emergency department at least once in 2009. Though our sample included more publicly insured and uninsured children, we found moderate to strong correlations of prevalence estimates when compared to health surveys and registry data at pre-specified geographic levels. Strongest correlations were found for asthma and mental health conditions by county among younger children (0.88, p=0.05 and 0.99, pdisease prevalence with higher geographic resolution. More studies are needed to investigate limitations of these methods and assess reliability of local disease estimates. What’s New This study demonstrated how emergency department surveillance may improve estimates of pediatric disease prevalence with higher geographic resolution. We identified 29% of New York City children with a single year of data and identified local hotspots of pediatric chronic diseases. PMID:28385326
Reynolds, Joshua C; Abraham, Michael K; Barrueto, Fermin F; Lemkin, Daniel L; Hirshon, Jon M
2013-09-01
Procedural sedation and analgesia is a core competency in emergency medicine. Propofol is replacing midazolam in many emergency departments. Barriers to performing procedural sedation include resource utilization. We hypothesized that emergency nursing time is shorter with propofol than midazolam, without increasing complications. Retrospective analysis of a procedural sedation registry for two community emergency departments with combined census of 100,000 patients/year. Demographics, procedure, and ASA physical classification status of adult patients receiving procedural sedation between 2007-2010 with midazolam or propofol were analyzed. Primary outcome was dedicated emergency nursing time. Secondary outcomes were procedural success, ED length of stay, and complication rate. Comparative statistics were performed with Mann-Whitney, Kruskal-Wallis, chi-square, or Fisher's exact test. Linear regression was performed with log-transformed procedural sedation time to define predictors. Of 328 procedural sedation and analgesia, 316 met inclusion criteria, of which 60 received midazolam and 256 propofol. Sex distribution varied between groups (midazolam 3% male; propofol 55% male; P = 0.04). Age, procedure, and ASA status were not significantly different. Propofol had shorter procedural sedation time (propofol 32.5 ± 24.2 minutes; midazolam 78.7 ± 51.5 minutes; P differences between complication rates (propofol 14%; midazolam 13%; P = 0.88) or emergency department length of stay (propofol 262.5 ± 132.8 minutes; midazolam 288.6 ± 130.6 minutes; P = 0.09). Use of propofol resulted in shorter emergency nursing time and higher procedural success rate than midazolam with a comparable safety profile. Copyright © 2013 Emergency Nurses Association. Published by Mosby, Inc. All rights reserved.
Hompoth, Emőke Adrienn; Töreki, Annamária; Pető, Zoltán
2018-01-01
Burnout has been described as a growing problem amongst healthcare workers. Emergency department staffs experience the burden of stress day by day, yet only a few studies have examined their burnout. In this study we wanted to investigate the burnout and its relations to other variables amongst the employees of the Department of Emergency Medicine in Szeged. Cross-sectional design utilizing a self-administered questionnaire was used to collect data from the staff of the Department. Burnout was measured using the Maslach Burnout Inventory. Burnout is considerably prevalent among the workers of the Emergency Department, especially nurses and physicians. The study found negative relation between burnout and age, number of children, number of years in the healthcare system, number of physical symptoms, social support and psychological immune system. Being single was a risk factor. The risks and protective factors found to be associated with burnout in this study might help to set up institutional prevention and intervention strategies. Orv Hetil. 2018; 159(3): 113-118.
Bo, Marco; Casagranda, Ivo; Charrier, Lorena; Gianino, Maria Michela
2012-10-01
To compare the knowledge and the willingness of emergency physicians and gynaecologists caring for women in Italian emergency departments (EDs) to prescribe levonorgestrel-only emergency contraceptive pills (LNG-EC pills). A cross-sectional survey was conducted in 2009; anonymous postal questionnaires were mailed to the medical staff working at the 30 EDs located in Piedmont (Italy). Emergency physicians and gynaecologists have similar knowledge of the pharmacokinetics and pharmacodynamics of LNG-EC pills, but do not feel at ease in prescribing these and consider the prescription of LNG-EC pills an inappropriate activity for ED staff. In Italy, unlike in most other European countries, LNG-EC pills are still prescription drugs. Thus it may be useful to further investigate the reasons why Italian ED medical staff do not feel the prescription of LNG-EC pills should be within their remit and whether women can successfully obtain the prescription from physicians working in other services that can be accessed around the clock.
Building an automated SOAP classifier for emergency department reports.
Mowery, Danielle; Wiebe, Janyce; Visweswaran, Shyam; Harkema, Henk; Chapman, Wendy W
2012-02-01
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. Copyright © 2011. Published by Elsevier Inc.
Kaizen: a method of process improvement in the emergency department.
Jacobson, Gregory H; McCoin, Nicole Streiff; Lescallette, Richard; Russ, Stephan; Slovis, Corey M
2009-12-01
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
Henson, Lesley; Gao, Wei; Higginson, Irene; Smith, Melinda; Davies, Joanna; Ellis-Smith, Clare; Daveson, Barbara
2015-02-26
Emergency department visits towards the end of life by people with cancer are increasing over time. This increase has occurred despite evidence of an association with poor patient outcomes, the majority of patients preferring home-based care, and significant overcrowding and capacity concerns for many emergency departments. We aimed to explore factors associated with emergency department attendance by cancer patients in the last month of life. We searched Medline, Embase, CINAHL, PsychINFO, and the Cochrane Library from inception to February, 2014, for studies investigating emergency department attendances by adult cancer patients (≥18 years) towards the end of life. No time or language limitations were applied. We performed meta-analysis of factors using a random-effects model, with results expressed as odds ratios (OR) for emergency department attendance. Sensitivity analysis explored heterogeneity. 30 studies were identified, reporting three demographic, five clinical, and 13 environmental factors; they included data from five countries and 1 181 842 patients. An increased likelihood of emergency department attendance was found for men versus women (OR 1·24, 95% CI 1·19-1·29), black versus white race (1·45, 1·40-1·50), patients with lung cancer versus other cancers (1·17, 1·10-1·23), and those of lowest versus highest socioeconomic status (1·15, 1·10-1·19). Patients receiving palliative care were less likely than those not receiving palliative care to attend the emergency department in the last month of life (OR 0·43, 95% CI 0·36-0·51). We have identified demographic (men, black race), clinical (lung cancer), and environmental (low socioeconomic status, no palliative care) factors associated with an increased risk of emergency department attendance. These findings could be used to develop screening interventions and assist policy makers in directing limited resources. Future studies should also investigate previously neglected areas of
DEFF Research Database (Denmark)
Hallas, Peter; Ellingsen, Trond
2006-01-01
Evaluation of the circumstances related to errors in diagnosis of fractures at an Emergency Department may suggest ways to reduce the incidence of such errors.......Evaluation of the circumstances related to errors in diagnosis of fractures at an Emergency Department may suggest ways to reduce the incidence of such errors....
Haghighinejad, Hourvash Akbari; Kharazmi, Erfan; Hatam, Nahid; Yousefi, Sedigheh; Hesami, Seyed Ali; Danaei, Mina; Askarian, Mehrdad
2016-01-01
Hospital emergencies have an essential role in health care systems. In the last decade, developed countries have paid great attention to overcrowding crisis in emergency departments. Simulation analysis of complex models for which conditions will change over time is much more effective than analytical solutions and emergency department (ED) is one of the most complex models for analysis. This study aimed to determine the number of patients who are waiting and waiting time in emergency department services in an Iranian hospital ED and to propose scenarios to reduce its queue and waiting time. This is a cross-sectional study in which simulation software (Arena, version 14) was used. The input information was extracted from the hospital database as well as through sampling. The objective was to evaluate the response variables of waiting time, number waiting and utilization of each server and test the three scenarios to improve them. Running the models for 30 days revealed that a total of 4088 patients left the ED after being served and 1238 patients waited in the queue for admission in the ED bed area at end of the run (actually these patients received services out of their defined capacity). The first scenario result in the number of beds had to be increased from 81 to179 in order that the number waiting of the "bed area" server become almost zero. The second scenario which attempted to limit hospitalization time in the ED bed area to the third quartile of the serving time distribution could decrease the number waiting to 586 patients. Doubling the bed capacity in the emergency department and consequently other resources and capacity appropriately can solve the problem. This includes bed capacity requirement for both critically ill and less critically ill patients. Classification of ED internal sections based on severity of illness instead of medical specialty is another solution.
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Marlène Karam
2017-10-01
Full Text Available This study aimed to assess interprofessional collaboration between general physicians and emergency departments in the French speaking regions of Belgium. Eight group interviews were conducted both in rural and urban areas, including in Brussels. Findings showed that the relational components of collaboration, which are highly valued by individuals involved, comprise mutual acquaintanceship and trust, shared power and objectives. The organizational components of collaboration included out-of-hours services, role clarification, leadership and overall environment. Communication and patient’s role were also found to be key elements in enhancing or hindering collaboration across these two levels of care. Relationships between general physicians and emergency departments’ teams were tightly linked to organizational factors and the general macro-environment. Health system regulation did not appear to play a significant role in promoting collaboration between actors. A better role clarification is needed in order to foster multidisciplinary team coordination for a more efficient patient management. Finally, economic power and private practice impeded interprofessional collaboration between the care teams. In conclusion, many challenges need to be addressed for achievement of a better collaboration and more efficient integration. Not only should integration policies aim at reinforcing the role of general physicians as gatekeepers, also they should target patients’ awareness and empowerment.
DEFF Research Database (Denmark)
Hertzum, Morten; Simonsen, Jesper
2016-01-01
Whiteboards are a central tool at emergency departments. We investigate how the substitution of electronic for dry-erase whiteboards affects emergency department clinicians’ mental workload and distribution of their time. With the electronic whiteboard, physicians and nurses spend more...... of their time in the work areas where other clinicians are present and whiteboard information is permanently displayed, and less in the patient rooms. Main reasons for these changes appear to be that the electronic whiteboard facilitates better timeouts and handovers. Physicians and nurses are, however......, in the patient rooms for longer periods at a time, suggesting a more focused patient contact. The physicians’ mental workload has increased during timeouts, whereas the nurses’ mental workload has decreased at the start of shifts when they form an overview of the emergency department. Finally, the secretaries...
Potential Child Abuse Screening in Emergency Department; a Diagnostic Accuracy Study
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Hossein Dinpanah
2017-01-01
Full Text Available Introduction: Designing a tool that can differentiate those at risk of child abuse with great diagnostic accuracyis of great interest. The present study was designed to evaluate the diagnostic accuracy of Escape instrumentin triage of at risk cases of child abuse presenting to emergency department (ED. Methods: The present diagnosticaccuracy study performed on 6120 of the children under 16 years old presented to ED during 3 years,using convenience sampling. Confirmation by the child abuse team (pediatrician, a socialworker, and a forensicphysician was considered as the gold standard. Screening performance characteristics of Escape were calculatedusing STATA 21. Results: 6120 children with the mean age of 2.19 § 1.12 years were screened (52.7% girls.137 children were suspected victims of child abuse. Based on child abuse team opinion, 35 (0.5% children wereconfirmed victims of child abuse. Sensitivity, specificity, positive and negative likelihood ratio and positive andnegative predictive values of this test with 95% CI were 100 (87.6 – 100, 98.3 (97.9 – 98.6, 25.5 (18.6 – 33.8, 100(99.9 – 100, 0.34 (0.25 – 0.46, and 0 (0 – NAN, respectively. Area under the ROC curve was 99.2 (98.9 – 99.4.Conclusion: It seems that Escape is a suitable screening instrument for detection of at risk cases of child abusepresenting to ED. Based on the results of the present study, the accuracy of this screening tool is 99.2%, which isin the excellent range.
Khan, Irum; Khan, Nadeem; Naeem, Rubaba; Kerai, Salima; Allen, Kate; Zia, Nukhba; Shahbaz, Sana; Afridi, Shiraz; Siddiqui, Emaduddin; Khan, Uzma; Hyder, Adnan A; Razzak, Junaid A
2015-01-01
Bomb blast injuries result in premature deaths and burdening of healthcare systems. The objective of this study was to explore the characteristics and outcome of patients presenting to the emergency departments in Pakistan with bomb blast injuries. Active surveillance was conducted in seven major emergency departments of Pakistan from November 2010-March 2011. All the sites are tertiary care urban centers. All the patients who presented to the hospital's emergency department (ED) following a bomb blast injury as per self-report or the ambulance personnel were included in the study. Frequency of demographics, injury pattern, and outcomes were calculated. A total of 103 patients with bomb blast injuries presented to the selected emergency departments. The median age of patients was 30 years. Around three-fourth of the patients were males (n = 74, 74.7%). Most of the bomb blast patients were seen in Peshawar (n = 41, 39.8%) and Karachi city (n = 31, 30.1%) and the most common mode of arrival was non-ambulance transport (n = 71, 76.3%). Upper limb injuries (n = 12, 40%) were common in the under 18 age group and lower limb injuries (n = 31, 39.2%) in the 18 years and above group. There were a total of 8 (7.7%) deaths reported out of these 103 patients. Bomb blast injuries in Pakistan generally affect young males. Non-ambulance transport is the most common way to access emergency departments (ED). Overall ED mortality is high and capturing data during a disaster in an emergency department is challenging.
2013-07-22
... titled, ``Department of Homeland Security/Federal Emergency Management Agency--006 Citizen Corps Database... DEPARTMENT OF HOMELAND SECURITY Office of the Secretary [Docket No. DHS-2013-0049] Privacy Act of 1974; Department of Homeland Security, Federal Emergency Management Agency--006 Citizen Corps Program...
MRI usage in a pediatric emergency department: an analysis of usage and usage trends over 5 years
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Scheinfeld, Meir H. [Montefiore Medical Center, Albert Einstein College of Medicine, Department of Radiology, Division of Emergency Radiology, Bronx, NY (United States); Moon, Jee-Young; Wang, Dan [Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, NY (United States); Fagan, Michele J. [Montefiore Medical Center, Albert Einstein College of Medicine, Department of Pediatrics, Division of Emergency Medicine, Bronx, NY (United States); Davoudzadeh, Reubin [Montefiore Medical Center, Department of Radiology, Bronx, NY (United States); Taragin, Benjamin H. [Montefiore Medical Center, Albert Einstein College of Medicine, Department of Radiology, Division of Pediatric Radiology, Bronx, NY (United States)
2017-03-15
Magnetic resonance imaging (MRI) usage has anecdotally increased due to the principles of ALARA and the desire to Image Gently. Aside from a single abstract in the emergency medicine literature, pediatric emergency department MRI usage has not been described. Our objective was to determine whether MRI use is indeed increasing at a high-volume urban pediatric emergency department with 24/7 MRI availability. Also, we sought to determine which exams, time periods and demographics influenced the trend. Institutional Review Board exemption was obtained. Emergency department patient visit and exam data were obtained from the hospital database for the 2011-2015 time period. MRI usage data were normalized using emergency department patient visit data to determine usage rates. The z-test was used to compare MRI use by gender. The chi-square test was used to test for trends in MRI usage during the study period and in patient age. MRI usage for each hour and each weekday were tabulated to determine peak and trough usage times. MRI usage rate per emergency department patient visit was 0.36%. Headache, pain and rule-out appendicitis were the most common indications for neuroradiology, musculoskeletal and trunk exams, respectively. Usage in female patients was significantly greater than in males (0.42% vs. 0.29%, respectively, P<0.001). Usage significantly increased during the 5-year period (P<0.001). Use significantly increased from age 3 to 17 (0.011% to 1.1%, respectively, P<0.001). Sixty percent of exams were performed after-hours, the highest volume during the 10 p.m. hour and lowest between 4 a.m. and 9 a.m. MRI use was highest on Thursdays and lowest on Sundays (MRI on 0.45% and 0.22% of patients, respectively). MRI use in children increased during the study period, most notably in females, on weekdays and after-hours. (orig.)
Venkat, Arvind; Wolf, Lisa; Geiderman, Joel M; Asher, Shellie L; Marco, Catherine A; McGreevy, Jolion; Derse, Arthur R; Otten, Edward J; Jesus, John E; Kreitzer, Natalie P; Escalante, Monica; Levine, Adam C
2015-03-01
The 2014 outbreak of Ebola Virus Disease (EVD) in West Africa has presented a significant public health crisis to the international health community and challenged US emergency departments to prepare for patients with a disease of exceeding rarity in developed nations. With the presentation of patients with Ebola to US acute care facilities, ethical questions have been raised in both the press and medical literature as to how US emergency departments, emergency physicians, emergency nurses and other stakeholders in the healthcare 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 US emergency physicians, emergency nurses and other stakeholders in the healthcare 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 US emergency departments in how they approach preparation for and management of potential patients with EVD. Copyright © 2015 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.
Increasing incidence of hypotension in the emergency department
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Holler, Jon G; Henriksen, Daniel P; Mikkelsen, Søren
2016-01-01
BACKGROUND: The epidemiology of hypotension as presenting symptom among patients in the Emergency Department (ED) is not clarified. The aim of this study was to describe the incidence, etiology, and overall mortality of hypotensive patients in the ED. METHODS: Population-based cohort study......,000 person years at risk (pyar) and etiological characteristics by means of the International Classification of Diseases, Tenth Revision (ICD-10), as well as 7-day, 30-day, and 90-day all-cause mortality. RESULTS: We identified 3,268 of 438,198 (1 %) cases with a mean overall IR of 125/100,000 pyar (95 % CI......: 121-130). The IR increased 28 % during the period (from 113 to 152 cases per 100,000 pyar). Patients ≥65 years had the highest IR compared to age
Dysuria: An Uncommon Presentation in Emergency Department Following Bladder Neck Disruption
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Ali Pourmand
2017-02-01
Full Text Available Prostate cancer is the most common life-threatening cancer diagnosed in men. Complications of prostatectomies vary and often include urinary incontinence, erectile dysfunction and pain, while other complications go unreported. While emergency physicians are already familiar with the more common post-operative complications presenting to their departments, including urinary retention, ileus, surgical site infections, venous thromboembolisms and urinary tract infections, they must have a high index of suspicion for rarer complications. We report a case of posterior bladder neck disruption as a complication of a robotic assisted laparoscopic prostatectomy that presented to the emergency department as dysuria and abdominal pain following urination.
Nugus, Peter; McCarthy, Sally; Holdgate, Anna; Braithwaite, Jeffrey; Schoenmakers, Anne; Wagner, Cordula
2017-02-01
Communication is commonly understood by health professional researchers to consist of relatively isolated exchanges of information. The social and organizational context is given limited credit. This article examines the significance of the environmental complexity of the emergency department (ED) in influencing communication strategies and makes the case for adopting a richer understanding of organizational communication. This study draws on approximately 12 months (1,600 hours) of ethnographic observations, yielding approximately 4,500 interactions across 260 clinicians and staff in the EDs of 2 metropolitan public teaching hospitals in Sydney, Australia. The study identifies 5 communication competencies of increasing complexity that emergency clinicians need to accomplish. Furthermore, it identifies several factors-hierarchy, formally imposed organizational boundaries and roles, power, and education-that contribute to the collective function of ensuring smooth patient transfer through and out of the ED. These factors are expressed by and shape external communication with clinicians from other hospital departments. This study shows that handoff of patients from the ED to other hospital departments is a complex communication process that involves more than a series of "checklistable" information exchanges. Clinicians must learn to use both negotiation and persuasion to achieve objectives. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
Arbon, Paul; Cusack, Lynette; Ranse, Jamie; Shaban, Ramon Z; Considine, Julie; Kako, Mayumi; Woodman, Richard J; Mitchell, Belinda; Bahnisch, Laura; Hammad, Karen
2013-08-01
Much of the literature about emergency nurses willingness to work during disasters has been from a non-Australian perspective. Despite the many recent disasters, little is known of Australian nurse's willingness to participate in disaster response. This paper presents findings from a study that explored nurses willingness to attend work during a disaster and the factors that influenced this decision. Data were collected consecutively using a combination of focus group and interview methods. Participants in this study, registered nurses from emergency departments, were recruited through convenience sampling from four hospitals in Australia. Participant narrative was electronically recorded, transcribed and thematically analysed. The participants for both the focus groups and interviews compromised a mix of ages, genders and years of experience as emergency nurses from across four jurisdictions within Australia. Three major themes that influenced willingness emerged with a number of subthemes. Theme one reflected the uncertainty of the situation such as the type of disaster. The second theme surrounded the preparedness of the workplace, emergency nurse and colleagues, and the third theme considered personal and professional choice based on home and work circumstances and responsibilities. The decision to attend work or not during a disaster, includes a number of complex personal, work-related and professional factors that can change, depending on the type of disaster, preparedness of the work environment and the emergency nurses' personal responsibilities at that time. Copyright © 2013 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.
Health smart cards: differing perceptions of emergency department patients and staff.
Mohd Rosli, Reizal; Taylor, David McD; Knott, Jonathan C; Das, Atandrila; Dent, Andrew W
2009-02-01
An analytical, cross-sectional survey of 270 emergency department patients and 92 staff undertaken in three tertiary referral hospital emergency departments was completed to compare the perceptions of patients and staff regarding the use of health smart cards containing patient medical records. The study recorded data on a range of health smart card issues including awareness, privacy, confidentiality, security, advantages and disadvantages, and willingness to use. A significantly higher proportion of staff had heard of the card. The perceived disadvantages reported by patients and staff were, overall, significantly different, with the staff reporting more disadvantages. A significantly higher proportion of patients believed that they should choose what information is on the card and who should have access to the information. Patients were more conservative regarding what information should be included, but staff were more conservative regarding who should have access to the information. Significantly fewer staff believed that patients could reliably handle the cards. Overall, however, the cards were considered acceptable and useful, and their introduction would be supported.
E-FAST: A propos of hemopericardium in the Emergency Department
Directory of Open Access Journals (Sweden)
Alejandro Cardozo
2016-05-01
Full Text Available The extended-focused assessment with sonography in trauma is still recognized as a technique approach to patients whose trauma involves the chest and the abdomen, with the aim of ruling out conditions as pneumothorax, hemothorax, pericardial effusion/cardiac tamponade, and intraperitoneal free fluid. Although CT is the gold standard test, the inconvenience of moving unstable patients and the amount of time it takes to carry it out, makes it not always possible in the Emergency Department, which positions the ultrasound as an ideal tool in the evaluation of patients with trauma in the Emergency Department. In this case report, we presented the case of a patient who complains of multiple stab wounds, and the extended-focused assessment with sonography in trauma confirmed the diagnostic impressions.
Nikpay, Sayeh; Freedman, Seth; Levy, Helen; Buchmueller, Tom
2017-08-01
We assess whether the expansion of Medicaid under the Patient Protection and Affordable Care Act (ACA) results in changes in emergency department (ED) visits or ED payer mix. We also test whether the size of the change in ED visits depends on the change in the size of the Medicaid population. Using all-capture, longitudinal, state data from the Agency for Healthcare Research and Quality's Fast Stats program, we implemented a difference-in-difference analysis, which compared changes in ED visits per capita and the share of ED visits by payer (Medicaid, uninsured, and private insurance) in 14 states that did and 11 states that did not expand Medicaid in 2014. Analyses controlled for state-level demographic and economic characteristics. We found that total ED use per 1,000 population increased by 2.5 visits more in Medicaid expansion states than in nonexpansion states after 2014 (95% confidence interval [CI] 1.1 to 3.9). Among the visit types that could be measured, increases in ED visits were largest for injury-related visits and for states with the largest changes in Medicaid enrollment. Compared with nonexpansion states, in expansion states the share of ED visits covered by Medicaid increased 8.8 percentage points (95% CI 5.0 to 12.6), whereas the uninsured share decreased by 5.3 percentage points (95% CI -1.7 to -8.9). The ACA's Medicaid expansion has resulted in changes in payer mix. Contrary to other studies of the ACA's effect on ED visits, our study found that the expansion also increased use of the ED, consistent with polls of emergency physicians. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
Abourbih, Daniel; Armstrong, Sherry; Nixon, Kirsty; Ackery, Alun D
2015-02-01
The emergency department (ED) is a challenging and stressful work environment where communication lapses can lead to negative health outcomes. This article offers strategies to Emergency Medicine residents, nurses and staff physicians on how to improve communication to optimize patient care. © 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.
Henning, Daniel J; Carey, Jeremy R; Oedorf, Kimie; Day, Danielle E; Redfield, Colby S; Huguenel, Colin J; Roberts, Jonathan C; Sanchez, Leon D; Wolfe, Richard E; Shapiro, Nathan I
2017-06-01
This study evaluates whether emergency department septic shock patients without a fever (reported or measured) receive less IV fluids, have decreased antibiotic administration, and suffer increased in-hospital mortality. This was a secondary analysis of a prospective, observational study of patients with shock. The study was conducted in an urban, academic emergency department. The original study enrolled consecutive adult (aged 18 yr or older) emergency department patients from November 11, 2012, to September 23, 2013, who met one of the following shock criteria: 1) systolic blood pressure less than 90 mm Hg after at least 1L IV fluids, 2) new vasopressor requirement, or 3) systolic blood pressure less than 90 mm Hg and IV fluids held for concern of fluid overload. The current study is limited to patients with septic shock. Patients were grouped as febrile if they had a subjective fever or a measured temperature >100.4°F documented in the emergency department; afebrile patients lacked both. Among 378 patients with septic shock, 207 of 378 (55%; 50-60%) were febrile by history or measurement. Afebrile patients had lower rates of antibiotic administration in the emergency department (81% vs 94%; p < 0.01), lower mean volumes of IV fluids (2,607 vs 3,013 mL; p < 0.01), and higher in-hospital mortality rates (33% vs 11%; p < 0.01). After adjusting for bicarbonate less than 20 mEq/L, lactate concentration, respiratory rate greater than or equal to 24 breaths/min, emergency department antibiotics, and emergency department IV fluids volume, being afebrile remained a significant predictor of in-hospital mortality (odds ratio, 4.3; 95% CI, 2.2-8.2; area under the curve = 0.83). In emergency department patients with septic shock, afebrile patients received lower rates of emergency department antibiotic administration, lower mean IV fluids volume, and suffered higher in-hospital mortality.
Nguh, Jonas
2013-01-01
Ever since the terrorist attacks of 9/11, the federal government has increased funding for emergency preparedness. However, the literature continues to document several areas of weaknesses in public health emergency management by local health departments (LHD). This lack of preparedness affects the entire public. The purpose of this study was to determine whether or not Maryland LHDs have effectively put in place the information technology (IT) that is relevant for emergency preparedness. Base Firm-wide IT Infrastructure Services and the Feeny/Willcocks Framework for Core IS Capabilities are the two conceptual frameworks used in this study. This qualitative study used the survey method and the data were analyzed through content analysis. The results revealed that utilization, practice, and performance of IT by Maryland LHDs are not efficient or effective. Recommendations included the development of "best practices," increased funding for IT infrastructure and the establishment of strategic management framework for IT initiatives. Implications for positive social change include the development of recommendations to enhance emergency preparedness practice, and advancement of knowledge so as to facilitate the functions, and duties of health departments in emergency preparedness operations.
Work-Practice Changes Associated with an Electronic Emergency-Department Whiteboard
DEFF Research Database (Denmark)
Hertzum, Morten; Simonsen, Jesper
2013-01-01
, 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...
Lyme Disease: Emergency Department Considerations.
Applegren, Nathan D; Kraus, Chadd K
2017-06-01
Lyme disease (LD) is the most common vector-borne illness in North America. Reported cases of LD have increased from approximately 10,000 cases annually in 1991 to >25,000 cases in 2014. Greater recognition, enhanced surveillance, and public education have contributed to the increased prevalence, as have geographic expansion and the number of infected ticks. Cases are reported primarily in the Northeastern United States, Wisconsin, and Minnesota, with children having the highest incidence of LD among all age groups. The increased incidence and prevalence of LD in the United States makes it increasingly more common for patients to present to the emergency department (ED) for tick bites and LD-related chief complaints, such as the characteristic erythema migrans skin manifestation. We sought to review the etiology of LD, describe its clinical presentations and sequela, and provide a practical classification and approach to ED management of patients with LD-related presentations. In this review, ED considerations for LD are presented and clinical presentations and management of the disease at different stages is discussed. Delayed sequelae that have significant morbidity, including Lyme carditis and Lyme neuroborreliosis, are discussed. Diagnostic tests and management are described in detail. The increasing prevalence and growing geographic reach of Lyme disease makes it critically important for emergency physicians to consider the diagnosis in patients presenting with symptoms suggestive of LD and to initiate appropriate treatment to minimize the potential of delayed sequelae. Special consideration should be made for the epidemiology of LD and a high clinical suspicion should be present for patients in endemic areas or with known exposures to ticks. Emergency physicians can play a critical role in the recognition, diagnosis, and treatment of LD. Copyright © 2017 Elsevier Inc. All rights reserved.
Caterino, Jeffrey M; Karaman, Rowan; Arora, Vinay; Martin, Jacqueline L; Hiestand, Brian C
2009-01-01
Abstract Background More than one-third of US adults 65 and over fall every year. These falls may cause serious injury including substantial long-term morbidity (due declines in activities of daily living) and death. The emergency department (ED) visit represents an opportunity for identifying high risk elders and potentially instituting falls-related interventions. The unique characteristic of the ED environment and patient population necessitate that risk-assessment modalities be validated ...
Ríos-Risquez, M Isabel; García-Izquierdo, Mariano
2016-07-01
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.
Emergency department characteristics and capabilities in Beijing, China.
Wen, Leana S; Xu, Jun; Steptoe, Anne P; Sullivan, Ashley F; Walline, Joseph H; Yu, Xuezhong; Camargo, Carlos A
2013-06-01
Emergency Departments (EDs) are a critical, yet heterogeneous, part of international emergency care. We sought to describe the characteristics, resources, capabilities, and capacity of EDs in Beijing, China. Beijing EDs accessible to the general public 24 h per day/7 days per week were surveyed using the National ED Inventories survey instrument (www.emnet-nedi.org). ED staff were asked about ED characteristics during the calendar year 2008. Thirty-six EDs participated (88% response rate). All were located in hospitals and were independent hospital departments. Participating EDs saw a median of 80,000 patients (interquartile range 40,000-118,508). The vast majority (91%; 95% confidence interval [CI] 78-98%) had a contiguous layout, with medical and surgical care provided in one area. Most EDs (55%) saw only adults; 39% saw both adults and children, and 6% saw only children. Availability of technological and consultant resource in EDs was high. The typical ED length of stay was between 1 and 6 h in 49% of EDs (95% CI 32-67%), whereas in the other half, patients reportedly remained for over 6 h; 36% (95% CI 21-54%) of respondents considered their ED over capacity. Beijing EDs have high volume, long length of stay, and frequent reports of EDs being over capacity. To meet its rapidly growing health needs in urban areas, China should consider improving urban ED capacity and training more Emergency Medicine specialists capable of efficiently staffing its crowded EDs. Copyright © 2013 Elsevier Inc. All rights reserved.
Alisic, Eva; Conroy, Rowena; Magyar, Joanne; Babl, Franz E; O'Donnell, Meaghan L
2014-09-01
Approximately one in five children who sustain a serious injury develops persistent stress symptoms. Emergency Department nurses and physicians have a pivotal role in psychosocial care for seriously injured children. However, little is known about staff's views on this role. Our aim was to investigate Emergency Department staff's views on psychosocial care for seriously injured children. We conducted semi-structured interviews with 20 nurses and physicians working in an Australian Paediatric Emergency Department. We used purposive sampling to obtain a variety of views. The interviews were transcribed verbatim and major themes were derived in line with the summative analysis method. We also mapped participants' strategies for child and family support on the eight principles of Psychological First Aid (PFA). Five overarching themes emerged: (1) staff find psychosocial issues important but focus on physical care; (2) staff are aware of individual differences but have contrasting views on vulnerability; (3) parents have a central role; (4) staff use a variety of psychosocial strategies to support children, based on instinct and experience but not training; and (5) staff have individually different wishes regarding staff- and self-care. Staff elaborated most on strategies related to the PFA elements 'contact and engagement', 'stabilization', 'connection with social supports' and least on 'informing about coping'. The strong notion of individual differences in views suggests a need for training in psychosocial care for injured children and their families. In addition, further research on paediatric traumatic stress and psychosocial care in the ED will help to overcome the current paucity of the literature. Finally, a system of peer support may accommodate wishes regarding staff care. Copyright © 2014 Elsevier Ltd. All rights reserved.
Emergency department surge: models and practical implications.
Nager, Alan L; Khanna, Kajal
2009-08-01
Emergency Department crowding has long been described. Despite the daily challenges of managing emergency department volume and acuity; a surge response during a disaster entails even greater challenges including collaboration, intervention, and resourcefulness to effectively carry out pediatric disaster management. Understanding surge and how to respond with appropriate planning will lead to success. To achieve this, we sought to analyze models of surge; review regional and national data outlining surge challenges and factors that impact surge; and to outline potential solutions. We conducted a systemic review and included articles and documents that best described the theoretical and practical basis of surge response. We organized the systematic review according to the following questions: What are the elements and models that are delineated by the concept of surge? What is the basis for surge response based on regional and national published sources? What are the broad global solutions? What are the major lessons observed that will impact effective surge capacity? Multiple models of surge are described including public health, facility-based and community-based; a 6-tiered response system; and intrinsic or extrinsic surge capacity. In addition, essential components (4 S's of surge response) are described along with regional and national data outlining surge challenges, impacting factors, global solutions, and lesions observed. There are numerous shortcomings regionally and nationally affecting our ability to provide an effective and coordinated surge response. Planning, education, and training will lead to an effective pediatric disaster management response.
Directory of Open Access Journals (Sweden)
Naseem Sulyman
Full Text Available OBJECTIVE: The objectives of the current study are to provide nationally representative estimates of hospital based emergency department visits (ED attributed to self inflicted injuries and attempted suicides among children in United States; and to identify potential methods of such intentional self inflicted injuries and attempted suicides. METHODS: The Nationwide Emergency Department Sample (year 2007 was used. All ED visits occurring among children (aged ≤18 years with an External Cause of Injury for any of self inflicted injuries were selected. Outcomes examined include hospital ED charges and hospitalization charges. All estimates were projected to national levels. RESULTS: 77,420 visits to hospital based emergency departments were attributed to self inflicted injuries among children (26,045 males and 51,370 females. The average age of the ED visits was 15.7 years. 134 patients died in ED's (106 males and 28 females and 93 died in hospitals following in-patient admission (75 males and 18 females. A greater proportion of male ED visits were discharged routinely as opposed to female ED visits (51.1% versus 44%. A greater proportion of male ED visits also died in the emergency departments compared to female visits (0.4% versus 0.05%. 17,965 ED visits necessitated admission into same hospital. The mean charge for each ED visit was $1,874. Self inflicted injuries by poisoning were the most frequently reported sources accounting for close to 70% of all ED visits. CONCLUSIONS: Females comprise a greater proportion of ED visits attributed to self inflicted injuries. 227 children died either in the ED's or in hospitals. The current study results highlight the burden associated with such injuries among children.
Fletcher, Erica N; McKenzie, Lara B; Comstock, R Dawn
2014-01-01
Basketball is a popular US high school sport with more than 1 million participants annually. To compare patterns of athletes with basketball-related injuries presenting to US emergency departments from 2005 through 2010 and the high school athletic training setting from the 2005-2011 seasons. Descriptive epidemiology study. Data from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission and the High School Reporting Information Online database. Complex sample weights were used to calculate national estimates of basketball-related injuries for comparison. Adolescents from 13 to 19 years of age treated in US emergency departments for basketball-related injuries and athletes from 13 to 19 years of age from schools participating in High School Reporting Information Online who were injured while playing basketball. Nationally, an estimated 1,514,957 (95% confidence interval = 1,337,441, 1,692,474) athletes with basketball-related injuries reported to the emergency department and 1,064,551 (95% confidence interval = 1,055,482, 1,073,620) presented to the athletic training setting. Overall, the most frequent injuries seen in the emergency department were lacerations and fractures (injury proportion ratios [IPRs] = 3.45 and 1.72, respectively), whereas those seen in the athletic training setting were more commonly concussions and strains/sprains (IPRs = 2.23 and 1.19, respectively; all P values training setting (IPR = 1.18; all P values basketball players presenting for treatment in the emergency department and the athletic training setting. Understanding differences specific to clinical settings is crucial to grasping the full epidemiologic and clinical picture of sport-related injuries. Certified athletic trainers play an important role in identifying, assessing, and treating athletes with sport-related injuries who might otherwise present to clinical settings with higher costs, such as the emergency department.
Huang, I-Anne; Tuan, Pao-Lan; Jaing, Tang-Her; Wu, Chang-Teng; Chao, Minston; Wang, Hui-Hsuan; Hsia, Shao-Hsuan; Hsiao, Hsiang-Ju; Chang, Yu-Ching
2016-10-01
Pediatric emergency medicine is a young field that has established itself in recent decades. Many unanswered questions remain regarding how to deliver better pediatric emergency care. The implementation of full-time pediatric emergency physicians is a quality improvement strategy for child care in Taiwan. The aim of this study is to evaluate the quality of care under different physician coverage models in the pediatric emergency department (ED). The medical records of 132,398 patients visiting the pediatric ED of a tertiary care university hospital during January 2004 to December 2006 were retrospectively reviewed. Full-time pediatric emergency physicians are the group specializing in the pediatric emergency medicine, and they only work in the pediatric ED. Part-time pediatricians specializing in other subspecialties also can work an extra shift in the pediatric ED, with the majority working in their inpatient and outpatient services. We compared quality performance indicators, including: mortality rate, the 72-hour return visit rate, length of stay, admission rate, and the rate of being kept for observation between full-time and part-time pediatric emergency physicians. An average of 3678 ± 125 [mean ± standard error (SE)] visits per month (with a range of 2487-6646) were observed. The trends in quality of care, observed monthly, indicated that the 72-hour return rate was 2-6% and length of stay in the ED decreased from 11.5 hours to 3.2 hours over the study period. The annual mortality rate within 48 hours of admission to the ED increased from 0.04% to 0.05% and then decreased to 0.02%, and the overall mortality rate dropped from 0.13% to 0.07%. Multivariate analyses indicated that there was no change in the 72-hour return visit rate for full-time pediatric emergency physicians; they were more likely to admit and keep patients for observation [odds ratio = 1.43 and odds ratio = 1.71, respectively], and these results were similar to those of senior
An integration of Emergency Department Information and Ambulance Systems.
Al-Harbi, Nada; El-Masri, Samir; Saddik, Basema
2012-01-01
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.
Emergency department interpretation of CT of the brain: a systematic review.
Evans, Lachlan R; Fitzgerald, Mark C; Mitra, Biswadev; Varma, Dinesh
2017-08-01
CT of the brain (CTB) is one of the most common radiological investigations performed in the emergency department (ED). Emergency clinicians rely upon this imaging modality to aid diagnosis and guide management. However, their capacity to accurately interpret CTB is unclear. This systematic review aims to determine this capacity and identify the potential need for interventions directed towards improving the ability of emergency clinicians in this important area. A systematic review of the literature was conducted without date restrictions. We searched MEDLINE, EMBASE and Cochrane databases and studies reporting the primary outcome of concordance of CTB interpretation between a non-radiologist and a radiology specialist were identified. Studies were assessed for heterogeneity and a subgroup analysis of pooled data based on medical specialty was carried out to specifically identify the concordance of ED clinicians. The quality of evidence was assessed using the GRADE criteria. There were 21 studies included in this review. Among the included studies, 12 reported on the concordance of emergency clinicians, 5 reported on radiology trainees and 4 on surgeons. Clinical and statistical heterogeneity between studies was high (I 2 =97.8%, perror rate ranging from 0.02 to 0.24. Heterogeneity and the presence of bias limit our confidence in these findings. However, the variance in the interpretation of CTB between emergency clinicians and radiologists suggests that interventions towards improving accuracy may be useful. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Emergency department visits by pediatric patients for poisoning by prescription opioids.
Tadros, Allison; Layman, Shelley M; Davis, Stephen M; Bozeman, Rachel; Davidov, Danielle M
2016-09-01
Prescription medication abuse is an increasingly recognized problem in the United States. As more opioids are being prescribed and abused by adults, there is an increased risk of both accidental and intentional exposure to children and adolescents. The impact of pediatric exposures to prescription pain pills has not been well studied. We sought to evaluate emergency department (ED) visits for poisoning by prescription opioids in pediatric patients. This retrospective study looked at clinical and demographic data from the Nationwide Emergency Department Sample (NEDS) from 2006 to 2012. There were 21,928 pediatric ED visits for prescription opioid poisonings and more than half were unintentional. There was a bimodal age distribution of patients, with slightly more than half occurring in females. The majority of patients were discharged from the ED. More visits in the younger age group (0-5 years) were unintentional, while the majority of visits in the adolescent age group (15-17 years) were intentional. Mean charge per discharge was $1,840 and $14,235 for admissions and surmounted to over $81 million in total charges. Poisonings by prescription opioids largely impact both young children and adolescents. These findings can be used to help target this population for future preventive efforts.
[Chest pain in the emergency department : Differential diagnosis and diagnostic strategy].
Köhnlein, T
2017-01-01
Chest pain as the leading symptom in emergency patients can have numerous causes and requires an immediate and targeted diagnostic and therapeutic strategy. Clinical scoring systems facilitate risk assessment for individual patients. In the emergency department, critical factors for success are defined professional qualification standards for physicians and nursing staff combined with a well-functioning organization of all technical procedures.
Esteve-Esteve, Miguel; Bautista-Rentero, Daniel; Zanón-Viguer, Vicente
2018-02-01
To estimate the risk of influenza transmission in patients coming to a hospital emergency department during the week of highest incidence and to analyze factors associated with transmission. Retrospective observational analysis of a cohort of patients treated in the emergency room during the 2014-2015 flu season. The following variables were collected from records: recorded influenza diagnosis, results of a rapid influenza confirmation test, point of exposure (emergency department, outpatient clinic, or the community), age, sex, flu vaccination or not, number of emergency visits, time spent in the waiting room, and total time in the hospital. We compiled descriptive statistics and performed bivariate and multivariate analyses by means of a Poisson regression to estimate relative risk (RR) and 95% CIs. The emergency department patients had a RR of contracting influenza 3.29 times that of the communityexposed population (95% CI, 1.53-7.08, P=.002); their risk was 2.05 times greater than that of outpatient clinic visitors (95% CI, 1.04-4.02, P=.036). Emergency patients under the age of 15 years had a 5.27 greater risk than older patients (95% CI, 1.59-17.51; P=.007). The RR of patients visiting more than once was 11.43 times greater (95% CI, 3.58-36.44; P<.001). The risk attributable to visiting the emergency department risk was 70.5%, whereas risk attributable to community exposure was 2%. The risk of contracting influenza is greater for emergency department patients than for the general population or for patients coming to the hospital for outpatient clinic visits. Patients under the age of 15 years incur greater risk.
Southern Hospitality: How We Changed the NPO Practice in the Emergency Department.
Denton, Traci D
2015-07-01
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
The Feasibility of Utilizing a Comic for Education in the Emergency Department Setting.
Hanson, Aaron; Drendel, Amy L; Ashwal, Gary; Thomas, Alex
2017-05-01
The objective of this study was to determine the feasibility of a comic education module in the Emergency Department setting. A convenience sample of 50 injured children and their caregivers were enrolled. The comic was found to be likeable, easy to read, and provided important information to both children and their caregivers. Total time to read the comic was three minutes (SD 1.4, range 1.4-7.1). Most children (60%) read the comic independently, including all children over age 14 years. At 72-hour phone follow-up, 86% of caregivers had accurate recall of all three comic teaching points. This innovative comic educational module is feasible for use for children ages 4-18 years in the Emergency Department. Though this comic was intended to educate children, caregivers recalled all three teaching points 72 hours after discharge.
Experience of being a low priority patient during waiting time at an emergency department
Directory of Open Access Journals (Sweden)
Adolfsson A
2012-01-01
Full Text Available Ingrid Dahlen1,2, Lars Westin1, Annsofie Adolfsson11School of Life Sciences, University of Skövde, Skövde, Sweden; 2Emergency Department, Skaraborg Hospital, Skövde, SwedenBackground: Work in the emergency department is characterized by fast and efficient medical efforts to save lives, but can also involve a long waiting time for patients. Patients are given a priority rating upon their arrival in the clinic based on the seriousness of their problem, and nursing care for lower priority patients is given a lower prioritization. Regardless of their medical prioritization, all patients have a right to expect good nursing care while they are waiting. The purpose of this study was to illustrate the experience of the low prioritized patient during their waiting time in the emergency department.Methods: A phenomenological hermeneutic research method was used to analyze an interview transcript. Data collection consisted of narrative interviews. The interviewees were 14 patients who had waited more than three hours for surgical, orthopedic, or other medical care.Results: The findings resulted in four different themes, ie, being dependent on care, being exposed, being vulnerable, and being secure. Lower priority patients are not paid as much attention by nursing staff. Patients reported feeling powerless, insulted, and humiliated when their care was delayed without their understanding what was happening to them. Not understanding results in exposure that violates self-esteem.Conclusion: The goal of the health care provider must be to minimize and prevent suffering, prevent feelings of vulnerability, and to create conditions for optimal patient well being.Keywords: emergency department, patients, waiting times, nursing staff
Acute heart failure in the emergency department: a follow-up study.
Fabbri, Andrea; Marchesini, Giulio; Carbone, Giorgio; Cosentini, Roberto; Ferrari, Annamaria; Chiesa, Mauro; Bertini, Alessio; Rea, Federico
2016-02-01
Acute heart failure (AHF) is a major public health issue due to high incidence and poor prognosis. Only a few studies are available on the long-term prognosis and on outcome predictors in the unselected population attending the emergency department (ED) for AHF. We carried out a 1-year follow-up analysis of 1234 consecutive patients from selected Italian EDs from January 2011 to June 2012 for an episode of AHF. Their prognosis and outcome-associated factors were tested by Cox proportional hazard model. Patients' mean age was 84, with 66.0% over 80 years and 56.2% females. Comorbidities were present in over 50% of cases, principally a history of acute coronary syndrome, chronic obstructive pulmonary disease, diabetes, chronic kidney disease, valvular heart disease. Death occurred within 6 h in 24 cases (1.9%). At 30-day follow-up, death was registered in 123 cases (10.0%): 110 cases (89.4%) died of cardiovascular events and 13 (10.6%) of non-cardiovascular causes (cancer, gastrointestinal hemorrhages, sepsis, trauma). At 1-year follow-up, all-cause death was recorded in 50.1% (over 3 out of 4 cases for cardiovascular origin). Six variables (older age, diabetes, systolic arterial pressure capacity (AUC = 0.649; SE 0.015). Recurrence of AHF was registered in 31.0%. The study identifies a cluster of variables associated with 1-year mortality in AHF, but their predictive capacity is low. Old age and the presence of comorbidities, in particular diabetes are likely to play a major role in dictating the prognosis.
Reinventing Emergency Department Flow via Healthcare Delivery Science.
DeFlitch, Christopher; Geeting, Glenn; Paz, Harold L
2015-01-01
Healthcare system flow resulting in emergency departments (EDs) crowding is a quality and access problem. This case study examines an overcrowded academic health center ED with increasing patient volumes and limited physical space for expansion. ED capacity and efficiency improved via engineering principles application, addressing patient and staffing flows, and reinventing the delivery model. Using operational data and staff input, patient and staff flow models were created, identifying bottlenecks (points of inefficiency). A new flow model of emergency care delivery, physician-directed queuing, was developed. Expanding upon physicians in triage, providers passively evaluate all patients upon arrival, actively manage patients requiring fewer resources, and direct patients requiring complex resources to further evaluation in ED areas. Sustained over time, ED efficiency improved as measured by near elimination of "left without being seen" patients and waiting times with improvement in door to doctor, patient satisfaction, and total length of stay. All improvements were in the setting on increased patient volume and no increase in physician staffing. Our experience suggests that practical application of healthcare delivery science can be used to improve ED efficiency. © The Author(s) 2015.
Estimating Uncompensated Care Charges at Rural Hospital Emergency Departments
Bennett, Kevin J.; Moore, Charity G.; Probst, Janice C.
2007-01-01
Context: Rural hospitals face multiple financial burdens. Due to federal law, emergency departments (ED) provide a gateway for uninsured and self-pay patients to gain access to treatment. It is unknown how much uncompensated care in rural hospitals is due to ED visits. Purpose: To develop a national estimate of uncompensated care from patients…
Simulation modelling of a patient surge in an emergency department under disaster conditions
Directory of Open Access Journals (Sweden)
Muhammet Gul
2015-10-01
Full Text Available The efficiency of emergency departments (EDs in handling patient surges during disaster times using the available resources is very important. Many EDs require additional resources to overcome the bottlenecks in emergency systems. The assumption is that EDs consider the option of temporary staff dispatching, among other options, in order to respond to an increased demand or even the hiring temporarily non-hospital medical staff. Discrete event simulation (DES, a well-known simulation method and based on the idea of process modeling, is used for establishing ED operations and management related models. In this study, a DES model is developed to investigate and analyze an ED under normal conditions and an ED in a disaster scenario which takes into consideration an increased influx of disaster victims-patients. This will allow early preparedness of emergency departments in terms of physical and human resources. The studied ED is located in an earthquake zone in Istanbul. The report on Istanbul’s disaster preparedness presented by the Japan International Cooperation Agency (JICA and Istanbul Metropolitan Municipality (IMM, asserts that the district where the ED is located is estimated to have the highest injury rate. Based on real case study information, the study aims to suggest a model on pre-planning of ED resources for disasters. The results indicate that in times of a possible disaster, when the percentage of red patient arrivals exceeds 20% of total patient arrivals, the number of red area nurses and the available space for red area patients will be insufficient for the department to operate effectively. A methodological improvement presented a different distribution function that was tested for service time of the treatment areas. The conclusion is that the Weibull distribution function used in service process of injection room fits the model better than the Gamma distribution function.
[Reflections on ethnography in the emergency department].
Aredes, Janaína de Souza; Firmo, Josélia Oliveira Araújo; Leibing, Annette; Giacomin, Karla Cristina
2017-09-28
: Ethnography is the principal research method in Anthropology. With a broad scope, it allows using different data collection techniques and incorporates elements observed and obtained in the field into the analysis. In Public Health, it can contribute to understanding the health/disease process and health professionals' and patients' values and attitudes in different healthcare settings. The aim of this article is to present and discuss the ethnographic method based on an empirical study of physicians' hospital work in the face of the limits between life and death. Data collection involved nine months of participant observation and interviews with 43 physicians (25 men and 18 women), 28 to 69 years of age, treating critical patients in different departments of a metropolitan emergency hospital. The various social and cultural aspects experienced by the researcher and obtained from the interlocutors in the field provide a dense description of this hospital ethnography.
Referral Criteria from Community Clinics to Pediatric Emergency Departments
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Jacob Urkin
2008-01-01
Full Text Available Referral of patients to a pediatric emergency department (PED should be medically justified and the need for referral well communicated. The objectives of this paper were (1 to create a list of criteria for referral from the community to the PED, (2 to describe how community physicians categorize their need for referral, and (3 to determine agreement between the physician's referral letter and the selected criteria. We present a descriptive study of referrals to the PED of Soroka University Medical Center, Beer-Sheva, Israel, during February to April 2003. A list of 22 criteria for referral was created, using the Delphi method for reaching consensus. One or more criteria could be selected from this list for each referral, by the referring community physicians and, independently, based on the physicians' referral letters, by two consultants, and compared. There were 140 referrals included in the study. A total of 262 criteria for referral were selected by the referring community physicians. The criteria most frequently selected were: “Need for same-day consultation/laboratory/imaging result not available in the community” (32.1%, “Suspected life- or organ-threatening infection” (16.4%, and “Need for hospitalization” (15.7%. Rates of agreement regarding criteria for referral between the referring physicians and the two consultants, and a senior community pediatrician and a senior PED pediatrician, were 57.9 and 48.6%, respectively. We conclude that the standard referral letter does not convey in full the level of need for referral to the PED. A list of criteria for referral could augment efficient utilization of emergency department services and improve communication between community physicians and the PED.
The use of high‐flow nasal cannula in the pediatric emergency department
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Katherine N. Slain
2017-11-01
Conclusions: High‐flow nasal cannula should be considered for pediatric emergency department patients with respiratory distress not requiring immediate endotracheal intubation; prospective, pediatric emergency department‐specific trials are needed to better determine responsive patient populations, ideal high‐flow nasal cannula settings, and comparative efficacy vs. other respiratory support modalities.
An observation tool for studying patient-oriented workflow in hospital emergency departments.
Ozkaynak, M; Brennan, P
2013-01-01
Studying workflow is a critical step in designing, implementing and evaluating informatics interventions in complex sociotechnical settings, such as hospital emergency departments (EDs). Known approaches to studying workflow in clinical settings attend to the activities of individual clinicians, thus being inadequate to characterize patient care as a cooperative work. The purpose of this paper is twofold. First, we introduce a novel, theory-driven patient-oriented workflow methodology, which better addresses the complex, multiple-provider nature of patient care. Second, we report the development of an observational tool and protocol for use in studies of this type, and the results of an evaluation study. We created a tablet computer implementation of an instrument to efficiently capture patient-oriented workflow, and evaluated it through a field study in three EDs. We focused on activities occurring over time during a single patient care episode as well as the roles of the ED staff members who conducted the activities. The evidence generated supports the validity, viability, and reliability of the tool. The coverage of the tool in terms of activities and roles was satisfactory. The tool was able to capture the sequence of activity-role pairs for 108 patient care episodes. The inter-rater reliability assessment yielded a high kappa value (0.79). The patient-oriented workflow methodology has the potential to facilitate modeling patient care in EDs by characterizing both roles and activities in sequence. The methodology also provides researchers and practitioners a more realistic and comprehensive workflow perspective that can inform the design, implementation and evaluation of health information technology interventions.
Claret, Pierre-Géraud; Bobbia, Xavier; Macri, Francesco; Stowell, Andrew; Motté, Antony; Landais, Paul; Beregi, Jean-Paul; de La Coussaye, Jean-Emmanuel
2016-06-01
The adoption of computerized physician order entry is an important cornerstone of using health information technology (HIT) in health care. The transition from paper to computer forms presents a change in physicians' practices. The main objective of this study was to investigate the impact of implementing a computer-based order entry (CPOE) system without clinical decision support on the number of radiographs ordered for patients admitted in the emergency department. This single-center pre-/post-intervention study was conducted in January, 2013 (before CPOE period) and January, 2014 (after CPOE period) at the emergency department at Nîmes University Hospital. All patients admitted in the emergency department who had undergone medical imaging were included in the study. Emergency department admissions have increased since the implementation of CPOE (5388 in the period before CPOE implementation vs. 5808 patients after CPOE implementation, p=.008). In the period before CPOE implementation, 2345 patients (44%) had undergone medical imaging; in the period after CPOE implementation, 2306 patients (40%) had undergone medical imaging (p=.008). In the period before CPOE, 2916 medical imaging procedures were ordered; in the period after CPOE, 2876 medical imaging procedures were ordered (p=.006). In the period before CPOE, 1885 radiographs were ordered; in the period after CPOE, 1776 radiographs were ordered (pmedical imaging did not vary between the two periods. Our results show a decrease in the number of radiograph requests after a CPOE system without clinical decision support was implemented in our emergency department. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Trends in CT Request and Related Outcomes in a Pediatric Emergency Department
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S.M. Saiful Islam
2016-09-01
Full Text Available Objectives: To study and to establish the overall trends of computed tomography (CT use and associated outcomes in the pediatric emergency department (PED at Royal Hospital, Oman, from 2010 to 2014. Methods: The hospital electronic medical record was retrospectively searched to find children (from birth to 12 years old who had visited the PED and the number of CT requests between 1 January 2010 and 31 December 2014. The types of CT examinations ordered were analyzed according to anatomical location and were as follows; head, abdomen/pelvis, chest, cervical spine/neck, and others. Results: There were a total of 67 244 PED visits during the study period, 569 of which received 642 CT scans. There was a remarkable rise in CT uses per 1000 visits from 7 in 2010 to 12 in 2014. There was a 56% hike in CT requests from 87 in 2010 to 175 in 2014 while the number of pediatric emergency visits rose by about 28% from 11 721 to 15 052. Although head CT scans were the most common, cervical spine CT scans had the highest rate of increase (600% followed by the chest (112%, head (54% and abdomen (13%. There were no significant changes in other CT scan requests. The cost of CT scans increased from $18 096 to $36 400 during the study period, which increased the average PED cost by about $2 per visit. The average time between a CT being requested and then performed was 1.24 hours. Conclusions: CT use in the pediatric emergency department has risen significantly at a rate that markedly exceeds the growth of emergency visits. This is associated with an increase in PED costs and longer waiting times.
Predictors of psychiatric boarding in the emergency department.
Misek, Ryan K; DeBarba, Ashley E; Brill, April
2015-01-01
The emergency psychiatric care is system is overburdened in the United States. Patients experiencing psychiatric emergencies often require resources not available at the initial treating facility and frequently require transfer to an appropriate psychiatric facility. Boarding of psychiatric patients, defined as a length of stay greater than four hours after medical clearance, is ubiquitous throughout emergency departments (EDs) nationwide. Boarding is recognized as a major cause of ambulance diversions and ED crowding and has a significant adverse impact on healthcare providers, patient satisfaction, and hospital costs. We sought to identify differences between patients who boarded versus patients who did not board, to identify factors amenable to change and identify interventions that could lead to a decrease in overall psychiatric patient length of stay and improve patient care. This study is a retrospective multicenter cohort study of all patients assessed to require inpatient psychiatric hospitalization at two community EDs in Illinois from July 1, 2010 through June 30, 2012. We identified 671 patients and collected insurance status, sex, age, time of arrival, time of disposition and time of transfer. There was a statistically significant difference in the insurance status between the cohort of patients boarding in the ED compared to non-boarders prior to inpatient psychiatric admission. Our study identified 95.4% of uninsured patients who were boarded in the ED, compared to 71.8% of Medicare/Medicaid patients and 78.3% of patients with private insurance (χ(2)=50.6, df=2, pboarded significantly longer than Medicare/Medicaid and privately insured patients. Patients with private insurance boarded longer than those with Medicare/Medicaid. Patients transferred to publicly funded facilities had significantly longer ED length of stay than patients transferred to private facilities.
Management of priapism with a trial of exercise in the emergency department.
Gravel, Jonathan; LeBlanc, Constance; Varner, Catherine
2018-03-16
Priapism is characterized by persistent penile erection in the absence of sexual arousal or desire that does not subside with orgasm. Although relatively uncommon, it is a genitourinary emergency that necessities prompt work-up and appropriate management, as there is a time-dependent relationship between total duration of erection and an increasing risk of permanent erectile dysfunction. Confirming the type of priapism is key to proper management, but the majority of cases presenting to the emergency department are ischemic in nature. Conservative management strategies for ischemic priapism are sparsely described in the literature but generally include ice pack application to the area, cold showers, masturbation and rarely, exercise. These strategies lack sound evidence, but the risks of attempting them are minimal as long as access to more definitive treatment is not delayed. Lower-limb exercise as a first-line treatment warrants further study in the undifferentiated emergency department priapism population. The case we present and discuss here illustrates the potential benefits of a trial of acute lower-limb exercise, specifically stair climbing, as a treatment for medication-induced priapism. If effective, this simple non-invasive management strategy may decrease the time to effective treatment, requires minimal resource utilization, and ultimately, avoids the need for more invasive treatment.
Medical admissions through the emergency department: Who, how and how long?
DEFF Research Database (Denmark)
Arvidsen, Pernille; Pressel, Eckart
Objectives: The study aims to describe the clinical characteristics of elderly patients admitted to medical wards through the emergency department (ED).Methods: In a first part, we described demographic changes in the uptake area and ED visits of older patients in a 900 bed university hospital...... in Central Copenhagen from 2004-2014.In a second descriptive-retrospective part we studied clinical characteristics of patients >65 years admitted to the medical wards through the ED in January 2014 (n=132). We collected data on medication, comorbidities and admission rates to stationary wards .Results......: The number of ED visits of persons >65 years increased by 28.3% during the study period whereas the number of persons aged ≥65 years in the uptake area remained stable. 21.1 % of the patients admitted to the medical wardswere transferred to the geriatric department. Conclusion: •The growing number of older...
Management of inflammatory bowel disease flares in the emergency department [digest].
Burg, Michael D; Riccoboni, Steven T; Nusbaum, Jeffrey; Gupta, Nachi
2017-11-22
Because of the chronic relapsing nature of inflammatory bowel disease (IBD), emergency clinicians frequently manage patients with acute flares and complications. IBD patients present with an often-broad range of nonspecific signs and symptoms, and it is essential to differentiate a mild flare from a life-threatening intra-abdominal process. Recognizing extraintestinal manifestations and the presence of infection are critical. This issue reviews the literature on management of IBD flares in the emergency department, including laboratory testing, imaging, and identification of surgical emergencies, emphasizing the importance of coordination of care with specialists on treatment plans and offering patients resources for ongoing support. [Points & Pearls is a digest of Emergency Medicine Practice.].
Mortality Patterns In The Accident And Emergency Department Of An ...
African Journals Online (AJOL)
Mortality Patterns In The Accident And Emergency Department Of An Urban Hospital In Nigeria. ... Nigerian Journal of Clinical Practice ... subset being 4.6:1 and 1.2:1 respectively Most of the cases were of non-traumatic origin (79.8%), with the ...
A pilot cross-sectional study of patients presenting with cellulitis to emergency departments.
LENUS (Irish Health Repository)
Quirke, M
2014-11-01
To characterise the Emergency Department (ED) prevalence of cellulitis, factors predicting oral antibiotic therapy and the utility of the Clinical Resource Efficiency Support Team (CREST) guideline in predicting patient management in the ED setting, a prospective, cross-sectional study of consecutive adult patients presenting to 3 Irish EDs was performed. The overall prevalence of cellulitis was 12 per 1,000 ED visits. Of 59 patients enrolled, 45.8% were discharged. Predictors of treatment with oral antibiotics were: CREST, Class 1 allocation (odds ratio (OR) 6.81, 95% Cl =1.5-30.1, p=0.012), patient self-referral (OR= 6.2, 95% Cl 1.9- 20.0, p=0.03) and symptom duration longer than 48 hours (OR 1.2, 95% Cl = 1.0-1.5,p=0.049). In conflict with guideline recommendation, 43% of patients in CREST Class 1 received IV therapy. Treatment with oral antibiotics was predicted by CREST Class 1 allocation, self-referral, symptom duration of more than 48 hours and absence of pre-EO antibiotic therapy.
DEFF Research Database (Denmark)
Torkilsheyggi, Arnvør Martinsdóttir á; Hertzum, Morten
2015-01-01
Studies have shown that whiteboards support much cooperative work by for example strengthening awareness, improving communication, and reducing mental workload. In line with these predominantly positive findings, an emer-gency department (ED) turned to its whiteboard to improve the coordination...... of its work with blood tests. We investigate this use of the whiteboard through observations and in-formal interviews in the ED and analyze the ability of the whiteboard to support coordination and awareness in the work with blood tests. Our findings show limitations in the ability of the whiteboard...... to support awareness in a setting where the users are (locally) mobile, specifically in regard to information that requires continuous monitoring. We do however also find that the whiteboard safeguarded the work with blood tests against some risks by making blood-test information socially visible...
Effectiveness of a worksheet for diagnosing postmortem computed tomography in emergency departments
International Nuclear Information System (INIS)
Takahashi, Naoya; Higuchi, Takeshi; Shiotani, Motoi; Satou, Suguru; Hirose, Yasuo
2011-01-01
The aim of this study was to evaluate the effectiveness of a worksheet for diagnosing postmortem computed tomography (PMCT) in emergency departments (EDs). A total of 49 cases of clinically diagnosed nontraumatic deaths in the ED who underwent total body PMCT were enrolled. PMCT images were prospectively evaluated by four radiologists: two radiologists with 1.5 and 3.5 years of residency and two board-certified radiologists with >20 years of experience. Readers were independently instructed to detect and interpret findings with reference to fatal findings, postmortem features, changes caused by cardiopulmonary resuscitation, and other pathological findings according to a worksheet that was composed of the possible findings previously reported. Agreement on detection and interpretation of findings between each reader was measured using Cohen's kappa coefficients. For the detection of findings, there was substantial agreement among the four readers (kappa>0.60, P 0.60, P<0.0001) and near-substantial (kappa=0.60, P<0.0001) agreement in the interpretation of the finding. Results of our study suggest equivalency on diagnosing PMCT regardless of the reader's level of experience. We conclude that the worksheet is useful for diagnosing PMCT in emergency departments. (author)
House, Darlene R; Cheptinga, Philip; Rusyniak, Daniel E
2015-01-01
Objective. Mobile phones have been successfully used for Emergency Department (ED) patient follow-up in developed countries. Mobile phones are widely available in developing countries and may offer a similar potential for follow-up and continued care of ED patients in low and middle-income countries. The goal of this study was to determine the percentage of families with mobile phones presenting to a pediatric ED in western Kenya and rate of response to a follow-up phone call after discharge. Methods. A prospective, cross-sectional observational study of children presenting to the emergency department of a government referral hospital in Eldoret, Kenya was performed. Documentation of mobile phone access, including phone number, was recorded. If families had access, consent was obtained and families were contacted 7 days after discharge for follow-up. Results. Of 788 families, 704 (89.3%) had mobile phone access. Of those families discharged from the ED, successful follow-up was made in 83.6% of cases. Conclusions. Mobile phones are an available technology for follow-up of patients discharged from a pediatric emergency department in resource-limited western Kenya.
Directory of Open Access Journals (Sweden)
Hourvash Akbari Haghighinejad
2016-01-01
Full Text Available Background: Hospital emergencies have an essential role in health care systems. In the last decade, developed countries have paid great attention to overcrowding crisis in emergency departments. Simulation analysis of complex models for which conditions will change over time is much more effective than analytical solutions and emergency department (ED is one of the most complex models for analysis. This study aimed to determine the number of patients who are waiting and waiting time in emergency department services in an Iranian hospital ED and to propose scenarios to reduce its queue and waiting time. Methods: This is a cross-sectional study in which simulation software (Arena, version 14 was used. The input information was extracted from the hospital database as well as through sampling. The objective was to evaluate the response variables of waiting time, number waiting and utilization of each server and test the three scenarios to improve them. Results: Running the models for 30 days revealed that a total of 4088 patients left the ED after being served and 1238 patients waited in the queue for admission in the ED bed area at end of the run (actually these patients received services out of their defined capacity. The first scenario result in the number of beds had to be increased from 81 to179 in order that the number waiting of the “bed area” server become almost zero. The second scenario which attempted to limit hospitalization time in the ED bed area to the third quartile of the serving time distribution could decrease the numberwaiting to 586 patients. Conclusion: Doubling the bed capacity in the emergency department and consequently other resources and capacity appropriately can solve the problem. This includes bed capacity requirement for both critically ill and less critically ill patients. Classification of ED internal sections based on severity of illness instead of medical specialty is another solution.
Emergency department admissions are more profitable than non-emergency department admissions.
Henneman, Philip L; Lemanski, Michael; Smithline, Howard A; Tomaszewski, Andrew; Mayforth, Janice A
2009-02-01
We compare the contribution margin per case per hospital day of emergency department (ED) admissions with non-ED admissions in a single hospital, a 600-bed, academic, tertiary referral, Level I trauma center with an annual ED census of 100,000. This was a retrospective comparison of the contribution margin per case per day for ED and non-ED inpatient admissions for fiscal years 2003, 2004, and 2005 (October 1 through September 30). Contribution margin is defined as net revenue minus total direct costs; it is then expressed per case per hospital day. Service lines are a set of linked patient care services. Observation admissions and outpatient services are not included. Resident expenses (eg, salary and benefits) and revenue (ie, Medicare payment of indirect medical expenses and direct medical expenses) are not included. Overhead expenses are not included (eg, building maintenance, utilities, information services support, administrative services). For fiscal year 2003 through fiscal year 2005, there were 51,213 ED and 57,004 non-ED inpatient admissions. Median contribution margin per day for ED admissions was higher than for non-ED admissions: ED admissions $769 (interquartile range $265 to $1,493) and non-ED admissions $595 (interquartile range $178 to $1,274). Median contribution margin per day varied by site of admissions, by diagnosis-related group, by service line, and by insurance type. In summary, ED admissions in our institution generate a higher contribution margin per day than non-ED admissions.
International Nuclear Information System (INIS)
Choi, Young Hun; Jae, Hwan Jun; Shin, Cheong Il; Song, Su Jin; Cha, Won Cheol; Na, Dong Gyu
2008-01-01
The purpose of this study was to assess the clinician satisfaction of a newly introduced around-the-clock radiology coverage system for the emergency department. Seventeen emergency physicians (8 board certified physicians, 9 residents) were invited to fill out a survey pertaining to the newly introduced radiology coverage system for the emergency department. The questionnaire included 10 questions covering three major topics. The first topic related to the around-the-clock radiology coverage by two full-time radiology residents. The second topic focused on the preliminary interpretations of radiology residents. The last topic included the interpretation assistance system by board-certified radiologists. The answers to each question were assessed using a scoring system of 1 to 5. The mean satisfaction score of the around-the-clock radiology coverage system by the two full-time radiology residents was 4.6 (range 3-5). The mean score for the preliminary interpretation system by the radiology residents was 4.8 (range 4-5). The score for the reliability of the preliminary versus the final interpretation was 4.1 (range 4-5). Lastly, the mean score for the interpretation assistance system by board-certified radiologists was 4.9 (range 4-5). The results of this study indicate a high satisfaction rating among clinicians' of the new around-the-clock radiology coverage system for the emergency department
Whittaker, William; Anselmi, Laura; Kristensen, Søren Rud; Lau, Yiu-Shing; Bailey, Simon; Bower, Peter; Checkland, Katherine; Elvey, Rebecca; Rothwell, Katy; Stokes, Jonathan; Hodgson, Damian
2016-09-01
department visits (95% CI -6.4% to 0.2%). Our results were robust to several sensitivity checks. A lack of detailed cost reporting of the running costs of extended access and an inability to capture health outcomes and other health service impacts constrain the study from assessing the full cost-effectiveness of extended access to primary care. The study found that extending access was associated with a reduction in emergency department visits in the first 12 months. The results of the research have already informed the decision by National Health Service England to extend primary care access across Greater Manchester from 2016. However, further evidence is needed to understand whether extending primary care access is cost-effective and sustainable.
Directory of Open Access Journals (Sweden)
William Whittaker
2016-09-01
total emergency department visits (95% CI -6.4% to 0.2%. Our results were robust to several sensitivity checks. A lack of detailed cost reporting of the running costs of extended access and an inability to capture health outcomes and other health service impacts constrain the study from assessing the full cost-effectiveness of extended access to primary care.The study found that extending access was associated with a reduction in emergency department visits in the first 12 months. The results of the research have already informed the decision by National Health Service England to extend primary care access across Greater Manchester from 2016. However, further evidence is needed to understand whether extending primary care access is cost-effective and sustainable.
The perceived impact of an emergency department immediate reporting service: An exploratory survey
International Nuclear Information System (INIS)
Snaith, Beverly; Hardy, Maryann
2013-01-01
Background: Immediate reporting, commonly referred to as a ‘hot reporting’, has been advocated as a method of effectively supporting clinical decision making. However, its implementation nationally has been limited with poor understanding of its value in practice. Method: A cross sectional attitudinal survey was distributed to emergency department clinicians (medical and nursing staff) and radiographers to explore perceptions of an immediate reporting service in terms of its influence on professional role and autonomy, patient care and service quality. Results: A total of 87 (n = 87/155; 56.1%) completed questionnaires were returned. The findings suggest that significant support for immediate reporting exists. Immediate reporting is believed to improve service quality, reduce clinical errors and provide opportunity for image interpretation skills development. However, responses were not consistent across clinical professions and staff grades. Conclusion: The immediate reporting of emergency department images is perceived to benefit patient, emergency department clinicians and hospital organisation
Gershon, Andrea; Thiruchelvam, Deva; Moineddin, Rahim; Zhao, Xiu Yan; Hwee, Jeremiah; To, Teresa
2017-06-01
Knowing trends in and forecasting hospitalization and emergency department visit rates for chronic obstructive pulmonary disease (COPD) can enable health care providers, hospitals, and health care decision makers to plan for the future. We conducted a time-series analysis using health care administrative data from the Province of Ontario, Canada, to determine previous trends in acute care hospitalization and emergency department visit rates for COPD and then to forecast future rates. Individuals aged 35 years and older with physician-diagnosed COPD were identified using four universal government health administrative databases and a validated case definition. Monthly COPD hospitalization and emergency department visit rates per 1,000 people with COPD were determined from 2003 to 2014 and then forecasted to 2024 using autoregressive integrated moving average models. Between 2003 and 2014, COPD prevalence increased from 8.9 to 11.1%. During that time, there were 274,951 hospitalizations and 290,482 emergency department visits for COPD. After accounting for seasonality, we found that monthly COPD hospitalization and emergency department visit rates per 1,000 individuals with COPD remained stable. COPD prevalence was forecasted to increase to 12.7% (95% confidence interval [CI], 11.4-14.1) by 2024, whereas monthly COPD hospitalization and emergency department visit rates per 1,000 people with COPD were forecasted to remain stable at 2.7 (95% CI, 1.6-4.4) and 3.7 (95% CI, 2.3-5.6), respectively. Forecasted age- and sex-stratified rates were also stable. COPD hospital and emergency department visit rates per 1,000 people with COPD have been stable for more than a decade and are projected to remain stable in the near future. Given increasing COPD prevalence, this means notably more COPD health service use in the future.
LENUS (Irish Health Repository)
Walsh, K
2012-02-03
BACKGROUND AND OBJECTIVE: Adverse effects associated with difficult airway management can be catastrophic and include death, brain injury and myocardial injury. Closed-malpractice claims have shown prolonged and persistent attempts at endotracheal intubation to be the most common situation leading to disastrous respiratory events. To date, there has been no evaluation of the types of difficult airway equipment currently available in Irish departments of emergency medicine. The objective of this survey was to identify the difficult airway equipment available in Irish departments of emergency medicine. METHODS: Departments of emergency medicine in the Republic of Ireland with at least one dedicated Emergency Medicine consultant were surveyed via telephone. RESULTS: All of the departments contacted held at least one alternative device on site for both ventilation and intubation. The most common alternative ventilation device was the laryngeal mask airway (89%). The most common alternative intubating device was the surgical airway device (100%). CONCLUSIONS: Irish departments of emergency medicine compare well with those in the UK and USA, when surveyed concerning difficult airway equipment. However, we believe that this situation could be further improved by training inexperienced healthcare providers in the use of the laryngeal mask airway and intubating laryngeal mask airway, by placing greater emphasis on the ready availability of capnography and by the increased use of portable difficult airway storage units.
Physician Assistants Contribution to Emergency Department Productivity
Directory of Open Access Journals (Sweden)
Christopher Brook, MD
2012-05-01
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.
Forensic patients in the emergency department: Who are they and how should we care for them?
Filmalter, Celia J; Heyns, T; Ferreira, R
2017-10-16
Patients who suffer violent, crime related injuries are likely to seek medical assistance in emergency departments. Forensic patients may not disclose the cause of their injuries leading to the impairment of evidence. We explored healthcare providers' perceptions of forensic patients and how they should be cared for. The perceptions of physicians and nurses regarding the profiles and care of forensic patients were explored in three urban emergency departments. The data were collected through a talking wall and analysed collaboratively, with the participants, using content analysis. Healthcare providers in emergency departments differentiated between living and deceased forensic patients. Healthcare providers identified living forensic patients as victims of sexual assault, assault, gunshots and stab wounds, and abused children. Deceased patients included patients that were dead on arrival or died in the emergency departments. Healthcare providers acknowledged that evidence should be collected, preserved and documented. Every trauma patient in the emergency department should be treated asa forensic patient until otherwise proven. If healthcare providers are unable to identify forensic patients and collect the evidence present, the patients' human right to justice will be violated. Copyright © 2017 Elsevier Ltd. All rights reserved.
Medical Identity Theft in the Emergency Department: Awareness is Crucial
Directory of Open Access Journals (Sweden)
Michelino Mancini
2014-11-01
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.
Ansari, Sereena; Boyle, Adrian
2017-02-01
Domestic abuse represents a serious public health and human rights concern. Interventions to reduce the risk of abuse include staff training and standardized documentation improving detection and adherence to referral pathways. Interventional studies have been conducted in primary care, maternity and outpatient settings. Women disclosing abuse in emergency departments differ from women attending other healthcare settings, and it is unclear whether these interventions can be transferred to the emergency care setting. This review examines interventional studies to evaluate the effectiveness of emergency department-based interventions in reducing domestic abuse-related morbidity. Medline, EMBASE, CINAHL, PsycINFO and Cochrane Library were searched, according to prespecified selection criteria. Study quality was assessed using the Jadad scale. Of 273 search results, nine were eligible for review. Interventions involving staff training demonstrated benefits in subjective measures, such as staff knowledge regarding abuse, but no changes in clinical practice, based on detection and referral rates. When staff training was implemented in conjunction with supporting system changes - for example, standardized documentation for assessment and referral - clinically relevant improvements were noted. Interventions centred around staff training are insufficient to bring about improvements in the management and, thus, outcome of patients suffering abuse. Instead, system changes, such as standardized documentation and referral pathways, supported by training, may bring about beneficial changes. It remains uncertain whether surrogate outcomes employed by most studies translate to changes in abuse-related morbidity: the ultimate goal.
High inter-observer agreement of observer-perceived pain assessment in the emergency department
DEFF Research Database (Denmark)
Hangaard, Martin Høhrmann; Malling, Brian; Mogensen, Christian Backer
2018-01-01
degree of inter-observer agreement. The aim of the present study was to assess the inter-observer agreement of perceived pain among emergency department nurses and to evaluate if it was influenced by predetermined factors like age and gender. Method: A project assistant randomly recruited two nurses, who...... of 0.05 and 95% limits of agreement of +/-1 category. Patient age, gender, localization of pain, examination room or presence of a significant other did not affect the inter-observer agreement. Conclusion: We found 70% agreement on pain category between the nurses and it is justified that nurse......Background: Triage is used to prioritize the patients in the emergency department. The majority of the triage systems include the patients' pain score to assess their level of acuity by using a combination of patient reported pain and observer-perceived pain; the latter therefore requires a certain...
A pilot study of implantable cardiac device interrogation by emergency department personnel.
Neuenschwander, James F; Hiestand, Brian C; Peacock, W Frank; Billings, John M; Sondrup, Cole; Hummel, John D; Abraham, William T
2014-03-01
Implanted devices (eg, pacemakers and defibrillators) provide valuable information and may be interrogated to obtain diagnostic information and to direct management. During admission to an emergency department (ED), significant time and cost are spent waiting for device manufacturer representatives or cardiologists to access the data. If ED personnel could safely interrogate implanted devices, more rapid disposition could occur, thus leading to potentially better outcomes at a reduced cost. This was a pilot study examining the feasibility of ED device interrogation. This was a prospective convenience sample study of patients presenting to the ED with any chief complaint and who had an implantable device capable of being interrogated by a Medtronic reader. After obtaining informed consent, study patients underwent device interrogation by ED research personnel. After reviewing the device data, the physician documented their opinions of the value of data in aiding care. Patients were followed up at intervals ranging from 30 days out to 1 year to determine adverse events relating to interrogation. Forty-four patients underwent device interrogation. Their mean age was 56 ± 14.7 years (range, 28-83), 75% (33/44) were male and 75% (33/44) were hospitalized from the ED. The interrogations took less than 10 minutes 89% of the time. In 60% of the cases, ED physicians reported the data-assisted patient care. No adverse events were reported relating to the ED interrogations. In this pilot study, we found that ED personnel can safely and quickly interrogate implantable devices to obtain potentially useful clinical data.
Patients with Borderline Personality Disorder in Emergency Departments
Shaikh, Untara; Qamar, Iqra; Jafry, Farhana; Hassan, Mudasar; Shagufta, Shanila; Odhejo, Yassar Islamail; Ahmed, Saeed
2017-01-01
Borderline personality disorder (BPD) patients, when in crisis, are frequent visitors of emergency departments (EDs). When these patients exhibit symptoms such as aggressiveness, impulsivity, intense anxiety, severe depression, self-harm, and suicidal attempts or gestures, diagnosis, and treatment of the BPD becomes challenging for ED doctors. This review will, therefore, outline advice to physicians and health-care providers who face this challenging patient population in the EDs. Crisis intervention should be the first objective of clinicians when dealing with BPD in the emergency. For the patients with agitation, symptom-specific pharmacotherapy is usually recommended, while for non-agitated patients, short but intensive psychotherapy especially dialectical behavior therapy (DBT) has a positive effect. Although various psychotherapies, either alone or integrated, are preferred modes of treatment for this group of patients, the effects of psychotherapies on BPD outcomes are small to medium. Proper risk management along with developing a positive attitude and empathy toward these patients will help them in normalizing in an emergency setting after which treatment course can be decided. PMID:28824467
Nickolas, Thomas L.; Schmidt-Ott, Kai M.; Canetta, Pietro; Forster, Catherine; Singer, Eugenia; Sise, Meghan; Elger, Antje; Maarouf, Omar; Sola-Del Valle, David Antonio; O'Rourke, Matthew; Sherman, Evan; Lee, Peter; Geara, Abdallah; Imus, Philip; Guddati, Achuta; Polland, Allison; Rahman, Wasiq; Elitok, Saban; Malik, Nasir; Giglio, James; El-Sayegh, Suzanne; Devarajan, Prasad; Hebbar, Sudarshan; Saggi, Subodh J.; Hahn, Barry; Kettritz, Ralph; Luft, Friedrich C.; Barasch, Jonathan
2012-01-01
Objectives This study aimed to determine the diagnostic and prognostic value of urinary biomarkers of intrinsic acute kidney injury (AKI) when patients were triaged in the emergency department. Background Intrinsic AKI is associated with nephron injury and results in poor clinical outcomes. Several urinary biomarkers have been proposed to detect and measure intrinsic AKI. Methods In a multicenter prospective cohort study, 5 urinary biomarkers (urinary neutrophil gelatinase–associated lipocalin, kidney injury molecule-1, urinary liver-type fatty acid binding protein, urinary interleukin-18, and cystatin C) were measured in 1,635 unselected emergency department patients at the time of hospital admission. We determined whether the biomarkers diagnosed intrinsic AKI and predicted adverse outcomes during hospitalization. Results All biomarkers were elevated in intrinsic AKI, but urinary neutrophil gelatinase-associated lipocalin was most useful (81% specificity, 68% sensitivity at a 104-ng/ml cutoff) and predictive of the severity and duration of AKI. Intrinsic AKI was strongly associated with adverse in-hospital outcomes. Urinary neutrophil gelatinase-associated lipocalin and urinary kidney injury molecule 1 predicted a composite outcome of dialysis initiation or death during hospitalization, and both improved the net risk classification compared with conventional assessments. These biomarkers also identified a substantial subpopulation with low serum creatinine at hospital admission, but who were at risk of adverse events. Conclusion Urinary biomarkers of nephron damage enable prospective diagnostic and prognostic stratification in the emergency department. PMID:22240130
Predicting Hospital Admission for Emergency Department Patients using a Bayesian Network
Leegon, Jeffrey; Jones, Ian; Lanaghan, Kevin; Aronsky, Dominik
2005-01-01
Hospital admission delays in the Emergency Department (ED) reduce volume capacity and contribute to the nation’s ED diversion problem. This study evaluated the accuracy of a Bayesian network for the early prediction of hospital admission status using data from 16,900 ED encounters. The final model included nine variables that are commonly available in many ED settings. The area under the receiver operating characteristic curve was 0.894 (95% CI: 0.887-0.902) for the validati...
Jennings, Natasha; O'Reilly, Gerard; Lee, Geraldine; Cameron, Peter; Free, Belinda; Bailey, Michael
2008-04-01
The aim of this study was to evaluate the impact of the introduction of Emergency Nurse Practitioner Candidates (ENPC) on waiting times and length of stay of patients presenting to a major urban Emergency Department (ED) in Melbourne, Australia. As part of a Victorian state funded initiative to improve patient outcomes, the role of the Emergency Nurse Practitioner has been developed. The integration and implementation of this role, is not only new to the Alfred Emergency and Trauma Centre but to EDs in Melbourne, Australia, with aims of providing holistic and comprehensive care for patients. A retrospective case series of all patients with common ED diagnostic subgroups were included. The ENPC group (n = 572) included all patients managed by the ENPC and the Traditional Model (TM) group (n = 2584) included all patients managed by the traditional medical ED model of care. Outcome measures included waiting times and length of stay. Statistically significant differences were evident between the two groups in waiting times and length of stay in the ED. The overall median waiting time for emergency patients to be seen by the ENPC was less than for the TM group [median (IQR): ENPC 12 (5.5-28) minutes; TM 31 (11.5-76) minutes (Wilcoxon p times for ENPC shifts vs. non-ENPC shifts revealed significant differences [median (IQR): ENPC rostered 24 (9-52) minutes; ENPC not rostered 33 (13-80.5) minutes (Wilcoxon p Melbourne, Australia were associated with significantly reduced waiting times and length of stay for emergency patients. Emergency Nurse Practitioners should be considered as a potential long term strategy to manage increased service demands on EDs. Relevance to clinical practice. This study is the first in Australia with a significant sample size to vigorously compare ENPC waiting times and length of stay outcomes with the TM model of care in the ED. The study suggests that ENPCs can have a favourable impact on patient outcomes with regard to waiting times and length
du Toit, Marie; Malau-Aduli, Bunmi; Vangaveti, Venkat; Sabesan, Sabe; Ray, Robin A
2017-01-01
Background Telehealth has been used extensively in emergency departments to improve healthcare provision. However, its impact on the management of non-critical emergency presentations within rural and remote emergency department settings has not been adequately explored. The objective of this systematic review is to identify how telehealth has been used to assist in the management of non-critical presentations in rural and remote emergency departments and the outcomes. Methods Articles were identified through database searches of CINAHL, Cochrane, MEDLINE (OVID), Informit and SCOPUS, as well as the screening of relevant article reference and citation lists. To determine how telehealth can assist in the management of non-critical emergencies, information was extracted relating to telehealth programme model, the scope of service and participating health professionals. The outcomes of telehealth programmes were determined by analysing the uptake and usage of telehealth, the impact on altering a diagnosis or management plan as well as patient disposition including patient transfer, discharge, local hospital admission and rates of discharge against medical advice. Results Of the 2532 identified records, 15 were found to match the eligibility criteria and were included in the review. Uptake and usage increased for telehealth programmes predominantly utilised by nursing staff with limited local medical support. Teleconsultation conservatively altered patient diagnosis or management in 18-66% of consultations. Although teleconsultation was associated with increased patient transfer rates, unnecessary transfers were reduced. Simultaneously, an increase in local hospital admission was noted and fewer patients were discharged home. Discharge against medical advice rates were low at 0.9-1.1%. Conclusion The most widely implemented hub-and-spoke telehealth model could be incorporated into existing referral frameworks. Telehealth programmes may assist in reducing unnecessary
Five easy equations for patient flow through an emergency department
DEFF Research Database (Denmark)
Madsen, Thomas Lill; Kofoed-Enevoldsen, Allan
2011-01-01
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...
LENUS (Irish Health Repository)
Cronin, J G
2012-02-03
Triage is an integral part of the modern emergency department. The use of a recognised triage system has many advantages for the emergency department including reference to a recognised decision-making structure and support in the form of a professionally accepted and validated system. As part of a programme of internal change the Manchester triage system (MTS) was introduced to an emergency department in the Republic of Ireland. This article outlines the introduction of this method of triage and cites the domestic and international drivers of the change.
Managing pediatric dental trauma in a hospital emergency department.
Mitchell, Jonathan; Sheller, Barbara; Velan, Elizabeth; Caglar, Derya; Scott, Joanna
2014-01-01
The purpose of this study was to: (1) examine types of dental trauma presenting to a hospital emergency department (ED); (2) describe the medical services provided to these patients; and (3) quantify time spent during ED encounters for dental trauma emergencies. Records of 265 patients who presented to the ED with dental trauma over a three-year period were reviewed. Demographics, injury types, triage acuity, pain scores, and dental/medical treatment and times were analyzed. Patient demographics and injury types were similar to previous studies. Eighty-two percent of patients received mid-level triage scores; 41 percent of patients had moderate to severe pain. The most frequently provided medical services were administration of analgesics and/or prescriptions (78 percent). The mean times were: 51 minutes waiting for a physician; 55 minutes with dentists; and 176 minutes total time. Higher triage acuity and pain levels resulted in significantly longer wait times for physician assessment. Dental evaluation, including treatment, averaged 32 percent of time spent at the hospital. A dental clinic is the most efficient venue for treating routine dental trauma. Patients in this study spent the majority of time waiting for physicians and receiving nondental services. Most patients required no medical intervention beyond prescriptions commonly used in dental practice.
Emergency Department Frequent Users for Acute Alcohol Intoxication.
Klein, Lauren R; Martel, Marc L; Driver, Brian E; Reing, Mackenzie; Cole, Jon B
2018-03-01
A subset of frequent users of emergency services are those who use the emergency department (ED) for acute alcohol intoxication. This population and their ED encounters have not been previously described. This was a retrospective, observational, cohort study of patients presenting to the ED for acute alcohol intoxication between 2012 and 2016. We collected all data from the electronic medical record. Frequent users for alcohol intoxication were defined as those with greater than 20 visits for acute intoxication without additional medical chief complaints in the previous 12 months. We used descriptive statistics to evaluate characteristics of frequent users for alcohol intoxication, as well as their ED encounters. We identified 32,121 patient encounters. Of those, 325 patients were defined as frequent users for alcohol intoxication, comprising 11,370 of the encounters during the study period. The median maximum number of encounters per person for alcohol intoxication in a one-year period was 47 encounters (range 20 to 169). Frequent users were older (47 years vs. 39 years), and more commonly male (86% vs. 71%). Frequent users for alcohol intoxication had higher rates of medical and psychiatric comorbidities including liver disease, chronic kidney disease, ischemic vascular disease, dementia, chronic obstructive pulmonary disease, history of traumatic brain injury, schizophrenia, and bipolar disorder. In this study, we identified a group of ED frequent users who use the ED for acute alcohol intoxication. This population had higher rates of medical and psychiatric comorbidities compared to non-frequent users.
Emergency department attendance patterns during Ramadan.
Butt, Taimur; Khan, Hameed Ullah; Ahmed, Israr; Eldali, Abdelmoneim
2016-01-01
Patient attendance in the emergency department (ED) is inherently variable and unpredictable. Resources might be better allocated if use of the ER could be predicted during the month of fasting (Ramadan), healthy adult Muslims do not eat or drink from dawn to sunset and in the Middle East, social activities occur mostly during night. There is no published data that has reported changes in local ED attendance pattern during Ramadan. Determine if there are differences in tertiary care ed attendance during Ramadan compared to other times of the year. Retrospective, using data from the hospital integrated clinical information system. Tertiary care institution in Riyadh, Saudi Arabia. All ED visits during the Islamic calendar years of 1431-1434 (December 18, 2009-October 13, 2013) were analyzed. Patient volume, acuity, demographics and admission rate variability between Ramadan and other months. During the study period of 4 years, of 226075 ED patients, 129178 (57.14%) patients were seen during the day shift (07:00 to 18:59). During Ramadan, 10 293 (60%) patients presented during the night shift compared with the day shift (P many ED patients were actually fasting during the study period. This study was conducted in a tertiary care hospital and the patient population presenting to our ed is predominantly Muslim; therefore, the results may not be generalized to populations that are not predominantly Muslim.
Kim, Soo Hyun; Jung, Seung Eun; Oh, Sang Hoon; Park, Kyu Nam; Youn, Chun Song
2011-11-03
Severely injured trauma patients are exposed to clinically significant radiation doses from computed tomography (CT) imaging in the emergency department. Moreover, this radiation exposure is associated with an increased risk of cancer. The purpose of this study was to determine some effects of a radiation dose reduction strategy for CT in severely injured trauma patients in the emergency department. We implemented the radiation dose reduction strategy in May 2009. A prospective observational study design was used to collect data from patients who met the inclusion criteria during this one year study (intervention group) from May 2009 to April 2010. The prospective data were compared with data collected retrospectively for one year prior to the implementation of the radiation dose reduction strategy (control group). By comparison of the cumulative effective dose and the number of CT examinations in the two groups, we evaluated effects of a radiation dose reduction strategy. All the patients met the institutional adult trauma team activation criteria. The radiation doses calculated by the CT scanner were converted to effective doses by multiplication by a conversion coefficient. A total of 118 patients were included in this study. Among them, 33 were admitted before May 2009 (control group), and 85 were admitted after May 2009 (intervention group). There were no significant differences between the two groups regarding baseline characteristics, such as injury severity and mortality. Additionally, there was no difference between the two groups in the mean number of total CT examinations per patient (4.8 vs. 4.5, respectively; p = 0.227). However, the mean effective dose of the total CT examinations per patient significantly decreased from 78.71 mSv to 29.50 mSv (p trauma patients effectively decreased the cumulative effective dose of the total CT examinations in the emergency department. But not effectively decreased the number of CT examinations.
The impact of a temporary ice-rink on an emergency department service.
LENUS (Irish Health Repository)
Clarke, Heather J
2012-02-03
BACKGROUND: A temporary ice-rink opened close to Cork city for 6 weeks from 30 November 2003. During this time, a number of patients presented to the local emergency departments with ice-skating-related injuries. We documented these injuries. METHODS: All patients presenting to emergency departments in Cork city with ice-skating-related complaints were included. Information on age and sex, mechanism of injury, diagnosis, follow-up\\/disposition and ambulance service utilization was recorded. RESULTS: One hundred and twenty-five ice-rink-related attendances were reported at Cork emergency departments, representing 1.25% of total attendances. One hundred and twenty-three patients presented with skating-related injuries and two with medical complaints occurring at the ice-rink: 70.8% were female patients and 29.2% were male patients. In the 4-14-year age group, however, 48.5% were girls and 51.5% were boys. Most injuries were directly due to falls; 5.6% were due to skate blades. The commonest site of injury was the upper limb. Fractures and dislocations accounted for 53.9% of injuries, with 20.5% of these requiring orthopaedic admission. Lacerations and digital injuries accounted for 7.1%, with 11% of these required admission for surgery. One minor head injury was reported. 38.1% had soft tissue injuries. Fifteen patients were transported by ambulance. These attendances represented a minimum overall cost of 77,510 euro to the local health service. CONCLUSIONS: A temporary ice-rink had a significant impact on local emergency departments. Currently, there is no specific legislation in Ireland relating to public health and safety in ice-rinks. We recommend consultation with local public bodies before opening such facilities, and appropriate regulation.
Szyszkowicz, Mieczysław; Kousha, Termeh; Castner, Jessica; Dales, Robert
2018-05-01
Increasing evidence suggests that ambient air pollution is a major risk factor for both acute and chronic respiratory disease exacerbations and emergencies. The objective of this study was to determine the association between ambient air pollutants and emergency department (ED) visits for respiratory conditions in nine districts across the province of Ontario in Canada. Health, air pollutant (PM 2.5 , NO 2 , O 3 , and SO 2 ), and meteorological data were retrieved from April 2004 to December 2011. Respiratory diseases were categorized as: chronic obstructive pulmonary disease (COPD, including bronchiectasis) and acute upper respiratory diseases. A case-crossover design was used to test the associations between ED visits and ambient air pollutants, stratified by sex and season. For COPD among males, positive results were observed for NO 2 with lags of 3-6 days, for PM 2.5 with lags 1-8, and for SO 2 with lags of 4-8 days. For COPD among females, positive results were observed for O 3 with lags 2-4 days, and for SO 2 among lags of 3-6 days. For upper respiratory disease emergencies among males, positive results were observed for NO 2 (lags 5-8 days), for O 3 , (lags 0-6 days), PM 2.5 (all lags), and SO 2 (lag 8), and among females, positive results were observed for NO 2 for lag 8 days, for O 3 , PM 2.5 among all lags. Our study provides evidence of the associations between short-term exposure to air pollution and increased risk of ED visits for upper and lower respiratory diseases in an environment where air pollutant concentrations are relatively low. Crown Copyright © 2018. Published by Elsevier Inc. All rights reserved.
Connolly, Megan; Jacobs, Stephen; Scott, Karyn
2018-04-19
To examine clinical leadership of registered nurses in an emergency department, based on evidence that it is important for nurses to feel psychologically and structurally empowered in order to act as clinical leaders. Every registered nurse has the ability to act as a clinical leader. Clinical leadership is the registered nurse's behaviours that provide direction and support to patients and the team in the delivery of patient care. This study explores the connection between the need for structural and psychological empowerment and clinical leadership behaviours. A mixed method, non-experimental survey design was used to examine the psychological empowerment, structural empowerment and clinical leadership of registered nurses working in an emergency department. Emergency department nurses believe they show clinical leadership behaviours most of the time, even though their sense of being psychologically empowered is only moderate. While registered nurses believe they perform clinical leadership behaviours, it is also clear that improvements in structural and psychological empowerment would improve their ability to act as clinical leaders. The results show that for nurses to be able to provide clinical leadership to their patients and colleagues, management must create empowering environments. © 2018 John Wiley & Sons Ltd.
The impact of psychiatric patient boarding in emergency departments.
Nicks, B A; Manthey, D M
2012-01-01
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); P 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.
Carpenter, Christopher R; Griffey, Richard T; Stark, Susan; Coopersmith, Craig M; Gage, Brian F
2011-01-01
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 t...
New program for identification of child maltreatment in emergency department: preliminary data.
Milani, Gregorio P; Vianello, Federica A; Cantoni, Barbara; Agostoni, Carlo; Fossali, Emilio F
2016-07-13
Early detection of child maltreatment in pediatric emergency department is one of the most important challenges for the Italian and European medical care system. Several interventions have been proposed, but results are often unquantifiable or inadequate to face this problem. We promoted an educational program and built up an interdisciplinary team to improve the identification and management of maltreated children. Aim of this study is to report preliminary results of these interventions. Meetings structured with lecture-based teaching and case-based lessons were focused on identification and management of maltreatment cases. An interdisciplinary team with forensic physicians, dermatologists, orthopedics, radiologists, gynecologists, oculists, psychologists and psychiatrics, was created to manage children with suspected diagnosis of maltreatment. We analysed the characteristics of subjects diagnosed after these interventions and their number was compared with the one in the two previous years. An increased rate of diagnoses of 16.9 % was found. Results of the reported program are encouraging, but many efforts are still mandatory to improve the child maltreatment identification in emergency departments.
Emergency department characteristics and capabilities in Bogotá, Colombia.
Bustos, Yury; Castro, Jenny; Wen, Leana S; Sullivan, Ashley F; Chen, Dinah K; Camargo, Carlos A
2015-12-01
Emergency departments (EDs) are a critical, yet heterogeneous, part of international emergency care. The National ED Inventories (NEDI) survey has been used in multiple countries as a standardized method to benchmark ED characteristics. We sought to describe the characteristics, resources, capabilities, and capacity of EDs in the densely populated capital city of Bogotá, Colombia. Bogotá EDs accessible to the general public 24/7 were surveyed using the 23-item NEDI survey used in several other countries ( www.emnet-nedi.org ). ED staff were asked about ED characteristics with reference to calendar year 2011. Seventy EDs participated (82 % response). Most EDs (87 %) were located in hospitals, and 83 % were independent hospital departments. The median annual ED visit volume was approximately 50,000 visits. Approximately 90 % (95 % confidence interval (CI) 80-96 %) had a contiguous layout, with medical and surgical care provided in one area. Almost all EDs saw both adults and children (91 %), while 6 % saw only adults and 3 % saw only children. Availability of technological and consultant resources in EDs was variable. Nearly every ED had cardiac monitoring (99 %, 95 % CI 92-100 %), but less than half had a dedicated CT scanner (39 %, 95 % CI 28-52 %). While most EDs were able to treat trauma 24/7 (81 %, 95 % CI 69-89 %), few could manage oncological (22 %, 95 % CI 13-34 %) or dental (3 %, 95 % CI 0-11 %) emergencies 24/7. The typical ED length-of-stay was between 1 and 6 h in 59 % of EDs (95 % CI, 46-70 %), while most others reported that patients remained for >6 h (39 %). Almost half of respondents (46 %, 95 % CI 34-59 %) reported their ED was over capacity. Bogotá EDs have high annual visit volumes and long length-of-stay, and half are over capacity. To meet the emergency care needs of people in Bogotá and other large cities, Colombia should consider improving urban ED capacity and training more emergency medicine specialists capable of efficiently staffing its
Using data to drive emergency department design: a metasynthesis.
Welch, Shari J
2012-01-01
There has been an uptick in the field of emergency department (ED) operations research and data gathering, both published and unpublished. This new information has implications for ED design. The specialty suffers from an inability to have these innovations reach frontline practitioners, let alone design professionals and architects. This paper is an attempt to synthesize for design professionals the growing data regarding ED operations. The following sources were used to capture and summarize the research and data collections available regarding ED operations: the Emergency Department Benchmarking Alliance database; a literature search using both PubMed and Google Scholar search engines; and data presented at conferences and proceedings. Critical information that affects ED design strategies is summarized, organized, and presented. Data suggest an optimal size for ED functional units. The now-recognized arrival and census curves for the ED suggest a department that expands and contracts in response to changing census. Operational improvements have been dearly identified and are grouped into three categories: input, throughput, and outflow. Applications of this information are suggested. The sentinel premise of this meta-synthesis is that data derived from improvement work in the area of ED operations has applications for ED design. EDs can optimize their functioning by marrying good processes and operations to good design. This review paper is an attempt to bring this new information to the attention of the multidisciplinary team of architects, designers, and clinicians.
Allen, Michael H.; Abar, Beau W.; McCormick, Mark; Barnes, Donna H.; Haukoos, Jason; Garmel, Gus M.; Boudreaux, Edwin D.
2013-01-01
Joint Commission National Patient Safety Goal 15 calls for organizations "to identify patients at risk for suicide." Overt suicidal behavior accounts for 0.6% of emergency department (ED) visits, but incidental suicidal ideation is found in 3%-11.6%. This is the first multicenter study of suicide screening in EDs. Of 2,243 patients in…
[Emergency department triage: independent nursing intervention?].
Corujo Fontes, Sergio José
2014-03-01
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.
Management of Pneumothorax in Emergency Medicine Departments: Multicenter Trial
Ince, Abdulkadir; Ozucelik, Dogac Niyazi; Avci, Akkan; Nizam, Ozgur; Dogan, Halil; Topal, Mehmet Ali
2013-01-01
Background: Pneumothorax is common and life-threatening clinical condition which may require emergency treatment in Emergency Medicine Departments. Objectives: We aimed to reveal the epidemiological analysis of the patients admitted to the Emergency Department with pneumothorax. Material and Methods: This case-control and multi-center study was conducted in the patients treated with the diagnosis of pneumothorax between 01.01.2010-31.12.2010. Patient data were collected from hospital automation system. According to the etiology of the pneumothorax, study groups were arranged like spontaneous pneumothorax and traumatic pneumothorax. Results: 82.2% (n = 106) of patients were male and 17.8% (n = 23) of patients were female and mean age were 31.3 ± 20,2 (Minimum: 1, Maximum: 87). 68.2% (n = 88) of patients were spontaneous pneumothorax (61.36%, n=79 were primary spontaneous pneumothorax) and 31.8% (n = 41) of patients were traumatic pneumothorax (21.95% were iatrogenic pneumothorax). Main complaint is shortness of breath (52.3%, n=67) and 38% (n=49) of patients were smokers. Posteroanterior (PA) Chest X-Ray has been enough for 64.3% (n = 83) of the patients' diagnosis. Tube thoracostomy is applied to 84.5% (n = 109) of patients and surgery is applied to 9.3% (n = 12) of patients and 6.2% (n = 8) of patients were discharged with conservative treatment. Spontaneous pneumothorax showed statistically significant high recurrence compared with traumatic pneumothorax (P = 0.007). 4.65% of (n = 6) patients died. The average age of those who died (9.3 ± 19.9), statistically were significantly lower the mean age of living patients (32.4 ± 19.7) (t test, P = 0,006). 83.33% of the patients who died were neonatals and in the 0-1 years age group, and five of these patients were secondary spontaneous pneumothorax, and one of these patients were iatrogenic pneumothorax due to mechanical ventilation. Conclusions: Pneumothorax in adults can be treated by tube thoracostomy or
DVT presentations to an emergency department: a study of guideline based care and decision making
LENUS (Irish Health Repository)
Lillis, D
2016-02-01
Pre-test probability scoring and blood tests for deep venous thrombosis (DVT) assessment are sensitive, but not specific leading to increased demands on radiology services. Three hundred and eighty-five patients presenting to an Emergency Department (ED), with suspected DVT, were studied to explore our actual work-up of patients with possible DVT relating to risk stratification, further investigation and follow up. Of the 205 patients with an initially negative scan, 36 (17.6%) were brought for review to the ED Consultant clinic. Thirty-four (16.6%) patients underwent repeat compression ultrasound with 5 (2.4%) demonstrating a DVT on the second scan. Repeat compression ultrasound scans were performed on 34 (16.6%) patients with an initially negative scan, with essentially the same diagnostic yield as other larger studies where 100% of such patients had repeat scanning. Where there is ongoing concern, repeat above-knee compression ultrasound within one week will pick up a small number of deep venous thromboses.
Low-back pain at the emergency department: still not being managed?
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Rizzardo A
2016-02-01
Full Text Available Alessandro Rizzardo,1 Luca Miceli,1 Rym Bednarova,2 Giovanni Maria Guadagnin,1 Rodolfo Sbrojavacca,3 Giorgio Della Rocca11Department of Anesthesia and Intensive Care, Academic Hospital of Udine, University of Udine, Udine, 2Pain Medicine and Palliative Care, Health Company Number 2, Gorizia, 3Emergency Department, Academic Hospital of Udine, Udine, ItalyBackground: Low-back pain (LBP affects about 40% of people at some point in their lives. In the presence of “red flags”, further tests must be done to rule out underlying problems; however, biomedical imaging is currently overused. LBP involves large in-hospital and out-of-hospital economic costs, and it is also the most common musculoskeletal disorder seen in emergency departments (EDs.Patients and methods: This retrospective observational study enrolled 1,298 patients admitted to the ED, including all International Classification of Diseases 10 diagnosis codes for sciatica, lumbosciatica, and lumbago. We collected patients’ demographic data, medical history, lab workup and imaging performed at the ED, drugs administered at the ED, ED length of stay (LOS, numeric rating scale pain score, admission to ward, and ward LOS data. Thereafter, we performed a cost analysis.Results: Mean numeric rating scale scores were higher than 7/10. Home medication consisted of no drug consumption in up to 90% of patients. Oxycodone–naloxone was the strong opioid most frequently prescribed for the home. Once at the ED, nonsteroidal anti-inflammatory drugs and opiates were administered to up to 72% and 42% of patients, respectively. Imaging was performed in up to 56% of patients. Mean ED LOS was 4 hours, 14 minutes. A total of 43 patients were admitted to a ward. The expense for each non-ward-admitted patient was approximately €200 in the ED, while the mean expense for ward-admitted patients was €9,500, with a mean LOS of 15 days.Conclusion: There is not yet a defined therapeutic care process for the
What Factors Affect Physicians’ Decisions to Prescribe Opioids in Emergency Departments?
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Lauren E. Sinnenberg BA
2017-01-01
Full Text Available Objective: With 42% of all emergency department visits in the United States related to pain, physicians who work in this setting are tasked with providing adequate pain management to patients with varying primary complaints and medical histories. Complicating this, the United States is in the midst of an opioid overdose epidemic. State governments and national organizations have developed guidelines and legislation to curtail opioid prescriptions in acute care settings, while also incentivizing providers for patient satisfaction and completeness of pain control. In order to inform future policies that focus on provider pain medication prescribing, we sought to characterize the factors physicians weigh when considering treating pain with opioids in the emergency department. Methods: We conducted and transcribed open-ended, semistructured qualitative interviews with 52 physicians at a national emergency medicine conference. Results: Participants reported a wide range of factors contributing to their opioid prescribing patterns related to three domains: 1 provider assessment of pain characteristics, 2 patient-based considerations, and 3 practice environment. Pain characteristics include the characteristics of various acute and chronic pain syndromes, including physicians’ empathy due to their own experiences with pain. Patient characteristics include “trustworthiness,” race and ethnicity, and the concern for risk of misuse. Factors related to the practice environment include hospital policy, legislation/regulation, and guidelines. Conclusion: The decision to prescribe opioids to patients in the emergency department is complex and nuanced. Physicians are interested in guidance and are concerned about the competing pressures placed on their opioid prescribing due to incentives related to patient satisfaction scores on one hand and inflexible policies that do not allow for individualized, patient-centered decisions on the other.
Golf-related injuries treated in United States emergency departments.
Walsh, Brittany A; Chounthirath, Thiphalak; Friedenberg, Laura; Smith, Gary A
2017-11-01
This study investigates unintentional non-fatal golf-related injuries in the US using a nationally representative database. This study analyzed golf-related injuries treated in US hospital emergency departments from 1990 through 2011 using the National Electronic Injury Surveillance System database. Injury rates were calculated using golf participation data. During 1990 through 2011, an estimated 663,471 (95% CI: 496,370-830,573) individuals ≥7years old were treated in US emergency departments for golf-related injuries, averaging 30,158 annually or 12.3 individuals per 10,000 golf participants. Patients 18-54years old accounted for 42.2% of injuries, but injury rates per 10,000 golf participants were highest among individuals 7-17years old (22.1) and ≥55years old (21.8) compared with 18-54years old (7.6). Patients ≥55years old had a hospital admission rate that was 5.01 (95% CI: 4.12-6.09) times higher than that of younger patients. Injured by a golf club (23.4%) or struck by a golf ball (16.0%) were the most common specified mechanisms of injury. The head/neck was the most frequently injured body region (36.2%), and sprain/strain (30.6%) was the most common type of injury. Most patients were treated and released (93.7%) and 5.9% required hospitalization. Although golf is a source of injury among all age groups, the frequency and rate of injury were higher at the two ends of the age spectrum. Given the higher injury and hospital admission rates of patients ≥55years, this age group merits the special attention of additional research and injury prevention efforts. Copyright © 2017 Elsevier Inc. All rights reserved.
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Tomislav Svoboda
Full Text Available This study contrasted annual rates of difficult behaviours in emergency departments among cohorts of individuals who were homeless and low-income housed and examined predictors of these events.Interviews in 1999 with men who were chronically homeless with drinking problems (CHDP (n = 50, men from the general homeless population (GH (n = 61, and men residing in low-income housing (LIH (n = 58 were linked to catchment area emergency department records (n = 2817 from 1994 to 1999. Interview and hospital data were linked to measures of difficult behaviours.Among the CHDP group, annual rates of visits with difficult behaviours were 5.46; this was 13.4 (95% CI 10.3-16.5 and 14.3 (95% CI 11.2-17.3 times higher than the GH and LIH groups. Difficult behaviour incidents included physical violence, verbal abuse, uncooperativeness, drug seeking, difficult histories and security involvement. Difficult behaviours made up 57.54% (95% CI 55.43-59.65%, 24% (95% CI 19-29%, and 20% (95% CI 16-24% of CHDP, GH and LIH visits. Among GH and LIH groups, 87% to 95% were never involved in verbal abuse or violence. Intoxication increased all difficult behaviours while decreasing drug seeking and leaving without being seen. Verbal abuse and violence were less likely among those housed, with odds ratios of 0.24 (0.08, 0.72 and 0.32 (0.15, 0.69, respectively.Violence and difficult behaviours are much higher among chronically homeless men with drinking problems than general homeless and low-income housed populations. They are concentrated among subgroups of individuals. Intoxication is the strongest predictor of difficult behaviour incidents.
Bornemann-Shepherd, Melanie; Le-Lazar, Jamie; Makic, Mary Beth Flynn; DeVine, Deborah; McDevitt, Kelly; Paul, Marcee
2015-01-01
Hospital capacity constraints lead to large numbers of inpatients being held for extended periods in the emergency department. This creates concerns with safety, quality of care, and dissatisfaction of patients and staff. The aim of this quality-improvement project was to improve satisfaction and processes in which nurses provided care to inpatient boarders held in the emergency department. A quality-improvement project framework that included the use of a questionnaire was used to ascertain employee and patient dissatisfaction and identify opportunities for improvement. A task force was created to develop action plans related to holding and caring for inpatients in the emergency department. A questionnaire was sent to nursing staff in spring 2012, and responses from the questionnaire identified improvements that could be implemented to improve care for inpatient boarders. Situation-background-assessment-recommendation (SBAR) communications and direct observations were also used to identify specific improvements. Post-questionnaire results indicated improved satisfaction for both staff and patients. It was recognized early that the ED inpatient area would benefit from the supervision of an inpatient director, managers, and staff. Outcomes showed that creating an inpatient unit within the emergency department had a positive effect on staff and patient satisfaction. Copyright © 2015 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.
Pseudologia Fantastica in the Emergency Department: A Case Report and Review of the Literature
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Robyn Thom
2017-01-01
Full Text Available Psychiatrists commonly encounter deception in the emergency department. This article presents the case of a patient who presents to the emergency department with an unusual and elaborate web of deceptions along multiple themes including feigning medical illness, multiple losses, and grandiose academic and athletic achievements. We review the clinical characteristics of pseudologia fantastica and discuss how this patient’s constellation of malingering, factitious disorder, and personality disorder suggests this diagnosis.
Hung, Maria S Y; Pang, Samantha M C
2011-01-01
This paper is a report of a study to illuminate the experience of family members whose relatives survived the resuscitation in an accident and emergency department, and their preferences with regard to being present. Family presence during resuscitation can offer benefits to both patient and family members, and large healthcare organizations support and recommend offering the option for their presence. However, many staff believe that this is too distressing or traumatic for families and that they would interfere with the resuscitation process. An interpretive phenomenological approach was used to collect data in 2007-2008 with 18 family members of patients who survived life-sustaining interventions in an accident and emergency department in Hong Kong. Audio-recorded interviews were transcribed verbatim for thematic analysis and verified with the participants in second interviews. None of the family members was present in resuscitation room during the life-sustaining interventions, and five entered the room after the patients' condition was stable. The majority indicated a strong preference to be present if given the option. Three interrelated themes emerged: (i) emotional connectedness, (ii) knowing the patient, and (iii) perceived (in)appropriateness, with 10 subthemes representing affective, rational and contextual determinants of family presence preferences. The interplay of these determinants and how they contributed to strong or weak preference for family presence was analysed. Variations among the contributing determinants to each family member's preference to be present were revealed. Appropriate nursing interventions, policy and guidelines should be developed to meet individualized needs during such critical and life-threatening moments in accident and emergency departments. © 2010 Blackwell Publishing Ltd.
Benefit-cost analysis of SBIRT interventions for substance using patients in emergency departments.
Horn, Brady P; Crandall, Cameron; Forcehimes, Alyssa; French, Michael T; Bogenschutz, Michael
2017-08-01
Screening, brief intervention, and referral to treatment (SBIRT) has been widely implemented as a method to address substance use disorders in general medical settings, and some evidence suggests that its use is associated with decreased societal costs. In this paper, we investigated the economic impact of SBIRT using data from Screening, Motivational Assessment, Referral, and Treatment in Emergency Departments (SMART-ED), a multisite, randomized controlled trial. Utilizing self-reported information on medical status, health services utilization, employment, and crime, we conduct a benefit-cost analysis. Findings indicate that neither of the SMART-ED interventions resulted in any significant changes to the main economic outcomes, nor had any significant impact on total economic benefit. Thus, while SBIRT interventions for substance abuse in Emergency Departments may be appealing from a clinical perspective, evidence from this economic study suggests resources could be better utilized supporting other health interventions. Copyright © 2017 Elsevier Inc. All rights reserved.
Multiple performance measures are needed to evaluate triage systems in the emergency department.
Zachariasse, Joany M; Nieboer, Daan; Oostenbrink, Rianne; Moll, Henriëtte A; Steyerberg, Ewout W
2018-02-01
Emergency department triage systems can be considered prediction rules with an ordinal outcome, where different directions of misclassification have different clinical consequences. We evaluated strategies to compare the performance of triage systems and aimed to propose a set of performance measures that should be used in future studies. We identified performance measures based on literature review and expert knowledge. Their properties are illustrated in a case study evaluating two triage modifications in a cohort of 14,485 pediatric emergency department visits. Strengths and weaknesses of the performance measures were systematically appraised. Commonly reported performance measures are measures of statistical association (34/60 studies) and diagnostic accuracy (17/60 studies). The case study illustrates that none of the performance measures fulfills all criteria for triage evaluation. Decision curves are the performance measures with the most attractive features but require dichotomization. In addition, paired diagnostic accuracy measures can be recommended for dichotomized analysis, and the triage-weighted kappa and Nagelkerke's R 2 for ordinal analyses. Other performance measures provide limited additional information. When comparing modifications of triage systems, decision curves and diagnostic accuracy measures should be used in a dichotomized analysis, and the triage-weighted kappa and Nagelkerke's R 2 in an ordinal approach. Copyright © 2017 Elsevier Inc. All rights reserved.
An organizational metamodel for hospital emergency departments.
Kaptan, Kubilay
2014-10-01
I introduce an organizational model describing the response of the hospital emergency department. The hybrid simulation/analytical model (called a "metamodel") can estimate a hospital's capacity and dynamic response in real time and incorporate the influence of damage to structural and nonstructural components on the organizational ones. The waiting time is the main parameter of response and is used to evaluate the disaster resilience of health care facilities. Waiting time behavior is described by using a double exponential function and its parameters are calibrated based on simulated data. The metamodel covers a large range of hospital configurations and takes into account hospital resources in terms of staff and infrastructures, operational efficiency, and the possible existence of an emergency plan; maximum capacity; and behavior both in saturated and overcapacitated conditions. The sensitivity of the model to different arrival rates, hospital configurations, and capacities and the technical and organizational policies applied during and before a disaster were investigated. This model becomes an important tool in the decision process either for the engineering profession or for policy makers.
Zeller, Scott; Calma, Nicole; Stone, Ashley
2014-02-01
Mental health patients boarding for long hours, even days, in United States emergency departments (EDs) awaiting transfer for psychiatric services has become a considerable and widespread problem. Past studies have shown average boarding times ranging from 6.8 hours to 34 hours. Most proposed solutions to this issue have focused solely on increasing available inpatient psychiatric hospital beds, rather than considering alternative emergency care designs that could provide prompt access to treatment and might reduce the need for many hospitalizations. One suggested option has been the "regional dedicated emergency psychiatric facility," which serves to evaluate and treat all mental health patients for a given area, and can accept direct transfers from other EDs. This study sought to assess the effects of a regional dedicated emergency psychiatric facility design known at the "Alameda Model" on boarding times and hospitalization rates for psychiatric patients in area EDs. Over a 30-day period beginning in January 2013, 5 community hospitals in Alameda County, California, tracked all ED patients on involuntary mental health holds to determine boarding time, defined as the difference between when they were deemed stable for psychiatric disposition and the time they were discharged from the ED for transfer to the regional psychiatric emergency service. Patients were also followed to determine the percentage admitted to inpatient psychiatric units after evaluation and treatment in the psychiatric emergency service. In a total sample of 144 patients, the average boarding time was approximately 1 hour and 48 minutes. Only 24.8% were admitted for inpatient psychiatric hospitalization from the psychiatric emergency service. The results of this study indicate that the Alameda Model of transferring patients from general hospital EDs to a regional psychiatric emergency service reduced the length of boarding times for patients awaiting psychiatric care by over 80% versus
Conversion disorder in a neurological emergency department: Restrospective series
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Alejandro Cardozo
2017-01-01
Full Text Available Objective: To observe the conversion disorder in a neurological emergency department. Methods: It is common that the initial approach to this patients include the use of various diagnostic exams. In this series we reviewed 94 patients that arrived a neurological emergency room in a 3 year period.Results: 72 patients were females (76%, and the initial presumptive diagnosis were: neurovascular syndrome in 36 patients (38.3%, convulsive disorder in 20 patients (21.28%, and conversive disorder in 8 patients (8.51%. 82 patients had motor symptoms and 61 sensitive symptoms. 88 patients (93% required neuroimaging studies, 77 (81% patients underwent through basic biochemical panels. Other tests performed were: electroencephalogram in 12 patients (12.77%, electromyography in 11 patients (11.7%, lumbar punction in 8 patients (8.04% and regarding the medical consult in the care of these patients 11 were evaluated by 1 specialists, 35 (37.2% by 2 different specialties, 42 (44.63% patients required evaluation by 3, and 6 patients (6.38% required evaluation by 4 different specialties.Conclusions: Based on this data, we conclude that conversion disorders require a lot of resources in the emergency room and that the similarities with neurological diseases demands a complete workup including expensive diagnostic tools. However, this patients can be discharged safely without requiring hospitalization.
The use of high-flow nasal cannula in the pediatric emergency department
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Katherine N. Slain
Full Text Available Abstract Objectives: To summarize the current literature describing high-flow nasal cannula use in children, the components and mechanisms of action of a high-flow nasal cannula system, the appropriate clinical applications, and its role in the pediatric emergency department. Sources: A computer-based search of PubMed/MEDLINE and Google Scholar for literature on high-flow nasal cannula use in children was performed. Data summary: High-flow nasal cannula, a non-invasive respiratory support modality, provides heated and fully humidified gas mixtures to patients via a nasal cannula interface. High-flow nasal cannula likely supports respiration though reduced inspiratory resistance, washout of the nasopharyngeal dead space, reduced metabolic work related to gas conditioning, improved airway conductance and mucociliary clearance, and provision of low levels of positive airway pressure. Most data describing high-flow nasal cannula use in children focuses on those with bronchiolitis, although high-flow nasal cannula has been used in children with other respiratory diseases. Introduction of high-flow nasal cannula into clinical practice, including in the emergency department, has been associated with decreased rates of endotracheal intubation. Limited prospective interventional data suggest that high-flow nasal cannula may be similarly efficacious as continuous positive airway pressure and more efficacious than standard oxygen therapy for some patients. Patient characteristics, such as improved tachycardia and tachypnea, have been associated with a lack of progression to endotracheal intubation. Reported adverse effects are rare. Conclusions: High-flow nasal cannula should be considered for pediatric emergency department patients with respiratory distress not requiring immediate endotracheal intubation; prospective, pediatric emergency department-specific trials are needed to better determine responsive patient populations, ideal high-flow nasal cannula
Cycling Injuries Presenting to an Irish Emergency Department
LENUS (Irish Health Repository)
J Foley, J
2016-06-01
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
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Carmen Andrea Pfortmueller
2013-01-01
Full Text Available Introduction. In this era of high-tech medicine, it is becoming increasingly important to assess patient satisfaction. There are several methods to do so, but these differ greatly in terms of cost, time, and labour and external validity. The aim of this study is to describe and compare the structure and implementation of different methods to assess the satisfaction of patients in an emergency department. Methods. The structure and implementation of the different methods to assess patient satisfaction were evaluated on the basis of a 90-minute standardised interview. Results. We identified a total of six different methods in six different hospitals. The average number of patients assessed was 5012, with a range from 230 (M5 to 20 000 patients (M2. In four methods (M1, M3, M5, and M6, the questionnaire was composed by a specialised external institute. In two methods, the questionnaire was created by the hospital itself (M2, M4.The median response rate was 58.4% (range 9–97.8%. With a reminder, the response rate increased by 60% (M3. Conclusion. The ideal method to assess patient satisfaction in the emergency department setting is to use a patient-based, in-emergency department-based assessment of patient satisfaction, planned and guided by expert personnel.
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Sehnaz Akın Paker
2015-09-01
Full Text Available Objectives: In our study we aimed to investigate the quality and quantity of medical management inside ambulances for 14 and over 14 years old patients transported to a level three emergency department (ED. Material and methods: Our study was conducted prospectively at a level three ED. 14 and over 14 years old patients who were transported to the ED by ambulance were included in the study consecutively. “Lack of vital rate” was described as missing of one or more of five vital rates during ambulance transportation. Both of two attending emergency physicians evaluated the medical procedures and management of patients at the ambulance simultaneously and this was recorded on the study forms. Results: Four hundred and fifty six patients were included in the study. Missing vital signs were identified for 90.1% (n = 322 of the patients that were transported by physicians and 92.4% (n = 73 of the patients that were transported by paramedics. For five patients with cardiac arrest two (33.3% had cardiopulmonary resuscitation (CPR, one (20% was intubated, one (20% received adrenaline. Out of 120 patients, needed spinal immobilization, 69 (57.5% had spinal board. Cervical collar usage was 65.1% (n = 69 We have revealed that 316 (69.3% patients did not receive at least one of the necessary medical intervention or treatment. Conclusion: During ambulance transportation, life-saving procedures like cardiopulmonary resuscitation, vital sign measurement, crucial treatment administration, endotracheal intubation, defibrillation, fracture immobilization were not performed adequately. Increasing the training on the deficient interventions and performing administrative inspections may improve quality of patient care. Keywords: Emergency department, Ambulance, Prehospital emergency care
Fernández-Prada, María; González-Cabrera, Joaquín; Torres G, Francisco; Iribar-Ibabe, Concepción; María Peinado, José
2014-02-01
The high emotional burden of physicians working in emergency departments may affect their quality of life perception. To evaluate health related quality of life among resident physicians performing shifts at an emergency department. Seventy one physicians aged 26,3 ± 1,7 years (47 women), working as residents in an emergency department, answered the short version of the Short-Form Health Survey Questionnaire (SF-36®). This questionnaire analyses eight domains: physical function, body pain, general health, vitality, social function, emotional role and mental health. Women had a significantly worse perception than a reference population in four dimensions of the SF-36, especially mental health and social functioning. Men had scores similar to the reference population. Among women, vitality is the best predictor of mental health and social functioning. Women working as residents in an emergency department have a worse perception of their quality of life than men performing the same job.
Alcohol-Related Emergency Department Visits Associated with Collegiate Football Games
Shook, Janice; Hiestand, Brian C.
2011-01-01
Objective: In 2003, after several post-college football game riots, multiple strategies including strict enforcement of open container laws were instituted by the authors' city and university. The authors compared alcohol-related visits to the on-campus emergency department (ED) associated with home football games in 2002 and 2006, hypothesizing…
Taylor, Scott; Watt, Martin
2005-12-01
Peritonism is a finding that leads to a more cautious approach in the emergency department management of abdominal pain. This study examined whether peritonism assessment using inspiration, expiration and cough tests was associated with the patient's clinical management. This prospective observational study evaluated consecutive patients presenting directly to the emergency department for 3 months from June 2000 with abdominal pain. Triage initial observations of blood pressure, pulse, respiratory rate, oxygen saturation and temperature were recorded. The examining emergency physician recorded each patient's response and pain score to the individual peritonism tests and scored it as positive if there was an indication of it being a painful manoeuvre. The results were blinded from the receiving specialty if subsequent referral was required. Sixty-seven patients had peritonism tests performed. No individual test was more painful than the others with similar values in pain scores. In all, 70% (7/10) were admitted when all three tests were positive, compared with 21% (12/57) when two or less of the tests scored positive (P=0.004, Fisher's exact test). Admission was not associated with any individual test or combination of tests, or any other variable. The peritonism tests were not associated with any other physiological observation or measurement. These peritonism tests represent a simple investigation, and are significantly associated with admission when all three tests are positive. They seem to be a clinical predictor of cases in which continuing assessment was required, and may be useful as a departmental 'safety net' in the management of abdominal pain.
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Primiano Iannone
2015-06-01
Full Text Available Crowding adversely affects the performance of emergency departments (EDs by worsening efficiency, timeliness of care, clinical outcomes and patients’ satisfaction. We describe in this study our attempt at improving crowding by modifying the roles and workflow of the ED physicians. The observation unit physician was given the additional duty of prioritizing admissions and managing unclear, complex cases, which were previously under the responsibility of front line emergency physicians. We analyzed two corresponding periods, both before the intervention (9897 ED attendances in 2012 and after the intervention (10,297 attendances in 2013. Most of the crowding indices improved significantly, including timeliness of triage, of first medical contact, access to resus area, and overall length of stay in ED. Also, emergency hospital admissions, average specialist consultations and imaging studies per patient decreased significantly. The observation unit workload increased. There was no significant excess of adverse events.
Causes of poisoning in patients evaluated in a hospital emergency department in Konya, Turkey
International Nuclear Information System (INIS)
Kara, H.; Bayir, A.; Degirmenci, S.; Akinci, M.; Ak, A.; Azap, M.
2014-01-01
Objectives: To evaluate demographic and clinical characteristics of patients with poisoning at a community hospital. Methods: The retrospective study comprised records of patients who were admitted to the emergency department of Konya Numune Hospital, Turkey, because of poisoning between January 1, 2009, and December 31, 2011. Data was evaluated for age, gender, educational status, occupation, arrival time, mechanism of intoxication , body temperature, pulse, respiratory rate, Glasgow Coma Scale score, treatment applied, duration of hospital stay, duration of follow-up, test results, final diagnosis, clinical disposition, and outcome. Agents causing the poisoning were also determined. Results: Records of 1036 patients were evaluated. Of them, 764(74%) were female and 272(26%) were male. The predominant age range was 15-24 years in 617(60%) patients. The median time from substance exposure to admission to the emergency department was 2 hours. The most common cause of poisoning was attempted suicide in 955 (92%) patients and drug intoxication was the agent involved in 932 (90%). In the 15-24 year age range, there were 469(76%) female patients. Of the total female population in the study, 716(94%) attempted suicide. The median hospital stay was 24 hours. There were 908(88%) patients who were advised to seek further evaluation at the psychiatry clinic, and 9 (0.9%) patients were admitted to the psychiatry inpatient units after medical treatment. In patients who were hospitalized and followed up, 1 (0.1%) died because of multiple drug poisoning. Conclusion: Most admissions to the emergency department for poisoning related to young women had used drugs during a suicide attempt. (author)
Liles, Iyanna; Haddad, Lisa B; Lathrop, Eva; Hankin, Abigail
2016-05-01
Almost half of all pregnancies in the United States are unintended; these pregnancies are associated with adverse outcomes. Many reproductive-age females seek care in the emergency department (ED), are at risk of pregnancy, and are amenable to contraceptive services in this setting. Through a pilot study, we sought to assess ED providers' current practices; attitudes; and knowledge of emergency contraception (EC) and nonemergency contraception (non-EC), as well as barriers with respect to contraception initiation. ED physicians and associate providers in Georgia were e-mailed a link to an anonymous Internet questionnaire using state professional databases and contacts. The questionnaire included Likert scales with multiple-choice questions to assess study objectives. Descriptive statistics were generated as well as univariate analyses using χ(2) and Fisher exact tests. A total of 1232 providers were e-mailed, with 119 questionnaires completed. Participants were predominantly physicians (80%), men (59%), and individuals younger than 45 years (59%). Common practices were referrals (96%), EC prescriptions (77%), and non-EC prescriptions (40%). Common barriers were perceived as low likelihood for follow-up (63%), risk of complications (58%), and adverse effects (51%). More than 70% of participants correctly identified the highly effective contraceptive methods, 3% identified the correct maximum EC initiation time, and 42% correctly recognized pregnancy as a higher risk than hormonal contraception use for pulmonary embolism. Most ED providers in this pilot study referred patients for contraception; however, there was no universal contraceptive counseling and management. Many ED providers in this study had an incorrect understanding of the efficacy, risks, and eligibility associated with contraceptive methods. This lack of understanding may affect patient access and be a barrier to patient care.
Azizkhani, Reza; Bahadori, Azadeh; Shariati, Mohammadreza; Golshani, Keyhan; Ahmadi, Omid; Masoumi, Babak
2018-01-01
The present study was designed to evaluate the effectiveness of magnesium sulfate (MgSO 4 ) in procedural sedation and analgesia (PSA) when combined with ketamine in patients with fractures in emergency departments and required short and painful emergency procedures. In this study, 100 patients with fractures and dislocations who were presented to the emergency departments and required PSA for short and painful emergency procedures were randomly allocated to groups of ketamine plus MgSO 4 or ketamine alone. Train of four (TOF) stimulation pattern was assessed using nerve stimulator machine and compared between groups. The mean age of studied patients was 46.9 ± 9.3 years old. 48% were male and 52% were female. No significant differences were noted between groups in demographic variables. The status of TOF, 2 min after the injection of ketamine (1.5 mg/kg), in both groups was similar. After the injection of the second dose of ketamine (1 mg/kg) the status of TOF in four patients in ketamine plus MgSO 4 (0.45 mg/kg) group changed, it was three quarters but in ketamine group, the status of TOF in all patients was four quarters. The difference between groups was not statistically significant ( P = 0.12). The findings revealed that for muscle relaxation during medical procedures in the emergency department, ketamine in combination with MgSO 4 with this dose was not effective for muscle relaxation during procedures.
Katz, Manuel; Warshawsky, Sheila S; Rosen, Shirley; Barak, Nurit; Press, Joseph
2004-10-01
To develop and implement locally tailored pediatric admission guidelines for use in a pediatric emergency department and evaluate the appropriateness of admissions based on these guidelines. Our Study was based on the development of admission guidelines by senior physicians, using the Delphi Consensus Process, for use in the Pediatric Emergency Department (PED) at Soroka University Medical Center (Soroka). We evaluated the appropriateness of admissions to the pediatric departments of Soroka on 33 randomly selected days in 1999 and 2000 prior to guideline implementation and 30 randomly selected days in 2001, after guideline implementation. A total of 1037 files were evaluated. A rate of 12.4% inappropriate admissions to the pediatric departments was found based on locally tailored admission guidelines. There was no change in the rate of inappropriate admissions after implementation of admission guidelines in PED. Inappropriate admissions were associated with age above 3 years, hospital stay of two days or less and the season. The main reasons for evaluating an admission as inappropriate were that the admission did not comply with the guidelines and that the case could be managed in an ambulatory setting. There were distinctive differences in the characteristics of the Bedouin and Jewish populations admitted to the pediatric departments, although no difference was found in the rate of inappropriate admissions between these populations. Patient management in Soroka PED is tailored to the conditions of this medical center and to the characteristics of the population it serves. The admission guidelines developed reflect these special conditions. Lack of change in the rate of inappropriate admissions following implementation of the guidelines indicates that the guidelines reflect the physicians' approach to patient management that existed in Soroka PED prior to guideline implementation. Hospital admission guidelines have a role in the health management system; however
Diagnosing Achilles tendon injuries in the emergency department.
LENUS (Irish Health Repository)
Gibbons, Lynda
2013-09-01
Achilles tendon (AT) injury is an overuse injury often seen in professional and recreational athletes. It tends to affect men, particularly those in their thirties and forties, more than women, and is typically seen in people who are intermittently active. To ensure AT ruptures are identified and treated effectively, early intervention in emergency departments (EDs) is crucial. This article discusses how advanced nurse practitioners can use their comprehensive problem-solving, clinical decision-making and clinical judgement skills to manage patients who present with suspected AT injury. It also describes the anatomy of tendon rupture, the aetiology and mechanism of injuries, and the importance of assessment and diagnostic tools, therapeutic techniques and management strategies. Finally, it considers the psychological effect this injury can have on patients, while in the ED and after discharge. A case study is included as an example of ED management.
DEFF Research Database (Denmark)
Ilangkovan, Nivethitha; Mickley, Hans; Diederichsen, Axel
2017-01-01
OBJECTIVES: To determine the incidence of clinical, cardiac-related endpoints and mortality among patients presenting to an emergency or cardiology department with non-specific chest pain (NSCP), and who receive testing with a high-sensitivity troponin. A second objective was to identify risk...... factors for the above-noted endpoints during 12 months of follow-up. DESIGN: A prospective multicentre study. SETTING: Emergency and cardiology departments in Southern Denmark. SUBJECTS: The study enrolled 1027 patients who were assessed for acute chest pain in an emergency or cardiology department...
Emergency Department Frequent Users for Acute Alcohol Intoxication
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Marc L. Martel
2018-02-01
Full Text Available Introduction: A subset of frequent users of emergency services are those who use the emergency department (ED for acute alcohol intoxication. This population and their ED encounters have not been previously described. Methods: This was a retrospective, observational, cohort study of patients presenting to the ED for acute alcohol intoxication between 2012 and 2016. We collected all data from the electronic medical record. Frequent users for alcohol intoxication were defined as those with greater than 20 visits for acute intoxication without additional medical chief complaints in the previous 12 months. We used descriptive statistics to evaluate characteristics of frequent users for alcohol intoxication, as well as their ED encounters. Results: We identified 32,121 patient encounters. Of those, 325 patients were defined as frequent users for alcohol intoxication, comprising 11,370 of the encounters during the study period. The median maximum number of encounters per person for alcohol intoxication in a one-year period was 47 encounters (range 20 to 169. Frequent users were older (47 years vs. 39 years, and more commonly male (86% vs. 71%. Frequent users for alcohol intoxication had higher rates of medical and psychiatric comorbidities including liver disease, chronic kidney disease, ischemic vascular disease, dementia, chronic obstructive pulmonary disease, history of traumatic brain injury, schizophrenia, and bipolar disorder. Conclusion: In this study, we identified a group of ED frequent users who use the ED for acute alcohol intoxication. This population had higher rates of medical and psychiatric comorbidities compared to non-frequent users.
Acute asthma severity identification of expert system flow in emergency department
Sharif, Nurul Atikah Mohd; Ahmad, Norazura; Ahmad, Nazihah; Desa, Wan Laailatul Hanim Mat
2017-11-01
Integration of computerized system in healthcare management help in smoothening the documentation of patient records, highly accesses of knowledge and clinical practices guideline, and advice on decision making. Exploit the advancement of artificial intelligent such as fuzzy logic and rule-based reasoning may improve the management of emergency department in terms of uncertainty condition and medical practices adherence towards clinical guideline. This paper presenting details of the emergency department flow for acute asthma severity identification with the embedding of acute asthma severity identification expert system (AASIES). Currently, AASIES is still in preliminary stage of system validation. However, the implementation of AASIES in asthma bay management is hope can reduce the usage of paper for manual documentation and be a pioneer for the development of a more complex decision support system to smoothen the ED management and more systematic.
The effect of emergency department expansion on emergency department overcrowding.
Han, Jin H; Zhou, Chuan; France, Daniel J; Zhong, Sheng; Jones, Ian; Storrow, Alan B; Aronsky, Dominik
2007-04-01
To examine the effects of emergency department (ED) expansion on ambulance diversion at an urban, academic Level 1 trauma center. This was a pre-post study performed using administrative data from the ED and hospital electronic information systems. On April 19, 2005, the adult ED expanded from 28 to 53 licensed beds. Data from a five-month pre-expansion period (November 1, 2004, to March 1, 2005) and a five-month postexpansion period (June 1, 2005, to October 31, 2005) were included for this analysis. ED and waiting room statistics as well as diversion status were obtained. Total ED length of stay (LOS) was defined as the time from patient registration to the time leaving the ED. Admission hold LOS was defined as the time from the inpatient bed request to the time leaving the ED for admitted patients. Mean differences (95% confidence interval [CI]) in total time spent on ambulance diversion per month, diversion episodes per month, and duration per diversion episode were calculated. An accelerated failure time model was performed to test if ED expansion was associated with a reduction in ambulance diversion while adjusting for potential confounders. From pre-expansion to postexpansion, daily patient volume increased but ED occupancy decreased. There was no significant change in the time spent on ambulance diversion per month (mean difference, 10.9 hours; 95% CI = -74.0 to 95.8), ambulance diversion episodes per month (two episodes per month; 95% CI = -4.2 to 8.2), and duration of ambulance diversion per episode (0.3 hours; 95% CI = -4.0 to 3.5). Mean (+/-SD) total LOS increased from 4.6 (+/-1.9) to 5.6(+/-2.3) hours, and mean (+/-SD) admission hold LOS also increased from 3.0 (+/-0.2) to 4.1 (+/-0.2) hours. The proportion of patients who left without being seen was 3.5% and 2.7% (p = 0.06) in the pre-expansion and postexpansion periods, respectively. In the accelerated failure time model, ED expansion did not affect the time to the next ambulance diversion episode
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
Advanced Concepts and Controversies in Emergency Department Pain Management.
Motov, Sergey M; Nelson, Lewis S
2016-06-01
Pain is the most common complaint for which patients come to the emergency department (ED). Emergency physicians are responsible for pain relief in a timely, efficient, and safe manner in the ED. The improvement in our understanding of the neurobiology of pain has balanced the utilization of nonopioid and opioid analgesia, and simultaneously has led to more rational and safer opioid prescribing practices. This article reviews advances in pain management in the ED for patients with acute and chronic pain as well as describes several newer strategies and controversies. Copyright © 2016 Elsevier Inc. All rights reserved.
Solé-Casals, Montserrat; Chirveches-Pérez, Emilia; Puigoriol-Juvanteny, Emma; Nubó-Puntí, Núria; Chabrera-Sanz, Carolina; Subirana-Casacuberta, Mireia
2017-06-02
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.
Pharmacist advice is accepted more for medical than for surgical patients in an emergency department
DEFF Research Database (Denmark)
Backer Mogensen, Christian; Olsen, Inger; Thisted, Anette Rehn
2013-01-01
Pharmacists' advice may reduce medication errors in the emergency department (ED). However, pharmacists' recommendations are of little value if not acknowledged by physicians. The aim of the present study was to analyze how often and which categories of pharmacist recommendations were taken...
DEFF Research Database (Denmark)
Fedyszyn, Izabela E.; Erlangsen, Annette; Hjorthoj, Carsten
2016-01-01
Objective: Emergency departments are important, albeit underutilized, sites for suicide prevention. Preventive strategies and interventions could benefit from a greater understanding of factors influencing the course of suicide risk after emergency department contact due to attempted suicide...... = 1.74; 95% CI, 1.22-2.49). The cumulative rates of repeated attempts and suicide deaths in the total sample were particularly high within the first week of the index attempt, reaching 3.6% and 0.1%, respectively. Conclusions: Preventive efforts need to target the period close to discharge from....... The aim of our study was 2-fold: to identify predictors of repeated suicide attempts and suicide and to investigate the timing of these events. Methods: Data from Danish nationwide, longitudinal registers were used in this prospective, population-based study of all individuals first presenting...
Seasonal ARMA-based SPC charts for anomaly detection: Application to emergency department systems
Kadri, Farid; Harrou, Fouzi; Chaabane, Sondè s; Sun, Ying; Tahon, Christian
2015-01-01
Monitoring complex production systems is primordial to ensure management, reliability and safety as well as maintaining the desired product quality. Early detection of emergent abnormal behaviour in monitored systems allows pre-emptive action to prevent more serious consequences, to improve system operations and to reduce manufacturing and/or service costs. This study reports the design of a new methodology for the detection of abnormal situations based on the integration of time-series analysis models and statistical process control (SPC) tools for the joint development of a monitoring system to help supervising of the behaviour of emergency department services (EDs). The monitoring system developed is able to provide early alerts in the event of abnormal situations. The seasonal autoregressive moving average (SARMA)-based exponentially weighted moving average (EWMA) anomaly detection scheme proposed was successfully applied to the practical data collected from the database of the paediatric emergency department (PED) at Lille regional hospital centre, France. The method developed utilizes SARMA as a modelling framework and EWMA for anomaly detection. The EWMA control chart is applied to the uncorrelated residuals obtained from the SARMA model. The detection results of the EWMA chart are compared with two other commonly applied residual-based tests: a Shewhart individuals chart and a Cumulative Sum (CUSUM) control chart.
Seasonal ARMA-based SPC charts for anomaly detection: Application to emergency department systems
Kadri, Farid
2015-10-22
Monitoring complex production systems is primordial to ensure management, reliability and safety as well as maintaining the desired product quality. Early detection of emergent abnormal behaviour in monitored systems allows pre-emptive action to prevent more serious consequences, to improve system operations and to reduce manufacturing and/or service costs. This study reports the design of a new methodology for the detection of abnormal situations based on the integration of time-series analysis models and statistical process control (SPC) tools for the joint development of a monitoring system to help supervising of the behaviour of emergency department services (EDs). The monitoring system developed is able to provide early alerts in the event of abnormal situations. The seasonal autoregressive moving average (SARMA)-based exponentially weighted moving average (EWMA) anomaly detection scheme proposed was successfully applied to the practical data collected from the database of the paediatric emergency department (PED) at Lille regional hospital centre, France. The method developed utilizes SARMA as a modelling framework and EWMA for anomaly detection. The EWMA control chart is applied to the uncorrelated residuals obtained from the SARMA model. The detection results of the EWMA chart are compared with two other commonly applied residual-based tests: a Shewhart individuals chart and a Cumulative Sum (CUSUM) control chart.
Genuis, Emerson D; Doan, Quynh
2013-11-01
Providing patient care and medical education are both important missions of teaching hospital emergency departments (EDs). With medical school enrollment rising, and ED crowding becoming an increasing prevalent issue, it is important for both pediatric EDs (PEDs) and general EDs to find a balance between these two potentially competing goals. The objective was to determine how the number of trainees in a PED affects patient wait time, total ED length of stay (LOS), and rates of patients leaving without being seen (LWBS) for PED patients overall and stratified by acuity level as defined by the Pediatric Canadian Triage and Acuity Scale (CTAS) using discrete event simulation (DES) modeling. A DES model of an urban tertiary care PED, which receives approximately 40,000 visits annually, was created and validated. Thirteen different trainee schedules, which ranged from averaging zero to six trainees per shift, were input into the DES model and the outcome measures were determined using the combined output of five model iterations. An increase in LOS of approximately 7 minutes was noted to be associated with each additional trainee per attending emergency physician working in the PED. The relationship between the number of trainees and wait time varied with patients' level of acuity and with the degree of PED utilization. Patient wait time decreased as the number of trainees increased for low-acuity visits and when the PED was not operating at full capacity. With rising numbers of trainees, the PED LWBS rate decreased in the whole department and in the CTAS 4 and 5 patient groups, but it rose in patients triaged CTAS 3 or higher. A rising numbers of trainees was not associated with any change to flow outcomes for CTAS 1 patients. The results of this study demonstrate that trainees in PEDs have an impact mainly on patient LOS and that the effect on wait time differs between patients presenting with varying degrees of acuity. These findings will assist PEDs in finding a
Directory of Open Access Journals (Sweden)
Nolan Caldwell
Full Text Available We examined the charges, their variability, and respective payer group for diagnosis and treatment of the ten most common outpatient conditions presenting to the Emergency department (ED.We conducted a cross-sectional study of the 2006-2008 Medical Expenditure Panel Survey. Analysis was limited to outpatient visits with non-elderly, adult (years 18-64 patients with a single discharge diagnosis.We studied 8,303 ED encounters, representing 76.6 million visits. Median charges ranged from $740 (95% CI $651-$817 for an upper respiratory infection to $3437 (95% CI $2917-$3877 for a kidney stone. The median charge for all ten outpatient conditions in the ED was $1233 (95% CI $1199- $1268, with a high degree of charge variability. All diagnoses had an interquartile range (IQR greater than $800 with 60% of IQRs greater than $1550.Emergency department charges for common conditions are expensive with high charge variability. Greater acute care charge transparency will at least allow patients and providers to be aware of the emergency department charges patients may face in the current health care system.
Directory of Open Access Journals (Sweden)
Walter Darren
2007-12-01
Full Text Available Abstract Background A number of significant chemical incidents occur in the UK each year and may require Emergency Departments (EDs to receive and manage contaminated casualties. Previously UK EDs have been found to be under-prepared for this, but since October 2005 acute hospital Trusts have had a statutory responsibility to maintain decontamination capacity. We aimed to evaluate the level of preparedness of Emergency Departments in North West England for managing chemical incidents. Methods A face-to-face semi-structured interview was carried out with the Nurse Manager or a nominated deputy in all 18 Emergency Departments in the Region. Results 16/18 departments had a written chemical incident plan but only 7 had the plan available at interview. All had a designated decontamination area but only 11 felt that they were adequately equipped. 12/18 had a current training programme for chemical incident management and 3 had no staff trained in decontamination. 13/18 could contain contaminated water from casualty decontamination and 6 could provide shelter for casualties before decontamination. Conclusion We have identified major inconsistencies in the preparedness of North West Emergency Departments for managing chemical incidents. Nationally recognized standards on incident planning, facilities, equipment and procedures need to be agreed and implemented with adequate resources. Issues of environmental safety and patient dignity and comfort should also be addressed.
The Impact of Psychiatric Patient Boarding in Emergency Departments
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B. A. Nicks
2012-01-01
Full Text Available Objectives. Studies have demonstrated the adverse effects of emergency department (ED boarding. This study examines the impact of resource utilization, throughput, and financial impact for psychiatric patients awaiting inpatient placement. Methods. The authors retrospectively studied all psychiatric and non-psychiatric adult admissions in an Academic Medical Center ED (>68,000 adult visits from January 2007-2008. The main outcomes were ED length of stay (LOS and associated reimbursement. Results. 1,438 patients were consulted to psychiatry with 505 (35.1% requiring inpatient psychiatric care management. The mean psychiatric patient age was 42.5 years (SD 13.1 years, with 2.7 times more women than men. ED LOS was significantly longer for psychiatric admissions (1089 min, CI (1039–1140 versus 340 min, CI (304–375; <0.001 when compared to non-psychiatric admissions. The financial impact of psychiatric boarding accounted for a direct loss of ($1,198 compared to non-psychiatric admissions. Factoring the loss of bed turnover for waiting patients and opportunity cost due to loss of those patients, psychiatric patient boarding cost the department $2,264 per patient. Conclusions. Psychiatric patients awaiting inpatient placement remain in the ED 3.2 times longer than non-psychiatric patients, preventing 2.2 bed turnovers (additional patients per psychiatric patient, and decreasing financial revenue.
DEFF Research Database (Denmark)
Laursen, Christian B; Nielsen, Klaus; Riishede, Minna
2014-01-01
The first Danish Society for Emergency Medicine (DASEM) recommendations for the use of clinical ultrasound in emergency departments has been made. The recommendations describes what DASEM believes as being current best practice for training, certification, maintenance of acquired competencies...
Shippee, Nathan D; Shippee, Tetyana P; Hess, Erik P; Beebe, Timothy J
2014-01-01
Background Emergency department (ED) use is costly, and especially frequent among publicly insured populations in the US, who also disproportionately encounter financial (cost/coverage-related) and non-financial/practical barriers to care. The present study examines the distinct associations financial and non-financial barriers to care have with patterns of ED use among a publicly insured population. Methods This observational study uses linked administrative-survey data for enrollees of Minn...
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Asmaa Alyaemni
Full Text Available Background: Emergency department nurses are continuously exposed to violence on the job. Objectives: This study sought to identify the prevalence and pattern of workplace violence and the consequences of violence on nurses working in emergency departments in Riyadh. Design: Cross-sectional survey conducted from April to May 2015. Setting: Emergency departments of three hospitals in Riyadh. Participants: Nurses participated voluntarily and anonymously. Methods: Nurses were recruited by advertisement. A self-administered questionnaire with 23 items was given to participants by a head nurse. Violent acts were classified as physical or nonphysical. Descriptive statistics are presented and statistical comparisons were made to evaluate differences by gender, nationality, age, experience and other demographic variables. Results: Of 150 questionnaires distributed, 121 were returned (80.6%. One hundred were females (82.6% and 71 (58.7% had worked in nursing for less than or equal to 5 years. Most participants (n=108, 89.3% had experienced a violent incident in the past 12 months. Eighty (80/108, 74.1% of those who had experienced violence had experienced verbal abuse and 20 (20/108, 18.5% had faced verbal and physical violence during the past year. The type of violence was associated with gender and educational level. Patients (89/108, 82.4% and their relatives (70/108, 64.8% were the most common instigators of violence. Most nurses (78/108, 72.3% expressed dissatisfaction with the manner in which incidents were handled. Conclusion: Workplace violence was pervasive in the emergency departments of these three hospitals in Riyadh. The data are consistent with other reports of workplace violence in emergency departments in Saudi Arabia and in other countries. Recommendations: Suitable strategies to deal with the issue include establishing workplace violence management teams and creating appropriate rules and regulations that can improve workplace safety
Puuskari, Varpu; Aalto-Setälä, Terhi; Komulainen, Erkki; Marttunen, Mauri
2018-02-01
Studies have emphasized screening for psychiatric disorders, especially suicide risk in emergency departments. Psychiatric disorders and experimentation with alcohol increase in adolescence and intoxications among patients challenge the staff in emergency departments. This study examined the degree of suicidal ideation (SI) and suicidal behavior in adolescents, and the extent to which they differed from non-suicidal patients in terms of alcohol use, psychological distress, self-esteem, and perceived social support. The study comprised 120 adolescents, a mean age of 14.2 years. Of them 60% were females. We collected data on the clinical characteristics and assessed the patient's psychiatric status using self-report scales and analyzed blood samples for alcohol. A consulting psychiatrist interviewed each patient before discharge to evaluate potential SI or suicide attempt (SA) using structured and semi-structured scales. Of the 120 patients 20% had SI or had made a SA. High psychological distress in girls, low blood alcohol levels (BALs), as well as low scores on self-esteem, on social support and on familial support were associated with patients with SI/SA. Logistic regression showed that the most significant variables with suicidal patients included low BAL and low self-esteem and high alcohol consumption. Psychological distress had a direct and mediational role in the suicidal patients. Adolescents referred to the pediatric emergency department with intoxication displaying high psychological distress and low self-esteem represent a high-risk group of teens. In this group, careful assessment of mental health status, screening for suicidal ideation, and SAs seems warranted.
[Satisfaction according to health care insurance systems in an emergency department].
Dávila, F A; Herrera, J S; Yasnó, D A; Forero, L C; Alvarado, M V
Health satisfaction is a fundamental measure of the quality of health services. This study aims to validate and analyse the results of a quality of care questionnaire to assess the level of satisfaction of patients attended in the emergency department of a high complexity hospital. Observational, cross-sectional study, with a questionnaire designed to assess the quality of service and satisfaction at the end of care in the emergency department. Descriptive statistics of scale were established and presented, as well as determining the construct validity, overall reliability, internal and concurrent validity of an overall against a uni-dimensional scale. A total of 5,961 records were reviewed, most of them (77.3%) reported by patients in the Mandatory Health Plan. High levels of satisfaction overall and by subgroups were found. There were no significant differences between subgroups, with 86.8 for those with Pre-paid Medical Care Plan and 84.4 for mandatory health plan. Cronbach's alpha for the questionnaire was 0.90. The questionnaire proved to be reliable and valid in determining the quality and satisfaction with care. The results showed high levels of satisfaction overall and in the domains. A low consistency between the results of the multidimensional and unidimensional satisfaction scales suggests that there were aspects of satisfaction not investigated on the multidimensional scale. Ecologically-designed before and after studies are required to evaluate the effectiveness of interventions in satisfaction. Copyright © 2016 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.
Cost-effectiveness of emergency department-initiated treatment for opioid dependence.
Busch, Susan H; Fiellin, David A; Chawarski, Marek C; Owens, Patricia H; Pantalon, Michael V; Hawk, Kathryn; Bernstein, Steven L; O'Connor, Patrick G; D'Onofrio, Gail
2017-11-01
In a recent randomized trial, patients with opioid dependence receiving brief intervention, emergency department (ED)-initiated buprenorphine and ongoing follow-up in primary care with buprenorphine (buprenorphine) were twice as likely to be engaged in addiction treatment compared with referral to community-based treatment (referral) or brief intervention and referral (brief intervention). Our aim was to evaluate the relative cost-effectiveness of these three methods of intervening on opioid dependence in the ED. Measured health-care use was converted to dollar values. We considered a health-care system perspective and constructed cost-effectiveness acceptability curves that indicate the probability each treatment is cost-effective under different thresholds of willingness-to-pay for outcomes studied. An urban ED in the United States. Opioid-dependent patients aged 18 years or older. Self-reported 30-day assessment data were used to construct cost-effectiveness acceptability curves for patient engagement in formal addiction treatment at 30 days and the number of days illicit opioid-free in the past week. Considering only health-care system costs, cost-effectiveness acceptability curves indicate that at all positive willingness-to-pay values, ED-initiated buprenorphine treatment was more cost-effective than brief intervention or referral. For example, at a willingness-to-pay threshold of $1000 for 30-day treatment engagement, we are 79% certain ED-initiated buprenorphine is most cost-effective compared with other studied treatments. Similar results were found for days illicit opioid-free in the past week. Results were robust to secondary analyses that included patients with missing cost data, included crime and patient time costs in the numerator, and to changes in unit price estimates. In the United States, emergency department-initiated buprenorphine intervention for patients with opioid dependence provides high value compared with referral to community
Zhang, Wanqing; Baranek, Grace; Boyd, Brian
2018-01-01
We examined how demographic and clinical characteristics differ between emergency department (ED) visits for epilepsy (EP cohort) and ED visits for other reasons (non-EP cohort) in children with ASD. The data were drawn from the 2009 and 2010 Nationwide Emergency Department Sample. We performed both univariate and multivariate analyses to compare…
DEFF Research Database (Denmark)
Hvidberg, A; Christensen, N J; Hilsted, Jannik
1998-01-01
The aim of the study was (1) to describe hormone responses in insulin-induced hypoglycaemia and (2) to investigate if a combined treatment with intravenous glucose and intramuscular glucagon (group A) would improve glucose recovery as compared to treatment with intravenous glucose alone (group B)...... significantly elevated concentrations of adrenaline and glucagon were found in diabetic patients admitted with severe hypoglycaemia to an Accident and Emergency Department.......). Eighteen adult patients with insulin-treated diabetes mellitus admitted to the Accident and Emergency Department with hypoglycaemia (plasma glucose 1.23 +/- 0.15 mmol l(-1) on admission) were randomized to one of the above treatments and plasma glucose and counterregulatory hormones were measured before...
Pines, Jesse M
2006-05-01
Emergency Medicine plays a vital role in the health care continuum in the United States. Michael Porters' five forces model of industry analysis provides an insight into the economics of emergency care by showing how the forces of supplier power, buyer power, threat of substitution, barriers to entry, and internal rivalry affect Emergency Medicine. Illustrating these relationships provides a view into the complexities of the emergency care industry and offers opportunities for Emergency Departments, groups of physicians, and the individual emergency physician to maximize the relationship with other market players.
Ben-Assuli, Ofir; Leshno, Moshe
2016-09-01
In the last decade, health providers have implemented information systems to improve accuracy in medical diagnosis and decision-making. This article evaluates the impact of an electronic health record on emergency department physicians' diagnosis and admission decisions. A decision analytic approach using a decision tree was constructed to model the admission decision process to assess the added value of medical information retrieved from the electronic health record. Using a Bayesian statistical model, this method was evaluated on two coronary artery disease scenarios. The results show that the cases of coronary artery disease were better diagnosed when the electronic health record was consulted and led to more informed admission decisions. Furthermore, the value of medical information required for a specific admission decision in emergency departments could be quantified. The findings support the notion that physicians and patient healthcare can benefit from implementing electronic health record systems in emergency departments. © The Author(s) 2015.
Demographic Analysis of Emergency Department Patients at the Ruijin Hospital, Shanghai
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Wim Lammers
2011-01-01
Full Text Available Emergency medicine is an upcoming discipline that is still under development in many countries. Therefore, it is important to gain insight into the organization and patients presenting to the Emergency Department (ED. The aim of this cross-sectional study was to provide an epidemiological description of complaints and referrals of the patients visiting the ED of the Ruijin Hospital in Shanghai, China. A questionnaire was developed and completed for a convenience sample of all patients presenting to the Triage Desk of the ED. The study was performed in June 2008. A total of 2183 questionnaires were completed. The most common complaints were fever (15%, stomach/abdominal pain (15%, vertigo/dizziness (11%, and cough (10%. Following triage, patients were predominantly referred to an internist (41%, neurologist (14%, pulmonologist (11%, or general surgeon (9%. This study provides a better understanding of the reason for the ED visit and the triage system at the ED of the Ruijin Hospital. The results can be used in order to improve facilities appropriate for the specific population in the ED.
The Effect of Older Age on EMS Use for Transportation to an Emergency Department.
Jones, Courtney M C; Wasserman, Erin B; Li, Timmy; Amidon, Ashley; Abbott, Marissa; Shah, Manish N
2017-06-01
Introduction Previous studies have found that older adults are more likely to use Emergency Medical Services (EMS) than younger adults, but the reasons for this remain understudied. Hypothesis/Problem This study aimed to determine if older age is associated with using EMS for transportation to an emergency department (ED) after controlling for confounding variables. A cross-sectional survey study was conducted at a large academic medical center. Data on previous medical history, chief complaint, self-perceived illness severity, demographic information, and mode of arrival to the ED were collected on all subjects. Those who arrived to the ED via EMS also were asked reasons why they opted to call an ambulance for their illness/injury. Descriptive statistics were used to quantify survey responses, and multivariable regression was used to assess the independent effect of age on mode of ED arrival. Data from 1,058 subjects were analyzed, 449 (42%) of whom arrived to the ED via EMS. Compared to adultstransportation to the ED via ambulance; however, this effect is attenuated by number of chronic medical conditions and history of depression. Additional research is needed to account for confounders unmeasured in this study and to elucidate reasons for the increased frequency of EMS use among older adults. Jones CMC , Wasserman EB , Li T , Amidon A , Abbott M , Shah MN . The effect of older age on EMS use for transportation to an emergency department. Prehosp Disaster Med. 2017;32(3):261-268.
Nurse scheduling in a hospital emergency department: A case study at a Thai university hospital
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Aussadavut Dumrongsiri
2018-02-01
Full Text Available Common problems of Thai nurses are low quality of life, working long hours, and a high turnover rate. The workload imbalance among nurses also worsens the turnover rate. With careful schedule planning, nurses do not have to work in consecutive shifts and can rest more. We interviewed and collected data from an emergency department at a hospital administered by a Thai university, related to objectives and constraints of monthly nurse scheduling, and actual monthly schedules. A multi-objective mathematical model was developed using the open source “OpenSolver” software in MS-Excel for nurse schedulers to freely use. We tested the model using actual data collected from the department and found that the schedules created by the model tended to provide more balanced workloads and more days off compared to the schedules created manually by a real scheduler. The model also suggested an easy policy to increase the number of nurses for future expansion.
Management of everyday work in Emergency Departments - an exploratory study with Swedish Managers.
Andersson, Henrik; Wireklint Sundström, Birgitta; Nilsson, Kerstin; Jakobsson Ung, Eva
2014-10-01
Through their formal mandate, position and authority, managers are responsible for managing everyday work in Emergency Departments (EDs) as well as striving for excellence and dealing with the individual needs of practitioners and patients. The aim of the present study is to explore managers' experiences of managing everyday work in Swedish EDs. A qualitative and exploratory design has been used in this study. Seven managers were interviewed at two EDs. Data was analysed using qualitative content analysis with focus on latent content. Managers experience everyday work in the ED as lifesaving work. One of the characteristics of their approach to everyday work is their capability for rapidly identifying patients with life-threatening conditions and for treating them accordingly. The practitioners are on stand-by in order to deal with unexpected situations. This implies having to spend time waiting for the physicians' decisions. Management is characterised by a command and control approach. The managers experience difficulties in meeting the expectations of their staff. They strive to be proactive but instead they become reactive since the prevailing medical, bureaucratic and production-orientated systems constrain them. The managers demonstrate full compliance with the organisational systems. This threatens to reduce their freedom of action and influences the way they perform their managerial duties within and outside the EDs. Copyright © 2014 Elsevier Ltd. All rights reserved.
Meaney Christopher; Moineddin Rahim; Agha Mohammad; Zagorski Brandon; Glazier Richard Henry
2011-01-01
Abstract Background Emergency departments are medical treatment facilities, designed to provide episodic care to patients suffering from acute injuries and illnesses as well as patients who are experiencing sporadic flare-ups of underlying chronic medical conditions which require immediate attention. Supply and demand for emergency department services varies across geographic regions and time. Some persons do not rely on the service at all whereas; others use the service on repeated occasions...
The Epidemiology of Emergency Department Trauma Discharges in the United States.
DiMaggio, Charles J; Avraham, Jacob B; Lee, David C; Frangos, Spiros G; Wall, Stephen P
2017-10-01
Injury-related morbidity and mortality is an important emergency medicine and public health challenge in the United States. Here we describe the epidemiology of traumatic injury presenting to U.S. emergency departments (EDs), define changes in types and causes of injury among the elderly and the young, characterize the role of trauma centers and teaching hospitals in providing emergency trauma care, and estimate the overall economic burden of treating such injuries. We conducted a secondary retrospective, repeated cross-sectional study of the Nationwide Emergency Department Data Sample (NEDS), the largest all-payer ED survey database in the United States. Main outcomes and measures were survey-adjusted counts, proportions, means, and rates with associated standard errors (SEs) and 95% confidence intervals. We plotted annual age-stratified ED discharge rates for traumatic injury and present tables of proportions of common injuries and external causes. We modeled the association of Level I or II trauma center care with injury fatality using a multivariable survey-adjusted logistic regression analysis that controlled for age, sex, injury severity, comorbid diagnoses, and teaching hospital status. There were 181,194,431 (SE = 4,234) traumatic injury discharges from U.S. EDs between 2006 and 2012. There was a mean year-to-year decrease of 143 (95% CI = -184.3 to -68.5) visits per 100,000 U.S. population during the study period. The all-age, all-cause case-fatality rate for traumatic injuries across U.S. EDs during the study period was 0.17% (SE = 0.001%). The case-fatality rate for the most severely injured averaged 4.8% (SE = 0.001%), and severely injured patients were nearly four times as likely to be seen in Level I or II trauma centers (relative risk = 3.9 [95% CI = 3.7 to 4.1]). The unadjusted risk ratio, based on group counts, for the association of Level I or II trauma centers with mortality was risk ratio = 4.9 (95% CI = 4.5 to 5.3); however, after sex, age
Elliot, Alex J; Hughes, Helen E; Hughes, Thomas C; Locker, Thomas E; Shannon, Tony; Heyworth, John; Wapling, Andy; Catchpole, Mike; Ibbotson, Sue; McCloskey, Brian; Smith, Gillian E
2012-12-01
The London 2012 Olympic and Paralympic Games is a mass gathering event that will present a major public health challenge. The Health Protection Agency, in collaboration with the College of Emergency Medicine, has established the Emergency Department Sentinel Syndromic Surveillance System (EDSSS) to support the public health surveillance requirements of the Games. This feasibility study assesses the usefulness of EDSSS in monitoring indicators of disease in the community. Daily counts of anonymised attendance data from six emergency departments across England were analysed by patient demographics (age, gender, partial postcode), triage coding and diagnosis codes. Generic and specific syndromic indicators were developed using aggregations of diagnosis codes recorded during each attendance. Over 339,000 attendances were recorded (26 July 2010 to 25 July 2011). The highest attendances recorded on weekdays between 10:00 and 11:00 and on weekends between 12:00 and 13:00. The mean daily attendance per emergency department was 257 (range 38-435). Syndromic indicators were developed including: respiratory, gastrointestinal, cardiac, acute respiratory infection, gastroenteritis and myocardial ischaemia. Respiratory and acute respiratory infection indicators peaked during December 2010, concomitant with national influenza activity, as monitored through other influenza surveillance systems. The EDSSS has been established to provide an enhanced surveillance system for the London 2012 Olympics. Further validation of the data will be required; however, the results from this initial descriptive study demonstrate the potential for identifying unusual and/or severe outbreaks of infectious disease, or other incidents with public health impact, within the community.
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Weiland Tracey J
2010-11-01
Full Text Available Abstract Background Clinical supervision and feedback are important for the development of competency in junior doctors. This study aimed to determine the adequacy of supervision of junior medical staff in Australian emergency departments (EDs and perceived feedback provided. Methods Semi-structured telephone surveys sought quantitative and qualitative data from ED Directors, Directors of Emergency Medicine Training, registrars and interns in 37 representative Australian hospitals; quantitative data were analysed with SPSS 15.0 and qualitative data subjected to content analysis identifying themes. Results Thirty six of 37 hospitals took part. Of 233 potential interviewees, 95 (40.1% granted interviews including 100% (36/36 of ED Directors, and 96.2% (25/26 of eligible DEMTs, 24% (19/81 of advanced trainee/registrars, and 17% (15/90 of interns. Most participants (61% felt the ED was adequately supervised in general and (64.2% that medical staff were adequately supervised. Consultants and registrars were felt to provide most intern supervision, but this varied depending on shift times, with registrars more likely to provide supervision on night shift and at weekends. Senior ED medical staff (64% and junior staff (79% agreed that interns received adequate clinical supervision. Qualitative analysis revealed that good processes were in place to ensure adequate supervision, but that service demands, particularly related to access block and overcrowding, had detrimental effects on both supervision and feedback. Conclusions Consultants appear to provide the majority of supervision of junior medical staff in Australian EDs. Supervision and feedback are generally felt to be adequate, but are threatened by service demands, particularly related to access block and ED overcrowding.
Gustavsson, Maria; Ekberg, Kerstin
2015-01-01
This article reports on the findings of a planned workplace health promotion intervention, and the aim is to identify conditions that facilitated or restricted the learning to promote health at an emergency care department in a Swedish hospital. The study had a longitudinal design, with interviews before and after the intervention and follow-up…
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Kim Soo Hyun
2011-11-01
Full Text Available Abstract Background Severely injured trauma patients are exposed to clinically significant radiation doses from computed tomography (CT imaging in the emergency department. Moreover, this radiation exposure is associated with an increased risk of cancer. The purpose of this study was to determine some effects of a radiation dose reduction strategy for CT in severely injured trauma patients in the emergency department. Methods We implemented the radiation dose reduction strategy in May 2009. A prospective observational study design was used to collect data from patients who met the inclusion criteria during this one year study (intervention group from May 2009 to April 2010. The prospective data were compared with data collected retrospectively for one year prior to the implementation of the radiation dose reduction strategy (control group. By comparison of the cumulative effective dose and the number of CT examinations in the two groups, we evaluated effects of a radiation dose reduction strategy. All the patients met the institutional adult trauma team activation criteria. The radiation doses calculated by the CT scanner were converted to effective doses by multiplication by a conversion coefficient. Results A total of 118 patients were included in this study. Among them, 33 were admitted before May 2009 (control group, and 85 were admitted after May 2009 (intervention group. There were no significant differences between the two groups regarding baseline characteristics, such as injury severity and mortality. Additionally, there was no difference between the two groups in the mean number of total CT examinations per patient (4.8 vs. 4.5, respectively; p = 0.227. However, the mean effective dose of the total CT examinations per patient significantly decreased from 78.71 mSv to 29.50 mSv (p Conclusions The radiation dose reduction strategy for CT in severely injured trauma patients effectively decreased the cumulative effective dose of the total